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  • Study finds no need to delay cataract surgery in patients with elevated hemoglobin A1c

    Cataract/Anterior Segment, Retina/Vitreous

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    This study explored factors influencing visual outcomes after phacoemulsification in patients with cataracts and type 2 diabetes.

    Study design

    The authors retrospectively assessed the corrected distance visual acuity (CDVA) after cataract surgery in 65,370 patients, of which 34% had diabetes mellitus. The data were further stratified to determine if the duration of diabetes, degree of diabetic retinopathy (DR) or preoperative HbA1c score influenced the level of improvement in CDVA. Patients undergoing a combination procedure or who had preoperative macular edema were excluded from the study.                                                                                                                     

    Outcomes

    Of the group with diabetes, 28% had no retinopathy, 5% had non-proliferative DR and 1% had proliferative DR. The analysis revealed a mean 4-line improvement in CDVA in every patient group, regardless of the duration of diabetes, degree of DR or preoperative HbA1c score. The odds of having a postoperative CDVA of 20/25 or worse were not influenced by oral diabetes medication without insulin or an HbA1c score of 9.0% or more.

    Patients who had diabetes but no retinopathy had the same odds of achieving a CDVA of 20/20 as patients without diabetes. However, patients with retinopathy had a decreased likelihood of having a postoperative CDVA of 20/20, which decreased as the level of retinopathy increased.

    Limitations

    This was an observational and retrospective study with the associated limitations. People with diabetes were approached in a systemically different way than those without diabetes, in that those with diabetes received preoperative NSAIDs. The CDVA was obtained over a period of 3 weeks to 1 year, rather than at more specific time points. Finally, many patients had missing postoperative CDVA information.

    Clinical significance

    Understanding the role of HbA1c and the level of DR in regard to timing of patients’ cataract surgery is critical, as delaying cataract surgery can affect many activities of daily living. Based on this study, surgeons may not need to delay cataract surgery due to increased HbA1c, especially in patients without DR.