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Purpose: To investigate the 20-year outcome, in best-corrected visual acuity (BCVA), and subjective visual function (VF-questionnaire, VF-14) after cataract surgery in type 2 diabetics, compared with non-diabetics.

Methods: 109 type 2 diabetics and 698 non-diabetics, who had cataract surgery during 1 year at one institution, were included in this prospective, longitudinal, population-based cohort study. BCVA and VF-14 responses were recorded pre- and postoperatively, and every 5 years up to 20 years after surgery. Retinopathy was graded before surgery.

Results: There was no significant difference between diabetics and non-diabetics, in change in BCVA from 10 years or more after surgery, p = 0.45, p = 0.44 and p = 0.83, at 10, 15 and 20 years, respectively, as well as in self-perceived visual function (VF-14) at any time after surgery, p = 0.72, p = 0.20 and p = 0.78, 10–20 years, respectively.

At any follow-up, there was no significant difference in BCVA in relation to retinopathy level before surgery, p = 0.1 at 20 years. There was a trend from 10 years after surgery and onward that patients with no retinopathy at baseline lost fewer letters during the 20 years than diabetics with retinopathy. Patients with known type 2 diabetes at surgery had a significantly lower survival compared with the non-diabetics at each follow-up, p = 0.003.

Conclusion: In surviving diabetics, BCVA and subjective visual function were retained in most cases up to 20 years after cataract surgery. Cataract extraction is effective in causing a sustainable improvement in visual function also in type 2 diabetics. Knowledge of these long-term outcomes is essential when counselling diabetics for cataract surgery.

Background/Aims: Driving especially at night is a visually demanding task. Long-time outcome of cataract surgery in drivers is important to study, as many patients live for decades after surgery. The purpose of this study is to longitudinally investigate visual function in active car drivers, 20 years after cataract surgery.

Methods: From a population-based, prospective, cohort of cataract surgery patients, initiated in 1997–98, 114 of the 133 surviving patients were included. Preoperatively, postoperatively 5, 10, 15 and 20 years after surgery, the patients answered a visual function questionnaire including driving status and difficulty. Habitual visual acuity, best corrected visual acuity (BCVA), and low contrast acuity (LCVA) 10% and 2.5% were measured.

Results: The driving difficulties in daylight were almost absent after surgery and did not change over 20 years. Nighttime driving was more difficult and declined longitudinally after surgery, p=0.013, but were at 20 years still less than before cataract surgery. Patients with better BCVA experienced less difficulties driving in darkness, p=0.005. Self-reported problems with glare were significantly associated with BCVA of the better-seeing eye, LCVA 10% and LCVA 2.5% (p=0.046, p=0.033, and 0.024 respectively). Self-reported difficulties with seeing in low-contrast conditions were also significantly associated with BCVA, p=0.004.

Conclusion: Twenty years after cataract surgery, most active drivers have no or minor visual functional problems during driving in daytime. Difficulties in nighttime driving are more common and increase significantly over time. Twenty years after surgery, all current drivers had still better subjective ability to drive, compared with before surgery.

Purpose: To evaluate the number of postoperative visits after cataract surgery in two institutions with different routines.

Patients and Methods: A population-based prospective, observational, cohort study was conducted at two institutions in northern Sweden. All cataract surgery cases during a 1-year period were included. The study group was 1249 cases, who followed the standard routine at the Sunderby clinic, ie, no planned postoperative visit for patients without comorbidity who had uncomplicated surgery. All cases (n=1162) having surgery during the same 1-year period at the Umeå clinic were selected as the control group. The routine in Umeå was a planned postoperative visit for all patients after first eye surgery, and on second eye surgery patients with other ocular comorbidity.

Results: A postoperative visit was planned in 44% (555/1249) of the study group and in 83% of all control group cases (966/1162). Significantly less patients in the study group (9% vs 16%; p=0.000036) initiated an unplanned contact. Patients with a distance to the hospital of 70 km or longer were less inclined to seek unplanned care (p=0.016). There was no difference in postoperative outcomes between the patients who initiated contact and those who did not in the study and control hospitals.

Conclusion: Without compromising patient safety, it is possible to reduce the burden of postoperative visits in cases with uncomplicated cataract surgery. A reduction in the number of visits is obtained only if the standard routine is no planned postoperative visits in uncomplicated cases without ocular comorbidity for both first and second eye surgery.

PURPOSE: To examine the incidence and trends of late intraocular lens (IOL) dislocation/decentration and the frequency of pseudophakodonesis. DESIGN: Prospective, population-based cohort study. METHODS: A total of 800 patients were examined before cataract surgery in 1997-1998. Twenty years later, 100 of 133 survivors (75%) participated in the follow-up. An eye examination was performed including assessment for pseudophakodonesis and dislocation of the IOL. The medical records of all included patients at baseline were studied. Main outcome measures were previous IOL exchange or repositioning surgery, significant IOL dislocation, degree of pseudophakodonesis, and visual acuity. RESULTS: Twenty years after the original cataract surgery, 10 of the 800 patients at risk (1.2%) had needed dislocation surgery. Before cataract surgery, 39% of all patients had pseudoexfoliations (PXF). Mean time from cataract surgery to dislocation surgery was 12 years 6 months (range 3 years 9 months to 19 years 3 months). The cumulative incidence over 20 years was 6% in patients with PXF and 2% without PXF at surgery (P = .035). Mean age at cataract surgery in the 10 dislocated cases was 68.3 years (range 58-80). Twenty years after surgery, 5 of 98 (5%) patients had moderate/pronounced pseudophakodonesis. CONCLUSIONS: In this population-based cohort, the 20-year cumulative incidence of IOL dislocation needing surgical attention was significantly higher in patients with PXF than without PXF before surgery. The individual patient seems to have a low risk of being affected by this complication, but dislocated IOLs may cause a relatively large public health care burden, because of the large number of people in society with previous cataract surgery.

Purpose: To report the longitudinal visual functional outcome after cataract surgery over 20 years. 

Setting: Eye clinic, Norrlands University Hospital, Sweden.

Design: Prospective population-based cohort study. 

Methods: One hundred fourteen patients (86% of survivors) who had cataract surgery during a 1-year period (1997 to 1998) answered the same Visual Function Index-14 questionnaire (VF-14) preoperatively, 2 to 4 months postoperatively, and at 5, 10, 15, and 20 years after surgery. Most patients (100 [88%] of 114; 75% of survivors) also had a routine ocular examination, including corrected distance visual acuity (CDVA).

Results: The mean age of the114 patients in the study was 60.6 years (range 36 to 80 years) at the time of surgery. Twenty years after surgery, the median CDVA in the operated eye had deteriorated from Snellen acuity 20/20 (logarithm of the minimum angle of resolution [logMAR] 0.0) postoperatively to 20/23 (logMAR 0.07) (P =.001). Patients aged 70 years or older at surgery had the largest loss of CDVA at 20 years compared with younger patients. At 20 years, 63 (55%) of the 114 patients had no deterioration in subjective visual function and most patients (82 [72%]) had 10 points decline or less. Patients who were older at surgery had a more pronounced decline in VF-14 total score over 20 years (P =.002). Fifty-six (58%) of 96 patients had never been treated for posterior capsule opacification.

Conclusions: This prospective 20-year follow-up study provided estimates of longitudinal visual results. Cataract surgery also offered excellent long-term visual rehabilitation for the majority, especially younger patients, after 20 years, with a low requirement for Nd:YAG laser capsulotomy. The results in this study are of value for counseling younger patients with cataract and patients considering refractive lens surgery.

PURPOSE: To determine the cumulative risk and outcome of retinal redetachment after cataract surgery, in eyes with a history of retinal detachment repair by scleral buckling techniques.

DESIGN: Population-based, retrospective cohort study.

PARTICIPANTS: All phakic patients without previous ocular surgery or significant trauma who underwent scleral buckling surgery for rhegmatogenous retinal detachment between January 1, 2001, and December 31, 2010, at Norrlands University Hospital, Sweden (n = 537).

METHODS: International Classification of Diseases 10 diagnosis codes corresponding to rhegmatogenous retinal detachment were used to identify all cases. Medical charts of all patients identified were reviewed to confirm the diagnosis. Any recurrence of retinal detachment and the visual outcome in these cases were examined. The frequency of redetachment and the time span from cataract surgery to redetachment surgery were analyzed.

MAIN OUTCOME MEASURES: Any redetachment surgery after cataract surgery, best-corrected visual acuity (BCVA).

RESULTS: Three hundred and one (56%) male and 236 (44%) female patients were identified. During the follow-up period, 145 of 537 patients (27%) had phacoemulsification surgery, with a median time span of 3.4 years after the retinal detachment repair. Male patients had cataract surgery significantly more often (31% vs. 22%; P = 0.036), and at an earlier age, than female patients (65.6 vs. 69.4 years; P = 0.013). Recurrence of retinal detachment occurred in 3 patients (3/145; 2.1%), at 2.4, 3.9, and 6.9 years after cataract extraction, and their final BCVA was 20/70, 20/25, and 20/30, respectively. The cumulative percentage of redetachment surgery after phacoemulsification was 1% up to 10 years after the scleral buckling surgery, as calculated by life table analyses. Ten years after cataract surgery, the cumulative percentage of redetachment surgery was 5% in eyes with previous scleral buckling surgery.

CONCLUSIONS: In patients with a history of previous scleral buckling surgery, the risk of redetachment after cataract surgery is low. In these patients, phacoemulsification can be performed safely and there is no need for extended postoperative attention. It is, however, important to inform all patients with previous retinal detachment surgery to seek prompt medical care if they experience symptoms of redetachment. This is important even several years after the cataract surgery was performed.

Purpose: This study reports the change, over a 20-year period, in best-corrected visual acuity (BCVA), subjective visual function (VF-14 questionnaire), and YAG-frequency after cataract surgery.

Methods: This population-based prospective study reviewed 106 patients (79% of survivors), who underwent cataract surgery during a 1-year period 20 years previously (1997). All patients answered the same visual function questionnaire (VF-14) preoperatively, 4 months postoperatively, 5, 10, 15 and 20 years after surgery. Most patients (90%; 95/106; 70% of survivors) also had a routine ocular examination including BCVA and low contrast visual acuity (VA) 10% and 2.5%. Mean age at the time of surgery was 59 years (range 36-79) and 95% had a three-piece Acrysof® MA60BM implanted.

Results: Twenty years after surgery the median BCVA of the operated eye had deteriorated to a median of 0.06 (logMAR) (Snellen acuity: 20/23) from 0.0 (logMAR) (20/20) postoperatively, (p=0.001). Sixty-one percent of the patients (58/95) had less than 0.1 logMAR units worsening of BCVA compared with postoperatively. Seventeen percent of the patients (16/95) had worse BCVA 20 years after surgery compared with the preoperative VA. Forty-two percent (45/106) had no deterioration in subjective visual function (VF-14), and mean VF-14 score 20 years after surgery was 92 (range 33-100). The majority of patients (78%;82/106) had 10 points decline or less and 6 percent of the patients (6/106) had a worsening of more than 30 points. 61% of the patients (58/95) had never had Nd:YAG laser capsulotomy. In 7% of the patients (7/95) no cataract surgery had occurred in the fellow eye.

Conclusions: These prospective population-based, follow-up data provides estimates of extended long-term visual results. The effectiveness of cataract extraction, in offering good long-term visual rehabilitation for the majority of the patients, is confirmed. The extent and distribution of loss in subjective visual function is comparable to the outcome 10 and 15 years after surgery. Age-related macular degeneration remained the most common comorbidity causing large functional loss also 20 years after cataract surgery. Surprisingly, despite the low age at cataract surgery and the long time span, only a minority of patients had needed treatment for posterior capsular opacification.

Purpose: To evaluate safety perspectives when the standard routine after cataract surgery is no planned postoperative visit.

Setting: Eye Clinic, Sunderby Hospital, Lulea, Norrbotten County, Sweden.

Design: Prospective case series.

Methods: All cataract surgery cases during a 1-year period were included. The study group had the standard routine at the clinic, that is, no planned postoperative visit for patients without comorbidity and uneventful surgery. For the control group, patients who had surgery during 1 month of the 1-year period were chosen. All these patients had a planned postoperative visit. All surgeons involved were experienced. The outcome measures were any planned postoperative visit, any complication and/or adverse event, postoperative corrected distance visual acuity (CDVA), and any postoperative control/contact initiated by the patient.

Results: The study comprised 1249 patients (1115 in the study group and 134 in the control group). No significant differences in demographics, postoperative CDVA, frequency of planned visits because of ocular comorbidity, or postoperative patient-initiated contacts were found between the 2 groups. Of the 1249 patients, 9% (117 patients) initiated a postoperative contact, of whom 26% (30 patients) also had a scheduled visit. The reasons for the patient-initiated contacts were visual disturbance, redness and/or chafing, pain, and anxiety. An evaluation of all medidal records 2 years postoperatively found no reports of missed adverse events.

Conclusions: It was possible to refrain from planned,postoperafive visits for patients having uncomplicated cataract surgery. However, preoperatively, patients with comorbidities should be provided with individual planning of their postoperative follow-up. Preoperative counseling is important, and the clinic must have resources to answer questions from patients and be prepared for additional unplanned postoperative visits.

PURPOSE: To analyze the long-term change in light scattering caused by glistenings in hydrophobic acrylic intraocular lenses (IOLs) and the clinical implications on high-contrast and low-contrast visual acuity.

SETTING: Department of Clinical Sciences/Ophthalmology, Umeå University Hospital, Umeå, Sweden.

DESIGN: Prospective longitudinal case series.

METHODS: The study comprised patients who had an Acrysof MA60BM IOL implanted between 1997 and 1998. Light scattering from the IOLs was assessed with digital analysis using Scheimpflug photography (Pentacam HR) from both the 10- year and 15-year follow-up. Associations were made between corrected distance visual acuity, low-contrast visual acuity (LCVA) 10.0%, LCVA 2.5%, and the degree of light scattering from the IOL.

RESULTS: At the 15-year follow-up, the majority of the 90 patients had an increased amount of light scattering in all parts measured in the IOL than the patients at the 10-year follow-up. A subgroup of 71 patients without coexisting ocular pathology was selected for the visual function analyses. There was no correlation between light scattering and dioptric power. No clinically relevant reduction in visual function was detected in eyes with more pronounced light scattering. Patients with a larger increase in total light scattering of the IOL at the 15-year follow-up had significantly worse LCVA 2.5% than at the 10-year follow-up (P = .042).

CONCLUSIONS: Glistenings continued to increase in hydrophobic acrylic IOLs from 10 to 15 years after surgery. At 15 years, most patients had severe glistenings with a high level of light scattering from the IOL. No clinically significant effect on everyday visual function was found.

FINANCIAL DISCLOSURE: Neither author has a financial or proprietary interest in any material or method mentioned.

PURPOSE: To describe the change over a 15-year period in corrected distance visual acuity (CDVA), subjective visual function, and neodymium:YAG (Nd:YAG) frequency after cataract surgery. SETTING: Eye Clinic, Norrlands University Hospital, Umea, Sweden. DESIGN: Prospective longitudinal population-based cohort study. METHODS: Patients who had cataract surgery during a 1-year period, 15 years previously (1997 to 1998), were included. All patients answered the same Visual Function-14 (VF-14) questionnaire preoperatively, 4 months postoperatively, and 5, 10, and 15 years after surgery. Most patients (88%; 168/190; 74% of survivors) also had an ocular examination. The CDVA was measured with logMAR charts. RESULTS: The study included 190 patients (83% of survivors). Fifteen years after surgery, the median CDVA in the operated eye had deteriorated from 20/20 postoperatively to 20/25 (P = .0001). Sixty percent of the patients had worsening of CDVA of less than 0.1 logMAR units compared with postoperatively. Fifty-four percent (103/190) had no deterioration in subjective visual function (VF-14), and 79% (150/190) had 10 points of decline or less. Previous Nd:YAG laser capsulotomy was more common in those younger than 65 years at surgery (49% versus 25%) (P = .002). CONCLUSIONS: The study confirms the effectiveness of cataract extraction, offering good long-term visual rehabilitation for the majority of the patients. The most common comorbidity causing large functional loss 15 years after surgery was age-related macular degeneration. Fifteen years after surgery, one half of the patients younger than 65 years at surgery had not required a posterior Nd:YAG laser capsulotomy. (C) 2016 ASCRS and ESCRS