Cataract Surgery Protocol

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To perform safe and qualitative cataract surgery there is always a Need for a standard cataract protocol that guides for a uniform minimum standard of clinical practice needs to be in place. which result in a satisfied patient, satisfied surgeon which ultimately results in good quality of life. Here is the main part of the Cataract surgery protocol developed by Nepal Ophthalmic Society with Support from IAPB. 

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. A 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. A 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  practised Nepal Ophthalmic Society with support from IAPB and Apex Body for Eye Health, Ministry of Nepal had prepared Cataract Surgery Protocol

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Also, read COVID 19 Ophthalmology Practice Guidelines by Nepal Ophthalmic Society

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