Why Do People Remain Cataract Blind Despite Easily Accessible, Affordable Quality Service? Four-year Community-based Study

Abstract

Introduction: Cataract is a common cause of blindness in spite of providing free or subsidised cataract surgery in Indian subcontinent.

Objective: To understand why patients do not undergo cataract surgery despite availability of services in the vicinity of a low-income group settlement.

Methodology: This community-based survey was done over three years. A door-to-door eye screening was conducted in 2015-16 with a vision centre offering subsidised care. Census method was utilised for data collection. Those with operable cataracts were advised of the need for surgery. On follow-up visits in 2017, 2018, and 2019, those still visually impaired with unoperated cataracts were interviewed (questionnaire-based) to identify barriers to cataract surgery in an urban slum in Pune city, Maharashtra state of India, after ethics permission. SSPS.v16 software was used for analysis.

Result: The authors screened 45,535 individuals in 2015-16. In 2017, 474 still had blinding cataracts. Of them, 85 (25.8%) had undergone cataract surgery in 2018, and 245 still had cataracts. In 2019, of the 245 participants, 47 (24.7%) had undergone surgery, and 143 remained. The main barrier was the high cost (>50%) across all three years, especially among older respondents (2017, 2018: p=0.006; 2019: p=0.01). The other barriers were family/business obligations, and participants did not perceive cataracts as severe problem. This barrier was significantly more common among males (p=0.039) and those with longer cataract duration (p <0.001). Respondents with poor vision in the better eye had lower rate of family obligations as a barrier in all years (2017: p=0.008; 2018: p=0.013; 2019: p <0.001).

Conclusion: The community screening and vision centre addressed barriers such as lack of awareness, poor service and distance, but even the subsidised cost was a challenge. Family/business obligations and no prioritisation were other reasons. Qualitative
research is needed to understand the dynamics of these barriers and design appropriate interventions.