Effective cataract surgical coverage in India: Evidence from 31 districts
Vivek Gupta, Praveen Vashist, S Sarath, Noopur Gupta, Suraj Singh Senjam, Pallavi Shukla, Sumit Grover, B R Shamanna, Rajshekhar Vemparala, Meenakshi Wadhwani, Amit Bhardwaj, Promila Gupta, Jeewan S Titiyal- Ophthalmology
Background:
Effective Cataract Surgical Coverage (eCSC) is a core outcomes domain indicator to assess accessibility and quality of eye care services with limited available information.
Purpose:
To generate baseline estimates of eCSC for India.
Methods:
We performed the analysis of data pooled from Rapid Assessment of Avoidable Blindness surveys conducted in 31 districts of India during 2015-2019 among persons aged 50+ years. eCSC was calculated at various thresholds, the primary being operable cataract at best corrected visual acuity <6/12, good outcome at presenting visual acuity of 6/12.
Results:
Age-sex standardized and weighed eCSC in India was 36.7% (95% CI: 33.6, 39.9), and cataract surgical coverage (CSC) was 57.3% (95% CI: 53.3, 61.2), a relative quality gap in cataract surgery being 36.0%. eCSC in males was higher at 38.0% than females (35.6%). eCSC increased with education from 31.0% in illiterate participants to 59.7% in class 10 educated. On multivariate analysis, rural setting, increasing age, and residence in eastern or northeastern zones of India continued to be associated with poor/worse eCSC, while female gender was associated with higher eCSC. District-wide variations in eCSC were observed.
Conclusion:
Developmental factors have an important bearing on eCSC in India. Geographical variations point toward the need for targeted, locally relevant strategies.