Impact of Cataract Surgery on Vision-related Quality of Life in Patients with Strabismus: A Quasi-experimental Study

Abstract

Introduction: Reduction in visual acuity and glare are common indications for cataract surgery in patients with strabismus. The amblyopic eye is particularly sensitive to blur, despite reduced visual acuity and contrast sensitivity. However, the impact of cataracts on visual functions in strabismus patients is not well documented. Aim: To evaluate the Vision-related Quality of Life (VRQoL) after cataract surgery in strabismus patients. Materials and Methods: The present quasi-experimental study was conducted in the Department of Ophthalmology, RL Jalappa Hospital and Research Centre, Kolar, Karnataka, India, from August 2023 to September 2023. Study included 44 strabismus patients, which was assessed by Hirschberg and alternate cover tests. All patients underwent unilateral manual small incision cataract surgery on the worse eye. VRQoL was assessed using the Indian Vision-related Quality of Life Functioning Questionnaire-33 (IND-VFQ-33) questionnaire preoperatively and postoperatively. Statistical significance was determined using paired t-tests (p-value<0.05). Results: In the present study, the mean±Standard Deviation (SD) age of patients was 64.34±8.09 years (range: 42-79 years), with a predominance of females, 29 (66%). All patients underwent unilateral manual small incision cataract surgery on their worse eye. The degree of strabismus among the patients varied: 27 (61.36%) exhibited a 15° deviation, 12 (27.27%) had a 30° deviation and 5 (11.36%) exhibited a 45° deviation. A total of 41 (93.1%) patients presented with exotropia, while 3 (6.9%) exhibited esotropia. The results demonstrated significant improvements in Corrected Distance Visual Acuity (CDVA) from the preoperative to postoperative period. The IND-VFQ-33 questionnaire revealed substantial reductions in scores for general functioning, mobility, activity limitation, psychosocial impact and visual symptoms across the entire study population and in all strabismus groups (15°, 30° and 45° deviations), with a p-value of <0.05. Overall, 84.09% of patients had no to mild visual impairment postoperatively, with 27 (100%) patients with 15° strabismus, 7 (58.3%) patients with 30° strabismus, and 3 (60%) patients with 45° strabismus reporting no to mild visual impairment. 3 (25%) patients with 30° strabismus and 1 (20%) patient with 45° strabismus had moderate vision impairment postoperatively. Two (16.66%) patients with 30° strabismus and one patient with 45° strabismus had severe vision impairment postoperatively. Conclusion: A significant proportion of strabismus patients with cataracts were elderly, predominantly females. Exotropia and 15° strabismus were the most common findings. Cataract surgery significantly improved VRQoL, with the most substantial benefits observed in patients with a 15° deviation and the least in those with a 45° deviation.

Keywords

• amblyopia
• blindness
• corrected distance visual acuity
• diplopia
• small incision cataract surgery