title: Impact of cataract surgery on the visual ability of the very old.
abstract: OBJECTIVE
  To compare the functional outcome of cataract surgery in terms of visual ability between patients ages younger than 84 years, 85 to 89 years, and 90+ years. Survival time will be estimated at 4 years.
  
  
  METHODS
  Population-based, observational case series.
  
  
  METHODS
  We prospectively evaluated elderly cataract patients' self-assessed visual ability regarding reading, TV viewing, orientation ability, activities of daily life, satisfaction, and visual acuity (VA) before and approximately 3 months after cataract surgery. All patients operated on during a 1-year period from our geographically defined admitting area that participated with a questionnaire were included (n = 837). Survival was checked after 4 years.
  
  
  RESULTS
  Before surgery, the most elderly were significantly more dissatisfied with their visual function (P =.007). Seventy-six percent of 85+ improved their subjective ability to read, and two-thirds of those unable to read newspaper print were able to read after surgery. A total of 79% of 90+ experienced improved postoperative ability to manage their daily lives. Best-corrected VA (BCVA) improved in 94% (90+ years of age), 90% (85 to 89 years of age), and 97% (younger than 84 years of age), respectively. After surgery, VA was significantly worse with increasing age, also after adjustment for ocular comorbidity (P <.0001). Patients with a BCVA improvement of less than 0.3 logarithm of the minimal angle of resolution units, patients with comorbidity, and patients aged 90+ had approximately 3 times the odds of being dissatisfied with vision after surgery. A total of 43% of 90+ years and 62% of 85 to 89 years were alive 4 years after surgery.
  
  
  CONCLUSIONS
  Most patients aged 85 and older had improved visual ability, acuity, and satisfaction after cataract surgery. In terms of visual function, surgery of significant cataracts in the very old is beneficial also when life expectancy is taken in account.
authors.affiliation: Department of Clinical Sciences/Ophthalmology, Umeå University, Umeå, Sweden. eva.monestam@vll.se
authors.forename: Eva
authors.initials: E
authors.lastname: Mönestam
authors.forename: Lillemor
authors.initials: L
authors.lastname: Wachmeister
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D002387:Cataract Extraction; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction; D011446:Prospective Studies; D011788:Quality of Life; D011932:Reading; D011795:Surveys and Questionnaires; D015996:Survival Rate; D014787:Vision Tests; D014792:Visual Acuity / Q000502:physiology*