Cataract surgical coverage and outcome of cataract surgery in a rural district in Malawi

Courtright, Paul; Metcalfe, Nick; Hoechsmann, Alex; Chirambo, Moses; Lewallen, Susan; Barrows, John; Witte, Christine; Kanjaloti, Steve; Mtambo, Olga; Chipeta, Towera; Mekisini, George; Godia, Henry

doi:10.1016/s0008-4182(04)80049-8

Cited by 27 publications

(16 citation statements)

References 11 publications

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“…The proportion of good outcomes (and corresponding low percentage of poor outcomes) in clinic-based studies is higher than in population-based surveys in sub-Saharan Africa [14][15][16][17]. However, findings from clinic-based studies such as ours may not be representative of the wider population.…”

Section: Discussioncontrasting

confidence: 63%

Outcomes of manual small-incision cataract surgery using standard 22 dioptre intraocular lenses at Nkhoma Eye Hospital, Malawi

Sherwin

Dean

Schaefers³

et al. 2012

Int Ophthalmol

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The aim of this study was to investigate the outcomes of sutureless, manual small-incision cataract surgery (SICS) in rural sub-Saharan Africa using standard intraocular lenses (IOLs). In order to assess the quality of surgery, we prospectively evaluated the visual outcomes of 1455 consecutive cataract operations performed in 2006 in patients ≥40 years at Nkhoma Eye Hospital, Malawi. All operations used standard 22-dioptre IOLs without pre-operative biometry. Outcomes were categorised according to the World Health Organization criteria, and causes of a poor outcome were recorded. Mean age of patients was 71.5 ± 9.5 years, and 53 % were female. Pre-operatively, 64 % of eyes had a visual acuity (VA) <6/60, and 41.3 % of eyes were blind (VA < 3/60). Without correction (uncorrected VA), nearly eighty percent (78.7 %) achieved a 'good' outcome (VA 6/6-6/18), 19.8 % were 'borderline' (VA < 6/18-6/60), and 1.5 % had a poor (VA < 6/60) outcome. With pinhole-correction, the proportion of good outcomes increased to 89.4 %, and poor outcomes decreased to 0.9 %. Poor outcomes were most commonly due to ocular co-morbidities (54.5 %) and refractive error (36.4 %). Older age and pre-operative blindness were strongly associated with borderline or poor visual outcomes. The most common surgical complication was posterior capsule tear (without vitreous loss). In a rural African environment, using standard IOL power plus SICS can lead to a high proportion of good outcomes and a low frequency of surgical complications. A comparative study is required to determine if any additional benefit in visual outcomes can be gained by the addition of biometry.

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Section: Discussioncontrasting

confidence: 63%

Outcomes of manual small-incision cataract surgery using standard 22 dioptre intraocular lenses at Nkhoma Eye Hospital, Malawi

Sherwin

Dean

Schaefers³

et al. 2012

Int Ophthalmol

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“…[4][5][6][7][8] Even among patients who travel to 'outreach clinics,' the proportion with operable cataract who accept surgery varies from 51 to 93% (authors unpublished data from five programmes in eastern and southern Africa). However, it seems that a large proportion never get as far as the outreach site.…”

Section: Discussionmentioning

confidence: 99%

Acceptance of cataract surgery in a cohort of Tanzanians with operable cataract

Chibuga

Massae

Geneau

et al. 2007

Eye

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Background In spite of recent increases in the number of surgeries carried out within some hospitals and programmes in sub-Saharan Africa, there are indications that the acceptance of cataract surgery remains quite low. Methods We conducted a population-based prospective (cohort) study of cataract patients from 12 villages in Hai district of Kilimanjaro region, Tanzania. Those identified with operable cataract were informed of the regular community programmes (within 5 km) in place providing transportation and high-quality surgery. At years 1 and 2 after the survey, we traced the patients to determine uptake of cataract surgery. Results Among patients eligible for surgery (128), 31 could not be followed up after 1 year due to deaths, moving, and refusal. Among the remaining patients, 18 accepted surgery in the first year and four accepted in the second year. Among these 22 patients, only five were blind or with severe visual impairment. The most elderly were those least likely to accept surgery. Discussion Even with bridging strategies in place to make cataract surgery accessible and affordable, the uptake of cataract surgery remains low. Strategies aimed to identifying and referring all patients recognizing vision loss as a personal disability rather than using predefined vision cutoffs will likely be most successful in reducing the burden of vision loss due to cataract.

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“…Likewise, our cataract surgical coverage rates (34.5%-63.4%) were slightly lower than reported in Latinos in the United States (65.7%), 33 but generally higher than reported in developing regions (well below 50%). [34][35][36][37] Unfortunately, our study did not collect detailed information on the ''unmet needs'' for AES and LVS. Despite the lack of information in our report, the uptake of annual eye examination is known to be very low across the world, even among high risk populations living in developed countries.…”

Section: Discussionmentioning

confidence: 99%

How Much Eye Care Services Do Asian Populations Need? Projection from the Singapore Epidemiology of Eye Disease (SEED) Study

Zheng

Cheng

Lamoureux

et al. 2013

Invest. Ophthalmol. Vis. Sci.

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1,3-5PURPOSE. We quantified and measured the needs for specific eye care services, including refractive services (RS), annual eye examination services (AES), cataract surgery services (CSS), and low vision services (LVS) in urban adult populations in Asia. METHODS.We conducted three population-based studies of Singapore-resident Chinese, Malays, and Indians aged ‡40 years to measure the proportion of people who needed specific eye care services. RESULTS.Our data included 3353 Chinese, 3280 Malays, and 3400 Indians (participation rate 73.6%). Overall, approximately 70% of the populations needed eye care services and more than 30% had more than one need. The age-standardized proportion of people who need RS, AES, CSS, and LVS were 65.3%, 22.4%, 12.5%, and 0.5%, respectively, in Chinese. These figures were 49.6%, 33.6%, 11.0%, and 0.7%, respectively, in Malays, and 55.6%, 40.0%, 13.4%, and 0.8%, respectively, in Indians. With demographic change, our projection showed that the number of adults needing eye care services in urban Asia will grow from 437 million in 2010 to 827 million in 2030. Diabetes was a major cause of AES and a significant predictor for CSS, whereas higher blood pressure was a predictor for AES.CONCLUSIONS. The needs for eye care services in an urban setting in Asia is high, particularly the needs for RS, AES, and CSS. The high prevalences of diabetes and hypertension are the driving factors underlying these needs. The burden of providing such eye care services highlights the need for new strategies for improvements in primary care and capacity building for eye care professionals other than ophthalmologists. (Invest Ophthalmol Vis Sci.

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Cataract surgical coverage and outcome of cataract surgery in a rural district in Malawi

Cited by 27 publications

References 11 publications

Outcomes of manual small-incision cataract surgery using standard 22 dioptre intraocular lenses at Nkhoma Eye Hospital, Malawi

Outcomes of manual small-incision cataract surgery using standard 22 dioptre intraocular lenses at Nkhoma Eye Hospital, Malawi

Acceptance of cataract surgery in a cohort of Tanzanians with operable cataract

How Much Eye Care Services Do Asian Populations Need? Projection from the Singapore Epidemiology of Eye Disease (SEED) Study

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