VISUAL ACUITY THRESHOLD FOR CATARACT SURGERY: A REAL-WORLD EXPERIENCE FROM A TERTIARY EYE CARE CENTER OF A LOW RESOURCE SETTING OF PUNJAB, PAKISTAN

Abstract

Background: Cataract is the leading cause of preventable blindness worldwide. Over the years, cataract surgery has evolved significantly, aiming not only to restore optimal visual acuity but also to enhance the overall quality of vision.

Objective: To determine the visual acuity threshold for cataract surgery in a tertiary care center of Punjab Pakistan.

Methods: This retrospective study was conducted at Lahore General Hospital, Pakistan, involving 2,057 patients aged 40–80 years who underwent cataract surgery between January 2023 and December 2024. Data on demographics and visual acuity were collected, with visual impairment categorized as mild (6/9–6/18), moderate (6/24–6/36), or severe (≤6/60). Statistical analysis was performed using SPSS version 23.0, with results expressed as means (±SD) for continuous variables and frequencies (%) for categorical variables. Pre- and post-operative visual acuity were compared using the chi-square test, with p<0.05 considered statistically significant.

Results: The study analyzed 2,057 patients who underwent cataract surgery, with a mean age of 57.61 ± 13.07 years and a slightly higher proportion of females (52.1%). Preoperatively, 54.0% had severe visual impairment, which significantly improved after surgery, with 62.9% achieving normal best corrected visual acuity (p < 0.01). The majority (98.3%) had a normal posterior segment, while co-morbidities such as diabetes and hypertension were present in 22.2% and 21.8% of patients, respectively.

Conclusion: Patients in the Low- and middle-income countries present with severe visual impairment before cataract surgery affecting the final visual outcomes. This highlights the importance of community-based screening and awareness programs to detect and manage cataract at an early stage, particularly among underserved populations. It is high time to strengthen health education, improve access to eye care services, and address known barriers to early cataract surgery.

Keywords: Cataract, Visual Acuity, Best Corrected visual acuity, Low- and middle-income countries, Visual impairment.