Background: Visual impairment is one of the most common non-communicable causes of disability worldwide. Ninety-four million people suffer from cataracts, disproportionately in resource-poor settings with barriers to eye health services. Untreated cataracts can lead to social isolation, decreased economic productivity, increased risk of injury, and overall decrease in quality of life. This study aims to examine the extent that cataract surgery delivered at a field hospital affects vision-related quality of life (VRQOL) in Djibouti, and the determinants of VRQOL improvement.
Methods: A survey was administered to cataract patients assessing VRQOL at baseline and 2 months postoperatively. Patients completed face-to-face surveys using a translated “World Health Organization Prevention of Blindness and Deafness 20-item Visual Functioning Questionnaire”, containing subscales (overall vision, visual function, general function, and psychosocial impact).
Results: Five hundred and forty-two patients completed the surveys, with 73.4% (n=398) exhibiting improvement in visual acuity. On average, the overall score improved by 18.21 [standard deviation (SD) =18.78, P<0.001], representing 22.76% of total possible score improvement. Of the subscales, overall activity improved by 1.55 (SD =2.04, P<0.001), 19.38% of total possible improvement. General function improved by 11.53 (SD =12.42, P<0.001), 24% of total possible improvement. Visual function improved by 1.70 (SD =263, P<0.001), representing 21.25% of total possible improvement. Psychosocial impact improved by 3.42 (SD =4.08, P<0.001), representing 21.38% of total possible improvement. Multivariable regression identified significant predictors of VRQOL change as visual improvement (B=−1.870, P=0.03) and baseline score (B=−1.014, P<0.001). Sex and age were not significant variables in the regression model across all subscales.
Conclusions: Cataract surgery delivered in a field setting leads to significant improvement in the field hospital setting, as it would be expected in a regular health service, notably in the general function subscale. The intervention significantly improves outcomes regardless of age and sex in a socially inequitable, resource-poor society like Djibouti. Improvement in women’s health can lead to broader, equitable impact in household and community outcomes. Health care providers can consider policies encouraging cataract surgery regardless of age, as VRQOL will have significant improvement. In a society like Djibouti that is experiencing a demographic shift into aging populations, health policymakers must identify determinants that improve outcomes of age-related conditions, and monitor the outcomes of health interventions targeting the aging population.
