Implementation of a free cataract surgery program in rural China: a community-based randomized interventional study

Area of Science:

• Ophthalmology
• Public Health
• Rural Health

Background:

• Cataract surgery uptake remains low in many rural areas, particularly in developing countries.
• Identifying effective interventions is crucial to address visual impairment due to cataracts in underserved populations.

Purpose of the Study:

• To determine the most effective methods for increasing cataract surgery rates among elderly individuals in a rural Chinese setting.
• To compare the impact of informative reminders, free surgery, and subsidized transportation on surgical uptake.

Main Methods:

• A community-based randomized interventional study was conducted in Pucheng County, China.
• 432 patients aged 50+ with operable cataracts were identified; 355 eligible patients not yet scheduled for surgery were randomized into four groups.
• Interventions included informative reminders, free surgery, free surgery with transport reimbursement, and free surgery with free transportation.

Main Results:

• Overall, 26.5% of patients underwent surgery post-intervention.
• Free cataract surgery (27.8%) was significantly more effective than informative reminders (14.4%).
• Adding transport reimbursement or free rides to free surgery did not significantly increase uptake compared to free surgery alone.

Conclusions:

• Providing free cataract surgery is a highly effective strategy for increasing surgical uptake in rural populations.
• Financial barriers, such as surgery cost, appear more significant than transportation issues in preventing cataract surgery.
• Future interventions should focus on eliminating direct costs to improve access to sight-restoring procedures.