Cataract is the leading cause of blindness globally and surgery is the only known measure to deal with it effectively. Providing high quality cataract surgical services is critical if patients with cataract are to have their sight restored. A key focus of surgery is the outcome of the procedure. In cataract surgery this is measured predominantly, using visual acuity. Population- and hospital-based studies have revealed that the visual outcome of cataract surgery in many low and middle income settings is frequently sub-optimal, often failing to reach the recommended standards set by the World Health Organization (WHO). Another way of measuring outcome of cataract surgery is to ask patients for their views on whether surgery has changed the functioning of their eyes and their quality of life. There are different tools available to capture patient views and now, these patient-reported outcomes are becoming more widely used. This paper discusses the visual outcome of cataract surgery and frames the outcome of surgery within the context of the surgical service, suggesting that the process and outcome of care cannot be separated. It also discusses the components of patient-reported outcome tools and describes some available tools in more detail. Finally, it describes a hierarchy of challenges that need to be addressed before a high quality cataract surgical service can be achieved.

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Purpose: To evaluate the frequency of ocular cysticercosis and to demonstrate the changing trends in localisation of ocular cysticercosis along with a brief review of literature. Methods: A retrospective analysis of histology proven ocular cysticercosis cases seen over a period of 20 years (1981 through 2000) was done. The pathology record forms were reviewed for demographics, clinical features with speciÞ c reference to the location of cysts in four subgroups: subconjunctival; intraocular orbit and eyelid. The distribution of cases in four Þ ve-year periods namely group A: 1981-1985, group B: 1986-1990, group C: 1991-1995 and group D: 1996-2000 and the changing trends in the location of cysts was evaluated. Results: One hundred eighteen cysts from 118 patients aged 4-72 (mean 17.1) years were submitted to the pathology service of S D Eye Hospital, Hyderabad. Male to female ratio was 1: 1.2. Total number of cases in groups A, B, C and D were 33, 41, 16 and 25 respectively. Location of cysts was subconjunctival -74 (62.7%); intraocular-31 (26.3%); orbital-8 (7%) and lid-5 (4%). In last 20 years, signiÞ cant decrease (P=0.0001) was noted in subconjunctival cases (85% vs. 28%) with a signiÞ cant rise (P=0.0001) in intraocular cysticercosis (6% vs. 60%). Conclusions: Frequency of surgically excised ocular cysticercosis remained constant over last two decades with an increasing manifestation of intravitreal cysticercosis in the recent years. This could imply either improved diagnostic modalities, available expertise in vitreo-retinal surgery or ineffective medical treatment for intraocular parasitic infection. The relative decrease in extraocular cysticercosis is probably due to the increased preference and success with medical management.

PurposeTo determine the prevalence of cataract and its association with sun exposure and other environmental risk factors in three different geographically diverse populations of India. DesignPopulation based cross sectional study during ParticipantsPeople aged � 40 years residing in randomly sampled villages were enumerated (12021) and 9735 (81%) underwent ophthalmic evaluation from plains, hilly and coastal regions (3595, 3231, 2909 respectively) MethodsA detailed questionnaire-based interview about outdoor activity in present, past and remote past, usage of sun protective measures, exposure to smoke, and detailed ophthalmic examination including assessment of uncorrected and best corrected visual acuity, measurement of intraocular pressure, slit lamp examination, lens opacities categorization using LOCS III and posterior segment evaluation was done. Lifetime effective sun exposure was calculated using Melbourne formula and expressed as quintiles. These were supplemented with physical environmental measurements. PLOS ONE | https://doi.org/10.1371/journal.pone.Lifetime sun exposure hours, smoking, indoor kitchen smoke exposure and their association with cataract and subtypes. Prevalence of cataract calculated based on lens opacities or evidence of cataract surgery. ResultsCataract was identified in 3231 (33.3%) participants. Prevalence of cataract in males (32.3%) and females (34.1%) was similar. Nuclear cataract was the commonest sub-type identified in 94.7% of affected eyes. Sun exposure had a significant association with cataract with odds ratio (OR) increasing from 1.6 (95% Confidence Intervals [CI]: 1.4, 1.9) in 3 rd quintile, to 2.6 (CI: 2.2, 3.1) in 4 th quintile and 9.4 (CI: 7.9, 11.2) in 5 th quintile (p<0.0001). Cataract also showed a significant association with smoking (OR: 1.4, CI: 1.2, 1.6) and indoor kitchen smoke exposure (OR: 1.2, CI: 1.0-1.4). Nuclear cataract showed a positive association with increasing sun exposure in 3 rd (β coefficient 0.5, CI:0.2-0.7), 4 th (β: 0.9, CI: 0.7-1.1) and 5 th (β: 2.1, CI:1.8-2.4) quintiles of sun exposure, smoking (β: 0.4, CI: 0.2-0.6) and indoor kitchen smoke exposure (β: 0.3, CI: 01-0.5) while cortical cataract showed a positive association with sun exposure only in 5 th quintile (β: 2.6, CI:1.0-4.2). Posterior subcapsular cataract was not associated with any of the risk factors. ConclusionCataract is associated with increasing level of sun exposure, smoking and exposure to indoor kitchen smoke.Prevalence of cataract and its association with sun exposure in India PLOS ONE | https://doi.