Cataract Surgical Outcome and Predictors of Outcome in Lumbini Zone and Chitwan District of Nepal

Abstract

Purpose: To evaluate visual acuity outcome from cataract surgery based on a population-based survey among people aged 50 years and older in Lumbini Zone and Chitwan District of Nepal.

Methods: A randomly selected, population-based cross sectional epidemiological study of blindness, visual impairment and cataract surgical outcome was conducted. All subjects underwent a comprehensive ocular examination by an ophthalmic assistant, while people with visual impairment (visual acuity less than 6/18) after refraction and all cataract surgical cases underwent dilated fundus examination by an ophthalmologist.

Results: 5,916 people were enumerated and 5,141 (86.9%) examined. Among the 359 people who had cataract surgery, 485 eyes were included in the study. First eye surgery was before 2000 in 84 (23%), between 2000 and 2003 in 130 (36%), and after 2003 in 145 (41%). A presenting visual acuity ≥ 6/18 was achieved in 298 (61.4%) eyes (10 [17.8%] and 288 [67.1%] of aphakic and pseudophakic eyes, respectively) and best corrected vision ≥ 6/18 in 411 (84.7%) in all eyes. A presenting visual acuity less than 6/60 was found in 27 (6.3%) pseudophakic eyes. There was no significant difference in visual outcome based on age, sex, literacy, or institution. Uncorrected refractive error was the main cause (72.9%) of visual impairment in pseudophakic eyes.

Conclusions: Visual acuity outcome after cataract surgery requires further improvement to meet World Health Organization standards, particularly improvement in preoperative biometry and refractive services. The same quality cataract surgery was provided in and equitably distributed throughout Lumbini Zone and Chitwan District independent of age, sex, literacy or location.

KEYWORDS::

• cataract surgery
• Nepal
• population-based survey
• predictors of outcome
• visual acuity outcome

ACKNOWLEDGMENTS

The authors wish to thank Ram Chandra Shrestha and Tulasi Parajuli for their fieldwork throughout the study and Praveen Nirmalan and R.P. Pokhrel who served on a Technical Advisory Committee. In addition, the authors are grateful to Royes Joseph and the Aravind Eye Care System who conducted statistical analysis and the LEI that provided staff and logistical support.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.