Prevalence and Outcomes of Cataract Surgery in Rural China

Abstract

Purpose: To investigate the prevalence and visual acuity (VA) outcomes of cataract surgery in rural populations throughout China. Design: Population-based, cross-sectional study. Participants: Forty-five thousand seven hundred forty-seven adults 50 years of age and older. Methods: Geographically defined cluster sampling was used in randomly selecting a cross-section of residents from a representative rural county within each of 9 provinces in mainland China. Participants underwent VA measurements, refraction, and a slit-lamp examination at local examination sites; those with previous cataract surgery were queried as to the year and type of surgical facility. Surgical procedure and evidence of surgery complications were noted during the examination. The principal cause of visual impairment was identified for eyes with VA of 20/40 or worse. Main Outcome Measures: Cataract surgery procedure, presenting and best-corrected distance VA, and causes of visual impairment. Results: Of 50 395 enumerated eligible persons, 45 747 (90.8%) were examined and tested for VA. The overall prevalence of cataract surgery was 2.09%. Surgical coverage among those with VA worse than 20/200 in both eyes because of cataract was 35.7%. Unoperated cataract was associated with older age, female gender, lack of education, and geographic area (province). Among the 1174 cataract-operated eyes, 31.1% had presenting VA of 20/32 or better, 15.4% had presenting VA of 20/40 to 20/63, 30.0% had presenting VA worse than 20/63 to 20/200, and 23.5% had presenting VA worse than 20/200. With best correction, the percentages were 57.6%, 6.2%, 18.5%, and 17.7%, respectively. Posterior capsule opacification, refractive error, and retinal disorders were the main causes in cataract-operated eyes with VA worse than 20/63. Conclusions: Two thirds of those with bilateral visual impairment or blindness because of cataract remain in need of sight-restoring surgery. Posterior capsule opacification and refractive error, both readily amenable to treatment, were common in cataract-operated eyes. Sustained government efforts to provide access to affordable modern cataract surgery with a greater emphasis on postoperative follow-up and the quality of VA outcomes are needed.

Prevalence of cataract surgery and postoperative visual outcome in rural central India

“…The prevalence in our study was higher than that in recent studies in China, such as the Beijing Eye Study 2006 31 and 2009 32 and the recent China Nine-Province Survey. 20 Our figures in rural central India were similar to those reported in the Singapore Malay Eye Study, 19 the Beaver Dam Study in Wisconsin, 33 the Australian Blue Mountains Eye Study, 34 the Barbados Eye Study, 35 and the Singaporean Tanjong Pagar Study. 36 When the prevalence of cataract surgery in the various population-based studies is compared, one should consider that the Central India Eye and Medical Study included a rural region only, whereas most other studies included an urban or semi-urban region.…”

“…Similar data were reported in the China Nine-Province Survey. 20 In our study, in 42% of the eyes with postoperative visual impairment, visual acuity could be improved by corrective glasses, so visual impairment was no longer present. Similar figures were reported in the recent China Nine-Province Survey and in south India, where uncorrected postoperative refraction was the cause of visual impairment in 30% of subjects.…”

“…Similar figures were reported in the recent China Nine-Province Survey and in south India, where uncorrected postoperative refraction was the cause of visual impairment in 30% of subjects. 16,20 Our study indicates that the easiest, cheapest, and most efficient way to improve postoperative vision in patients after cataract surgery is to provide adequate glasses. It confirms the findings in previous studies of other populations and may be considered an important part of public health in ophthalmology.…”

Prevalence and causes of ocular morbidity seen among rural adult population of Osun State, southwest Nigeria

“…Similarly, in the nine province rural survey, to determine the prevalence and outcomes of cataract surgery in China, it was found out that two thirds of those with bilateral VI or blindness remained in need of sight-restoring surgery, while others with posterior capsule opacification after cataract surgery needed treatment, and refractive errors needing corrections were common. [11] In this study, we noticed that nobody presented with couching. This was rather surprising.…”

Prevalence of Vision Impairment in Older Adults in Rural China in 2014 and Comparisons With the 2006 China Nine-Province Survey

“…6 In addressing the need for updated, comparative data among the rural populations of China, the Ministry of Health commissioned a ‘‘China Nine-Province Survey’’ in 2006. 7,8 This survey was carried out in 9 rural areas within the 4 municipalities, 22 provinces, and 5 autonomous regions of mainland China: 1 municipality (Beijing) and 2 provinces (Jiangsu and Guangdong) in the East Coast region; 3 provinces (Heilongjiang, Jiangxi, and Hebei) in the inland Middle region; and 1 autonomous region (Xinjiang), 1 municipality (Chongqing), and 1 province (Yunnan) in the West region.…”