Uptake Of Cataract Surgery Research Articles

Overcoming the challenges of cataract blindness in Nigeria: An action plan for ophthalmologists

Abstract Purpose: The purpose of this study was to explore the eye care provider factors responsible for low cataract surgical rates (CSRs) in Nigeria and to develop an action plan to boost the CSR. Methods: This was a cross-sectional survey of ophthalmologists practicing in Nigeria. An online questionnaire was distributed via E-mail and social media platforms to respondents. Data collected included sociodemographic characteristics, type, and location of the eye hospital where respondents practiced, cataract surgeries performed monthly, frequency and type of outreach activities by the eye hospitals, barriers to uptake of cataract surgery at the hospitals, and suggestions on measures to overcome such barriers. Statistical analysis was done using IBM-SPSS version 20, and the level of significance was P < 0.05. Results: A total of 201 ophthalmologists responded to the survey. Majority (88.0%) were practicing in university or government hospitals while only 8 (4.0%) were working in mission hospitals. The average monthly cataract surgeries performed per hospital ranged from 0 to 600, with a median of 30 surgeries. Mission hospitals were more likely to perform ≥50 cataract surgeries per month compared to other hospitals (P = 0.003). Majority (75.1%) of hospitals organized outreach activities to identify cataract patients. Higher frequency of outreach activities (P = 0.028) and combining surgery with screening (P = 0.036) were associated with a higher likelihood that the cataract patients that were identified received surgery. Conclusion: The conduct of frequent outreach activities in which eye screening and cataract surgery are combined should boost CSRs and reduce the burden of cataract blindness in Nigeria.

A qualitative study on the effect of a decision aid on knowledge of cataractsurgery in patients in developing countries.

Despite cataract surgery being a safe procedure with a low incidence of perioperative complications rates, poor knowledge, concerns about the effectiveness of treatment and cost-benefit analysis of the procedure significantly hinder cataract surgery uptake rates in Africa. This study describes the effect of a decision aid on knowledge and decision conflict on cataract patients in Africa. 120 patients with cataracts reporting to a tertiary hospital in Ghana were randomly assigned to receive a decision aid containing information on the possible outcomes of cataract surgery or a control booklet containing general knowledge about cataracts without information about cataract surgery. The primary outcome measured was the effect of the decision aid on their knowledge of cataract surgery. A score greater than 6/12 (50%) was deemed adequate knowledge. The secondary outcome was the decision conflict experienced by the participants assessed using the Decision Conflict Scale. Compared to the control group, the participants in the intervention group scored higher marks across all sections of the questionnaire (2.92 vs 2.7, p = 0.042 in section"Background"; 2.62 vs 1.77, p < 0.001 in section"Materials"; 1.87 vs 1.55, p = 0.03 in section"Results"). The average total score was higher in the intervention group than in the control (36.7% difference; p < 0.001). Participants in the intervention group also demonstrated lower decision conflict scores than those in the control group (13.00 vs 37.17; p < 0.001). The decision aid increased knowledge of cataract surgery and reduced decision conflict among patients in a developing country.

Alternative community-led intervention to improve uptake of cataract surgery services in rural Tanzania-The Dodoma Community Cataract Acceptance Trial (DoCCAT): a protocol for intervention co-designing and implementation in a cluster-randomized controlled trial.

Age-related lens opacification (cataract) remains the leading cause of visual impairment and blindness worldwide. In low- and middle-income countries, utilization of cataract surgical services is often limited despite community-based outreach programmes. Community-led research, whereby researchers and community members collaboratively co-design intervention is an approach that ensures the interventions are locally relevant and that their implementation is feasible and socially accepted in the targeted contexts. Community-led interventions have the potential to increase cataract surgery uptake if done appropriately. In this study, once the intervention is co-designed it will be implemented through a cluster-randomized controlled trial (cRCT) with ward as a unit of randomization. This study will utilise both the qualitative methods for co-designing the intervention and the quantitative methods for effective assessment of the developed community-led intervention through a cRCT in 80 rural wards of Dodoma region, Tanzania (40 Intervention). The 'intervention package' will be developed through participatory community meetings and ongoing evaluation and modification of the intervention based on its impact on service utilization. Leask's four stages of intervention co-creation will guide the development within Rifkin's CHOICE framework. The primary outcomes are two: the number of patients attending eye disease screening camps, and the number of patients accepting cataract surgery. NVivo version 12 will be used for qualitative data analysis and Stata version 12 for quantitative data. Independent and paired t-tests will be performed to make comparisons between and within groups. P-values less than 0.05 will be considered statistically significant.

Barriers to uptake of cataract surgery among elderly patients in rural China: a cross-sectional study

ObjectiveTo investigate factors that differentiate elderly adults in rural China who accept free vision screening and cataract surgery from those who could benefit from vision care but refuse it when...

Barriers to the Uptake of Cataract Surgery in Lumbini Nepal and Aranyaprathet Thailand

Barriers to the Uptake of Cataract Surgery in Lumbini Nepal and Aranyaprathet Thailand

Patterns and determinants of incident cataract surgery in China from 2011 to 2015 using a nationally representative longitudinal database

ObjectivesTo investigate incident cataract surgery and to investigate determinants of cataract surgery uptake in Chinese adults.DesignThis nationally representative longitudinal study recorded self-reported incident cataract surgery, and measured biological, clinical and...

Geographical Inequality on Cataract Surgery Uptake in 200,000 Australians: Findings from the "45 and Up Study".

Using a geographical information system (GIS), we investigated the spatiotemporal evolution of a cataract surgery service and its association with socioeconomic factors and private insurance, based on 10-year real-world medical claim data in an Australian population. The data collected cover a decade (2007–2016) from the “45 and Up Study”. A total of 234,201 participants within the cataract surgery service were grouped into 88 Statistical Area Level 3 (SA3s) according to their residential postcodes in New South Wales Australia. We analyzed the spatiotemporal variations and geographical distribution inequality in cataract surgery incidence and its respect to socioeconomic status (SES) and private health insurance coverage by Spearman correlation analysis and Moran's I test. Then these variations were intuitive displayed by six-quartile maps and a local indicator of spatial association (LISA) maps based on GIS. The average cumulative age-gender-standardized of the incidence of cataract surgery (ICS) was 8.85% (95% CI, 5.33–15.6). Spatial variation was significant (univariate Moran's I = 0.45, P = 0.001) with incidence gradually decreasing from the coastal regions to the north-western inland regions, suggesting inequality in the cataract surgery service across the state of New South Wales. Notably, clustering of the low incidence areas had gradually disappeared over the decade, suggesting that the cataract surgery service has improved over time. Low scores on the “index of socioeconomic disadvantages” (IRSD) and high private health insurance coverage were significantly associated with a higher incidence of cataract surgery (bivariate Moran's I = −0.13 and 0.23, P < 0.01; Spearman correlation r = 0.25 and −0.25, P = 0.02), which is displayed on the map visually and obviously. Spatiotemporal variations in the incidence of cataract surgery are significant, but the low incidence area had gradually disappeared over time. High socioeconomic status and private insurance contribute to a higher incidence of cataract surgery in Australia.

Exploring the Reasons for Low Cataract Surgery Uptake Among Patients Detected in a Community Outreach Program in Cameroon: Focused Ethnographic Mixed Methods Study

Background Vision 2020: The Right to Sight, was one potential way to deal with the barriers surrounding cataract surgery and improve access to eye care. To this effect, the Magrabi International Council of Ophthalmology (ICO) Cameroon Eye Institute (MICEI) has performed more than 1000 sight-restoring cataract surgeries among patients referred from outreach camps. However, quite a good number of patients diagnosed with cataracts during community screening camps fail to present for surgery. This study sought to explore some of the challenges to accepting cataract surgery among community-diagnosed patients with cataract, patients operated for cataract, and community members. Objective The study objective was 5-fold: (1) to assess the level of awareness about cataract and available treatment, (2) to explore barriers to cataract surgery uptake, (3) to assess people’s perception about the outcome of cataract surgery, (4) to understand people’s perception about free cataract surgery, and (5) to explore reasons for outright refusal of cataract surgery. Methods This was a focused ethnographic study from December 2018 through February 2019 in 3 different communities of the Center Region of Cameroon, in which patients with cataract were diagnosed. The study sample was composed of patients operated for cataract, those diagnosed with cataract, key informants, and community members. Focus group discussions (FGDs), personalized in-depth interviews, and a short demographic questionnaire were used to collect data. Data were analyzed using a Microsoft Excel spreadsheet and Stata 14 (StataCorp). Data were presented using tabular and graphical methods. Results A total of 29 subjects (19 men) with a mean age of 54.5 (SD 14.5) years took part in the study. The most prominent barriers to cataract surgery were found to be cost (25/29, 86%) and fear of surgery (17/29, 59%). It was also noted by 41% (12/29) of subjects that those who do not take up cataract surgery turn to traditional medicine. Other barriers included the lack of awareness of available treatment (6/29, 21%), no perceived need (5/29, 17%), cultural beliefs and superstition (4/29, 14%), and negligence (4/29, 14%). Conclusions We found cost (25/29, 86%) and fear (17/29, 59%) to be the main barriers. Belief in traditional medicine and superstition were the main drivers of fear. The implementation of a tiered pricing system, counseling training for key informants, incentives for the referral of patients with cataract, mass media engagement, advocacy, training and active involvement of traditional doctors as key informants, acquisition of a 4×4 outreach van, and motorbikes for camp organizers were some of the recommendations based on our results.

Peer Review of “Exploring the Reasons for Low Cataract Surgery Uptake Among Patients Detected in a Community Outreach Program in Cameroon: Focused Ethnographic Mixed Methods Study”

Peer Review of “Exploring the Reasons for Low Cataract Surgery Uptake Among Patients Detected in a Community Outreach Program in Cameroon: Focused Ethnographic Mixed Methods Study”

Authors’ Response to Peer Reviews of “Exploring the Reasons for Low Cataract Surgery Uptake Among Patients Detected in a Community Outreach Program in Cameroon: Focused Ethnographic Mixed Methods Study”

Authors’ Response to Peer Reviews of “Exploring the Reasons for Low Cataract Surgery Uptake Among Patients Detected in a Community Outreach Program in Cameroon: Focused Ethnographic Mixed Methods Study”

Peer Review of “Exploring the Reasons for Low Cataract Surgery Uptake Among Patients Detected in a Community Outreach Program in Cameroon: Focused Ethnographic Mixed Methods Study”

Peer Review of “Exploring the Reasons for Low Cataract Surgery Uptake Among Patients Detected in a Community Outreach Program in Cameroon: Focused Ethnographic Mixed Methods Study”

Peer Review of “Exploring the Reasons for Low Cataract Surgery Uptake Among Patients Detected in a Community Outreach Program in Cameroon: Focused Ethnographic Mixed Methods Study”

Peer Review of “Exploring the Reasons for Low Cataract Surgery Uptake Among Patients Detected in a Community Outreach Program in Cameroon: Focused Ethnographic Mixed Methods Study”

Peer Review of “Exploring the Reasons for Low Cataract Surgery Uptake Among Patients Detected in a Community Outreach Program in Cameroon: Focused Ethnographic Mixed Methods Study”

Peer Review of “Exploring the Reasons for Low Cataract Surgery Uptake Among Patients Detected in a Community Outreach Program in Cameroon: Focused Ethnographic Mixed Methods Study”

Barriers for the uptake of cataract surgery: A rural community-based study

Background: Cataract is the leading cause of blindness. Various national programmes have been undertaken to reduce its prevalence. Several barriers in the rural community and individuals exist which decreases the uptake of cataract surgery. Knowledge of factors would help in improving surgical uptake in rural patients and a decrease in blindness rate.Aim: This study aimed to evaluate the factors preventing cataract surgery acceptance in rural patients.Setting: An observational cross-sectional study was conducted between June 2019 to December 2019 in eye screening camps in rural areas of south Karnataka, India.Methods: An observational cross-sectional study was conducted between June 2019 and December 2019. A total of 4114 patients were screened at camps, out of which 500 patients above the age of 50 years, diagnosed with cataracts but had refused cataract surgery earlier, were included. Data were collected on demography, visual acuity, cataract or lens status, source of information on cataract surgery in camps, reasons for refusal of cataract surgery previously. Barriers to cataract surgery uptake (CSU) were classified as attitudinal, social, economical and psychological factors and reasons for uptake of cataract surgery in the current visit were recorded in the form of a questionnaire and analysed.Results: The mean age of the participants was 65.8 years. The male to female ratio was 1.1:1. The prevalence of cataract blindness in our study population was 11.5%, which was significant (p = 0.000). Announcements and pamphlets were the most common source of information on cataract surgery in camps. Significant barriers to CSU were attitudinal factors, mainly the ability to manage daily work (66.4%) with cataract; one eye had an adequate vision (57.4%). The next common barrier was an economic factor as they waited for a camp to avail themselves of free service (61.5%). The least common barriers were female gender (13.2%), fear related to surgery (11.8%), old age (9.6%), God’s will/fate (6.2%), lack of transport (5.4%). The critical factors in CSU in the camps were a provision of free surgery, accessible transport, the camp being conducted closer to their home and motivation by the health workers.Conclusion: Although economic barriers were efficiently taken care of by the government through national programmes, attitudinal barriers seem to be the most important barriers to achieve the goal of reducing blindness because of cataract in rural population.

Application of Andersen–Newman model to assess cataract surgery uptake among older Australian women: findings from the Australian Longitudinal Study on Women’s Health (ALSWH)

IntroductionAlthough Cataract Surgery Rate is increasing, the availability of surgery is outstripped by the increasing number of cataract cases as populations age.AimThe study aimed to identify factors associated with cataract surgery uptake in terms of predisposing, enabling, and need factors in very old Australian women.MethodThis study used ALSWH data included 6229 women aged 79–84 to 85–90 years. Women were asked whether they had undergone eye surgery (including cataracts) three years prior to each survey. Generalised estimating equation modelling was used to determine factors associated with these surgeries.ResultAt baseline (2005), more than half of the participants either had undergone surgery (43.5%) or had unoperated cataracts (7.6%). Increasing age (AOR = 1.11, 95% CI = 1.07, 1.15) and being current or ex-smokers (AOR = 1.15, 95% CI = 1.03, 1.29) were associated with higher odds of cataract surgery (predisposing factors). Women who had private health insurance had 27% higher odds of having surgery (AOR = 1.27, 95% CI = 1.16, 1.39) (enabling factor). Need factors of more General Practitioner visits (AOR = 1.16, 95% CI = 1.09, 1.25) and skin cancer (AOR = 1.09, 95% CI = 1.01, 1.17) also increased the odds of cataract surgery. Women who had no difficulty seeing newspaper print were more likely to have had cataract surgery (AOR = 1.35, 95% CI = 1.23, 1.48).ConclusionNeed factors are the major drivers of cataract surgery; however, predisposing and enabling factors also play a role, including access to private health insurance. This finding indicates some inequity regarding access to cataract surgery in the Australian setting.

Prevalence of cataract and factors associated with cataract surgery uptake among older persons in Malaysia: A cross-sectional study from the National Eye Survey II.

Nationally-representative evidence is limited on factors affecting uptake of cataract surgery in Malaysia. We found the prevalence of cataract among older persons to be 26.8%. The two most common barriers were 'need not felt' (43.5%) and 'fear of surgery or poor result' (16.2%). Reluctance for surgical intervention was greater outside the Central zone.

WHITE SENILE CATARACTS: INTERMEDIATE ASSESSMENT OF IMPACT OF VISION 2020-THE RIGHT TO SIGHT PROGRAM IN RURAL NORTHERN INDIA

Worldwide cataract is the leading cause of avoidable blindness. In India according to a survey, blindness due to cataract accounts for over 2 seventy percent of avoidable blindness. The goal of vision 2020 1 program is elimination of avoidable blindness. Since cataract is major cause of avoidable blindness in developing countries like India, the key to success of vision 2020 initiative lies in addressing cataract 3 blindness. India is the signatory of vision 2020 program, initiated by World Health Organization (WHO) in 1999. The latest reports assessing impact of the program in India indicate increase in number of 4 cataract surgery rate. The cataract surgery rate (CSR) is the number of cataract surgeries per million populations per year. CSR is an important quantitative measure of cataract surgical service delivery within dened population. However, CSR only partly measure the impact of a program designed to eliminate the avoidable blindness. Another indicator, which measures proportion of persons receiving cataract surgery of the eligible visually impaired individuals, is cataract surgical coverage (CSC). CSC serves as an indicator to measure the extent to which services have covered the need of the 5 population. Most of the published literatures assessing impact of vision 2020 program have focused on CSR, and only few have dealt 6, 7 with CSC. Senile cataracts turning white are consequence of normal maturity process of crystalline lens, and often considered as resultant of delayed cataract surgery. Their prevalence in community is an indirect indicator of impact of program targeting blindness due to cataract. The study was aimed to determine hospital based incidence of white senile cataracts and to nd causes for delay in uptake of cataract surgery

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.

Understanding patient health-seeking behaviour to optimise the uptake of cataract surgery in rural Kenya, Zambia and Uganda: findings from a multisite qualitative study.

BackgroundCataract is a major cause of visual impairment globally, affecting 15.2 million people who are blind, and another 78.8 million who have moderate or severe visual impairment. This study was designed to explore factors that influence the uptake of surgery offered to patients with operable cataract in a free-of-charge, community-based eye health programme.MethodsFocus group discussions and in-depth interviews were conducted with patients and healthcare providers in rural Zambia, Kenya and Uganda during 2018–2019. We identified participants using purposive sampling. Thematic analysis was conducted using a combination of an inductive and deductive team-based approach.ResultsParticipants consisted of 131 healthcare providers and 294 patients. Two-thirds of patients had been operated on for cataract. Two major themes emerged: (1) surgery enablers, including a desire to regain control of their lives, the positive testimonies of others, family support, as well as free surgery, medication and food; and (2) barriers to surgery, including cultural and social factors, as well as the inadequacies of the healthcare delivery system.ConclusionsCultural, social and health system realities impact decisions made by patients about cataract surgery uptake. This study highlights the importance of demand segmentation and improving the quality of services, based on patients’ expectations and needs, as strategies for increasing cataract surgery uptake.

Factors associated with delayed uptake of cataract surgery among adult patients at Mulago National Referral Hospital, Uganda.

Cataract is the leading cause of blindness globally. Many patients with cataract in developing countries delay to come for cataract surgery. This study aimed to determine the factors associated with delayed uptake of cataract surgery among adult patients seen at Mulago National Referral Hospital eye clinic in Uganda. Employing a hospital based cross-sectional study, adult patients with cataract and having moderate visual impairment or blindness were recruited. Patient-related factors for delayed surgery were assessed using a predetermined questionnaire. Data was analyzed using stata version 14.2. Logistic regressions were used to determine the factors associated with delayed uptake of cataract surgery among these patients. Eighty two participants with operable cataract were evaluated. Females were 44 (54%) and the mean age of participants was 67 years. Fifty three (65%) had delayed uptake of cataract surgery. The factors associated with delayed uptake of cataract surgery among patients with cataract were financial constraint, felt no need for surgery and good unilateral vision. Financial constraints, no felt need for cataract surgery and having good unilateral vision are the factors associated with delayed uptake of cataract surgery among cataract patients. We recommend cataract surgical outreach to remote areas and health education.