Reasons for poor cataract surgery uptake – a qualitative study in rural South Africa

Abstract

SummaryOBJECTIVES To understand the reasons for poor cataract surgery uptake in people with blindness or severe visual impairment in rural South Africa. METHODSMETHODS A qualitative analysis of detailed, domiciliary interviews with a community-based random sample of elderly Zulus who were blind or severely visually impaired as a result of operable cataract, who had previously been invited for surgery but had failed to attend. RESULTS RESULTSFear of surgery and a fatalistic attitude to the inevitability and irreversibility of blindness in old age were the main reasons for failure to attend for surgery. There was a lower level of disability and perceived need than had been assumed for people with such poor visual acuity. Non-surgical western style health care for systemic illness was common but few patients had sought any form of assistance for their poor vision. Issues of cost and accessibility were relatively unimportant.CONCLUSIO N CONCLUSION Provision of affordable and accessible cataract surgery for the blind and severely visually impaired members of a community does not guarantee that it will be taken up. Other barriers to surgery may be revealed when practical issues such as cost and accessibility are addressed. Perceptions of visual disability among subjects with cataract may differ from simple objective clinical standards.

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

“…[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travel to 'outreach clinics,' the proportion with operable cataract who accept surgery varies from 51 to 93% (authors unpublished data from five programmes in eastern and southern Africa).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.…”

What is practical in glaucoma management?

“…[51][52][53] Problems with recruitment for cataract surgery appear to be universal in developing countries, although the major barriers to acceptance vary. 52,53 Not surprisingly, the cost and the distance to be travelled have been identified as important barriers.…”

“…There was a lower level of disability and perceived need than had been assumed for people with such poor visual acuity, and many said that they were able to cope without any intervention. 51 Although these patients had cataract rather than glaucoma, it is reasonable to assume that many of the same attitudes towards the treatment and prevention of blindness would be the same. If anything, patients offered glaucoma surgery would be even less likely to accept since their level of visual handicap would not be as significant and the results of treatment less certain.…”

Awareness and Attitude Regarding Cataract Surgery Among Senile Cataract Cases Attending Camps

“…7,8 A few studies, mostly from other developing countries, have addressed barriers to accepting surgery for cataract. 9,10 Analysing the obstacles that come in way in utilising eye care services will help in formulating strategies to prevent blindness.…”