Should our decision to practice cataract surgery be only based on visual acuity?

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An obvious minimum criterion for cataract surgery is the likelihood that the surgery will be beneficial to visual function of the patient. Visual function is in practice often simplified to visual acuity VA. Although, most surgeons agree that VA is the most important parameter, it is also agreed there are other visual function factors to consider, corresponding to complaints such as glare, hazy vision, face recognition problems. This may suggest a complicated multidimensional array of visual functions to be important. To address this question in a comprehensive way, the functional point-spread-function is useful. The effect of cataract can be summarized by its small angle effect, dominating VA (and contrast sensitivity), and its large angle effect, corresponding to straylight SL. The question then is how important this large angle domain of visual function is for the cataract patient. Results of 2 studies will be presented, a questionnaire study in cataract patients, and a study of referral practice for CE. Subjective complaints were documented before and after surgery by the 39-item National Eye Institute Visual Function Questionnaire (NEI VFQ-39). Both studies show dominance of VA, but with an important second place for SL.

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