Prevalence and causes of blindness, visual impairment, and cataract surgery in Timor-Leste

Abstract

PurposeTo estimate the prevalence and causes of blindness and visual impairment, cataract surgical coverage (CSC), visual outcome of cataract surgery, and barriers to uptake cataract surgery in Timor-Leste.MethodIn a nationwide rapid assessment of avoidable blindness (RAAB), the latest population (1,066,409) and household data were used to create a sampling frame which consists of 2,227 population units (study clusters) from all 13 districts, with populations of 450–900 per unit. The sample size of 3,350 was calculated with the assumed prevalence of blindness at 4.5% among people aged ≥50 years with a 20% tolerable error, 95% CI, and a 90% response rate. The team was trained in the survey methodology, and inter-observer variation was measured. Door-to-door visits, led by an ophthalmologist, were made in preselected study clusters, and data were collected in line with the RAAB5 survey protocol. An Android smart phone installed with mRAAB software was used for data collection.ResultThe age–gender standardized prevalence of blindness, severe visual impairment, and visual impairment were 2.8%, (1.8–3.8), 1.7% (1.7–2.3), and 8.1% (6.6–9.6), respectively. Cataract was the leading cause of blindness (79.4%). Blindness was more prevalent in the older age group and in women. CSC was 41.5% in cataract blind eyes and 48.6% in cataract blind people. Good visual outcome in the cataract-operated eyes was 62% (presenting) and 75.2% (best corrected). Two important barriers to not using available cataract surgical services were accessibility (45.5%) and lack of attendants to accompany (24.8%).ConclusionThe prevalence of blindness and visual impairment in Timor-Leste remains high. CSC is unacceptably low; gender inequity in blindness and CSC exists. Lack of access is the prominent barrier to cataract surgery.

Building a national eye-care service in post-conflict Timor-Leste

“… 6 For those with poor vision or impaired mobility this may not be possible. One-fifth of Timorese (23 of 121 surveyed) with disabling cataract did not feel the need for treatment, despite knowledge of availability and acceptability of treatment services; 5 this could in part be due to the perception that poor vision is a normal part of ageing. Since 2005, monthly outreach trips from the capital city to regional districts have provided in situ management of refractive errors and operative management of cataract to overcome barriers to care.…”

“…These numbers indicate that at least 93.0% (146 468/157 500) of all disabling visual impairment in Timor-Leste is treatable. 5 Currently, there is one national referral hospital in the capital city, Díli, and five secondary referral hospitals with inpatient capability, in addition to 91 peripheral centres. 6 The health-care system is provided free of charge to all citizens.…”

“…Over 45% of people with unoperated cataract and severe visual impairment identify access as the main barrier to care. 5 Most Timorese still seek medical services by foot, with many walking over two hours to reach health outposts. 6 For those with poor vision or impaired mobility this may not be possible.…”

Advocacy for global surgery: a Pacific perspective

“…34 Academic surgery and research capability in the Pacific and PNG require further development as this will strengthen local leadership and provide evidence on which to base NSOAPs and other capacity building initiatives. Nonetheless, Global Surgical Research from Australia, NZ, Timor, PNG and the Pacific published papers on POMR, 20,[29][30][31][32][33] Bellwether access, 36 the global burden of surgical disease [37][38][39] and the graduation and retention of surgical, obstetric and anaesthesia specialists. 7,40 Lessons learned from the introduction of emergency medicine specialists and their training in PNG, 41,42 informed a successful and rapid implementation in Myanmar.…”

“…As Ophthalmology in the Pacific and PNG, and otorhinolaryngology in PNG, have formed their own associations, their contribution to addressing the burden of disease, training the workforce and advocacy for investment, need to be included and coordinated within the forthcoming NSOAPs. 17,39,[57][58][59][60]…”