The impact of cataract surgery on visual acuity, visual field, and quality of life for patients in the CIGTS.

E.J. Rockwood1, G.L. Spaeth², J.R. Piltz-Seymour³, S.J. Berke⁴, P.P. Chen⁵, P.R. Lichter⁶, D.C. Musch⁶, N.J. Janz⁶, P.A. Wren⁶, K.E. Guire⁶, and the CIGTS Study Group.

¹Cole Eye Institute, Cleveland, OH;
²Wills Eye Hospital, Philadelphia, PA;
³Scheie Eye Institute, Philadelphia, PA;
⁴Ophthalmic Consultants of Long Island, Lynbrook, NY;
⁵University of Washington, Seattle, WA;
⁶University of Michigan, Ann Arbor, MI

Purpose: To describe the effect of cataract surgery on visual acuity, visual field, and health-related quality of life (QOL) for patients in the CIGTS.

Methods: Within the context of a multicenter, randomized controlled clinical trial in which 607 patients with newly diagnosed open-angle glaucoma were treated either with topical medication or trabeculectomy, 79 patients have undergone cataract extraction with intraocular lens implantation. Clinical examination and QOL interview data were collected before and after surgery, and changes were evaluated.

Results: Those treated initially with trabeculectomy had a significantly higher probability of cataract surgery (p=0.0001, log-rank test). As expected, visual acuity (VA) improved significantly after cataract surgery, resulting in a mean improvement of over 4 lines of vision (21.6 letters on the ETDRS VA chart; p<0.0001, paired t-test). The CIGTS visual field score also showed a significant improvement of 4.1 units (p<0.0001, paired t-test). The overall score and many of the QOL dimensions from the Visual Acuity Questionnaire (VAQ) also improved significantly, with the most improvement seen in the acuity (p<0.0001), glare (p=0.0005), depth perception (p=0.0002), and peripheral vision categories (p=0.008). No significant change was seen in color discrimination and visual search dimensions of the VAQ, or the CESD measure of depression.

Conclusion: Cataract surgery resulted in expected improvements in both clinically measured and patient-reported measures of visual function. The CIGTS visual field score improved significantly, indicating its sensitivity to cataractous change. Aspects of the patient's reported visual function varied in the extent of response to cataract surgery, but all demonstrated some degree of improvement. These data reveal the wider scope of improvement in visual function upon removing a patient's cataract.

Supported by NIH Grant U10 EY09149

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