Cataract surgery can be more challenging in high myopes and result in greater incidence of unpredictable refractive errors and perioperative complications, yet these individuals generally have higher expectations for post-op visual function since they tend to develop cataracts at a younger age than those with normal axial lengths (ALs). Despite these previous assumptions, new research found that patients with high myopia achieve greater improvements in both BCVA and quality of life (QOL) following cataract extraction and at a faster rate than those with normal ALs.

The investigative team from China reported high myopes’ BCVA improved from 0.62 logMAR preoperatively to 0.13 after surgery, and their QOL composite score increased from 65.8 preoperatively to 87.5 following the procedure. Additionally, overall surgery outcome satisfaction was very high at 92.5% in high myopes.

The study enrolled 90 patients who were about 63 years old with bilateral high myopia and 90 age-matched patients with normal ALs who underwent phacoemulsification surgery. The investigators measured vision-related QOL based on the results of the 25-item National Eye Institute Visual Function Questionnaire preoperatively and again six months after cataract surgery. During the same period, the authors measured the participants’ BCVA.

Postoperatively, BCVA improved significantly in the high myopia group, with 78 patients (87%) gaining 0.2 or more logMAR units. This number was higher than the one found in the control group (61%).

Although the preoperative vision QOL composite score was lower in high myopia patients compared with the controls (65.8±4.7 vs. 77.3±3.8), the postoperative results were about the same between high myopes and those with normal ALs (87.5±2.6 vs. 90.4±1.6). Additionally, changes in composite scores and those found in seven subscales were greater in the high myopia group vs. the controls.

Also of note, in high myopes (but not in controls), patient age was negatively associated with the change in the composite score. Additionally, pre-op BCVA was positively linked to changes in the composite score for both groups.

These results may provide a valuable reference for surgeons to develop therapeutic scenarios for high myopia patients based on the expectation of the benefit of undergoing cataract surgery and will give those with the condition more confidence to undergo the procedure, the authors suggested.

Tan Y, Liu L, Li J, et al. Effect of cataract surgery on vision-related quality of life among cataract patients with high myopia: a prospective, case-control observational study. Eye. July 21, 2021. [Epub ahead of print].