title: Prevalence of blindness and outcomes of cataract surgery in Hainan Province in South China.
abstract: OBJECTIVE
  To define the prevalence of blindness and visual impairment (VI) in people in rural Hainan using the rapid assessment of avoidable blindness (RAAB) and to report the outcomes of cataract surgery among the residents.
  
  
  METHODS
  Population-based, cross-sectional survey.
  
  
  METHODS
  A total of 6482 rural residents of the Hainan province.
  
  
  METHODS
  A total of 136 clusters, each of which consisted of 50 people aged ≥50 years, were selected through probability-proportionate-to-size sampling. Door-to-door visits were performed by 2 outreach teams. Visual acuity (VA) was measured on site, and those with VA <6/18 in either eye were examined by an ophthalmologist. Causes of blindness and VI were determined. The causes of poor visual outcome after cataract surgery were evaluated. Information regarding barriers to receiving surgery was collected by trained interviewers.
  
  
  METHODS
  Prevalence and causes of blindness (VA <3/60), severe VI (SVI) (VA <6/60 but ≥3/60), and VI (VA <6/18 but ≥6/60) based on presenting VA (PVA) were assessed. Outcomes of cataract surgery performed in public and private hospitals and charitable organizations were compared.
  
  
  RESULTS
  A total of 6482 subjects were examined (response rate, 95.3%). The sample prevalence of blindness was 4.4% (95% confidence interval [CI], 2.0-6.8). The prevalence of SVI and VI was 1.9% (95% CI, 0-4.3) and 9.9% (95% CI, 7.6-12.2), respectively. Age and sex were associated with increased prevalence of blindness, SVI, and VI. Overall, cataract accounted for approximately 60% of blindness and SVI. Of the 524 eyes that had received cataract surgery, 87.2% had intraocular lenses implanted, 21% had a poor visual outcome (PVA <6 /60), and 20% had a borderline visual outcome (PVA <6/18 but ≥6/60). Eyes that received surgery in charitable organizations had a higher rate of intraocular lens implantation and good visual outcome (VA ≥6/18) compared with eyes that were operated on elsewhere.
  
  
  CONCLUSIONS
  The prevalence of blindness, SVI, and VI was high among rural residents in Hainan. Cataract remained the leading cause of avoidable blindness. Outcomes of cataract surgery performed in public hospitals were suboptimal. Quality-control initiatives should be introduced to improve cataract surgery outcomes.
authors.affiliation: Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China; Project Vision Charitable Foundation, Hong Kong SAR, China; Hong Kong Eye Hospital, Kowloon, Hong Kong SAR, China.
authors.forename: Emmy Y
authors.initials: EY
authors.lastname: Li
authors.forename: Yingpeng
authors.initials: Y
authors.lastname: Liu
authors.forename: Xingkai
authors.initials: X
authors.lastname: Zhan
authors.forename: Yuan Bo
authors.initials: YB
authors.lastname: Liang
authors.forename: Xiujuan
authors.initials: X
authors.lastname: Zhang
authors.forename: Chongren
authors.initials: C
authors.lastname: Zheng
authors.forename: Vishal
authors.initials: V
authors.lastname: Jhanji
authors.forename: Ping
authors.initials: P
authors.lastname: Xu
authors.forename: David F
authors.initials: DF
authors.lastname: Chang
authors.forename: Dennis S C
authors.initials: DS
authors.lastname: Lam
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001766:Blindness / Q000453:epidemiology*; D002386:Cataract / Q000453:epidemiology*; D002387:Cataract Extraction / Q000706:statistics & numerical data*; D002681:China / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D016304:Hospitals, Private / Q000706:statistics & numerical data; D006779:Hospitals, Public / Q000706:statistics & numerical data; D006801:Humans; D019654:Lens Implantation, Intraocular / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012424:Rural Population / Q000706:statistics & numerical data*; D017678:Sex Distribution; D016896:Treatment Outcome; D015354:Vision, Low / Q000453:epidemiology*; D014792:Visual Acuity / Q000502:physiology; D019987:Persons with Visual Disabilities / Q000706:statistics & numerical data*