To combat the prevalence of avoidable blindness, there has been emphasis on increasing the availability of cataract operations. However, a focus purely on number of cataract surgeries is not an accurate indicator of the true objective of cataract surgery — to restore sight. It fails to measure the quality of cataract surgical services available, and risks undesired complacency in cataract service delivery. Measuring cataract surgery outcomes is a critical element in tracking progress towards the goal of eliminating avoidable blindness.
The Foundation’s ophthalmology trainees and clinicians routinely record cataract visual acuity outcomes and surgical complications, which are then monitored against international standards. This routine monitoring helps surgeons identify trends in their results over time, increase self-awareness of causes of poor outcomes and address these causes to improve outcomes. It also allows The Foundation to monitor the real effect of the surgeries performed on the lives of the patients, and ensure The Foundation’s programmes continue to achieve first-class eye care in the Pacific.
An independent assessment of cataract surgery outcomes at three months and 12 months post operation was undertaken at the Pacific Eye Institute in Fiji in 2015. The results demonstrate that small incision cataract surgery provided at the Pacific Eye Institute is effective, exceeding the World Health Organisation’s benchmark standard for cataract surgery outcomes (Bhikoo et al., 2017).
Below is a summary of the prospective study. You can access the full articles, including details on surgical outcomes, in The Royal Australian and New Zealand College of Ophthalmologists’ journal, Experimental and Clinical Ophthalmology.
Between September 2014 and January 2015, 156 patients underwent small-incision cataract surgery at the Pacific Eye Institute, Suva, Fiji. 74 percent of surgeries were performed by trainee ophthalmologists. Pre- and post-op eye examinations were performed by two independent investigators. 91 percent and 67 percent of operated eyes were available for examination at three months and 12 months, respectively.
At three months, 74 percent of surgeries achieved “good” (≥6/18) unaided vision, with 94 percent achieving good visual outcomes when corrected with appropriate spectacles. At 12 months, these figures had dropped slightly to 69 percent and 91 percent, respectively. Cataract surgery outcomes were largely stable — the cases where vision had reduced were caused by posterior capsule opacification, a common complication of cataract surgery, which was corrected at follow-up, and development of other conditions including diabetic maculopathy and glaucoma.
Notably, the best corrected visual acuity outcomes at both three and 12 months exceed the World Health Organisation benchmark of ≥90 percent “good” visual outcomes. Refinements in techniques that minimise residual refractive error, and reduce post-operative complications, may allow a higher proportion of patients to achieve better vision without the need for glasses.
These results suggest that patients in the Pacific region can achieve and maintain a good level of corrected vision following small incision cataract surgery, and the outcomes of The Foundations’ clinicians and ophthalmology trainees at the Pacific Eye Institute meet international standards.
Bhikoo, R., Vellara, H., Lolokabaira, S., Murray, N., Sikivou, B., & McGhee, C. (2017). Short‐term outcomes of small incision cataract surgery provided by a regional population in the Pacific. Clinical & experimental ophthalmology, 45(8), 812-819.
Bhikoo, R., Vellara, H., Lolokabaira, S., & McGhee, C. N. (2017). Small incision cataract surgery provided by a regional population in the Pacific: a 12‐month follow‐up. Clinical & experimental ophthalmology.