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Year : 2011  |  Volume : 55  |  Issue : 1  |  Page : 22-24  

A study on visual outcomes after cataract surgery with intraocular lens implants at the rural health training center, Paithan, Maharashtra


1 Assistant Professor, Department of Preventive and Social Medicine, MNR Medical College, Sangareddy, Andhra Pradesh, India
2 Associate Professor, Department of Preventive and Social Medicine, Government Medical College, Aurangabad, India
3 Assistant Professor, Department of Preventive and Social Medicine, Government Medical College, Aurangabad, India
4 Professor and Head, Department of Preventive and Social Medicine, Dr. S.C. Government Medical College, Nanded, Maharashtra, India
5 Senior Consultant, State Health System Resource Center, Pune, Maharashtra, India

Date of Web Publication30-Jun-2011

Correspondence Address:
Vijay K Domple
Assistant Professor, Department of Preventive and Social Medicine, MNR Medical College, Fasalwadi, Sangareddy, Andhra Pradesh - 502 294
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-557X.82539

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   Abstract 

A study was conducted to assess the visual outcomes of patients after cataract surgery with intraocular lens implants with reference to visual acuity (VA) and visual function (VF) and to assess patient satisfaction with surgical outcome. The retrospective study was carried out using operation theatre records at the Rural Health Training Centre (RHTC), Paithan, during 2007. Out of 819 cataract surgery patients operated in 2007 a total of 50 were selected randomly. Door-to-door visits were paid by investigator and multipurpose worker to previously operated patients for VA examination and to fill predesigned questionnaire. Statistical analysis was done by using SPSS 17.0 Version; 50% patients had VA in fair vision range of <6/18-6/60 and 52% showed the VF in the range of 76-100. Of the 32 satisfied patients, majority were in the age group 70-79 years. The patients with good visual outcomes achieved after surgery would act as pamphlets for the community.

Keywords: Cataract surgery, Patient satisfaction, Visual acuity, Visual function


How to cite this article:
Domple VK, Gaikwad AV, Khadilkar HA, Doibale MK, Kulkarni AP. A study on visual outcomes after cataract surgery with intraocular lens implants at the rural health training center, Paithan, Maharashtra. Indian J Public Health 2011;55:22-4

How to cite this URL:
Domple VK, Gaikwad AV, Khadilkar HA, Doibale MK, Kulkarni AP. A study on visual outcomes after cataract surgery with intraocular lens implants at the rural health training center, Paithan, Maharashtra. Indian J Public Health [serial online] 2011 [cited 2019 Nov 17];55:22-4. Available from: http://www.ijph.in/text.asp?2011/55/1/22/82539

A growing body of research indicates that visual acuity (VA) alone is an inadequate measure of visual impairment. The impact on visual function (VF) is closely related to patient-perceived outcomes and has become a significant factor in the evaluation of the outcome of surgical interventions. Although patients may benefit from an increase in VA and VF after cataract surgery, their satisfaction may be limited. Assessment of patient satisfaction gives additional information on the result of surgery and is therefore of further importance in evaluating surgical outcome. [1]

There have been a number of previous studies to find out only VA after cataract surgery with intraocular lens implants, [2],[3],[4],[5] but no study was done on a combination of all these criteria, that is, VA, VF, and patient satisfaction in Marathwada region of Maharashtra. So the present study was planned in Paithan taluka of Aurangabad district of Maharashtra with the objectives of assessing the visual outcomes of patients after cataract surgery with intraocular lens implants with reference to VA and VF and to assess the patient satisfaction with surgical outcome.

Rural Health Training Centre (RHTC), Paithan, is the subunit of Department of Preventive and Social Medicine, Government Medical College and Hospital (GMCH), Aurangabad, where curative, preventive, and promotive health care services are catered. In curative services, cataract surgeries are one of the important aspects. Records of surgeries done during weekly camps by Department of Ophthalmology, GMCH, Aurangabad, were collected for the study. Patients who underwent cataract surgery at RHTC, Paithan, between Jan 1, 2007 and Dec 31, 2007 (one year), were identified from operation theater records. The type of cataract surgery done by surgeons was standardized extracapsular cataract extraction with posterior chamber intraocular lens implants (ECCE +PC-IOL) for all the patients. Records revealed that a total of 819 cataract surgeries were performed by three ophthalmic surgeons. Out of the three ophthalmic surgeons, the name of one surgeon was selected randomly. A total of 150 cataract surgeries were performed by the selected surgeon in the year 2007. From the list of the 150 patients who were operated by the surgeon a total of 50 patients were selected by systematic random sampling. Their case sheets and admission papers were retrieved from the record section. The 50 patients belonged to 7 different villages and the distances of these villages were in the range of 5-15 km radius of Paithan town. Door-to-door visits were paid to these patients between March 1 and April 30, 2009 by Investigator along with local multipurpose workers (MPW). It was decided to interview all those patients who were personally available during home visits and willing to participate in the study. Verbal informed consent was obtained from every patient. A predesigned questionnaire was used to interview patients; it contained questions about the demography, VF-11 questionnaire (modified version of VF-14 questionnaire) adapted from previously published study of Friedman et al., [6] and the questions about the levels of satisfaction of patients adapted from Mozaffarieh et al. [1]

Preoperative VA of patients (using Landolts's C-chart [7] ) were obtained from case sheets of patients. During house to house visit, for recording VA of postoperative patients, a shaded area was selected near to the house and used the same chart. Distances of 3 and 6 m were then marked out using a measuring tape. VA was recorded as the best corrected VA in the eye that had undergone cataract surgery. VA was measured by the same investigator for all patients, in operated eye after surgery.

Assessment of VF by using a validated VF-11 questionnaire was used in the present survey. Since majority of patients were illiterate, the questionnaire was explained orally to them in their local language (Marathi) and responses were noted by investigators. For analysis of VF-11 questionnaire, we averaged all item scores. The averaged number is multiplied by 25 and the resultant number was taken as VF score of that patient. The score ranges from 0 (worst level of visual function) to 100 (best level of visual function).

Satisfaction with cataract surgery was assessed by improvement or deterioration in VA and their fulfillment of expectation regarding surgical outcome. We used three dichotomous questions (Yes/No) regarding satisfaction of patient. We decided that satisfaction is indicated by any two affirmative answers out of three and dissatisfaction is indicated by only one of the three answers in the affirmative. Statistical analysis was done by using SPSS 17.0 Version.

Out of 50 operated patients, 2 had migrated, 1 died and 1 was untraceable even after four visits. Therefore 46 eyes/46 patients were examined. Conner-Spady et al., [8] in their study, found that the mean age of the patients was 73.4 years and 61.9% were females. In our study, earliest age at which a patient was operated for cataract was 40 years, mean age was 63.13 ± 9.82 years, and 67.4% women. In the present study, improvement in VA to good vision was observed in 20% patients, that is, to ≥6/18. Majority (50%) of patients showed improvement to fair vision, that is, in the range of <6/18-6/60 and remaining (30%) patients showed very marginal improvement [Table 1]. This poor outcome could be because of associated pre-existing ocular diseases, such as chronic glaucoma, age-related macular degeneration, and diabetic retinopathy, and so on, intra- and postoperative complication and uncorrected refractive errors, such as significant astigmatism and uncorrected ametropia. Kapoor et al. [4] reported that good vision (6/18 or better) was found in 44.5% of the eyes and poor outcome of visual acuity was 1.9% of ECCE with IOL. Bourne et al. [5] showed that 13.6% of ECCE + IOL surgeries resulted in less than 6/18 vision, and none was worse than 6/60. This difference might be because of higher numbers of old patients got operated in present study (70-79 years) whose VA < 6/60 preoperatively.
Table 1: Visual acuity outcome of pre- and postoperative cataract surgery patients

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Review of literature revealed that studies to determine VF score and for patient satisfaction were all done by phacoemulsification surgical procedure. So no study was available to compare with VF status of the patients in the present study. Around 50% of the operated patients showed their score in the range of 76-100 for visual function [Table 2]. In the present study, more than 2/3 patients found to be satisfied after cataract surgery. Majority of satisfied patients (32.6%) belonged to 70-79 years. However, the observed difference was not statistically significant (P > 0.05).
Table 2: Distribution of Visual Function (VF-11) scores of postoperative cataract surgery patients

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Significant limitation of this study is small sample size, which may preclude statistical significance. The patients with good visual acuity achieved after surgery would act as pamphlets for the community and that would facilitate the health care seeking behavior of the cataract patients. Ultimately quality services provided through National Programme for Control of Blindness would give benefit to a maximum number of persons.

 
   References Top

1.Mozaffarieh M, Heinzl H, Sacu S, Wedrich A. Clinical outcomes of phacoemulsification cataract surgery in diabetes patients: Visual function (VF-14), visual acuity and patient satisfaction. Acta Ophthalmol Scand 2005;83:176-83.  Back to cited text no. 1
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2.Bourne R, Dineen B, Jadoon Z, Lee PS, Khan A, Johnson GJ, et al. Outcomes of cataract surgery in Pakistan: Results from the Pakistan national blindness and visual impairment survey. Br J Ophthalmol 2007;91:420-6.  Back to cited text no. 2
[PUBMED]  [FULLTEXT]  
3.Malik AR, Qazi ZA, Gilbert C. Visual outcome after high volume cataract surgery in Pakistan. Br J Ophthalmol 2003;87:937-40.  Back to cited text no. 3
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4.Kapoor H, Chatterjee A, Daniel R, Foster A. Evaluation of visual outcome of cataract surgery in an Indian eye camp. Br J Ophthalmol 1999;83:343-6.  Back to cited text no. 4
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5.Bourne RR, Dineen BP, Ali SM, Huq DM, Johnson GJ. Outcomes of cataract surgery in Bangladesh: Results from a population based nationwide survey. Br J Ophthalmol 2003;87:813-9.  Back to cited text no. 5
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6.Friedman DS, Tielsch JM, Vitale S, Bass EB, Schein OD, Steinberg EP. VF-14 item specific responses in patients undergoing first eye cataract surgery: Can the length of the VF-14 be reduced? Br J Ophthalmol 2002;86:885-91.  Back to cited text no. 6
[PUBMED]  [FULLTEXT]  
7.Khurana AK. Comprehensive Ophthalmology. 4 th ed. New Delhi: New Age International (P) Limited Publishers; 2010. p. 465.  Back to cited text no. 7
    
8.Conner-Spady BL, Sanmugasunderam S, Courtright P, McGurran JJ, Noseworthy TW. Determinants of patient satisfaction with cataract surgery and length of time on the waiting list. Br J Ophthalmol 2004;88:1305-9.  Back to cited text no. 8
    



 
 
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