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Elizabeth Kurian and Prem Kumar SG look at impact of cataract surgery on women beneficiaries…
55% of the world’s vision impaired are women. In industrialised countries this is because women live longer than men, but in non-industrialised settings, where cataract is responsible for most blindness, it is simply because women do not get to access services with the same frequency as men. For example, the cataract surgical coverage among women in sub-Saharan Africa and south Asia is nearly always lower, sometimes only half that in men[1].
Barriers prevent both women and men from receiving surgery and they are often more problematic for women. They include lack of awareness, distance of service providers and cost. Cataract is often viewed as an inevitable consequence of ageing[2]. In a recent study in North East India, female patients reported accessibility as the primary barrier, due to poor road conditions and challenging terrains, while male patients reported misinformation and misconceptions, often due to poor surgical outcomes, as primary significant barriers[3].
Eye health for women is a priority for the Mission for Vision (MFV) programme in India. MFV’s works with its partners to impact hundreds of communities, and cataract is a key area of intervention. Strategies to support girls and women to access care include screening events in remote communities, separate wards in eye hospitals, community mobilisation by women health workers, availability of women staff at the hospital, and more.
In order to determine the impact of cataract surgery on its beneficiary communities, we studied 3,015 persons operated for cataract during the financial year 2016-17 at eighteen leading, not-for-profit eye centres spread across thirteen states in India. We used a structured questionnaire that was administered twice – a couple of days before cataract surgery and again after six months. This was done using our PRISM methodology.
This article highlights our observations among beneficiaries who are women, who formed half of our sample (50.6%), and is part of a wider study by MFV[4].
The majority of the women were 41 to 60 years old (58.4%), currently married (67%), living in rural areas (80%) and working on their own or on others’ fields (66%). 75% were illiterate and 90.1% possessed social security cards, indicating that they belonged to poor households. Comparatively, most of the men covered by this study were between 61 and 80 years of age (55.7%), married (90%) and had some level of education (60.6%). Other factors were similar.
Baseline visual acuity in the operated eye among the subjects was found to be similar among men and women (65.8% and 67% respectively), and of the men and women having poor vision (<6/60) before cataract surgery, respectively.
The impact of cataract surgery on visual acuity was similar among male and female subjects. While over two-thirds had poor vision (<6/60) before surgery, the large majority (89%) had good vision (6/6 to 6/18) after surgery.
Difficulties with visual function was found to be similar among the male and female subjects. While over one-third of the subjects reported difficulties before surgery, the situation vastly improved after cataract surgery, with about 92% reporting no difficulties post-surgery.
In terms of general functioning, while two-thirds of the women reported moderate to extreme difficulties before cataract surgery, over 95% reported significant reduction in difficulties post-surgery. Men too reported similar improvements in general functionality post cataract surgery.
This study shows a similar impact among men and women after cataract surgery. There is no variation in the outcomes between male and female patients in the three parameters that were assessed. It may also be concluded that all the 17 MFV partner hospitals were providing gender-equitable services to the vulnerable communities they served.
The findings from such studies could provide valuable evidence while developing strategies for eye health and in efforts to eliminate inequity and poverty.
[1] https://www.iapb.org/knowledge/what-is-avoidable-blindness/gender-and-blindness/
[2] http://apps.who.int/iris/bitstream/handle/10665/68885/a85574.pdf;jsessionid=E9043D380842C9A54CCB8AAE9093126D?sequence=1
[3] Kumar SGP, Mondal A, Vishwakarma P, Kundu S, Lalrindiki R, Kurian E. Factors limiting the Northeast Indian elderly population from seeking cataract surgical treatment: Evidence from Kolasib district, Mizoram, India. Indian J Ophthalmol 2018;66:969-74.
