Beltranena Fernando, Casasola Karin, Silva Juan Carlos, Limburg Hans
Hospital Rodolfo Robles, Committee for the Blind and Deaf of Guatemala, Guatemala City, Guatemala.
Ophthalmology. 2007 Aug;114(8):1558-63. doi: 10.1016/j.ophtha.2006.11.015. Epub 2007 Mar 6.
To assess prevalence of visual impairment resulting from cataract and cataract surgical services in 4 departments (provinces) of Guatemala to facilitate further health care planning.
Cross-sectional study.
Ninety-eight enumeration areas were selected by systematic sampling in 4 departments in southwest Guatemala, with a combined population of 1,339,508 (2002 census). Ninety-eight clusters of 50 persons > or =50 years of age (4900 eligible persons) were selected by random walk, 1 in each selected enumeration area. A total of 4806 persons were examined (coverage, 98.1%): 1808 (37.6%) men and 2998 (62.4%) women. Mean age was 63.7 years.
Each eligible participant was interviewed and underwent an assessment of visual acuity and ophthalmic examination to assess lens status.
Visual acuity of each eye with available correction and with pinhole correction; lens status; cause of visual impairment in 1 or both eyes; reason(s) why cataract operation had not been performed; and details of previous cataract surgery.
Cataract is the major cause of bilateral blindness (66.1%). The adjusted prevalence of bilateral cataract blindness (best-corrected visual acuity [BCVA], <20/400) in people 50 years of age and older was 2.3% (95% confidence interval [CI], 1.8%-3.0%), or an estimated 3726 persons. The cataract surgical coverage was 49% for men and 28% for women. The adjusted prevalence of bilateral cataract and BCVA<20/200 in persons 50 years of age and older was 3.7% (95% CI, 2.9%-4.4%), or an estimated 5887 persons. In this last group, the surgical coverage was 29% (persons) and 19% (eyes). Of all operated eyes, 36% could not see 20/200. Being unaware of cataract (68%), inability to afford the procedure (12%), and fear of the procedure (10%) were mentioned most often as the reason why surgery had not been performed.
There is a backlog in unoperated cataract in the survey area that will increase with ageing. Awareness campaigns, reducing cost, improving the outcome of cataract surgery, and expansion of surgical services may help to increase the cataract surgical rate. Women should be offered more cataract surgery. These results will enable health managers to plan effective interventions in line with Vision 2020.
评估危地马拉4个省白内障导致的视力损害患病率及白内障手术服务情况，以促进进一步的医疗保健规划。
横断面研究。
通过系统抽样在危地马拉西南部4个省选取98个普查区，总人口为1339508人（2002年人口普查数据）。通过随机抽样在每个选定的普查区选取98组50岁及以上的人群（每组50人，共4900名符合条件的人）。共检查了4806人（覆盖率98.1%）：男性1808人（37.6%），女性2998人（62.4%）。平均年龄为63.7岁。
对每位符合条件的参与者进行访谈，并进行视力评估和眼科检查以评估晶状体状况。
每只眼睛在可矫正状态及针孔矫正状态下的视力；晶状体状况；单眼或双眼视力损害的原因；未进行白内障手术的原因；以及既往白内障手术的详细情况。
白内障是双眼失明的主要原因（66.1%）。50岁及以上人群中双侧白内障失明（最佳矫正视力[BCVA]<20/400）的校正患病率为2.3%（95%置信区间[CI]，1.8%-3.0%），即约3726人。男性白内障手术覆盖率为49%，女性为28%。50岁及以上人群中双侧白内障且BCVA<20/200的校正患病率为3.7%（95%CI，2.9%-4.4%），即约5887人。在这最后一组人群中，手术覆盖率为29%（人数）和19%（眼数）。在所有接受手术的眼中，36%的视力达不到20/200。未进行手术的最常见原因是不了解白内障（68%）、无力承担手术费用（12%）和害怕手术（10%）。
调查地区存在未手术白内障积压问题，且会随着老龄化加剧。开展宣传活动、降低成本、改善白内障手术效果以及扩大手术服务可能有助于提高白内障手术率。应为女性提供更多白内障手术。这些结果将使卫生管理人员能够根据“视觉2020”计划有效的干预措施。
