June 2023
Volume 64, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2023
Visual outcomes of bilaterally blind patients undergoing cataract surgery across seven developing world countries
Author Affiliations & Notes
  • Suyoung Choi
    Stanford University School of Medicine, Stanford, California, United States
  • Arthur abrant
    Stanford University School of Medicine, Stanford, California, United States
  • Suzann Pershing
    Stanford University School of Medicine, Stanford, California, United States
    VA Palo Alto Health Care System, Palo Alto, California, United States
  • Natasha Gonzalez
    University of California San Francisco School of Medicine, San Francisco, California, United States
  • Akwasi Ahmed
    Komfo Anokye Teaching Hospital, Kumasi, Ashanti, Ghana
  • Andrew DesLauriers
    University of Vermont Larner College of Medicine, Burlington, Vermont, United States
  • Geoff C. Tabin
    Stanford University School of Medicine, Stanford, California, United States
    VA Palo Alto Health Care System, Palo Alto, California, United States
  • Footnotes
    Commercial Relationships   Suyoung Choi None; Arthur abrant None; Suzann Pershing Acumen LLC, Verana Health, Code C (Consultant/Contractor); Natasha Gonzalez None; Akwasi Ahmed None; Andrew DesLauriers None; Geoff Tabin None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2023, Vol.64, 445. doi:
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      Suyoung Choi, Arthur abrant, Suzann Pershing, Natasha Gonzalez, Akwasi Ahmed, Andrew DesLauriers, Geoff C. Tabin; Visual outcomes of bilaterally blind patients undergoing cataract surgery across seven developing world countries. Invest. Ophthalmol. Vis. Sci. 2023;64(8):445.

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      © ARVO (1962-2015); The Authors (2016-present)

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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.

 

Table 1: Visual Outcomes

Table 1: Visual Outcomes

 

Table 2: MVR odds of bilaterally blind to not blind

Table 2: MVR odds of bilaterally blind to not blind

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