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Joanna M. Jefferis, John-Paul Taylor, Michael P. Clarke; Can We Predict Visual Quality Of Life Based On The Grading Of Lens Opacities?. Invest. Ophthalmol. Vis. Sci. 2012;53(14):5452.
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Cataract surgery is the most common surgical intervention in the developed world. A decision of whether to operate on a patient with age-related cataract is typically based on patient symptoms, visual acuity and examination findings. More advanced cataracts would be expected to have a greater impact on a patient’s vision and their quality of life. We set out to determine whether we can predict the effect of cataract on a patient’s visual quality of life based on the degree of their lens opacity.
We recruited 27 patients aged 75 years or over presenting with bilateral cataracts. We excluded patients with any other significant eye diseases, including age related macular degeneration. We used the Lens Opacities Classification System III (LOCSIII) at the slit lamp to grade nuclear, cortical and posterior subcapsular cataract. The highest grade for each eye (nuclear, cortical or posterior) was taken as the predominant cataract type and these figures were used in the analysis. We used the 25 item National Eye Institute Visual Function Questionnaire (NEI-VFQ 25) to grade visual quality of life. Visual acuity was assessed using a standardised ETDRS chart at 4m. Data was analysed using partial correlations.
The predominant cataract types were nuclear (39 eyes), cortical (13 eyes) and posterior subcapsular (2 eyes). Best corrected visual acuity was significantly correlated with VFQ-25 score after correcting for age and LOCSIII score (R=0.66, p<0.001). However, neither better eye nor worse eye LOCSIII grades were correlated with VFQ-25 scores after correcting for age and visual acuity (R=0.28, p=0.18 and R=0.09, p=0.66 respectively).
We have shown that whilst visual acuity directly impacts visual quality of life, the grade of lens opacity is a poor predictor of visual quality of life. These results confirm the importance of taking a thorough visual history when deciding whether to list a patient for cataract surgery. The appearance of the lens alone is a poor predictor of the impact of cataract on quality of life and visual function.
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