The Cataract BOOST Story

Professor, Division of Preventive Ophthalmology and State Key Laboratory, Zhongshan Ophthalmic Centre;
Ulvercroft Prof of Global Eye Health, Translational Research for Equitable Eyecare (TREE) Centre, Queen's University Belfast;
and Orbis

An East Asian man with a patch on his right eye, with a wide smile--post cataract surgery

We published the results (open access) of the PRECOG study in the inaugural issue of Lancet Global Health. While visual outcomes of cataract surgery have usually been evaluated weeks or even months post-operatively, this study of 4000 patients at 40 hospitals in developing regions, where few patients return after their operation, demonstrated that assessment of vision the day after surgery could provide a reliable index of quality.

A group of the non-governmental organizations (NGOs) who supported PRECOG are now working with the Aravind Eye Hospital, one of the largest eyecare facilities in the world, and other investigators to create a freely-downloadable app which will lead users in low and middle income countries (LMICs) through the data collection protocols validated in PRECOG. An informal market survey of 90 hospitals in Africa, Asia, Latin America and the Pacific showed strong demand for easy-to-use software which would allow users to measure and benchmark their surgical results against other practitioners locally and globally in a cloud-based database, while also providing simple advice on methods to improve 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 and entered 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 40 facilities in the PRECOG database, and subsequently against other users of BOOST. Secondly, users choose from among three reasons for poor vision outcomes (refractive problems, surgical mis-adventure, presence of ocular co-morbidity) among 20 consecutive patients returning at least 6 weeks after surgery with presenting vision <= 6/60.  The app then automatically suggests changes in pre- and post-clinical care designed 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 will be field-tested at hospitals from the initial PRECOG network and participants in the initial market survey. Hospitals performing cataract surgery in LMICs and interested to test and provide formal feedback on V1.0 of BOOST are welcome to contact us at ncongdon1@gmail.com. Funding is being sought to modify V1.0 on the basis of user feedback, and migrate it to the Android platform as an app. This will be made widely available on the websites of supporting NGOs, eye hospitals, national ophthalmic organizations and other members of the eye health community. We hope in this way to transform our research result into a practical tool to improve cataract surgical quality in areas of limited resources.

For more detail, here is a Powerpoint presentation on BOOST.