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M. R. Mitsuhiro, A. Berezovsky, N. B. Siarpelleti, R. Belfort, Jr., S. R. Salomao; Barriers for Cataract Surgery Uptake in Brazil: The São Paulo Eye Study. Invest. Ophthalmol. Vis. Sci. 2009;50(13):1246.
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© ARVO (1962-2015); The Authors (2016-present)
Investigate barriers for cataract surgery uptake in a low-middle income population in São Paulo, Brazil.
Cluster sampling based on geographically-defined census sectors was used in randomly selecting individuals ≥50 years of age for visual acuity measurement, refraction, and slit-lamp examination during 2004-2005. Those in need for cataract surgery in either eye were referred to the local public hospital for expedited and free of charge surgical services. Two years after the original study, a household survey was performed in the referred participants. The participant or a household member was contacted by personal interview and/or by phone. A questionnaire addressing barriers for cataract surgery was administered to subjects who had not had cataract surgery.
A total of 4224 eligible persons were enumerated and 3678 (87.1%) were examined. Out of these, 219 (5.95%) were referred to cataract surgery. In a two-year follow-up 170 participants/household members were interviewed (77.6%), 35 participants had passed away (16.0%) and 14 (6.4%) had moved from the household. Only 55 (32.35%) participants had been operated for cataract, predominantly females (N=40) and individuals 60 years of age and older (N=51). In the non-operated group (N=115), 81 (70.43%) were female and 84 (73.04%) were 70 years of age or older. Co-existing health conditions contra-indicating cataract surgery, fear of operation and fear of losing eyesight were the most frequently appointed barriers for cataract surgery.
A substantial proportion of low-middle income Brazilian participants who could have benefited from cataract surgery had not used available services. The current results indicate that providing expedited and free cataract surgical services is not sufficient to ensure their use. Strategies to improve awareness about cataract and its effective treatment have to be implemented along with sustained initiatives to provide adequate services.
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