Outcome of cataract surgery at one year in Kenya, the Philippines and Bangladesh
- Robert Lindfield (robert.lindfield{at}lshtm.ac.uk),
- Hannah Kuper,
- Sarah Polack,
- Christina Eusebio,
- Wanjiku Mathenge,
- Zakia Wadud,
- Rashid Mamun,
- Allen Foster
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, United Kingdom
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, United Kingdom
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, United Kingdom
- Cataract Foundation of the Philippines, Philippines
- Rift Valley Provincial Hospital, Kenya
- Child Sight Foundation, Bangladesh
- CHER Foundation, Bangladesh
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, United Kingdom
- Published Online First 11 February 2009
Abstract
Aims: To assess the change in vision following cataract surgery in Kenya, Bangladesh and the Philippines and to identify causes and predictors of poor outcome.
Methods: Cases were identified through cross-sectional surveys, community outreach and hospital clinics. They underwent pre-operative visual acuity measurement and ophthalmic examination. Cases were re-examined by an ophthalmologist 8-15 months after cataract surgery. Information on age, gender, poverty and literacy was collected at baseline.
Results: 452 eyes of 346 people underwent surgery. 124 (27%) eyes had an adverse outcome. In Kenya and the Philippines the main cause of adverse outcome was refractive error (37% and 49% respectively of all adverse outcomes) then co-morbid ocular disease (26% and 27%), whilst in Bangladesh this was co-morbid disease (58%) then surgical complications (21%). There was no significant association between adverse outcome and gender, age, literacy, poverty or pre-operative visual acuity.
Conclusions: Adverse outcomes following cataract surgery were frequent in the three countries. The main causes were uncorrected refractive error and pre-operative co-morbidities. Cataract surgical programmes need to improve post-operative outcomes, as many patients are not reaching the potential vision available with modern surgery. There should be a focus on correcting refractive error either through operative techniques or post-operative refraction alongside a system for assessing co morbidities and communicating risk to patients. These can only be achieved if there is a commitment to ongoing surgical audit.
