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主题 : Operated and unoperated cataract in Australia
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楼主  发表于: 2009-06-05   

Operated and unoperated cataract in Australia

ABSTRACT bTy' 5"  
Purpose: To quantify the prevalence of cataract, the outcomes 65`'Upu  
of cataract surgery and the factors related to [&O:qaD^  
unoperated cataract in Australia. ^?S@v1~7d  
Methods: Participants were recruited from the Visual $=QGua V  
Impairment Project: a cluster, stratified sample of more than 5 1CU@1Ie  
5000 Victorians aged 40 years and over. At examination @,>=X:7  
sites interviews, clinical examinations and lens photography C&s }m0R  
were performed. Cataract was defined in participants who @!O&b%8X%  
had: had previous cataract surgery, cortical cataract greater )hZ}$P1  
than 4/16, nuclear greater than Wilmer standard 2, or  !k??Kj  
posterior subcapsular greater than 1 mm2. 4Z T  
Results: The participant group comprised 3271 Melbourne 4kY{X%9  
residents, 403 Melbourne nursing home residents and 1473 5SWX v+  
rural residents.The weighted rate of any cataract in Victoria F>_lp,G   
was 21.5%. The overall weighted rate of prior cataract Y*X6lo  
surgery was 3.79%. Two hundred and forty-nine eyes had RKJWLofX&  
had prior cataract surgery. Of these 249 procedures, 49 A`U2HC   
(20%) were aphakic, 6 (2.4%) had anterior chamber /$4?.qtu  
intraocular lenses and 194 (78%) had posterior chamber uY%3X/^j  
intraocular lenses.Two hundred and eleven of these operated S?z j&X Y3  
eyes (85%) had best-corrected visual acuity of 6/12 or zB7dCw  
better, the legal requirement for a driver’s license.Twentyseven $Qc%9p @i  
(11%) had visual acuity of less than 6/18 (moderate /s0VyUV=  
vision impairment). Complications of cataract surgery SD.*G'N&2f  
caused reduced vision in four of the 27 eyes (15%), or 1.9% cXE y>U|/  
of operated eyes. Three of these four eyes had undergone Mn{Rg>X  
intracapsular cataract extraction and the fourth eye had an ['YRY B  
opaque posterior capsule. No one had bilateral vision 3&d +U)E  
impairment as a result of cataract surgery. Surprisingly, no =&G|} M  
particular demographic factors (such as age, gender, rural x=r6vOj  
residence, occupation, employment status, health insurance e&7}N Za  
status, ethnicity) were related to the presence of unoperated R =c  
cataract. (%IstR|u:  
Conclusions: Although the overall prevalence of cataract is <6@NgSFz'  
quite high, no particular subgroup is systematically underserviced {7szo`U2  
in terms of cataract surgery. Overall, the results of 2/gj@>dt  
cataract surgery are very good, with the majority of eyes 8l,hP.  
achieving driving vision following cataract extraction. aRKG)0=  
Key words: cataract extraction, health planning, health yBjWPx?  
services accessibility, prevalence 'WgwLE_  
INTRODUCTION ] :#IZ0#  
Cataract is the leading cause of blindness worldwide and, in Gjh7cm>  
Australia, cataract extractions account for the majority of all iiFKt(  
ophthalmic procedures.1 Over the period 1985–94, the rate W8rn8Rh  
of cataract surgery in Australia was twice as high as would be PG]mwaj])  
expected from the growth in the elderly population.1 %),O9*[9  
Although there have been a number of studies reporting } dlNMW  
the prevalence of cataract in various populations,2–6 there is 3"%44'  
little information about determinants of cataract surgery in v0J1%{/xs  
the population. A previous survey of Australian ophthalmologists 3c6)  
showed that patient concern and lifestyle, rather 2DQC)Pe+z  
than visual acuity itself, are the primary factors for referral :!\./z8v  
for cataract surgery.7 This supports prior research which has ?P]md9$(+e  
shown that visual acuity is not a strong predictor of need for }7v2GfEkM  
cataract surgery.8,9 Elsewhere, socioeconomic status has $ wB  
been shown to be related to cataract surgery rates.10 " <AljgF  
To appropriately plan health care services, information is 5q >u }J  
needed about the prevalence of age-related cataract in the J[AgOUc  
community as well as the factors associated with cataract Uij$ eBN  
surgery. The purpose of this study is to quantify the prevalence L+CSF ]  
of any cataract in Australia, to describe the factors Z&!$G'X  
related to unoperated cataract in the community and to  S_6 ;e|  
describe the visual outcomes of cataract surgery. S22; g  
METHODS Q+dI,5YF  
Study population g5[3[Z(.  
Details about the study methodology for the Visual Z%=E/xT  
Impairment Project have been published previously.11 K-5)Y+| >  
Briefly, cluster sampling within three strata was employed to Bnv%W4  
recruit subjects aged 40 years and over to participate. D bJ(N h  
Within the Melbourne Statistical Division, nine pairs of jL$X3QS:  
census collector districts were randomly selected. Fourteen \266N;JrN  
nursing homes within a 5 km radius of these nine test sites i/Z5/(z F  
were randomly chosen to recruit nursing home residents. Mt`.|N;y!  
Clinical and Experimental Ophthalmology (2000) 28, 77–82 @<L.#gtP  
Original Article 2]wh1)  
Operated and unoperated cataract in Australia _6( =0::x  
Catherine A McCarty PhD, MPH, Mukesh B Nanjan PhD, Hugh R Taylor MD WYL.J5O  
Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia b`mEnI VIz  
n Correspondence: Dr Cathy McCarty MPH, Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, 32 Gisborne Street, East Melbourne, 9Wn0YIc  
Victoria 3002, Australia. Email: cathy@cera.unimelb.edu.au cW\7yZh  
78 McCarty et al. "cx" d:  
Finally, four pairs of census collector districts in four rural z,WrLZC  
Victorian communities were randomly selected to recruit rural >e%Po,Fg$  
residents. A household census was conducted to identify .:}\Z27-c  
eligible residents aged 40 years and over who had been a p[ Es4S}N  
resident at that address for at least 6 months. At the time of Bb)J8,LQ  
the household census, basic information about age, sex, ~n?U{ RmH  
country of birth, language spoken at home, education, use of #@ G2n@Hj  
corrective spectacles and use of eye care services was collected. =0S7tNut  
Eligible residents were then invited to attend a local KH-.Z0 2U  
examination site for a more detailed interview and examination. TocqoYX{{  
The study protocol was approved by the Royal Victorian +e\u4k{3V  
Eye and Ear Hospital Human Research Ethics Committee. Kmtr.]Nj  
Assessment of cataract BLRrHaX0  
A standardized ophthalmic examination was performed after r?$\`,;  
pupil dilatation with one drop of 10% phenylephrine J0`?g6aY  
hydrochloride. Lens opacities were graded clinically at the (/^&3xs9  
time of the examination and subsequently from photos using pP .   
the Wilmer cataract photo-grading system.12 Cortical and ${?Px c{-  
posterior subcapsular (PSC) opacities were assessed on 5HB4B <2  
retroillumination and measured as the proportion (in 1/16) WJ%b9{<  
of pupil circumference occupied by opacity. For this analysis, 2b<0g@~X  
cortical cataract was defined as 4/16 or greater opacity, rpvm].4  
PSC cataract was defined as opacity equal to or greater than >[#4Pb7_Y  
1 mm2 and nuclear cataract was defined as opacity equal to ',.Xn`c  
or greater than Wilmer standard 2,12 independent of visual GxBj N7"  
acuity. Examples of the minimum opacities defined as cortical, up`6IWlLE  
nuclear and PSC cataract are presented in Figure 1. {*: C$"L  
Bilateral congenital cataracts or cataracts secondary to f"[C3o2P  
intraocular inflammation or trauma were excluded from the F$caKWzny5  
analysis. Two cases of bilateral secondary cataract and eight @? t)UE  
cases of bilateral congenital cataract were excluded from the f}fM%0/5  
analyses. 2Bx\nLf/ K  
A Topcon® SL5 photo slit-lamp (Topcon America Corp., se?nx7~  
Paramus, NJ, USA) with a 0.1 mm slit beam of 9.0 mm in ]WS 7l@  
height set to an incident angle of 30° was used for examinations. uQ{M<%K  
Ektachrome® 200 ASA colour slide film (Eastman Wg#>2)>  
Kodak Company, Rochester, NY, USA) was used to photograph +UB. M  
the nuclear opacities. The cortical opacities were a^,Xm(Wb}  
photographed with an Oxford® retroillumination camera 5-MI 7I@l  
(Marcher Enterprises Ltd, Hereford, UK) and T-MAX® 400 ^JH 4: h  
film (Eastman Kodak). Photographs were graded separately d hh`o\$  
by two research assistants and discrepancies were adjudicated F&ux9zP  
by an independent reviewer. Any discrepancies .(! $j-B  
between the clinical grades and the photograph grades were vzfWPjpKW  
resolved. Except in cases where photographs were missing, +"K a #Z  
the photograph grades were used in the analyses. Photograph t1D6#JP(a  
grades were available for 4301 (84%) for cortical }e1f kjWk  
cataract, 4147 (81%) for nuclear cataract and 4303 (84%) aK 'BC>uFI  
for PSC cataract. Cataract status was classified according to aCQAh[T  
the severity of the opacity in the worse eye. 1X]?-+',.  
Assessment of risk factors HG{OkDx]fl  
A standardized questionnaire was used to obtain information xse8fGs  
about education, employment and ethnic background.11 Py K)ks!6  
Specific information was elicited on the occurrence, duration rxt)l  
and treatment of a number of medical conditions, (r.[b  
including ocular trauma, arthritis, diabetes, gout, hypertension Nv w'[?m  
and mental illness. Information about the use, dose and Ubv<3syR'  
duration of tobacco, alcohol, analgesics and steriods were  "H#2  
collected, and a food frequency questionnaire was used to b{_J%p  
determine current consumption of dietary sources of antioxidants it \3-  
and use of vitamin supplements. s>ilxLSX]  
Data management and statistical analysis (} ?")$.  
Data were collected either by direct computer entry with a *6<<6f`(  
questionnaire programmed in Paradox© (Carel Corporation, OF-$*  
Ottawa, Canada) with internal consistency checks, or O!#r2Y"?K1  
on self-coding forms. Open-ended responses were coded at Dg W*Br8<  
a later time. Data that were entered on the self-coded forms opc`n}Fc  
were entered into a computer with double data entry and BS!VAHO"V  
reconciliation of any inconsistencies. Data range and consistency k^K>*mcJ  
checks were performed on the entire data set. q8#zv_>K  
SAS© version 6.1 (SAS Institute, Cary, North Carolina) was B:;$5PUTc  
employed for statistical analyses. gM>geWB<  
Ninety-five per cent confidence limits around the agespecific "n'kv!?\  
rates were calculated according to Cochran13 to wwUa+6?  
account for the effect of the cluster sampling. Ninety-five ip8%9fG\>  
per cent confidence limits around age-standardized rates B63puX{u#  
were calculated according to Breslow and Day.14 The strataspecific kn %i#Fz  
data were weighted according to the 1996 iC2``[m"  
Australian Bureau of Statistics census data15 to reflect the ;S0Kf{DN2  
cataract prevalence in the entire Victorian population. e|> 5 R  
Univariate analyses with Student’s t-tests and chi-squared sBm)D=Kll  
tests were first employed to evaluate risk factors for unoperated \w#)uYK{i_  
cataract. Any factors with P < 0.10 were then fitted z;iNfs0i$  
into a backwards stepwise logistic regression model. For the P_}wjz}9ZX  
Figure 1. Minimum levels of cortical (a), nuclear (b), and posterior subcapsular (c) cataract. duQ ,6  
final multivariate models, P < 0.05 was considered statistically [ |&#A;{F#  
significant. Design effect was assessed through the use g ^I ?u$&E  
of cluster-specific models and multivariate models. The {f"oq ry_g  
design effect was assumed to be additive and an adjustment 7D&O5Z=%+  
made in the variance by adding the variance associated with @B \$ me  
the design effect prior to constructing the 95% confidence >)^Q p-  
limits. X{Ij30Bmv  
RESULTS InA=ty]"_U  
Study population F/ o }5H  
A total of 3271 (83%) of the Melbourne residents, 403 'C7$,H'  
(90%) Melbourne nursing home residents, and 1473 (92%) 'D'H)J  
rural residents participated. In general, non-participants did nD.K*#u  
not differ from participants.16 The study population was Yz)+UF,  
representative of the Victorian population and Australia as :'2h0 5R  
a whole. xL [3R   
The Melbourne residents ranged in age from 40 to [2{2w68D!  
98 years (mean = 59) and 1511 (46%) were male. The  qC6@  
Melbourne nursing home residents ranged in age from 46 to 6t=)1T   
101 years (mean = 82) and 85 (21%) were men. The rural hx!:F"#  
residents ranged in age from 40 to 103 years (mean = 60) f cnv[B..{  
and 701 (47.5%) were men. 4&AGVplgF  
Prevalence of cataract and prior cataract surgery n"w>Y)C(X)  
As would be expected, the rate of any cataract increases 4Ss*h,Y  
dramatically with age (Table 1). The weighted rate of any 6zIK%<  
cataract in Victoria was 21.5% (95% CL 18.1, 24.9). Ax6zx  
Although the rates varied somewhat between the three :}-VLp4b  
strata, they were not significantly different as the 95% confidence cJ\ 1ndBH  
limits overlapped. The per cent of cataractous eyes &z05h<]  
with best-corrected visual acuity of less than 6/12 was 12.5% Dtox/ ,"  
(65/520) for cortical cataract, 18% for nuclear cataract D+u\ORj  
(97/534) and 14.4% (27/187) for PSC cataract. Cataract P~84#5R1  
surgery also rose dramatically with age. The overall %Z8wUG  
weighted rate of prior cataract surgery in Victoria was =gC% =  
3.79% (95% CL 2.97, 4.60) (Table 2). 9"?;H%.  
Risk factors for unoperated cataract (coaGQ@d  
Cases of cataract that had not been removed were classified Yfx ?3  
as unoperated cataract. Risk factor analyses for unoperated 7)RRCsn  
cataract were not performed with the nursing home residents !D!"ftOm  
as information about risk factor exposure was not IOa@dUh7a,  
available for this cohort. The following factors were assessed n\< uT1n  
in relation to unoperated cataract: age, sex, residence ^ U);MH8  
(urban/rural), language spoken at home (a measure of ethnic i|0!yID0@  
integration), country of birth, parents’ country of birth (a W6RjQ1  
measure of ethnicity), years since migration, education, use &;R BG$t  
of ophthalmic services, use of optometric services, private &UVqF o  
health insurance status, duration of distance glasses use, 3vkzN  
glaucoma, age-related maculopathy and employment status. wb%4f6i  
In this cross sectional study it was not possible to assess the lk[u  
level of visual acuity that would predict a patient’s having /z(d!0_q|v  
cataract surgery, as visual acuity data prior to cataract ;X:Bh8tEV  
surgery were not available. qoZe<jW (  
The significant risk factors for unoperated cataract in univariate 0d$LUQ't  
analyses were related to: whether a participant had TEbIU8{Y  
ever seen an optometrist, seen an ophthalmologist or been  N!Xn)J  
diagnosed with glaucoma; and participants’ employment KO/#t~  
status (currently employed) and age. These significant J\ N &u#  
factors were placed in a backwards stepwise logistic regression }rnu:7  
model. The factors that remained significantly related eep/96G ?  
to unoperated cataract were whether participants had ever <<V"4 C2  
seen an ophthalmologist, seen an optometrist and been Bat@  
diagnosed with glaucoma. None of the demographic factors ;2[OI  
were associated with unoperated cataract in the multivariate /`t}5U>S_  
model. #ApmJLeCO  
The per cent of participants with unoperated cataract @1q dnU  
who said that they were dissatisfied or very dissatisfied with t3*.Bm:^  
Operated and unoperated cataract in Australia 79 @LY[kt6o  
Table 1. Prevalence of any cataracta (excluding previous cataract surgery) by age, gender and cohort 3 lKs>HE0  
Age group Sex Urban Rural Nursing home Weighted total CYsLyk  
(years) (%) (%) (%) !| q19$  
40–49 Male 2.56 4.04 0.00 3.00 (1.91, 4.08) ?kRx;S+  
Female 2.61 1.70 0.00 2.36 (1.61, 3.10) B,` `2\B  
50–59 Male 7.69 6.94 0.00 7.47 (5.80, 9.15) Q'Uv5p"X  
Female 6.67 7.56 0.00 6.92 (5.60, 8.24) zm_8{Rta}  
60–69 Male 20.7 25.0 10.0 22.0 (18.1, 26.0) mR|']^!SE  
Female 27.9 35.7 37.5 30.3 (26.0, 34.7) fo <nk|i  
70–79 Male 43.1 58.7 39.1 48.1 (41.2, 55.1) m 0Uu2Z4  
Female 58.6 66.2 55.6 61.0 (56.0, 65.9) :.f( }sCS  
80–89 Male 74.0 89.3 92.0 79.3 (72.3, 86.3) dp2FC   
Female 91.9 97.0 80.2 92.6 (86.4, 98.8) #Fgybokm  
90 + Male 100.0 100.0 75.0 98.8 (96.2, 100.0) vg1E@rH|}  
Female 100.0 100.0 93.8 98.6 (97.0, 100.0) 1uEM;O  
Age-standardized 6KE64: \;  
(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) !Q}Bz*Y  
aCortical > 4/16, nuclear > standard 2, posterior subcapsular > 1 mm2 \5a;_N[Ed  
their current vision was 30% (290/683), compared with 27% MM&qLAa"f  
(26/95) of participants with prior cataract surgery (chisquared, w}M)]kY  
1 d.f. = 0.25, P = 0.62). iszVM  
Outcomes of cataract surgery ^`RMf5i1m  
Two hundred and forty-nine eyes had undergone prior f1B t6|W%  
cataract surgery. Of these 249 operated eyes, 49 (20%) were %6&c3,?U\n  
left aphakic, 6 (2.4%) had anterior chamber intraocular 0Ca/[_  
lenses and 194 (78%) had posterior chamber intraocular ]w]:9w  
lenses. The rate of capsulotomy in the eyes with intact UnyJD%a  
posterior capsules was 36% (73/202). Fifteen per cent of x4`|[  
eyes (17/114) with a clear posterior capsule had bestcorrected 4F!%mMq  
visual acuity of less than 6/12 compared with 43% r jnf30  
of eyes (6/14) with opaque capsules, and 15% of eyes 7{VN27Fa_  
(11/73) with prior capsulotomies (chi-squared, 2 d.f. = 7.21, G*-7}7OAs  
P = 0.027).  Sg(\+j=  
The percentage of eyes with best-corrected visual acuity 7p {2&YhB  
of 6/12 or better was 96% (302/314) for eyes without qg*xdefQ%  
cataract, 88% (1417/1609) for eyes with prevalent cataract y+7A?"s)  
and 85% (211/249) for eyes with operated cataract (chisquared, N0YJ'.=8,  
2 d.f. = 22.3), P < 0.001). Twenty-seven of the MEtKFC|p  
operated eyes (11%) had visual acuities of less than 6/18 jz I,B  
(moderate vision impairment) (Fig. 2). A cause of this A8ClkLC;I  
moderate visual impairment (but not the only cause) in four V|4k=_-  
(15%) eyes was secondary to cataract surgery. Three of these R?:(~ X\  
four eyes had undergone intracapsular cataract extraction #BIY[{!  
and the fourth eye had an opaque posterior capsule. No one vfh\X1Ui}  
had bilateral vision impairment as a result of their cataract QQ99sy  
surgery. Wf&i{3z[  
DISCUSSION O5JG!bGE_F  
To our knowledge, this is the first paper to systematically ?u{D-by%&  
assess the prevalence of current cataract, previous cataract %,udZyO3uR  
surgery, predictors of unoperated cataract and the outcomes wNl "y  
of cataract surgery in a population-based sample. The Visual hNF,sA  
Impairment Project is unique in that the sampling frame and Z}>+!Z  
high response rate have ensured that the study population is iv6bXV'N  
representative of Australians aged 40 years and over. Therefore, (2/i1)Cq  
these data can be used to plan age-related cataract ho6,&Bp8  
services throughout Australia. ^!K 8nW{*  
We found the rate of any cataract in those over the age lH>6;sE  
of 40 years to be 22%. Although relatively high, this rate is 6/|"y  
significantly less than was reported in a number of previous .1[pO_  
studies,2,4,6 with the exception of the Casteldaccia Eye B_0]$D0 ^  
Study.5 However, it is difficult to compare rates of cataract lp5 b&I_  
between studies because of different methodologies and w)Y}hlcq  
cataract definitions employed in the various studies, as well m8&XW2S  
as the different age structures of the study populations. <}AmzeHr+  
Other studies have used less conservative definitions of _;k))K^  
cataract, thus leading to higher rates of cataract as defined. ~h444Hp=  
In most large epidemiologic studies of cataract, visual acuity &- ZRS/_d>  
has not been included in the definition of cataract. l4q7,%G  
Therefore, the prevalence of cataract may not reflect the jHc/ EZB  
actual need for cataract surgery in the community. V(n3W=#kky  
80 McCarty et al. cONfHl{  
Table 2. Prevalence of previous cataract by age, gender and cohort A Zv| |8p  
Age group Gender Urban Rural Nursing home Weighted total f{#Mc  
(years) (%) (%) (%) |( R[5q  
40–49 Male 1.14 0.00 0.00 0.80 (0.00, 1.81) |1Ko5z  
Female 0.00 0.00 0.00 0.00 ( .t{?doOT  
50–59 Male 0.68 0.58 0.00 0.65 (0.13, 1.17) A>}] =Ii/  
Female 0.57 0.00 0.00 0.41 (0.00, 1.00) F2["AkNM  
60–69 Male 2.12 7.59 0.00 3.80 (1.41, 6.19) CV6W)B%Se  
Female 2.11 3.51 0.00 2.54 (1.81, 3.26) SP5t=#M6  
70–79 Male 8.22 9.85 8.70 8.75 (6.38, 11.1) IR*:i{  
Female 7.21 7.86 7.02 7.41 (5.36, 9.46) |-VbJd  
80–89 Male 25.0 30.0 14.3 26.2 (17.0, 35.4) ktK/s!bgY  
Female 27.9 25.6 18.3 26.7 (20.2, 33.3) eR5+1b  
90 + Male 0.00 16.7 66.7 9.19 (0.00, 21.5) Hxd ^oE  
Female 58.3 100.0 26.9 63.1 (44.4, 81.8) ^->vUf7PX  
Age-standardized k3t2{=&'&x  
(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) 6c&OR2HGqO  
Figure 2. Visual acuity in eyes that had undergone cataract 'P~6_BW  
surgery, n = 249. h, Presenting; j, best-corrected. WjMP]ND#c  
Operated and unoperated cataract in Australia 81 N_>}UhZ  
The weighted prevalence of prior cataract surgery in the _fANl}Mf:  
Visual Impairment Project (3.6%) was similar to the crude {v}jV{'^um  
rate in the Beaver Dam Eye Study4 (3.1%), but less than the zs@[!?A,  
crude rate in the Blue Mountains Eye Study6 (6.0%). MEn#MT/Cz  
However, the age-standardized rate in the Blue Mountains VR0#"  
Eye Study (standardized to the age distribution of the urban EM.rO/qcW  
Visual Impairment Project cohort) was found to be less than UQ 'U 4q  
the Visual Impairment Project (standardized rate = 1.36%, [u2)kH$  
95% CL 1.25, 1.47). The incidence of cataract surgery in H@WQO]P A  
Australia has exceeded population growth.1 This is due, H=k*;'  
perhaps, to advances in surgical techniques and lens >w=xGb7  
implants that have changed the risk–benefit ratio. %S<( z5  
The Global Initiative for the Elimination of Avoidable "A?_)=zZ  
Blindness, sponsored by the World Health Organization, vXM``|  
states that cataract surgical services should be provided that m=< ;)  
‘have a high success rate in terms of visual outcome and v+Q# O[  
improved quality of life’,17 although the ‘high success rate’ is |!{ BjOAD'  
not defined. Population- and clinic-based studies conducted \;A\ vQ[  
in the United States have demonstrated marked improvement {XNu4d9w(  
in visual acuity following cataract surgery.18–20 We vv,(ta@t2  
found that 85% of eyes that had undergone cataract extraction q qYH}%0dz  
had visual acuity of 6/12 or better. Previously, we have f V.(v&  
shown that participants with prevalent cataract in this g3%t+>$*  
cohort are more likely to express dissatisfaction with their 7>m#Y'ppl@  
current vision than participants without cataract or participants IczEddt@'  
with prior cataract surgery.21 In a national study in the I -obfyije  
United States, researchers found that the change in patients’ -j9R%+YW<  
ratings of their vision difficulties and satisfaction with their +:d))r=n  
vision after cataract surgery were more highly related to jL)aU> kN  
their change in visual functioning score than to their change L$x/T3@  
in visual acuity.19 Furthermore, improvement in visual function hGF(E*  
has been shown to be associated with improvement in *R>I%?]V3  
overall quality of life.22 P"u*bqk  
A recent review found that the incidence of visually Nu{RF  
significant posterior capsule opacification following ,Fg&<Be}Jx  
cataract surgery to be greater than 25%.23 We found 36% nx,67u/Pb  
capsulotomy in our population and that this was associated ki^[~JS>'  
with visual acuity similar to that of eyes with a clear Xb3vvHdI  
capsule, but significantly better than that of eyes with an *(d^ k;  
opaque capsule. cVn7jxf  
A number of studies have shown that the demand and AJ:@c7:eS  
timing of cataract surgery vary according to visual acuity, ,^o^@SI)   
degree of handicap and socioeconomic factors.8–10,24,25 We ;Xgy2'3  
have also shown previously that ophthalmologists are more =GM!M@~,Ab  
likely to refer a patient for cataract surgery if the patient is ~rY<y%K  
employed and less likely to refer a nursing home resident.7 =4JVUu~Z  
In the Visual Impairment Project, we did not find that any e@^}y4 C  
particular subgroup of the population was at greater risk of 9i|6  
having unoperated cataract. Universal access to health care 2 >xV&  
in Australia may explain the fact that people without 7@tr^JykO  
Medicare are more likely to delay cataract operations in the Z@C D1+G  
USA,8 but not having private health insurance is not associated KS(T%mk\  
with unoperated cataract in Australia. nNilT J   
In summary, cataract is a significant public health problem <6L$ :vT_  
in that one in four people in their 80s will have had cataract <!OP b(g2  
surgery. The importance of age-related cataract surgery will QTn-n)AE  
increase further with the ageing of the population: the PL+fLCk,I  
number of people over age 60 years is expected to double in 6lWO8j^BN  
the next 20 years. Cataract surgery services are well U;V. +onv  
accessed by the Victorian population and the visual outcomes x-Mp6  
of cataract surgery have been shown to be very good. +Qc^A  
These data can be used to plan for age-related cataract @#Xzk?+  
surgical services in Australia in the future as the need for Ugdm"  
cataract extractions increases. M;43F*   
ACKNOWLEDGEMENTS [#R%jLEJ2  
The Visual Impairment Project was funded in part by grants *10e)rzM  
from the Victorian Health Promotion Foundation, the ZA9']u%EJ  
National Health and Medical Research Council, the Ansell ap6Vmp  
Ophthalmology Foundation, the Dorothy Edols Estate and B EI/OGp  
the Jack Brockhoff Foundation. Dr McCarty is the recipient )7i?8XiSZF  
of a Wagstaff Fellowship in Ophthalmology from the Royal VhW;=y>}  
Victorian Eye and Ear Hospital. ;!~;05^iD  
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