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Long-term outcome after cataract surgery: a longitudinal study
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background Cataract surgery is the most common surgical procedure carried out in the developed world and surgery volumes have increased considerably during the last decades. Various aspects of the surgical procedure, including surgical incision size and intraocular lens materials, have changed substantially, improving the safety and the quality of the outcome. Previous research has primarily focused on the visual function results with a short follow-up time. Long-term population-based studies, exceeding a few years, presenting visual functional results postoperatively, have not been published.

Aims To determine the effects of cataract surgery on subjectively experienced visual function and visual acuity in a defined population, and compare the results between sub-groups, on a long-term basis.

Methods In this prospective, population-based investigation, all patients with presenile and senile cataract (n=810), operated on during a one-year period (1997-98), at Umeå University Hospital were included. The frequency of cataract surgery at that time, was 5.2 per 1000 population studied. Visual acuity was tested and an eye examination was performed before surgery, 4-8 weeks postoperatively, and five and ten years after surgery. Subjective visual function was assessed using self-administered questionnaires (VF-14) at all occasions. Statistical evaluations comprised analyses of variance, Mann-Whitney U-test, chi-square test, multiple linear regression, a life-table calculation, and Cox’s proportional hazard model.

Results Five years after cataract surgery, subjective and objective visual function remained stable in most patients. The most frequent cause of deterioration of visual acuity and decrease in VF-14 scores was agerelated macular degeneration (ARMD). Two thirds of the patients in the cohort were women. They were significantly older than the men and more often operated on both eyes. After adjustment for age and visual acuity, women cataract surgery patients assessed their visual function worse than men both before surgery and 4 months postoperatively. Five years after surgery these differences were no longer significant. At baseline, 13% of the patients were diabetics. At the five-year followup, subjective and objective visual function remained stable in most surviving diabetics, and the longitudinal visual function was not significantly worse compared with the non-diabetics. Ten years after surgery, 28% had received treatment for posterior capsular opacification (PCO). A significantly larger proportion of patients less than 65 years at surgery (37%) compared with those 65 years or older (20%) had been treated.

Conclusions Most patients sustain their level of visual acuity and visual function also five and ten years after cataract surgery. Ocular co-morbidity, such as ARMD, is the major cause of longitudinally reduced visual function. Patients suffering from diabetes did not have a significantly worse visual function after five years. A surprisingly large proportion of patients had received treatment for PCO after ten years.

Place, publisher, year, edition, pages
Umeå: Umeå university , 2009. , 107 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1319
Keyword [en]
cataract, cataract surgery outcome, longitudinal study, subjective visual acuity
National Category
Ophthalmology
Research subject
Ophtalmology
Identifiers
URN: urn:nbn:se:umu:diva-30346ISBN: 978-91-7264-911-8 (print)OAI: oai:DiVA.org:umu-30346DiVA: diva2:281763
Public defence
2010-01-22, Sal B, 9 tr, tandläkarhögskolan, 90185 Umeå, Umeå, 09:00 (English)
Opponent
Supervisors
Available from: 2009-12-22 Created: 2009-12-17 Last updated: 2010-05-06Bibliographically approved
List of papers
1. Longitudinal changes in subjective and objective visual function 5 years after cataract surgery: prospective population-based study
Open this publication in new window or tab >>Longitudinal changes in subjective and objective visual function 5 years after cataract surgery: prospective population-based study
2006 (English)In: Journal of cataract and refractive surgery, ISSN 0886-3350, E-ISSN 1873-4502, Vol. 32, no 11, 1944-1950 p.Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To investigate the long-term outcomes of cataract surgery by analyzing data collected 5 years after surgery and comparing with preoperative and postoperative subjective and objective visual function results.

SETTING: Norrlands University Hospital, Umeå, Sweden.

METHODS: A prospective longitudinal population-based cohort study comprised 810 patients who had cataract surgery during a 1-year period within a geographically defined area. Evaluated were visual acuity data and Visual Function-14 questionnaire (VF-14) results before and after surgery. Five years later, the 590 patients still alive were offered eye examinations and asked to fill out the questionnaire.

RESULTS: Of the 590 patients asked to participate at 5 years, 530 answered the questionnaire and 467 had eye examinations. The median VF-14 total score for all patients after surgery was 100; at 5 years, the score decreased to 96.7 (P = .001). Five years after surgery, 46% of patients had unchanged or better visual acuity in the operated eye, 37% had lost more than 0.1 logMAR unit, and 22% had a reduction in VF-14 score of 10 points or more. The two main reasons for the decline in visual acuity and VF-14 scores were age-related macular degeneration (ARMD) (47% and 60%, respectively) and glaucoma (12% and 11%, respectively). Age, co-morbidity, and VF-14 scores after surgery were independently associated with the VF-14 score 5 years after surgery.

CONCLUSIONS: Subjective and objective visual function 5 years after cataract surgery remained stable in most patients. Co-morbidity, most commonly ARMD, was the most frequent cause of deterioration of visual acuity and decrease in VF-14 scores. Age and co-morbidity were independently associated with the VF-14 score 5 years after surgery.

Keyword
Cataract surgery
Identifiers
urn:nbn:se:umu:diva-30342 (URN)10.1016/j.jcrs.2006.06.023 (DOI)17081901 (PubMedID)
Available from: 2009-12-17 Created: 2009-12-17 Last updated: 2011-04-13Bibliographically approved
2. Gender-related differences in cataract surgery outcome: a 5-year follow-up
Open this publication in new window or tab >>Gender-related differences in cataract surgery outcome: a 5-year follow-up
2008 (English)In: Acta Ophthalmologica Scandinavica, ISSN 1395-3907, E-ISSN 1600-0420, Vol. 86, no 5, 543-548 p.Article in journal (Refereed) Published
Abstract [en]

PURPOSE: A prospective, longitudinal, population-based cohort study was performed to analyse gender-related differences in subjective and objective visual function 5 years after cataract surgery.

METHODS: All patients (n = 810) who underwent cataract surgery during a 1-year period (1997-98) at Norrlands University Hospital in Umeå, Sweden, were studied with visual acuity (VA) data and questionnaires (VF-14) before and after surgery, as well as 5 years later. Five hundred and thirty patients (177 men, 353 women) answered the questionnaire, constituting 90% (530/590) of the survivors. Four hundred and sixty-seven (156 men, 311 women) also underwent an eye examination.

RESULTS: The women were significantly older (P = 0.009) and were more often operated on both eyes (P = 0.005). Before surgery and postoperatively, the women had a significantly lower age- and VA-adjusted VF-14 score (P = 0.000 and P = 0.036, respectively). This difference was not significant 5 years after surgery (P = 0.16). Five years after surgery, a significantly larger proportion of women had a decline of more than 0.1 logarithm of the minimum angle of resolution of the better-seeing eye (P = 0.013). There were no significant gender-related differences in the operated eye.

CONCLUSION: Female cataract surgery patients assess their visual function worse than males after adjustment for age and VA preoperatively and postoperatively. These differences were not significant 5 years after surgery although the men had better best-corrected visual acuity (BCVA) of their better eye. It is important to be aware of gender-related differences in perception when performing questionnaire-based outcome studies.

Keyword
cataract surgery outcome, gender, long-term results
National Category
Ophthalmology
Research subject
Ophtalmology
Identifiers
urn:nbn:se:umu:diva-20929 (URN)10.1111/j.1600-0420.2007.01099.x (DOI)18752528 (PubMedID)744 (Local ID)744 (Archive number)744 (OAI)
Available from: 2009-03-30 Created: 2009-03-30 Last updated: 2010-08-18Bibliographically approved
3. Longitudinal changes in subjective and objective visual function in diabetics 5 years after cataract surgery: Prospective population-based study.
Open this publication in new window or tab >>Longitudinal changes in subjective and objective visual function in diabetics 5 years after cataract surgery: Prospective population-based study.
2006 (English)In: Journal of cataract and refractive surgery, ISSN 0886-3350, E-ISSN 1873-4502, Vol. 32, no 11, 1944-1950 p.Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To investigate the long-term outcomes of cataract surgery by analyzing data collected 5 years after surgery and comparing with preoperative and postoperative subjective and objective visual function results. SETTING: Norrlands University Hospital, Umeå, Sweden. METHODS: A prospective longitudinal population-based cohort study comprised 810 patients who had cataract surgery during a 1-year period within a geographically defined area. Evaluated were visual acuity data and Visual Function-14 questionnaire (VF-14) results before and after surgery. Five years later, the 590 patients still alive were offered eye examinations and asked to fill out the questionnaire. RESULTS: Of the 590 patients asked to participate at 5 years, 530 answered the questionnaire and 467 had eye examinations. The median VF-14 total score for all patients after surgery was 100; at 5 years, the score decreased to 96.7 (P = .001). Five years after surgery, 46% of patients had unchanged or better visual acuity in the operated eye, 37% had lost more than 0.1 logMAR unit, and 22% had a reduction in VF-14 score of 10 points or more. The two main reasons for the decline in visual acuity and VF-14 scores were age-related macular degeneration (ARMD) (47% and 60%, respectively) and glaucoma (12% and 11%, respectively). Age, co-morbidity, and VF-14 scores after surgery were independently associated with the VF-14 score 5 years after surgery. CONCLUSIONS: Subjective and objective visual function 5 years after cataract surgery remained stable in most patients. Co-morbidity, most commonly ARMD, was the most frequent cause of deterioration of visual acuity and decrease in VF-14 scores. Age and co-morbidity were independently associated with the VF-14 score 5 years after surgery.

Keyword
cataract surgery, population-based study
National Category
Ophthalmology
Research subject
Ophtalmology
Identifiers
urn:nbn:se:umu:diva-30427 (URN)10.1016/j.jcrs.2006.06.023 (DOI)000241783200039 ()17081901 (PubMedID)
Conference
22nd Congress of the European-Society-of-Cataract-and-Refractive-Surgery. Paris, FRANCE, SEP 18-22, 2004
Available from: 2009-12-22 Created: 2009-12-22 Last updated: 2014-08-07Bibliographically approved
4. Ten-year longitudinal visual function and Nd: YAG laser capsulotomy rates in patients less than 65 years at cataract surgery
Open this publication in new window or tab >>Ten-year longitudinal visual function and Nd: YAG laser capsulotomy rates in patients less than 65 years at cataract surgery
2010 (English)In: American Journal of Ophthalmology, ISSN 0002-9394, E-ISSN 1879-1891, Vol. 149, no 2, 238-244 p.Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To investigate the longitudinal subjective and objective visual functional results in adult cataract patients younger than 65 years at surgery. To evaluate the 10-year cumulative incidence of neodymium-yttrium-aluminum-garnet (Nd:YAG) laser treatment.

DESIGN: A prospective, longitudinal, population-based cohort study.

METHODS: The study comprised 116 patients younger than 65 years who had cataract surgery during 1 year at Norrlands University Hospital, Umeå, Sweden. Most patients (94%) had received implantation with a hydrophobic acrylic intraocular lens. Evaluated were visual acuity (VA) and visual function questionnaire (VF-14) results before and after surgery. A comparison with patients 65 years or older at surgery was made. Ten years later, 102 survivors were offered eye examinations and again asked to fill out the questionnaire. Past Nd:YAG laser treatment, as well as high- and low-contrast VA results, were analyzed.

RESULTS: Ten years postoperatively, 37% of the patients under 65 at surgery had been treated with Nd:YAG in comparison to 20% of the older patients. The cumulative incidence for not having Nd:YAG over 10 years was 72% for those under 65 and 85% for the patients 65 years or more at surgery. Eighteen percent of the younger patients had lost more than 0.1 logarithm of the minimal angle of resolution (logMAR) units of the operated eye, compared with 37% of the older (P = .00003). A reduction in VF-14 score of 10 points or more was found in 9% of the younger and 28% of the older cataract surgery patients (P = .00004).

CONCLUSION: Ten years after surgery, subjective and objective visual function remained stable in most patients younger than 65 years at surgery. More than one-third had received a posterior capsulotomy. Only a few patients with posterior capsular opacification requiring Nd:YAG were untreated at the 10-year follow-up.

Keyword
visual function, cataract surgery, longitudinal study
National Category
Ophthalmology
Research subject
Ophtalmology
Identifiers
urn:nbn:se:umu:diva-30345 (URN)10.1016/j.ajo.2009.08.029 (DOI)19926068 (PubMedID)
Available from: 2009-12-17 Created: 2009-12-17 Last updated: 2011-04-11Bibliographically approved

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