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主题 : Operated and unoperated cataract in Australia
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Operated and unoperated cataract in Australia

ABSTRACT ya=51~ by"  
Purpose: To quantify the prevalence of cataract, the outcomes /;1FZ<zU  
of cataract surgery and the factors related to Y@eUvz  
unoperated cataract in Australia. C~*m&,@TT^  
Methods: Participants were recruited from the Visual i :72FVo  
Impairment Project: a cluster, stratified sample of more than -D(!B56_  
5000 Victorians aged 40 years and over. At examination "AVc^>  
sites interviews, clinical examinations and lens photography o6oYJ`PY  
were performed. Cataract was defined in participants who e ^QOn  
had: had previous cataract surgery, cortical cataract greater I6_+3}Hm{  
than 4/16, nuclear greater than Wilmer standard 2, or ~c"c9s+o  
posterior subcapsular greater than 1 mm2. xC(PH?_  
Results: The participant group comprised 3271 Melbourne Z)~ 2{)  
residents, 403 Melbourne nursing home residents and 1473 &V$R@~x  
rural residents.The weighted rate of any cataract in Victoria  T7`Jtqf  
was 21.5%. The overall weighted rate of prior cataract >8so'7(  
surgery was 3.79%. Two hundred and forty-nine eyes had -|5&3HVz  
had prior cataract surgery. Of these 249 procedures, 49  "d'@IN  
(20%) were aphakic, 6 (2.4%) had anterior chamber d {4br  
intraocular lenses and 194 (78%) had posterior chamber qM)^]2_-  
intraocular lenses.Two hundred and eleven of these operated Qa=;Elp:[  
eyes (85%) had best-corrected visual acuity of 6/12 or !VW#hc \A5  
better, the legal requirement for a driver’s license.Twentyseven Ty m!7H2  
(11%) had visual acuity of less than 6/18 (moderate Y `wi=(  
vision impairment). Complications of cataract surgery (`&g  
caused reduced vision in four of the 27 eyes (15%), or 1.9% @({65gJ*  
of operated eyes. Three of these four eyes had undergone fXN;N&I  
intracapsular cataract extraction and the fourth eye had an dFlx6H+R!0  
opaque posterior capsule. No one had bilateral vision x AI<<[-  
impairment as a result of cataract surgery. Surprisingly, no ty ~U~  
particular demographic factors (such as age, gender, rural <m!\Ma  
residence, occupation, employment status, health insurance I?=Q *og  
status, ethnicity) were related to the presence of unoperated lH[N*9G(  
cataract. ev>: 3_ s  
Conclusions: Although the overall prevalence of cataract is :mij%nQ>$  
quite high, no particular subgroup is systematically underserviced &wJ"9pQ~6E  
in terms of cataract surgery. Overall, the results of Kxg09\5i  
cataract surgery are very good, with the majority of eyes \(Iy>L.  
achieving driving vision following cataract extraction. 3KGDS9I  
Key words: cataract extraction, health planning, health )gE:@ 3  
services accessibility, prevalence B!:(*lF  
INTRODUCTION !cfn%+0  
Cataract is the leading cause of blindness worldwide and, in | .PLfc;  
Australia, cataract extractions account for the majority of all TR#5V@e.m  
ophthalmic procedures.1 Over the period 1985–94, the rate 9s}--_k?F2  
of cataract surgery in Australia was twice as high as would be :Z<-J`  
expected from the growth in the elderly population.1  hHdC/mR  
Although there have been a number of studies reporting E@?jsN7  
the prevalence of cataract in various populations,2–6 there is # H4dmnV  
little information about determinants of cataract surgery in "B.l j)  
the population. A previous survey of Australian ophthalmologists "kMpa]<c-6  
showed that patient concern and lifestyle, rather IE3GM^7\  
than visual acuity itself, are the primary factors for referral mFT[[Z#  
for cataract surgery.7 This supports prior research which has ='~C$%  
shown that visual acuity is not a strong predictor of need for EPyFM_k  
cataract surgery.8,9 Elsewhere, socioeconomic status has Zcc6E2  
been shown to be related to cataract surgery rates.10 gbF.Q7?$u  
To appropriately plan health care services, information is tL D.e  
needed about the prevalence of age-related cataract in the J|s4c`=  
community as well as the factors associated with cataract Q+S>nL!*#1  
surgery. The purpose of this study is to quantify the prevalence 4%B${zP(.}  
of any cataract in Australia, to describe the factors "}EydG"=  
related to unoperated cataract in the community and to  Y]P]^3  
describe the visual outcomes of cataract surgery. F`' e/  
METHODS 1h|JKu0  
Study population 'H+pwp"M@  
Details about the study methodology for the Visual q W) ,)i  
Impairment Project have been published previously.11 2uz<n}IV  
Briefly, cluster sampling within three strata was employed to UA}k"uM  
recruit subjects aged 40 years and over to participate. 2U i)'0  
Within the Melbourne Statistical Division, nine pairs of x2;92I{5C,  
census collector districts were randomly selected. Fourteen BH\qm (X  
nursing homes within a 5 km radius of these nine test sites zf#V89!]C"  
were randomly chosen to recruit nursing home residents. \S3C"P%w  
Clinical and Experimental Ophthalmology (2000) 28, 77–82 .BZw7 YV  
Original Article v@[MX- ,8  
Operated and unoperated cataract in Australia R|`}z"4C  
Catherine A McCarty PhD, MPH, Mukesh B Nanjan PhD, Hugh R Taylor MD #BF(#1:  
Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia tPc'# .  
n Correspondence: Dr Cathy McCarty MPH, Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, 32 Gisborne Street, East Melbourne, ,Epg&)wC]  
Victoria 3002, Australia. Email: cathy@cera.unimelb.edu.au |>Kf_b Y#  
78 McCarty et al. -_v[oqf$  
Finally, four pairs of census collector districts in four rural P6dIU/w  
Victorian communities were randomly selected to recruit rural {6*h';~  
residents. A household census was conducted to identify H;%a1  
eligible residents aged 40 years and over who had been a %.[t(F  
resident at that address for at least 6 months. At the time of e$fxC-sZ  
the household census, basic information about age, sex, WADNr8.  
country of birth, language spoken at home, education, use of Z'hW;^e%_z  
corrective spectacles and use of eye care services was collected. e=QnGT*b5  
Eligible residents were then invited to attend a local >?'cZTNk]  
examination site for a more detailed interview and examination. (F +if  
The study protocol was approved by the Royal Victorian  Hi|'  
Eye and Ear Hospital Human Research Ethics Committee. C 3b  
Assessment of cataract #Q"el3P+q  
A standardized ophthalmic examination was performed after xLPyV&j-  
pupil dilatation with one drop of 10% phenylephrine U_y)p Cd  
hydrochloride. Lens opacities were graded clinically at the [ w i "  
time of the examination and subsequently from photos using *4dA(N\k"  
the Wilmer cataract photo-grading system.12 Cortical and [89#8|+  
posterior subcapsular (PSC) opacities were assessed on N yFa2Ihd  
retroillumination and measured as the proportion (in 1/16) g < M\zD  
of pupil circumference occupied by opacity. For this analysis, Ul)2A  
cortical cataract was defined as 4/16 or greater opacity, .TSj8,  
PSC cataract was defined as opacity equal to or greater than "9>~O`l,  
1 mm2 and nuclear cataract was defined as opacity equal to 1}}.e^Tsfr  
or greater than Wilmer standard 2,12 independent of visual kzMCI)>"  
acuity. Examples of the minimum opacities defined as cortical, s 'u6Ep/V  
nuclear and PSC cataract are presented in Figure 1. =;9Wh!{  
Bilateral congenital cataracts or cataracts secondary to s0~a5Ti3  
intraocular inflammation or trauma were excluded from the x;?4AJ{  
analysis. Two cases of bilateral secondary cataract and eight "@;q! B.qo  
cases of bilateral congenital cataract were excluded from the =) $a>N  
analyses. Kzb&aOw  
A Topcon® SL5 photo slit-lamp (Topcon America Corp., hHm &u^xY  
Paramus, NJ, USA) with a 0.1 mm slit beam of 9.0 mm in *RD9 gIze  
height set to an incident angle of 30° was used for examinations. 2G=Bav\n+  
Ektachrome® 200 ASA colour slide film (Eastman >2_BL5<S  
Kodak Company, Rochester, NY, USA) was used to photograph Zz'(!h Uy  
the nuclear opacities. The cortical opacities were V<$g^Vb  
photographed with an Oxford® retroillumination camera vR pMZ)e  
(Marcher Enterprises Ltd, Hereford, UK) and T-MAX® 400 ; =ai]AYW  
film (Eastman Kodak). Photographs were graded separately H [wJ; l  
by two research assistants and discrepancies were adjudicated Oz# $ x  
by an independent reviewer. Any discrepancies I,(m\NalK  
between the clinical grades and the photograph grades were 2asA]sY  
resolved. Except in cases where photographs were missing, 3ZGU?Z;R  
the photograph grades were used in the analyses. Photograph mT <4@RrB  
grades were available for 4301 (84%) for cortical E{[c8l2B  
cataract, 4147 (81%) for nuclear cataract and 4303 (84%) >eQ;\j  
for PSC cataract. Cataract status was classified according to G"T)+! 6t  
the severity of the opacity in the worse eye. 9$c0<~B\  
Assessment of risk factors T^B&GgW  
A standardized questionnaire was used to obtain information iA3d[%tBb  
about education, employment and ethnic background.11 yv =LT~  
Specific information was elicited on the occurrence, duration ?7 e|gpQ|  
and treatment of a number of medical conditions, X aW@CW  
including ocular trauma, arthritis, diabetes, gout, hypertension Z $ Fh4  
and mental illness. Information about the use, dose and 'g$~ij ;x  
duration of tobacco, alcohol, analgesics and steriods were  T OdH  
collected, and a food frequency questionnaire was used to )HNbWGu  
determine current consumption of dietary sources of antioxidants jz QmYcd  
and use of vitamin supplements. l~!Tnp\M  
Data management and statistical analysis C(Ujx=G+3  
Data were collected either by direct computer entry with a I~ \j%zD  
questionnaire programmed in Paradox© (Carel Corporation, -%*>z'|{  
Ottawa, Canada) with internal consistency checks, or }`&#{>]2  
on self-coding forms. Open-ended responses were coded at 7Oe |:Z  
a later time. Data that were entered on the self-coded forms rVowHP  
were entered into a computer with double data entry and ?`V%[~4_I  
reconciliation of any inconsistencies. Data range and consistency zuUf:%k}I  
checks were performed on the entire data set. yx"xb Cc#  
SAS© version 6.1 (SAS Institute, Cary, North Carolina) was q4@n pbx  
employed for statistical analyses. . \M@oF   
Ninety-five per cent confidence limits around the agespecific Rcs7 'q5  
rates were calculated according to Cochran13 to fq ZqPcT0  
account for the effect of the cluster sampling. Ninety-five ) [yM4QFl  
per cent confidence limits around age-standardized rates 85Zy0 l  
were calculated according to Breslow and Day.14 The strataspecific =;!C7VS  
data were weighted according to the 1996 ke_Dd?  
Australian Bureau of Statistics census data15 to reflect the c) Zid1  
cataract prevalence in the entire Victorian population. _? #}@?  
Univariate analyses with Student’s t-tests and chi-squared &MsnQP  
tests were first employed to evaluate risk factors for unoperated ^eQK.B (  
cataract. Any factors with P < 0.10 were then fitted <^6|ZgR  
into a backwards stepwise logistic regression model. For the Os' 7h  
Figure 1. Minimum levels of cortical (a), nuclear (b), and posterior subcapsular (c) cataract. h~{TCK+I  
final multivariate models, P < 0.05 was considered statistically g+;m?VJ  
significant. Design effect was assessed through the use ]n1@!qa48  
of cluster-specific models and multivariate models. The [U@#whEO  
design effect was assumed to be additive and an adjustment cdVh_"[  
made in the variance by adding the variance associated with Q4\EI=4P]  
the design effect prior to constructing the 95% confidence "f/lm 2<  
limits. d]6.$"\" p  
RESULTS hz{=@jX  
Study population CM?dB$AwX  
A total of 3271 (83%) of the Melbourne residents, 403 P,lKa.  
(90%) Melbourne nursing home residents, and 1473 (92%) LnP={s  
rural residents participated. In general, non-participants did Gh}sk-Xk=  
not differ from participants.16 The study population was pe$" nUy|  
representative of the Victorian population and Australia as ~6L\9B )  
a whole. d?^bCf+<  
The Melbourne residents ranged in age from 40 to nylrF"'e  
98 years (mean = 59) and 1511 (46%) were male. The `6;%HbP$W+  
Melbourne nursing home residents ranged in age from 46 to Y5 e6|b|  
101 years (mean = 82) and 85 (21%) were men. The rural 0)n#$d>  
residents ranged in age from 40 to 103 years (mean = 60) gBb+Q,  
and 701 (47.5%) were men. N@Pf\D  
Prevalence of cataract and prior cataract surgery \g& P5  
As would be expected, the rate of any cataract increases ovJwo r  
dramatically with age (Table 1). The weighted rate of any a[d6@!  
cataract in Victoria was 21.5% (95% CL 18.1, 24.9). MebL Y $&8  
Although the rates varied somewhat between the three  %~Vgz(/  
strata, they were not significantly different as the 95% confidence H:byCFN-  
limits overlapped. The per cent of cataractous eyes 0Snl_@s  
with best-corrected visual acuity of less than 6/12 was 12.5% > __t 2  
(65/520) for cortical cataract, 18% for nuclear cataract x&>zD0\ :\  
(97/534) and 14.4% (27/187) for PSC cataract. Cataract 'Vq_/g!?1  
surgery also rose dramatically with age. The overall $j=c;+W  
weighted rate of prior cataract surgery in Victoria was {]Tb  
3.79% (95% CL 2.97, 4.60) (Table 2). 6t@kft>Nv  
Risk factors for unoperated cataract Mg3>/!  
Cases of cataract that had not been removed were classified b.HfxYt(  
as unoperated cataract. Risk factor analyses for unoperated ('k;Ikut  
cataract were not performed with the nursing home residents <NRW^#g<x  
as information about risk factor exposure was not O#Y;s;)i"  
available for this cohort. The following factors were assessed 9w\ yWxl  
in relation to unoperated cataract: age, sex, residence ^APPWQUl  
(urban/rural), language spoken at home (a measure of ethnic K??(>0Qr}r  
integration), country of birth, parents’ country of birth (a ^yLiyRe\  
measure of ethnicity), years since migration, education, use 'Pk1 4`/  
of ophthalmic services, use of optometric services, private xZ2^lsY  
health insurance status, duration of distance glasses use, +<qmVW^X  
glaucoma, age-related maculopathy and employment status. YT:])[gVV  
In this cross sectional study it was not possible to assess the $TU)O^c  
level of visual acuity that would predict a patient’s having jm~(O Lg  
cataract surgery, as visual acuity data prior to cataract w]2tb  
surgery were not available. n`'v8 `a]  
The significant risk factors for unoperated cataract in univariate VL6_in(  
analyses were related to: whether a participant had }?PvNK]",  
ever seen an optometrist, seen an ophthalmologist or been (H=7(  
diagnosed with glaucoma; and participants’ employment gN"Abc  
status (currently employed) and age. These significant Y;qA@|  
factors were placed in a backwards stepwise logistic regression ~r(/)w\  
model. The factors that remained significantly related Hzos$1DJ  
to unoperated cataract were whether participants had ever wD9Gl.uQ  
seen an ophthalmologist, seen an optometrist and been WsHC%+\'  
diagnosed with glaucoma. None of the demographic factors X MkyX&y  
were associated with unoperated cataract in the multivariate "v%|&@  
model. XLG6f(B=F  
The per cent of participants with unoperated cataract z 'iAj  
who said that they were dissatisfied or very dissatisfied with <|qh5Scp  
Operated and unoperated cataract in Australia 79 xw1@&QwM  
Table 1. Prevalence of any cataracta (excluding previous cataract surgery) by age, gender and cohort z x e6M~+  
Age group Sex Urban Rural Nursing home Weighted total {u 7%Z}<0  
(years) (%) (%) (%) a04I.5!  
40–49 Male 2.56 4.04 0.00 3.00 (1.91, 4.08) BbCt_z'  
Female 2.61 1.70 0.00 2.36 (1.61, 3.10) H2EKr#(  
50–59 Male 7.69 6.94 0.00 7.47 (5.80, 9.15) 4JOw@/nE  
Female 6.67 7.56 0.00 6.92 (5.60, 8.24) <4DSk9/  
60–69 Male 20.7 25.0 10.0 22.0 (18.1, 26.0) kTCWyc  
Female 27.9 35.7 37.5 30.3 (26.0, 34.7) kaKV{;UM  
70–79 Male 43.1 58.7 39.1 48.1 (41.2, 55.1) Q#wl1P  
Female 58.6 66.2 55.6 61.0 (56.0, 65.9) 2!UNFv#=$  
80–89 Male 74.0 89.3 92.0 79.3 (72.3, 86.3) NTj:+z0  
Female 91.9 97.0 80.2 92.6 (86.4, 98.8) KN41 kkN  
90 + Male 100.0 100.0 75.0 98.8 (96.2, 100.0) Muhq,>!U  
Female 100.0 100.0 93.8 98.6 (97.0, 100.0) =%wwepz6  
Age-standardized ;t^8lC?>V  
(95% CL) Combined 19.7 (16.3, 23.1) 23.2 (16.1, 30.2) 16.5 (2.06, 30.9) 21.5 (18.1, 25.0) $ N7J:Q  
aCortical > 4/16, nuclear > standard 2, posterior subcapsular > 1 mm2 "0ITW46n  
their current vision was 30% (290/683), compared with 27% )JYt zc  
(26/95) of participants with prior cataract surgery (chisquared, |?a 4Nl?  
1 d.f. = 0.25, P = 0.62). #<^ngoOj  
Outcomes of cataract surgery 8ec6J*b  
Two hundred and forty-nine eyes had undergone prior AX {~A:B  
cataract surgery. Of these 249 operated eyes, 49 (20%) were 4sj:%% UE  
left aphakic, 6 (2.4%) had anterior chamber intraocular =f4v: j}'|  
lenses and 194 (78%) had posterior chamber intraocular pO2Y'1*  
lenses. The rate of capsulotomy in the eyes with intact ZO`{t1   
posterior capsules was 36% (73/202). Fifteen per cent of .:<-E%  
eyes (17/114) with a clear posterior capsule had bestcorrected 4V$DV!dPQ}  
visual acuity of less than 6/12 compared with 43% dWg09sx  
of eyes (6/14) with opaque capsules, and 15% of eyes 3IrmDT  
(11/73) with prior capsulotomies (chi-squared, 2 d.f. = 7.21, 1|+Z mo"  
P = 0.027). evbqBb21b  
The percentage of eyes with best-corrected visual acuity (l|:$%[0  
of 6/12 or better was 96% (302/314) for eyes without OS X5S:XS  
cataract, 88% (1417/1609) for eyes with prevalent cataract c]qq *k#  
and 85% (211/249) for eyes with operated cataract (chisquared, kQr\ktN\  
2 d.f. = 22.3), P < 0.001). Twenty-seven of the L_3undy,  
operated eyes (11%) had visual acuities of less than 6/18 p6qza @  
(moderate vision impairment) (Fig. 2). A cause of this z[7j`J|Kk  
moderate visual impairment (but not the only cause) in four O<@S,/Q4  
(15%) eyes was secondary to cataract surgery. Three of these Cg~GlZk}  
four eyes had undergone intracapsular cataract extraction 4 Ar\`{c>  
and the fourth eye had an opaque posterior capsule. No one w(sD}YA)  
had bilateral vision impairment as a result of their cataract 1T{A(<:o$  
surgery. Bf&,ACOf  
DISCUSSION 7~t,Pt)  
To our knowledge, this is the first paper to systematically H;QE',a9+i  
assess the prevalence of current cataract, previous cataract rA/jNX@S  
surgery, predictors of unoperated cataract and the outcomes Ha U6`IP  
of cataract surgery in a population-based sample. The Visual s^ t1T&  
Impairment Project is unique in that the sampling frame and (s/hK  
high response rate have ensured that the study population is S nMHk3(\  
representative of Australians aged 40 years and over. Therefore, U!GG8;4  
these data can be used to plan age-related cataract [V\0P,l  
services throughout Australia. RhJ{#G~:%  
We found the rate of any cataract in those over the age RHV& m()Q  
of 40 years to be 22%. Although relatively high, this rate is -y8?"WB(b  
significantly less than was reported in a number of previous Cf-R?gn]  
studies,2,4,6 with the exception of the Casteldaccia Eye qO yg&]7  
Study.5 However, it is difficult to compare rates of cataract aY^_+&&G  
between studies because of different methodologies and ;C1 ]gJZ,  
cataract definitions employed in the various studies, as well HG(J+ocn   
as the different age structures of the study populations. AE:IXP|c  
Other studies have used less conservative definitions of 93z oJiLRf  
cataract, thus leading to higher rates of cataract as defined. &zl=}xeA  
In most large epidemiologic studies of cataract, visual acuity ,tdV-9N[O  
has not been included in the definition of cataract. Kh)SgJ3B@  
Therefore, the prevalence of cataract may not reflect the 9{gY|2R_  
actual need for cataract surgery in the community. ]!yuD/4A  
80 McCarty et al. "3kIQsD|j  
Table 2. Prevalence of previous cataract by age, gender and cohort gO0X- fN8  
Age group Gender Urban Rural Nursing home Weighted total x|#R$^4CY  
(years) (%) (%) (%) jhd&\z-  
40–49 Male 1.14 0.00 0.00 0.80 (0.00, 1.81) ZK =`Y@  
Female 0.00 0.00 0.00 0.00 ( W^}fAcQKH  
50–59 Male 0.68 0.58 0.00 0.65 (0.13, 1.17) \2q!2XWgK  
Female 0.57 0.00 0.00 0.41 (0.00, 1.00) -)bi SU,  
60–69 Male 2.12 7.59 0.00 3.80 (1.41, 6.19) <cQ)*~hN  
Female 2.11 3.51 0.00 2.54 (1.81, 3.26) #0K122oY  
70–79 Male 8.22 9.85 8.70 8.75 (6.38, 11.1) Pr |u_^  
Female 7.21 7.86 7.02 7.41 (5.36, 9.46) s-V5\Lip,  
80–89 Male 25.0 30.0 14.3 26.2 (17.0, 35.4) (vX+ Yw  
Female 27.9 25.6 18.3 26.7 (20.2, 33.3) 0 K T.@P  
90 + Male 0.00 16.7 66.7 9.19 (0.00, 21.5) W@R\m=e2  
Female 58.3 100.0 26.9 63.1 (44.4, 81.8) jV83%%e  
Age-standardized #t.)4$  
(95% CL) Combined 3.31 (2.70, 3.93) 4.36 (2.67, 6.06) 2.26 (0.82, 3.70) 3.79 (2.97, 4.60) 7(RtPL pZ  
Figure 2. Visual acuity in eyes that had undergone cataract *VJT]^_  
surgery, n = 249. h, Presenting; j, best-corrected. Up:<NHJT  
Operated and unoperated cataract in Australia 81 FsZW,  
The weighted prevalence of prior cataract surgery in the qmNgEz%  
Visual Impairment Project (3.6%) was similar to the crude J2rw4L  
rate in the Beaver Dam Eye Study4 (3.1%), but less than the tOn 6  
crude rate in the Blue Mountains Eye Study6 (6.0%). :A+nmz!z  
However, the age-standardized rate in the Blue Mountains FW](GWp`:  
Eye Study (standardized to the age distribution of the urban TvV_Tz4e  
Visual Impairment Project cohort) was found to be less than O=2"t%Gc  
the Visual Impairment Project (standardized rate = 1.36%, G/l 28yt  
95% CL 1.25, 1.47). The incidence of cataract surgery in 2 ~yYwX  
Australia has exceeded population growth.1 This is due, : ,0F_["3  
perhaps, to advances in surgical techniques and lens R07 7eX  
implants that have changed the risk–benefit ratio. K9{]v=#I  
The Global Initiative for the Elimination of Avoidable ,ALEfepo  
Blindness, sponsored by the World Health Organization, +48a..4sN  
states that cataract surgical services should be provided that %}T' 3  
‘have a high success rate in terms of visual outcome and -&L(0?*qo  
improved quality of life’,17 although the ‘high success rate’ is XTzz/.T;Z  
not defined. Population- and clinic-based studies conducted ,C4gA(')K  
in the United States have demonstrated marked improvement 0keqtr  
in visual acuity following cataract surgery.18–20 We s&>U-7fx"  
found that 85% of eyes that had undergone cataract extraction Y~FN` =O  
had visual acuity of 6/12 or better. Previously, we have uT")j,tz  
shown that participants with prevalent cataract in this Sbf+;:D  
cohort are more likely to express dissatisfaction with their  1rnbUE  
current vision than participants without cataract or participants \J]qd4tF  
with prior cataract surgery.21 In a national study in the 17hFwo`  
United States, researchers found that the change in patients’ @;^7kt  
ratings of their vision difficulties and satisfaction with their o@o0V  
vision after cataract surgery were more highly related to `~~.0QC  
their change in visual functioning score than to their change a$}n4p  
in visual acuity.19 Furthermore, improvement in visual function u]<7}R@s  
has been shown to be associated with improvement in (x+C =1,  
overall quality of life.22 Mk:k0,z  
A recent review found that the incidence of visually 5eP0W#  
significant posterior capsule opacification following VG)Y$S8.>  
cataract surgery to be greater than 25%.23 We found 36% Ym]Dlz,o  
capsulotomy in our population and that this was associated )&jE<C0  
with visual acuity similar to that of eyes with a clear oBBL7/L  
capsule, but significantly better than that of eyes with an <'Ppu  
opaque capsule. /,tQdD&  
A number of studies have shown that the demand and >Rnj6A|Q  
timing of cataract surgery vary according to visual acuity, l.Psh7B2  
degree of handicap and socioeconomic factors.8–10,24,25 We yf lt2 R  
have also shown previously that ophthalmologists are more O8!> t7x  
likely to refer a patient for cataract surgery if the patient is Ke 5fe#  
employed and less likely to refer a nursing home resident.7 x)^/3  
In the Visual Impairment Project, we did not find that any ^GS,4[)H  
particular subgroup of the population was at greater risk of =Wgz\uGJ  
having unoperated cataract. Universal access to health care Vm3e6Y,K  
in Australia may explain the fact that people without `S&$y4|Vs  
Medicare are more likely to delay cataract operations in the @2Spfj_e  
USA,8 but not having private health insurance is not associated =P,h5J  
with unoperated cataract in Australia. ~9tPT 0^+  
In summary, cataract is a significant public health problem iJ7?6)\  
in that one in four people in their 80s will have had cataract .b3c n  
surgery. The importance of age-related cataract surgery will !)nA4l= S#  
increase further with the ageing of the population: the Sz"rp9x+  
number of people over age 60 years is expected to double in 2V-zmyJs5  
the next 20 years. Cataract surgery services are well vv9=g*"j  
accessed by the Victorian population and the visual outcomes O<:"Irq\qr  
of cataract surgery have been shown to be very good.  GD]yP..  
These data can be used to plan for age-related cataract McXid~  
surgical services in Australia in the future as the need for ^hMJNy&R  
cataract extractions increases. szDd!(&pv  
ACKNOWLEDGEMENTS P:p@Iep  
The Visual Impairment Project was funded in part by grants N'!:  
from the Victorian Health Promotion Foundation, the 9"jhS0M  
National Health and Medical Research Council, the Ansell gbl`_t/  
Ophthalmology Foundation, the Dorothy Edols Estate and @77%15_Jz  
the Jack Brockhoff Foundation. Dr McCarty is the recipient [VsTyqV a  
of a Wagstaff Fellowship in Ophthalmology from the Royal LH" CIL2  
Victorian Eye and Ear Hospital. |KC!6<}T~9  
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