title: Uptake, Barriers and Outcomes in the Follow-up of Patients Referred for Free-of-Cost Cataract Surgery in the Sao Paulo Eye Study.
abstract: OBJECTIVE
  To determine uptake, barriers and outcomes in the follow-up of patients referred for free-of-charge, expedited cataract surgery in the Sao Paulo Eye Study (SPES).
  
  
  METHODS
  SPES was a population-based study of urban, low-middle income residents aged ≥50 years. Presenting visual acuity (PVA), best-corrected visual acuity, refraction, and slit-lamp examination were performed in 3677 participants. For subjects with cataract as a principal cause of best-corrected visual acuity ≤20/40, surgery was offered free of charge. Two years after the baseline study, surgery uptake, barriers to surgery, and visual outcomes were analyzed.
  
  
  RESULTS
  Among 210 (5.71%) participants who had a cataract surgery indication at baseline, 164 (78.1%) were successfully contacted and 55 (33.5%) reported being operated on for cataract, with 51 agreeing to be re-examined. In a multiple logistic regression model, age, sex, schooling, previous cataract surgery, and PVA at baseline were not significantly associated with surgery uptake. Co-existing health conditions (20.4%), fear of surgery (12.2%) and fear of losing eyesight (11.6%) were the most frequent barriers to cataract surgery adherence. Among the 69 eyes operated on in the interval between baseline and follow-up, PVA ≥20/63 was observed in 50 (72.6%, 95% confidence interval, CI, 62.2-82.3%), PVA <20/63-20/200 in 11 (15.8%, 95% CI 8.9-22.9%) and PVA <20/200 in 8 (11.6%, 95% CI 5.3-17.9%).
  
  
  CONCLUSIONS
  Quality of surgery is an increasing determinant of uptake rates. Although free-of-charge and expedited cataract surgery was offered, surgical outcomes might have influenced the low uptake. Aside from cataract surgery campaigns, improvement of surgeon skills, accurate biometry, treatment of ocular comorbidities, postoperative follow-up and eye-care education are needed.
authors.affiliation: Departamento de Oftalmologia, Escola Paulista de Medicina, Universidade Federal de Sao Paulo , Sao Paulo, SP , Brasil and.
authors.forename: Marcia H
authors.initials: MH
authors.lastname: Mitsuhiro
authors.forename: Adriana
authors.initials: A
authors.lastname: Berezovsky
authors.forename: Rubens
authors.initials: R
authors.lastname: Belfort
authors.forename: Leon B
authors.initials: LB
authors.lastname: Ellwein
authors.forename: Solange R
authors.initials: SR
authors.lastname: Salomao
mesh_terms: D000368:Aged; D001938:Brazil / Q000453:epidemiology; D002386:Cataract / Q000453:epidemiology; D002387:Cataract Extraction / Q000191:economics* / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008483:Medical Assistance; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012017:Referral and Consultation; D012029:Refraction, Ocular / Q000502:physiology; D066167:Slit Lamp; D014792:Visual Acuity / Q000502:physiology; D019987:Persons with Visual Disabilities / Q000706:statistics & numerical data
keywords: Barriers; cataract; cataract surgery; outcomes; uptake