Factors Influencing Visual Improvement after Phacoemulsification Surgery among Malaysian Cataract Patients

Abstract

Blindness and visual impairment are part of the global burden of eye disease, with cataract being one of the leading causes of blindness. This study aimed to determine the factors affecting visual acuity (VA) improvement among cataract patients after phacoemulsification surgery in Malaysia. Cataract patients aged over 18 who underwent phacoemulsification surgery between January 2014 and December 2018 were included in this retrospective cohort study. Patients’ sociodemographic, comorbidities, surgical, and related complication factors were extracted from the National Eye Database. The outcome was measured by the difference in visual acuity before and after the operation and was categorized as “improved”, “no change”, and “worse”. A total of 180,776 patients were included in the final analysis. Multinomial logistic regression analysis showed “no changes in VA” was significantly higher in patients aged less than 40 years old (OR: 1.66; 95% CI: 1.22, 2.26), patients with ocular comorbidities (OR: 1.65; 95% CI: 1.53, 1.77), patients who had undergone surgery lasting more than 60 min (OR: 1.39; 95% CI: 1.14, 1.69), patients who had surgery without an intraocular lens (IOL) (OR: 1.64; 95% CI: 1.20, 2.26), and patients with postoperative complications (OR: 8.76; 95% CI: 8.13, 9.45). Worsening VA was significantly higher among male patients (OR: 1.11; 95% CI: 1.01, 1.22), patients who had ocular comorbidities (OR: 1.76; 95% CI: 1.59, 1.96), patients who had undergone surgery lasting more than 60 min (OR: 1.94; 95% CI: 1.57, 2.41), patients who had surgery without an IOL (OR: 2.03; 95% CI: 1.48, 2.80), and patients with postoperative complications (OR: 21.46; 95% CI: 19.35, 23.80). The factors impacting “no changes” in and “worsening” of VA after cataract surgery were the following: older age, male gender, ethnicity, ocular comorbidities, surgeon grade, absence of IOL, intraoperative complication, and postoperative problems.

Overview of visual acuity improvement in postoperative cataract patients using a monofocal lens and phacoemulsification techniques

“…This study found that all patients who underwent phacoemulsification showed a visual improvement one month after surgery. A study reported a visual improvement of 0.33 after surgery (95% CI: [0.31, 0.35]), with the predictor of ocular comorbidities such as diabetic retinopathy, glaucoma, and complication risk factors (i.e., high-risk surgery) (AlRyalat et al, 2022), age category (<40 years old), duration of operation (>60 minutes), or surgery without IOL (Sa'at et al, 2022). A study in Bali reported a visual acuity improvement with zero cases of blindness remaining.…”

Long‐Term Outcomes of Phacoemulsification Surgeries at ECWA Eye Hospital: A Prospective Clinical Cohort Study

“…In particular, 96.1% of the operated eyes achieved a good result with acuity of 6/6–6/18, while 3.9% experienced a moderate acuity change to <6/18−6/60, and there were no cases of poor outcome ( Table 2 ). A related study reported an improvement in visual acuity of 96.4% in Malaysians after phacoemulsification surgery among cataract patients [ 23 ]. Given the very high rate of successful outcomes in our study, the data suggest that phacoemulsification is an appropriate technique for cataract surgeries.…”

“…Age could potentially explain the lower likelihood of significantly improved visual acuity after surgery in these cases. Previous research has shown that age is a significant prognostic factor affecting visual acuity gains after cataract surgery [ 23 ]. Specifically, older patients tend to have less robust visual improvement compared to younger cohorts.…”