Operated and unoperated cataract in Australia

Purpose: To quantify the prevalence of cataract, the outcomes of cataract surgery and the factors related to unoperated cataract in Australia. Methods: Participants were recruited from the Visual Impairment Project: a cluster, stratified sample of more than 5000 Victorians aged 40 years and over. At examination sites interviews, clinical examinations and lens photography were performed. Cataract was defined in participants who had: had previous cataract surgery, cortical cataract greater than 4/16, nuclear greater than Wilmer standard 2, or posterior subcapsular greater than 1 mm². Results: The participant group comprised 3271 Melbourne residents, 403 Melbourne nursing home residents and 1473 rural residents. The weighted rate of any cataract in Victoria was 21.5%. The overall weighted rate of prior cataract surgery was 3.79%. Two hundred and forty-nine eyes had had prior cataract surgery. Of these 249 procedures, 49 (20%) were aphakic, 6 (2.4%) had anterior chamber intraocular lenses and 194 (78%) had posterior chamber intraocular lenses. Two hundred and eleven of these operated eyes (85%) had best-corrected visual acuity of 6/12 or better, the legal requirement for a driver's license. Twenty-seven (11%) had visual acuity of less than 6/18 (moderate vision impairment). Complications of cataract surgery caused reduced vision in four of the 27 eyes (15%), or 1.9% of operated eyes. Three of these four eyes had undergone intracapsular cataract extraction and the fourth eye had an opaque posterior capsule. No one had bilateral vision impairment as a result of cataract surgery. Surprisingly, no particular demographic factors (such as age, gender, rural residence, occupation, employment status, health insurance status, ethnicity) were related to the presence of unoperated cataract. Conclusions: Although the overall prevalence of cataract is quite high, no particular subgroup is systematically under-serviced in terms of cataract surgery. Overall, the results of cataract surgery are very good, with the majority of eyes achieving driving vision following cataract extraction.