Reducing inequity of cataract blindness and vision impairment is a global priority, but where is the evidence?

Throughout the world, people who are socially or economically disadvantaged disproportionately experience blindness and vision impairment caused by cataract. Reducing vision loss from cataract and its unequal distribution must be a priority if the WHO's aim of 'universal eye health' is to be realised. To help achieve this, decision-makers and service planners need evidence on which strategies improve access to cataract services among disadvantaged populations, and under what circumstances. Unfortunately, despite many strategies to improve cataract services being implemented in recent decades, evidence of what works, for who and in what circumstances is not readily available. This paper summarises the extent of the evidence on interventions to reduce inequity of vision loss from cataract and makes suggestions for how the evidence base can be strengthened

The appointment system influences uptake of cataract surgical services in Rwanda

Funding: G.F.K. received funding to undertake a master’s degree from the British Council for the Prevention of Blindness, the Commonwealth Scholarships Commission UK, and the University of Rwanda (UR). Data collection was funded by the Travel Trust Fund at the London School of Hygiene and Tropical Medicine. J.R. was a Commonwealth Rutherford Fellow, funded by the UK government through the Commonwealth Scholarship Commission in the UK. J.R.’s position at the University of Auckland is funded by the Buchanan Charitable Foundation, New Zealand.The aim of this study was to investigate barriers and enablers associated with the uptake of cataract surgery in Rwanda, where financial protection is almost universally available. This was a hospital-based cross-sectional study where potential participants were adults aged >18 years who accepted an appointment for cataract surgery during the study period (May-July 2019). Information was collected from hospital records and a semi-structured questionnaire was used for data collection. Of the 297 people with surgery appointments, 221 (74.4%) were recruited into the study, 126 (57.0%) of whom had attended their appointment. People more likely to attend their surgical appointment were literate, had fewer than 8 children, had poorer visual acuity, had access to a telephone in the family, received a specific date to attend their appointment, received a reminder, and reported no difficulties walking (95% significance level, p < 0.05). The most commonly reported barriers were insufficient information about the appointment (n = 40/68, 58.8%) and prohibitive indirect costs (n = 29/68, 42.6%). This study suggests that clear communication of appointment information and a subsequent reminder, together with additional support for people with limited mobility, are strategies that could improve uptake of cataract surgery in Rwanda.Publisher PDFPeer reviewe

Inequality in cataract blindness and services: moving beyond unidimensional analyses of social position.

OBJECTIVE: Inequalities in cataract blindness are well known, but data are rarely disaggregated to explore the combined effects of a range of axes describing social disadvantage. We examined inequalities in cataract blindness and services at the intersection of three social axes. METHODS: Three dichotomous social variables (sex (male/female); place of residence (urban/rural); literacy (literate/illiterate)) from cross-sectional national blindness surveys in Pakistan (2001-2004; n=16 507) and Nigeria (2005-2007; n=13 591) were used to construct eight subgroups, with disadvantaged subgroups selected a priori (ie, women, rural dwellers, illiterate). In each data set, the social distribution of cataract blindness, cataract surgical coverage (CSC) and effective cataract surgical coverage (eCSC) were examined. Inequalities were assessed comparing the best-off and worst-off subgroups using rate differences and rate ratios (RRs). Logistic regression was used to assess cumulative effects of multiple disadvantage. RESULTS: Disadvantaged subgroups experienced higher prevalence of cataract blindness, lower CSC and lower eCSC in both countries. A social gradient was present for CSC and eCSC, with coverage increasing as social position improved. Relative inequality in eCSC was approximately twice as high as CSC (Pakistan: eCSC RR 2.7 vs CSC RR 1.3; Nigeria: eCSC RR 8.7 vs CSC RR 4.1). Cumulative disadvantage was observed for all outcomes, deteriorating further with each additional axis along which disadvantage was experienced. CONCLUSIONS: Each outcome tended to be worse with the addition of each layer of social disadvantage. Illiterate, rural women fared worst in both settings. Moving beyond unidimensional analyses of social position identified subgroups in most need; this permits a more nuanced response to addressing the inequitable distribution of cataract blindness