Extended long-term outcomes of cataract surgery

Purpose: To longitudinally report the changes in visual acuity (VA) and subjective visual function, 10 years after cataract surgery.

Methods: This population-based prospective study reviewed 335 patients (85% of survivors) who underwent cataract surgery during a 1-year period in 1997-98, 289 of whom were also re-examined. The patients underwent a routine eye examination and answered the same visual function questionnaire (VF-14), preoperatively, 4 months postoperatively, 5 years and 10 years after surgery.

Results: Ten years after surgery, the best corrected VA (BCVA) of the operated eye had deteriorated to a median of 0.06 (logMAR) (Snellen acuity: 20/23) from 0.046 (logMAR) (20/22) postoperatively (p = 0.001). More than two-thirds of the patients had <0.1 logMAR units worsening of BCVA compared with postoperatively. Approximately half of the patients had no deterioration in subjective visual function, and 77% had 10 points decline or less. Twelve per cent of the patients (42/335) had a worsening of more than 30 points. Effect size was calculated for the VF-14 total score at all three occasions of follow-up after surgery and was largest approximately 4 months postoperatively. Long-time follow-up of 10 years shows still moderate effect size.

Conclusion: These results confirm the effectiveness of cataract extraction, offering good long-term visual rehabilitation for the majority of the patients. The most common cause for large functional loss after 10 years is age-related macular degeneration.