Abstract
BACKGROUND: Data on the evolving characteristics of patients seeking cataract surgery, surgical techniques used, preoperative vision, postoperative visual outcomes, and surgery costs provide critical insights for improving care delivery and making progress towards global eye care targets. We aimed to establish long-term trends in these factors. METHODS: Retrospective analysis of all cataract surgeries performed at Aravind Eye Hospitals during 2012-2023. FINDINGS: In 3.6 M cataract surgeries, the mean preoperative uncorrected visual acuity improved from 1.32 logMAR units (Snellen fraction ≈ 6/120) in 2012 to 1.15 (Snellen fraction ≈ 6/85) in 2023. The trend was observed in females and males, with females presenting with worse vision than males, in all age groups, and among outreach, subsidized and paying patients. Postoperative visual acuity outcomes steadily improved, with larger gains in Manual Small Incision Cataract Surgeries than in phacoemulsification. Mean prices for paying patients rose slightly faster than the Consumer Price Index for health. Surgeries supported by insurance and government assistance increased from 4.4% in 2012 to 28.7% in 2023. Male patients consistently paid about 10% higher prices than female patients because they chose more expensive intraocular lenses. INTERPRETATION: Over this period, patients sought cataract surgery sooner, received better surgical outcomes, and were willing to pay more for the improvements. However, female patients continued to face inequities, presenting with worse vision, and receiving lower expenditures for surgery, indicating the need for targeted approaches to address sex inequity both on the demand generation and treatment provision sides. FUNDING: None.