[Show abstract][Hide abstract] ABSTRACT: To study the differences in ophthalmology resident training between China and the Hong Kong Special Administrative Region (HKSAR).
Training programs were selected from among the largest and best-known teaching hospitals. Ophthalmology residents were sent an anonymous 48-item questionnaire by mail. Work satisfaction, time allocation between training activities and volume of surgery performed were determined.
50/75 residents (66.7 %) from China and 20/26 (76.9 %) from HKSAR completed the survey. Age (28.9 ± 2.5 vs. 30.2 ± 2.9 years, p = 0.15) and number of years in training (3.4 ± 1.6 vs. 2.8 ± 1.5, p = 0.19) were comparable between groups. The number of cataract procedures performed by HKSAR trainees (extra-capsular, median 80.0, quartile range: 30.0, 100.0; phacoemulsification, median: 20.0, quartile range: 0.0, 100.0) exceeded that for Chinese residents (extra-capsular: median = 0, p < 0.0001; phacoemulsification: median = 0, p < 0.0001). Chinese trainees spent more time completing medical charts (>50 % of time on charts: 62.5 % versus 5.3 %, p < 0.0001) and received less supervision (≥90 % of training supervised: 4.4 % versus 65 %, p < 0.0001). Chinese residents were more likely to feel underpaid (96.0 % vs. 31.6 %, p < 0.0001) and hoped their children would not practice medicine (69.4 % vs. 5.0 %, p = 0.0001) compared HKSAR residents.
In this study, ophthalmology residents in China report strikingly less surgical experience and supervision, and lower satisfaction than HKSAR residents. The HKSAR model of hands-on resident training might be useful in improving the low cataract surgical rate in China.
BMC Medical Education 12/2015; 15(1). DOI:10.1186/s12909-015-0440-0 · 1.22 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objectives:
We estimated the prevalence of metabolic syndrome (MetS) and compared associations of different MetS definitions with coronary heart disease (CHD), stroke, and peripheral arterial disease (PAD) in a rural Chinese population.
Among 4,748 residents (2,145 men and 2,603 women) aged 30+ years in rural China from 2006 to 2007, the prevalence of MetS was estimated by using five different definitions: modified World Health Organization (WHO), Chinese Diabetes Society (CDS), the updated National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) for Asian-Americans, International Diabetes Federation (IDF), and Joint Interim Statement (JIS). Multivariable logistic regression analyses were implemented to estimate the association between MetS and the prevalence of CHD, stroke and PAD, respectively.
Prevalence of MetS in men was 11.5% (WHO), 14.8% (CDS), 32.4% (NCEP-ATP III), 27.5% (IDF) and 39.7% (JIS) and in women was 15.7% (WHO), 20.7% (CDS), 54.2% (NCEP-ATP III), 51.5% (IDF) and 54.2% (JIS), respectively. Respective ORs (95% CI) for associating MetS with CHD in men were 1.79 (1.02-3.17), 1.25 (0.69-2.26), 1.61 (1.01-2.58), 1.84 (1.14-2.96), and 1.53 (0.96-2.43). Corresponding ORs (95% CI) for stroke in men were 2.18 (95% CI 1.20 to 3.97), 2.20 (95% CI 1.25 to 3.89), 1.71 (95% CI 1.02 to 2.84), 1.30 (95% CI 0.77 to 2.23), and 1.61 (95% CI 0.97 to 2.68), respectively. In women, CHD and stroke were significantly associated with MetS using all five definitions of MetS. In addition, PAD was associated with all five MetS definitions in men, but not in women. Only hyperglycemia and BMI were significantly associated with PAD in women.
In this rural Chinese population, the JIS, IDF and CDS criteria may not be more suitable than WHO and updated NCEP-ATPIII definitions for screening high-risk individuals and estimating the risk of CHD and stroke from MetS, especially in men.
PLoS ONE 05/2015; 10(5):e0126832. DOI:10.1371/journal.pone.0126832 · 3.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Glaucoma is the second leading cause of blindness worldwide. To examine the relationship between angle closure and the retinal vessel diameter in Chinese adults, we conducted Handan Eye Study (HES), a large population-based cross-sectional study, which enrolled 6830 participants >30 year-old living in 13 randomly selected villages of Yongnian County. After adjusting for age, gender, spherical equivalent (SE), diabetes, and hypertension, the mean central retinal artery equivalent (CRAE, μm) was 127.1 ± 7.0 and 145.6 ± 4.4 in primary open-angle glaucoma (POAG) and primary angle closure glaucoma (PACG), respectively; narrower than that in normal control (156.1 ± 0.4), primary angle-closure suspect (PACS) (156.3 ± 1.1) or primary angle closure (PAC) (156.0 ± 3.4) (P = 0.001). The mean central retinal vein equivalent (CRVE, μm) was 229.0 ± 5.9 and 215.8 ± 9.5 in POAG and PACG, respectively; narrower than that in normal control (238.3 ± 0.5), PACS (241.2 ± 1.4) or PAC (242.2 ± 4.6) (P = 0.001). There was no significant difference in the mean CRAE or CRVE between PACG and POAG. Compared to the normal control (0.66), the mean arterio-venous ratio (AVR) was smaller in POAG (0.64) and PACG (0.59), whereas larger in PACS (0.65) and PAC (0.67) (P = 0.003). To conclude, PACG and POAG individuals have narrower retinal arteries and veins.
[Show abstract][Hide abstract] ABSTRACT: To evaluate patient-perceived quality of life with glaucoma and to assess whether ophthalmologists fully appreciate patients' perceptions through utility analysis.
Utility values were obtained from 87 glaucoma patients by linear rating scale (RS), standard gamble for blindness (SG), and time trade-off (TTO) methods. Identical questionnaires were delivered to ophthalmologists (n=26) at the same center, who were asked to assume they had mild (MD in better-seeing eye ≥-6 dB) or moderate to severe (MD in better-seeing eye <-6 dB) glaucoma. Responses from patients and ophthalmologists were compared.
Patients with mild glaucoma gave a utility value of 0.70±0.14, 0.85±0.14, and 0.77±0.14 with RS, SG, and TTO method, respectively. Those with moderate to severe glaucoma generated corresponding utilities of 0.56±0.20, 0.75±0.20, and 0.78±0.11. RS and SG utilities were affected by disease severity and history of glaucoma surgery, whereas TTO utility was mainly related with education level and employment status of the patients. Ophthalmologists reported higher utility values than their patients when mild glaucoma was assumed (0.81±0.14, 0.96±0.05, and 0.95±0.05 for RS, SG, and TTO methods, respectively; P<0.05). Given the scenario of moderate to severe glaucoma, ophthalmologists gave significantly lower RS (0.35±0.21, P<0.001), but similar SG (0.74±0.27, P=0.84) and TTO (0.82±0.13, P=0.40) utility values, than the patients.
Utility values are considerably decreased in Chinese patients with glaucoma. Ophthalmologists tend to substantially underestimate the impact of mild glaucoma on patients' quality of life. Better understanding patients' perceptions of glaucoma would be helpful for the establishment of shared decision making and patient-centered care.
Journal of Glaucoma 11/2014; Publish Ahead of Print(7). DOI:10.1097/IJG.0000000000000056 · 2.11 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Assessment of the optic disc and retinal nerve fiber layer (RNFL) is essential for the diagnosis and monitoring of glaucoma. Knowledge of normal optic disc topography provides a benchmark for evaluating glaucomatous pathologic changes, especially in its early stages. The purpose of this study was to evaluate the characteristics and correlation factors of the optic disc parameters using the Heidelberg Retina Tomograph II (HRT II) in a large sample of normal eyes of adult Chinese subjects.
Disc data were obtained from 6 830 subjects aged >30 years from the Handan Eye Study. All participants underwent comprehensive eye examinations and physical examinations. The associations of gender, age, body mass index, blood pressure, waist-to-hip ratio; refractive error, intraocular pressure, axial length, and disc area were assessed using simple and multiple regression analysis. The correlation between HRT II parameters was evaluated.
Of the 7 557 eligible subjects, 6 830 took part in the study (90.4% response rate) and 2 633 normal eyes with good-quality HRT II images were selected. The mean disc area was 2.28 mm(2) (standard deviation (SD) 0.43) and mean neural rim area was 1.80 mm(2) (SD 0.29). In multiple regression analysis, optic disc area significantly correlated with age, gender, and axial length (P < 0.001). All optic disc parameters showed a significant correlation with disc area (0.054 <r <0.736, P < 0.01). The association between mean RNFL thickness and rim area is statistically significant but not strong (regression linear equation: rim area = 1.42 × mean RNFL thickness + 1.32 mm(2), P < 0.001; R(2) = 0.070). The global RNFL cross-sectional area was significantly associated with global rim area (regression linear equation: rim area = 1.14 × RNFL cross-sectional area + 0.44 mm(2), P < 0.001; R(2) = 0.271).
The optic disc area in rural Chinese population is larger than reported in white and Japanese populations, similar to that of Indian population and urban Chinese population. Most optic disc measurements were moderately or weakly affected by disc area. In addition to the RNFL, there may be other factors affecting the rim area. The relationship between optic disc and axial length may suggest a link between larger disc area, thinning of the lamina cribrosa, and increased glaucoma susceptibility in myopic eyes.
Chinese medical journal 05/2014; 127(9):1702-9. DOI:10.3760/cma.j.issn.0366-6999.20133312 · 1.05 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To describe the prevalence and associations of posterior vitreous detachment (PVD) in a rural adult Chinese population.
All eligible subjects were requested to carry out a comprehensive eye examination; PVD was a pre-specified outcome variable and was determined via biomicroscopical examination (slit-lamp biomicroscopy) with a +90-D preset lens after mydriasis. Prevalence was standardized to China population census (2000).
5890 (86.2%) subjects completed the examination of slit-lamp biomicroscopy with a +90-D lens. PVD was present in 160 participants (2.7%); the standardized prevalence was 2.0% (95% confidence interval [CI], 1.6-2.3%). PVD developed increasingly with age (P for trend < 0.001) for both men and women. Using a multivariate regression model, older people were found to run a higher risk of developing PVD than younger people, and women were found to have a higher risk than men (OR, 2.9; 95% CI,1.5-5.9). Diabetes, hypertension, smoking, drinking, and intraocular pressure (IOP) were not significantly associated with PVD.
About one in fifty people is found to have PVD in this population-based study. Age and female are independently associated with PVD occurrence.
[Show abstract][Hide abstract] ABSTRACT: Background
Microalbuminuria is an early marker of chronic kidney disease (CKD). Previous studies have shown that either metabolic syndrome (MetS) or chronic inflammation is related to renal impairment. The aim of this study was to investigate the association between MetS, C-reactive protein (CRP) and microalbuminuria in a rural Chinese population.
This was a cross-sectional study using data from the Handan Eye Study. MetS was defined according to the Chinese Diabetes Society (CDS) criteria. CRP levels ≥ 3 mg/L were classified as high CRP. Microalbuminuria was defined as a urinary albumin/creatinine ratio (ACR) of 30–300 mg/g.
We included 4191 subjects aged ≥ 30 years in this analysis. The prevalence of MetS and microalbuminuria in the group was 25.7% and 15.6%, respectively. The odds ratio (OR) of microalbuminuria in subjects with MetS was 1.25 (95% confidence interval (CI): 1.03 − 1.51) compared with those without microalbuminuria. In multivariate logistic regression analysis, high blood pressure (OR 1.36, 95% CI: 1.10 − 1.67) and high fasting blood glucose (OR 1.44, 95% CI: 1.17 − 1.76) were independently associated with microalbuminuria. Subjects with high CRP and MetS had a 1.46-fold greater risk of having microalbuminuria compared with those with low CRP without MetS (95% CI: 1.06 − 2.01).
In this rural Chinese population aged ≥30 years, MetS and microalbuminuria were independently related and the combination of high CRP and MetS was associated with an increased risk of microalbuminuria.
[Show abstract][Hide abstract] ABSTRACT: Purpose:
To quantify the effect of laser peripheral iridotomy (LPI) on angle widening in primary angle closure with and without peripheral anterior synechia (PAS).
Patients and methods:
Prospective hospital-based study of 44 consecutive patients (69 eyes) with primary angle closure. Comprehensive ophthalmic examination and ultrasound biomicroscopy were performed at enrollment and 2 weeks following LPI. The following angle parameters: angle opening distance, trabecular-iris angle, and angle recess area were obtained. On the basis of the presence of PAS, angle quadrants were divided into 3 groups: group A comprised quadrants in PAS-negative eyes; group B, the unaffected quadrants in PAS-positive eyes; and group C, the quadrants with PAS in PAS-positive eyes. Correlation between PAS and angle width was determined and changes in angle parameters following LPI were compared between groups.
Sixty-six eyes of 42 patients (31 eyes with PAS) were available for analysis. Groups A, B, and C provided 140, 66, and 58 quadrants, respectively, for analysis. There was a moderate negative correlation between angle width changes (angle opening distance, trabecular-iris angle, angle recess area) after LPI and PAS extent at baseline (r=-0.46 to -0.39; P<0.01). The change in angle width was significantly different between groups A and B compared to group C (P<0.01); there was no difference between groups A and B.
Changes in anterior chamber angle following LPI were inversely correlated with presence of PAS. Quadrants unaffected by PAS can be expected to widen as much as in eyes with only appositional closure. In quadrants with PAS the ultrasound biomicroscopy parameters did not change following LPI.
Journal of glaucoma 05/2013; 22(5). DOI:10.1097/IJG.0b013e318241ba1d · 2.11 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background
To date, studies on the role played by cigarette smoking in primary open-angle glaucoma (POAG) remains controversial. The current study evaluated cigarette smoking as a risk factor of POAG and its relationships with vertical cup-to-disc ratio (VCDR), central corneal thickness (CCT) and intraocular pressure (IOP) in a Chinese cohort.
In a total of 248 unrelated individuals including 30 juvenile-onset POAG (JOAG), 92 adult-onset POAG (AOAG) and 126 sex-matched senile cataract controls, underwent comprehensive ophthalmic examination. Their smoking was obtained and documented by questionnaire. Association of cigarette smoking with POAG was performed using logistic regression controlled for age and sex. Effects of cigarette smoking on VCDR, IOP and CCT were analyzed with multiple linear regression.
In either JOAG or AOAG, no association of cigarette smoking was found with disease onset (P = 0.692 and 0.925 respectively). In controls and JOAG, no significant effects of smoking were found on VCDR, IOP or CCT (all P > 0.05). Smoking was found to be correlated with decreased CCT in AOAG and combined POAG (JOAG + AOAG) (P = 0.009 and 0.003), but no association with VCDR or IOP was observed (P > 0.05).
Although cigarette smoking was not found to be risk factor for onset of POAG, it was correlated with CCT in AOAG, and thus might still play a role in the disease course, especially for AOAG.
[Show abstract][Hide abstract] ABSTRACT: Background:
Our purpose was to determine the relationship of metabolic syndrome (MetS) and its components with retinal microvascular abnormalities in a rural Chinese population.
The Handan Eye Study, a population-based survey, recruited 6,830 (90.4 % of eligible) rural Chinese ≥30 years of age. A diagnosis of metabolic syndrome was based on the International Diabetes Federation definition. Retinal microvascular signs and arteriolar and venular diameters were assessed from fundus photographs by graders who were trained at the Retinal Vascular Imaging Centre, University of Melbourne.
After adjusting for age, gender, and smoking status, 5,519 participants with MetS, or with the specific components of large waist circumference, elevated blood pressure (BP), or elevated fasting blood glucose (FG), were more likely to have retinopathy, arteriovenous nicking, focal arteriolar narrowing, enhanced arteriolar wall reflex, and generalized retinal arteriolar narrowing than those without MetS or the corresponding component. Individuals with elevated triglycerides were significantly more likely to have arteriovenous nicking and retinopathy.
These results show that individual components of MetS are associated with different retinal microvascular signs and with changes in retinal arteriolar and venular diameters.
Albrecht von Graæes Archiv für Ophthalmologie 09/2012; 250(12). DOI:10.1007/s00417-012-2109-2 · 1.91 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study aimed to describe the rate of cataract surgical coverage (CSC) and the quality-of-life (QoL) outcomes after cataract surgery in rural China.
A clustered, random sampling procedure was used to select 7557 Chinese patients aged 30 years and older from Handan, China. Comprehensive eye examinations, including standardized refraction and classification of lens characteristics, were offered to all eligible subjects. Visual impairment was defined as any individual with presenting visual acuity of less than 20/60 in the better-seeing eye. The main outcome measures were CSC rate and a summary measure assessing QoL in visually impaired (VI) participants.
Of 5592 participants older than 40 years, there were 41 cataract patients operated on and 54 VI cataract patients not operated on. The CSC rate among individuals with VI was 43.2%. Older age was significantly negatively associated with a history of cataract surgery (adjusted odds ratio, 0.44 per 10-year increase in age; 95% confidence interval, 0.26-0.74). Women were less likely to have had cataract surgery compared with men, although not significantly (adjusted odds ratio, 0.44; 95% confidence interval, 0.17-1.12). The QoL summary measure was significantly better in the cataract group operated on than that not operated on (P < 0.01).
There is a large unmet need for cataract surgery in rural Handan, China. Those who had surgery were more likely to have better QoL outcomes than those who did not. There is a potential need to promote cataract surgery and develop age- and sex-sensitive interventions in rural China.
[Show abstract][Hide abstract] ABSTRACT: Metabolic syndrome is a common risk factor for cardiovascular disease. Chronic kidney disease (CKD) is a worldwide public health problem. We investigated the association between metabolic syndrome and CKD in a rural Chinese population.
This was a cross-sectional study using data from the Handan Eye Study.
4944 of participants aged ≥ 30 y were included in this analysis. Participants with metabolic syndrome had a higher prevalence of CKD (20.9% vs.15.8%, P<0.001) than those without. As the number of metabolic syndrome components increased, so did the prevalence of CKD (P<0.001). The multivariate-adjusted odds ratio (OR) of chronic kidney disease in participants with metabolic syndrome was 1.293 (95% CI 1.093-1.529) compared with those without. In multivariate logistic regression analysis, high blood pressure (OR 1.348; 95% CI 1.122-1.619) and high fasting glucose (OR 1.501; 95% CI 1.235-1.794) were independently associated with the risk for CKD. Compared with participants without any component, multivariate adjusted OR for CKD was 1.316 (95%CI 1.004-1.723), 1.397(95%CI 1.038-1.882), 1.672 (95%CI 1.183-2.363) for those with 2, 3, 4 or 5 components, respectively.
In this rural Chinese population aged ≥ 30 y, metabolic syndrome was associated with CKD.
Clinica chimica acta; international journal of clinical chemistry 10/2011; 412(21-22):1983-8. DOI:10.1016/j.cca.2011.07.014 · 2.82 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To investigate the prevalence and characteristics of primary angle-closure suspect (PACS), primary angle closure (PAC), and primary angle-closure glaucoma (PACG) in a rural population in China.
In all, 6716 Han Chinese 30 years of age and older (5480 subjects 40 years of age and older) from 13 villages in Handan were randomly selected and completed an ophthalmologic examination, including visual acuity, intraocular pressure (IOP), slit-lamp examination, gonioscopy and stereoscopic photography, and visual field. PACS was defined as present if either eye had the posterior trabecular meshwork not visible for 180° or more on gonioscopy. PAC was present in an eye with PACS and peripheral anterior synechiae (PAS) and/or IOP ≥ 21 mm Hg, but without glaucomatous neuropathy (GON). PACG was defined as PAC with evidence of GON.
The standardized prevalences of PACG, PAC, and PACS were 0.5% (95% confidence interval [CI]: 0.3-0.7%), 1.5% (95% CI: 1.2-1.8%), and 10.4% (95% CI: 9.6-11.2%) in those 40 years of age and older. The prevalence of all three conditions increased with age (P < 0.001). Females had much higher rates of PACS, PAC, and PACG (P < 0.05); 21 persons with PACG (65%) were blind in at least one eye: 13 were due to glaucoma and the other 8 likely had other causes.
The prevalence of PACS, PAC, and PACG in this rural population is similar to what was previously reported in urban Chinese residents. Two thirds of those with PACG were blind in at least one eye. Strategies to detect and treat this preventable disease in rural China are needed.
[Show abstract][Hide abstract] ABSTRACT: Chronic kidney disease (CKD) is a worldwide public health problem. The purpose of this study was to investigate the prevalence of CKD and associated factors in a rural adult population in Northern China.
This was a cross-sectional study using data from the Handan Eye Study. A total of 5,105 subjects aged >or=30 years were included in this analysis. Spot urine albumin-to-creatinine ratio was determined. Glomerular filtration rate was estimated with the modified Modification of Diet in Renal Disease equation. CKD was defined by the guidelines proposed by the Kidney Disease Outcomes Quality Initiative. The associations between age, gender, diabetes, hypertension, and kidney damage were examined.
Albuminuria and reduced renal function were detected in 16.8 and 0.4% of subjects, respectively. The age-standardized prevalence of albuminuria, reduced renal function and CKD was 14.9% (95% confidence interval (CI) 13.9-15.9), 0.38% (95% CI 0.21-0.55) and 15.2% (95% CI 14.2-16.2), respectively. The prevalence of CKD was greater in women than in men (16.7 vs. 12.9%, respectively, p < 0.001). The increased prevalence of CKD with increasing age was observed in both genders. Older age, female gender, diabetes and hypertension were independently associated with albuminuria. Older age was independently associated with reduced renal function.
The prevalence of CKD in the rural Chinese population is relatively high. Factors associated with CKD are similar to those of urban areas in China and developed countries. CKD is a major public health problem in rural China.
Nephron Clinical Practice 04/2010; 114(4):c295-302. DOI:10.1159/000276582 · 1.40 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We studied the association of C-reactive protein (CRP), gamma-glutamyltransferase (GGT) and type 2 diabetes in Chinese.
A population-based cross-sectional study.
CRP and GGT levels were significantly higher in participants with diabetes than in those without (P<0.001). Higher CRP levels were positively associated with prevalent type 2 diabetes after adjustment for age, sex, smoking, alcohol consumption, physical activity, family history of diabetes, body mass index, waist circumference, waist/hip ratio, education, systolic blood pressure, triglycerides, high density lipoprotein cholesterol, use of antihypertensive drugs, aspirin and lipid-lowering agents, with multivariable odds ratios (OR) of 1.55 (95% confidence interval (CI), 1.05-2.27, P trend=0.005, comparing quartile 4 to quartile 1). However, after further adjustment for GGT, the association was completely attenuated (fourth quartile OR 1.23, 95% CI, 0.83-1.82, P trend=0.127). Moreover, the association of CRP and prevalent type 2 diabetes was stronger in subjects with GGT values above the median than in those with GGT values below the median. Increasing serum GGT quartiles were positively associated with prevalent type 2 diabetes after adjustment for potential confounding variables (P for trend <0.001).
CRP may not be an independent risk factor for type 2 diabetes, at least in Chinese people.
Clinica chimica acta; international journal of clinical chemistry 11/2009; 411(3-4):198-203. DOI:10.1016/j.cca.2009.11.002 · 2.82 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To explore the relationship between C-reactive protein (CRP) and metabolic syndrome (MetS) in a rural Chinese population.
We performed a population-based cross-sectional study.
The median CRP was 0.90 mg/L. After exclusion of subjects with a CRP value >10 mg/L, The median CRP with 0, 1, 2, 3, 4, and 5 components of MetS were 0.61, 0.61, 0.73, 1.07, 1.51, and 1.16 mg/L (P=0.029 for linear trend) in men, and were 0.37, 0.45, 0.62, 1.10, 1.52, and 2.17 mg/L (P=0.002 for linear trend) in women, respectively. After adjustment for potential confounders, compared with those without components of MetS, those with 1, 2, 3, 4, and 5 components of MetS had ORs of 1.39, 1.08, 1.84, 2.65, and 1.21 for elevated CRP in men and 1.91, 2.06, 3.10, 4.06, and 6.01 in women, respectively.
In this rural Chinese population, the CRP concentration was lower than that of Caucasians and strongly related to the MetS, especially in women.
[Show abstract][Hide abstract] ABSTRACT: 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.
[Show abstract][Hide abstract] ABSTRACT: While many papers have been published regarding age-related eye diseases in Mainland China in the past two decades, the variable quality of those reports limit the conclusions that can be drawn. Many of these studies assessed blindness and low vision rates, and these estimates are likely accurate. However, due to lack of standardization of techniques for assessing cataract, glaucoma, age-related macular degeneration, and diabetic retinopathy, estimates of the burden of these diseases on the population are less reliable. Owing to the rapid economic development of China in the last decade, resources to address eyecare problems are more likely to be available. Therefore, an accurate assessment of the burden of various eye diseases is needed in order to improve blindness prevention planning and program development.