Vision plays a critical role in every facet of life. It contributes towards daily living. Cataracts are a leading cause of avoidable blindness.
According to the World Report on Vision (WHO 2019), globally one billion people have a vision impairment that can be prevented or yet to be addressed.
Of the one billion people, 65,2 million people have cataracts. Cataract is an eye condition that is age related, mainly affecting individuals aged 50 years and above.
The symptoms include cloudiness in the lens of the eye leading to increasingly blurred vision.
If left untreated, the condition worsens over time, leading to severe visual impairment or blindness.
This often results in significant limitations in performing daily tasks.
Multiple factors cause cataracts over a person’s life, which lead to aging of the lens.
These factors include smoking, poor nutrition, ultraviolet exposure, diabetes, some medical conditions or medication, severe dehydration, injuries or previous eye surgeries. In children, congenital cataracts can occur within the first year of life, usually from birth and often caused by a faulty gene passed from the parent to the child.
If congenital cataract goes undetected in an infant, it can lead to permanent visual loss. Some people develop cataract in both eyes.
This is known as bilateral cataract, while the development of cataract in one eye is called unilateral cataract.
Causes of unilateral cataract include trauma, radiation exposure, diseases such as diabetes.
The burden of cataract is not borne equally due to inadequate services and uneven distribution.
The Rapid Assessment of Avoidable Blindness conducted in Manicaland (2016), Masvingo and Matabeleland South Provinces (2019) revealed an estimated average of 65% of people aged 50 years and above suffer from untreated cataract, hence cataract is a major contributor to avoidable blindness in the country.
The studies revealed that most people did not access cataract surgery because of fear, high cost of services including patient out of pocket payments and distance to health facilities among other barriers.Vision impairment caused by cataracts can be corrected through surgical interventions by removing the cloudy lens.
The procedure is performed by an Ophthalmologist.In most cases the manual small incision cataract surgery is done.
There has been advances in surgical techniques, such as phacoemulsification surgery.Removing the lens entails that the eye is not able to focus, and the correction is done by replacing the lens with an artificial one, known as an intraocular lens. Cataract surgery is a relatively simple procedure that can be performed within 15 to 20 minutes.However, it can take longer due to other underlying conditions. Therefore, a pre-operative cataract assessment is necessary to inform the procedure.
For those with bilateral cataract, the procedure for each eye is done six to 12 weeks apart to allow for recovery on one eye before the next procedure. It is a day case procedure.
However, in most cases, depending on the context and hospital facilities, a patient is kept overnight to enable monitoring and measuring of day one post operative visual acuity.
Some people leave hospital soon after surgery with instructions and return the following day for the post operative assessment. Patients will be provided with eye drops to use for four weeks after surgery. For most people, surgery restores vision with no complications.
However, some people may experience complications such as continued vision loss, ongoing eye pain and infections among others.
An ophthalmologist can successfully treat most complications. Good outcome thresholds are defined to promote improved quality in cataract surgery.
Usually, people are set up for clear distance vision after surgery and may need to wear a pair of spectacles for reading or close up work.
This also depends on the type of intraocular lens that would have been inserted.
A pair of spectacles will protect the eyes from harmful ultra-violet rays.
Recommendations
Vision loss due to cataracts requires a comprehensive approach that includes promotional, preventative treatment and rehabilitative interventions.
Cataract surgery is considered a cost-effective intervention in health care.Therefore, resources should be provided to avoid unnecessary vision impairment or blindness.
The provision of resources should include eye health professionals training, financing, strengthening health information systems and advocacy to increase quality and equity.
Providing cataract surgery on outreach will address inequities experienced in accessing eye care services and increase access to cataract surgery.
Eye care services should be integrated in the primary health services to strengthen the early detection and referral of people who require cataract surgery.
To enhance the efficiency and quality of cataract surgery, eye health professionals should be trained in addition to creating an enabling environment to provide services. Effective cataract service delivery requires a patient centred approach that ensures services are affordable, especially in less resourced settings by offering subsidised services. Patient education is of importance considering that several people are afraid of going through cataract surgery.
Therefore, highlighting the benefits of surgery and demystifying myths and misconceptions is essential.Pre and post operative guidance and counselling will provide clear information about the procedure, recovery and risks to patients.
The quality of cataract surgery done by an ophthalmologist improves with the increase in the number of operations.
But that should not be the only determining factor for good outcomes.It is important to invest in modern cataract surgery technology such as phacoemulsification, which is less invasive and allows for quicker recovery.
Regular training should be provided to eye health surgeons and staff to maintain high standards of care.The regular monitoring of surgical outcomes and complications will improve surgical quality and safety.
Periodic follow-up of patients after surgery will enable health professionals to check for complications and ensure healing.
This is because several people do not return for hospital reviews due to the high costs of patient out of pocket payments.Addressing specific needs of vulnerable populations, such as the elderly or women, will ensure that they are not left behind in accessing cataract surgery.
Service delivery should be culturally sensitive to the norms and languages of the populations being served.Adopting cost effective models that include high volume surgical centres will make the services more accessible without compromising on the quality of surgery.