The Cataract Surgical Rate should be improved first
By: Prof. Jialiang Zhao
Cataract Surgical Rate (CSR) refers to the number of cataract operation in every million people per year. The National Medical Journal of China published writings about Shanghai and Jiangsu Province, analyzing the CSR of the recent years and giving some advice to improve it, which is worth great consideration. Cataract is a common blinding eye disease. Ever since the eighties of the last century, the prevention of cataract has always been the key point of the international blindness prevention. According to the latest estimates of visual impairment this year published by WHO, there is about 39,000,000 blind person, of whom 51% was caused by cataract. And 2.46 billion people are suffering from moderate or severe visual impairment, of which 33% were caused by cataract. That is why recovering the sight of cataract blinding person and those with moderate or severe visual impairment is the key point of international blindness prevention. It is common that the treatment of cataract patients is delayed because of the limited service ability, especially in the developing countries. It is same in our country, though many projects dealing with cataract with surgery were carried out ever since the eighties of the last century, the blindness is still extending. According to a survey in nine provinces in 2006, the rate of blindness and moderate or severe visual impairment is 1.93% and 5.31% among people older than 50. It is easy to figure out that, among the people older than 50, there is about 5,400,000 blind persons, and 14,870,000 patients of moderate or severe visual impairment. Among the factors causing blindness, cataract accounts for 66.9%. As an age-related disease, the prevalence of cataract is especially high in the old.
Surgery is the only effective way to treat or prevent cataract, and is also one of the most successful treatment. To compare the blindness-preventing level, the CSR was adopted as the indication of evaluation internationally. As an index easy to understand and figure out, the CSR takes the number of cataract surgery in every country as well as the population into consideration. Setting CSR as the index of blindness-treatment evaluation is based on the universality of cataract. Cataract is a kind of progressive, slow degenerated change with the crystalline lens’ optical quality descended. The causing factor of cataract, such as ultraviolet radiation, smoking, diabetes and so on, though varies with regions, but exists everywhere. The great difference existing in the cataract-treating level of different countries or regions can be seen clearly by CSR. Recently, the CSR of developed countries is over than 9,000, while the CSR of India has been more than 6,000. Meanwhile, the CSR of the developing countries is relatively lower. Our national CSR of the year 2000 is only 370 in every million people per year. With the development of the related work and ophthalmic service ability, CSR is increasing gradually. The CSR of year 2005, 2010, 2012 is 440, 915, 1072 in every million people per year separately. When take the number of cataract surgery as the indicator, we can think that there are a lot of cataract surgery operated in our country. But, when take CSR as the indicator, it is easy to see that we have to work really hard to keep pace with the other countries. Of course, considering the difference existing in the cataract prevalence rate of different countries, it is quite reasonable that the CSR of every country is different. But since the occurrence of cataract is common, the difference in CSR may be able to indicate the great gap in blindness-preventing ability and ophthalmic service ability.
Ever since taking the CSR as the indicator of blindness prevention and treatment ability, the shortcoming of considering CSR only also appeared.
1) The CSR fails to take the difference in cataract case rate of different races into consideration. Where the cataract case rate is high, the CSR is defined to be high, and vice versa.
2) The CSR fails to take the difference in surgical conditions of different countries into consideration. And that difference is surely to lead to the difference in CSR.
3) The CSR fails to take the excessive medical treatment into consideration. A few doctors perform operations on the early-stage cataract or even transparent lens, which doesn’t influence sight, to chase after the high surgery rate and interest, leading to the excessive medical treatment and waste of medical resources, also the development of CSR.
4) The CSR fails to take the surgery quality into consideration. Even not perfect, the CSR is also the easiest indicator, and the easiest one to understand for most doctors, public health experts, epidemiologists. According to the “International blindness-preventing plan, 2014-2019” passed in this year’ World health Assembly, the CSR is determined to be one of the national indicators of blindness-preventing evaluation, also shows it’s importance in evaluating the prevention and treatment of cataract.
Recently, our national CSR is still of low quality. In the Western Pacific Ocean, our national CSR is not only lower than some developed countries, such as Japan, Australia, but also lower than some developing countries, such as Thailand, Vietnam, Laos, Kampuchea, Philippines. Somebody said, that people in those countries are more easily to get cataract, making their CSR higher. In fact, we can compare the CSR of mainland with Taiwan. The CSR of Taiwan is 6520. We are of the same language and same race, and live across the Taiwan Straits. So the prevalence of cataract is very similar. But such a big difference existing in CSR is worth deep consideration.
Why our national CSR is so low, and how to improve it rapidly is the question which needs to think deeply and solve rapidly.
1. Government should do more in blindness prevention and treatment, esp. in the cataract blinding people. In the recent years, the government is playing the leading role in the blindness prevention and treatment work, and has carried out a series of projects to help the cataract patients. But, as a long-term task related to the daily life of the public, the blindness prevention and treatment asks more projects to dealing with the problems of the cataract patients. Facing with the coming challenge because of the expanding and aging of population, we should pay more attention to the construction of long-term system and blindness prevention and treatment net, and try to make full use of the ophthalmology organizations of every level.
2. Better the distribution of resources. The improper distribution of ophthalmology resources, including ophthalmology organizations, operation equipment and oculists, leads to the condition that plenty of cataract patients in rural or remote areas can’t be treated immediately. And that may also accounts for the slow improvement of CSR. Recently, our basic service ability is quite insufficient, because of the obsolete equipment, shortage of the necessary equipment, or shortage of oculists. So our government and related academic organizations should come up with the standard of basic ophthalmology equipment and service, strengthen the cultivation and training of oculists, and encourage the advanced areas to help the rural and remote areas. So the service ability of county-level hospitals can be improved, making the rapid development of our national CSR possible.
3. To enhance the economic investment. The improvement of CSR asks for economic investment. In the recent years, our country has invested much in the cataract prevention projects, but the quantity of the investment is not enough yet. Every cataract surgery has been given 800 yuan only. With the increase of the medical fee, the improvement of requirements and the increase of preoperative examination project, the shortage of economic investment has greatly blocked the operation of cataract and the improvement of CSR. So, our government should invest more and offer proper help through the new rural cooperative medical system and medical insurance for urban workers. And at the same time, we should concentrate on the poor cataract patients.
4. To strengthen the publicity and education. The slow development of CSR also has something to do with the cultural awareness. Someone also has some misunderstandings with cataract and some old people even think it is natural to see faintly, leading to the patient and their children’s rejecting towards treatment. Some patients think that the best expert, equipment and material are the must for an operation. So some basic ophthalmology organizations can’t be made full use of, and getting treatment in the hospitals of some big cities are even more hard and expensive. So it is of great importance to spread the related knowledge to make the public understand cataract more.
5. The medical staff of ophthalmology should master the advanced conception and technology of blindness prevention and treatment to do cataract operation efficiently. There are three rules which should be obeyed. First, “proper”, that means that we should take realistic measures. Second, “affordable”, that is to say, the technology should be affordable for the society and individuals. Third, “approachable”, making the service easy to access for the people in need is extremely important. Experience has proved that the rules are of great importance. We should make full use of the resources to improve cataract-related equipment’s popularity rate, utilization rate and coverage. Proper technology, equipment and materials are greatly wanted.
6. To pay more attention to the indicator CSR: The government and related blindness-preventing ministry should take CSR as an important indicator of the evaluation the blindness-preventing work. Leaders of ophthalmology and oculists should pay attention to not only the number of the cataract surgery, nut also the CSR of every province and region. National Ministry of Health had given notice in 2009 to make the operation condition of cataract handed in immediately by every hospital or area. Recently, the omission and mistake also exists, which should be corrected.
The article is taken from “National Medical Journal of China”.