Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Estimating the rate of severe visual loss (wipe-out) following cataract surgery, a British Ophthalmological Surveillance Unit (BOSU) study

Eye volume 37, pages 3787–3792 (2023)Cite this article

Subjects

Abstract

Background

A sudden, irreversible reduction in visual acuity (‘wipe-out’) is a feared complication of cataract surgery. Current literature on wipe-out is limited in quantity and quality, and largely predates modern cataract surgery and imaging techniques. The objectives of our study were to estimate the incidence of wipe-out and to identify potential risk factors.

Methods

We prospectively collated cases of wipe-out occurring in the UK during a 25-month study period using the British Ophthalmic Surveillance Unit reporting system. A total of 21 potential cases of wipe-out were reported, 5 of which met all inclusion and exclusion criteria.

Results

The estimated incidence of wipe-out during the study period was 0.00000298, or approximately 3 cases per million cataract operations. All cases of wipe-out occurred exclusively in patients with advanced glaucoma (mean deviation −21.0 decibels or worse in the operated eye), with an over-representation of black people (40%) in our case series. A prior diagnosis of retinal vein occlusion (60%) and elevated post-operative IOP (40%) were more common among individuals suffering from wipe-out compared to the general population, suggesting these factors may contribute to the pathogenesis of wipe-out.

Conclusions

Our study shows that wipe-out is a rare complication, affecting approximately 3 per million undergoing cataract surgery. Patients with advanced glaucoma, black patients, and those with previous retinal vein occlusions may be at greater risk of wipe-out. We hope that the findings of our study will be used to help inform treatment decision-making and the cataract surgery consent process.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Sharma N, Ooi J-L, Francis IC, Sharma S, Papalkar D, Kim P, et al. Sudden visual loss after uneventful cataract surgery: Snuff syndrome. J Cataract Refract Surg. 2004;30:2435–7.

    PubMed  Google Scholar 

  2. GBD 2019 Blindness and Vision Impairment Collaborators, Vision Loss Expert Group of the Global Burden of Disease Study. Causes of blindness and vision impairment in 2020 and trends over 30 years, and prevalence of avoidable blindness in relation to VISION 2020: the Right to Sight: an analysis for the Global Burden of Disease Study. Lancet Glob Health. 2021;9:e144–60.

  3. Rahman F, Zekite A, Bunce C, Jayaram H, Flanagan D. Recent trends in vision impairment certifications in England and Wales. Eye. 2020;34:1271–8.

    Article  PubMed  PubMed Central  Google Scholar 

  4. AGIS (Advanced Glaucoma Intervention Study) Investigators. The Advanced Glaucoma Intervention Study: 8. Risk of cataract formation after trabeculectomy. Arc Opthamol. 2001;119:1771–9.

    Article  Google Scholar 

  5. Musch DC, Gillespie BW, Niziol LM, Janz NK, Wren PA, Rockwood EJ, et al. Cataract extraction in the collaborative initial glaucoma treatment study: incidence, risk factors, and the effect of cataract progression and extraction on clinical and quality-of-life outcomes. Arch Ophthalmol. 2006;124:1694–700.

    Article  PubMed  Google Scholar 

  6. Deva NC, Insull E, Gamble G, Danesh-Meyer HV. Risk factors for first presentation of glaucoma with significant visual field loss. Clin Exp Ophthalmol. 2008:36:217–21.

  7. Ng WS, Agarwal PK, Sidiki S, McKay L, Townend J, Azuara-Blanco A. The effect of socio-economic deprivation on severity of glaucoma at presentation. Br J Ophthalmol. 2010;94:85–7.

  8. Graefe von A. Beiträge zur Pathologie und Therapie des Glaucoms. Arch Opthalmol. 1869;15:108–252.

  9. Kolker A. Visual prognosis in advanced glaucoma: a comparison of medical and surgical therapy for retention of vision in 101 eyes with advanced glaucoma. Trans Am Ophthalmol Soc. 1977;75:539

  10. O’Connell EJ, Karseras AG. Intraocular surgery in advanced glaucoma. Br J Ophthalmol. 1976;60:124–31

  11. Aggarwal SP, Hendeles S. Risk of sudden visual loss following trabeculectomy in advanced primary open-angle glaucoma. Br J Ophthalmol. 1986;70:97–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Levene RZ. Central visual field, visual acuity, and sudden visual loss after glaucoma surgery. Ophthalmic Surg. 1992;23:388–94.

    CAS  PubMed  Google Scholar 

  13. Moster MR, Moster ML. Wipe-out: a complication of glaucoma surgery or just a blast from the past?. Am J Ophthalmol. 2005;140:705–6.

    Article  PubMed  Google Scholar 

  14. Altmeyer M, Wirbelauer C, Häberle H, Pham D. Katarakt-Operation bei Patienten mit Glaucoma fere absolutum. Klin Monatsbl Augenheilkd. 2006;223:297–302.

    Article  CAS  PubMed  Google Scholar 

  15. Law SK, Nguyen AM, Coleman AL, Caprioli J. Severe loss of central vision in patients with advanced glaucoma undergoing trabeculectomy. Arch Ophthalmol. 2007;125:1044–50.

    Article  PubMed  Google Scholar 

  16. Foot B, Stanford M, Rahi J, Thompson J. British Ophthalmological Surveillance Unit Steering Committee. The British Ophthalmological Surveillance Unit: an evaluation of the first 3 years. Eye (London, England). Eye. 2003;17:9–15. Jan

    Article  CAS  PubMed  Google Scholar 

  17. Eurostat. Eurostat - Data Explorer. 2022. http://appsso.eurostat.ec.europa.eu/nui/submitViewTableAction.do.

  18. Zhang N, Wang J, Li Y, Jiang B. Prevalence of primary open angle glaucoma in the last 20 years: a meta-analysis and systematic review. Sci Rep. 2021;11:1–12.

    Google Scholar 

  19. Keel S, Xie J, Foreman J, van Wijngaarden P, Taylor HR, Dirani M. Prevalence of retinal vein occlusion in the Australian National Eye Health Survey. Clin Exp Ophthalmol. 2018;46:260–5.

    Article  PubMed  Google Scholar 

  20. Grzybowski A, Kanclerz P Do we need day-1 postoperative follow-up after cataract surgery? Arch Opthalmol. 2019;257:855–61.

  21. Cultural identity - Office for National Statistics. 2022. https://www.ons.gov.uk/peoplepopulationandcommunity/culturalidentity.

  22. Martin MJ, Sommer A, Gold EB, Diamond EL. Race and primary open-angle glaucoma. American Journal of Ophthalmology. Am J Ophthalmol. 1985;99:383–7.

    Article  CAS  PubMed  Google Scholar 

  23. Wild S, Roglic G, Green A, Sicree R, King H Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care 2004;27:1047–53.

  24. Donachie PH, Sparrow JM. NOD audit annual reports - resources - NOD - National Ophthalmology Database Audit. 2017. nodaudit.org.uk.

  25. Tapela N, Collister J, Clifton L, Turnbull I, Rahimi K, Hunter DJ. Prevalence and determinants of hypertension control among almost 100 000 treated adults in the UK. Open Heart. Arch Dis Child. 2021;8:e001461.

    Google Scholar 

  26. Friedman D, O’Colmain B, Munoz B, Tomany S, McCarty C, de Jong PTVM, et al. Prevalence of age-related macular degeneration in the United States. Arch Ophthalmol. 2004;122:564–72.

    Article  PubMed  Google Scholar 

  27. Day AC, Donachie PHJ, Sparrow JM, Johnston RL, Royal College of Ophthalmologists’ National Ophthalmology Database. The Royal College of Ophthalmologists’ National Ophthalmology Database Study of cataract surgery: report 2, relationships of axial length with ocular copathology, preoperative visual acuity, and posterior capsule rupture. Eye. 2015;29:1528–37.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Sarraf D, Rahimy E, Fawzi AA, Sohn E, Barbazetto I, Zacks DN, et al. Paracentral acute middle maculopathy: a new variant of acute macular neuroretinopathy associated with retinal capillary ischemia. JAMA ophthalmology. JAMA Ophthalmol. 2013;131:1275–87.

    Article  PubMed  Google Scholar 

  29. Bernal-Morales C, Velazquez-Villoria D, Cubero-Parra JM, Keane PA, Sim DA, Adán A, et al. Paracentral acute middle maculopathy after uneventful ocular surgery with local anaesthetic blocks. Eye. 2022;36:219–27.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The aim of this research is to answer a question first posed to the authors by Aleck Crichton, who has advanced glaucoma and was put off undergoing cataract surgery due to the risk of wipe-out. Research starts with a question, so thank you Aleck for this question. The authors would also like to thank all of the ophthalmologists who regularly report cases through BOSU and specifically those who reported cases of wipe-out. We also extend our thanks to the BOSU steering committee, who guided our research question, and colleagues who helped by validating our questionnaire. Finally, this research would not have been possible without the generous grant supplied by Moorfields Eye Charity GR000135 or the time and consideration of our reporting consultants Michael Blundell, Chrisjan Dees, Aman Chandra, Stephen White, Sanjiv Banerjee, Thomas Kersey and Johnathan Clarke. Supplemental material is available at Eye’s website.

Funding

The research was funded by Moorfields Eye Charity through a grant, GR000135. CB’s post is part funded by the NIHR BRC at the Royal Marsden NHS Foundation Trust and the Institute of Cancer Research, London. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.

Author information

Author notes

  1. These authors contributed equally: Conor Ramsden, Yusrah Shweikh.

Authors and Affiliations

  1. West of England Eye Unit, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK

    Conor Ramsden

  2. Institute of Ophthalmology, University College London, London, UK

    Conor Ramsden

  3. Sussex Eye Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, UK

    Yusrah Shweikh

  4. Massachusetts Eye and Ear Infirmary, Boston, MA, USA

    Yusrah Shweikh

  5. Moorfields Eye Hospital NHS Foundation Trust, London, UK

    Ronald Kam

  6. Research Data & Statistics Unit (RDSU), Royal Marsden Clinical Trials Unit (RM-CTU), London, UK

    Catey Bunce

  7. Royal College of Ophthalmologists, London, UK

    Barny Foot

  8. NIHR BRC at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK

    Ananth Viswanathan

Authors
  1. Conor Ramsden
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yusrah Shweikh
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ronald Kam
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Catey Bunce
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Barny Foot
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ananth Viswanathan
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conception: CR, YS, RK, AV Concept Development: BF Data Collection: CR Data Analysis: CR, CB Manuscript Preparation: CR, YS, RK, CB, BF, AV.

Corresponding author

Correspondence to Conor Ramsden.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ramsden, C., Shweikh, Y., Kam, R. et al. Estimating the rate of severe visual loss (wipe-out) following cataract surgery, a British Ophthalmological Surveillance Unit (BOSU) study. Eye 37, 3787–3792 (2023). https://doi.org/10.1038/s41433-023-02606-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41433-023-02606-9

Search

Advanced search

Quick links