Population-based assessment of the outcome of cataract surgery in an urbanpopulation in southern India

PURPOSE: To assess the outcome of cataract surgery in an urban population i n southern India. METHODS: As part of a population-based cross-sectional epidemiologic study, the Andhra Pradesh Eye Disease Study, 2,522 people of all ages, including 1,399 individuals 30 years of age or older, from 24 clusters representative of the population of Hyderabad in southern India underwent a detailed inte rview and ocular evaluation including logarithm of minimal angle of resolut ion (logMAR) visual acuity, refraction, slit-lamp biomicroscopy, applanatio n tonometry, gonioscopy, dilation, cataract grading, aphakia/pseudophakia s tatus, and stereoscopic fundus evaluation. Automated threshold visual field s and slit-lamp and fundus photography were performed when indicated by sta ndardized criteria. Very poor outcome in an eye that had undergone cataract surgery was defined as presenting distance visual acuity worse than 20/200 , and poor outcome was defined as visual acuity worse than 20/60 to 20/200. RESULTS: In subjects 50 years of age or older, after adjustment for age and sex distribution, the rate of having had cataract surgery in one or both e yes was 14.6% (95% confidence interval [CI], 11.4% to 17.8%). Of 131 eyes ( 91 subjects) that had undergone cataract surgery, 28 (21.4%; 95% CI, 14.4% to 28.4%) had very poor outcome and another 40 (30.5%; 95% CI, 22.6% to 38. 4%) had poor outcome. The very poor outcome in 20 (71.4%) of 28 eyes and po or outcome in 23 (57.5%) of 40 eyes could be attributed to surgery-related causes or inadequate refractive correction, With multivariate analysis, ver y poor outcome as a result: of surgery-related causes or inadequate refract ive correction was more likely to be associated with intracapsular cataract extraction than with extracapsular cataract extraction (odds ratio, 9.34; 95% CI, 2.49 to 35.06) in subjects belonging to the lowest socioeconomic st atus (odds ratio, 4.92; 95% CI, 1.16 to 20.93) and with date of surgery 3 o r fewer years before the survey than with more than 3 years (odds ratio, 4. 52; 95% CI, 1.33 to 15.39). Also, very poor or poor outcome as a result: of surgery-related causes or inadequate refractive correction was associated with women (odds ratio, 2.55; 95% CI, 1.06 to 6.16). CONCLUSIONS: The very high rate of very poor and poor visual outcome, predo minantly as a result of surgery-related causes and inadequate refractive co rrection, in this urban population of India suggests that more attention is needed to improve the visual outcome of cataract surgery. In order to deal with cataract-related visual impairment in India, as much emphasis on surg ical quality, refractive correction, and follow-up care is necessary as on the number of surgeries. (Am J Ophthalmol 1999;127:650-658. (C) 1999 by Els evier Science Inc. All rights reserved.).