A Global View on Output and Outcomes of Cataract Surgery With National Indices of Socioeconomic Development.

PURPOSE

Cataract blindness accounts for a substantial proportion of blindness worldwide. Understanding the correlations between national levels of socioeconomic development with the quantity and quality of cataract surgery may provide insight for the prioritization and resource allocation for blindness prevention programs.

METHODS

The relationships between human development index (HDI), gross domestic product (GDP) per capita, and cataract surgical coverage (CSC) and visual outcome of cataract surgery were examined in a multinational study utilizing secondary data from the repository for Rapid Assessment of Avoidable Blindness (RAAB), World Health Organization, Global Burden of Disease, United Nations, and the World Bank.

RESULTS

A total of 266 RAAB studies across 73 countries/territories were retrieved. Linear regression model results revealed strong associations of HDI with prevalence of cataract blindness (β = -7.056, P < 0.001), CSC (β = 60.808, P = 0.004), proportion of intraocular lens (IOL) implantation (β = 87.040, P = 0.001), and proportion of cases with good vision outcomes among operated eyes (β = 73.351, P < 0.001) in studies performed between 1995 and 2009. Similar associations were observed for studies performed between 2010 and 2015. In addition, countries with lower GDP per capita showed a higher rate of cataract blindness (β = -0.527, P = 0.001), lower CSC (β = 9.800, P < 0.001), lower percentage of IOL implantation (β = 6.871, P = 0.001), and fewer patients with good vision outcomes after surgery (β = 7.959, P < 0.001). After controlling survey year, country, and other factors, GDP per capita and HDI were also found to be significantly associated with CSC and visual outcomes after cataract surgery (all P < 0.05).

CONCLUSIONS

We documented the strong associations of socioeconomic indices with quantity and quality of cataract surgery. These socioeconomic indicators should be considered as important factors for developing strategies aimed to improve worldwide cataract surgery service delivery.