Approximately two-thirds of individuals with type 2 diabetes achieve good visual outcomes after cataract surgery, according to research published in the British Journal of Ophthalmology.
Researchers conducted a retrospective case-control study of patients enrolled in the Action to Control Cardiovascular Risk in Diabetes (ACCORD, ClinicalTrials.gov Identifier: NCT00000620) and ACCORD-eye substudy (ClinicalTrials.gov Identifier: NCT00542178) to evaluate visual acuity (VA) outcomes of cataract surgery among individuals with type 2 diabetes and to identify clinical and sociodemographic factors associated with good visual outcomes in this population. The primary outcome measure was achievement of postoperative VA of 20/40 or better.
A total of 1136 eyes of 784 ACCORD participants (mean age, 65.6±6.3 years; 58.4% men; 68.5% White) were included in the study. Participants all had type 2 diabetes and were followed for a median of 5.0 years (interquartile range, 4.1–5.7 years).
The researchers report that 67.1% of eyes achieved visual outcomes of 20/40 or better. The study shows higher levels of education (college vs some high school; odds ratio [OR], 2.35; 95% confidence interval [CI], 1.44-3.82; P <.001), bilateral cataract surgery (OR, 1.55; 95% CI, 1.14-2.10; P=.005), and preoperative VA (20/20 or better vs worse than 20/200; OR, 10.59; 95% CI, 4.07-27.54; P <.001) were predictive factors for good visual outcome.
Age, sex, race, smoking, diabetes duration, blood pressure, and lipid and hemoglobin A1C levels were not significantly associated (P >.05) with better visual outcomes, according to the study. In the subsample of 362 eyes, the researchers found the absence of diabetic retinopathy was associated with good visual outcome (OR, 1.73; 95% CI, 1.02-2.94; P =.04).
“Despite new clinical guidelines and medical developments, [the rate of good visual outcome in individuals with type 2 diabetes] remained comparable to prior reports and lower than the general population,” the researchers report. “Notable factors associated with visual outcomes included preoperative VA and diabetic retinopathy, but not HbA1C, underscoring that while certain ocular measures may help to evaluate visual potential, systemic parameters may not be as valuable. Socioeconomic status and related issues may also be important considerations.”
Limitations of the study included the retrospective design, potential non-generalizability of clinical trial data to the general population, infrequent measurement of visual acuity, variation in the time intervals between the report of surgery and visual acuity measurements, and variation in the time intervals between the reporting of and actual date of surgery.
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. 2022;106(11):1496-1502. doi:10.1136/bjophthalmol-2020-317793