DELAYED CATARACT SURGERY IN RURAL AND UNDERSERVED POPULATIONS: A SYSTEMATIC REVIEW OF BARRIERS, CLINICAL CONSEQUENCES, AND STRATEGIES TO IMPROVE SURGICAL UPTAKE
Keywords:
Cataract surgery, Surgical uptake, Barriers, Rural populations, Underserved populationsAbstract
Background: Delayed cataract surgery remains an important barrier to reducing avoidable visual impairment in rural and underserved populations. Delay may occur through delayed presentation, delayed acceptance, or prolonged non-utilization.
Objective: To systematically review barriers, clinical consequences, and strategies associated with delayed cataract surgery in rural and underserved populations.
Methods: A systematic review was conducted of studies evaluating delayed presentation, delayed uptake, or non-utilization of cataract surgery or related services. Data were extracted on barriers, clinical consequences, and strategies to improve surgical uptake. Findings were synthesized descriptively.
Results: Twenty-six studies published from 1991 to 2024 were included. The most frequently reported barriers were financial constraints, geographic and transportation difficulties, lack of perceived need, inadequate knowledge, fear of surgery, and limited family or social support. Delayed or untreated cataract was frequently associated with substantial visual impairment and blindness, with advanced cataract and lens-related complications reported in some settings. Strategies included financial assistance, transportation support, counselling, community education, outreach, and decentralized services. Regular same-location outreach was associated with higher surgical acceptance in one South Indian study.
Conclusions: Delayed cataract surgery is multifactorial, involving financial and geographic barriers, perceived need, knowledge, fear, and social support. Multicomponent strategies addressing affordability, accessibility, and counselling may improve surgical uptake.
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