Prevalence And Surgery Status Of Cataract In Adult Rural Bai, Yi And Han Nationality In Yunnan Province

Objective To assess the prevalence of cataract, the prevalence of cataract surgery, the rate of cataract surgical coverage, the rate of cataract social burden, and the outcome of cataract sugery. Methods A population-based, cross-sectional survey of Chinese Bai, Yi and Han Nationality aged≥50 years from randomly selected block groups in Yunnan province was conducted. Participants underwent presenting visual acuity (PVA) and best-corrected visual acuity (BCVA) measurements, refraction, and a slit-lamp examination, including the evaluation of lens status and cataract surgical status. The principal cause of visual impairment was identified by a VA of worse than 20/63. Multiple logistic regression analysis was employed to analyze the prevalence of cataract, cataract surgical coverage rate, cataract social burden rate and outcomes of surgery among different ages, sex, educational status, year of surgery and IOL status. Results In 6546 subjects,3172 case of cataract were found, the prevalence of cataract was 48.5% among adults 50 or above, in which Bai33.3%, Han 58.2% and Yi 53.4%. Han, increased aged, female gender, illiterate, thinner, shorter, higher systolic blood pressure, and never drinking were factors that were associated with an increased risk for cataracts (P<0.01). The prevalence of cataract surgery was 6.0%, in which Bai 4.6%, Yi 7.0% and Han 6.4%. Among the 525 cataract-operated eyes, the rate of intraocular lens implantation was 86.7%, in which Bai 79.8%, Yi 92.5%, and Han 85.3%. The rate of cataract surgical coverage was 53.3%, in which Bai 52.8%, Yi 64.2%, and Han 45.3%. The rate of cataract social burden rate was 7.9%, in which Bai 6.8%, Yi 7.2%, and Han 9.7%. The cataract blindness social burden rate was associated with Han, older age, female gender, and illiterate (P<0.05). The rate of cataract surgical coverage and unoperated cataract were associated with Han, older age, and illiterate (P<0.05).The main barrier to cataract surgery was unaware of having a cataract, being told to wait until the cataract gets mature, could not afford to undergo cataract surgery, and being told that there was a contraindication. Post-operative PVA and BCVA of 20/63 or better was 44.5% and 67.2% of operated eyes respectively, in which Bai 48.1% and 65.9%, Yi 47.8% and 75.4%, Han 39.1% and 59.9%. Han, aphakia, earlier year of surgery, lower-level surgical hospitals and illiterate were significantly associated with postoperative visual impairment defined by PVA, while Han, aphakia, and illiterate were significantly associated with postoperative visual impairment by BCVA. Of 291 cataract-operated eyes with PVA worse than 20/63, the principal causes were posterior capsule opacification, refractive error, retinal disorders,and glaucoma.Conclusions Cataract prevalence in adults rural Bai, Yi and Han nationality aged≥50 years is among the highest reported in China. The Cataract surgical coverage is not low but the cataract social burden rate is heavy in ethnic groups living in rural Yunnan, especially in the Han, aged, female, and illiterate persons. Surgical uptake and visual outcomes should be further improved in the future.