A global scoping review of clinical practice guidelines for cataract surgery

Purpose: The World Health Organization (WHO) has specified a global target for "effective cataract surgery coverage" for monitoring progress towards tincreasing eye care quality across populations. The WHO is committed to providing evidence-based guidance for components of cataract surgerythat could lead to better outcomes. The first step is a scoping review of from existing guidelines, including the evidence base and gaps in the evidence for those guidelines. Design: We developed a conceptual framework for the scoping review that compartmentalized stages of cataract surgery into pre-operative, operative, and postoperative phases and identified potential outcome indicators. A search strategy was developed. Methods: In 2024, we used a multipronged approach to identify existing guidelines that support cataract surgery programs, reviewed known publicly available cataract surgery quality improvement programs, searched the Trip Medical Database, and reviewed materials sent to us directly from WHO. We noted the evidence-base of the guidelines. Results: Of the 156 sources, 34 had guidelines. Seven guidelines were cited by multiple sources with good evidence; these include use of pre-operative povidone-iodine, a "time-out" checklist, intracameral antibiotics, and phacoemulsification. Some guidelines were inconsistent and require harmonization, such as the necessity for pre-operative medical visits and laboratory testing, and benchmarks for outcome assessment. Gaps in evidence were also found, such as details on what constitutes "accurate" biometry. Conclusions: While these results are a reasonable starting point for WHO to begin the development of guidance for effective cataract surgery, there is an urgent need to generate data that will fill identified gaps in evidence and to harmonize inconsistencies going forward.