Long-time outcome of cataract surgery-20 years results from a prospective study

Purpose: This study reports the change, over a 20-year period, in best-corrected visual acuity (BCVA), subjective visual function (VF-14 questionnaire), and YAG-frequency after cataract surgery. Methods: This population-based prospective study reviewed 106 patients (79% of survivors), who underwent cataract surgery during a 1-year period 20 years previously (1997). All patients answered the same visual function questionnaire (VF-14) preoperatively, 4 months postoperatively, 5, 10, 15 and 20 years after surgery. Most patients (90%; 95/106; 70% of survivors) also had a routine ocular examination including BCVA and low contrast visual acuity (VA) 10% and 2.5%. Mean age at the time of surgery was 59 years (range 36-79) and 95% had a three-piece Acrysof® MA60BM implanted. Results: Twenty years after surgery the median BCVA of the operated eye had deteriorated to a median of 0.06 (logMAR) (Snellen acuity: 20/23) from 0.0 (logMAR) (20/20) postoperatively, (p=0.001). Sixty-one percent of the patients (58/95) had less than 0.1 logMAR units worsening of BCVA compared with postoperatively. Seventeen percent of the patients (16/95) had worse BCVA 20 years after surgery compared with the preoperative VA. Forty-two percent (45/106) had no deterioration in subjective visual function (VF-14), and mean VF-14 score 20 years after surgery was 92 (range 33-100). The majority of patients (78%;82/106) had 10 points decline or less and 6 percent of the patients (6/106) had a worsening of more than 30 points. 61% of the patients (58/95) had never had Nd:YAG laser capsulotomy. In 7% of the patients (7/95) no cataract surgery had occurred in the fellow eye. Conclusions: These prospective population-based, follow-up data provides estimates of extended long-term visual results. The effectiveness of cataract extraction, in offering good long-term visual rehabilitation for the majority of the patients, is confirmed. The extent and distribution of loss in subjective visual function is comparable to the outcome 10 and 15 years after surgery. Age-related macular degeneration remained the most common comorbidity causing large functional loss also 20 years after cataract surgery. Surprisingly, despite the low age at cataract surgery and the long time span, only a minority of patients had needed treatment for posterior capsular opacification.