Among the 2.52 million participants (mean age: 70.67 years), 42.5% had VA impairment. Over a mean follow-up of 4.99 years (accumulating 12,560,718.9 person-years), 348,501 deaths occurred, including 153,758 CVD deaths. In the fully adjusted model, each 1-logMAR unit increase in BVA (greater visual impairment) was associated with a 3% higher risk of all-cause mortality (HR: 1.03; 95% CI: 1.03-1.04) and a 3% higher risk of CVD mortality (HR: 1.03; 95% CI: 1.02-1.03). A graded association was observed when VA was categorized by quartiles, with the worst quartile (Q4) showing significantly elevated risks for all-cause (HR: 1.25; 95% CI: 1.24-1.26) and CVD mortality (HR: 1.30; 95% CI: 1.28-1.32) compared to the best quartile (Q1). Stratified analysis indicated that the association was stronger in younger participants (65-70 years). Dose-response analysis revealed a significant nonlinear association, with mortality risk rising steeply at lower levels of impairment and plateauing at higher levels. Competing risk and sensitivity analysis confirmed the robustness of these findings.
What is needed is the retinal age algortithm to be made available simply by people giving retinal photographs. It may be more reliable than DNA methylation as a biological clock and can be measured noinvasively.
From the paper, it appears that the independent variable was operationally defined on chart-based visual acuity and not the retina’s ability to resolve images (which would seem to be the target variable). As an older pilot, I have learned in recent flight physicals that I have developed early stage cataracts. They are of a clear type but effectively prevent correcting my vision to better than 20:25 OU. They also require increased light to resolve at the same level. The examination estimated that when I have cataract surgery, I will be able to restore acuity to 20:20 or better. In fact, I will have to decide how much near-point versus far-point acuity I want and augment the other distances with corrective lenses. Practically speaking, it is a complex decision to balance the various life style demands on acuity with the current array of replacement lenses available, along with the disadvantages of each. In the case of this study, undiagnosed cataracts appears to have been uncontrolled for.
I may have the same problem. And, determining whether to opt for close-up vision as the default with distance vision requiring glasses or vice versa is a difficult decision. I don’t have to make that decision today, but the time is approaching.
The one option I ruled out, a common one, is opting to correct one eye to near-point and the other to far-point. This causes the brain to suppress the discordant eye and, of course, you lose near point stereopsis.
For what it is worth, my study so far favors Light Adjustable Lens. The LAL is a silicone IOL whose refractive power can be adjusted after implantation, by directed UV light treatments in the office, typically 3–5 weeks post-op. You wear UV-blocking glasses continuously between surgery and lock-in to prevent ambient UV from triggering changes. Once you’ve fine-tuned the refraction and you’re happy, a final “lock-in” UV treatment polymerizes the lens permanently. The appeal: instead of betting on biometric calculations and hoping you land at plano, you titrate the actual refractive outcome based on what you’re experiencing in real life. For a high-precision target (a pilot who wants to be certain they’re at plano or at a specific intermediate target), this is genuinely useful.
AI was a great help in plodding through the issues and its persistent recommendation was not to settle for a second-rate clinic or previous generation measuring equipment, and insist that the top-rated person do your surgery. Suggested interview questions for the pre-feasibility visit:
If it’s useful, here’s the list I’d take into a surgeon consultation, in priority order:
What is your annual cataract surgery volume, and your specific volume of [LAL / Vivity / Eyhance / whichever lens you’re considering]?
What is your refractive prediction accuracy — what percentage of your cases land within ±0.50 D of target?
What is your posterior capsule rupture rate?
What biometer do you use, and which IOL calculation formulas?
What is your protocol for managing ocular surface disease before biometry?
Do you use image guidance for toric IOL alignment? Intraoperative aberrometry?
What is your bilateral surgery timing protocol, and how do you use first-eye data to refine the second eye?
What lens would you recommend for my profile and target, and what are the cases where you would not recommend that lens?
Thank you very much. You’ve given me more to think about.
As an interesting anecdote I took a list of questions to my ophthalmologist some months ago about his cataract surgery volume, etc. and he just gave it back to me and said it’s not time yet. He’s a nice guy, but I didn’t like that response, especially after I done research and found things I wanted to know. I didn’t push the issue because I did not want him to get defensive, but as I said I did not like his response.
Based on what I have been able to learn in my area, look for a specialized eye surgery clinic with at least one board certified, fellowship trained ophthalmologist with advanced specialized surgical and medical training on corneal conditions, standard and complex cataract surgeries, and refractive surgery including LASIK and PRK. Specific equipment brands and models also separate the best from other surgical clinics but an advanced trained surgeon is not likely to work in a place with previous generation equipment.