Visual acuity after cataract surgery in patients with optic neuropathies

Purpose To compare visual acuity outcomes of cataract surgery between patients with and without non-glaucomatous optic neuropathies. Methods Retrospective case-control study of patients with and without optic neuropathies who underwent cataract surgery from 2010 to 2017. For all eyes, the last preoperative best corrected visual acuity (BCVA) and first BCVA greater than 1 month postoperatively (to ensure sustained refractive stabilization) were recorded in logarithm of the minimum angle of resolution (logMAR) units. Results Thirty patients (42 eyes) with optic neuropathies and 30 control patients (42 eyes) underwent uncomplicated cataract surgery. The mean age at surgery was significantly younger in the optic neuropathy group (64 versus 71.2 years, p < 0.01). The mean improvement in visual acuity in the optic neuropathy group was 0.4 +/- 0.6 logMAR units (roughly 4 Snellen lines) from 0.7 +/- 0.8 units preoperatively to 0.3 +/- 0.5 postoperatively. Between the cases and controls, there was no significant difference in preoperative BCVA (p = 0.48), postoperative BCVA (p = 0.42), or the mean improvement in BCVA (p = 0.82). When stratified by optic neuropathy subtype, patients with optic neuropathies secondary to multiple sclerosis (n = 12) or non-arteritic ischaemic optic neuropathy (n = 11) had significant improvement in BCVA postoperatively (p < 0.01 and p = 0.03, respectively). Conclusion Contrary to what may be expected from such a severe ocular comorbidity, our data suggest that the mean BCVA improvement after cataract surgery in patients with non-glaucomatous optic neuropathies was comparable to that of control patients. Cataract surgery may be performed in patients with both optic neuropathies and advanced cataracts with a reasonable preoperative expectation that visual acuity improvement can be significant.