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PLoS One. 2017 Mar 1;12(3):e0172342. doi: 10.1371/journal.pone.0172342. eCollection 2017.

Effective cataract surgical coverage: An indicator for measuring quality-of-care in the context of Universal Health Coverage.

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School of Social Sciences, Faculty of Arts and Social Sciences, University of New South Wales, Sydney, New South Wales, Australia.
School of Population Health, University of Auckland, Auckland, New Zealand.
Department Clinical Research, Faculty Infectious & Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.
International Agency for the Prevention of Blindness, London, United Kingdom.
Health Information Services, Nijenburg 32, Grootebroek, Netherlands.



To define and demonstrate effective cataract surgical coverage (eCSC), a candidate UHC indicator that combines a coverage measure (cataract surgical coverage, CSC) with quality (post-operative visual outcome).


All Rapid Assessment of Avoidable Blindness (RAAB) surveys with datasets on the online RAAB Repository on April 1 2016 were downloaded. The most recent study from each country was included. By country, cataract surgical outcome (CSOGood, 6/18 or better; CSOPoor, worse than 6/60), CSC (operated cataract as a proportion of operable plus operated cataract) and eCSC (operated cataract and a good outcome as a proportion of operable plus operated cataract) were calculated. The association between CSC and CSO was assessed by linear regression. Gender inequality in CSC and eCSC was calculated.


Datasets from 20 countries were included (2005-2013; 67,337 participants; 5,474 cataract surgeries). Median CSC was 53.7% (inter-quartile range[IQR] 46.1-66.6%), CSOGood was 58.9% (IQR 53.7-67.6%) and CSOPoor was 17.7% (IQR 11.3-21.1%). Coverage and quality of cataract surgery were moderately associated-every 1% CSC increase was associated with a 0.46% CSOGood increase and 0.28% CSOPoor decrease. Median eCSC was 36.7% (IQR 30.2-50.6%), approximately one-third lower than the median CSC. Women tended to fare worse than men, and gender inequality was slightly higher for eCSC (4.6% IQR 0.5-7.1%) than for CSC (median 2.3% IQR -1.5-11.6%).


eCSC allows monitoring of quality in conjunction with coverage of cataract surgery. In the surveys analysed, on average 36.7% of people who could benefit from cataract surgery had undergone surgery and obtained a good visual outcome.

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