Accepted Manuscript Cataract Situation in Latin America: Barriers to Cataract Surgery Juan Francisco Batlle, Van Charles Lansingh, Juan Carlos Silva, Kristen Allison Eckert, Serge Resnikoff PII:
S0002-9394(14)00222-0
DOI:
10.1016/j.ajo.2014.04.019
Reference:
AJOPHT 8896
To appear in:
American Journal of Ophthalmology
Received Date: 19 December 2013 Revised Date:
17 April 2014
Accepted Date: 22 April 2014
Please cite this article as: Batlle, JF, Lansingh VC, Silva JC, Eckert KA, Resnikoff S, Cataract Situation in Latin America: Barriers to Cataract Surgery, American Journal of Ophthalmology (2014), doi: 10.1016/ j.ajo.2014.04.019. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
Abstract Purpose: To provide an update of cataract data and cataract surgical barriers in Latin America.
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Design: review; longitudinal study
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Methods: Cataract surgical rates and other related indicators that have been reported to the VISION 2020 Latin America program since 2005 were reviewed. PubMed was searched for publications on regional epidemiological studies related to cataract, cataract surgery, barriers, outcomes and cataract prevalence from January 2012 to October 2013 to obtain the most up to date data from 19 countries.
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Results: The weighted mean regional cataract surgical rate has increased by an impressive 70% since 2005, from 1,562 to 2,672 cataract surgeries per 1 million inhabitants. The weighted mean number of ophthalmologists per 1 million inhabitants in the region is approximately 62. Cataract surgical coverage varies widely in Latin America from a meager 15% in El Salvador to a more satisfactory 77% in Uruguay. Five recent surveys indicate that lack of awareness of cataract and the surgical treatment option and the cost of surgery are the main cataract surgical barriers.
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Conclusions: In spite of the increasing cataract surgical rates and the more than adequate number of ophthalmologists in Latin America, it is not known how many ophthalmologists actually perform surgery. Coverage remains less than satisfactory across the region. Cataract surgical barriers hinder the efforts of eye care programming. More comprehensive eye care programs and training centers are needed that focus on reaching the underserved and unaware communities, increasing surgical output and uptake, and improving outcomes.
ACCEPTED MANUSCRIPT 1 Cataract Situation in Latin America: Barriers to Cataract Surgery Short Title: Cataract Surgical Barriers in Latin America
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Juan Francisco Batlle,1,2 Van Charles Lansingh,§,3,4 Juan Carlos Silva,5 Kristen Allison Eckert,6 Serge Resnikoff 7 1
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Regional Chair, International Agency for the Prevention of Blindness Latin America, Centro Cristiano de Servicios Médicos, Canta La Rana, Los Alcarrizos, D.N. Santo Domingo, Dominican Republic; 2Employee of Hospital Elias Santana, Centro Cristiano de Servicios Médicos, Canta La Rana, Los Alcarrizos, D.N. Santo Domingo, Dominican Republic; §Corresponding author, Alcatraces 53, Col. Las Margaritas, 54050 Tlanepantla, Mexico, Mexico Tel/fax: (+1) 954-684-8179 Email: [email protected] 3 International Agency for the Prevention of Blindness Latin America, Alcatraces 53, Col. Las Margaritas, 54050 Tlanepantla, Mexico, Mexico; 4Voluntary Assistant Professor of Ophthalmology, Miller School of Medicine, University of Miami 900 NW 17th St. Miami, FL, USA 33136; 5Pan American Health Organization, Calle 66 No.11 -50, 6th floor, Edificio Villorrio, Pbx: 3144141, Bogotá, DC, Colombia; 6Public Health Consultant, 221 Mathews St. Apt. 7 Fort Collins, CO 80524 USA; 7Brien Holden Vision Institute, University of New South Wales, Level 4, North Wing, Rupert Myers Building, Gate 14/Barker St, Sydney NSW 2052, Australia
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Introduction Since the year 1999, the VISION 2020: The Right to Sight initiative of the World Health Organization and the International Agency for the Prevention of Blindness has served as the global partnership for the elimination of avoidable blindness with the collaboration of international non-governmental organizations, professional associations, eye care institutions, and industry. The basis of this initiative was to curb the frightening rise in global blindness by eliminating all avoidable blindness by the year 2020. According to the World Health Organization, approximately 39 million people in the world have blindness and 246 million have moderate and severe visual impairment.1 Cataract is the main cause of global blindness, accounting for 51% of the cases reported and one-third of visual impairment. According to the 2010 Global Burden Disease Study,2 standardized, national prevalence rates for blindness for the population ≥50 years (the age group most at risk for cataract blindness) in Latin America range from 1.1% in Uruguay to 3.8% in Guatemala. The prevalence rates for moderate and severe visual impairment for the same age group in Latin America range from 7.5% in Argentina to 4.4% in Brazil. Latin America is considered one of the global regions with the most number of epidemiological studies on blindness and visual impairment since 1999.3-19 Cataract data and related indicators have been reported annually to the VISION 2020 Latin America program since 2005. In 2010, we reported progress with the regional cataract surgical rates, noting a general increase in rates in Latin American countries from 20052008.20 In 2012, the most comprehensive Latin American review to date on the prevalence of blindness and visual impairment for all causes of blindness, including cataract, was carried out by Furtado et al.21 The purpose of this current study is to provide an update of the cataract situation in Latin America, including a longitudinal review of cataract data from 2005 – 2012, and to review the barriers to cataract surgery from the most recent epidemiological studies.
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Methods A longitudinal review of cataract data in Latin America was carried out for 2005 – 2012 with an updated literature review of epidemiological studies on blindness and visual impairment in the region. Latin America is referred to in this study as the 19 countries of VISION 2020 Latin America: Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Cuba, Dominican Republic, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, Uruguay, and Venezuela. The methodology for cataract data collection was previously described in the first longitudinal review of Latin American data for 2005-2008;20 the current study updated the data review through 2012. Country representatives from the national V2020 committees, national committees for the prevention of blindness, national societies of ophthalmology, and/or the ministries of health continue to annually report cataract surgical rate data. The cataract surgical rate is an indicator of cataract surgical services; it is the annual number of cataract surgeries carried out per 1 million population. The representatives also report annually on the number of ophthalmologists working in each country. These data are available with other key health personnel, infrastructure, pricing, economic, and demographic data that are also periodically reported and
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updated on the VISION 2020 Latin America website: http://www.v2020la.org/StatPlanet/StatPlanet.html. PubMed was also searched for publications on Rapid Assessment of Cataract Surgical Services or Rapid Assessment of Avoidable Blindness studies from Latin America related to cataract, cataract surgical barriers, outcomes, and cataract prevalence from January 2012 through October 2013. The search of epidemiological studies was limited specifically to Rapid Assessment of Cataract Surgical Services or Rapid Assessment of Avoidable Blindness studies, as they are considered the standard methodologies and provide directly comparable data.22,23 Also included were data from the recent Rapid Assessment of Avoidable Blindness reports from 2011 onward, which haven not yet been published but were submitted to the International Agency for the Prevention of Blindness and World Health Organization. Authors provided their authorization through email communications to allow their data to be used in this current study. Publications previously reviewed21 were also reviewed for the prevalence of blindness, causes of blindness, and cataract surgical coverage. Cataract surgical coverage is another indicator of cataract surgical services; it is the annual “proportion of people, blind or visually-impaired due to cataract, which have been operated in one or both eyes” in a given area.24 Cataract surgical coverage reflects the distribution and equity of services across different regions and populations. The cataract surgical coverages used in this study are based on the number of people with cataract that need surgery at the following visual acuity (VA) thresholds:
S0002-9394(14)00222-0
DOI:
10.1016/j.ajo.2014.04.019
Reference:
AJOPHT 8896
To appear in:
American Journal of Ophthalmology
Received Date: 19 December 2013 Revised Date:
17 April 2014
Accepted Date: 22 April 2014
Please cite this article as: Batlle, JF, Lansingh VC, Silva JC, Eckert KA, Resnikoff S, Cataract Situation in Latin America: Barriers to Cataract Surgery, American Journal of Ophthalmology (2014), doi: 10.1016/ j.ajo.2014.04.019. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
Abstract Purpose: To provide an update of cataract data and cataract surgical barriers in Latin America.
RI PT
Design: review; longitudinal study
SC
Methods: Cataract surgical rates and other related indicators that have been reported to the VISION 2020 Latin America program since 2005 were reviewed. PubMed was searched for publications on regional epidemiological studies related to cataract, cataract surgery, barriers, outcomes and cataract prevalence from January 2012 to October 2013 to obtain the most up to date data from 19 countries.
M AN U
Results: The weighted mean regional cataract surgical rate has increased by an impressive 70% since 2005, from 1,562 to 2,672 cataract surgeries per 1 million inhabitants. The weighted mean number of ophthalmologists per 1 million inhabitants in the region is approximately 62. Cataract surgical coverage varies widely in Latin America from a meager 15% in El Salvador to a more satisfactory 77% in Uruguay. Five recent surveys indicate that lack of awareness of cataract and the surgical treatment option and the cost of surgery are the main cataract surgical barriers.
AC C
EP
TE D
Conclusions: In spite of the increasing cataract surgical rates and the more than adequate number of ophthalmologists in Latin America, it is not known how many ophthalmologists actually perform surgery. Coverage remains less than satisfactory across the region. Cataract surgical barriers hinder the efforts of eye care programming. More comprehensive eye care programs and training centers are needed that focus on reaching the underserved and unaware communities, increasing surgical output and uptake, and improving outcomes.
ACCEPTED MANUSCRIPT 1 Cataract Situation in Latin America: Barriers to Cataract Surgery Short Title: Cataract Surgical Barriers in Latin America
RI PT
Juan Francisco Batlle,1,2 Van Charles Lansingh,§,3,4 Juan Carlos Silva,5 Kristen Allison Eckert,6 Serge Resnikoff 7 1
AC C
EP
TE D
M AN U
SC
Regional Chair, International Agency for the Prevention of Blindness Latin America, Centro Cristiano de Servicios Médicos, Canta La Rana, Los Alcarrizos, D.N. Santo Domingo, Dominican Republic; 2Employee of Hospital Elias Santana, Centro Cristiano de Servicios Médicos, Canta La Rana, Los Alcarrizos, D.N. Santo Domingo, Dominican Republic; §Corresponding author, Alcatraces 53, Col. Las Margaritas, 54050 Tlanepantla, Mexico, Mexico Tel/fax: (+1) 954-684-8179 Email: [email protected] 3 International Agency for the Prevention of Blindness Latin America, Alcatraces 53, Col. Las Margaritas, 54050 Tlanepantla, Mexico, Mexico; 4Voluntary Assistant Professor of Ophthalmology, Miller School of Medicine, University of Miami 900 NW 17th St. Miami, FL, USA 33136; 5Pan American Health Organization, Calle 66 No.11 -50, 6th floor, Edificio Villorrio, Pbx: 3144141, Bogotá, DC, Colombia; 6Public Health Consultant, 221 Mathews St. Apt. 7 Fort Collins, CO 80524 USA; 7Brien Holden Vision Institute, University of New South Wales, Level 4, North Wing, Rupert Myers Building, Gate 14/Barker St, Sydney NSW 2052, Australia
ACCEPTED MANUSCRIPT 2
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Introduction Since the year 1999, the VISION 2020: The Right to Sight initiative of the World Health Organization and the International Agency for the Prevention of Blindness has served as the global partnership for the elimination of avoidable blindness with the collaboration of international non-governmental organizations, professional associations, eye care institutions, and industry. The basis of this initiative was to curb the frightening rise in global blindness by eliminating all avoidable blindness by the year 2020. According to the World Health Organization, approximately 39 million people in the world have blindness and 246 million have moderate and severe visual impairment.1 Cataract is the main cause of global blindness, accounting for 51% of the cases reported and one-third of visual impairment. According to the 2010 Global Burden Disease Study,2 standardized, national prevalence rates for blindness for the population ≥50 years (the age group most at risk for cataract blindness) in Latin America range from 1.1% in Uruguay to 3.8% in Guatemala. The prevalence rates for moderate and severe visual impairment for the same age group in Latin America range from 7.5% in Argentina to 4.4% in Brazil. Latin America is considered one of the global regions with the most number of epidemiological studies on blindness and visual impairment since 1999.3-19 Cataract data and related indicators have been reported annually to the VISION 2020 Latin America program since 2005. In 2010, we reported progress with the regional cataract surgical rates, noting a general increase in rates in Latin American countries from 20052008.20 In 2012, the most comprehensive Latin American review to date on the prevalence of blindness and visual impairment for all causes of blindness, including cataract, was carried out by Furtado et al.21 The purpose of this current study is to provide an update of the cataract situation in Latin America, including a longitudinal review of cataract data from 2005 – 2012, and to review the barriers to cataract surgery from the most recent epidemiological studies.
AC C
EP
Methods A longitudinal review of cataract data in Latin America was carried out for 2005 – 2012 with an updated literature review of epidemiological studies on blindness and visual impairment in the region. Latin America is referred to in this study as the 19 countries of VISION 2020 Latin America: Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Cuba, Dominican Republic, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, Uruguay, and Venezuela. The methodology for cataract data collection was previously described in the first longitudinal review of Latin American data for 2005-2008;20 the current study updated the data review through 2012. Country representatives from the national V2020 committees, national committees for the prevention of blindness, national societies of ophthalmology, and/or the ministries of health continue to annually report cataract surgical rate data. The cataract surgical rate is an indicator of cataract surgical services; it is the annual number of cataract surgeries carried out per 1 million population. The representatives also report annually on the number of ophthalmologists working in each country. These data are available with other key health personnel, infrastructure, pricing, economic, and demographic data that are also periodically reported and
ACCEPTED MANUSCRIPT 3
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updated on the VISION 2020 Latin America website: http://www.v2020la.org/StatPlanet/StatPlanet.html. PubMed was also searched for publications on Rapid Assessment of Cataract Surgical Services or Rapid Assessment of Avoidable Blindness studies from Latin America related to cataract, cataract surgical barriers, outcomes, and cataract prevalence from January 2012 through October 2013. The search of epidemiological studies was limited specifically to Rapid Assessment of Cataract Surgical Services or Rapid Assessment of Avoidable Blindness studies, as they are considered the standard methodologies and provide directly comparable data.22,23 Also included were data from the recent Rapid Assessment of Avoidable Blindness reports from 2011 onward, which haven not yet been published but were submitted to the International Agency for the Prevention of Blindness and World Health Organization. Authors provided their authorization through email communications to allow their data to be used in this current study. Publications previously reviewed21 were also reviewed for the prevalence of blindness, causes of blindness, and cataract surgical coverage. Cataract surgical coverage is another indicator of cataract surgical services; it is the annual “proportion of people, blind or visually-impaired due to cataract, which have been operated in one or both eyes” in a given area.24 Cataract surgical coverage reflects the distribution and equity of services across different regions and populations. The cataract surgical coverages used in this study are based on the number of people with cataract that need surgery at the following visual acuity (VA) thresholds:
