Prognostic indicators and outcome measures for surgical removal of symptomatic nonadvanced cataract

Objectives: To report changes in perceived visual functioning after surgery for symptomatic cataract with preoperative corrected distance visual acuity [CDVA] of 0.4 logMAR or better (Snellen equivalent, 20/50) and to investigate the relationship between any observed changes and preoperative physical characteristics and psychophysical consequences of the lens opacity and any changes in psychophysical findings after the procedure. Methods: Eighty-five patients with cataract completed a validated questionnaire concerning functional vision satisfaction and a series of visual performance assessments before and 2 months after cataract surgery. The lens optical density and Lens Opacities Classification System III score of the cataract were recorded. Correlations between changes in the Rasch-analyzed questionnaire score and changes in visual performance after cataract surgery, as well as preoperative psychophysical measures, lens optical density, and Lens Opacities Classification System III score, were determined. Results: The mean (SD) questionnaire score improved from 2.15 (0.36) to 1.54 (0.41) (P<.001). The preoperativequestionnaire score (r=-0.44), preoperative mesopic glare disability [GD] (at 1.5 cycles per degree [cpd] [r=0.34] and 3.0 cpd [r=0.27]), and preoperative photopic GD (at 1.5 cpd [r=0.24] and 3.0 cpd [r=0.30]) showed statistically significant correlations with perceived improvements in visual functioning after surgery (P<.05). Changes in perceived visual functioning correlated significantly with changes in mesopic GD (at 1.5 cpd [r=-0.43] and 3.0 cpd [r=-0.28]; P<.05) and photopic GD (at 1.5 cpd [r=-0.24] and 3.0 cpd [r=-0.39]; P<.05). Neither preoperative CDVA nor change in CDVA after surgery correlated significantly with perceived improvement in visual functioning after the procedure (P>.05 for both). Conclusion: Psychophysical tests alternative to CDVA better represent improvements in self-reported visual functioning following removal of symptomatic nonadvanced cataract.