Several factors affect VA outcomes after cataract surgery in patients with type 2 diabetes
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Key takeaways:
- Two-thirds of patients with diabetes achieved a visual outcome of 20/40 or better after cataract surgery.
- Preoperative visual acuity and diabetic retinopathy were associated with visual outcomes.
Although visual prognosis after cataract surgery is usually favorable, factors such as diabetic retinopathy may still limit visual potential in those with type 2 diabetes, according to a study published in the British Journal of Ophthalmology.
“This is one of the largest studies to assess VA outcomes in people with diabetes undergoing cataract surgery,” Debora Lee, from the division of epidemiology and clinical applications at the National Eye Institute, and colleagues wrote. “Furthermore, this study provides an updated benchmark of the prevalence of good visual outcome after cataract surgery in a contemporary population with diabetes.”
Cataract surgery outcomes were influenced more by ocular parameters than systemic. Image: Adobe Stock
Researchers from the National Eye Institute and Wake Forest University conducted a retrospective case-control study of patients with type 2 diabetes enrolled in the multicenter, randomized Action to Control Cardiovascular Risk in Diabetes (ACCORD) study and ACCORD-eye substudy. They evaluated 1,136 eyes of 784 participants (mean age, 65.6 years; 58.4% men) who underwent cataract surgery from 2001 to 2014.
Of a subsample of 362 eyes from 251 patients who received fundus photographs gradable for diabetic retinopathy, 49.4% had no diabetic retinopathy, 13.8% had mild non-proliferative diabetic retinopathy (NPDR), 34.3% had moderate NPDR, 0.8% had severe NPDR, and 1.7% had proliferative diabetic retinopathy.
According to results, 762 eyes (67.1%) achieved a good visual outcome of at least 20/40, and among the subset that underwent fundus photographs, 265 eyes (73.2%) achieved a good outcome.
Significant predictors of good visual outcome included high level of education (OR = 2.35), bilateral cataract surgery (OR = 1.55) and preoperative visual acuity (OR = 10.59). In the subsample of 362 eyes, the presence or absence of diabetic retinopathy also influenced visual outcomes (OR = 1.73).
Factors that were not significantly associated with visual outcome included age, sex, race, smoking, diabetes duration, blood pressure, lipid levels and HbA1C.
“Notable factors associated with visual outcomes included preoperative VA and diabetic retinopathy, but not HbA1C, underscoring that while certain ocular measures may help to evaluate visual potential, systemic parameters may not be as valuable. Socioeconomic status and related issues may also be important considerations,” Lee and colleagues wrote.
Perspective
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Although the success rate of cataract surgery in diabetic patients from this study follows the range established by previous studies, the factors determining this success rate deserve more attention. While in school, heavy emphasis was placed on systemic factors, such as the blood pressure, lipid and blood sugar levels. This study suggests that these factors do not have as significant of an effect on postoperative visual outcomes. Instead, factors such as the patient’s education level and socioeconomic status played a bigger role in achieving good visual acuity outcomes. This is likely due to the increased probability of these patients having easier access to postoperative care and being more motivated to seek it. Early postoperative clinical visits are relevant for identification and early intervention on correctable common complications of cataract surgery such as posterior capsular opacification or refractive error.
With that said, patient education is key to minimizing this disparity. Given the ideal clinicians’ regular busy clinic schedules, it is easy to overlook the importance of thorough patient education. Ensuring that the patient’s questions are answered, communicating medical terminology in laymen’s terms, and providing written copies of education for patients to reference at home are some ways to achieve this goal. Taking the time to do so can improve the outcome of patients’ postop visual acuity and, ultimately, their quality of life.
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