Poor postsurgical visual acuity in low-, middle-income patients with cataracts
Postsurgical visual acuity in patients with cataracts showed significant inequalities in low-income and middle-income countries, according to a study published in British Journal of Ophthalmology.
“The reported visual outcomes were less ideal based on the WHO recommendation criteria, especially in [low-income and middle-income countries (LMICs)],” Xiaotong Han, MD., PhD, from the Zhongshan Ophthalmic Center at Sun Yat-Sen University. “Significant inequalities in cataract surgery quality were observed within and among different countries and regions, which call for regional and global actions to tackle this problem.”
Han and colleagues reviewed 31 cross-sectional studies, 26 conducted in LMICs and five conducted in high-income countries (HICs) and observed the significant differences in postoperative visual acuity (VA).
Among different LMICs, the proportion of patients with postsurgical VA 0.32 were below 70% and varied significantly (Nigeria, 29.9%; Suriname, 80.5%), even within the same country (India, 37%-74.6%). Among HICs, the proportion of patients with postsurgical VA 0.32 were above 70.
“With the continuous global effort leading to increasing cataract surgical volume in recent decades, equal attention must be paid to ensure the cataract surgical quality and adequate postoperative care,” the authors concluded.
Perspective
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Although most of the studies compiled in this article originate from low-income and middle-income countries, the same principles can be applied to routine practice in high-income countries like ours. The postop visits I encounter often vary in satisfaction for many of the same reasons: ocular comorbidities, residual refractive error and postop complications. Preop visits are crucial for setting realistic expectations, especially when it comes to visual acuity.
A simple test that can be done in-office to achieve this goal is the potential acuity meter. I often pull this out for patients with macular pathology to predict postsurgical outcomes.
Perhaps the most crucial step in the preop process is getting accurate IOL calculations, which can be inhibited by ocular surface disease. Greater availability of specialty IOLs can also reduce postsurgical visual impairment. Although toric IOLs are still considered premium lenses, they produce better refractive outcomes in astigmats than corneal relaxing incisions. In postop patients who defer full-time correction, refractive surgery may be an option.
Education is key to improving compliance with postop care. Understanding the patient’s goals is also important to improve satisfaction. Although 20/20 vision is ideal, I strongly believe in 20/happy as the target acuity for all patients.
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