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Transforming research of ocular comorbidity) for each of 1 Congdon N, Yan X, Lansingh V, et al.
Assessment of cataract surgical outcomes in
20 consecutive patients returning
results into useful tools 6 weeks or more after surgery with
settings where follow-up is poor:
PRECOG, a multicentre observational study.
for global health: BOOST presenting vision of 6/60 or less. The Lancet Glob Health 2013; 1: e37–45.

app then suggests changes in practice

We reported the results of the PRECOG to remediate the most common cause
study 1 in the inaugural issue of of poor vision identified for a user.
The Lancet Global Health (July, 2013). At this point, programmers at
Although visual outcomes of cataract Aravind have completed a Microsoft
surgery have usually been assessed Windows version of the software,
weeks or months after surgery, this which will be field-tested at facilities
study of 4000 patients at 40 hospitals participating in the initial market
in low-income and middle-income survey. Hospitals performing cataract
countries (LMICs), where few patients surgery in LMICs and interested to
return after operations, demonstrated test and provide feedback on V1.0
that assessment of vision the day of BOOST are welcome to contact
after surgery could reliably measure the authors. Funding is being sought
operative quality. We felt the readers to modify V1.0 on the basis of user
of The Lancet Global Health might be feedback, and migrate it to the
interested to hear about the next Android platform. The app will be
chapter of this work. made freely available on websites of
A group of the non-governmental supporting NGOs, eye hospitals, and
organisations (NGOs) who supported national ophthalmic organisations.
PRECOG are now working with We hope in this way to transform our
Aravind Eye Hospital (Madurai, India), research result into a practical tool to
one of the largest eyecare facilities in improve cataract surgical quality in
the world, to create an app leading areas of limited resources.
users in LMICs through data collection We declare no competing interests. NC is supported
protocols validated in PRECOG. An by a Thousand Man Plan programme grant from the
Chinese Government, and by the Ulverscroft
informal market survey of 90 hospitals
Foundation. No payment was received by any funder
in LMICs showed strong demand or outside source for the writing of this letter.
for user-friendly software allowing Copyright © Congdon et al. Open Access article
users to measure and benchmark distributed under the terms of CC BY.
their surgical results against other
*Nathan Congdon,
practitioners in a cloud-based
Ganesh-Babu Suburaman,
database, while also providing simple
Thulasiraj Ravilla, Beatrice Varga,
advice on improving outcomes. Serge Resnikoff, Joan McLeod,
On the basis of this feedback, our Hugh Taylor, Hans Limburg,
app, called BOOST (Better Operative Van Lansingh, Elena Schmidt,
Outcomes Software Technology), steps Richard LeMesurier
the user through two rounds of data ncongdon1@gmail.com
collection. First, uncorrected (without Centre for Public Health, Queen’s University Belfast,
glasses) visual acuity the day after Belfast BT12 6BA, UK (NC); Preventive
surgery is measured for 60 consecutive Ophthalmology and State Key Laboratory,
Zhongshan Ophthalmic Center, Sun Yat-sen
patients. This round allows outcome University, Guangzhou 510060, China (NC); Orbis
quality (proportion of patients with International, New York, NY, USA (NC, JM); Aravind
good [≥6/18] and bad [≤6/60] visual Eye Care System, Madurai, India (G-BS, TR); Fred
Hollows Foundation, Sydney, NSW, Australia (BV);
acuity) to be benchmarked, initially
Brien Holden Vision Institute, Sydney, NSW, Australia
against the PRECOG database, and (SR, RLM); Centre for Eye Research Australia,
subsequently against other BOOST Melbourne, VIC, Australia (HT); International Centre
users. Second, users choose from for Eye Health, London School of Hygiene & Tropical
Medicine, London, UK (HL); International Agency for
among three reasons for poor vision the Prevention of Blindness/VISION 2020 Latin
outcomes (refractive problems, America Regional Office, Miami, FL, USA (VL); and
surgical misadventure, presence Sight Savers International, London, UK (ES)

www.thelancet.com/lancetgh Vol 4 February 2016 e96

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