Visual Outcomes of Cataract Surgery in the United States, Canada, Denmark, and Spain

Abstract

To compare visual outcomes obtained following cataract surgery in 4 sites in North America and Europe where considerable differences in the organization of care and patterns of clinical practice have been previously described. Methods: Patients scheduled for first eye-cataract surgery and aged 50 years or older were enrolled consecutively in a prospective multicenter study that collected clinical and patient interview data preoperatively and postoperatively. From the United States, 772 patients were enrolled; from the Province of Manitoba (Canada), 159; from Denmark, 291; and from the City of Barcelona (Spain), 200. Preoperative and 4-month postoperative visual acuity was obtained for 92% of the patients (n = 1291). Results: The mean 4-month postoperative visual acuity of eyes operated on varied significantly across the 4 sites (PϽ.001) and had the following Snellen decimal fraction measurements: 0.49 in Barcelona, 0.65 in Denmark, 0.66 in Manitoba, and 0.74 in the United States. However, while crude visual acuity outcome figures varied significantly, no significant difference was observed across the 4 sites regarding the risk of poorer visual outcome after controlling for differences in age, preoperative visual acuity, and general health status for patients with no ocular comorbidity. Older age, poorer preoperative visual acuity, poorer preoperative general health status, and coexisting ocular comorbidity were predictors of a poorer visual outcome. Conclusion: A previously identified variation in treatment modalities across the 4 sites did not seem to affect patients' visual acuity outcomes.

Regular review: Effect of increasing age on cataract surgery outcomes in very elderly patients

“…Similarly, in Schein et al's study, people aged 75 to 95 were 3.6 times (1.3 to 10.0 times) more likely not to improve in at least one cataract surgery outcome, including self perceived visual function, than people aged 50-64 years, after adjustment for ocular comorbidities and other factors 20. The independent effect of age has been shown consistently in other populations 4. The explanation of this phenomenon is not obvious but may be related to combinations of unrecognised or subclinical comorbidity, subtle age related effects on macular function, and the tendency of older people to perceive functional impairment irrespective of vision.…”

Effect of age on visual outcome following cataract extraction

“…Increasing age is the most important risk factor for the development of cataract,10 11 but increasing age is also known to influence the visual acuity that is achieved after cataract extraction 34 12 We have shown that, in patients older than 80 years of age, the likelihood of achieving an acuity of 6/12 or better postoperatively is reduced by a factor of 4.6 compared with patients aged 60–69 years.…”

“…Although it has been reported that the visual outcome following cataract surgery declines in the elderly,3 the magnitude of this effect has not been determined. We have therefore examined the effect of age on postoperative visual acuity outcome in a large consecutive case series of patients over 60 years of age undergoing cataract extraction.…”

Critical Flicker Frequency as a Potential Vision Technique in the Presence of Cataracts

“…[1][2][3][4][5] For example, the percentage of eyes achieving 6/12 (20/40) after cataract surgery decreases to 89.7% (from 95.5%) 6 and to 77% (from 92%) 5 if patients with coexisting eye disease are included. Given the annual rate of cataract operation, which is more than 1 million in the United States, these percentages indicate that a significant number of patients obtain poor postoperative visual outcome.…”