Preoperative Aberrometry And Straylight Measurement As Predictors Of Patient-Reported Outcomes After Cataract Surgery

The current indication for cataract surgery relies on patient-reported complaints, visual acuity (VA), and slit-lamp assessment. However, preoperative VA has been shown to be a poor predictor of surgical outcome, and no tool reliably predicts which patients will experience meaningful functional improvement with surgery. Objective optical quality metrics, such as aberrometry and straylight measurement, may provide a more direct measure of lens-induced optical degradation, independent of subjective reporting. This study investigates whether preoperative aberrometry and straylight predict postoperative patient-reported visual function as measured with the Catquest-9SF.

Prospective observational cohort study at the Department of Ophthalmology, Amphia hospital, Breda, the Netherlands. Patients with bilateral cataract scheduled for phacoemulsification with bilateral implantation of a (toric) monofocal or extended-depth-of focus intraocular lens (IOL) were enrolled.

Fifty-three patients (73 ± 7 years) underwent preoperative and one-month postoperative aberrometry (iTrace) and straylight measurement (C-Quant) in both eyes. Aberrometry was expressed as the log of Visual Strehl ratio, an optical metric that incorporates an age-related neural contrast sensitivity function at 900 trolands. Straylight was expressed as log[s]. Visual function was assessed with the Catquest-9SF questionnaire before and after surgery. Uncorrected (UDVA), corrected (CDVA), and spectacle-corrected distance VA (SCDVA) were also measured. A linear mixed-effects model (random intercept for patient) assessed whether preoperative log[VSX], log[s], baseline Catquest-9SF score, and age predicted postoperative Catquest-9SF Rasch score.

Cataract surgery significantly improved VA (right, left eyes): SCDVA preop 0.32±0.18, 0.29±0.18; UDVA postop 0.16±0.26, 0.16±0.23; CDVA postop 0.01±0.11, 0.00±0.07. Aberrations (log[VSX]) (right, left eyes) improved from -1.39±0.72 to -0.74±0.41, from -1.44±0.72 to -0.76±0.38, and straylight (log[s]) from 1.51±0.23 to 1.19±0.25, from 1.49±0.21 to 1.24±0.23 (all p<0.0001). Patient-reported visual function also improved significantly: Catquest-9SF Rasch score changed from -1.10±1.25 to -2.86±0.70 (p<0.0001). In a linear mixed model adjusted for preoperative Catquest-9SF, log[VSX], log[s], and age, only age independently predicted postoperative patient-reported outcome (β=-0.03, p=0.01).

Despite marked improvements in objective optical quality and patient-reported visual function following cataract surgery, preoperative log[VSX] and log[s] were not associated with postoperative Catquest-9SF outcomes. These findings indicate that the relationship between measured optical degradation and postoperative patient-reported visual function is not straightforward. Further research is needed to better understand how objective optical metrics relate to patient-reported outcomes.