Socioeconomic factors affecting visual acuity in cataract camps

Cataracts are the leading cause of reversible blindness worldwide. Though temporary and resource-intensive, cataract camps provide large-scale treatment of the condition. This study sought for associations between country-level socioeconomic factors and short-term improvements in visual acuity observed in cataract camps across 17 countries.

This observational study represents 52 camps in 17 low- and middle-income countries. Nested mixed-effects linear regression models were used to analyze associations between changes in LogMAR score of uncorrected visual acuity (UCVA) one to four days post-operation and socioeconomic factors including per capita GDP, Human Development Index, Cataract Surgical Rate, and density of in-country ophthalmologists.

Among 4110 patients, after accounting for age and sex, LogMAR UCVA significantly decreased over the first four days postoperatively (p < 0·0001). This decrease was also associated with the number of ophthalmologists per million performing cataract surgery (p = 0·0227). Patients who underwent extracapsular cataract extraction (ECCE) exhibited a greater decrease in LogMAR UCVA per day post-op (p < 0·0001). Per capita GDP was not significantly associated with the change in LogMAR UCVA per day post-op.

This ecological analysis shows that countries with fewer ophthalmologists performing cataract surgery correlated with the most short-term improvement in vision. Considering that cataract camps often target populations with severe baseline cataracts, training local ophthalmologists to perform ECCE surgery may help lift a high burden of cataract-induced blindness in low-resource settings.