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Parajuli S, Dhakhwa P, Adhikary R. Deferring Postoperative Follow‑Up Visits up to 4 Weeks After Uneventful Cataract Surgery in a Tertiary Level Eye Hospital: Protocol for a Prospective, Quantitative, Experimental Control Study. JMIR Res Protoc 2023; 12:e48616. [PMID: 37651180 PMCID: PMC10502588 DOI: 10.2196/48616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Routine examination after cataract surgery, including a refraction test 4 to 6 weeks after surgery, is mandatory in most hospitals. In recent years, there has been growing interest in exploring alternative approaches to postoperative follow-up in cataract surgery patients due to the increasing number of cataract surgeries being performed, the limited availability of health care resources, and the need to optimize the use of health care services. OBJECTIVE We aim to compare postoperative visual outcomes after a day 0 examination in patients with 2 follow‑ups, one on day 7 and other on day 30, and patients with a single ophthalmic follow‑up between days 25 to 30. METHODS A prospective, quantitative, experimental control study will be carried out in Reiyukai Eiko Masunaga Eye Hospital, located in Banepa, Kavrepalanchok, Nepal. All patients undergoing cataract surgery meeting the inclusion and exclusion criteria irrespective of the type of surgery (small-incision cataract surgery or phacoemulsification) will be included in the study. The patients will be randomly assigned to 1 of 2 groups. Patients in group 1 will be examined on day 1, day 7, and day 30, whereas patients in group 2 will be examined on day 1 and once between days 25 to 30. The minimum clinically important difference (MCID) in our study will be set according to the improvement in the Snellen visual acuity chart. RESULTS The study is expected to be completed within 6 to 8 months from the start of the project. Data analysis and report writing will be carried out in a 2-month period. Best-corrected visual acuity will be compared between the 2 groups to determine if the MCID is achieved. The cost-effectiveness of the new approach will also be analyzed. CONCLUSIONS We aim to conclude that we can safely defer the 1-week postoperative follow-up visit in patients undergoing uncomplicated cataract surgery and that, moreover, we can reduce the patient load at the hospital and decrease patient expenses by decreasing the frequency of hospital visits. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/48616.
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Chow SC, Lam PY, Choy BNK. Patient-centred care in ophthalmology: current practices, effectiveness and challenges. Graefes Arch Clin Exp Ophthalmol 2022; 260:3149-3159. [PMID: 35445876 DOI: 10.1007/s00417-022-05666-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/16/2022] [Accepted: 04/08/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To summarise different patient-centred care approaches that can be used in ophthalmology and review their effectiveness. METHODS An Entrez Pubmed search on publications concerning different patient-centred care was performed on September 7, 2021. Articles on animal research, non-English language and review articles were excluded after manually screening by two authors. RESULTS A total of 16 articles were reviewed after curation by the authors for relevance. Patient-centred care has advantages in improving disease knowledge, enhancing doctor-patient communications and improving mental well-being of patients. Various methods including intensive patient education, patient-centred communication techniques during consultations, personal disease records, education programme for caregivers, on-site ocular care for residential care home resident and shared medical appointments can be used to enhance patient-centred care. CONCLUSIONS Current strategies in patient-centred care in ophthalmology were found to be useful. However, they have not been widely practised and more studies would be required generate an evidence-based recommendation for future use.
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Affiliation(s)
- Shing Chuen Chow
- LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Pun Yuet Lam
- LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Bonnie Nga Kwan Choy
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Room 301, Block B, Cyberport 4, Cyberport, Hong Kong, Hong Kong.
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Bedaso A, Mekonnen N, Duko B. Prevalence and factors associated with preoperative anxiety among patients undergoing surgery in low-income and middle-income countries: a systematic review and meta-analysis. BMJ Open 2022; 12:e058187. [PMID: 35277412 PMCID: PMC8919464 DOI: 10.1136/bmjopen-2021-058187] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES This review aimed to determine the pooled prevalence of preoperative anxiety and its associated factors among patients undergoing surgery in low/middle-income countries (LMICs). METHODS We searched PubMed, SCOPUS, CINAHL, Embase and PsychINFO to identify peer-reviewed studies on the prevalence and factors associated with preoperative anxiety among patients undergoing surgery using predefined eligibility criteria. Studies were pooled to estimate the prevalence of preoperative anxiety using a random-effect meta-analysis model. Heterogeneity was assessed using I² statistics. Funnel plot asymmetry and Egger's regression tests were used to check for publication bias. RESULT Our search identified 2110 studies, of which 27 studies from 12 countries with 5575 participants were included in the final meta-analysis. Of the total 27 studies, 11 used the State-Trait Anxiety Inventory to screen anxiety, followed by the Amsterdam Preoperative Anxiety and Information scale, used by four studies. The pooled prevalence of preoperative anxiety among patients undergoing surgery in LMICs was 55.7% (95% CI 48.60 to 62.93). Our subgroup analysis found that a higher pooled prevalence of preoperative anxiety was found among female surgical patients (59.36%, 95% CI 48.16 to 70.52, I2=95.43, p<0.001) and studies conducted in Asia (62.59%, 95% CI 48.65 to 76.53, I2=97.48, p<0.001). CONCLUSION Our meta-analysis indicated that around one in two patients undergoing surgery in LMICs suffer from preoperative anxiety, which needs due attention. Routine screening of preoperative anxiety symptoms among patients scheduled for surgery is vital. PROSPERO REGISTRATION NUMBER CRD42020161934.
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Affiliation(s)
- Asres Bedaso
- Hawassa University, College of Medicine and Health Sciences, School of Nursing, Hawassa, Ethiopia
- Australian Centre for Public and Population Health Research, School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Nibretie Mekonnen
- Hawassa University, College of Medicine and Health Sciences, School of Nursing, Hawassa, Ethiopia
| | - Bereket Duko
- Hawassa University, College of Medicine and Health Sciences, School of Nursing, Hawassa, Ethiopia
- Curtin University, School of Population Health, Department of Public Health, Perth, Western Australia, Australia
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Ravindran RD, Gupta S, Haripriya A, Ravilla T, S AV, Subburaman GBB. Seven-year trends in cataract surgery indications and quality of outcomes at Aravind Eye Hospitals, India. Eye (Lond) 2021; 35:1895-1903. [PMID: 32913291 PMCID: PMC8225659 DOI: 10.1038/s41433-020-0954-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 04/27/2020] [Accepted: 04/30/2020] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To report trends in cataract surgery indications, visual acuity outcomes, complication rates and reoperation rates at ten Aravind Eye Hospitals in Tamil Nadu, India. METHODS In this retrospective database study we analyzed seven years of data of cataract surgeries at Aravind during January 1, 2012 to December 31, 2018. Our main outcome measures were preoperative and 1-month postoperative uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA); and rates of intraoperative complications and reoperations. We performed Cochran-Armitage trend tests. RESULTS In 1.86 million eyes that underwent cataract surgery, the percentage of eyes undergoing phacoemulsification (PE) showed an increasing trend (p < 0.0001), from 26.8% in 2012 to 33.5% in 2018. The percentage of eyes undergoing manual small incision cataract surgery (SICS) showed a decreasing trend (p < 0.0001), from 70.0% in 2012 to 65.1% in 2018. For SICS, the percentages of eyes with good postoperative UCVA and BCVA showed increasing trends (p < 0.0001 for each), and the percentages of eyes with poor postoperative UCVA and BCVA showed decreasing trends (p < 0.0001 for each). Results for PE surgeries were mixed. For both PE and SICS rates of intraoperative complications showed a declining trend (p < 0.0001 for each) and a slight increasing trend for reoperations (PE p < 0.02; SICS p < 0.0001). CONCLUSIONS During this seven-year period there were noticeable trends in cataract surgeries performed at Aravind in terms of the mix of surgical procedures, preoperative vision, and cataract surgical outcomes.
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Affiliation(s)
| | - Sachin Gupta
- SC Johnson College of Business, Cornell University, Ithaca, NY, USA
| | | | | | - Ashok Vardhan S
- Cataract Services, Sri Venkateswara Aravind Eye Hospital, Tirupati, India
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Factors associated with visual outcomes after cataract surgery: A cross-sectional or retrospective study in Liberia. PLoS One 2020; 15:e0233118. [PMID: 32421741 PMCID: PMC7233528 DOI: 10.1371/journal.pone.0233118] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 04/28/2020] [Indexed: 11/29/2022] Open
Abstract
Objective To report the initial outcomes and associated risk factors for poor outcome of cataract surgery performed in Liberia Methods and analysis LV Prasad Eye Institute (LVPEI), Hyderabad, started providing eye care in Liberia since July 2017. Electronic Medical Records of 573 patients operated for age-related cataract from July 2017 to January 2019 were reviewed. One eye per patient was included for analysis. All patients underwent either phacoemulsification or manual small incision cataract surgery (MSICS). Pre and postoperative uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA) were recorded at one day, 1–3 weeks and 4–11 weeks. Main outcome measure was BCVA at 4–11 weeks; Intraoperative complications and preoperative ocular comorbidities (POC) were noted. BCVA less than 6/12 was classified as visual impairment (VI). Risk factor for VI was analysed using the logistic regression model. Results Of the 573 patients, 288 were males and 285 were females (49.7%). Mean age was 65.9±10.9 years; 14.3% had POC. The surgical technique was mainly MSICS (94.59%, n = 542). At 4–11 weeks, good outcome of 6/12 or better was noted in 38.55% (UCVA) and 82.54% (BCVA). Visual acuity (VA) of 6/18 or better as UCVA and BCVA was noted in 63.5% and 88% eyes respectively. Poor outcome of less than 6/60 was noted as UCVA (11.11%) and BCVA (5.22%). Multivariable analysis showed poor visual outcomes significantly higher in patients with POC (odds ratio 3.28; 95% CI: 1.70, 6.34). Conclusion The cataract surgical outcomes in Liberia were good; with ocular comorbidities as the only risk factor.
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Louie A, Meyerle C, Francomano C, Srikumaran D, Merali F, Doyle JJ, Bower K, Bloom L, Boland MV, Mahoney N, Daoud Y, Singman EL. Survey of Ehlers-Danlos Patients' ophthalmic surgery experiences. Mol Genet Genomic Med 2020; 8:e1155. [PMID: 31989797 PMCID: PMC7196452 DOI: 10.1002/mgg3.1155] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 01/07/2020] [Accepted: 01/11/2020] [Indexed: 01/24/2023] Open
Abstract
Background Ehlers‒Danlos Syndrome (EDS) is a rare disease affecting approximately 1 in 5,000 people. Although ophthalmic conditions associated with EDS have been described, little data exist concerning ophthalmic surgical outcomes experienced by EDS patients. Methods Patients with EDS were surveyed via the EDS Society and asked about their ophthalmic surgical experiences including procedure, complications, and the timing with respect to receiving the EDS diagnosis. Complications were confirmed as such by subspecialists. Results Of 579 respondents, 467 reported confirmed EDS, and 112 of those had an ophthalmic procedure, including refractive surgery, cataract/lens surgery, retinal surgery, strabismus surgery, oculoplastic surgery, corneal surgery, and laser surgery for glaucoma. The rate of confirmed complications was: 23%‐refractive, 33%‐lens/cataract, 33%‐retina, 59%‐strabismus, 23%‐ oculoplastics, 0%‐cornea, and 25%‐glaucoma laser. In addition, 76% of patients underwent surgery prior to the EDS diagnosis. Conclusions Patients with EDS may have elevated risk of postoperative ophthalmic surgical complications. It would seem reasonable to systemically and prospectively explore how patients with EDS respond to ophthalmic surgery. Furthermore, it would seem circumspect to ask surgical candidates patients about whether they carry a diagnosis of EDS or have signs and symptoms of EDS prior to surgery.
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Affiliation(s)
- Anita Louie
- Johns Hopkins University, Baltimore, MD, USA
| | | | - Clair Francomano
- Harvey Institute for Medical Genetics of Greater Baltimore Medical Center, Baltimore, MD, USA
| | - Divya Srikumaran
- Wilmer Eye Institute of Johns Hopkins Hospital, Baltimore, MD, USA
| | - Farhan Merali
- Wilmer Eye Institute of Johns Hopkins Hospital, Baltimore, MD, USA
| | | | - Kraig Bower
- Wilmer Eye Institute of Johns Hopkins Hospital, Baltimore, MD, USA
| | | | - Michael V Boland
- Wilmer Eye Institute of Johns Hopkins Hospital, Baltimore, MD, USA
| | - Nicholas Mahoney
- Wilmer Eye Institute of Johns Hopkins Hospital, Baltimore, MD, USA
| | - Yassine Daoud
- Wilmer Eye Institute of Johns Hopkins Hospital, Baltimore, MD, USA
| | - Eric L Singman
- Wilmer Eye Institute of Johns Hopkins Hospital, Baltimore, MD, USA
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Mueller B, Ibraimova S, Mamutalieva E, Limburg H, Ibraimova A, Paduca A. Findings from a Rapid Assessment of Avoidable Blindness (RAAB) in the Southwest Region of Kyrgyzstan. Ophthalmic Epidemiol 2019; 27:141-147. [PMID: 31813309 DOI: 10.1080/09286586.2019.1701040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: Reliable data on eye care needs in Kyrgyzstan are not readily available. The purpose of this study was to determine the prevalence and causes of blindness and visual impairment in persons aged 50 and above in the southwest of Kyrgyzstan and to support the Ministry of Health (MoH) in the planning of eye care in the region.Methods: A population-based survey was conducted in three states (Oblast) in the southwest region of Kyrgyzstan. Sixty clusters of 50 people aged 50 years and older were selected by probability proportionate to size sampling. Ethical approval was obtained from the MoH, consent was obtained from each participant.Results: A total number of 3,000 persons aged 50 and older were sampled. Among these 2,897 (95.9%) were examined. The prevalence of bilateral blindness was 1.7% [95%CI: 1.1-2.4]. Cataract (43.3%) was the main cause of blindness, followed by glaucoma (30%), age-related macular degeneration (ARMD) (8.3%), other posterior segment diseases (6.7%) and non-trachomatous corneal opacities (5%). The prevalence of blindness and visual impairment increased strongly with age. The cataract surgical coverage in blind persons was 59%.Conclusion: Cataract and glaucoma were the major causes of blindness and visual impairment in persons 50 and above. The majority of the causes (85%) were avoidable, with 45% (cataract and uncorrected aphakia) treatable, 6.7% (corneal opacity and phthisis) preventable by primary health care/eye care services and 33.3% (cataract surgical complications, glaucoma) preventable by specialized ophthalmic services. The data suggest that an expansion of eye care services to reduce avoidable blindness is needed, as ageing will lead to an increase in older people at risk and a higher demand for eye care in the future.
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Affiliation(s)
- Brigitte Mueller
- International Cooperation Department, Swiss Red Cross, International Cooperation, Wabern, Switzerland
| | | | - Elzat Mamutalieva
- International Cooperation Department, Swiss Red Cross, International Cooperation, Wabern, Switzerland
| | - Hans Limburg
- Health Information Services, Grootebroek, Netherlands
| | - Aigul Ibraimova
- Bishkek Scientific Research Centre of Traumatology and Orthopedics, Bishkek, Kyrgyzstan
| | - Ala Paduca
- Ophthalmology Department, State University of Medicine and Pharmacy "Nicolae Testemitanu", Chisinau, Republic of Moldova
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Gupta S, Ravindran RD, Subburaman GBB, S AV, Ravilla T. Predictors of patient compliance with follow-up visits after cataract surgery. J Cataract Refract Surg 2019; 45:1105-1112. [PMID: 31174984 DOI: 10.1016/j.jcrs.2019.02.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 02/13/2019] [Accepted: 02/20/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To identify patient characteristics associated with follow-up compliance and to draw implications for better cataract treatment services. SETTING Aravind Eye Hospital, Madurai, India. DESIGN Retrospective case study. METHODS The data of all cataract surgeries performed in 2015 were analyzed. After each surgery, patients were asked to return for follow-up after 1 month. The follow-up rates were compared between patients with different demographic characteristics, surgical factors, and preoperative and discharge visual acuities. The behaviors of patients who complied with the follow-up advice were analyzed, including the number of days from surgery to follow-up and number of follow-up visits. Multivariate regression models were used to identify predictors associated with these behaviors. RESULTS The overall follow-up rate for the 86 776 surgeries analyzed was 85.6%. Patients more likely to follow-up were women, younger than 70 years, and paying (versus subsidized or free) and had phacoemulsification rather than manual small-incision cataract surgery (all P < .001). Patients who had complications, reoperations, or poorer visual acuity at discharge were less likely to comply with the follow-up advice (P < .001). CONCLUSIONS Targeted interventions to boost follow-up rates should be directed to patients with the characteristics found in this study. Furthermore, average measures of visual outcomes at 4 weeks are likely to be overstated relative to the truth.
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Affiliation(s)
- Sachin Gupta
- Johnson Graduate School of Management, Cornell University, Ithaca, New York, USA
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Fortané M, Bensaid P, Resnikoff S, Seini K, Landreau N, Paugam JM, Nagot N, Mura T, Serrand C, Villain M, Daien V. Outcomes of cataract surgery performed by non-physician cataract surgeons in remote North Cameroon. Br J Ophthalmol 2018; 103:1042-1047. [PMID: 30291137 DOI: 10.1136/bjophthalmol-2018-312428] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 07/12/2018] [Accepted: 08/28/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To report the outcomes of cataract surgery performed by non-physician cataract surgeons due to lack of ophthalmologists in remote areas of North Cameroon. DESIGN Prospective cohort study. SETTING The main centre of the non-governmental organisation Ophtalmo Sans Frontières in Lagdo. PARTICIPANTS AND INTERVENTIONS Age-related cataract surgery performed between 28 November 2016 and 17 May 2017. MAIN OUTCOMES MEASURES The main outcome measure was presenting visual acuity (PVA) 1-4 weeks after surgery, classified according to the WHO as good (PVA ≥6/18), borderline (PVA 6/60-6/18) and poor (PVA <6/60). The WHO definition of blindness (visual acuity <3/60) and severe visual acuity (visual acuity 3/60-6/60) was used to assess the proportion of patients with a change in WHO category. RESULTS We included 474 eyes of 474 patients; the mean (SD) age was 63.9 (15) years (42.2% female). At 1-4 weeks after surgery, the surgical outcome was good for 170 patients (41.1%), borderline for 213 (51.5%) and poor for 31 (7.5%). In all, 224 patients (47.2%) had blindness or severe visual impairment before cataract surgery and 22 (5.3%) at 1-4 weeks after surgery. Poor visual outcome was associated with older age (p=0.018), preoperative blindness or severe impairment (p=0.012) and surgical complications (p=0.019). CONCLUSION Blindness and severe visual impairment were significantly decreased in the early postoperative period. Poor outcomes were associated with older age, low preoperative binocular visual acuity and intraoperative complications. Non-physician cataract surgeons may compensate for the lack of ophthalmologists in remote areas of low-income and middle-income countries.
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Affiliation(s)
- Magali Fortané
- Department of Ophthalmology, Gui De Chauliac Hospital, Montpellier, France
| | | | - Serge Resnikoff
- Brien Holden Vision Institute, University of New South Wales, Sydney, New South Wales, Australia.,Organisation Pour la prévention de la Cécité (OPC), Paris, France
| | - Kali Seini
- Ophtalmo Sans Frontières, Lagdo, Cameroon
| | | | | | - Nicolas Nagot
- Department of Medical Information, La Colombière Hospital, Montpellier, France
| | - Thibault Mura
- Department of Medical Information, La Colombière Hospital, Montpellier, France.,INSERM (Institut National de la Santé Et de la Recherche Médicale), Montpellier, France
| | - Chris Serrand
- Department of Medical Information, La Colombière Hospital, Montpellier, France
| | - Max Villain
- Department of Ophthalmology, Gui De Chauliac Hospital, Montpellier, France
| | - Vincent Daien
- Department of Ophthalmology, Gui De Chauliac Hospital, Montpellier, France .,INSERM (Institut National de la Santé Et de la Recherche Médicale), Montpellier, France.,The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
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Rapp DE, Colhoun A, Morin J, Bradford TJ. Assessment of communication technology and post-operative telephone surveillance during global urology mission. BMC Res Notes 2018; 11:149. [PMID: 29467031 PMCID: PMC5822548 DOI: 10.1186/s13104-018-3256-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 02/14/2018] [Indexed: 11/10/2022] Open
Abstract
Objective Compliance with post-operative follow-up in the context of international surgical trips is often poor. The etiology of this problem is multifactorial and includes lack of local physician involvement, transportation costs, and work responsibilities. We aimed to better understand availability of communication technologies within Belize and use this information to improve follow-up after visiting surgical trips to a public hospital in Belize City. Accordingly, a 6-item questionnaire assessing access to communication technologies was completed by all patients undergoing evaluation by a visiting surgical team in 2014. Based on this data, a pilot program for patients undergoing surgery was instituted for subsequent missions (2015–2016) that included a 6-week post-operative telephone interview with a visiting physician located in the United States. Results Fifty-four (n = 54) patients were assessed via survey with 89% responding that they had a mobile phone. Patients reported less access to home internet (59%), local internet (52%), and email (48%). Of 35 surgical patients undergoing surgery during 2 subsequent surgical trips, 18 (51%) were compliant with telephone interview at 6-week follow-up. Issues were identified in 3 (17%) patients that allowed for physician assistance. The cost per patient interview was $10 USD. Electronic supplementary material The online version of this article (10.1186/s13104-018-3256-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- David E Rapp
- University of Virginia School of Medicine, Charlottesville, Virginia, USA. .,Global Surgical Expedition, 5829 Ascot Glen Drive, Glen Allen, VA, 23059, USA.
| | - Andrew Colhoun
- Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA.,Virginia Urology, Richmond, Virginia, USA
| | - Jacqueline Morin
- Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Timothy J Bradford
- Virginia Urology, Richmond, Virginia, USA.,Global Surgical Expedition, 5829 Ascot Glen Drive, Glen Allen, VA, 23059, USA
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Visual Acuity at 6 Weeks after Small Incision Cataract Surgery and Role of Audit in Predicting Visual Acuity. Eur J Ophthalmol 2018; 20:345-52. [DOI: 10.1177/112067211002000214] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Aliyu H, Mustak H, Cook C. Using the Postoperative Visual Acuity to Monitor the Quality of Cataract Surgery: Does the Day One Visual Acuity following Cataract Surgery Correlate with the Final Visual Acuity? Middle East Afr J Ophthalmol 2017; 24:91-93. [PMID: 28936053 PMCID: PMC5598309 DOI: 10.4103/meajo.meajo_279_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
PURPOSE: Monitoring the visual acuity following cataract surgery is used as a measure of the quality of the surgery in blindness prevention programs in middle- and low-income countries. While the day 1 visual acuity is usually available, the (final) visual acuity after several weeks may not be available, as the majority of patients may not return for review. This study was undertaken to ascertain if the early and late visual acuities are correlated and if the day 1 visual acuity can be used to predict the likely final visual acuity. METHODS: A retrospective case note review was undertaken of all eyes having cataract surgery over a 6-month period. RESULTS: There was a positive correlation between the day 1 and week 6 visual acuities in both the World Health Organization categories (Spearman coefficient = 0.4666, P = 0.001) and the logMAR visual acuity scores (Spearman coefficient = 0.5425, P = 0.001). CONCLUSION: In blindness prevention programs in middle- and low-income countries with poor postoperative follow-up where it is not possible to document the final visual acuity in all the operated cases, there is merit in documenting and monitoring the day 1 visual acuity as a quality control measure.
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Affiliation(s)
- Halimatu Aliyu
- Department of Surgery, Ophthalmology Unit, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Hamzah Mustak
- Division of Ophthalmology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Colin Cook
- Division of Ophthalmology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
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Buchan JC, Dean WH, Foster A, Burton MJ. What are the priorities for improving cataract surgical outcomes in Africa? Results of a Delphi exercise. Int Ophthalmol 2017. [PMID: 28634930 PMCID: PMC6061020 DOI: 10.1007/s10792-017-0599-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE The quality of cataract surgery delivered in sub-Saharan Africa (SSA) is a significant constraint to achieving the elimination of avoidable blindness. No published reports from routine SSA cataract services attain the WHO benchmarks for visual outcomes; poor outcomes (<6/60) often comprise 20% in published case series. This Delphi exercise aimed to identify and prioritise potential interventions for improving the quality of cataract surgery in SSA to guide research and eye health programme development. METHODS An initial email open-question survey created a ranked list of priorities for improving quality of surgical services. A second-round face-to-face discussion facilitated at a Vision 2020 Research Mentorship Workshop in Tanzania created a refined list for repeated ranking. RESULTS Seventeen factors were agreed that might form target interventions to promote quality of cataract services. Improved training of surgeons was the top-ranked item, followed by utilisation of biometry, surgical equipment availability, effective monitoring of outcomes of cataract surgery by the surgeon, and well-trained support staff for the cataract pathway (including nurses seeing post-operative cases). CONCLUSION Improving the quality of cataract surgery in SSA is a clinical, programmatic and public health priority. In the absence of other evidence, the collective expert opinion of those involved in ophthalmic services regarding the ranking of factors to promote quality improvement, refined through this Delphi exercise, provides us with candidate intervention areas to be evaluated.
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Affiliation(s)
- J C Buchan
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - W H Dean
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - A Foster
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - M J Burton
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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Ramke J, Gilbert CE, Lee AC, Ackland P, Limburg H, Foster A. Effective cataract surgical coverage: An indicator for measuring quality-of-care in the context of Universal Health Coverage. PLoS One 2017; 12:e0172342. [PMID: 28249047 PMCID: PMC5382971 DOI: 10.1371/journal.pone.0172342] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 02/03/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To define and demonstrate effective cataract surgical coverage (eCSC), a candidate UHC indicator that combines a coverage measure (cataract surgical coverage, CSC) with quality (post-operative visual outcome). METHODS All Rapid Assessment of Avoidable Blindness (RAAB) surveys with datasets on the online RAAB Repository on April 1 2016 were downloaded. The most recent study from each country was included. By country, cataract surgical outcome (CSOGood, 6/18 or better; CSOPoor, worse than 6/60), CSC (operated cataract as a proportion of operable plus operated cataract) and eCSC (operated cataract and a good outcome as a proportion of operable plus operated cataract) were calculated. The association between CSC and CSO was assessed by linear regression. Gender inequality in CSC and eCSC was calculated. FINDINGS Datasets from 20 countries were included (2005-2013; 67,337 participants; 5,474 cataract surgeries). Median CSC was 53.7% (inter-quartile range[IQR] 46.1-66.6%), CSOGood was 58.9% (IQR 53.7-67.6%) and CSOPoor was 17.7% (IQR 11.3-21.1%). Coverage and quality of cataract surgery were moderately associated-every 1% CSC increase was associated with a 0.46% CSOGood increase and 0.28% CSOPoor decrease. Median eCSC was 36.7% (IQR 30.2-50.6%), approximately one-third lower than the median CSC. Women tended to fare worse than men, and gender inequality was slightly higher for eCSC (4.6% IQR 0.5-7.1%) than for CSC (median 2.3% IQR -1.5-11.6%). CONCLUSION eCSC allows monitoring of quality in conjunction with coverage of cataract surgery. In the surveys analysed, on average 36.7% of people who could benefit from cataract surgery had undergone surgery and obtained a good visual outcome.
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Affiliation(s)
- Jacqueline Ramke
- School of Social Sciences, Faculty of Arts and Social Sciences, University of New South Wales, Sydney, New South Wales, Australia
- School of Population Health, University of Auckland, Auckland, New Zealand
- * E-mail:
| | - Clare E. Gilbert
- Department Clinical Research, Faculty Infectious & Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Arier C. Lee
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Peter Ackland
- International Agency for the Prevention of Blindness, London, United Kingdom
| | - Hans Limburg
- Health Information Services, Nijenburg 32, Grootebroek, Netherlands
| | - Allen Foster
- Department Clinical Research, Faculty Infectious & Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Mavrakanas N, Dhalla KA, Jecha J, Kapesa I, Odouard C, Murdoch I. Results and safety profile of trainee cataract surgeons in a community setting in East Africa. Indian J Ophthalmol 2016; 64:818-821. [PMID: 27958204 PMCID: PMC5200983 DOI: 10.4103/0301-4738.195594] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Purpose: To evaluate the results and safety profile of assistant medical officer ophthalmologists (AMO-O) performing cataract surgery in the last stage of their surgical training, before their appointment to local communities. Methods: We retrospectively analyzed the records of patients who underwent cataract surgery by AMO-Os at Dar es Salaam, Comprehensive Community Based Rehabilitation for Tanzania Disability Hospital between September 2008 and June 2011. Surgical options were either extracapsular cataract extraction (ECCE) or manual small incision cataract surgery (MSICS), both with polymethylmethacrylate intraocular lens implantation. Results: Four hundred and fourteen patients were included in the study. Two hundred and twenty-five (54%) underwent ECCE and 189 had MSICS. Mean logarithm of the minimum angle of resolution (logMAR) uncorrected visual acuity (UCVA) improved from 2.4 ± 0.6 preoperatively to 1.3 ± 0.8 1 week postoperatively (t-test, P < 0.001) and to 1.1 ± 0.7 3 months postoperatively (t-test, P < 0.001). Mean logMAR best-corrected visual acuity (BCVA) was 0.7 ± 0.5 1 week postoperatively and 0.6 ± 0.5 3 months postoperatively. There was no significant difference in mean logMAR UCVA (P = 0.7) and BCVA (P = 0.7) postoperatively between ECCE and MSICS. 89.5% achieved BCVA better than 6/60 and 57.3% better than 6/18 with a follow-up of 3 months. Posterior capsule rupture and/or vitreous loss occurred in 34/414 patients (8.2%) and was more frequent (P = 0.047) in patients undergoing ECCE (10.2%) compared with MSICS (5.3%). Conclusion: AMO-O cataract surgeons at the end of their training offer significant improvement in the visual acuity of their patients. Continuous monitoring of outcomes will guide further improvements in surgical skills and minimize complications.
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Affiliation(s)
- Nikolaos Mavrakanas
- Department of Ophthalmology, Glaucoma Service, Moorfields Eye Hospital, London, UK
| | - Kazim A Dhalla
- Department of Ophthalmology, Comprehensive Community Based Rehabilitation in Tanzania Disability Hospital, Dar es Salaam, Tanzania
| | - Jerry Jecha
- Department of Ophthalmology, Comprehensive Community Based Rehabilitation in Tanzania Disability Hospital, Dar es Salaam, Tanzania
| | - Imani Kapesa
- Department of Ophthalmology, Comprehensive Community Based Rehabilitation in Tanzania Disability Hospital, Dar es Salaam, Tanzania
| | - Capucine Odouard
- Department of Ophthalmology, Sydney Hospital and Sydney Eye Hospital, Sydney, Australia
| | - Ian Murdoch
- Institute of Ophthalmology, University College London, London, UK
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Pawiroredjo JC, Minderhoud J, Mans DRA, Themen HCI, Bueno de Mesquita-Voigt AMT, Siban MR, Forster-Pawiroredjo CM, Moll AC, van Nispen RMA, Limburg H. The cataract situation in Suriname: an effective intervention programme to increase the cataract surgical rate in a developing country. Br J Ophthalmol 2016; 101:89-93. [PMID: 27836828 DOI: 10.1136/bjophthalmol-2016-308659] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 09/26/2016] [Accepted: 10/21/2016] [Indexed: 11/03/2022]
Abstract
AIMS To provide an overview of cataract data in Suriname and to describe and evaluate a programme to control cataract blindness in a developing country. DESIGN Evaluation of hospital data and findings from a population-based cross-sectional survey. METHODS The implementation of a new cataract surgical intervention programme was described and retrospectively evaluated by analysing the number of cataract operations and other related indicators at the Suriname Eye Centre (SEC) in the period 2006-2014. Findings of the recent Rapid Assessment of Avoidable Blindness (2013-2014) survey were used to evaluate the national cataract situation in Suriname in people aged ≥50 years (n=2998), including prevalence of cataract blindness, outcome and cataract surgical rate (CSR). RESULTS Since the implementation of a new cataract intervention programme, the number of cataract operations at the SEC has increased from 1150 in 2006 to 4538 in 2014, leading to an estimated national CSR of 9103 per one million inhabitants. The prevalence of bilateral cataract blindness in Suriname was 0.8% (95% CI 0.2% to 1.3%) in individuals aged ≥50 years. The proportion of eyes with a postoperative visual acuity <6/60 (poor outcome) was lowest in eyes operated at the SEC (8.5%) and highest in surgeries performed by foreign humanitarian ophthalmic missions. CONCLUSIONS The cataract situation in Suriname is well under control since the implementation of the new intervention programme. Important factors contributing to this success were the introduction of phacoemulsification, intensive training, and improvement in the affordability and accessibility of cataract surgery. The proportion of poor outcomes was still >5%.
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Affiliation(s)
| | - Janna Minderhoud
- Suriname Eye Centre, Academic Hospital Paramaribo, Paramaribo, Suriname.,Department of Ophthalmology and EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Dennis R A Mans
- Department of Pharmacology, Faculty of Medical Sciences, Anton de Kom University of Suriname, Paramaribo, Suriname
| | - Herman C I Themen
- Suriname Eye Centre, Academic Hospital Paramaribo, Paramaribo, Suriname
| | | | - Michael R Siban
- Suriname Eye Centre, Academic Hospital Paramaribo, Paramaribo, Suriname
| | | | - Annette C Moll
- Department of Ophthalmology and EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Ruth M A van Nispen
- Department of Ophthalmology and EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Hans Limburg
- Health Information Services, Grootebroek, The Netherlands
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17
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Yang K, Jin L, Li L, Zeng S, Dan A, Chen T, Wang X, Li G, Congdon N. Preoperative characteristics and compliance with follow-up after trabeculectomy surgery in rural southern China. Br J Ophthalmol 2016; 101:131-137. [PMID: 27073204 DOI: 10.1136/bjophthalmol-2015-308331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 03/05/2016] [Accepted: 03/19/2016] [Indexed: 11/03/2022]
Abstract
PURPOSE To evaluate preoperative characteristics and follow-up in rural China after trabeculectomy, the primary treatment for glaucoma there. METHODS Patients undergoing trabeculectomy at 14 rural hospitals in Guangdong and Guangxi Provinces and their doctors completed questionnaires concerning clinical and sociodemographic information, transportation, and knowledge and attitudes about glaucoma. Follow-up after surgery was assessed as cumulative score (1 week: 10 points, 2 weeks: 7 points, 1 month: 5 points). RESULTS Among 212 eligible patients, mean preoperative presenting acuity in the operative eye was 6/120, with 61.3% (n=130) blind (≤6/60). Follow-up rates were 60.8% (129/212), 75.9% (161/212) and 26.9% (57/212) at 1 week, 2 weeks and 1 month, respectively. Patient predictors of poor follow-up included elementary education or less (OR=0.37, 95% CI 0.20 to 0.70, p=0.002), believing follow-up was not important (OR=0.62, 95% CI 0.41 to 0.94, p=0.02), lack of an accompanying person (OR=0.14, 95% CI 0.07 to 0.29, p<0.001), family annual income <US$800 (OR=0.28, 95% CI 0.11 to 0.72, p=0.008) and not requiring removal of scleral flap sutures postoperatively (OR=0.11, 95% CI 0.06 to 0.22, p<0.001). Age, sex, employment, travel distance/time/costs, patient preoperative clinical factors and physician factors were unassociated with follow-up. CONCLUSIONS Follow-up after 2 weeks was inadequate to provide optimal clinical care, and surgery is being applied too late to avoid blindness in the majority of patients. Earlier surgery, support for return visits and better explanations of the importance of follow-up are needed. Directing all patients to return for possible scleral flap suture removal may be a valid strategy to improve follow-up.
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Affiliation(s)
- Ke Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.,Department of Ophthalmology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Ling Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Li Li
- Department of Ophthalmology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Siming Zeng
- Department of Ophthalmology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Aihua Dan
- Red Cross Hospital of Yunnan Province, Kunming, China
| | - Tingting Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xiuqin Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.,Affiliated Hospital of Guangdong Medical College, Zhanjiang, Guangdong, China
| | - Guirong Li
- Department of Ophthalmology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Nathan Congdon
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.,ORBIS International, New York, USA.,Queen's University Belfast, Belfast, UK
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18
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Pikacha N, Murray N. Cataract Surgery Outcomes From a Resident Training in a Low-Resource Setting in the Pacific. Asia Pac J Ophthalmol (Phila) 2015; 4:346-9. [PMID: 26270009 DOI: 10.1097/apo.0000000000000135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The aim of the study was to assess the overall quality of the cataract surgeries performed by a single resident during training in a core surgical competency in a low-resource environment. DESIGN This was a retrospective cohort review of cataract surgeries performed by a single surgeon. METHODS A retrospective chart review of all consecutive cases of cataract surgery, in patients older than age 20, performed by 1 resident during the residency period was undertaken. The low-resource residency training program was based in Suva, Fiji, and provided outreach services to other Pacific Islands. The main outcome measures were visual outcomes and sentinel complications in terms of World Health Organization recommendations and reports from high- and low-resource settings that were used as quality benchmarks. RESULTS Complete data were available for 95% (670) of cataract surgeries. Five hundred eighty-nine patients (87.9%) had preoperative vision worse than 6/60. Three hundred eighty-seven surgeries (53.6%) were performed on outreach. Five hundred eighty-three (87%) achieved final postoperative best-corrected visual acuity of 6/18 or greater. The overall sentinel complication rate was 4% (26) and comprised posterior capsule rupture 2.7% (18), vitreous loss 1% (7), and endophthalmitis 0.15% (1). CONCLUSIONS Visual outcomes and sentinel complication rates were comparable not only with World Health Organization recommendations but also with other low- and high-resource environment training programs.
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Affiliation(s)
- Nola Pikacha
- From *National Referral Hospital, Honiara, Guadalcanal, Solomon Islands; and †The Fred Hollows Foundation New Zealand, Auckland, New Zealand
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19
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Oliver G, Murray N, Gusmao JM, Dawson Hayes J. Benchmarking cataract surgical outcomes in Timor-Leste. Clin Exp Ophthalmol 2015; 44:212-3. [PMID: 26383699 DOI: 10.1111/ceo.12654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 09/12/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Genevieve Oliver
- National Eye Centre, Guido Valadares National Hospital, Bidau, Dili, East Timor.,The Fred Hollows Foundation of New Zealand, Auckland, New Zealand
| | - Neil Murray
- The Fred Hollows Foundation of New Zealand, Auckland, New Zealand
| | - Januario M Gusmao
- National Eye Centre, Guido Valadares National Hospital, Bidau, Dili, East Timor.,The Fred Hollows Foundation of New Zealand, Auckland, New Zealand
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20
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Lansingh VC, Eckert KA, Strauss G. Benefits and risks of immediately sequential bilateral cataract surgery: a literature review. Clin Exp Ophthalmol 2015; 43:666-72. [PMID: 25824813 DOI: 10.1111/ceo.12527] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 03/23/2015] [Indexed: 11/28/2022]
Abstract
Immediately sequential bilateral cataract surgery (ISBCS) is a highly contended issue in ophthalmology, mainly due to the risk of bilateral endophthalmitis and financial penalties that many ophthalmologists face when performing simultaneous cataract surgeries. The purpose of this review is to understand the current status of the knowledge of ISBCS, mainly its benefits and risks and how they compare with the standard of care, delayed sequential bilateral cataract surgery. Evidence, although limited, increasingly supports ISBCS for providing faster rehabilitation, improved visual outcomes, and cost and time savings. Evidence does not support the fear of bilateral endophthalmitis resulting from the simultaneous procedure. However, stronger and greater evidence is needed before ISBCSs can be considered the standard of care. Where ISBCS can potentially create the most beneficial impact is in public eye health programmes in developing countries, but this has not yet been explored.
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Affiliation(s)
- Van C Lansingh
- Instituto Mexicano de Oftalmología Circuito Exterior Estadio Corregidora S/N, Querétaro, Querétaro, Mexico.,Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Science Center, Memphis, Tennesee, USA.,HelpMeSee, New York, New York, USA
| | - Kristen A Eckert
- Independent Consultant in Prevention of Blindness, Tapachula, Chiapas, Mexico
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21
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Lundström M, Manning S, Barry P, Stenevi U, Henry Y, Rosen P. The European registry of quality outcomes for cataract and refractive surgery (EUREQUO): a database study of trends in volumes, surgical techniques and outcomes of refractive surgery. EYE AND VISION 2015; 2:8. [PMID: 26613089 PMCID: PMC4660846 DOI: 10.1186/s40662-015-0019-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 04/21/2015] [Indexed: 11/24/2022]
Abstract
Background A European web-based registry for refractive surgery was established in 2008; The European Registry of Quality Outcomes for Cataract and Refractive Surgery (EUREQUO). The aim of the registry was to improve treatment and standards of care for refractive surgery. Further aims were to offer a tool for benchmarking by establishing a reference database and for surgeons to enter and analyze their own outcomes. The purpose of this study was to characterize the registry and analyze the data collected during its first decade. Methods The characteristics of the web-based registry are described. Data collected from February 4th 2004 until June 30th 2014 are included in the analysis. The database is analyzed in terms of surgical technique, indications for surgery, complications, and refractive and visual outcomes. Results Data have been reported from 47 centers in 14 countries until mid-2014. About 4,000 procedures were reported annually. The most frequent procedure was laser-assisted in-situ keratomileusis (LASIK) with 11697 reported surgeries. Over time in the database, LASIK declined (p < 0.001) while photorefractive keratectomy (PRK) and refractive lens exchange (RLE) increased (p < 0.001 for both procedures). The indications for surgery, in terms of preoperative refraction and age, were stable over time, for all types of procedures. Surgical complications were reported infrequently and with a well-known relationship to the type of surgical procedure. The reported refractive outcomes were good. The visual outcomes indicate a significant increase of visual acuity after high myopia treatment by phakic intraocular lens in the anterior (phakic IOL AC) and the posterior (phakic IOL PC) chamber and a poorer visual outcome, after both myopia and hyperopia treatment, by epithelial LASIK (Epi-LASIK). Conclusions We describe the establishment of a European registry for refractive surgery. The database increases at a rate of approximately 4000 refractive procedures per year. The most frequent procedure is LASIK, but both PRK and RLE are an increasing part of the reported procedures. The indications for surgery have been stable over time. Surgical complications and visual outcome vary, depending on the type of surgery.
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Affiliation(s)
- Mats Lundström
- Department of Clinical Sciences, Ophthalmology, Faculty of Medicine, Lund University, Lund, Sweden
| | - Sonia Manning
- Department of Ophthalmology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Peter Barry
- Department of Ophthalmology, St. Vincent's University Hospital, Dublin, Ireland
| | - Ulf Stenevi
- Department of Ophthalmology, Sahlgren's University Hospital, Molndal, Sweden
| | - Ype Henry
- Department of Ophthalmology, Vumc, Amsterdam, The Netherlands
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Haastrup OOO, Buchan JC, Cassels-Brown A, Cook C. Are we monitoring the quality of cataract surgery services? A qualitative situation analysis of attitudes and practices in a large city in South Africa. Middle East Afr J Ophthalmol 2015; 22:220-5. [PMID: 25949081 PMCID: PMC4411620 DOI: 10.4103/0974-9233.151878] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
PURPOSE To evaluate the current quality "assurance" and "improvement" mechanisms, the knowledge, attitudes and practices of cataract surgeons in a large South African city. METHODOLOGY A total of 17 in-depth semi-structured interviews were conducted with ophthalmologists in June 2012 at 2 tertiary institutions in the Republic of South Africa. Recruitment of the purposive sample was supplemented by snowball sampling. The study participants were 5 general ophthalmologists and 2 pediatric ophthalmologists; 4 senior and 4 junior registrars and a medical officer. Participants were interviewed by a trained qualitative interviewer. The interview lasted between 20 and 60 min. The interviews were recorded, transcribed verbatim and analyzed for thematic content. RESULTS Mechanisms for quality assurance were trainee logbooks and subjective senior staff observation. Clinicians were encouraged, but not obliged to self-audit. Quality improvement is incentivized by personal integrity and ambition. Poorly performing departments are inconspicuous, especially nationally, and ophthalmologists rely on the impression to gauge the quality of service provided by colleagues. Currently, word of mouth is the method for determining the better cataract surgical centers. CONCLUSION The quality assurance mechanisms were dependent on insight and integrity of the individual surgeons. No structures were described that would ensure the detection of surgeons with higher than expected complication rates. Currently, audits are not enforced, and surgical outcomes are not well monitored due to concerns that this may lead to lack of openness among ophthalmologists.
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Affiliation(s)
| | - John C. Buchan
- Department of Ophthalmology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Andy Cassels-Brown
- Academic Unit of Public Health, Nuffield Institute for International Health, Leeds Institute for Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Colin Cook
- Department of Ophthalmology, Grootes Schuur Hospital, University of Cape Town, Cape Town, South Africa
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Ademuyiwa A, Alabi E, Idiodi-Thomas H, Bankole O, Elebute O, Alakaloko F, Desalu I, Bode C. Surgical management of pygopagus parasiticus in a developing country: Challenges and review of the literature. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2015. [DOI: 10.1016/j.epsc.2014.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Olawoye OO, Ashaye AO, Bekibele CO, Ajayi BGK. Visual outcome after cataract surgery at the university college hospital, ibadan. Ann Ib Postgrad Med 2014; 9:8-13. [PMID: 25161481 PMCID: PMC4111036 DOI: 10.4314/aipm.v9i1.72428] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Aim: The aim of this study was to determine the visual outcome
of patients who had cataract surgery in the University College
Hospital Ibadan. Methodology: This is an observational descriptive, longitudinal
study of consecutive patients undergoing cataract surgery at
the University College Hospital conducted between May and
October 2007. A total of 184 patients who presented to the
hospital and met the inclusion criteria were recruited into the
study. Patients were examined preoperatively, 1st day
postoperatively and 8th week postoperatively. Results: The mean age was 66.5 years; and the male to female
ratio was 1.2:1. Preoperatively, 137 patients (74.5%) were blind
in the operated eye, while 39 patients (23.6%) were blind in
both eyes at presentation. At 1st day postoperatively, 87 patients
(47.3%) had pinhole visual acuity of 6/6-6/18. Best corrected
vision after refraction eight weeks postoperatively showed that
127 patients out of 161 patients (78.8%) had good vision while
28 patients (17.4%) had borderline vision, and six patients (3.8%)
had severe visual impairment after refraction. The number of
bilaterally blind patients also reduced from 39 (23.6%) to one
(0.6%). Uncorrected refractive error was the commonest cause
of poor vision prior to refraction. Glaucoma was the commonest
ocular co-morbidity accounting for poor vision in 9.1% of
patients eight weeks after cataract surgery. Conclusion: This study demonstrates that good results can be
obtained with cataract surgery and intraocular lens implantation
in the developing world. More attention should be directed
towards ensuring that successful outcomes are indeed being
realized by continued monitoring of postoperative visual
outcomes and prompt refraction for all patients.
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Affiliation(s)
- O O Olawoye
- Department of Ophthalmology, University College Hospital Ibadan, Nigeria
| | - A O Ashaye
- Department of Ophthalmology, University College Hospital Ibadan, Nigeria
| | - C O Bekibele
- Department of Ophthalmology, University College Hospital Ibadan, Nigeria
| | - B G K Ajayi
- Ojulowo Specialist Eye Centre, Mokola Ibadan
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Habtamu E, Eshete Z, Burton MJ. Cataract surgery in Southern Ethiopia: distribution, rates and determinants of service provision. BMC Health Serv Res 2013; 13:480. [PMID: 24245754 PMCID: PMC3842739 DOI: 10.1186/1472-6963-13-480] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 11/04/2013] [Indexed: 11/29/2022] Open
Abstract
Background Cataract is the leading cause of blindness worldwide, with the greatest burden found in low-income countries. Cataract surgery is a curative and cost-effective intervention. Despite major non-governmental organization (NGO) support, the cataract surgery performed in Southern Region, Ethiopia is currently insufficient to address the need. We analyzed the distribution, productivity, cost and determinants of cataract surgery services. Methods Confidential interviews were conducted with all eye surgeons (Ophthalmologists & Non-Physician Cataract Surgeons [NPCS]) in Southern Region using semi-structured questionnaires. Eye care project managers were interviewed using open-ended qualitative questionnaires. All eye units were visited. Information on resources, costs, and the rates and determinants of surgical output were collected. Results Cataract surgery provision is uneven across Southern Region: 66% of the units are within 200 km of the regional capital. Surgeon to population ratios varied widely from 1:70,000 in the capital to no service provision in areas containing 7 million people. The Cataract Surgical Rate (CSR) in 2010 was 406 operations/million/year with zonal CSRs ranging between 204 and 1349. Average number of surgeries performed was 374 operations/surgeon/year. Ophthalmologists and NPCS performed a mean of 682 and 280 cataract operations/surgeon/year, respectively (p = 0.03). Resources are underutilized, at 56% of capacity. Community awareness programs were associated with increased activity (p = 0.009). Several factors were associated with increased surgeon productivity (p < 0.05): working for >2 years, working in a NGO/private clinic, working in an urban unit, having a unit manger, conducting outreach programs and a satisfactory work environment. The average cost of cataract surgery in 2010 was US$141.6 (Range: US$37.6–312.6). Units received >70% of their consumables from NGOs. Mangers identified poor staff motivation, community awareness and limited government support as major challenges. Conclusions The uneven distribution of infrastructure and personnel, underutilization by the community and inadequate attention and support from the government are limiting cataract surgery service delivery in Southern Ethiopia. Improved human resource management and implementing community-oriented strategies may help increase surgical output and achieve the “Vision 2020: The Right to Sight” targets for treating avoidable blindness.
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Affiliation(s)
- Esmael Habtamu
- International Centre for Eye Health, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.
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Abstract
PURPOSE To determine the visual outcomes achieved in terms of efficacy and safety during a mass eye surgery campaign in a low-income developing country. METHODS Three hundred fifteen eyes of 305 patients underwent extracapsular cataract extraction with intraocular lens implantation in a prospective, analytical, experimental, and nonrandomized study on patients who underwent cataract surgery during the campaign that two Spanish nongovernmental organizations conducted in December 2008 in a district hospital in Bobo-Dioulasso (Burkina Faso). RESULTS Mean age was 61.97 ± 14.39 years. The mean uncorrected distance visual acuity before surgery was 2.17 ± 0.7 (20/3000), which improved to 0.86 ± 0.64 logMAR (20/150) 3 months after cataract surgery. The mean spherical equivalent at 3 months was -0.87 ± 1.90 diopters. The corrected distance visual acuity was 0.52 ± 0.44 logMAR (20/60) 3 months after surgery, 68.7% of the patients had good visual outcomes, and 9.16% had poor outcomes. A total of 41.4% of the operated eyes showed a spherical equivalent within ± 1.00 diopter of emmetropia. The most common intraoperative complication was posterior capsule rupture (incidence, 2.9%, 9 of 315), and the most serious complication was expulsive hemorrhage (incidence, 0.3%, 1 of 315). Three months after surgery, 2.9% (9 of 315) of the eyes was affected by posterior capsular opacity. CONCLUSIONS A mass cataract campaign performed in a developing country with the proper technique and standardized protocols of action improved the visual outcome of the patients. The rate of incidence of extracapsular extractions is comparable to that estimated for developed countries.
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Assessment of cataract surgical outcomes in settings where follow-up is poor: PRECOG, a multicentre observational study. LANCET GLOBAL HEALTH 2013; 1:e37-45. [PMID: 25103584 DOI: 10.1016/s2214-109x(13)70003-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Poor follow-up after cataract surgery in developing countries makes assessment of operative quality uncertain. We aimed to assess two strategies to measure visual outcome: recording the visual acuity of all patients 3 or fewer days postoperatively (early postoperative assessment), and recording that of only those patients who returned for the final follow-up examination after 40 or more days without additional prompting. METHODS Each of 40 centres in ten countries in Asia, Africa, and Latin America recruited 40-120 consecutive surgical cataract patients. Operative-eye best-corrected visual acuity and uncorrected visual acuity were recorded before surgery, 3 or fewer days postoperatively, and 40 or more days postoperatively. Clinics logged whether each patient had returned for the final follow-up examination without additional prompting, had to be actively encouraged to return, or had to be examined at home. Visual outcome for each centre was defined as the proportion of patients with uncorrected visual acuity of 6/18 or better minus the proportion with uncorrected visual acuity of 6/60 or worse, and was calculated for each participating hospital with results from the early assessment of all patients and the late assessment of only those returning unprompted, with results from the final follow-up assessment for all patients used as the standard. FINDINGS Of 3708 participants, 3441 (93%) had final follow-up vision data recorded 40 or more days after surgery, 1831 of whom (51% of the 3581 total participants for whom mode of follow-up was recorded) had returned to the clinic without additional prompting. Visual outcome by hospital from early postoperative and final follow-up assessment for all patients were highly correlated (Spearman's rs=0·74, p<0·0001). Visual outcome from final follow-up assessment for all patients and for only those who returned without additional prompting were also highly correlated (rs=0·86, p<0·0001), even for the 17 hospitals with unprompted return rates of less than 50% (rs=0·71, p=0·002). When we divided hospitals into top 25%, middle 50%, and bottom 25% by visual outcome, classification based on final follow-up assessment for all patients was the same as that based on early postoperative assessment for 27 (68%) of 40 centres, and the same as that based on data from patients who returned without additional prompting in 31 (84%) of 37 centres. Use of glasses to optimise vision at the time of the early and late examinations did not further improve the correlations. INTERPRETATION Early vision assessment for all patients and follow-up assessment only for patients who return to the clinic without prompting are valid measures of operative quality in settings where follow-up is poor. FUNDING ORBIS International, Fred Hollows Foundation, Helen Keller International, International Association for the Prevention of Blindness Latin American Office, Aravind Eye Care System.
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Kalua K, Lewallen S, Courtright P. Update on cataract and its management in Africa. EXPERT REVIEW OF OPHTHALMOLOGY 2013. [DOI: 10.1586/eop.13.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Luján S, Alburquerque M, Pizango O. Use of quality of life questionnaires for the evaluation of patients subjected to cataract surgery. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2013; 88:162-163. [PMID: 23597649 DOI: 10.1016/j.oftal.2012.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Accepted: 04/08/2012] [Indexed: 06/02/2023]
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Murthy GVS, John N, Shamanna BR, Pant HB. Elimination of avoidable blindness due to cataract: where do we prioritize and how should we monitor this decade? Indian J Ophthalmol 2013; 60:438-45. [PMID: 22944756 PMCID: PMC3491272 DOI: 10.4103/0301-4738.100545] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: In the final push toward the elimination of avoidable blindness, cataract occupies a position of eminence for the success of the Right to Sight initiative. Aims: Review existing situation and assess what monitoring indicators may be useful to chart progress towards attaining the goals of Vision 2020. Settings and Design: Review of published papers from low and middle income countries since 2000. Materials and Methods: Published population-based data on prevalence of cataract blindness/visual impairment were accessed and prevalence of cataract blindness/visual impairment computed, where not reported. Data on prevalence of cataract blindness, cataract surgical coverage at different visual acuity cut offs, surgical outcomes, and prevalence of cataract surgery were analyzed. Scatter plots were used to look at relationships of some variables, with Human Development Index (HDI) rank. Available data on Cataract Surgical Rate (CSR) was plotted against prevalence of cataract surgery reported from surveys. Results: Worse HDI Ranks were associated with higher prevalence of cataract blindness. Most studies showed that a significant proportion of the blind were covered by surgery, while a fifth showed that a significant proportion, were operated before they went blind. A good visual outcome after surgery was positively correlated with higher surgical coverage. CSR was positively correlated with cataract surgical coverage. Conclusions: Cataract surgical coverage is increasing in most countries at vision <3/60 and visual outcomes after cataract surgery are improving. Establishing population-based surveillance of cataract surgical need and performance is a strong monitoring tool and will help program planners immensely.
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Affiliation(s)
- Gudlavalleti V S Murthy
- Indian Institute of Public Health and South Asia Centre for Disability Inclusive Development and Research, Hyderabad, India
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Mörchen M, Mao N, Ang C, Bonn TS. Outcome and Monitoring of Cataract Surgical Services at Takeo Province, Cambodia. ASIA-PACIFIC JOURNAL OF OPHTHALMOLOGY (PHILADELPHIA, PA.) 2012; 1:340-4. [PMID: 26107726 DOI: 10.1097/apo.0b013e3182710eff] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate outcome and monitoring of cataract surgical services at Takeo Eye Hospital, Cambodia DESIGN A prospective, hospital-based report using a cataract surgical record form from the International Center for Eye Health, London. METHODS Data including preoperative and postoperative visual acuity (VA), proportion of ocular pathology, intraoperative and postoperative complications, type of surgery, and causes of poor outcome of all patients with cataract were collected. Exclusion criteria were age of patients being younger than 20 years, combined cataract-glaucoma surgeries, and having traumatic cataract. RESULTS A total of 8211 cataract surgeries were performed from January 2007 to December 2011. Preoperatively, the presenting VA was less than 6/60 in 65.8%. At discharge, 51.8% had a presenting VA of 6/18 or better.Outcome was poor (VA < 6/60) in 10.6%. Over 5 years, the percentage of patients with poor outcome decreased from 12.6% to 8.5%. Total operative complications decreased from 18.2% in 2007 to 3.3% in 2011, with a reduction of vitreous loss from 6.5% to 1.8%. Of all surgeries, 21.2% were performed by resident physicians. At the first follow-up 1 to 3 weeks postoperatively, 62.6% of the patients presented, whereas 23.9% presented for a second follow-up after 4 to 6 weeks. CONCLUSIONS Monitoring of cataract surgical services indicated an increase in quantity and quality. Hospital-based data collection as recommended by the World Health Organization action plan for the prevention of avoidable blindness is possible, but biased data collection has to be considered in the interpretation of the data.
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Affiliation(s)
- Manfred Mörchen
- From the Caritas Takeo Eye Hospital, Takeo Province, Cambodia
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Outcomes of manual small-incision cataract surgery using standard 22 dioptre intraocular lenses at Nkhoma Eye Hospital, Malawi. Int Ophthalmol 2012; 32:341-7. [PMID: 22556104 DOI: 10.1007/s10792-012-9565-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Accepted: 04/12/2012] [Indexed: 12/13/2022]
Abstract
The aim of this study was to investigate the outcomes of sutureless, manual small-incision cataract surgery (SICS) in rural sub-Saharan Africa using standard intraocular lenses (IOLs). In order to assess the quality of surgery, we prospectively evaluated the visual outcomes of 1455 consecutive cataract operations performed in 2006 in patients ≥40 years at Nkhoma Eye Hospital, Malawi. All operations used standard 22-dioptre IOLs without pre-operative biometry. Outcomes were categorised according to the World Health Organization criteria, and causes of a poor outcome were recorded. Mean age of patients was 71.5 ± 9.5 years, and 53 % were female. Pre-operatively, 64 % of eyes had a visual acuity (VA) <6/60, and 41.3 % of eyes were blind (VA < 3/60). Without correction (uncorrected VA), nearly eighty percent (78.7 %) achieved a 'good' outcome (VA 6/6-6/18), 19.8 % were 'borderline' (VA < 6/18-6/60), and 1.5 % had a poor (VA < 6/60) outcome. With pinhole-correction, the proportion of good outcomes increased to 89.4 %, and poor outcomes decreased to 0.9 %. Poor outcomes were most commonly due to ocular co-morbidities (54.5 %) and refractive error (36.4 %). Older age and pre-operative blindness were strongly associated with borderline or poor visual outcomes. The most common surgical complication was posterior capsule tear (without vitreous loss). In a rural African environment, using standard IOL power plus SICS can lead to a high proportion of good outcomes and a low frequency of surgical complications. A comparative study is required to determine if any additional benefit in visual outcomes can be gained by the addition of biometry.
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Huang G, Crooms R, Chen Q, Congdon N, He M. Compliance with Follow-up after Cataract Surgery in Rural China. Ophthalmic Epidemiol 2012; 19:67-73. [DOI: 10.3109/09286586.2011.628777] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Briesen S, Roberts H. The challenge of follow-up visits after cataract surgery in the developing world. Clin Exp Ophthalmol 2012; 40:119-20. [PMID: 22417181 DOI: 10.1111/j.1442-9071.2012.02754.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bani A, Wang D, Congdon N. Early assessment of visual acuity after cataract surgery in rural Indonesia. Clin Exp Ophthalmol 2011; 40:155-61. [DOI: 10.1111/j.1442-9071.2011.02667.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Walia T, Yorston D. Improving surgical outcomes. COMMUNITY EYE HEALTH 2008; 21:58-9. [PMID: 19287544 PMCID: PMC2643034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Tony Walia
- Ophthalmologist and Medical Director, PCEA Kikuyu Hospital, Kikuyu Eye Unit, Kikuyu, Kenya
| | - David Yorston
- Consultant Ophthalmologist, Tennent Institute of Ophthalmology, Gartnavel Hospital, 1053 Great Western Road, Glasgow G12 0YN, UK
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Yorston D. Cataract complications. COMMUNITY EYE HEALTH 2008; 21:1-3. [PMID: 18504465 PMCID: PMC2377378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- David Yorston
- Consultant Ophthalmologist, Tennent Institute of Ophthalmology, Gartnavel Hospital, 1053 Great Western Road, Glasgow G12 0YN, Scotland
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Ezegwui IR, Ajewole J. Monitoring cataract surgical outcome in a Nigerian mission hospital. Int Ophthalmol 2007; 29:7-9. [PMID: 18087677 DOI: 10.1007/s10792-007-9182-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2007] [Accepted: 11/29/2007] [Indexed: 11/26/2022]
Abstract
AIM To evaluate the visual outcome of cataract operations in a Nigerian mission hospital. METHODS The computer system cataract surgery record forms were used to collect data on the first 100 consecutive cataract surgeries performed in January and part of February 2003 at a Nigerian mission hospital, Mercy Eye Centre, Abak. RESULTS There were 54 males and 30 females (100 eyes). Sixteen patients had bilateral cataract. The mean age was 58.45 years (SD 13.58). Four patients were hypertensive, 3 diabetic, 2 both hypertensive and diabetic; and also 2 both hypertensive and asthmatic. Four patients had post-uveitic cataract, 3 traumatic cataract, 1 subluxated cataract not related to trauma and the rest had age-related cataract. One patient each had age-related macular degeneration and glaucoma. Only 42 patients (49 eyes) kept with their follow-up visits until 12 weeks post-operatively. Among these, pin hole or corrected visual acuity of 6/6-6/18 was achieved in 35.4%, <6/18-6/60 in 50%, and <6/60 in 14.6%. Almost half of those with poor outcome were attributed to inappropriate selection. CONCLUSION The main cause of poor visual outcome in our centre is unsuspected co-morbidity. In spite of this, there is potential for good quality cataract surgery in Africa. As we pay more attention to appropriate patient selection we expect our outcome to improve. Provision of facilities for biometry would also be a great help in this direction.
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Affiliation(s)
- Ifeoma Regina Ezegwui
- Department of Ophthalmology, Enugu State University of Science & Technology Teaching Hospital, Parklane, Enugu, Nigeria.
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Chang MA, Congdon NG, Baker SK, Bloem MW, Savage H, Sommer A. The surgical management of cataract: barriers, best practices and outcomes. Int Ophthalmol 2007; 28:247-60. [PMID: 17712529 DOI: 10.1007/s10792-007-9121-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2006] [Accepted: 06/11/2007] [Indexed: 10/22/2022]
Abstract
Cataract is the leading cause of blindness in the world. Cataract surgery has been shown by multiple studies to be one of the most cost-effective health interventions, and leads to a dramatic increase in quality of life and productivity for many patients. Though there has been marked improvement in the last several decades, surgical delivery services in developing nations are still suboptimal, and a large backlog in cataract cases continues to grow. To decrease this backlog, barriers to surgery, such as direct and indirect patient costs, geographic access to surgical facilities and surgeons, cultural factors, and patient education, must be addressed. In particular, access to services by women and rural patients needs to be improved. It is clear that extracapsular techniques are cost-effective and lead to better post-operative outcomes than intracapsular cataract extraction with aphakic correction. In addition, monitoring surgical outcomes is essential for improving the quality of surgical services. However, other issues regarding the delivery of cataract surgical services, including the role of average power intraocular lenses and the role of non-physician surgeons, are yet unresolved. Information about the true cost of surgery, including costs of surgeon training, equipment, and patient outreach programs, is needed so that the goal of self-sustaining programs may be obtained.
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Affiliation(s)
- Margaret A Chang
- The Johns Hopkins University Schools of Medicine and Public Health, 600 N. Wolfe Street, Wilmer 120, Baltimore, MD 21287, USA.
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Mathenge W, Nkurikiye J, Limburg H, Kuper H. Rapid assessment of avoidable blindness in Western Rwanda: blindness in a postconflict setting. PLoS Med 2007; 4:e217. [PMID: 17608561 PMCID: PMC1904464 DOI: 10.1371/journal.pmed.0040217] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2006] [Accepted: 05/09/2007] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The World Health Organization estimates that there were 37 million blind people in 2002 and that the prevalence of blindness was 9% among adults in Africa aged 50 years or older. Recent surveys indicate that this figure may be overestimated, while a survey from southern Sudan suggested that postconflict areas are particularly vulnerable to blindness. The aim of this study was to conduct a Rapid Assessment for Avoidable Blindness to estimate the magnitude and causes of visual impairment in people aged > or = 50 y in the postconflict area of the Western Province of Rwanda, which includes one-quarter of the population of Rwanda. METHODS AND FINDINGS Clusters of 50 people aged > or = 50 y were selected through probability proportionate to size sampling. Households within clusters were selected through compact segment sampling. Visual acuity (VA) was measured with a tumbling "E" chart, and those with VA below 6/18 in either eye were examined by an ophthalmologist. The teams examined 2,206 people (response rate 98.0%). The unadjusted prevalence of bilateral blindness was 1.8% (95% confidence interval [CI] 1.2%-2.4%), 1.3% (0.8%-1.7%) for severe visual impairment, and 5.3% (4.2%-6.4%) for visual impairment. Most bilateral blindness (65%) was due to cataract. Overall, the vast majority of cases of blindness (80.0%), severe visual impairment (67.9%), and visual impairment (87.2%) were avoidable (i.e.. due to cataract, refractive error, aphakia, trachoma, or corneal scar). The cataract surgical coverage was moderate; 47% of people with bilateral cataract blindness (VA < 3/60) had undergone surgery. Of the 29 eyes that had undergone cataract surgery, nine (31%) had a best-corrected poor outcome (i.e., VA < 6/60). Extrapolating these estimates to Rwanda's Western Province, among the people aged 50 years or above 2,565 are expected to be blind, 1,824 to have severe visual impairment, and 8,055 to have visual impairment. CONCLUSIONS The prevalence of blindness and visual impairment in this postconflict area in the Western Province of Rwanda was far lower than expected. Most of the cases of blindness and visual impairment remain avoidable, however, suggesting that the implementation of an effective eye care service could reduce the prevalence further.
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Affiliation(s)
- Wanjiku Mathenge
- Rift Valley Provincial Hospital, Nakuru, Kenya
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Hans Limburg
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Hannah Kuper
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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Eusebio C, Kuper H, Polack S, Enconado J, Tongson N, Dionio D, Dumdum A, Limburg H, Foster A. Rapid assessment of avoidable blindness in Negros Island and Antique District, Philippines. Br J Ophthalmol 2007; 91:1588-92. [PMID: 17567662 PMCID: PMC2095536 DOI: 10.1136/bjo.2007.119123] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To conduct rapid assessments of avoidable blindness to estimate the magnitude and causes of blindness in people aged >/=50 years in Negros Island and Antique district, Philippines. METHODS Clusters of 50 people aged >/=50 years were sampled with probability proportionate to size. Households within clusters were selected through compact segment sampling. Visual acuity (VA) was measured with a tumbling "E" chart. Ophthalmologists examined people with VA<6/18 in either eye. RESULTS In Negros, 2774 of 3649 enumerated subjects were examined (76.0%) and 3177 of 3842 enumerated subjects in Antique (82.7%). The prevalence of blindness (presenting VA<3/60 in better eye) was 2.6% (95% CI = 2.0 to 3.2%) in Negros and 3.0% (2.4 to 3.6%) in Antique. The leading cause of blindness was untreated cataract, and was refractive error for visual impairment (VA<6/18 to >/=6/60). Most of the cases of blindness (67% in Negros, 82% in Antique) and visual impairment (94% in Negros, 95% in Antique) were avoidable (ie, operated and unoperated cataract, refractive error and corneal scar). In Negros, 23% of eyes had a poor outcome after cataract surgery, and 13% in Antique. CONCLUSIONS The prevalence of blindness in two areas in the Philippines was relatively low. Since most cases were avoidable, further reductions are possible.
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Affiliation(s)
- Cristina Eusebio
- London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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Lindfield R, Polack S, Wadud Z, Choudhury KA, Rashid AKMM, Kuper H. Causes of poor outcome after cataract surgery in Satkhira district, Bangladesh. Eye (Lond) 2007; 22:1054-6. [PMID: 17435682 DOI: 10.1038/sj.eye.6702836] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
AIMS Recent data have raised concerns about visual outcome following cataract surgery. The aim of this study was to assess the frequency and causes of poor and borderline outcome after cataract surgery in a population-based case series in Satkhira district, Bangladesh. METHODS A population-based case series was conducted within a population-based cluster survey of people aged over 50 years in Satkhira district where 4868 people underwent visual acuity (VA) screening. Eyes operated for cataract with VA<6/18 were examined in detail by an ophthalmologist, including a full history and dilated fundoscopy, to determine the cause of the visual outcome. RESULTS Cataract surgery was performed on 213 eyes. Outcome was good (VA>6/18) for 128 eyes (60.1%), borderline (VA<6/18 to 6/60) for 35 eyes (16.4%), and poor (VA<6/60) for 50 eyes (23.5%) with available correction. Borderline and poor outcomes were most commonly due to lack of spectacles (25.8%), poor selection (33.8%), or surgical complications (30.6%). Surgical sequelae, namely posterior capsule opacification, was a less common cause of poor or borderline outcome (9.7%). CONCLUSIONS Quality of surgical outcomes is of concern in Satkhira district. Increased emphasis on selection of subjects for surgery, provision of spectacles, and monitoring of surgery may improve outcomes.
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Affiliation(s)
- R Lindfield
- Maidstone & Tunbridge Wells National Health Service Trust, Maidstone Hospital, Maidstone, UK
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Oye JE, Kuper H. Prevalence and causes of blindness and visual impairment in Limbe urban area, South West Province, Cameroon. Br J Ophthalmol 2007; 91:1435-9. [PMID: 17389739 PMCID: PMC2095403 DOI: 10.1136/bjo.2007.115840] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIM To conduct a rapid assessment of cataract surgical services to estimate the prevalence and causes of blindness and visual impairment in members of the population aged >/=40 years in the Limbe urban area, Cameroon. METHODS Clusters of 50 people aged >/=40 years were sampled with probability proportionate to size. Compact segment sampling was used to select households within clusters. All eligible people had their visual acuity (VA) measured by an ophthalmic nurse. An ophthalmologist examined people with VA<6/18. RESULTS 2215 people were examined (response rate = 92.3%). The prevalence of bilateral blindness was 1.1% (95% CI: 0.7-1.5%), 0.3% (0.1-0.6%) for severe visual impairment and 3.0% (2.0-4.0%) for visual impairment. Posterior-segment disease was the leading cause of blindness (29%), followed by cataracts (21%) and optic atrophy (21%). Cataracts were the most common cause of severe visual impairment (43%) and visual impairment (48%). Most cases of blindness (50%), severe visual impairment (57%) and visual impairment (78%) were avoidable (that is, they were caused by cataracts, refractive error, corneal scar, onchocerciasis or phthisis/no globe). The cataract surgical coverage was relatively high, although 57% of eyes operated upon had a poor outcome (presenting VA<6/60). CONCLUSIONS Although the prevalence of blindness was relatively low, most of the cases were avoidable. The implementation of an effective eye-care programme remains a priority in the Limbe urban area.
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Affiliation(s)
- Joseph Enyegue Oye
- Sight Savers International, West Africa Regional Office, P.O. Box: 18190 KIA, Accra, Ghana
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Beltranena F, Casasola K, Silva JC, Limburg H. Cataract blindness in 4 regions of Guatemala: results of a population-based survey. Ophthalmology 2007; 114:1558-63. [PMID: 17337062 DOI: 10.1016/j.ophtha.2006.11.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2006] [Revised: 11/08/2006] [Accepted: 11/10/2006] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To assess prevalence of visual impairment resulting from cataract and cataract surgical services in 4 departments (provinces) of Guatemala to facilitate further health care planning. DESIGN Cross-sectional study. PARTICIPANTS Ninety-eight enumeration areas were selected by systematic sampling in 4 departments in southwest Guatemala, with a combined population of 1,339,508 (2002 census). Ninety-eight clusters of 50 persons > or =50 years of age (4900 eligible persons) were selected by random walk, 1 in each selected enumeration area. A total of 4806 persons were examined (coverage, 98.1%): 1808 (37.6%) men and 2998 (62.4%) women. Mean age was 63.7 years. METHODS Each eligible participant was interviewed and underwent an assessment of visual acuity and ophthalmic examination to assess lens status. MAIN OUTCOME MEASURES Visual acuity of each eye with available correction and with pinhole correction; lens status; cause of visual impairment in 1 or both eyes; reason(s) why cataract operation had not been performed; and details of previous cataract surgery. RESULTS Cataract is the major cause of bilateral blindness (66.1%). The adjusted prevalence of bilateral cataract blindness (best-corrected visual acuity [BCVA], <20/400) in people 50 years of age and older was 2.3% (95% confidence interval [CI], 1.8%-3.0%), or an estimated 3726 persons. The cataract surgical coverage was 49% for men and 28% for women. The adjusted prevalence of bilateral cataract and BCVA<20/200 in persons 50 years of age and older was 3.7% (95% CI, 2.9%-4.4%), or an estimated 5887 persons. In this last group, the surgical coverage was 29% (persons) and 19% (eyes). Of all operated eyes, 36% could not see 20/200. Being unaware of cataract (68%), inability to afford the procedure (12%), and fear of the procedure (10%) were mentioned most often as the reason why surgery had not been performed. CONCLUSIONS There is a backlog in unoperated cataract in the survey area that will increase with ageing. Awareness campaigns, reducing cost, improving the outcome of cataract surgery, and expansion of surgical services may help to increase the cataract surgical rate. Women should be offered more cataract surgery. These results will enable health managers to plan effective interventions in line with Vision 2020.
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Affiliation(s)
- Fernando Beltranena
- Hospital Rodolfo Robles, Committee for the Blind and Deaf of Guatemala, Guatemala City, Guatemala
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Abstract
PURPOSE To determine the prevalence of visually significant and unoperated blinding cataract, and the coverage, characteristics and outcome of cataract surgery in Timor-Leste. METHODS Based on the World Health Organization Rapid Assessment of Cataract Surgical Services protocol, a population-based cross-sectional survey was conducted in 2005. By two-stage cluster random sampling, 50 clusters of 30 people aged 40 years and older were selected. Each eye with a presenting visual acuity worse than 6/18 and/or a history of cataract surgery was examined. RESULTS Of the 1470 people enumerated, 96.2% were examined. Of the eyes examined, 11.5% were blind (presenting vision less than 6/60). Cataract caused 66.3% of this, and 40.2% of vision impairment (presenting vision less than 6/18). For those people who were blind (7.7%; presenting vision less than 6/60 in the better eye), cataract was the most frequent cause (76.1%). Cataract surgery had occurred in 2% of participants. Gender and domicile were not associated with cataract blindness or surgery. Cataract Surgical Coverage (6/60) was 16.3% for Eyes and 20.2% for Persons. Surgical outcomes were poor, falling well short of World Health Organization guidelines. Astigmatism and posterior capsule opacity were important contributors to this. CONCLUSIONS Until census data are available, age-gender-domicile correction of sample findings cannot be calculated. In the meantime, it is estimated there are 11 500 cataract blind in Timor-Leste. Long-term, indigenous cataract surgical services need to be capable of significantly increased output. Better surgical outcomes are required to ensure scarce resources are well used. Laser capsulotomy needs to be planned for as surgical numbers increase.
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Affiliation(s)
- Garry Brian
- The Fred Hollows Foundation (New Zealand), Auckland, New Zealand.
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Mathenge W, Kuper H, Limburg H, Polack S, Onyango O, Nyaga G, Foster A. Rapid assessment of avoidable blindness in Nakuru district, Kenya. Ophthalmology 2006; 114:599-605. [PMID: 17141319 DOI: 10.1016/j.ophtha.2006.06.057] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2005] [Revised: 06/01/2006] [Accepted: 06/01/2006] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To estimate the prevalence of avoidable blindness in > or =50-year-olds in Nakuru district, Kenya, and to evaluate the Rapid Assessment for Avoidable Blindness (RAAB), a new methodology to measure the magnitude and causes of blindness. DESIGN Cross-sectional population-based survey. PARTICIPANTS Seventy-six clusters of 50 people 50 years or older were selected by probability proportionate to size sampling of clusters. Households within clusters were selected through compact segment sampling. Three thousand seven hundred eighty-four eligible subjects were selected, of whom 3503 (92.6%) were examined. METHODS Participants underwent a comprehensive ophthalmic examination in their homes by an ophthalmologist, including measurement of visual acuity (VA) with a tumbling-E chart and the diagnosis of the principal cause of visual impairment. Those who had undergone cataract surgery were questioned about the details of the operation and their satisfaction with surgery. Those who were visually impaired from cataract were asked why they had not gone for surgery. MAIN OUTCOME MEASURES Visual acuity and principal cause of VA<6/18. RESULTS The prevalence of bilateral blindness (presenting VA < 3/60) was 2.0% (95% confidence interval [CI], 1.5%-2.4%), and prevalence of bilateral visual impairment (VA of <6/18-> or =6/60) was 5.8% (95% CI, 4.8%-6.8%) in the sample. Definite avoidable causes of blindness (i.e., cataract, refractive error, trachoma, and corneal scarring) were responsible for 69.6% of bilateral blindness and 74.9% of bilateral visual impairment. Cataract was the major cause of blindness (42.0%) and visual impairment (36.0%). The cataract surgical coverage was high, with 78% of those with bilateral cataract who needed surgery having had surgery at VA<3/60. The quality of surgery was of concern because 22% of the 222 eyes that had undergone cataract surgery had VA<6/60 with best correction. The main barriers to surgery were lack of awareness and cost. The RAAB methodology was easy to use, and each team could visit one cluster per day. CONCLUSIONS The prevalence of blindness in > or =50-year-olds in Nakuru district was low, in part due to the high cataract surgical coverage. The RAAB is easy to use and inexpensive and provides information about the magnitude and causes of avoidable blindness that can be used for planning and monitoring eye care services.
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Nano ME, Nano HD, Mugica JM, Silva JC, Montaña G, Limburg H. Rapid assessment of visual impairment due to cataract and cataract surgical services in urban Argentina. Ophthalmic Epidemiol 2006; 13:191-7. [PMID: 16854773 DOI: 10.1080/09286580600584699] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
AIM To present results of a rapid assessment on visual impairment due to cataract and on cataract surgical services in the Northwestern districts of Buenos Aires, Argentina. These results will enable health managers to plan effective interventions in this area in line with VISION 2020. METHODS One hundred fifteen clusters of 40 persons of 50 years and older in each cluster (4600 eligible persons) were selected by systematic sampling from the Northwestern districts of Buenos Aires, Argentina. This area consists of 10 districts with a total population of 2,716,573 (2001 census), from whom 4302 persons were examined (coverage 93.5%). The visual acuity was measured with a tumbling E-chart and the lens status with distant direct ophthalmoscopy. RESULTS Cataract is the major cause of bilateral blindness (54.2%). The age and sex adjusted prevalence of bilateral cataract blindness (presenting VA < 20/400) in people of 50 years and older was 0.5% (95% CI: 0.4-0.8%), an estimated number of 2,985 persons. The cataract surgical coverage at this level was 70% for males and 78% for females. The prevalence of bilateral cataract and VA < 20/200 in persons of 50 years and older was 0.8% (95% CI: 0.6-1.1), an estimated 4,705 persons. In this last group, the surgical coverage was 66% (persons) and 57% (eyes). Of all operated eyes, 10% could not see 20/200. 'Cannot afford' (32%), 'unaware of cataract' (21%) and 'contraindication for surgery' (18%) were mentioned most as reason why surgery had not been done. CONCLUSION The cataract problem is getting under control in this area. Coverage indicators are fairly high, and the outcome data better than in other studies. The cataract surgical rate could be raised further by awareness campaigns and by making cataract surgery more affordable.
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Affiliation(s)
- Maria Eugenia Nano
- Hugo D. Nano Ophthalmology Foundation, San Miguel Buenos Aires, Argentina
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Wadud Z, Kuper H, Polack S, Lindfield R, Akm MR, Choudhury KA, Lindfield T, Limburg H, Foster A. Rapid assessment of avoidable blindness and needs assessment of cataract surgical services in Satkhira District, Bangladesh. Br J Ophthalmol 2006; 90:1225-9. [PMID: 16870654 PMCID: PMC1857455 DOI: 10.1136/bjo.2006.101287] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
AIMS To estimate the magnitude and causes of blindness in people aged > or =50 years in Satkhira district, Bangladesh, and to assess the availability of cataract surgical services. METHODS 106 clusters of 50 people aged > or =50 years were selected by probability-proportionate to size sampling. Households were selected by compact segment sampling. Eligible participants had their visual acuity measured. Those with visual acuity <6/18 were examined by an ophthalmologist. A needs assessment of surgical services was conducted by interviewing service providers. RESULTS 4868 people were examined (response rate 91.9%). The prevalence of bilateral blindness was 2.9% (95% confidence interval (CI) 2.4% to 3.5%), that of severe visual impairment was 1.6% (95% CI 1.2% to 2.0%) and that of visual impairment was 8.4% (95% CI 7.5% to 9.3%). 79% of bilateral blindness was due to cataract. The cataract surgical coverage was moderate; 61% of people with bilateral cataract blindness (visual acuity <3/60) had undergone surgery. 20% of the 213 eyes that had undergone cataract surgery had a best-corrected poor outcome (visual acuity <6/60). The cataract surgical rate (CSR) in Satkhira was 547 cataract surgeries per million people per year. CONCLUSIONS Although the prevalence of blindness and visual impairment was lower than expected, the CSR is inadequate to meet the existing need, and the quality of surgery needs to be improved.
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Affiliation(s)
- Z Wadud
- Child Sight Foundation, Dhaka, Bangladesh
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Brian G, Ramke J, Szetu J, Le Mesurier R, Moran D, du Toit R. Towards standards of outcome quality: a protocol for the surgical treatment of cataract in developing countries. Clin Exp Ophthalmol 2006; 34:383-7. [PMID: 16764664 DOI: 10.1111/j.1442-9071.2006.01262.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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