Visual outcomes of cataract surgeries performed at a network of rural eye centres in southern and eastern India - A model for scaling effective cataract surgical coverage.

PURPOSE: To report the visual outcomes of cataract surgeries performed at a network of rural secondary eyecare centres in southern and eastern India.

METHODS

The multicentric, retrospective data analysis was carried out on cataract surgeries of L V Prasad Eye Institute (Phacoemulsification or Manual Small Incision Cataract Surgeries (MSICS)) performed at 20 rural centres during 2016 to 2020. Patients aged ≥40 years and with the first eye operated during the study period were included. Other surgical procedures were excluded. Data were collected from electronic medical records on age, sex, free or paying surgeries, visual acuity (VA), operated eye, surgical techniques, surgeon category, intraoperative major complications, and associated ocular and systemic diseases. Preoperative and postoperative best-corrected VAs (BCVAs) between 3 and 11 weeks (spectacle appointment) are reported. Risk factors for poor outcomes were analyzed for pseudophakic eyes using univariable and multivariable regression analyses based on BCVA <6/12 and <6/18.

RESULTS

Of the 123,685 cataract surgeries performed, 82% were MSICS. The mean age of the patients was 62.75 years, and 71,542 (57.84%) were females. Free surgeries were offered to 75,158 (60.77%) patients. Ocular (7.86%) and systemic (5.22%) comorbidities were noted. Follow-up visit data at spectacle appointment were available for 98,999 (80%) patients. Preoperative BCVA <6/12 was noted in 110,037 (88.97%), and postoperative BCVA ≥6/12 at spectacle appointment was in 90,191 (91.1%) patients. The risk factors for poor outcomes on regression analysis for BCVA <6/12 were older age, free surgeries, MSICS, intraoperative complications, ocular comorbidities, and surgeries by fellows.

CONCLUSION

Good cataract surgical outcomes are possible in rural secondary centres with the majority of surgeries being performed by the fellows and residents.