The Impact of Cataract Surgery on Vision-Related Quality of Life and Psychological Distress in Monocular Patients

Abstract

Purpose. To determine the changes in vision-related quality of life and psychological distress after cataract surgery in monocular patients and to compared these with a control group of age- and gender-matched binocular patients. Methods. We enrolled 40 monocular patients and 40 binocular patients who underwent cataract surgery from August 2017 to December 2018. All participants undertook eye examinations and answered questionnaires (the National Eye Institute Visual Function Questionnaire, Self-rating Anxiety Scale, and Self-rating Depression Scale) before and after cataract surgery. Result. The monocular patients had significantly worse mean CDVA than the binocular patients before and after surgery. However, there was no significant difference between the increases gained by the two groups. Mean composite VFQ-25 scores of the monocular group were significantly lower than those of the binocular group before and after surgery, but the improvement experienced by the monocular group was statistically larger than the binocular group (37.20 ± 12.84 vs. 19.11 ± 5.13, P < 0.001 ). Mean standard SAS scores of monocular patients were significantly higher than those of binocular controls before and after surgery, while monocular patients experienced a significant greater decline of SAS scores (−9.41 ± 5.39 VS −3.84 ± 1.61, P < 0.001 ). Mean standard SDS scores of the monocular group were significantly higher than those of the control group before and after surgery, but the monocular group experienced a significantly greater decline of SDS scores following cataract surgery (−11.91 ± 6.38 VS −4.78 ± 1.79, P < 0.001 ). There was a significant correlation between the preoperative logMAR CDVA and both the postoperative logMAR CDVA (r = 0.63, P < 0.001 ) and the changes in the logMAR CDVA (r = −0.881, P < 0.001 ) for monocular patients. Linear regression analyses suggested that higher postoperative VFQ-25 scores had significant associations with better preoperative CDVA and the absence of systemic comorbidity (both P < 0.05 ). Age and ocular comorbidity were significantly associated with postoperative SAS scores (both P < 0.05 ). Age and systemic comorbidity remained significant impact factors for SDS scores (both P < 0.05 ). Conclusion. Monocular patients reported greater improvement in vision-related quality of life and greater decline in the level of anxiety and depression than binocular control subjects, despite having similar CDVA gains after cataract surgery. We argue that it is not a better choice for monocular patients to delay cataract surgery until the cataract is very advanced. A clear understanding of the impact of cataract surgery on vision-related quality of life and psychological distress in monocular patients is needed by ophthalmologists when making surgery decision.

Vision-Related Quality of Life following Combined Cataract and Minimally Invasive Glaucoma Surgery or Cataract Surgery Alone in Glaucoma Patients

“…Additional studies that have investigated patients undergoing cataract surgery in which there were no ocular diseases with the exception of cataracts have also reported finding a significantly improved VFQ-25 score [14,15]. The predictive factor for postoperative VR-QOL improvement has been reported to be a low pre-operative VR-QOL and the BCVA [14].…”

A Multisite Longitudinal Investigation of Psychological Outcomes Following Cataract Surgery in India

“…While there was only one study, to the best of the authors' knowledge, that reported longitudinal data on the impact of cataract surgery on GA, 15 however, there were a handful of studies that reported data on depressive symptoms previously, whose findings were comparable to that of ours. [6][7][8][9]11,14,15,[18][19][20][21][22][23] Compared to the general population in India, patients with untreated cataracts examined in this study were 9-fold as likely to suffer from depressive symptoms and 2-fold from GA. 1 As expected, the mean scores for depression and GA witnessed a significant drop post-surgery across all three groups. Restoration of vision post-surgery had the highest impact on both depressive and GA symptoms in the short-run (at 6 months), while regaining functional independence post-surgery seems to contribute to improved mental health symptoms at 12 months.…”

“…Studies that evaluated depression before and after cataract surgery thus far have revealed that cataract surgery positively affected depressive symptoms in adults. [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] No longitudinal studies have looked at the impact of cataract surgery on psychological attributes among Indian adults. With one in seven Indians affected by mental disorders of varying severity and cataracts being the leading cause of reversible blindness in India, corrective cataract surgery may be an effective strategy for decreasing the burden of mental health disorders among those with VI in the country.…”

Only Eye Study 5 (OnES 5): A Quantitative Study of Patient Experiences of Undergoing Surgery

“…Few studies, however, have investigated the experiences of patients undergoing only eye surgery [2,10,11]. The Only Eye Study 2 by Jones et al [2] explored the experience of only eye surgery patients by qualitative analysis of semi-structured interviews.…”