How Data, Targeted Support and a Free Mobile App Helped Improve Cataract Surgery in Ethiopia

Across the hospitals involved, the share of patients with good vision after surgery rose from 32.2% to 56.0% within months — an important step towards the World Health Organization benchmark of 80%.

The study, led by Orbis, focused on the Better Operative Outcome Software Tool (BOOST), a free app that allows surgeons to track surgical outcomes in real time. By reviewing their own data, teams were able to identify patterns that had previously been difficult to spot and better understand why some patients were not achieving good visual outcomes after surgery.

The findings showed that poor outcomes were often not due to surgical skill, but to undetected co-morbidities such as glaucoma or retinal disease. In other words, some patients were not the right candidates for cataract surgery alone — and better preoperative screening was needed to identify that earlier.

As Noelle Whitestone, Orbis researcher and co-author of the study, explained: “The app gave our partners in Ethiopia a mirror to see their own performance. We discovered that frequently it wasn’t the surgery failing; it was the screening.”

Using insights from BOOST, Orbis worked with partner hospitals to strengthen preoperative assessment and case selection. Each hospital received $2,500 in targeted support, along with diagnostic equipment, to address the most common causes of poor outcomes identified through the data. In some cases, that included tools such as indirect ophthalmoscopes to help teams better detect underlying eye conditions before surgery.

The lesson was straightforward but important: improving quality does not always require major infrastructure investment. Reliable data, practical tools and support tailored to local needs can make a measurable difference.

The study also highlighted the importance of health systems being able to respond to what the data shows. While hospitals in Ethiopia saw rapid improvements, five partner hospitals in Zambia faced procurement and supply-chain challenges that delayed implementation during the study period. The findings underline that digital tools are most effective when they are backed by the administrative, financial and training support needed to act on the results.

As the global eye care community works towards the WHO 2030 targets, the BOOST Africa Study offers a practical model for improving quality. The BOOST app helps surgeons monitor their own outcomes over time, identify areas for improvement and use data in a supportive way to strengthen learning and decision-making. It also creates opportunities for ongoing skills exchange and continuous improvement across settings.

This study was funded by Lions Clubs International Foundation, whose support helped make the BOOST Africa Study possible in Ethiopia and Zambia. The work was also made possible by the commitment of local surgeons, hospital teams and partners, and our colleagues at Orbis Ethiopia, who are using data to strengthen care and improve outcomes for patients.