Cataract surgical burden and district level disparities in Bangladesh: A retrospective study
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Objective
To describe trends in cataract surgical volume, district-level surgical burden, and early postoperative visual outcomes among patients treated through a multi-district outreach programme in Bangladesh.
Methods and Analysis
This retrospective study was conducted using data from patients undergoing cataract surgery through the outreach eye-camp programme of Bashundhara Eye Hospital and Research Institute across eight districts of Bangladesh, between 2016 and 2025 (excluding 2021 because of COVID-19). Annual surgical volume trend was assessed using Poisson regression. Postoperative visual outcome on day 1 was categorized as good, borderline, or poor per WHO criteria. Univariable and multivariable ordinal logistic regression identified predictors of worse outcome.
Results
1,929 cataract-surgery records were included. Surgical volume rose from 34 cases in 2016 to a peak of 677 in 2023 (IRR = 1.20; 95% CI: 1.180, 1.220; p-value< 0.001). Small incision cataract surgery (SICS) was used in 99.43% cases. On postoperative day 1, 70.09% of eyes had a good outcome, 19.44% borderline, and 10.47% poor. Increasing age was independently associated with worse outcome, with 2 to 3 times higher odds among patients over 70. District was independently associated with outcome, with Chapainawabganj and Kushtia having lower odds of worse outcome than Brahmanbaria. Sex was significant only in unadjusted analysis.
Conclusion
Surgical volume rose substantially over time. About seven in ten eyes achieved a good outcome on day 1, with age and district as the main predictors of worse outcome. Limitations include a single early assessment, exclusion of incomplete records, no standardized refraction, and unmeasured predictors.
KEY MESSAGES
What is already known on this topic
Cataract is the leading cause of avoidable blindness in Bangladesh and other low- and middle-income countries, but existing evidence on cataract surgical services in Bangladesh comes mainly from cross-sectional population surveys, which cannot track how surgical volume, district-level burden, or postoperative outcomes have changed over time.
What this study adds
Using ten years of registry data from a multi-district outreach programme, this study shows about 20% annual rise in cataract surgical volume, with near-exclusive use of small incision cataract surgery, and postoperative day-1 visual outcomes vary independently by patient age and district of residence.
How this study might affect research, practice or policy
These findings support continued scale-up of small incision cataract surgery, routine postoperative refraction to improve functional vision, and standardized outcome monitoring to guide more equitable allocation of eye-care resources in Bangladesh.
