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主题 : Operated and unoperated cataract in Australia
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楼主  发表于: 2009-06-04   

Operated and unoperated cataract in Australia

ABSTRACT G j1_!.T  
Purpose: To quantify the prevalence of cataract, the outcomes FqifriLN  
of cataract surgery and the factors related to @KA4N`  
unoperated cataract in Australia. S$k&vc(0  
Methods: Participants were recruited from the Visual b2]Kx&!  
Impairment Project: a cluster, stratified sample of more than `kr?j:g  
5000 Victorians aged 40 years and over. At examination HqTjl4ai  
sites interviews, clinical examinations and lens photography W l1 6`9  
were performed. Cataract was defined in participants who yBRC*0+Vy  
had: had previous cataract surgery, cortical cataract greater 4sM.C9W  
than 4/16, nuclear greater than Wilmer standard 2, or ~v83pu1!2s  
posterior subcapsular greater than 1 mm2. KU;9}!#  
Results: The participant group comprised 3271 Melbourne iCyf Oh  
residents, 403 Melbourne nursing home residents and 1473 2[CdZ(k]5  
rural residents.The weighted rate of any cataract in Victoria Il.K"ll  
was 21.5%. The overall weighted rate of prior cataract tu?MYp;  
surgery was 3.79%. Two hundred and forty-nine eyes had "mN q&$  
had prior cataract surgery. Of these 249 procedures, 49 FN; ^"H  
(20%) were aphakic, 6 (2.4%) had anterior chamber o14cwb  
intraocular lenses and 194 (78%) had posterior chamber c"Sq~X  
intraocular lenses.Two hundred and eleven of these operated .~}1+\~5  
eyes (85%) had best-corrected visual acuity of 6/12 or d7i]FV  
better, the legal requirement for a driver’s license.Twentyseven 0;ji65  
(11%) had visual acuity of less than 6/18 (moderate cAc@n6[`3  
vision impairment). Complications of cataract surgery ?s _5&j7  
caused reduced vision in four of the 27 eyes (15%), or 1.9% 6&-(&( _  
of operated eyes. Three of these four eyes had undergone D0q ":WvE  
intracapsular cataract extraction and the fourth eye had an yZ`wfj$Jj  
opaque posterior capsule. No one had bilateral vision Uwi7)  
impairment as a result of cataract surgery. Surprisingly, no N?>vd*  
particular demographic factors (such as age, gender, rural jSAjcLR  
residence, occupation, employment status, health insurance 7 yba04D)  
status, ethnicity) were related to the presence of unoperated o lxByzTh>  
cataract. j)GtEP<n#  
Conclusions: Although the overall prevalence of cataract is W];dD$Oqg  
quite high, no particular subgroup is systematically underserviced ^VACf|0  
in terms of cataract surgery. Overall, the results of u4_9)P`]0  
cataract surgery are very good, with the majority of eyes F\KUZ[%  
achieving driving vision following cataract extraction. /SrAW`;"  
Key words: cataract extraction, health planning, health l\?c}7k  
services accessibility, prevalence hG:|9Sol,  
INTRODUCTION \j)E 5b+  
Cataract is the leading cause of blindness worldwide and, in AFfAtu  
Australia, cataract extractions account for the majority of all \_U$"/$4VH  
ophthalmic procedures.1 Over the period 1985–94, the rate TuYCR>P[  
of cataract surgery in Australia was twice as high as would be ss e.*75U  
expected from the growth in the elderly population.1 M|[oaanY'  
Although there have been a number of studies reporting ))i}7 chc  
the prevalence of cataract in various populations,2–6 there is kM@zyDn,  
little information about determinants of cataract surgery in i2^>vYCsl  
the population. A previous survey of Australian ophthalmologists kE(mVyLQ  
showed that patient concern and lifestyle, rather tdaL/rRe  
than visual acuity itself, are the primary factors for referral F*K_+ ?m  
for cataract surgery.7 This supports prior research which has 'XBFv9&  
shown that visual acuity is not a strong predictor of need for ?KI,cl  
cataract surgery.8,9 Elsewhere, socioeconomic status has d5z`BH.  
been shown to be related to cataract surgery rates.10 ~F?u)~QZ #  
To appropriately plan health care services, information is V,?yPi$#E  
needed about the prevalence of age-related cataract in the "2T#M O/  
community as well as the factors associated with cataract O5t[  
surgery. The purpose of this study is to quantify the prevalence 4I?^t"  
of any cataract in Australia, to describe the factors qWKAM@  
related to unoperated cataract in the community and to $"&{aa   
describe the visual outcomes of cataract surgery. %-e 82J1  
METHODS AjgF6[B  
Study population Gm.]sE?.  
Details about the study methodology for the Visual 9,'ncw$/C  
Impairment Project have been published previously.11 yq iq,=OvP  
Briefly, cluster sampling within three strata was employed to U2~kJ  
recruit subjects aged 40 years and over to participate. Q({ r@*g  
Within the Melbourne Statistical Division, nine pairs of =k:,qft2  
census collector districts were randomly selected. Fourteen h.s+) fl\  
nursing homes within a 5 km radius of these nine test sites (4 1|'eB\\  
were randomly chosen to recruit nursing home residents. B i<Q=x'Z;  
Clinical and Experimental Ophthalmology (2000) 28, 77–82 _1L![-ac  
Original Article x*&|0n.D  
Operated and unoperated cataract in Australia nSAdCJ;4  
Catherine A McCarty PhD, MPH, Mukesh B Nanjan PhD, Hugh R Taylor MD [o5Hl^  
Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia m&?r%x  
n Correspondence: Dr Cathy McCarty MPH, Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, 32 Gisborne Street, East Melbourne, >q1L2',pK  
Victoria 3002, Australia. Email: cathy@cera.unimelb.edu.au ;Nj7qt  
78 McCarty et al. "E?2xf|.  
Finally, four pairs of census collector districts in four rural @)&=%  
Victorian communities were randomly selected to recruit rural T+k{W6  
residents. A household census was conducted to identify dIBE!4 V[  
eligible residents aged 40 years and over who had been a N;j)k;  
resident at that address for at least 6 months. At the time of &<U0ZvrsH  
the household census, basic information about age, sex, W+X6@/BO  
country of birth, language spoken at home, education, use of .oUTqki  
corrective spectacles and use of eye care services was collected. <r`2)[7N  
Eligible residents were then invited to attend a local 7 uKY24  
examination site for a more detailed interview and examination. '>ssqBnI  
The study protocol was approved by the Royal Victorian [ )dXIIM  
Eye and Ear Hospital Human Research Ethics Committee. b4ONh%  
Assessment of cataract 6@0OQb  
A standardized ophthalmic examination was performed after .KUv( -  
pupil dilatation with one drop of 10% phenylephrine :'l^kSP_*C  
hydrochloride. Lens opacities were graded clinically at the D"?fn<2  
time of the examination and subsequently from photos using $,}E   
the Wilmer cataract photo-grading system.12 Cortical and CZI66pDy  
posterior subcapsular (PSC) opacities were assessed on :G2k5xD/E  
retroillumination and measured as the proportion (in 1/16) Rt!FPoN,y  
of pupil circumference occupied by opacity. For this analysis, @A89eZbW  
cortical cataract was defined as 4/16 or greater opacity, j; y#[|  
PSC cataract was defined as opacity equal to or greater than L(-b@Joh  
1 mm2 and nuclear cataract was defined as opacity equal to b@f$nS B  
or greater than Wilmer standard 2,12 independent of visual &Ao+X=qw  
acuity. Examples of the minimum opacities defined as cortical, dCk3;XU  
nuclear and PSC cataract are presented in Figure 1. &NoS=(s,  
Bilateral congenital cataracts or cataracts secondary to (ECnM ti +  
intraocular inflammation or trauma were excluded from the k!HK 97qA  
analysis. Two cases of bilateral secondary cataract and eight $5< #n@  
cases of bilateral congenital cataract were excluded from the -w_QJ_z_  
analyses. _p&]|~a  
A Topcon® SL5 photo slit-lamp (Topcon America Corp., ~r`9+b[9{  
Paramus, NJ, USA) with a 0.1 mm slit beam of 9.0 mm in SB |Qa}62  
height set to an incident angle of 30° was used for examinations. NzSoqh{R  
Ektachrome® 200 ASA colour slide film (Eastman lWc:$qnR-K  
Kodak Company, Rochester, NY, USA) was used to photograph L3--r  
the nuclear opacities. The cortical opacities were aV?@s4  
photographed with an Oxford® retroillumination camera ()+ <)hg}2  
(Marcher Enterprises Ltd, Hereford, UK) and T-MAX® 400 `~Zs0  
film (Eastman Kodak). Photographs were graded separately @&:ar  
by two research assistants and discrepancies were adjudicated PCM-i{6/  
by an independent reviewer. Any discrepancies (>GK \=:<  
between the clinical grades and the photograph grades were 7Ka l"Ew  
resolved. Except in cases where photographs were missing, !~&R"2/  
the photograph grades were used in the analyses. Photograph 5>j)kx=J9  
grades were available for 4301 (84%) for cortical [[Fx[  
cataract, 4147 (81%) for nuclear cataract and 4303 (84%) tj4VWJK  
for PSC cataract. Cataract status was classified according to CS-uNG6  
the severity of the opacity in the worse eye. ;YX4:OBqr  
Assessment of risk factors I'iGt~4$  
A standardized questionnaire was used to obtain information ;z:UN}  
about education, employment and ethnic background.11  &8_gRP  
Specific information was elicited on the occurrence, duration b7tOo7aH)  
and treatment of a number of medical conditions, 5HO9 +i  
including ocular trauma, arthritis, diabetes, gout, hypertension >W`4aA  
and mental illness. Information about the use, dose and `~;rblo;  
duration of tobacco, alcohol, analgesics and steriods were C@W"yYt  
collected, and a food frequency questionnaire was used to &2zq%((r  
determine current consumption of dietary sources of antioxidants e\JojaV  
and use of vitamin supplements. }S$@ Ez6  
Data management and statistical analysis x{c/$+Z[  
Data were collected either by direct computer entry with a Z%Zd2 v  
questionnaire programmed in Paradox© (Carel Corporation, ),!;| bh  
Ottawa, Canada) with internal consistency checks, or 5~WGZc  
on self-coding forms. Open-ended responses were coded at WT`4s  
a later time. Data that were entered on the self-coded forms XW s"jt  
were entered into a computer with double data entry and R&';Oro  
reconciliation of any inconsistencies. Data range and consistency ez!C?  
checks were performed on the entire data set. 09kt[  
SAS© version 6.1 (SAS Institute, Cary, North Carolina) was snnbb0J  
employed for statistical analyses. '@CR\5 @  
Ninety-five per cent confidence limits around the agespecific e-*.Ca  
rates were calculated according to Cochran13 to 3UQ;X**F  
account for the effect of the cluster sampling. Ninety-five 1, ~SS  
per cent confidence limits around age-standardized rates 0,rTdjH7  
were calculated according to Breslow and Day.14 The strataspecific O Wj@< N  
data were weighted according to the 1996 (%o2jroQ#  
Australian Bureau of Statistics census data15 to reflect the X2i}vjkY  
cataract prevalence in the entire Victorian population. 9Q-*@6G  
Univariate analyses with Student’s t-tests and chi-squared { e5/+W  
tests were first employed to evaluate risk factors for unoperated JA_BKA  
cataract. Any factors with P < 0.10 were then fitted 3^ ~KB'RZ  
into a backwards stepwise logistic regression model. For the `TPOCxM Mo  
Figure 1. Minimum levels of cortical (a), nuclear (b), and posterior subcapsular (c) cataract. t2iv(swTe  
final multivariate models, P < 0.05 was considered statistically R$Tp8G>j  
significant. Design effect was assessed through the use (q7 Ry4-  
of cluster-specific models and multivariate models. The P7f,OY<@%o  
design effect was assumed to be additive and an adjustment (%:>T Q(  
made in the variance by adding the variance associated with t/PlcV_M"  
the design effect prior to constructing the 95% confidence d/e|'MPX  
limits. d{de6 `  
RESULTS TSsKfexQ  
Study population .pvV1JA'  
A total of 3271 (83%) of the Melbourne residents, 403 5rV( (  
(90%) Melbourne nursing home residents, and 1473 (92%) H7k PM[  
rural residents participated. In general, non-participants did cFF*Z=L _  
not differ from participants.16 The study population was 5+jf/}t A  
representative of the Victorian population and Australia as zn @N'R/  
a whole. tD Cw-  
The Melbourne residents ranged in age from 40 to M}wXJ8aF?  
98 years (mean = 59) and 1511 (46%) were male. The q0bHB_|wL  
Melbourne nursing home residents ranged in age from 46 to %D`,k*X  
101 years (mean = 82) and 85 (21%) were men. The rural D*Q.G8(  
residents ranged in age from 40 to 103 years (mean = 60) Q!FLR>8  
and 701 (47.5%) were men. ?<yM7O,4  
Prevalence of cataract and prior cataract surgery ;|cTHGxbE  
As would be expected, the rate of any cataract increases Wi}FY }f  
dramatically with age (Table 1). The weighted rate of any TV}}dw  
cataract in Victoria was 21.5% (95% CL 18.1, 24.9). m%8q Zzqk  
Although the rates varied somewhat between the three 1]T`n/d V  
strata, they were not significantly different as the 95% confidence S-nlr@w8  
limits overlapped. The per cent of cataractous eyes 9=/N|m8.  
with best-corrected visual acuity of less than 6/12 was 12.5% )P>u9=?,=E  
(65/520) for cortical cataract, 18% for nuclear cataract OW(&s,|6x  
(97/534) and 14.4% (27/187) for PSC cataract. Cataract 6dEyv99  
surgery also rose dramatically with age. The overall rB%$;<`/  
weighted rate of prior cataract surgery in Victoria was 8 %~t  
3.79% (95% CL 2.97, 4.60) (Table 2). 5ZAb]F90  
Risk factors for unoperated cataract 2n`Lg4=  
Cases of cataract that had not been removed were classified m!OMrZ%)}  
as unoperated cataract. Risk factor analyses for unoperated @)8]e S7  
cataract were not performed with the nursing home residents u.|~$yP.!  
as information about risk factor exposure was not 5H:@ 8,B  
available for this cohort. The following factors were assessed C+MSVc  
in relation to unoperated cataract: age, sex, residence wp.TfKxw  
(urban/rural), language spoken at home (a measure of ethnic ".~{:=  
integration), country of birth, parents’ country of birth (a 7=*VpX1  
measure of ethnicity), years since migration, education, use WIh@y2&R  
of ophthalmic services, use of optometric services, private i3 )xX@3  
health insurance status, duration of distance glasses use, [ev-^[  
glaucoma, age-related maculopathy and employment status. '?Iif#Z1  
In this cross sectional study it was not possible to assess the >AI<60/<  
level of visual acuity that would predict a patient’s having ,dd WBwMK  
cataract surgery, as visual acuity data prior to cataract J%dJw}  
surgery were not available. twk&-:'  
The significant risk factors for unoperated cataract in univariate %>XN%t'6aT  
analyses were related to: whether a participant had s!6=|SS7  
ever seen an optometrist, seen an ophthalmologist or been `!w^0kZ  
diagnosed with glaucoma; and participants’ employment 8 HoP( +?  
status (currently employed) and age. These significant C 7n Kk/r  
factors were placed in a backwards stepwise logistic regression \-. Tg!Q6  
model. The factors that remained significantly related iG[? ]]  
to unoperated cataract were whether participants had ever ^@}#me@  
seen an ophthalmologist, seen an optometrist and been N5 q725zJ  
diagnosed with glaucoma. None of the demographic factors j.QHkI1.  
were associated with unoperated cataract in the multivariate BQjam+u6  
model. Z|`fHO3j  
The per cent of participants with unoperated cataract A'"-m)1P  
who said that they were dissatisfied or very dissatisfied with 9)yG.9d1  
Operated and unoperated cataract in Australia 79 Y5jYmP<  
Table 1. Prevalence of any cataracta (excluding previous cataract surgery) by age, gender and cohort ;1LG&h,K  
Age group Sex Urban Rural Nursing home Weighted total U4_"aT>M y  
(years) (%) (%) (%) :z~!p~  
40–49 Male 2.56 4.04 0.00 3.00 (1.91, 4.08) @ u1Q-:  
Female 2.61 1.70 0.00 2.36 (1.61, 3.10) kQ}s/*  
50–59 Male 7.69 6.94 0.00 7.47 (5.80, 9.15) &LU'.jY  
Female 6.67 7.56 0.00 6.92 (5.60, 8.24) r69WD .  
60–69 Male 20.7 25.0 10.0 22.0 (18.1, 26.0) BQ#jwu0e  
Female 27.9 35.7 37.5 30.3 (26.0, 34.7) VC=6uB  
70–79 Male 43.1 58.7 39.1 48.1 (41.2, 55.1) yH(V&Tv  
Female 58.6 66.2 55.6 61.0 (56.0, 65.9) 0QR.   
80–89 Male 74.0 89.3 92.0 79.3 (72.3, 86.3) xzK>Xi?  
Female 91.9 97.0 80.2 92.6 (86.4, 98.8) D9ywg/Q91  
90 + Male 100.0 100.0 75.0 98.8 (96.2, 100.0) <R~KM=rL  
Female 100.0 100.0 93.8 98.6 (97.0, 100.0) d[U1.SNL  
Age-standardized q)Je.6$#X  
(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) {U P_i2`.  
aCortical > 4/16, nuclear > standard 2, posterior subcapsular > 1 mm2 n^6TP'r  
their current vision was 30% (290/683), compared with 27% J3\)Jy  
(26/95) of participants with prior cataract surgery (chisquared, hgj0tIi/  
1 d.f. = 0.25, P = 0.62). <`mOU} 0 )  
Outcomes of cataract surgery AJWLEc4XK  
Two hundred and forty-nine eyes had undergone prior Ty}R^cy{d  
cataract surgery. Of these 249 operated eyes, 49 (20%) were Q=XA"R  
left aphakic, 6 (2.4%) had anterior chamber intraocular htg'tA^CtS  
lenses and 194 (78%) had posterior chamber intraocular YlB["@\[B  
lenses. The rate of capsulotomy in the eyes with intact mdt ?:F4Q  
posterior capsules was 36% (73/202). Fifteen per cent of [EOMCH2Ki  
eyes (17/114) with a clear posterior capsule had bestcorrected GFY-IC+fc  
visual acuity of less than 6/12 compared with 43% !pV<n  
of eyes (6/14) with opaque capsules, and 15% of eyes 9T]va]w?#  
(11/73) with prior capsulotomies (chi-squared, 2 d.f. = 7.21, &}|0CR.(  
P = 0.027). i/M+t~   
The percentage of eyes with best-corrected visual acuity Qq>ElQ@  
of 6/12 or better was 96% (302/314) for eyes without iGyVG41U  
cataract, 88% (1417/1609) for eyes with prevalent cataract A<;0L . J  
and 85% (211/249) for eyes with operated cataract (chisquared, V!}L<cN  
2 d.f. = 22.3), P < 0.001). Twenty-seven of the ;HT0w_,  
operated eyes (11%) had visual acuities of less than 6/18 e)b r`CD%  
(moderate vision impairment) (Fig. 2). A cause of this cnC_#kp  
moderate visual impairment (but not the only cause) in four `-5cQ2>"  
(15%) eyes was secondary to cataract surgery. Three of these ~"RQ!&U  
four eyes had undergone intracapsular cataract extraction w8U2y/:>  
and the fourth eye had an opaque posterior capsule. No one ^U" q|[qy  
had bilateral vision impairment as a result of their cataract B_b8r7Vn`  
surgery. j5'.P~  
DISCUSSION T?Z OHH8  
To our knowledge, this is the first paper to systematically -wBnwn-  
assess the prevalence of current cataract, previous cataract IZ|c <#r6  
surgery, predictors of unoperated cataract and the outcomes _y|[Z;  
of cataract surgery in a population-based sample. The Visual :Q8g?TZ  
Impairment Project is unique in that the sampling frame and M3)v- "  
high response rate have ensured that the study population is QZqp F9Eu  
representative of Australians aged 40 years and over. Therefore, ![qRoYpbg8  
these data can be used to plan age-related cataract XlE$.  
services throughout Australia. 2f s9JP{^0  
We found the rate of any cataract in those over the age u;$I{b@M]  
of 40 years to be 22%. Although relatively high, this rate is a"MTQFm'  
significantly less than was reported in a number of previous @F>[DW]O  
studies,2,4,6 with the exception of the Casteldaccia Eye p, !1 3X  
Study.5 However, it is difficult to compare rates of cataract axHxqhO7zp  
between studies because of different methodologies and 5ENov!$H  
cataract definitions employed in the various studies, as well YmdsI+DbIu  
as the different age structures of the study populations. cq- e c7  
Other studies have used less conservative definitions of (D:KqGqoT  
cataract, thus leading to higher rates of cataract as defined. GZ; Z  
In most large epidemiologic studies of cataract, visual acuity hB?U5J  
has not been included in the definition of cataract. hnH)Jy;>  
Therefore, the prevalence of cataract may not reflect the  pb,{$A  
actual need for cataract surgery in the community. O@G<B8U,K  
80 McCarty et al. >\N$>"~a  
Table 2. Prevalence of previous cataract by age, gender and cohort cL-6M^!a  
Age group Gender Urban Rural Nursing home Weighted total 37.) @  
(years) (%) (%) (%) yYVW"m  
40–49 Male 1.14 0.00 0.00 0.80 (0.00, 1.81) ;igE IGR  
Female 0.00 0.00 0.00 0.00 ( C@l +\M(  
50–59 Male 0.68 0.58 0.00 0.65 (0.13, 1.17) RlG'|xaT  
Female 0.57 0.00 0.00 0.41 (0.00, 1.00) bcGn8  
60–69 Male 2.12 7.59 0.00 3.80 (1.41, 6.19) Y- z~#;  
Female 2.11 3.51 0.00 2.54 (1.81, 3.26) q>Dr)x)  
70–79 Male 8.22 9.85 8.70 8.75 (6.38, 11.1) MVu[gB  
Female 7.21 7.86 7.02 7.41 (5.36, 9.46) EBN] >zz  
80–89 Male 25.0 30.0 14.3 26.2 (17.0, 35.4) =|DkD- O  
Female 27.9 25.6 18.3 26.7 (20.2, 33.3) s.k`];wo  
90 + Male 0.00 16.7 66.7 9.19 (0.00, 21.5) }W Bm%f  
Female 58.3 100.0 26.9 63.1 (44.4, 81.8) L%=BCmMx  
Age-standardized gu~- }  
(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) EX[l0]fj  
Figure 2. Visual acuity in eyes that had undergone cataract x_>"Rnv:K  
surgery, n = 249. h, Presenting; j, best-corrected. _&8KB1~  
Operated and unoperated cataract in Australia 81 F ~11 _  
The weighted prevalence of prior cataract surgery in the m-&a~l  
Visual Impairment Project (3.6%) was similar to the crude Lt#:R\;&  
rate in the Beaver Dam Eye Study4 (3.1%), but less than the P^o"PKA  
crude rate in the Blue Mountains Eye Study6 (6.0%). =qVAvo'  
However, the age-standardized rate in the Blue Mountains \dQ2[Ek  
Eye Study (standardized to the age distribution of the urban Tk2&{S"  
Visual Impairment Project cohort) was found to be less than d3\l9R{}  
the Visual Impairment Project (standardized rate = 1.36%, QvyUd%e'5A  
95% CL 1.25, 1.47). The incidence of cataract surgery in a'L7y%  
Australia has exceeded population growth.1 This is due, f{oxF?|89  
perhaps, to advances in surgical techniques and lens _ 3-,3ia  
implants that have changed the risk–benefit ratio. hPX2 Bp  
The Global Initiative for the Elimination of Avoidable ,m_& eF  
Blindness, sponsored by the World Health Organization, LO Yyj?^7  
states that cataract surgical services should be provided that 9EY_R&Yq%  
‘have a high success rate in terms of visual outcome and `;8u9Ff  
improved quality of life’,17 although the ‘high success rate’ is #|2g{7 g*  
not defined. Population- and clinic-based studies conducted gP"Mu#/D  
in the United States have demonstrated marked improvement Mz#S5 s  
in visual acuity following cataract surgery.18–20 We z8rh*Rfxd  
found that 85% of eyes that had undergone cataract extraction bN~'cs8 e  
had visual acuity of 6/12 or better. Previously, we have n ;$}pg ~  
shown that participants with prevalent cataract in this OY CFx2{  
cohort are more likely to express dissatisfaction with their I.n{ "=$B@  
current vision than participants without cataract or participants F b`7 aFIf  
with prior cataract surgery.21 In a national study in the  IBsO  
United States, researchers found that the change in patients’ X/C54%T ~  
ratings of their vision difficulties and satisfaction with their iH -x  
vision after cataract surgery were more highly related to 5;uX"z G  
their change in visual functioning score than to their change E`LIENm  
in visual acuity.19 Furthermore, improvement in visual function f0s<Y  
has been shown to be associated with improvement in c`[uQXv  
overall quality of life.22 [8(9.6f  
A recent review found that the incidence of visually b J5z??  
significant posterior capsule opacification following MjeI?k}LJ  
cataract surgery to be greater than 25%.23 We found 36% rzY@H }u  
capsulotomy in our population and that this was associated [,V92-s;N  
with visual acuity similar to that of eyes with a clear x@(f^P  
capsule, but significantly better than that of eyes with an #1lS\!  
opaque capsule. h]z|OhG  
A number of studies have shown that the demand and 9w<_XXQ  
timing of cataract surgery vary according to visual acuity, PL2Q!i`[o  
degree of handicap and socioeconomic factors.8–10,24,25 We n`2"(7Wj  
have also shown previously that ophthalmologists are more nylIP */  
likely to refer a patient for cataract surgery if the patient is Xg)FIaw]eT  
employed and less likely to refer a nursing home resident.7 ?26[%%  
In the Visual Impairment Project, we did not find that any OehB"[;+  
particular subgroup of the population was at greater risk of hLA =7  
having unoperated cataract. Universal access to health care -m-WUox4"  
in Australia may explain the fact that people without by3kfY]4s  
Medicare are more likely to delay cataract operations in the PH=8'GN  
USA,8 but not having private health insurance is not associated  ZuV  
with unoperated cataract in Australia. ?UZ yu 4O%  
In summary, cataract is a significant public health problem ~}l,H:jk@  
in that one in four people in their 80s will have had cataract VL1z$<vVXt  
surgery. The importance of age-related cataract surgery will ^IZ0M1&W;  
increase further with the ageing of the population: the ?Qp_4<(5  
number of people over age 60 years is expected to double in s'w 0pZqj  
the next 20 years. Cataract surgery services are well DEp: vlW@  
accessed by the Victorian population and the visual outcomes 'vClZGQ1  
of cataract surgery have been shown to be very good. )[Cm*Xxa$  
These data can be used to plan for age-related cataract yXmp]9$  
surgical services in Australia in the future as the need for id9T[^h  
cataract extractions increases. 9_dsiM7CT  
ACKNOWLEDGEMENTS 2}#PDh n  
The Visual Impairment Project was funded in part by grants 5qko`r@#  
from the Victorian Health Promotion Foundation, the /! 3:K<6@  
National Health and Medical Research Council, the Ansell \Ki#"%S  
Ophthalmology Foundation, the Dorothy Edols Estate and T!E LH!  
the Jack Brockhoff Foundation. Dr McCarty is the recipient <H#K`|Ag  
of a Wagstaff Fellowship in Ophthalmology from the Royal Un+Jz ?Y  
Victorian Eye and Ear Hospital. JC3)G/m(03  
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