New insight into unhappy 20/20 cataract patients

Cataract patients who report few problems performing near daily life activities before surgery are at greater risk of being dissatisfied after surgery even when they achieve 20/20 best corrected vision, according to a new study, Mats H Lundstrom MD PhD told the ESCR Symposium of the ISRIS Refractive Surgery Day at the 2013 AAO annual meeting.

His review of the study data suggest that many of the unhappy patients may have had slowly advancing nuclear sclerosis, and retained good near vision function but had poor distance vision before surgery. “This is new knowledge for us,” said Dr Lundstrom, a pioneer in cataract surgery outcomes research who led development of the ESCRS-supported European Registry of Quality Outcomes for Cataract and Refractive Surgery. The study involved nearly 15,000 cataract patients recorded in the Swedish National Cataract Register, who were asked to rate their visual function before and after surgery using the Catquest-9SF questionnaire.

The results were then compared with their clinically measured visual acuity. Overall, 7,341 patients, or 49 per cent, achieved 20/20 best corrected vision for both near and far distances. Among these, 6,854 self-reported improved visual function at near and far, consistent with their clinical refractive improvement. However, 487 20/20 patients, or 6.6 per cent, reported reduced visual ability after surgery, Dr Lundstrom noted. Their mean self-assessed near ability fell from about 70 before surgery to about 55 after surgery on a scale of 100, while their distance ability was nearly the same.

By contrast, satisfied patients reported a mean increase in near vision ability from about 45 to 82, and an increase from 55 to 90 for distance. Analysing data from the 42 participating clinics individually reinforced the results, Dr Lundstrom said. In all clinics, dissatisfied patients tended to report worse near vision ability and unchanged distance vision after surgery.