Factors Determining Late Presentation Among Patients with Blinding Total Senile Cataract

 
Diabaté Z^1*, Koffi KAP¹, Yohan BVB², Babayeju ORL¹, Godé LE¹, Koffi KFH¹, Goulé AM¹, Diomandé GF¹, Bilé PEFK¹, Ouattara Y¹, Diomandé IA¹

¹Ophthalmology Department at the Teaching Hospital of Bouaké, Côte d’Ivoire
²National Training Institute For Health Workers; Investigator, Côte d’Ivoire

*Correspondence author: Zana Diabaté, Ophthalmology Department at the Teaching Hospital of Bouaké, Côte d’Ivoire; Email: doczdiabate@gmail.com

Citation: Diabaté Z, et al. Factors Determining Late Presentation Among Patients with Blinding Total Senile Cataract. J Ophthalmol Adv Res. 2025;6(3):1-7.

Copyright^© 2025 by Diabaté Z, et al. All rights reserved. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Table 1: Distribution of patients according to their occupation.

Housewives were the most represented group, accounting for 40% of the study population (Table 2). 

Table 2: Distribution of patients according to the distance traveled to receive care.

It emerges that 30% of patients had to travel more than 40 km to access eye care (Table 3). 

Table 3: Distribution of patients according to the duration of symptom progression.

The majority of patients (56%) had symptoms that had been evolving for a duration of 3 to 4 years (Table 4). 

Table 4: Distribution of patients according to their initial reaction at the onset of symptoms.

The majority of patients had systematically resorted to traditional medicine as soon as their symptoms first appeared (Table 5). 

Table 5: Distribution of patients according to the main factor determining delay in consultation.

Cultural factors and lack of information were the main determinants of delayed consultation, accounting for 42% and 30% of cases, respectively (Table 6). 

Table 6: Distribution of patients according to their suggestions to promote earlier consultations.

The reduction of healthcare costs and the organization of awareness sessions in local languages were the most frequently suggested measures by patients to promote early consultations.

Discussion

In our study, patients aged 60 to 70 years constituted the majority (64% of the sample), with a mean age of 69.5 years. This finding is consistent with the definition of senile cataract, which typically occurs after the age of 65. Our results align closely with those reported by Sovogui and Djiguimbé, who found mean ages of 65.53 years and 62.47 years, respectively [11,12]. Similarly, in Côte d’Ivoire, Diomandé, et al., observed that individuals aged 60-65 years represented the largest group affected by cataract [13]. Collectively, these findings confirm that advanced age remains the primary etiological factor for cataract development.

A female predominance was observed in our cohort, with a male-to-female ratio of 0.78. This trend is consistent with studies conducted by Ebana, in Cameroon and Amedome in Togo, which reported sex ratios of 0.77 and 0.4, respectively [14,15]. Conversely, other studies-such as that of Okundo in Nigeria-found a male predominance [16]. To date, no study has demonstrated a direct biological correlation between sex and cataract incidence, suggesting that observed differences likely stem from sociocultural or economic factors rather than pathophysiological ones. In our context, the higher representation of women among late presenters may be attributed to their limited financial autonomy, as most are homemakers without independent income, making it difficult to afford consultation fees and related expenses.

Our study revealed that 30% of patients traveled more than 40 km to access ophthalmological care. This considerable distance likely contributes to delayed consultation, particularly given that most senile cataract patients are elderly and often suffer from comorbidities and reduced mobility. In Cameroon, Afetane noted that 61.37% of patients with unoperated cataract in his series resided outside Yaoundé and distance was cited as a barrier to care for many [5]. Similarly, in Ethiopia, patients attributed delays in cataract management to the remoteness of healthcare facilities [17].

The majority of our patients (56%) reported a symptom duration of 3 to 4 years before seeking care. This finding is comparable to Okundo’s study in Nigeria, where 49.1% of patients had experienced symptoms for approximately 3 years prior to consultation [16]. Likewise, in India, Priyadharshini, et al., found that 35.4% of patients endured visual symptoms for up to 5 years before their first eye was treated [18]. These data, including our own, clearly indicate that patients have ample time to notice the progressive decline in their vision yet still delay seeking professional care=demonstrating that the delay cannot be attributed to a lack of time or sudden onset of symptoms.

Notably, 60% of patients in our study initially turned to traditional medicine upon symptom onset. This tendency reflects a broader cultural context in which visual impairment is often attributed to non-medical causes. For instance, Diabaté reported that 22.22% of blind patients in his study attributed their condition to mystical or supernatural forces [19]. Generally, in our setting, individuals are more likely to consult traditional healers before considering hospital-based care.

Cultural beliefs emerged as the most frequently cited reason for delayed consultation, followed by a lack of information about the disease. It is widely recognized that cultural factors significantly influence healthcare-seeking behavior. Culture, alongside other social determinants, shapes how individuals perceive health, illness and appropriate treatment pathways. As Kodjo, observed, some communities lack familiarity with germ theory and instead strongly believe in fatalism, witchcraft or demonic influence as explanations for disease [20]. Under such belief systems, accepting a medical diagnosis becomes challenging. In certain traditions, disability is even viewed as a shameful condition or as divine punishment for violating social or spiritual taboos. Fainzang documented that, in some cultures, visual impairment is interpreted as a sanction for transgressing ancestral or communal norms [21]. Others believe blindness results from ancestral retribution for serious familial wrongdoing [22]. Such deeply rooted beliefs inevitably delay timely access to ophthalmic care.

Additionally, insufficient public knowledge about eye health and widespread misinformation or rumors regarding cataract surgery in hospitals further contribute to late presentation. In rural China, Yin, identified lack of awareness as the primary barrier to cataract treatment [23].

When asked for suggestions to encourage earlier consultation, patients overwhelmingly emphasized two key measures: reducing or eliminating the cost of eye care and bringing ophthalmic services closer to local communities. These recommendations highlight the critical need for both financial accessibility and improved geographic availability of eye care services to address the persistent problem of late presentation in cataract management.

Conclusion

Several barriers hinder the early management of blinding senile cataract in our region. This situation underscores the critical role healthcare providers must play in raising awareness to eliminate obstacles that contribute to delayed consultation among individuals suffering from blinding total senile cataract in the Adzopé area. There is a clear need to address the cost of ophthalmological care, promote free cataract surgery campaigns and strengthen community education about eye diseases and their treatment-while taking into account local cultural beliefs and practices.

Conflict of Interest

The author declares no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Funding Details

No funding was received for this review.

Author’s Contributions

All authors have contributed equally to this work and have reviewed and approved the final manuscript for publication.

Consent For Publication

Not applicable.

Ethical Statement

The study abided by the tenets of declaration of Helsinki for studies involving human subjects, human material and data.

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