One in eight elderly patients experiences long-term vision loss after cataract surgery

This prospective study assessed the sustainability of visual outcomes after cataract surgery in patients age 65 and over. One in eight patients lost at least two lines in pinhole visual acuity (VA) over the two-year postoperative period. Age and the presence of macular lesions were the strongest predictors of this deterioration.

Subjects were 1,294 Australian patients 65 years of age and older. Overall mean improvement in VA between postoperative months one and 24 was 2.2 letters. VA improved at least two lines in 25.4 percent of patients, remained stable in 57.4 percent and worsened by at least two lines in 17.2 percent. Pinhole VA improved at least two lines in 15.4 percent, remained stable in 71.9 percent and worsened by at least two lines in 12.7 percent. After adjusting for age and gender, pre-existing macular conditions (early AMD, macular hole or previous laser treatment) were associated with pinhole VA reduction (P = 0.02). At the two-year visit, 58.1 percent of those presenting with VA improvement wore distance spectacles.

The authors conclude that realistic expectations of long-term visual outcome after cataract surgery should be explained to patients who are elderly and/or have macular lesions. Regular eye examinations of patients after cataract surgery may help to maximize the surgical benefits over the long term.