Publication:

Long-term visual outcome among adults availing free cataract surgery in Southern India

Background Cataract surgery aims to restore vision and independence, yet long-term follow-up in low-resource settings remains low. This study evaluates the sustainability of visual outcomes in patients who received free cataract surgery in South India.

Methods A multicenter, observational study was conducted among adults who underwent cataract surgery at six tertiary care hospitals in Tamil Nadu and Karnataka. Two cohorts were assessed: individuals operated 2 years prior (n=319) and 4 years prior (n=361). Participants were selected using random-proportional sampling followed by convenience sampling. Data collection included home-based interviews and visual acuity assessment using a Snellen tumbling E chart. Baseline visual acuity obtained from medical records was compared with follow-up measurements. Both uncorrected and pinhole-corrected visual acuity were analyzed in LogMAR units. Paired t-tests and ANOVA were used to assess differences.

Results In the 2-year cohort, mean uncorrected VA remained stable from baseline (0.34±0.37 LogMAR) to follow-up (0.35±0.30; p=0.08). Pinhole-corrected VA also showed no significant change (0.34±0.36 to 0.25±0.29; p=0.05). In the 4-year cohort, a significant decline in visual acuity was observed. Uncorrected VA worsened from 0.23±0.20 at baseline to 0.31±0.31 at 4 years (p=0.03). Similarly, pinhole-corrected VA declined from 0.17±0.22 to 0.21±0.28 (p=0.01).

Conclusions While visual outcomes remained stable at 2 years post-surgery, a significant decline was evident at the 4-year follow-up among South Indian patients who underwent free cataract surgery. This underscores the necessity for structured, long-term postoperative care and monitoring systems in resource-limited settings to sustain the initial benefits of cataract intervention and address late complications.