Demographic differences in the impact of cataract surgery on quality of life: Results from the AGPA cataract outcomes measurement project

Purpose. In 1993, the American Group Practice Association (AGPA) embarked on a large-scale prospective cataract outcomes measurement project designed to measure changes in: 1) objective measures of visual acuity; 2) complication rates; 3) visual functioning; and 4) overall health status in patients undergoing cataract extraction. This study examines whether demographic differences exist in the effect of cataract surgery on quality of life in patients undergoing first eye surgery. Methods. Patients undergoing cataract extraction alone by one of 26 surgeons at each of 6 large group practices were enrolled in this project. Clinical and surgical information was obtained preoperatively, immediately postoperatively and 3-9 months following surgery. Measures of overall health status were also obtained pre and postoperatively using the SF-36 Health Status questionnaire. The 17-item Cataract TyPE-Spec questionnaire, previously validated by us, was administered at the same times. Multivariate analyses were performed to adjust for differences in age, race, gender, education, medical and ocular comorbidity, baseline SF-36 and visual functioning. Results. To date, 3507 patients have been enrolled in the study and undergone first eye surgery. 62.6% were female and 3.9% were African-Americans. The average age was 71.9 yrs. 91.4% of these patients experienced an improvement in visual acuity and 86.4% of patients an improvement in visual functioning (a mean of 20 points). For the entire cohort, there were small statistically significant declines in nearly all SF-36 dimensions with the exception of health perception which showed a small statistically significant increase. In multivariate analysis, improvement in visual function was significantly associated with improved QOL for all dimensions except pain and limitation due to emotional disability. Compared with female gender, male gender was associated significantly less pain and better physical functioning both preoperatively and postoperatively. Cataract surgery was associated with significantly more positive/less negative change in physical functioning scores for males than females. Compared with Caucasians, African-Americans were associated with significantly lower physical functioning preoperatively, but greater social functioning. Postoperatively, they were associated lower vitality, but less limitation due to physical disability. Cataract surgery was associated with significantly more positive/less negative change in limitation due to physical disability scores compared with Caucasians. Conclusions. These results from the AGPA Cataract Outcomes Project are comparable to previously published reports showing that improvements in visual functioning can attenuate the decline in quality of life seen in this population. To our knowledge, these gender and racial differences in QOL associated with cataract surgery have not been previously reported.