The challenges in improving outcome of cataract surgery in low and middle income countries

• Main Authors: Robert Lindfield, Kalluru Vishwanath, Faustin Ngounou, Rohit C Khanna
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2012-01-01
• Series: Indian Journal of Ophthalmology
• Subjects: Diabetes-related blindness; diabetic retinopathy; key informant; rapid assessment of avoidable blindness; retinopathy of prematurity; tele-ophthalmology; Blindness; disability; equity; health economics; health policy; health and development; social exclusion; Community eye health; prevention of blindness; ophthalmogical residency; VISION 2020; Visual impairment; blindness; inequality; social class; income; educational status; gender and ethnic groups; Advocacy; effective service delivery; enabling environment; stakeholders; resources; Avoidable blindness and visual impairment; impact; scaling up; Global blindness; prevalence; visual impairment; visual acuity; Comprehensive eye care; eye care model; pyramidal model; optometrist; optometry regulation; eye health; India; Economics; market; government; cost; Millennium development goals; Vision 2020 the Right to Sight; eye care services; planning rapid assessment methods; Avoidable blindness; cataract surgical rate; corneal blindness; Compliance; services; Human resource development; service delivery; social entrepreneurship; uncorrected refractive error; cataract extraction; cataract; coverage; data aggregation; population; Case detection; comprehensive eye examination; developing countries; glaucoma; integrated approach; training requirements; Child health policy; childhood blindness; social determinants of eye health; Access; Asia-pacific; funding; low vision; policy; Funding; vision research priorities; peer review; research; Cataract surgery; clinical outcome; patient-reported outcome; quality improvement; quality
• Online Access: http://www.ijo.in/article.asp?issn=0301-4738;year=2012;volume=60;issue=5;spage=464;epage=469;aulast=Lindfield

Cataract is the leading cause of blindness globally and surgery is the only known measure to deal with it effectively. Providing high quality cataract surgical services is critical if patients with cataract are to have their sight restored. A key focus of surgery is the outcome of the procedure. In cataract surgery this is measured predominantly, using visual acuity. Population- and hospital-based studies have revealed that the visual outcome of cataract surgery in many low and middle income settings is frequently sub-optimal, often failing to reach the recommended standards set by the World Health Organization (WHO). Another way of measuring outcome of cataract surgery is to ask patients for their views on whether surgery has changed the functioning of their eyes and their quality of life. There are different tools available to capture patient views and now, these patient-reported outcomes are becoming more widely used. This paper discusses the visual outcome of cataract surgery and frames the outcome of surgery within the context of the surgical service, suggesting that the process and outcome of care cannot be separated. It also discusses the components of patient-reported outcome tools and describes some available tools in more detail. Finally, it describes a hierarchy of challenges that need to be addressed before a high quality cataract surgical service can be achieved.