Abstract
PurposeThe quality of cataract surgery delivered in sub-Saharan Africa (SSA) is a significant constraint to achieving the elimination of avoidable blindness. No published reports from routine SSA cataract services attain the WHO benchmarks for visual outcomes; poor outcomes (<6/60) often comprise 20% in published case series. This Delphi exercise aimed to identify and prioritise potential interventions for improving the quality of cataract surgery in SSA to guide research and eye health programme development.MethodsAn initial email open-question survey created a ranked list of priorities for improving quality of surgical services. A second-round face-to-face discussion facilitated at a Vision 2020 Research Mentorship Workshop in Tanzania created a refined list for repeated ranking.ResultsSeventeen factors were agreed that might form target interventions to promote quality of cataract services. Improved training of surgeons was the top-ranked item, followed by utilisation of biometry, surgical equipment availability, effective monitoring of outcomes of cataract surgery by the surgeon, and well-trained support staff for the cataract pathway (including nurses seeing post-operative cases).ConclusionImproving the quality of cataract surgery in SSA is a clinical, programmatic and public health priority. In the absence of other evidence, the collective expert opinion of those involved in ophthalmic services regarding the ranking of factors to promote quality improvement, refined through this Delphi exercise, provides us with candidate intervention areas to be evaluated.
Highlights
In the absence of other evidence, the collective expert opinion of those involved in ophthalmic services regarding the ranking of factors to promote quality improvement, refined through this Delphi exercise, provides us with candidate intervention areas to be evaluated
One in three of the world’s 32.4 million blind people (\3/60 presenting visual acuity (VA) in the betterseeing eye) are blind due to cataract, and this proportion is closer to one half in sub-Saharan Africa (SSA) [1, 2]
The availability of cataract surgical services in SSA is by no means universal, but even where services are available, uptake has mostly been below the level required for elimination of cataract blindness [3]
Summary
One in three of the world’s 32.4 million blind people (\3/60 presenting visual acuity (VA) in the betterseeing eye) are blind due to cataract, and this proportion is closer to one half in sub-Saharan Africa (SSA) [1, 2]. There are many millions more who have significant visual impairment from cataract. This is despite an effective, low-cost cure for cataract having been known for decades. The availability of cataract surgical services in SSA is by no means universal, but even where services are available, uptake has mostly been below the level required for elimination of cataract blindness [3]. Cataract surgical rates (CSR) of around 500 operations/million population/annum are frequently. A commonly cited barrier to acceptance of surgery is concern about poor outcomes from surgery amongst potential beneficiaries [6,7,8,9]
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