title: The impact of cataract surgery on health related quality of life in Kenya, the Philippines, and Bangladesh.
abstract: OBJECTIVE
  To assess the impact of cataract surgery on vision related quality of life (VRQoL) and generic health related quality of life (HRQoL) in Kenya, Bangladesh and the Philippines.
  
  
  METHODS
  A multi-center intervention study was conducted. At baseline 651 cases aged ≥50 years with visually impairing cataract (corrected visual acuity (VA) <6/24) and 561 age- gender-matched controls with normal vision (VA>6/18) were interviewed about VRQoL (using the World Health Organization/ Prevention of Blindness and Deafness 20-item Visual Functioning Questionnaire [WHO/PBD VF20]) and generic HRQoL (EuroQol). Cases were offered free/subsidized cataract surgery. Approximately 1 year later participants were re-interviewed.
  
  
  RESULTS
  Response rate at follow up was 84% for operated cases and 80% for controls. At baseline, cases had significantly poorer VRQoL scores, were more likely to report problems with the EuroQol 5D five descriptive (EQ-SD) domains (mobility, daily activities, self-care, pain, depression/anxiety) and had significantly poorer self-rated health compared to controls. At follow up VRQoL scores of operated cases improved significantly to approximately equal those of controls. Effect sizes were large (> 0.8) regardless of pre-operative VA. Poor outcome from surgery (VA < 6/60) was associated with smaller VRQoL gains. Among operated cases frequency of reported problems with all the EQ-5D reduced significantly compared to baseline in Kenya and the Philippines, and in mobility, daily activities and self-care in Bangladesh. Self-rated health scores increased significantly in each country. HRQoL of controls remained stable from baseline to follow up.
  
  
  CONCLUSIONS
  This study among adults undergoing cataract surgery in 3 different low-income settings found evidence of improved VRQoL and generic HRQoL to approximately equal that of controls with normal vision.
authors.affiliation: London School of Hygiene & Tropical Medicine, London, UK. sarah.polack@lshtm.ac.uk
authors.forename: Sarah
authors.initials: S
authors.lastname: Polack
authors.forename: Christina
authors.initials: C
authors.lastname: Eusebio
authors.forename: Wanjiku
authors.initials: W
authors.lastname: Mathenge
authors.forename: Zakia
authors.initials: Z
authors.lastname: Wadud
authors.forename: A K M
authors.initials: AK
authors.lastname: Mamunur
authors.forename: Astrid
authors.initials: A
authors.lastname: Fletcher
authors.forename: Allen
authors.initials: A
authors.lastname: Foster
authors.forename: Hannah
authors.initials: H
authors.lastname: Kuper
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D001459:Bangladesh / Q000453:epidemiology; D002386:Cataract / Q000453:epidemiology; D002387:Cataract Extraction / Q000706:statistics & numerical data*; D005260:Female; D006304:Health Status; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008297:Male; D010679:Philippines / Q000453:epidemiology; D011203:Poverty; D011788:Quality of Life; D018434:Sickness Impact Profile; D011795:Surveys and Questionnaires; D015354:Vision, Low / Q000503:physiopathology / Q000534:rehabilitation*; D014785:Vision, Ocular / Q000502:physiology*; D014792:Visual Acuity / Q000502:physiology