Purpose To assess whether improved visual acuity (VA) is sustained 2 years after the cataract surgery.

Methods The Cataract Surgery and Age-Related Macular Degeneration (CSAMD) study followed 1936 patients aged ≥65 years undergoing phacoemulsification cataract surgery at Westmead Hospital (Sydney, Australia) between 2004 and 2007. Presenting and pinhole VA were assessed and retinal photography was performed annually. VA improvement or reduction was defined if VA differed by ≥2 lines between 1 and 24 months.

Results VA data were available for 1809 patients at 1 month and 1294 at both postoperative visits (71.5% of 1809). At the 2-year visit, 930 patients (71.9%) maintained the same pinhole VA levels that they had at 1 month postoperatively, 199 (15.4%) had an improvement and 165 (12.7%) a reduction in pinhole VA. After adjusting for age and gender, pre-existing macular conditions (early AMD, macular hole or previous laser treatment) were associated with pinhole VA reduction (p=0.02). At the 24-month visit, 58.1% of those with presenting VA improvement wore distance spectacles.

Conclusions One in eight cataract surgical patients lost at least two lines in pinhole VA over the 2-year postoperative period. Regular eye examinations of patients after cataract surgery may help to maximise the surgical benefits over the long term.