Abstract
PurposeTo investigate the prevalence and visual acuity (VA) outcomes of cataract surgery in adults of the Bai Nationality populations in rural China.MethodsWe conducted a population-based cross-sectional survey (from randomly selected block groups) of Chinese Bai Nationality aged ≥50 years in southwestern China. Presenting visual acuity (PVA), best corrected visual acuity (BCVA) were recorded and a detailed eye examination was carried out. For all aphakic and pseudophakic subjects identified, information on the date, setting, type, and complications of cataract surgery were recorded. In eyes with VA <20/63, the principal cause of visual impairment was identified.ResultsOf 2133 (77.8% of 2742) subjects, 99 people (129 eyes) had undergone cataract surgery. The prevalence of cataract surgery was 4.6%. Surgical coverage among those with PVA <20/200 in both eyes because of cataract was 52.8%. Unoperated cataract was associated with older age. The main barrier to cataract surgery was lack of awareness and knowledge, cost, and fear. Among the 129 cataract-operated eyes, 22.5% had PVA of ≥20/32, 25.6% had PVA of 20/40 to 20/63, 23.3% had PVA <20/63 to 20/200, and 28.7% had PVA<20/200. With BCVA, the percentages were 42.6%, 23.3%, 10.9%, and 23.3%, respectively. Aphakia (odds ratio [OR], 8.49; P<0.001) and no education (OR, 10.18; P = 0.001) or less education (OR, 6.49; P = 0.014) were significantly associated with postoperative visual impairment defined by PVA, while aphakia (OR, 8.49; P<0.001) and female gender (OR, 4.19; P = 0.004) were significantly associated with postoperative visual impairment by BCVA. The main causes of postoperative visual impairment were refractive error, retinal disorders and glaucoma.ConclusionsHalf of those with bilateral visual impairment or blindness because of cataract remain in need of cataract surgery in Bai population. Surgical uptake and visual outcomes should be further improved in the future.
Highlights
Cataract is avoidable, it remains the leading cause of blindness worldwide, and is responsible for 47.8% or 17.7 million blind people [1]
As a part of Yunnan Minority Eye Study (YMES), the purpose of this study was to report the prevalence of cataract surgery, surgical coverage among those visually impaired or blind as a result of cataract, risk factors for unoperated cataract, self-reported barriers to cataract surgery, visual acuity outcomes of cataract surgery, and risk factors and causes contributing to poor outcomes in adult rural Chinese populations of the Bai nationality in Dali
A total of 2742 subjects aged $50 years were enumerated, and a total of 2133 (77.8%) subjects were successfully examined. 99 persons (129 eyes) had undergone cataract surgery in one (69 subjects, 69.7%) or both eyes (30 subjects, 30.3%), representing a cataract surgery prevalence of 4.6% (Table 1), age- and sex-standardized prevalence 3.7%
Summary
It remains the leading cause of blindness worldwide, and is responsible for 47.8% or 17.7 million blind people [1]. Cataract surgery is the only currently available and effective method of restoring vision for those with visual impairment due to cataract. Population-based studies in different regional, racial and ethnic groups have suggested significant differences in cataract prevalence, surgical uptake and the quality of cataract surgeries. People in developing countries have had limited access to cataract surgery, but even if this is available the uptake of surgery can still be low. Recent population studies have reported that barriers such as cost, fear, ageism, and lack of awareness and knowledge restrict the uptake of available services [2,3,4,5,6,7,8,9]. Where services are available, there are concerns that they are often of poor quality [10]. Poor outcome may be due to other ocular pathology, surgical complications and uncorrected refractive error [10]
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