Second eye cataract surgery improves quality of life

Second-eye cataract surgery improves visual function and quality of life beyond levels obtained after first-eye surgery, according to a study reported by Nakul Shekhawat MD MPH, Vanderbilt University School of Medicine, Nashville, Tennessee, US. For some aspects of vision-related quality of life, second-eye surgery results in just as much improvement as first-eye surgery.

The findings contradict prior studies that showed a mixed or non-definitive benefit for second eye surgery, Dr Shekhawat said. However, he believes these mixed results reflect issues in measuring benefit rather than a problem with outcomes.

Dr Shekhawat retrospectively reviewed patients who underwent bilateral phacoemulsification cataract surgery at five Veterans Affairs hospitals from 2009 through 2012 for which complete preoperative and postoperative data were available for the first and/or second eye. Patients were administered the National Eye Institute Visual Function Questionnaire before and 30 to 90 days after surgery on each eye to assess visual function. Patients who had undergone previous ocular surgery or had retinal detachment or endopthalmitis following surgery were excluded, as were patients with dementia, anxiety, difficulty hearing, a history of drug abuse, or who were re-operated within 30 days. A total of 328 patients were examined in each of the first and second eye groups.

NEI VFQ scores were taken before and after surgery, the differences calculated and the differences compared head to head between the first and second eye groups. Analysis was conducted using the instrument’s original scoring approach, in which 11 subscale scores, including near and distance function, driving, depression, etc., were calculated along with a composite score. A second Rasch-refined analysis was applied to two psychometrically validated subscales, visual function and socioemotional status.

Not surprisingly, best corrected visual acuity improved more in first eye surgery, from about 20/70 to between 20/20 and 20/25, compared with 20/40 to nearly 20/20 in the second eye.

Using the traditional NEI-VFQ scoring method, absolute postop scores for visual function were consistently higher for all 11 subscales and the composite score at P<0.001. The psychometrically validated subscores of visual function and socioemotional factors were also significantly higher after the second surgery at P<0.001.

Looking at improvement in scores after the first and second surgery, there was no significant difference in four of the 11 traditional subscales, general vision, performance of near activities, mental health and role function. In other words, patients benefited just as much from second eye surgery as in first eye in these domains. In the psychometrically validated subscales, patients did gain more visual function from the first surgery, but their socioemotional status improved just as much from second eye surgery, Dr Shekhawat said. Socioemotional questions included things like how long patients can work, their ability to leave home, dependence on others, and frustration level.

Regarding previous meta-analyses and studies finding mixed evidence, Dr Shekhawat noted that all clinicians know of patients who benefited enormously in day-to-day function and quality of life after second-eye surgery. “Therefore we believe this is a measurement challenge, not a surgical outcomes challenge. The challenge remains in capturing the benefit of second eye surgery in a validated instrument in high-quality research