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The impact of cataract surgery on health related quality of life and time use in Kenya, Bangladesh and the Philippines
  1. S. Polack1,
  2. C. Eusebio2,
  3. W. Mathenge3,
  4. Z. Wadud4,
  5. A. K. M. Mamunur5,
  6. A. Foster1,
  7. H. Kuper1
  1. 1
    London School of Hygiene & Tropical Medicine, Keppel Street, London, UK
  2. 2
    Cataract Foundation of the Philippines, Bacolod, Philippines
  3. 3
    Rift Valley Provincial Hospital, Nakuru, Kenya
  4. 4
    Child Sight Foundation, Dhaka, Bangladesh
  5. 5
    CSS Rawm Hospital, Khulna, Bangladesh

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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.