Social Sustainability In Cataract Care: Follow-Up Capture And Visual Outcomes By Funding Pathway

To evaluate social sustainability in cataract care by quantifying disparities in follow-up capture and visual outcomes across funding pathways (PAY, FREE, CAMP) in a high-volume service.

Multisite cataract program (2025) with funding pathway recorded at surgery and postoperative follow-up Best Corrected Visual Acuity (FU BCVA) recorded when available.

Retrospective cohort analysis of 498,020 cataract operations. Funding pathways were analysed as recorded (PAY, FREE, CAMP). Primary outcomes were FU BCVA capture rate and FU BCVA thresholds (6/12+ and 6/6). Unadjusted risk ratios (RR) with 95% CI were calculated for key vision endpoints among eyes with FU BCVA recorded.

A total of 498,020 cataract operations were analysed: PAY 206,831; FREE 184,906; CAMP 106,283. Follow-up visual acuity capture differed substantially by pathway: 94.6% (PAY), 89.1% (FREE) and 69.5% (CAMP). Among eyes with follow-up recorded, ≥6/12 was achieved in 87.4% (PAY) versus 73.4% (FREE) and 73.5% (CAMP). Achieving 6/6 was 59.1% in PAY compared with 29.2% in FREE (RR 2.02; 95% CI 2.01–2.04) and 26.5% in CAMP (RR 2.23; 95% CI 2.20–2.26).

Marked pathway-based differences in follow-up capture and visual outcomes indicate a social sustainability gap, with particularly low follow-up capture in CAMP and lower 6/6 outcomes in FREE/CAMP versus PAY. Strengthening follow-up systems for subsidized pathways is a scalable social sustainability intervention to improve equity in outcomes.