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

ABSTRACT $t?e=#G  
Purpose: To quantify the prevalence of cataract, the outcomes kF7Al]IgT  
of cataract surgery and the factors related to @TT[H*,  
unoperated cataract in Australia. d":{a6D*d  
Methods: Participants were recruited from the Visual J)+eEmrU  
Impairment Project: a cluster, stratified sample of more than :H 7 "W<  
5000 Victorians aged 40 years and over. At examination qdZYaS ~  
sites interviews, clinical examinations and lens photography c }cboe2  
were performed. Cataract was defined in participants who EORAx  
had: had previous cataract surgery, cortical cataract greater l{yPO@ut`F  
than 4/16, nuclear greater than Wilmer standard 2, or w,$17+]3  
posterior subcapsular greater than 1 mm2. [Hf FC3U  
Results: The participant group comprised 3271 Melbourne 1gr jK.x  
residents, 403 Melbourne nursing home residents and 1473 w[_Uv4M  
rural residents.The weighted rate of any cataract in Victoria i vk|-C'\  
was 21.5%. The overall weighted rate of prior cataract =+WFx3/  
surgery was 3.79%. Two hundred and forty-nine eyes had /J:j '6  
had prior cataract surgery. Of these 249 procedures, 49 D.} b<kDD  
(20%) were aphakic, 6 (2.4%) had anterior chamber &3. 8i%  
intraocular lenses and 194 (78%) had posterior chamber ];YOP%2   
intraocular lenses.Two hundred and eleven of these operated SfR_#"Uu  
eyes (85%) had best-corrected visual acuity of 6/12 or gS 3&,^  
better, the legal requirement for a driver’s license.Twentyseven cPS pPx  
(11%) had visual acuity of less than 6/18 (moderate r+crE %-  
vision impairment). Complications of cataract surgery C09@2M'  
caused reduced vision in four of the 27 eyes (15%), or 1.9% R!ij CF\  
of operated eyes. Three of these four eyes had undergone FS0SGBo  
intracapsular cataract extraction and the fourth eye had an 7y&`H  
opaque posterior capsule. No one had bilateral vision $I%]jAh6  
impairment as a result of cataract surgery. Surprisingly, no f QdQ[  
particular demographic factors (such as age, gender, rural !xSGZ D=AD  
residence, occupation, employment status, health insurance e"Z~%,^A  
status, ethnicity) were related to the presence of unoperated `B~%TEvMh  
cataract. {^F_b% a4z  
Conclusions: Although the overall prevalence of cataract is +9t@eHJT1  
quite high, no particular subgroup is systematically underserviced 3-0Y<++W3>  
in terms of cataract surgery. Overall, the results of O\?ei+(H7  
cataract surgery are very good, with the majority of eyes q :gH`5N  
achieving driving vision following cataract extraction. !#QD;,SE+  
Key words: cataract extraction, health planning, health PeOgXg)L`z  
services accessibility, prevalence \VW.>@s~  
INTRODUCTION '` n\YO.N  
Cataract is the leading cause of blindness worldwide and, in lxbZM9A2  
Australia, cataract extractions account for the majority of all zT@vji%Y  
ophthalmic procedures.1 Over the period 1985–94, the rate \|kU{d0  
of cataract surgery in Australia was twice as high as would be Kgcg:r:  
expected from the growth in the elderly population.1 ~b e&T:7.  
Although there have been a number of studies reporting -1[ri8t;nV  
the prevalence of cataract in various populations,2–6 there is Z|u_DaSrr|  
little information about determinants of cataract surgery in r(RJ&\ !  
the population. A previous survey of Australian ophthalmologists No I=t  
showed that patient concern and lifestyle, rather |m~|  
than visual acuity itself, are the primary factors for referral +IMP<  
for cataract surgery.7 This supports prior research which has LGK}oL'  
shown that visual acuity is not a strong predictor of need for I3$v-OiL  
cataract surgery.8,9 Elsewhere, socioeconomic status has `*! .B  
been shown to be related to cataract surgery rates.10 Upf1*$p  
To appropriately plan health care services, information is #+XKfumLk  
needed about the prevalence of age-related cataract in the fZg Z  
community as well as the factors associated with cataract 3?C$Tl2G8  
surgery. The purpose of this study is to quantify the prevalence G'!Hc6OZ  
of any cataract in Australia, to describe the factors 'EXp[*  
related to unoperated cataract in the community and to Ltc>@  
describe the visual outcomes of cataract surgery. =r`>tWs  
METHODS *5 wb8 [  
Study population Dp>/lkk.  
Details about the study methodology for the Visual V;.=O}Lr  
Impairment Project have been published previously.11 5<9}{X+@o  
Briefly, cluster sampling within three strata was employed to {whR/rX`  
recruit subjects aged 40 years and over to participate. 6 ZX{K1_q  
Within the Melbourne Statistical Division, nine pairs of +YXyfTa  
census collector districts were randomly selected. Fourteen ;R}:2  
nursing homes within a 5 km radius of these nine test sites lBl`R|Gt  
were randomly chosen to recruit nursing home residents. IpHGit28  
Clinical and Experimental Ophthalmology (2000) 28, 77–82 *r=6bpi  
Original Article e_7a9:2e  
Operated and unoperated cataract in Australia *&!&Y*Jzg  
Catherine A McCarty PhD, MPH, Mukesh B Nanjan PhD, Hugh R Taylor MD (;\JCeGA  
Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia 7N 7W0Ky  
n Correspondence: Dr Cathy McCarty MPH, Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, 32 Gisborne Street, East Melbourne, `N;JM3 ck  
Victoria 3002, Australia. Email: cathy@cera.unimelb.edu.au whr[rWt@>  
78 McCarty et al. [/\}:#MLe  
Finally, four pairs of census collector districts in four rural J&2cf#  
Victorian communities were randomly selected to recruit rural IOomBy:  
residents. A household census was conducted to identify Dhv ^}m@  
eligible residents aged 40 years and over who had been a 1)w^.8f  
resident at that address for at least 6 months. At the time of \\xoOA.  
the household census, basic information about age, sex, Xnpw'<~X  
country of birth, language spoken at home, education, use of :.J Ad$>P  
corrective spectacles and use of eye care services was collected. l*^c?lp)  
Eligible residents were then invited to attend a local M:rE^El  
examination site for a more detailed interview and examination. Gg$4O8  
The study protocol was approved by the Royal Victorian ?t46TV'G  
Eye and Ear Hospital Human Research Ethics Committee. "MOM@4\  
Assessment of cataract c<fl6o)  
A standardized ophthalmic examination was performed after B _k+Oa2!  
pupil dilatation with one drop of 10% phenylephrine f0S$p R  
hydrochloride. Lens opacities were graded clinically at the =*>ri  
time of the examination and subsequently from photos using #? u#=]  
the Wilmer cataract photo-grading system.12 Cortical and Xw)W6H|  
posterior subcapsular (PSC) opacities were assessed on N3"O#C  
retroillumination and measured as the proportion (in 1/16) 9(eTCe-~6  
of pupil circumference occupied by opacity. For this analysis, +`=rzL"0I7  
cortical cataract was defined as 4/16 or greater opacity, ~)vq0]MRg  
PSC cataract was defined as opacity equal to or greater than 3e,"B S)+  
1 mm2 and nuclear cataract was defined as opacity equal to Cs9o_Z~  
or greater than Wilmer standard 2,12 independent of visual "!,)Pv  
acuity. Examples of the minimum opacities defined as cortical, DXyRNE<G[C  
nuclear and PSC cataract are presented in Figure 1. '8Wu9 phT  
Bilateral congenital cataracts or cataracts secondary to x<d2/[(}mT  
intraocular inflammation or trauma were excluded from the 0Sx$6:-~  
analysis. Two cases of bilateral secondary cataract and eight SJ*qgI?}T  
cases of bilateral congenital cataract were excluded from the `?=Y^+*!-  
analyses. wDp5HZ>  
A Topcon® SL5 photo slit-lamp (Topcon America Corp., A9Kt^HR  
Paramus, NJ, USA) with a 0.1 mm slit beam of 9.0 mm in [jnA?Ge:  
height set to an incident angle of 30° was used for examinations. L NS O]\  
Ektachrome® 200 ASA colour slide film (Eastman F,}7rhY(U^  
Kodak Company, Rochester, NY, USA) was used to photograph 6v?tZ&, G  
the nuclear opacities. The cortical opacities were FeL!%z  
photographed with an Oxford® retroillumination camera ,4mb05w;d  
(Marcher Enterprises Ltd, Hereford, UK) and T-MAX® 400 >lkjoEVQ  
film (Eastman Kodak). Photographs were graded separately '+&!;Jj,  
by two research assistants and discrepancies were adjudicated cB0"vbdO  
by an independent reviewer. Any discrepancies Lrjp  
between the clinical grades and the photograph grades were _J&IL!S2  
resolved. Except in cases where photographs were missing, ^UmhSxQ##  
the photograph grades were used in the analyses. Photograph 7<0oK|~c#  
grades were available for 4301 (84%) for cortical ;q?WU> c{?  
cataract, 4147 (81%) for nuclear cataract and 4303 (84%) Ve\.7s  
for PSC cataract. Cataract status was classified according to M#}k@ ;L3  
the severity of the opacity in the worse eye. [hJ ASX9  
Assessment of risk factors lw `$( ,  
A standardized questionnaire was used to obtain information K |^OnM  
about education, employment and ethnic background.11 yk0^m/=C(  
Specific information was elicited on the occurrence, duration B-p ] .  
and treatment of a number of medical conditions, }6To(*  
including ocular trauma, arthritis, diabetes, gout, hypertension II]-mb  
and mental illness. Information about the use, dose and SoHw9FtS  
duration of tobacco, alcohol, analgesics and steriods were ra F+Bt`  
collected, and a food frequency questionnaire was used to t vp kc;  
determine current consumption of dietary sources of antioxidants xf3;:soC  
and use of vitamin supplements. Dco3 `4pl  
Data management and statistical analysis DD'RSV5]  
Data were collected either by direct computer entry with a :gM_v?sy  
questionnaire programmed in Paradox© (Carel Corporation, 9w <k1j  
Ottawa, Canada) with internal consistency checks, or ._p^0UxT  
on self-coding forms. Open-ended responses were coded at _N"c,P 0  
a later time. Data that were entered on the self-coded forms YK V"bI  
were entered into a computer with double data entry and 6$G@>QCBS  
reconciliation of any inconsistencies. Data range and consistency vv1W<X0e<  
checks were performed on the entire data set. $aY:Z_s  
SAS© version 6.1 (SAS Institute, Cary, North Carolina) was Zr|\T7w 3  
employed for statistical analyses. `aL4YH-v  
Ninety-five per cent confidence limits around the agespecific  z:d+RMA  
rates were calculated according to Cochran13 to o(YF`;OhvS  
account for the effect of the cluster sampling. Ninety-five 'ALe>\WO  
per cent confidence limits around age-standardized rates nXW]9zC"/  
were calculated according to Breslow and Day.14 The strataspecific i%otvDn1  
data were weighted according to the 1996 X?S LYm@v  
Australian Bureau of Statistics census data15 to reflect the O7xBMq Mf  
cataract prevalence in the entire Victorian population. (!koz'f  
Univariate analyses with Student’s t-tests and chi-squared J1d|L|M  
tests were first employed to evaluate risk factors for unoperated e ls&_BPE  
cataract. Any factors with P < 0.10 were then fitted hQ Lh}}B  
into a backwards stepwise logistic regression model. For the M7 gM#bv>L  
Figure 1. Minimum levels of cortical (a), nuclear (b), and posterior subcapsular (c) cataract. e:(~=9}Li  
final multivariate models, P < 0.05 was considered statistically eQsoZQA1  
significant. Design effect was assessed through the use C-;}a%c"  
of cluster-specific models and multivariate models. The fVxRK\a\\  
design effect was assumed to be additive and an adjustment =ve, !  
made in the variance by adding the variance associated with Ffr6P }I  
the design effect prior to constructing the 95% confidence V2*m/J yeB  
limits. 0u8(*?  
RESULTS jIL$hqo  
Study population {-,^3PI\  
A total of 3271 (83%) of the Melbourne residents, 403 hionR)R4  
(90%) Melbourne nursing home residents, and 1473 (92%) Ge4 tc  
rural residents participated. In general, non-participants did {#%;HqP  
not differ from participants.16 The study population was -O>*` O>M  
representative of the Victorian population and Australia as W'M\DKJ?  
a whole. U4,hEnJBT  
The Melbourne residents ranged in age from 40 to n`g:dz  
98 years (mean = 59) and 1511 (46%) were male. The eO=!(  
Melbourne nursing home residents ranged in age from 46 to aoS]Qp  
101 years (mean = 82) and 85 (21%) were men. The rural # fl%~Y  
residents ranged in age from 40 to 103 years (mean = 60) s*W)BK|+?  
and 701 (47.5%) were men. Ow7I`#P  
Prevalence of cataract and prior cataract surgery 9 TILrK  
As would be expected, the rate of any cataract increases Ue0Q| h  
dramatically with age (Table 1). The weighted rate of any Eb=;D1)y]  
cataract in Victoria was 21.5% (95% CL 18.1, 24.9). 9wC:8@`6E  
Although the rates varied somewhat between the three fO{E65uA  
strata, they were not significantly different as the 95% confidence IWcYa.=tZ  
limits overlapped. The per cent of cataractous eyes !T 3 Esv  
with best-corrected visual acuity of less than 6/12 was 12.5% mLn =SU{#  
(65/520) for cortical cataract, 18% for nuclear cataract :cK;|{f  
(97/534) and 14.4% (27/187) for PSC cataract. Cataract O[fgn;@|  
surgery also rose dramatically with age. The overall c~UYs\  
weighted rate of prior cataract surgery in Victoria was U-EX)S^T[{  
3.79% (95% CL 2.97, 4.60) (Table 2). DqHVc)9  
Risk factors for unoperated cataract zorTZ #5  
Cases of cataract that had not been removed were classified v#`Wf}G  
as unoperated cataract. Risk factor analyses for unoperated {G%!M+n<  
cataract were not performed with the nursing home residents -j_J 1P0,  
as information about risk factor exposure was not cuP5cL/Y  
available for this cohort. The following factors were assessed %.R_[.W  
in relation to unoperated cataract: age, sex, residence ^50/.Z >  
(urban/rural), language spoken at home (a measure of ethnic $|YIr7?R  
integration), country of birth, parents’ country of birth (a 8EPV\M1%  
measure of ethnicity), years since migration, education, use ?%h JZm;  
of ophthalmic services, use of optometric services, private {P #&e>)v{  
health insurance status, duration of distance glasses use, >cD+&h34  
glaucoma, age-related maculopathy and employment status. 5Ffz^;i  
In this cross sectional study it was not possible to assess the sy` : wp  
level of visual acuity that would predict a patient’s having (K+TqJw  
cataract surgery, as visual acuity data prior to cataract 5b[:B~J  
surgery were not available. _|Ml6;1aZ  
The significant risk factors for unoperated cataract in univariate -j[n^y'v  
analyses were related to: whether a participant had *[7,@S/<F  
ever seen an optometrist, seen an ophthalmologist or been %1]2+_6  
diagnosed with glaucoma; and participants’ employment ;NRT a*  
status (currently employed) and age. These significant As (C8C<  
factors were placed in a backwards stepwise logistic regression 2`vCQV  
model. The factors that remained significantly related 5 ^iU1 \(L  
to unoperated cataract were whether participants had ever E!V AA=  
seen an ophthalmologist, seen an optometrist and been ,/W< E  
diagnosed with glaucoma. None of the demographic factors *4qsM,t  
were associated with unoperated cataract in the multivariate R\:C|/6f  
model. VSZ6;&2^  
The per cent of participants with unoperated cataract =,[46 ;q  
who said that they were dissatisfied or very dissatisfied with ja7Z v[  
Operated and unoperated cataract in Australia 79 q'hV 'U  
Table 1. Prevalence of any cataracta (excluding previous cataract surgery) by age, gender and cohort MQY1he2M  
Age group Sex Urban Rural Nursing home Weighted total !Y]}& pUP  
(years) (%) (%) (%) @?Y^=0  
40–49 Male 2.56 4.04 0.00 3.00 (1.91, 4.08) ;*W]]4 fy  
Female 2.61 1.70 0.00 2.36 (1.61, 3.10) Q '+N72=  
50–59 Male 7.69 6.94 0.00 7.47 (5.80, 9.15) @LL&ggV?  
Female 6.67 7.56 0.00 6.92 (5.60, 8.24) : 1fik  
60–69 Male 20.7 25.0 10.0 22.0 (18.1, 26.0) +H&_Z38n  
Female 27.9 35.7 37.5 30.3 (26.0, 34.7) N0vd>b  
70–79 Male 43.1 58.7 39.1 48.1 (41.2, 55.1) ri JyH;)  
Female 58.6 66.2 55.6 61.0 (56.0, 65.9) HnP;1Gi  
80–89 Male 74.0 89.3 92.0 79.3 (72.3, 86.3) X^|oY]D  
Female 91.9 97.0 80.2 92.6 (86.4, 98.8) E tu>z+P!  
90 + Male 100.0 100.0 75.0 98.8 (96.2, 100.0) Q"hI!PO+  
Female 100.0 100.0 93.8 98.6 (97.0, 100.0) =|U2 }U;  
Age-standardized =(n'#mV  
(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) Gr6ma*)y~t  
aCortical > 4/16, nuclear > standard 2, posterior subcapsular > 1 mm2  +rT(  
their current vision was 30% (290/683), compared with 27% oyr2lfz*  
(26/95) of participants with prior cataract surgery (chisquared, z}Z`kq+C  
1 d.f. = 0.25, P = 0.62). #Y5I_:k  
Outcomes of cataract surgery Eq8OAuN  
Two hundred and forty-nine eyes had undergone prior D@^F6am%  
cataract surgery. Of these 249 operated eyes, 49 (20%) were KFZ[gqW8YY  
left aphakic, 6 (2.4%) had anterior chamber intraocular 4o*V12_r'4  
lenses and 194 (78%) had posterior chamber intraocular __ mtZ{  
lenses. The rate of capsulotomy in the eyes with intact li%-9Jd  
posterior capsules was 36% (73/202). Fifteen per cent of Mt YP3:  
eyes (17/114) with a clear posterior capsule had bestcorrected AltE~D/4  
visual acuity of less than 6/12 compared with 43% 87^ 4",  
of eyes (6/14) with opaque capsules, and 15% of eyes 13QCM0#  
(11/73) with prior capsulotomies (chi-squared, 2 d.f. = 7.21, @qC:% |>  
P = 0.027). 0&.lSw a  
The percentage of eyes with best-corrected visual acuity t <|s &  
of 6/12 or better was 96% (302/314) for eyes without ya_'Oz!C  
cataract, 88% (1417/1609) for eyes with prevalent cataract vLS9V/o  
and 85% (211/249) for eyes with operated cataract (chisquared, T8441qo{>  
2 d.f. = 22.3), P < 0.001). Twenty-seven of the iCK$ o_`?  
operated eyes (11%) had visual acuities of less than 6/18 pMquu&Td  
(moderate vision impairment) (Fig. 2). A cause of this qE{cCS  
moderate visual impairment (but not the only cause) in four KNg5Ptk  
(15%) eyes was secondary to cataract surgery. Three of these hX_p5a1t  
four eyes had undergone intracapsular cataract extraction 9(l'xuX  
and the fourth eye had an opaque posterior capsule. No one 8QN8bGxK   
had bilateral vision impairment as a result of their cataract -{*V) J_Co  
surgery. PbPP1G')  
DISCUSSION Dq?HUb^ X  
To our knowledge, this is the first paper to systematically )/Xrhhx  
assess the prevalence of current cataract, previous cataract =Yj[MVn  
surgery, predictors of unoperated cataract and the outcomes E`4=C@NN+,  
of cataract surgery in a population-based sample. The Visual \Ep/'Tj&  
Impairment Project is unique in that the sampling frame and v,+ l xY  
high response rate have ensured that the study population is BNCJT$t YX  
representative of Australians aged 40 years and over. Therefore, ]2%P``Yj  
these data can be used to plan age-related cataract VQ?H:1R  
services throughout Australia. |<|,RI?  
We found the rate of any cataract in those over the age G r|@CZq  
of 40 years to be 22%. Although relatively high, this rate is r65NKiQD  
significantly less than was reported in a number of previous otSPi7|k  
studies,2,4,6 with the exception of the Casteldaccia Eye =(X'c.%i  
Study.5 However, it is difficult to compare rates of cataract \u _v7g  
between studies because of different methodologies and >.hGoT!_k  
cataract definitions employed in the various studies, as well +Jka:]MW!  
as the different age structures of the study populations. U9o*6`"o  
Other studies have used less conservative definitions of I!7.fuO  
cataract, thus leading to higher rates of cataract as defined. g**% J Xo  
In most large epidemiologic studies of cataract, visual acuity e6i./bf3  
has not been included in the definition of cataract. C9g~l}=$&  
Therefore, the prevalence of cataract may not reflect the '}`hY1v  
actual need for cataract surgery in the community. mjl!Nth:<  
80 McCarty et al. 3d'ikkXK  
Table 2. Prevalence of previous cataract by age, gender and cohort A%*DQ1N  
Age group Gender Urban Rural Nursing home Weighted total ;]ShC\1  
(years) (%) (%) (%) q AVfbcb  
40–49 Male 1.14 0.00 0.00 0.80 (0.00, 1.81) _d0-%B 9m  
Female 0.00 0.00 0.00 0.00 ( Vc52s+7=8  
50–59 Male 0.68 0.58 0.00 0.65 (0.13, 1.17) vx5o k1UY  
Female 0.57 0.00 0.00 0.41 (0.00, 1.00) q\b ?o!# _  
60–69 Male 2.12 7.59 0.00 3.80 (1.41, 6.19) &Y>~^$`J  
Female 2.11 3.51 0.00 2.54 (1.81, 3.26) 0HJqsSZ$mW  
70–79 Male 8.22 9.85 8.70 8.75 (6.38, 11.1) F}B/-".^  
Female 7.21 7.86 7.02 7.41 (5.36, 9.46) 7YXXkdgbd  
80–89 Male 25.0 30.0 14.3 26.2 (17.0, 35.4) YaVc9du7  
Female 27.9 25.6 18.3 26.7 (20.2, 33.3) ~\:j9cC  
90 + Male 0.00 16.7 66.7 9.19 (0.00, 21.5) &8_f'+i0  
Female 58.3 100.0 26.9 63.1 (44.4, 81.8) c7l!G~yx'  
Age-standardized Q"6hD?6.  
(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) ?` eYW Z">  
Figure 2. Visual acuity in eyes that had undergone cataract 'q};L6  
surgery, n = 249. h, Presenting; j, best-corrected. QVG0>,+}$  
Operated and unoperated cataract in Australia 81 spU!t-n67  
The weighted prevalence of prior cataract surgery in the + ptF-  
Visual Impairment Project (3.6%) was similar to the crude ^0-e,d 9h  
rate in the Beaver Dam Eye Study4 (3.1%), but less than the Y0L5W;iM  
crude rate in the Blue Mountains Eye Study6 (6.0%). fs3 -rXoB  
However, the age-standardized rate in the Blue Mountains (| 36!-(iK  
Eye Study (standardized to the age distribution of the urban r8 Zyld_@  
Visual Impairment Project cohort) was found to be less than (w#slTFT  
the Visual Impairment Project (standardized rate = 1.36%, {glqWFT  
95% CL 1.25, 1.47). The incidence of cataract surgery in _8x'GK tU  
Australia has exceeded population growth.1 This is due, u_p7Mcb  
perhaps, to advances in surgical techniques and lens fNAo$O4cm  
implants that have changed the risk–benefit ratio. (ifqwl62  
The Global Initiative for the Elimination of Avoidable \=EY@ *=  
Blindness, sponsored by the World Health Organization, u>t|X}JH  
states that cataract surgical services should be provided that z)ft3(!  
‘have a high success rate in terms of visual outcome and 2Z/][?Jj{  
improved quality of life’,17 although the ‘high success rate’ is M}=s3[d(,  
not defined. Population- and clinic-based studies conducted  \8>  
in the United States have demonstrated marked improvement k%Ma4_Z  
in visual acuity following cataract surgery.18–20 We Qc&-\kQ:$u  
found that 85% of eyes that had undergone cataract extraction SG dfhno;  
had visual acuity of 6/12 or better. Previously, we have B@"SOX  
shown that participants with prevalent cataract in this pBg|n=^  
cohort are more likely to express dissatisfaction with their 8 l'bRyuS  
current vision than participants without cataract or participants b(.-~c('  
with prior cataract surgery.21 In a national study in the 7x[LF ^o  
United States, researchers found that the change in patients’ \A'|XdQ  
ratings of their vision difficulties and satisfaction with their ba(arGZ+{  
vision after cataract surgery were more highly related to 6?3/Ul }  
their change in visual functioning score than to their change IgPV#  
in visual acuity.19 Furthermore, improvement in visual function wMH[QYb<*  
has been shown to be associated with improvement in toS(UM n  
overall quality of life.22 E3 ~,+68U  
A recent review found that the incidence of visually "*Lj8C3|n  
significant posterior capsule opacification following :X'*8,]KHH  
cataract surgery to be greater than 25%.23 We found 36% 5cyddlaat  
capsulotomy in our population and that this was associated 4zo4 H~@gk  
with visual acuity similar to that of eyes with a clear F[>7z3I  
capsule, but significantly better than that of eyes with an U}tl_5%)  
opaque capsule. 0K=Qf69Y  
A number of studies have shown that the demand and A[u)wX^`f^  
timing of cataract surgery vary according to visual acuity, l,*yEkU  
degree of handicap and socioeconomic factors.8–10,24,25 We ;]2 x  
have also shown previously that ophthalmologists are more Uj4Lu  
likely to refer a patient for cataract surgery if the patient is %v5)s(Yu  
employed and less likely to refer a nursing home resident.7 <U@P=G<t  
In the Visual Impairment Project, we did not find that any y bo#K  
particular subgroup of the population was at greater risk of |ZS 57c:  
having unoperated cataract. Universal access to health care u9TzZ  
in Australia may explain the fact that people without -'I _*fu  
Medicare are more likely to delay cataract operations in the q>^hoW2$C  
USA,8 but not having private health insurance is not associated 3^!Hl8P7  
with unoperated cataract in Australia. m_cO<LB  
In summary, cataract is a significant public health problem ao)Ck3]  
in that one in four people in their 80s will have had cataract ;knd7SC   
surgery. The importance of age-related cataract surgery will RS'} nY}  
increase further with the ageing of the population: the #2h+dk$1  
number of people over age 60 years is expected to double in i\(\MzW*'  
the next 20 years. Cataract surgery services are well D,MyI#  
accessed by the Victorian population and the visual outcomes *Wzwbwg  
of cataract surgery have been shown to be very good. +AB6lv  
These data can be used to plan for age-related cataract O~.U:45t  
surgical services in Australia in the future as the need for s0r"N7~  
cataract extractions increases. IQT cYl  
ACKNOWLEDGEMENTS HeCcF+  
The Visual Impairment Project was funded in part by grants 9ftN 8Svw  
from the Victorian Health Promotion Foundation, the vK(I3db !  
National Health and Medical Research Council, the Ansell Yrpxy.1=F5  
Ophthalmology Foundation, the Dorothy Edols Estate and [(1O"  
the Jack Brockhoff Foundation. Dr McCarty is the recipient O7v]p  
of a Wagstaff Fellowship in Ophthalmology from the Royal So#dJ>   
Victorian Eye and Ear Hospital. o w2$o\hC  
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