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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 #Z A YP  
Purpose: To quantify the prevalence of cataract, the outcomes j7&l&)5  
of cataract surgery and the factors related to e+wd>iiB  
unoperated cataract in Australia. eORt qX8*  
Methods: Participants were recruited from the Visual tF|bxXs Z  
Impairment Project: a cluster, stratified sample of more than bb{+  
5000 Victorians aged 40 years and over. At examination D_Y;N3E/rS  
sites interviews, clinical examinations and lens photography ry'(m M  
were performed. Cataract was defined in participants who 4rm/+Zes  
had: had previous cataract surgery, cortical cataract greater k bY@Y,:w  
than 4/16, nuclear greater than Wilmer standard 2, or @lwqk J  
posterior subcapsular greater than 1 mm2. F r~xN!  
Results: The participant group comprised 3271 Melbourne V;"'!dVX  
residents, 403 Melbourne nursing home residents and 1473 Dng^4VRd  
rural residents.The weighted rate of any cataract in Victoria U&6f}=v C  
was 21.5%. The overall weighted rate of prior cataract QUt!fF@t  
surgery was 3.79%. Two hundred and forty-nine eyes had J ?&9ofj&  
had prior cataract surgery. Of these 249 procedures, 49 $)U RY~;i  
(20%) were aphakic, 6 (2.4%) had anterior chamber 4T:ZEvdzf  
intraocular lenses and 194 (78%) had posterior chamber ?g'l/xuRe  
intraocular lenses.Two hundred and eleven of these operated <t8})  
eyes (85%) had best-corrected visual acuity of 6/12 or V|7 c dX#H  
better, the legal requirement for a driver’s license.Twentyseven vQ;Z 0_  
(11%) had visual acuity of less than 6/18 (moderate u>BR WN  
vision impairment). Complications of cataract surgery x-[l`k.V  
caused reduced vision in four of the 27 eyes (15%), or 1.9% /O9z-!Jz  
of operated eyes. Three of these four eyes had undergone *`kh}  
intracapsular cataract extraction and the fourth eye had an ){v nmJJ%  
opaque posterior capsule. No one had bilateral vision Qi9SN00F.  
impairment as a result of cataract surgery. Surprisingly, no qg_=5s  
particular demographic factors (such as age, gender, rural MD+Q_  
residence, occupation, employment status, health insurance ;aSEv"iWX  
status, ethnicity) were related to the presence of unoperated bS*9eX=K  
cataract. T!8,R{V]4  
Conclusions: Although the overall prevalence of cataract is 8IO4>CMkv  
quite high, no particular subgroup is systematically underserviced _T1|_9b  
in terms of cataract surgery. Overall, the results of YQ]W<0(  
cataract surgery are very good, with the majority of eyes =m UtBD.;  
achieving driving vision following cataract extraction. <%! EI@N  
Key words: cataract extraction, health planning, health Gx!Y 4Q}-  
services accessibility, prevalence l2i[wc"9  
INTRODUCTION @I9A"4Im  
Cataract is the leading cause of blindness worldwide and, in y6f YNB  
Australia, cataract extractions account for the majority of all G22u+ua  
ophthalmic procedures.1 Over the period 1985–94, the rate `j9 ;9^  
of cataract surgery in Australia was twice as high as would be +Y-Gp4"  
expected from the growth in the elderly population.1 G@s rQum(  
Although there have been a number of studies reporting `Ps&N^[  
the prevalence of cataract in various populations,2–6 there is 5 y0 N }}  
little information about determinants of cataract surgery in vr"O9L w  
the population. A previous survey of Australian ophthalmologists <m'W{n%Pp  
showed that patient concern and lifestyle, rather kZ$2Uss  
than visual acuity itself, are the primary factors for referral c~SR@ZU  
for cataract surgery.7 This supports prior research which has ew?4;  
shown that visual acuity is not a strong predictor of need for Q\rf J||  
cataract surgery.8,9 Elsewhere, socioeconomic status has kntYj}F(  
been shown to be related to cataract surgery rates.10 }p5_JXBV  
To appropriately plan health care services, information is g8k S}7/  
needed about the prevalence of age-related cataract in the VkFMr8@|  
community as well as the factors associated with cataract /*P) C'_M  
surgery. The purpose of this study is to quantify the prevalence y*=sboX  
of any cataract in Australia, to describe the factors S#kYPe  
related to unoperated cataract in the community and to G>=Fdt7Oc  
describe the visual outcomes of cataract surgery. # ~Doz7~  
METHODS >v2/0>U  
Study population 'Fy"|M;2  
Details about the study methodology for the Visual AXF 1{  
Impairment Project have been published previously.11 /yHjd s  
Briefly, cluster sampling within three strata was employed to {xx}xib3  
recruit subjects aged 40 years and over to participate. eAmI~oku  
Within the Melbourne Statistical Division, nine pairs of Unvl~lm6  
census collector districts were randomly selected. Fourteen BmKf%:l}  
nursing homes within a 5 km radius of these nine test sites -0UR%R7q  
were randomly chosen to recruit nursing home residents. !B 4zU:d  
Clinical and Experimental Ophthalmology (2000) 28, 77–82 ,Kl:4 Tv  
Original Article ! ui   
Operated and unoperated cataract in Australia ,`JYFh M  
Catherine A McCarty PhD, MPH, Mukesh B Nanjan PhD, Hugh R Taylor MD rRg,{:;A  
Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia hw,nA2w\  
n Correspondence: Dr Cathy McCarty MPH, Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, 32 Gisborne Street, East Melbourne, s3eS` rK-  
Victoria 3002, Australia. Email: cathy@cera.unimelb.edu.au :`e#I/,  
78 McCarty et al. Kf1J;*i|\  
Finally, four pairs of census collector districts in four rural 9j|v D  
Victorian communities were randomly selected to recruit rural  q[ _qZ  
residents. A household census was conducted to identify QuqznYSY{  
eligible residents aged 40 years and over who had been a g!R7CRt%  
resident at that address for at least 6 months. At the time of 0W(mx-[H/  
the household census, basic information about age, sex, +9w[/n^,G  
country of birth, language spoken at home, education, use of 9T;4aP>6j#  
corrective spectacles and use of eye care services was collected. `*Yw-HL  
Eligible residents were then invited to attend a local 5X20/+aT  
examination site for a more detailed interview and examination. )[ A-d(y=  
The study protocol was approved by the Royal Victorian &cL1 EQ(  
Eye and Ear Hospital Human Research Ethics Committee. >x{("``D0y  
Assessment of cataract cc|W1,q  
A standardized ophthalmic examination was performed after >G:Q/3jh  
pupil dilatation with one drop of 10% phenylephrine U?#wWbE1  
hydrochloride. Lens opacities were graded clinically at the moM? aYm  
time of the examination and subsequently from photos using )O]6dd  
the Wilmer cataract photo-grading system.12 Cortical and eR$@Q   
posterior subcapsular (PSC) opacities were assessed on :j]1wp+  
retroillumination and measured as the proportion (in 1/16) 5EFt0?G   
of pupil circumference occupied by opacity. For this analysis, /K#k_k  
cortical cataract was defined as 4/16 or greater opacity, lI<jYd 0fZ  
PSC cataract was defined as opacity equal to or greater than X:oOp=y]|  
1 mm2 and nuclear cataract was defined as opacity equal to C|V7ZL>W  
or greater than Wilmer standard 2,12 independent of visual `,qft[1  
acuity. Examples of the minimum opacities defined as cortical, {y9G "  
nuclear and PSC cataract are presented in Figure 1.  k,:W]KD  
Bilateral congenital cataracts or cataracts secondary to &DLWlMGq  
intraocular inflammation or trauma were excluded from the xDo0bR(  
analysis. Two cases of bilateral secondary cataract and eight 3`bQ0-D;  
cases of bilateral congenital cataract were excluded from the :W.H#@'(  
analyses. .nPOjwEx&Y  
A Topcon® SL5 photo slit-lamp (Topcon America Corp., XQo\27Fo  
Paramus, NJ, USA) with a 0.1 mm slit beam of 9.0 mm in =W~7fs  
height set to an incident angle of 30° was used for examinations. i#'K7XM2  
Ektachrome® 200 ASA colour slide film (Eastman ], lLD UZ\  
Kodak Company, Rochester, NY, USA) was used to photograph Tqt- zX|>  
the nuclear opacities. The cortical opacities were D0Dz@25-  
photographed with an Oxford® retroillumination camera dKzG,/1W[m  
(Marcher Enterprises Ltd, Hereford, UK) and T-MAX® 400 S%iK);  
film (Eastman Kodak). Photographs were graded separately EtcT:k?y  
by two research assistants and discrepancies were adjudicated e$[O J<t  
by an independent reviewer. Any discrepancies wW%b~JX  
between the clinical grades and the photograph grades were 0>28o.  
resolved. Except in cases where photographs were missing, GHsDZ(d3.  
the photograph grades were used in the analyses. Photograph \ lbH   
grades were available for 4301 (84%) for cortical |5^ iqW  
cataract, 4147 (81%) for nuclear cataract and 4303 (84%) Gdo w[x  
for PSC cataract. Cataract status was classified according to s~Eo]e  
the severity of the opacity in the worse eye.  ``/L18  
Assessment of risk factors jj{:=l ZB  
A standardized questionnaire was used to obtain information In?rQiD9  
about education, employment and ethnic background.11 WsHD Ip  
Specific information was elicited on the occurrence, duration %r^tZ;; l  
and treatment of a number of medical conditions, aT,W XW*  
including ocular trauma, arthritis, diabetes, gout, hypertension K*:=d }^  
and mental illness. Information about the use, dose and ntIR#fB  
duration of tobacco, alcohol, analgesics and steriods were ~cm4e>o  
collected, and a food frequency questionnaire was used to uH89oA/H  
determine current consumption of dietary sources of antioxidants 2hHRitt36  
and use of vitamin supplements. tR!C8:u  
Data management and statistical analysis )<QX2~m<  
Data were collected either by direct computer entry with a Yi9Y`~J  
questionnaire programmed in Paradox© (Carel Corporation, XpANaqH\  
Ottawa, Canada) with internal consistency checks, or PJK:LZw  
on self-coding forms. Open-ended responses were coded at }XUL\6U  
a later time. Data that were entered on the self-coded forms "}X+vd``  
were entered into a computer with double data entry and .s\lfBo9  
reconciliation of any inconsistencies. Data range and consistency &<><4MQ  
checks were performed on the entire data set. _n:RA)4*  
SAS© version 6.1 (SAS Institute, Cary, North Carolina) was OG{*:1EP  
employed for statistical analyses. p-j6H  
Ninety-five per cent confidence limits around the agespecific -3ePCAtXbe  
rates were calculated according to Cochran13 to >$ZhhM/} J  
account for the effect of the cluster sampling. Ninety-five +s<6eHpm  
per cent confidence limits around age-standardized rates reR@@O  
were calculated according to Breslow and Day.14 The strataspecific 6D| F1UFU  
data were weighted according to the 1996 Fug4u?-n  
Australian Bureau of Statistics census data15 to reflect the &B5&:ib1 D  
cataract prevalence in the entire Victorian population. bGwOhd<.  
Univariate analyses with Student’s t-tests and chi-squared zHKP$k8  
tests were first employed to evaluate risk factors for unoperated 5BA:^4zr?  
cataract. Any factors with P < 0.10 were then fitted a( ~X  
into a backwards stepwise logistic regression model. For the Hya.OW{  
Figure 1. Minimum levels of cortical (a), nuclear (b), and posterior subcapsular (c) cataract. :^W}$7$T  
final multivariate models, P < 0.05 was considered statistically .RmFYV0,  
significant. Design effect was assessed through the use Y;R,ph.a  
of cluster-specific models and multivariate models. The n><ad*|MX  
design effect was assumed to be additive and an adjustment +8xT}mX  
made in the variance by adding the variance associated with <b'*GB w$  
the design effect prior to constructing the 95% confidence VsTgK  
limits. 8N)Lck2PR  
RESULTS G(?1 Urxi  
Study population bp/l~h.7W  
A total of 3271 (83%) of the Melbourne residents, 403 xKUWj<+/  
(90%) Melbourne nursing home residents, and 1473 (92%) ;1yF[<a  
rural residents participated. In general, non-participants did !\|  
not differ from participants.16 The study population was [f\Jcjc  
representative of the Victorian population and Australia as <V)z{uK  
a whole. .h4NG4FIF  
The Melbourne residents ranged in age from 40 to X*MK(aV3  
98 years (mean = 59) and 1511 (46%) were male. The Z796;qk  
Melbourne nursing home residents ranged in age from 46 to >VZxDJ$R  
101 years (mean = 82) and 85 (21%) were men. The rural W{J e)N  
residents ranged in age from 40 to 103 years (mean = 60) F3vywN1$,  
and 701 (47.5%) were men. OmkJP  
Prevalence of cataract and prior cataract surgery wZ0bD&B  
As would be expected, the rate of any cataract increases wEq&O|Vj  
dramatically with age (Table 1). The weighted rate of any SFh<>J^ 0a  
cataract in Victoria was 21.5% (95% CL 18.1, 24.9). (;=|2N>7  
Although the rates varied somewhat between the three e wT K2  
strata, they were not significantly different as the 95% confidence @f"[*7Q`/  
limits overlapped. The per cent of cataractous eyes 1p5'.~J+Q  
with best-corrected visual acuity of less than 6/12 was 12.5% fe<7D\Sp@  
(65/520) for cortical cataract, 18% for nuclear cataract 4$, W\d  
(97/534) and 14.4% (27/187) for PSC cataract. Cataract LN (\B:wAY  
surgery also rose dramatically with age. The overall FZ%h7Oe  
weighted rate of prior cataract surgery in Victoria was PX?%}~ v  
3.79% (95% CL 2.97, 4.60) (Table 2). CAviP61T  
Risk factors for unoperated cataract LEjq<t1&  
Cases of cataract that had not been removed were classified JFc, f  
as unoperated cataract. Risk factor analyses for unoperated "oiN8#Hf  
cataract were not performed with the nursing home residents ?fP3R':s  
as information about risk factor exposure was not ^ )"Il  
available for this cohort. The following factors were assessed u4T$  
in relation to unoperated cataract: age, sex, residence I6;6x  
(urban/rural), language spoken at home (a measure of ethnic %{IgY{X  
integration), country of birth, parents’ country of birth (a :zo5`[P  
measure of ethnicity), years since migration, education, use V:j^!*  
of ophthalmic services, use of optometric services, private XM+.Hel  
health insurance status, duration of distance glasses use, 0+1!-Wo  
glaucoma, age-related maculopathy and employment status. VI9rezZ*  
In this cross sectional study it was not possible to assess the :4 z\Q]  
level of visual acuity that would predict a patient’s having OAiW8B Ae  
cataract surgery, as visual acuity data prior to cataract _kRc"MaB  
surgery were not available. JW><&hY$"  
The significant risk factors for unoperated cataract in univariate NTX0vQG  
analyses were related to: whether a participant had yU/?4/G!  
ever seen an optometrist, seen an ophthalmologist or been {Mb<on W  
diagnosed with glaucoma; and participants’ employment @8`I!fZ  
status (currently employed) and age. These significant MC,Qv9 m  
factors were placed in a backwards stepwise logistic regression b'SP,}s5"  
model. The factors that remained significantly related zRLJ|ejMP  
to unoperated cataract were whether participants had ever w(`g)`  
seen an ophthalmologist, seen an optometrist and been *XWu)>*o  
diagnosed with glaucoma. None of the demographic factors #m UQ@X@K  
were associated with unoperated cataract in the multivariate #6#n4`%ER  
model. @}R y7H0O  
The per cent of participants with unoperated cataract xc @$z* w  
who said that they were dissatisfied or very dissatisfied with NTZ3Np`  
Operated and unoperated cataract in Australia 79 F~E)w5?\O  
Table 1. Prevalence of any cataracta (excluding previous cataract surgery) by age, gender and cohort 'xai5X  
Age group Sex Urban Rural Nursing home Weighted total %=2sz>M+  
(years) (%) (%) (%) UE5,Ml~X  
40–49 Male 2.56 4.04 0.00 3.00 (1.91, 4.08) YwY?tOxBe  
Female 2.61 1.70 0.00 2.36 (1.61, 3.10) /@ g 8MUq7  
50–59 Male 7.69 6.94 0.00 7.47 (5.80, 9.15) 6r mx{Bt  
Female 6.67 7.56 0.00 6.92 (5.60, 8.24) a""9%./B  
60–69 Male 20.7 25.0 10.0 22.0 (18.1, 26.0) e~)4v  
Female 27.9 35.7 37.5 30.3 (26.0, 34.7) }oG6XI9  
70–79 Male 43.1 58.7 39.1 48.1 (41.2, 55.1) W[`ybGR<  
Female 58.6 66.2 55.6 61.0 (56.0, 65.9) zi O(`"v  
80–89 Male 74.0 89.3 92.0 79.3 (72.3, 86.3) E>*b,^J7g  
Female 91.9 97.0 80.2 92.6 (86.4, 98.8) <bCB-lG*Kb  
90 + Male 100.0 100.0 75.0 98.8 (96.2, 100.0) [{xY3WS  
Female 100.0 100.0 93.8 98.6 (97.0, 100.0) # Dgkl  
Age-standardized 7u^wO<  
(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) GadY#]}(  
aCortical > 4/16, nuclear > standard 2, posterior subcapsular > 1 mm2 b9i_\  
their current vision was 30% (290/683), compared with 27% a}VR>!b  
(26/95) of participants with prior cataract surgery (chisquared, .L#4#IO  
1 d.f. = 0.25, P = 0.62). RB""(<  
Outcomes of cataract surgery <)O#Y76s  
Two hundred and forty-nine eyes had undergone prior 75 R4[C6T  
cataract surgery. Of these 249 operated eyes, 49 (20%) were 8aRmHy"9l  
left aphakic, 6 (2.4%) had anterior chamber intraocular lc fAb@}2  
lenses and 194 (78%) had posterior chamber intraocular Z(4/;v <CT  
lenses. The rate of capsulotomy in the eyes with intact GpXf).a@  
posterior capsules was 36% (73/202). Fifteen per cent of P*?2+.  
eyes (17/114) with a clear posterior capsule had bestcorrected E)I&? <g  
visual acuity of less than 6/12 compared with 43% ~KGE(o4p  
of eyes (6/14) with opaque capsules, and 15% of eyes Wx;%W"a  
(11/73) with prior capsulotomies (chi-squared, 2 d.f. = 7.21, :nnch?J_  
P = 0.027).  L=!h`k  
The percentage of eyes with best-corrected visual acuity "AMwo(Yi  
of 6/12 or better was 96% (302/314) for eyes without #|:q"l9  
cataract, 88% (1417/1609) for eyes with prevalent cataract BgCEv"G5  
and 85% (211/249) for eyes with operated cataract (chisquared, FRPd fo37  
2 d.f. = 22.3), P < 0.001). Twenty-seven of the 1,Pg^Xu  
operated eyes (11%) had visual acuities of less than 6/18 #gf0*:p  
(moderate vision impairment) (Fig. 2). A cause of this u,YmCEd_V  
moderate visual impairment (but not the only cause) in four $'*{&/@  
(15%) eyes was secondary to cataract surgery. Three of these 98zJ?NaD&  
four eyes had undergone intracapsular cataract extraction e *D,2>o  
and the fourth eye had an opaque posterior capsule. No one tg/!=g  
had bilateral vision impairment as a result of their cataract 6_9@s*=d>  
surgery. ky]L`w  
DISCUSSION !,7)ZW?*8  
To our knowledge, this is the first paper to systematically h;cw=G  
assess the prevalence of current cataract, previous cataract ^\VVx:]  
surgery, predictors of unoperated cataract and the outcomes G-o6~"J\  
of cataract surgery in a population-based sample. The Visual K7qR  
Impairment Project is unique in that the sampling frame and %|2x7@&s  
high response rate have ensured that the study population is {FN4BC`3+  
representative of Australians aged 40 years and over. Therefore, ~ /K'n  
these data can be used to plan age-related cataract ;t.)A3 PL  
services throughout Australia. KC<K*UHPAH  
We found the rate of any cataract in those over the age [A;0I jKam  
of 40 years to be 22%. Although relatively high, this rate is NeewV=[%  
significantly less than was reported in a number of previous [RDY(}P%  
studies,2,4,6 with the exception of the Casteldaccia Eye weOga\  
Study.5 However, it is difficult to compare rates of cataract W>u$x=<T  
between studies because of different methodologies and 3XUie;*`  
cataract definitions employed in the various studies, as well Fdx4jc13w  
as the different age structures of the study populations. CT=5V@_u\  
Other studies have used less conservative definitions of 8tT/w5  
cataract, thus leading to higher rates of cataract as defined. /EVXkf0  
In most large epidemiologic studies of cataract, visual acuity C8 $KVZ  
has not been included in the definition of cataract. ~.S/<:`U  
Therefore, the prevalence of cataract may not reflect the - l0X]&Ex  
actual need for cataract surgery in the community. cw~-%%/  
80 McCarty et al. 2<_|1%C  
Table 2. Prevalence of previous cataract by age, gender and cohort gYw=Z_z  
Age group Gender Urban Rural Nursing home Weighted total X'7MW? q@  
(years) (%) (%) (%) 3+vMi[YO  
40–49 Male 1.14 0.00 0.00 0.80 (0.00, 1.81) <ZoMKUuB  
Female 0.00 0.00 0.00 0.00 ( }~ga86:n0  
50–59 Male 0.68 0.58 0.00 0.65 (0.13, 1.17) ^QTkre  
Female 0.57 0.00 0.00 0.41 (0.00, 1.00) Lyjp  
60–69 Male 2.12 7.59 0.00 3.80 (1.41, 6.19) !$,e)89  
Female 2.11 3.51 0.00 2.54 (1.81, 3.26) ENZYrWl  
70–79 Male 8.22 9.85 8.70 8.75 (6.38, 11.1) >% E= l  
Female 7.21 7.86 7.02 7.41 (5.36, 9.46) KC-@2,c9V  
80–89 Male 25.0 30.0 14.3 26.2 (17.0, 35.4) YD;"_yH  
Female 27.9 25.6 18.3 26.7 (20.2, 33.3) J['?ud}@  
90 + Male 0.00 16.7 66.7 9.19 (0.00, 21.5) q{Gf@  
Female 58.3 100.0 26.9 63.1 (44.4, 81.8) S\A9r!2  
Age-standardized =K6{AmG$  
(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) 2D{`AJ  
Figure 2. Visual acuity in eyes that had undergone cataract ,k6V?{ZA  
surgery, n = 249. h, Presenting; j, best-corrected. l]geQl:7`r  
Operated and unoperated cataract in Australia 81 lT F#efcW  
The weighted prevalence of prior cataract surgery in the od]1:8OF  
Visual Impairment Project (3.6%) was similar to the crude O['5/:-  
rate in the Beaver Dam Eye Study4 (3.1%), but less than the *>7Zc  
crude rate in the Blue Mountains Eye Study6 (6.0%). h1QrFPQnu  
However, the age-standardized rate in the Blue Mountains Vg1MA  
Eye Study (standardized to the age distribution of the urban 0"xD>ue&  
Visual Impairment Project cohort) was found to be less than ]*yUb-xY  
the Visual Impairment Project (standardized rate = 1.36%, Vg8c}>7  
95% CL 1.25, 1.47). The incidence of cataract surgery in 9rM6kLD  
Australia has exceeded population growth.1 This is due, xw~&OF&  
perhaps, to advances in surgical techniques and lens :LX (9f   
implants that have changed the risk–benefit ratio. , Y cF~  
The Global Initiative for the Elimination of Avoidable {{e+t8J??  
Blindness, sponsored by the World Health Organization, sn:wLc/GAd  
states that cataract surgical services should be provided that OA8iTn  
‘have a high success rate in terms of visual outcome and WRfhxl  
improved quality of life’,17 although the ‘high success rate’ is ./E<v  
not defined. Population- and clinic-based studies conducted GF^ ?#Jh  
in the United States have demonstrated marked improvement _6{XqvWqb  
in visual acuity following cataract surgery.18–20 We q b7ur;  
found that 85% of eyes that had undergone cataract extraction ,L9ioYbp  
had visual acuity of 6/12 or better. Previously, we have Vh5Z'4N  
shown that participants with prevalent cataract in this ;\)N7SJ  
cohort are more likely to express dissatisfaction with their /&g~*AL  
current vision than participants without cataract or participants "o>gX'm*  
with prior cataract surgery.21 In a national study in the =/L ;}m)7  
United States, researchers found that the change in patients’ zkmfu~_)  
ratings of their vision difficulties and satisfaction with their ! )PV-[2  
vision after cataract surgery were more highly related to L Ke ~  
their change in visual functioning score than to their change *HXx;:  
in visual acuity.19 Furthermore, improvement in visual function xO2CgqEb  
has been shown to be associated with improvement in 23~KzC  
overall quality of life.22 R`! 'c(V  
A recent review found that the incidence of visually JN:EcVuy  
significant posterior capsule opacification following 55]E<2't  
cataract surgery to be greater than 25%.23 We found 36% Y;OqdO  
capsulotomy in our population and that this was associated }Gg:y?  
with visual acuity similar to that of eyes with a clear yi$Jk}w  
capsule, but significantly better than that of eyes with an |B/A)(c yV  
opaque capsule. ?wQaM3 |^:  
A number of studies have shown that the demand and [W{WfJ-HwG  
timing of cataract surgery vary according to visual acuity,  (:ObxJ*  
degree of handicap and socioeconomic factors.8–10,24,25 We `oUuAL  
have also shown previously that ophthalmologists are more {Mx3G*hr  
likely to refer a patient for cataract surgery if the patient is -^+!:0';  
employed and less likely to refer a nursing home resident.7 1hnw+T<<W  
In the Visual Impairment Project, we did not find that any Zr U9oy&!C  
particular subgroup of the population was at greater risk of &m J +#vT  
having unoperated cataract. Universal access to health care WC<K(PP  
in Australia may explain the fact that people without a2tRmil  
Medicare are more likely to delay cataract operations in the lyY i2& %  
USA,8 but not having private health insurance is not associated "U DV4<|^k  
with unoperated cataract in Australia. ;)nV  
In summary, cataract is a significant public health problem ollk {N  
in that one in four people in their 80s will have had cataract A:-r 2;xB  
surgery. The importance of age-related cataract surgery will L 2k?Pl  
increase further with the ageing of the population: the <B %s9Zy  
number of people over age 60 years is expected to double in xOAA1#   
the next 20 years. Cataract surgery services are well uO,9h0y0W  
accessed by the Victorian population and the visual outcomes 50l! f7  
of cataract surgery have been shown to be very good. d|RqS`h ]  
These data can be used to plan for age-related cataract 6bXR?0$*M.  
surgical services in Australia in the future as the need for ;&N=t64"  
cataract extractions increases. f,_EPh>  
ACKNOWLEDGEMENTS <*4BT}r,^2  
The Visual Impairment Project was funded in part by grants `$5 QTte  
from the Victorian Health Promotion Foundation, the v==b. 2=  
National Health and Medical Research Council, the Ansell jLZ^EM-  
Ophthalmology Foundation, the Dorothy Edols Estate and !lk -MN.  
the Jack Brockhoff Foundation. Dr McCarty is the recipient ".Q``d&X  
of a Wagstaff Fellowship in Ophthalmology from the Royal i 6@c@n  
Victorian Eye and Ear Hospital. RrG5`2  
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