Low-cost high-volume extracapsular cataract extraction with posterior chamber intraocular lens implantation in Nepal

Ruit, Sanduk; Tabin, Geoffrey; Nissman, Steven A.; Paudyal, Govinda; Gurung, Rita

doi:10.1016/s0161-6420(99)90397-4

Cited by 65 publications

(54 citation statements)

References 14 publications

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“…Fixed costs can place constraints on surgical capabilities and patient outcomes. In the past, some researchers advocated using a single intraocular lens (IOL) power [4][5][6][7][8] or a small range of IOL powers 9 to decrease mission costs. However, with this strategy, many patients would likely achieve less than optimum visual outcomes.…”

Section: Online Videomentioning

confidence: 99%

Intraocular lens power requirements for humanitarian missions

Lombard

McClatchey²,

Borges³

2009

Journal of Cataract and Refractive Surgery

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Section: Online Videomentioning

confidence: 99%

Intraocular lens power requirements for humanitarian missions

Lombard

McClatchey²,

Borges³

2009

Journal of Cataract and Refractive Surgery

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“…Cataract surgery in developing countries should cost no more than $50-$100 US for each eye [23][24][25]. This is achieved by lowering the cost of surgical materials, increasing productivity to decrease the relative overhead costs, practicing cost recovery, and encouraging subsidies for those who cannot pay.…”

Section: Cost-effectiveness and Cost-control Mechanismsmentioning

confidence: 99%

“…When only provider costs are considered, the cost for MSICS is comparable ECCE, at $15.68 versus $15.82 in one study [110], and $17.03 versus $16.25 in another study [24]. However, these numbers are underestimations that do not account for crosssubsidization from paying patients and spectacle sales, and the real cost likely lies between US $50-100 per case [23][24][25]. The lower patient cost of MSICS is likely due to the decreased need for surgical sutures, faster visual recovery time, and improved uncorrected post-operative visual outcome [110].…”

Section: Surgical Techniquementioning

confidence: 99%

“…However, others have found that eyes with less than 4.5 diopters (D) of preoperative refractive error would have had a similar amount of residual post-operative refractive error if implanted with a standard +20.0 D intraocular lens, rather than the lens chosen using pre-operative biometric measurements [117]. Several groups in developing countries have explored implantion of a single power of IOL during extracapsular cataract surgery [25,92,118,119]. In Nepal, a +21.0 D intraocular lens was implanted into over 200 patients undergoing extracapsular cataract surgery in a rural surgical center, with 54% achieving uncorrected post-operative visual acuity of 20/60 or better [25].…”

Section: Role Of A-scan Biometry and Iol Selectionmentioning

confidence: 99%

“…Several groups in developing countries have explored implantion of a single power of IOL during extracapsular cataract surgery [25,92,118,119]. In Nepal, a +21.0 D intraocular lens was implanted into over 200 patients undergoing extracapsular cataract surgery in a rural surgical center, with 54% achieving uncorrected post-operative visual acuity of 20/60 or better [25]. An additional 20% improved to 20/60 or better with spectacle correction.…”

Section: Role Of A-scan Biometry and Iol Selectionmentioning

confidence: 99%

See 2 more Smart Citations

The surgical management of cataract: barriers, best practices and outcomes

et al. 2007

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Cataract is the leading cause of blindness in the world. Cataract surgery has been shown by multiple studies to be one of the most cost-effective health interventions, and leads to a dramatic increase in quality of life and productivity for many patients. Though there has been marked improvement in the last several decades, surgical delivery services in developing nations are still suboptimal, and a large backlog in cataract cases continues to grow. To decrease this backlog, barriers to surgery, such as direct and indirect patient costs, geographic access to surgical facilities and surgeons, cultural factors, and patient education, must be addressed. In particular, access to services by women and rural patients needs to be improved. It is clear that extracapsular techniques are cost-effective and lead to better post-operative outcomes than intracapsular cataract extraction with aphakic correction. In addition, monitoring surgical outcomes is essential for improving the quality of surgical services. However, other issues regarding the delivery of cataract surgical services, including the role of average power intraocular lenses and the role of non-physician surgeons, are yet unresolved. Information about the true cost of surgery, including costs of surgeon training, equipment, and patient outreach programs, is needed so that the goal of self-sustaining programs may be obtained.

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Use of Global Visual Acuity Data in a Time Trade-off Approach to Calculate the Cost Utility of Cataract Surgery

Lansingh

Carter²

2009

Arch Ophthalmol

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To determine the cost utility of cataract surgery worldwide using visual acuity (VA) outcomes and utility values determined by the time trade-off (TTO) method. Data Sources: Some cost data were taken from a previous search conducted for 1995 to 2006 and we searched MEDLINE and Scopus and Google for more recent data (2006 and 2007). Study Selection: Articles were identified from the literature using "cataract surgery" in combination with the terms outcome or visual acuity. Additional searches were conducted using individual countries as a term in combination with VA, outcome, or cost. Regression curves were constructed from utility values derived from a TTO study and VA data. Gains in quality-adjusted life-years (QALYs) were calculated based on life expectancy tables from the World Health Organization and discounts of 3% for both cost and benefit. Sensitivity analyses explored the effect of changes in discounting, life expectancy, preoperative VA, and cost. Data Extraction: If the data were usable, they were kept; otherwise they were discarded. Data Synthesis: Preoperative VA (logMAR) correlated with increasing gross national income per capita (Pearson correlation coefficient, −0.784; PϽ.001) and showed that in developing countries preoperative vision is much poorer compared with developed countries.

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Low-cost high-volume extracapsular cataract extraction with posterior chamber intraocular lens implantation in Nepal

Cited by 65 publications

References 14 publications

Intraocular lens power requirements for humanitarian missions

Intraocular lens power requirements for humanitarian missions

The surgical management of cataract: barriers, best practices and outcomes

Use of Global Visual Acuity Data in a Time Trade-off Approach to Calculate the Cost Utility of Cataract Surgery

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