title: Preliminary clinical outcomes from the Peruvian National Cataract Elimination Plan.
abstract: OBJECTIVE
  to evaluate the clinical outcomes of a publicly funded cataract elimination program.
  
  
  METHODS
  outcomes of all patients (186) who received extracapsular cataract extraction (ECCE) surgery free of charge at the Instituto Regional de Oftalmología in northern Peru in the first year (August 2008 to July 2009) of the Peruvian National Cataract Elimination Plan were compared retrospectively with the outcomes of all patients (68) who paid in the highest charge tier for ECCE surgery during the same period. Preoperatively, the median uncorrected visual acuity (UCVA) of National Plan patients was Hand Motion; the UCVA of paying patients was Counting Fingers (P = 0.09). Complication frequency and visual acuity (uncorrected visual acuity, pinhole visual acuity, and best correct visual acuity) were the primary outcome measures. The World Health Organization (WHO) Vision 2020 goal is for 85% of operated eyes to achieve 20/60 vision; the Ministerio de Salud del Perú goal is for 75% of eyes to achieve 20/50.
  
  
  RESULTS
  one month postoperatively, only 24% of National Plan patients achieved a UCVA of 20/60. The median UCVA for both groups was 20/100 (P = 0.23). Intraoperative complications occurred in 27% of all patients; postoperative complications occurred in 39%. Patients more likely to have a poor outcome (UCVA < 20/200) were those who experienced a postoperative complication (odds ratio [OR] 3.3, P = 0.002), who experienced an intraoperative complication (OR 2.5, P = 0.01), and who were 75 years or older (OR 2.7, P = 0.008). National Plan patients were more likely to have an OCTET Grade II intraoperative complication (OR 4.2, P = 0.03) and were less likely to receive refractive services (OR 1.5, P = 0.002).
  
  
  CONCLUSIONS
  neither WHO nor Peruvian benchmarks for surgical outcome were achieved in the first year of the Peruvian National Cataract Elimination Plan. Providing more comprehensive services to patients and addressing variables correlated with poor outcomes may improve interventions and help achieve Vision 2020 goals.
authors.affiliation: Oliver Wendell Holmes Society, Harvard Medical School, Boston, Massachusetts, United States of America. stryjewski@hms.harvard.edu
authors.forename: Tomasz P
authors.initials: TP
authors.lastname: Stryjewski
authors.forename: Daniel Bitrán
authors.initials: DB
authors.lastname: Benadretti
authors.forename: Sihai Dave
authors.initials: SD
authors.lastname: Zhao
authors.forename: Susannah
authors.initials: S
authors.lastname: Rowe
authors.forename: Carole D
authors.initials: CD
authors.lastname: Mitnick
mesh_terms: D000368:Aged; D002387:Cataract Extraction; D005260:Female; D006078:Government Programs; D006801:Humans; D008297:Male; D010568:Peru; D012189:Retrospective Studies; D016896:Treatment Outcome