title: Cataract Surgery Visual Outcomes and Associated Risk Factors in Secondary Level Eye Care Centers of L V Prasad Eye Institute, India.
abstract: OBJECTIVE
  To evaluate cataract surgery visual outcomes and associated risk factors in rural secondary level eye care centers of L V Prasad Eye Institute (LVPEI), India.
  
  
  METHODS
  The Eye Health pyramid of LVPEI has a network of rural secondary care centres (SCs) and attached vision centres (VCs) that provide high quality comprehensive eye care with permanent infrastructure to the most disadvantaged sections of society. The most common procedure performed at SCs is cataract surgery. We audited the outcome of a random sample of 2,049 cataract surgeries done from October 2009-March 2010 at eight rural SCs. All patients received a comprehensive ophthalmic examination, both before and after surgery. The World Health Organization recommended cataract surgical record was used for data entry. Visual outcomes were measured at discharge, 1-3 weeks and 4-11 weeks follow up visits. Poor outcome was defined as best corrected visual acuity <6/18.
  
  
  RESULTS
  Mean age was 61.8 years (SD: 8.9 years) and 1,133 (55.3%) surgeries were performed on female patients. Pre-existing ocular co-morbidity was present in 165 patients (8.1%). The most common procedure was small incision cataract surgery (SICS) with intraocular lens (IOL) implantation (91.8%). Intraoperative complications were seen in 29 eyes (1.4%). At the 4-11 weeks follow-up visit, based on presenting visual acuity (PVA), 61.8% had a good outcome and based on best-corrected visual acuity (BCVA), 91.7% had a good outcome. Based on PVA and BCVA, those with less than 6/60 were only 2.9% and 1.6% respectively. Using multivariable analysis, poor visual outcomes were significantly higher in patients aged ≥70 (OR 4.63; 95% CI 1.61, 13.30), in females (OR 1.58; 95% CI 1.04, 2.41), those with preoperative comorbidities (odds ratio 4.68; 95% CI 2.90, 7.57), with intraoperative complications (OR 8.01; 95% CI 2.91, 22.04), eyes that underwent no IOL or anterior chamber-IOL (OR 12.63; 95% CI 2.65, 60.25) and those undergoing extracapsular cataract extraction (OR 9.39; 95% CI 1.18, 74.78).
  
  
  CONCLUSIONS
  This study demonstrates that quality cataract surgeries can be achieved at rural SCs. The concept of the LVPEI SCs can be applied to other developing countries, allowing rural patients to attain better vision through cataract surgery. Despite improvements in quality of cataract surgery, gender discrimination in terms of outcome continues to be an issue and needs further investigation.
authors.affiliation: Andhra Pradesh Right to Sight Society, Hyderabad, India.
authors.forename: Sumathi
authors.initials: S
authors.lastname: Matta
authors.affiliation: Massachusetts Institute of Technology, Cambridge, United States of America.
authors.forename: Jiwon
authors.initials: J
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa city, IA, United States of America.
authors.forename: Ghanshyam
authors.initials: G
authors.lastname: Palamaner Subash Shantha
authors.affiliation: Allen Foster Research Centre for Community Eye Health, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India.|Brien Holden Eye Research Centre, L.V. Prasad Eye Institute, Banjara Hills, Hyderabad, India.
authors.forename: Rohit C
authors.initials: RC
authors.lastname: Khanna
authors.affiliation: Allen Foster Research Centre for Community Eye Health, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India.|Brien Holden Eye Research Centre, L.V. Prasad Eye Institute, Banjara Hills, Hyderabad, India.
authors.forename: Gullapalli N
authors.initials: GN
authors.lastname: Rao
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D002386:Cataract / Q000473:pathology / Q000503:physiopathology / Q000534:rehabilitation*; D002387:Cataract Extraction / Q000379:methods*; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D007194:India; D019654:Lens Implantation, Intraocular; D007908:Lens, Crystalline / Q000473:pathology / Q000601:surgery*; D007910:Lenses, Intraocular; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D063728:Secondary Care Centers; D012737:Sex Factors; D016896:Treatment Outcome; D014792:Visual Acuity