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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 GbO j% a  
Purpose: To quantify the prevalence of cataract, the outcomes D 1.59mHsD  
of cataract surgery and the factors related to FBl,Mky  
unoperated cataract in Australia. bj i#ID2]%  
Methods: Participants were recruited from the Visual @\F7nhSfa  
Impairment Project: a cluster, stratified sample of more than R8[VD iM6E  
5000 Victorians aged 40 years and over. At examination cV>?*9z0  
sites interviews, clinical examinations and lens photography .<Q KQ%-  
were performed. Cataract was defined in participants who "&SE!3*m`I  
had: had previous cataract surgery, cortical cataract greater C2R"96M7q  
than 4/16, nuclear greater than Wilmer standard 2, or nq?+b >//  
posterior subcapsular greater than 1 mm2. 4Vi*Qa_,y  
Results: The participant group comprised 3271 Melbourne g"sb0d9  
residents, 403 Melbourne nursing home residents and 1473 5P <"I["  
rural residents.The weighted rate of any cataract in Victoria 8US35t:M  
was 21.5%. The overall weighted rate of prior cataract e- `9-U%6  
surgery was 3.79%. Two hundred and forty-nine eyes had 9K}Dm S  
had prior cataract surgery. Of these 249 procedures, 49 *1v3x:pQ'  
(20%) were aphakic, 6 (2.4%) had anterior chamber ;sA 5&a>!  
intraocular lenses and 194 (78%) had posterior chamber c),UO^EqV  
intraocular lenses.Two hundred and eleven of these operated b [HnhAI  
eyes (85%) had best-corrected visual acuity of 6/12 or GjEV]hqR  
better, the legal requirement for a driver’s license.Twentyseven I*U7YqDC9  
(11%) had visual acuity of less than 6/18 (moderate vrmMEWPV  
vision impairment). Complications of cataract surgery P}AwE,&Q  
caused reduced vision in four of the 27 eyes (15%), or 1.9% @8J*vY =e  
of operated eyes. Three of these four eyes had undergone Ow?~+) 4  
intracapsular cataract extraction and the fourth eye had an ISZEP8w  
opaque posterior capsule. No one had bilateral vision t_I-6`8o]  
impairment as a result of cataract surgery. Surprisingly, no qK;J:GT>  
particular demographic factors (such as age, gender, rural G :+D1J]  
residence, occupation, employment status, health insurance vB7]L9=@"  
status, ethnicity) were related to the presence of unoperated S~ckIN]  
cataract. w@P86'< v  
Conclusions: Although the overall prevalence of cataract is ^&F.T-(A  
quite high, no particular subgroup is systematically underserviced 1| WDbk  
in terms of cataract surgery. Overall, the results of 9_*3xu<7i  
cataract surgery are very good, with the majority of eyes 8}oe))b  
achieving driving vision following cataract extraction. 4Vj]bm  
Key words: cataract extraction, health planning, health ?aaYka]  
services accessibility, prevalence toG- Dz&  
INTRODUCTION J'#o6Ud  
Cataract is the leading cause of blindness worldwide and, in |&S^L}V.C  
Australia, cataract extractions account for the majority of all `aMnTF5:  
ophthalmic procedures.1 Over the period 1985–94, the rate R,!a X"]|  
of cataract surgery in Australia was twice as high as would be Ki :98a$  
expected from the growth in the elderly population.1 z5^Se!`5  
Although there have been a number of studies reporting 4[r:DM|8  
the prevalence of cataract in various populations,2–6 there is 5?#AS#TD'  
little information about determinants of cataract surgery in w &^Dbme  
the population. A previous survey of Australian ophthalmologists  #s=\  
showed that patient concern and lifestyle, rather $xcU*?=K  
than visual acuity itself, are the primary factors for referral B`%%,SLJ  
for cataract surgery.7 This supports prior research which has :$^sI"hO  
shown that visual acuity is not a strong predictor of need for nzi)4"3O  
cataract surgery.8,9 Elsewhere, socioeconomic status has y9GaxW* &  
been shown to be related to cataract surgery rates.10 6~Zq  
To appropriately plan health care services, information is g;nPF*(  
needed about the prevalence of age-related cataract in the sgeME^v  
community as well as the factors associated with cataract W-"FRTI4  
surgery. The purpose of this study is to quantify the prevalence TSd;L u%hr  
of any cataract in Australia, to describe the factors JA?P jo  
related to unoperated cataract in the community and to w5&,AL:  
describe the visual outcomes of cataract surgery. 9y"\]G77E  
METHODS TCO^9RP<  
Study population A!5)$>!o  
Details about the study methodology for the Visual L}U fd >*  
Impairment Project have been published previously.11 !bD`2m[Q  
Briefly, cluster sampling within three strata was employed to `Df)wNN1  
recruit subjects aged 40 years and over to participate. n&uD=-  
Within the Melbourne Statistical Division, nine pairs of }3mIj<I1;  
census collector districts were randomly selected. Fourteen 4#@zn 2l  
nursing homes within a 5 km radius of these nine test sites X 5D}<J2"  
were randomly chosen to recruit nursing home residents. [VwoZX:  
Clinical and Experimental Ophthalmology (2000) 28, 77–82 Mi"dFx^Md  
Original Article KGb3n;]  
Operated and unoperated cataract in Australia U ()36  
Catherine A McCarty PhD, MPH, Mukesh B Nanjan PhD, Hugh R Taylor MD 6~0. YZ9  
Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia Z:}d\~`x$%  
n Correspondence: Dr Cathy McCarty MPH, Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, 32 Gisborne Street, East Melbourne, 2s@<k1EdPl  
Victoria 3002, Australia. Email: cathy@cera.unimelb.edu.au qS|t7*  
78 McCarty et al. +V6N/{^ 5  
Finally, four pairs of census collector districts in four rural <$' OSN`!  
Victorian communities were randomly selected to recruit rural  qTL]  
residents. A household census was conducted to identify &iDX+*(  
eligible residents aged 40 years and over who had been a k:0HsN!F9  
resident at that address for at least 6 months. At the time of \?e{/hXnl  
the household census, basic information about age, sex, mmG+"g$|  
country of birth, language spoken at home, education, use of 3Vl?;~ :5  
corrective spectacles and use of eye care services was collected. P*6B+8h"5g  
Eligible residents were then invited to attend a local r0)X] l7  
examination site for a more detailed interview and examination. ^?H3:C S  
The study protocol was approved by the Royal Victorian EnGVp<6R  
Eye and Ear Hospital Human Research Ethics Committee. w QX,a;Br  
Assessment of cataract h$EH|9HAb  
A standardized ophthalmic examination was performed after ;|f|d?Q\  
pupil dilatation with one drop of 10% phenylephrine W7lR 54%|  
hydrochloride. Lens opacities were graded clinically at the y pv ~F  
time of the examination and subsequently from photos using 2n] Br  
the Wilmer cataract photo-grading system.12 Cortical and rn7eY  
posterior subcapsular (PSC) opacities were assessed on J?~ El&  
retroillumination and measured as the proportion (in 1/16) W0&NX`m  
of pupil circumference occupied by opacity. For this analysis, $]eITyC`P  
cortical cataract was defined as 4/16 or greater opacity, a'zf8id  
PSC cataract was defined as opacity equal to or greater than B'OUT2cgB  
1 mm2 and nuclear cataract was defined as opacity equal to v&p|9C@  
or greater than Wilmer standard 2,12 independent of visual 82.::J'e  
acuity. Examples of the minimum opacities defined as cortical, IvFxI#.ju  
nuclear and PSC cataract are presented in Figure 1. Fy^=LrH=D  
Bilateral congenital cataracts or cataracts secondary to S: IhJQ4K  
intraocular inflammation or trauma were excluded from the |kPjjVGF{  
analysis. Two cases of bilateral secondary cataract and eight Em?Z  
cases of bilateral congenital cataract were excluded from the eM";P/XaX  
analyses. E-Nc|A  
A Topcon® SL5 photo slit-lamp (Topcon America Corp., kcg{z8cd'r  
Paramus, NJ, USA) with a 0.1 mm slit beam of 9.0 mm in OT[&a6_  
height set to an incident angle of 30° was used for examinations. +{(f@,&~{  
Ektachrome® 200 ASA colour slide film (Eastman ]W^F!p~eC  
Kodak Company, Rochester, NY, USA) was used to photograph 3mI(5~4A]?  
the nuclear opacities. The cortical opacities were i^SuVca  
photographed with an Oxford® retroillumination camera ]}t6V]`Q  
(Marcher Enterprises Ltd, Hereford, UK) and T-MAX® 400 By& T59  
film (Eastman Kodak). Photographs were graded separately 5L6_W -n{  
by two research assistants and discrepancies were adjudicated vS#Y,H:yAj  
by an independent reviewer. Any discrepancies 0wM2v[^YO  
between the clinical grades and the photograph grades were b.mcP@  
resolved. Except in cases where photographs were missing, u s j:I`>  
the photograph grades were used in the analyses. Photograph GRM:o)4;#  
grades were available for 4301 (84%) for cortical ,sw|OYb  
cataract, 4147 (81%) for nuclear cataract and 4303 (84%) 0&M~lJ  
for PSC cataract. Cataract status was classified according to ENZjRf4  
the severity of the opacity in the worse eye. Q=YIAGK  
Assessment of risk factors PIk2mX/D_6  
A standardized questionnaire was used to obtain information WP*xu-(:  
about education, employment and ethnic background.11 f4%Z~3P  
Specific information was elicited on the occurrence, duration LxdF;JCz:  
and treatment of a number of medical conditions, y vIeK6  
including ocular trauma, arthritis, diabetes, gout, hypertension s fD@lW3  
and mental illness. Information about the use, dose and ,7HlYPec  
duration of tobacco, alcohol, analgesics and steriods were s#Os?Q?  
collected, and a food frequency questionnaire was used to t QR qQ  
determine current consumption of dietary sources of antioxidants 77 g<`}{  
and use of vitamin supplements. .rPg   
Data management and statistical analysis "SMRvi57T  
Data were collected either by direct computer entry with a YR'dl_  
questionnaire programmed in Paradox© (Carel Corporation, \wZ 4enm  
Ottawa, Canada) with internal consistency checks, or Lm-f0\(  
on self-coding forms. Open-ended responses were coded at 8 '>yB  
a later time. Data that were entered on the self-coded forms et`1#_o  
were entered into a computer with double data entry and  3VZ}5  
reconciliation of any inconsistencies. Data range and consistency ?4`f@=}'K  
checks were performed on the entire data set. G;ihm$Cad  
SAS© version 6.1 (SAS Institute, Cary, North Carolina) was m|uVmg!*  
employed for statistical analyses. wiFA 3_\G  
Ninety-five per cent confidence limits around the agespecific (X?HuWTm  
rates were calculated according to Cochran13 to &gLXS1O  
account for the effect of the cluster sampling. Ninety-five xc QD]"   
per cent confidence limits around age-standardized rates xe4`D>LUo  
were calculated according to Breslow and Day.14 The strataspecific .DR*MQI9  
data were weighted according to the 1996 \? n<UsI  
Australian Bureau of Statistics census data15 to reflect the 9GX'+$R]  
cataract prevalence in the entire Victorian population. n-he|u  
Univariate analyses with Student’s t-tests and chi-squared qV#,]mX  
tests were first employed to evaluate risk factors for unoperated og?L 9  
cataract. Any factors with P < 0.10 were then fitted []-<-TqJ  
into a backwards stepwise logistic regression model. For the {_G_YL[  
Figure 1. Minimum levels of cortical (a), nuclear (b), and posterior subcapsular (c) cataract. cd&sAK"  
final multivariate models, P < 0.05 was considered statistically Eo`'6 3  
significant. Design effect was assessed through the use z8dBfA<z  
of cluster-specific models and multivariate models. The A  I v  
design effect was assumed to be additive and an adjustment {,=U]^A  
made in the variance by adding the variance associated with -]Ny-[P  
the design effect prior to constructing the 95% confidence R].xT-1  
limits. _n0NE0  
RESULTS ,:{+-v(  
Study population a`D`v5G t  
A total of 3271 (83%) of the Melbourne residents, 403 vW0U~(XlN  
(90%) Melbourne nursing home residents, and 1473 (92%) !TN)6e7`  
rural residents participated. In general, non-participants did t:P]G>)x|  
not differ from participants.16 The study population was l15Z8hYh j  
representative of the Victorian population and Australia as \D-X _.v  
a whole. pI1g<pe  
The Melbourne residents ranged in age from 40 to ,E8g~ZUY9  
98 years (mean = 59) and 1511 (46%) were male. The ^e]h\G  
Melbourne nursing home residents ranged in age from 46 to fjMmlp  
101 years (mean = 82) and 85 (21%) were men. The rural ;3iWV"&_A  
residents ranged in age from 40 to 103 years (mean = 60) braI MIQ`  
and 701 (47.5%) were men. sT,*<^  
Prevalence of cataract and prior cataract surgery K."W/A!  
As would be expected, the rate of any cataract increases 4j(*%da  
dramatically with age (Table 1). The weighted rate of any 5'[yw:P-8  
cataract in Victoria was 21.5% (95% CL 18.1, 24.9). #@ F   
Although the rates varied somewhat between the three ;<=z^1X9  
strata, they were not significantly different as the 95% confidence L+lX$k  
limits overlapped. The per cent of cataractous eyes z"*3p8N  
with best-corrected visual acuity of less than 6/12 was 12.5% _`Dz%(c  
(65/520) for cortical cataract, 18% for nuclear cataract (r Q)0 g@  
(97/534) and 14.4% (27/187) for PSC cataract. Cataract Bw.?Me)mf|  
surgery also rose dramatically with age. The overall g(R!M0hdF  
weighted rate of prior cataract surgery in Victoria was [4-u{Tu  
3.79% (95% CL 2.97, 4.60) (Table 2). gu1n0N`b  
Risk factors for unoperated cataract 0IQ|`C.  
Cases of cataract that had not been removed were classified K,!f7KKo  
as unoperated cataract. Risk factor analyses for unoperated BPu>_$C  
cataract were not performed with the nursing home residents $gdGII&n  
as information about risk factor exposure was not %1M!4**W  
available for this cohort. The following factors were assessed w69G6G(  
in relation to unoperated cataract: age, sex, residence RPkOtRKL=w  
(urban/rural), language spoken at home (a measure of ethnic ,%KMi-w]q,  
integration), country of birth, parents’ country of birth (a XeXK~  
measure of ethnicity), years since migration, education, use S/6I9zOP  
of ophthalmic services, use of optometric services, private a61?G!]  
health insurance status, duration of distance glasses use, :Ek3]`q#  
glaucoma, age-related maculopathy and employment status. Jh%k:TrBm  
In this cross sectional study it was not possible to assess the {'G u@l  
level of visual acuity that would predict a patient’s having 9-?kamA  
cataract surgery, as visual acuity data prior to cataract Of{'A  
surgery were not available. _aOsFFB1KF  
The significant risk factors for unoperated cataract in univariate "HbrYYRb'  
analyses were related to: whether a participant had SFa^$w  
ever seen an optometrist, seen an ophthalmologist or been ~wd~57i@  
diagnosed with glaucoma; and participants’ employment V__n9L /t  
status (currently employed) and age. These significant yGPi9j{QXq  
factors were placed in a backwards stepwise logistic regression CYC6:g|)  
model. The factors that remained significantly related h_h6@/1l  
to unoperated cataract were whether participants had ever s}":lXkrw  
seen an ophthalmologist, seen an optometrist and been 2@ f E!  
diagnosed with glaucoma. None of the demographic factors !& xc.39  
were associated with unoperated cataract in the multivariate 5$f*fMd;  
model. _:9-x;0H2  
The per cent of participants with unoperated cataract )IZ~!N|-w  
who said that they were dissatisfied or very dissatisfied with 610 hw376B  
Operated and unoperated cataract in Australia 79 # FV`*G  
Table 1. Prevalence of any cataracta (excluding previous cataract surgery) by age, gender and cohort Gnmxp%&}P|  
Age group Sex Urban Rural Nursing home Weighted total @T+pQ)0{{  
(years) (%) (%) (%) `'<&<P  
40–49 Male 2.56 4.04 0.00 3.00 (1.91, 4.08) ^k}jPc6  
Female 2.61 1.70 0.00 2.36 (1.61, 3.10) }!g^}BWWp  
50–59 Male 7.69 6.94 0.00 7.47 (5.80, 9.15) kzb1iBe 6m  
Female 6.67 7.56 0.00 6.92 (5.60, 8.24) 79Vp^GG7  
60–69 Male 20.7 25.0 10.0 22.0 (18.1, 26.0) WD5ulm?91|  
Female 27.9 35.7 37.5 30.3 (26.0, 34.7) zos#B30  
70–79 Male 43.1 58.7 39.1 48.1 (41.2, 55.1) K-*q3oh G  
Female 58.6 66.2 55.6 61.0 (56.0, 65.9) c\pPwG  
80–89 Male 74.0 89.3 92.0 79.3 (72.3, 86.3) g:nU&-x#R  
Female 91.9 97.0 80.2 92.6 (86.4, 98.8) ?QXo]X;f&  
90 + Male 100.0 100.0 75.0 98.8 (96.2, 100.0) a<K@rgQ  
Female 100.0 100.0 93.8 98.6 (97.0, 100.0) A">A @`}  
Age-standardized yjP;o`z%  
(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) ?(CMm%(8  
aCortical > 4/16, nuclear > standard 2, posterior subcapsular > 1 mm2 fX2PteA0qX  
their current vision was 30% (290/683), compared with 27% AyMMr_q  
(26/95) of participants with prior cataract surgery (chisquared, r:Xui-  
1 d.f. = 0.25, P = 0.62). ~IKPi==@,  
Outcomes of cataract surgery Y +tXWN"8  
Two hundred and forty-nine eyes had undergone prior V/G'{ q  
cataract surgery. Of these 249 operated eyes, 49 (20%) were }]H_|V*f  
left aphakic, 6 (2.4%) had anterior chamber intraocular }$ Am;%?p  
lenses and 194 (78%) had posterior chamber intraocular Dyj5a($9"{  
lenses. The rate of capsulotomy in the eyes with intact &@xixbg  
posterior capsules was 36% (73/202). Fifteen per cent of 2|)3 Ly9  
eyes (17/114) with a clear posterior capsule had bestcorrected [EJ[Gg0m  
visual acuity of less than 6/12 compared with 43% r^k:$wJbRK  
of eyes (6/14) with opaque capsules, and 15% of eyes NVMhbpX6  
(11/73) with prior capsulotomies (chi-squared, 2 d.f. = 7.21, \S@;>A<J  
P = 0.027). 8uX1('+T*  
The percentage of eyes with best-corrected visual acuity t "J"G@1)  
of 6/12 or better was 96% (302/314) for eyes without 1;[\xqJ  
cataract, 88% (1417/1609) for eyes with prevalent cataract q@p-)+D;  
and 85% (211/249) for eyes with operated cataract (chisquared, y.~y*c6,g  
2 d.f. = 22.3), P < 0.001). Twenty-seven of the Q- %Q7n'c  
operated eyes (11%) had visual acuities of less than 6/18 s45Y8!c  
(moderate vision impairment) (Fig. 2). A cause of this J8$G-~MeJ  
moderate visual impairment (but not the only cause) in four ++ :vO  
(15%) eyes was secondary to cataract surgery. Three of these 5[M?O4mi  
four eyes had undergone intracapsular cataract extraction S ; x;FU  
and the fourth eye had an opaque posterior capsule. No one 9LGJ-gL  
had bilateral vision impairment as a result of their cataract  KD^>Vv#  
surgery. H>[1D H#b  
DISCUSSION A}sb 2P  
To our knowledge, this is the first paper to systematically *tjE#TW  
assess the prevalence of current cataract, previous cataract !=#E/il,  
surgery, predictors of unoperated cataract and the outcomes !Ljs9 =UF  
of cataract surgery in a population-based sample. The Visual |$":7)e H!  
Impairment Project is unique in that the sampling frame and pK#Ze/!  
high response rate have ensured that the study population is z_eP  
representative of Australians aged 40 years and over. Therefore, A8hj"V47  
these data can be used to plan age-related cataract #"6(Q2| l  
services throughout Australia. ]YZ+/:#U7  
We found the rate of any cataract in those over the age >>wb yj8  
of 40 years to be 22%. Although relatively high, this rate is 2s;/*<WM  
significantly less than was reported in a number of previous yE-&TW_q:>  
studies,2,4,6 with the exception of the Casteldaccia Eye _h7+.U=  
Study.5 However, it is difficult to compare rates of cataract f 5_n 2  
between studies because of different methodologies and $GUSTV  
cataract definitions employed in the various studies, as well dh%C@n:B  
as the different age structures of the study populations. ;k/y[ x}  
Other studies have used less conservative definitions of <dDGV>n4;  
cataract, thus leading to higher rates of cataract as defined. T.!GEUQ  
In most large epidemiologic studies of cataract, visual acuity `ItMn&P  
has not been included in the definition of cataract. B @UaaWh  
Therefore, the prevalence of cataract may not reflect the H]Q Z4(  
actual need for cataract surgery in the community. t</rvAH E  
80 McCarty et al. Q wk  
Table 2. Prevalence of previous cataract by age, gender and cohort oGly|L>  
Age group Gender Urban Rural Nursing home Weighted total ;Mc\>i/  
(years) (%) (%) (%) !~m)_Q5?~  
40–49 Male 1.14 0.00 0.00 0.80 (0.00, 1.81) -Duy: C6W  
Female 0.00 0.00 0.00 0.00 ( 2<yi8O\  
50–59 Male 0.68 0.58 0.00 0.65 (0.13, 1.17) ,2[laJ  
Female 0.57 0.00 0.00 0.41 (0.00, 1.00) /lm;.7_J+  
60–69 Male 2.12 7.59 0.00 3.80 (1.41, 6.19) b3 MgJT"mN  
Female 2.11 3.51 0.00 2.54 (1.81, 3.26) VCcLS3  
70–79 Male 8.22 9.85 8.70 8.75 (6.38, 11.1) 7NMQUN7k '  
Female 7.21 7.86 7.02 7.41 (5.36, 9.46) kG &.|  
80–89 Male 25.0 30.0 14.3 26.2 (17.0, 35.4) @ I LG3"  
Female 27.9 25.6 18.3 26.7 (20.2, 33.3) s,"<+80%  
90 + Male 0.00 16.7 66.7 9.19 (0.00, 21.5) wZh&w<l'  
Female 58.3 100.0 26.9 63.1 (44.4, 81.8) ._~_OVU  
Age-standardized @ _U]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) Iujly f  
Figure 2. Visual acuity in eyes that had undergone cataract c\-5vw||b  
surgery, n = 249. h, Presenting; j, best-corrected. :qc@S&v@]  
Operated and unoperated cataract in Australia 81 4Ucg<Z&%  
The weighted prevalence of prior cataract surgery in the rm;'/l8Y-E  
Visual Impairment Project (3.6%) was similar to the crude X~sl5?  
rate in the Beaver Dam Eye Study4 (3.1%), but less than the =;7gxV3;  
crude rate in the Blue Mountains Eye Study6 (6.0%). (LA%q6  
However, the age-standardized rate in the Blue Mountains M3odyO(  
Eye Study (standardized to the age distribution of the urban @R_a'v-  
Visual Impairment Project cohort) was found to be less than BdG~y1%:  
the Visual Impairment Project (standardized rate = 1.36%, VtUe$ft  
95% CL 1.25, 1.47). The incidence of cataract surgery in \acJ9N  
Australia has exceeded population growth.1 This is due, ]U!vZY@\  
perhaps, to advances in surgical techniques and lens 2BXpk^d5y  
implants that have changed the risk–benefit ratio. w0)V3  
The Global Initiative for the Elimination of Avoidable ,G!M?@Q  
Blindness, sponsored by the World Health Organization, ]{{A/ j\  
states that cataract surgical services should be provided that YFv/t=`  
‘have a high success rate in terms of visual outcome and V8ZE(0&II}  
improved quality of life’,17 although the ‘high success rate’ is Gi~p-OS,  
not defined. Population- and clinic-based studies conducted ~YA* RCe  
in the United States have demonstrated marked improvement (wEaa'XL  
in visual acuity following cataract surgery.18–20 We Y;8Ys&/t  
found that 85% of eyes that had undergone cataract extraction n.ZLR=P4  
had visual acuity of 6/12 or better. Previously, we have '3 w=D )  
shown that participants with prevalent cataract in this I@+h| n  
cohort are more likely to express dissatisfaction with their 6v (}<2~  
current vision than participants without cataract or participants p~6/+ap  
with prior cataract surgery.21 In a national study in the vH%AXz IA  
United States, researchers found that the change in patients’ K*&M:u6E  
ratings of their vision difficulties and satisfaction with their au@ LQxKQ  
vision after cataract surgery were more highly related to $,v '>  
their change in visual functioning score than to their change A-^[4&rb  
in visual acuity.19 Furthermore, improvement in visual function f uQbDb&  
has been shown to be associated with improvement in !O6e,l  
overall quality of life.22 7K,Quq.%+  
A recent review found that the incidence of visually 8] skAh  
significant posterior capsule opacification following 59!yz'feF  
cataract surgery to be greater than 25%.23 We found 36% 0{^vqh.La  
capsulotomy in our population and that this was associated u\wdb^8ds  
with visual acuity similar to that of eyes with a clear d9>*a$x;/  
capsule, but significantly better than that of eyes with an n8UQIa4&=  
opaque capsule. BZejqDr*  
A number of studies have shown that the demand and ZUP\)[~  
timing of cataract surgery vary according to visual acuity, ,@kD9n5#  
degree of handicap and socioeconomic factors.8–10,24,25 We [zv>Wlf,%  
have also shown previously that ophthalmologists are more nw swy]e8/  
likely to refer a patient for cataract surgery if the patient is b&[9m\AX`  
employed and less likely to refer a nursing home resident.7 =y -L'z&r  
In the Visual Impairment Project, we did not find that any e8g"QDc  
particular subgroup of the population was at greater risk of KiYO,nD;\  
having unoperated cataract. Universal access to health care OzY55  
in Australia may explain the fact that people without mkgGX|k;  
Medicare are more likely to delay cataract operations in the ;,P-2\V/  
USA,8 but not having private health insurance is not associated :W]?6=  
with unoperated cataract in Australia. &7Frg`B&:  
In summary, cataract is a significant public health problem Q|QV m,m  
in that one in four people in their 80s will have had cataract dp`xyBQ3  
surgery. The importance of age-related cataract surgery will dv=y,q@W  
increase further with the ageing of the population: the r@N 0 %JZZ  
number of people over age 60 years is expected to double in -c-af%xD  
the next 20 years. Cataract surgery services are well .N2yn`  
accessed by the Victorian population and the visual outcomes OS8 ^mC  
of cataract surgery have been shown to be very good. &:}e`u@5|  
These data can be used to plan for age-related cataract kwxb~~S}h(  
surgical services in Australia in the future as the need for Rs +rlJq  
cataract extractions increases. EvZ;i^.8LS  
ACKNOWLEDGEMENTS l`lo5:w  
The Visual Impairment Project was funded in part by grants zNSix!F  
from the Victorian Health Promotion Foundation, the *M5 : \+  
National Health and Medical Research Council, the Ansell xlPUu m-o  
Ophthalmology Foundation, the Dorothy Edols Estate and 6#~"~WfPQ  
the Jack Brockhoff Foundation. Dr McCarty is the recipient }~P%S(zB  
of a Wagstaff Fellowship in Ophthalmology from the Royal [NcS[*qp  
Victorian Eye and Ear Hospital. /lAB  
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