Investigating Differences in Cataract Surgery Outcomes Monitoring Results Across Fred Hollows Foundation NZ Supported Clinics in Fiji

Abstract

Background: Access to high-quality cataract surgery is essential to reduce and eliminate the high prevalence of cataract-caused visual impairment. A key indicator used by ophthalmologists at Fred Hollows Foundation NZ supported clinics, including the Pacific Eye Institute (PEI), the Mobile Eye Clinic (MEC) and surgical outreaches, to monitor the quality of surgery is that of postoperative visual acuity. This indicator is known as Cataract Surgical Outcomes Monitoring (CSOM). Aims: This study aimed to identify whether there are differences in CSOM results between the PEI, the MEC and Fiji surgical outreaches. Methods: A retrospective analysis of routinely collected data from the PEI, the MEC and Fiji outreaches from 2016 to 2019 was conducted to investigate differences in CSOM results across the three sites. Results: Between 2016 and 2019, 4,460 cataract surgeries were performed at the PEI, the MEC and Fiji outreaches. Excluding those with pre-existing conditions, the postoperative uncorrected (p < 0.001) and best-corrected (p < 0.001) visual outcomes of patients varied by clinic. At the PEI, only 2.3% of patients had poor (<6/60) uncorrected visual acuity compared to 8.3% of patients at the MEC and 5.0% of patients at the surgical outreaches. Although with best-correction, visual acuity of all patients at each clinic improved, 6.6% of patients at the MEC still had poor best-corrected visual acuity compared to 4.5% of patients at the surgical outreaches and 2.1% of patients at the PEI. Using multiple logistic regression, it was found that patients at the MEC were more likely to have comparatively poor postoperative uncorrected visual acuity (OR = 2.42, p < 0.001) and poor best-corrected visual acuity (OR = 2.31, p = 0.002) than patients at the PEI. Conclusion: The results of the study showed there were differences in CSOM results by clinic. Patients who received cataract surgery at the PEI had better visual outcomes than those who received surgery at the MEC and surgical outreaches. Patients at the MEC, in particular, were more likely to have poor postoperative outcomes. Further study will be required to explain these described differences so that appropriate actions can be taken to ensure that every patient can achieve the best possible postoperative outcome regardless of where they receive surgery.