Exploring the effect of cataract surgery on functional difficulties and quality of life (eCASE)

• Measure change in self-reported functional difficulties, stigma, participation in economic activities, and vision-related and general quality of life from before to after cataract surgery, among patients in Nampula Province.
• To estimate the cost of cataract surgery in Mozambique (Nampula Inclusive Eye Health Project).
• Explore perceived changes in functioning among male and female cataract surgical patients with different functional difficulties.
• Explore the extent to which cataract surgery and better visual outcomes modify stigma as it manifests in the cataract patients’ socio-economic life
• Identify the factors associated with changes in the following outcomes: self-reported functional difficulties; participation in economic activities; quality of life; stigma

The general goal of this study was to explore how cataract surgery affects how individuals’ function across a range of domains, their quality of life, and their ability to engage in a range of activities linked to economic productivity in Nampula Province, Mozambique.

The study will not only interrogate how we conceptualise disability when considering cataract patients, but also how we understand the overall impact of cataract surgery on individuals’ functioning and well-being.

Stigma is a major concern for people diagnosed with severe vision impairment in rural Mozambique and cataract-related disability is both a medical and social issue.

Cataract surgery was associated with marked improvements in vision, functioning, health, economic participation and reduction in stigma, showing its value as both a clinical and socioeconomic intervention in underserved rural settings.

Linking cataract services with livelihood support or social protection programmes may further help sustain gains in participation and household wellbeing among poorer patients. Expanding access to cataract surgery in low-resource settings represents a viable strategy to improve wellbeing and independence among ageing populations.

• Mixed methods

Experiencing stigma is extremely common, with 59% of participants reporting at least one stigmatising attitude. The study also established a strong link between these experiences and general wellbeing: patients with poor self-rated general health were significantly more likely to report both internalised and experienced stigma.

Before surgery, participants reported severe limitations in daily tasks, work and social activities. Many experienced isolation, stigma and diminished self-esteem. After surgery, most participants described restored vision as a return to normalcy, enabling them to do things on their own and contribute to the household, farming and engagement in community and religious life. For some, surgery helped to enhance confidence, dignity and agency. Sustaining these improvements was more challenging for older participants and those with other health conditions or persistent visual impairment.

After surgery, participants reporting difficulty in seeing reduced from 80.2% to 4.6%, and other difficulties from 58.6% to 14.4%. Reports of poor general health decreased from 22.7% to 5.0%. More people were able to participate in paid work from 9.4% before surgery to 18.9% after, and own work from 35.4% to 76.1%. There was also less food and income insufficiency. Internalised stigma decreased from 54.0% to 3.0%, and community stigma from 37.1% to 2.4%.

Read the publication: Changes in quality of life, daily functioning, stigma experiences and economic productivity after cataract surgery among adults with severe vision impairment in rural Mozambique 

Read the publication: Patient narratives on the lived experiences of physical, psychosocial and economic changes after cataract surgery

Read the publication: Prevalence and factors associated with stigma among adults diagnosed with severe vision impairment in rural Mozambique