A population-based eye survey of older adults in a rural district of Rajasthan II. Outcomes of cataract surgery

Purpose: To assess the outcomes of cataract surgery in rural northwest Indi a. Design: Population-based, cross-sectional study. Participants: A total of 549 cataract-operated persons (723 operated eyes). Methods: Cluster sampling was used in randomly selecting a cross-sectional sample of persons 50 years of age or older for visual acuity measurement, r efraction, and slit-lamp and direct ophthalmoscope examination early in 199 9. Those operated on for cataract were queried as to the date and place of surgery. The principal cause of reduced vision was identified for all exami ned eyes with presenting visual acuity worse than 6/18. Main Outcome Measures: Presenting and best-corrected visual acuity and caus e of vision loss. Results: Presenting visual acuity was less than 6/60 in the better eye in 3 3.7% of cataract-operated persons and greater than or equal to 6/18 in both eyes in 8.2%; 31.7% were bilaterally operated on. Of cataract-operated eye s, 44.1% initially had visual acuity less than 6/60 and 31.5% greater than or equal to 6/18; with best correction, the corresponding percentages were 14.0% and 61.5%. Intracapsular cataract extraction was used in 92% of cases , and 66% had been operated on in surgery camps. Surgical complications wer e common and a major cause of vision impairment. In multiple logistic regre ssion modeling, female gender and residence in a rural area were associated negatively with both presenting and best-corrected visual acuity outcomes, and surgery conducted before 1990 was associated negatively with best-corr ected visual acuity. Place of surgery and subject schooling were not associ ated with vision outcomes. Conclusions: Cataract surgery subjects in rural areas of India that are wit hout adequately equipped facilities and skilled surgeons, and lack of avail ability of intraocular lenses, are not realizing the full sight-restoring p otential of modern-day surgery. Emphasis on the quality of cataract surgery outcomes must be increased to keep pace with that being given to increasin g surgical volume. (C) 2001 by the American Academy of Ophthalmology.