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

Abstract

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.

The effect of a visual aid on the comprehension of cataract surgery in a rural, indigent South Indian population

“…[1][2][3][4] Ineffective communication between health care providers and patients is a major factor in reduced care. [5][6][7] Roadblocks to effective communication can include limited formal education, illiteracy, and misinformation or misunderstanding among the population being served regarding medical interventions. 5,7 Informed consent is a critical component of invasive medical procedures, helping to establish a healthy doctor-patient relationship by educating patients about the methods, risks, and benefits of procedures.…”

“…[5][6][7] Roadblocks to effective communication can include limited formal education, illiteracy, and misinformation or misunderstanding among the population being served regarding medical interventions. 5,7 Informed consent is a critical component of invasive medical procedures, helping to establish a healthy doctor-patient relationship by educating patients about the methods, risks, and benefits of procedures. 8 Moseley et al 9 examined the use of a poster and video presentation combined with a verbal informed consent in a highly educated population and demonstrated a significant increase in patient understanding of cataract surgery.…”

Perioperative antibiotics for prevention of acute endophthalmitis after cataract surgery.

“…Results of the 2011 American Society of Cataract and Refractive Surgery (ASCRS) member survey showed fewer than 20% of physicians utilizing intracameral antibiotics (Leaming 2012;Vazirani 2013). In the United States, incorporating intracameral antibiotics into standard prophylaxis practice appears to be related to surgeon volume (Chang 2008), and increased surgeon volume has been reported to be associated with reduced risk of postoperative endophthalmitis (Keay 2012). In both the US and the UK, physicians not using intracameral antibiotics cite concerns regarding dilution errors and risk of contamination when compounding the drugs for doses needed for ocular injection (Gore 2009;Leaming 2012).…”

Comparing Three Post-Op Regiments for Management of Inflammation Post Uncomplicated Cataract Surgery. “Are Steroids Really Necessary?”

“…Cataract is the leading cause of blindness worldwide and cataract extraction is the treatment of choice leading to the improvement in the quality of life [1], cognitive function [2], and productivity as reported by multiple published studies. To maximize the outcome of cataract surgery, post-operative treatments of uncomplicated cataract extraction include three topical pharmaceutical agents: an antimicrobial, a potent corticosteroid and a non-steroidal anti-inflammatory drug (NSAID) [3].…”