Changing indications for cataract surgery: a 5 year study of three national cataract surgery databases

Session Details

Session Title: Cataract Surgery Practice Styles

Session Date/Time: Wednesday 17/09/2014 | 08:00-09:30

Paper Time: 08:12

Venue: Boulevard B

First Author: : M.Lundström SWEDEN

Co Author(s): :    P. Goh   Y. Henry   M. Salowi   P. Rosen   S. Manning   P. Barry

Abstract Details

Purpose:

The aim of this study was to describe changing indications and outcomes for cataract surgery over time and discuss optimal timing for doing the surgery.

Setting:

Clinics in Holland, Malaysia and Sweden

Methods:

Two different databases with 5-year data of cataract surgery was studied: The European Registry of Quality Outcomes for Cataract and Refractive Surgery (EUREQUO) and the Malaysian National Cataract Registry. EUREQUO includes complete data from the Dutch National Cataract Register and from the Swedish National Cataract Register. Data from 2008 to 2012 was included in the study. The changing trends of the following variables was studied: Preoperative data: Age; Visual acuity in the eye to be operated on; Ocular co-morbidity in the surgery eye (Age-related Macular Degeneration, Glaucoma and Diabetic Retinopathy) in per cent before surgery. Surgical procedure: Capsule complication during surgery. Postoperative data: Visual acuity at follow up.

Results:

Included in this study were 404,714 cataract extractions from Holland, 412,542 from Sweden and 137,524 from Malaysia. The mean age at the time of cataract surgery was highest in Sweden (74.6) and lowest in Malaysia (64.6). The 5-year trend shows slowly sinking mean age in Sweden and slowly increasing mean age in Malaysia. The preoperative visual acuity in the eye to be operated on differed very much between the three countries. The percentage of eyes with a visual acuity of LogMAR 1.0 or worse was in 2008 7.1% in Holland, 20.6% in Sweden and 72% in Malaysia. In all three countries the 5-year trend was decreasing numbers of this visual acuity level. The percentage of cases with a preoperative visual acuity of LogMAR 0.0 or better was slowly rising over time. A capsule complication was decreasing over time in all three registries and the occurrence of a capsule complication was strongest related to the preoperative visual acuity. The postoperative visual acuity improved over time in all three registries, but the improvement of visual acuity from before surgery to after surgery decreased slowly over time. A worse visual outcome after surgery was significantly related to a good preoperative vision.

Conclusions:

Preoperative visual acuity becomes significantly better and better over time irrespective of the previous CSR. This is not only an effect of increasing second-eye surgeries because preoperative visual acuity becomes better for both 1st-eye surgeries and 2nd-eye surgeries over time. We found no evidence for that a change in mean age could explain the preoperative improvement of visual acuity. Furthermore, changing trends in ocular co-morbidity did not influence the steady improvement of preoperative visual acuity. Our explanation is that changing thresholds of visual impairment as an indication for surgery cause the trend of better preoperative visual acuity. Capsule complications decreases significantly over time. The different levels of capsule complications coincide with different levels of preoperative visual acuity. There is a significant relationship between capsule complication and preoperative visual acuity. Poorer preoperative average visual acuity means higher incidence of capsule complications. The visual outcome becomes significantly better and better over time in all three registries. This trend occurs irrespective of varying frequency of ocular co-morbidity. The visual improvement by surgery shows a moderate decreasing trend over time in all three registries. The visual improvement was largest in the Malaysian database where the preoperative visual acuity is poorest. A worse visual outcome is significantly related to an excellent preoperative visual acuity.

Financial Interest:

NONE