Prevalence of cataract surgery and postoperative visual outcome in rural central India Central India Eye and Medical Study

PURPOSE: To determine the prevalence of cataract surgery and the postoperative visual outcomes in rural central India. SETTING: Villages in rural central India. DESIGN: Cohort study. METHODS: The population-based Central India Eye and Medical Study examined the prevalence of surgical pseudophakia/aphakia, the postoperative visual acuity, and the reasons for decreased postoperative vision in subjects aged 30+ in rural central India. Visual impairment was defined as (1) presenting visual acuity worse than 6/18 or (2) corrected distance visual acuity (CDVA) worse than 6/18. RESULTS: Of the 9392 eyes (99.7%) of 4711 subjects with available data on the lens status, 318 eyes (3.4%) (234 patients, 129 women) had had cataract surgery (5.0% +/- 0.3%). Cataract surgery was significantly associated with age (P<.001), female sex (P=.008), shorter axial length (P<.001), and diabetes mellitus (P<.001). The prevalence of postoperative presenting visual impairment was 63% (201/318 eyes) and of postoperative CDVA impairment, 36% (117/318 eyes). The major cause of the former was incorrect intraocular lens (IOL) power (42%); the major causes of the latter were posterior capsule opacification (24%), surgical complications (21%), age-related macular degeneration (10.3%), other macular disorders (4.3%), corneal opacities (3.4%), and glaucoma (2.0%). Surgical complications were significantly more common in the aphakic group than in the pseudophakic group (46.4% versus 2.0%; P<.001). CONCLUSIONS: Approximately 5% of the central India population aged 30 years or older had had cataract surgery. Postoperative visual impairment was present in 2 of 3 eyes. The major reasons were incorrect IOL power and surgical complications. Improved IOL power calculations and improved surgical techniques may markedly improve postoperative outcome.