Practical use of indicators csr csc outcomes susan lewallen md
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Practical use of indicators: CSR, CSC & outcomes Susan Lewallen, MD. A place to start. CSC would probably be the most important indicator to tell us how well we’re serving people Ideally we’d have a CSC of 100% in every “district” and country ( assuming all surgeries had a good outcome !).

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Practical use of indicators: CSR, CSC & outcomes Susan Lewallen, MD

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Practical use of indicators: CSR, CSC & outcomesSusan Lewallen, MD


A place to start

  • CSC would probably be the most important indicator to tell us how well we’re serving people

  • Ideally we’d have a CSC of 100% in every “district” and country (assuming all surgeries had a good outcome!)


Inconvenient reality…

  • Measuring CSC requires a population based survey

    • Expensive

    • Difficult

  • Most “VISION 2020 Districts” will never have such a survey


CSR is more practical to measure

  • Limitations:

    • requires proper record keeping to know where patient resides

    • requires cooperation and reporting from all providers

    • still not measured properly in most districts

    • country level CSR hides inequalities among districts

    • does not consider outcomes

  • But it’s still the best we’ve got for planning and monitoring

So what CSR over time would lead to a 100% CSC?


Incident cataracts

Eyes with unop’d cataract

People (eyes) who die unoperated

Operated eyes

How many surgeries required to do all the cataracts?


How can we get incidence data in developing countries?

It can be modeled from age specific prevalence data obtained in population based surveys, such as RAABs

Target CSR should equal annual incidence of cataract.


AFRICAVariation in target CSR needed for 100% CSC (eyes at <6/18)

Hypothesis: variation due to genetic differences?


Other factors that determine what target CSR should be

Population structure


LATIN AMERICAVariation in target CSR needed for 100% CSC (eyes at <6/18)

Much of the variation due to age structure differences


Better pre op VA requires higher CSR

Other factors that determine what target CSR should be

VA at which cataracts are operated


Target CSR varies with VA


Another inconvenient reality…

Not all surgeries result in sight restoration.

Some bad outcomes occur


Outcomes (RAAB)


Monitoring outcomes

  • Some hospitals/programmes do it

  • Most do not. Why?

    • Extra work for someone

    • Culture not established

    • Donors not demanding it

    • WHO guidelines designed for use at 6 weeks

  • But it could be done at discharge, at the hospital. Much better than nothing.


CSC meaningful but not practical to measure

Target CSR to achieve 100% CSC can be modeled from RAAB data. Useful planning tool

Actual CSR canbe monitored annually

Requires reasonable records

Requires cooperation among all eye care providers

Can be monitored by District or by country

Outcomes -just as important as CSC

Most practical is to measure at hospital level

Summary- use of indicators


Thank you


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