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Carol M. Mangione, MD, MSPH; Russell S. Phillips, MD; Mary G. Lawrence, MD; Johanna M. Seddon, MD; E. John Orav, PhD; Lee Goldman, MD, MPH

Arch Ophthalmol. 1994;112(11):1419-1425.

Abstract
Objective
To measure the effect of cataract extraction and lens implantation on elderly persons' health-related quality of life and on their ability to perform visual activities.

Design
Evaluations of health status were conducted preoperatively and at 3 and 12 months after surgery on patients scheduled for cataract extraction.

Setting
Patients were enrolled from the General Eye Service of the Massachusetts Eye and Ear Infirmary and 33 Boston practices.

Patients
The cohort consisted of 464 patients aged 65 years or older who were identified from the surgical schedule of the Massachusetts Eye and Ear Infirmary. At 3 to 12 months after surgery, 458 (99%) of the participants were successfully contacted. Health-related quality of life data were available for 419 (90%) to assess changes after surgery.

Main Outcome Measures
Ophthalmologic examinations were performed preoperatively and during the follow-up period. The Activities of Daily Vision Scale (ADVS) and the Medical Outcomes Study 36-item short form (SF-36) were administered before surgery and at 3 and 12 months postoperatively to assess changes in health status.

Results
At 12 months after surgery, 95% of patients had improved Snellen visual acuity, 80% had improved ADVS scores, but only 36% had improved SF-36 physical functioning. Average scores on seven of eight SF-36 sub-scales worsened at 12 months. Patients with improved ADVS scores had significantly smaller declines across all SF-36 dimensions except for role limitations due to emotional problems.

Conclusion
Improved visual function after cataract surgery was associated with better health-related quality of life, suggesting that age-related declines in health may be attenuated by improvements in visual function.

Author Affiliations
From the Divisions of Clinical Epidemiology (Drs Mangione, Orav, and Goldman) and General Medicine, Department of Medicine, Brigham and Women's Hospital; the Division of Clinical Epidemiology, Beth Israel Hospital (Drs Phillips and Goldman); and the Epidemiology Unit (Dr Seddon) and Cataract Consultation Service (Dr Lawrence) and General Eye Service (Dr Lawrence), Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School; and the Department of Biostatistics, Harvard School of Public Health (Dr Orav), Boston, Mass. Dr Mangione is now with UCLA Medical School, Los Angeles, Calif.

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