The impact of cataract, cataract types, and cataract grades on vision-specific functioning using Rasch analysis

Am J Ophthalmol. 2012 Jul;154(1):29-38.e2. doi: 10.1016/j.ajo.2012.01.033. Epub 2012 Apr 26.


Purpose: To determine the impact of cataracts and their types and grades on vision-specific functioning.

Design: Prospective population-based cross-sectional study.

Methods: The Singapore Indian Eye Study examined 3400 of 4497 (75.6% response rate) ethnic Indians 40 years of age and older living in Singapore. Three thousand one hundred sixty-eight (93.2%) fulfilled inclusion criteria with complete information for final analysis. Cataracts were assessed on slit-lamp examination and were graded according to the Lens Opacity Classification System III. Vision-specific functioning scores were explored with the Visual Function scale, validated using Rasch analysis.

Results: Two hundred sixty-nine (8.5%) and 740 (23.4%) of the study participants had unilateral and bilateral cataracts, respectively, and 329 (10.4%), 800 (25.2%), and 128 (4.1%) participants had nuclear, cortical, and posterior subcapsular (PSC) cataracts, respectively. In multivariate linear regression models, the presence of bilateral rather than unilateral cataract (β = -0.12; 95% confidence interval, -0.20 to 0.00) was associated independently with poorer vision-specific functioning, even after adjusting for undercorrected refractive error (β = -0.11; 95% confidence interval, -0.21 to 0.00). Bilateral nuclear, cortical, and PSC cataracts also were associated with poorer vision-specific functioning (β = -0.31, -0.15, and -1.15, respectively), with combinations of them having even greater impact. Significantly poorer vision-specific functioning occurred at Lens Opacity Classification System grades 4 (nuclear opalescence), 5 (nuclear color), 3 (cortical), and 1 (PSC) or higher.

Conclusions: People with bilateral but not unilateral cataracts experience difficulty with performing vision-specific daily activities independent of refractive error, with PSC cataracts and cataract combinations having the greatest impact. Cataract types cause poorer vision-specific functioning beginning at different severity grades.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Activities of Daily Living
  • Adult
  • Aged
  • Cataract / classification*
  • Cataract / physiopathology*
  • Cross-Sectional Studies
  • Female
  • Humans
  • India / ethnology
  • Male
  • Middle Aged
  • Prospective Studies
  • Psychometrics
  • Quality of Life
  • Reproducibility of Results
  • Sickness Impact Profile
  • Singapore / epidemiology
  • Surveys and Questionnaires
  • Vision Disorders / physiopathology*
  • Visual Acuity / physiology*