The impact of eye health and low-vision rehabilitation services on quality of life (QoL)

Zoe Gray - IAPB

Peter Ackland - IAPB

GBM roundelIncreasingly evidence is being collected to determine how much eye health interventions have improved people’s overall health and well-being, and the impact on a person’s income and economic participation. To determine impact on Quality of Life (QoL) researchers can use research instruments that collect information on improvements in such areas as mobility, depression and social participation. For economic impact, this can include hours worked and increase in income. The data collected makes a clear case that treating avoidable vision impairment and blindness has considerable impacts on the social and economic well-being of the individual and the family, and can have major effects in low-income settings, greatly reducing levels of poverty and ill-health.

A study conducted in four provinces in Vietnam provides useful evidence on the potentially major short-term and long-term impacts of Cataract surgery. Applying a widely used measure of health-related quality of life (HRQoL ), they found a significant improvement in physical and mental health after Cataract surgery. Further, patients reported an increase in median annual household income (US$58) and median total asset ownership (US$338). There was a decrease in the proportion of people experiencing hardship (defined as due to costs such as phone and utility bills, medications, health insurance premiums).

The reduction in hardship effect was greater amongst women, underscoring the economic importance of ensuring women’s access to surgery

At the 12 months follow-up there was a major increase in hours worked per month for those in formal work and informal work pre-surgery, along with a reduction in catastrophic expenditure.

Vietnamese four-province Study: the impact of Cataract surgery

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Studying the impact of Cataract on income and QoL

The ‘Cataract Impact Study’ explored the impact of Cataract surgery on health-related quality of life (HRQoL ), daily activities and economic poverty among adults aged over 50 years in Kenya, the Philippines and Bangladesh. People with visual impairment from Cataract (‘cases’) and age- gender- matched peers without visual impairment from Cataract (‘controls’) were identified and interviewed about their HRQoL, daily activities and poverty indicators. All cases were offered free or subsidized surgery. Approximately one year later cases and controls were re-interviewed. Comparing the controls and cases, the study found that before surgery, people with Cataract:

  • had poorer health-related quality of life
  • were poorer in terms of assets, self-rated wealth and household per capita expenditure
  • were less likely to engage in, and spent less time on, productive activities
  • were more likely to have assistance with daily activities

One year after surgery, a significant improvement in all these indicators was observed for the people who had undergone Cataract surgery, and parity was obtained with the control group. Figures 1 and 2 below show the extent of the improvement made by Cataract surgery on monthly expenditure and HRQoL respectively.

A follow up of the study was undertaken in Bangladesh and the Philippines six years after surgery and it was found that the improvements in these indicators were maintained and remained comparable with the control group.

Fig 1: The impact of Cataract surgery on monthly expenditure
Fig 2: The impact of Cataract surgery on quality of life
The potential to change lives, just like in Uganda

A further impact assessment on the National Intervention in Uncorrected Refractive Errors (NIURE) in Uganda , mainly using qualitative research methods, found that ‘NIURE has great potential to change lives‘.

Patient QoL surveys have also been used to assess low-vision rehabilitation programmes, such as in the state of Victoria, Australia, where research on the impact of a multi-disciplinary approach for adults attending low-vision rehabilitation for the first time demonstrated considerable benefits. At an average of just over 80 years old, the majority of those surveyed had Age-Related Macular Degeneration and were moderately to severely vision-impaired, but with access to tailored services such as occupational therapists, braille, low-vision devices, and talking books, the researchers found significant improvements in the overall QoL, with the highest impact on emotional well-being.

The research described here illustrates the dramatic difference eye health interventions can make

Conclusive proof

The research described here illustrates the dramatic difference eye health interventions can make to people’s lives. When quality services are delivered, particularly in low-income settings with limited infrastructure, the benefits can be far-reaching. With major gaps in eye health services globally, the data bolsters the important social and economic argument to rectify this and ensure availability and access to quality eye health services for all.

I can write better…

Aluma Sukurani“I could not see properly and it started when I was young. I was in Aleke Primary School, and could not see the blackboard. I stayed in Aleke Primary School for three years without being promoted to another class. I could not see people very well. I was transferred to Army Primary School by my mother. Before, I would sit behind but I would not see; I was then put in front and could still not see. The teacher identified that I had a bigger problem even before the programme started so after the training of the teachers I was amongst the first children whose eyes were checked. I got spectacles. I started seeing things on the blackboard and I am already writing better. I fear playing with the spectacles as they may break.”
Story told by Aluma Sukurani,
primary school student, Uganda

Treating avoidable vision impairment and blindness has considerable impacts on the social and economic well-being of the individual and the family

Quality of life

Ugandan study on children given glasses

Improvements in…
School Performance
Curricular Activities
Co-Curricular Activities
School Attendance

Ugandan study on adults given glasses

Improvements in…
Daily Life
Efficiency at Work
Family Affairs
Confidence & Self Esteem

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