The association of pseudo-exfoliation syndrome (PXF) with functional visual improvement after cataract surgery: Results of the Ophthalmic Surgical Outcomes Data (OSOD) Project

Abstract

Purpose: To compare functional visual improvement in eyes with pseudo-exfoliation syndrome versus those without.

Methods: Retrospective analysis of 4,923 cataract surgery cases in the VA Ophthalmic Surgical Outcomes Data (OSOD) Project. Included cases of eyes which had both pre-operative and post-operative National Eye Institute-Visual Functioning Questionnaire (NEI-VFQ) submitted. Analyzed and compared NEI-VFQ composite scores using Wilcoxon signed rank test and a linear mixed model accounting for repeated measures and adjusting for multiple variables. Difference in mean change in composite scores pre-to post surgery was measured by analysis of variance.

Results: Of the 4,923 cases, 3,143 in the OSOD database completed both pre- and post- NEI-VFQ questionnaires. Of those, 79 (2.5%) had PXF and 3064 (97.5%) did not. Preoperative and postoperative questionnaires were submitted by 64.22% of PXF and 64.15% of no PXF cases. Analysis of overall VFQ composite score showed that cataract surgery on eyes with PXF led to a significant increase in visual function (82.14 ± 16.85, P<0.0001); as well as in eyes without PXF (84.17 ± 16.79, P<0.0001). When comparing improvement from pre- to post-surgery between the two groups, eyes without PXF had significantly more improvement (P=0.0132). When analyzing eyes with pre-operative best-corrected visual acuity (BCVA) better than or equal to 20/40, those without PXF had significantly better composite scores on their post-surgery NEI-VFQ compared to those with PXF (P<0.0001). Eyes without PXF with pre-operative BCVA worse than 20/40, had significantly better composite scores on the post-surgery NEI-VFQ when compared to those with PXF (P<0.0001).

Conclusions: Cataract surgery offers significant functional visual improvement for eyes in both groups, though the benefit appears greater for those without PXF.