Department of Community Ophthalmology and Public Health Research, Dr Shroff's Charity Eye Hospital, New Delhi; The Bodhya Eye Consortium a. Dr Shroff's Charity Eye Hospital, New Delhi, b. Sadguru Netra Chikitsalaya, Jankikund, Chitrakoot, Madhya Pradesh, c. Regional Institute of Ophthalmology and Sitapur Eye Hospital, Sitapur, Uttar Pradesh, d. MGM Eye Institute, Raipur, Chhattisgarh, e. CL Gupta Eye Institute, Moradabad, Uttar Pradesh, India, f. LJ Eye Institute, Ambala City, Haryana, India.
Centre for Community Ophthalmology, Sadguru Netra Chikitsalaya, Chitrakoot, Madhya Pradesh; The Bodhya Eye Consortium a. Dr Shroff's Charity Eye Hospital, New Delhi, b. Sadguru Netra Chikitsalaya, Jankikund, Chitrakoot, Madhya Pradesh, c. Regional Institute of Ophthalmology and Sitapur Eye Hospital, Sitapur, Uttar Pradesh, d. MGM Eye Institute, Raipur, Chhattisgarh, e. CL Gupta Eye Institute, Moradabad, Uttar Pradesh, India, f. LJ Eye Institute, Ambala City, Haryana, India.
Indian J Ophthalmol. 2021 Dec;69(12):3498-3502. doi: 10.4103/ijo.IJO_134_21.
Cataract remains the leading cause of blindness and visual impairment in most low-and middle-income countries, with the greatest burden borne by women. To achieve Global Action Plan targets, cataract programs must target people, especially women, with maximum need. This study examines whether cataract surgical programs in three major north Indian eyecare institutions are equitable and describes a refined indicator for reporting equity.
Retrospective one-year cross-sectional study of cataract surgery utilization using routine administrative data from three north Indian eyecare institutions. Patient data were categorized by paying category, sex, and preoperative visual acuity. Comparisons were made between payment categories and sexes.
Out of the total number of patients operated, 86,230 were in the non-paying category and 56,738 in the paying category. Overall, 8.2% were blind, 21.1% were severely visual impaired (SVI) or worse, and 86.1% were moderate visual impaired (MVI) or worse. Non-paying patients had a significantly higher proportion of poorer visual categories compared to paying patients [(blind, 9.7% vs. 5.8%; SVI or worse, 24.6% vs. 15.8%; and MVI or worse, 89.1% vs. 81.6%, respectively, (P < 0.001)]. Women had significantly higher proportion of poorer visual categories than men [(blind, 8.9% vs. 7.4%, SVI or worse, 21.9% vs. 20.3% and MVI or worse 87.6 vs. 84.7%) (P < 0.001)].
The institutions primarily provided surgery to patients with maximum need: too poor to pay, low visual acuity, and women. Similar data from all service providers of a region can help estimate the proposed "equitable cataract surgical rate": the proportion of patients operated with maximum need among those operated in a year. This can be used for targeting people in need.
白内障仍然是大多数中低收入国家失明和视力损害的主要原因，其中女性负担最重。为了实现全球行动计划的目标，白内障项目必须针对有最大需求的人群，特别是妇女。本研究考察了印度北部三家主要眼科医疗机构的白内障手术项目是否公平，并描述了一个用于报告公平性的改良指标。
使用来自印度北部三家眼科医疗机构的常规行政数据，对白内障手术利用情况进行回顾性一年的横断面研究。根据付费类别、性别和术前视力，对患者数据进行分类。比较了付费类别和性别的差异。
在已手术的患者总数中，86230 名属于非付费类别，56738 名属于付费类别。总体而言，8.2%的患者失明，21.1%为严重视力受损（SVI）或更差，86.1%为中度视力受损（MVI）或更差。与付费患者相比，非付费患者视力较差的比例明显更高[（失明，9.7%比 5.8%；SVI 或更差，24.6%比 15.8%；MVI 或更差，89.1%比 81.6%，分别为 P < 0.001）]。女性视力较差的比例明显高于男性[（失明，8.9%比 7.4%；SVI 或更差，21.9%比 20.3%；MVI 或更差，87.6%比 84.7%，分别为 P < 0.001）]。
这些机构主要为有最大需求的患者提供手术：太穷而无法支付费用、视力较低、以及女性。该地区所有服务提供者的类似数据可帮助估计拟议的“公平白内障手术率”：一年内接受最大需求手术的患者比例。这可用于确定需要帮助的人群。
