Patient reported outcome measurements (PROM) of cataract surgery: comparison of outcomes between hospital-based versus outreach cataract centre: a prospective cohort study

Abstract

Objectives: This study aims to compare the outcomes of cataract surgery using Patient reported outcome measures (PROM) between a general tertiary hospital setting and an outreach cataract centre. PROM reports the benefits of surgery from the point of view of the patient instead of a clinical evaluation, which reduces the biases by practitioners.

Methods: Prospective Cohort Analysis. Patients were recruited at Hospital Selayang and The Hospital Selayang-MAIWP Cataract Care Centre (Pusat Pembedahan Katarak Hospital Selayang-MAIWP or PPKM in Malay) prior to their cataract surgery between 1 July 2022 and 30 October 2022. Printed Questionnaires were given to patients according to their language preferences, i.e. English, Malay Language and Mandarin. The Catquest-9SF questionnaires were completed prior to their cataract surgery and 6 weeks post-surgery. Patient demographics, visual acuity and data were retrieved from electronic medical records at both centres. Mean comparisons between centres were made for post-operative visual acuity in LogMar and post-operative Catquest-9SF scores. Logistic regression analysis was performed for each domain of the Catquest-9SF to the patient's demographic data, underlying illnesses, first eye surgery, pre-operative, and post-operative visual acuity.

Results: Both centres revealed identical demographic constitution of patients. By comparing means of post operative visual acuity and post operative Catquest-9SF scores, there were no significant differences between the two centres. This is also supported by the improvement/ non-improvement of Catquest-9SF scores, which showed no significant difference between the two centres. Patients from Hospital Selayang had higher percentages of improvements with subcategories Ca (difficulty in everyday life), Cb (satisfaction with current sight), C2 (Recognising faces), and C5 (Seeing to do handicrafts, woodwork). Logistic regression analysis revealed that pre-op visual acuity appears to be associated with an improvement of functional daily fine visual acuity tasks, whilst patients with cardiovascular and cerebrovascular diseases were associated with leisure associated fine visual acuity tasks. Patients with hypertension however were associated with significant improvements in domains Ca (difficulty in everyday life), C3 (seeing prices of goods), C5 (Seeing to do handicrafts, woodwork) and C6 (Reading Subtitles).

Conclusion: Improvements in patient reported visual functioning were not significantly different between the two centres. This validates the dedicated outreach cataract centres as places where good clinical and patient reported outcomes can be achieved.

Keywords: Cataract surgery; Catquest-9SF; Patient reported outcomes; Vision related quality of life; Visual function.