Investigating Differences in Cataract Surgery Outcomes: a comparative study of three clinics in Fiji

Abstract

Investigating Differences in Cataract Surgery Outcomes: a comparative study of three clinics in Fiji

ABSTRACT

Purpose: Access to high-quality cataract surgery is essential to reduce cataract-caused visual impairment. Post-operative visual acuity is a key indicator used to monitor the quality of surgery by ophthalmologists. This indicator, known as Cataract Surgical Outcomes Monitoring (CSOM), is used to monitor post-surgical outcomes in the Pacific Eye Institute (PEI), the Mobile Eye Clinic (MEC) and surgical outreaches in Fiji.

Methods: A retrospective analysis of routinely collected data from the PEI, the MEC and Fiji outreaches from 2016 to 2019 was conducted to investigate differences in CSOM results across the three clinics. Comparisons were made using Chi-squared and Kruskal–Wallis tests. Odds of poor post-operative visual activity were assessed using logistic regression.

Findings: Between 2016 and 2019, 4,460 cataract surgeries were performed at the PEI, the MEC and Fiji outreaches. Excluding those with pre-existing conditions, the post-operative best-corrected visual outcomes of patients varied by clinic (p<0.001). At the MEC, 6.6% of patients had poor best-corrected visual acuity compared with 4.5% of patients at the surgical outreaches and 2.1% of patients at the PEI. Using multiple logistic regression, patients at the MEC were more likely to have poor best-corrected visual acuity (Odds ratio 2.31, 95% confidence interval 1.36–3.92, p=0.002) than patients at the PEI.

Conclusion: This study demonstrated differences in CSOM results in Fiji by clinic in which the surgery was performed. Reasons for these differences are important to examine to ensure equitable outcomes, within reason, for all patients receiving cataract surgery.