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Lack of knowledge, poor perception of quality limit cataract surgery rates in rural China
Invest Ophthalmol Vis Sci. 2009;50(3):1069-1075.
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Residents with less knowledge of cataract and concerns about the quality of local services were the primary impediments to those individuals seeking cataract surgery in rural China.
Half of China’s ophthalmologists perform surgery and 80% of the country’s eye doctors are in urban areas.
The authors used data from two population-based studies: the Handan Eye Study and Yangjiang Eye Study. All subjects had undergone cataract surgery or had poor visual acuity because of nonoperated cataract.
Subjects took a questionnaire designed to gauge attitudes on four potential impediments to cataract surgery: knowledge about cataract, perceptions of local care quality, transportation/cost and resources. A total of 214 subjects with poor vision from nonsurgical cataract in at least one eye and 131 surgical subjects responded to the questionnaire. The nonsurgical group had a mean age of 71.8 years; the surgical group had a mean age of 73.7 years.
Data adjusted for age, gender and geographic location showed that patients who had undergone surgery had more knowledge of cataract and better perceptions of surgical quality than those who had not undergone surgery.
There is a gap between service providers and end users. This study could help bridge the gap by identifying the principal barriers to cataract surgery. This does not only suggest a direction for modification of local eye care services, it also helps to facilitate program design for non-governmental organizations planning to offer free or low-cost cataract surgery in rural China. The need to enhance patients’ knowledge on cataract and its treatment is highlighted. Modern equipment and structured training to improve preoperative screening, surgical techniques and postoperative management should be introduced to improve outcomes and booster confidence in service quality. By addressing the above two principal barriers, the chance of increasing the cataract surgical rate in China could be enhanced.
– Dennis S.C. Lam, MD, FRCOphth
Associate Editor, OSN Asia-Pacific Edition