title: Outcomes of cataract surgery in Pakistan: results from The Pakistan National Blindness and Visual Impairment Survey.
abstract: OBJECTIVE
  To evaluate the outcomes of cataract surgery in Pakistan.
  
  
  METHODS
  Cross-sectional, nationally representative sample of 16 507 adults (aged >or=30 years). Each underwent interview, logarithm of the minimum angle of resolution visual acuity (VA), autorefraction, examination of optic disc. Those with <6/12 VA on presentation underwent best-corrected VA and dilated biomicroscopic ocular examination.
  
  
  RESULTS
  1317 subjects (633 men) had undergone surgery in one or both eyes. Of the 1788 operated eyes, 1099 (61%) had undergone intracapsular cataract extraction (ICCE) and 607 (34%) extracapsular surgery with an intraocular lens (ECCE+IOL). Presenting VA: 275 (15.4%) eyes: 6/12 or better; 253 (14.1) <6/12 >or=6/18; 632 (35.3%) 6/18 to 6/60; 85 (4.8%): 6/60 to 3/60; 528 (29.5%): <3/60. With "best" refractive correction, these values were: 563 (31.5%), 332 (18.6%), 492 (27.5%), 61 (3.4%), 334 (18.7%), respectively. Of the 1498 eyes with VA <or=6/12 on presentation, 352 (23.5%) were the result of coincident disease, 800 (53.4%) refractive error and 320 (21.4%) operative complications. Eye camp surgery (OR 1.72, p = 0.002), ICCE (OR 3.78; p<0.001), rural residence (OR 1.36, p = 0.01), female gender (OR 1.55, p<0.001) and illiteracy (OR 2.44, p<0.001) were associated with VA of <6/18. More recent ICCE surgeries were associated with a poorer outcome. The ratio of ECCE+IOL:ICCE in the last 3 years was 1.2:1, compared with 1:3.3 >or=4 years before the survey.
  
  
  CONCLUSIONS
  Almost a third of cataract operations result in a presenting VA of <6/60, which could be halved by appropriate refractive correction. This study highlights the need for an improvement in quality of surgery with a more balanced distribution of services.
authors.affiliation: Department of Ophthalmology, Hinchingbrooke Hospital, Huntingdon, Cambridgeshire, England. rupert.bourne@lshtm.ac.uk
authors.forename: Rupert
authors.initials: R
authors.lastname: Bourne
authors.forename: Brendan
authors.initials: B
authors.lastname: Dineen
authors.forename: Zahid
authors.initials: Z
authors.lastname: Jadoon
authors.forename: Pak S
authors.initials: PS
authors.lastname: Lee
authors.forename: Aman
authors.initials: A
authors.lastname: Khan
authors.forename: Gordon J
authors.initials: GJ
authors.lastname: Johnson
authors.forename: Allen
authors.initials: A
authors.lastname: Foster
authors.forename: Daud
authors.initials: D
authors.lastname: Khan
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002387:Cataract Extraction / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D003906:Developing Countries; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D010154:Pakistan; D017678:Sex Distribution; D016896:Treatment Outcome; D014786:Vision Disorders / Q000209:etiology; D014792:Visual Acuity