Effective cataract surgical coverage in India: Evidence from 31 districts

Abstract

Background: Effective Cataract Surgical Coverage (eCSC) is a core outcomes domain indicator to assess accessibility and quality of eye care services with limited available information.

Purpose: To generate baseline estimates of eCSC for India.

Methods: We performed the analysis of data pooled from Rapid Assessment of Avoidable Blindness surveys conducted in 31 districts of India during 2015-2019 among persons aged 50+ years. eCSC was calculated at various thresholds, the primary being operable cataract at best corrected visual acuity <6/12, good outcome at presenting visual acuity of 6/12.

Results: Age-sex standardized and weighed eCSC in India was 36.7% (95% CI: 33.6, 39.9), and cataract surgical coverage (CSC) was 57.3% (95% CI: 53.3, 61.2), a relative quality gap in cataract surgery being 36.0%. eCSC in males was higher at 38.0% than females (35.6%). eCSC increased with education from 31.0% in illiterate participants to 59.7% in class 10 educated. On multivariate analysis, rural setting, increasing age, and residence in eastern or northeastern zones of India continued to be associated with poor/worse eCSC, while female gender was associated with higher eCSC. District-wide variations in eCSC were observed.

Conclusion: Developmental factors have an important bearing on eCSC in India. Geographical variations point toward the need for targeted, locally relevant strategies.

Figure 1

Relative gender gap in eCSC in districts of India among participants aged 50 years and more in the National Blindness and Visual Impairment Survey, India (2015-2019). Legend: Gender variations in eCSC in 31 districts of India. Dots represent the point estimates of eCSC, and the whiskers represent 95% confidence intervals. Numbers represent the relative gender gap (Male eCSC–Female eCSC/Male eCSC). The threshold of operable cataract is BCVA worse than 6/12, and a good outcome after cataract surgery is PVA better than equal to 6/12

Figure 2

District-wide variations in eCSC at various BCVA thresholds of operable cataract with good outcome of PVA of 6/12 or better among participants aged 50 years and more in the National Blindness and Visual Impairment Survey, India (2015-2019). Legend: Variations in eCSC by various BCVA thresholds of operable cataract in 31 districts of India. Dots represent the point estimates of eCSC. Numbers represent the absolute gap (eCSC at BCVA 6/18–eCSC at BCVA 6/12). The threshold of operable cataract considered is BCVA worse than 6/12, 6/18, 6/60, and 3/60, and good outcome after cataract surgery is PVA better than equal to 6/12