THE MADURAI INTRAOCULAR-LENS STUDY - III - VISUAL FUNCTIONING AND QUALITY-OF-LIFE OUTCOMES

PURPOSE: To compare the effects of extracapsular cataract extraction w ith posterior chamber intraocular lens (ECCE/PC-IOL) vs intracapsular cataract extraction with aphakic glasses (ICCE-AG) on everyday visual functioning and quality of life. METHODS: In a nonmasked randomized co ntrolled clinical trial, 3,400 bilateral vision-impaired patients, age d 40 to 75 years, with operable cataract were randomly assigned to rec eive one of the two treatment options. One half in each group were ran domly selected for interviewer administration of visual functioning an d quality of life questionnaires before surgery and at 6 and 12 months after surgery. RESULTS: Both ICCE-AG and ECCE/PC-IOL produced dramati c improvements in visual functioning and quality of life scores. Patie nts receiving ECCE/PC-IOL reported larger beneficial changes than did those receiving ICCE-AG, compatible with additional beneficial effects of a moderate magnitude for visual functioning and of a smaller benef icial magnitude for quality of life. All between group differences wer e highly statistically significant (P < .00001). The additional benefi ts of ECCE/PC-IOL are not explained by visual acuity differences. A hi gher proportion of patients in the ICCE-AG group reported problems on a vision problem checklist at 6 months (more than 50%) than did patien ts in the ECCE/PC-IOL group (approximately 30%). CONCLUSIONS: In this developing-country setting, ICCE-AG and ECCE/PC-IOL were associated wi th substantial benefits in improved everyday vision function and visio n related quality of life. Patients who received ECCE/PC-IOL reported greater benefits and fewer problems with vision than did patients who received ICCE-AG.