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Purpose To report trends in cataract surgery indications, visual acuity outcomes, complication rates and reoperation rates at ten Aravind Eye Hospitals in Tamil Nadu, India. Methods In this retrospective database study we analyzed seven years of data of cataract surgeries at Aravind during January 1, 2012 to December 31, 2018. Our main outcome measures were preoperative and 1-month postoperative uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA); and rates of intraoperative complications and reoperations. We performed Cochran-Armitage trend tests. Results In 1.86 million eyes that underwent cataract surgery, the percentage of eyes undergoing phacoemulsification (PE) showed an increasing trend (p < 0.0001), from 26.8% in 2012 to 33.5% in 2018. The percentage of eyes undergoing manual small incision cataract surgery (SICS) showed a decreasing trend (p < 0.0001), from 70.0% in 2012 to 65.1% in 2018. For SICS, the percentages of eyes with good postoperative UCVA and BCVA showed increasing trends (p < 0.0001 for each), and the percentages of eyes with poor postoperative UCVA and BCVA showed decreasing trends (p < 0.0001 for each). Results for PE surgeries were mixed. For both PE and SICS rates of intraoperative complications showed a declining trend (p < 0.0001 for each) and a slight increasing trend for reoperations (PE p < 0.02; SICS p < 0.0001). Conclusions During this seven-year period there were noticeable trends in cataract surgeries performed at Aravind in terms of the mix of surgical procedures, preoperative vision, and cataract surgical outcomes.

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Telemedicine is increasingly used across the developing world to expand access to healthcare, to improve outcomes, and to reduce costs. One common model is that of telemedicine centers, which are small primary care facilities run by midlevel (nonphysician) providers who conduct a preliminary examination and then facilitate a telemedicine visit with a remote physician in real time. However, the impact of this channel of care delivery—particularly on existing physical healthcare-delivery channels—has not been thoroughly examined. We use data from one of the largest tele-ophthalmology implementations in the world to examine this issue. Using a quasi-experimental difference-in-differences approach, we find that opening a nearby telemedicine center generates a 31% increase in the overall network visit rate from the population within 10 km of the new center, 62% of which is driven by new patients, suggesting a substantial increase in access. The rate of eyeglasses prescriptions to correct for simple refractive errors increases by 18.5%, whereas the rate of cataract surgery to replace the natural lens in a patient’s eye with an artificial lens remains unchanged. The increase in access and treatment rates does not significantly impact the direct costs incurred by patients, but reduces their indirect costs (measured as travel distance) by 30% (12 km). Finally, we find significant spatial heterogeneity in these effects, which vary with the distance of patients to facilities. These results have important implications for the design of telemedicine networks and the portfolio of healthcare services provided through them. This paper was accepted by Stefan Scholtes, healthcare management.

Purpose: To examine the difference in post-operative visual outcomes of cataract surgeries between a tertiary and secondary centre at Aravind Eye Hospitals in Tamil Nadu, India. Methods: Our retrospective cross-sectional study analysed cataract surgeries at a secondary centre and its associated tertiary centre in 2021. Our main outcome measures were postoperative best corrected visual acuity (BCVA), spherical equivalent, and intraoperative and postoperative complications. Two-sample proportion tests, regression analyses, and logistic probability analyses were performed. Results: The analysis of 32,302 cataract surgeries in 2021 of which 4,357 were performed at the secondary centre and 27,945 were performed at the tertiary centre showed that the tertiary centre operated on more advanced cataract condition (p<0.001) and had higher incidence of patients with ocular comorbidity (p<0.001). Intraoperative (p<0.001) and post-operative complication rates (p<0.001) were higher in the tertiary centre. The odds of effective outcomes (BCVA >=6/12) controlling for all covariates are poorer (p<0.0001) in the tertiary centre for both phacoemulsification (phaco) and manual small incision cataract surgeries (MSICS). Conclusion: World Health Organization recommendations for the effective outcome of cataract surgery are met by both the tertiary and secondary centres, but the odds of effective outcomes in MSICS in the tertiary centre was lower after adjusting for all known factors. Further investigations of the causes of poor vision in MSICS in the tertiary centre are needed to improve the situation.