Purpose: To evaluate the effectiveness of cataract surgery in achieving sight restoration and vision-related quality-of-life (QOL) in patients from rural southern China.
Design: Population-based, cross-sectional study.
Participants: A total of 109 cataract operated persons (152 eyes) and 654 unoperated persons.
Methods: Cluster sampling was used in identifying a random sample of 5342 persons 50 years of age and older for visual acuity and eye examinations. Visual functioning (VF) and QOL questionnaires were administered to aphakic and pseudophakic individuals, unoperated persons with presenting visual acuity less than 0.10 in either eye, and a sample of those with normal vision.
Main outcome measures: Distance visual acuity, VF, and QOL questionnaire scores.
Results: Among the cataract operated participants, 43 (39.4%) were bilaterally operated on, 32.1% had presenting visual acuity less than 0.10 in both eyes with 8.3% greater than or equal to 0.32 in both eyes. Of operated eyes, 52.6% presented with visual acuity less than 0.10, 23.7% greater than or equal to 0.32; with best correction, the corresponding percentages were 21.1% and 42.1%. Uncorrectable aphakia due to surgical complications was common. In a multivariate regression model, better visual acuity outcomes were associated with higher level surgeon practice settings and recent surgery. On a 0 to 100 scale, mean VF and QOL scores for the cataract operated population were 41.6 and 54.5, respectively. Mean scores ranged from 84.4 and 93.4, respectively, for the unoperated persons with normal vision, to 14.6 and 31.2, respectively, for those with visual acuity less than 0.05 in both eyes. The VF and QOL scores were closely correlated with presenting visual acuity in both cataract operated and unoperated populations (r = 0.49-0.64). Scores among the cataract operated population were not influenced by age, gender, or education level. Among the unoperated population, lack of education was associated with lower VF and QOL scores (P = 0.017 and P = 0.005, respectively), and older age was associated with lower QOL scores (P < 0.001).
Conclusion: Patients in rural southern China are not realizing the full sight-restoring potential of modern-day cataract surgery. Remedial efforts are needed to improve the performance of local eye surgeons.