July 2019
Volume 60, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2019
Visual acuity outcomes of cataract surgery in persons with type 2 diabetes: the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Study
Author Affiliations & Notes
  • Debora Hana Lee
    National Eye Institute, Bethesda, Maryland, United States
  • Elvira Agron
    National Eye Institute, Bethesda, Maryland, United States
  • Tiarnan D L Keenan
    National Eye Institute, Bethesda, Maryland, United States
  • Craig M Greven
    Ophthalmology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States
  • Ronald P Danis
    Ophthalmology & Visual Sciences, University of Wisconsin, Madison, Madison, Wisconsin, United States
  • James F Lovato
    Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States
  • Walter T Ambrosius
    Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States
  • Emily Y Chew
    National Eye Institute, Bethesda, Maryland, United States
  • Footnotes
    Commercial Relationships   Debora Lee, None; Elvira Agron, None; Tiarnan Keenan, None; Craig Greven, None; Ronald Danis, None; James Lovato, None; Walter Ambrosius, None; Emily Chew, None
  • Footnotes
    Support  Supported by contracts (N01-HC-95178, N01-HC-95179, N01- HC-95180, N01-HC-95181, N01-HC-95182, N01-HC-95183, N01- HC-95184, IAA-Y1-HC-9035, and IAA-Y1-HC-1010) from the National Heart, Lung, and Blood Institute and the National Institutes of Health, with additional support from the National Institute of Diabetes and Digestive and Kidney Diseases, the National Eye Institute, the National Institute on Aging, and the Centers for Disease Control and Prevention.
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 2067. doi:https://doi.org/
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      Debora Hana Lee, Elvira Agron, Tiarnan D L Keenan, Craig M Greven, Ronald P Danis, James F Lovato, Walter T Ambrosius, Emily Y Chew; Visual acuity outcomes of cataract surgery in persons with type 2 diabetes: the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Study. Invest. Ophthalmol. Vis. Sci. 2019;60(9):2067. doi: https://doi.org/.

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      © ARVO (1962-2015); The Authors (2016-present)

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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.

 

Table 1. Factors associated with post-operative visual acuity ≥20/40 (multivariate analysis).

Table 1. Factors associated with post-operative visual acuity ≥20/40 (multivariate analysis).

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