The impact of glaucoma on functional visual improvement after cataract surgery: Results of the Veterans Affairs (VA) Ophthalmic Surgical Outcomes Data (OSOD) Project

Abstract

Purpose: To analyze functional visual improvement after cataract surgery in glaucomatous versus non-glaucomatous eyes.

Methods: The VA OSOD Project included 4,923 cataract surgery cases. In our retrospective analysis, we included eyes of patients who submitted both pre-operative and post-operative National Eye Institute-Visual Functioning Questionnaires (NEI-VFQ). We analyzed the NEI-VFQ composite scores using the Wilcoxon signed rank test as well as a linear mixed model that accounted for repeated measures and multiple variables. The difference in mean change in composite scores pre to post surgery was measured by analysis of variance.

Results: Of the 4,923 patients, 3,149 in the OSOD database completed both pre- and post-surgery NEI-VFQ questionnaires. Of those, 422 (13.4%) had glaucoma and 2,727 (86.6 %) did not. Pre-operative and post-operative questionnaires were submitted by 69.4% of glaucoma and 63.3% of non-glaucoma patients. Analysis of overall NEI-VFQ composite scores showed that cataract surgery led to a significant increase in visual function in glaucomatous (80.17 ± 19.13, p<0.0001) and non-glaucomatous eyes (84.71 ± 16.33, p<0.0001). Overall, eyes without glaucoma had significantly more improvement (p<0.0001). When stratified by pre-operative best-corrected visual acuity (BCVA), eyes without glaucoma had significantly better NEI-VFQ composite scores when the pre-operative BCVA was better than or equal to 20/40 (p<0.0001) or when the pre-operative BCVA was worse than 20/40 (p<0.0001).

Conclusions: Cataract surgery offers significant functional visual improvement for glaucomatous and non-glaucomatous eyes regardless of pre-operative BCVA, though the benefit appears greater for those without glaucoma.