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The aim of this study was to assess the refractive stability and validity of automated refraction obtained at day one after surgery for dense cataracts in a developing country setting, where patient follow-up is often erratic. In a prospective study in rural Kenya, we compared automated refraction and visual acuity (VA) after manual small incision cataract surgery (SICS) and phacoemulsification cataract surgery (Phaco) at day one with autorefraction and subjective refraction obtained at a later visit. Ninety eyes of 83 patients fulfilled the ultimate inclusion criteria (21 SICS eyes and 69 Phaco eyes). The correlation between refraction at day one and at a later follow-up was moderately good for both SICS and Phaco (R1 = 0.61 and R2 = 0.58). Spherical equivalent (SE) values measured at day one were within one dioptre of those obtained later in 68 eyes (72 per cent); (SICS: 67 per cent; Phaco: 74 per cent) and within two dioptres in 83 eyes (92 per cent); (SICS: 86 per cent; Phaco: 94 per cent). At post-operative days 14, 28 and more than 42 for SICS and Phaco eyes, the mean SE was 0.58 and 0.48, 0.55 and 0.19, and 0.9 and 0.31 more hypermetropic than the mean SE of post-operative day one, respectively. First-day accuracy was higher in eyes with better pre-operative VA, softer cataracts and lower post-operative prediction error. The surgical technique (SICS versus Phaco) had no influence on first-day accuracy in our set-up. Refractive data from the early post-operative period can provide useful data for qualitative control and monitoring of post-operative refractive outcomes in a setup, where 'better' data are often not available; however, its accuracy is limited and, ultimately, there is no alternative to good follow up of operated patients. [ABSTRACT FROM AUTHOR]

Objectives To understand the reasons that hinder people from uptake of sponsored cataract surgery. Methods A mixed methods (qualitative and quantitative) approach was used. During routine screening activities at Kwale District, Kenya, local residents with visually impairing cataract were clinically assessed and offered free surgery. Interviews were conducted using a semi-structured guide that covered different aspects related to acceptance of cataract surgery including knowledge of others who underwent surgery and their outcome. Analysis focused on differences between people accepting and people refusing surgery and the reasons for non-acceptance of surgery. Results Ninety interviews were conducted, 48 with people accepting and 42 with people refusing free surgery. Those who accepted surgery generally reported good outcome in others, while people who refused surgery often reported to know someone who worsened or even become blind after surgery. Many of these ‘failed cases’ were prominent figures in the local community, and most of them had already died. Glaucoma was the single most common underlying medical condition. On being re-interviewed, several people admitted that they had actually never met someone who had unsuccessful surgery but only heard rumours. Conclusion In Africa, a rumour of blinding eye surgery is not uncommonly being used by patients to justify their refusal to have cataract surgery. Underlying reasons appear to be related to shame, fear of surgery or missing social support. Improved awareness of the general population regarding eye conditions and their management, involvement of the family and local community in decision making, good surgical outcomes and appropriate counselling are possible methods to enhance acceptance. [ABSTRACT FROM AUTHOR]

Purpose: To explore the fear of cataract surgery experienced by the residents of the Kwale district of southern Kenya. Methods: The Kwale Eye Centre (KEC) is the only stationary specialist hospital in the Kwale County of southern Kenya. Patients attending the Centre as a walk-in clients during the data collection period were screened and recruited to the study. Fully informed consent was obtained. Qualitative semi-structured interviews (SSI's) were used for data collection. Each interview followed a question guide and was recorded in a digital-audio format. The interviews were transcribed verbatim and thematic analysis performed on the consequent transcripts. Results: A total of 20 SSI's were performed. Most preoperative fears are directly linked to or provoked by "rumours" that surround cataract surgery; 65% of participants identified fear originating from narratives passed on to them by friends and family. These rumours ranged from inaccurate reporting of the process of cataract surgery to completely unfounded information. The most common intraoperative fear of cataract surgery was concern over the injection. A frequently noted postoperative fear was that of suffering further eye damage. Conclusion: The long-standing service the KEC has provided might have decreased the fear surrounding cataract surgery as a consequence of increased awareness. Yet, even when accurate information is provided, rumours continue to spread. Knowledge of the cataract surgery plays an incredibly important role in decreasing fear across all the operative stages. This study shows a great deal of fear is not rational and may perhaps be significantly lessened if addressed. [ABSTRACT FROM AUTHOR]

Purpose: To determine how much difference biometry makes to refractive outcomes in a population in Sub-Saharan Africa compared to using standard-power intraocular lenses (IOLs)., Methods: In a secondary eye-clinic in Kenya, IOL-powers in half diopters (D) were implanted according to biometry prediction in patients undergoing routine cataract surgery with small-incision techniques. A model was generated to predict refractive outcomes if standard-IOLs had been used., Results: Three-hundred-twenty-five eyes of 290 patients were operated on; 232 (71%) using phacoemulsification, the remainder using manual small-incision cataract surgery. Two-hundred-sixty-seven eyes (82.2%) achieved corrected visual acuity (VA) >or=6/18 and 202 eyes (62%) uncorrected VA >or=6/18. Pre-existing comorbidity was the single most common reason for a worse postoperative VA. Restricting analysis to one eye per patient, with biometry 71.1% had a good refractive outcome (defined as +1 to -1.5 D spherical equivalent), 27.6% became more than -1.5 D myopic and 1.3% more than +1.00 D hyperopic. With standard-power-IOLs 57.3% would have had a good refractive outcome and 16% would have become >1 D hyperopic. Using the post-op refractive data for A-constant optimization could potentially further increase good refractive outcomes to over 80%., Conclusion: Biometry in combination with small-incision techniques improves refractive outcomes and decreases undesired postoperative hyperopia. Assuming good surgical skills, better outcomes with biometry justify cataract operation at an earlier stage, thereby reducing intra- and postoperative complications and avoiding years of visual disability.

Purpose: To determine possible differences in visual acuity, socio-demographic factors and vision-related Quality of Life (QoL) between people accepting and people refusing sponsored cataract surgery., Methods: Three hundred and fifty seven local residents with visually impairing cataract, presenting at screening sites in Kwale District, Kenya were clinically assessed and interviewed. The World Health Organization (WHO) QoL-questionnaire WHO/Prevention of Blindness and Deafness Visual Functioning Questionnaire 20 (PBD-VFQ20) was used to determine the vision-related QoL. A standardized questionnaire asked for socio-demographic data and prior cataract surgery in one eye. After interview, patients were offered free surgery. Primary outcome was the mean QoL-score between acceptors and non-acceptors. Secondary outcomes were visual acuity and socio-demographic factors and their contribution to QoL-scores and the decision on acceptance or refusal., Results: Fifty nine people (16.5%) refused and 298 accepted cataract surgery. Vision-related QoL was poorer in people accepting than in those refusing (mean score 51.54 and 43.12 respectively). People with poor visual acuity were only slightly more likely to accept surgery than people with better vision; the strongest predictors of acceptance were the QoL-score and gender. Men were twice as likely to accept compared to women. Of people who accepted surgery, 73.8% had best eye vision of 20/200 or better., Conclusion: In this population, visual acuity was of limited use to predict a person's decision to accept or refuse cataract surgery. QoL-scores provide further insight into which individuals will agree to surgery and it might be useful to adapt the QoL-questions for field use. Gender inequities remain a matter of concern with men being more likely to get sight-restoring surgery.