Outcomes of and barriers to cataract surgery in Sao Paulo State, Brazil

Abstract

BackgroundCataract is the leading cause of blindness in developing countries and identification of the barriers to accessing treatment is essential for developing appropriate public healthcare interventions. To evaluate the barriers to cataract surgery after diagnosis and assess the postoperative outcomes in Sao Paolo State, Brazil.MethodsThis prospective study evaluated cataract patients from 13 counties in São Paulo State in 2014. Cataract was diagnosed in the community by a mobile ophthalmic unit and patients were referred to a hospital for management. Gender, age, distance to the hospital and local municipal health structure were evaluated as possible barriers. Data were analyzed for postoperative outcomes and the impact on blindness and visual impairment.ResultsSix hundred patients were diagnosed with cataract with a mean age of 68.8±10.3 years and 374 (62.3%) were females. Two hundred and fifty-four (42.3%) patients presented to the referral hospital. One hundred forty-four (56.7%) underwent surgery, 56 (22.0%) decided not to undergo surgery, 40 (15.7%) required only YAG-Laser and 14 (5.5%) required a spectacle prescription only. Visual acuity increased statistically significantly from 1.07±0.73 logMAR at presentation to 0.25±0.41 logMAR at the final visit after intraocular lens implantation (p=0.000). There was a statistically significantly decrease from 17 (11.8%) blind patients and 55 (38.2%) visually impaired patients at presentation to 2 (1.4%) and 5 (3.5%) patients respectively after treatment (p=0.000).ConclusionLess than half of the individuals with cataract presented to the hospital for surgery. Among the patients who underwent treatment, there was an overall decrease in the number of blind individuals and visually impaired individuals. The barriers to cataract surgery were older age, greater distance to the hospital, municipalities with fewer inhabitants and less ophthalmic services.

Barriers to Cataract Surgery Utilization Among Cataract Patients Attending Surgical Outreach Sites in Ethiopia: A Dual Center Study

“…Both sites are further away from eye health institutions with cataract surgery services and also lack of eye health professionals can contribute for low awareness for cataract surgery. 16,19 Lack of income/ cost of surgery were another barrier distinguished in this study. This was supported by different studies.…”

“…This is a common challenge in developing countries and was supported by different literatures. 1,7,11,16 This might be due to lack of income for transportation and long duration of waiting time in the hospital makes the patient ignorant of the cataract surgery. The availability of eye health institutions on both sites in this study might be one more reason for delaying utilization of cataract.…”

“…12 A study in Brazil showed that the barriers to cataract surgery were older age, greater distance to the hospital, municipalities with fewer inhabitants and fewer ophthalmic services. 16 A study in Sri Lanka showed that fear of surgery, no desire to improve vision and lack of awareness were the most frequently reported barriers. 17 Understanding factors that contribute to poor utilization of cataract surgical services in different localities is important because the factors may differ among various areas and it helps to address the factors leading to reduced burden of cataract blindness.…”

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

“…Cataract is a leading cause of blindness globally 1 . Additional one million people develop cataract blindness annually.…”

“…Additional one million people develop cataract blindness annually. In developing countries, cataract causes 51% of blindness compared to 5% in developed counterparts 1 , 2 . Cataractblindness is more in Africa and parts of China 1 , 2 .…”