Cataract surgical coverage and self-reported barriers to cataract surgery in a rural Myanmar population.

PURPOSE: The aim of this study is to determine the cataract surgical coverage and investigate the barriers to cataract surgery as reported by those with cataract-induced visual impairment in rural Myanmar. METHODS: A cross-sectional, population-based survey of inhabitants 40 years of age and over from villages in the Meiktila District (central Myanmar); 2481 eligible participants were identified and 2076 participated. Data recording included corrected visual acuity, dilated slit lamp examination and stereoscopic fundus examination. Lens opacity was graded using the Lens Opacities Classification System III. Participants with cataract-induced visual impairment (acuity < 6/18 in better eye) were also invited to respond to a verbal questionnaire about barriers to cataract surgery. RESULTS: Cataract surgical coverage for visual acuity cut-offs of <6/18, <6/60 and <3/60 was 9.74%, 20.11% and 22.3%, respectively, for people and 4.18%, 9.39% and 13.47%, respectively, for eyes. Cataract surgical coverage was higher for men than women, but gender was not associated with refusal of services. Of the 239 who responded to the extra questionnaire, 216 were blind or had low vision owing to cataract. Three quarters refused referral for surgery: cost and fear of surgery were the most frequently reported barriers. CONCLUSION: Cost plays a large role in the burden of cataract in this region. Implementation of educational programmes, reforms to local health service and subsidization of ophthalmic care may improve the uptake of cataract surgery.

Prevalence of trachoma-related trichiasis and corneal opacity in rural Myanmar: the Meiktila Eye Study.

OBJECTIVE: To describe the prevalence of trachomatous trichiasis and corneal opacity (CO) within central Myanmar. DESIGN: Population-based cross-sectional ophthalmic survey. PARTICIPANTS: Random, stratified, cluster sampling of the inhabitants > or =40 years of age from villages in the Meiktila District was performed; 2481 eligible participants were identified and 2076 participated in the study. METHODS: Visual acuity was measured using an E Snellen chart at 6 meters. Lid, ocular surface, and anterior segment examinations were performed at the slit lamp. MAIN OUTCOME MEASURES: Trachoma was graded as trachomatous trichiasis (TT) or CO according to the World Health Organization grading system. RESULTS: The population prevalence of trachoma (TT and CO) was 2.6% (95% confidence interval [CI]. 1.67%-3.42%). For every 1-year increase in age, the odds of trachoma increased by 5.3% (95% CI, 4.9%-5.7%). There was no significant effect of gender on the prevalence of trachoma (P = 0.5). No formal schooling was a strong predictor of trachoma (odds ratio, [OR], 4.9; 95% CI, 3.9-6.1), and having <3 children in the house was protective (OR, 0.75; 95% CI, 0.61-0.93); however, neither occupation nor the number of people in a household had an effect on trachoma. CONCLUSIONS: The prevalence of blinding trachoma in central Myanmar remains relatively low. This is a tribute to the success of the Burma Trachoma Control Program and demonstrates the need for such a program to remain an integral part of public health care and community health services to further diminish the prevalence of this condition. This will be facilitated by a focus on trachoma risk factors and further research into the prevalence of inflammatory trachoma within the pediatric population.