Visual Outcomes of Cataract Surgery Usually Favorable in Patients With Diabetes

By Reuters Staff

October 19, 2021

NEW YORK (Reuters Health) - Two-thirds of patients with diabetes achieve a good visual outcome of 20/40 or better after cataract surgery, according to one of the largest studies to assess visual acuity in people with diabetes undergoing cataract surgery.

The 67% rate of good visual outcomes in treated eyes in the study is comparable to prior reports and lower than the general population, Dr. Emily Chew of the National Eye Institute, in Bethesda, Maryland, and colleagues note in the British Journal of Ophthalmology.

Their findings are based on adults with type-2 diabetes enrolled in the ACCORD study and ACCORD-eye substudy (784 participants, 1,136 eyes receiving cataract surgery).

Better preoperative visual acuity was significantly associated with good visual outcomes after surgery and "may be valuable in the surgical evaluation for several reasons," the authors say.

"Worse preoperative VA may indicate ocular comorbidities, either independent from (eg, amblyopia, macular or corneal disease) or as a secondary cause of (eg, anterior uveitis) cataract, that could limit visual potential after surgery," they note.

"Reduced preoperative VA can also reflect a more advanced or dense cataract, which may increase the risk for intraoperative and postoperative complications (eg, capsular rupture, macular oedema) and impair postoperative VA. Additionally, lower preoperative PVA can indicate inadequately corrected refractive error and an individual who may, thus, be unable to obtain or less likely to wear updated eyeglasses even after surgery," they add.

The team says other notable factors predictive of good visual outcome included a higher level of education and bilateral cataract surgery.

Factors not significantly associated with visual outcome after cataract surgery were age, sex, race, smoking, diabetes duration, blood pressure, lipid levels and hemoglobin A1c levels.

In a subsample of 362 eyes, the absence of diabetic retinopathy was associated with good visual outcomes. "The severity of diabetic retinopathy could also be important, though this study did not have a large enough sample size to detect any significant effect," the authors note.

"Although the current visual prognosis after cataract surgery is usually favorable, certain factors still limit the visual potential in those with diabetes and continued efforts to improve visual outcomes are necessary. Identifying factors associated with good visual outcome may help to predict visual acuity after cataract surgery and to determine areas for further improvement," they conclude.

SOURCE: British Journal of Ophthalmology, online October 8, 2021.