WORLD VIEW

Outcomes of cataract surgery in Pakistan: results from The Pakistan National Blindness and Visual Impairment Survey

Rupert Bourne¹, Brendan Dineen², Zahid Jadoon³, Pak S Lee⁴, Aman Khan³, Gordon J Johnson², Allen Foster² and Daud Khan³

¹ Department of Ophthalmology, Hinchingbrooke Hospital, Hinchingbrooke Park, Huntingdon, Cambridgeshire, England
² Clinical Research Unit, Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, England
³ Pakistan Institute of Community Ophthalmology, Khyber Institute of Ophthalmic Medical Sciences, Peshawar, Pakistan
⁴ Department of Epidemiology and International Eye Health, Institute of Ophthalmology, University College London & Moorfields Eye Hospital, London, England

Correspondence to:
Correspondence to:
Dr R Bourne
Clinical Research Unit, Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, England; rupert.bourne{at}lshtm.ac.uk

Aim: To evaluate the outcomes of cataract surgery in Pakistan.

Methods: Cross-sectional, nationally representative sample of 16 507 adults (aged 30 years). Each underwent interview, logarithm of the minimum angle of resolution visual acuity (VA), autorefraction, examination of optic disc. Those with <6/12 VA on presentation underwent best-corrected VA and dilated biomicroscopic ocular examination.

Results: 1317 subjects (633 men) had undergone surgery in one or both eyes. Of the 1788 operated eyes, 1099 (61%) had undergone intracapsular cataract extraction (ICCE) and 607 (34%) extracapsular surgery with an intraocular lens (ECCE+IOL). Presenting VA: 275 (15.4%) eyes: 6/12 or better; 253 (14.1) <6/12 6/18; 632 (35.3%) 6/18 to 6/60; 85 (4.8%): 6/60 to 3/60; 528 (29.5%): <3/60. With "best" refractive correction, these values were: 563 (31.5%), 332 (18.6%), 492 (27.5%), 61 (3.4%), 334 (18.7%), respectively. Of the 1498 eyes with VA 6/12 on presentation, 352 (23.5%) were the result of coincident disease, 800 (53.4%) refractive error and 320 (21.4%) operative complications. Eye camp surgery (OR 1.72, p = 0.002), ICCE (OR 3.78; p<0.001), rural residence (OR 1.36, p = 0.01), female gender (OR 1.55, p<0.001) and illiteracy (OR 2.44, p<0.001) were associated with VA of <6/18. More recent ICCE surgeries were associated with a poorer outcome. The ratio of ECCE+IOL:ICCE in the last 3 years was 1.2:1, compared with 1:3.3 4 years before the survey.

Conclusion: Almost a third of cataract operations result in a presenting VA of <6/60, which could be halved by appropriate refractive correction. This study highlights the need for an improvement in quality of surgery with a more balanced distribution of services.

Abbreviations: ECCE+IOL, extracapsular cataract extraction with intraocular lens; ICCE, intracapsular cataract extraction; IOL, intraocular lens; logMAR, logarithm of the minimum angle of resolution; NWFP, North West Frontier province; VA, visual acuity; Nd:YAG, neodymium–yttrium–aluminium–garnet; YAG, yttrium–aluminium–garnet

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