This large prospective study found a high prevalence of blindness and visual impairment among rural residents in the Hainan province, even after completion of the largest ever nongovernmental cataract surgery program in China.
The authors write that approximately 30,000 cataract surgeries were completed in the Hainan Cataract-Free Zone cataract surgery program undertaken in 2009 and 2010. This produced a cataract surgery rate of approximately 3,550/million population without counting the cataract surgeries performed in local hospitals or by other organizations.
To assess the full effect of this program, the authors used the Rapid assessment of avoidable blindness (RAAB) method to define the prevalence of blindness and visual impairment in people aged ≥ 50 years in rural Hainan, China’s southernmost and smallest province.
A total of 6,482 subjects were examined, for a response rate of 95.3 percent. The sample prevalence of blindness was 4.4 percent, while the prevalence of severe visual impairment and visual impairment were 1.9 percent and 9.9 percent, respectively.
While the impact of this program was reflected in the increased cataract surgical coverage in Hainan, the prevalence of blindness in Hainan was still high compared with many other areas in China. They write that if the 30,000 cataract surgeries offered were all performed for those with cataract-related blindness, approximately 45 percent of the cataract-related blindness would have been eradicated and the prevalence of blindness should have decreased by 22 percent.
There are a number of reasons why those with the worst vision have not received surgery through the free cataract surgery program. First, poor vision might limit their mobility and thus access to the service. Second, those with more severe cataract and cataract-related blindness tend to be older patients with multiple medical illnesses. Lastly, some individuals with long-standing cataract-related blindness might be habituated to poor vision and therefore decline surgery.
Age and sex were associated with increased prevalence of blindness, severe visual impairment, and visual impairment. Overall, cataract accounted for approximately 60 percent of blindness and severe visual impairment.
Of the 524 eyes that had received cataract surgery, 87.2 percent had IOLs implanted, 21 percent had a poor visual outcome (visual acuity < 6 /60), and 20 percent had a borderline visual outcome (visual acuity < 6/18 but ≥6/60). Eyes that received surgery from charitable organizations had a higher rate of IOL implantation and better outcomes (visual acuity ≥ 6/18) than eyes that were operated on elsewhere. The authors write that this may be due to a well-established quality-control system and structured surgical training in charitable organizations compared with local public or private hospitals.
They conclude that continuing actions should be taken to eliminate cataract-related blindness. They say the study showed that there is significant room for improvement in the quality of surgeries performed in public hospitals. Improved strategies for screening, public awareness programs and patient education might help increase uptake of cataract surgery and cataract surgical coverage.