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Original Research (Original Article) 


Elizebeth Olufunke Oke et al, 2019;3(1):036–042.

International Journal of Medicine in Developing Countries

The effect of cataract surgery on patients’ quality of life in Jazan, Saudi Arabia

Yara Mohammed Mobarki1*, Majid Moafa2, Mohammed Yahya Faqihi3, Abdulrahman Mohammed Adawi4, Azza Jabir Mohanna5, Abdullrahman Darraj6

Correspondence to: Yara Mohammed Mobarki

*Jazan University, Jazan, Saudi Arabia.

Email: yara.41994 [at] gmail.com

Full list of author information is available at the end of the article.

Received: 28 November 2018 | Accepted: 15 December 2018


ABSTRACT

Background:

Cataract is the leading cause of blindness, affecting more than 10.8 million patients in the year 2010. Cataract surgery is the most cost-effective treatment for this condition. It is believed that the quality of life is significantly improved after the surgery. This study investigates the effect of cataract surgery on patients’ quality of life in Jazan, Saudi Arabia, in addition to identifying the influencing factors.


Methodology:

This cross-sectional observational study included 225 adult patients who underwent cataract surgery in the ophthalmology clinic of Prince Mohammed Bin Nasser Hospital, Jazan, Saudi Arabia. Data were collected using a designed self-administered questionnaire.


Results:

Male patients constituted two-thirds of the study population (68.0%). More than one-half of the patients (59.1%) had the surgery done in both eyes. The majority of patients (80.0%) said that their vision was improved after having the surgery, 79.6% said that they would advise others to undergo surgery, 85.8% said that their daily life was recovered after having the surgery, and 84.4% said that their psychological status was improved after the surgery. Male gender (p < 0.001) and using sunglasses (p = 0.001) were significantly associated with better quality of life, while residency (p = 0.245), diabetes (p = 0.348), and hypertension (p = 0.999) showed no effect on the quality of life.


Conclusion:

Cataract surgery can enhance the quality of life of patients undergoing surgery. Male gender and using sunglasses have a significant beneficial effect, while diabetes, hypertension, and residency have no significant effect on the quality of life.


Keywords:

Cataract, quality of life, diabetes, hypertension, Jazan, Saudi Arabia.

Introduction

When an eye lens loses its clarity, a cataract is formed causing the light to be obscured from entering the eye which negatively affects the visual perception. Cataracts can be age-related or can be secondary to external causes [1]. It is considered as the leading cause of blindness affecting more than 10.8 million people in 2010, while an additional 35.2 million individuals suffered moderate or intense visual impairment due to cataract [2].

Some of the risk factors of cataract formation are aging, female gender, low educational or socioeconomic status, exposure to ultraviolet rays, consumption of high glycemic index carbohydrates, and malnutrition. Other factors include diabetes and hypertension [1]. Cataracts cause a variety of symptoms, including blurry and double vision, glare, especially during night time driving, and poor vision [3].

Treatment of cataracts can be effectively done through surgery during which, the clouded lens is removed and a clear artificial one is inserted. Some studies report good long-term visual benefits lasting for up to 15 years after surgery [1]. This is the most cost-effective treatment available [4]. Delaying the cataract surgery causes a decline in the quality of life, inability to work, a larger probability of falling, blindness, and depression [58].

Visual acuity and refractive error are commonly assessed after cataract surgery. Physicians recognized that the quality of life is an important aspect that should be taken into consideration, as well as clinical observations. Enhanced vision after undergoing cataract surgery can greatly enhance the quality of life regarding everyday activities, as well as the emotional and social life aspects [6].

The “Cataract Impact Study” was an interventional study carried out to investigate the impact of cataract and cataract surgery on health-related quality of life (HRQoL), everyday activities, and poverty among adults over 50 years of age in Kenya, the Philippines, and Bangladesh. At baseline, it was uncovered that the patients who were suffering from cataracts had inferior vision-specific and basic HRQoL. They spent less time on fruitful activities and were more liable to have support with everyday activities. They were poorer regarding possessions, self-rated wealth, and expenditure. A year after the cataract surgery intervention, several changes occurred to those items measured and it was uncovered that the vision-specific and basic health-related quality was enhanced for the patients who had cataract surgery. Those people were more likely to carry out industrious activities and were less prone to report receiving assistance. Their expenditure had also increased [9].

Blindness and visual impairment affect 0.7% and 10.9% of the southwestern Saudi population, respectively. Cataracts are responsible for the loss of vision of more than 50% of that number of patients, in addition to visually impaired of more than 20% [10]. Therefore, this study was done to provide better insights concerning the quality of life before and after cataract surgery, in addition to exploring the factors affecting the quality of life after cataract surgery. This can help predict the influencing factors and identify the most appropriate measures to ensure a better quality of life for those patients.

Materials and Methods

This was a cross-sectional study done to evaluate the patients’ quality of life before and after cataract surgery, as well as the factors affecting the quality of life after cataract surgery. This was done using a designed self-administered questionnaire. The questionnaire was initially validated in a pilot study that included 15 participants. Included in the study were 225 patients who underwent cataract surgery. Patients of both genders aged between 23 and 82 years were included. The study was conducted in the ophthalmology clinic of Prince Mohammed Bin Nasser Hospital in Jazan city, Kingdom of Saudi Arabia.

Data were collected using a self-administered questionnaire. The questionnaires were answered verbally, while for illiterate patients, the optometrist wrote the patient’s answers. Informed written consent was obtained from all participants before inclusion in the study.

The questionnaire collected data points regarding the quality of life before and after the surgery. Data were collected about the socio-demographic characteristics (age, sex, marital status, educational level, occupation, and residency), medical history, diet, using Kat, co-morbid conditions such as diabetes and blood pressure and whether these conditions are controlled or not. Data about the quality of life before and after cataract surgery were also collected, as well as the patient’s optical health history. Questions about previous eye injuries, UV exposure, and visual strength were asked, as well as questions about glasses used, the impact of cataracts on working ability, daily activities, watching TV, driving, the emotional health, and sexual activity.

Taking into consideration that no prior study on the same topic has been conducted in Jazan, p = 50%, confidence interval = 95% and considering an error rate not more than 7% and a non-response rate of 10%, a sample size of 225 subjects would be enough to achieve the study objective.

Data were statistically described regarding frequencies (number of cases) and valid percentages for categorical variables. Mean, standard deviations, minimum, and maximum were used to describe numerical variables. Unpaired t-test was used to compare the numerical variables between the subgroups. p values less than 0.05 were considered statistically significant. All statistical calculations were done using computer program IBM SPSS (Statistical Package for the Social Science; IBM Corp, Armonk, NY) release 21 for Microsoft Windows.

Ethical approval was obtained from the University before conducting any study-related procedures. During the research activities, the confidentiality of the collected information was maintained by the data collector.

Results

There were 225 patients involved in this study presenting at the ophthalmology clinic of Prince Mohammed Bin Nasser Hospital for cataract surgery. The number of males was 153 (68%) and the number of females was 72 (32%). The mean ± SD age of the population enrolled in the study was 62.77 ± 12 years.

The patients included in the study were categorized according to their marital status. While most of the patients were married making up 88% of the enrolled population, the remaining patients were as follows: 7.6% widowed, 2.2% divorced, and 2.2% single.

Almost half of the patients (40%) who were enrolled were unemployed. 37.8% were retired, 20.4% were employed, and 1.8% were missing data.

The type of occupation these patients had was also categorized. Nearly, 43.1% were field-workers, 17.8% were office based, and 6.7% had other types of occupation. Data were missing for 32.4%.

The patients were asked about their educational background. It was found that 98 (43.6%) of the patients were illiterate, 27 (12%) could read and write, 20 (8.9%) received intermediate education, 32 (14.2%) had finished primary school, 20 (8.9%) had finished secondary school, while 28 (12.4%) had completed their university education.Village dwellers made up 68.4% of the population, while those who lived in the city made up 29.8%. Data were missing for four (1.8%) patients. More details are provided in Table 1.

The patients were asked about their medical history and 105 (46.7%) said that they were diabetic, while 124 (55.1%) were hypertensive. The majority of the patients enrolled (93.8%) were not following any diet regimens.

Data about Khat (Qat) use were also collected. The majority, 159 (70.7%) of the patients claimed that they do not use it, while six (27.1%) admitted using it. Data were missing for five (2.2%) patients.

Regarding ophthalmology medical history, 207 (92%) of the patients had never experienced an eye injury before. Regarding the exposure to UV light, 202 (89.9%) patients claimed that they were usually exposed to UV light, 18 (8%) denied that, while this information was missing for five (2.2%) patients.The patients were also queried about the duration of having vision problems, and the mean ± SD duration was 32.74 ± 39.58 months with a minimum of 2 months and a maximum of 180 months. More details are shown in Figure 1.

The patients were asked some questions concerning the surgery and their current condition, where 40.9% of the patients said that they had the surgery done in one eye and 59.1% had the surgery done in both eyes. Around one-third of the patients (34.2%) said that they use long-distance glasses and the patients constituting the same percentage (34.2%) said that they use short distance glasses.

The patients were asked about the quality of life they experienced before and after having the cataract surgery Figure 2 and 3. These questions tackled different aspects of the patients’ life to estimate the effect of the surgery on their daily life experience. The participants were asked if the cataract affected their daily activity where 4% strongly agreed, 38.2% agreed, 47.6% disagreed, 5.8% strongly disagreed, and 4.4% did not know.As for work, 0% strongly agreed, 40.4% agreed, 47.1% disagreed, and 8% strongly disagreed that the cataract did not affect their work, while 4.4% did not know.

Table 1. Demographic characteristics.

Parameter Answers Frequency Percent
Gender Female 72 32.0
Male 153 68.0
Total 225 100.0
Marital status Divorced 5 2.2
Married 198 88.0
Single 5 2.2
Widowed 17 7.6
Total 225 100.0
Employment Employed 46 20.4
Retired 85 37.8
Unemployed 90 40.0
Missing 4 1.8
Total 225 100.0
Occupation Field-worker 97 43.1
Office-based 40 17.8
Other 15 6.7
Missing 73 32.4
Total 225 100.0
Residence City 67 29.8
Village 154 68.4
Missing 4 1.8
Total 225 100.0
Education I can read and write 27 12.0
Illiterate 98 43.6
Intermediate 20 8.9
Primary 32 14.2
Secondary 20 8.9
University 28 12.4
Total 225 100.0

Regarding driving skills, 1.8% strongly agreed, 16.4% agreed, 31.1% disagreed, and 3.6% strongly disagreed that the cataract affected their driving, while 38.2% did not know. Data for 8.9% were missing.

Another activity that was challenged was watching TV. Around 0% strongly agreed, 29.3% agreed, 61.3% disagreed, and 1.8% strongly disagreed that the cataract affected their ability to watch clearly, while 7.6% did not know. Data for 8.9% were missing.

As for familial relationships, 3.6% strongly agreed, 67.1% agreed, 9.3% disagreed, and 4% strongly disagreed that the cataract affected them negatively, while 16% did not know.

Figure 1. Ophthalmology medical history.

Concerning sexual life, 2.2% strongly agreed, 49.8% agreed, 1.8% disagreed, and 0% strongly disagreed that the cataract affected it as well, while 46.2% did not know.

In conclusion, 1.8% strongly agreed, 60% agreed, 14.2% disagreed, and 5.3% strongly disagreed that the cataract did not affect their daily life, while 18.7% did not know.

The patients were asked about the changes in the quality of their vision after the surgery. Around 1.8% strongly agreed, 9.3% agreed, 69.8% disagreed, and 10.2% strongly disagreed that their vision was different after the surgery, while 6.7% did not know. Data for 2.2% were missing.

When asked if they would advise others not to undergo cataract surgery, 1.8% strongly agreed, 6.2% agreed, 77.8% disagreed, and 9.8% strongly disagreed, while 4.4% did not know.Around 13.8% strongly agreed, 72% agreed, 6.2% disagreed, and 4% strongly disagreed that their daily life improved after the surgery, while 4% did not know.Also, 12% strongly agreed, 72% agreed, 1.8% disagreed, and 1.8% strongly disagreed that their psychological status improved after the surgery, while 12% did not know.As for watching television, 12.4% strongly agreed, 73.8% agreed, 0% disagreed, and 1.8% strongly disagreed that the cataract surgery improved their ability to watch clearly, while 12% did not know.

Concerning sexual life, 1% strongly agreed, 20.4% agreed, 4% disagreed, and 0% strongly disagreed that it was improved after the surgery, while 73.8% did not know.

Regarding driving skills, 8% strongly agreed, 42.2% agreed, 2.2% disagreed, and 1.8% strongly disagreed that the surgery improved their ability to drive, while 45.8% did not know.Around 60.4% agreed and 30.2% strongly agreed that they were satisfied with their new vision in contrast with 1.8% who disagreed and 1.8% who strongly disagreed with that statement, while 5.8% did not know.

Figure 2. Quality of life before cataract surgery.

Figure 3. Quality of life after cataract surgery.

Female gender was considered a risk factor (p-value < 0.001) affecting the quality of life after cataract surgery as the mean ± SD quality of life score among females after the surgery (28.9 ± 2.6) was significantly lower (p < 0.001) than that among males (30.8 ± 3.6).

On the other hand, residency was found to have no significant effect on patient’s quality of life after cataract surgery as the mean ± SD score of city residents (29.9 ± 2.1) did not significantly differ (p = 0.245) from that of village residents (30.5±).

With 46.7% of patients being diabetic and 55.1% being hypertensive, it was found that both conditions did not significantly affect the quality of life after cataract surgery (p = 0.348 and p = 0.999, respectively).On the other hand, using sunglasses was considered to significantly enhance the quality of life after cataract surgery as the mean ± SD score of patients who use sunglasses (31.4 ± 2.7) was significantly higher (p = 0.001) than that of patients who did not use sunglasses (29.7 ± 3.6).

Discussion

The study results showed that male gender and using sunglasses were associated with a higher score of quality of life as an outcome of cataract surgery.

In the current study, female gender was associated with a lower quality of life score compared to males (p < 0.001). By these findings, a study conducted by Lundström et al. [11] proved that men get significantly better outcomes of cataract surgery. A study discussing the 5-year incidence of cataract surgery revealed that women are at a higher risk of undergoing a cataract surgery as compared to males [12]. In Tirunelveli district of south India, age, gender, education, and area of residence were not predictors of the visual outcomes of the cataract surgery although there were significantly more illiterate females affected by cataracts [13]. This trend was also observed to be statistically significant in the Beaver Dam Eye Study [14]. Another study conducted in Saudi Arabia stated that good visual outcome due to cataract surgery was seen in males more significantly than females [15].

In the current study, diabetes and hypertension were found to have no significant effect on the quality of life after cataract surgery (p = 0.348 and p = 0.999, respectively). To the best of our knowledge, the effect of diabetes and hypertension on the quality of life after cataract surgery was not discussed in previous studies. However, a study conducted on Asian patients uncovered that diabetics were more likely to develop cataracts and have the surgery done. This was especially true of the Indians and Malays (p < 0.001, p < 0.001) recruited in the study. Hypertension was observed to be significant only among Chinese patients [16]. A Saudi study that was conducted from January to June 2014 had included all the patients who had cataract surgery at King Abdulaziz Medical City, Riyadh. That study claimed that the main ailments that hindered the eyes from achieving the visual acuity of 20/40 or higher after cataract surgery were diabetic retinopathy, age-related macular degeneration, and glaucoma [17].

As for the socioeconomic status, patients from lower classes <AQ10> have a prevalence of cataract and with a lower incidence of cataract surgery [12]. Un-operated cataract remains the leading cause of blindness in low- and middle-income countries [18]. In Saudi Arabia, educated patients with higher economical levels and greater visual requirements usually visit private sector hospitals to undergo surgery at earlier stages of cataract development [15].

Gains in visual functioning and quality of life (health and vision-related) have been demonstrated following cataract surgery [19]. The effects were observed within 1 year of surgery. The improvement encompassed life functions such as driving, community activities, home activities, mental health, and life satisfaction. Also, the patients with cataracts showed significantly greater improvement in measures of vision than did the non-cataract group [20]. This improvement in the quality of life was also measured to be significant by another team using the Glasgow Benefit Inventory, who reported that it could occur within a few weeks after the surgery. The improvement was not significantly correlated to gender, unlike our study [21]. Despite the perceived benefits of cataract surgery, the patients in our study do not advise others to go through with it.

In a national cohort of United States Medicare beneficiaries with cataract, cataract surgery was associated with decreased all-cause mortality [22]. The presence of cataracts was associated with increased mortality in males than females (p < 0.001), especially those who are illiterate, smokers who suffered from hypertension or diabetes [23]. A possible explanation for that is that common ocular conditions may share attributes with systemic conditions associated with increased mortality such as diabetes and hypertension [24,25]. Another possible reason is that the excess mortality is a consequence of visual impairment, which increases the risk of falls and depression, particularly in the elderly [26].

Conclusion

From the discussed results, it can be concluded that cataract surgery can enhance the quality of life of patients regarding daily activities, psychological status, and vision. Male gender and eye-protection from direct sunlight using sunglasses have a significant beneficial effect on the quality of life of patients undergoing cataract surgery. On the other hand, comorbidities such as diabetes and hypertension, as well as residency have not significant effect on the quality of life.

List of Abbreviations <AQ11>

HRQoL Health-related quality of life

IBM International Business Machines

SPSS Statistical Package for the Social Sciences


Funding

None.


Declaration of conflicting interests

None.


Consent for publication

Informed consent was obtained from the participants


Ethical approval

Ethical approval was obtained from the Ministry of Health in Jazan via letter no. 1438-1027719, dated 7-3-2017.


Author details

Yara Mohammed Mobarki1*, Majid Moafa2, Mohammed Yahya Faqihi3 , Abdulrahman Mohammed Adawi4, Azza Jabir Mohanna5 , Abdullrahman Darraj2

  1. Jazan University, Jazan, Saudi Arabia
  2. Qassim University, Al-Mulida, Saudi Arabia
  3. Prince Mohammed Bin Nasser Hospital, Jazan, Saudi Arabia

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How to Cite this Article
Pubmed Style

Mobarki YM, Moafa M, Faqihi MY, Adawi AM, Mohanna AJ, Darraj A, . The effect of cataract surgery on patients quality of life in Jazan, Saudi Arabia. IJMDC. 2019; 3(1): 36-42. doi:10.24911/IJMDC.51-1542871571


Web Style

Mobarki YM, Moafa M, Faqihi MY, Adawi AM, Mohanna AJ, Darraj A, . The effect of cataract surgery on patients quality of life in Jazan, Saudi Arabia. https://www.ijmdc.com/?mno=18347 [Access: January 28, 2022]. doi:10.24911/IJMDC.51-1542871571


AMA (American Medical Association) Style

Mobarki YM, Moafa M, Faqihi MY, Adawi AM, Mohanna AJ, Darraj A, . The effect of cataract surgery on patients quality of life in Jazan, Saudi Arabia. IJMDC. 2019; 3(1): 36-42. doi:10.24911/IJMDC.51-1542871571



Vancouver/ICMJE Style

Mobarki YM, Moafa M, Faqihi MY, Adawi AM, Mohanna AJ, Darraj A, . The effect of cataract surgery on patients quality of life in Jazan, Saudi Arabia. IJMDC. (2019), [cited January 28, 2022]; 3(1): 36-42. doi:10.24911/IJMDC.51-1542871571



Harvard Style

Mobarki, Y. M., Moafa, . M., Faqihi, . M. Y., Adawi, . A. M., Mohanna, . A. J., Darraj, . A. & (2019) The effect of cataract surgery on patients quality of life in Jazan, Saudi Arabia. IJMDC, 3 (1), 36-42. doi:10.24911/IJMDC.51-1542871571



Turabian Style

Mobarki, Yara Mohammed, Majid Moafa, Mohammed Yahya Faqihi, Abdulrahman Mohammed Adawi, Azza Jabir Mohanna, Abdullrahman Darraj, and . 2019. The effect of cataract surgery on patients quality of life in Jazan, Saudi Arabia. International Journal of Medicine in Developing Countries, 3 (1), 36-42. doi:10.24911/IJMDC.51-1542871571



Chicago Style

Mobarki, Yara Mohammed, Majid Moafa, Mohammed Yahya Faqihi, Abdulrahman Mohammed Adawi, Azza Jabir Mohanna, Abdullrahman Darraj, and . "The effect of cataract surgery on patients quality of life in Jazan, Saudi Arabia." International Journal of Medicine in Developing Countries 3 (2019), 36-42. doi:10.24911/IJMDC.51-1542871571



MLA (The Modern Language Association) Style

Mobarki, Yara Mohammed, Majid Moafa, Mohammed Yahya Faqihi, Abdulrahman Mohammed Adawi, Azza Jabir Mohanna, Abdullrahman Darraj, and . "The effect of cataract surgery on patients quality of life in Jazan, Saudi Arabia." International Journal of Medicine in Developing Countries 3.1 (2019), 36-42. Print. doi:10.24911/IJMDC.51-1542871571



APA (American Psychological Association) Style

Mobarki, Y. M., Moafa, . M., Faqihi, . M. Y., Adawi, . A. M., Mohanna, . A. J., Darraj, . A. & (2019) The effect of cataract surgery on patients quality of life in Jazan, Saudi Arabia. International Journal of Medicine in Developing Countries, 3 (1), 36-42. doi:10.24911/IJMDC.51-1542871571