Reasons for Refusing Cataract Surgery in Illiterate Individuals in a Tribal Area of Andhra Pradesh, India

Abstract

Purpose: To assess the reasons for refusing cataract surgery in illiterate individuals in a tribal area of India.

Methods: A prospective study evaluated 1046 subjects who had undergone screening in eye camps and included 398 of 492 referred subjects with cataract who refused to seek cataract surgery. Subjects were assessed to elicit general and specific reasons for non-compliance. Multiple logistic regression analysis was applied to determine the associations; p < 0.05 was considered significant.

Results: Overall, 83% (329/398) of subjects reported that they could manage with their current vision. The five most common reasons they did not proceed with cataract surgery were: fear of losing current vision, work priority, lack of support systems, a dependency due to old age, and expenses required after surgery. Odds of seeking treatment were lower among unemployed subjects (odds ratio, OR, 0.4, 95% confidence interval, CI, 0.19–0.86; p = 0.01) and in patients with family income <1000 Indian rupees per month (OR 0.5, 95% CI 0.34–0.94; p = 0.02), and higher among those unilaterally blind (OR 10.8, 95% CI 3.3–35.6; p ≤ 0.01).

Conclusion: In a tribal setting, 83% of individuals referred for cataract surgery did not proceed with surgery. Reasons given for non-compliance were not directly related to the surgery but focused on valid day-to-day difficulties anticipated to increase following surgery. Beyond accessibility and cost of surgery, other social and infrastructural factors need to be addressed to increase the uptake of cataract surgery.

• Barriers
• blindness
• cataract
• treatment seeking behavior
• tribal

Acknowledgements

It is noteworthy that this study was the Master of Community Eye Health thesis of the second author who would like to acknowledge the support of ICARE - LV Prasad Eye Institute, Hyderabad, India and School of Optometry and Vision Science of University of New South Wales, Sydney Australia; National programme for the control of Blindness, Government of Andhra Pradesh, India and Andhra Pradesh Right To Sight Society, Hyderabad, India. The authors are also thankful to all study subjects, internal reviewers of Brien Holden Vision Institute and specially acknowledge the technical support of Dr Judith Flanagan for editing and reviewing this paper.