Quality of Life and willingness to accept cataract surgery

Abstract

Background: Cataract is the major cause of blindness worldwide. Programmes like Vision 2020 make a great effort to eliminate avoidable blindness; but still acceptance and uptake of cataract surgical services remain low in developing countries. The barriers and factors that lead to refusal of cataract surgery are of great interest in contemporary applied research activities. There is growing recognition that measurement of a person's ability to perform daily activities which require vision is more meaningful than measurement of his distance visual acuity. Vision-related Quality of Life (VRQoL) Scales are a sensitive and useful tool to determine a patient's impairment in his daily life. So far little is known about the correlation between subjective perception of the visual impairment and the decision making processes towards cataract surgery. Aim: The aim of the study was to determine whether the vision related Quality of Life scores differ among people who accept and those who refuse cataract surgery. Further objectives were to determine the socioeconomic variables influencing QoL scores and the decision to accept cataract surgery. Methods: 144 people with visual impairment due to •c• ataract were interviewed during outreach activities at Kwale District. 33 of them refused and III accepted free cataract surgery. The WHO Quality of Life questionnaire WHO/PBD VFQ-20 was used to determine the vision related Quality of Life; the socioeconomic variables were collected using structured questionnaires. Results: There was a strong correlation between Visual Acuity and vision related QoL-scores, as expected. The second variable independently influencing QoL score was Literacy (Education). People with 10)Ver educational level had poorer QoL scores. Other sociodemographic factors like gender or marital status did not independently influence QoL scores. People with poor visual acuity were not more likely to accept surgery than people with better vision. The strongest predictor of acceptance was the QoL score. For every point decrease in QoL there was a 1.08 fold higher chance that surgery was accepted. The other factor that influenced acceptance independently was the gender. Males were 4,4 times more likely to accept than females. Conclusion: Visual acuity was not a predictor of someone's decision whether to accept or refuse free cataract surgery. The factors independently influencing acceptance were the QoL scores and being male. QoL scales are a useful tool to find out about someone's affection due to visual impairment and his potential willingness to accept free surgery.