The World Health Organization (WHO survey in 2002, estimated that cataract is cause of reversible blindness in more than 17 million (47.8%) out of 37 million blind individuals in the world. In a National Survey on Blindness (2004-5), 53% blindness was reported due to cataract.¹⁻³

Globally approximately 15 million cataract operations are performed annually with an estimated increase of 5 million from only 5 years ago. In 1994 approximately 500 ophthalmologists performed 140,000 cataract surgeries in Pakistan. Cataract surgery is not readily available in many countries, which is especially true for women, those living in rural areas, and those who are illiterate.⁴

The difference between cataract prevalence and its surgery done shows that there are some factors which cause delay in cataract surgery. Therefore, these barriers must be evaluated to get surgery in time so that normal functioning could be achieved by better vision. Cataract is most commonly due to aging but may also happen due to trauma or radiation exposure, can be present from birth, or may occur due to eye surgery for other problems.³,⁵

Surgical treatment becomes necessary only if the cataract is causing problems which results in an improved quality of life. It is the most cost effective treatment of cataract. The procedures used for cataract surgery are extra-capsular cataract extraction (ECCE), intra-capsular cataract extraction (ICCE) and Pars plana lensectomy.⁶,⁷

Visual acuity is the most important need of daily life for normal functioning. Untreated cataract is the major cause of visual dysfunction throughout the world. In developing countries like Pakistan, cataract is the major cause of blindness. The purpose of this research is to find out the barriers towards cataract surgery among patients visiting the General OPD of Ayub Teaching Hospital Abbottabad.

A cross sectional study was done at outpatient department (OPD) of Ayub Teaching Hospital, Abbottabad to find out the barriers towards the uptake of cataract surgery. Study was done from June 2019 to January 2020. Sample size was calculated by following formula, n=Z² .pq/e2 according to which simple size was 340 with prevalence 33.2% at 95% confidence limit. Consecutive non-random sampling technique was used. Willing patients of both gender of age >35 years having visual acuity less than 6/18 without any ocular pathology except cataract were included in the study. An interview based structured questionnaire was used for data collection. The questionnaire consisted of five sections, first section was comprised of sociodemographic data, second section consisted of visual acuity, third section had awareness questions, the forth section had availability questions and fifth part had preference questions. All the individuals had visual acuity examination. For the detailed ocular examination, eyes of patients were dilated. After dilation patients were fully examined i.e. starting from eye lids till retina on ophthalmoscope by ophthalmologist to document cataract or any other pathology. Those patients who met the inclusion criteria were included in the sample. Informed consent was taken from each individual and each individual was interviewed to fill a structured questionnaire by the investigator. Data was entered in SPSS version 22. After entering data in the SPSS, data was cleaned by running frequencies, percentages and any discrepancy was removed. Descriptive analysis was done by running percentages & frequencies for the categorical variables and mean & standard deviation for continuous variables.

Total 340 subjects included in this study. More than half of the patients were females comprising 53.8% in total data. Mean age of the subjects was 57.5 years ranging from 35 to 83 years. The educational level of majority of the respondents was primary 62.9%. More than half (192, 56.5%) respondents were not working due to poor vision.

Barriers towards Cataract Surgery: Majority of respondents (280, 82.4%) had difficulty in vision due to cataract. More than 53.5% (182) subjects had no knowledge about cataract and 62.1 %( 211) subjects did not know about the treatment of cataract. One hundred and ninety-two (58.2%) were fear of cataract surgery (Table-I).

More than half 69.7 %( 237) subjects had no eye hospital near their homes. Public transport was used by 70.0 %( 238) subjects while 51.8 %( 176) subjects paid fare more than one thousand for one turn. It was preferred by 34.1% (116) subjects that males should get their treatment first (Table- II).  

Table- I: Awareness of Cataract & Its Treatment (N=340)

Table- II: Availability of services for Cataract Surgery (n=340)

Bettadapura et al reported that waiting for maturity of cataract to be the major barriers.⁸ Barriers related to patient attitude like (ability to manage routine work, cataract not mature, could see clearly with the other eye, busy with work), then to issues of service delivery or cost and affordability (insufficient family income) were found as barriers by Dhaliwal and Gupta.⁹ Bhagwan et al reported that 70.69% cases wanted operation only when able to see nothing.¹⁰ Rabiu reported the main barriers for seeking cataract surgery were cost of the service (61%) and better vision in the other eye (18%).¹¹ Saikumar et al reported lack of escort, fear of surgery, socioeconomic reasons, adverse media reports of failures of surgery and surgery not needed to be the main barriers.¹² Studies done in adjacent regions also found similar reasons for not taking surgical care as ours Yin et al reported lack of knowledge about cataract and concerns about the quality of local services as barriers.¹³ Snellingen et al in their study in Nepal found economic (48%) and logistical (44.8%) constraints followed by fear of surgery (33.3%) and lack of time (18.8%) to be the most frequent reasons for not accepting surgery.¹⁴ Vaidyanathan et al reported that 24% of people bilaterally blind and 33% of those unilaterally blind, found waiting for cataract to get mature. Second barrier they found (21.6% of the bilaterally blind) was “no one to accompany” and “Fear of operation” in 12.3% of the bilaterally blind population as a barrier. In our study the proportion of females was higher in almost all the reported barriers. Males mentioned waiting for cataract to get mature more than females while females (24.9%) stated “no one to accompany” nearly twice as frequently as males (14.2%) in other study.¹⁵ Addressing of barriers reported in the present study planning and policy making could improve utilization of services and cataract surgery uptake. However even when surgery is free and transport facility is available, cataract acceptance rates are low as indicated.

Non- availability, lack of awareness, non-affordability, transport and fear of surgery were the major factors delaying cataract surgery.

Disclaimer:
Nothing to declare.

Acknowledgement:
The author thank the department medical staffs for their help and support. They keep patient record properly and managed the data carefully which helped in completing this research.

Authors’ CONTRIBUTION:

^1,2,3 Conceptualized the study and contributed in the data collection and aided in drafting of the article, Active Participation in active methodology.

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