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People with visual impairment are assumed to experience poorer quality of life and restricted engagement in daily activities but there is little evidence for this from low income countries. There is also a widespread assumption that there is a vicious cycle between poverty and blindness, as poor people are more likely to become blind and blind people are more likely to become poor, but there is little research confirming or refuting this theory.

To address these gaps in knowledge we carried out the cataract impact study in 2005-2006 which assessed the impact of cataract surgery on poverty, activities and health related quality of life in Kenya, Bangladesh and the Philippines. The study highlighted some key benefits of cataract surgery to a population of older adults in low-income countries after one year.

As it remained unclear whether the benefits of cataract surgery are sustained over time, in 2012 we undertook a six year follow up study in Bangladesh and the Philippines. This has indicated sustained long term benefits of cataract surgery to a population of older adults in low-income countries in terms of household economics, health related quality of life and activities.

Reports

Summary of findings

Cataract impact study: Six year follow up

This study found that six years after cataract surgery:

  • There was a sustained increase in per capita expenditure of households with operated cases
  • There was an increase in asset ownership among households with operated cases compared to baseline
  • The proportion of cases who took part in productive activities was higher and the proportion who received assistance with activities was lower compared to before cataract surgery
  • There was a sustained improvement in vision related and health related quality of life among
  • After six years cases and controls were similar in terms of economic measures, activities and vision related and health related quality of life

Cataract impact study

This study found that at baseline compared to controls without visual impairment, cases with cataract:

  • were poorer in terms of assets, self-rated wealth and monthly expenditure
  • were less likely to engage in and spent less time on productive activities and were more likely to have assistance with daily activities
  • had poorer vision related and generic health related quality of life

One year after cataract surgery the study found that compared to baseline:

  • there was increase in per capita expenditure of households with people who had undergone cataract surgery
  • people who undergone cataract surgery were more likely to undertake and spent more time on productive activities and were less likely to report assistance with activities
  • vision-related and generic health-related quality of life of cases had improved among people who had undergone cataract surgery

More information

If you would like further information on the original or follow-up study please contact Hannah Kuper (hannah.kuper@lshtm.ac.uk) or Sarah Polack (sarah.polack@lshtm.ac.uk).

Acknowledgements

We would like express sincere thanks to:

  • All the people in who took part in this study;
  • Drs Mamunur Rashid and Zakia Wadud (Bangladesh) , Cristina Eusebio (Philipinnes) and Wanjiku Mathenge (Kenya) for leading the project sites and making this research possible;
  • The ophthalmologists, ophthalmic assistants, interviewers and office staff for their hard work;
  • Fred Hollows Foundation for funding the six year follow up of Cataract Impact Study
  • CBM, ORBIS and Sightsavers for funding the original Cataract Impact Study

Publications

  • Syed A, Polack S, Eusebio C, Mathenge W, Wadud Z, Mamunur AK, Foster A, Kuper H. Predictors of attendance and barriers to cataract surgery in Kenya, Bangladesh and the Philippines. Disabil Rehabil. 2013 Jan 23. Epub ahead of print. Free abstract: http://www.ncbi.nlm.nih.gov/pubmed/23339719.
  • Polack S, Eusebio C, Mathenge W, Wadud Z, Mamunur AK, Fletcher A, Foster A, Kuper H. The impact of cataract surgery on health related quality of life in Kenya, the Philippines, and Bangladesh. Ophthalmic Epidemiol. 2010 Dec;17(6):387-99. Free abstract: http://www.ncbi.nlm.nih.gov/pubmed/21090912.
  • Kuper H, Polack S, Mathenge W, Eusebio C, Wadud Z, Rashid M, Foster A. Does cataract surgery alleviate poverty? Evidence from a multi-centre intervention study conducted in Kenya, the Philippines and Bangladesh. PLoS One. 2010 Nov 9;5(11):e15431. Free download from PLoS ONE: http://bit.ly/wXzC3f
  • Polack S, Eusebio C, Mathenge W, Wadud Z, Rashid M, Foster A, Kuper H. The impact of cataract surgery on activities and time-use: results from a longitudinal study in Kenya, Bangladesh and the Philippines. PLoS One. 2010 Jun 1;5(6):e10913. Free download from PubMed Central: http://1.usa.gov/A9UuXz.
  • Polack S, Eusebio C, Fletcher A, Foster A, Kuper H. Visual impairment from cataract and health related quality of life: results from a case-control study in the Philippines. Ophthalmic Epidemiol. 2010 Jun;17(3):152-9. http://www.ncbi.nlm.nih.gov/pubmed/20455844.
  • Lindfield R, Kuper H, Polack S, Eusebio C, Mathenge W, Wadud Z, Rashid AM, Foster A. Outcome of cataract surgery at one year in Kenya, the Philippines and Bangladesh. Br J Ophthalmol. 2009 Jul;93(7):875-80. Epub 2009 Feb 11. http://bjo.bmj.com/content/93/7/875.long.
  • Kuper H, Polack S, Eusebio C, Mathenge W, Wadud Z, Foster A. A case-control study to assess the relationship between poverty and visual impairment from cataract in Kenya, the Philippines, and Bangladesh. PLoS Med 2008 Dec 16;5(12):e244. http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0050244
  • Polack S, Kuper H, Eusebio C, Mathenge W, Wadud Z, Foster A. The impact of cataract on time-use: results from a population based case-control study in Kenya, the Philippines and Bangladesh. Ophthalmic Epidemiol 2008 Nov-Dec;15(6):372-82. http://www.informaworld.com/smpp/content~db=all?content=10.1080/09286580802478716.
  • Lindfield R, Polack S, Wadud Z, Choudhury KA, Rashid AKMM, Kuper H. Causes of poor outcome after cataract surgery in Satkhira district, Bangladesh. Eye 2008 Aug;22(8):1054-6. Free abstract from PubMed: http://www.ncbi.nlm.nih.gov/pubmed/17435682.
  • Polack S. Restoring sight: how cataract surgery improves the lives of older adults. Community Eye Health J 2008;21(66): 24-25 http://www.cehjournal.org/0953-6833/21/jceh_21_66_024.htm
  • Eusebio C, Kuper H, Polack SR, Enconada J, Tongson N, Dionio D, DumDum A, Limburg H, Foster A. Rapid assessment of avoidable blindness in Negros Island and Antique district, Philippines. Br J Ophthalmol 2007 Dec;91(12):1588-92. http://bjo.bmj.com/content/91/12/1588.
  • Polack S, Kuper H, Mathenge W, Fletcher A, Foster A. Cataract visual impairment and quality of life in a Kenyan population. Br J Ophthalmol 2007 91(7):927-932. http://bjo.bmj.com/content/91/7/927.full.
  • Mathenge W, Kuper H, Limburg H, Polack S, Onyango O, Nyaga G, Foster A. Rapid assessment of avoidable blindness in Nakuru district, Kenya. Ophthalmology 2007 Mar;114(3):599-605. Free abstract from PubMed: http://www.ncbi.nlm.nih.gov/pubmed/17141319.
  • Kuper H, Polack S, Limburg H. Rapid assessment of avoidable blindness. Community Eye Health J 2006;19(60):68-69. http://www.cehjournal.org/0953-6833/19/jceh_19_60_068.html
  • Wadud Z, Kuper H, Polack S, Lindfield R, Akm MR, Choudhury KA, Lindfield T, Limburg H, Foster A. Rapid assessment of avoidable blindness and needs assessment of cataract surgical services in Satkhira District, Bangladesh. Br J Ophthalmol 2006; 90(10):1225-1229. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1857455

Image credit: Measuring visual acuity, Kenya. Sarah Polack

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