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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 >jhcSvM6  
Purpose: To quantify the prevalence of cataract, the outcomes M*gvYo  
of cataract surgery and the factors related to 0j!3\=P$  
unoperated cataract in Australia. sPvs}}Z]P  
Methods: Participants were recruited from the Visual =f!A o:Uc  
Impairment Project: a cluster, stratified sample of more than cLf90|YFp  
5000 Victorians aged 40 years and over. At examination zl :by?  
sites interviews, clinical examinations and lens photography p7Wt(A  
were performed. Cataract was defined in participants who n!/0yR2S  
had: had previous cataract surgery, cortical cataract greater <|_>r`@%l  
than 4/16, nuclear greater than Wilmer standard 2, or `KA==;0  
posterior subcapsular greater than 1 mm2. -@(LN%7!C  
Results: The participant group comprised 3271 Melbourne Wn@oG@}~  
residents, 403 Melbourne nursing home residents and 1473 yM@sGz6c!  
rural residents.The weighted rate of any cataract in Victoria uE')<fVX(  
was 21.5%. The overall weighted rate of prior cataract )v_Wn[Y.H  
surgery was 3.79%. Two hundred and forty-nine eyes had g@>l lve{  
had prior cataract surgery. Of these 249 procedures, 49 _dd! nU\A|  
(20%) were aphakic, 6 (2.4%) had anterior chamber IsI5c  
intraocular lenses and 194 (78%) had posterior chamber 3=uhy|f! /  
intraocular lenses.Two hundred and eleven of these operated EO)JMV?6  
eyes (85%) had best-corrected visual acuity of 6/12 or q1:dcxR[  
better, the legal requirement for a driver’s license.Twentyseven 5`p9Xo>)yW  
(11%) had visual acuity of less than 6/18 (moderate qG;tD>jy  
vision impairment). Complications of cataract surgery T4.wz 58  
caused reduced vision in four of the 27 eyes (15%), or 1.9% gW~T{+f  
of operated eyes. Three of these four eyes had undergone Ak@!F6~  
intracapsular cataract extraction and the fourth eye had an )]C]KB  
opaque posterior capsule. No one had bilateral vision ?m*e$!M0  
impairment as a result of cataract surgery. Surprisingly, no p\ =T #lb  
particular demographic factors (such as age, gender, rural h<%$?h+}  
residence, occupation, employment status, health insurance %RV81H9B  
status, ethnicity) were related to the presence of unoperated ASbI c"S6  
cataract. %J-0%-/_S:  
Conclusions: Although the overall prevalence of cataract is >M2~p& Si  
quite high, no particular subgroup is systematically underserviced A3/[9}(U  
in terms of cataract surgery. Overall, the results of \"ahs7ABT  
cataract surgery are very good, with the majority of eyes 7e+C5W*9b  
achieving driving vision following cataract extraction. ZXb|3|D  
Key words: cataract extraction, health planning, health =8 @DYz'  
services accessibility, prevalence nu\ AEFT  
INTRODUCTION y-+W  
Cataract is the leading cause of blindness worldwide and, in iG5 4 +]  
Australia, cataract extractions account for the majority of all 5oG~Fc  
ophthalmic procedures.1 Over the period 1985–94, the rate B%\&Q @X  
of cataract surgery in Australia was twice as high as would be ;iiCay37F  
expected from the growth in the elderly population.1 p48enH8CO  
Although there have been a number of studies reporting ExtC\(X;  
the prevalence of cataract in various populations,2–6 there is 1=J& ^O{W  
little information about determinants of cataract surgery in \|S%zX  
the population. A previous survey of Australian ophthalmologists JY CMW! ~  
showed that patient concern and lifestyle, rather gPCf+>X{  
than visual acuity itself, are the primary factors for referral 1@OpvO5  
for cataract surgery.7 This supports prior research which has 2|bt"y-5r  
shown that visual acuity is not a strong predictor of need for =OF hM7  
cataract surgery.8,9 Elsewhere, socioeconomic status has qvc< _k^  
been shown to be related to cataract surgery rates.10 :-jbIpj'  
To appropriately plan health care services, information is &7\}S qp  
needed about the prevalence of age-related cataract in the E$ \l57  
community as well as the factors associated with cataract #@DJf  
surgery. The purpose of this study is to quantify the prevalence !nl-}P,  
of any cataract in Australia, to describe the factors ~NIhS!  
related to unoperated cataract in the community and to +TqrvI.  
describe the visual outcomes of cataract surgery. TXi|  
METHODS s\mA3t  
Study population t4UK~ {gh  
Details about the study methodology for the Visual } +Sp7F1q  
Impairment Project have been published previously.11 Ac U@H0  
Briefly, cluster sampling within three strata was employed to )dfhy  
recruit subjects aged 40 years and over to participate. P0m9($JBD  
Within the Melbourne Statistical Division, nine pairs of 2z !05]B%  
census collector districts were randomly selected. Fourteen z` 6$p1U  
nursing homes within a 5 km radius of these nine test sites ~v(c9I)  
were randomly chosen to recruit nursing home residents. E\D,=|Mul  
Clinical and Experimental Ophthalmology (2000) 28, 77–82 }i^M<A O  
Original Article =aB+|E  
Operated and unoperated cataract in Australia m^XO77"  
Catherine A McCarty PhD, MPH, Mukesh B Nanjan PhD, Hugh R Taylor MD Zocuc"j  
Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia J\+fkN<.  
n Correspondence: Dr Cathy McCarty MPH, Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, 32 Gisborne Street, East Melbourne, I<RARB-j  
Victoria 3002, Australia. Email: cathy@cera.unimelb.edu.au v CsE|e MP  
78 McCarty et al. ;!f~  
Finally, four pairs of census collector districts in four rural =SmU ;t>t/  
Victorian communities were randomly selected to recruit rural KgM|:'  
residents. A household census was conducted to identify )T9Cv8  
eligible residents aged 40 years and over who had been a SM)"vr_  
resident at that address for at least 6 months. At the time of F-ZTy"z  
the household census, basic information about age, sex, ^@/wXj:  
country of birth, language spoken at home, education, use of 3M?O(oO  
corrective spectacles and use of eye care services was collected. <m\Y$Wv  
Eligible residents were then invited to attend a local 1v:Ql\^cT  
examination site for a more detailed interview and examination. rNhS\1-  
The study protocol was approved by the Royal Victorian HgW!Q(*  
Eye and Ear Hospital Human Research Ethics Committee. 8Kl&_-l{b  
Assessment of cataract @BLB.=  
A standardized ophthalmic examination was performed after G?v <-=I  
pupil dilatation with one drop of 10% phenylephrine -cUbIbW  
hydrochloride. Lens opacities were graded clinically at the >|Ro LV  
time of the examination and subsequently from photos using &V 7J5~_  
the Wilmer cataract photo-grading system.12 Cortical and ;g8v7>p  
posterior subcapsular (PSC) opacities were assessed on Hc8^w6S1@  
retroillumination and measured as the proportion (in 1/16) *VXx\&  
of pupil circumference occupied by opacity. For this analysis, G)YmaHeI;[  
cortical cataract was defined as 4/16 or greater opacity, LkHH7Pd@  
PSC cataract was defined as opacity equal to or greater than (D[~Z!   
1 mm2 and nuclear cataract was defined as opacity equal to }U=}5`_]D  
or greater than Wilmer standard 2,12 independent of visual {9;-5@b  
acuity. Examples of the minimum opacities defined as cortical, ).GM 0-y  
nuclear and PSC cataract are presented in Figure 1. ?IQDk|<%  
Bilateral congenital cataracts or cataracts secondary to dY. X/f  
intraocular inflammation or trauma were excluded from the 0VQBm^$(  
analysis. Two cases of bilateral secondary cataract and eight Zc38ht\r;  
cases of bilateral congenital cataract were excluded from the eQyc <  
analyses. zQO 1% g  
A Topcon® SL5 photo slit-lamp (Topcon America Corp., \ H>Psv{  
Paramus, NJ, USA) with a 0.1 mm slit beam of 9.0 mm in :I /9j=@1  
height set to an incident angle of 30° was used for examinations. 78:x{1nUM[  
Ektachrome® 200 ASA colour slide film (Eastman P//nYPyzg  
Kodak Company, Rochester, NY, USA) was used to photograph I+W,%)vb  
the nuclear opacities. The cortical opacities were s^6,"C  
photographed with an Oxford® retroillumination camera <]z4;~/&  
(Marcher Enterprises Ltd, Hereford, UK) and T-MAX® 400 4gEw } WiP  
film (Eastman Kodak). Photographs were graded separately _d7;Z%  
by two research assistants and discrepancies were adjudicated h 8M_Uk  
by an independent reviewer. Any discrepancies p;7wH\c  
between the clinical grades and the photograph grades were F5H*z\/={  
resolved. Except in cases where photographs were missing, R$IsP,Uw  
the photograph grades were used in the analyses. Photograph dtV*CX.D.7  
grades were available for 4301 (84%) for cortical CD#U`jf  
cataract, 4147 (81%) for nuclear cataract and 4303 (84%) DfGq m-c  
for PSC cataract. Cataract status was classified according to =B+dhZ+#S$  
the severity of the opacity in the worse eye. w(S&X"~  
Assessment of risk factors +3AX1o%p,#  
A standardized questionnaire was used to obtain information .#sX|c=W  
about education, employment and ethnic background.11 u f<%!=e  
Specific information was elicited on the occurrence, duration F#Pn]  
and treatment of a number of medical conditions, }9B},  
including ocular trauma, arthritis, diabetes, gout, hypertension fTX|vy<EMI  
and mental illness. Information about the use, dose and YsiH=x  
duration of tobacco, alcohol, analgesics and steriods were #/9Y}2G|]  
collected, and a food frequency questionnaire was used to bx6=LK  
determine current consumption of dietary sources of antioxidants MVQ6I/EA4  
and use of vitamin supplements. 2RqV\Jik  
Data management and statistical analysis RxPD44jVA  
Data were collected either by direct computer entry with a 41.xi9V2  
questionnaire programmed in Paradox© (Carel Corporation, i(e=  
Ottawa, Canada) with internal consistency checks, or 6_rgRo&  
on self-coding forms. Open-ended responses were coded at #U3q +d+^  
a later time. Data that were entered on the self-coded forms kDR5kD iS  
were entered into a computer with double data entry and BlT)hG(M>  
reconciliation of any inconsistencies. Data range and consistency zw5Ol%JF  
checks were performed on the entire data set. -m=!SQ >9  
SAS© version 6.1 (SAS Institute, Cary, North Carolina) was ?mVSc/  
employed for statistical analyses. ]H`pM9rC  
Ninety-five per cent confidence limits around the agespecific !w!k0z]  
rates were calculated according to Cochran13 to |XQ\c.A  
account for the effect of the cluster sampling. Ninety-five g38 MF  
per cent confidence limits around age-standardized rates siV]NI ':|  
were calculated according to Breslow and Day.14 The strataspecific t!FC)iY  
data were weighted according to the 1996 ofYZ! -V  
Australian Bureau of Statistics census data15 to reflect the K1;b4Sl?A  
cataract prevalence in the entire Victorian population. ycIcM~<4  
Univariate analyses with Student’s t-tests and chi-squared r M}o)  
tests were first employed to evaluate risk factors for unoperated w&hCt c  
cataract. Any factors with P < 0.10 were then fitted Nd;pkssd  
into a backwards stepwise logistic regression model. For the 7coVl$_Zl  
Figure 1. Minimum levels of cortical (a), nuclear (b), and posterior subcapsular (c) cataract. yS?5&oMl  
final multivariate models, P < 0.05 was considered statistically GJ?J6@|  
significant. Design effect was assessed through the use Ak}`zIo  
of cluster-specific models and multivariate models. The c4Q%MRR  
design effect was assumed to be additive and an adjustment .F _u/"**  
made in the variance by adding the variance associated with v[DxWs8q  
the design effect prior to constructing the 95% confidence %bG\  
limits. @a B7dtM  
RESULTS !Ap*PL  
Study population urL@SeV+$  
A total of 3271 (83%) of the Melbourne residents, 403 %?/vC 6  
(90%) Melbourne nursing home residents, and 1473 (92%) [*H h6  
rural residents participated. In general, non-participants did h>z5m   
not differ from participants.16 The study population was ) 2jH&}K  
representative of the Victorian population and Australia as zf\$T,t)  
a whole. Io /;+R .  
The Melbourne residents ranged in age from 40 to 3r?T|>|  
98 years (mean = 59) and 1511 (46%) were male. The y"_rDj`  
Melbourne nursing home residents ranged in age from 46 to P|;v>  
101 years (mean = 82) and 85 (21%) were men. The rural :o:/RRp[  
residents ranged in age from 40 to 103 years (mean = 60) #~r+Z[(,p  
and 701 (47.5%) were men. |b!Bb<5  
Prevalence of cataract and prior cataract surgery L5wFbc"u  
As would be expected, the rate of any cataract increases Ga <=Di):  
dramatically with age (Table 1). The weighted rate of any Q[T)jo,j%  
cataract in Victoria was 21.5% (95% CL 18.1, 24.9). ' 1dhdm8  
Although the rates varied somewhat between the three -(#`JT8  
strata, they were not significantly different as the 95% confidence +Q:)zE  
limits overlapped. The per cent of cataractous eyes b: I0Zv6  
with best-corrected visual acuity of less than 6/12 was 12.5% {JfL7%  
(65/520) for cortical cataract, 18% for nuclear cataract GIS,EwA  
(97/534) and 14.4% (27/187) for PSC cataract. Cataract *M$$%G(4  
surgery also rose dramatically with age. The overall Ud#xgs'  
weighted rate of prior cataract surgery in Victoria was =< P$mFP2*  
3.79% (95% CL 2.97, 4.60) (Table 2). ^>y|{;`  
Risk factors for unoperated cataract @~i : 8  
Cases of cataract that had not been removed were classified H[?l)nZ}  
as unoperated cataract. Risk factor analyses for unoperated GCxmqoQ  
cataract were not performed with the nursing home residents :4Y 5  
as information about risk factor exposure was not >ATccv  
available for this cohort. The following factors were assessed 0"mr*hyj  
in relation to unoperated cataract: age, sex, residence TO/SiOd  
(urban/rural), language spoken at home (a measure of ethnic Ai`0Ud,M@  
integration), country of birth, parents’ country of birth (a z E\~Oa;  
measure of ethnicity), years since migration, education, use ypTH=]y  
of ophthalmic services, use of optometric services, private @M(+YCi:e@  
health insurance status, duration of distance glasses use, w!Ii   
glaucoma, age-related maculopathy and employment status. )jw!, "_4  
In this cross sectional study it was not possible to assess the ?+byRoY>&g  
level of visual acuity that would predict a patient’s having 6 _#CvQ  
cataract surgery, as visual acuity data prior to cataract W: 3fLXk+  
surgery were not available. @CA{uP;  
The significant risk factors for unoperated cataract in univariate y# IUDnRJ  
analyses were related to: whether a participant had 1 @q"rPE^  
ever seen an optometrist, seen an ophthalmologist or been }Gd^r  
diagnosed with glaucoma; and participants’ employment uAV-wc  
status (currently employed) and age. These significant S\@U3|Q5  
factors were placed in a backwards stepwise logistic regression $A)[s$  
model. The factors that remained significantly related ,d8*7my  
to unoperated cataract were whether participants had ever Htce<H-P  
seen an ophthalmologist, seen an optometrist and been is{H >#+"  
diagnosed with glaucoma. None of the demographic factors cXt]55"  
were associated with unoperated cataract in the multivariate YS>VQl  
model. "X-"uIc  
The per cent of participants with unoperated cataract 5&}p'6*K  
who said that they were dissatisfied or very dissatisfied with X7)B)r}AG  
Operated and unoperated cataract in Australia 79 T{*!.+E  
Table 1. Prevalence of any cataracta (excluding previous cataract surgery) by age, gender and cohort mzn#4;m$  
Age group Sex Urban Rural Nursing home Weighted total #mRT>]di`D  
(years) (%) (%) (%) H|<Zm:.%$  
40–49 Male 2.56 4.04 0.00 3.00 (1.91, 4.08) >8gb/?z  
Female 2.61 1.70 0.00 2.36 (1.61, 3.10) F?4&qbdD  
50–59 Male 7.69 6.94 0.00 7.47 (5.80, 9.15) v3r<kNW_  
Female 6.67 7.56 0.00 6.92 (5.60, 8.24) nOU.=N v`  
60–69 Male 20.7 25.0 10.0 22.0 (18.1, 26.0) H) q_9<;  
Female 27.9 35.7 37.5 30.3 (26.0, 34.7) 4R9y~~+  
70–79 Male 43.1 58.7 39.1 48.1 (41.2, 55.1) t0 )XdIl8  
Female 58.6 66.2 55.6 61.0 (56.0, 65.9) R(#ZaFuo[  
80–89 Male 74.0 89.3 92.0 79.3 (72.3, 86.3) #9q ]jjH E  
Female 91.9 97.0 80.2 92.6 (86.4, 98.8) uVzvUz{b  
90 + Male 100.0 100.0 75.0 98.8 (96.2, 100.0) U;FJSy  
Female 100.0 100.0 93.8 98.6 (97.0, 100.0) jJe?pT]o  
Age-standardized Di &XDW/  
(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) :E2 ww`  
aCortical > 4/16, nuclear > standard 2, posterior subcapsular > 1 mm2 $u::(s} x<  
their current vision was 30% (290/683), compared with 27% dEPLkv  
(26/95) of participants with prior cataract surgery (chisquared, 6Vu)   
1 d.f. = 0.25, P = 0.62). B[;aNyd<  
Outcomes of cataract surgery >]ZW.?1h  
Two hundred and forty-nine eyes had undergone prior 1F{,Zr  
cataract surgery. Of these 249 operated eyes, 49 (20%) were __,F_9M  
left aphakic, 6 (2.4%) had anterior chamber intraocular Eb9n6Fg  
lenses and 194 (78%) had posterior chamber intraocular Tvd: P^ C  
lenses. The rate of capsulotomy in the eyes with intact (E7C 9U*  
posterior capsules was 36% (73/202). Fifteen per cent of S X[  
eyes (17/114) with a clear posterior capsule had bestcorrected @ [%K D  
visual acuity of less than 6/12 compared with 43% .:B;%*  
of eyes (6/14) with opaque capsules, and 15% of eyes 5a2+6N  
(11/73) with prior capsulotomies (chi-squared, 2 d.f. = 7.21, !u|s8tN.U  
P = 0.027). :d wP  
The percentage of eyes with best-corrected visual acuity )Qh*@=$-  
of 6/12 or better was 96% (302/314) for eyes without $dF$-y<[0  
cataract, 88% (1417/1609) for eyes with prevalent cataract P5&8^YV`N  
and 85% (211/249) for eyes with operated cataract (chisquared, !twYjOryH[  
2 d.f. = 22.3), P < 0.001). Twenty-seven of the JHg y&/  
operated eyes (11%) had visual acuities of less than 6/18 lec3rv0)  
(moderate vision impairment) (Fig. 2). A cause of this a.fdCI]%  
moderate visual impairment (but not the only cause) in four k;jXVa  
(15%) eyes was secondary to cataract surgery. Three of these ^CP>|JWD^  
four eyes had undergone intracapsular cataract extraction Oe lf^&m  
and the fourth eye had an opaque posterior capsule. No one nRs:^Q~o  
had bilateral vision impairment as a result of their cataract Hh* KcIRX  
surgery. - #-Bo  
DISCUSSION r\FduyOXv  
To our knowledge, this is the first paper to systematically xMFEeSzl>S  
assess the prevalence of current cataract, previous cataract u=7 #_ZC9L  
surgery, predictors of unoperated cataract and the outcomes $>rKm  
of cataract surgery in a population-based sample. The Visual 4mnVXKt%.  
Impairment Project is unique in that the sampling frame and 9s?gI4XN  
high response rate have ensured that the study population is Bv#? .0Ez;  
representative of Australians aged 40 years and over. Therefore, 'u6n,yRm  
these data can be used to plan age-related cataract z-h?Q4;  
services throughout Australia. L9d|7.b  
We found the rate of any cataract in those over the age f9vitFkb+  
of 40 years to be 22%. Although relatively high, this rate is 'l_F@ZO{(  
significantly less than was reported in a number of previous 3ej[  
studies,2,4,6 with the exception of the Casteldaccia Eye se*k56,  
Study.5 However, it is difficult to compare rates of cataract <7`U1DR=  
between studies because of different methodologies and svtqX-Vj"  
cataract definitions employed in the various studies, as well ~Gl5O`w(  
as the different age structures of the study populations. :"cKxd  
Other studies have used less conservative definitions of }yw>d\] f  
cataract, thus leading to higher rates of cataract as defined. k}!'@  
In most large epidemiologic studies of cataract, visual acuity ?RS4oJz,5g  
has not been included in the definition of cataract. ~cV";cD5  
Therefore, the prevalence of cataract may not reflect the zF(abQ0  
actual need for cataract surgery in the community. ll*Ez"  
80 McCarty et al. P_)=sj!>-  
Table 2. Prevalence of previous cataract by age, gender and cohort syCT)}T6z  
Age group Gender Urban Rural Nursing home Weighted total  1fC)&4W  
(years) (%) (%) (%) 4/OmgBo '  
40–49 Male 1.14 0.00 0.00 0.80 (0.00, 1.81) }z qo<o  
Female 0.00 0.00 0.00 0.00 ( Y^y:N$3$\  
50–59 Male 0.68 0.58 0.00 0.65 (0.13, 1.17) E6M*o+Y  
Female 0.57 0.00 0.00 0.41 (0.00, 1.00) Q\N >W+d  
60–69 Male 2.12 7.59 0.00 3.80 (1.41, 6.19) [z!pm-Ir  
Female 2.11 3.51 0.00 2.54 (1.81, 3.26) kSEgq<i!  
70–79 Male 8.22 9.85 8.70 8.75 (6.38, 11.1) P)LOAe1'  
Female 7.21 7.86 7.02 7.41 (5.36, 9.46) .[Qi4jm>`  
80–89 Male 25.0 30.0 14.3 26.2 (17.0, 35.4) }pGjc_:']  
Female 27.9 25.6 18.3 26.7 (20.2, 33.3) | GN/{KH]  
90 + Male 0.00 16.7 66.7 9.19 (0.00, 21.5) =woP~+  
Female 58.3 100.0 26.9 63.1 (44.4, 81.8) |~&cTDd  
Age-standardized Fk9]u^j  
(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) 9e.$x%7 j  
Figure 2. Visual acuity in eyes that had undergone cataract \U##b~Z,g  
surgery, n = 249. h, Presenting; j, best-corrected. vU(fd!V ?  
Operated and unoperated cataract in Australia 81 Z#D*HAd`  
The weighted prevalence of prior cataract surgery in the fxmY,{{  
Visual Impairment Project (3.6%) was similar to the crude 3Tp8t6*nL  
rate in the Beaver Dam Eye Study4 (3.1%), but less than the Y*{5'q+2  
crude rate in the Blue Mountains Eye Study6 (6.0%). btC6R>0   
However, the age-standardized rate in the Blue Mountains u:tcL-;U  
Eye Study (standardized to the age distribution of the urban mn*}U R  
Visual Impairment Project cohort) was found to be less than #{#k;va  
the Visual Impairment Project (standardized rate = 1.36%, MZxU)QW1  
95% CL 1.25, 1.47). The incidence of cataract surgery in RCoDdtMo  
Australia has exceeded population growth.1 This is due, Db;>MWt+e  
perhaps, to advances in surgical techniques and lens U#Iwe=  
implants that have changed the risk–benefit ratio. 5.DmMG[T^=  
The Global Initiative for the Elimination of Avoidable [:q J1^UU  
Blindness, sponsored by the World Health Organization, (ti!Y"e2  
states that cataract surgical services should be provided that 9U4[o<G]=  
‘have a high success rate in terms of visual outcome and `Q#)N0  
improved quality of life’,17 although the ‘high success rate’ is J<4_<.o(a  
not defined. Population- and clinic-based studies conducted W~a|AU8]C  
in the United States have demonstrated marked improvement :RwURv+kT  
in visual acuity following cataract surgery.18–20 We f`_{SU"3  
found that 85% of eyes that had undergone cataract extraction _wX(OB  
had visual acuity of 6/12 or better. Previously, we have {u9n?Z%  
shown that participants with prevalent cataract in this BE],PCpPr  
cohort are more likely to express dissatisfaction with their  R0F [  
current vision than participants without cataract or participants uXvE>VpJG  
with prior cataract surgery.21 In a national study in the 7i'clB9!  
United States, researchers found that the change in patients’ ^:mKTiA-  
ratings of their vision difficulties and satisfaction with their 3orL;(.G  
vision after cataract surgery were more highly related to i )$+#N  
their change in visual functioning score than to their change a=x &sz\x  
in visual acuity.19 Furthermore, improvement in visual function 1?3+>  
has been shown to be associated with improvement in %_CL/H   
overall quality of life.22 M?Q \ Hw  
A recent review found that the incidence of visually g& f)WQ(  
significant posterior capsule opacification following g_k95k3V'  
cataract surgery to be greater than 25%.23 We found 36% a`]ZyG*P  
capsulotomy in our population and that this was associated 6}0_o[23  
with visual acuity similar to that of eyes with a clear +2}Ar<el P  
capsule, but significantly better than that of eyes with an |9Yx`_DF  
opaque capsule. 9 C{Xpu  
A number of studies have shown that the demand and SG&H^V8  
timing of cataract surgery vary according to visual acuity, k6GQH@y!  
degree of handicap and socioeconomic factors.8–10,24,25 We Ux{QYjF E  
have also shown previously that ophthalmologists are more RBg2iG$ 8|  
likely to refer a patient for cataract surgery if the patient is d{) =E8wE  
employed and less likely to refer a nursing home resident.7 'J!Gip ,  
In the Visual Impairment Project, we did not find that any gp~-n7'~O  
particular subgroup of the population was at greater risk of 20}]b* C}  
having unoperated cataract. Universal access to health care B<h4ZK%  
in Australia may explain the fact that people without +ut%C.1  
Medicare are more likely to delay cataract operations in the Z0D&ayzkh^  
USA,8 but not having private health insurance is not associated .i*ja*   
with unoperated cataract in Australia. -em3 #V  
In summary, cataract is a significant public health problem -;RAW1]}Y$  
in that one in four people in their 80s will have had cataract 0"+QWh  
surgery. The importance of age-related cataract surgery will cIkA ~F  
increase further with the ageing of the population: the l^o>7 cM  
number of people over age 60 years is expected to double in a8%T*mk(  
the next 20 years. Cataract surgery services are well xlgT1b:6  
accessed by the Victorian population and the visual outcomes C:bA:O  
of cataract surgery have been shown to be very good. h"}F3E  
These data can be used to plan for age-related cataract -XkjO$=!=  
surgical services in Australia in the future as the need for T2mZkK?rA  
cataract extractions increases. L;b-=mF  
ACKNOWLEDGEMENTS ?V_v=X%w  
The Visual Impairment Project was funded in part by grants YhAO  
from the Victorian Health Promotion Foundation, the ;;U&mhz`  
National Health and Medical Research Council, the Ansell Ls.g\Gl3  
Ophthalmology Foundation, the Dorothy Edols Estate and zx"0^r}  
the Jack Brockhoff Foundation. Dr McCarty is the recipient Yx ;j  
of a Wagstaff Fellowship in Ophthalmology from the Royal 7Bf4ojKt  
Victorian Eye and Ear Hospital. Z vyF"4QN  
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