The Impact of Cataract Surgery on Health Related Quality of Life in Kenya, the Philippines, and Bangladesh

Abstract

Purpose: To assess the impact of cataract surgery on vision related quality of life (VRQoL) and generic health related quality of life (HRQoL) in Kenya, Bangladesh and the Philippines.

Methods: A multi-center intervention study was conducted. At baseline 651 cases aged ≥50 years with visually impairing cataract (corrected visual acuity (VA) <6/24) and 561 age- gender-matched controls with normal vision (VA>6/18) were interviewed about VRQoL (using the World Health Organization/ Prevention of Blindness and Deafness 20-item Visual Functioning Questionnaire [WHO/PBD VF20]) and generic HRQoL (EuroQol). Cases were offered free/subsidized cataract surgery. Approximately 1 year later participants were re-interviewed.

Results: Response rate at follow up was 84% for operated cases and 80% for controls. At baseline, cases had significantly poorer VRQoL scores, were more likely to report problems with the EuroQol 5D five descriptive (EQ−SD) domains (mobility, daily activities, self-care, pain, depression/anxiety) and had significantly poorer self-rated health compared to controls. At follow up VRQoL scores of operated cases improved significantly to approximately equal those of controls. Effect sizes were large (> 0.8) regardless of pre-operative VA. Poor outcome from surgery (VA < 6/60) was associated with smaller VRQoL gains. Among operated cases frequency of reported problems with all the EQ-5D reduced significantly compared to baseline in Kenya and the Philippines, and in mobility, daily activities and self-care in Bangladesh. Self-rated health scores increased significantly in each country. HRQoL of controls remained stable from baseline to follow up.

Conclusion: This study among adults undergoing cataract surgery in 3 different low-income settings found evidence of improved VRQoL and generic HRQoL to approximately equal that of controls with normal vision.

KEYWORDS::

• Bangladesh
• Cataract surgery
• Health related quality of life
• Kenya
• Low-income countries
• Philippines
• Vision related quality of life

ACKNOWLEDGMENTS

We would like to thank all the participants who took part in the survey. We would also like to thank the ophthalmologists, the ophthalmologist’s assistants, the interviewers, and data entry clerks. We are very grateful to Sight Savers International, CBM and ORBIS International for funding this study.

This study was funded by grants from Sight Savers International, CBM and ORBIS International.

Declaration of Interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.