title: Prevalence and outcomes of cataract surgery in rural China the China nine-province survey.
abstract: OBJECTIVE
  To investigate the prevalence and visual acuity (VA) outcomes of cataract surgery in rural populations throughout China.
  
  
  METHODS
  Population-based, cross-sectional study.
  
  
  METHODS
  Forty-five thousand seven hundred forty-seven adults 50 years of age and older.
  
  
  METHODS
  Geographically defined cluster sampling was used in randomly selecting a cross-section of residents from a representative rural county within each of 9 provinces in mainland China. Participants underwent VA measurements, refraction, and a slit-lamp examination at local examination sites; those with previous cataract surgery were queried as to the year and type of surgical facility. Surgical procedure and evidence of surgery complications were noted during the examination. The principal cause of visual impairment was identified for eyes with VA of 20/40 or worse.
  
  
  METHODS
  Cataract surgery procedure, presenting and best-corrected distance VA, and causes of visual impairment.
  
  
  RESULTS
  Of 50 395 enumerated eligible persons, 45 747 (90.8%) were examined and tested for VA. The overall prevalence of cataract surgery was 2.09%. Surgical coverage among those with VA worse than 20/200 in both eyes because of cataract was 35.7%. Unoperated cataract was associated with older age, female gender, lack of education, and geographic area (province). Among the 1174 cataract-operated eyes, 31.1% had presenting VA of 20/32 or better, 15.4% had presenting VA of 20/40 to 20/63, 30.0% had presenting VA worse than 20/63 to 20/200, and 23.5% had presenting VA worse than 20/200. With best correction, the percentages were 57.6%, 6.2%, 18.5%, and 17.7%, respectively. Posterior capsule opacification, refractive error, and retinal disorders were the main causes in cataract-operated eyes with VA worse than 20/63.
  
  
  CONCLUSIONS
  Two thirds of those with bilateral visual impairment or blindness because of cataract remain in need of sight-restoring surgery. Posterior capsule opacification and refractive error, both readily amenable to treatment, were common in cataract-operated eyes. Sustained government efforts to provide access to affordable modern cataract surgery with a greater emphasis on postoperative follow-up and the quality of VA outcomes are needed.
  
  
  BACKGROUND
  The author(s) have no proprietary or commercial interest in any materials discussed in this article.
authors.affiliation: Chinese Academy of Medical Sciences, and Department of Ophthalmology, Peking Union Medical College Hospital, Beijing, China. zhaojialiang@medmail.com.cn
authors.forename: Jialiang
authors.initials: J
authors.lastname: Zhao
authors.forename: Leon B
authors.initials: LB
authors.lastname: Ellwein
authors.forename: Hao
authors.initials: H
authors.lastname: Cui
authors.forename: Jian
authors.initials: J
authors.lastname: Ge
authors.forename: Huaijin
authors.initials: H
authors.lastname: Guan
authors.forename: Jianhua
authors.initials: J
authors.lastname: Lv
authors.forename: Xianzhi
authors.initials: X
authors.lastname: Ma
authors.forename: Jinglin
authors.initials: J
authors.lastname: Yin
authors.forename: Zheng Qin
authors.initials: ZQ
authors.lastname: Yin
authors.forename: Yuansheng
authors.initials: Y
authors.lastname: Yuan
authors.forename: Hu
authors.initials: H
authors.lastname: Liu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002386:Cataract / Q000453:epidemiology*; D002387:Cataract Extraction / Q000706:statistics & numerical data*; D002681:China / Q000453:epidemiology; D003430:Cross-Sectional Studies; D004493:Education; D005260:Female; D006297:Health Services Accessibility; D006302:Health Services Research; D006306:Health Surveys; D006801:Humans; D019654:Lens Implantation, Intraocular; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012424:Rural Population / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology