WORLD VIEW

Visual acuity and quality of life outcomes in cataract surgery patients in Hong Kong

Joseph Lau¹, John J Michon^2,*, Wing-Shing Chan¹ and Leon B Ellwein³

Series editors: W V Good and S Ruit

¹ Centre for Clinical Trials and Epidemiological Research, The Chinese University of Hong Kong, Hong Kong
² Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
³ National Eye Institute, National Institutes of Health

Correspondence to:
Correspondence to:
Leon B Ellwein, PhD, National Eye Institute, 31 Center Drive, Bethesda, MD 20892–2510, USA

Background: Visual acuity, visual functioning, and vision related quality of life outcomes after cataract surgery were assessed in a population based study in a suburban area of Hong Kong.

Methods: A cluster sampling design was used to select apartment buildings within housing estates for enumeration. All enumerated residents 60 years of age or over were invited for an eye examination and visual acuity measurement at a site within each estate. Visual functioning (VF) and vision related quality of life (QOL) questionnaires were administered to interview subjects who had undergone cataract surgery and to unoperated people with presenting visual acuity less than 6/60 in either eye, and a sample of those with normal visual acuity.

Results: 36.6% of the 310 cataract operated individuals had presenting visual acuity 6/18 or better in both eyes, and 40.0% when measured by pinhole. 4.5% were blind, with presenting visual acuity less than 6/60 in both eyes. Of operated eyes, 59.6% presented with visual acuity 6/18 or better. 11.2% of the operated eyes were blind with vision less than 6/60. Visual acuity outcomes 6/18 or better were marginally associated with surgery in private versus public hospitals. Lens status (pseudophakic versus aphakic) and surgical period (within the most recent 3 years versus before) were not significantly related to vision outcomes. Mean VF and QOL scores decreased consistently with decreasing vision status. Spearman correlation with vision status was 0.420 for VF scores and 0.313 for QOL scores. Among VF/QOL subscales, correlation was strongest for visual perception (r = 0.447) among VF subscales and weakest for self care (r = 0.171) among QOL subscales. Regression adjusted VF and QOL total scores for cataract operated individuals were slightly lower than for those of visually comparable unoperated individuals (p<0.05).

Conclusions: Cataract operations in Hong Kong did not consistently produce good presenting visual acuity outcomes, suggesting that postoperative monitoring would be useful to minimise visual impairment in this population. Although vision outcomes were consistently correlated with all VF/QOL subscale scores, there was a differential impact with VF subscales usually being affected more by reduced acuity than the more general QOL subscales.

Keywords: cataract outcomes; quality of life; epidemiology; Hong Kong

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