Elsevier

Ophthalmology

Volume 121, Issue 11, November 2014, Pages 2138-2146
Ophthalmology

Original article
A Multicenter Prospective Cohort Study of Quality of Life and Economic Outcomes after Cataract Surgery in Vietnam: The VISIONARY Study

https://doi.org/10.1016/j.ophtha.2014.05.014Get rights and content

Purpose

To measure the change in quality of life and economic circumstances after cataract surgery and identify the predictors of an improvement in these outcomes.

Design

A multicenter, prospective, longitudinal cohort study.

Participants

Participants aged ≥18 years were recruited to the study if the clinical assessment of their best-uncorrected vision was ≥6/18 in the better eye because of cataract.

Methods

Cataract surgery.

Main Outcome Measures

Data were collected on quality of life and a multidimensional assessment of household economic circumstances (work status, income, asset ownership, household economic hardship, and catastrophic health expenditure).

Results

At 12 months follow-up, 381 of 480 participants were re-interviewed, and all had undergone surgery. There was a significant improvement in quality of life. Household economic circumstances also improved (mean change paid work participation/month: 44.5 hours, P < 0.0001; mean change unpaid work participation/month: 89.5 hours, P < 0.0001; change in proportion with hardship: −17%, P < 0.0001; and change in proportion with catastrophic health expenditure: −7%, P = 0.02). Improvements were most likely in near-poor households and were related to the type of surgery and complications after surgery.

Conclusions

This research showed that cataract surgery is associated with meaningful improvements in quality of life and household economic circumstances that are indicative of positive transitions out of poverty. Given the unmet need for cataract surgery in low- and middle-income countries where cataract impairment is substantial, this research demonstrates the potential of a relatively simple, low-cost health intervention to greatly improve household economic circumstances.

Section snippets

Methods

Ethical approval was obtained from the University of Sydney (13407), and all study participants provided written informed consent using certified translations of approved participant information and consent forms.

The methods have been published.19 VISIONARY was a multicenter prospective longitudinal cohort study conducted in 4 provinces of Vietnam: Hue, Binh Dinh, Vinh Long, and Thai Binh. Health centers in each Province provide eye health services and coordinate regular eye health outreach,

Results

A total of 480 participants consented to the study and completed baseline assessments (Fig 1). A total of 462 of 480 participants (96%) underwent first cataract surgery before their scheduled 6-month interview. The 12-month follow-up was completed in November 2012, and the average follow-up period was 357.2 days (SD, 58.6). At baseline, individuals lost to follow-up were older (mean difference = 4.1 years, P = 0.0005), less likely to be married (P = 0.01), and less likely to have voluntary

Discussion

This study demonstrated that cataract surgery is associated with clinically meaningful improvements in quality of life 12 months after surgery.31 These results underscore the potentially profound social and health benefits associated with improved vision after removal of a cataract and support other findings on the important relationship between vision and quality of life.4, 5 Given the relatively poor vision measured in the study population before surgery and the high uptake of surgery,

Acknowledgments

The VISIONARY study team includes the named authors and the following researchers who contributed to the development and piloting of the study tools and assisted with data collection: Nguyen Ly Kieu Trang, Nguyen Thanh Long, Le Thi Thuy Trang, Nguyen The Hung, Vo Ke Dien, Tran Quoc Dung, Luong Tuan Thien, and Do Thanh Huyen.

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  • Cited by (0)

    Supplemental material is available at www.aaojournal.org.

    Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

    VISIONARY is a collaborative academic study coordinated jointly by investigators at The George Institute for Global Health and the Fred Hollows Foundation in Australia and Vietnam. The study is funded by a grant provided by the Fred Hollows Foundation, Australia. The research team had full control of all primary data and were not limited in any way by the funder in the completion of this study or the reporting of results. During the course of this work B.E. was in receipt of an Ian Potter Foundation Fellowship and support from a National Health and Medical Research Council (NHMRC) Capacity Building Grant (571372), S.J. received an NHMRC Senior Research Fellowship, M.H. received an NHMRC Population Health Career Development Award and a National Heart Foundation Future Leader Fellowship, and L.K. received an Australian Research Council Postdoctoral Fellowship. These funding bodies had no role in the conduct or reporting of the review.

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