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Visual acuity outcomes after cataract surgery in type 2 diabetes: the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study
  1. Debora Lee1,
  2. Elvira Agron1,
  3. Tiarnan Keenan1,
  4. James Lovato2,
  5. Walter Ambrosius2,
  6. Emily Y Chew1
  7. On behalf of the ACCORD Eye Study Research Group
  1. 1Division of Epidemiology and Clinical Applications, National Eye Institute, Bethesda, Maryland, USA
  2. 2Department of Statistics, Wake Forest University Division of Public Health Sciences, Winston-Salem, North Carolina, USA
  1. Correspondence to Dr Emily Y Chew, National Institutes of Health, Bethesda, MD 20892, USA; echew{at}


Aims To evaluate visual acuity (VA) outcomes of cataract surgery, and factors associated with good visual outcomes, among a population with diabetes.

Methods Participants with type 2 diabetes enrolled in The Action to Control Cardiovascular Risk in Diabetes (ACCORD) study and ACCORD-eye substudy. 1136 eyes of 784 ACCORD participants receiving cataract surgery during follow-up (2001–2014) were included. Of these, 362 eyes had fundus photographs gradable for diabetic retinopathy. The main outcome measure was the achievement of postoperative VA of 20/40 or better.

Results In the sample of 1136 eyes, 762 eyes (67.1%) achieved good visual outcome of 20/40 or better. Factors predictive of good visual outcome were higher level of educational attainment (college vs some high school, OR 2.35 (95% CI 1.44 to 3.82)), bilateral cataract surgery (OR 1.55 (1.14 to 2.10)) and preoperative VA (20/20 or better vs worse than 20/200, OR 10.59 (4.07 to 27.54)). Factors not significantly associated (p>0.05) included age, sex, race, smoking, diabetes duration, blood pressure, lipid levels and haemoglobin A1C (HbA1C). In the subsample of 362 eyes, absence of diabetic retinopathy was associated with good visual outcome (OR 1.73 (1.02 to 2.94)).

Conclusion Among individuals with diabetes, two-thirds of eyes achieved good visual outcome after cataract surgery. Notable factors associated with visual outcome included preoperative VA and diabetic retinopathy, but not HbA1C, underscoring that while certain ocular measures may help evaluate visual potential, systemic parameters may not be as valuable. Sociodemographic factors might also be important considerations. Although the current visual prognosis after cataract surgery is usually favourable, certain factors still limit the visual potential in those with diabetes.

  • lens and zonules
  • epidemiology
  • vision

Data availability statement

Data may be obtained from a third party and are not publicly available. Action to Control Cardiovascular Risk in Diabetes (ACCORD)

Statistics from

Data availability statement

Data may be obtained from a third party and are not publicly available. Action to Control Cardiovascular Risk in Diabetes (ACCORD)

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  • Contributors DL, EA, TK, EC contributed to research design, data analysis and manuscript preparation of the study. JL and WA contributed to research design, data acquisition of the study, and manuscript preparation of the study. EC is the guarantor of the study.

  • Funding This work was supported by the intramural program funds and contracts (N01-HC-95178, N01-HC-95179, N01-HC-95180, N01-HC-95181, N01-HC-95182, N01-HC-95183, N01-HC-95184, IAA-Y1-HC-9035, IAA-Y1-HC-1010 and HHSN268201100027C) from the National Heart, Lung, and Blood Institute of the National Institutes of Health (NIH), with additional support from the National Institute of Diabetes and Digestive and Kidney Diseases, the National Institute on Aging, and the National Eye Institute. General clinical research centres provided support at many sites. We also acknowledge the support of the NIH Medical Research Scholars Program (DHL), a public–private partnership supported jointly by the NIH and contributions to the Foundation for the NIH from the Doris Duke Charitable Foundation (DDCF Grant number 2014194), the American Association for Dental Research, the Colgate-Palmolive Company, Genentech, Elsevier and other private donors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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