Impact of Cataract Surgery on Low Luminance Visual Acuity Deficit Measurements

Mengxi Shen; Yingying Shi; Liang Wang; Jonathan F Russell; Xiaoshuang Jiang; Rita Laiginhas; Prashanth Iyer; Omer Trivizki; Marie Thulliez; Sonia H Yoo; Terri P Rose; Ranya G Habash; Guillermo Amescua; William J Feuer; Giovanni Gregori; Philip J Rosenfeld

doi:10.1016/j.xops.2022.100170

Impact of Cataract Surgery on Low Luminance Visual Acuity Deficit Measurements

Ophthalmol Sci. 2022 May 18;2(3):100170. doi: 10.1016/j.xops.2022.100170. eCollection 2022 Sep.

Authors

Affiliations

¹ Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
² Institute for Vision Research and Department of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, Iowa.

Abstract

Purpose: The impact of cataract surgery on low luminance visual acuity deficit (LLVAD) measurements was investigated by measuring the LLVAD before and after cataract surgery.

Design: Prospective, longitudinal study.

Participants: Patients undergoing cataract surgery.

Methods: Photopic luminance (PL)-best-corrected visual acuity (BCVA) and low luminance (LL)-BCVA were obtained using the ETDRS chart. Low luminance visual acuity deficit scores were calculated by subtracting the LL-BCVA letter score from the PL-BCVA letter score. To demonstrate the reproducibility of these visual acuity measurements, we used data from drusen-only eyes previously published in the Complement Inhibition with Eculizumab for the Treatment of Nonexudative Age-Related Macular Degeneration (COMPLETE) study. The PL-BCVA, LL-BCVA, and LLVAD measurements obtained at an interval of 3 months in this cohort were used for comparison. In the current study, the impact of cataract surgery on LLVAD measurements was analyzed by comparing the PL-BCVA, LL-BCVA, and LLVAD measurements before and after cataract surgery.

Main outcome measures: The reproducibility of the visual acuity measurements and the changes in LLVAD measurement after cataract surgery.

Results: In the COMPLETE study, no clinically significant differences were found in the PL-BCVA, LL-BCVA, or LLVAD measurements between baseline and the 3-month follow-up visits with a change of -1.1 letters, -1.3 letters, and 0.1 letters, respectively (P = 0.02, P = 0.11, and P = 0.88, respectively). In the current study, significant increases were found in the PL-BCVA and LL-BCVA measurements, with a change of 7.3 letters and 10.2 letters after cataract surgery (P < 0.001 for both), and a statistically significant decrease in LLVAD measurements was found, with a change of -3.0 letters after cataract surgery (P = 0.002).

Conclusions: Because of the variable effect of cataracts on LL-BCVA measurements and the significant change in LLVAD measurements after cataract surgery, investigators should be aware that cataract surgery during a trial will have an unpredictable impact on LLVAD measurements, and pseudophakic and phakic patients should be analyzed separately.

Keywords: AMD, age-related macular degeneration; BCVA, best-corrected visual acuity; COMPARE, Comparison of Low-Luminance Visual Acuity Testing before and after Cataract Surgery; COMPLETE, Complement Inhibition with Eculizumab for the Treatment of Nonexudative Age-Related Macular Degeneration; Cataract surgery; GA, geographic atrophy; GEE, generalized estimating equation; LL, low luminance; LLVAD, low luminance visual acuity deficit; Low luminance visual acuity deficit; PL, photopic luminance.