Cataract surgery in outreach camps gave poorer vision than fixed facilities, and the gap has not closed

Design

Pooled cross-sectional analysis of 168 population-based RAAB surveys

Population

41,881 cataract-operated eyes in adults aged 50+, 61 countries, 2000–2020

Primary outcome

Presenting visual acuity 6/18 or better

Effect

Outreach vs fixed: 60.6% vs 66.6%, OR 0.59 (0.50–0.70); private vs government OR 1.56 (1.25–1.94)

This pooled analysis used 168 Rapid Assessment of Avoidable Blindness surveys in 61 countries, covering 41,881 eyes operated for cataract between 2000 and 2020 in adults aged 50 and over. Outcome was presenting visual acuity of 6/18 or better, adjusted for age, sex, year and region.

Outreach camps performed 9.7% of the surgeries and had a lower adjusted probability of a good outcome than fixed facilities (60.6% vs 66.6%; OR 0.59, 95% CI 0.50–0.70). Within fixed facilities, government hospitals reached 64.8%, NGO hospitals 66.8% and private hospitals 69.5%; private hospitals did better than government ones (OR 1.56, 1.25–1.94), while NGO hospitals were similar. Outcomes improved over time in every model, but the differences between settings stayed the same.

Outreach camps remain a major route to cataract surgery in rural India. These data do not argue against camps — they reach patients who would not otherwise be operated — but they point to where quality work is needed: biometry, refraction and spectacles after surgery, and follow-up. Presenting acuity includes uncorrected refractive error, so part of the gap is likely unprescribed spectacles rather than surgical complications.

• Perform biometry for every camp patient rather than using standard lens powers
• Refract and provide spectacles at the postoperative visit
• Audit presenting and best-corrected acuity separately for camp and base-hospital surgery
• Ensure every camp patient has a defined follow-up at a fixed facility
• Track posterior capsule rupture and endophthalmitis rates by setting

Why it matters

Where camps carry much of the surgical volume, their outcomes set the ceiling on effective cataract coverage.

Don't overread it

Cross-sectional survey data — the gap may reflect patient differences and missing spectacles as much as surgical quality.

The statistics, in plain English

An odds ratio of 0.59 means the odds of a good outcome in camps were about 40% lower, which translated into 6 fewer good outcomes per 100 eyes. The surveys measure presenting vision years after surgery, so they mix surgical quality with refractive correction and later eye disease, and patients operated in camps may differ in ways not adjusted for.

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