Visual Acuity Outcomes After Cataract Surgery Similar Between Sexes Despite Differences in Comorbidities and Surgical...

The role of sex hormones in ophthalmic diseases is an emerging area of research; however, the magnitude of the impact of biological sex relative to other factors is unclear in cataract surgery. This study evaluated sex differences in pre-operative risk factors, surgical complexity, and outcomes of cataract surgery across the lifespan and identified other contributing factors.

This retrospective cohort study included patients ≥18 years of age who underwent cataract surgery at The University of Kansas Health System between 2015 and 2019. Chi-square, Fisher's exact, Mann-Whitney U, and t-tests compared demographics, systemic/ocular comorbidities, wait times, appointment adherence, complications, and visual acuity (VA) outcomes between sexes. Linear and logistic regressions identified predictors of post-operative VA and complications.

Of the 1606 patients, 639 (39.8%) were male and 967 (60.2%) were female. Wait times and appointment adherence were similar between sexes. While females had higher rates of ocular comorbidities (48.0% M vs 53.3% F; p = 0.041), and males had higher rates of complex surgery (44.1% M vs 34.1% F; p < 0.001) and intra-operative complications (16.7% M vs 10.8% F; p < 0.001), post-operative uncorrected VA (LogMAR 0.18 [IQR 0.05-0.35] M vs 0.18 [0.05-0.32] F; p = 0.986) and best corrected VA (0.10 [0.00-0.24] M vs 0.10 [0.00-0.24] F; p = 0.257) were similar between sexes, as was the percentage of patients who met their refractive target (77.8% M vs 79.9% F; p = 0.298). Age and sex were not identified as significant predictors of post-operative VA and complications, but ethnicity and specific comorbidities were.

While sex differences were observed, the findings of this study suggest that socio-demographics and comorbidities are stronger drivers of differences in cataract surgery outcomes. Future work can evaluate how these disparities can be addressed to optimize outcomes for all patients.