BOOSTing surgical outcomes: Pavilion Presentation

Man after cataract surgery


This is a post from Nathan Congdon, on BOOST, an app created to boost surgical outcomes.

Un-operated cataract remains the world’s leading cause of blindness. Training new surgeons to perform high-quality operations is critical to managing the problem, but it is impossible to improve quality without being able to measure it. And the low rates of follow-up after cataract surgery in many low-resource areas makes measurement of outcomes challenging.

Consequently, a group of non-governmental organizations (NGOs) are working with Aravind Eye Hospital, one of the largest eyecare facilities in the world, to create an app leading users in Low and Middle Income Countries (LMICs) through data collection protocols validated in an earlier study called PRECOG.

An informal market survey of 90 hospitals in LMICs showed strong demand for user-friendly software allowing users to measure and benchmark their surgical results against other practitioners in a cloud-based database, while also providing simple advice on improving outcomes.

Based on this feedback, our app, called BOOST (Better Operative Outcomes Software Technology), steps the user through two rounds of data collection: First, uncorrected (without glasses) visual acuity the day after surgery is measured for 60 consecutive patients.  This allows outcome quality (proportion of patients with good [>= 6/18] and bad [<= 6/60] visual acuity) to be benchmarked, initially against the PRECOG database, and subsequently against other BOOST users.

Secondly, users choose from among three reasons for poor vision outcomes (refractive problems, surgical mis-adventure, presence of ocular co-morbidity) for each of 20 consecutive patients returning >= 6 weeks after surgery with presenting vision <= 6/60.

The app then suggests changes in practice to remediate the most common cause of poor vision identified for a user. At this point, programmers at Aravind have completed a Windows version of the software, which has been field-tested at facilities participating in the initial market survey.

We are using support from the Standard Chartered Bank Seeing Is Believing Global Innovation Fund to complete an Android version of BOOST, V1.0 of which should be available for testing by the time of 10GA in Durban. The app will be made freely available on websites of supporting NGOs, eye hospitals and national ophthalmic organizations.

We hope in this way to transform our research result into a practical tool to improve cataract surgical quality in areas of limited resources.

To learn more, be a part Course 32: Assessing and Delivering Quality in Cataract Surgical Training and Service by Nathan Congdon, or attend the BOOST session at the pavilion.

Photo: Submission from Lindsay Hampejskova for the #StrongerTogether Photo Competition.