A multicentric cross-sectional study measuring the equity of cataract surgical services in three high-volume eyecare organizations in North India: Equitable cataract surgical rate as a new indicator

Abstract

Purpose: Cataract remains the leading cause of blindness and visual impairment in most low-and middle-income countries, with the greatest burden borne by women. To achieve Global Action Plan targets, cataract programs must target people, especially women, with maximum need. This study examines whether cataract surgical programs in three major north Indian eyecare institutions are equitable and describes a refined indicator for reporting equity. Methods: Retrospective one-year cross-sectional study of cataract surgery utilization using routine administrative data from three north Indian eyecare institutions. Patient data were categorized by paying category, sex, and preoperative visual acuity. Comparisons were made between payment categories and sexes. Results: Out of the total number of patients operated, 86,230 were in the non-paying category and 56,738 in the paying category. Overall, 8.2% were blind, 21.1% were severely visual impaired (SVI) or worse, and 86.1% were moderate visual impaired (MVI) or worse. Non-paying patients had a significantly higher proportion of poorer visual categories compared to paying patients [(blind, 9.7% vs. 5.8%; SVI or worse, 24.6% vs. 15.8%; and MVI or worse, 89.1% vs. 81.6%, respectively, ( P < 0.001)]. Women had significantly higher proportion of poorer visual categories than men [(blind, 8.9% vs. 7.4%, SVI or worse, 21.9% vs. 20.3% and MVI or worse 87.6 vs. 84.7%) ( P < 0.001)]. Conclusion: The institutions primarily provided surgery to patients with maximum need: too poor to pay, low visual acuity, and women. Similar data from all service providers of a region can help estimate the proposed “equitable cataract surgical rate”: the proportion of patients operated with maximum need among those operated in a year. This can be used for targeting people in need.

Harnessing Generalizable Real-World Ophthalmic Big Data: Descriptive Analysis of the Bodhya Eye Consortium Model for Collaborative Research

“…Furthermore, the use of proforma driven data recorded during consultations meant that although this was a retrospective study, the low (2%) patient exclusion rates, made the research valuable in the field, subverting the need for techniques to overcome data "missingness" [25]. Currently, there are almost thirty more studies underway, at various stages of the writing and submission process, with six already published, and two more accepted [11][12][13][14][15][16]. While at present the consortium is in a nascent stage and the impact of its research is being measured primarily thorugh publications, in the medium to long term, as we grow more impactful in terms of health policy and behaviour, we will expand our considerations to not only include impact factors but also other relevant factors.…”

“…Authors: Ishaana Sood, 1,13 Shalinder Sabherwal, 2,13 Umang Mathur, 3,13 Elesh Jain, 4,13 Madhu Bhadauria, 5,13 Deepshikha Agrawal, 6,13 Ashi Khurana, 7,13 Vikas Mittal, 8,13 Avinash Mahindrakar, 9,13 Vishal Govindahari, 10,13 Sucheta Kulkarni, 11,13 Ken K. Nischal 12,13 Affiliations:…”

“…The data that needed to excluded because of quality was less than 2%. Since then the collaborative efforts have led to the successful completion of various research projects based on retrospective and prospectively collected data: a further eight peer-reviewed studies have been published or accepted by international and national journals [11][12][13][14][15][16]. At present the consortium's research effectiveness is measured through its ability to publish such high-quality research.…”