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.