Delayed Cataract Surgery Research Articles

GJA3 Genetic Variation and Autosomal Dominant Congenital Cataracts and Glaucoma Following Cataract Surgery

The p.Asp67Tyr genetic variant in the GJA3 gene is responsible for congenital cataracts in a family with a high incidence of glaucoma following cataract surgery. To describe the clinical features of a family with a strong association between congenital cataracts and glaucoma following cataract surgery secondary to a genetic variant in the GJA3 gene (NM_021954.4:c.199G>T, p.Asp67Tyr). This was a retrospective, observational, case series, genetic association study from the University of Iowa spanning 61 years. Examined were the ophthalmic records from 1961 through 2022 of the family members of a 4-generation pedigree with autosomal dominant congenital cataracts. Frequency of glaucoma following cataract surgery and postoperative complications among family members with congenital cataract due to the p.Asp67Tyr GJA3 genetic variant. Medical records were available from 11 of 12 family members (7 male [63.6%]) with congenital cataract with a mean (SD) follow-up of 30 (21.7) years (range, 0.2-61 years). Eight of 9 patients with congenital cataracts developed glaucoma, and 8 of 8 patients who had cataract surgery at age 2 years or younger developed glaucoma following cataract surgery. The only family member with congenital cataracts who did not develop glaucoma had delayed cataract surgery until 12 and 21 years of age. Five of 11 family members (45.5%) had retinal detachments after cataract extraction and vitrectomy. No patients developed retinal detachments after prophylactic 360-degree endolaser. The GJA3 genetic variant, p.Asp67Tyr, was identified in a 4-generation congenital cataract pedigree from Iowa. This report suggests that patients with congenital cataract due to some GJA3 genetic variants may be at especially high risk for glaucoma following cataract surgery. Retinal detachments after cataract extraction in the first 2 years of life were also common in this family, and prophylactic retinal endolaser may be indicated at the time of surgery.

Имплантация интраокулярной линзы с механизмом формирования волнового фронта при хирургическом лечении катаракты у пациентов после сквозной кератопластики

Purpose. The article presents a clinical case of cataract surgery with implantation and preoperative calculation of the AcrySof IQ Vivity intraocular lens (IOL) (Alcon, USA) in a patient who underwent penetrating keratoplasty 15 months ago. Material and methods. IOL calculation was based on the actual data of the optical biometry, keratotopographic measurements. Considering complaints, a decrease in the quality of life, ophthalmic status data, it was decided to perform a penetrating subtotal keratoplasty of the right eye, followed by remote phacoemulsification and implantation of an intraocular lens. Results. Patient reports good quality of vision at a distance and average distance; does not experience difficulties when working with computer, feels comfortable while driving at night. Conclusion. Delayed cataract surgery with IOL implantation with the wavefront formation mechanism after penetrating subtotal keratoplasty, only in cases of donor material stabilization, allows to get accurate refraction. Even despite the high probability of refractive error, this type and design features of the lens made it possible to obtain the optimal quality of vision for the patient. Keywords: penetrating keratoplasty, cataract, intraocular lens, refractive error.

PD43 Estimating Societal Costs Associated With Vision Loss And Delayed Cataract Surgery: The Potential Impact Of The COVID-19 Pandemic

IntroductionCataract surgery is the most commonly performed surgical procedure in the UK (approx. 472,000 annually). The suspension of interventions due to the COVID-19 pandemic, has had a devastating impact on patients’ access to care. In the UK a complete cessation of elective cataract surgery during the crisis has been an unfortunate reality and encompassed a 14 week hiatus to services in the National Health Service. Patients on prolonged waiting lists may experience negative outcomes during the wait period, including vision loss, increased risk of falls, and ultimately, poorer health-related quality of life (HRQoL). The objective of this research was to estimate the potential societal costs associated with vision-loss related to prolonged waiting times for cataract surgery, as a consequence of COVID-19 in the UK.MethodsIn this analysis, we present estimates relating to two cohorts: a hypothetical cohort of 1,000 cataract surgeries and quarterly estimates of cataract surgeries in the UK. Quarterly estimates (n=122,969) were chosen to reflect a suspension of cataract surgeries for 14 weeks during the COVID-19 crisis. UK cataract surgery numbers were attained from EUROSTAT. Estimates for decreasing visual acuity for those waiting for surgery were attained from the literature, as were the cost estimates associated with cataract-related sight-loss, which were made up of direct, indirect and intangible costs. Five scenarios (at 20% intervals) were simulated for the cost estimates, assuming from 20 percent to 100 percent clearing of waiting lists.ResultsFor cohort 1 (1,000 patients), the societal costs associated patients remaining on waiting list for one year, ranged between GBP 237,765 (EUR 279,533) (20% of patients remain untreated) to GBP 1.18m (EUR 1.39m) (100% remain untreated). For cohort 2 (n=122,969) cost estimates are in the region of GBP 29.23m to GBP 146.18m (EUR 34.36m to EUR 171.73m). Estimates consist of direct (15.6%), indirect (28.7%) and intangible costs (55.6%).ConclusionsCataract surgery is a sight saving procedure and its impact on HRQoL is overwhelmingly positive. Prolonged waiting times for cataract patients due to COVID-19 is likely to be associated with significant societal costs.

A Study to Evaluate the Causes of Delayed Presentation for Cataract Surgery at a Tertiary Eye Centre, Odisha, India

Introduction: Inspite of being advised surgery by doctor and several health schemes made available by the Government of India for the economically backward section, people still present late for surgery, inviting many complications in the long run. Aim: To study the causes of delayed cataract surgery in Below Poverty Line (BPL) patients in a tertiary health care centre in Eastern India. Materials and Methods: The present hospital-based and cross- sectional study included 58 patients who presented to the Outpatient and Emergency Department of a tertiary care hospital in Eastern India between December 2020 to April 2021. At presentation, detailed history was taken and patients were asked questions related to the cause of delay, which was categorised into- barriers to patient’s attitude and barriers related to cost, affordability and service delivery. Comprehensive ophthalmological examination for each and every patient was done. Routine blood investigations needed for cataract surgery were done. Surgery was done for all cases by a single surgeon and intraocular complications if any were noted. Results: A total of 58 patients included in this study, females (57%) were more than males (43%). Majority of them were from semi urban areas (13.79%). A 60% were dependent on family members for their expenses. About 94.8% had government insurance schemes but still had financial constraints which caused delayed presentation. A 70.7% of people did not attend hospital due to negative peer group effects and almost 84.5% people had no direct means of transportation to the hospital. Fear of surgery (96.6%) and fear of contracting Coronavirus Disease-2019 (COVID-19) (94.8%) were certain other factors which caused delay in presentation for surgery. Conclusion: Through this study, certain possible reasons were found, catering to social, economic as well as factors like fear of surgery, negative peer pressure, financial constraints responsible for the delay in acceptance of cataract surgery in such a set up.

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

Factors protecting against diabetic retinopathy in a geriatric Indian cohort.

Purpose:Diabetic retinopathy (DR) is a potentially sight-threatening complication of diabetes mellitus. The majority of cases are in older adults. This study aims to evaluate modifiable and nonmodifiable protective factors against DR in a geriatric Indian population.Methods:This retrospective observational study uses data from a multitiered ophthalmology network to evaluate several demographic and clinical variables against diabetic retinopathy and visual acuity.Results:Our data show that high myopia, the female sex, and no cataract surgery are associated with lower prevalence of DR (OR = 0.21, 0.65, and 0.76, respectively; P < 0.001). We also found that among those with DR, people categorized as payers, retirees, and those living in urban or metropolitan areas have better visual acuity (OR = 0.65, 0.65, 0.83, and 0.73, respectively; P < 0.001). Among those with DR, females, presence of cataracts, and no cataract surgery had lower associations with sight-threatening DR (STDR) (OR = 0.68, 0.37, and 0.76, respectively; P < 0.001). Prevalence of DR decreased in older age groups while controlling for DM duration.Conclusion:It is probable that high myopia, the female sex, and better glycemic control are protective against DR and STDR in our study cohort of adults over 60 years of age. It is possible that occupations involving manual labor, delayed cataract surgery, and living past the age of 70 are also protective against DR.

PMD33 Estimating Societal Costs Associated with Vision Loss and Delayed Cataract Surgery: The Potential IMPACT of the COVID-19 Pandemic.

Cataract surgery is the most commonly performed surgical procedure in the EU (approx. 4 million annually). The suspension of interventions due to the COVID-19 pandemic, has had a devastating impact on patients’ access to care. For many countries, complete cessation of elective cataract surgery during the crisis has been an unfortunate reality. Patients on prolonged waiting lists may experience negative outcomes during the wait period, including vision loss, increased risk of falls, and ultimately, poorer health-related quality of life (HRQoL).

Comparison of visual outcome and complications following early and delayed cataract surgery in phacolytic glaucoma

To compare the Visual outcome, intraoperative and post operative complications following early and delayed Cataract surgery in Phacolytic glaucoma. A Prospective and interventional study in a district hospital. Confirmed cases of phacolytic glaucoma after medical control grouped into group A and group B. Group A patients under went small incision cataract surgery (SICS) within 7 days (early) and group B patients after 7 days(delayed). They were compared for complications and post operative distant corrected visual acuity (DCVA) at the end of 8 weeks.There were38 eyes from 38 patients. The demographic factors and clinical findings are comparable between two group. Cumulative intraoperative complications like difficulty in doing continuous curvilinear capsulorhexis (CCC), Zonular dialysis and posterior capsule (PC) tear with vitreous disturbance were more in group B 55.6%(10/18) compare to group A 35.0% (7/20). Postoperative DCVA of 6/12 or more was comparable between two group A and B 60.0% (12/20) and 55.6 % (10/18) respectively. Post operative persistent corneal edema in 5.0% (1/20) in group A, 5.5% (1/18) persistent uveitis and 5.5% (1/18) optic nerve damage in group B observed. Early surgical intervention is to be preferred choice in all cases of phacolytic glaucoma. However in patients with genuine personal, family and socio economical reasons delayed surgery will not alter final visual outcome. Adequate preoperative preparation are to be taken to reduce and handle intra operative complication.

Preoperative Medical Testing and Falls in Medicare Beneficiaries Awaiting Cataract Surgery

Delaying cataract surgery is associated with an increased risk of falls, but whether routine preoperative testing delays cataract surgery long enough to cause clinical harm is unknown. We sought to determine whether the use of routine preoperative testing leads to harm in the form of delayed surgery and falls in Medicare beneficiaries awaiting cataract surgery. Retrospective, observational cohort study using 2006-2014 Medicare claims. Medicare beneficiaries 66+ years of age with a Current Procedural Terminology claim for ocular biometry. We measured the mean and median number of days between biometry and cataract surgery, calculated the proportion of patients waiting ≥ 30 days or ≥ 90 days for surgery, and determined the odds of sustaining a fall within 90 days of biometry among patients of high-testing physicians (testing performed in ≥ 75% of their patients) compared with patients of low-testing physicians. We also estimated the number of days of delay attributable to high-testing physicians. Incidence of falls occurring between biometry and surgery, odds of falling within 90 days of biometry, and estimated delay associated with physician testing behavior. Of 248 345 beneficiaries, 16.4% were patients of high-testing physicians. More patients of high-testing physicians waited ≥ 30 days and ≥ 90 days to undergo surgery (31.4% and 8.2% vs. 25.0% and 5.5%, respectively; P < 0.0001 for both). Falls before surgery in patients of high-testing physicians increased by 43% within the 90 days after ocular biometry (1.0% vs. 0.7%; P < 0.0001). The adjusted odds ratio of falling within 90 days of biometry in patients of high-testing physicians versus low-testing physicians was 1.10 (95% confidence interval [CI], 1.03-1.19; P= 0.008). After adjusting for surgical wait time, the odds ratio decreased to 1.07 (95% CI, 1.00-1.15; P= 0.06). The delay associated with having a high-testing physician was approximately 8 days (estimate, 7.97 days; 95% CI, 6.40-9.55 days; P < 0.0001). Other factors associated with delayed surgery included patient race (non-White), Northeast region, ophthalmologist ≤ 40 years of age, and low surgical volume. Overuse of routine preoperative medical testing by high-testing physicians is associated with delayed surgery and increased falls in cataract patients awaiting surgery.

A study to assess the barriers for cataract surgery uptake among elderly population of Aligarh

Background: As cataract being one of the commonest cause of avoidable blindness in India, the study of the barriers that delay the surgical uptake becomes important. This study been done to report the barriers delaying the surgical management and socio-demographic association of delay period. Methods: This study was part of community based cross-sectional study carried out among elderly population residing at field practice area of Rural Health Training Centre and Urban Health Training Centre, JN Medical College, AMU, Aligarh. A sample of 550 was taken from the registered elderly population aged 60 years and above using systematic random sampling with PPS. Barriers for 1st eye surgery were reported among 277 un-operated elderly and for the 2nd eye surgery among those 65 elderly who had operable cataract (defined as cataract in both eyes with low vision affecting daily activities) in one eye with aphaki/pseudophakia in the other. Factors contributing for the delay in uptake of surgery were assessed among operated individuals only (120). Results: Major barriers reported in the study were lack of awareness (33.2%), not able to afford treatment (25.3%), waiting for the cataract to get mature (19.9%). For second eye surgery major barriers reported were, waiting period for maturation (36.9%) followed by corrected vision in the other eye (24.6%) and non-affordability (23%). Significant association of the delay period reported with area, age, sex, education and SLI. Conclusions: Lack of awareness, non-affordability, waiting for the cataract to get, corrected vision in the other eye were the major factors delaying cataract surgery among elderly.

Surgery for cataracts in people with age-related macular degeneration.

Cataract and age-related macular degeneration (AMD) are common causes of decreased vision that often occur simultaneously in people over age 50. Although cataract surgery is an effective treatment for cataract-induced visual loss, some clinicians suspect that such an intervention may increase the risk of worsening of underlying AMD and thus have deleterious effects on vision. The objective of this review was to evaluate the effectiveness and safety of cataract surgery compared with no surgery in eyes with AMD. We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) (2016, Issue 11), Ovid MEDLINE, Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE Daily (January 1946 to December 2016), Embase (January 1980 to December 2016), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to December 2016), the ISRCTN registry (www.isrctn.com/editAdvancedSearch), ClinicalTrials.gov (www.clinicaltrials.gov), and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 2 December 2016. We included randomized controlled trials (RCTs) and quasi-randomized trials that enrolled participants whose eyes were affected by both cataract and AMD in which cataract surgery was compared with no surgery. Two review authors independently evaluated the search results against the inclusion and exclusion criteria. Two review authors independently extracted data, assessed risk of bias for included studies, and graded the certainty of evidence. We followed methods as recommended by Cochrane. We included two RCTs with a total of 114 participants (114 study eyes) with visually significant cataract and AMD. We identified no ongoing trials. Participants in each RCT were randomized to immediate cataract surgery (within two weeks of enrollment) or delayed cataract surgery (six months after enrollment). The risk of bias was unclear for most domains in each study; one study was registered prospectively.In one study conducted in Australia outcomes were reported only at six months (before participants in the delayed-surgery group had cataract surgery). At six months, the immediate-surgery group showed mean improvement in best-corrected visual acuity (BCVA) compared with the delayed-surgery group (mean difference (MD) -0.15 LogMAR, 95% confidence interval (CI) -0.28 to -0.02; 56 participants; moderate-certainty evidence). In the other study, conducted in Austria, outcomes were reported only at 12 months (12 months after participants in the immediate-surgery group and six months after participants in the delayed-surgery group had cataract surgery). There was uncertainty as to which treatment group had better improvement in distance visual acuity at 12 months (unit of measure not reported; very low-certainty evidence).At 12 months, the mean change from baseline between groups in cumulated drusen or geographic atrophy area size was small and there was uncertainty which, if either, of the groups was favored (MD 0.76, 95% CI -8.49 to 10.00; 49 participants; low-certainty evidence). No participant in one study had exudative AMD develop in the study eye during 12 months of follow-up; in the other study, choroidal neovascularization developed in the study eye of 1 of 27 participants in the immediate-surgery group versus 0 of 29 participants in the delayed-surgery group at six months (risk ratio 3.21, 95% CI 0.14 to 75.68; 56 participants; very low-certainty evidence). Quality of life was measured using two different questionnaires. Scores on the Impact of Vision Impairment (IVI) questionnaire suggested that the immediate-surgery group fared better regarding vision-related quality of life than the delayed-surgery group at six months (MD in IVI logit scores 1.60, 95% CI 0.61 to 2.59; low-certainty evidence). However, we could not analyze scores from the Visual Function-14 (VF-14) questionnaire from the other study due to insufficient data. No postoperative complication was reported from either study. At this time, it is not possible to draw reliable conclusions from the available data as to whether cataract surgery is beneficial or harmful in people with AMD after 12 months.Although cataract surgery provides short-term (six months) improvement in BCVA in eyes with AMD compared with no surgery, it is unclear whether the timing of surgery has an effect on long-term outcomes. Physicians must make recommendations to their AMD patients regarding cataract surgery based on experience and clinical judgment until large controlled trials are conducted and their findings published.There is a need for prospective RCTs in which cataract surgery is compared with no surgery in people with AMD to better evaluate whether cataract surgery is beneficial or harmful in all or a subset of AMD patients. However, ethical considerations preclude withholding surgery, or delaying it for several years, if it may be a potentially beneficial treatment. Designers of future trials are encouraged to utilize existing standardized systems for grading cataract and AMD and for measuring key outcomes: visual acuity, change in visual acuity, worsening of AMD, quality of life measures, and adverse events.

Refractive outcomes of combined phacovitrectomy and delayed cataract surgery in retinal detachment

ObjectiveTo compare the accuracy of refractive outcomes between combined pars plana vitrectomy (PPV) and cataract surgery and delayed cataract surgery after PPV in cases with rhegmatogenous retinal detachment (RD). DesignRetrospective case series. ParticipantsThirty-eight eyes underwent combined phacovitrectomy (combined group) and 25 eyes underwent delayed cataract surgery after PPV (delayed group). MethodsRD height was measured using optical coherence tomography. Refractive outcomes were evaluated using mean absolute error (MAE; the difference between final refractive error and target refractive error). ResultsCombined group showed significant myopic shift (mean error; –0.40 ± 1.07 vs 0.07 ± 0.56 D, p = 0.028) and large MAE (0.81 ± 0.81 vs 0.48 ± 0.29 D, p = 0.028) compared with delayed group. Multiple logistic regression analysis revealed that only RD height was significantly associated with MAE greater than 2 D after combined surgery (in 100-µm unit, odds ratio 3.23, 95% CI 1.04–10.02, p = 0.042). RD height was also significantly correlated with the difference in axial length (AL) between 2 eyes of the patients (p = 0.006, r = 0.406) and the difference in AL measured at pre- versus post-RD repair in the delayed group (p < 0.001, r = 0.774). ConclusionsCombined phacovitrectomy in patients with rhegmatogenous RD induced significant myopic shift because of underestimation of AL, especially in patients with high RD height. Thus, in cases with high temporal RD or large AL differences between eyes, either delayed cataract surgery or combined cataract surgery using the contralateral AL is recommended.

A junction of transparency. Focus on “Functional effects of Cx50 mutations associated with congenital cataracts”

cataract, clouding of the optical lens of the eye, is an important health problem accounting for most of the blindness in the world. Eliminating cataract or even delaying cataract surgery (for those lucky enough to have access to surgery) would dramatically reduce health costs, but our ability to formulate pharmacological approaches to this end is hindered by our poor understanding of lens physiology. However, the situation is improving. A model that proposes an intrinsic lens fluid circulation (9) has proven an effective stimulus to innovative experiments in the lens and is receiving increasing experimental support. Knockout mouse studies have clarified the distinct roles played by connexin 50 (cx50, GJA8), connexin 46 (cx46), and connexin 43 (cx43) in lens development and maintenance of clarity. Knockout of either cx46 or cx50 (or both) produces a cataract, but only knockout of cx50 reduces lens size through a diminished rate of epithelial cell proliferation (7, 12, 13). Recent experiments have shown convincingly that connexins, especially cx46, provide a critical pathway for water flow driven by hydrostatic pressure (4). Like connexins, aquaporins play a critical role in lens transparency and naturally occurring mutants in many species including humans show that AQP0 is vital for lens transparency. At least three functions have been suggested for AQP0 in the lens: water channel (3, 10), adhesion molecule (5, 6, 14), and beaded filament anchor. Importantly, AQP0 interacts with connexin 50 (2, 8), the subject of the article by Rubinos et al. (11) in this issue of American Journal of Physiology-Cell Physiology. What is evident from the above is that even though we are making progress toward understanding lens physiology, there are clearly a myriad of details to be uncovered, and these will likely emerge from unexpected sources. The paper of Rubinos et al. provides a look at both the difficulties we face and the ways in which progress may be achieved. Rubinos et al. examine the functional properties of three cx50 mutants (as noted above a major player in maintaining lens clarity) that all produce congenital autosomal dominant cataracts in humans. The investigators focus on the single-channel properties and interactions with other connexins and identify three modes of disruption of the essential properties of connexin 50. One mutant cannot form conductive gap junctions on its own and disrupts the properties of wild-type junctions, hence the autosomal dominant phenotype. Another mutant cannot form channels on its own but can when mixed with either cx50 or cx46 wild-type connexins. So the dominant negative effect of this mutation is due to some other property of the mutant, perhaps defects in signaling, alteration of the permeability of the mixed (heteromeric) channels, or possibly altered interactions with AQP0. A third mutant forms channels with vastly different voltage gating properties from wild type and probably disrupts the conductance of wild-type channels leading to the autosomal dominant cataract phenotype. Taken together, Rubinos et al. characterize a zoo of point-mutation effects, all of which lead to autosomal dominant cataract, but in quite different fashion. Some of the mutations show dominant negative alteration of the channel properties of wild type, but one does not. Thus the results of this study both expand our understanding of the roles of cx50 in the lens as well as increase the perception of our ignorance concerning how cx50 interacts with other proteins in the lens. What are the immediate questions arising from this study to which we might wish answers? I have a few favorites. One avenue for future investigation is how the interactions between proteins contribute to lens transparency and how disruption of interactions spoils transparency. Another avenue is determining the role of genetic background on the penetrance of the mutations that Rubinos and colleagues have investigated. Related to this point, a classic study (1) revealed the importance of genetic background in either facilitating or preventing cataracts in the presence of a connexin mutation. In other words, the study of Rubinos et al. both increases our optimism that systematic study of lens physiology will eventually lead to a useful understanding of how to eliminate or delay cataract as well as warns us that the story is far from complete.

Barriers to cataract surgical uptake in central ethiopia

Purpose:The aim of this study was to assess the factors that delay surgical intervention in patients suffering from age related mature cataract in Ethiopia.Materials and Methods:A short term descriptive study was performed that evaluated patients with mature cataract presenting to outreach eye care clinics in rural central Ethiopia. Patients were interviewed to determine the reasons for delay in their cataract surgeries.Result:A total of 146 subjects (57 male and 89 females) with operable age related cataract were evaluated at 31 outreach clinics. Over 86% of the respondents were above 55 years of age, (range, 45–78 years). The male to female ratio was 1:1.5 and 30.2% of the subjects were blind bilaterally (best corrected visual acuity <3/60). The majority of the respondents were farmers (53.4%) and 86.3% were illiterate. The major factors that delayed cataract surgery included: Cost of surgery (91.8%), insufficient family income (78.1%), good vision in the fellow (unaffected) eye (39.7%), and the distance to hospital from their village (47.9%).Conclusion:Surgical cost, insufficient family income, and the distance to an eye care centre were the major factors delaying cataract surgery in rural Ethiopia.

Gender Disparity in Delayed Treatment-Seeking Behavior for Cataract

This study was conducted to explore the role of gender in delayed treatment seeking for cataract at the Impact Jibon Tari Floating Hospital in rural Bangladesh. Existing clinical records were analyzed for patient characteristics based on sex and the role of gender in delayed cataract surgery. A total of 11 174 patients (41.7% female) received surgical treatment for cataract, among which 69.9% (male = 67.7%; female = 73.2%) had visual acuity (VA) of less than 6/60. After adjustment for hypertension, diabetes, side of eye with cataract, and age above 65, women were more likely to come to surgery after VA became less than 6/60 (adjusted odds ratio = 1.19; 95% confidence interval = 1.1-1.29). Gender appeared to play a role in seeking treatment at later stages of cataract. Further qualitative studies are needed to determine the mechanism of delayed treatment among women.