High Volume Cataract Surgery Research Articles

Impact of digital cataract workflow on time and resource efficiencies in cataract surgery: time and motion study.

To compare time and resource-saving with integration of digital cataract workflow to the existing workflow in high-volume cataract surgery clinics. L V Prasad Eye Institute, Hyderabad, India (Site 1) and Narayana Nethralaya, Bengaluru, India (Site 2). Prospective, time-and-motion. The total time to complete each step (preoperative measurements, surgical planning, and surgical procedures) of the cataract workflow, number of data fields entered, and support staff required for both workflows were recorded. All study measurements were determined first for existing EMR cataract workflow followed by digital workflow (integrated data management system with data reviewer, surgical planner, and data transfer to OR) at both sites. A total of 85 (Site 1, 44; Site 2, 41) cataract workflows were analyzed. The integration of digital workflow into the site's existing EMR workflow reduced the mean time for preoperative measurements by 25.3% (P = .006), surgical planning by 55.1% (P = .008), and surgical procedures by 22.6% (P = .002). The mean±SD overall time for the surgery was significantly shorter in the digital group (887.3±103.3 vs 1271.3±300.7 seconds; P < .0001). For both sites, the number of data fields recorded and the number of support staff needed was significantly lesser for the digital workflow (P < .0001, for both). Integration of digital workflow significantly reduced the overall cataract surgery time, variability of overall time, number of data fields recorded, and resource utilization. Complete digitalization has important implications for improving the efficiency and standardization of cataract surgery workflow.

Acute fulminant post-operative endophthalmitis by Pasteurella caecimuris: A rare case report

The incidence of acute post-operative endophthalmitis (APOE) following cataract surgery in India is comparable to most of the developed world despite performing high-volume cataract surgery. Most infections are caused by bacteria, Streptococcus and Staphylococcus species being the predominant pathogens, which are similar to the findings of most published literatures. However, there is also a significant number of infections seen to be caused by Gram-negative bacteria and fungus. Amid Gram-negative microbes, Pseudomonas aeruginosa is the most common organism followed by Acinetobacter spp., Klebsiella spp., Escherichia coli, Enterobacter spp., and Alkaligenes spp. Another rare newly emerging ocular pathogen is Pasteurella species. Human infections by some species of Pasteurella involving soft tissue, skin, bone, joints, and wounds have been reported following animal exposure. However, there are no documented cases of ocular involvement in humans by Pasteurella caecimuris. We herein report the first case of APOE by this species. P. caecimuris induced endophthalmitis is very fulminant in nature and should be dealt with aggressive intervention.

The impact of antibiotic prophylaxis with intracameral cefuroxime on postoperative infectious endophthalmitis rates in a high-volume cataract surgery center

Our purpose was to compare postoperative infectious endophthalmitis rates before and after the introduction of antibiotic prophylaxis via intracameral with cefuroxime (ATB-P IC) in a high-volume cataract surgery service. Retrospective cohort study considering patients who underwent cataract surgery at Ophthal Hospital Especializado, São Paulo, Brazil, from January/2011 to December/2019. Patients operated from 2013 to 2019 comprised the ATB-P IC group while those operated from 2011 to 2013 formed the control group without the ATB-P IC protocol. A total of 23,184 cataract surgeries were included, with 6,207 in the Control Group and 16,977 in the ATB-P Group. A significantly higher rate of endophthalmitis was observed in the control group (0.0967%) when compared to the ATB-P group (0.0177%) (p = 0.014). Surgeries performed with ATB-P showed 80% less chance of reported endophthalmitis (OR = 0.20; 95% CI 0.05–0.72; p = 0.014) than those without ATB-P. Of the six cases confirmed by culture in the control group, all tested positive for Pseudomonas aeroginosa and the only case confirmed by culture in the ATB-P group was positive for Staphylococcus epidermidis. Our findings strongly support the use of intracameral antibiotic prophylaxis with cefuroxime to reduce postoperative infectious endophthalmitis rates, and we recommend its incorporation into cataract surgery protocols.

Intraocular pressure screening during high-volume cataract surgery outreach in Ethiopia

IntroductionGlaucoma is the leading cause of irreversible blindness worldwide and is often undetected in resource-limited settings. Early screening and treatment of elevated intraocular pressure (IOP) reduces both the development and progression of visual field defects. IOP screening in developing countries is limited by access to ophthalmic equipment, trained ophthalmic staff, and follow up. High-volume cataract surgery outreaches in resource-limited countries provide ample opportunity for glaucoma screening, intervention and follow up.MethodsThis prospective cross-sectional study took place during a cataract outreach campaign sponsored by the Himalayan Cataract Project (HCP) in partnership with Felege Hiwot Hospital in Bahir Dar, Ethiopia, during April 5th – April 10th 2021. IOP was measured on the surgical eye of patients before undergoing small incision cataract surgery (SICS) using rebound tonometry with an iCare tonometer model IC100.ResultsIntraocular pressure (IOP) was measured in 604 eyes of 595 patients who received SICS. Mean IOP was 12.1 mmHg (SD = 5.0 mmHg). A total of 29 patients had an IOP greater than 21 mmHg representing 4.8% of total IOP measurements. A total of 17 patients received oral acetazolamide prior to surgery to acutely lower IOP. Six of these patients had their surgery delayed due to elevated IOP and 9 patients received excisional goniotomy at the time of SICS. A temporal approach during SCIS was taken for all patients with elevated IOP to allow for possible trabeculectomy at a future date.DiscussionIOP screening during high-volume cataract outreach campaigns can be performed safely, accurately and on a large scale with minimal resources and supplemental training. Pre-operative IOP measurement can improve surgical care at the time of cataract surgery as well as help establish long-term follow up for patients with glaucoma.

Efficacy, safety and visual outcomes of cataract surgeries performed during blindness prevention programs in different locations in Kenya.

To determine the visual outcomes achieved in terms of efficacy and safety during high-volume cataract surgery programs in different locations in Kenya. Eight hundred eighty-one eyes of 849 patients underwent extracapsular cataract extraction with intraocular lens implantation in a retrospective, observational, consecutive cohort study on patients who underwent cataract surgery in five programs that a Spanish non-governmental organization conducted between 2013 and 2019 for the prevention of blindness in different geographical areas of Kenya: Thika, Athi River, Kissi, Bagavathi, and Nakuru. The programs were carried out by Spanish and Kenyan surgeons working together. Mean age was 66.81 ± 14.47 years. Fifty-one percent of the operated eyes (447 eyes) were women. 94% of patients belonged to six ethnic groups. The mean uncorrected distance visual acuity (UDVA) before surgery was 1.98 ± 0.98 logMAR (20/2000), which changed to 0.82 ± 0.68 logMAR (20/150) 3 months after surgeries. The corrected distance visual acuity (CDVA) was 0.4 ± 0.53 logMAR (20/50) 3 months after surgery, 77.5% of the patients had good visual outcomes, and 6.3% had poor outcomes. Preoperative UDVAs were significantly different with respect to the different geographical areas (Kruskal-Wallis; p < 0.001). The most common intraoperative complication was posterior capsule rupture (incidence, 4.2%, 37 of 881), and the most serious complication was expulsive hemorrhage (incidence, 0.1%, 1 of 881). Cataract programs performed in a middle-income country with the proper technique and standardized protocols of action improved the visual outcome of the patients. Dissimilar baseline status was found in different areas regarding preoperative visual acuities. Training programs of local surgeons should be reinforced.

Comparative study between the visual outcome of phacoemulsification and small incision cataract surgery

Introduction Cataract is still one of the most common causes of visual impairment worldwide. Phacoemulsification is the primary method for cataract surgery in developed countries. However, it is associated with high cost and small incision cataract surgery (SICS), which has become an alternative surgery for phacoemulsification, mostly in developing countries. Patients and methods This study was carried out aiming to compare the effectiveness [postoperative visual acuity (VA)] of phacoemulsification versus SICS. Four hundred and fifty cataract patients, allocated into two groups with no statistically significant differences in their basic characteristics, were included in the current study. Patients in the first group underwent phacoemulsification and those in the second group underwent SICS; patients were followed up for 28 days. Results This study revealed no statistically significant differences between the phacoemulsification and SICS groups in visual outcome or proportion of patients with normal vision at follow-up. Furthermore, no statistically significant differences were found between both methods in the incidence of intraoperative or postoperative complications. The effectiveness of phacoemulsification and SICS in improving VA was found to be similar. SICS should be considered for more frequent use in high-volume mass cataract surgery. Conclusion In conclusion, SICS has comparable effectiveness with phacoemulsification in improving VA and should be considered in developing countries and rural areas.

Cataract surgery in surgical camps: outcomes in a rural area of Cameroon.

To assess the complications and visual outcomes of cataract surgery during an outreach eye camp in Cameroon in which two foreign ophthalmologists operate alongside a local one. This is a retrospective and comparative cohort study. The patients were consecutively assigned to three groups depending on the ophthalmologist who performed the cataract surgeries. All eyes underwent manual sutureless incision cataract surgery with posterior chamber intraocular lens (PCIOL) implantation under peribulbar anesthesia. Postoperative visits were scheduled for the first day, first week and second month after the procedures. Intra- and postoperative complications, best-corrected visual acuity and also refractive errors were assessed. A total of 263 eyes underwent cataract extraction with PCIOL implantation. The percentage of eyes in which two or more lines of corrected distance visual acuity decreased were 2.4%, 2.7% and 0% for groups A, B and C, respectively. The percentage of eyes with good visual outcome (uncorrected distance visual acuity UDVA > 20/60) were, respectively, 82.09%, 81.43% and 80.82% for the three groups. Similar results were found between the three groups regarding complications. Ocular hypertension, transient corneal edema and hyphema were the incidences registered at the first postoperative control performed 24h after surgery. The most common complication observed 2months after surgery was posterior capsular opacity (2.6%). High-volume cataract surgery in low- and middle-income countries may have good visual outcomes and a low rate of complications when the procedures are performed by either foreign or local ophthalmologists. A program of high-volume cataract surgery carried out in a rural environment with few resources can give good visual outcomes in the hands of both foreign and local experienced ophthalmologists.

Intra-operative and Immediate Post-operative Complications in a High Volume Cataract Surgery Center

Purpose: To find out the frequency of complications in a high volume phacoemulsification set up at a tertiary care eye hospital in Lahore.&#x0D; Study Design: Quasi experimental study.&#x0D; Place and Duration of Study: Al-Ehsan Eye Hospital, Lahore, from July 2017 to June 2019.&#x0D; Methods: Surgical outcomes of 6902 patients who had undergone phacoemulsification were included. Patients were excluded if they had ocular infections, lid margin diseases, adnexal diseases, those requiring a secondary anterior chamber surgery and those unfit for the procedure due to medical grounds. Every patient underwent a detailed history and complete clinical examination. All patients underwent the standard phacoemulsification technique and at the end of each surgery, subconjunctival injections of dexamethasone and gentamycin were given to the patients. Complications encountered during high volume cataract surgery were recorded and their percentages were calculated.&#x0D; Results: A total of 6902 patients underwent cataract surgery with 2.66% intra-operative and 6.94% immediate post-operative complications. The most common intra-operative complication was posterior capsular rupture (1.15%). In patients with capsular rupture the intra ocular lens was implanted within the sulcus in 61 cases (0.88%) while in 12 cases (0.17%) anterior chamber lens was implanted because of lack of capsular support. During the surgery intra ocular lens could not be implanted in 7 cases (0.10%) and they were left aphakic. The commonest immediate post-operative adverse outcome was corneal edema with striate keratopathy and decements folds in 197 cases (2.85%).&#x0D; Conclusion: High volume cataract surgery using appropriate techniques and sterilization does not compromise the quality of outcomes.&#x0D; Key Words: Cataract, Phacoemulsification, Vitreous loss.

Comparision of surgical induced astigmatism between sics superior and sics temporal

: The aim of this study was to analyze the surgically induced astigmatism in comparison to site of incision superior and temporal in commonly performed SICS technique of cataract surgery. : A prospective interventional study was done on 30 patients who underwent manual small incision cataract surgery (MSICS) divided into two groups namely sics superior group and sics tempral group based on incision-site. The two techniques were compared with respect uncorrected visual acuity, surgically induced astigmatism and type of astigmatism drift. In our study, There was significant difference between techniques regarding best uncorrected visual acuity on 40 post operative day. Greater proportion of patients had good outcomes in both the groups as regards to final visual acuity. Superior incision induced post operative ATR drift (75%) and temporal incision induced WTR astigmatism (70%). : Incision on steep axis is an economical and effective way of reducing pre-existing astigmatism in high-volume and low-cost cataract surgery.

Perbandingan komplikasi antara fakoemulsifikasi dan manual Small-Incision Cataract Surgery (mSICS) pada operasi katarak massal: Sebuah penelitian kohort retrospektif

Cataract is the most common cause of reversible blindness, and its prevalence have been increasing in the community depend on the age. Phacoemulsification and manual Small-Incision Cataract Surgery (mSICS) were the techniques of cataract surgery that was frequently used in high-volume cataract surgery setting. This study aimed to compare the complications between phacoemulsification and mSICS in high-volume cataract surgery. This research was a retrospective cohort study with the data taken from the medical record of high-volume cataract surgery organized by Community Ophthalmology Division, Department of Ophthalmology Universitas Gadjah Mada (UGM) from January 2018 to November 2018. Cataract surgery was performed by consultant ophthalmologists, general ophthalmologist, and senior ophthalmology resident for phacoemulsification and by senior ophthalmology resident and junior ophthalmology resident for mSICS. Intraoperative and postoperative complications (i.e. posterior capsule rupture, vitreous prolapse, aphakia, iridodialysis, endophthalmitis) until four weeks of follow up were compared in both techniques. There were 483 patients who had been operated, 188 (38.9%) patients underwent phacoemulsification and 295 (61.1%) patients underwent mSICS. Intraoperative and postoperative complications in phacoemulsification and mSICS performed by senior ophthalmology resident were no statistically significant different (p &gt; 0.05). Nevertheles, there was statistically significant different in the complication of posterior capsule rupture and aphakia in phacoemulsification based on the level of surgeon’s skill (p &lt; 0.05). Most of them performed by senior ophthalmology resident in 11 (35.5%) cases and 5 (16.1%) cases respectively. However, complications in mSICS were no significantly different based on the level of surgeon’s skill performed by senior ophthalmology resident and junior ophthalmology resident (p &gt; 0.05). Complications in phacoemulsification and mSICS performed by senior ophthalmology resident with relatively similar in the level of surgeon’s skill were not significantly different. However, the complication of posterior capsule rupture and aphakia in phacoemulsification was significantly different based on the level of surgeon’s skill.

Study of Outcome of High Volume Manual Small Incision Cataract Surgery and Complications in Garhwal Himalayan Region

Aim of the Study: To compare High Volume with Low Volume Cataract Surgery Outcomes in a tertiary eye care hospital in Garhwal Himalayan Region, over a 30-day period, in terms of Quality as gauged in terms of Intra-operative complications and their management and Post-operative complications and their management (on day 1 and day 30).&#x0D; Materials and Methods: A prospective, randomized, observational study conducted on 300 eyes of 300 patients at a tertiary hospital, total duration of 4 months was taken for data collection. Patients were divided into 2 groups: A) those coming in the low volume season (summer months) and B) those coming in the high volume season (winter months). Normal standard protocols were followed pre/per/post operatively.&#x0D; Results: Intra-operative complications between the two months (settings) by independent t-test the p value was 1.00 which was not statistically significant (mean of complication: August=0.86+1.83; December=0.86 + 1.29). 1 month post-operative complications between the two months (settings) by independent t-test the p value was 0.56 which was not statistically significant (mean of complication: August=0.09 + 0.30; December=0.18 + 0.4).&#x0D; Conclusion: Intra-operative, post-operative complications on 1st day and at one month follow up, High Volume Cataract Surgery (greaterthan 40 Manual Small Incision Cataract surgeries) does not affect the quality when compared with Low Volume Cataract Surgery over a 30-days period in a tertiary institute in Central India.

SMEC eye care system: Profile and its role in eliminating avoidable blindness in Indonesia

Untreated cataract remains the leading cause of avoidable blindness in Indonesia, as it pointed out 1.9% prevalence of the total population, with incidence of 0.1% and the backlog between 320,000 and 350,000 cases per year. It is reported that 51.6% of people do not know if they suffer from cataracts, 11.6% because they cannot afford it, and 8.1% due to fear of surgery. SMEC eye care system was established with a model similar to Aravind’s to increase the number of cataract surgeries with high volume, high quality, affordable, and accessible cataract surgery, combined with well-designed outreach programs to increase demand. The results are that there are 29 branches of eye hospitals and eye clinics from west to east region of Indonesia, with a total of 58,000 cataract surgeries per year. SMEC also collaborates with private and public hospitals to develop their eye clinics to reach out to more people with blindness. Although with a high volume of cataract surgeries, SMEC only contributed cataract surgical rate of 225, as compared to the national target of 2000, which means that only 11% of total untreated cataract were cured by SMEC. At this rate, SMEC, along with the government and ophthalmologists in Indonesia, still has a lot of homework to do to give more hope to people with blindness.

PHACOEMULSIFICATION

Introduction: Objectives: To find out improvement in visual acuity andcomplications in low socioeconomic status patients that underwent phacoemulsification withlow price IOL in a teaching hospital. Study Design: Descriptive study. Setting: Departmentof Ophthalmology Independent University Hospital, Faisalabad. Period: One year from 01-04-2016 to 31-03-2017. Material and Methods: Composed of 100 patients. In this study Inclusioncriteria was poor old aged patients of both gender having grade one to grade three nuclearsclerosis with or without posterior sub capsular cataract. However patients having history ofuncontrolled hypertension or diabetes mellitus, inadequate dilated pupil, subluxated lens orhaving previous history ocular surgery were excluded. Results: In this study 100 eyes withcataract operated by phacoemulsification with low cost rigid IOL under peribulbar anesthesia.The mean age of patients was 67.50 years (range 50-85 years). Male patients in this studywere fifty Two (52%) While 48% were female Patients. Regarding the visual acuity in operatedeyes with or without glasses, 80 eyes (80 %) had visual acuity of 6/6-6/12, visual acuity of 6/18to 6/36 in 12 eyes and 6 eyes (6 %) had a best corrected visual acuity of 6/60 to CF. Whilevisual acuity less than counting finger (CF) was percent in only 2 percent patients. Discussion:Un-operated cataract can induced severe visual impairment or blindness in cataract patients.In a study conducted in Pakistan reported that in about 76% cases of poor socioeconomicstatus most important barrier to cataract surgery was cost of surgery. According to this studydifferent methods that can be adopted to reduce the cost of surgery by improving efficiencyby conducting high volume cataract surgery and bulk purchasing of consumables surgicalitems especially cheaper intraocular lenses thus allowing even the poorest patients to haveophthalmic care. So it was observed that in patients of poor socioeconomic status numbersof barriers are being faced by such community in which cost is frequently mentioned andproviding low cost phaco surgery with good postoperative vision allow to underwent cataractsurgery who would not otherwise have it. Conclusion: In this study it was concluded that indeveloping countries like Pakistan in which majority of population belong to low socioeconomicstatus phacoemulsification with low cost rigid IOL not only yield good post-operative visualacuity but also reduced cataract induced blindness.

Financial modelling of femtosecond laser-assisted cataract surgery within the National Health Service using a ‘hub and spoke’ model for the delivery of high-volume cataract surgery

AimsTo develop financial models which offset additional costs associated with femtosecond laser (FL)-assisted cataract surgery (FLACS) against improvements in productivity and to determine important factors relating to its implementation into...

An experience of management of cluster endophthalmitis in western hilly rural region of Nepal: A descriptive, interventional study

Infectious endophthalmitis is among the most serious complications of cataract surgery. Cluster endophthalmitis is defined as five or more cases of endophthalmitis occurring on a particular day in a single operating room in one centre. The study aimed to find out causative organisms, ocular status and visual outcome after an outbreak of cluster endophthalmitis in a high volume cataract surgery in a camp. A descriptive, interventional study was carried out in 18 suspected cases of acute endophthalmitis after manual small incision cataract surgery in a single day. All clinically suspected cases underwent vitreous tap and received intravitreal injections. Vitreous samples were sent for staining and KOH mount, culture, sub-culture and sensitivity test was carried out in all vitreous specimens. Standard treatment protocol was followed. Patients were followed up till six weeks. Of the 89 eyes operated, 18 (20.2%) eyes underwent vitreous tap and intravitreal injections. Mean duration of presentation was 36 hours (24 – 48 hours). Commonest presenting symptom was redness 18 (100%), pain 83.3% (15) followed by decreased vision 77.8% (14). 10 (55.6%) eyes were culture negatives while, 8 (44.4%) were culture positive for pseudomonas aeruginosa. Six (33.3%) eyes needed core vitrectomy and repeat intravitreal injections, whereas 2 (11.1%) eyes needed repeat intravitreal injections only. Eight eyes (44.4%) got a normal visual acuity; two eyes (11.1%) fair and 8 eyes (44.4%) had poor visual acuity according to World Health Organisation (WHO) guidelines. Four eyes (22.2%) needed evisceration, while three (16.7%) eyes progressed to phthisis bulbi. Acute post operative endophthalmitis is a serious complication following cataract surgery. Prognosis of cluster endophthalmitis with proven culture positivity to pseudomonas infection is poor even with prompt standard management.

Intraoperative complications of high volume sutureless cataract surgery in Nepal: a prospective study.

With high backlog of cataract blindness in the developing countries sutureless high volume cataract surgery is preferred surgical technique. To report the intraoperative complications of high volume sutureless cataract surgery at secondary level eye care centre of Nepal. This prospective study consisting 1087 eyes that underwent manual small incision cataract surgery from 2nd to 28th December 2007 at Shree Janaki Eye Hospital, Janakpur, Nepal and operated by a single eye surgeon. Preoperative and postoperative ocular findings together with intraoperative complications were carefully noted in every individual case. At post operative day one each patient was examined including uncorrected visual acuity and post operative complications which were subsequently recorded in Performa. Data were analysed using SPSS 11.5. Sixty-three eyes (5.8%) of 1087 eyes developed intraoperative complications. Out of 63 eyes that had intra operative complications, posterior capsular rupture were seen in 42 (3.9%), sclera corneal tunnel suturing in 12 eyes (1.1%), iridodialysis 5 eyes (0.5%) and Descemet stripping in 4 eyes (0.4%). 62.1% of patients attained uncorrected visual acuity 6/18 or better and in 91.7% of eyes, there were no post operative complications. High volume suture less cataract surgery is safe surgery and should be continue in developing countries to achieve the goal of vision 2020, where there is huge backlog of cataract blindness.

Topical Anesthesia in High Volume Cataract Surgery: Pain Evaluation and Feasibility Study

Context: This study was undertaken to evaluate the use of topical anesthesia for Manual small incision cataract surgery in high volume cataract surgery setup. Aims: The primary aim was to evaluate the pain experience of the patients undergoing Manual Small Incision Cataract Surgery (MSICS) under topical anesthesia using 2% lignocaine jelly in high volume cataract surgery setup. Secondary aims were to study any relation between the pain experience and education status, gender and age of the patients. Settings and Design: The study was an Interventional case series conducted at a tertiary care eye hospital. Methods and Material: Patients screened at the peripheral field camps were transported to base hospital and underwent MSICS under topical anesthesia using lignocaine 2% jelly and intracameral 0.5% lignocaine solution. Demographic data and pain experience of the patients during the surgery was recorded and analyzed. Statistical analysis: Statistical analysis was done using MedCalc® version 12.2.1.0 software for Windows 7. Descriptive analysis, Mann-Whitney test, Kruskal-Wallis test, and Spearman’s rho coefficient were used to analyze the data. Results: The study included 270 patients, with average age 62.7 years. Average pain score was 1.6 units (SD ± 0.72, scale 1-5) with ~85% patients reporting comfortable experience. Pain perception had no relation to gender, education status or age. Conclusions: Manual Small Incision Cataract Surgery under topical anesthesia using lignocaine 2% jelly and intracameral lignocaine, in high volume cataract surgeries safe and comfortable to majority of patients and is unaffected by gender, age or educational status of the patients.

Outcome of an outreach microsurgical project in rural Nepal

PurposeThis study is aimed at evaluation of the outcome of an outreach program conducted in the remote Himalayan part of Nepal. Conclusions will be used to improve blindness prevention projects in this country. MethodsA temporary outreach microsurgical clinic was established in Diktel, Nepal. All patients who reported to the clinic were examined. Cases requiring surgical treatment, mostly cataracts, were operated on. Minor ocular diseases were treated on the spot, while the complicated ones were diagnosed, given initial treatment and referred to the nearest eye hospital. ResultsExamination was performed on 1296 patients; 84 subjects underwent manual small incision cataract surgery with intraocular lens implantation. Intraoperative complications included 1 posterior capsule rupture (1.2%). Six weeks following the treatment 98.6% of the operated patients achieved corrected distance visual acuity of 0.3 or better. Out of all 1296 examined individuals, 224 (17.3%) presented visual impairment; 634 (24.5%) of the total number of eyes presented visual acuity of <0.3. In 90.2% of eyes the determinant of loss of sight was avoidable. ConclusionHigh percentage of avoidable blindness, with the majority caused by cataract and refractive errors alone, indicate that appropriate programs focused on these diseases should be implemented. High volume cataract surgery in a camp setting with the application of appropriate surgical techniques and standardized protocols of disinfection and sterilization do not have to compromise on the quality of the outcome.

Follow-Up Survey of Cataract Surgical Coverage and Barriers to Cataract Surgery at Nkhoma, Malawi

Purpose: Nkhoma Eye Hospital, Malawi provides high volume, high quality free cataract surgery to people in its catchment region of Central-Malawi. However, a previous survey in 2000 indicated that only 1 in 7 people with bilateral blindness from cataract had received surgery in a 10-mile radius of Nkhoma.Methods: We conducted a population-based survey in 2006 in the 32 villages within a 10-mile radius of Nkhoma Hospital in people aged ≥ 40 years in order to investigate the cataract surgical coverage (CSC) and barriers to cataract surgery.Results: The prevalence of blindness (visual acuity [VA] <3/60 in better eye) in 835 people aged ≥ 40 was 1.3% (95% CI 0.5–2.1), of which 36.4% was due to cataract. Overall, the CSC was 83.3%, and for eyes (VA<3/60) was 66.0%. The CSC was lower in females compared to males (73.3% vs. 100.0%. P < 0.001). The most common barrier to surgery was cost (58%).Conclusion: Our results demonstrate a 5-fold increase in coverage in the 6 years, primarily by increasing efficiency of the service provider and providing a community screening and referral service. Supporting the ophthalmic personnel with appropriate infrastructure and management has been central to this shift. Implementing an active case finding and referral mechanism has enabled this unit to provide regular high volume cataract surgery. There is a need to understand the factors influencing perceptions about cost as a barrier in this community and the disparity between need and access to services for women.

Pearls and pitfalls of high quality high volume cataract surgery

Pearls and pitfalls of high quality high volume cataract surgery