Cataract surgery. Outcome assessments and epidemiologic aspects.

Part one defines the topics and study purposes. The 12 studies reviewed in this survey focuses on following 3 topics of which the current knowledge is very limited: Assessment of outcome of cataract surgery (effectiveness studies). Pre-operative prediction of outcome of cataract surgery. Epidemiologic aspects of cataract surgery. These three topics were chosen as study objectives because more accurate knowledge of these points is necessary to assure a better cataract treatment in future, and as a basis for securing sufficient resource allocation to cataract surgery in the public health care. Each topic will be treated separately in the following 3 parts. Part two concerns the effectiveness studies on cataract surgery (publ. I-VI). Primary, a visual functioning index is presented and evaluated. The index is meant as a new supplementary tool for evaluation of the rehabilitation effect. This index, together with visual acuity and other outcome evaluators, was then used for assessment of the effectiveness of cataract extraction generally and in different sub-groups, supplemented with quantitative assessment of rehabilitation problems and analysis of outcome predictors. In a consecutive series of patients, in which intraocular lenses were not used, it was found, that 82% of the patients obtained a final visual acuity of 0.5 or better and 74% of the patients had normal or near normal basic visual functioning at one year follow-up. In spite of these good results, the rehabilitation of these aphakics were difficult. The difference between the two figures above represents some of the 'aphakic vision cripples' with severe difficulties of adaptation to aphakic spectacles. 26% of cataract extracted patients in a normal consecutive group were found to be dissatisfied with the outcome. Two main reasons for dissatisfaction were found: macular disease and low quality of vision with aphakic spectacles, especially in monaphakics, of which 75% had complaints about vision. Although monaphakics nearly reach the same level in basic functioning as the biaphakics, the latter are much more satisfied. It seems likely that basic visual functioning is gained by first eye surgery and more delicate visual functioning and a subjective 'visual comfort' is obtained by second eye surgery. Adaptation to aphakic spectacles seem to be far less difficult for the biaphakics. In series of patients rehabilitated with intraocular lenses or extended-wear contact lenses, the monaphakics appear to have a generally better visual functioning and they are much more satisfied with outcome than spectacles corrected monaphakics.(ABSTRACT TRUNCATED AT 400 WORDS)