Monitoring and modernization to improve visual outcomes of cataract surgery in a community eyecare center in western India.

PURPOSE: To determine whether routine monitoring leads to better visual outcomes over time after cataract surgery. SETTING: Comprehensive community eyecare center in western India. DESIGN: Comparative case series. METHODS: Operative case sheets of all patients having cataract surgery were collected. Preoperative information, surgical details, and follow-up findings were included in the audit. The outcome measure was postoperative corrected distance visual acuity (CDVA), which was graded as good (≥ 6/18), borderline, or poor (<6/60). If the outcome was poor, the causes were classified as follows: selection, surgery, spectacles, or sequelae. The surgeons were briefed about their performance twice a year. RESULTS: The audit included 16,382 cataract surgeries. The proportion of eyes having a CDVA of 6/18 or better 6 weeks postoperatively improved significantly, from 86.5% (95% confidence interval [CI], 84.8%-88.3%) in 2002 to 90.5% (95% CI, 89.3%-91.8%) in 2005, while CDVA worse than 6/60 declined from 5.9% in 2002 to 2.5% in 2005. Manual small-incision cataract surgery was more popular than conventional extracapsular cataract surgery in 2004 and 2005. The incidence of posterior capsule tear and vitreous loss declined in the later years, although the rate of striate keratitis remained the same. Younger patients, women, those without ocular comorbidity, and those with a preoperative CDVA of better than 6/60 had better visual acuity 8 weeks postoperatively. CONCLUSION: Routine monitoring and modernization of technique helped increase good visual outcomes and reduce poor visual outcomes after cataract surgery.