Investigator(s)
| Submitter |
Ugyen Zangmo Wangdue Hospital Ugyen Zangmo 
|
| Principal Investigator |
Ugyen Zangmo Wangdue Hospital Ugyen Zangmo
|
| Co-Investigator(s) |
Sandip Tamang Eastern Regional Referral Hospital, Mongar, Bhutan Sandip Tamang
|
| Co-Investigator(s) |
Sonam Choden Tshering Eastern Regional Referral Hosptial, Mongar, Bhutan Sonam Choden Tshering
|
| Co-Investigator(s) |
Chencho Gem Central Regional Referral Hospital, Sarpang, Bhutan Chencho Gem
|
| Co-Investigator(s) |
Chhimi Wangmo Central Regional Referral Hospital, Sarpang, Bhutan Chhimi Wangmo
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| Co-Investigator(s) |
Adwitya Powdyel Central Regional Referral Hospital Adwitya Powdyel
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| Co-Investigator(s) |
Lhacha Wangdi Jigme Dorji Wangchuck National Referral Hospital KGUMSB Lhacha Wangdi
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| Co-Investigator(s) |
Tshering Jamtsho MERCIT, KGUMSB Tshering Jamtsho
|
| Co-Investigator(s) |
Zimba Letho Faculty of Nursing and Public health, KGUMSB Zimba Letho
|
Title(s) and abstract
| Scientific title | Visual outcomes of Manual Small Incision Cataract Surgery in Bhutan: A retrospective cross-sectional |
| Public title | Visual outcomes of Manual Small Incision Cataract Surgery in Bhutan: A retrospective cross-sectional study |
| Background | Cataract, the opacification of the natural crystalline lens, is among the leading causes of avoidable blindness globally and regionally (1,2). It causes varying severity of visual impairment, and it remains a major public health challenge in developing countries, including Bhutan (2,3). The prevalence of cataracts is increasing due to aging and a growing population (3). The definitive treatment is surgical; phacoemulsification, manual small incision cataract surgery, and extracapsular cataract extraction are all acceptable surgical techniques. Manual Small Incision Cataract Surgery (SICS) is widely adopted in resource-limited settings due to its cost-effectiveness and comparable outcomes to phacoemulsification in terms of visual outcome and complication rate (4,5). Postoperative presenting visual acuity, the key postoperative outcome data, is an objective assessment of surgical outcome. It is categorized as a good, borderline or poor outcome (6). It is imperative to systematically evaluate and monitor surgical performance and patient outcome (6,8). Quantification of a good visual outcome (presenting visual acuity of ≥6/12) is vital for calculating Effective Cataract Surgical Coverage (eCSC). It is an indicator of access to and quality eye care (7). World Health Organization guidelines mandate that ≥80% should be considered for the percentage of patients attaining a good postoperative presenting visual acuity tested between 4 and 12 weeks (8). A Rapid Assessment of Avoidable Blindness (RAAB) survey conducted in Bhutan reported an eCSC of almost 70% (2). However, there are very limited systematically audited or published evidence of SICS outcome and its predictors in Bhutan and the region. Identification of independent and modifiable determinants of poor visual outcome will provide crucial evidence for targeted intervention aimed at improving the quality of cataract surgical services. Thus, this specific study is designed to assess the postoperative presenting visual acuity and its determinants in Bhutan. |
| Objectives | Among patients who underwent manual small incision cataract surgery in three hospitals in Bhutan from 1st June 2025 to 31st May 2026: 1. To describe postoperative presenting visual acuity (good, borderline, or poor) 2. To assess preoperative and intraoperative factors associated with good, borderline, or poor visual acuity at six weeks |
| Study Methods | Study Design: A retrospective cross-sectional study through record review Study setting: The study will be conducted in three hospitals in the country, namely Wangdue Hospital (WH), Eastern Regional Referral Hospital, and Central Regional Referral Hospital (CRRH). WH delivers secondary-level medical care to the populations of Wangduephodrang and its neighboring dzongkhags in Western Bhutan; meanwhile, ERRH and CRRH cater tertiary care services to Eastern and Central Bhutan, respectively. These hospitals have ophthalmologists providing ophthalmic operative services and are referral centers for the other health facilities across the country. Every patient needing cataract surgery is preoperatively assessed. This includes comprehensive ocular examination and systemic evaluation for identification of factors impacting visual outcomes or surgical complexity, assessing surgical fitness, and for surgical preparation. For cataract, only manual small incision cataract surgery is done in these hospitals. It is performed aligning with the local Standard Operating Procedure, adapted based on WHO recommendations. The Cataract Surgical Outcome Form is maintained within the Ophthalmic Department in the respective hospital. Study Duration: The review of cataract surgical monitoring forms at the respective hospitals will be conducted for eyes operated on for cataract over a period of one year, commencing from 1st June 2025 to 31st May 2026. Study population: Records of patients who underwent manual small incision cataract surgery in three hospitals in Bhutan during the study period Inclusion Criteria ● Completed records of patients who underwent manual small incision cataract surgery during the study period and completed six weeks of follow-up Exclusion Criteria ● Combined surgeries Sampling method:Total population sampling approx 400 Data source: The study will use the cataract surgical outcome monitoring form and the surgical register as its primary data source. The form is a standardized document used by eye care professionals to monitor cataract surgical outcomes. |
| Expected outcomes and use of results | The study will give descriptive data of manual small incision cataract surgical outcomes, divided into good, borderline, and poor outcomes, and preoperative and intraoperative factors. The study is expected to establish the association of the preoperative and intraoperative factors with surgical outcomes. |
| Keywords | small incision catarct surgery, visual outocme, presenting visual acuity, ocular comorbidities, intraoperative complications |
Research Details
| Student research | No |
| Start Date | 01-Aug-2026 |
| End Date | 30-Jun-2027 |
| Key Implementing Institution | KGUMSB |
| Multi-country research | No |
| Nationwide research | Yes, with randomly selected geographical areas |
| Bhutan | |
| Research Domain(s) | Non-communicable diseases & Healthy Lifestyles |
| Research field(s) | Health Care Seeking/Utilization |
| Involves human subjects | Yes |
| Operational Research | |
| Data Collection | Secondary data |
| Proposal reviewed by other Committee | No |