Visual Acuity, Quality of Life and Visual Function Outcomes after Cataract Surgery in Bali

Abstract

Purpose: To assess post-cataract surgery intermediate-term (>6 months) data of visual acuity (VA), surgical complications, refractive outcomes, quality of life (QOL) and visual function (VF) from a non-governmental organization program in Indonesia.

Methods: Retrospective cohort study design. Participants were a selection of patients who underwent cataract surgery by the John Fawcett Foundation between 2006 and 2011, with at least 6 months follow-up. Patients underwent comprehensive ophthalmic examinations. QOL and VF questionnaires were administered.

Results: From a total of 1557 invited to attend, 547 patients participated; 99.8% of eyes had presenting VA <6/60. At day 1 postoperatively, 52.1% of patients had a good outcome by World Health Organization criteria (unaided VA ≥ 6/18). Six months or later postoperatively, 85% of eyes had best-corrected VA ≥ 6/18 and 5.6% of eyes had best-corrected VA < 3/60. At final follow-up, mean postoperative spherical equivalent refraction was −2.35 diopters (standard deviation 1.75, n = 542). On a scale of 1–100, median converted values for QOL were 25.0 preoperatively and 74.0 postoperatively, a statistically significant improvement (p < 0.001). Of eyes with VA better than 3/60 on postoperative day 1, 5.7% (95% confidence interval 3.6–7.9%) became blind (VA < 3/60) at the 6-month or later time point.

Conclusion: Cataract surgery in this population markedly improved QOL, despite a trend towards myopic refractive outcomes. These findings raise questions about biometric methodology, intraocular lens power calculations and refractive targets. Postoperative day 1 VA data may be a reasonable proxy of the intermediate-term rate of non-blind eyes.

• Cataract
• Indonesia
• quality of life
• visual function and epidemiology

Acknowledgments

We are grateful to Drs. J. Byrne, P. Graham, I. Spencer, G. Bougher, W. Chan, John Fawcett, David Yates, Gede Bingin, and YKI staff for their contributions to and support of the project.

Some preliminary data from the audit was presented at the South Australian state branch meeting of the Royal Australian and New Zealand College of Ophthalmologists, in July 2013.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

The John Fawcett Foundation provided the funding for this study. None of the authors are financial beneficiaries of The John Fawcett Foundation. Professor Crompton is affiliated with The John Fawcett Foundation as an Executive Board Member and is involved in ongoing ophthalmic training to the Indonesian surgeons.