Surgeon effects on cataract refractive outcomes are minimal compared with patient comorbidity and gender: an analysis of 490 987 cases

AimTo investigate effect of patient age, gender, comorbidities and surgeon on refractive outcomes following cataract surgery.MethodsStudy population: patients on UK national ophthalmic cataract database on cataract operations undertaken between 1 April 2010 and 31 August 2018. Variables examined included gender, age, diabetic retinopathy, glaucoma, high myopia, inherited retinal disease, optic nerve disease, uveitis, pseudoexfoliation, vitreous opacities, retinal pathology, cataract type, previous surgery and posterior capsular rupture. A multivariate normal cross-classified model was fitted to the refractive outcome using Markov Chain Monte Carlo (MCMC) methods with diffuse priors to approximate maximum likelihood estimation. A MCMC chain was generated with a burn-in of 5000 iterations and a monitoring chain of 50 000 iterations.Results490 987 cataract operations were performed on 351 864 patients by 2567 surgeons. Myopic and astigmatic errors were associated with posterior capsule rupture (−0.38/+0.04×72), glaucoma (−0.10/+0.05×95), previous vitrectomy (−0.049/+0.03×66) and high myopia (−0.07/+0.03×57). Hyperopic and astigmatic errors were associated with diabetic retinopathy (+0.08/+0.03×104), pseudoexfoliation (+0.07/+0.01×158), male gender (+0.12/+0.05×91) and age (−0.01/+0.06×97 per increasing decade). Inherited retinal disease, optic nerve disease, previous trabeculectomy, uveitis, brunescent/white cataract had no significant impact on the error of the refractive outcome. The effect of patient gender and comorbidity was additive. Surgeons only accounted for 4% of the unexplained variance in refractive outcome.ConclusionPatient comorbidities and gender account for small but statistically significant differences in refractive outcome, which are additive. Surgeon effects are very small.

Approach to: Acute vision loss

Acute vision loss is the temporary reduction of visual acuity or visual field, lasting from a few minutes to a few days. The etiologies of acute vision loss may be divided into anterior segment disease, retinal disease, optic nerve disease, or neurovascular disease. It is recommended to refer all presentations of acute vision loss for ophthalmologic consultation; however, the primary care physician plays an important role in determining the urgency of referral. The following article describes an approach to narrowing the differential diagnosis of acute vision loss, using relevant ocular history and physical exam findings. The features of common eye disorders relating to acute vision loss and their treatments are also discussed.

Modelling normal age-related changes in individual retinal layers using location-specific OCT analysis

Current descriptions of retinal thickness across normal age cohorts are mostly limited to global analyses, thus overlooking spatial variation across the retina and limiting spatial analyses of retinal and optic nerve disease. This retrospective cross-sectional study uses location-specific cluster analysis of 8 × 8 macular average grid-wise thicknesses to quantify topographical patterns and rates of normal, age-related changes in all individual retinal layers of 253 eyes of 253 participants across various age cohorts (n = 23–69 eyes per decade). Most retinal layers had concentric spatial cluster patterns except the retinal nerve fibre layer (RNFL) which displayed a nasal, asymmetric radial pattern. Age-related thickness decline mostly occurred after the late 4th decade, described by quadratic regression models. The ganglion cell layer (GCL), inner plexiform layer (IPL), inner nuclear layer (INL), and outer nuclear layer + Henle’s fibre layer (ONL+HFL) were significantly associated with age (p < 0.0001 to < 0.05), demonstrating similar rates of thickness decline (mean pooled slope = − 0.07 µm/year), while the IS/OS had lesser mean pooled thickness slopes for all clusters (− 0.04 µm/year). The RNFL, OPL, and RPE exhibited no significant age-related thickness change, and the RNFL were significantly associated with sex. Analysis using spatial clusters compared to the ETDRS sectors revealed more extensive spatial definition and less variability in the former method. These spatially defined, clustered normative data and age-correction functions provide an accessible method of retinal thickness analysis with more spatial detail and less variability than the ETDRS sectors, potentially aiding the diagnosis and monitoring of retinal and optic nerve disease.

Epidemiology of visually impaired and blindness as a medical and social problem

The article provides comparative data on the level of visual impairment and blindness in different countries and in the world as a whole. We found out that 1.3 billion people worldwide suffer from visual impairment, among which 36 million are blind. The main causes of visual impairment were cataracts, refraction disorders and glaucoma. Up to 80 % of the causes of visual impairment are thought to be possibly prevented or cured. However, taking into account the low availability of ophthalmological care, it is difficult to achieve. The proportion of visual impairment resulting from cataract and trachoma is projected to decrease in the near future, but the proportion of refraction, glaucoma, diabetic retinopathy and age-related macular degeneration will increase. In Russia, there is a steady increase in disability as a result of ophthalmopathology, the prevalence of which reaches 28.8 per 10 thousand adults, with the first five causes of disability being retinal disease (25 %), glaucoma (24.9 %), degenerative myopia (19.3 %), optic nerve disease (15.1 %), lens pathology (4.4 %). Despite ongoing research, which would reduce the burden of ophthalmopathology, the problem of visually impaired and blindness remains relevant worldwide to date. The development and implementation of preventive programs will contribute to the prevention of visual impairment and blindness among the population with eye diseases