Sex-Based Disparities after Cataract Surgery based on Operative Complications and Visual Acuity Outcomes

Abstract

Purpose : To investigate sex differences in the frequency of intra- and post-operative complications and visual outcomes following cataract surgery.

Methods : A retrospective chart review (2014 to 2019) was conducted on the medical records of patients who had phacoemulsification cataract surgery at the Sue Anschutz-Rodgers Eye Center, University of Colorado School of Medicine. Data collected included the patient's health history, ocular comorbidities, operative and post-operative complications, and the post-operative best corrected visual acuity (BCVA). The data were analyzed using univariate and multivariable logistic regression with generalized estimating equations to account for the correlation of some patients having two eyes included in the study.

Results : A total of 12,549 eyes from 7,650 patients were included in the study. Ocular comorbidities were different by sex, with males having significantly higher percentages of traumatic cataracts, intraocular injections, prior ocular surgery, mature cataracts, and planned pars plana vitrectomy (PPV). Conversely, females had significantly higher rates of pseudoexfoliation. In multivariable analysis, males had 1.7 higher odds of posterior capsular rupture (PCR) (95% CI:1.0-2.7, p=0.0398) and 1.6 higher odds of vitreous loss (95% CI:1.1-2.5, p=0.0211). Post-operatively, males had a significantly increased risk of retinal detachment, but in multivariable analysis this was no longer significant, and were significantly less likely to undergo Nd:YAG laser capsulotomy for posterior capsule opacification (OR=0.8, 95% CI=0.7-0.9, p=0.002). The best corrected visual acuity (BCVA) was slightly worse for males pre-operatively (mean logMAR 0.376 (Snellen equivalent 20/47) vs. 0.340 (Snellen equivalent 20/44) for females, p=0.002); but post-operatively, both sexes exhibited similar visual acuity of Snellen equivalent 20/25 (p=0.2096) with exclusion of traumatic cataracts, combined surgeries with PPV, and complicated surgeries.

Conclusions : Our study found significant differences by sex in patient presentation and outcomes following cataract surgery. These findings underscore the importance of incorporating sex into studies that investigate cataract surgery outcomes.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.