Seven-year trends in cataract surgery indications and quality of outcomes at Aravind Eye Hospitals, India

Abstract

Purpose To report trends in cataract surgery indications, visual acuity outcomes, complication rates and reoperation rates at ten Aravind Eye Hospitals in Tamil Nadu, India. Methods In this retrospective database study we analyzed seven years of data of cataract surgeries at Aravind during January 1, 2012 to December 31, 2018. Our main outcome measures were preoperative and 1-month postoperative uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA); and rates of intraoperative complications and reoperations. We performed Cochran-Armitage trend tests. Results In 1.86 million eyes that underwent cataract surgery, the percentage of eyes undergoing phacoemulsification (PE) showed an increasing trend (p < 0.0001), from 26.8% in 2012 to 33.5% in 2018. The percentage of eyes undergoing manual small incision cataract surgery (SICS) showed a decreasing trend (p < 0.0001), from 70.0% in 2012 to 65.1% in 2018. For SICS, the percentages of eyes with good postoperative UCVA and BCVA showed increasing trends (p < 0.0001 for each), and the percentages of eyes with poor postoperative UCVA and BCVA showed decreasing trends (p < 0.0001 for each). Results for PE surgeries were mixed. For both PE and SICS rates of intraoperative complications showed a declining trend (p < 0.0001 for each) and a slight increasing trend for reoperations (PE p < 0.02; SICS p < 0.0001). Conclusions During this seven-year period there were noticeable trends in cataract surgeries performed at Aravind in terms of the mix of surgical procedures, preoperative vision, and cataract surgical outcomes.

Addressing the environmental sustainability of eye health-care delivery: a scoping review

“…2 Beyond the low engagement with the issue of climate change by the international research community, the other finding of this Review is the difference between the carbon footprint of similar services delivered in different settings: one phacoemulsification in the UK produces more than 20 times the greenhouse gas emissions of one phacoemulsification in India, with both having excellent clinical outcomes. 22,26,63 This contrast is also portrayed visually in images taken for The Lancet Global Health Commission on Global Eye Health: vision beyond 2020, 20 which showed the waste generated for one phacoemulsification procedure in the UK and the waste produced for 32 phacoemulsifications in India (figure 3).…”

“…Where comparable outcomes can be delivered at reduced environmental costs, 49,63 an opportunity exists for the migration of practice; convenient lifecycle assessment tools such as the Eyefficiency App permit the evaluation and cyclical audit of the carbon footprint of cataract surgical services. 31,38 However, authors also attribute the large difference between the Indian and UK cataract services to the policies in HIC settings that prevent the adoption of sustainable practices.…”

“…Some reduction in that total could be possible working within current policies. However, to realise the goal of carbon neutral economies, changes in HIC policy environments will be needed to permit cataract surgical providers to adopt practices similar to those in LMIC settings that have been shown to be clinically safe, 63,65 and protect population and planetary health by protecting finite environmental resources.…”

Cataract Surgery in One-Eyed Patients: A Cohort Study of 100 Patients

“…Nderitu and Ursell have shown a significantly increased operative time when surgery is performed by a junior surgeon [ 15 ]. In the last decade, rates of intraoperative complications after cataract surgery decreased a lot due to improved instrumentation and techniques and training programs [ 18 , 19 ]. Ravindran et al found a rate of intraoperative complications for phacoemulsification that fell from 1.3% in 2012 to 0.7% in 2018 [ 18 ].…”

“…In the last decade, rates of intraoperative complications after cataract surgery decreased a lot due to improved instrumentation and techniques and training programs [ 18 , 19 ]. Ravindran et al found a rate of intraoperative complications for phacoemulsification that fell from 1.3% in 2012 to 0.7% in 2018 [ 18 ]. In 2018, Staropoli et al published a rate of intraoperative complications of 2.4% in the simulator-trained resident group versus 5.1% in the simulator-naïve group [ 19 ].…”