Effective cataract surgical coverage: An indicator for measuring quality-of-care in the context of Universal Health Coverage

Abstract

Objective To define and demonstrate effective cataract surgical coverage (eCSC), a candidate UHC indicator that combines a coverage measure (cataract surgical coverage, CSC) with quality (post-operative visual outcome). Methods All Rapid Assessment of Avoidable Blindness (RAAB) surveys with datasets on the online RAAB Repository on April 1 2016 were downloaded. The most recent study from each country was included. By country, cataract surgical outcome (CSOGood, 6/18 or better; CSOPoor, worse than 6/60), CSC (operated cataract as a proportion of operable plus operated cataract) and eCSC (operated cataract and a good outcome as a proportion of operable plus operated cataract) were calculated. The association between CSC and CSO was assessed by linear regression. Gender inequality in CSC and eCSC was calculated. Findings Datasets from 20 countries were included (2005–2013; 67,337 participants; 5,474 cataract surgeries). Median CSC was 53.7% (inter-quartile range[IQR] 46.1–66.6%), CSOGood was 58.9% (IQR 53.7–67.6%) and CSOPoor was 17.7% (IQR 11.3–21.1%). Coverage and quality of cataract surgery were moderately associated—every 1% CSC increase was associated with a 0.46% CSOGood increase and 0.28% CSOPoor decrease. Median eCSC was 36.7% (IQR 30.2–50.6%), approximately one-third lower than the median CSC. Women tended to fare worse than men, and gender inequality was slightly higher for eCSC (4.6% IQR 0.5–7.1%) than for CSC (median 2.3% IQR -1.5–11.6%). Conclusion eCSC allows monitoring of quality in conjunction with coverage of cataract surgery. In the surveys analysed, on average 36.7% of people who could benefit from cataract surgery had undergone surgery and obtained a good visual outcome.

Rapid assessment of avoidable blindness in Papua New Guinea: a nationwide survey

“…We found that PNG is below the recommended target. However, as several countries are yet to reach the recommended cataract surgery outcome targets,20 our findings are similar to other low-income, middle-income countries, indicating the continuing need for increased surgical coverage and improved outcomes potentially through increasing resources, training and personnel. Currently there are 14 practising ophthalmologists and 5 in training, most of which are based in more urban areas.…”

“…Based on available RAAB data, the median CSC is 53.7 for operable cataracts (pinhole VA <6/60) across low-income, middle-income countries in Asia, Africa and South America 20. PNG had an estimated combined national CSC of 32.3%.…”

Population-based assessment of visual acuity outcomes following cataract surgery in Australia: the National Eye Health Survey

“…The eCSC rate is a population-based measure to understand accessibility and quality of cataract surgery within populations 21. We report a high eCSC rate among non-Indigenous Australians (88.5%) suggesting that the healthcare system within Australia is close to meeting demand for cataract surgeries and further indicating an overall good quality of cataract surgical services and postoperative care for non-Indigenous Australians.…”

“…We report a high eCSC rate among non-Indigenous Australians (88.5%) suggesting that the healthcare system within Australia is close to meeting demand for cataract surgeries and further indicating an overall good quality of cataract surgical services and postoperative care for non-Indigenous Australians. Of note, comparisons of the eCSC rates with previous studies21 should be made with extreme caution as we adopted more stringent cut-offs for operable cataract (best-corrected VA <6/12 vs best-corrected VA <6/60) and postsurgery good VA outcomes (PVA ≥6/12 vs PVA ≥6/18). This definition was adopted as 6/12 is a legal requirement for driving in Australia, and lower thresholds for cataract surgery exist 23.…”

“…The eCSC was calculated to assess the number of non-Indigenous and Indigenous Australians with operated cataract and a good outcome as a proportion of those having operable combined with operated cataract 21. In this study, operable cataract was defined as best-corrected VA of worse than 6/12 where probable or definite cataracts were present.…”