Prevalence and visual outcomes of cataract surgery and cataract surgical coverage in Sri Lanka: findings from the National Blindness and Visual Impairment Survey

Abstract

Introduction: Cataract surgical coverage and visual acuity outcomes are important population level indicators for monitoring access to and the quality of cataract surgery, allowing subgroups with poorer access to be identified. Data on these indicators are not available for Sri Lanka at national level. Objectives: Determine cataract surgical coverage and the outcomes of cataract surgery in a nationally representative sample of adults aged >=40 years. Methods: Cluster random sampling with proportionate to size procedures was used. All participants were interviewed to obtain data on education level, movable assets, and the year and place of cataract surgery, if applicable. Presenting and best corrected visual acuities were measured. All participants underwent slit lamp examination, including a dilated examination of the fundus. Cataract surgical coverage was calculated at the person level vision of <3/30, <6/60 and <6/18. Outcomes of cataract surgery were categorized as good (6/18 or better), borderline (<6/18-6/60) or poor (<6/60). Results: A total of 345 persons among the 5,779 participants who were examined had undergone cataract surgery in one or both eyes (486 eyes). Cataract surgical coverage, which was high overall 85.4% for vision <3/60; 79.1% for vision (<6/60), was significantly higher in younger age groups (Odds Ratio [OR] 5.65, 95% confidence interval [CI] 1.42-22.52), those in urban areas (OR 2.8, 95% CI 1.01-7.74) those with higher socio-economic status (OR 6.0; 95% CI 1.96-18.4). Coverage ranged from 60% in Uva Province to 100% in Southern Province. 59.7% of eyes had good outcomes at presentation increasing to 75.1% with correction. Conclusions: Cataract surgery indicators for Sri Lanka are good, being better than most other Asian countries. Services should target those living in underserved Provinces.