Why are patients with no visual symptoms on cataract waiting lists?

BACKGROUND: Some patients waiting for cataract surgery report limited or no visual symptoms when responding to standardized visual function questions. This has led some to argue that too many patients are undergoing cataract surgery.
METHODS: One hundred and forty-nine consecutive patients who reported no symptoms on the Visual Function Index questionnaire (VF-14) were asked if they had any visual symptoms not included in the VF-14, why they thought they were on the waiting list, and what they expected to gain from surgery. They were interviewed after their surgery to see if they were satisfied with the procedure and if their vision had improved.
RESULTS: Of 149 patients, 108 described some degree of visual impairment, 28 stated they were undergoing surgery at their doctor's suggestion, and 13 did not describe any reason for their surgery. By the second interview, 105 patients had had surgery, of whom 85% were very or extremely satisfied and 75% felt their vision was markedly improved. There was no statistically significant difference in satisfaction rates between the symptomatic, asymptomatic, or doctor's suggestion groups, or between patients undergoing first or second eye surgery.
INTERPRETATION: Patients on cataract waiting lists who scored 100 (no complaints) on the VF-14 are likely to have some visual complaints not identified by the test and are likely to experience significant visual gain after undergoing cataract surgery. The adoption of the VF-14 questionnaire to determine the threshold for cataract surgery would be detrimental, because many patients who clearly could benefit from surgery would be denied appropriate health care.