The association of American Society of Anesthesiologists (ASA) class 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 grouped by ASA class.

Methods: Retrospective analysis of 4,923 cataract surgery cases in the Veterans Affairs (VA) Ophthalmic Surgical Outcomes Data (OSOD) Project. Included cases of eyes which had both preoperative and postoperative National Eye Institute-Visual Function Questionnaire (NEI-VFQ) submitted. Cataract surgery cases in ASA classes 1 and 2 (group A) were compared to those in ASA classes 3 and 4 (group B). 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, 3,141 in the OSOD database completed both pre- and post-NEI-VFQ questionnaires. Of those, 622 (19.8%) were in ASA classes 1 and 2 (group A) and 2519 (80.2%) in classes 3 and 4 (group B). Preoperative and postoperative questionnaires were submitted by 71.08% of cases in group A and 62.47% of cases in group B. Analysis of overall VFQ composite score showed that cataract surgery on eyes in group A led to a significant increase in visual function (85.99 ± 16.43, P<0.0001), as well as in group B (83.70 ± 16.85, P<0.0001). When comparing improvement from pre- to post-surgery between group A and group B, group A had significantly more improvement (p<0.014). When analyzing eyes with pre-operative BCVA better than or equal to 20/40, those in group A had significantly better composite scores on their post-surgery NEI-VFQ compared to eyes in group B (P<0.0001). Eyes in group A with pre-operative BCVA worse than 20/40, had significantly better composite scores on the post-surgery NEI-VFQ when compared to those in group B (P<0.0001).

Conclusions: Cataract surgery offers significant functional visual improvement for eyes in both groups, though the benefit appears greater for those in lower ASA classes (group A).