Outreach camp cataract surgery gave worse vision than fixed facilities in 61 countries, and the gap has not closed

Design

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

Population

41,881 cataract-operated eyes, adults 50 and over, 61 countries

Primary outcome

Presenting visual acuity 6/18 or better

Effect

Camps 60.6% vs fixed 66.6%; OR 0.59 (0.50 to 0.70); private vs government OR 1.56 (1.25 to 1.94)

This analysis pooled 168 population-based Rapid Assessment of Avoidable Blindness surveys from 61 countries, covering 41,881 eyes of adults aged 50 or over operated between 2000 and 2020. Surgical setting was compared for presenting visual acuity of 6/18 or better, adjusting for age, sex, year and region.

Outreach camps — about 10% of surgeries — had a lower probability of a good outcome than fixed facilities (60.6% vs 66.6%; OR 0.59, 95% CI 0.50 to 0.70). Among fixed facilities, outcomes were 64.8% in government, 66.8% in NGO and 69.5% in private hospitals; private hospitals did better than government ones (OR 1.56). Outcomes improved everywhere over two decades, but the gaps between settings did not narrow.

For India, where camps and government programmes carry much of the cataract load, this is directly relevant. The answer is not to stop outreach but to treat it as a way to bring patients to well-equipped surgery, with biometry, proper refraction and follow-up, and to measure outcomes in every setting. Presenting acuity also reflects uncorrected refractive error, so postoperative spectacles matter.

• Audit presenting visual acuity after cataract surgery in every setting, including camps
• Where possible, use camps for screening and transport patients to a fixed surgical facility
• Ensure biometry and appropriate IOL power for every eye, including camp surgery
• Provide postoperative refraction and spectacles, as presenting acuity depends on them
• Track outcomes separately for outreach and base-hospital surgery

Why it matters

Coverage without quality leaves many operated eyes still visually impaired.

Don't overread it

Cross-sectional survey data cannot separate the setting from differences in patients, case mix or follow-up.

The statistics, in plain English

An odds ratio of 0.59 means about 40% lower odds of a good result in camps. The absolute difference is six percentage points — six more poor outcomes per 100 operations.

Read the rest in the app

You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.

Get Daily Doctor — free

Scan to keep reading on your phone. No account needed to start.