Functional Improvement after One- and Two-Eye Cataract Surgery in the Salisbury Eye Evaluation

Abstract

Purpose To determine the impact cataract and cataract surgery have on clinical measurements of vision, reading speed, objective mobility performance, and subjective visual functioning. Design Prospective, population-based study Participants 1,739 Salisbury Eye Evaluation (SEE) participants without previous cataract surgery with bilateral baseline best corrected visual acuity (BCVA) of logarithm of the Minimum Angle of Resolution (logMAR) ≤ 0.3 (20/40 or better) or cataract surgery between round 1 and 2. Methods Participants were categorized based on cataract surgery by round 2 into: no surgery, unilateral surgery, or bilateral surgery. Visual performance, mobility-based tasks, and the Activities of Daily Vision Scale (ADVS) were measured at baseline and two years. Mobility score was converted into a z-score, by subtracting the participant’s time from the population baseline average then dividing by the standard deviation. Comparisons were made between the no surgery and surgery groups using multivariate linear regression. Main Outcome Measures Change in bilateral best corrected visual acuity in logMAR, contrast sensitivity, reading speed in words per minute (wpm), mobility score, and ADVS. Results During the study period, 29 participants had cataract surgery on both eyes, 90 had unilateral surgery, and 1,620 had none. After adjusting for baseline value, demographics, depression and mental status, the unilateral surgery group BCVA improved 0.04 logMAR (p=0.001) and the bilateral group improved 0.13 compared to no surgery (p<0.001). Overall mobility declined in all groups. The unilateral group z-score declined 0.18 more than the no surgery group (p=0.02), while the bilateral group showed a 0.18 z-score improvement compared to no surgery (p=0.19). Change in reading speed significantly improved in the unilateral and bilateral groups compared to no surgery (12 and 31 words per minute, respectively). The bilateral surgery group showed significant positive change in ADVS compared to no surgery (5 points relative improvement, p = 0.01), while the unilateral group showed a 5-point relative decline (p<0.001). Conclusions Cataract negatively affects both subjective quality of life and objective performance measures. Unilateral cataract surgery improves visual functioning, but the largest gains are found in patients who undergo second-eye cataract surgery. This finding supports second-eye cataract surgery for patients with visual or functional complaints even after successful first-eye surgery.

Rejuvenation Effects of Cataract Surgery with Ultraviolet Blocking Intra-Ocular Lens on Circadian Rhythm and Gait Speed

“…Cataract surgery is recognized to both reduce the risk of falls, a serious injury in older adults, [22][23][24][25][26][27][28][29] and improve driving safety 30,31 probably due to the remarkable improvement in visual recognition after surgery. Therefore, gait speed is a useful health index to evaluate the systemic effects of cataract surgery, 32 and we previously developed an estimation of remaining years of life based on gait speed in cataract patients.…”

Visual acuity and depressive symptoms before and after first eye cataract surgery in elderly patients

“…Also previous studies have found a link between depressive symptoms and level of visual acuity (9)(10)(11)(12)14,15,24,(35)(36)(37)(38)(39)(40)(41)(42)(43).…”

“…The level of visual acuity of the non-operated eye is an important element in the level of depressive symptoms (14)(15)(16).…”

Clinical practice variation in cataract surgery

“…Its importance stems from the fact that 30-60% of surgical interventions involve the second eye. 8,118 The last factor to be taken into account in this subject is the level of surgical activity developed by a given health service and the social or political tolerance to the existence of waiting lists, 20 which brings up a number of significant issues such as the repercussions derived from remaining in waiting lists for long periods of time 119 as well as the prioritization of patients for accessing said surgery. 116,117 It is estimated that in the future the number of second eye surgeries would increase significantly, which in turn would increase the CSR.…”