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. 2025 May 21:13:e64500.
doi: 10.2196/64500.

Effectiveness of the Better Operative Software Outcomes Tool for Monitoring Cataract Surgery Outcomes in Inhambane Province, Mozambique: Prospective Pilot Diagnostic Accuracy Study

Mónica Lecumberri  1   2   3 , Dórcia Mandlate  4 , Vasco Cote  5 , Montserrat Martín-Baranera  6 , Carlos L Moser  1   2
Affiliations

Effectiveness of the Better Operative Software Outcomes Tool for Monitoring Cataract Surgery Outcomes in Inhambane Province, Mozambique: Prospective Pilot Diagnostic Accuracy Study

Mónica Lecumberri et al. JMIR Mhealth Uhealth. .

Abstract

Background: Cataract is the world's leading cause of avoidable blindness. High-quality cataract surgery is a cost-effective procedure to restore vision. In low- and middle-income countries (LMIC), there are high rates of poor outcomes after surgery and inadequate follow-up, which makes it difficult to effectively monitor surgical outcomes. To address this issue, the Better Operative Outcomes Software Tool (BOOST Cataract app) assesses the final outcome on the first postoperative day and records the reasons for poor outcomes at 6 weeks postoperatively, offering specific advice to improve outcomes.

Objective: The aim of this study is to evaluate the real-world utility of the BOOST Cataract app for monitoring cataract surgical outcomes in Inhambane Province (Mozambique) and to analyze the data collected by the app during a surgical campaign conducted therein.

Methods: This prospective study of diagnostic accuracy included patients older than 50 years who underwent manual small-incision cataract surgery. The BOOST Cataract app was used to collect data on visual acuity (VA) on the first postoperative day and to assess surgical outcomes. The sensitivity and specificity (with their 95% CIs) and area under the curve of the BOOST Cataract app (index test) were calculated to identify suboptimal outcomes (moderate and poor) compared with outcomes 6 weeks after surgery (reference standard). The causes of poor outcomes after 6 weeks were recorded and evaluated using the app.

Results: A total of 141 patients who underwent surgery during a cataract campaign in Inhambane Province (Mozambique) between April 2022 and May 2022 were included in the study. The mean age was 70 (SD 10.2) years, and 48.2% (68/141) of the participants were women. Of the 141 patients, 8 (5.7%) did not complete the study. The BOOST Cataract app had a sensitivity of 94.44% and a specificity of 59% for detecting suboptimal outcomes. The area under the curve was 0.825. The campaign outcomes were as follows: good (VA ≥6/18) in 45.9% (61/133) of cases, moderate (VA <6/18 to ≥6/60) in 33.8% (45/133), and poor (VA<6/60) in 20.3% (27/133) of cases. The main cause of a poor outcome was surgical complication, while refractive error was the main cause of a moderate outcome.

Conclusions: The BOOST Cataract app is a valuable tool for assessing suboptimal cataract surgery outcomes without waiting for the completion of postoperative treatment in settings where postoperative follow-up is incomplete. In resource-limited eye care systems, the BOOST Cataract app provides an opportunity to assess outcomes and analyze results to develop specific strategies to improve quality at a local level.

Keywords: cataract extraction; developing countries; health care; outcome assessment; software; visual acuity.

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Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Flow diagram of participants. BOOST: Better Operative Software Outcomes Tool; PVA: presenting visual acuity.
See this image and copyright information in PMC

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