Improving cataract outcomes through good postoperative care

Cataract surgery is one of the most successful and frequently performed operations worldwide, and yet cataract remains the commonest cause of global blindness.1 This is in part due to the shortage and uneven distribution of trained personnel in some countries. More worryingly, a high rate of cataract blindness also reflects poor visual outcomes after surgery, as has been documented in many RAAB (rapid assessment of avoidable blindness) studies.2 In turn, poor visual acuity outcomes can be the result of inadequate pre-operative assessment (such as inaccurate biometry and/or a failure to detect signs which indicate that surgery may be complicated), complications during the surgical procedure itself, and poor postoperative management (including a lack of refraction). Postoperative care does not always receive the attention it deserves. For example, when looking for information online, there are six times as many search results available about cataract surgery as there are about postoperative care – despite the latter being a vital component in achieving a good visual outcome. In this issue of the Community Eye Health Journal, Dr George Ohito from St Mary’s Mission Hospital, Langata, Kenya, describes postoperative care as “an integral part of cataract management, with the objectives of minimising patient discomfort and pain, preventing injury and complications, and improving surgical and vision outcomes” (page 26). This definition covers all aspects: counselling, advice following surgery, and – importantly – postoperative refraction. The latter is important as there is often residual refractive error after cataract surgery, whether from astigmatism or inaccurate biometry. The VISION 2020 initiative3 requires three components – trained personnel, equipment and facilities, and community participation. Good postoperative care starts even before surgery and involves patients and the community by means of counselling to allay fears and manage expectations (see the article on page 23). Patients may not access eye care services because they fear surgery or worry that they won’t be able to work after an operation. Patients and their carers need reassurance and advice and must know what to do when they return home. If this is done well, and the outcomes are good, others in the community will have confidence in the eye team and be more likely to present themselves for surgery when their time comes. Although the surgical team’s responsibility doesn’t stop when the patient leaves the operating theatre, patients also have a role to play. Postoperative care