Impact of cataract surgery on the visual ability of the very old

Outcomes of cataract surgeries performed in 8 eyes of centenarians

Cataract surgery outcomes in centenarian patients have not previously been explored. This study aimed to examine characteristics and report clinical results of people aged ≥100 years undergoing cataract surgery. This was a retrospective observational study, including patients aged ≥100 years who underwent cataract surgery between 2003 and 2021 at Miyata Eye Hospital in Japan. Medical charts were reviewed for information on cataract severity, surgery type, anesthesia, as well as ocular and medical comorbidities. Using Mann-Whitney test, visual acuity, intraocular pressure, and corneal endothelial cell density were compared before and after surgery. Eight eyes of 5 patients were included in the study (mean age, 101.5 ± 1.2 years). Seven of these eyes (87.5%) belonged to women. All surgeries were performed under topical anesthesia using phacoemulsification and insertion of the intraocular lens fixed in the bag. All patients had multiple preoperative medical comorbidities; however, there were no intraoperative, postoperative ocular, or general complications. The postoperative best-corrected visual acuity was significantly improved compared to that before surgery (1.18 ± 0.74 and 0.29 ± 0.52, respectively, P = .004). Neither intraocular pressure nor corneal endothelial cell density demonstrated a significant difference postoperatively. Cataract surgery can be safely performed under topical anesthesia in centenarians without complications using proper perioperative medical control and preparation.

Prevalence of cataract and its contributing factors in Iranian elderly population: the Gilan eye study

PURPOSE

To report the prevalence and the associated factors leading to cataract among the Iranian population living in Gilan Province, Iran.

METHODS

This population-based cross-sectional study was performed from June to November 2014 on 2,975 residents aged ≥ 50 years old living in urban and rural regions of the Gilan Province in Iran. A representative sample of residents in the province was recruited into the study through door-to-door visiting, and baseline data were collected by questionnaire. All participants were referred to the medical center for comprehensive ophthalmic examination, laboratory tests, and blood pressure measurement.

RESULTS

Among the population, 2,588 (86.99%) subjects were eligible to be included in this study, categorized either into the cataract or the non-cataract group. The mean age of participants was 62.59 ± 8.92 years, and 57.5% were female. Higher prevalence of cataract was found in individuals of older ages (odds ratio (OR) = 1.13; 95% confidence interval (CI) = 1.10 to 1.16; P < 0.001) and a history of previous ocular surgery (OR = 5.78; 95% CI = 2.28 to 14.63; P < 0.001). At the same time, a lower prevalence of cataract was seen in patients exposed to sunlight for more than 4 h per day (OR = 0.49; 95% CI = 0.32 to 0.73; P = 0.001).

CONCLUSION

Cataract affects 50.50% of the study population, especially those over 80. The mildest form of cataract, grade zero, is the most common. Surgery for cataract has good outcomes. The risk of cataract is higher for those older or who have had eye surgeries. People not affected by cataract tend to be exposed to more sunlight.

Prevalence of pseudophakia: U.S. population-based study

PURPOSE

To determine the current prevalence and trends of pseudophakia in a well-defined U.S. population, calculating values for Olmsted County, Minnesota, from 1988 through 2018.

SETTING

Mayo Clinic, Rochester, Minnesota.

DESIGN

Population-based cohort study.

METHODS

Rochester Epidemiology Project (REP) databases were used to identify all cases of pseudophakia in Olmsted County, Minnesota, between January 1, 1988, and December 31, 2018. Age- and sex-specific prevalence rates were calculated in 1988, 1998, 2008, and 2018 using REP census population estimates and mortality counts. Poisson regression analysis was used to assess changes in prevalence over time. Mortality rates were estimated by Kaplan-Meier analysis.

RESULTS

In 2018, 10 024 county residents were pseudophakic in at least 1 eye, for a total population prevalence of 6.5%. The prevalence increased 67% in the last 10 years and 590% in the last 30 years (P < .001). By 2018, 51% of residents aged 75 years and 88% of residents aged 85 years and older were pseudophakic in at least 1 eye, 53% of residents with pseudophakia aged 65 years and older were bilaterally pseudophakic, and 29% of residents with pseudophakia had lived with pseudophakia for more than 10 years. The prevalence was higher among women than men and increased with age (P < .001). Overall, pseudophakia had a lower all-cause mortality compared with the general Minnesota population (P < .001).

CONCLUSIONS

In 2018, most residents aged 75 years and older were pseudophakic in at least 1 eye. These numbers underscore the changing visual status of older adults and the large number of adults who benefit from cataract surgery.

Cataract Surgery in Very Old Patients: A Case-Control Study

Advancements in surgical techniques and increased life expectancy have made cataract surgery more common among very old patients. However, surgical outcomes seem impaired in patients older than 90 years, especially with ocular comorbidities. A retrospective case-control study of 53 eyes of 53 very old patients (mean 92.6 ± 3.0) and 140 eyes of 140 matched patients (mean 75.2 ± 7.6) was undertaken. Groups were matched in terms of gender and systemic and ocular comorbidities. In very old patients, higher phacoemulsification energy (cumulative dissipated energy [CDE], 25.0 ± 22.4 vs. 16.1 ± 10.7, p = 0.01) and rate of intraoperative floppy iris syndrome (IFIS, 9.4% vs. 1.4%, p = 0.02) were observed compared to controls. Uncorrected (UCVA) and best-corrected distance visual acuity (BCVA) gains were significantly poorer among the very old patients than among the control at postoperative day 30 (0.20 ± 0.70 vs. 0.56 ± 0.61 logMAR, p < 0.001 and 0.27 ± 0.64 vs. 0.55 ± 0.62 logMAR, p = 0.006, respectively). Even after including CDE and IFIS as covariates, age remained an independent factor for poor visual gain at 30 days (p < 0.001). Cataract surgery in very old patients may demand more experienced surgeons due to higher nuclear density and the rates of IFIS. Expectations in visual acuity gains should be aligned with the patient’s age.

Improvement in Activities of Daily Living after Cataract Surgery in the Very Old

BACKGROUND

The benefits of cataract surgery for patients aged ≥90 years in terms of improvements in activities of daily living (ADL) have been poorly evaluated using only limited data. Using a large nationwide administrative database of hospitalized patients, we investigated the improvement of ADL after cataract surgery in the very old (age of ≥90 years).

METHODS

We identified 84,747 patients with cataracts aged 80 to 89 years and 7,253 patients with cataracts aged ≥90 years who underwent cataract surgery in both eyes during hospitalization from April 2014 to March 2015. A retrospective matched-pair cohort study was performed to compare the proportion of patients with improved ADL after cataract surgery. We also compared the length of hospital stay between the two groups.

RESULTS

Patients aged ≥90 years were more likely to be female and have a lower ADL score at admission. In the 1:4 matched-pair analysis with 7,253 versus 29,012 pairs, a lower proportion of patients aged ≥90 years had an improved ADL score (odds ratio, 0.33; 95% confidence interval, 0.29-0.36; P < 0.001) even after adjusting for other variables. Patients aged ≥90 years had a slightly shorter length of hospital stay than those aged 80 to 89 years (7.5 vs. 8.2 days, respectively; P < 0.001).

CONCLUSIONS

In this large nationwide cohort of patients with cataracts, those aged ≥90 years showed significantly poorer improvement of ADL than did patients aged 80 to 89 years. Cataract surgery before the age of 90 years may be recommended for patients with cataracts.

Epidemiology of Pars Plana Vitrectomy in the Elderly: A Retrospective 10-Year Survey of 592 Cases

Purpose

To report the epidemiology of the surgical indications of pars plana vitrectomy in patients aged 75 years or older.

Patients and Methods

The medical records of patients who underwent vitrectomy surgery in a single center between 2008 and 2018 were evaluated retrospectively for demographics, medical background, and surgical indications. Data on patients aged 75–85 were compared to those of patients older than 85 years and those recorded between 2008–2013 and 2014–2018.

Results

A total of 592 patients were included, of whom 55% were males. The mean±standard deviation age of the cohort at presentation was 80.4±4.60 years, and the mean visual acuity was 1.3±0.93 logMAR. The main indications for surgery were retinal detachment (n=117, 19.7%), epiretinal-membrane/vitreomacular traction (n=140, 23.6%), dropped intraocular lens/retained lens (n=89, 15%), macular hole (n=64, 11%), submacular hemorrhage (n=40, 6.7%), diagnostic vitrectomy (n=37, 6.2%), non-diabetic vitreous hemorrhage (n=30, 5.1%), and diabetic vitreous hemorrhage and other diabetic complications (n=33, 5.6%). Patients aged 85 years and older had higher rates of urgent surgeries (65%), such as for submacular hemorrhage and trauma (p=0.0000039 and p=0.001, respectively), and lower rates of non-urgent surgeries, such as for epiretinal membrane and macular hole (p=0.000032 and p=0.02, respectively), compared to patients aged 75–84 years. Additionally, the surgical rate for submacular hemorrhage decreased during 2008–2014 compared to 2014–2018 (p=0.000014).

Conclusion

Understanding the unique distribution of indications for vitrectomy among elderly patients is essential for appropriate management and treatment. Urgent cases represent 65% of the surgeries performed in the older population.

Accuracy of IOL power calculations in the very elderly

Background/objectives

To analyze the refractive predictability and outcomes of cataract surgery in the very elderly (≥85 years old).

Subjects/methods

A retrospective case-series performed at the Shiley Eye Institute, University of California San Diego, USA. Electronically pulled data of 2444 surgeries revealed 147 surgeries on 133 very elderly patients. Chart review was conducted for all very elderly and corresponding control patients (75–84 years old). The first operated eyes of patients with final best-corrected visual acuity ≥20/40, axial length (AL) 22–26 mm, and implanted SN60WF IOL were included. Patients with ocular comorbidities and/or intra- or post-operative complications were excluded. Prediction errors of refractive outcome and percentage of eyes within ±0.50D and ±1.00D were compared between the groups for the Holladay 1 and Barrett Universal II (Barrett) formulas. Logistic regression analysis for achievement of ±1.00D was conducted.

Results

Final analysis included 90 eyes (n = 44, very elderly, n = 46, control patients). Median absolute refractive error (MedAE) with Holladay 1, but not Barrett formula, was significantly higher in the older group (p = 0.02 and p = 0.07, respectively). The MedAE in the older group was lower using the Barrett compared to Holladay 1 (p = 0.02). Fewer older patients than younger patients achieved refraction within ±0.50D and ±1.00D from goal, using the Holladay 1 (p = 0.049 and p = 0.002 respectively). Logistic regression analysis supported the relationship between Holladay 1 predictive refractive error of >1.00D and patient’s age (p = 0.046).

Conclusions

Very elderly patients undergoing cataract surgery may be prone to reduced refractive precision, particularly with utilization of the Holladay 1 formula.

Intake of Vegetables and Fruits and the Risk of Cataract Incidence in a Japanese Population: The Japan Public Health Center-Based Prospective Study

Background

Although the consumption of vegetables and fruits is reported to influence the risk of cataract, no prospective study of this association from Asia has yet appeared. Here, we investigated the association between vegetable and fruit intake and cataract incidence in a large-scale population-based prospective cohort study in Japan.

Methods

This study included 32,387 men and 39,333 women aged 45–74 years who had no past history of cataract and had completed a dietary questionnaire of the Japan Public Health Center-based Prospective Cohort Study. The incidence of cataract was evaluated after 5-year follow-up. We used multiple logistic regression analyses to estimate the sex-specific odds ratios (ORs), with adjustment for confounding factors.

Results

We identified 1,836 incident cataracts in 594 men and 1,242 women. In men, the OR for cataract was decreased with higher intake of vegetables (OR_{Q5 vs Q1}, 0.77; 95% confidence interval [CI], 0.59–1.01; P_trend across quartile categories = 0.03) and cruciferous vegetables (OR_{Q5 vs Q1}, 0.74; 95% CI, 0.57–0.96; P_trend = 0.02). In contrast, the OR for cataract was increased with higher intake of vegetables among women (OR_{Q5 vs Q1}, 1.28; 95% CI, 1.06–1.53; P_trend = 0.01). Green and yellow vegetable and fruit intake were not associated with cataract in either sex.

Conclusions

This study suggests that vegetables may reduce the risk of cataract in men, but not in women.

[Cataract Surgery in Very Old Patients]

BACKGROUND

In recent years, there has been an increase in the number of very old patients requiring a cataract operation. However, there is little information on the intraoperative complications and safety in these patients. For various reasons, operations on patients from age 85 may be demanding: dense nuclear cataract, narrow pupils, low count of endothelial cells, loose zonula, and other ocular or systemic diseases. The aim of this retrospective study was to compare very old to younger cataract patients with respect to intraoperative complications and the maturity of the cataract.

PATIENTS AND METHODS

This was a retrospective study on 4065 cataract patients treated in our department with IOL implantation with the corneal small incision technique between January 2015 and January 2018. The patients were split by age (from 85 and under 85).

RESULTS

Of the 4065 cataract operations, 10.6% (431/4065) were performed on patients aged at least 85, 1.7% (69/4065) on patients aged at least 90 and 0.1% (4/4065) on patients of at least 95 years. There were statistically significant differences between the younger and older patients with respect to pupil dilatation (4.6 vs. 6.0%), use of the capsule tension ring (0.4 vs. 0%) and in capsule staining (5.5 vs. 7.0%). There were no intraoperative complications (e.g. anterior capsule laceration) in patients aged at least 85 and in 0.71% of patients aged under 85; loss of vitreous fluid was recorded in none of the patients in the older group and in 0.41% of patients in the younger group.

CONCLUSION

Our study confirms that advanced age alone is not a contraindication for a cataract operation and is not associated with a greater rate of intraoperative complications. Cataract operations on very old patients are generally successful, but should be undertaken early - particularly on multimorbid patients or those with dementia - in order to support the psychological status. The age of the patient is irrelevant.

The Royal College of Ophthalmologists' National Ophthalmology Database Study of cataract surgery. Report 5: Clinical outcome and risk factors for posterior capsule rupture and visual acuity loss following cataract surgery in patients aged 90 years and older

BACKGROUND

Older age is commonly associated with an increased risk of surgical complications and comparatively poor outcomes.

PURPOSE

To report cataract surgery outcomes and risk indicators for patients aged 90 years and older.

METHODS

Data collected as part of routine cataract care in 34 centres contributing to the United Kingdom Royal College of Ophthalmologists' National Ophthalmology Database (NOD) were analysed. Very elderly people undergoing cataract surgery were profiled in terms of demographics, pre- and postoperative best-measured visual acuity (VA), ocular co-morbidities, intraoperative posterior capsule rupture (PCR) or vitreous loss or both, and risk indicators for operative PCR and adverse VA outcome.

RESULTS

25,856 cataract operations in 19,166 people of 90 years or older between 2000 and 2014 are reported. Preoperative VA was available for 82.4% eyes, being 0.30 LogMAR or better in 21.5%. Postoperative VA was available for 61.8% eyes, being 0.30 LogMAR or better in 74.4%. For those without ocular co-morbidity, postoperative VA was 0.30 LogMAR or better in 84.7%. Various co-morbidities were present in 49% and contributed to an adverse VA outcome. PCR data were available for all operations and occurred in 2.7%. Significant risk indicators for PCR included pseudoexfoliation/phakodonesis, mature cataract, smaller pupil and worse preoperative VA.

CONCLUSIONS

Slightly poorer cataract surgery outcome results were noted in patients of 90 years or older, more so in patients with ocular co-morbidity which was highly prevalent. However, surgeons should not be deterred from offering cataract surgery to the very elderly as successful visual rehabilitation remains achievable.

Visual acuity improvement after phacoemulsification cataract surgery in patients aged ≥90 years

Background

Visual acuity (VA) outcomes after phacoemulsification cataract surgery in the very elderly (≥90 years) compared to those in younger patients remain unclear till date.

Methods

We retrospectively investigated 138 (group 1) and 152 (group 2) eyes in patients aged ≥90 and < 80 years, respectively, with senile cataracts who underwent phacoemulsification and intraocular lens implantation between 2014 and 2016. Four highly experienced ophthalmic surgeons performed the procedures. Intra- and post-operative complications were compared between the two groups. To investigate the effectiveness of cataract surgery in improving best-corrected VA (BCVA) at 1 and 3 months postoperatively, multiple regression analysis was performed with variables of age, cataract grades, sex, and history of diabetes mellitus (DM) and hypertension.

Results

The intra- and post-operative complication rates were similar between the two groups. After adjusting for the difference in cataract grades, multiple regression analysis indicated that BCVA improvement was equally favorable in both groups at 1 and 3 months postoperatively but was less favorable in patients with a history of DM at 3 months postoperatively (P = 0.042).

Conclusion

Phacoemulsification in patients aged ≥90 years improves VA as effectively and safely as it does in younger patients, at least when performed by experienced surgeons.

Cataract surgery outcomes in the very elderly

The prevalence of very elderly patients (aged 85 years and older) with visually significant cataracts continues to rise in the United States. We conducted a focused review of literature using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to investigate the impact of very old age on cataract surgery outcomes. The studies suggest that very elderly patients, relative to their younger counterparts, had similar complication rates after adjusting for their higher rates of age-related ocular and systemic comorbidities. In addition, most very elderly patients gained improvement in visual acuity, enjoyed increased quality of life, and had survival rates that extend beyond 1 year after surgery. Although many of the studies were small and lacked statistical power to exclude clinically important differences in outcome, findings generally supported cataract surgery in the very elderly. Further studies are required to augment evidence-based surgical decision-making in elderly persons with ocular comorbidities and visually significant cataracts.

Increased Gait Speed After Cataract Surgery Confers Longer Predicted Survival

PURPOSE

Cataract surgery has potential systemic health effects. Gait speed is a potential health index of predicted life expectancy and incidence of severe illness. We thus measured quality of vision and gait speed before and after cataract surgery.

DESIGN

A prospective clinical study.

METHODS

We followed up 30 patients for 6 months following cataract surgery by implantation of a yellow soft acrylic lens. A 4-m gait speed was determined, and patients were evaluated before and after surgery using the National Eye Institute Visual Function Questionnaire (vision-related quality of life) as well as ophthalmological and systemic examinations. Life span was estimated on the basis of standard curves derived from a literature.

RESULTS

Mean preoperative gait speed was 0.81 ± 0.23 m/s, with significant increases recorded at 2 and 6 months after surgery to 0.85 ± 0.20 and 0.91 ± 0.22 m/s, respectively (P < 0.01, paired t test). According to patient survival determined by gait speed, life expectancy (years) before and 6 months after surgery was approximately 83.4 and 84.9, respectively, for men (1.5-year increase) and 88.8 and 89.8, respectively, for women (1.0-year increase). The mean preoperative 25-item Visual Function Questionnaire score was 59.2 ± 16.3, and significant improvements were observed 2 months (76.2 ± 13.9) and 6 months (78.6 ± 14.4) after surgery (P < 0.001, vs preoperative score).

CONCLUSION

In conclusion, cataract surgery improved quality of vision and gait speed for 6 months.

Clinical outcomes of cataract surgery in very elderly adults

OBJECTIVES

To investigate the clinical outcomes of cataract surgery elderly adults.

DESIGN

Retrospective cohort study.

SETTING

Two clustered hospitals.

PARTICIPANTS

Two hundred seven individuals aged 90 and older who underwent cataract surgery for primary senile cataracts.

MEASUREMENTS

Best-corrected preoperative and postoperative Snellen visual acuity, type of cataract, surgical techniques, preoperative systemic or ocular comorbidities, and intraoperative and postoperative complications were assessed. Improvement of visual acuity was defined as a decrease in logMAR acuity of 0.1. Factors associated with visual outcome within 6 months after surgery were identified using logistic regression modeling. The duration of postoperative survival was calculated.

RESULTS

In the 207 participants (mean age 92.0 ± 2.1), 79.7% achieved visual improvement after cataract surgery. Forty-eight percent (mean age 97.4 ± 2.8) were alive on December 31, 2012. The most common systemic comorbidities were hypertension (66.2%), diabetes mellitus (25.1%), and myocardial infarction (19.8%). Age-related macular degeneration (AMRD) (15.9%), glaucoma (10.6%), and myopic degeneration (5.3%) were the three most common ocular comorbidities. Uncomplicated cataract surgery was performed in 87.0% cases. The most common complications were vitreous loss (8.2%), posterior capsular rupture (7.2%), and zonular rupture (4.8%). Participants with AMRD (P = .001, odds ratio (OR) = 4.77, 95% confidence interval (CI) = 1.86-12.26) and vitreous loss (P = .001, OR = 12.86, 95% CI = 2.71-61.10) were less likely to achieve postoperative visual improvement.

CONCLUSION

Despite a high prevalence of systemic and ocular comorbidities in very elderly adults, good clinical outcomes of cataract surgery were attainable. ARMD and vitreous loss were associated with a lower chance of postoperative visual improvement.

Comparison of Patient's Satisfaction Level after Different Types of Posterior Chamber Intraocular Lens Implantation

Objective. To compare patient's satisfaction level in performing routine activities during daylight and night vision after implantation with rigid, foldable, or rollable posterior chamber intraocular lens implants in uneventful cataract surgery. Design. Retrospective, cross-sectional. Place and Duration of Study. PNS SHIFA Hospital, Karachi, from Nov. 2009 to Nov. 2010. Methodology. 91 cataract surgery patients who had uneventful phacoemulsification, within the bag placement of intraocular lens and achieved best corrected visual acuity 6/9 or better were included in the study. Patients who developed postoperative complications were excluded. A specially designed questionnaire was used to assess patient's satisfaction level of vision for those who underwent cataract surgery at least 3 months ago. Finally, they were categorized into five groups ranging from "very good" to "very poor." SPSS version 16 was used to analyze the results. Results. There was a difference in satisfaction level between three groups. Vision was good in the day and the night with foldable posterior chamber intraocular lens implants. Conclusion. It was concluded that visual satisfaction level of patients who had foldable posterior chamber intraocular lens implantation was better during the day and night as compared to patients who had rigid or rollable posterior chamber intraocular lenses implantation.

Cataract surgery in patients older than 90 years of age

OBJECTIVE

The aim of this study was to examine whether differences exist after cataract surgery is performed in patients over and under 90 years of age.

STUDY DESIGN

Retrospective, nonrandomized study.

PARTICIPANTS

Cataract surgery was performed in 21 patients (31 eyes) who were older than 90 years of age and in 45 patients (70 eyes) who were younger than 90 years of age.

METHODS

The medical records of all patients who underwent cataract surgery between January 2005 and September 2010 at Dokkyo Medical University Koshigaya Hospital were reviewed. Factors evaluated included systemic disease, changes in systemic condition, surgical time, preoperative and postoperative visual acuity, corneal endothelial cell density, and intraoperative complications.

RESULTS

The group of patients older than 90 years of age experienced greater occurrences of systemic disease (p < 0.05; χ(2) test) and intraoperative changes in systemic conditions (p < 0.001; χ(2) test). These patients also had significantly lower preoperative visual acuity (p < 0.001; Student t test). No differences were noted between the 2 age groups in surgical time, postoperative visual acuity, preoperative corneal endothelial cell density, or intraoperative complications.

CONCLUSIONS

Poorer cataract surgery outcome results were noted in patients older than 90 years due to systemic disease and intraoperative changes in systemic condition. Factors that need to be taken into consideration prior to performing cataract surgery in older patients include age, systemic disease, and the likelihood of intraoperative changes in systemic condition.

COMPUTER-BASED IDENTIFICATION OF CATARACT AND CATARACT SURGERY EFFICACY USING OPTICAL IMAGES

The eyes are complex sensory organs, they are designed to capture images under varying light conditions. Eye disorders, such as cataract, among the elderly are a major health problem. Cataract is a painless clouding of the eye lens which develops over a long period of time. During this time, the eyesight gradually worsens. It can eventually lead to blindness and, is common in older people. In fact, about a third of people over 65 have cataracts in one or both eyes.

In this paper, we made use of two types of classifiers for identification of normal, cataract (early and developed stage), and post-cataract eyes using features extracted from optical images. These classifiers are artificial neural network and support vector machine. A database of 174 subjects, using the cross-validation strategy, is used to test the effectiveness of both classifiers. We demonstrate a sensitivity of more than 90% for both of these classifiers. Furthermore, they have a specificity of 100% and, as such, the results obtained are very promising. The proposed feature extraction and classification systems are ready clinically to run on a large amount of data sets.

The impact of cataract surgery questionnaire: re-evaluation using Rasch analysis

PURPOSE

The Impact of Cataract Surgery (ICS) questionnaire was designed to assess cataract surgery outcomes. The aim of this study was to describe the psychometric properties of the ICS questionnaire using the Rasch model in a cataract population.

METHODS

Ninety-one patients waiting to undergo cataract surgery in the first or second eye at the Flinders Medical Centre, Adelaide, South Australia self-administered the four-item ICS questionnaire. Rasch analysis was performed to assess behaviour of response categories, ability to differentiate between participants' visual abilities (person separation; minimum acceptable 2.0), if items measure a single underlying construct [i.e. unidimensionality assessed by fit statistics and further by principal components analysis (PCA)] and matching of item difficulty to participant ability (targeting; ideal < 0.5 logits). Adequate person separation was defined as basic requirement for a measure, failing which further assessment such as PCA was not performed.

RESULTS

The four-item ICS questionnaire did not meet the required measurement properties (person separation zero). Response categories did not behave as intended, requiring the collapsing of categories for one item (read ordinary newspaper-size print). One item misfit (estimating distance) indicating that it was not measuring the same construct as other items. However, person separation failed to improve following the deletion of this item. Targeting was -0.46 logits, indicating that the item difficulty was well suited to the visual abilities of the participants.

CONCLUSION

In its present form, the ICS is unsuitable for visual disability assessment in patients awaiting cataract surgery. Other, better visual function questionnaires are available and preferred.

Cataract surgery complications in nonagenarians

PURPOSE

To investigate whether nonagenarians relative to octogenarians are at increased risk of ocular complications from cataract surgery in the US Veterans Health Administration (VHA).

DESIGN

A retrospective cohort study.

PARTICIPANTS

A total of 554 nonagenarians and 11 407 octogenarians who received cataract surgery in the VHA.

METHODS

Nonagenarians and octogenarians who received 1 cataract surgery without a second surgery within 90 days between October 1, 2005, and September 30, 2007, were identified using the National Patient Care Database (NPCD). Data collected include demographics, preoperative systemic and ocular comorbidities, intraoperative complications, and 90-day postoperative complications. The adjusted odds ratio (OR) of complications in nonagenarians using octogenarians as a reference group was calculated using logistic regression modeling.

MAIN OUTCOME MEASURES

Intraoperative and postoperative ocular complications within 90 days of cataract surgery in nonagenarians versus octogenarians.

RESULTS

The most common systemic comorbidity for both age groups was diabetes mellitus (DM), and the most common ocular comorbidity for both age groups was age-related macular degeneration (AMD). Octogenarians had a higher prevalence of most systemic comorbidities, and nonagenarians had a higher prevalence of most ocular comorbidities. The most common intraoperative and postoperative complications for both age groups were vitreous loss or posterior capsular tear and posterior capsular opacification. The risk of having any intraoperative or postoperative complication was 13.5% for octogenarians and 13.4% for nonagenarians (P = 0.9001). The OR of having any intraoperative or postoperative complication in nonagenarians with octogenarians as a reference group was 0.94 (95% confidence interval, 0.73-1.22).

CONCLUSIONS

Nonagenarians relative to octogenarians are not at increased risk of ocular complications from cataract surgery in the VHA. Further studies are needed to evaluate other outcome parameters, such as visual function and quality of life, in nonagenarians undergoing cataract surgery.

Visual acuity level, ocular morbidity, and the better seeing eye affect sensitivity and responsiveness of the visual function index

PURPOSE

To examine the relation between Visual Function Index-14 (VF-14) scores and VA by accounting for concurrent ocular comorbidities, effect of the better seeing eye (BSE), and VA before and after cataract surgery.

DESIGN

Prospective cohort study.

PARTICIPANTS

A total of 4335 patients with cataract who completed the VF-14 before and after cataract surgery.

METHODS

Collaborating clinicians provided demographic and clinical data before and after cataract surgery. Lowess curves, general linear models, and Spearman correlation coefficients were used to study the relation between the VF-14 and the VA.

MAIN OUTCOME MEASURES

Scores in the VF-14 preintervention, change in VF-14 after surgery, VA before surgery, and VA change after surgery.

RESULTS

General linear models and Spearman correlation coefficients showed a significant (P < 0.0001) association between VF-14 score and VA (measured in decimal fraction) when the preoperative VA was ≤0.5 (20/40) and no association (P > 0.4020) when the VA was >0.5 (20/40). Small VA gains (≤0.5) after surgery only led to significant gains (P < 0.0001) in functionality in patients with other ocular pathologies and whose BSE was the surgical eye. Gains in VA >0.5 had a significant (P < 0.02) effect on VF-14 change scores in most patients.

CONCLUSIONS

The VF-14 seems to be more sensitive when the preoperative VA is <0.5 (20/40), especially in patients whose BSE is the surgical eye. The VF-14 seems responsive to increases in VA if the gains exceed 0.5. For gains <0.5, the VF-14 seems unresponsive, except for patients with other ocular pathologies in whom the BSE before and after surgery is the surgical eye.

Long-time visual functional results of cataract surgery on low vision patients

BACKGROUND/AIMS

To assess longitudinal 5-year results of cataract surgery on low vision patients.

METHODS

In this prospective, long-time, observational case-series, we report the outcome regarding the subjective visual function (n = 35) assessed by a visual function questionnaire (VF-14) and the visual acuity (n = 30) of surviving low vision patients 5 years after surgery. We compare with data recorded on the same patients before surgery and 4 months postoperatively.

RESULTS

Five years after surgery, 57% had unchanged or better VF-14 score compared with preoperatively, and 37% compared with postoperatively. Maculopathy patients had a significantly larger deterioration 5 years after surgery compared with postoperatively (40.2 versus 51.7, p = 0.004), but for the glaucoma patients there was no significant change (52.6 versus 53.1). There were no significant associations between age of the patient and change in VF-14 score or change in visual acuity 5 years after surgery, neither compared with before surgery nor postoperatively.

CONCLUSION

Results suggest a favorable functional outcome 5 years after cataract surgery on most low-vision patients. Glaucoma patients have a more stable outcome than patients with macular degeneration. The severity of the disease-process for each individual patient might be the most important factor affecting the long-time results.

Long-time results and associations between subjective visual difficulties with car driving and objective visual function 5 years after cataract surgery

PURPOSE

To determine results and associations between subjective visual difficulties while driving and objective visual function in drivers who had cataract surgery 5 years previously.

SETTING

Norrlands University Hospital, Umeå, Sweden.

METHODS

This prospective outcomes study examined 189 active drivers who had cataract surgery 5 years earlier. Visual acuity and low-contrast visual acuity (LCVA) were measured, and a questionnaire with driving-specific questions (VF-14 based) was completed. The results were compared with data before and after surgery.

RESULTS

Five years after cataract surgery, only a small proportion of patients (3%) drove without fulfilling the visual requirements. Few patients (5%) reported visual difficulties while driving in daylight, but a large proportion (43%) experienced difficulties in darkness, with glare being the most common problem. There was a statistically significant association between an LCVA of less than 20/50 and reporting subjective visual difficulties while driving (odds ratio [OR], 2.6; 95% confidence interval [CI], 1.1 to 6.8). Women had 1.8 times the odds of reporting visual difficulties compared with men (95% CI, 1.0 to 3.5).

CONCLUSIONS

Most active drivers had excellent visual acuity and no difficulty with daytime driving and distance estimation 5 years after cataract surgery. A large proportion of patients experienced difficulties while driving at night. These data suggest an adjusted association between LCVA and self-assessed visual difficulties while driving 5 years after cataract surgery. Our data confirm the importance of LCVA in relation to driving, especially in darkness.