Patient-reported outcome measures in cataract surgery: a systematic review and meta-analysis of visual function and quality of life.

OBJECTIVE: To evaluate the improvement in vision-related quality of life, as measured by validated patient-reported outcome measures (PROMs) (NEI-VFQ-14, NEI-VFQ-25) after cataract surgery, and to explore sources of variability in outcomes. METHODS: MEDLINE, EMBASE, and CINAHL were searched, with supplementary grey‑literature screening, for primary studies reporting preoperative and postoperative PROM scores following cataract surgery. Eligible instruments were the Visual Function Index (NEI-VFQ-14), National Eye Institute Visual Function Questionnaire (NEI‑VFQ‑25/‑14), Catquest‑9SF, and related tools. Two reviewers independently performed study selection, data extraction, and risk‑of‑bias assessment using design‑specific CLARITY/U.S. National Institutes of Health frameworks. Random-effects meta-analyses pooled mean change scores for NEI-VFQ-14 and NEI-VFQ-25. Heterogeneity (τ², I²), 95% prediction intervals, small-study effects (Egger's test), and trim-and-fill were assessed. Risk of bias used design-specific CLARITY/NIH tools. RESULTS: From 3473 records, 122 studies met inclusion criteria. Forty‑seven were prospective cohorts, 9 were randomized controlled trials, and 38 were case series; 52% were judged at moderate risk of bias. Fifty-six NEI-VFQ-14 cohorts (k = 56) and 33 NEI-VFQ-25 cohorts (k = 33) were pooled. Mean improvements were +21.8 points (95% CI: 17.4-26.3; I² = 99.9%; PI: -11.3 to 54.9) for NEI-VFQ-14 and +19.3 points (95% CI: 17.0-21.6; I² = 99.4%; PI: 6.5-32.1) for NEI-VFQ-25. For NEI-VFQ-25, Egger's test suggested small-study effects (p = .002); trim-and-fill imputed 3 studies, yielding +18.2 (95% CI: 16.0-20.4). CONCLUSIONS: Cataract extraction consistently enhances patient‑perceived visual function and quality of life. Unfortunately, high heterogeneity limits precision and suggests that gains in PROM score may vary by patient and procedural factors, and small-study effects may overestimate the true benefit recorded by NEI-VFQ-25. Routine integration of validated PROMs into cataract pathways will better capture outcomes that matter to patients, given that the very high heterogeneity, standardized reporting, and longer follow‑up are priorities.