Interventions to improve access to cataract surgical services and their impact in low- and middle-income countries

Full citation: Ramke J, Petkovic J, Welch V, Blignault I, Gilbert C, Blanchet K, Christensen R, Zwi AB, Tugwell P. Interventions to improve access to cataract surgical services and their impact on equity in low- and middle-income countries. Cochrane Database of Systematic Reviews 2017, Issue 11. Art. No.: CD011307. DOI: 10.1002/14651858.CD011307.pub2

What is the aim of this review
The aim of this Cochrane Review was to find out if there are ways to make it easier for people in low- and middle-income countries (LMICs) to have cataract surgery, and to make cataract surgery available fairly (no inequity) within LMICs.

Cochrane researchers collected and analysed all relevant studies to answer this question and found two studies.

Key messages 
The review shows that offering free surgery may increase uptake of surgery in LMICs. There is no evidence on whether this might reduce the level of sight loss due to cataract in the community, or whether this helps reduce inequity (makes things fairer). Help with transport, additional information or counselling may not improve uptake, again with no evidence on levels of cataract blindness or inequity. The evidence was from two small studies in rural China.

What was studied in the review
As people get older, the lens of the eye becomes cloudy leading to sight loss and blindness. The cloudy lens is known as a cataract. Doctors can remove the cataractand replace it with an artificial lens. This is usually successful surgery and restores sight.

Cataract surgery is distributed unfairly in the world. More people in LMICs have cataracts that cause sight loss and blindness because it is harder to get cataractsurgery. When some people have less chance of good health care, such as cataractsurgery, this is known as inequity. There is also inequity within LMICs as poorer people and women also have less chance of having cataract surgery.

To address this problem, Cochrane researchers wanted to find out if there are ways to improve the chances of getting cataract surgery in LMICs and so lower the burden of cataract. They also wanted to see if this makes it fairer (less inequity) and helps everyone to get an equal chance to have cataract surgery. They planned to consider many different aspects including acceptability, affordability and availability of cataract services.

What are the main results of the review
The Cochrane researchers found two relevant studies. Both studies were from China and took place in a rural area. One study gave people additional information and counselling and compared this with giving no additional information or counselling. The other study looked at providing free cataract surgery, and help with the costs of transport to hospital, compared with low-cost cataract surgery and no help with transport. The findings were as follows.

• Offering more information or counselling may not improve referral and uptake of surgery (low-certainty evidence).
• Offering free cataract surgery may increase the uptake of surgery (low-certainty evidence).
• There was no evidence on what happens to the levels of cataract in the community.

How up-to-date is this review
The Cochrane researchers searched for studies that had been published up to 12 April 2017.

Image information
© Peter Martin, Licence: CC BY-NC 2.0, Published in: Community Eye Health Journal