Visual functioning and quality of life outcomes among cataract operated and unoperated blind populations in Nepal

• Published in: British journal of ophthalmology Vol. 82; no. 6; pp. 606 - 610
• Main Authors: Pokharel, G P, Selvaraj, S, Ellwein, Leon B
• Format: Journal Article
• Language: English
• Published: BMA House, Tavistock Square, London, WC1H 9JR BMJ Publishing Group Ltd 01.06.1998; BMJ; BMJ Publishing Group LTD
• Subjects: Aged; Biological and medical sciences; Blindness - epidemiology; Blindness - physiopathology; Blindness - surgery; Cataract - epidemiology; Cataract - physiopathology; Cataract Extraction; cataract surgery; Cataracts; Clinical trials; Developing countries; Eye surgery; Eyes & eyesight; Female; Health Surveys; Hospitals; Humans; Interviews; LDCs; Male; Medical sciences; Middle Aged; Nepal - epidemiology; Original articles - Clinical science; Patient satisfaction; Quality Assurance, Health Care; Quality of Life; Questionnaires; Refraction, Ocular; Studies; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the eye and orbit; Surveys and Questionnaires; Tropical medicine; visual acuity; Visual Acuity - physiology; Visual Fields - physiology; visual functioning; Asia; Nepal; Human; Postoperative; Eye disease; Cataract; Lens disease; Prognosis; Treatment; Surgery; Visual acuity; Anterior segment disease; Quality of life
• ISSN: 0007-1161; 1468-2079
• DOI: 10.1136/bjo.82.6.606

BACKGROUND Visual acuity and vision related quality of life outcomes in cataract surgery were evaluated in a population based survey in two geographic zones in Nepal. METHODS Case finding was based on random sampling using a stratified cluster design with door to door enumeration of people aged ⩾45 years followed by eye examinations at village sites. All aphakics/pseudophakics, those with visual acuity less than 6/60 in either eye, and a sample of those with normal visual acuity were administered visual functioning (VF) and quality of life (QOL) questionnaires. RESULTS 15% of the 159 cataract operated cases had presenting visual acuity ⩾6/18 in both eyes, 38% with best corrected visual acuity. 21% were still blind with presenting visual acuity <6/60 in both eyes, 7% with best correction. On a 0–100 scale, mean VF and QOL scores were 87.2 and 93.9 respectively in normally sighted unoperated individuals, dropping to 15.6 and 29.5 for those severely blind (<3/60). Among the cataract operated, mean VF and QOL scores were 47.5 and 55.4, respectively. VF and QOL scores correlated with vision status at statistically significant levels (p <0.0001) CONCLUSION Cataract surgery outcomes, whether measured by traditional visual acuity or by patient reported VF/QOL, are at levels many would consider unacceptably low. It is apparent that in the quest to reduce cataract blindness much more attention must be given to improving surgery outcomes.