The Role of Demographic Characteristics in the Outcomes of Cataract Surgery and Gender Roles in the Uptake of Postoperative Eye Care: A Hospital-based Study

Hashemi, Hassan; Mohammadi, Seyed Farzad; Z-Mehrjardi, Hadi; Majdi, Mercede; Ashrafi, Elham; Mehravaran, Shiva; Mazouri, Arash; Roohipoor, Ramak; Khabazkhoob, Mehdi

doi:10.3109/09286586.2012.691600

Cited by 15 publications

(18 citation statements)

References 39 publications

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“…As seen in other studies, increasing age was one of the risk factor for poor outcome [ 4 , 7 , 26 – 28 ] Despite controlling for ocular comorbidities, increasing age was found to be one of the predictor for poor outcome. It is likely that those older had a denser cataract and therefore ocular co-morbidities in this group of patients were missed pre-operatively.…”

Section: Discussionsupporting

confidence: 59%

Cataract Surgery Visual Outcomes and Associated Risk Factors in Secondary Level Eye Care Centers of L V Prasad Eye Institute, India

et al. 2016

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PurposeTo evaluate cataract surgery visual outcomes and associated risk factors in rural secondary level eye care centers of L V Prasad Eye Institute (LVPEI), India.MethodsThe Eye Health pyramid of LVPEI has a network of rural secondary care centres (SCs) and attached vision centres (VCs) that provide high quality comprehensive eye care with permanent infrastructure to the most disadvantaged sections of society. The most common procedure performed at SCs is cataract surgery. We audited the outcome of a random sample of 2,049 cataract surgeries done from October 2009-March 2010 at eight rural SCs. All patients received a comprehensive ophthalmic examination, both before and after surgery. The World Health Organization recommended cataract surgical record was used for data entry. Visual outcomes were measured at discharge, 1–3 weeks and 4–11 weeks follow up visits. Poor outcome was defined as best corrected visual acuity <6/18.ResultsMean age was 61.8 years (SD: 8.9 years) and 1,133 (55.3%) surgeries were performed on female patients. Pre-existing ocular co-morbidity was present in 165 patients (8.1%). The most common procedure was small incision cataract surgery (SICS) with intraocular lens (IOL) implantation (91.8%). Intraoperative complications were seen in 29 eyes (1.4%). At the 4–11 weeks follow-up visit, based on presenting visual acuity (PVA), 61.8% had a good outcome and based on best-corrected visual acuity (BCVA), 91.7% had a good outcome. Based on PVA and BCVA, those with less than 6/60 were only 2.9% and 1.6% respectively. Using multivariable analysis, poor visual outcomes were significantly higher in patients aged ≥70 (OR 4.63; 95% CI 1.61, 13.30), in females (OR 1.58; 95% CI 1.04, 2.41), those with preoperative comorbidities (odds ratio 4.68; 95% CI 2.90, 7.57), with intraoperative complications (OR 8.01; 95% CI 2.91, 22.04), eyes that underwent no IOL or anterior chamber-IOL (OR 12.63; 95% CI 2.65, 60.25) and those undergoing extracapsular cataract extraction (OR 9.39; 95% CI 1.18, 74.78).ConclusionsThis study demonstrates that quality cataract surgeries can be achieved at rural SCs. The concept of the LVPEI SCs can be applied to other developing countries, allowing rural patients to attain better vision through cataract surgery. Despite improvements in quality of cataract surgery, gender discrimination in terms of outcome continues to be an issue and needs further investigation.

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Section: Discussionsupporting

confidence: 59%

Cataract Surgery Visual Outcomes and Associated Risk Factors in Secondary Level Eye Care Centers of L V Prasad Eye Institute, India

et al. 2016

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“…The high global 18 and Hashemi et al 19 mean cost per patient improved from interventions such as telephone calls and transportation support may be compared with the ICER $52.05 (spontaneous + telephone interventions) in Asia (in the best case where all patients accepted postoperative care) because of the low cost of glasses and transportation there. Reduction in the cost of glasses and treatment of complications due to government, insurance, or other external subsidies or by other means, such as the use of ready-made spectacles, 28 would likely improve acceptance and thus the effect on VA and costeffectiveness.…”

Section: Discussionmentioning

confidence: 99%

Cost and Expected Visual Effect of Interventions to Improve Follow-up After Cataract Surgery

Meltzer

Congdon

Kymes³

et al. 2017

JAMA Ophthalmol

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IMPORTANCE Some experts recommend increasing low rates of follow-up after cataract surgery in low-and middle-income countries using various interventions. However, little is known about the cost and effect of such interventions.OBJECTIVE To examine whether promoting follow-up after cataract surgery creates economic value. DESIGN, SETTING, AND PARTICIPANTSThe Prospective Review of Early Cataract Outcomes and Grading (PRECOG) is a cohort study with data from patients undergoing cataract surgery from January 19, 2010, to April 18, 2012. Final follow-up was completed on August 10, 2012. Data were collected before surgery, at discharge, and at follow-up at least 40 days after surgery from 27 centers in 8 countries in Asia, Africa, and Latin America. Each center enrolled 40 to 120 consecutive patients undergoing cataract surgery. If patients did not return to the hospital for the follow-up visit, hospitals could use telephone calls or transportation subsidies to increase follow-up rate. Data were analyzed from December 2013 to January 2016. MAIN OUTCOMES AND MEASURES Cost of interventions (telephone calls and transportationsubsidies) to increase follow-up at least 40 days after surgery, visual acuity (VA) in the eye undergoing cataract surgery, presence of complications, patient and facility costs per visit, and willingness to pay for treatment or glasses if needed. The maximum incremental cost of improving VA in 1 patient (incremental cost-effect ratio [ICER]) was calculated for spontaneous follow-up (compared with no follow-up) and follow-up with the telephone and transportation interventions. Expected ICERs were estimated including only those patients willing to pay. RESULTS Among 2487 patients (1068 men [42.9%]; 1405 women [56.5%]; 14 missing [0.6%]; mean [SD] age, 68.4 [11.3] years), 2316 (93.1%) received follow-up, of whom 369 (16.0%) were seen in an outside facility or home and were in the cost-effectiveness analysis as unable to follow up. A grand mean (a mean of means of the different countries) of 56.3% of patients needed glasses, of whom 56.9% were willing to pay, and 1.6% had treatable complications, of whom 39.4% were willing to pay. Maximum proportions with improved VA (and corresponding ICERs) were 0.08 for no follow-up, 0.45 ($151.56) for spontaneous follow-up, 0.53 ($164.46) for a telephone intervention, and 0.53 ($133.07) for a transportation intervention. These results were most sensitive to the cost of follow-up. Expected proportions (ICERs) were 0.08, 0.27

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“…Older age, lower levels of education, presence of ocular co-morbidity 22,23 , surgical complications, worse baseline visual acuity 22 , along with the need for capsulotomy, spectacle prescription and other care have been shown to be associated with a poorer cataract surgery outcome. 23 In a recent study in rural India, the major cause of presenting visual impairment after cataract surgery was incorrect intraocular lens power (42%), with posterior capsule opacification (24%), surgical complications (21%) and age-related macular degeneration (10.3%) being the major causes of best-corrected visual impairment.…”

Section: Discussionmentioning

confidence: 99%

“…23 In a recent study in rural India, the major cause of presenting visual impairment after cataract surgery was incorrect intraocular lens power (42%), with posterior capsule opacification (24%), surgical complications (21%) and age-related macular degeneration (10.3%) being the major causes of best-corrected visual impairment. 24 Among studies in Brazil, refractive error 1,19 , retinal disorders and macular degeneration 1 , and posterior capsule opacification 1,19 were the main causes of visual impairment in cataract operated eyes.…”

Section: Discussionmentioning

confidence: 99%

Uptake, Barriers and Outcomes in the Follow-up of Patients Referred for Free-of-Cost Cataract Surgery in the Sao Paulo Eye Study

Mitsuhiro

Berezovsky

Belfort

et al. 2014

Ophthalmic Epidemiology

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Purpose To determine uptake, barriers and outcomes in the follow-up of patients referred for free-of-charge, expedited cataract surgery in the Sao Paulo Eye Study (SPES). Methods SPES was a population-based study of urban, low-middle income residents ≥50 years old. Presenting (PVA) and best-corrected (BCVA) visual acuity, refraction, and slit-lamp examination were performed in 3,677 participants. For subjects with cataract as a principal cause of BCVA ≤ 20/40, surgery was offered free-of-charge. Two years after the baseline study, surgery uptake, barriers to surgery, and visual outcomes were analyzed. Results Among 210 (5.71%) participants who had cataract surgery indication at baseline, 164 (78.1%) were successfully contacted and 55 (33.5%) reported being operated on for cataract, with 51 agreeing to be re-examined. In a multiple logistic regression model, age, gender, schooling, previous cataract surgery, and PVA at baseline were not significantly associated with surgery uptake. Co-existing health conditions (20.4%), fear of surgery (12.2%) and fear of losing eyesight (11.6%) were the most frequent barriers for cataract surgery adherence. Among the 69 eyes operated on in the interval between baseline and follow-up, PVA ≥20/63 was observed in 50 (72.6%; 95% confidence interval 62.2%-82.3%), PVA <20/63-20/200 in 11 (15.9%; 8.9%-22.9%) and PVA <20/200 in 8 (11.6%; 5.3%-17.9%). Conclusions Quality of surgery is an increasing determinant of uptake rates. Although free-of-charge and expedited cataract surgery were offered, surgical outcomes might have influenced the low uptake. Besides cataract surgery campaigns, improvement of surgeon skills, accurate biometry, treatment of ocular comorbidities, postoperative follow-up, and eye-care education are needed.

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The Role of Demographic Characteristics in the Outcomes of Cataract Surgery and Gender Roles in the Uptake of Postoperative Eye Care: A Hospital-based Study

Cited by 15 publications

References 39 publications

Cataract Surgery Visual Outcomes and Associated Risk Factors in Secondary Level Eye Care Centers of L V Prasad Eye Institute, India

Cataract Surgery Visual Outcomes and Associated Risk Factors in Secondary Level Eye Care Centers of L V Prasad Eye Institute, India

Cost and Expected Visual Effect of Interventions to Improve Follow-up After Cataract Surgery

Uptake, Barriers and Outcomes in the Follow-up of Patients Referred for Free-of-Cost Cataract Surgery in the Sao Paulo Eye Study

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