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Rohit Chandramohan Khanna, Matta Sumathi, Jiwon Park, Gullapalli N Rao; Cataract Surgery Visual Outcomes And Associated Risk Factors In Secondary Level Eye Care Centers Of L V Prasad Eye Institute, India. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):667.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate cataract surgery visual outcomes and associated risk factors in rural secondary level Eye care centers of L V Prasad Eye Institute (LVPEI), India
The Eye Health pyramid of LVPEI has a network of rural secondary care centres (SC) that provide high quality comprehensive eye care to the most disadvantaged sections of society. The most common procedure performed at SC 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 SC attached to LVPEI Eye Health pyramid. All patients received a comprehensive ophthalmic examination. World Health Organization (WHO) 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 less than 6/18.
Mean 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%). Most common procedure was small incision cataract surgery (SICS) with intraocular lens (IOL) implantation (91.8%). Intraoperative complication was seen in 29 eyes (1.4%). At 4-11 weeks follow-up visit, based on presenting visual acuity (PVA), 61.8% had good outcome and based on best corrected visual acuity (BCVA), 91.7% had good outcome. Based on PVA and BCVA, those with less than 6/60 were only 2.9% and 1.6% respectively. Based on multivariable analysis, poor visual outcomes were significantly higher in patients aged 70 or above (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).
This study demonstrates that quality cataract surgeries can be achieved at rural, SC in India. The concept of SC can be applied to other developing countries, allowing more rural patients to attain better vision through cataract surgery. Despite improvement in quality of cataract surgery, gender discrimination in terms of outcome continue to be an issue and need further investigation.
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