The RCOphth National Ophthalmology Database study of cataract surgery: Visual outcomes for eyes with a preoperative visual acuity of count fingers or worse

Introduction: There is little published evidence to inform the consent process, or the clinical decision to offer cataract surgery to patients presenting with preoperative visual acuity (VA) of Counting Fingers (CF), Hand Movements (HM) or Perception of Light (PL). For those whose primary pathology is advanced cataract, often obscuring the view of the retina and optic nerve, the chance of obtaining good postoperative VA is unknown. Eyes with other co-pathologies may be the main reason for poor vision but where there is some element of cataract, commissioners may ask whether cataract surgery is a good use of limited healthcare funds when the prognosis is uncertain. This analysis aimed to investigate post-cataract VA in eyes with a preoperative VA of CF or worse using data submitted to the RCOphth NOD. Method(s): Eligible cataract operations were performed between 01/04/2010 and 31/03/2023 in centres with data for at least 50 operations with both a preoperative and postoperative VA. Eyes with preoperative VA of CF, HM and PL from these centres were included. UK driving standard VA and severe sight impaired (SSI) were defined as VA <=0.30 LogMAR and >1.30 LogMAR respectively. Result(s): Eligible for analysis were 95,725 operations performed on 91,454 patients from 189 centres by 4409 surgeons with operations 81.8% performed by fully qualified surgeons. Preoperative VA was CF for 52,708 (55.1%) eyes, HM for 34,717 (36.3%) eyes and PL for 8,300 (8.7%) eyes. The median ages of patients were 71, 73 and 66 years for first eye, second eye and immediate sequential bilateral cataract surgery respectively. Brunescent/white/mature cataract +/- no fundal view/vitreous opacity was present in 36,387 (38.0%) eyes, and in 34.5% CF, 48.4% HM and 17.2% PL eyes. Posterior Capsule Rupture (PCR) occurred in 4.12% of eyes. The median postoperative VA was 0.18 LogMAR, UK driving standard VA was achieved by 76.9% eyes, and by 78.1%, 76.9%, and 74.4% of CF, HM and PL eyes respectively. Postoperative VA remained in the SSI range for 5.5% eyes, and for 4.2%, 5.6%, and 8.0% of CF, HM and PL eyes respectively. Brunescent/white/mature cataract +/- no fundal view/ vitreous opacity was absent in 59,338 (62.0%) eyes, and in 67.7% CF, 28.9% HM and3.5% PL eyes. AMD was present in 14.6% eyes, DR in 8.5% eyes, glaucoma in 10.1% eyes, and 2.04% experienced PCR. The median postoperative VA was 0.20 LogMAR, UK driving standard VA was achieved by 70.2% eyes, and by 73.6%, 64.3% and 54.8% of CF, HM and PL eyes respectively. Postoperative VA remained in SSI range for 10.0% eyes, and for 6.9%, 15.4%, and 25.7% of CF, HM, and PL eyes respectively. Conclusion(s): UK driving standard VA was achieved by 76.9% eyes with preoperative VA of CF or worse due to brunescent/ white/mature cataract +/- no fundal view/ vitreous opacity. Even where copathologies are identified (primarily AMD, DR and Glaucoma) and the advanced cataract is not recorded, the UK driving standard was achieved in 70.2% of eyes with CF or worse preoperatively. This information is useful for preoperative counselling the informed consent process.

Citation

Monachan et al (2025). The RCOphth National Ophthalmology Database study of cataract surgery: Visual outcomes for eyes with a preoperative visual acuity of count fingers or worse. Eye 39 (Suppl 2), 191–318 (2025). https://doi.org/10.1038/s41433-025-03831-0

DOI

10.1038/s41433-025-03831-0

URI

https://hdl.handle.net/20.500.14709/1290