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To explore the impact of cataract surgery on health related quality of life (HRQoL) and time-use among adults aged ⩾50 years Kenya, The Philippines and Bangladesh.
This was a multi-centre intervention study. Across the three countries at baseline, 651 population-based cases aged ⩾50 years visually impaired from cataract (visual acuity in the better eye <6/24), and 561 age-gender-cluster-matched controls with normal vision were identified. All participants were interviewed in their homes about vision related quality of life (WHO/PBD VF20), generic HRQoL (Euroqol) and time-use. Cases were offered free/subsidised cataract surgery. Approximately one year later participants were re-interviewed using the same questionnaires. Response rate at follow up was 84% for operated cases, and 80% for controls.
At baseline, cases had substantially poorer vision specific and generic HRQoL compared to controls. Cases were also spent significantly less time on productive activities (paid and non-paid work) and more time in inactivity. Approximately one year after cataract surgery, mean vision specific and generic HRQoL improved (p<0.001) to the level of controls with normal vision. Effect sizes for change in VRQoL were large (>1.0) regardless of pre-operative VA, but were larger for those who had perception of light at baseline and for people who were operated in both eyes. Poor VA outcome from surgery was a constraint to achieving optimal post-operative VRQoL. At follow-up, operated cases were more likely to undertake and spent 1–2 hours more on productive activities compared to baseline (p<0.001). Time spent in “inactivity” in Kenya and Bangladesh decreased by approximately 2 hours. Frequency of reported assistance with activities was more than halved in each setting among operated cases (p<0.001).
Using three different outcome measures, this study demonstrated positive impacts of cataract surgery on the lives of older adults in three low-income settings, which has advocacy implications for blindness prevention programs. The observed increased time spent on productive activities, reduced time in inactivity and reduced assistance has positive implications for well-being and inclusion and supports arguments of economic benefit at the household level from cataract surgery.
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