Key Takeaways

• Cataract surgery performed in outreach camps was associated with a lower adjusted probability of achieving presenting visual acuity of 6/18 or better than surgery performed at fixed facilities, 60.6% versus 66.6%
• Among fixed facilities, private hospitals had better outcomes than government hospitals, whereas outcomes at NGO and government hospitals were statistically similar
• Visual outcomes improved across all cataract surgery delivery models over time, but differences between settings persisted, highlighting potential opportunities to improve outreach and public-sector cataract services

Cataract surgery performed in outreach camps was associated with poorer visual outcomes than surgery conducted at fixed facilities, according to a large international analysis published in the British Journal of Ophthalmology.¹

The study, which included 41,881 cataract-operated eyes across 61 countries, also identified differences among fixed-facility providers. Private hospitals had better outcomes than government hospitals, while outcomes at nongovernmental organization (NGO) hospitals were similar to those at government facilities.

The findings suggest that although cataract surgical outcomes have improved across different models of care, persistent differences associated with where surgery is delivered could affect efforts to reduce avoidable vision impairment.

Investigators conducted a pooled cross-sectional analysis using data from 168 population-based "Rapid Assessment of Avoidable Blindness" surveys. The analysis included cataract-operated eyes from adults aged 50 years and older and was restricted to surgeries performed between 2000 and 2020.

The primary outcome was presenting visual acuity of 6/18 or better following cataract surgery. Researchers used multilevel logistic regression to examine the relationship between surgical setting and visual outcomes, accounting for clustering at the country, survey, cluster and individual levels. Analyses were adjusted for age at surgery, sex, year of surgery and Global Burden of Disease super-region.

Outreach camps accounted for 9.7% of cataract procedures included in the analysis. The adjusted probability of achieving presenting visual acuity of 6/18 or better was 60.6% following surgery in an outreach camp compared with 66.6% following surgery at a fixed facility.

Overall, outreach surgery was associated with significantly lower odds of achieving this level of visual acuity compared with surgery at fixed facilities (OR, 0.59; 95% CI, 0.50-0.70).

The researchers separately examined outcomes among government, NGO and private hospitals operating as fixed facilities.

The adjusted probability of achieving presenting visual acuity of 6/18 or better was 64.8% at government hospitals, 66.8% at NGO hospitals, and 69.5% at private hospitals.

Compared with government hospitals, NGO hospitals did not demonstrate a statistically significant difference in outcomes (OR, 1.21; 95% CI, 0.95-1.53). Patients undergoing surgery at private hospitals, however, had greater odds of achieving presenting visual acuity of 6/18 or better than those treated at government hospitals (OR, 1.56; 95% CI, 1.25-1.94).

Visual outcomes improved over time across all of the cataract surgery delivery models evaluated. However, the differences between surgical settings persisted, according to the investigators.

The findings have potential implications for global initiatives focused on effective cataract surgical coverage, which considers not only whether patients receive cataract surgery but also whether surgery produces an adequate visual outcome.

The investigators concluded that in regions where outreach programs perform a substantial share of cataract procedures, poorer outcomes associated with these services could limit improvements in effective cataract surgical coverage.

Reference

1. Arazi M, Burd D, Henok SH, et al; Variation in cataract surgical outcomes by facility type: evidence from 168 population-based surveys in 61 countries. Br J Ophthalmol. Published online August 26, 2026. doi:10.1136/bjo-2026-329992.