ABSTRACT ;Efcw[<
Purpose: To quantify the prevalence of cataract, the outcomes azP+GM=i7
of cataract surgery and the factors related to XM<KF&pVB
unoperated cataract in Australia. zKFp5H1!%+
Methods: Participants were recruited from the Visual `mH %!{P
Impairment Project: a cluster, stratified sample of more than J4=_w
5000 Victorians aged 40 years and over. At examination I5AO?BzJ
sites interviews, clinical examinations and lens photography |xoF49
were performed. Cataract was defined in participants who PS
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had: had previous cataract surgery, cortical cataract greater O8U<{jgAG
than 4/16, nuclear greater than Wilmer standard 2, or ki;UY~
posterior subcapsular greater than 1 mm2. { m8+Wju}
Results: The participant group comprised 3271 Melbourne ^O^:$nXhYy
residents, 403 Melbourne nursing home residents and 1473 ]ALc;lb-}
rural residents.The weighted rate of any cataract in Victoria P%Ay3cR+E
was 21.5%. The overall weighted rate of prior cataract X~Rl 6/,
surgery was 3.79%. Two hundred and forty-nine eyes had ?hYqcT[%
had prior cataract surgery. Of these 249 procedures, 49 2 }vg U$a
(20%) were aphakic, 6 (2.4%) had anterior chamber V+wH?H=
intraocular lenses and 194 (78%) had posterior chamber nL]^$J$
intraocular lenses.Two hundred and eleven of these operated \
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eyes (85%) had best-corrected visual acuity of 6/12 or $trAC@3O@
better, the legal requirement for a driver’s license.Twentyseven w-N1.^
(11%) had visual acuity of less than 6/18 (moderate ALd;$fd qf
vision impairment). Complications of cataract surgery {Z{o"56f
caused reduced vision in four of the 27 eyes (15%), or 1.9% R@T6U:1
of operated eyes. Three of these four eyes had undergone BRG|Asg(
intracapsular cataract extraction and the fourth eye had an 1D([@)^
opaque posterior capsule. No one had bilateral vision 9vGs;
impairment as a result of cataract surgery. Surprisingly, no ?Ce#BwQ>
particular demographic factors (such as age, gender, rural ?T:
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residence, occupation, employment status, health insurance N1
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status, ethnicity) were related to the presence of unoperated GtI6[ :1t
cataract. |@VF.)_
Conclusions: Although the overall prevalence of cataract is vrl[BPI
quite high, no particular subgroup is systematically underserviced 2C+(":=}
in terms of cataract surgery. Overall, the results of $. e)
cataract surgery are very good, with the majority of eyes ~0tdfK0c
achieving driving vision following cataract extraction. 8LM#WIm?
Key words: cataract extraction, health planning, health (
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services accessibility, prevalence CUmH,`hu
INTRODUCTION Zy]s`aa
Cataract is the leading cause of blindness worldwide and, in -]"T^wib
Australia, cataract extractions account for the majority of all ~5#)N{GbY
ophthalmic procedures.1 Over the period 1985–94, the rate _3^y|_!
of cataract surgery in Australia was twice as high as would be pz}mF D&[
expected from the growth in the elderly population.1 $-pbw@7
Although there have been a number of studies reporting N7.
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the prevalence of cataract in various populations,2–6 there is 3B18dv,V
little information about determinants of cataract surgery in wa3F
the population. A previous survey of Australian ophthalmologists LdTIR]
showed that patient concern and lifestyle, rather P1d,8~;
than visual acuity itself, are the primary factors for referral C!UEXj`l9
for cataract surgery.7 This supports prior research which has :I/
shown that visual acuity is not a strong predictor of need for }$)&{d G
cataract surgery.8,9 Elsewhere, socioeconomic status has Zq?_dIX
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been shown to be related to cataract surgery rates.10 X ]s"5ju|t
To appropriately plan health care services, information is nP_=GI
needed about the prevalence of age-related cataract in the 6VR18Y!y
community as well as the factors associated with cataract d^aNR
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surgery. The purpose of this study is to quantify the prevalence 0BC`iql5
of any cataract in Australia, to describe the factors Ow3a0cF[9
related to unoperated cataract in the community and to xii$e
describe the visual outcomes of cataract surgery. IA4+ad'\E
METHODS X%J%A-k]
Study population pN k8! k
Details about the study methodology for the Visual V4?Oc2mS
Impairment Project have been published previously.11 ,kE=TR.|
Briefly, cluster sampling within three strata was employed to #<}kISV0
recruit subjects aged 40 years and over to participate. twv
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Within the Melbourne Statistical Division, nine pairs of W?PWJkIw
census collector districts were randomly selected. Fourteen *f*f&l