title: Visual Acuity, Quality of Life and Visual Function Outcomes after Cataract Surgery in Bali.
abstract: OBJECTIVE
  To assess post-cataract surgery intermediate-term (>6 months) data of visual acuity (VA), surgical complications, refractive outcomes, quality of life (QOL) and visual function (VF) from a non-governmental organization program in Indonesia.
  
  
  METHODS
  Retrospective cohort study design. Participants were a selection of patients who underwent cataract surgery by the John Fawcett Foundation between 2006 and 2011, with at least 6 months follow-up. Patients underwent comprehensive ophthalmic examinations. QOL and VF questionnaires were administered.
  
  
  RESULTS
  From a total of 1557 invited to attend, 547 patients participated; 99.8% of eyes had presenting VA <6/60. At day 1 postoperatively, 52.1% of patients had a good outcome by World Health Organization criteria (unaided VA ≥ 6/18). Six months or later postoperatively, 85% of eyes had best-corrected VA ≥ 6/18 and 5.6% of eyes had best-corrected VA < 3/60. At final follow-up, mean postoperative spherical equivalent refraction was -2.35 diopters (standard deviation 1.75, n = 542). On a scale of 1-100, median converted values for QOL were 25.0 preoperatively and 74.0 postoperatively, a statistically significant improvement (p < 0.001). Of eyes with VA better than 3/60 on postoperative day 1, 5.7% (95% confidence interval 3.6-7.9%) became blind (VA < 3/60) at the 6-month or later time point.
  
  
  CONCLUSIONS
  Cataract surgery in this population markedly improved QOL, despite a trend towards myopic refractive outcomes. These findings raise questions about biometric methodology, intraocular lens power calculations and refractive targets. Postoperative day 1 VA data may be a reasonable proxy of the intermediate-term rate of non-blind eyes.
authors.affiliation: South Australian Institute of Ophthalmology, University of Adelaide , South Australia .
authors.forename: Lachlan
authors.initials: L
authors.lastname: Farmer
authors.forename: Cecilia
authors.initials: C
authors.lastname: Innes-Wong
authors.forename: Caroline
authors.initials: C
authors.lastname: Bergman-Hart
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Casson
authors.forename: John
authors.initials: J
authors.lastname: Crompton
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002386:Cataract / Q000503:physiopathology / Q000523:psychology*; D002387:Cataract Extraction; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007214:Indonesia / Q000453:epidemiology; D007431:Intraoperative Complications; D019654:Lens Implantation, Intraocular; D008297:Male; D008875:Middle Aged; D019591:Pseudophakia / Q000503:physiopathology / Q000523:psychology*; D011788:Quality of Life / Q000523:psychology*; D012029:Refraction, Ocular / Q000502:physiology*; D012189:Retrospective Studies; D018434:Sickness Impact Profile; D011795:Surveys and Questionnaires; D014792:Visual Acuity / Q000502:physiology*
keywords: Cataract; Indonesia; quality of life; visual function and epidemiology