Economic benefits of cataract surgery: A pilot prospective cohort study

Purpose : Cataract is the most prevalent cause of avoidable blindness worldwide. Poverty and blindness are inextricably linked. We developed a protocol to evaluate the potential economic benefits of cataract surgery for the household in resource-limited settings. This report describes baseline characteristics of the current cohort and lessons learned from following-up patients during the pandemic. Methods : In this prospective cohort study, patients 40 years or older with symptomatic age-related cataract seeking care at Instituto Mexicano de Oftalmologia (Queretaro, Mexico) and residing within 30 km of the facility were eligible. Patients with complicated cataracts and coexisting eye conditions were ineligible. Patients received a comprehensive eye exam, assessment of economic status at baseline, and standard clinical care for cataract. Follow-up is planned at 6, 12, and 36 months using surveys on surgical and economic outcomes, including monthly household income and total household budget (USD). Results : The present cohort includes 42 patients. 61.90% were women and 38.09% were men. The mean age was 71 (standard deviation;SD 10.30). 19.04% were uninsured, 45.23% were covered by the Institute of Health for the Wellbeing and 35.71% were covered by employment-based government insurance entities. 42.85% and 57.14% of patients lived in a rural and urban area, respectively. At baseline, average monthly household income was $438 (SD = $377 USD);it was $330. USD (SD = $320) for patients in rural areas and $508 (SD = $400) for patients in urban areas. The average monthly household budget before cataract surgery (including food basket, health, educational, housing, personal and housing expenses) was $240 (SD = $294) and $144 (SD = $114) for patients in urban and rural areas, respectively. Of 5 patients followed up at 6 months, the average monthly household income was $239 (SD = $46), with a difference of $199 from baseline. Recruitment was challenging because we restricted eligibility by how far patients lived from the hospital. Follow-up in the context of the Covid-19 pandemic continues to be a challenge, although administering surveys by phone may facilitate it. Conclusions : Our findings show feasibility of conducting this study. To ensure a representative patient sample, effort is underway to implement the study protocol at multiple centers in Mexico, India and Brazil.