Change in Quality of Life after Cataract Surgery: Results of a Prospective Follow up Trial Between 04/2001 and 03/2002

¹Lohmeier A., ²Dick H. B., ³Krummenauer F.,
¹Johannes-Gutenberg-Universität Mainz, Koordinierungszentrum für Klinische Studien (Mainz)
²Johannes-Gutenberg-Universität Mainz, Universitäts-Augenklinik (Mainz)
³Johannes-Gutenberg-Universität Mainz, Koordinierungszentrum für Klinische Studien (KKS) (Mainz)

Purpose: Many publications on cataract surgery refer to the intraindividual change in visual acuity as a surrogate endpoint for quality of life. This trial was performed to psychometrically evaluate the subjective self-reported determinants for quality of life in cataract patients and their correlation with the change in visual acuity as an objective clinical endpoint. In addition, the feasibility of the underlying questionnaire should be evaluated concerning the explicit indication under consideration.
Method: 1 day before and 4-6 weeks after cataract surgery written psychometrical information was obtained from all patients, who underwent cataract surgery between 04/2001 and 03/2002 at the University Eye Hospital of Mainz. 85 items on all-days mobility, physical and psychological disorder, clinical care before and after surgery, social activity, surgery-associated complications and overall satisfaction with the intervention were assessed using a four-valued Liekert scale. These items were aggregated to global scores ranging from 1.0 (optimum satisfaction) to 4.0 (maximum dissatisfaction). The latter were correlated with the postoperative change in visual acuity using Spearman’s rank correlation coefficient. Group comparisons for these scores were performed using medians and quartiles for data description and two sample Wilcoxon tests to assess statistical significance. Intraindividual changes were analysed using sign tests; p values < 0.01 were regarded as an indication for local statistical significance.
Results: For 136 patients (response rate 86%, 76 female and 58 male, median age 73 years) data on the above aspects could be obtained. A median increase of two stages in visual acuity (interquartile range 0-4 stages, p < 0.01) was observed. The postoperative score for the patients’ all-days mobility was 1.8 (1.3-2.5), for their satisfaction with clinical care before and after surgery 1.3 (1.2-1.8), for social activity 2.3 (1.6-2.9), for surgery-associated complications 1.0 (1.0-1.4) and for the patients’ overall physical and psychological stability 2.5 (1.9-3.1). None of the “subjective” dimensions showed neither a clinically relevant nor a statistically significant correlation with the “objective” change in visual acuity (all correlations < 20%, p > 0.10, respectively).
Conclusions: Subjective self-reported quality of life and its change after cataract surgery hardly correlate with the change in visual acuity. None of the dimensions considered in the underlying questionnaire dominate the overall patients’ rating of the intervention, i.e. none of the above aspects associated with quality of life should be omitted in the questionnaire. The moderate correlation with the change in visual acuity illustrates the additional information contained in the subjective quality of life data as compared to the objective clinical endpoints. Regarding the encouraging response rate and the acceptance of the questionnaire, a flexible and informative instrument for the health economical evaluation of cataract surgical interventions seems to be at hand.

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