Delayed sequential bilateral cataract surgery yields better refractive outcomes: JAMA

USA: Compared to delayed sequential bilateral cataract surgery (DSBCS-14) or DSBCS-90, immediate sequential bilateral cataract surgery (ISBCS) is associated with worse visual outcomes, a recent study has found. This may or may not be clinically significant depending on patients' additional risk factors.

The findings of this study were published in the journal JAMA Ophthalmology on 1st July 2021.

In the United States, around 2 million cataract surgeries are performed each year, and patterns of cataract surgery delivery are shifting to meet the rising demand. As a result, a comparison of visual acuity results following ISBCS vs delayed sequential bilateral cataract surgery (DSBCS) is critical for guiding future best practices. The purpose of this study was to examine the refractive results of patients who had ISBCS, short-interval (1-14 days between operations) DSBCS (DSBCS-14), and long-interval (15-90 days) DSBCS (DSBCS-90).

The American Academy of Ophthalmology Intelligent Research in Sight (IRIS) Registry was used for this retrospective cohort research. A total of 1 824 196 IRIS Registry patients who had bilateral visual acuity assessments and had bilateral cataract surgery were evaluated. Based on the time of the second eye operation, participants were separated into three groups (DSBCS-90, DSBCS-14, and ISBCS). The refractive results of the first and second surgery eyes were analyzed using univariable and multivariable linear regression models. Mean postoperative uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA) following cataract surgery were the primary outcomes to be evaluated.

The key findings of this study are:

1. This research looked at data from 1824 196 people who had bilateral cataract surgery.

2. After age, self-reported race, insurance status, history of age-related macular degeneration, diabetic retinopathy, and glaucoma were controlled for, the UCVA of the first surgical eye was higher by 0.41 letters and the BCVA was higher by 0.89 letters in the DSBCS-14 group, whereas the UCVA was lower by 2.79 letters and the BCVA was lower by 1.64 letters in the ISBCS group.

3. Similarly, as compared to the DSBCS-90 group, the UCVA in the DSBCS-14 group was 0.79 letters higher and the BCVA was 0.48 letters lower, but in the ISBCS group, the UCVA was 1.67 letters lower and the BCVA was 1.88 letters higher.

In conclusion, ISBCS was shown to be related to poorer outcomes than DSBCS, despite the fact that the minor but statistically significant differences may not be clinically meaningful. The slight but statistically significant differences seen might be attributed to nonrandom surgical group assignment, confounding variables, and large sample size. More research is needed to evaluate if these criteria may be deemed clinically important when advising patients prior to cataract surgery.

Reference:

Owen JP, Blazes M, Lacy M, et al. Refractive Outcomes After Immediate Sequential vs Delayed Sequential Bilateral Cataract Surgery. JAMA Ophthalmol. 2021;139(8):876–885. doi:10.1001/jamaophthalmol.2021.2032