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


Bourne, RR; Dineen, BP; Jadoon, Z; Lee, PS; Khan, A; Johnson, GJ; Foster, A; Khan, D; (2006) Outcomes of cataract surgery in Pakistan: results from The Pakistan National Blindness and Visual Impairment Survey. The British journal of ophthalmology, 91 (4). pp. 420-6. ISSN 0007-1161 DOI: https://doi.org/10.1136/bjo.2006.106724

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Abstract

AIM: To evaluate the outcomes of cataract surgery in Pakistan. METHODS: Cross-sectional, nationally representative sample of 16 507 adults (aged >or=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 >or=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 <or=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 >or=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.

Item Type: Article
Faculty and Department: Faculty of Infectious and Tropical Diseases > Dept of Clinical Research
Research Centre: The International Centre for Evidence in Disability
International Centre for Eye Health
PubMed ID: 17151060
Web of Science ID: 245037700008
URI: http://researchonline.lshtm.ac.uk/id/eprint/10673

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