Travel and financial burdens of cataract surgical care in South India: Comparison of postoperative follow-up at local vision centers versus an urban eye hospital.

Abstract

Purpose: Access to eye surgical care in low- and middle-income countries (LMICs) remains limited due to geographical and financial barriers. This survey evaluated the travel and financial burden on patients and caregivers attending perioperative cataract care at an urban base hospital (UBH) versus community clinics (vision centers [VC]) at the Aravind Eye Care System in South India.

Methods: This cross-sectional study surveyed 105 cataract surgery patients divided into three groups based on perioperative appointment location: UBH-only (appointments at UBH), VC-only (appointments at VCs), and UBH/VC (Day 1 postoperative appointment at VCs, others at UBH). Descriptive statistics and linear regression assessed associations between subgroups and travel and financial burden. The UBH/VC group reported their preferred location and the reasons.

Results: Over the entire appointment period, transport time for VC-only (353 ± 118 min) was over 3 h lower than UBH-only (589 ± 418 min) and UBH/VC (568 ± 230 min; P < 0.001). Total appointment time was lowest for VC-only (562 ± 177; 1069 ± 439 in UBH-only; 1021 ± 383 min in UBH/VC; P < 0.001). Compared to UBH-only, the VC-only group had the lowest transport time (-236 min, 95% CI: -371 to -102, P = 0.001) and total appointment time (-507 min, 95% CI: -673 to -340, P < 0.001). Transport costs and missed wages were lower for VC-only participants for preoperative and postoperative Day 1 appointments (P < 0.001). Among UBH/VC, 63% (n = 22) preferred VC, while 37% (n = 13) preferred UBH.

Conclusions: Decentralized perioperative follow-up care is associated with reduced travel and financial burdens for cataract surgery patients in rural, low-resource settings. Further research is needed to evaluate the clinical effectiveness and operational feasibility of decentralized postoperative care in LMICs.