The Pyhajarvi Cataract Study. I. Study design, baseline characteristics and the demand for cataract surgery

Purpose: The Pyhajarvi Cataract Study aims to study demand for cataract surgery in the population of a rural town in Finland. Methods: A random, population-based sample of 881 persons aged >= 60 years were interviewed by telephone to obtain a Visual Function-14 (VF-14) score. A total of 294 persons were invited for an ophthalmic examination based on three categories of VF-14 score. Of these, 230 (78%) responded, 10 of whom were excluded as a result of prior bilateral surgery. The New Zealand Priority Criteria (NZPC) and the 15-Dimension Quality of Life (15-D) instruments were administered. In addition, another group of 96 patients waiting for cataract surgery were examined and scored using the VF-14, NZPC and 15-D instruments. A modified Lens Opacities Classification System (LOCS) III classification was used for grading the cataract. Results: Only one (0.5%) of the 220 examined subjects was referred for cataract surgery. Many patients with relatively good visual acuity (VA), including six people with a 100-point VF-14 score suggesting no visual symptoms, were waiting for surgery. Demographic factors were not associated with access to cataract surgery. The patients examined from the waiting list for cataract surgery had more cataractous changes in the lens(es), poorer VA, were older, and scored higher on the NZPC instrument than the population sample examined. Conclusions: Practically no hidden demand for cataract surgery was found in the study population as defined by the national criteria for cataract surgery in Finland. This reflects the fact that the current Finnish health care system appears to recognize and treat cataract patients very well, even in rural areas. Although VA tests may not be sufficient for evaluating need for cataract surgery, the role of questionnaires is not clear either.