Long-term outcome of cataract surgery: 20-year results from a population-based prospective study

Purpose: To report the longitudinal visual functional outcome after cataract surgery over 20 years. Setting: Eye clinic, Norrlands University Hospital, Sweden. Design: Prospective population-based cohort study. Methods: One hundred fourteen patients (86% of survivors) who had cataract surgery during a 1-year period (1997 to 1998) answered the same Visual Function Index-14 questionnaire (VF-14) preoperatively, 2 to 4 months postoperatively, and at 5, 10, 15, and 20 years after surgery. Most patients (100 [88%] of 114; 75% of survivors) also had a routine ocular examination, including corrected distance visual acuity (CDVA). Results: The mean age of the114 patients in the study was 60.6 years (range 36 to 80 years) at the time of surgery. Twenty years after surgery, the median CDVA in the operated eye had deteriorated from Snellen acuity 20/20 (logarithm of the minimum angle of resolution [logMAR] 0.0) postoperatively to 20/23 (logMAR 0.07) (P =.001). Patients aged 70 years or older at surgery had the largest loss of CDVA at 20 years compared with younger patients. At 20 years, 63 (55%) of the 114 patients had no deterioration in subjective visual function and most patients (82 [72%]) had 10 points decline or less. Patients who were older at surgery had a more pronounced decline in VF-14 total score over 20 years (P =.002). Fifty-six (58%) of 96 patients had never been treated for posterior capsule opacification. Conclusions: This prospective 20-year follow-up study provided estimates of longitudinal visual results. Cataract surgery also offered excellent long-term visual rehabilitation for the majority, especially younger patients, after 20 years, with a low requirement for Nd:YAG laser capsulotomy. The results in this study are of value for counseling younger patients with cataract and patients considering refractive lens surgery. (C) 2019 ASCRS and ESCRS