Variations in post-operative cataract surgery instructions among eye health workers in Tanzania: a cross-sectional survey

To investigate variations in post-operative cataract surgery instructions among eye health workers in Tanzania and identify areas requiring standardization.

A cross-sectional survey was conducted among 142 eye health workers across all health workers providing cataract surgery or post-operative care in Tanzania. The survey assessed counselling practices, timing recommendations for resuming 23 daily activities, medication prescription patterns, and follow-up protocols. Variation indices (VI) were calculated to quantify the degree of disagreement among providers using the formula: VI = 1 - (modal frequency/total responses). Variation was classified as low (VI < 0.40), moderate (0.40-0.60), high (0.60-0.70), or very high (> 0.70).

Survey respondents included ophthalmology residents (28%), consultant ophthalmologists (22%), ophthalmic nursing officers (17%), assistant medical officers (13%), and optometrists (12.0%). Only 30%of providers routinely provide written post-operative instructions to patients. Substantial variations existed across most activities examined: watching television (VI = 0.775), computer use (VI = 0.761), smartphone use (VI = 0.754), bending for prayers (VI = 0.725), and sexual activity (VI = 0.690). Recommendations for activity resumption ranged from Day 1 to 6 weeks post-operatively (a 41-day span) for most activities. Good consensus existed only for phone use (59.2% allow Day 1, VI = 0.323) and eating normal diet (48.6% allow Day 1, VI = 0.434). Provision of written instructions varied significantly by professional designation (χ²=28.85, p = 0.0013), but activity recommendations showed no significant correlation with designation, years of experience, or surgical volume. The modal number of follow-up visits was 4 (32.4%), with the last visit most commonly scheduled at 8 weeks (30.3%).

Substantial variations in post-operative cataract surgery instructions reflect the absence of evidence-based guidelines rather than individual provider factors. The critical deficit in written instruction provision (only 30%) and wide variation in activity restrictions have significant implications for patient compliance, quality of life, and economic productivity. Development of standardized, evidence-based, culturally appropriate guidelines is urgently needed for Tanzania and similar settings in sub-Saharan Africa.