Chronological age was not an independent predictor of visual recovery following cataract surgery in adults aged ≥ 75 years: a retrospective tertiary referral centre audit.

Abstract

Purpose: To evaluate whether chronological age independently influences surgical success, intraoperative challenges, complications and visual outcomes following cataract surgery in patients aged ≥ 75 years.

Methods: This retrospective clinical audit included 189 eyes from 183 consecutive patients aged ≥ 75 years who underwent cataract surgery at a tertiary referral centre. Demographic data, ocular and systemic comorbidities, intraoperative challenges, complications and postoperative visual outcomes were analysed. The primary outcome was best-corrected visual acuity (BCVA) ≥ 6/12 at six weeks. Multivariable logistic regression identified independent predictors of visual success.

Results: The mean patient age was 80.98 ± 4.28 years. Systemic multimorbidity was present in 97.8% of patients and ocular comorbidities were identified in 49.2% of eyes. Phacoemulsification was performed in 92.6% of eyes, while 7.4% underwent planned or conversion to extracapsular cataract extraction (ECCE). Intraoperative challenges included small pupils (52.9%), hazy corneas (20.6%), floppy iris syndrome (14.7%) and patient restlessness (11.8%). Intraoperative complications occurred in 18.5% of eyes. At six weeks, 76.7% achieved BCVA ≥ 6/12 and 89.9% showed visual improvement. Independent predictors of failure to achieve BCVA ≥ 6/12 were severe preoperative visual impairment ( adjusted odds ratio [aOR] 0.13, p < 0.001), ocular comorbidities (aOR = 0.35, p = 0.015) and intraoperative complications (aOR = 0.31, p = 0.012). Chronological age was not independently associated with visual outcome.

Conclusion: Patients aged ≥ 75 years can achieve favourable visual outcomes after cataract surgery despite having multiple comorbidities and increased surgical complexity. Postoperative visual recovery is primarily determined by ocular status and intraoperative complications rather than age factor alone. Advanced age should not be a deterrent for cataract surgery if required.