Visual Outcomes After Cataract Surgery in Diabetic Eyes

New research from investigators at the Cole Eye Institute is revealing more about the impact of cataract extraction with intraocular lens (IOL) implantation in eyes with and without diabetic retinopathy.

Presented at the American Academy of Ophthalmology (AAO) 2019 Annual Meeting in San Francisco, results of the study revealed eyes with diabetic retinopathy had similar gains to eyes without the condition, but eyes with severe nonproliferative diabetic retinopathy(NPDR) had the most potential for improvement.

In their study of diabetic eyes, all of which underwent cataract extraction at the Cleveland Clinic between 2013 and 2019, improvements in BCVA were noted among all eyes, regardless of disease state(P<0.0001). Of the eyes examined, 138 had no diabetic retinopathy, 102 had mild/moderate NPDR, 24 had severe NPDR, and 73 had proliferative diabetic retinopathy.

Investigators observed mean improvements of 16.4 ± 18.7 letters in eyes without diabetic retinopathy, 16.3 ± 19.1 in eyes with mild/moderate NPDR, 25.3 ± 20.1 in eyes with severe NPDR, and 18.7 ± 21.2 in eyes with proliferative diabetic retinopathy.

For more on the clinical takeaways of the analysis, hear from study co-author Katherine Talcott, MD, of Cole Eye Institute, in the video below.

MD Mag: What were the results of your study examining visual outcomes after cataract extraction in patients with diabetic retinopathy?

Talcott: So, I think it's a little confusing for sort of us as retina specialists to sort of figure out when to refer people for cataract surgery versus not if they have something like diabetic retinopathy because it's hard to sometimes tell if the cataract is affecting their vision or if it's the retina that's affecting their vision.

So, we wanted to sort of better tease out among different severities of diabetic retinopathy sort of how much visual acuity you could potentially get after having cataract surgery. We look sort of retrospectively at those patients to be able to tease that out and we basically found that when you sort of stratify patients by their diabetic retinopathy the patients who had more severe retinopathy had more visual acuity gain than those who had less severe, but if you looked at sort of what final vision they end up with they still end up with not as good final vision as the patients who have less severe retinopathy.

So, I think that means that we're probably referring those patients less to have cataract surgery then you would someone who doesn't have as much retinopathy or those patients are sort of presenting to us later when they have sort of more extensive disease both in terms of retinopathy and in terms of cataract. I think a lot of retina specialist are probably less likely to refer those patients. Those patients still get a lot of benefit from cataract surgery, but we need to sort of temper patient expectations as to what visual acuity they might end up with after cataract surgery.