Investigating the impact of age and sex on cataract surgery complications and outcomes

Abstract

Cataract surgery, a common procedure for vision restoration, exhibits variable outcomes based on patient demographics. This study aimed to elucidate the effects of age and sex on risk factors, intraoperative complications, and postoperative outcomes of cataract surgery. A single-center retrospective cohort study analyzed 691 eyes from 589 individuals who underwent surgery at a tertiary referral center, using electronic medical records to assess preoperative risk factors, intraoperative complications, and best corrected visual acuity (BCVA) pre- and post-operatively, alongside demographic data. The study found that males aged 65-75 years had significantly higher rates of functional postoperative BCVA (91% for males vs. 79% for females, p = 0.007), a disparity not attributable to differences in surgical complications or risk factor prevalence. Age-specific thresholds were identified where BCVA improvements significantly declined beyond 65 years for females and 75 years for males. The likelihood of worsened BCVA post-surgery increased with age for both sexes, with a notable decline in BCVA improvement between the 55-65 years and 65-75 years age groups. These findings underscore the critical influence of sex and age on cataract surgery outcomes, advocating for the integration of these factors into preoperative evaluations to better tailor the timing and planning of cataract surgery and optimize clinical outcomes.

Keywords: Age; Cataract surgery; Complications; Residents; Risk factors; Sex.

Fig. 1

Comparative Analysis of Pre- and post-operative Best Corrected Visual Acuity (BCVA) and Percentage of Improvement Across Age Groups. The dual-axis graph presents Best Corrected Visual Acuity (BCVA) measured in LogMAR before (blue bars) and after (orange bars) cataract surgery, alongside the percentage of visual acuity improvement (red line), across five distinct age groups. The left vertical axis corresponds to the BCVA values, with lower scores indicating better visual acuity. The right vertical axis denotes the percentage of BCVA improvement, with higher values representing greater visual recovery. Error bars indicate the standard deviation (SD) within each age group, providing a measure of variability around the mean BCVA scores. Statistical significance between consecutive age groups, following Bonferroni correction for multiple comparison, is marked by the respective p-value, illustrating the differential impact of surgery on visual outcomes by age.

Fig. 2

Stratified Visual Acuity Outcomes by Age Group and Sex Before and After Surgery. Best Corrected Visual Acuity (BCVA) measured in LogMAR for males (blue and dark green bars for pre-operative and post-operative, respectively) and females (red and light green bars for pre-operative and post-operative, respectively) across different age groups. Additionally, the lines indicate the percentage of visual acuity improvement post-surgery for each sex (male in blue, female in red). The left vertical axis corresponds to BCVA values, with lower scores indicating better visual acuity, while the right vertical axis represents the improvement percentage. Error bars indicate the standard deviation (SD) within each age group, providing a measure of variability around the mean BCVA scores. Statistically significant differences, post Bonferroni correction for multiple comparisons, between consecutive age groups are noted with p-values, showing how surgical outcomes and recovery rates vary with age and between sexes. 'M' denotes males, 'F' denotes females, and ‘VA’ stands for Visual Acuity.

Fig. 3

Sex-Based Comparison of Functional Pre- and Post-Operative BCVA Across Age Groups. The left graph compares the percentages of functional pre-operative Best Corrected Visual Acuity (BCVA) (< 0.3 LogMAR) between females and males across various age groups. The right graph mirrors this comparison for post-operative BCVA, highlighting the significant sex differences in visual acuity outcomes. Point of statistical significance marked with the respective p-value.