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

ABSTRACT 8r|LFuI  
Purpose: To quantify the prevalence of cataract, the outcomes 9e=*jRs]l^  
of cataract surgery and the factors related to k@Tt,.];  
unoperated cataract in Australia. * =Fcu@  
Methods: Participants were recruited from the Visual ;PHnv5 x@f  
Impairment Project: a cluster, stratified sample of more than 5cADC`q  
5000 Victorians aged 40 years and over. At examination us cR/d  
sites interviews, clinical examinations and lens photography :U*[s$  
were performed. Cataract was defined in participants who ]@P*&FRcZ  
had: had previous cataract surgery, cortical cataract greater t}tKm  
than 4/16, nuclear greater than Wilmer standard 2, or Mm;)O'XDE  
posterior subcapsular greater than 1 mm2. ~4^e a  
Results: The participant group comprised 3271 Melbourne ?4Lo"igAA  
residents, 403 Melbourne nursing home residents and 1473 4 5lg&oO  
rural residents.The weighted rate of any cataract in Victoria +{I\r|  
was 21.5%. The overall weighted rate of prior cataract op*+fJHD  
surgery was 3.79%. Two hundred and forty-nine eyes had J$Q-1fjj  
had prior cataract surgery. Of these 249 procedures, 49 )yP>}ME  
(20%) were aphakic, 6 (2.4%) had anterior chamber f+6l0@K2  
intraocular lenses and 194 (78%) had posterior chamber m&q;.|W  
intraocular lenses.Two hundred and eleven of these operated Cg Sdyg@  
eyes (85%) had best-corrected visual acuity of 6/12 or xD=D *W  
better, the legal requirement for a driver’s license.Twentyseven {dwV-qz  
(11%) had visual acuity of less than 6/18 (moderate Lk9>7xY  
vision impairment). Complications of cataract surgery 6`C27  
caused reduced vision in four of the 27 eyes (15%), or 1.9% WI6E3,ejB1  
of operated eyes. Three of these four eyes had undergone *eP4dGe&  
intracapsular cataract extraction and the fourth eye had an ]SL&x:/-  
opaque posterior capsule. No one had bilateral vision A 5 X+Z  
impairment as a result of cataract surgery. Surprisingly, no h+UscdU l  
particular demographic factors (such as age, gender, rural `<zb  
residence, occupation, employment status, health insurance uKy*N*}  
status, ethnicity) were related to the presence of unoperated x]oQl^ F  
cataract. \6hL W_q1  
Conclusions: Although the overall prevalence of cataract is F9\Ot^~  
quite high, no particular subgroup is systematically underserviced (NdgF+'=  
in terms of cataract surgery. Overall, the results of <6C9R>  
cataract surgery are very good, with the majority of eyes ?+5{HFx  
achieving driving vision following cataract extraction. rcx;3Vne  
Key words: cataract extraction, health planning, health P|4E1O  
services accessibility, prevalence 7omGg~!k(  
INTRODUCTION 0> =)  
Cataract is the leading cause of blindness worldwide and, in ?d<:V.1U@  
Australia, cataract extractions account for the majority of all @$d\5Q(G  
ophthalmic procedures.1 Over the period 1985–94, the rate "g%:#'5  
of cataract surgery in Australia was twice as high as would be O'-Zn]@.]  
expected from the growth in the elderly population.1 9K46>_TyH  
Although there have been a number of studies reporting F/*fQAa"  
the prevalence of cataract in various populations,2–6 there is :ECK $Cu  
little information about determinants of cataract surgery in +){a[@S@x  
the population. A previous survey of Australian ophthalmologists ;b?+:L  
showed that patient concern and lifestyle, rather P9"D[uz  
than visual acuity itself, are the primary factors for referral 0ITA3v8{  
for cataract surgery.7 This supports prior research which has @ P"`=BU&  
shown that visual acuity is not a strong predictor of need for 5**5b9bj-9  
cataract surgery.8,9 Elsewhere, socioeconomic status has *{dD'9Bg  
been shown to be related to cataract surgery rates.10 1mn$Rh&dO  
To appropriately plan health care services, information is n5k^v $'  
needed about the prevalence of age-related cataract in the :+ 9Ft>  
community as well as the factors associated with cataract  ,eeL5V  
surgery. The purpose of this study is to quantify the prevalence ?PE1aB+{:  
of any cataract in Australia, to describe the factors ;}eEG{`Y  
related to unoperated cataract in the community and to m0A@jWgd  
describe the visual outcomes of cataract surgery. K~Au?\{  
METHODS J;=aIiN]R  
Study population }8V;s-1  
Details about the study methodology for the Visual W|H4i;u  
Impairment Project have been published previously.11 FJjF*2 .  
Briefly, cluster sampling within three strata was employed to ;h-G3>Il  
recruit subjects aged 40 years and over to participate. O5TK&j  
Within the Melbourne Statistical Division, nine pairs of )1Ma~8Y%r  
census collector districts were randomly selected. Fourteen lYZ@a4TA  
nursing homes within a 5 km radius of these nine test sites j |'# 5H`  
were randomly chosen to recruit nursing home residents. mU?&\w=v$  
Clinical and Experimental Ophthalmology (2000) 28, 77–82 UOLTCp?M;J  
Original Article E%k ]cZ  
Operated and unoperated cataract in Australia yA !3XUi  
Catherine A McCarty PhD, MPH, Mukesh B Nanjan PhD, Hugh R Taylor MD 1(:b{Bl  
Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia p9&gEW  
n Correspondence: Dr Cathy McCarty MPH, Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, 32 Gisborne Street, East Melbourne, G {pP}  
Victoria 3002, Australia. Email: cathy@cera.unimelb.edu.au 7dufY }}  
78 McCarty et al. mq{$9@3  
Finally, four pairs of census collector districts in four rural 6"7:44O;G  
Victorian communities were randomly selected to recruit rural zfP[1  
residents. A household census was conducted to identify m0BG9~p|  
eligible residents aged 40 years and over who had been a A{ i][1N  
resident at that address for at least 6 months. At the time of aR="5{en{:  
the household census, basic information about age, sex, , `[Z`SUk`  
country of birth, language spoken at home, education, use of _o&,  
corrective spectacles and use of eye care services was collected. XDP6T"h  
Eligible residents were then invited to attend a local m0%iw1OsH%  
examination site for a more detailed interview and examination. w L/p.@  
The study protocol was approved by the Royal Victorian zH=/.31Q  
Eye and Ear Hospital Human Research Ethics Committee. _ bXVg3oDt  
Assessment of cataract Yn IM-  
A standardized ophthalmic examination was performed after !~lVv&YO  
pupil dilatation with one drop of 10% phenylephrine AMh37Xo  
hydrochloride. Lens opacities were graded clinically at the AQnJxIL:  
time of the examination and subsequently from photos using  <?> I\  
the Wilmer cataract photo-grading system.12 Cortical and =RW* %8C  
posterior subcapsular (PSC) opacities were assessed on lQp89*b?=U  
retroillumination and measured as the proportion (in 1/16) QoW ( tM  
of pupil circumference occupied by opacity. For this analysis, 27Kc -rcB  
cortical cataract was defined as 4/16 or greater opacity, 3i]"#wK  
PSC cataract was defined as opacity equal to or greater than wE,=%?"  
1 mm2 and nuclear cataract was defined as opacity equal to i$`|Y*  
or greater than Wilmer standard 2,12 independent of visual WX%h4)z*  
acuity. Examples of the minimum opacities defined as cortical, 26\HV  
nuclear and PSC cataract are presented in Figure 1. L?3VyBE  
Bilateral congenital cataracts or cataracts secondary to lF; ziF  
intraocular inflammation or trauma were excluded from the T8,k7 7  
analysis. Two cases of bilateral secondary cataract and eight '\ph `Run  
cases of bilateral congenital cataract were excluded from the |uQn|"U4  
analyses. !7:EE,W~  
A Topcon® SL5 photo slit-lamp (Topcon America Corp., q=P f^Xp  
Paramus, NJ, USA) with a 0.1 mm slit beam of 9.0 mm in S  KB@  
height set to an incident angle of 30° was used for examinations. %-h7Z3YcN  
Ektachrome® 200 ASA colour slide film (Eastman D 7Gd%  
Kodak Company, Rochester, NY, USA) was used to photograph $Qn& jI38  
the nuclear opacities. The cortical opacities were B8bvp:Ho|  
photographed with an Oxford® retroillumination camera w;N{>)hv  
(Marcher Enterprises Ltd, Hereford, UK) and T-MAX® 400 lSZ"y Q+  
film (Eastman Kodak). Photographs were graded separately K%Usjezv&  
by two research assistants and discrepancies were adjudicated .Lr`j8  
by an independent reviewer. Any discrepancies QT`fix{  
between the clinical grades and the photograph grades were #D!$~ h&i  
resolved. Except in cases where photographs were missing, b*lKT]D,  
the photograph grades were used in the analyses. Photograph }U2[?  
grades were available for 4301 (84%) for cortical 'b LP ~  
cataract, 4147 (81%) for nuclear cataract and 4303 (84%) pWMiCXnW  
for PSC cataract. Cataract status was classified according to @Djs[Cs<*  
the severity of the opacity in the worse eye. PfVEv *  
Assessment of risk factors b cC\  
A standardized questionnaire was used to obtain information kFS0i%Sr  
about education, employment and ethnic background.11 cNdu.c[@  
Specific information was elicited on the occurrence, duration ^bF}_CSE  
and treatment of a number of medical conditions, M#=Y~PU  
including ocular trauma, arthritis, diabetes, gout, hypertension $`^H:Djr  
and mental illness. Information about the use, dose and B#J{F  
duration of tobacco, alcohol, analgesics and steriods were Bfbl#ZkyL  
collected, and a food frequency questionnaire was used to j1'\R+4U  
determine current consumption of dietary sources of antioxidants Q]!6uA$A  
and use of vitamin supplements. wG_4$kyj  
Data management and statistical analysis cB{%u '  
Data were collected either by direct computer entry with a |__d 8a  
questionnaire programmed in Paradox© (Carel Corporation, 0 9tikj1  
Ottawa, Canada) with internal consistency checks, or ! &Z*yH  
on self-coding forms. Open-ended responses were coded at A3xbT\xdg  
a later time. Data that were entered on the self-coded forms bSQ_"  
were entered into a computer with double data entry and "_t4F4z  
reconciliation of any inconsistencies. Data range and consistency cvxIp#FbW  
checks were performed on the entire data set. ',DeP>'%>  
SAS© version 6.1 (SAS Institute, Cary, North Carolina) was TV? ^c?{5  
employed for statistical analyses. XnD0eua#  
Ninety-five per cent confidence limits around the agespecific %?@x]B9Y8E  
rates were calculated according to Cochran13 to yj>) {NcX  
account for the effect of the cluster sampling. Ninety-five 9_eS`,'  
per cent confidence limits around age-standardized rates 0"hiCGm'  
were calculated according to Breslow and Day.14 The strataspecific .Xi2G@D  
data were weighted according to the 1996 sbzeY 1  
Australian Bureau of Statistics census data15 to reflect the n>n"{!  
cataract prevalence in the entire Victorian population. miPmpu!  
Univariate analyses with Student’s t-tests and chi-squared P?xA$_+  
tests were first employed to evaluate risk factors for unoperated ;jF%bE3  
cataract. Any factors with P < 0.10 were then fitted r9<V%PH v  
into a backwards stepwise logistic regression model. For the o94P I*.  
Figure 1. Minimum levels of cortical (a), nuclear (b), and posterior subcapsular (c) cataract. (:JjQ`i  
final multivariate models, P < 0.05 was considered statistically ej<`CQ  
significant. Design effect was assessed through the use }N@n{bu+  
of cluster-specific models and multivariate models. The  M' YJ"  
design effect was assumed to be additive and an adjustment 6I"C~&dt  
made in the variance by adding the variance associated with Mg+4huT  
the design effect prior to constructing the 95% confidence N_0pO<<cs  
limits. *aI~W^N3  
RESULTS 1}`2\3,  
Study population (,shiK[5f  
A total of 3271 (83%) of the Melbourne residents, 403 Gj)uy jct  
(90%) Melbourne nursing home residents, and 1473 (92%) Y^yG/F  
rural residents participated. In general, non-participants did yYg   
not differ from participants.16 The study population was >C:If0S4X  
representative of the Victorian population and Australia as M= atls  
a whole. CPVmF$A-  
The Melbourne residents ranged in age from 40 to @\!ww/QT  
98 years (mean = 59) and 1511 (46%) were male. The kwO eHdV^  
Melbourne nursing home residents ranged in age from 46 to BK*z 4m  
101 years (mean = 82) and 85 (21%) were men. The rural a/:]"`)  
residents ranged in age from 40 to 103 years (mean = 60) ;sCU [4  
and 701 (47.5%) were men. 0_Lm#fE U  
Prevalence of cataract and prior cataract surgery Rh[Ibm56  
As would be expected, the rate of any cataract increases >GmN~"iJ  
dramatically with age (Table 1). The weighted rate of any ",T` \8&@e  
cataract in Victoria was 21.5% (95% CL 18.1, 24.9). >J>>\Y(p  
Although the rates varied somewhat between the three i0iez9B  
strata, they were not significantly different as the 95% confidence V'C-'Ythwf  
limits overlapped. The per cent of cataractous eyes x_k S g  
with best-corrected visual acuity of less than 6/12 was 12.5% @R UP $  
(65/520) for cortical cataract, 18% for nuclear cataract J$rJd9t  
(97/534) and 14.4% (27/187) for PSC cataract. Cataract R2CQXhiJ  
surgery also rose dramatically with age. The overall Fav ^^vf*1  
weighted rate of prior cataract surgery in Victoria was =tnTdp0F  
3.79% (95% CL 2.97, 4.60) (Table 2). m9woredS,  
Risk factors for unoperated cataract }I]W'<jY  
Cases of cataract that had not been removed were classified GZ"&L?ti  
as unoperated cataract. Risk factor analyses for unoperated mbGcDG[HQ  
cataract were not performed with the nursing home residents l=xt;c!  
as information about risk factor exposure was not bs BZ E  
available for this cohort. The following factors were assessed Gnk|^i;t  
in relation to unoperated cataract: age, sex, residence >J@egIKzP  
(urban/rural), language spoken at home (a measure of ethnic $ o " L;j  
integration), country of birth, parents’ country of birth (a d@Q][7  
measure of ethnicity), years since migration, education, use E23w *']  
of ophthalmic services, use of optometric services, private C38%H  
health insurance status, duration of distance glasses use, XGhwrI^  
glaucoma, age-related maculopathy and employment status. St2Q7K5s{  
In this cross sectional study it was not possible to assess the ~{P:sjs U  
level of visual acuity that would predict a patient’s having Y1WHy *s?  
cataract surgery, as visual acuity data prior to cataract <wa(xDBw  
surgery were not available. {@45?L('  
The significant risk factors for unoperated cataract in univariate +9C;<f  
analyses were related to: whether a participant had PtqGX=u  
ever seen an optometrist, seen an ophthalmologist or been `s%QeAde  
diagnosed with glaucoma; and participants’ employment ABZ06S/  
status (currently employed) and age. These significant ,VWGq@o%  
factors were placed in a backwards stepwise logistic regression O|7yP30?M  
model. The factors that remained significantly related ZV( w  
to unoperated cataract were whether participants had ever sUbF Rq  
seen an ophthalmologist, seen an optometrist and been >XnO&hW  
diagnosed with glaucoma. None of the demographic factors 8YKQIt K  
were associated with unoperated cataract in the multivariate K$ AB} Fvc  
model. :".w{0l@  
The per cent of participants with unoperated cataract |xeE3,8  
who said that they were dissatisfied or very dissatisfied with uREu2T2  
Operated and unoperated cataract in Australia 79 Pr/]0<s  
Table 1. Prevalence of any cataracta (excluding previous cataract surgery) by age, gender and cohort S(w\ZC  
Age group Sex Urban Rural Nursing home Weighted total <xqba4O  
(years) (%) (%) (%) >0T Za  
40–49 Male 2.56 4.04 0.00 3.00 (1.91, 4.08) o\goE^,aeR  
Female 2.61 1.70 0.00 2.36 (1.61, 3.10) $H;+}VQ  
50–59 Male 7.69 6.94 0.00 7.47 (5.80, 9.15) gc,Ps  
Female 6.67 7.56 0.00 6.92 (5.60, 8.24) !M^\f N1  
60–69 Male 20.7 25.0 10.0 22.0 (18.1, 26.0) 7kd|K b(  
Female 27.9 35.7 37.5 30.3 (26.0, 34.7) u(2BQO7  
70–79 Male 43.1 58.7 39.1 48.1 (41.2, 55.1) @ae>b  
Female 58.6 66.2 55.6 61.0 (56.0, 65.9) qd8pF!u|#  
80–89 Male 74.0 89.3 92.0 79.3 (72.3, 86.3) ?wCs&tM  
Female 91.9 97.0 80.2 92.6 (86.4, 98.8) *<q4S(l  
90 + Male 100.0 100.0 75.0 98.8 (96.2, 100.0) Y`^o7'Z2^P  
Female 100.0 100.0 93.8 98.6 (97.0, 100.0) h'!V8'}O?  
Age-standardized u]bz42]  
(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) ET+'Pj3  
aCortical > 4/16, nuclear > standard 2, posterior subcapsular > 1 mm2 RUX8qT(Z  
their current vision was 30% (290/683), compared with 27% s5A gsMq  
(26/95) of participants with prior cataract surgery (chisquared, h[Mdr  
1 d.f. = 0.25, P = 0.62). vi|Zit  
Outcomes of cataract surgery n_P(k-^U*  
Two hundred and forty-nine eyes had undergone prior +'%\Pr(  
cataract surgery. Of these 249 operated eyes, 49 (20%) were GA@ Ue9  
left aphakic, 6 (2.4%) had anterior chamber intraocular wko2M[  
lenses and 194 (78%) had posterior chamber intraocular 9-93aC.|}  
lenses. The rate of capsulotomy in the eyes with intact GX5W^//}  
posterior capsules was 36% (73/202). Fifteen per cent of T V;BNCg  
eyes (17/114) with a clear posterior capsule had bestcorrected +?V0:Kz]  
visual acuity of less than 6/12 compared with 43% \ 3G*j`  
of eyes (6/14) with opaque capsules, and 15% of eyes  2d~LNy  
(11/73) with prior capsulotomies (chi-squared, 2 d.f. = 7.21, BKZ v9  
P = 0.027). :kN5?t=  
The percentage of eyes with best-corrected visual acuity ETm]o  
of 6/12 or better was 96% (302/314) for eyes without WW6yFriuW  
cataract, 88% (1417/1609) for eyes with prevalent cataract yQwVQUW8B  
and 85% (211/249) for eyes with operated cataract (chisquared, ~p^7X2% !  
2 d.f. = 22.3), P < 0.001). Twenty-seven of the pL)xqKj  
operated eyes (11%) had visual acuities of less than 6/18 9[sG1eP!  
(moderate vision impairment) (Fig. 2). A cause of this 1J'pB;.]s  
moderate visual impairment (but not the only cause) in four 6w!e?B2/%  
(15%) eyes was secondary to cataract surgery. Three of these a2X h>{  
four eyes had undergone intracapsular cataract extraction `j:M)2:*y  
and the fourth eye had an opaque posterior capsule. No one }$:#+ (17  
had bilateral vision impairment as a result of their cataract j6og3.H-  
surgery. 1LyT7h  
DISCUSSION Y%h}U<y  
To our knowledge, this is the first paper to systematically OHhs y|W  
assess the prevalence of current cataract, previous cataract $+TYvA'N  
surgery, predictors of unoperated cataract and the outcomes u}m.}Mws  
of cataract surgery in a population-based sample. The Visual >b43%^yii  
Impairment Project is unique in that the sampling frame and _uJVuCc  
high response rate have ensured that the study population is pU hc3L  
representative of Australians aged 40 years and over. Therefore, C#$6O8O  
these data can be used to plan age-related cataract yZ~b+=UM  
services throughout Australia. QPV@'.2m  
We found the rate of any cataract in those over the age 48k 7/w\  
of 40 years to be 22%. Although relatively high, this rate is gDv$DB8-  
significantly less than was reported in a number of previous 7t3X`db  
studies,2,4,6 with the exception of the Casteldaccia Eye N33AcV!*8  
Study.5 However, it is difficult to compare rates of cataract .HCaXFW  
between studies because of different methodologies and JaFUcpZk$  
cataract definitions employed in the various studies, as well zHqhl}  
as the different age structures of the study populations. FW5}oD( H  
Other studies have used less conservative definitions of >|(%2Zl  
cataract, thus leading to higher rates of cataract as defined. @`Wt4<  
In most large epidemiologic studies of cataract, visual acuity , 02w@we5  
has not been included in the definition of cataract. Oa1'oYIHg  
Therefore, the prevalence of cataract may not reflect the Otxa<M+"  
actual need for cataract surgery in the community. }+_9"Y Q:  
80 McCarty et al. hMWo\qM  
Table 2. Prevalence of previous cataract by age, gender and cohort -~} tq]  
Age group Gender Urban Rural Nursing home Weighted total o"\{OX  
(years) (%) (%) (%) 2md.S$V$,  
40–49 Male 1.14 0.00 0.00 0.80 (0.00, 1.81) MISE C[/  
Female 0.00 0.00 0.00 0.00 ( Tw UsVM(~  
50–59 Male 0.68 0.58 0.00 0.65 (0.13, 1.17) M2L0c?  
Female 0.57 0.00 0.00 0.41 (0.00, 1.00) 5v+L';wx[T  
60–69 Male 2.12 7.59 0.00 3.80 (1.41, 6.19) ~M; gM]r;  
Female 2.11 3.51 0.00 2.54 (1.81, 3.26) vU{jda$$#  
70–79 Male 8.22 9.85 8.70 8.75 (6.38, 11.1) a-:pJE.'p  
Female 7.21 7.86 7.02 7.41 (5.36, 9.46) @ 'Q%Jc(  
80–89 Male 25.0 30.0 14.3 26.2 (17.0, 35.4) cPJ7E  
Female 27.9 25.6 18.3 26.7 (20.2, 33.3) {IrJLlq  
90 + Male 0.00 16.7 66.7 9.19 (0.00, 21.5) 4/f[`].#W  
Female 58.3 100.0 26.9 63.1 (44.4, 81.8) 5Fh8*8u6hL  
Age-standardized SKW;MVC  
(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) ^7<[}u;qF  
Figure 2. Visual acuity in eyes that had undergone cataract l:x _j\  
surgery, n = 249. h, Presenting; j, best-corrected. g/!Otgfu  
Operated and unoperated cataract in Australia 81 mgxz1d  
The weighted prevalence of prior cataract surgery in the v/x*]c!"`  
Visual Impairment Project (3.6%) was similar to the crude u,\xok"  
rate in the Beaver Dam Eye Study4 (3.1%), but less than the RpjSTV8Tkm  
crude rate in the Blue Mountains Eye Study6 (6.0%). &%}bRPUl  
However, the age-standardized rate in the Blue Mountains v23TL  
Eye Study (standardized to the age distribution of the urban _En]@xK3&  
Visual Impairment Project cohort) was found to be less than kv/(rKLp*  
the Visual Impairment Project (standardized rate = 1.36%, K/~Y!?:J r  
95% CL 1.25, 1.47). The incidence of cataract surgery in GgT=t)}wu  
Australia has exceeded population growth.1 This is due, 6S)$3Is  
perhaps, to advances in surgical techniques and lens f7S^yA[[  
implants that have changed the risk–benefit ratio. |^Ur  
The Global Initiative for the Elimination of Avoidable tjt=N\;  
Blindness, sponsored by the World Health Organization, `9:v*KuM#R  
states that cataract surgical services should be provided that  KzIt  
‘have a high success rate in terms of visual outcome and yB|]LYh  
improved quality of life’,17 although the ‘high success rate’ is p FXd4*  
not defined. Population- and clinic-based studies conducted )ynA:LXx  
in the United States have demonstrated marked improvement ocq2  
in visual acuity following cataract surgery.18–20 We Y7*'QKz2  
found that 85% of eyes that had undergone cataract extraction xu`d`!Tx  
had visual acuity of 6/12 or better. Previously, we have S[ws0Y60  
shown that participants with prevalent cataract in this DS.39NY  
cohort are more likely to express dissatisfaction with their 2lX[hFa5  
current vision than participants without cataract or participants \ YjB+[.  
with prior cataract surgery.21 In a national study in the S.qk%NTTD  
United States, researchers found that the change in patients’ =%:JjgKc*t  
ratings of their vision difficulties and satisfaction with their i=,B88ko  
vision after cataract surgery were more highly related to p,3go[9X:R  
their change in visual functioning score than to their change B:.;,@r]  
in visual acuity.19 Furthermore, improvement in visual function >OF:"_fh  
has been shown to be associated with improvement in olUqBQ&ol  
overall quality of life.22 S7@ZtFf  
A recent review found that the incidence of visually j+z'  
significant posterior capsule opacification following o06A=4I  
cataract surgery to be greater than 25%.23 We found 36% AH"g^ gw~T  
capsulotomy in our population and that this was associated HV#?6,U}  
with visual acuity similar to that of eyes with a clear Pu/-Qpqh  
capsule, but significantly better than that of eyes with an yVu^ >  
opaque capsule. 0KWy?6 X  
A number of studies have shown that the demand and F^/~@^{P  
timing of cataract surgery vary according to visual acuity, [R@q]S/  
degree of handicap and socioeconomic factors.8–10,24,25 We GU;TK'Yy?  
have also shown previously that ophthalmologists are more *il]$i  
likely to refer a patient for cataract surgery if the patient is \N'hbT=  
employed and less likely to refer a nursing home resident.7 ZmYa.4'L  
In the Visual Impairment Project, we did not find that any F3H:I"4  
particular subgroup of the population was at greater risk of :N+K^gI)  
having unoperated cataract. Universal access to health care !ch[I#&J-  
in Australia may explain the fact that people without #XYLVee,  
Medicare are more likely to delay cataract operations in the : . FfE  
USA,8 but not having private health insurance is not associated [Ls2k&)0  
with unoperated cataract in Australia. 2>_brz|7:|  
In summary, cataract is a significant public health problem qxg7cj2  
in that one in four people in their 80s will have had cataract Uy_}@50"l  
surgery. The importance of age-related cataract surgery will 3; -@<9  
increase further with the ageing of the population: the &t9XK8S  
number of people over age 60 years is expected to double in +r#=n7 t  
the next 20 years. Cataract surgery services are well #1,>Qnl  
accessed by the Victorian population and the visual outcomes !4b; >y=m  
of cataract surgery have been shown to be very good. cfy/*|  
These data can be used to plan for age-related cataract 5,=B 1  
surgical services in Australia in the future as the need for #:Sy`G6!?  
cataract extractions increases. !lt\2A e  
ACKNOWLEDGEMENTS |=h)efo}  
The Visual Impairment Project was funded in part by grants M~g~LhsF  
from the Victorian Health Promotion Foundation, the fjK]m.w  
National Health and Medical Research Council, the Ansell 7}iewtdy,  
Ophthalmology Foundation, the Dorothy Edols Estate and 5LhJ8$W  
the Jack Brockhoff Foundation. Dr McCarty is the recipient 9B?t3:  
of a Wagstaff Fellowship in Ophthalmology from the Royal BF1O|Q|d6  
Victorian Eye and Ear Hospital. #G4~]Qml  
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