Yin Qiuxia, Hu Ailian, Liang Yuanbo, Zhang Jian, He Mingguang, Lam Dennis S C, Ge Jian, Wang Ningli, Friedman David S, Zhao Jialiang, Congdon Nathan
State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
Invest Ophthalmol Vis Sci. 2009 Mar;50(3):1069-75. doi: 10.1167/iovs.08-2783. Epub 2008 Nov 21.
China has among the lowest cataract surgical rates in Asia. This study was conducted to identify barriers to cataract surgery in rural China.
All subjects having undergone cataract surgery and persons with presenting visual acuity <or=6/60 (in Yangjiang) or <or=6/18 (in Handan) in >or=1 eye due to nonsurgically treated cataract were identified in two population-based studies in southern (Yangjiang) and northern (Handan) China. The subjects were administered a questionnaire assessing attitudes in four areas constituting potential barriers to surgery: knowledge about cataract, perceptions of local surgical quality, transportation and cost, and available resources.
Interviews were completed on 71% to 86% of eligible subjects in both sites. Interviewed subjects did not differ significantly from nonrespondents with regard to age, sex, and presenting acuity in the better-seeing eye. A total of 214 (80.4%) nonsurgical and 131 (76.6%) surgical participants were interviewed, with a mean age of 71.8 +/- 8.0 and 73.7 +/- 7.4 years, respectively (P > 0.1). Among the nonsurgical subjects, 67.8% were blind (presenting vision, <or=6/60) in >or=1 eye due to cataract, whereas among the surgical participants, 25.2% remained blind in the eye that had undergone surgical removal of the cataract. In a multivariate analysis adjusted for age, sex, and site, increased knowledge and higher estimates of the quality of surgery were associated with having had surgery, whereas cost and transportation scores were not.
Lack of knowledge about cataract and concerns about the quality of local services appear to be the principal barriers to cataract surgery in rural China.
中国的白内障手术率在亚洲处于最低水平。本研究旨在确定中国农村地区白内障手术的障碍因素。
在华南地区（阳江）和华北地区（邯郸）开展的两项基于人群的研究中，纳入了所有接受过白内障手术的患者，以及因非手术治疗的白内障导致一只或多只眼睛的视力低于或等于6/60（阳江）或低于或等于6/18（邯郸）的患者。对这些受试者进行问卷调查，评估构成手术潜在障碍的四个方面的态度：关于白内障的知识、对当地手术质量的看法、交通和费用以及可用资源。
两个地点均有71%至86%的 eligible 受试者完成了访谈。在年龄、性别和较好眼的视力方面，接受访谈的受试者与未受访者没有显著差异。总共访谈了214名（80.4%）非手术参与者和131名（76.6%）手术参与者，平均年龄分别为71.8±8.0岁和73.7±7.4岁（P>0.1）。在非手术受试者中，67.8%因白内障导致一只或多只眼睛失明（视力低于或等于6/60），而在手术参与者中，25.2%接受白内障手术的眼睛仍为失明。在对年龄、性别和地点进行调整的多因素分析中，对白内障知识的增加和对手术质量的较高估计与接受过手术相关，而费用和交通得分则无关。
对白内障知识的缺乏以及对当地服务质量的担忧似乎是中国农村地区白内障手术的主要障碍。
