Re: Commentary on ten-year incidence of cataract surgery in urban south China: the Liwan Eye Study

© Annals of Eye Science. All rights reserved. Ann Eye Sci 2020;5:39 | http://dx.doi. org/10.21037/aes-2020-02 We would like to thank Koo et al. for their comments regarding our study on the 10-year incidence of cataract surgery and its associations in an urban adult Chinese population aged 50 years and older (1). Our study indicated that although the annual incidence of cataract surgery in our study (0.9%) was higher than that previously reported by the Beijing Eye Study, it was notably lower than those in other high-income countries, especially for those aged 75 years and older. Participants with higher income, higher education levels, and diabetes at baseline were more likely to have cataract surgery during the 10-year follow-up period. Our study reported an overall cataract surgery incidence of 9.4% over a 10-year period, which is significantly lower than that of the Beaver Dam Eye Study (13%), the Blue Mountains Eye Study (17.8%), and the Age-Related Eye Disease Study (29.1%) which are considered representative of the economically developed countries. In China, the cataract surgical rate seems to vary greatly across the different regions of the country; the annual incidence of cataract surgery in our study was higher than that in the Beijing Eye Study, which recruited younger participants (≥40 years) from four rural districts and three urban districts, while it was similar to that in the Shihpai Eye Study. In contrast, about 16% of our study participants developed visual impairment over the 10-year period, most of whom needed cataract surgery. Thus, the low cataract surgery rate in the Liwan Eye Study suggests a great potential for further improvement on the number of cataract surgeries performed in urban and rural China. We sincerely appreciate Koo et al.’s commentary in regards to their agreeing with our statement that “education and income were two important factors for the accessibility of cataract surgery”. Cost has proven to be a major barrier to cataract surgery uptake in many countries. Results of one cross-sectional study with 833 participants who underwent free cataract surgery showed that financial concern was the primary barrier for their participation in the free surgery program in urban south China (2). It was also confirmed that reducing the surgery cost can significantly increase the surgery uptake in rural south China (3). Lack of awareness of cataracts may be another common factor both in China and in other developing countries. We previously conducted a cross-sectional study to investigate the barriers to cataract surgery by trained interviewers. The results indicated that lack of knowledge about cataracts and concerns about the quality of local services were the principal barriers to cataract surgery in rural south China (4). Another part of our study showed that the most common reason mentioned by the 62 participants [among the 339 participants with visually significant cataract (presenting visual acuity <6/60) in rural southern China] unwilling to pay anything for surgery was that they were unaware of their cataract and felt that their vision was still good (5). Data from a free cataract surgery program conducted in urban south China found that most of the participants had poor health awareness and a low level of education (2). Gender inequality has been previously demonstrated to be an important factor of surgery uptake with women being less likely to have cataract surgery. However, our previous Letter to the Editor