Assessment of the impact of cataract surgery on subjective quality of vision across different intraocular lens type using the portuguese-validated QoV questionnaire.

BACKGROUND

Investigating cataract surgery outcomes is essential to capture patients' subjective perception of visual quality. This study evaluated quality of vision (QoV) before and after cataract surgery by comparing different intraocular lens (IOL) models using a Rasch-validated Brazilian Portuguese version of the QoV questionnaire.

METHODS

This prospective study recruited patients from the Cataract Department of the Hospital Oftalmológico de Brasília. Participants were ≥ 50 years old, underwent bilateral phacoemulsification with implantation of the same IOL model, and had preoperative best-corrected visual acuity of 20/50 or better. Included IOLs were monofocal, premium monofocal, extended depth of focus (EDOF), and multifocal lenses. The Rasch-validated QoV questionnaire was administered pre- and postoperatively.

RESULTS

Fifty-eight patients were analyzed: 10% received EDOF, 18% monofocal, and 70% trifocal IOLs (p < 0.001). Mean age was 64.53 years. For the whole cohort, median satisfaction with uncorrected distance vision increased from 7.50 preoperatively to 8.00 postoperatively (p = 0.002). Median near-vision satisfaction improved from 3.50 to 8.00 (p < 0.001). Median uncorrected visual acuity improved from 0.40 to 0.00 logMAR in both eyes (p < 0.001). In the monofocal group, QoV frequency scores decreased from 35.48 to 21.36 (p = 0.047) and severity scores from 33.87 to 16.99 (p = 0.019), indicating fewer symptoms. Although visual acuity and patient satisfaction significantly improved after surgery, no significant differences in QoV outcomes were identified between IOL groups in the linear mixed-effects models, which constituted the primary inferential analysis.

CONCLUSIONS

Cataract surgery significantly improved visual acuity and patient-reported satisfaction. However, no statistically significant differences in QoV outcomes were detected between IOL categories during the early postoperative period. Given the small and highly unbalanced sample, these findings should not be interpreted as evidence of equivalence among IOL types, and the study may have been underpowered to detect subtle but clinically meaningful differences.