Intermediate- and longer-term visual outcomes after cataract surgery: the Blue Mountains Eye Study

Background: Limited data are available on long‐term cataract surgical outcomes. We aimed to compare intermediate‐term (up to 5 years) and longer‐term (5–10 years) post‐surgery visual outcomes in an older Australian population. Design: Population‐based cohort. Participants: Persons aged 49+ years, living in the Blue Mountains area, west of Sydney. Methods: Of 3654 baseline participants of Blue Mountains Eye Study, 75% of survivors were seen at each of the 5‐ and 10‐year follow‐up visits; 90 participants (130 eyes) underwent incident cataract surgery during the first 5 years and returned to both follow‐up visits. Main Outcome Measures: Changes in visual acuity over time, and ocular conditions affecting visual acuity. Results: After the first (intermediate‐term) follow‐up period, 33/128 eyes (26%) had presenting visual acuity <6/12. Similarly, after the second (longer‐term) period, 27/119 eyes (23%) had presenting visual acuity <6/12. Uncorrected refractive error accounted for 22/33 eyes (66%) with reduced presenting visual acuity at the intermediate term and for 16/27 eyes (59%) at the longer‐term follow‐up visits. Of 10 eyes with reduced best‐corrected visual acuity after longer term, five (50%) were attributed to posterior capsular opacification. Of 115 eyes with refractive error data, 82 (71%) and 70 (61%) were emmetropic, at the intermediate‐term and longer‐term visits, respectively. Conclusion: Over a longer term post cataract surgery, three quarters of eyes achieved presenting visual acuity ≥6/12 and nearly two‐thirds achieved emmetropia. Uncorrected refractive error and posterior capsular opacification were the main causes of poor vision in operated eyes, a finding emphasizing the need for ongoing eye care services post cataract surgery.