Correlation between postoperative visual recovery and subjective visual satisfaction in cataract patients with...

To investigate the correlation between postoperative visual recovery and subjective visual satisfaction in cataract patients with varying degrees of corneal astigmatism, and to identify factors influencing patient-reported outcomes following modern cataract surgery.

This retrospective cohort study analyzed 682 eyes of cataract patients who underwent phacoemulsification with standard monofocal non-toric intraocular lens (IOL) implantation targeting emmetropia between January 2022 and December 2022. Patients were stratified into four groups based on preoperative corneal astigmatism: Group 1 (< 0.75 D, n = 250), Group 2 (0.75-1.50 D, n = 245), Group 3 (1.51-2.50 D, n = 121), and Group 4 (> 2.50 D, n = 66). Primary outcomes included best-corrected visual acuity (BCVA), uncorrected distance visual acuity (UDVA), and patient satisfaction scores measured using the modified NEI VFQ-25 questionnaire. Secondary outcomes encompassed visual symptoms and spectacle independence for distance vision.

Mean postoperative UDVA improved significantly across all groups (p < 0.001), with Group 1 achieving 0.12 ± 0.08 logMAR compared to 0.36 ± 0.14 logMAR in Group 4. Postoperative BCVA was ≥ 20/30 in 97.1% of all eyes, confirming good visual potential across groups. Patient satisfaction composite scores decreased progressively with increasing astigmatism magnitude (Group 1: 88.4 ± 9.2 vs. Group 4: 67.1 ± 15.8; p < 0.001). Spectacle independence for distance vision was achieved in 92.5% of Group 1 patients versus 45.5% in Group 4. Multiple regression analysis revealed that postoperative UDVA (β =  - 0.42, p < 0.001), residual astigmatism (β =  - 0.38, p < 0.001), and severity of glare symptoms (β =  - 0.21, p = 0.003) were significant independent predictors of reduced satisfaction (adjusted R2 = 0.57).

Higher degrees of preoperative corneal astigmatism are associated with reduced postoperative visual satisfaction despite good BCVA outcomes. These findings support a low threshold for astigmatism management and highlight the importance of comprehensive patient counseling regarding expected visual outcomes based on preoperative astigmatism magnitude.