Abstract
PurposeTo evaluate cataract surgery visual outcomes and associated risk factors in rural secondary level eye care centers of L V Prasad Eye Institute (LVPEI), India.MethodsThe Eye Health pyramid of LVPEI has a network of rural secondary care centres (SCs) and attached vision centres (VCs) that provide high quality comprehensive eye care with permanent infrastructure to the most disadvantaged sections of society. The most common procedure performed at SCs is cataract surgery. We audited the outcome of a random sample of 2,049 cataract surgeries done from October 2009-March 2010 at eight rural SCs. All patients received a comprehensive ophthalmic examination, both before and after surgery. The World Health Organization recommended cataract surgical record was used for data entry. Visual outcomes were measured at discharge, 1–3 weeks and 4–11 weeks follow up visits. Poor outcome was defined as best corrected visual acuity <6/18.ResultsMean age was 61.8 years (SD: 8.9 years) and 1,133 (55.3%) surgeries were performed on female patients. Pre-existing ocular co-morbidity was present in 165 patients (8.1%). The most common procedure was small incision cataract surgery (SICS) with intraocular lens (IOL) implantation (91.8%). Intraoperative complications were seen in 29 eyes (1.4%). At the 4–11 weeks follow-up visit, based on presenting visual acuity (PVA), 61.8% had a good outcome and based on best-corrected visual acuity (BCVA), 91.7% had a good outcome. Based on PVA and BCVA, those with less than 6/60 were only 2.9% and 1.6% respectively. Using multivariable analysis, poor visual outcomes were significantly higher in patients aged ≥70 (OR 4.63; 95% CI 1.61, 13.30), in females (OR 1.58; 95% CI 1.04, 2.41), those with preoperative comorbidities (odds ratio 4.68; 95% CI 2.90, 7.57), with intraoperative complications (OR 8.01; 95% CI 2.91, 22.04), eyes that underwent no IOL or anterior chamber-IOL (OR 12.63; 95% CI 2.65, 60.25) and those undergoing extracapsular cataract extraction (OR 9.39; 95% CI 1.18, 74.78).ConclusionsThis study demonstrates that quality cataract surgeries can be achieved at rural SCs. The concept of the LVPEI SCs can be applied to other developing countries, allowing rural patients to attain better vision through cataract surgery. Despite improvements in quality of cataract surgery, gender discrimination in terms of outcome continues to be an issue and needs further investigation.
Highlights
Cataract is the major cause of blindness accounting for 51% of total blindness [1] and there are regional variations in it [2,3] with America having the lowest prevalence and the highest being in South-East Asia [2,3]
Intraoperative complications were seen in 29 eyes (1.4%)
Poor visual outcomes were significantly higher in patients aged 70, in females, those with preoperative comorbidities, with intraoperative complications, eyes that underwent no intraocular lens (IOL) or anterior chamber-IOL and those undergoing extracapsular cataract extraction
Summary
Cataract is the major cause of blindness accounting for 51% of total blindness [1] and there are regional variations in it [2,3] with America having the lowest prevalence and the highest being in South-East Asia [2,3]. There is urban-rural differences seen [8] This variability in outcomes could be due to the quality of surgery or the surgical facility, surgeons’ skills, post-operative use of spectacles or co-existing ocular co-morbidities. These differences can be due to the fact that population-based studies include all cases, some of which might have been operated on many years ago. It is likely that there is a reporting bias in hospital-based studies, with hospitals having good outcomes reporting on a regular basis, whereas others do not. Apart from this, there is need to routinely monitor the outcomes of cataract surgery
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