Low-cost Cataract Surgery Research Articles

Willingness to pay for cataract surgery in baiyin district, northwestern China

ABSTRACT Purpose To investigate willingness to pay for cataract surgery, and its associations, in Northwestern China. Methods Four hundred thirty-eight persons aged 50 years and above, diagnosed with cataract indicated for surgery, identified in an outreach screening program were included. Subjects were offered a willingness-to-pay interview for the maximal amount that the subjects would be willing to pay for a cataract surgery. Age, gender, literacy, education level, occupation, and annual household income were recorded. Results Among 328 (74.9%) subjects who completed the interview, 197 (60.1%) participants were willing to pay something for the cataract surgery (mean, 902.9 ± 856.7 renminbi[RMB], [US$ 145 ± 137]; median, 500RMB, US$ 78). Individuals with presenting visual acuity (PVA) in the worse eye ≤6/60 (OR: 2.1, 95% CI: 1.3–3.2) and a high annual household incomes (OR: 2.0, 95% CI: 0.9–4.6) were likely to be willing to pay for the surgery, as revealed in the regression models. Willingness to pay any amount for cataract surgery was more likely among literate persons (OR: 1.5, 95% CI: 1.0–2.4) and persons with non-agricultural occupation (OR: 1.8, 95% CI: 1.0–3.2). Conclusions The amount that subjects were willing to pay is significantly less than the current cost of cataract surgery (5000 RMB, US$320) in the area. Providing low-cost cataract surgery to patients in a financially sustainable manner is important to increase uptake of cataract surgery among rural residents in Northwest China.

Comparision of surgical induced astigmatism between sics superior and sics temporal

: The aim of this study was to analyze the surgically induced astigmatism in comparison to site of incision superior and temporal in commonly performed SICS technique of cataract surgery. : A prospective interventional study was done on 30 patients who underwent manual small incision cataract surgery (MSICS) divided into two groups namely sics superior group and sics tempral group based on incision-site. The two techniques were compared with respect uncorrected visual acuity, surgically induced astigmatism and type of astigmatism drift. In our study, There was significant difference between techniques regarding best uncorrected visual acuity on 40 post operative day. Greater proportion of patients had good outcomes in both the groups as regards to final visual acuity. Superior incision induced post operative ATR drift (75%) and temporal incision induced WTR astigmatism (70%). : Incision on steep axis is an economical and effective way of reducing pre-existing astigmatism in high-volume and low-cost cataract surgery.

A Sustainable Model For Delivering High-Quality, Efficient Cataract Surgery In Southern India.

Cataracts are a leading cause of reversible blindness in India, where millions of people can be effectively treated for this condition with surgery. The Aravind Eye Care System in southern India developed an efficient system for delivering high-quality and low-cost cataract surgery. We provide a detailed accounting of costs of cataract surgery at the system and a cost-utility analysis. Total costs per operation were US$120, or $195 per quality-adjusted life-year gained. Using these data and population-based estimates of cataract prevalence, we calculate that eliminating cataract-related blindness and low vision in India would cost $2.6billion and would yield a net societal benefit of $13.5billion. Factors contributing to the highly cost-effective care at the Aravind Eye Care System include the domestic manufacturing of supplies, the use of a specialized workforce and standardized protocols, and the presence of few regulatory hurdles. Lessons learned from the system can help improve the delivery of cataract surgery and other ambulatory care surgeries in India and abroad.

Barriers for Poor Cataract Surgery Uptake among Patients with Operable Cataract in a Program of Outreach Screening and Low-cost Surgery in Rural China

Aims: To identify the reasons for poor uptake of cataract surgery in a program of outreach screening and low-cost surgery in Pucheng County, a rural area in northwestern China.Methods: Detailed interviews with a semi-structured questionnaire were conducted by telephone or face-to-face for participants who had been advised to attend a low-cost cataract surgery program but did not schedule the surgery within 3 months after the initial screening.Results: Among 432 eligible subjects, 355 (82.2%) were interviewed (mean age 70.6 ± 6.6 years, 73.8% female). A total of 138 subjects (38.9%) were interviewed by phone and 217 (61.1%) were interviewed face-to-face. Lack of family support (n = 106, 29.9%) and failure to understand the need for surgery (n = 96, 27.0%) were the two main reasons for not undergoing cataract surgery. Other factors included fear of surgery (n = 62, 17.5%), lack of faith in doctors (n = 36, 10.1%), financial constraints (n = 25, 7.0%) and lack of transportation (n = 4, 1.1%).Conclusion: The principal barriers to low-cost cataract surgery uptake in rural China included lack of family support and failure to understand the need for surgery. Education targeting entire families to eliminate these barriers and development of community support systems at the family level are required to achieve greater uptake of low-cost cataract surgery programs in rural China.

Implementation of a Free Cataract Surgery Program in Rural China: A Community-Based Randomized Interventional Study

To identify effective methods to increase the number of cataract surgeries in a rural setting in Pucheng County of Shaanxi Province, northwestern China. Community-based randomized interventional study. Four hundred thirty-two patients 50 years of age or older with operable cataract who had not undergone surgery 3 months after participation in a cataract outreach screening program. Three hundred fifty-five (82.2%) patients eligible for surgery, but not scheduling it on their own, were contacted and were assigned randomly into 4 groups. Participants in group 1 (n = 86) were given informative reminders by telephone or in person by a trained facilitator about undergoing low-cost cataract surgery. Group 2 (n = 86) was offered free cataract surgery. Group 3 (n = 90) was offered free surgery and reimbursement of transportation expenses. Group 4 (n = 93) was provided with free rides from home to hospital in addition to the reminder and free surgery. Number of participants undergoing cataract surgery after interventions. In total, 94 patients (26.5%) underwent cataract surgery after interventions. In group 1, 13 patients (14.4%) underwent surgery, which was significantly lower than the number in group 2 (n = 25 [27.8%]; P = 0.027), group 3 (n = 28 [31.1%]; P = 0.012), and group 4 (n = 26 [28%]; P = 0.038). There were no significant differences between groups 2 and 3 (P = 0.768) or between groups 2 and 4 (P = 0.869). Provision of free cataract surgery was twice as effective as giving patients an informative reminder when it came to increasing the uptake of cataract surgery. However, offering reimbursement of transportation expenses or provision of free rides had minimal added impact on the response rate of participants to undergo cataract surgery.

Structured extracapsular cataract extraction-intraocular lens microsurgical training: Report of a trainee′s experience

The aim was to report the experience an ophthalmologist gained in a structured intraocular lens (IOL) microsurgery training program for the information and benefit of colleagues in ophthalmology training institutions. An ophthalmologist was trained in extracapsular cataract extraction (ECCE)-IOL implant in Aravind Eye Hospital (AEH), Madurai, for a period of 8 weeks. Details of patients operated on, procedures observed, and conferences attended were prospectively recorded in a log book. Training was available in conventional ECCE with posterior chamber IOL (ECCE-PCIOL), small incision sutureless cataract surgery, and phacoemulsification. During the period, this trainee observed a total of 1527 cataract extractions, administered 528 retrobulbar and 1047 facial blocks, and also operated on 75 patients. The trainee gained experience and confidence to perform high-quality, low-cost cataract surgery. Hands-on experience and competence in quality ECCE-IOL implant microsurgery can be acquired in a short period of time in a high-volume cataract center. Trainees can also be exposed to other techniques of cataract surgery. Ophthalmology training centers with diminishing surgical training opportunities can also benefit from this structured training in a high-volume cataract center like Aravind Eye Hospital.

A virtual training simulator for learning cataract surgery with phacoemulsification

This paper presents the development of a low-cost cataract surgery simulator for trainees to practise phacoemulsification procedures with computer-generated models in virtual environments. It focuses on the training of cornea incision, capsulorrhexis and phaco-sculpting, which are simulated interactively with computationally efficient algorithms developed for tissue deformation, surface cutting and volume sculpting. Intuitive two-handed human–computer interactions are achieved with six degrees-of-freedom haptic devices. Performance of trainees on manual dexterity is recorded with quantifiable metrics. The proposed virtual-reality system has the potential to serve as an alternative training tool to supplement conventional cataract surgery education.

Making Healthcare Affordable for All: A Proposed Model for Transferring Technology Innovations Case Discussion: Aurolab

vision of its founder Dr. V, and its committed and talented senior management. A significant reason for its success is its large captive customer, the Aravind Eye Care System, which give it the scale needed to commercialize its innovations. With such a ready-made market, Aurolab’s entrepreneurial managers were able to re-engineer technologies available in the West to suit local conditions, and design manufacturing systems that allowed it to provide inexpensive lenses for Aravind’s low cost cataract surgery. Almost 60 percent of the nearly 200,000 surgeries that Aravind performs annually are highly subsidized—most patients pay a basic fee (about half the US$18 cost of surgery), and the other 40 percent, who are provided with additional service features (such as a private room or a hot meal), pay a market price of nearly US$50. The surplus margins gained from this 40 percent of the market provide the fuel for the scale and reach for Aravind’s charitable mission-to-provide eyesight for those in need, regardless of their ability to pay. The average income of an Indian citizen is US$600 and Aravind was able to provide cataract surgery for US$18(cost), or 3 percent of the average income. In the United States, where the average income is US$32,000, the cost of the surgery is US$1,800, or 6 percent. So Aravind’s system innovation is all the more impressive, the surgery is twice as affordable (using a cost benchmark) for the average Indian citizen than his or her U.S. counterpart. At 6 percent of annual income, an Indian surgery at about US$36 or so would still be affordable to the Indian poor. Even so, the price of the lens could not exceed about US$10 to be within the 40 percent cost of supplies for a cataract surgery in India, as shown in Figure 2 of the

Attacking the backlog of India's curable blind. The Aravind Eye Hospital model.

The number of individuals in developing nations with preventable blindness from cataract and other disorders is increasing. New programs incorporating local customs and efficiently using available resources must be created to prevent the escalation of blindness and to rehabilitate patients already disabled with cataracts. We describe a system of high-quality, high-volume, cost-effective cataract surgery, using screening eye camps and a resident hospital. This has enabled us to provide efficient low-cost cataract surgery and overcome barriers of adequate eye care in southern India. We have been successful in locating patients with treatable eye problems, educating them about the availability of ophthalmic care, and providing free eye care. Our structure stresses the following: community involvement, identification of individuals most likely to benefit from screening, efficient utilization of both medical and paramedical personnel, and a streamlined approach to screening patients. This system may be capable of modification for use in other developing areas to decrease the backlog of cataract blindness.

Present challenges in the global prevention of blindness

Cataract is responsible for 50% of world blindness, with at present an estimated backlog of 13.5 million cases in need of surgery. Low-cost cataract surgery must be made more available in developing countries, making use of alternative approaches for outpatient surgery and optimal management of available resources. Trachoma control needs to be targeted at the worst affected areas in endemic countries, with more emphasis on behavioural, educational and community aspects of the disease. Vitamin A deficiency and xerophthalmia control are becoming matters of maternal and child health care, with early intervention during infancy in view of the mortality issue. There are good prospects for the prevention of blindness from onchocerciasis, through the availability of ivermectin, but large-scale distribution schemes are still needed in most of the African countries concerned. The early detection and management of open-angle glaucoma still poses a major problem in developing countries, and further development of appropriate technology is needed in this field. Another area where more efforts are needed is ocular trauma, which is commonly the cause of unilateral loss of vision. General preventive measures must be enforced and better training provided to health personnel to deal competently with such cases, in order to prevent late complications. Diabetes, finally, is on the increase in many developing countries, giving rise to problems in dealing effectively with the ensuing retinopathy.(ABSTRACT TRUNCATED AT 250 WORDS)