Vision Change and Quality of Life in the Elderly: Response to Cataract Surgery and Treatment of Other Chronic Ocular Conditions

Abstract

OBJECTIVE: Evaluation of health care in older populations has increasingly focused on quality of life as a critical outcome of treatment. Vision is assumed to be central to functioning. Data suggest that aging, in itself, is associated with a decline in visual functioning, which, in turn, is related to a decline in physical and mental functioning. Other studies indicate that cataract surgery is followed by significant improvement in vision and visual function. Our objective was to test these assumptions. DESIGN: Prospective study of 1021 patients, consecutively drawn from 76 randomly selected ophthalmologists' offices in three cities. Structured interviews were completed at baseline, 2 months, and 1 year after entry. PATIENTS: Six hundred thirteen patients with cataracts and 408 other ophthalmic patients drawn from the same offices but treated for other chronic ocular disorders. All received refractive services as needed. SETTING: Patients from three cities (Baltimore, Md, St Louis, Mo, and San Diego, Calif) were interviewed once in their homes and twice by telephone. INTERVENTIONS: The study involved the measurement of the effects of usual treatment for cataracts and other degenerative eye diseases. MAJOR OUTCOME MEASURES: Visual, social, and psychological functioning. RESULTS: Within 1 year of treatment, change in visual function was accompanied by significant changes, in the same direction, in quality of life functions: night-time driving, daytime driving, community activities, home activities, mental health, and life satisfaction. In addition, the patients with cataracts showed significantly greater improvement in measures of vision than did the noncataract group. CONCLUSIONS: Regardless of treatment, improvement across quality of life functions occurred when visual function improved. Thus, many types of functional degeneration observed in older populations, attributed to a decline in vision, can be slowed, or even reversed, when visual function is improved. Cataract surgery was effective in improving vision and quality of life functions.