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

ABSTRACT aR2Vvo  
Purpose: To quantify the prevalence of cataract, the outcomes ' 1jG?D  
of cataract surgery and the factors related to e\[z Q 2Z3  
unoperated cataract in Australia. kzK4i!}  
Methods: Participants were recruited from the Visual 2$fFl,v!z  
Impairment Project: a cluster, stratified sample of more than /|)VO?*D  
5000 Victorians aged 40 years and over. At examination Zs(I]^w;d  
sites interviews, clinical examinations and lens photography vLc7RL  
were performed. Cataract was defined in participants who n)n>|w_  
had: had previous cataract surgery, cortical cataract greater n0nvp@?7bJ  
than 4/16, nuclear greater than Wilmer standard 2, or }Sxuc/%:  
posterior subcapsular greater than 1 mm2. iut[?#f^  
Results: The participant group comprised 3271 Melbourne qG=>eRR  
residents, 403 Melbourne nursing home residents and 1473 D)]U+Qk  
rural residents.The weighted rate of any cataract in Victoria  /z0X  
was 21.5%. The overall weighted rate of prior cataract pZYcCc>6&  
surgery was 3.79%. Two hundred and forty-nine eyes had T;4& ^5 n  
had prior cataract surgery. Of these 249 procedures, 49 =&5^[:ksB  
(20%) were aphakic, 6 (2.4%) had anterior chamber h6yXW! 8  
intraocular lenses and 194 (78%) had posterior chamber 9i&(VzY[=  
intraocular lenses.Two hundred and eleven of these operated DaA9fJ7a   
eyes (85%) had best-corrected visual acuity of 6/12 or /|kR= ~  
better, the legal requirement for a driver’s license.Twentyseven l@h|os  
(11%) had visual acuity of less than 6/18 (moderate M_:_(y>l  
vision impairment). Complications of cataract surgery SRUg2)d  
caused reduced vision in four of the 27 eyes (15%), or 1.9% ?$ft3p}  
of operated eyes. Three of these four eyes had undergone ke+3J\;>  
intracapsular cataract extraction and the fourth eye had an 0ESxsba  
opaque posterior capsule. No one had bilateral vision 4(h19-V  
impairment as a result of cataract surgery. Surprisingly, no b`lLqV<[cB  
particular demographic factors (such as age, gender, rural y@T 0 jI  
residence, occupation, employment status, health insurance S  .KZ)  
status, ethnicity) were related to the presence of unoperated ?4[IIX-  
cataract. !XJvhsKXy  
Conclusions: Although the overall prevalence of cataract is lBYc(cr  
quite high, no particular subgroup is systematically underserviced ?!uj8&yyf  
in terms of cataract surgery. Overall, the results of oHW:s96e  
cataract surgery are very good, with the majority of eyes E#0_ y4  
achieving driving vision following cataract extraction. :EkhF6B/  
Key words: cataract extraction, health planning, health 2 SJ N;A~}  
services accessibility, prevalence [i9.#*  
INTRODUCTION ;Nd,K C0k  
Cataract is the leading cause of blindness worldwide and, in +K@wh  
Australia, cataract extractions account for the majority of all {mkD{2)KQ  
ophthalmic procedures.1 Over the period 1985–94, the rate 'l&),]|$)  
of cataract surgery in Australia was twice as high as would be cnm*&1EzV  
expected from the growth in the elderly population.1 o>#ue<Bc6  
Although there have been a number of studies reporting Xcy Xju#"p  
the prevalence of cataract in various populations,2–6 there is Ai~j q  
little information about determinants of cataract surgery in ^L,Uz:[J  
the population. A previous survey of Australian ophthalmologists zL%ruWNG  
showed that patient concern and lifestyle, rather <%SG <|t  
than visual acuity itself, are the primary factors for referral ^z _m<&r  
for cataract surgery.7 This supports prior research which has 'Avp16zg  
shown that visual acuity is not a strong predictor of need for jQV.U~25Q  
cataract surgery.8,9 Elsewhere, socioeconomic status has :Sd"~\N+  
been shown to be related to cataract surgery rates.10 )R- e^Cb  
To appropriately plan health care services, information is HRG2sv T4t  
needed about the prevalence of age-related cataract in the Jtv~n  
community as well as the factors associated with cataract W/ \M9  
surgery. The purpose of this study is to quantify the prevalence 4e0/Q!o,  
of any cataract in Australia, to describe the factors RyN}Gz/YN  
related to unoperated cataract in the community and to vhEXtjL  
describe the visual outcomes of cataract surgery. WlF}R\N!  
METHODS -!ARVf *  
Study population K,$ Ro@!  
Details about the study methodology for the Visual s (hJ *  
Impairment Project have been published previously.11 X`+8r O[  
Briefly, cluster sampling within three strata was employed to 8 etNS~^  
recruit subjects aged 40 years and over to participate. .O1Kwu  
Within the Melbourne Statistical Division, nine pairs of vz *'1ugaA  
census collector districts were randomly selected. Fourteen %"C%pA  
nursing homes within a 5 km radius of these nine test sites NmH:/xU?^  
were randomly chosen to recruit nursing home residents. .Jvy0B} B  
Clinical and Experimental Ophthalmology (2000) 28, 77–82 6%^9`|3  
Original Article ^]_5oFRIj  
Operated and unoperated cataract in Australia rmq^P;At  
Catherine A McCarty PhD, MPH, Mukesh B Nanjan PhD, Hugh R Taylor MD 5{.g~3"  
Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia br[n5  
n Correspondence: Dr Cathy McCarty MPH, Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, 32 Gisborne Street, East Melbourne, g3h:oQCS  
Victoria 3002, Australia. Email: cathy@cera.unimelb.edu.au WNa#X]*E)  
78 McCarty et al. 8YLS/dN0 w  
Finally, four pairs of census collector districts in four rural \qA^3L~;5  
Victorian communities were randomly selected to recruit rural Cr;d !=  
residents. A household census was conducted to identify }vof| (Yh  
eligible residents aged 40 years and over who had been a h]w5N2$}?  
resident at that address for at least 6 months. At the time of ss4<s 5:y  
the household census, basic information about age, sex, &# w~S~  
country of birth, language spoken at home, education, use of @0qDhv s  
corrective spectacles and use of eye care services was collected. ~|!f6=  
Eligible residents were then invited to attend a local =I6u*$9<  
examination site for a more detailed interview and examination. ->0OqVQA  
The study protocol was approved by the Royal Victorian B*,Qw_3dG  
Eye and Ear Hospital Human Research Ethics Committee. sO;]l"{<  
Assessment of cataract 2TZ+R7B?  
A standardized ophthalmic examination was performed after Z,ZebS@yG  
pupil dilatation with one drop of 10% phenylephrine M)T{6 w  
hydrochloride. Lens opacities were graded clinically at the /U1 jCLR'  
time of the examination and subsequently from photos using h=`1sfz  
the Wilmer cataract photo-grading system.12 Cortical and d O'apey  
posterior subcapsular (PSC) opacities were assessed on j1hx{P'  
retroillumination and measured as the proportion (in 1/16) |AS`MsbI9  
of pupil circumference occupied by opacity. For this analysis, w*3DIVlxL  
cortical cataract was defined as 4/16 or greater opacity, I$#)k^Q  
PSC cataract was defined as opacity equal to or greater than Ac@ zTK6>  
1 mm2 and nuclear cataract was defined as opacity equal to }F;Nh7?  
or greater than Wilmer standard 2,12 independent of visual GSh~j-C'  
acuity. Examples of the minimum opacities defined as cortical, -1P*4H2a  
nuclear and PSC cataract are presented in Figure 1. Jc74A=sT  
Bilateral congenital cataracts or cataracts secondary to 6d% |yl  
intraocular inflammation or trauma were excluded from the *?Pbk+}%  
analysis. Two cases of bilateral secondary cataract and eight 1}$GVb%i  
cases of bilateral congenital cataract were excluded from the M^$liS.D  
analyses. ;&9A Yh.  
A Topcon® SL5 photo slit-lamp (Topcon America Corp., ~LKX2Q:S  
Paramus, NJ, USA) with a 0.1 mm slit beam of 9.0 mm in 6'^Gh B  
height set to an incident angle of 30° was used for examinations. ?V>\9?zb  
Ektachrome® 200 ASA colour slide film (Eastman e=<%{M&  
Kodak Company, Rochester, NY, USA) was used to photograph nYF *f  
the nuclear opacities. The cortical opacities were FKN!*}3  
photographed with an Oxford® retroillumination camera YhzDi>hob  
(Marcher Enterprises Ltd, Hereford, UK) and T-MAX® 400 YV 5kzq  
film (Eastman Kodak). Photographs were graded separately  4X prVB  
by two research assistants and discrepancies were adjudicated nU6WT|  
by an independent reviewer. Any discrepancies T P5?%SlJ  
between the clinical grades and the photograph grades were Gw;[maM!%`  
resolved. Except in cases where photographs were missing, yye( ^  
the photograph grades were used in the analyses. Photograph M-B-  
grades were available for 4301 (84%) for cortical o@d+<6Um  
cataract, 4147 (81%) for nuclear cataract and 4303 (84%) b)eKa40Z  
for PSC cataract. Cataract status was classified according to \AT]$`8@_  
the severity of the opacity in the worse eye. U/|H%b  
Assessment of risk factors 6.!3g(w   
A standardized questionnaire was used to obtain information :cmQ w  
about education, employment and ethnic background.11 y.LJ 5K$&a  
Specific information was elicited on the occurrence, duration qhPvU( ,  
and treatment of a number of medical conditions, iSZiJ4AUq  
including ocular trauma, arthritis, diabetes, gout, hypertension <KFE.\*Z4  
and mental illness. Information about the use, dose and bwm?\l.A  
duration of tobacco, alcohol, analgesics and steriods were Y\qiYra  
collected, and a food frequency questionnaire was used to gyI(O>e  
determine current consumption of dietary sources of antioxidants f.o,VVYi  
and use of vitamin supplements. #()u=)  
Data management and statistical analysis [;Q8xvVZ'  
Data were collected either by direct computer entry with a b$24${*'  
questionnaire programmed in Paradox© (Carel Corporation, B~_='0Gm[  
Ottawa, Canada) with internal consistency checks, or =!G3YZ  
on self-coding forms. Open-ended responses were coded at g* NKY`,  
a later time. Data that were entered on the self-coded forms NjCdkT&g  
were entered into a computer with double data entry and J#0oL_xY#  
reconciliation of any inconsistencies. Data range and consistency ,=9e]pQ  
checks were performed on the entire data set. &~u=vuX  
SAS© version 6.1 (SAS Institute, Cary, North Carolina) was I$Q%i Z{  
employed for statistical analyses. ,_ XDCu @  
Ninety-five per cent confidence limits around the agespecific H:X=v+W  
rates were calculated according to Cochran13 to H<M ggs-  
account for the effect of the cluster sampling. Ninety-five  '8NKrI  
per cent confidence limits around age-standardized rates o b  
were calculated according to Breslow and Day.14 The strataspecific $XqfwlUu/4  
data were weighted according to the 1996 h^P>,dy0  
Australian Bureau of Statistics census data15 to reflect the OXC7 m  
cataract prevalence in the entire Victorian population. A2o ;YyF  
Univariate analyses with Student’s t-tests and chi-squared L%8>deE>;D  
tests were first employed to evaluate risk factors for unoperated ^|6%~jkD5  
cataract. Any factors with P < 0.10 were then fitted lD!o4ZAo  
into a backwards stepwise logistic regression model. For the ;SzOa7  
Figure 1. Minimum levels of cortical (a), nuclear (b), and posterior subcapsular (c) cataract. V| >u,  
final multivariate models, P < 0.05 was considered statistically *f~X wy"  
significant. Design effect was assessed through the use GNXQD}L?b?  
of cluster-specific models and multivariate models. The _/"m0/,  
design effect was assumed to be additive and an adjustment td@F%*  
made in the variance by adding the variance associated with IKM=Q. 7j  
the design effect prior to constructing the 95% confidence =|n NC  
limits. |X9YVZC  
RESULTS =KwG;25hX  
Study population ?op6_a-wm  
A total of 3271 (83%) of the Melbourne residents, 403 "v-\nAu  
(90%) Melbourne nursing home residents, and 1473 (92%) im^G {3z  
rural residents participated. In general, non-participants did 22L#\qVkl  
not differ from participants.16 The study population was o<e AZ  
representative of the Victorian population and Australia as EA 4a Z6%  
a whole. Vtm5&-  
The Melbourne residents ranged in age from 40 to x%ZjGDFm  
98 years (mean = 59) and 1511 (46%) were male. The "k\W2,q[  
Melbourne nursing home residents ranged in age from 46 to 2.Ym  
101 years (mean = 82) and 85 (21%) were men. The rural |b'fp1</  
residents ranged in age from 40 to 103 years (mean = 60) >?yaG=  
and 701 (47.5%) were men. /4j'?hB<g  
Prevalence of cataract and prior cataract surgery FqiC zP4  
As would be expected, the rate of any cataract increases A>^\jIB>  
dramatically with age (Table 1). The weighted rate of any #rzq9}9tB  
cataract in Victoria was 21.5% (95% CL 18.1, 24.9). 6q?C"\_  
Although the rates varied somewhat between the three AFL*a*  
strata, they were not significantly different as the 95% confidence q@P5c  
limits overlapped. The per cent of cataractous eyes J0w[vrs&]  
with best-corrected visual acuity of less than 6/12 was 12.5% zT0rvz1),M  
(65/520) for cortical cataract, 18% for nuclear cataract aT"q}UTK  
(97/534) and 14.4% (27/187) for PSC cataract. Cataract }:YS$'by  
surgery also rose dramatically with age. The overall wFpt#_fS  
weighted rate of prior cataract surgery in Victoria was BOn2`|oLuF  
3.79% (95% CL 2.97, 4.60) (Table 2). nCEt*~t9VE  
Risk factors for unoperated cataract t/HMJ  
Cases of cataract that had not been removed were classified 3> -/sii  
as unoperated cataract. Risk factor analyses for unoperated e{Pgz0sO Q  
cataract were not performed with the nursing home residents gKcP\m  
as information about risk factor exposure was not ROr$ Sz  
available for this cohort. The following factors were assessed W'rft@J$  
in relation to unoperated cataract: age, sex, residence b&~r Z  
(urban/rural), language spoken at home (a measure of ethnic ^]^Y~$u  
integration), country of birth, parents’ country of birth (a Ua\g*Cxh  
measure of ethnicity), years since migration, education, use g=Q#2/UQ<  
of ophthalmic services, use of optometric services, private ;%odN d  
health insurance status, duration of distance glasses use, ?s#DD,  
glaucoma, age-related maculopathy and employment status. EbuOPa  
In this cross sectional study it was not possible to assess the ItHKpTe r  
level of visual acuity that would predict a patient’s having %I;ej{*c  
cataract surgery, as visual acuity data prior to cataract ]3xnq<  
surgery were not available. 3>yb$ZU"-  
The significant risk factors for unoperated cataract in univariate 8Z:NT_Ss  
analyses were related to: whether a participant had ${ad[hs  
ever seen an optometrist, seen an ophthalmologist or been ;2@MPx  
diagnosed with glaucoma; and participants’ employment Wk$[;>NU3  
status (currently employed) and age. These significant KQaw*T[Q3w  
factors were placed in a backwards stepwise logistic regression /cexd_l|f  
model. The factors that remained significantly related CspY+%3$  
to unoperated cataract were whether participants had ever h&L+Qx  
seen an ophthalmologist, seen an optometrist and been i;y<gm"  
diagnosed with glaucoma. None of the demographic factors }E[S %W[  
were associated with unoperated cataract in the multivariate #?YQ&o~gZ  
model. LR]P?  
The per cent of participants with unoperated cataract fOm=#:O  
who said that they were dissatisfied or very dissatisfied with Nj*J~&6G  
Operated and unoperated cataract in Australia 79 M/:kh,3  
Table 1. Prevalence of any cataracta (excluding previous cataract surgery) by age, gender and cohort >e($T !}Z  
Age group Sex Urban Rural Nursing home Weighted total Cd#[b)d ?^  
(years) (%) (%) (%) !h}x,=`z/  
40–49 Male 2.56 4.04 0.00 3.00 (1.91, 4.08) ^F5[2<O/!  
Female 2.61 1.70 0.00 2.36 (1.61, 3.10) {jcrTjmxe  
50–59 Male 7.69 6.94 0.00 7.47 (5.80, 9.15) acdaDY  
Female 6.67 7.56 0.00 6.92 (5.60, 8.24) `n Y!nh6!  
60–69 Male 20.7 25.0 10.0 22.0 (18.1, 26.0) A &~G  
Female 27.9 35.7 37.5 30.3 (26.0, 34.7) hvQOwA;e  
70–79 Male 43.1 58.7 39.1 48.1 (41.2, 55.1) }?$d~]t)  
Female 58.6 66.2 55.6 61.0 (56.0, 65.9) fMlxtj+5   
80–89 Male 74.0 89.3 92.0 79.3 (72.3, 86.3) `XB(d@%  
Female 91.9 97.0 80.2 92.6 (86.4, 98.8) Pan^@B=Q  
90 + Male 100.0 100.0 75.0 98.8 (96.2, 100.0) `8\ _ ]w0  
Female 100.0 100.0 93.8 98.6 (97.0, 100.0) D!Owm&We  
Age-standardized BR8z%R  
(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) K!7o#"GM  
aCortical > 4/16, nuclear > standard 2, posterior subcapsular > 1 mm2 m%m/#\J E  
their current vision was 30% (290/683), compared with 27% |+mhY q|`  
(26/95) of participants with prior cataract surgery (chisquared, (zwxrOS  
1 d.f. = 0.25, P = 0.62). 8&qCH>Cf  
Outcomes of cataract surgery ]QJLES  
Two hundred and forty-nine eyes had undergone prior 2shr&M fp[  
cataract surgery. Of these 249 operated eyes, 49 (20%) were U O YM   
left aphakic, 6 (2.4%) had anterior chamber intraocular 5]:fkx  
lenses and 194 (78%) had posterior chamber intraocular <,(6*b  
lenses. The rate of capsulotomy in the eyes with intact xop9*Z$  
posterior capsules was 36% (73/202). Fifteen per cent of c|X.&<lX  
eyes (17/114) with a clear posterior capsule had bestcorrected AA;\7;k{  
visual acuity of less than 6/12 compared with 43% :aV(i.LW  
of eyes (6/14) with opaque capsules, and 15% of eyes "pa5+N&2-  
(11/73) with prior capsulotomies (chi-squared, 2 d.f. = 7.21, F[ N{7C3  
P = 0.027). YC - -&66  
The percentage of eyes with best-corrected visual acuity RnPJ,Z5s&&  
of 6/12 or better was 96% (302/314) for eyes without  gG1%.q  
cataract, 88% (1417/1609) for eyes with prevalent cataract afqLTWU S  
and 85% (211/249) for eyes with operated cataract (chisquared, T)6p,l  
2 d.f. = 22.3), P < 0.001). Twenty-seven of the ;Z-xum{  
operated eyes (11%) had visual acuities of less than 6/18 AFGWlC#`  
(moderate vision impairment) (Fig. 2). A cause of this H[U$4 %t  
moderate visual impairment (but not the only cause) in four (NyS2 `  
(15%) eyes was secondary to cataract surgery. Three of these x$QOOE]  
four eyes had undergone intracapsular cataract extraction 1"RO)&  
and the fourth eye had an opaque posterior capsule. No one o/@.*Rj>Bg  
had bilateral vision impairment as a result of their cataract |lm   
surgery. Qv(}*iq]  
DISCUSSION /zMiy?  
To our knowledge, this is the first paper to systematically PCF!Y (l  
assess the prevalence of current cataract, previous cataract oJK1~;:  
surgery, predictors of unoperated cataract and the outcomes ;Xk-hhR  
of cataract surgery in a population-based sample. The Visual cW4: eh  
Impairment Project is unique in that the sampling frame and R(@B4M2  
high response rate have ensured that the study population is m{9m.~d  
representative of Australians aged 40 years and over. Therefore, Bwj^9J/ob  
these data can be used to plan age-related cataract Rx<m+=  
services throughout Australia. "*CQ<@+  
We found the rate of any cataract in those over the age lCLz!k2di  
of 40 years to be 22%. Although relatively high, this rate is U']DB h  
significantly less than was reported in a number of previous #56}RV1  
studies,2,4,6 with the exception of the Casteldaccia Eye oXRmnt  
Study.5 However, it is difficult to compare rates of cataract yoGe^gar  
between studies because of different methodologies and D^yZ!}Kl  
cataract definitions employed in the various studies, as well Tjma'3H*T0  
as the different age structures of the study populations.  }&BE*U8_  
Other studies have used less conservative definitions of C&YJvMu  
cataract, thus leading to higher rates of cataract as defined. 6d&dB  
In most large epidemiologic studies of cataract, visual acuity ,l^; ZE  
has not been included in the definition of cataract. vM!lL6T:  
Therefore, the prevalence of cataract may not reflect the 2a8ZU{wjn  
actual need for cataract surgery in the community. f2ygN6(>  
80 McCarty et al. Cj"+` C)l  
Table 2. Prevalence of previous cataract by age, gender and cohort u>o<u a p  
Age group Gender Urban Rural Nursing home Weighted total k,wr6>'Vt  
(years) (%) (%) (%) Vp{! Ft8>  
40–49 Male 1.14 0.00 0.00 0.80 (0.00, 1.81) @{ *z1{  
Female 0.00 0.00 0.00 0.00 ( f1w&D ]|S+  
50–59 Male 0.68 0.58 0.00 0.65 (0.13, 1.17) )'3(=F$+l  
Female 0.57 0.00 0.00 0.41 (0.00, 1.00) oE \Cwd  
60–69 Male 2.12 7.59 0.00 3.80 (1.41, 6.19) gw' uY$  
Female 2.11 3.51 0.00 2.54 (1.81, 3.26) cK4Q! l6O  
70–79 Male 8.22 9.85 8.70 8.75 (6.38, 11.1) 12qX[39/  
Female 7.21 7.86 7.02 7.41 (5.36, 9.46) H~IR:WOw  
80–89 Male 25.0 30.0 14.3 26.2 (17.0, 35.4) %EkV-%o*  
Female 27.9 25.6 18.3 26.7 (20.2, 33.3) C^9G \s'  
90 + Male 0.00 16.7 66.7 9.19 (0.00, 21.5) ]S; ^QZ  
Female 58.3 100.0 26.9 63.1 (44.4, 81.8) k+#6  
Age-standardized g} \$9  
(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) D=Ia$O0.  
Figure 2. Visual acuity in eyes that had undergone cataract qd$Y"~Mco  
surgery, n = 249. h, Presenting; j, best-corrected. =v^LShD2^  
Operated and unoperated cataract in Australia 81 K; kaWV  
The weighted prevalence of prior cataract surgery in the $>Md]/I8  
Visual Impairment Project (3.6%) was similar to the crude WqQAt{W/<  
rate in the Beaver Dam Eye Study4 (3.1%), but less than the RW| LL@r  
crude rate in the Blue Mountains Eye Study6 (6.0%). RhwqAok|lj  
However, the age-standardized rate in the Blue Mountains 3h t>eaHi  
Eye Study (standardized to the age distribution of the urban ;#-yyU  
Visual Impairment Project cohort) was found to be less than 1 EE4N\  
the Visual Impairment Project (standardized rate = 1.36%, ` ;KU^dH  
95% CL 1.25, 1.47). The incidence of cataract surgery in 5?6U@??]  
Australia has exceeded population growth.1 This is due, +9mE1$C  
perhaps, to advances in surgical techniques and lens K @x4>9 3n  
implants that have changed the risk–benefit ratio. 99 W-sV  
The Global Initiative for the Elimination of Avoidable m# y`  
Blindness, sponsored by the World Health Organization, 2stBW5v3  
states that cataract surgical services should be provided that JF{yhx,+ p  
‘have a high success rate in terms of visual outcome and dL{zU4iUR  
improved quality of life’,17 although the ‘high success rate’ is K>%}m,  
not defined. Population- and clinic-based studies conducted )v\zaz  
in the United States have demonstrated marked improvement ]M^ k ~Xa  
in visual acuity following cataract surgery.18–20 We 3PRg/vD3  
found that 85% of eyes that had undergone cataract extraction k55s-%Ayr  
had visual acuity of 6/12 or better. Previously, we have u7PtGN0r%  
shown that participants with prevalent cataract in this =[ A5qwyv  
cohort are more likely to express dissatisfaction with their etnq{tE5  
current vision than participants without cataract or participants K<k!sh   
with prior cataract surgery.21 In a national study in the ~!V5Ug_2  
United States, researchers found that the change in patients’ +M )ep\j  
ratings of their vision difficulties and satisfaction with their 7TDt2:;]  
vision after cataract surgery were more highly related to j?c"BF.  
their change in visual functioning score than to their change ,=TY:U;?  
in visual acuity.19 Furthermore, improvement in visual function 'YQVf]4P  
has been shown to be associated with improvement in s R~D3-  
overall quality of life.22 ]|H`?L  
A recent review found that the incidence of visually c#)!-5E~H  
significant posterior capsule opacification following 5Z8Zb.  
cataract surgery to be greater than 25%.23 We found 36% uUhqj.::<Y  
capsulotomy in our population and that this was associated /z=xEnU#  
with visual acuity similar to that of eyes with a clear a:q>7V|%$  
capsule, but significantly better than that of eyes with an #'5C*RO  
opaque capsule. iX&eQ{LB  
A number of studies have shown that the demand and Xu.Wdl/{Ra  
timing of cataract surgery vary according to visual acuity, yr;~M {{4  
degree of handicap and socioeconomic factors.8–10,24,25 We 95XQ?%  
have also shown previously that ophthalmologists are more f6of8BOg  
likely to refer a patient for cataract surgery if the patient is cVV@MC  
employed and less likely to refer a nursing home resident.7 v[7iWBqJ  
In the Visual Impairment Project, we did not find that any l Rk )  
particular subgroup of the population was at greater risk of LL0Y$pHV  
having unoperated cataract. Universal access to health care #oYPe:8|m  
in Australia may explain the fact that people without _YK66cS3E/  
Medicare are more likely to delay cataract operations in the *XU2%"Sc  
USA,8 but not having private health insurance is not associated ~cf*Oq  
with unoperated cataract in Australia. A,'F`au  
In summary, cataract is a significant public health problem MQ#nP_i  
in that one in four people in their 80s will have had cataract cko^_V&x  
surgery. The importance of age-related cataract surgery will Yy 8? X9r.  
increase further with the ageing of the population: the gh?3[q6  
number of people over age 60 years is expected to double in SzTa[tJ+  
the next 20 years. Cataract surgery services are well "y9]>9:$-  
accessed by the Victorian population and the visual outcomes cb3Q{.-.#  
of cataract surgery have been shown to be very good. =#Z+WD-E  
These data can be used to plan for age-related cataract 6(1S_b=a  
surgical services in Australia in the future as the need for S{Q2KD  
cataract extractions increases. \[J\I   
ACKNOWLEDGEMENTS 6uTFgSqZ  
The Visual Impairment Project was funded in part by grants M*-]<!))7  
from the Victorian Health Promotion Foundation, the KXiStwS  
National Health and Medical Research Council, the Ansell !jTxMf  
Ophthalmology Foundation, the Dorothy Edols Estate and vf@toYc[E  
the Jack Brockhoff Foundation. Dr McCarty is the recipient Be~ '@  
of a Wagstaff Fellowship in Ophthalmology from the Royal =T-jG_.H  
Victorian Eye and Ear Hospital. Yh["IhjR  
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23. Schaumberg DA, Dana MR, Christen WG, Glynn RJ. A k4 %> F  
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