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Nathan Congdon, Xixi Yan, Van Lansingh, Ving Chan, Andreas Mueller, Ling Jin, Mirjam Meltzer, Sasipriya Karumanchi, Chunhong Guan, Alemayehu Sisay; PRECOG: Validating the early assessment of vision after cataract surgery. Invest. Ophthalmol. Vis. Sci. 2013;54(15):858.
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Poor post-operative follow-up after cataract surgery makes it difficult in many developing areas to assess outcomes several weeks after surgery, as commonly recommended. We sought to validate early vision measurement as an alternative for assessing surgical quality by comparing vision at hospital discharge with that measured > 50 days later.
Each of 40 centers in 11 countries in Asia, Africa and Latin America recruited 50-100 consecutive patients aged > 30 years without ocular co-morbidities who were undergoing surgery for age-related cataract (ECCE, phacoemulsification or small-incision [SICS]). Centers included small rural clinics and large urban hospitals. Corrected (BCVA) and uncorrected (UCVA) vision in the operative eye were recorded before surgery, at discharge (< 4 days post-operatively) and > 50 days post-operatively. Vision was examined in clinic for patients returning spontaneously, patients not returning by 2 months were contacted by phone and/or offered transportation help, and remaining patients were examined at home.
Among 3712 participants (62% SICS, 84.1% with pre-operative UCVA <= 6/60 in the operative eye), 92.8% had follow-up vision data, and only 44% returned spontaneously to clinic. Final (> 50 days) UCVA was >= 6/18 in 66.7%. The 90th, 75th, 50th and 25th %ile values for proportion of patients with discharge UCVA >= 6/18 were 71.8%, 59.1%, 40.0% and 30.8% respectively. Discharge and final UCVA were highly-correlated (Spearman r = 0.59). When hospitals were ranked by proportion of patients with UCVA >= 6/18, rankings based on discharge UCVA were highly-correlated with those based on final UCVA (r = 0.55). This correlation was not improved by using BCVA (r = 0.54) or dropping patients (10%) undergoing ECCE (r = 0.50). Eliminating the 20% of patients with worst discharge UCVA at each hospital improved the correlation to 0.65. When dividing hospitals into Good (top 25% by proportion with UCVA >= 6/18), Medium (middle 50%) and Poor (bottom 25%), rankings based on discharge and final VA were the same in 26/40 (65%) of hospitals, and no hospital was ranked Good at discharge and Poor at final assessment or vice-versa.
Recording uncorrected vision at hospital discharge is a simple tool for even small, rural clinics performing ECCE to accurately assess cataract surgical quality where follow-up rates are low. These data suggest standards for discharge vision outcomes.
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