Visual outcomes and vision-related quality of life in veterans with dementia or cognitive impairment: Results from the Veterans Affairs Ophthalmic Surgery Outcomes Data Project

Abstract

Purpose : To analyze visual acuity outcomes and functional visual improvement after cataract surgery in veterans who have a diagnosis of dementia or cognitive impairment.

Methods : We analyzed 3154 of 4,923 cataract surgery cases, either without (Group A) or with dementia or cognitive impairment (Group B), who completed both pre- and postoperative National Eye Institute-Visual Function Questionnaire (NEI-VFQ 25), in the Veterans Affairs (VA) Ophthalmic Surgical Outcomes Data (OSOD) Project. The two groups were compared on best-corrected visual acuity (BCVA, logMAR scale) and all NEI-VFQ 25 subscales. Data were analyzed using analysis of variance and nonparametric tests. Correlation was estimated using Pearson’s correlation coefficient.

Results : 3052 (96.8%) of 3154 cases were in Group A, 93 (2.9%) cases were in Group B, and 9 (0.3%) had missing data. BCVA improved significantly from pre-to post-surgery in Group A (0.08 ± 0.23, P<.0001) and in Group B (0.14 ± 0.31, P<.0001). There was comparable improvement in BCVA in both the groups from pre-to post-surgery (P=.91). Dementia or cognitive impairment, as defined by the OSOD, did not increase the risk of postoperative BCVA worse than 20/40 compared to Group A (A:6.6% vs B:9.4%, OR 1.36, 95% CI 0.59 – 2.73, P=.45, adjusted for systemic comorbidities)
VFQ composite scores increased significantly from pre- to post-surgery in Group A (83.8 ± 16.9, P<.0001), as well as in Group B (74.3 ± 21.8, P<.0001). The improvement in VFQ composite scores in Group A was comparable to improvement in Group B (P=.17). For veterans in Group A, the improvement in BCVA correlated significantly with improvement in VFQ composite scores (Pearson’s r =0.17, P<.0001). In Group B, the correlation between the improvements in vision and vision-related quality of life (VRQoL) was not significant (r=0.13, P=0.24).

Conclusions : Cataract surgery offers significant and comparable improvement in vision and VRQoL for eyes in both groups. Among veterans with dementia or cognitive impairment, there was no significant correlation between improvement in BCVA and VRQoL. So factors other than improvement in vision may be affecting the gains in VrQoL. Further research is necessary to explore this aspect.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.