Outcomes of cataract surgery in Pakistan: results from The Pakistan National Blindness and Visual Impairment Survey
- Rupert Richard Bourne (rupert.bourne{at}lshtm.ac.uk),
- Brendan P Dineen,
- Zahid Jadoon,
- Pak S Lee,
- Aman Khan,
- Gordon J Johnson,
- Allen Foster,
- Daud Khan
- London School of Hygiene & Tropical Medicine, United Kingdom
- London School of Hygiene & Tropical Medicine, United Kingdom
- Pakistan Institute of Community Ophthalmology, Pakistan
- Institute of Ophthalmology, London, United Kingdom
- Pakistan Institute of Community Ophthalmology, Pakistan
- London School of Hygiene & Tropical Medicine, United Kingdom
- London School of Hygiene & Tropical Medicine, United Kingdom
- Pakistan Institute of Community Ophthalmology, Pakistan
- Published Online First 6 December 2006
Abstract
Aim: To evaluate the outcome of cataract surgery in Pakistan.
Methods: Cross-sectional, nationally representative sample of 16,507 adults (aged ≥30 years). Each underwent: interview, logMAR visual acuity (VA), autorefraction, optic disc examination. 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/both eyes. Of 1788 operated eyes, 1099 (61%) had undergone intracapsular cataract extraction (ICCE) and 607 (34%) extracapsular surgery with intraocular lens (ECCE+IOL). Presenting VA: 275 eyes (15.4%): 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 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 to 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.
