Aims: To evaluate the cataract surgical outcome in Tilganga Eye Centre (TEC) and its outreach microsurgical eye clinic, to determine the barriers to patient uptake of cataract services in both urban (TEC) and rural (outreach clinic) settings, and to explore gender-specific health care-seeking behaviour.
Methods: The records of 562 patients who had undergone cataract surgery in the hospital from 1 January 2006 to 30 June 2006 and of 178 patients treated by the outreach clinics were analysed. Surgical outcomes were measured using the OUTCOME software package. An open-ended questionnaire was used to interview 80 cataract patients with visual acuity <6/60 (38 in hospital, 42 in outreach clinics), in order to explore possible gender-specific barriers to cataract surgery.
Results: At discharge from the hospital, 69.9% of patients presented with visual acuity (VA)>6/18 and 78% presented with best corrected visual acuity (BCVA)>6/18. At the three-week follow-up, 79.4% presented with VA >6/18. On providing them with best correction, VA was >6/18 in 93.2%. A total of 50 (8.9%) presented with VA <6/60 at discharge. At three-week follow-up, 2.8% presented with VA <6/60, which improved to 2.4% when best corrected. At discharge from the outreach clinic, 79.2% of patients presented with VA >6/18 and 85.5% presented with BCVA >6/18. At the three-week follow-up, 72.8% presented with VA >6/18. When best corrected, VA was >6/18 in 93.6% . A total of 16 (9%) presented with VA <6/60 at discharge. At three-week follow-up, 5.8% presented with VA <6/60, which improved to 2.6% when best corrected. The rate of complications was 7.8% in the hospital and 6.7% in the outreach clinics. The causes of poor outcome were surgical complications and case selection in the hospital, and refractive error (p = 0.02)and case selection in the outreach clinics. Urban women chose to seek cataract services later, as they felt able to cope with their deteriorating vision, whereas rural women gave the long distance to services as the main reason for postponing surgery. For urban and rural men, the main barriers were cost and the lack of someone to accompany them.
Conclusion: Good visual outcome can be achieved in outreach clinics if strict protocols are followed. Operative complications and the rate of poor vision are not significantly different in both settings, despite the differences in environment. To bridge the barriers presented by distance and a lack of money, it is possible to carry out operations with good outcomes closer to rural communities.