Cataract Services Research Articles

Willingness to pay for cataract surgery and its associated factors in selected medical centers in Urmia, Iran

IntroductionCataracts represent a significant public health issue and are the most prevalent vision disorder following refractive errors. They can restrict the economic, social, and psychological activities of those affected, thereby diminishing their quality of life. This study was undertaken to examine the willingness to pay for cataract surgery and the factors influencing this decision in selected medical centers in Urmia. The two-stage Heckman model was utilized to aid decision-making in financing this service.MethodsThis research was a descriptive-analytical study evaluating the economic aspects of health interventions, conducted from the patient’s perspective. In this cross-sectional study, a sample size of 217 patients with cataract issues was selected using Michel Carson’s table. These patients were from Imam Khomeini Hospital and Aftab Urmia Surgery Center in 2023. Data was collected using a conditional valuation approach to determine the maximum amount patients were willing to pay, as gathered through a questionnaire. The factors influencing the willingness to pay for cataract surgery were estimated using the two-stage Heckman regression model. The final effect value of each variable was calculated using Stata version 14 software.ResultsIn this study, 81.11% of participants (176 individuals) expressed a willingness to pay for cataract surgery, with the average amount they were willing to pay being $206.3. However, out of the 217 respondents, 41 rejected the proposed amounts and were not willing to pay anything. The results of the Hemken model indicated that the income of patients and the size of their households significantly influenced their willingness to pay for cataract surgery. However, other variables investigated did not have a significant impact.ConclusionThe study results revealed a significant influence of both income and household size on the likelihood of willingness to pay, as well as the extent of willingness to pay for cataract surgery. Consequently, it is crucial to formulate policies and provisions that guarantee access to cataract services, particularly for individuals from large households with low income and high costs.

Assessing the cataract surgical rate and gender equity in cataract services in south-east Nigeria

BackgroundIn 2020, almost 100 million people were blind or visually impaired from cataract. Cataract surgery is a cost-effective treatment for cataracts. In Nigeria, twice as many women are cataract blind...

Implementing immediate sequential bilateral cataract surgery at Buckinghamshire Healthcare NHS Trust.

Immediate sequential bilateral cataract surgery (ISBCS) was first introduced into NICE guidelines in 2017. In this approach, patients undergo cataract surgery on both eyes on the same day. Although increasingly popular, only 0.5% of all cataract operations nationally are performed using this approach. We redesigned our service to routinely offer ISBCS and are now one of the leading NHS providers of ISBCS in the UK. We audited our cataract operations in 2022 and report our initial experiences with ISBCS here. We redesigned our cataract service to routinely offer ISBCS on the NHS. We audited all cataract operations performed in calendar year 2022. We performed 4652 NHS cataract operations including 498 (10.7%) operations on 249 patients using the ISBCS approach. Trainee surgeons performed 32.5% of these cases. There were two intraoperative complications, both during the second eye operation. One was a suspected suprachoroidal haemorrhage and the other was a posterior capsular rupture post lens implantation. Post-operatively there was one case of retinal detachment requiring vitrectomy following uncomplicated ISBCS and five cases of Irvine-Gass syndrome that were managed medically. From this data, ISBCS does not pose a greater risk to patients in terms of complications. Allowing trainees to operate on ISBCS cases improves the trainee experience. With appropriate pre-operative counselling, patients listed for unilateral surgery can be converted to ISBCS on the day of operation to fully utilise theatre capacity. Patients listed for ISBCS can also be converted to unilateral surgery on the day of operation when surgeons need time to deal with complications safely.

Influence of COVID-19 pandemic on the cataract services in a district hospital

Purpose: In March 2020, COVID-19 was declared a pandemic by the World Health Organization. The COVID-19 pandemic significantly disrupted the healthcare system, including the number of elective ophthalmic procedures conducted worldwide, resulting in a large-scale deferment of cataract surgeries after the Malaysian government recommended to postpone all nonessential elective surgeries to minimise the virus transmission and to augment the hospital resources to cope with a surge in COVID-19 cases. This study assessed the influence and impact of the COVID-19 pandemic on the cataract services in a district hospital. Study design: Retrospective descriptive analysis. Methods: This study analysed cataract surgery services in the period between January 1, 2017 and 31 December 31, 2021. Data were extracted from the electronic medical records. The study population was further divided into 3 groups according to the COVID-19 pandemic status: pre-pandemic, lockdown and recovery phase. Results: A total of 8,125 eyes were included in this study. During the lockdown phase, there was a 42% decline in the number of surgeries done compared to the pre-COVID-19 phase. A higher number of patients (53.5%) presented with severe visual impairment or blindness during the lockdown phase as compared to 40.2% during the pre-COVID-19 phase. The number of lens-related complications was markedly higher (2.58%) during the lockdown phase, as compared to the pre-COVID-19 phase (0.64%). During the end of the recovery phase studied, there was an early increment in the number of surgeries done, surpassing that of the pre-COVID-19 phases. Conclusion: The COVID-19 pandemic caused a drastic reduction in the number of cataract surgeries performed during the lockdown phase, causing more patients to suffer from avoidable blindness due to cataract, and leading to a higher rate of lens-related complications. An intuitive approach and reorganisation of ophthalmic care services are essential in order to lessen the backlog without causing burnout among healthcare workers.

Cataract surgery workload estimates in Theni district, India

Background/aimsTo estimate the annual cataract surgery workload in Theni district, Tamil Nadu, India based on current utilisation of cataract services, prevalence of blindness and vision impairment (VI), and cataract burden-reduction...

Vision impairment and differential access to eye health services in Aotearoa New Zealand: a scoping review

IntroductionIn Aotearoa New Zealand, Māori and Pacific People experience worse health outcomes compared with other New Zealanders. No population-based eye health survey has been conducted, and eye health services do...

A Hospital-Based Study of Profile of Patients Availing Free Cataract Services at Tertiary Eye Hospital of Nepal

A Hospital-Based Study of Profile of Patients Availing Free Cataract Services at Tertiary Eye Hospital of Nepal

Prevalence of Age-Related Cataracts Among Patients Utilizing Eye Services in Cross River State Eye Care Programme, Calabar, Nigeria

Background: Cataract is the leading cause of blindness worldwide. Its prevalence in the area of study needs to be assessed due to the unawareness of older adults, who need to identify the risk factors and access to cataract services. Aims: The study aimed to determine the prevalence of age-related cataracts between 2019 and 2022 among patients attending the Cross River State Eye Care clinic in Calabar, Nigeria. Methods: The study utilized a retrospective research design. The case notes of 200 patients aged 50 years and above who attended the clinic during the period under study were reviewed. Relevant data was extracted from the patients’ folders into a checklist and was analysed using descriptive statistics (frequency and percentage). Chi-square was used to test the hypothesis. Findings: The result of the data analysed showed that most of the study participants (41%) were in the age range of 71 years and above. There were more females (51%) than males in the study. The prevalence of cataracts was 68%. The prevalence rate was higher in females (70.6%) than males (65.3%). A chi-square analysis of the hypothesis showed that the calculated X2 value of 25.92 is far greater than the critical X2 value of 5.99 at a 0.05 level of significance. The null hypothesis was therefore rejected, implying a significant relationship between gender and age-related cataracts. Conclusion: The high prevalence of cataracts recorded in this study highlights the need for nurses to ask about the state of vision of their patients during the initial assessment of all patients on first contact with the health facility. If this is done, patients who complain of decreased vision can be arranged to be evaluated accordingly. Recommendation: Based on these findings, eye screening, health promotion, and health education on the availability and utilization of cataract services should be considered a routine part of healthcare services.

Reducing the carbon footprint of cataract surgery: co-creating solutions with a departmental Delphi process.

Climate change is arguably the greatest threat to global health of the 21st century. Although cataract surgery is a major contributor to global greenhouse gas emissions, recent literature review identified a paucity of evidence-based strategies for improving the environmental impact of cataract services. Our study aimed to assess the effectiveness of a departmental Delphi process for improving cataract services' environmental sustainability. All members of ophthalmology theatre teams in a UK teaching hospital were invited to participate in a three-stage Delphi process. Team members were surveyed for suggestions for reducing the department's environmental impact. Suggested interventions were refined during a plenary face-to-face discussion and ranked. The highest ranked interventions were combined into a mutually agreed action plan. Data on the economic and environmental cost of cataract services was collected prior to and six months after the Delphi process using the Eyefficiency mobile application. Twenty-three interventions were suggested by a range of staff cadres. Interventions were ranked by 24 team members. The 2nd, 4th, 5th, 8th and 11th ranked interventions were combined into an "Eco-packs" project in collaboration with suppliers (Bausch + Lomb), saving 675 kg of waste and 350 kg of CO2 equivalent annually. The Delphi process is an effective method for provoking departmental engagement with the sustainability agenda that we would encourage all ophthalmology departments to consider utilising. The baseline per case CO2 equivalent measured in our department was reproducible and could serve as a maximum benchmark to be improved upon.

Commentary: The never-ending story of COVID-19: Accustoming to the new abnormal in glaucoma practice.

Commentary: The never-ending story of COVID-19: Accustoming to the new abnormal in glaucoma practice.

Cataract services for all: Strategies for equitable access from a global modified Delphi process.

Vision loss from cataract is unequally distributed, and there is very little evidence on how to overcome this inequity. This project aimed to engage multiple stakeholder groups to identify and prioritise (1) delivery strategies that improve access to cataract services for under-served groups and (2) population groups to target with these strategies across world regions. We recruited panellists knowledgeable about cataract services from eight world regions to complete a two-round online modified Delphi process. In Round 1, panellists answered open-ended questions about strategies to improve access to screening and surgery for cataract, and which population groups to target with these strategies. In Round 2, panellists ranked the strategies and groups to arrive at the final lists regionally and globally. 183 people completed both rounds (46% women). In total, 22 distinct population groups were identified. At the global level the priority groups for improving access to cataract services were people in rural/remote areas, with low socioeconomic status and low social support. South Asia and Sub-Saharan Africa were the only regions in which panellists ranked women in the top 5 priority groups. Panellists identified 16 and 19 discreet strategies to improve access to screening and surgical services, respectively. These mostly addressed health system/supply side factors, including policy, human resources, financing and service delivery. We believe these results can serve eye health decision-makers, researchers and funders as a starting point for coordinated action to improve access to cataract services, particularly among population groups who have historically been left behind.

Practice of immediate sequential bilateral cataract surgery (ISBCS): A teaching hospital experience in United Kingdom.

Utilisation of ISBCS has been encouraged since COVID-19 in line with the RCOphth recommendations. This study aims to share experience from a UK teaching hospital on ISBCS and to evaluate pre-, intra- and post-operative outcomes from the ISBCS cohort. Of 3402 cataract surgeries performed between July 2020 and July 2021 (1 year since the reopening of the cataract service from COVID-19), 208 eyes of 104 patients (6.1%) undergoing ISBCS were retrospectively studied on their demographics, biometry, surgeon grades, and pre-, intra- and post-operative data. The mean age was 74.5 ± 9.4 years and 62% were female. Eighty-nine percent of the eyes were performed under local anaesthesia and 70% were 'routine' cases. Other risk factors included: short eyes requiring pre-operative mannitol infusion (10%), high myopia (8%), poor dilation (2%) and a 'glaucoma' cohort [angle closure (2%) and prior trabeculectomy (1%)]. Three eyes (1%) had complications intra-operatively in second eye (1 case each: posterior capsule rupture, corneal oedema and zonular dehiscence). Two patients (1%) had complications in the first eye (1 case each: suprachoroidal haemorrhage, conjunctival & iris haemorrhage), hence had their second eye postponed. Twelve months post-operatively, 20 eyes (10%) had recorded post-op complications with cystoid macular oedema being the commonest (4.5%) and no endophthalmitis. Eighty-six percent were discharged with satisfaction. No significant differences were found in pre-operative features, complication rates and post-operative outcomes between consultant and non-consultant surgeons (p > 0.05). Our experience which included a cohort of high-risk patients showed safe and successful practice of ISBCS without having a negative impact on training.

The true cost of hidden waiting times for cataract surgery in Australia.

Cataract surgery is a safe, effective and common elective procedure in Australia but access is inequitable. True waiting times for cataract care are undisclosed or inconsistently reported by governments. Estimates of true waiting times range from 4 to 30 months and have been extended during the coronavirus disease 2019 (COVID-19) pandemic. Comparative analysis revealed that reducing waiting periods from 12 to 3 months would result in estimated public health system cost savings of $6.6 million by preventing 50 679 falls. Investment in public cataract services to address current unmet needs would prevent avoidable vision impairment and associated negative consequences.

Prevalence, Causes, and Risk Factors of Visual Impairment in Emiratis and Non-Emiratis of Dubai: A Subnational Population-Based Cross-Sectional Survey.

Purpose To study the prevalence, causes, and risk factors of visual impairment (VI) among the Dubai Emiratis and non-Emiratis. Methods The survey was a population-based cross-sectional eye health study conducted 2019-2020. Cluster sampling was used to randomly select local (Emirati) and expatriate (non-Emirati) Dubai residents aged 40 years and older. Ocular examinations were conducted in selected eye clinics to determine the visual acuity (VA) and cause(s) of VI if any. Trained nurses, optometrists, and ophthalmologists did the examinations. VA was measured using ETDRS visual chart. The World Health Organization VI and blindness definitions and classifications for the cause(s) of VI were used. Results A total of 892 participants were included in the final analysis. The mean age [SD] was 52.09 [9.48] years, with 55.8% as males. Prevalence of presenting mild, moderate, and severe VI was 4.7% (2.94–7.11%), 1.8% (0.78–3.5%), and 0% for Emiratis, and 3.6% (2.06–5.76), 1.6% (0.63–3.21), and 0% for non-Emiratis, respectively. Four Emirati participants were blind, with a prevalence of 0.9% (0.25%–2.28%). Men had lower likelihood of VI than women (odds ratio [OR] (95% CI): 0.42 (0.24–0.77)) after adjustment for covariates. Diabetes (OR (95% CI): 1.91 (1.04–3.52)) was an independent risk factor for VI. Higher education level was associated with a lower likelihood of VI (OR (95% CI): 0.34 (0.13–0.89). Leading causes of VI among Emiratis were uncorrected refractive error (52%) and cataract (17.2%). Glaucoma, optic atrophy, and absent globe were the causes of blindness. Conclusions Prevalence of VI is comparably low with leading causes readily treatable. An effective strategy to improve spectacle correction and cataract services would reduce the VI burden.

Prevalence and 11-Year Incidence of Cataract and Cataract Surgery and the Effects of Socio-Demographic and Lifestyle Factors.

PurposeTo assess the impact of cataract in ageing population by evaluating the prevalence, incidence, and background factors of cataract and cataract surgery.Patients and MethodsTwo health examination surveys representing Finnish population in 2000 and 2011 included 7380 and 5930 participants aged 30 years or older with cataract status known. An 11-year follow-up included 4840 persons who participated in both the surveys. The data include information on physician-made diagnoses, socio-demographic factors, and lifestyle factors based on self-reported assessment. Cataract diagnoses and surgeries recorded in the Finnish Care Register for Health Care were linked to the survey data. Cataract patients were compared to those without cataract using logistic regression. Differences in cataract surgery age were evaluated using linear regression. Univariable and multivariable models were included.ResultsDuring 2000–2011, the prevalence of cataract increased from 8.8% to 13.6% and cataract surgery from 5.7% to 8.9% in a representative sample of the Finnish adult population. Cataract and cataract surgery were associated with age, smoking, and high alcohol consumption. Cataract was also associated with female gender and low income in 2000, but this association declined during the 11 years. Smoking and high alcohol consumption were associated with younger surgery age.ConclusionThe prevalence of cataract and cataract surgery is increasing with the ageing of the population. The increase in cataract surgery is likely also reflecting the improvements in eye care. The possibility to equally use health-care services throughout a country can reduce the impact of socio-demographic status. Healthy lifestyle delays the development of cataract, whereas smoking and high alcohol consumption are associated with earlier cataract development. Therefore, the availability of cataract services and promotion of healthy lifestyle will be the key to prevent the detrimental effects of cataract on patients and the society in countries where the population is rapidly ageing.

165 Cataract Surgery: What Intraoperative Factors Impact Surgical Outcomes in Low- and Middle- Income Countries (LMICs)

Abstract Aim To describe what intraoperative factors affect the outcomes of cataract surgery in LMICs. Method The following databases were screened to find relevant articles: EMBASE (1974–2019), MEDLINE (1946–2019), Global health (1973–2019), PubMed, Cochrane library and Cumulative Index to Nursing and Allied Health Literature. Following this, duplicates were removed, and articles underwent screening. Results Perioperative checks – It has been recommended for LMICs to implement similar surgical checklists to what is used in the UK, to reduce the chance of surgical complications. Having the right team - The cataract surgery team may vary in different countries. For example, in Ethiopia the staffing model includes ophthalmologists, non-physician cataract surgeons (NPCS), ophthalmic officers, ophthalmic nurses, operating room nurses and integrated eye care workers. It is common in LMICs for NPCS to outnumber ophthalmologists. Adequately skilled professionals – It’s important to consider having vitreoretinal surgical input available should surgical complications arise. This will help to optimise outcomes. Surgical technique – Techniques performed in LMICs include ICCE (intracapsular cataract extraction), ECCE (extracapsular cataract extraction and MSICS (manual small incision surgery) and phacoemulsification. ECCE and MSICS is the most commonly used in LMICS due to comparable outcomes with phacoemulsification and cost effectiveness. Surgical training and skills transfer – Various international training programmes such as the HelpMeSee programme is designed to help train ophthalmologists and NPCS in MSICS via simulation. Conclusions The above factors are important considerations which influence surgical availability and success. LMICs have an increasingly aging population and cataract services will be required to adapt to the increase demand.

Survey of Blindness in Saki East, Oyo State, Nigeria.

Background:This survey was undertaken in a rural local government area (LGA) where eye care services recently commenced, with no known previous data on blindness or visual impairment.Aim and Objectives:The aim was to generate evidence for further planning and monitoring of the on-going eye care program. The objectives included determination of the prevalence of blindness and visual impairment, causes of blindness and visual impairment, and assessment of cataract services and barriers to cataract surgery uptake.Materials and Methods:This was a cross-sectional observational study. A population-based rapid assessment of avoidable blindness (RAAB) was undertaken among eligible individuals, aged 50 years and above, who were residents of Saki East LGA. A three-stage cluster sampling technique with probability proportional to size was employed to recruit 1100 respondents. Field data were analysed using the RAAB 5 computer software package.Results:The age- and sex-adjusted prevalence of blindness was 1.7% (95% confidence interval: 0.1–3.3). Cataract was the commonest cause of blindness (37.8%) and severe visual impairment (56.3%), whereas refractive error was the leading cause of moderate visual impairment (68.3%). The prevalence of blindness significantly increased with age (χ2= 38.01, P = 0.000). Avoidable conditions were responsible for 94.6% of the blindness.Conclusion:The burden of blindness and visual impairment in the survey area is significant, with more than 90% due to avoidable causes. Cataract, glaucoma, and uncorrected refractive error were important causes needing urgent attention.

Barriers and enablers to access childhood cataract services across India. A qualitative study using the Theoretical Domains Framework (TDF) of behaviour change.

Early presentation for childhood cataract surgery is an important first step in preventing related visual impairment and blindness. In the absence of neonatal eye screening programmes in developing countries, the early identification of childhood cataract remains a major challenge. The primary aim of this study was to identify potential barriers to accessing childhood cataract services from the perspective of parents and carers, as a critical step towards increasing the timely uptake of cataract surgery. In-depth interviews were conducted using a pre-designed topic guide developed for this study to seek the views of parents and carers in nine geographic locations across eight states in India regarding their perceived barriers and enablers to accessing childhood cataract services. A total of 35 in-depth interviews were conducted including 30 at the hospital premises and 5 in the participants' homes. All interviews were conducted in the local language and audio taped for further transcription and analysis. Data were organised using NVivo 11 and a thematic analysis was conducted utilising the Theoretical Domains Framework (TDF), an integrative framework of behavioural theories. The themes identified from interviews related to 11 out of 12 TDF domains. TDF domains associated with barriers included: 'Environmental context and resources', 'Beliefs about consequences' and 'Social influences'. Reported enablers were identified in three theoretical domains: 'Social influences', 'Beliefs about consequences' and 'Motivations and goals'. This comprehensive TDF approach enabled us to understand parents' perceived barriers and enablers to accessing childhood cataract services, which could be targeted in future interventions to improve timely uptake.

A proposed redesign of elective cataract services in Scotland – pilot project

BackgroundThe demand for cataract surgery is expected to increase by 25% in the next 10 years as the result of our ageing population. A new pathway is being proposed to improve efficiency by utilising the new General Ophthalmic Services code 2.9 for community optometrists in Scotland for Cataract Referral Refinement and Consenting process. A pilot project has been undertaken at NHS Grampian enabling patients to be assessed and undergo surgery at a single visit to the Eye Outpatient Department.ObjectivesTo determine the suitability of community cataract referrals for a one stop cataract surgery service and target areas for referral refinement.Methods300 consecutive cataract referrals were assessed for suitability for one stop cataract surgery, determined by the documentation of pertinent clinical findings. All suitable referrals were offered a telephone consultation to confirm suitability and those patients were subsequently offered on the day cataract surgery. A telephone led patient satisfaction survey was then completed.Results71 (24%) suitable patients were identified from vetting 300 referrals. 54 patients from this group were selected for one-stop service following telephone consultation. 51 patients subsequently attended for surgery. There was a 100% conversion rate to same day surgery and no intraoperative complications reported.ConclusionThe waiting time was significantly reduced, by 30 weeks, for one-stop patients. Approximately one quarter of referrals were deemed suitable for a one-stop service. Many more patients may have been suitable for same day surgery but there was not sufficient information in their referrals to determine their suitability.

Socio-economic disparity in visual impairment from cataract.

To investigate the association of visual impairment from cataract with human development index (HDI) by years lived with disability (YLDs). Published data on national age-standardized YLD rates caused by cataract and national HDIs in 2019 were obtained. Age-standardized YLD rates from 1990 to 2019 were analyzed to explore cataract burden among patients with different income levels. Age-standardized YLD rates in different HDI groups were compared by different degrees of visual impairment. Association between national age-standardized YLD rates and HDI in 2019 was analyzed. The age-standardized YLD rates of populations with visual impairment or blindness due to cataract declined from 1990 to 2019, especially among those with lower middle income. Multiple comparison tests revealed that countries with low HDI had significantly higher age-standardized YLD rates of blindness due to cataract than those with high and very high HDI (P<0.001). The age-standardized YLD rates of populations with blindness (β=-0.588, P<0.001), severe vision loss (β=-0.378, P<0.001), and moderate vision loss (β=-0.389, P<0.001) inversely correlated with HDI. Age-standardized YLD rates caused by cataract have declined since 1990. The burden of visual impairment due to cataract inversely correlate with national socioeconomic development and is more concentrated in countries with low HDI than those with high HDI, especially among the blind. These findings highlight the need to provide additional cataract services and cataract surgery coverage to developing countries to decrease the burden of avoidable blindness caused by cataract.