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Outcomes of cataract surgery in Pakistan: results from The Pakistan National Blindness and Visual Impairment Survey
  1. Rupert Bourne1,
  2. Brendan Dineen2,
  3. Zahid Jadoon3,
  4. Pak S Lee4,
  5. Aman Khan3,
  6. Gordon J Johnson2,
  7. Allen Foster2,
  8. Daud Khan3
  1. 1Department of Ophthalmology, Hinchingbrooke Hospital, Hinchingbrooke Park, Huntingdon, Cambridgeshire, England
  2. 2Clinical Research Unit, Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, England
  3. 3Pakistan Institute of Community Ophthalmology, Khyber Institute of Ophthalmic Medical Sciences, Peshawar, Pakistan
  4. 4Department of Epidemiology and International Eye Health, Institute of Ophthalmology, University College London & Moorfields Eye Hospital, London, England
  1. 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}


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.

  • 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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  • Published Online First 6 December 2006

  • Funding: Sightsavers International; Christoffel Blinden Mission, Fred Hollows Foundation, World Health Organization, Pakistan Office.

  • Competing interests: None declared.