Dissatisfaction with cataract surgery in relation to visual results in a population-based study in Sweden

To evaluate dissatisfied patients and those with subjectively worse visual ability after cataract surgery and to analyze how these factors relate to poor visual acuity results (worse than 20/40).

Department of Ophthalmology, Norrlands University Hospital, Umeå, Sweden.

A prospective, population-based study of cataract surgery outcome was conducted. All patients (459 surgeries) who had cataract surgery during a 1 year period were studied using self-administered questionnaires and data from patient records. Outcome measures were (1) patient degree of satisfaction with the result, (2) subjective visual ability after surgery of visually demanding tasks such as reading, television viewing, orientation in unfamiliar surroundings, and distance estimation far and near, and (3) visual acuity results.

After surgery, 37 of the 459 cases (8%) were dissatisfied. These patients had a significantly lower age-corrected visual acuity in the operated eye than the satisfied patients (P < .0001). Ten percent said 1 or more visual ability was worse after their cataract surgery. Logistic regression analysis revealed that the visual acuity in the better eye before surgery and age-related maculopathy were the most significant risk factors. Poor visual acuity after surgery in the operated eye was found in 22%, mostly as a result of concurrent age-related maculopathy, diabetes, or glaucoma. Four percent had no improvement in visual acuity in the operated eye.

Dissatisfaction seemed to rely mostly on visual acuity in the operated eye. Low visual acuity in the better eye before surgery and age-related maculopathy were the most significant risk factors for subjectively worse visual ability after surgery. The degree of satisfaction after cataract surgery and changes in visual ability differed in important ways from visual acuity as a measure of visual function.