Some patients may lose two lines in pinhole visual acuity 2 years after phaco

Br J Ophthalmol. 2011;95(12):1652-1655.

Results of the Cataract Surgery and Age-Related Macular Degeneration Study showed that one in eight cataract surgery patients lost at least two lines in pinhole visual acuity over the first 2 postoperative years.

"We found that about 13%-17% of a large cohort of cataract surgical patients had lost at least two lines of vision (presenting or pinhole) within the first 2 years following surgery, and 15%-25% of patients had gained two or more lines of vision during the same period," the researchers said.

They assessed whether improved visual acuity is sustained 2 years after surgery.

Of the 1,936 patients who were age 65 years or older who underwent phacoemulsification, visual acuity data were available for 1,809 at 1 month and 1,294 at 2 years. Surgery was performed at Westmead Hospital in Sydney, Australia, between 2004 and 2007. The researchers assessed both presenting and pinhole visual acuity. Retinal photography was also performed.

Results at 2 years showed that 71.9% of patients maintained the pinhole visual acuity levels that they had at 1 month. Further, 15.4% had an improvement in pinhole visual acuity and 12.7% had a reduction. The researchers said the strongest predictors of reduction in vision after surgery are age and the presence of macular lesions.

"Realistic expectations about the long-term visual outcome after cataract surgery should be explained to patients with these risk factors," they wrote. "Regular eye examinations are also needed to maintain good [visual acuity] in the long term after cataract surgery."