CSR is a critical index used to show that cataract blindness is being eliminated; the rate is higher in well-developed countries, while it is still very low in some parts of Africa and Asia11.
Increment in cataract surgery rate from 2013 to 2014 for MAIWP-HS indicated a progress and the availability of eye health care in Malaysia although CSR is still very low in some parts of Africa and Asia. As stated in study done by Lee MY et al 12 this trend is a result of investment in increasing surgical capacity in the government hospitals and change in practice pattern among ophthalmologists. However, in 2015, there was a declined about 33% before back on track in 2016 due to construction on hospital infrastructures for upgrading purposes.
Almost 100% of the patients in MAIWP-HS preferred IOL since the used of IOLs has become almost universal. According to Yorston D 13 the benefits of IOL safety was proven through randomised clinical trials and the cost of high-quality IOL has fallen as they are manufactured in India, Nepal, and Eritrea.
Although the use of intraocular lenses may be associated with slightly increased costs, this is more than outweighed by the improved outcome of surgery, the opportunity for earlier intervention, and the resulting increase in the number of operations.
The amount of cataract surgery in a community is influenced by a few factors including the age structure of the population, indications and thresholds for the surgery, access to surgical services, and the financial systems for paying and incentivising surgeons14.
Similar scenario to the Australia population was found where majority of the patients went for cataract surgery were those aged 60 and above years old as compared to those aged 40 and below years old15.
Increase in age is significantly associated with increasing prevalence of cataract in developing countries and it is a cumulative effect of the complex interaction of exposure many factors over time that contribute to the development of cataract16.
Our results also showed that female patients constituted more than 50% of all operated patients each year and aged adjusted for gender of cataract surgery (per 100,000 inhabitants) has been significantly higher for females than for males for all age groups between 60 and 79 years old. Differences in gender may be because of a higher prevalence of cataract in female subjects17. Observations in some part of China also showed that female had a significantly higher prevalence of visual impairment18. Female subjects have According to Resnikoff et al 19, women are more likely to have a visual impairment compared to men in every region of the world. Apart from that Olofsson, et al 20 found that female subjects who went for cataract surgery also visit the healthcare provider for other reasons more often than male subjects. This may also contribute to the higher rate of surgery for female subjects.
Cataract surgery has evolved from intracapsular cataract extraction (ICCE) to extracapsular cataract extraction (ECCE) and today the preferred choice by most ophthalmologists is phacoemulsification (Phaco) that uses modern technology. Furthermore, study done by Thevi, Reddy and Shantakumar5 in Pahang, Malaysia concluded that visual outcome was significantly better in Phaco as compared to ECCE procedure (p = 0.001) and recommended that Phaco equipments should be supplied in the district hospitals with adequate facilities for performing intraocular surgery. The results also showed that hospital performs estimated average of 2,000 cataract surgeries annually. Phacoemulsification is the routine surgery of choice at this hospital.
Moreover, 98% of the surgery in Swedish National Cataract Register in 200017 and 99.5% of cataract and refractive surgery in The European Registry of Quality Outcome chose this type of surgery 21. Not only that few surveys such as New Zealand surveys which involved almost 100% of the respondents that conducted in 2007 22, survey on American Society of Cataract and Refractive Surgeons members in 2003 24, 94% of Japanese ophthalmologists in 1999 25 and 92% among ophthalmologists who responded to a nationwide survey in Singapore also preferred phacoemulsification as type of surgery 25.
According to Yorston 26, important factors such as cost of surgery and IOL, lack of awareness, poor service, and long distances from surgical centres were the barriers of cataract surgery in developing countries.
Growing rate of cataract surgeries in private hospitals in recent years should also be consider and not be overlooked. Similar conditions such as outcome and cost, reasons why more cataract patients prefer to have surgery in private settings and problems arise, that eye doctors in public hospitals should ponder 27.
Previous studies also showed that important risk factors associated with cataract including income and educational level 28, smoking 29, diabetes 30, sunlight exposure 31,32, body mass index 33, drug intake 33,34, oestrogen replacement therapy 35 and alcohol 36.