Cataract Surgery Protocol

Cataract surgery protocal by Nepal Ophthalmic Society

Blindness  has  profound  human  and  economic  consequences  in  all  societies  due  to  loss  of independence, self esteem and economic productivity among those affected and their families. There are  also  additional  costs  involved  in  providing  special  needs  education  for  children  and rehabilitation  services  for  those  with  irreversible  loss  of  vision.  Globally  blindness  affects approximately 45 million people. Cataract is the commonest cause of avoidable blindness (19 million)  and  the  second  commonest  cause  of  visual  impairment  after  refractive  error. The  vast majority  of  individuals  with  visual  loss  due  to  cataract  live  in  developing  countries.  The disproportionate magnitude of cataract in developing countries is due to the social determinants of  health  which  are  consequences  of  poverty  in  its  broadest  sense  i.e.  greater  exposure  to  risk factors  on  one  hand  and  inadequate  access  to  and/or  provision  and  uptake  of  services  on  the other. Cataract occurs  when  the  normally  clear  lens  of  the  eye  becomes  cloudy  leading  to  gradual, progressive  loss  of  vision  (usually  in  both  eyes)  which  can  ultimately  lead  to  blindness.
Cataracts, which are straightforward to diagnose, are primarily an age related disorder, affecting individuals worldwide. Although cataracts cannot be prevented they can be treated by highly cost effective  surgery  which  leads  to  good  visual  outcomes. Indeed,  there  is  now  a  considerable body of high quality evidence from clinical trials and other studies which demonstrates the cost effectiveness of the surgical techniques most frequently used in low and middle income countries (i.e.  small  incision  cataract  surgery)  and  that  intraocular  lens  (IOL)  implantation  dramatically improves visual   outcomes.

The   World   Health   Organization   (WHO)   has   established standards for visual acuity after cataract surgery  and tools for monitoring visual outcomes have been  developed. However,  evidence  from  population  based  surveys  indicates  that  visual acuity outcomes following cataract surgery are not always as good as they might be. Studies have shown that successful cataract surgery can have a dramatic impact on individuals’ lives  including  being  able  to  return  to  their  previous  activities including  income  generation which has an impact on alleviating poverty. Services for cataract, therefore, contribute directly to the achievement of the MDGs as well as improving quality of life.

Despite technical advances in the management of cataract, the volume of cataract surgery in  low  and  middle  income  countries  is  usually  inadequate  to  control  cataract  blindness. For  example,  the  cataract  surgical  rate  is  less  than  500/million/year  in  many  of  the countries   in   sub Saharan   African   as   compared   with   a   cataract   surgical   rate   of 7,000/million population in most industrialized countries. The low output is due to a combination of factors including weak health systems, insufficient community awareness and participation, poverty, and poor infrastructure and primary health care. Control of cataract through the provision of high quality services which are scalable, adaptable, cost effective and responsive to the population remains a priority

The aims of modern cataract surgery include: 

  • Restoration of vision to meet the patient’s needs
  • Achievement of the desired refractive outcome
  • Improvement in quality of life
  • Ensuring patient safety and satisfaction

Aim of the guidelines

The aim of these guidelines is to identify good clinical practice, set standards of patient care and
safety and provide a benchmark for outcomes within which high quality cataract surgery can be
practiced Nepal Ophthalmic Society with support form IAPB & Apex Body for Eye Health, Ministry of Nepal had prepared Cataract Surgery Protocol Click here to download