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

ABSTRACT &x0C4Kh  
Purpose: To quantify the prevalence of cataract, the outcomes Kd3QqVJBz1  
of cataract surgery and the factors related to .$ Bwb/a  
unoperated cataract in Australia. M$A#I51  
Methods: Participants were recruited from the Visual . uR M{Bs  
Impairment Project: a cluster, stratified sample of more than /APcL5:=  
5000 Victorians aged 40 years and over. At examination Z^zbWFO]5  
sites interviews, clinical examinations and lens photography v7IzDz6gF  
were performed. Cataract was defined in participants who $ [7 Vgs  
had: had previous cataract surgery, cortical cataract greater S &JJIFftO  
than 4/16, nuclear greater than Wilmer standard 2, or "+|L_iuNQ  
posterior subcapsular greater than 1 mm2. by86zX  
Results: The participant group comprised 3271 Melbourne H9` f0(H  
residents, 403 Melbourne nursing home residents and 1473 ~ y;y(4<  
rural residents.The weighted rate of any cataract in Victoria J!h^egP  
was 21.5%. The overall weighted rate of prior cataract u@=?#a$$  
surgery was 3.79%. Two hundred and forty-nine eyes had U,; xZe  
had prior cataract surgery. Of these 249 procedures, 49 S #8 >ZwQ  
(20%) were aphakic, 6 (2.4%) had anterior chamber ALGg AX3t  
intraocular lenses and 194 (78%) had posterior chamber l#bAl/c`  
intraocular lenses.Two hundred and eleven of these operated s_eOcm  
eyes (85%) had best-corrected visual acuity of 6/12 or |}[nH>  
better, the legal requirement for a driver’s license.Twentyseven u3ZCT" !  
(11%) had visual acuity of less than 6/18 (moderate GXX+}=b7qO  
vision impairment). Complications of cataract surgery &ZJgQ-Pc(m  
caused reduced vision in four of the 27 eyes (15%), or 1.9% : reTJQwr  
of operated eyes. Three of these four eyes had undergone xh0xSqDM  
intracapsular cataract extraction and the fourth eye had an TJy4<rb  
opaque posterior capsule. No one had bilateral vision 4MW ]EQ-  
impairment as a result of cataract surgery. Surprisingly, no %<Q*Jf  
particular demographic factors (such as age, gender, rural onte&Ed\  
residence, occupation, employment status, health insurance .q;ED`  G  
status, ethnicity) were related to the presence of unoperated |L:Cn J  
cataract. nr2r8u9r  
Conclusions: Although the overall prevalence of cataract is YQ(Po!NI\'  
quite high, no particular subgroup is systematically underserviced `/Y+1 aD  
in terms of cataract surgery. Overall, the results of M{N(~ql  
cataract surgery are very good, with the majority of eyes d^V$Z6* ]  
achieving driving vision following cataract extraction. 3Wx,oq;4-  
Key words: cataract extraction, health planning, health Jb(Y,LO^  
services accessibility, prevalence 8SmjZpQ?  
INTRODUCTION w+AuMc  
Cataract is the leading cause of blindness worldwide and, in :tGYs8UK  
Australia, cataract extractions account for the majority of all TbhH&kG)1  
ophthalmic procedures.1 Over the period 1985–94, the rate MagM ZR  
of cataract surgery in Australia was twice as high as would be wu~hqd  
expected from the growth in the elderly population.1 "="O >  
Although there have been a number of studies reporting F $yO  
the prevalence of cataract in various populations,2–6 there is Vk}49O<K/  
little information about determinants of cataract surgery in SUdm 0y  
the population. A previous survey of Australian ophthalmologists ^toAw8A=@0  
showed that patient concern and lifestyle, rather pY}/j;.[  
than visual acuity itself, are the primary factors for referral d;G~hVu  
for cataract surgery.7 This supports prior research which has =Hu0v}i/  
shown that visual acuity is not a strong predictor of need for mLwY]2T"  
cataract surgery.8,9 Elsewhere, socioeconomic status has @}LZ! y  
been shown to be related to cataract surgery rates.10 y?z\L   
To appropriately plan health care services, information is XGs^rIf  
needed about the prevalence of age-related cataract in the VWf %v  
community as well as the factors associated with cataract e%6{ME 3  
surgery. The purpose of this study is to quantify the prevalence lrEj/"M  
of any cataract in Australia, to describe the factors f~M8A.  
related to unoperated cataract in the community and to F9Z @x)  
describe the visual outcomes of cataract surgery. >1|g5  
METHODS Vb4;-?s_  
Study population 4\2V9F{s  
Details about the study methodology for the Visual PEXq:TA  
Impairment Project have been published previously.11 8b&uU [  
Briefly, cluster sampling within three strata was employed to #Ob]]!y  
recruit subjects aged 40 years and over to participate. =!.m GW-Q}  
Within the Melbourne Statistical Division, nine pairs of 'ZHdV,dd  
census collector districts were randomly selected. Fourteen v 1.*IV5Y  
nursing homes within a 5 km radius of these nine test sites T1 MY X  
were randomly chosen to recruit nursing home residents. -T_\f?V8 8  
Clinical and Experimental Ophthalmology (2000) 28, 77–82 n^9  ?~  
Original Article E_:QSy5G  
Operated and unoperated cataract in Australia u<Xog$esu  
Catherine A McCarty PhD, MPH, Mukesh B Nanjan PhD, Hugh R Taylor MD W |UtY`1  
Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia fE;Q:# Z.  
n Correspondence: Dr Cathy McCarty MPH, Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, 32 Gisborne Street, East Melbourne, *|RS*ABte  
Victoria 3002, Australia. Email: cathy@cera.unimelb.edu.au 3N4.$#>#9@  
78 McCarty et al. +x1/-J8_sg  
Finally, four pairs of census collector districts in four rural <y=ovkM3  
Victorian communities were randomly selected to recruit rural \"^% 90F  
residents. A household census was conducted to identify  ?J&)W,~  
eligible residents aged 40 years and over who had been a f&I7 ,"v  
resident at that address for at least 6 months. At the time of AU{:;%.g  
the household census, basic information about age, sex, lOerrP6f(  
country of birth, language spoken at home, education, use of uP|FJLY  
corrective spectacles and use of eye care services was collected. j%tEZ"H  
Eligible residents were then invited to attend a local S@}4-\  
examination site for a more detailed interview and examination. ycpE=fso'  
The study protocol was approved by the Royal Victorian h)dRR_  
Eye and Ear Hospital Human Research Ethics Committee. Mg? L-C  
Assessment of cataract 2*OxA%QELM  
A standardized ophthalmic examination was performed after 5h^[^*A ?  
pupil dilatation with one drop of 10% phenylephrine =ApY9`  
hydrochloride. Lens opacities were graded clinically at the ?q$P>guH6-  
time of the examination and subsequently from photos using 3% vis\~^  
the Wilmer cataract photo-grading system.12 Cortical and ]VjLKFb~U  
posterior subcapsular (PSC) opacities were assessed on <GZhH:  
retroillumination and measured as the proportion (in 1/16) jD9lz-Y@  
of pupil circumference occupied by opacity. For this analysis, {bkGYx5.C  
cortical cataract was defined as 4/16 or greater opacity, )I9aC~eAD  
PSC cataract was defined as opacity equal to or greater than DY3:#X`4  
1 mm2 and nuclear cataract was defined as opacity equal to Q[_Ni15  
or greater than Wilmer standard 2,12 independent of visual -c={+z "  
acuity. Examples of the minimum opacities defined as cortical, ]w22@s  
nuclear and PSC cataract are presented in Figure 1. (%DRt4u <H  
Bilateral congenital cataracts or cataracts secondary to 4iBxPo(0  
intraocular inflammation or trauma were excluded from the z,+m[x=/N  
analysis. Two cases of bilateral secondary cataract and eight !: |nI77|  
cases of bilateral congenital cataract were excluded from the !-(J-45  
analyses. </Z Ha:=7  
A Topcon® SL5 photo slit-lamp (Topcon America Corp., .^H1\p];Lw  
Paramus, NJ, USA) with a 0.1 mm slit beam of 9.0 mm in NG)7G   
height set to an incident angle of 30° was used for examinations. -\,VGudM}  
Ektachrome® 200 ASA colour slide film (Eastman 3"tg+DncC  
Kodak Company, Rochester, NY, USA) was used to photograph SALCuo"L  
the nuclear opacities. The cortical opacities were jt% WPkY:  
photographed with an Oxford® retroillumination camera bZ1 0v;  
(Marcher Enterprises Ltd, Hereford, UK) and T-MAX® 400 Ar5JP_M`E  
film (Eastman Kodak). Photographs were graded separately C->[$HcRa  
by two research assistants and discrepancies were adjudicated :BDviUC7Z  
by an independent reviewer. Any discrepancies g& >m P?  
between the clinical grades and the photograph grades were h7RD `k:mF  
resolved. Except in cases where photographs were missing, V *uEJ6T  
the photograph grades were used in the analyses. Photograph YiNo#M91  
grades were available for 4301 (84%) for cortical 6#-Z@fz%  
cataract, 4147 (81%) for nuclear cataract and 4303 (84%) ULrbQ}"cva  
for PSC cataract. Cataract status was classified according to 2w7@u/OC'  
the severity of the opacity in the worse eye. U\;Ml  
Assessment of risk factors :z124Zf  
A standardized questionnaire was used to obtain information Oo$%Yh51~  
about education, employment and ethnic background.11 N$ *>suQ,  
Specific information was elicited on the occurrence, duration 6(sfpK'  
and treatment of a number of medical conditions,  l58l  
including ocular trauma, arthritis, diabetes, gout, hypertension `|NevpXY1  
and mental illness. Information about the use, dose and a6 * Y%?  
duration of tobacco, alcohol, analgesics and steriods were Qvs(Rt3?y  
collected, and a food frequency questionnaire was used to =mAGD*NK u  
determine current consumption of dietary sources of antioxidants @Zh8 QI+  
and use of vitamin supplements. 81cv:|"  
Data management and statistical analysis eb(m8vLR  
Data were collected either by direct computer entry with a 739l%u }<  
questionnaire programmed in Paradox© (Carel Corporation, <vO8_2,V-  
Ottawa, Canada) with internal consistency checks, or RNl\`>Cz  
on self-coding forms. Open-ended responses were coded at O]4W|WI3  
a later time. Data that were entered on the self-coded forms |)*m[_1  
were entered into a computer with double data entry and E)RI!0Ra  
reconciliation of any inconsistencies. Data range and consistency hE9'F(87a  
checks were performed on the entire data set. 1h& )I%`?  
SAS© version 6.1 (SAS Institute, Cary, North Carolina) was \qRjXadj  
employed for statistical analyses. ~7KynE  
Ninety-five per cent confidence limits around the agespecific   zd.1  
rates were calculated according to Cochran13 to Y^T-A}?`  
account for the effect of the cluster sampling. Ninety-five X*43!\  
per cent confidence limits around age-standardized rates tOu90gu  
were calculated according to Breslow and Day.14 The strataspecific U+I3P  
data were weighted according to the 1996 mNGb} lR  
Australian Bureau of Statistics census data15 to reflect the 1"*Nb5s  
cataract prevalence in the entire Victorian population. }6yxt9  
Univariate analyses with Student’s t-tests and chi-squared oC ^z_AtZ  
tests were first employed to evaluate risk factors for unoperated ghE?8&@ iq  
cataract. Any factors with P < 0.10 were then fitted }7f 1(#{7  
into a backwards stepwise logistic regression model. For the  oaH+c9v  
Figure 1. Minimum levels of cortical (a), nuclear (b), and posterior subcapsular (c) cataract. "E4i >g  
final multivariate models, P < 0.05 was considered statistically 9`hpa-m@  
significant. Design effect was assessed through the use dn:|m^<)  
of cluster-specific models and multivariate models. The ]l9,t5Y  
design effect was assumed to be additive and an adjustment a3DoLq"/  
made in the variance by adding the variance associated with h$:&1jVY{  
the design effect prior to constructing the 95% confidence Q{(,/}kA-  
limits. b{9HooQ{  
RESULTS Q_UCF'f;}  
Study population 61t-  
A total of 3271 (83%) of the Melbourne residents, 403 Hzk1LKsT#  
(90%) Melbourne nursing home residents, and 1473 (92%) 6c;?`C  
rural residents participated. In general, non-participants did  A[wxa  
not differ from participants.16 The study population was &</ @0  
representative of the Victorian population and Australia as U)T/.L{0i  
a whole. @et3}-c  
The Melbourne residents ranged in age from 40 to z}Mb4{d 1  
98 years (mean = 59) and 1511 (46%) were male. The 4)c"@Zf  
Melbourne nursing home residents ranged in age from 46 to )BM WC k  
101 years (mean = 82) and 85 (21%) were men. The rural 1^Y:XJ73  
residents ranged in age from 40 to 103 years (mean = 60) b(.o|d/P  
and 701 (47.5%) were men. ~ 33@H  
Prevalence of cataract and prior cataract surgery RvgAI`T7$  
As would be expected, the rate of any cataract increases ? ><   
dramatically with age (Table 1). The weighted rate of any F".IB^} $  
cataract in Victoria was 21.5% (95% CL 18.1, 24.9). ` wsMybe#  
Although the rates varied somewhat between the three }lQn]q  
strata, they were not significantly different as the 95% confidence ~[bMfkc3  
limits overlapped. The per cent of cataractous eyes RQ$o'U9A  
with best-corrected visual acuity of less than 6/12 was 12.5% rym\5 `)  
(65/520) for cortical cataract, 18% for nuclear cataract /:c,v-  
(97/534) and 14.4% (27/187) for PSC cataract. Cataract 'yAoZ P\|  
surgery also rose dramatically with age. The overall hdNZ":1s  
weighted rate of prior cataract surgery in Victoria was ~wd?-$;070  
3.79% (95% CL 2.97, 4.60) (Table 2). VIlQzM;%^  
Risk factors for unoperated cataract 3dzqV aV  
Cases of cataract that had not been removed were classified &@.=)4Y  
as unoperated cataract. Risk factor analyses for unoperated nR|uAw  
cataract were not performed with the nursing home residents HS7 G_  
as information about risk factor exposure was not "Qm~;x2kB  
available for this cohort. The following factors were assessed 5a/ A_..+I  
in relation to unoperated cataract: age, sex, residence '\vmfp =  
(urban/rural), language spoken at home (a measure of ethnic #I@[^^Vw  
integration), country of birth, parents’ country of birth (a e+=G-u5}-  
measure of ethnicity), years since migration, education, use !j\&BAxTEk  
of ophthalmic services, use of optometric services, private H_nOE(i<z  
health insurance status, duration of distance glasses use, J$=b&$I(  
glaucoma, age-related maculopathy and employment status. n<(5B|~y  
In this cross sectional study it was not possible to assess the U3R`mHr0  
level of visual acuity that would predict a patient’s having d'@H@  
cataract surgery, as visual acuity data prior to cataract Fl|&eO,e  
surgery were not available. ,Z\,IRn  
The significant risk factors for unoperated cataract in univariate !z6/.>QJ~  
analyses were related to: whether a participant had t6>Q e  
ever seen an optometrist, seen an ophthalmologist or been d4=u`2w  
diagnosed with glaucoma; and participants’ employment 5r}(|86O/  
status (currently employed) and age. These significant K#pt8Q  
factors were placed in a backwards stepwise logistic regression #i#.tc  
model. The factors that remained significantly related hI#M {cz  
to unoperated cataract were whether participants had ever sf&K<C](  
seen an ophthalmologist, seen an optometrist and been x?& xz;  
diagnosed with glaucoma. None of the demographic factors ]R.Vq\A%S  
were associated with unoperated cataract in the multivariate Tqh  Rs  
model. g,]5&C T3v  
The per cent of participants with unoperated cataract 38S&7>0@|q  
who said that they were dissatisfied or very dissatisfied with -2u+m  
Operated and unoperated cataract in Australia 79 42[:s:  
Table 1. Prevalence of any cataracta (excluding previous cataract surgery) by age, gender and cohort 745V!#3!M  
Age group Sex Urban Rural Nursing home Weighted total & 7nfTc  
(years) (%) (%) (%) ,]N%(>ot  
40–49 Male 2.56 4.04 0.00 3.00 (1.91, 4.08) G:s:NXy^  
Female 2.61 1.70 0.00 2.36 (1.61, 3.10) _BA_lkN+D  
50–59 Male 7.69 6.94 0.00 7.47 (5.80, 9.15) dWWkO03 |  
Female 6.67 7.56 0.00 6.92 (5.60, 8.24) =ZL}Av}  
60–69 Male 20.7 25.0 10.0 22.0 (18.1, 26.0) j`pR;XL1[  
Female 27.9 35.7 37.5 30.3 (26.0, 34.7) ee?ZkU#@  
70–79 Male 43.1 58.7 39.1 48.1 (41.2, 55.1) +>%+r  
Female 58.6 66.2 55.6 61.0 (56.0, 65.9) LjAIB(*  
80–89 Male 74.0 89.3 92.0 79.3 (72.3, 86.3) rNO;yL4)ey  
Female 91.9 97.0 80.2 92.6 (86.4, 98.8) UR=s{nFd  
90 + Male 100.0 100.0 75.0 98.8 (96.2, 100.0) 51'SA B09  
Female 100.0 100.0 93.8 98.6 (97.0, 100.0) Q]:%Jj2  
Age-standardized 2^lT!X@  
(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) ==r|]~x  
aCortical > 4/16, nuclear > standard 2, posterior subcapsular > 1 mm2 #a l^Uqd  
their current vision was 30% (290/683), compared with 27% zQ _[wM-  
(26/95) of participants with prior cataract surgery (chisquared, 3k0%H]wt  
1 d.f. = 0.25, P = 0.62). / kGX 6hh  
Outcomes of cataract surgery G* 6<pp  
Two hundred and forty-nine eyes had undergone prior 8dB~09Z7  
cataract surgery. Of these 249 operated eyes, 49 (20%) were 1uQf}  
left aphakic, 6 (2.4%) had anterior chamber intraocular /RmCMT  
lenses and 194 (78%) had posterior chamber intraocular aH"c0 A  
lenses. The rate of capsulotomy in the eyes with intact !r <|F  
posterior capsules was 36% (73/202). Fifteen per cent of _x{x#d;L3  
eyes (17/114) with a clear posterior capsule had bestcorrected 8PS:yBkA|  
visual acuity of less than 6/12 compared with 43% }O{"qs#)  
of eyes (6/14) with opaque capsules, and 15% of eyes C^tC} n1D(  
(11/73) with prior capsulotomies (chi-squared, 2 d.f. = 7.21, ]~ M -KT  
P = 0.027). &Hxr3[+$  
The percentage of eyes with best-corrected visual acuity 2ow\d b  
of 6/12 or better was 96% (302/314) for eyes without Q1[s{,  
cataract, 88% (1417/1609) for eyes with prevalent cataract uoHhp4>^  
and 85% (211/249) for eyes with operated cataract (chisquared, es]m 6A  
2 d.f. = 22.3), P < 0.001). Twenty-seven of the +rY0/T_0,  
operated eyes (11%) had visual acuities of less than 6/18 7A-rF U$  
(moderate vision impairment) (Fig. 2). A cause of this t_Wn<)XA  
moderate visual impairment (but not the only cause) in four uNg.y$>CX  
(15%) eyes was secondary to cataract surgery. Three of these U8!njLC  
four eyes had undergone intracapsular cataract extraction B)dynGF8i  
and the fourth eye had an opaque posterior capsule. No one D ]eF3a.G  
had bilateral vision impairment as a result of their cataract ]0le=Ee^%  
surgery. )Cl&"bX  
DISCUSSION }D O#{@af  
To our knowledge, this is the first paper to systematically ja2]VbB  
assess the prevalence of current cataract, previous cataract |M_Bbo@ud  
surgery, predictors of unoperated cataract and the outcomes 9Ba<'wk/>"  
of cataract surgery in a population-based sample. The Visual VJaL$Wv)H  
Impairment Project is unique in that the sampling frame and K~>kruO";  
high response rate have ensured that the study population is 5EUk p6Y  
representative of Australians aged 40 years and over. Therefore, )J0VB't  
these data can be used to plan age-related cataract o_n.,=/cZ  
services throughout Australia. ?6bE!36  
We found the rate of any cataract in those over the age #p >PNW-  
of 40 years to be 22%. Although relatively high, this rate is ceCshxTU  
significantly less than was reported in a number of previous uJ$,e5q  
studies,2,4,6 with the exception of the Casteldaccia Eye G`z 48  
Study.5 However, it is difficult to compare rates of cataract PhS"tOGtX  
between studies because of different methodologies and {65X37W  
cataract definitions employed in the various studies, as well S}E@*t2 h  
as the different age structures of the study populations. r.GjM#X  
Other studies have used less conservative definitions of c#DTL/8"DO  
cataract, thus leading to higher rates of cataract as defined. 1"k@O)?JP  
In most large epidemiologic studies of cataract, visual acuity rSk $]E]Z  
has not been included in the definition of cataract. (ni$wjq=z^  
Therefore, the prevalence of cataract may not reflect the MqqS3   
actual need for cataract surgery in the community. '9)@U+yfQ  
80 McCarty et al. L[K_!^MZ  
Table 2. Prevalence of previous cataract by age, gender and cohort n7G$gLX  
Age group Gender Urban Rural Nursing home Weighted total /d4xHt5a  
(years) (%) (%) (%) w~9gZ&hdp  
40–49 Male 1.14 0.00 0.00 0.80 (0.00, 1.81) cg~FW2Q  
Female 0.00 0.00 0.00 0.00 ( vB p5&*  
50–59 Male 0.68 0.58 0.00 0.65 (0.13, 1.17) -|lnJg4  
Female 0.57 0.00 0.00 0.41 (0.00, 1.00) 'K1w.hC<  
60–69 Male 2.12 7.59 0.00 3.80 (1.41, 6.19)  4Zq5  
Female 2.11 3.51 0.00 2.54 (1.81, 3.26) :9 7`IV%  
70–79 Male 8.22 9.85 8.70 8.75 (6.38, 11.1) Qi%A/~  
Female 7.21 7.86 7.02 7.41 (5.36, 9.46) FueJe/~t  
80–89 Male 25.0 30.0 14.3 26.2 (17.0, 35.4) .UcS4JU  
Female 27.9 25.6 18.3 26.7 (20.2, 33.3) (_T&2%  
90 + Male 0.00 16.7 66.7 9.19 (0.00, 21.5) /vhh2`  
Female 58.3 100.0 26.9 63.1 (44.4, 81.8) )mEF_ &  
Age-standardized - zkB`~u_  
(95% CL) Combined 3.31 (2.70, 3.93) 4.36 (2.67, 6.06) 2.26 (0.82, 3.70) 3.79 (2.97, 4.60) Nl+2m4  
Figure 2. Visual acuity in eyes that had undergone cataract g#AA.@/Z  
surgery, n = 249. h, Presenting; j, best-corrected. (xTHin$  
Operated and unoperated cataract in Australia 81 MS b{ve_  
The weighted prevalence of prior cataract surgery in the n)0{mDf%  
Visual Impairment Project (3.6%) was similar to the crude y.nw6.`MR  
rate in the Beaver Dam Eye Study4 (3.1%), but less than the y8L:nnSj  
crude rate in the Blue Mountains Eye Study6 (6.0%). [B4?Z-K%  
However, the age-standardized rate in the Blue Mountains 82<L07fB  
Eye Study (standardized to the age distribution of the urban CtfSfSAUuu  
Visual Impairment Project cohort) was found to be less than Xy{b(b;9  
the Visual Impairment Project (standardized rate = 1.36%, =4I361oMf  
95% CL 1.25, 1.47). The incidence of cataract surgery in JB-j@  
Australia has exceeded population growth.1 This is due, ~ce. &C7cR  
perhaps, to advances in surgical techniques and lens YmwVa s  
implants that have changed the risk–benefit ratio. }PXWRv.gW  
The Global Initiative for the Elimination of Avoidable uODsXi{z  
Blindness, sponsored by the World Health Organization, =nsY [ s<  
states that cataract surgical services should be provided that x6,RW],FGR  
‘have a high success rate in terms of visual outcome and YMWy5 \  
improved quality of life’,17 although the ‘high success rate’ is IP >An8+  
not defined. Population- and clinic-based studies conducted Rl(b tr1w  
in the United States have demonstrated marked improvement }bHpFe  
in visual acuity following cataract surgery.18–20 We 8(A:XQN"h  
found that 85% of eyes that had undergone cataract extraction R%Z} J R.  
had visual acuity of 6/12 or better. Previously, we have kA3kh`l  
shown that participants with prevalent cataract in this s:_5p`w>  
cohort are more likely to express dissatisfaction with their K'tz_:d|  
current vision than participants without cataract or participants A@#dv2JzP  
with prior cataract surgery.21 In a national study in the b,'./{c0  
United States, researchers found that the change in patients’ xs:{%ki  
ratings of their vision difficulties and satisfaction with their mZ5UaSG  
vision after cataract surgery were more highly related to R|vF*0)>W  
their change in visual functioning score than to their change dlU=k9N-  
in visual acuity.19 Furthermore, improvement in visual function Vlf@T  
has been shown to be associated with improvement in :Cuae?O,  
overall quality of life.22 XyIw5 9  
A recent review found that the incidence of visually Ia\Nj _-%L  
significant posterior capsule opacification following Mqpo S  
cataract surgery to be greater than 25%.23 We found 36% yTEuf@  
capsulotomy in our population and that this was associated DXiD>1(q  
with visual acuity similar to that of eyes with a clear &a:aW;^A7  
capsule, but significantly better than that of eyes with an ;~K($_#H  
opaque capsule. @ !S$gTz  
A number of studies have shown that the demand and w.3R1}R  
timing of cataract surgery vary according to visual acuity, &yN<@.  
degree of handicap and socioeconomic factors.8–10,24,25 We #i,O "`4  
have also shown previously that ophthalmologists are more ^\I$tnY`  
likely to refer a patient for cataract surgery if the patient is KYQ6U.%W  
employed and less likely to refer a nursing home resident.7 aJF` rLm  
In the Visual Impairment Project, we did not find that any 1Y`MJ \9  
particular subgroup of the population was at greater risk of 9D<HJ(  
having unoperated cataract. Universal access to health care . FruI#99  
in Australia may explain the fact that people without qL#R XUTP  
Medicare are more likely to delay cataract operations in the ieI-_]|[  
USA,8 but not having private health insurance is not associated l\5 NuCgRY  
with unoperated cataract in Australia. U}7[8&k1  
In summary, cataract is a significant public health problem <ZiO[dEV  
in that one in four people in their 80s will have had cataract %Xl@o  
surgery. The importance of age-related cataract surgery will \5Jv;gc\\  
increase further with the ageing of the population: the v\Hyu1;8  
number of people over age 60 years is expected to double in _e'mG'P(  
the next 20 years. Cataract surgery services are well L:<'TXsRA  
accessed by the Victorian population and the visual outcomes W@tLT[}CG  
of cataract surgery have been shown to be very good. N_<n$3P\?f  
These data can be used to plan for age-related cataract |2# Ro*  
surgical services in Australia in the future as the need for N9Ml&*%oX{  
cataract extractions increases. #q- _   
ACKNOWLEDGEMENTS R<=t{vTJ5  
The Visual Impairment Project was funded in part by grants pr"flRQr#  
from the Victorian Health Promotion Foundation, the `g=~u{ 0  
National Health and Medical Research Council, the Ansell =N c`hP  
Ophthalmology Foundation, the Dorothy Edols Estate and X&IY(CX  
the Jack Brockhoff Foundation. Dr McCarty is the recipient D\R^*k@V  
of a Wagstaff Fellowship in Ophthalmology from the Royal zvD5i,I  
Victorian Eye and Ear Hospital. 7h2bL6Y88  
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