The Royal College of Ophthalmologists’ National Ophthalmology Database: Report 15, Severe Vision Loss following Cataract Surgery

Background/ Objectives To investigate rates of severe vision loss post-cataract surgery. Subjects / Methods Post-cataract severe vision loss (SVL) was defined as a loss of ≥0.60 LogMAR between preoperative presenting visual acuity and postoperative visual acuity. The term ‘legally blind’ was used for eyes with a corrected visual acuity of worse than 1.30 LogMAR. Between 2010 and 2024, there were 1 750 553 eligible operations performed on 1 217 267 patients by 3 766 surgeons from 132 centres supplying data to the Royal College of Ophthalmologists National Ophthalmology Database Cataract Audit. Results Severe vision loss was recorded in 3 723 (0.21%) eyes, including 3 eyes (2 patients) from 2 718 immediate sequential bilateral cataract surgery (ISBCS) eyes. The highest observed SVL rate was 10.68% for eyes recorded as left aphakic after surgery, and the second highest observed SVL rate (3.32%) was when posterior capsular rupture occurred. The SVL rate was higher than the overall rate for eyes with previous intravitreal injections (0.76%), eyes with optic nerve or central nervous system problems (0.74%), age-related macular degeneration (0.52%), previous vitrectomy surgery (0.49%), diabetic retinopathy (0.45%), glaucoma (0.42%), or corneal pathology (0.33%). Of 1 642 386 (93.8%) eyes who were not preoperatively legally blind, 2 731 (0.2%) were postoperatively legally blind. Of these, 2 294 (84.0%) eyes experienced severe vision loss. Conclusions: Severe vision loss from any cause following cataract surgery occurs infrequently. However, it has a higher prevalence in eyes left aphakic, when PCR occurs and for certain ocular comorbidities.