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  • Cataract/Anterior Segment

    This prospective study found that unilateral cataract surgery objectively improves visual functioning, but the largest gains are found in patients who undergo second-eye cataract surgery.

    Subjects were 1,739 participants from the Salisbury Eye Evaluation (SEE) who underwent no surgery, unilateral cataract surgery, or bilateral cataract surgery.

    After adjusting for demographics, depression, and mental status, the unilateral surgery group's BCVA improved 0.04 logMAR (P = 0.001) and the bilateral group's BCVA improved 0.13 logMAR (P < 0.001) compared with no surgery. Overall mobility declined in all groups. Reading speed significantly improved in the unilateral and bilateral groups compared with no surgery.

    The bilateral surgery group showed significant improvement in the Activities of Daily Vision Scale, measured at baseline and two years, compared with no surgery (P = 0.01), whereas the unilateral group showed a significant decline (P < 0.001).

    The authors write that one may argue that individuals who do not undergo second-eye surgery make this decision because their second eye will not benefit from surgery or they have attained sufficient satisfaction from first-eye surgery. However, a subgroup analysis showed that even those who underwent unilateral surgery and ended up with good fellow-eye vision do not perform as well at follow-up as those who underwent second-eye surgery.

    They conclude that given the greater benefit observed in patients who underwent bilateral cataract surgery, providers should closely follow patients who may benefit from second-eye surgery. This includes asking patients who have already undergone unilateral cataract surgery if they are experiencing continued difficulty with contrast sensitivity, reading, mobility, or other visual functions, even if their visual acuity seems to be satisfactory. When treating a patient with diminished visual function, providers should not assume that operating on only one eye has restored maximum function, even if the outcome of the first surgery was excellent.