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Ophthalmology’s most life-changing procedures revealed

Seventy-five percent of ophthalmic interventions investigated in a major study have shown evidence of improving quality of life for patients with eye disease, with cataract surgery and anti-VEGF therapy singled out as some of the most important procedures.

The cross-sectional study of systematic reviews published in JAMA Ophthalmology this month is thought to be the first global synthesis of the evidence about quality of life (QOL) and eye health and even highlighted certain interventions – such as supplements for macular disease – that didn’t positively impact people’s lives.

During the past decade, QOL measures have gained popularity in ophthalmology research, aligning with a greater recognition of wellbeing and visual function when determining patient outcomes.

The study found there was a “consistent association between vision impairment, eye diseases, and reduced quality of life”. Overall, 33 interventions were investigated, of which 25 were found to improve QOL compared with baseline measurements or a group receiving no intervention.

“Projections from 2015 suggested that in 2020, 127.7 million people will have moderate or severe vision impairment because of uncorrected refractive error, 57.1 million because of cataract, 8.8 million because of AMD, and 3.2 million because of diabetic retinopathy,” the researchers stated.

“Three interventions (cataract surgery, corrective lenses, and anti-VEGF therapy) provide opportunities to improve the quality of life of more than 150 million individuals globally. Other interventions, such as treating rhinoconjunctivitis in children and adults, trichiasis in endemic areas, and uveitis in those with active and inactive disease, and low-vision rehabilitation, also have the potential to improve quality of life.”

However, the researchers noted ophthalmic interventions differed in their association with quality of life. For example, treating cataracts immediately after diagnosis – even in those with competing conditions such as AMD and who had already received a first cataract surgery – improved quality of life.

The study also found 11 ophthalmic interventions were not associated with improved quality of life.

Among them were radiotherapy and supplementation with lutein and zeaxanthin for AMD, supplementation with nutrients for hereditary retinal dystrophies, early open-angle glaucoma treatment with laser trabeculoplasty and topical beta-blockers, and open-angle glaucoma treatment with selective laser trabeculoplasty and/or medications.

The authors noted that while the significant associations between QOL and ophthalmic procedures were expected overall, previous literature suggests even more eye diseases are associated with worse quality of life, with dry eye being a notable example. However, it was excluded from the study because of a lack of appropriate criteria for critical appraisal.

“Vision impairment and eye conditions are associated with lower quality of life, and ophthalmic interventions can lead to significant improvement in quality of life,” the researchers concluded.

“Scaling up interventions, such as cataract surgery, refractive error correction, and anti-VEGF therapy at a global level, has the potential to improve the quality of life of millions of people worldwide.”

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