The consequences of waiting for cataract surgery: a systematic review

Abstract

Background: Cataract surgery is the most common operative procedure performed in Canada, and how patients are affected by wait times for this surgery has important clinical, public health and health policy considerations. We conducted a systematic review to understand the relation between wait time for cataract surgery and patient outcomes and the variables that modify this relation. Methods:We performed an electronic search of 11 databases and the proceedings of 4 conferences. The search was restricted to studies published after the transition to phacoemulsification (1990). We assessed the quality of the included studies using the Jadad Scale for randomized controlled trials and the Newcastle-Ottawa Scale for cohort and case-control studies. The data were found to be inappropriate for meta-analysis, thus we performed a qualitative synthesis. Results:We found a total of 27 studies that met our inclusion criteria. When these studies were reviewed, a dichotomy was observed for the wait time-outcome relation: outcomes associated with wait times of ≤ 6 weeks were better than outcomes associated with wait times of ≥ 6 months. Patients who waited more than 6 months to receive cataract surgery experienced more vision loss, a reduced quality of life and had an increased rate of falls compared with patients who had wait times of less than 6 weeks. The outcomes associated with wait times between 6 weeks and 6 months remain unclear. Interpretation:Patients who wait more than 6 months for cataract surgery may experience negative outcomes during the wait period, including vision loss, a reduced quality of life and an increased rate of falls. CMAJ 2007;176(9):1285-90 Abstract

Visual loss and falls: a review

“…55 Fewer patients who received expedited surgery fell two or more times compared with the group still awaiting surgery (18% (28/154) vs 25% (38/152), P ¼ 0.04).…”

Psychophysical impact and optical and morphological characteristics of symptomatic non-advanced cataract

“…[1][2][3][4] Not surprisingly, cataract surgery by phacoemulsification and intraocular lens (IOL) implantation is the most commonly performed surgical procedure worldwide. 3,[5][6][7] Valid evaluation of cataract and its visual consequences is indispensable for the purpose of investigating possible risk factors for cataract formation and for documenting progression of cataract in epidemiologic and cohort studies. Also, reliable and valid assessment of cataract and its visual sequelae is equally important for clinical practice, if the ophthalmologist is to accurately evaluate the impact of age-related cataract on patient's visual performance and experience, and therefore identify those who are likely to benefit from surgical intervention.…”

Risk of Fractures Following Cataract Surgery in Medicare Beneficiaries

“…8 A systematic review found that patients who wait more than 6 months for cataract surgery had an increased rate of falls. 9 Furthermore, cataracts have been found to be the most common cause of fracturerelated visual impairment, 10 with untreated cataract causing up to 49% of visual impairment in patients with femoral neck fractures related to decreased vision. 10 Despite the association of poor vision and cataracts with increased fall and fracture risk, only a limited number of studies [11][12][13][14][15] have examined the influence of cataract surgery on fall incidence in visually impaired adults, and only 2 of these studies 11,12 examined the incidence of fractures secondary to falls.…”