Clinical and Experimental Ophthalmology
mR@d4(:J? 2006;
#.HnO_sK_ 34
v:/!OvLe : 880–885
0'pB7^y doi:10.1111/j.1442-9071.2006.01342.x
+z?gf*G_W' © 2006 Royal Australian and New Zealand College of Ophthalmologists
V^[&4 ]9/A=p?J@ Correspondence:
HOWpTu( Dr Garry Brian, 5 Hazelmere Parade, Sherwood, Qld 4075, Australia. Email:
grbrian@tpg.com.au W&
0R/y7 Received 11 April 2006; accepted 19 June 2006.
QA0uT{x90 Original Article
h>GbJ/^ Cataract and its surgery in Papua New Guinea
`+\$ Jambi N Garap
6X h7Bx1 MMed(Ophthal)
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A@ Sethu Sheeladevi
b=MW;]F MHM
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T2w4D! Garry Brian
zi6J|u FRANZCO
F=e;[uK\ ,
iEtR<R>= 2,4
Fik;hB BR Shamanna
}?mSMqnB MD
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F6yFKNK!n Praveen K Nirmalan
+\_\53 MPH
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oZY|o0/9 and Carmel Williams
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EL3X8H 1
l]zQSXip The Fred Hollows Foundation – Papua New Guinea Eye Care Program,
Ir>4- @ 2
Xv!Gg6v6 Department of Ophthalmology, School of Medicine and Health
u=qK_$d4 Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea;
7M~ /
q. 3
}W 5ks-L6 International Center for Advancement of Rural Eye Care,
l([aKm# L.V. Prasad Eye Institute, Hyderabad, India; and
OV;VsF 4
&)Qq%\EP4 The Fred Hollows Foundation (New Zealand), Auckland, New Zealand
"0PsCr}! Key words:
Ve"(}z blindness
Ip7#${f5M ,
n5"oXpcIx cataract
Yu" Q ,
].J;8} Papua New Guinea
6:%lxG ,
s/hWhaS< surgery
P]^OSPRg ,
|z3!3?%R vision impairment
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lqH/>`> I
'/UT0{2;rS NTRODUCTION
QpQ 2hNf Just north of Australia, tropical Papua New Guinea (PNG)
zOSUYn has more than five million people spread across several major
!\{2s!l~ and hundreds of other smaller islands. Almost 50% of the
?F]
P=S
:x land area is mountainous, and 85% of inhabitants are rural
E-X
z dwellers. Forty per cent of the population is age 14 years or
;0m J4G younger, and 9% is 50 years or older.
6|q"lS*$S 1
3YLfh`6 Papua New Guinea was administered by Australia until
)! rD&l$tE 1975, when independence was granted. Since that time, governance,
Ws3z-U>j particularly budgetary, economic performance, law
S) z
w[m and justice, and development and management of basic
f@ |[pT health and other services have declined. Today, 37% of the
=/'>.p3/S population is said to live below the poverty line, personal
a"xRc and property security are problematic, and health is poor.
d_$0 There are significant and growing economic, health and education
rMJ@oc disparities between urban and rural inhabitants.
m=E/um[D Papua New Guinea has one referral hospital, in Port
\6a' p
Q, Moresby. This has an eye clinic with one part-time and two
'MYKAnZ-i full-time consultant ophthalmologists, and several ophthalmology
1yF9zKs&_ training registrars. There are also two private ophthalmologists
`UzH *w@e in the city. Elsewhere, four provincial hospitals
H(n
fHp.3 have eye clinics, each with one consultant ophthalmologist.
UGM:'xa<T One of these, supported by Christian Blind Mission and
)Rbt0 based at Goroka, provides an extensive outreach service.
{}'Jr1 Visiting Australian and New Zealand ophthalmology teams
:tFcPc' and an outreach team from Port Moresby General Hospital
J| &aqY provide some 6 weeks of provincial service per year.
7lF;(l^Z>} Cataract and its surgery account for a significant proportion
N4VZl[7? of ophthalmic resource allocation and services delivered
*wqR .n? in PNG. Although the National Department of Health keeps
VWdTnu some service-related statistics, and cataract has been considered
l8+1{
6xP in three PNG publications of limited value (two district
d<ES service reports
9
fbo 2,3
h){ #dU+& and a community assessment
[W[awGf 4
EqD@o ), there has
8TH;6-RT been no systematic assessment of cataract or its surgery.
{7IZN< e A
!T)_(}|6} BSTRACT
Wn;%B].I Purpose:
||cI~qg To determine the prevalence of visually significant
4>Ht_B<< cataract, unoperated blinding cataract, and cataract surgery
,{iMF
(Nj for those aged 50 years and over in Papua New Guinea.
FR50y+h^$ Also, to determine the characteristics, rate, coverage and
Wkb>JnPo outcome of cataract surgery, and barriers to its uptake.
[}Rs Methods:
>PdrLwKS Using the World Health Organization Rapid
BB1_EdoG Assessment of Cataract Surgical Services protocol, a population-
&kWT<*;J) based cross-sectional survey was conducted in
.gRb' 2005. By two-stage cluster random sampling, 39 clusters of
bTYR=^9 30 people were selected. Each eye with a presenting visual
FDGzh/ acuity worse than 6/18 and/or a history of cataract surgery
5D^2
+`$/ was examined.
p*zTuB~e < Results:
E7SmiD@) Of the 1191 people enumerated, 98.6% were
HsG3s?* examined. The 50 years and older age-gender-adjusted
|a0@4
: prevalence of cataract-induced vision impairment (presenting
iy8Ln,4z( acuity less than 6/18 in the better eye) was 7.4% (95%
aJs! bx>K confidence interval [CI]: 6.4, 10.2, design effect [deff]
]REF1<)4z =
|D;I>O^"R 1.3).
[4])\q^q That for cataract-caused functional blindness (presenting
7
0R_O&f-k acuity less than 6/60 in the better eye) was 6.4% (95% CI:
uXGAcUx( 5.1, 7.3, deff
*L<<S=g$2 =
ob)c0Pz 1.1). The latter was not associated with
` a
pCu gender (
w0.;86<MV P
,}^;q58 =
JAmpU^(C 0.6). For the sample, Cataract Surgical Coverage
kf' 4C
"} at 6/60 was 34.5% for Eyes and 45.3% for Persons. The
2tp95E
`(O Cataract Surgical Rate for Papua New Guinea was less than
}f6_7W%5 500 per million population per year. The age-genderadjusted
*M~BN}. prevalence of those having had cataract surgery
YO.+06X was 8.3% (95% CI: 6.6, 9.8, deff
`qy@Qo =
S]c&