Abstract
Purpose :
Cataract is the leading cause of blindness in developing nations. While recent development of inexpensive intraocular lenses (IOL) has led to tens of thousands of cataract surgeries performed annually in developing countries, the range of outcomes across countries remains poorly understood. We analyzed bilaterally blind patients in seven developing regions undergoing cataract surgery to identify variability in outcomes.
Methods :
Bilaterally blind (20/200 or worse) patients who underwent cataract surgery in seven developing nations between 2020 and 2021 were included. We obtained postoperative visual acuity (VA) and patient characteristics including age, sex, and target IOL power. We used multivariate regression (MVR) to study the effects of patient characteristics and preoperative vision on postoperative VA.
Results :
Among the 24,269 patients, the mean pre- to postoperative VA increased from 1.92 (counting fingers) to 0.84 logMAR (20/140). Nepal and Kenya had the highest mean postoperative VAs (0.26 and 0.43 logMAR, respectively) while Ghana and Ethiopia had the lowest (0.93 and 0.84 logMAR, respectively). The adjusted odds of becoming non-blind were highest for Nepalese and Indian compared to Ghanaian (8.23; 95% CI 4.33 – 15.64 and 5.48; 95% CI 4.34 – 6.92) patients (Table 2).
Conclusions :
Visual outcomes in bilaterally blind patients varied across countries from 6% to 35% (India to Ghana) remaining blind (Table 1). Countries with more established cataract programs (India and Nepal) had dramatically better outcomes. There are likely a multitude of contributing factors. We likely underestimate the number of Ghanaian and Ethiopian patients who recover sight because (1) only ~10% of patients had a postop day 30 visit (~70% for Nepal and India) and (2) the majority of surgeries were in outreach settings, where postoperative VA is measured suboptimally (unrefracted and often minutes after eye patch removal). Other contributing factors include ocular comorbidities (3-6x higher rates of glaucoma, sickle cell retinopathy, and no pre-operative B-scans), lower-fidelity preoperative biometry, and possible differences in surgically induced astigmatism and complications. Given the alarming disparity in outcomes (94% vs 65% recovering vision), additional studies should be conducted to identify modifiable contributors.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.