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

ABSTRACT {zb'Z Yz  
Purpose: To quantify the prevalence of cataract, the outcomes aoN\n]g  
of cataract surgery and the factors related to LIID(s!bX  
unoperated cataract in Australia. ~~/,2^   
Methods: Participants were recruited from the Visual ^@^8iZ  
Impairment Project: a cluster, stratified sample of more than ?6:qAF w  
5000 Victorians aged 40 years and over. At examination 60+zoL'  
sites interviews, clinical examinations and lens photography :'p)xw4K|  
were performed. Cataract was defined in participants who 0/Q_% :  
had: had previous cataract surgery, cortical cataract greater 9lYKG ^#D  
than 4/16, nuclear greater than Wilmer standard 2, or xk,Uf,,>  
posterior subcapsular greater than 1 mm2. $Z G&d  
Results: The participant group comprised 3271 Melbourne mo| D  
residents, 403 Melbourne nursing home residents and 1473 =7Ud-5c  
rural residents.The weighted rate of any cataract in Victoria !K-1tp$  
was 21.5%. The overall weighted rate of prior cataract F1yn@a "=J  
surgery was 3.79%. Two hundred and forty-nine eyes had p'h'Cz  
had prior cataract surgery. Of these 249 procedures, 49 CPJ<A,V  
(20%) were aphakic, 6 (2.4%) had anterior chamber [K4cxqlfk  
intraocular lenses and 194 (78%) had posterior chamber Ub3$`  
intraocular lenses.Two hundred and eleven of these operated oZ%uq78#[%  
eyes (85%) had best-corrected visual acuity of 6/12 or b-& rMML  
better, the legal requirement for a driver’s license.Twentyseven [edF'7La  
(11%) had visual acuity of less than 6/18 (moderate o-8{C0>:  
vision impairment). Complications of cataract surgery ~-'2jb*8  
caused reduced vision in four of the 27 eyes (15%), or 1.9% TQn!MUj/^  
of operated eyes. Three of these four eyes had undergone fV"Y/9}(  
intracapsular cataract extraction and the fourth eye had an JT 7WZc)  
opaque posterior capsule. No one had bilateral vision pf8'xdExH)  
impairment as a result of cataract surgery. Surprisingly, no H9T~7e+  
particular demographic factors (such as age, gender, rural ; <FAc R  
residence, occupation, employment status, health insurance RE t &QP  
status, ethnicity) were related to the presence of unoperated Vl^x_gs#_]  
cataract. N]W*ei  
Conclusions: Although the overall prevalence of cataract is &E`Nu (e  
quite high, no particular subgroup is systematically underserviced 5p.rd0T]l3  
in terms of cataract surgery. Overall, the results of mlByE,S2E  
cataract surgery are very good, with the majority of eyes *B&P[n  
achieving driving vision following cataract extraction. 6m&GN4Ca  
Key words: cataract extraction, health planning, health (XOz_K6c%K  
services accessibility, prevalence 5X0ex.  
INTRODUCTION sPK]:i C  
Cataract is the leading cause of blindness worldwide and, in Xq1#rK(  
Australia, cataract extractions account for the majority of all j}Tv/O,f  
ophthalmic procedures.1 Over the period 1985–94, the rate 0Jv6?7]LKa  
of cataract surgery in Australia was twice as high as would be Sj ovL@X  
expected from the growth in the elderly population.1 :3M ,]W]  
Although there have been a number of studies reporting e,s  S.  
the prevalence of cataract in various populations,2–6 there is Apu- 9|oP  
little information about determinants of cataract surgery in 6@|!m'  
the population. A previous survey of Australian ophthalmologists l i<9nMZ<  
showed that patient concern and lifestyle, rather xiW}P% bf  
than visual acuity itself, are the primary factors for referral [ &Wy $  
for cataract surgery.7 This supports prior research which has C 9%bD  
shown that visual acuity is not a strong predictor of need for lz=DGm  
cataract surgery.8,9 Elsewhere, socioeconomic status has ta&z lZt  
been shown to be related to cataract surgery rates.10 (U5XB [r_P  
To appropriately plan health care services, information is ywm"{ U? 8  
needed about the prevalence of age-related cataract in the -F`gRAr-  
community as well as the factors associated with cataract og$dv 23  
surgery. The purpose of this study is to quantify the prevalence -}@ C9Ja[?  
of any cataract in Australia, to describe the factors kYS#P(1  
related to unoperated cataract in the community and to gB#!g@  
describe the visual outcomes of cataract surgery. tLJ 7tnB  
METHODS #NT~GhWFf  
Study population a3A-N] ;f  
Details about the study methodology for the Visual AYNz {9  
Impairment Project have been published previously.11 OY"BaSEOw}  
Briefly, cluster sampling within three strata was employed to 6+sz4  
recruit subjects aged 40 years and over to participate. >o"s1* {  
Within the Melbourne Statistical Division, nine pairs of LZ#A`&qUd  
census collector districts were randomly selected. Fourteen Z+R-}<   
nursing homes within a 5 km radius of these nine test sites bIt{kzuQC  
were randomly chosen to recruit nursing home residents. rDaiA x&  
Clinical and Experimental Ophthalmology (2000) 28, 77–82 v 'L"sgW6I  
Original Article (|W6p%(  
Operated and unoperated cataract in Australia !OV+2suu1  
Catherine A McCarty PhD, MPH, Mukesh B Nanjan PhD, Hugh R Taylor MD =]Y'xzJuu  
Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia "`K73M,c?9  
n Correspondence: Dr Cathy McCarty MPH, Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, 32 Gisborne Street, East Melbourne, 6mZpyt  
Victoria 3002, Australia. Email: cathy@cera.unimelb.edu.au I<lkociUCG  
78 McCarty et al. yaj1nq! *"  
Finally, four pairs of census collector districts in four rural i/N68  
Victorian communities were randomly selected to recruit rural c1%ki%J#  
residents. A household census was conducted to identify G* mLb1  
eligible residents aged 40 years and over who had been a K<l dl.  
resident at that address for at least 6 months. At the time of aj+I+r"~  
the household census, basic information about age, sex, M>Ws}Y  
country of birth, language spoken at home, education, use of h" YA>_1  
corrective spectacles and use of eye care services was collected. Re\V<\$J  
Eligible residents were then invited to attend a local ~xZ )btf  
examination site for a more detailed interview and examination. Qa16x<Xlm  
The study protocol was approved by the Royal Victorian 5geZ6]|  
Eye and Ear Hospital Human Research Ethics Committee. \4q1<j  
Assessment of cataract ]kkH|b$[T  
A standardized ophthalmic examination was performed after ( (mNB]sy  
pupil dilatation with one drop of 10% phenylephrine M\9p-%"L  
hydrochloride. Lens opacities were graded clinically at the EJrQ9"x&n  
time of the examination and subsequently from photos using zQ eXN7$  
the Wilmer cataract photo-grading system.12 Cortical and gJn_8\,C>Q  
posterior subcapsular (PSC) opacities were assessed on x:Tm4V{  
retroillumination and measured as the proportion (in 1/16) _1Iw"K49Qx  
of pupil circumference occupied by opacity. For this analysis, 0SLn0vD!  
cortical cataract was defined as 4/16 or greater opacity, `Axn   
PSC cataract was defined as opacity equal to or greater than ;fDs9=3#  
1 mm2 and nuclear cataract was defined as opacity equal to D(S^g+rd  
or greater than Wilmer standard 2,12 independent of visual ~|)'vK8W  
acuity. Examples of the minimum opacities defined as cortical, "^iw {]~U  
nuclear and PSC cataract are presented in Figure 1. ;i&'va$  
Bilateral congenital cataracts or cataracts secondary to VJ(#FA2  
intraocular inflammation or trauma were excluded from the #PRkqg+|  
analysis. Two cases of bilateral secondary cataract and eight '.DFyHsq  
cases of bilateral congenital cataract were excluded from the PM%Gsy]q  
analyses. Yf(QU`w_  
A Topcon® SL5 photo slit-lamp (Topcon America Corp., vvG#O[| O  
Paramus, NJ, USA) with a 0.1 mm slit beam of 9.0 mm in y| %rW  
height set to an incident angle of 30° was used for examinations. o;@T6-VH  
Ektachrome® 200 ASA colour slide film (Eastman 4h~o>(Sq  
Kodak Company, Rochester, NY, USA) was used to photograph 5eW GX  
the nuclear opacities. The cortical opacities were E|d 8vt  
photographed with an Oxford® retroillumination camera 3v%V\kO=F  
(Marcher Enterprises Ltd, Hereford, UK) and T-MAX® 400 <Cw)S8t  
film (Eastman Kodak). Photographs were graded separately (-(sBQa+  
by two research assistants and discrepancies were adjudicated "V;M,/Q|  
by an independent reviewer. Any discrepancies  + >oA@z  
between the clinical grades and the photograph grades were J_A5,K*r|  
resolved. Except in cases where photographs were missing, auTApYS53  
the photograph grades were used in the analyses. Photograph IPoNAi<b  
grades were available for 4301 (84%) for cortical Q0_UBm^f  
cataract, 4147 (81%) for nuclear cataract and 4303 (84%) IOsitMOX:  
for PSC cataract. Cataract status was classified according to Ln})\ UDK)  
the severity of the opacity in the worse eye. w#5^A(NR  
Assessment of risk factors y#Ao6Od6  
A standardized questionnaire was used to obtain information d[5?P?h')  
about education, employment and ethnic background.11 )FkJ=P0  
Specific information was elicited on the occurrence, duration V\"x#uB  
and treatment of a number of medical conditions, Z`23z( +  
including ocular trauma, arthritis, diabetes, gout, hypertension DUxj^,mf,  
and mental illness. Information about the use, dose and G:QaWqUb  
duration of tobacco, alcohol, analgesics and steriods were 2#:h.8  
collected, and a food frequency questionnaire was used to `2y2Bk  
determine current consumption of dietary sources of antioxidants ~ FW@  
and use of vitamin supplements. s HSZIkB-r  
Data management and statistical analysis ~1Q$Fg Lk  
Data were collected either by direct computer entry with a |>(;gr/5(  
questionnaire programmed in Paradox© (Carel Corporation, z ) 2h\S  
Ottawa, Canada) with internal consistency checks, or  h +Dp<b  
on self-coding forms. Open-ended responses were coded at y1!c:&  
a later time. Data that were entered on the self-coded forms lz?F ,].  
were entered into a computer with double data entry and & Me%ZM0  
reconciliation of any inconsistencies. Data range and consistency e.%` tK3J  
checks were performed on the entire data set. mYf7?I~  
SAS© version 6.1 (SAS Institute, Cary, North Carolina) was cTpAU9|(  
employed for statistical analyses.  "MD  
Ninety-five per cent confidence limits around the agespecific C3 ^QNhv  
rates were calculated according to Cochran13 to y,i:BQJ<  
account for the effect of the cluster sampling. Ninety-five ;H5PiSq;z  
per cent confidence limits around age-standardized rates \-Mzs 0R  
were calculated according to Breslow and Day.14 The strataspecific K'EGm #I  
data were weighted according to the 1996 Z> jk\[  
Australian Bureau of Statistics census data15 to reflect the 7RQ.oe e  
cataract prevalence in the entire Victorian population. pZx'%-\-T  
Univariate analyses with Student’s t-tests and chi-squared {k=H5<FV  
tests were first employed to evaluate risk factors for unoperated 01VEz 8[\  
cataract. Any factors with P < 0.10 were then fitted #E%0 o  
into a backwards stepwise logistic regression model. For the h0ufl.N_%  
Figure 1. Minimum levels of cortical (a), nuclear (b), and posterior subcapsular (c) cataract. m0+X 109  
final multivariate models, P < 0.05 was considered statistically |X/ QSL  
significant. Design effect was assessed through the use j^ VAA\  
of cluster-specific models and multivariate models. The kZXsL  
design effect was assumed to be additive and an adjustment y%A!|aBu  
made in the variance by adding the variance associated with LP?E  
the design effect prior to constructing the 95% confidence J0@<6~V6o  
limits. *5'U3py  
RESULTS ,2\?kPoc8  
Study population x9Veg4Z7  
A total of 3271 (83%) of the Melbourne residents, 403 42X N*br  
(90%) Melbourne nursing home residents, and 1473 (92%) +cS%b}O`$  
rural residents participated. In general, non-participants did [J4 Aig   
not differ from participants.16 The study population was \*{tAF  
representative of the Victorian population and Australia as o4I&?d7 ;"  
a whole. ^MJTlRUb  
The Melbourne residents ranged in age from 40 to qI-q%]l  
98 years (mean = 59) and 1511 (46%) were male. The 3QlV,)}  
Melbourne nursing home residents ranged in age from 46 to x2gnB@t  
101 years (mean = 82) and 85 (21%) were men. The rural -:92<G\D  
residents ranged in age from 40 to 103 years (mean = 60) .yp"6S^b  
and 701 (47.5%) were men. L`E^B uP/  
Prevalence of cataract and prior cataract surgery A#&Q(g\YE  
As would be expected, the rate of any cataract increases Y@WCp  
dramatically with age (Table 1). The weighted rate of any a o_A %?Ld  
cataract in Victoria was 21.5% (95% CL 18.1, 24.9). q^nSYp#  
Although the rates varied somewhat between the three m Iu-  
strata, they were not significantly different as the 95% confidence -P!_<\q\l  
limits overlapped. The per cent of cataractous eyes BPAz.K Q  
with best-corrected visual acuity of less than 6/12 was 12.5% iO^z7Y7  
(65/520) for cortical cataract, 18% for nuclear cataract 0fc]RkHs"  
(97/534) and 14.4% (27/187) for PSC cataract. Cataract }T !2IaAB  
surgery also rose dramatically with age. The overall nsChNwPX  
weighted rate of prior cataract surgery in Victoria was b?&=gm%oU  
3.79% (95% CL 2.97, 4.60) (Table 2). C^Jf&a  
Risk factors for unoperated cataract (GnwK1f  
Cases of cataract that had not been removed were classified Wj N0KA  
as unoperated cataract. Risk factor analyses for unoperated v]*(Wd~|  
cataract were not performed with the nursing home residents J:M)gh~#  
as information about risk factor exposure was not Bsm>^zZ`YU  
available for this cohort. The following factors were assessed UloZo? e`  
in relation to unoperated cataract: age, sex, residence oYWcX9R  
(urban/rural), language spoken at home (a measure of ethnic %\=oy=f  
integration), country of birth, parents’ country of birth (a 9T*%CI  
measure of ethnicity), years since migration, education, use  .*H0{  
of ophthalmic services, use of optometric services, private xJ"CAg|B  
health insurance status, duration of distance glasses use, ,z}wR::%  
glaucoma, age-related maculopathy and employment status. X8T7(w<0%f  
In this cross sectional study it was not possible to assess the W68d"J%>_  
level of visual acuity that would predict a patient’s having 5- Q`v/w;  
cataract surgery, as visual acuity data prior to cataract nU"V@_?\  
surgery were not available. =l`xXma  
The significant risk factors for unoperated cataract in univariate Yuy7TeJRx  
analyses were related to: whether a participant had g%w@v$  
ever seen an optometrist, seen an ophthalmologist or been md[FtcY\  
diagnosed with glaucoma; and participants’ employment ^&t(O1.-  
status (currently employed) and age. These significant Z-m,~Hh  
factors were placed in a backwards stepwise logistic regression ZyqTtA!A  
model. The factors that remained significantly related t;+6>sTu  
to unoperated cataract were whether participants had ever Fz+0h"  
seen an ophthalmologist, seen an optometrist and been nLq7J:  
diagnosed with glaucoma. None of the demographic factors H[%F o  
were associated with unoperated cataract in the multivariate 1Oo^  
model. +j5u[X  
The per cent of participants with unoperated cataract zx\N^R;Jq  
who said that they were dissatisfied or very dissatisfied with v>Il #  
Operated and unoperated cataract in Australia 79 >Uvtsj#  
Table 1. Prevalence of any cataracta (excluding previous cataract surgery) by age, gender and cohort %+$P<Rw7  
Age group Sex Urban Rural Nursing home Weighted total r @~T}<I  
(years) (%) (%) (%) &sL5 Pt_  
40–49 Male 2.56 4.04 0.00 3.00 (1.91, 4.08) x&R&\}@G m  
Female 2.61 1.70 0.00 2.36 (1.61, 3.10) A"Rzn1/  
50–59 Male 7.69 6.94 0.00 7.47 (5.80, 9.15) @M4~,O6-  
Female 6.67 7.56 0.00 6.92 (5.60, 8.24) 8QYG"CA6/  
60–69 Male 20.7 25.0 10.0 22.0 (18.1, 26.0) w_^&X;0^  
Female 27.9 35.7 37.5 30.3 (26.0, 34.7) c> K/f7  
70–79 Male 43.1 58.7 39.1 48.1 (41.2, 55.1) MAR kTxzi  
Female 58.6 66.2 55.6 61.0 (56.0, 65.9) t; n6Q0  
80–89 Male 74.0 89.3 92.0 79.3 (72.3, 86.3) 14\%2nE  
Female 91.9 97.0 80.2 92.6 (86.4, 98.8) S$]:3  
90 + Male 100.0 100.0 75.0 98.8 (96.2, 100.0) tH:ea$A  
Female 100.0 100.0 93.8 98.6 (97.0, 100.0) ?9X#{p>q  
Age-standardized S^)r,cC  
(95% CL) Combined 19.7 (16.3, 23.1) 23.2 (16.1, 30.2) 16.5 (2.06, 30.9) 21.5 (18.1, 25.0) Hi|2z5=V  
aCortical > 4/16, nuclear > standard 2, posterior subcapsular > 1 mm2 L5yxaF{]  
their current vision was 30% (290/683), compared with 27% ~<, \=;b/  
(26/95) of participants with prior cataract surgery (chisquared, O)Nt"k7 b  
1 d.f. = 0.25, P = 0.62). CpS' 2@6  
Outcomes of cataract surgery 7OtQK`P"A  
Two hundred and forty-nine eyes had undergone prior q~trn'X>  
cataract surgery. Of these 249 operated eyes, 49 (20%) were &t%CuU]/@  
left aphakic, 6 (2.4%) had anterior chamber intraocular A&9l|b-"  
lenses and 194 (78%) had posterior chamber intraocular n{BC m %  
lenses. The rate of capsulotomy in the eyes with intact j)-D.bY0  
posterior capsules was 36% (73/202). Fifteen per cent of lha )'   
eyes (17/114) with a clear posterior capsule had bestcorrected p w>A Q  
visual acuity of less than 6/12 compared with 43% Ynz^M{9)K  
of eyes (6/14) with opaque capsules, and 15% of eyes Y1k/ngH  
(11/73) with prior capsulotomies (chi-squared, 2 d.f. = 7.21, #]lUJ &M}e  
P = 0.027). h| UT/:  
The percentage of eyes with best-corrected visual acuity {'DP/]nK  
of 6/12 or better was 96% (302/314) for eyes without V2VsJ  
cataract, 88% (1417/1609) for eyes with prevalent cataract Nr`nL_DQ  
and 85% (211/249) for eyes with operated cataract (chisquared, {+xUAmd  
2 d.f. = 22.3), P < 0.001). Twenty-seven of the >.{ ..~"K  
operated eyes (11%) had visual acuities of less than 6/18 eaX`S.!jR  
(moderate vision impairment) (Fig. 2). A cause of this <;=Y4$y[  
moderate visual impairment (but not the only cause) in four e982IP  
(15%) eyes was secondary to cataract surgery. Three of these m6;Xo}^w  
four eyes had undergone intracapsular cataract extraction 'R,d?ikY  
and the fourth eye had an opaque posterior capsule. No one s=%HTfw  
had bilateral vision impairment as a result of their cataract r`;C9#jZ  
surgery. g~B@=R  
DISCUSSION d:pp,N~2o  
To our knowledge, this is the first paper to systematically "L8V!M_e  
assess the prevalence of current cataract, previous cataract {Y0I A97,  
surgery, predictors of unoperated cataract and the outcomes mCz6&  
of cataract surgery in a population-based sample. The Visual WHNb.>  
Impairment Project is unique in that the sampling frame and q#p)E=$  
high response rate have ensured that the study population is 'nT#3/rL  
representative of Australians aged 40 years and over. Therefore, eGTK^p  
these data can be used to plan age-related cataract xJ"Zg]d{  
services throughout Australia. <rC#1wR4  
We found the rate of any cataract in those over the age Qy70/on9  
of 40 years to be 22%. Although relatively high, this rate is F}AbA pTv  
significantly less than was reported in a number of previous 9~; Ju^b  
studies,2,4,6 with the exception of the Casteldaccia Eye v P GuEfz  
Study.5 However, it is difficult to compare rates of cataract [e}]K:  
between studies because of different methodologies and /y!Vs`PZ!  
cataract definitions employed in the various studies, as well u}:O[DG  
as the different age structures of the study populations. h7y*2:l6  
Other studies have used less conservative definitions of N |~&Q!A&  
cataract, thus leading to higher rates of cataract as defined. d#d~t[=  
In most large epidemiologic studies of cataract, visual acuity vJCL m/}*  
has not been included in the definition of cataract. 5 rWRE-  
Therefore, the prevalence of cataract may not reflect the |M?HdxPa  
actual need for cataract surgery in the community. ]OrFW4tiE  
80 McCarty et al. v8@dvT<  
Table 2. Prevalence of previous cataract by age, gender and cohort dXDD/8E  
Age group Gender Urban Rural Nursing home Weighted total |{ [i M  
(years) (%) (%) (%) amSyGQ2  
40–49 Male 1.14 0.00 0.00 0.80 (0.00, 1.81) 9F+bWo_m  
Female 0.00 0.00 0.00 0.00 ( m2! 7M%]GC  
50–59 Male 0.68 0.58 0.00 0.65 (0.13, 1.17) oTfbx+i/G  
Female 0.57 0.00 0.00 0.41 (0.00, 1.00) UQR"wUiiV  
60–69 Male 2.12 7.59 0.00 3.80 (1.41, 6.19) bVx]r[  
Female 2.11 3.51 0.00 2.54 (1.81, 3.26) V[m Q;:=  
70–79 Male 8.22 9.85 8.70 8.75 (6.38, 11.1) $G_<YVXcG  
Female 7.21 7.86 7.02 7.41 (5.36, 9.46) ry\']\k  
80–89 Male 25.0 30.0 14.3 26.2 (17.0, 35.4) FSmi.7  
Female 27.9 25.6 18.3 26.7 (20.2, 33.3) uqUo4z5T  
90 + Male 0.00 16.7 66.7 9.19 (0.00, 21.5) nKO&ffb'<  
Female 58.3 100.0 26.9 63.1 (44.4, 81.8) #TgJ d  
Age-standardized <e^/hR4O  
(95% CL) Combined 3.31 (2.70, 3.93) 4.36 (2.67, 6.06) 2.26 (0.82, 3.70) 3.79 (2.97, 4.60) ~ YK <T+  
Figure 2. Visual acuity in eyes that had undergone cataract q KM]wu0Et  
surgery, n = 249. h, Presenting; j, best-corrected. j vV8`BQ{  
Operated and unoperated cataract in Australia 81 %p9bl ,x  
The weighted prevalence of prior cataract surgery in the nsT|,O  
Visual Impairment Project (3.6%) was similar to the crude ?lK!OyCkc  
rate in the Beaver Dam Eye Study4 (3.1%), but less than the wuzz%9;@B  
crude rate in the Blue Mountains Eye Study6 (6.0%). nnG2z @$-  
However, the age-standardized rate in the Blue Mountains !Ia"pNDf  
Eye Study (standardized to the age distribution of the urban  IR LPUP  
Visual Impairment Project cohort) was found to be less than $5b|@  
the Visual Impairment Project (standardized rate = 1.36%, v-3zav  
95% CL 1.25, 1.47). The incidence of cataract surgery in ymZ/(:3_  
Australia has exceeded population growth.1 This is due, >bN~p  
perhaps, to advances in surgical techniques and lens D-GU"^-9  
implants that have changed the risk–benefit ratio. RfBb{?PP)  
The Global Initiative for the Elimination of Avoidable u-{l,p_H  
Blindness, sponsored by the World Health Organization, 2?T:RB}  
states that cataract surgical services should be provided that dz|*n'd  
‘have a high success rate in terms of visual outcome and #/Fu*0/)`  
improved quality of life’,17 although the ‘high success rate’ is HY4E  
not defined. Population- and clinic-based studies conducted  <%D"eD  
in the United States have demonstrated marked improvement ,-3(^d\1F  
in visual acuity following cataract surgery.18–20 We c@- K  
found that 85% of eyes that had undergone cataract extraction E`fssd~  
had visual acuity of 6/12 or better. Previously, we have \Byk`} 9  
shown that participants with prevalent cataract in this %^=!s  
cohort are more likely to express dissatisfaction with their hIQ[:f  
current vision than participants without cataract or participants q#&#*6 )B  
with prior cataract surgery.21 In a national study in the kc'0NE4oq  
United States, researchers found that the change in patients’ $p3Wjf:bH  
ratings of their vision difficulties and satisfaction with their ~H|LWCU)K8  
vision after cataract surgery were more highly related to .'b3iG&  
their change in visual functioning score than to their change :6$4K"^1  
in visual acuity.19 Furthermore, improvement in visual function W)!{U(X  
has been shown to be associated with improvement in NWHH.1|  
overall quality of life.22 g!p_c  
A recent review found that the incidence of visually 1Bk*G>CX9(  
significant posterior capsule opacification following a\69,%!:  
cataract surgery to be greater than 25%.23 We found 36% 7ml0  
capsulotomy in our population and that this was associated %HF$  
with visual acuity similar to that of eyes with a clear zrU$SWU  
capsule, but significantly better than that of eyes with an Q^Z<RA(C  
opaque capsule. 9LEilmPs  
A number of studies have shown that the demand and boF4d'g"  
timing of cataract surgery vary according to visual acuity, reM  
degree of handicap and socioeconomic factors.8–10,24,25 We U aj`  
have also shown previously that ophthalmologists are more ]X: rby$  
likely to refer a patient for cataract surgery if the patient is #1't"R+3M  
employed and less likely to refer a nursing home resident.7 6l\UNG7  
In the Visual Impairment Project, we did not find that any nG ^M 2)(8  
particular subgroup of the population was at greater risk of [ lzy &To  
having unoperated cataract. Universal access to health care UiK+c30FU  
in Australia may explain the fact that people without ^[seK) S=  
Medicare are more likely to delay cataract operations in the a4jnu:e  
USA,8 but not having private health insurance is not associated kh?#={]Z  
with unoperated cataract in Australia. f_4S>C$  
In summary, cataract is a significant public health problem YoF\ MT]W  
in that one in four people in their 80s will have had cataract Q Bfhyo_  
surgery. The importance of age-related cataract surgery will => uVp  
increase further with the ageing of the population: the 11B{gUv.]  
number of people over age 60 years is expected to double in pKxX{i1l  
the next 20 years. Cataract surgery services are well T`g?)/  
accessed by the Victorian population and the visual outcomes  &6\r  
of cataract surgery have been shown to be very good. FI`nRFq)C  
These data can be used to plan for age-related cataract 7TV>6i+7  
surgical services in Australia in the future as the need for j$|j8?  
cataract extractions increases. 1=/doo{^  
ACKNOWLEDGEMENTS } T/}0W]0  
The Visual Impairment Project was funded in part by grants rysP)e  
from the Victorian Health Promotion Foundation, the Q$?7)yyu+  
National Health and Medical Research Council, the Ansell "$~}'`(]  
Ophthalmology Foundation, the Dorothy Edols Estate and &?/N}g @K  
the Jack Brockhoff Foundation. Dr McCarty is the recipient b:FEp'ZS  
of a Wagstaff Fellowship in Ophthalmology from the Royal 3@PUg(M  
Victorian Eye and Ear Hospital. Ei{(  
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