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

ABSTRACT R~PD[.\u  
Purpose: To quantify the prevalence of cataract, the outcomes {OH "d  
of cataract surgery and the factors related to =0 mf   
unoperated cataract in Australia. NirG99kyo  
Methods: Participants were recruited from the Visual 9jBP|I{xI  
Impairment Project: a cluster, stratified sample of more than 1-.6psE  
5000 Victorians aged 40 years and over. At examination Lzm9Kh;  
sites interviews, clinical examinations and lens photography M&wf4)*%0+  
were performed. Cataract was defined in participants who GHaD32  
had: had previous cataract surgery, cortical cataract greater F-D9nI4{X  
than 4/16, nuclear greater than Wilmer standard 2, or CD]"Q1 t}  
posterior subcapsular greater than 1 mm2. J!YB_6b  
Results: The participant group comprised 3271 Melbourne qT5q3A(8  
residents, 403 Melbourne nursing home residents and 1473 CC"}aV5  
rural residents.The weighted rate of any cataract in Victoria waT'|9{  
was 21.5%. The overall weighted rate of prior cataract vgKZr  
surgery was 3.79%. Two hundred and forty-nine eyes had =r:(g a  
had prior cataract surgery. Of these 249 procedures, 49 AAuH}W>n  
(20%) were aphakic, 6 (2.4%) had anterior chamber }$ C;ccWL  
intraocular lenses and 194 (78%) had posterior chamber "{>BP$Jz  
intraocular lenses.Two hundred and eleven of these operated "Tt5cqUQoY  
eyes (85%) had best-corrected visual acuity of 6/12 or w5Lev}Rb  
better, the legal requirement for a driver’s license.Twentyseven 7n}$|h5D  
(11%) had visual acuity of less than 6/18 (moderate 2 zE gAc  
vision impairment). Complications of cataract surgery 5! -+5TJI  
caused reduced vision in four of the 27 eyes (15%), or 1.9% >L4q> S^v  
of operated eyes. Three of these four eyes had undergone #w]UP#^io  
intracapsular cataract extraction and the fourth eye had an H. o=4[  
opaque posterior capsule. No one had bilateral vision =2XAQiUR\  
impairment as a result of cataract surgery. Surprisingly, no }ZqnsLu[)  
particular demographic factors (such as age, gender, rural *3@ =XY7  
residence, occupation, employment status, health insurance VcX89c4\  
status, ethnicity) were related to the presence of unoperated 8SGqDaRt  
cataract. kLE("I:7  
Conclusions: Although the overall prevalence of cataract is emT/5'y  
quite high, no particular subgroup is systematically underserviced BFnp[93N  
in terms of cataract surgery. Overall, the results of .o#A(3&n  
cataract surgery are very good, with the majority of eyes F% < ZEVm  
achieving driving vision following cataract extraction. GD-L0kw5  
Key words: cataract extraction, health planning, health {e!3|&AX  
services accessibility, prevalence #IvHxSo&  
INTRODUCTION 0?,<7}"<X  
Cataract is the leading cause of blindness worldwide and, in D]=V6l=  
Australia, cataract extractions account for the majority of all EQ [K  
ophthalmic procedures.1 Over the period 1985–94, the rate zFi)R }Ot  
of cataract surgery in Australia was twice as high as would be `(uN_zvH  
expected from the growth in the elderly population.1 <s=i5t My5  
Although there have been a number of studies reporting 7S/ \;DF  
the prevalence of cataract in various populations,2–6 there is ()^tw5e'^  
little information about determinants of cataract surgery in ~F " w  
the population. A previous survey of Australian ophthalmologists 719lfI&s  
showed that patient concern and lifestyle, rather f = 'AI  
than visual acuity itself, are the primary factors for referral |mQC-=6t;Y  
for cataract surgery.7 This supports prior research which has M{t/B-'4  
shown that visual acuity is not a strong predictor of need for 3~%M4(  
cataract surgery.8,9 Elsewhere, socioeconomic status has 9 lXnNK |]  
been shown to be related to cataract surgery rates.10 "cwvx8un  
To appropriately plan health care services, information is k x%\Cz  
needed about the prevalence of age-related cataract in the GYrUB59  
community as well as the factors associated with cataract R$x(3eyx  
surgery. The purpose of this study is to quantify the prevalence B{K_?ae!  
of any cataract in Australia, to describe the factors >r>pM(h  
related to unoperated cataract in the community and to bE!z[j]  
describe the visual outcomes of cataract surgery. Ip0`R+8  
METHODS UNA!vzOb  
Study population Y,m=&U  
Details about the study methodology for the Visual <u  ImZC  
Impairment Project have been published previously.11 &8dj*!4H  
Briefly, cluster sampling within three strata was employed to ]P2Wa   
recruit subjects aged 40 years and over to participate. 2;7n0LOs}  
Within the Melbourne Statistical Division, nine pairs of )0\D1IFJ  
census collector districts were randomly selected. Fourteen ] u\-_PP  
nursing homes within a 5 km radius of these nine test sites nj#kzD[n>  
were randomly chosen to recruit nursing home residents. zUA -  
Clinical and Experimental Ophthalmology (2000) 28, 77–82 U9XOs)^  
Original Article CN6b 982&  
Operated and unoperated cataract in Australia ?]\v%[ho  
Catherine A McCarty PhD, MPH, Mukesh B Nanjan PhD, Hugh R Taylor MD gWl49'S>+  
Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia 8"ulAx74>  
n Correspondence: Dr Cathy McCarty MPH, Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, 32 Gisborne Street, East Melbourne, (Bss%\  
Victoria 3002, Australia. Email: cathy@cera.unimelb.edu.au BSY7un+`:  
78 McCarty et al. {A\y 4D@  
Finally, four pairs of census collector districts in four rural VO<P9g$UD  
Victorian communities were randomly selected to recruit rural loD:4e1  
residents. A household census was conducted to identify t?FPmbj v  
eligible residents aged 40 years and over who had been a Bam 4%G5  
resident at that address for at least 6 months. At the time of ={I( i6  
the household census, basic information about age, sex, %.s"l6 W  
country of birth, language spoken at home, education, use of mpzm6I eu  
corrective spectacles and use of eye care services was collected. gFxaUrZA  
Eligible residents were then invited to attend a local J6J; !~>_  
examination site for a more detailed interview and examination. npcL<$<6X  
The study protocol was approved by the Royal Victorian m$bNQ7  
Eye and Ear Hospital Human Research Ethics Committee. !I Byv%m&\  
Assessment of cataract 4K!@9+Mz  
A standardized ophthalmic examination was performed after 41o ~5:&  
pupil dilatation with one drop of 10% phenylephrine JjG>$z  
hydrochloride. Lens opacities were graded clinically at the KCfcEz  
time of the examination and subsequently from photos using }#E~XlX^  
the Wilmer cataract photo-grading system.12 Cortical and \)BDl  
posterior subcapsular (PSC) opacities were assessed on vUg o)C#<  
retroillumination and measured as the proportion (in 1/16) k^\>=JTq=  
of pupil circumference occupied by opacity. For this analysis, MU~nvs;:  
cortical cataract was defined as 4/16 or greater opacity, 6M@m`c  
PSC cataract was defined as opacity equal to or greater than -42jeJS  
1 mm2 and nuclear cataract was defined as opacity equal to _pR7sNeV  
or greater than Wilmer standard 2,12 independent of visual u )KtvC!  
acuity. Examples of the minimum opacities defined as cortical, xkkW?[&  
nuclear and PSC cataract are presented in Figure 1. 0& ?/TSC  
Bilateral congenital cataracts or cataracts secondary to }@jT-t]P  
intraocular inflammation or trauma were excluded from the #zw 'H9l  
analysis. Two cases of bilateral secondary cataract and eight q/t~`pH3  
cases of bilateral congenital cataract were excluded from the QP4`r#,  
analyses. qEB]Tj e[  
A Topcon® SL5 photo slit-lamp (Topcon America Corp., xZ(VvINL'  
Paramus, NJ, USA) with a 0.1 mm slit beam of 9.0 mm in %-~T;_.  
height set to an incident angle of 30° was used for examinations. xnG,1doa  
Ektachrome® 200 ASA colour slide film (Eastman |%-:qk4rG  
Kodak Company, Rochester, NY, USA) was used to photograph OcGHMGdn  
the nuclear opacities. The cortical opacities were ejC== Fkc  
photographed with an Oxford® retroillumination camera (eJYv: ^  
(Marcher Enterprises Ltd, Hereford, UK) and T-MAX® 400 & l NHNu[  
film (Eastman Kodak). Photographs were graded separately oyY0!w,Y  
by two research assistants and discrepancies were adjudicated Yet!qmZ  
by an independent reviewer. Any discrepancies aqAWaO  
between the clinical grades and the photograph grades were ok7yFm1\  
resolved. Except in cases where photographs were missing, Mlr}v^"G  
the photograph grades were used in the analyses. Photograph . ;q 4<_  
grades were available for 4301 (84%) for cortical VwV`tKit  
cataract, 4147 (81%) for nuclear cataract and 4303 (84%) GS4 HYF  
for PSC cataract. Cataract status was classified according to f*^)0Po  
the severity of the opacity in the worse eye. ONw;NaE,  
Assessment of risk factors -(fvb  
A standardized questionnaire was used to obtain information =+j>?Yi  
about education, employment and ethnic background.11 Q1?G7g]N  
Specific information was elicited on the occurrence, duration NuqWezJm&  
and treatment of a number of medical conditions, ;f7;U=gl,  
including ocular trauma, arthritis, diabetes, gout, hypertension >-{)wk;1&  
and mental illness. Information about the use, dose and xW;-=Q  
duration of tobacco, alcohol, analgesics and steriods were l[q%1-N  
collected, and a food frequency questionnaire was used to N{<=s]I%x  
determine current consumption of dietary sources of antioxidants oG)JH)!  
and use of vitamin supplements. $MEKt}S  
Data management and statistical analysis j&. MT@  
Data were collected either by direct computer entry with a @]H:=Q'gj  
questionnaire programmed in Paradox© (Carel Corporation, Ex ?)FL$4  
Ottawa, Canada) with internal consistency checks, or 1cyX9X  
on self-coding forms. Open-ended responses were coded at Q-!a;/  
a later time. Data that were entered on the self-coded forms :>.~"uWo{  
were entered into a computer with double data entry and EQkv&k 5X  
reconciliation of any inconsistencies. Data range and consistency 6uYCU|JsU  
checks were performed on the entire data set. 8S>T1st  
SAS© version 6.1 (SAS Institute, Cary, North Carolina) was I T)rhi:  
employed for statistical analyses. b0 CtQe  
Ninety-five per cent confidence limits around the agespecific 1CiK&fQ'  
rates were calculated according to Cochran13 to  @ t  
account for the effect of the cluster sampling. Ninety-five qF{u+Ms  
per cent confidence limits around age-standardized rates ! Q`GA<ikv  
were calculated according to Breslow and Day.14 The strataspecific #L{QnV.3  
data were weighted according to the 1996 aZYa<28?L%  
Australian Bureau of Statistics census data15 to reflect the ;wfzlUBC  
cataract prevalence in the entire Victorian population. L[d 7@  
Univariate analyses with Student’s t-tests and chi-squared Z~t OR{q  
tests were first employed to evaluate risk factors for unoperated  t]Xdzy  
cataract. Any factors with P < 0.10 were then fitted ;/W;M> ^  
into a backwards stepwise logistic regression model. For the A-O@e e  
Figure 1. Minimum levels of cortical (a), nuclear (b), and posterior subcapsular (c) cataract. j(!M  
final multivariate models, P < 0.05 was considered statistically |2\6X's  
significant. Design effect was assessed through the use <h2WM (n  
of cluster-specific models and multivariate models. The Da!A1|"  
design effect was assumed to be additive and an adjustment _-%A_5lCRE  
made in the variance by adding the variance associated with E ?(  
the design effect prior to constructing the 95% confidence  M SU| T  
limits. -DrR6kGjR  
RESULTS maLKUSgo  
Study population Dx =ms^oN5  
A total of 3271 (83%) of the Melbourne residents, 403 {T Z7>k  
(90%) Melbourne nursing home residents, and 1473 (92%) Z&%#,0>]  
rural residents participated. In general, non-participants did "w0>  
not differ from participants.16 The study population was 1@C0c%  
representative of the Victorian population and Australia as FFl[[(`%D  
a whole. W6D|Rr.q  
The Melbourne residents ranged in age from 40 to E)m{m$Hb  
98 years (mean = 59) and 1511 (46%) were male. The 8/*q#j  
Melbourne nursing home residents ranged in age from 46 to ~]DGf(   
101 years (mean = 82) and 85 (21%) were men. The rural 5Ya TE<G  
residents ranged in age from 40 to 103 years (mean = 60) o&1ewE(O]  
and 701 (47.5%) were men. s)#FqB8  
Prevalence of cataract and prior cataract surgery c4oQ4  
As would be expected, the rate of any cataract increases  Q0' xn  
dramatically with age (Table 1). The weighted rate of any j^T.7Zv  
cataract in Victoria was 21.5% (95% CL 18.1, 24.9). 4 mJ4)  
Although the rates varied somewhat between the three ps"DL4*  
strata, they were not significantly different as the 95% confidence LY[XPV]t  
limits overlapped. The per cent of cataractous eyes =vMFCp;mv  
with best-corrected visual acuity of less than 6/12 was 12.5% W[[3'JTF  
(65/520) for cortical cataract, 18% for nuclear cataract o ^L 3Xiv  
(97/534) and 14.4% (27/187) for PSC cataract. Cataract >S3iP?V7  
surgery also rose dramatically with age. The overall @FKNB.>  
weighted rate of prior cataract surgery in Victoria was .{x-A{l  
3.79% (95% CL 2.97, 4.60) (Table 2). uPc}a3'?  
Risk factors for unoperated cataract L6Ykv/V  
Cases of cataract that had not been removed were classified -;cZW.<  
as unoperated cataract. Risk factor analyses for unoperated l=U@j T  
cataract were not performed with the nursing home residents +0\BI<aG  
as information about risk factor exposure was not ?9nuL}m!a  
available for this cohort. The following factors were assessed 5v"QKI  
in relation to unoperated cataract: age, sex, residence ZIQy}b'  
(urban/rural), language spoken at home (a measure of ethnic bB@1tp0+  
integration), country of birth, parents’ country of birth (a ya3A^&:  
measure of ethnicity), years since migration, education, use ,\q9>cZ!  
of ophthalmic services, use of optometric services, private ED&>~~k)  
health insurance status, duration of distance glasses use, yKF"\^`@  
glaucoma, age-related maculopathy and employment status. 2apR7  
In this cross sectional study it was not possible to assess the =#dW^ ?p  
level of visual acuity that would predict a patient’s having a]-F,MJ  
cataract surgery, as visual acuity data prior to cataract }.ZX.qYX  
surgery were not available. #4iSQ$0  
The significant risk factors for unoperated cataract in univariate awh<CmcZ  
analyses were related to: whether a participant had kx0(v1y3gT  
ever seen an optometrist, seen an ophthalmologist or been ^.)oQo SE  
diagnosed with glaucoma; and participants’ employment ]W39HL  
status (currently employed) and age. These significant "vI:B}  
factors were placed in a backwards stepwise logistic regression 6U5L>sQ  
model. The factors that remained significantly related N|-M|1w96  
to unoperated cataract were whether participants had ever LdnHz#  
seen an ophthalmologist, seen an optometrist and been xR}^~14Bz  
diagnosed with glaucoma. None of the demographic factors '4k l$I  
were associated with unoperated cataract in the multivariate ){^o"A?-:  
model. f Ne9as  
The per cent of participants with unoperated cataract ;:2]++G  
who said that they were dissatisfied or very dissatisfied with Qc1NLU9:  
Operated and unoperated cataract in Australia 79 ieuq9ah#  
Table 1. Prevalence of any cataracta (excluding previous cataract surgery) by age, gender and cohort `&y Qtj# '  
Age group Sex Urban Rural Nursing home Weighted total J=?`~?Vbo  
(years) (%) (%) (%) B8A-|S!,U  
40–49 Male 2.56 4.04 0.00 3.00 (1.91, 4.08) zA/ tHlKc  
Female 2.61 1.70 0.00 2.36 (1.61, 3.10) QS(aA*D  
50–59 Male 7.69 6.94 0.00 7.47 (5.80, 9.15) Q(v*I&k  
Female 6.67 7.56 0.00 6.92 (5.60, 8.24) `o|Y5wQ@  
60–69 Male 20.7 25.0 10.0 22.0 (18.1, 26.0) Ai>=n;  
Female 27.9 35.7 37.5 30.3 (26.0, 34.7) Wk<heF  
70–79 Male 43.1 58.7 39.1 48.1 (41.2, 55.1) [ye!3h&]  
Female 58.6 66.2 55.6 61.0 (56.0, 65.9) -u+@5K;^Y  
80–89 Male 74.0 89.3 92.0 79.3 (72.3, 86.3) _mSDz=!Z3  
Female 91.9 97.0 80.2 92.6 (86.4, 98.8) VPOzt7:  
90 + Male 100.0 100.0 75.0 98.8 (96.2, 100.0) 6!F@?3qCyg  
Female 100.0 100.0 93.8 98.6 (97.0, 100.0) ].ZfTrM]  
Age-standardized ` mvPbZ0<  
(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) E3..$x-/  
aCortical > 4/16, nuclear > standard 2, posterior subcapsular > 1 mm2 P;~`%,+S  
their current vision was 30% (290/683), compared with 27% a ]~Rp  
(26/95) of participants with prior cataract surgery (chisquared, L As#g||M  
1 d.f. = 0.25, P = 0.62). o ,qq*}=  
Outcomes of cataract surgery hSAdD!  
Two hundred and forty-nine eyes had undergone prior RB Ob/.$  
cataract surgery. Of these 249 operated eyes, 49 (20%) were D;?cf+6$  
left aphakic, 6 (2.4%) had anterior chamber intraocular tL#~U2K  
lenses and 194 (78%) had posterior chamber intraocular 6=pE5UfT  
lenses. The rate of capsulotomy in the eyes with intact S7!+8$2mc_  
posterior capsules was 36% (73/202). Fifteen per cent of I1f4u6\*X  
eyes (17/114) with a clear posterior capsule had bestcorrected O$eNG$7  
visual acuity of less than 6/12 compared with 43% 6DkFI kS  
of eyes (6/14) with opaque capsules, and 15% of eyes SI)QX\is8  
(11/73) with prior capsulotomies (chi-squared, 2 d.f. = 7.21, Fal##6B  
P = 0.027). ,|}}Ml  
The percentage of eyes with best-corrected visual acuity +DsdzR`Gx,  
of 6/12 or better was 96% (302/314) for eyes without ~`Y!_'(x  
cataract, 88% (1417/1609) for eyes with prevalent cataract o}4~CN9}  
and 85% (211/249) for eyes with operated cataract (chisquared, a^vTBJXo  
2 d.f. = 22.3), P < 0.001). Twenty-seven of the {<}9r6k;f  
operated eyes (11%) had visual acuities of less than 6/18 !+FrU'^  
(moderate vision impairment) (Fig. 2). A cause of this '^|u\$&U  
moderate visual impairment (but not the only cause) in four 8(zE^W,[8"  
(15%) eyes was secondary to cataract surgery. Three of these !-veL1r  
four eyes had undergone intracapsular cataract extraction WrHY'  
and the fourth eye had an opaque posterior capsule. No one WEaG/)y  
had bilateral vision impairment as a result of their cataract m{gw:69h  
surgery. BQ:hUF3  
DISCUSSION eae`#>XP  
To our knowledge, this is the first paper to systematically ?S<`*O +  
assess the prevalence of current cataract, previous cataract \Ota~A  
surgery, predictors of unoperated cataract and the outcomes ^7Rc\   
of cataract surgery in a population-based sample. The Visual 5i@WBa  
Impairment Project is unique in that the sampling frame and Jn&^5,J]F8  
high response rate have ensured that the study population is pi|=3W  
representative of Australians aged 40 years and over. Therefore, f6,?Yex8B  
these data can be used to plan age-related cataract OWys`2W  
services throughout Australia. $5wf{iZY.Q  
We found the rate of any cataract in those over the age `N}aV Ns  
of 40 years to be 22%. Although relatively high, this rate is ~@\sN+VS  
significantly less than was reported in a number of previous GU|(m~,`  
studies,2,4,6 with the exception of the Casteldaccia Eye I=pFGU  
Study.5 However, it is difficult to compare rates of cataract `%/w0,0  
between studies because of different methodologies and Y 8n*o3jM  
cataract definitions employed in the various studies, as well oCxy(q'y  
as the different age structures of the study populations. n_{az{~  
Other studies have used less conservative definitions of K=Z.<f  
cataract, thus leading to higher rates of cataract as defined. l4> c  
In most large epidemiologic studies of cataract, visual acuity /E-s g, k  
has not been included in the definition of cataract. #OlPnP2  
Therefore, the prevalence of cataract may not reflect the hCb2<_3CR  
actual need for cataract surgery in the community. 0V ZC7@  
80 McCarty et al. $-p9cyk  
Table 2. Prevalence of previous cataract by age, gender and cohort ^kK% 8 u  
Age group Gender Urban Rural Nursing home Weighted total 8shx7"  
(years) (%) (%) (%) h0?w V5H  
40–49 Male 1.14 0.00 0.00 0.80 (0.00, 1.81) 9&bJ]  
Female 0.00 0.00 0.00 0.00 ( NM"5.   
50–59 Male 0.68 0.58 0.00 0.65 (0.13, 1.17) Pj1k?7  
Female 0.57 0.00 0.00 0.41 (0.00, 1.00) "vX\Q rL  
60–69 Male 2.12 7.59 0.00 3.80 (1.41, 6.19) vSy[lB|)24  
Female 2.11 3.51 0.00 2.54 (1.81, 3.26) ^'n;W<\p)  
70–79 Male 8.22 9.85 8.70 8.75 (6.38, 11.1) )O2IEwPd.  
Female 7.21 7.86 7.02 7.41 (5.36, 9.46) N 9s+Tm  
80–89 Male 25.0 30.0 14.3 26.2 (17.0, 35.4) q8!]x-5$6j  
Female 27.9 25.6 18.3 26.7 (20.2, 33.3) *c>B-Fo/D  
90 + Male 0.00 16.7 66.7 9.19 (0.00, 21.5) 8#w%qij  
Female 58.3 100.0 26.9 63.1 (44.4, 81.8) <.2jQ#So  
Age-standardized =ea.+  
(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) n]6-`fpD  
Figure 2. Visual acuity in eyes that had undergone cataract T! I3.  
surgery, n = 249. h, Presenting; j, best-corrected. DYoGtks(  
Operated and unoperated cataract in Australia 81 {:|b,ep T  
The weighted prevalence of prior cataract surgery in the !;4Hh)2  
Visual Impairment Project (3.6%) was similar to the crude K $WMrp  
rate in the Beaver Dam Eye Study4 (3.1%), but less than the CDPu(,^  
crude rate in the Blue Mountains Eye Study6 (6.0%). wD:2sri  
However, the age-standardized rate in the Blue Mountains ~uV(/?o%  
Eye Study (standardized to the age distribution of the urban PuhvJHT  
Visual Impairment Project cohort) was found to be less than * F_KOf9p  
the Visual Impairment Project (standardized rate = 1.36%, w:/3%-  
95% CL 1.25, 1.47). The incidence of cataract surgery in CvR-lKV<  
Australia has exceeded population growth.1 This is due, T2n3g|4  
perhaps, to advances in surgical techniques and lens 1:r#m- \  
implants that have changed the risk–benefit ratio. O~v~s ' c&  
The Global Initiative for the Elimination of Avoidable K&,";9c  
Blindness, sponsored by the World Health Organization, f-634KuP  
states that cataract surgical services should be provided that K9]zUe&#w  
‘have a high success rate in terms of visual outcome and &8Z .m,s]  
improved quality of life’,17 although the ‘high success rate’ is T|0+o+i  
not defined. Population- and clinic-based studies conducted LlS~J K  
in the United States have demonstrated marked improvement C#4_`4{  
in visual acuity following cataract surgery.18–20 We IA{W-RRb  
found that 85% of eyes that had undergone cataract extraction =6+99<G|%M  
had visual acuity of 6/12 or better. Previously, we have L^zh|MEyzk  
shown that participants with prevalent cataract in this }dHdy{$  
cohort are more likely to express dissatisfaction with their lD, ~%  
current vision than participants without cataract or participants L`e19I$  
with prior cataract surgery.21 In a national study in the V#5$J Xp  
United States, researchers found that the change in patients’ Vh>cV  
ratings of their vision difficulties and satisfaction with their UG=]8YY!  
vision after cataract surgery were more highly related to GKjtX?~1  
their change in visual functioning score than to their change =Xg/[J%  
in visual acuity.19 Furthermore, improvement in visual function 4P"bOt5izR  
has been shown to be associated with improvement in 5&h">_j  
overall quality of life.22 "DA%vdu  
A recent review found that the incidence of visually 01n132k  
significant posterior capsule opacification following =<#G~8WYz  
cataract surgery to be greater than 25%.23 We found 36% T1*.3_wtP  
capsulotomy in our population and that this was associated K!.t}s.t  
with visual acuity similar to that of eyes with a clear EFljUT?&  
capsule, but significantly better than that of eyes with an 1^2Q`~,g  
opaque capsule. 5OtdB'UITd  
A number of studies have shown that the demand and l_yF;5|?z  
timing of cataract surgery vary according to visual acuity, 3l45(%g+  
degree of handicap and socioeconomic factors.8–10,24,25 We w$AR  
have also shown previously that ophthalmologists are more -4sKB>b  
likely to refer a patient for cataract surgery if the patient is <+-n lK4  
employed and less likely to refer a nursing home resident.7 ^/#G,MxNy  
In the Visual Impairment Project, we did not find that any 83SK<V6  
particular subgroup of the population was at greater risk of kY'Wf`y(  
having unoperated cataract. Universal access to health care Q}OloA(+  
in Australia may explain the fact that people without >e R^G5rn;  
Medicare are more likely to delay cataract operations in the GT)7VFrL  
USA,8 but not having private health insurance is not associated ! CcDA/0  
with unoperated cataract in Australia. rU&Y/  
In summary, cataract is a significant public health problem iiMS3ueF  
in that one in four people in their 80s will have had cataract 7xv9v1['  
surgery. The importance of age-related cataract surgery will N+B!AK0.  
increase further with the ageing of the population: the qar{*>LCG  
number of people over age 60 years is expected to double in GT6i9*tb #  
the next 20 years. Cataract surgery services are well 1' U  
accessed by the Victorian population and the visual outcomes VGD~) z57  
of cataract surgery have been shown to be very good. 7=^}{  
These data can be used to plan for age-related cataract o]Ne|PEpO  
surgical services in Australia in the future as the need for T@U,<[,   
cataract extractions increases. 1:](=%oM&k  
ACKNOWLEDGEMENTS #f24a?n|  
The Visual Impairment Project was funded in part by grants 7<!x:G?C  
from the Victorian Health Promotion Foundation, the KFHZ3HZ:>  
National Health and Medical Research Council, the Ansell eG!ma`v  
Ophthalmology Foundation, the Dorothy Edols Estate and *)-@'{]uB  
the Jack Brockhoff Foundation. Dr McCarty is the recipient <3BGW?=WP  
of a Wagstaff Fellowship in Ophthalmology from the Royal CU\gx*=E  
Victorian Eye and Ear Hospital. j67ppt  
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