Retinal Age Gap as a Biomarker for Patient Satisfaction and Visual Quality After Cataract Surgery.

PURPOSE: To evaluate whether the difference between artificial intelligence (AI)-estimated retinal biological age and chronological age-the retinal age gap (RAG)-is associated with postoperative visual function after cataract surgery.

DESIGN

Retrospective, consecutive interventional case series.

METHODS

Consecutive cataract surgeries at Machida Municipal Hospital (February 2024-May 2025) targeting postoperative emmetropia were included. Eligible eyes had preoperative corneal astigmatism <1 diopter and no prior ocular surgery or other ocular disease. Overall, 142 eyes (mean age, 77.6 ± 6.2 years) received a monofocal intraocular lens (IOL) or an enhanced monofocal IOL. Retinal age was estimated with the Japan Ocular Imaging Registry (JOIR) AI model, and RAG was computed as retinal age minus chronological age. Quartiles (Q1-Q4) were defined; after age matching between Q1 and Q4, 1-month outcomes-visual acuity, contrast sensitivity (CS), patient satisfaction, spectacle independence, and dysphotopsia-were compared. Multivariable logistic regression assessed factors associated with satisfaction.

RESULTS

The JOIR model's mean absolute error was 6.98 years and root-mean-square error was 8.97 years. RAG correlated negatively with chronological age (Spearman's ρ = -0.671, P < .001). With age matching, most visual acuity and contrast sensitivity measures did not differ; however, Q1 showed higher satisfaction, higher spectacle independence, and more patients reporting no glare and no waxy vision (all P < .01). Larger RAG independently predicted lower satisfaction, irrespective of corrected distance visual acuity (P < .05).

CONCLUSIONS

Smaller RAG was associated with greater postoperative satisfaction. RAG may serve as a practical biomarker to personalize intraocular lens selection.