Journal Article

Article summary for presentation: Clinical Outcomes of Cataract Surgery in very Elderly Adults.

The goal: of the study was to assess the clinical outcomes of cataract surgery in Elderly adults 

This article was a retrospective cohort study of 207 older adult participants aged 90 years and older (majority were women 76.3%). The study explores the clinical outcomes of participants after cataract surgery for age related cataracts (surgery on 109 left eyes and 98 right eyes) between January 2002 and December 2009. Patients who underwent surgery under general anesthesia were excluded. The participants, however, underwent the surgeries in Hong Kong. The study also explores the effects of systemic and ocular comorbidities on the outcome of cataract surgery in elderly adults. Clinical data was retrieved from clinical notes and EHR systems. The data included best-corrected preoperative and post-operative Snellen visual acuity, the type of cataracts, surgical technique, other systemic and ocular comorbidities and intra operative and post-operative complications. Improvement in visual acuity was defined as a drop in logMAR acuity of 0.1. Mean follow up was about 24.2 months. Phacoemulsification accounted for most of the surgeries (77.3%). 

Primary outcome: The percentage of participants w/ improved visual acuity after surgery.

Secondary outcomes: Systemic and ocular co-morbidities, intra and postoperative complications. Surgical techniques.

Results: The results of the study showed that 79.7% (165 cases) of participants had visual improvement within 6 months following surgery. 18.4% had the same visual acuity and 4 cases had worse visual acuity. These patients also had other co-morbidities such as hypertension (most common), DM, and MI, and ocular co-morbidities such as age-related macular degeneration, and glaucoma. 180 cases (87% of the surgery cases were uncomplicated.) systemic co-morbidities were not significantly associated with lower chances of post op visual improvement but ocular co-morbidities slightly were.  The most common complication noted was vitreous fluid loss. There were also capsular and zonular ruptures noted. 

Their study found that patients with AMRD and vitreous fluid loss were less likely to achieve postoperative visual improvement. Overall, they found that good clinical outcomes were still attainable in the elderly population.

Limitations: Some of the limitations of this study I found include the fact that it is an older study and the sample size is quite small. What could have contributed to the strength of this study is to have a larger sample size with a longer duration of follow up. This study also did not explore the functional, psychological, and cognitive effects of surgery on elderly adults.