Study on barriers causing delay in cataract surgery of bilateral cataract blind at a tertiary eye care center in urban India

Abstract

Purpose: To study the barriers for cataract surgery among walk-in bilateral cataract blind in a paying outpatient department (OPD) at a tertiary eye care center in urban India. Materials and Methods: One hundred consecutive walk-in patients attending the paying OPD at a tertiary eye hospital in a tier two city of India and diagnosed to be bilateral cataract blind (better eye vision 10/200 or less) were recruited for the study. The duration of the study was 6 months. A structured interview was administered by a consultant ophthalmologist in the patient's language, and response was recorded in the pro forma. Patient was allowed to go through the system like any other regular OPD patient being advised surgery. Results: The dataset showed 67 (67%) females, 47 (47%) urban, 8 (8%) literate, 47 (47%) living within a distance of 25 km from hospital, and the average age of the patient was 67.18 years (95% confidence interval - 65.27–69.09). The top three reasons that patients cited which caused the delay was cost of the cataract surgery (27 patients), followed by residence location (staying in a rural area 22 patients) and the delay caused in getting fit for surgery due to systemic illness (17 patients). A sizable number of patients also complained late about their diminishing vision (16 out of 100) causing the delay in their reporting to the hospital. Although cost was the top reason cited for the delay in the surgery, none of the patients approached for 100% charity. Conclusion: While cost remains an important barrier to cataract surgery, factors such as coexisting system illness, staying in rural areas and no one to accompany, and fear of surgery are other important factors that we observed through the study. Opting for surgery with the basic package or not approaching for charity reinforces role of factors other than financial.

Keywords

• Bilateral mature cataract
• barriers
• cataract surgery
• cataract blind
• illiteracy
• rural areas