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主题 : Operated and unoperated cataract in Australia
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楼主  发表于: 2009-06-04   

Operated and unoperated cataract in Australia

ABSTRACT o93`|yWl  
Purpose: To quantify the prevalence of cataract, the outcomes / oriW;OF  
of cataract surgery and the factors related to 7x@A%2J  
unoperated cataract in Australia. U-|NY  
Methods: Participants were recruited from the Visual 9^j &V mF  
Impairment Project: a cluster, stratified sample of more than {DR`;ea])1  
5000 Victorians aged 40 years and over. At examination RRI"d~~F6  
sites interviews, clinical examinations and lens photography PbmDNKEh{  
were performed. Cataract was defined in participants who v&=gF/$  
had: had previous cataract surgery, cortical cataract greater ~/P&Tub^  
than 4/16, nuclear greater than Wilmer standard 2, or *FMMjz  
posterior subcapsular greater than 1 mm2. 0:T|S>FsAm  
Results: The participant group comprised 3271 Melbourne /C6k+0ApMT  
residents, 403 Melbourne nursing home residents and 1473  w/kt3Lw  
rural residents.The weighted rate of any cataract in Victoria .dav8n*  
was 21.5%. The overall weighted rate of prior cataract W' s  
surgery was 3.79%. Two hundred and forty-nine eyes had ^3UGV*Ypk  
had prior cataract surgery. Of these 249 procedures, 49 >Vwc3d  
(20%) were aphakic, 6 (2.4%) had anterior chamber H(Z88.OM  
intraocular lenses and 194 (78%) had posterior chamber 4B^ZnFJ%m  
intraocular lenses.Two hundred and eleven of these operated {o>j6RS\  
eyes (85%) had best-corrected visual acuity of 6/12 or !Y[lQXv  
better, the legal requirement for a driver’s license.Twentyseven eb=D/  
(11%) had visual acuity of less than 6/18 (moderate hX=A)73(  
vision impairment). Complications of cataract surgery cj1cZ-  
caused reduced vision in four of the 27 eyes (15%), or 1.9% LL3#5AA"k|  
of operated eyes. Three of these four eyes had undergone 6e[VgN-s  
intracapsular cataract extraction and the fourth eye had an  [@5Ytv H  
opaque posterior capsule. No one had bilateral vision SgS~ {4Zx*  
impairment as a result of cataract surgery. Surprisingly, no 2u5|8  
particular demographic factors (such as age, gender, rural (w}H]LQ  
residence, occupation, employment status, health insurance <psZQdH  
status, ethnicity) were related to the presence of unoperated U15H@h  
cataract. E(Z8  
Conclusions: Although the overall prevalence of cataract is Z7=`VNHc  
quite high, no particular subgroup is systematically underserviced <y?r!l=Am  
in terms of cataract surgery. Overall, the results of C,v(:ZE$J7  
cataract surgery are very good, with the majority of eyes !;KCU^9  
achieving driving vision following cataract extraction. ]3X@ _NYj  
Key words: cataract extraction, health planning, health -(~!Jo_*'  
services accessibility, prevalence -@0GcUE:r  
INTRODUCTION U G~ba  
Cataract is the leading cause of blindness worldwide and, in v%iof1 T'  
Australia, cataract extractions account for the majority of all f)^_|8  
ophthalmic procedures.1 Over the period 1985–94, the rate ]zWon~  
of cataract surgery in Australia was twice as high as would be V7Ek-2M  
expected from the growth in the elderly population.1 V4KMOYqm  
Although there have been a number of studies reporting Q|D @Yd\  
the prevalence of cataract in various populations,2–6 there is d~JKH&x<  
little information about determinants of cataract surgery in +P cmJ  
the population. A previous survey of Australian ophthalmologists @ CZ  T  
showed that patient concern and lifestyle, rather N<IT w/@^  
than visual acuity itself, are the primary factors for referral ^$'z!+QRM  
for cataract surgery.7 This supports prior research which has .ZJRO>S  
shown that visual acuity is not a strong predictor of need for 2C9V|[U,  
cataract surgery.8,9 Elsewhere, socioeconomic status has ,Q HU_jt  
been shown to be related to cataract surgery rates.10 -6n K<e`  
To appropriately plan health care services, information is HLV2~5Txc  
needed about the prevalence of age-related cataract in the [&#/]Ul'  
community as well as the factors associated with cataract woD>!r>)  
surgery. The purpose of this study is to quantify the prevalence ck.w 5|$  
of any cataract in Australia, to describe the factors 4'!c*@Y  
related to unoperated cataract in the community and to TwVlg ;  
describe the visual outcomes of cataract surgery. @AIaC-,~]  
METHODS >76\nGO  
Study population :"xzj<(  
Details about the study methodology for the Visual w (/aiV  
Impairment Project have been published previously.11 }l],.J\BGX  
Briefly, cluster sampling within three strata was employed to ~s]iy9i  
recruit subjects aged 40 years and over to participate. [g:$K5\64  
Within the Melbourne Statistical Division, nine pairs of @M5#S7q";  
census collector districts were randomly selected. Fourteen p4-o/8rO  
nursing homes within a 5 km radius of these nine test sites O]1y0BOQ  
were randomly chosen to recruit nursing home residents. Z`KC%!8K  
Clinical and Experimental Ophthalmology (2000) 28, 77–82 %|oJ>+  
Original Article 17G'jiY H  
Operated and unoperated cataract in Australia .tz G_  
Catherine A McCarty PhD, MPH, Mukesh B Nanjan PhD, Hugh R Taylor MD or';A'k  
Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia F=a<~EpZ  
n Correspondence: Dr Cathy McCarty MPH, Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, 32 Gisborne Street, East Melbourne, ZGYr$C~  
Victoria 3002, Australia. Email: cathy@cera.unimelb.edu.au & '}/f5s|  
78 McCarty et al. f=mZu1(FZ  
Finally, four pairs of census collector districts in four rural glF; e T  
Victorian communities were randomly selected to recruit rural qIIv6''5@  
residents. A household census was conducted to identify X  .5aMm  
eligible residents aged 40 years and over who had been a ( 8c9 /7h  
resident at that address for at least 6 months. At the time of 0QOBL'{7)  
the household census, basic information about age, sex, 'zGo? a  
country of birth, language spoken at home, education, use of pt?q#EfFJ  
corrective spectacles and use of eye care services was collected. +i2}/s@JJ  
Eligible residents were then invited to attend a local B9H@ e#[  
examination site for a more detailed interview and examination. }` != m  
The study protocol was approved by the Royal Victorian 9)gC6 IiW  
Eye and Ear Hospital Human Research Ethics Committee. 2VJR$Pao  
Assessment of cataract !Y\D?rKZ  
A standardized ophthalmic examination was performed after 0Pe>Es|^A#  
pupil dilatation with one drop of 10% phenylephrine pFHz" ]  
hydrochloride. Lens opacities were graded clinically at the ~( IB0=A{v  
time of the examination and subsequently from photos using Lg*B>=  
the Wilmer cataract photo-grading system.12 Cortical and }=8B*  
posterior subcapsular (PSC) opacities were assessed on 4@ML3d/  
retroillumination and measured as the proportion (in 1/16) S& \L-@  
of pupil circumference occupied by opacity. For this analysis, K/3)g9Z&io  
cortical cataract was defined as 4/16 or greater opacity, Qe5U<3{JZ  
PSC cataract was defined as opacity equal to or greater than !/3B3cG  
1 mm2 and nuclear cataract was defined as opacity equal to j.L-{6_s>~  
or greater than Wilmer standard 2,12 independent of visual PUBWZ^63  
acuity. Examples of the minimum opacities defined as cortical, e*;c(3>(  
nuclear and PSC cataract are presented in Figure 1. /s[l-1zW  
Bilateral congenital cataracts or cataracts secondary to <B6&I$Wc+  
intraocular inflammation or trauma were excluded from the (s7;^)}zx  
analysis. Two cases of bilateral secondary cataract and eight l:<?{)N`  
cases of bilateral congenital cataract were excluded from the JNa"8  
analyses. fbL\?S,w  
A Topcon® SL5 photo slit-lamp (Topcon America Corp., bV$)!]V  
Paramus, NJ, USA) with a 0.1 mm slit beam of 9.0 mm in krC{ed  
height set to an incident angle of 30° was used for examinations. Mc%Nf$XQ  
Ektachrome® 200 ASA colour slide film (Eastman fe_yqIdk  
Kodak Company, Rochester, NY, USA) was used to photograph ]zQo>W$  
the nuclear opacities. The cortical opacities were E  gal4  
photographed with an Oxford® retroillumination camera bBS,-vN  
(Marcher Enterprises Ltd, Hereford, UK) and T-MAX® 400 J]G? Rc  
film (Eastman Kodak). Photographs were graded separately x7<\] 94  
by two research assistants and discrepancies were adjudicated '`XX "_k3  
by an independent reviewer. Any discrepancies ?}RSwl  
between the clinical grades and the photograph grades were DV\`Wv  
resolved. Except in cases where photographs were missing, N\#MwLm  
the photograph grades were used in the analyses. Photograph *hQTO=WF  
grades were available for 4301 (84%) for cortical >9q&PEc  
cataract, 4147 (81%) for nuclear cataract and 4303 (84%) mN>h5G>a  
for PSC cataract. Cataract status was classified according to 5fm?Lxr&?  
the severity of the opacity in the worse eye. 9 P~\Mpk  
Assessment of risk factors OnF3lCmu  
A standardized questionnaire was used to obtain information HE'2"t[a  
about education, employment and ethnic background.11 dd\n8f  
Specific information was elicited on the occurrence, duration =9z[[dQ|L  
and treatment of a number of medical conditions, m^H21P"z  
including ocular trauma, arthritis, diabetes, gout, hypertension +> WM[o^I  
and mental illness. Information about the use, dose and ;[W"mlM  
duration of tobacco, alcohol, analgesics and steriods were XP1~d>j  
collected, and a food frequency questionnaire was used to :k3Nt5t!  
determine current consumption of dietary sources of antioxidants V\{tmDE  
and use of vitamin supplements. (vB<%l.&  
Data management and statistical analysis m <w "T7  
Data were collected either by direct computer entry with a TP"1\O  
questionnaire programmed in Paradox© (Carel Corporation, K\$J4~EtG  
Ottawa, Canada) with internal consistency checks, or ?@6/E<-Z$  
on self-coding forms. Open-ended responses were coded at ' /$d0`3B>  
a later time. Data that were entered on the self-coded forms i@B[ eta  
were entered into a computer with double data entry and MUA%^)#u4Q  
reconciliation of any inconsistencies. Data range and consistency $ KRI'4  
checks were performed on the entire data set. !Yw3 d   
SAS© version 6.1 (SAS Institute, Cary, North Carolina) was 8-lOB  
employed for statistical analyses. oX DN+4ge  
Ninety-five per cent confidence limits around the agespecific fn NYX]_bk  
rates were calculated according to Cochran13 to m1IKVa7-\}  
account for the effect of the cluster sampling. Ninety-five A^RR@D  
per cent confidence limits around age-standardized rates v 0kqu  
were calculated according to Breslow and Day.14 The strataspecific J8"[6vId~  
data were weighted according to the 1996 Qq@G\eRo  
Australian Bureau of Statistics census data15 to reflect the NO0"*c;  
cataract prevalence in the entire Victorian population. fsEzpUY:{W  
Univariate analyses with Student’s t-tests and chi-squared I`w4Xrd  
tests were first employed to evaluate risk factors for unoperated Z1h ]  
cataract. Any factors with P < 0.10 were then fitted AxZD-|.  
into a backwards stepwise logistic regression model. For the O4g+D#Lu  
Figure 1. Minimum levels of cortical (a), nuclear (b), and posterior subcapsular (c) cataract. Wfz\ `y  
final multivariate models, P < 0.05 was considered statistically {w8 NN-n  
significant. Design effect was assessed through the use )OLq_':^ @  
of cluster-specific models and multivariate models. The }HG#s4  
design effect was assumed to be additive and an adjustment +e-,ST&w(  
made in the variance by adding the variance associated with WH$e2[+Y  
the design effect prior to constructing the 95% confidence x%<  
limits. 1Fe^Qb5G  
RESULTS S#b-awk  
Study population >;#=gM  
A total of 3271 (83%) of the Melbourne residents, 403 k78Vh$AA6%  
(90%) Melbourne nursing home residents, and 1473 (92%) ';G1A  
rural residents participated. In general, non-participants did `' 153M]  
not differ from participants.16 The study population was <|*'O5B  
representative of the Victorian population and Australia as ur\qOX|{  
a whole. Nk;iiz+_p  
The Melbourne residents ranged in age from 40 to M0' a9.d  
98 years (mean = 59) and 1511 (46%) were male. The '&FjW-`" G  
Melbourne nursing home residents ranged in age from 46 to +"ueq  
101 years (mean = 82) and 85 (21%) were men. The rural o3Vn<Z$/Cl  
residents ranged in age from 40 to 103 years (mean = 60) 6QNs\Ucb+  
and 701 (47.5%) were men. /:\3 \{?0m  
Prevalence of cataract and prior cataract surgery 1mSaS4!"B  
As would be expected, the rate of any cataract increases C*X G_b ]  
dramatically with age (Table 1). The weighted rate of any gFPi7 o1  
cataract in Victoria was 21.5% (95% CL 18.1, 24.9). m7 %C#+67  
Although the rates varied somewhat between the three _ OaRY]  
strata, they were not significantly different as the 95% confidence ,&YTj>  
limits overlapped. The per cent of cataractous eyes k]rLjcB  
with best-corrected visual acuity of less than 6/12 was 12.5% tehUD&  
(65/520) for cortical cataract, 18% for nuclear cataract '(#g1H3  
(97/534) and 14.4% (27/187) for PSC cataract. Cataract v8I{XU@%  
surgery also rose dramatically with age. The overall '+*-s7o{  
weighted rate of prior cataract surgery in Victoria was S)A'Y]2X  
3.79% (95% CL 2.97, 4.60) (Table 2). Sg] J7;]  
Risk factors for unoperated cataract &s)0z)mR8&  
Cases of cataract that had not been removed were classified =Z  sGT  
as unoperated cataract. Risk factor analyses for unoperated CiL94Nkd9  
cataract were not performed with the nursing home residents A%vsno!  
as information about risk factor exposure was not Ae?e 70bY  
available for this cohort. The following factors were assessed 0m+8P$)C%  
in relation to unoperated cataract: age, sex, residence 1Xyp/X2rI  
(urban/rural), language spoken at home (a measure of ethnic # 4|9Fj??  
integration), country of birth, parents’ country of birth (a VG*'"y *%w  
measure of ethnicity), years since migration, education, use 3]n0 &MZAR  
of ophthalmic services, use of optometric services, private -)<m  S  
health insurance status, duration of distance glasses use, "L3Xd][  
glaucoma, age-related maculopathy and employment status. 8,o17}NY,  
In this cross sectional study it was not possible to assess the MFg'YA2 /  
level of visual acuity that would predict a patient’s having (Q-I8Y8l8  
cataract surgery, as visual acuity data prior to cataract Cj&$%sO1  
surgery were not available. K@@9:T$  
The significant risk factors for unoperated cataract in univariate 3ViM ?p  
analyses were related to: whether a participant had ,.g}W~S)  
ever seen an optometrist, seen an ophthalmologist or been cD{8|B*  
diagnosed with glaucoma; and participants’ employment Lm.`+W5  
status (currently employed) and age. These significant [[qwaI  
factors were placed in a backwards stepwise logistic regression z};ZxN  
model. The factors that remained significantly related v3JPE])/  
to unoperated cataract were whether participants had ever <{019Oa  
seen an ophthalmologist, seen an optometrist and been !*P&Eat  
diagnosed with glaucoma. None of the demographic factors )o8g=7Jm  
were associated with unoperated cataract in the multivariate *?8RXer  
model. PZ34*q  
The per cent of participants with unoperated cataract ?mOg@) wx  
who said that they were dissatisfied or very dissatisfied with M}!A]@  
Operated and unoperated cataract in Australia 79 cw+g z!!  
Table 1. Prevalence of any cataracta (excluding previous cataract surgery) by age, gender and cohort ;,0lUcV  
Age group Sex Urban Rural Nursing home Weighted total !"! i i$@  
(years) (%) (%) (%) l(Cf7o!  
40–49 Male 2.56 4.04 0.00 3.00 (1.91, 4.08) 5.k}{{+  
Female 2.61 1.70 0.00 2.36 (1.61, 3.10)  E&%jeR  
50–59 Male 7.69 6.94 0.00 7.47 (5.80, 9.15) 5OB]x?4]  
Female 6.67 7.56 0.00 6.92 (5.60, 8.24) j@ C0af  
60–69 Male 20.7 25.0 10.0 22.0 (18.1, 26.0) ~Oh=   
Female 27.9 35.7 37.5 30.3 (26.0, 34.7) l<2oklo5  
70–79 Male 43.1 58.7 39.1 48.1 (41.2, 55.1) $WNG07]tU  
Female 58.6 66.2 55.6 61.0 (56.0, 65.9) |yAK@ Hl'  
80–89 Male 74.0 89.3 92.0 79.3 (72.3, 86.3) a Qmfrx  
Female 91.9 97.0 80.2 92.6 (86.4, 98.8) k2OM="Ei}  
90 + Male 100.0 100.0 75.0 98.8 (96.2, 100.0) ou;qO 5CT  
Female 100.0 100.0 93.8 98.6 (97.0, 100.0) DVzssP g  
Age-standardized 966<I56+  
(95% CL) Combined 19.7 (16.3, 23.1) 23.2 (16.1, 30.2) 16.5 (2.06, 30.9) 21.5 (18.1, 25.0) \ 522,n`  
aCortical > 4/16, nuclear > standard 2, posterior subcapsular > 1 mm2  ,F}r@  
their current vision was 30% (290/683), compared with 27% sVcdj|j  
(26/95) of participants with prior cataract surgery (chisquared, M,JA;a, _  
1 d.f. = 0.25, P = 0.62). <N5rv3 s  
Outcomes of cataract surgery ^5>du~d  
Two hundred and forty-nine eyes had undergone prior 8;8YA1 @w  
cataract surgery. Of these 249 operated eyes, 49 (20%) were +',^((o  
left aphakic, 6 (2.4%) had anterior chamber intraocular .ujj:>  
lenses and 194 (78%) had posterior chamber intraocular ?k::tNv0  
lenses. The rate of capsulotomy in the eyes with intact =Pj@g/25u  
posterior capsules was 36% (73/202). Fifteen per cent of U,38qKE  
eyes (17/114) with a clear posterior capsule had bestcorrected FbBX}n  
visual acuity of less than 6/12 compared with 43% mb~./.5F  
of eyes (6/14) with opaque capsules, and 15% of eyes 77^ "xsa  
(11/73) with prior capsulotomies (chi-squared, 2 d.f. = 7.21, s~)L_ p  
P = 0.027). J& )#G@fRX  
The percentage of eyes with best-corrected visual acuity DH/L`$  
of 6/12 or better was 96% (302/314) for eyes without UE {,.s  
cataract, 88% (1417/1609) for eyes with prevalent cataract +/w(K,  
and 85% (211/249) for eyes with operated cataract (chisquared, 2pjW,I!`  
2 d.f. = 22.3), P < 0.001). Twenty-seven of the h*G #<M  
operated eyes (11%) had visual acuities of less than 6/18 ;n` $+g:>  
(moderate vision impairment) (Fig. 2). A cause of this ?-d Ain1w  
moderate visual impairment (but not the only cause) in four fPOEVmj<  
(15%) eyes was secondary to cataract surgery. Three of these  A<2I!  
four eyes had undergone intracapsular cataract extraction hc6.#~i  
and the fourth eye had an opaque posterior capsule. No one ^J0zXe -d  
had bilateral vision impairment as a result of their cataract &7fY_~)B  
surgery. % <^[j^j}o  
DISCUSSION 8i[" .9}G\  
To our knowledge, this is the first paper to systematically z;U LQ  
assess the prevalence of current cataract, previous cataract 70duk:Ri0  
surgery, predictors of unoperated cataract and the outcomes aN:HG)$@  
of cataract surgery in a population-based sample. The Visual @T5YsX]qb7  
Impairment Project is unique in that the sampling frame and xcw%RUC-  
high response rate have ensured that the study population is =?wMESU  
representative of Australians aged 40 years and over. Therefore, lD9%xCo9(  
these data can be used to plan age-related cataract o*-h%Z.  
services throughout Australia. Sy4 mZ}:  
We found the rate of any cataract in those over the age 7Nd*,DV_  
of 40 years to be 22%. Although relatively high, this rate is c]e`m6  
significantly less than was reported in a number of previous k\nH&nb  
studies,2,4,6 with the exception of the Casteldaccia Eye ^GE^Q\&D&  
Study.5 However, it is difficult to compare rates of cataract *Yj~]E0`1  
between studies because of different methodologies and } /[_  
cataract definitions employed in the various studies, as well k& WS$R?u  
as the different age structures of the study populations. Tt{U"EFO  
Other studies have used less conservative definitions of -)4uYK*  
cataract, thus leading to higher rates of cataract as defined. Hde]DK,d  
In most large epidemiologic studies of cataract, visual acuity W\&WS"=~  
has not been included in the definition of cataract. :a# F  
Therefore, the prevalence of cataract may not reflect the L[CU  
actual need for cataract surgery in the community. /&*m1EN#o  
80 McCarty et al. g@<sU0B  
Table 2. Prevalence of previous cataract by age, gender and cohort zt-' SY  
Age group Gender Urban Rural Nursing home Weighted total c:3@[nF ~  
(years) (%) (%) (%) $7msL#E7  
40–49 Male 1.14 0.00 0.00 0.80 (0.00, 1.81) |P^]@om  
Female 0.00 0.00 0.00 0.00 ( =Dh$yC-Zr  
50–59 Male 0.68 0.58 0.00 0.65 (0.13, 1.17) G /NT e  
Female 0.57 0.00 0.00 0.41 (0.00, 1.00)  KYnW7|*  
60–69 Male 2.12 7.59 0.00 3.80 (1.41, 6.19) ;%BhhmR)[  
Female 2.11 3.51 0.00 2.54 (1.81, 3.26) n^* >a  
70–79 Male 8.22 9.85 8.70 8.75 (6.38, 11.1) ;[;)P tFz\  
Female 7.21 7.86 7.02 7.41 (5.36, 9.46) U(rr vNt:t  
80–89 Male 25.0 30.0 14.3 26.2 (17.0, 35.4) X*TuQ\T  
Female 27.9 25.6 18.3 26.7 (20.2, 33.3) ^;0~6uBEJr  
90 + Male 0.00 16.7 66.7 9.19 (0.00, 21.5) 9=Y,["br$_  
Female 58.3 100.0 26.9 63.1 (44.4, 81.8) \?bwm&6+r  
Age-standardized )$ ofl%+  
(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) i!CKA} ",  
Figure 2. Visual acuity in eyes that had undergone cataract <{$ ev&bQ  
surgery, n = 249. h, Presenting; j, best-corrected. 4y|xUO:  
Operated and unoperated cataract in Australia 81 P]!LN\[  
The weighted prevalence of prior cataract surgery in the E9yFREvQc  
Visual Impairment Project (3.6%) was similar to the crude X)`(nj  
rate in the Beaver Dam Eye Study4 (3.1%), but less than the wm); aWP  
crude rate in the Blue Mountains Eye Study6 (6.0%). >/7KL2*  
However, the age-standardized rate in the Blue Mountains M[:O(  
Eye Study (standardized to the age distribution of the urban :NwMb^>  
Visual Impairment Project cohort) was found to be less than :N^@a-  
the Visual Impairment Project (standardized rate = 1.36%, ]I{qp~^#n  
95% CL 1.25, 1.47). The incidence of cataract surgery in 3v9gb,)y\  
Australia has exceeded population growth.1 This is due, S[W9G)KWp  
perhaps, to advances in surgical techniques and lens ^4u3Q  
implants that have changed the risk–benefit ratio. 8CHb~m@^$  
The Global Initiative for the Elimination of Avoidable /3)YWFZZc  
Blindness, sponsored by the World Health Organization, K^!e-Xi6  
states that cataract surgical services should be provided that naec"Kut  
‘have a high success rate in terms of visual outcome and >>oASo  
improved quality of life’,17 although the ‘high success rate’ is QOkE\ro  
not defined. Population- and clinic-based studies conducted E3CiZ4=5  
in the United States have demonstrated marked improvement Hj5WJ{p.  
in visual acuity following cataract surgery.18–20 We Vu|Br  
found that 85% of eyes that had undergone cataract extraction p|bc=`TD  
had visual acuity of 6/12 or better. Previously, we have l5\B2 +}7  
shown that participants with prevalent cataract in this /%J&/2Wz  
cohort are more likely to express dissatisfaction with their G1#Bb5q:  
current vision than participants without cataract or participants yNhscAMNn  
with prior cataract surgery.21 In a national study in the f>\bUmk(  
United States, researchers found that the change in patients’ @\%)'WU  
ratings of their vision difficulties and satisfaction with their P`Hd*xh".j  
vision after cataract surgery were more highly related to [6,]9|~  
their change in visual functioning score than to their change .R$+#_  
in visual acuity.19 Furthermore, improvement in visual function 5CY@R  
has been shown to be associated with improvement in  qrkRD*a  
overall quality of life.22 Ac5o K  
A recent review found that the incidence of visually  =BqaGXr  
significant posterior capsule opacification following Ww'TCWk@  
cataract surgery to be greater than 25%.23 We found 36% eZR8<Z %  
capsulotomy in our population and that this was associated ctc`^#q  
with visual acuity similar to that of eyes with a clear #czyr@  
capsule, but significantly better than that of eyes with an fncwe ';?  
opaque capsule. [/+dHW|  
A number of studies have shown that the demand and sO{0hZkc  
timing of cataract surgery vary according to visual acuity, |oBdryi  
degree of handicap and socioeconomic factors.8–10,24,25 We OU)p)Y_z  
have also shown previously that ophthalmologists are more g6@NPQ  
likely to refer a patient for cataract surgery if the patient is VHgF#6'   
employed and less likely to refer a nursing home resident.7 .kB3jfw0,  
In the Visual Impairment Project, we did not find that any k@t,[  
particular subgroup of the population was at greater risk of YA;8uMqh;  
having unoperated cataract. Universal access to health care px [1#*  
in Australia may explain the fact that people without -aH?7HV}  
Medicare are more likely to delay cataract operations in the G"U>fwFuK  
USA,8 but not having private health insurance is not associated "f&i 251  
with unoperated cataract in Australia. n6%jhv9H  
In summary, cataract is a significant public health problem j6R{  
in that one in four people in their 80s will have had cataract t7!>5e)C}  
surgery. The importance of age-related cataract surgery will OuBMVn  
increase further with the ageing of the population: the z W" 3K  
number of people over age 60 years is expected to double in -EkDG]my  
the next 20 years. Cataract surgery services are well #H|j-RM2  
accessed by the Victorian population and the visual outcomes 5>1Y="B  
of cataract surgery have been shown to be very good. P7 >C4rmQ  
These data can be used to plan for age-related cataract ^zWO[$n}tP  
surgical services in Australia in the future as the need for IjB*myN.  
cataract extractions increases. se n{f^U  
ACKNOWLEDGEMENTS L$TKO,T  
The Visual Impairment Project was funded in part by grants TNFm7}=  
from the Victorian Health Promotion Foundation, the li_pM!dWU_  
National Health and Medical Research Council, the Ansell {ZsWZJ!  
Ophthalmology Foundation, the Dorothy Edols Estate and Acq>M^ E3  
the Jack Brockhoff Foundation. Dr McCarty is the recipient xwH|ryfs,Z  
of a Wagstaff Fellowship in Ophthalmology from the Royal DT(Zv2  
Victorian Eye and Ear Hospital. kG;\ i  
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