As technology evolves and newer techniques for cataract surgery are performed, patients with diabetes who undergo cataract surgery are experiencing consistently good visual outcomes. A study called Action to Control Cardiovascular Risk in Diabetes (ACCORD) aimed to identify the predictors of these visual outcomes specifically in people with diabetes.

A total of 1,136 eyes of 784 participants receiving cataract surgery during follow-up were included, with 67% achieving good visual outcome (20/40 or better), compared to prior studies—dating back to more than 15 years—reporting a range of 62% to 89%.

Some factors predictive of good visual outcome were college-educated patients, bilateral cataract surgery and preoperative visual acuity (VA). Factors not significantly associated included age, sex, race, smoking, diabetes duration, blood pressure, lipid levels and hemoglobin A1c. Absence of diabetic retinopathy was associated with good visual outcome in 362 eyes.

The authors noted visual outcomes remained comparable to previous studies, which could be due to many reasons, including the prevalence and severity of diabetic retinopathy and factors related to cataract surgery, including surgical techniques and/or postoperative care, among others.

“While prior studies measured best-corrected VA (BCVA), this study measured PVA to better reflect day-to-day functional vision,” the authors added in their study. “Visual impairment from uncorrected refractive error is a common condition in the U.S., with rates higher in certain populations, including those with diabetes. Despite advances in the refractive components of cataract surgery, differences between postoperative BCVA and PVA may remain if individuals in whom residual refractive error exists are left uncorrected.”

Additionally, the authors noted sociodemographic factors might also be significant considerations. “It may be important to consider the role of such factors for those undergoing cataract surgery,” the authors explain in their study. “In the current study, visual outcomes were notably associated with clinical center network and education level. These factors may serve as a proxy for socioeconomic status and be particularly significant in elucidating areas for improvement. 

“For instance, among persons with diabetes and diabetic retinopathy, lower educational attainment has been linked to reduced access to and utilization of eye care services,” they wrote. “This is especially relevant for those undergoing cataract surgery, as easily correctable issues such as posterior capsular opacification and refractive error remain among the most common complications of cataract surgery.” Such cases may require stronger emphasis on postoperative follow-up, and doctors should be diligent about noting the impact of social factors on visual outcomes, they concluded.

Lee D, Agron E, Keenan T, et al. Visual acuity outcomes after cataract surgery in type 2 diabetes: the action to control cardiovascular risk in diabetes (ACCORD) study. Br J Ophthalmol. Epub ahead of print.