Abstract
Purpose :
Historically, outcomes of cataract surgery have been reported as less favorable in individuals with diabetes. This study evaluated visual acuity (VA) outcomes of cataract surgery and factors associated with good visual outcomes in persons with type 2 diabetes.
Methods :
From 2001 to 2014, the ACCORD Study and the Follow-On (ACCORDION) Study followed 10,251 participants with type 2 diabetes at high risk for cardiovascular disease for a median of 9.2 years. Cataract surgery was documented at annual study visits and VA was measured on ETDRS charts every 2 years. Eyes that received cataract surgery during follow-up and VA measurements within 2 years of surgery were included in the analysis. The outcome was post-operative VA ≥20/40, and its association with various factors was evaluated using repeated measures logistic regression.
Results :
There were 2,748 eyes with incident cataract surgery and, after applying the inclusion criteria, 1,136 eyes (784 participants) remained in the analysis. Of these, 762 eyes (67.1%) achieved or maintained post-operative VA ≥20/40. According to multivariate analysis, the factors associated with post-operative VA ≥20/40 were education level (reference, some high school; HS graduate OR 1.89 [1.22-2.92]; some college OR 1.73 [1.11-2.69]; college graduate OR 2.44 [1.49-3.99]), clinical center network (reference, Northeastern US; highest, Veterans Affairs OR 3.61 [1.94-6.71]), pre-operative VA (OR 1.03 [1.02-1.03]), diabetic retinopathy (OR 0.37 [0.26-0.54]), and bilateral cataract surgery (OR 1.53 [1.12-2.09]) (see Table). Factors not significantly associated (p>0.05) included age, sex, race, body mass index, smoking, diabetes duration, blood pressure, lipid levels, and HbA1C.
Conclusions :
In the ACCORD population, two thirds of eyes receiving cataract surgery achieved or maintained good VA, equivalent to driving-level vision. This suggests that, in the modern era of small-incision cataract surgery and tighter glycemic control, good visual outcomes are attainable despite the presence of diabetes. This appears to hold true irrespective of age, sex, race, or glycemic control. Visual outcomes vary across education level and clinical center network. Pre-operative VA and diabetic retinopathy are important predictors of visual outcome.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.