Assessment of cataract surgical outcomes in settings where follow-up is poor: PRECOG, a multicentre observational study

Background Poor follow-up after cataract surgery in developing countries makes assessment of operative quality uncertain. We aimed to assess two strategies to measure visual outcome: recording the visual acuity of all patients 3 or fewer days postoperatively (early postoperative assessment), and recording that of only those patients who returned for the fi nal follow-up examination after 40 or more days without additional prompting. Methods Each of 40 centres in ten countries in Asia, Africa, and Latin America recruited 40–120 consecutive surgical cataract patients. Operative-eye best-corrected visual acuity and uncorrected visual acuity were recorded before surgery, 3 or fewer days postoperatively, and 40 or more days postoperatively. Clinics logged whether each patient had returned for the fi nal follow-up examination without additional prompting, had to be actively encouraged to return, or had to be examined at home. Visual outcome for each centre was defi ned as the proportion of patients with uncorrected visual acuity of 6/18 or better minus the proportion with uncorrected visual acuity of 6/60 or worse, and was calculated for each participating hospital with results from the early assessment of all patients and the late assessment of only those returning unprompted, with results from the fi nal follow-up assessment for all patients used as the standard. Findings Of 3708 participants, 3441 (93%) had fi nal follow-up vision data recorded 40 or more days after surgery, 1831 of whom (51% of the 3581 total participants for whom mode of follow-up was recorded) had returned to the clinic without additional prompting. Visual outcome by hospital from early postoperative and fi nal follow-up assessment for all patients were highly correlated (Spearman’s rs=0·74, p<0·0001). Visual outcome from fi nal followup assessment for all patients and for only those who returned without additional prompting were also highly correlated (rs=0·86, p