Most diabetic retinopathy (DR) patients will likely benefit from cataract surgery without severe macular issues, but poorer visual acuity prior to the procedure and a greater severity of the disease can limit visual outcomes, a study in Ophthalmology Retina suggests.      

A research team from Ohio evaluated the changes in best-corrected visual acuity (BCVA) in patients 18 or older who underwent cataract extraction at the Cleveland Clinic from 2013 to 2018. The study did a chart review and used OCT to examine the change in BCVA over the first postoperative year, as well as the association of the central subfield thickness (CST) at baseline with change in BCVA over the same time period. The researchers also considered age, race, gender, laterality, insulin use, HbA1c, creatinine, blood urea nitrogen and estimated glomerular filtration rate.

The study divided the patients into four groups: diabetic eyes without DR (138), eyes with mild/moderate non-proliferative DR (125), severe non-proliferative DR (20) and proliferative DR (72).

A year after surgery, eyes without DR gained about 11 ETDRS letters from 65 before surgery. Eyes with mild/moderate DR gained approximately 10 letters from 65 at baseline. The severe non-proliferative DR group gained roughly 20.5 letters from 55, and eyes with proliferative DR gained 15 letters from 55.

Eyes without DR or mild/moderate non-proliferative DR had marked improvements in VA a year after surgery compared with eyes with severe non-proliferative or proliferative DR, with less expected visual acuity gain in the more severe cases. However, this outcome was not as pronounced in eyes that had a higher baseline VA before surgery.

Also of note: the length of the disease appeared to be related to its severity at baseline.

“Baseline retinopathy is a significant driver of VA change post-surgery and significantly interacts with baseline ETDRS,” the researchers wrote in their paper.

Han MM, Song W, Conti T, et al. Visual acuity outcomes after cataract extraction with intraocular lens implantation in eyes with diabetic retinopathy. Ophthalmology Retina. January 7, 2020. [Epub ahead of print].