Improving Patient-Assessed Outcomes after Cataract Surgery

2017 ◽  
Vol 27 (4) ◽  
pp. 454-459 ◽  
Author(s):  
Behrad Samadi ◽  
Mats Lundström ◽  
Maria Kugelberg

Purpose To identify and evaluate possible causes of poor patient-reported visual function after cataract surgery. Methods We obtained retrospective data from the Swedish National Cataract Register on patient self-assessed visual function before and after cataract surgery based on the Catquest-9SF questionnaire. We identified patients who self-reported similar or more difficulties postoperatively than preoperatively, and looked at possible causative variables such as sex, age, preoperative and postoperative corrected distance visual acuity (CDVA) and refractive errors, and ocular comorbidity. Results Nearly 75% of the 119 patients identified had a better postoperative CDVA; the mean CDVA increased by over 0.2 logarithm of the minimum angle of resolution visual acuity. Patients with low or high preoperative CDVA had poor self-assessed outcomes postoperatively. Younger patients (52-68 years) had a lower self-assessed outcome than more elderly patients. Surgical complications and poor near vision yielded lower outcomes. Anisometropia, ocular comorbidity, and sex did not significantly affect the outcome in this specific group. Conclusions Patients content with their visual function despite the presence of a cataract should defer surgery. This may also include patients younger than 68 years with good visual function. Detailed information given to the patients about their ophthalmic condition, the surgical procedure and risks, and the eventual need for reading glasses postoperatively may result in higher self-assessed visual function outcomes among patients.

2021 ◽  
Author(s):  
Nesrin Tutas Gunaydın ◽  
Ayse Aydın Oral

Abstract Background: To evaluate the factors influencing final visual acuity in pediatric traumatic cataracts. Methods: Data of patients who presented with traumatic cataracts were reviewed retrospectively. We evaluated sex; age at trauma; trauma type, cause, and zone; duration between the time of trauma and cataract surgery; surgical method used; time, location, and type of intraocular lens (IOL) implantation; initial and final corrected distance visual acuity (CDVA); amblyopia rate and complications. Results: In all, 61 eyes of 59 patients with cataracts after trauma, under 16 years of age, were included. The mean age of the children was 7.2 ± 3.9 years. Primary IOL implantation was performed in 70.9% of eyes. The CDVA was 0.7 LogMAR or better in 16.3% of the 49 eyes where the visual acuity could be measured at the time of trauma and in 69.1% of 55 eyes in which it could be measured after treatment. The evaluation of factors potentially influencing the final visual acuity revealed that eyes that had undergone posterior capsulotomy (PC) and anterior vitrectomy (AV) during cataract surgery had significantly better final vision compared to eyes that did not undergo these procedures. Conclusion: Good visual results can be obtained in children with traumatic cataracts using PC and AV together with lens aspiration and IOL implantation, followed by effective amblyopia treatment and close monitoring.


2021 ◽  
Author(s):  
Takushi Kawamorita ◽  
Hiroshi Uozato ◽  
Tetsuro Oshika ◽  
Kazuno Negishi ◽  
Takashi Fujikado ◽  
...  

Abstract This prospective observational study aimed to evaluate the eye shape and visual function of Japanese people through a multicenter approach and to create a Japanese model eye. Uncorrected and corrected distance visual acuity (UDVA and CDVA, respectively) in the log minimum angle of resolution (logMAR), subjective and objective spherical equivalent values (SE) of ocular refraction, anterior and posterior corneal curvature (ACC and PCC, respectively), anterior and posterior corneal asphericity (ACA and PCA, respectively), central corneal thickness (CCT), anterior chamber depth (ACD), and ocular axial length (AL) were measured in the eyes of 250 participants (mean age = 46.5 ± 18.0 years, range: 20–90 years) across five institutions in Japan. The mean UDVA, CDVA, subjective SE, objective SE, ACC, PCC, ACA, PCA, CCT, ACD, and AL were 0.68, -0.08, -2.42 D, -2.66 D, 7.77 mm, 6.33 mm, -0.31, -0.39, 0.55 mm, 2.92 mm, and 24.78 mm, respectively. Age-related changes and sex-based differences were observed in the visual acuity, refraction, corneal shape, ACD, and AL. Although the sample size needs to be increased, the results of this study can be applied to the development of refractive correction methods and various vision-related fields.


2020 ◽  
Vol 4 (1) ◽  
pp. 63-68
Author(s):  
Adelia Lisnawati

Cataract is a condition when the lens become cloudy and often occurs in elderly patients. Cataract is the leading cause of visual impairment and blindness in the world. Cataract can reduce productivity and social life, that will decrease the quality of life in elderly patients. It also reduces the visual acuity leading to decreasing visual function and the quality of life. This disease can change physical, cognitive and psychosocial life. This study aimed to analyze the difference of quality of life in elderly patients before and after cataract surgery at SMEC eye clinic in Samarinda. This study was observational analytic study. Data were taken from interview the patients with visual function questionnaire 14 (VFQ 14) and from the medical record of SMEC eye clinic in Samarinda. The results showed a significant difference of quality of life in elderly patients before and after cataract surgery (p = 0,000) with the mean score of quality of life before surgery (x̅= 63,65) was lower than after cataract surgery (x̅= 95,35) and there was significant improvement of the visual acuity after cataract surgery (p = 0,000). Based on these results it can be concluded that there were difference of quality of life in elderly patients before and after cataract surgery.


2021 ◽  
Vol 25 (6) ◽  
pp. 1-68
Author(s):  
Alexander C Day ◽  
Jennifer M Burr ◽  
Kate Bennett ◽  
Rachael Hunter ◽  
Catey Bunce ◽  
...  

Background Cataract surgery is one of the most common operations. Femtosecond laser-assisted cataract surgery (FLACS) is a technique that automates a number of operative steps. Objectives To compare FLACS with phacoemulsification cataract surgery (PCS). Design Multicentre, outcome-masked, randomised controlled non-inferiority trial. Setting Three collaborating NHS hospitals. Participants A total of 785 patients with age-related cataract in one or both eyes were randomised between May 2015 and September 2017. Intervention FLACS (n = 392 participants) or PCS (n = 393 participants). Main outcome measures The primary outcome was uncorrected distance visual acuity in the study eye after 3 months, expressed as the logarithm of the minimum angle of resolution (logMAR): 0.00 logMAR (or 6/6 if expressed in Snellen) is normal (good visual acuity). Secondary outcomes included corrected distance visual acuity, refractive outcomes (within 0.5 dioptre and 1.0 dioptre of target), safety and patient-reported outcome measures at 3 and 12 months, and resource use. All trial follow-ups were performed by optometrists who were masked to the trial intervention. Results A total of 353 (90%) participants allocated to the FLACS arm and 317 (81%) participants allocated to the PCS arm attended follow-up at 3 months. The mean uncorrected distance visual acuity was similar in both treatment arms [0.13 logMAR, standard deviation 0.23 logMAR, for FLACS, vs. 0.14 logMAR, standard deviation 0.27 logMAR, for PCS, with a difference of –0.01 logMAR (95% confidence interval –0.05 to 0.03 logMAR; p = 0.63)]. The mean corrected distance visual acuity values were again similar in both treatment arms (–0.01 logMAR, standard deviation 0.19 logMAR FLACS vs. 0.01 logMAR, standard deviation 0.21 logMAR PCS; p = 0.34). There were two posterior capsule tears in the PCS arm. There were no significant differences between the treatment arms for any secondary outcome at 3 months. At 12 months, the mean uncorrected distance visual acuity was 0.14 logMAR (standard deviation 0.22 logMAR) for FLACS and 0.17 logMAR (standard deviation 0.25 logMAR) for PCS, with a difference between the treatment arms of –0.03 logMAR (95% confidence interval –0.06 to 0.01 logMAR; p = 0.17). The mean corrected distance visual acuity was 0.003 logMAR (standard deviation 0.18 logMAR) for FLACS and 0.03 logMAR (standard deviation 0.23 logMAR) for PCS, with a difference of –0.03 logMAR (95% confidence interval –0.06 to 0.01 logMAR; p = 0.11). There were no significant differences between the arms for any other outcomes, with the exception of the mean binocular corrected distance visual acuity with a difference of –0.02 logMAR (95% confidence interval –0.05 to 0.00 logMAR) (p = 0.036), which favoured FLACS. There were no significant differences between the arms for any health, social care or societal costs. For the economic evaluation, the mean cost difference was £167.62 per patient higher for FLACS (95% of iterations between –£14.12 and £341.67) than for PCS. The mean QALY difference (FLACS minus PCS) was 0.001 (95% of iterations between –0.011 and 0.015), which equates to an incremental cost-effectiveness ratio (cost difference divided by QALY difference) of £167,620. Limitations Although the measurement of outcomes was carried out by optometrists who were masked to the treatment arm, the participants were not masked. Conclusions The evidence suggests that FLACS is not inferior to PCS in terms of vision after 3 months’ follow-up, and there were no significant differences in patient-reported health and safety outcomes after 12 months’ follow-up. In addition, the statistically significant difference in binocular corrected distance visual acuity was not clinically significant. FLACS is not cost-effective. Future work To explore the possible differences in vision in patients without ocular co-pathology. Trial registration Current Controlled Trials ISRCTN77602616. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 6. See the NIHR Journals Library website for further project information. Moorfields Eye Charity (grant references GR000233 and GR000449 for the endothelial cell counter and femtosecond laser used).


2021 ◽  
Author(s):  
Cesar A Sanchez Galeana

Abstract Purpose To assess the safety and efficacy of a novel compound with low -dose pilocarpine, brimonidine and oxymetazoline (PBO) in the near vision of a group of healthy presbyopic individuals. Design Prospective, consecutive, noncomparative, nonrandomized interventional study. Subjects Twenty-six healthy presbyopic patients presented from August to September 2021 to our clinic and were willing to participate in the study. Methods PBO compound was instilled in both eyes to assess its effect in near vision one hour after instillation.Main Outcome Measures Under corrected near visual acuity using the Jaeger notation, under corrected and corrected distance visual acuity, photopic and scotopic pupil diameter was registered before and one hour after instillation of the compound. Results Baseline binocular Jaeger notation was 5.86 +/-1.39 SD range (3-9). One hour after drop instillation, binocular Jaeger was 2.53 +/ 1.71 SD range (1 – 6) (p ≤ 0.0001) Lines gained 3.30 +/-1.40 SD range (0 – 6). Mean photopic pupilar diameter was 3.69 mm +/- 0.67 SD range (2.5 – 5 mm). Mean scotopic pupilar diameter was 4.61 mm +/- 0.78 SD range (3 – 6 mm). The mean photopic pupilar diameter was 2.27 mm +/-052 SD (1.5 – 3) (p ≤ 0.000). Scotopic pupilar diameter was 2.63 mm +/-0.53 SD range (2 – 3) (p ≤ 0.000). One patient reported no improvement in near vision. (3.8%). One patient reported dim vision rated 5 in a VAS (1 –10) (3.8%). Conclusion Low-dose pilocarpine, brimonidine, and oxymetazoline showed efficacy, improving near-distance vision one hour after instillation in a group of presbyopic patients, and safety showed few and transient secondary effects.


2021 ◽  
pp. 112067212110464
Author(s):  
Oya Donmez ◽  
Bilgehan Sezgin Asena ◽  
Yonca Aydin Akova

Purpose: To evaluate the clinical outcomes and quality of life following implantation of PanOptix toric intraocular lens (IOL) and to compare the outcomes following femtosecond laser assisted cataract surgery (FLACS) and standard cataract surgery (SCS). Methods: This comparative retrospective study included 79 eyes of 55 patients underwent cataract or refractive lens exchange surgery between April 2017 and January 2020 in Bayindir Hospital and Kaskaloglu Eye Hospital. Corneal (CA) and refractive astigmatism (RA), uncorrected visual acuities for distant, intermediate, and near (UDVA, UIVA, and UNVA), low contrast distance visual acuity, rotational stability, defocus curves, photopic and mesopic contrast sensitivity (CS), visual function-14 (VF-14) test, presence of dysphotopsia, and need for spectacles were evaluated at postoperative third month. Outcomes were compared between FLACS and SCS group. Results: The mean UDVA, UIVA, and UNVA were 0.05 ± 0.07, 0.08 ± 0.08, and 0.06 ± 0.07 logMAR, respectively. All patients achieved ⩾0.3 logMAR uncorrected visual acuity for all distances. UDVA was found significantly better in FLACS group ( p = 0.03). All eyes had ⩽1 D of subjective postoperative RA. Defocus curve had two peaks at 0 and −1.50 D. Spectacle independence was achieved in 88.7% of patients. Photopic and mesopic CS was within normal range in all patients. The mean VF-14 score was 98 ± 2. The mean IOL axis rotation was 2.1° ± 2.3°. Only one patient reported seeing disturbing halos. Conclusions: This trifocal toric IOL effectively reduced refractive astigmatism and provided excellent visual outcomes with high spectacle independence, patients’ satisfaction, and good rotational stability. FLACS might have an impact on optimal postoperative results.


2021 ◽  
Vol 2 (1) ◽  
pp. 41-49
Author(s):  
You-Jin Kim ◽  
Young-Gap Jin ◽  
Bon-Yeop Koo ◽  
Jung-Un Jang ◽  
Ki-Choong Mah

Background: In golf, a player hits a ball with a club, aiming to transfer the ball successively into a series of hole cups in a course consisting of 18 (or fewer) holes. This study aimed to compare the impact of visual function and the presence and number of aiming lines on golf putting alignment between beginner and expert golfers. Methods: In this prospective comparative study, 43 participants with a mean ± standard deviation (SD) of corrected distance binocular visual acuity of –0.07 ± 0.74 logarithm of the minimum angle of resolution, who knew their average golf scores, were divided into beginner and expert golfers. Six visual function tests were conducted to assess heterotropia, dominant eye, verification of current spectacles, static visual acuity, stereopsis, and fixation disparity. At the putting distances of 1.5 m and 3 m, alignment errors were measured five times each, using golf balls with 1 and 3 aiming line(s) and putters with 1 and 3 aiming line(s). Results: The mean ± SD of age was 48.33 ± 10.07 years for study participants overall. The accuracy of ball alignment was not affected by the career or number of aiming lines, but the putter alignment was higher for the 3-lines putter than for the 1-line putter (P < 0.05). When the number and shape of the aiming line were the same for both the ball and putter, the aiming accuracy was found to be higher. In both stereopsis and fixation disparity, the combination of putting distance and a 3-lines ball showed negative values; all other combinations showed positive values, but no statistically significant correlation was detected (all P > 0.05). Conclusions: The accuracy of golf ball alignment did not depend on the number of aiming lines and the golfer’s career. However, the predicted putting success rate and subjective satisfaction were increased when three-line golf balls and putters were used, as compared to when one-line golf balls and putters were used. How to cite this article: Kim YJ, Jin YG, Koo BY, Jang JU, Mah KC. Effects of aiming lines and visual function on the golf putting alignment. Med Hypothesis Discov Innov Optom.2021 Spring; 2(1): 41-49. DOI: https://doi.org/10.51329/mehdioptometry124


2018 ◽  
pp. 79-82
Author(s):  
Van Minh Pham ◽  
Van Nam Phan ◽  
Thi Thu Nguyen

Objectives: To investigate the clinical characteristics of cataract patients with small pupils and to evaluate the result of cataract surgery on the eye have small pupils by phacotechnique. Subjects and methods: Descriptive study, prospective, uncontrolled interventions. Sample selection. The sample size of 70 patients with 70 eyes of cataracts with small pupils was treated by phaco technique and intraocular lens implant within posterior chamber. Follow up to 3 months. Results: 70 eyes, the percentage of men and women was not different from 54.2% (38 male) compared to 45.8% (32 female). The mean age was 80 ± 8.74, from 58 to 99 years. The disease was mainly found in the age group over 70 years old with over 80% (51.5%). Visual acuity before surgery was very poor under 3m CF (count finger) for 68.6% (48/70). Visual acuity over 1/10 was only a small amount with 2.8% (2 eyes). Pseudoexfoliation was the most common reason complications of mydriasis with 32/70 eyes (45.7%) and 22/70 eyes (31.4%) for age. The preoperative pupilarysizewas mostly small with 63/70 eyes (90.0%), non-dilated pupils (7/70 eyes) (10.0%). Average pupil size was 3.34 mm (2 - 4mm). Iris condition: iris atrophy 20/10 eyes (28.6%), iris synechiae 11/10 (15.7%), irregular iris muscle with 51, 4% and good iris muscle accounted for 48.6%. Grade of cataract: Grade III: 31/70 eyes (44.3%), Grade IV: 32/70 eyes (45.7%), Grade II: 5/70 eyes (7.1%) and V:2/70 eyes (2.9%). Pupil expander technique: OVD injection with 42/70 eyes (60%), using iris hook with 23/70 eyes (32.9%). Pupillary size before and after intervention has changed from 3.7mm to 4.48mm. Conclusions: Iris expander techniques have been shown to have good dilated pupils: 60.0% OVD injection, iris hook was 32.9%, other methods 7.1% One-week visibility of good visual acuity was higher than that of postoperative one day (12.2%) and increased at 1 month and 3 months (20.0%). Very good visual acuity was not available and low vision group was 1.4% after 3 months. Key words: cataract surgery; phacoemusification, small pupil


2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Gregory Katz ◽  
Alexandra Rouquette ◽  
François Lignereux ◽  
Thierry Mourgues ◽  
Michel Weber ◽  
...  

Abstract Background The Catquest-9SF questionnaire is a patient reported outcome measure that quantifies the visual benefits from cataract surgery. The purpose of this study was to translate and adapt the Catquest-9SF questionnaire for France, to assess its psychometric properties via Rasch analysis, and to assess its validity when completed using an electronic notepad. Methods The Catquest-9SF questionnaire was translated following the guidelines of the International Society for Pharmacoeconomics and Outcomes Research. Catquest-9SF and clinical data were collected from patients before and after routine cataract surgery. All questionnaire data were collected via an electronic notepad. Rasch analysis was performed to assess psychometric properties, and sensitivity to change was analysed for patients with complete paired pre- and post-operative questionnaires. Results A complete filled-in preoperative questionnaire was obtained for 848 patients. Rasch analysis showed good precision (person separation: 2.32, person reliability: 0.84), ordered category probability curves, no item misfit, and unidimensionality. The respondents were slightly more able than the level of item difficulty (targeting: −1.12 logits). Sensitivity was analysed on 211 paired questionnaires, and the postoperative questionnaires showed a clear ceiling effect. The effect size was 2.6. The use of an electronic notepad for completing the questionnaire worked out very well after some adjustments. Conclusions The French version of Catquest-9SF has good psychometric properties and is suitable for use in French-speaking patients. The use of the Catquest-9SF questionnaire in an electronic format showed good validity.


2020 ◽  
Vol 1 (3) ◽  
pp. 145-153
Author(s):  
Sheng-Xia Wang ◽  
◽  
Yun-Hong Du ◽  
Wen-Jing Liu ◽  
Ping Liu ◽  
...  

AIM: To assess the patient-reported outcome of phacoemulsification with posterior chamber single focus foldable intraocular lens (SIOL) using the Chinese version of Catquest-8SF questionnaire (Catquest-8SF-CN), evaluate the applicability of Catquest-8SF scale in northern Chinese and its sensitivity to cataract surgery. METHODS: Prospective clinical case follow-up study. The patients were recruited from the Central Hospital of Tai’an and completed the Catquest-8SF questionnaire by face-to-face interviews before and 3mo after surgery at the hospital. RESULTS: A total of 120 cataract patients with median age 67.6y and 52.5% female completed the Catquest-8SF. The Cronbach’s α coefficient of the total scale, daily-activity sub-table and comprehensive-evaluation sub-table were 0.861, 0.853 and 0.748 respectively. There was a high level of consistency between two investigators. The cumulative contribution rate was 66.64% by using the principal component analysis and the maximum variance orthogonal rotation method. The preoperative score of the Catquest-8SF-CN had a significant negative correlation with preoperative binocular mean weighted visual acuity and age (P<0.05), while a significant positive correlation with education level (F=6.094, P<0.001). The patients without systemic comorbidities got higher score than those who with (P<0.05). Three months after surgery, 102 (85%) patients came for follow-up and completed the questionnaire. Significant improvement of visual acuity was observed in both binocular and monocular surgery groups (t=10.404, P<0.001). There was higher improvement in binocular weighted visual acuity of binocular surgery group than in monocular surgery group (t=-20.77, P<0.001). The postoperative score was significantly higher in both groups than before (P<0.001). There was a significant improvement in the total score after cataract surgery. The 94 patients (92.2%) were very satisfied or satisfied with the operation; 92 patients (90.2%) thought the surgery achieved their expectations, and they all felt satisfactory. The degree of satisfaction was significantly correlated with the improvement score of the scale and it was also correlated with their expectation of the surgery. CONCLUSION: The Chinese version of Catquest-8SF questionnaire is suitable for the age-related cataract population in northern China. It is highly responsive to cataract surgery and brief, so it may have the potential to become part of a routine clinical assessment for cataract surgery in China. The patient’s overall satisfaction is high, which illustrates that the medical service we provide matches the patient’s needs. The degree of satisfaction was significantly correlated with the improvement score of the scale and it was also correlated with their expectation of the surgery.


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