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Mingzhi Zhang, Jing Wu, Liping Li, Daocheng Xu, Dennis S. C. Lam, Jack Lee, Sian Griffiths, Nathan Congdon; Impact of Cataract Screening Outreach in Rural China. Invest. Ophthalmol. Vis. Sci. 2010;51(1):110-114. doi: 10.1167/iovs.09-4190.
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To examine differences between patients with cataract detected during screening and presenting to clinic in rural China.
Subjects were recruited from 27 screenings and an eye clinic in the same town. All had pinhole-corrected vision ≤6/18 in ≥1 eye due to ophthalmologist-diagnosed cataract. Subjects were administered a previously validated questionnaire on barriers to surgery in four areas: knowledge (K), perceptions of quality (Q), transportation (T), and cost (C).
Screening group (SG; n = 120) and clinic group (CG; n = 120) participants did not differ from eligible, examined screening and clinic patients respectively in age, gender, or vision. SG participants were significantly more likely to be female (P = 0.002) and had a smaller housing area and less education (P < 0.001 for both) than those in the CG. Those in the CG were more likely to be blind (habitual VA ≤ 6/60) in the better-seeing eye (P = 0.05) and more willing to undergo and pay for cataract surgery (P < 0.001 for both) than SG. In logistic regression models, SG subjects had significantly lower quality scores (P < 0.001) and better habitual vision (P = 0.02) than did CG participants, and SG subjects who agreed to cataract surgery (78.3%) had significantly higher knowledge scores (P < 0.001) than those who refused.
Screening outreach has the potential to ameliorate disparities in access to cataract surgery in rural China, as it appears more likely to detect patients with cataract with gender-related, economic, educational, and attitudinal barriers to surgery. However, education may be needed to convince screening subjects to undergo surgery.
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