Cataract Surgery Outcomes in Glaucomatous Eyes: Results From the Veterans Affairs Ophthalmic Surgery Outcomes Data Project.

PubMed

Turalba, Angela; Payal, Abhishek R; Gonzalez-Gonzalez, Luis A; Cakiner-Egilmez, Tulay; Chomsky, Amy S; Vollman, David E; Baze, Elizabeth F; Lawrence, Mary; Daly, Mary K

2015-10-01

To compare visual acuity outcomes, vision-related quality of life, and complications related to cataract surgery in eyes with and without glaucoma. Retrospective cohort study. Cataract surgery outcomes in cases with and without glaucoma from the Veterans Affairs Ophthalmic Surgical Outcomes Data Project were compared. We identified 608 glaucoma cases and 4306 controls undergoing planned cataract surgery alone. After adjusting for age, pseudoexfoliation, small pupil, prior ocular surgery, and anterior chamber depth, we found that glaucoma cases were more likely to have posterior capsular tear with vitrectomy (odds ratio [OR] 1.8, P = .03) and sulcus intraocular lens placement (OR 1.65, P = .03) during cataract surgery. Glaucoma cases were more likely to have postoperative inflammation (OR 1.73, P < .0001), prolonged elevated intraocular pressure (OR 2.96, P = .0003), and additional surgery within 30 days (OR 1.92, P = .03). Mean best-corrected visual acuity (BCVA) and Visual Function Questionnaire (VFQ) scores significantly improved after cataract surgery in both groups (P < .0001), but there were larger improvements in BCVA (P = .01) and VFQ composite scores (P < .0001) in the nonglaucoma vs the glaucoma group. A total of 3621 nonglaucoma cases (94.1%) had postoperative BCVA 20/40 or better, compared to 466 glaucoma cases (89.6%) (P = .0003). Eyes with glaucoma are at increased risk for complications and have more modest visual outcomes after cataract surgery compared to eyes without glaucoma. Despite this, glaucoma patients still experience significant improvement in vision-related outcomes after cataract extraction. Further study is needed to explore potential factors that influence cataract surgery outcomes in glaucomatous eyes. Published by Elsevier Inc.

A population based eye survey of older adults in Tirunelveli district of south India: blindness, cataract surgery, and visual outcomes

PubMed Central

Nirmalan, P K; Thulasiraj, R D; Maneksha, V; Rahmathullah, R; Ramakrishnan, R; Padmavathi, A; Munoz, S R; Ellwein, L B

2002-01-01

Aims: To assess the prevalence of vision impairment, blindness, and cataract surgery and to evaluate visual acuity outcomes after cataract surgery in a south Indian population. Methods: Cluster sampling was used to randomly select a cross sectional sample of people ≥50 years of age living in the Tirunelveli district of south India. Eligible subjects in 28 clusters were enumerated through a door to door household survey. Visual acuity measurements and ocular examinations were performed at a selected site within each of the clusters in early 2000. The principal cause of visual impairment was identified for eyes with presenting visual acuity <6/18. Independent replicate testing for quality assurance monitoring was performed in subjects with reduced vision and in a sample of those with normal vision for six of the study clusters. Results: A total of 5795 people in 3986 households were enumerated and 5411 (93.37%) were examined. The prevalence of presenting and best corrected visual acuity ≥6/18 in both eyes was 59.4% and 75.7%, respectively. Presenting vision <6/60 in both eyes (the definition of blindness in India) was found in 11.0%, and in 4.6% with best correction. Presenting blindness was associated with older age, female sex, and illiteracy. Cataract was the principal cause of blindness in at least one eye in 70.6% of blind people. The prevalence of cataract surgery was 11.8%—with an estimated 56.5% of the cataract blind already operated on. Surgical coverage was inversely associated with illiteracy and with female sex in rural areas. Within the cataract operated sample, 31.7% had presenting visual acuity ≥6/18 in both eyes and 11.8% were <6/60; 40% were bilaterally operated on, with 63% pseudophakic. Presenting vision was <6/60 in 40.7% of aphakic eyes and in 5.1% of pseudophakic eyes; with best correction the percentages were 17.6% and 3.7%, respectively. Refractive error, including uncorrected aphakia, was the main cause of visual impairment in cataract operated eyes. Vision <6/18 was associated with cataract surgery in government, as opposed to that in non-governmental/private facilities. Age, sex, literacy, and area of residence were not predictors of visual outcomes. Conclusion: Treatable blindness, particularly that associated with cataract and refractive error, remains a significant problem among older adults in south Indian populations, especially in females, the illiterate, and those living in rural areas. Further study is needed to better understand why a significant proportion of the cataract blind are not taking advantage of free of charge eye care services offered by the Aravind Eye Hospital and others in the district. While continuing to increase cataract surgical volume to reduce blindness, emphasis must also be placed on improving postoperative visual acuity outcomes. PMID:11973242

Loupe magnification for small incision cataract surgery--an alternative to microscope magnification?

PubMed

Singh, S K; Winter, I; Hennig, A

2008-01-01

A Prospective randomized controlled study was conducted to compare outcome of Small Incision Cataract Surgery (SICS) using microscope or loupe magnification. Two hundred fifty one patient with mature cataract were randomly allocated to SICS-Fishhook Technique with either microscope (127 eyes) or loupe (124 eyes) magnification. Intra- and postoperative complications and immediate visual outcome were analyzed. Nearly two third (microscope 65% and magnifying loupe 62.9%) of all patients had good visual outcome on first postoperative day. Poor outcome (<6/60) was recorded in 8% (microscope group) and 7% (magnifying loupe group). Mean visual acuity with Snellen was 0.39 (SD 0.2) in microscope group and 0.38 (SD 0.2) in magnifying loupe group. Intra operative complications were comparable in both groups. Mean surgery time with loupe magnification was significantly shorter. Comparatively equivalent good surgical outcome was achieved with loupe as well as with microscope magnification. However performing SICS with loupe magnification is significantly faster. Small incision cataract surgery with loupe magnification is safe and effective procedure for cataract surgery so it can play a role in reducing cataract blindness in developing countries of the world.

Effect of anterior capsule contraction on visual function after cataract surgery.

PubMed

Hayashi, Ken; Hayashi, Hideyuki

2007-11-01

To examine the effect of contraction of the anterior capsule opening after cataract surgery on visual acuity and contrast sensitivity. Hayashi Eye Hospital, Fukuoka, Japan. Thirty-two eyes of 32 consecutive patients who showed marked contraction of the anterior capsule opening after implantation of an intraocular lens were recruited. The area of the anterior capsule opening was measured by Scheimpflug videophotography before and after neodymium:YAG (Nd:YAG) laser anterior capsulotomy and was correlated with visual acuity and contrast sensitivity. After Nd:YAG laser anterior capsulotomy, the mean area of the anterior capsule opening increased significantly from 8.2 mm(2) to 18.0 mm(2) (P<.0001). Contrast sensitivity at most visual angles also improved significantly after Nd:YAG anterior capsulotomy, although visual acuity did not. The area of the anterior capsule opening before anterior capsulotomy was correlated significantly with contrast sensitivity but not with visual acuity, whereas there was no correlation between the opening area after anterior capsulotomy and visual acuity or contrast sensitivity. Contraction of the anterior capsule opening after cataract surgery significantly diminished contrast sensitivity in proportion to the opening area but did not markedly worsen visual acuity. Neodymium:YAG laser anterior capsulotomy improved contrast sensitivity.

Visual outcome and impact on quality of life after surgeries differ in children operated for unilateral and bilateral cataract (Pune study 2011)

PubMed Central

Paryani, Mukesh; Khandekar, Rajiv B.; Dole, Kuldeep; Dharmadhikari, Sheetal; Rishikeshi, Nikhil

2012-01-01

Background: We compared vision and quality of life (VQL) of children aged 5-15 years and operated for unilateral and bilateral cataract between 2008 and 2010 in western India. Materials and Methods: In this cohort study, ophthalmologists assessed vision, anterior and posterior segment of eyes with cataract. Children completed a functional vision questionnaire (LVP-FVQ). Follow up at 6 months after surgery included the best corrected visual acuity (BCVA), FVQ and eye assessment. The improvement of BCVA and quality of life were compared in group of unilateral and bilateral cataract. Result: A total of 20 (70%) bilateral and 7 (39%) unilateral cataract were operated within 1 month of detection. All 48 eyes with bilateral cataract were congenital and 12 (67%) unilateral cataract were traumatic. Among bilateral group, 27 eyes [56.2% (95% confidence interval (CI) 44.4-72.2)] and in unilateral group 11 eyes [61.1% (95% CI 38.6-83.6)] had vision ≥ 20/60 at 6 months follow up. The visual gain was significantly higher in children who were operated between 1 month and 1 year of detection (adjusted Odds ratio (OR) = 15.6 P = 0.03). Positive impact on VQL in bilateral group was noted in 50%, 27%, and 13% children for subscale of distant vision, near vision, and field of vision, respectively. There was positive impact in these subscales among children with unilateral cataract. Thirty percent eyes with bilateral cataract and 22% of eyes with unilateral cataract improved their vision. Surgery within 1 month of cataract was significant predictor of improved vision (OR = 16.6 P = 0.02). Conclusion: Vision and VQL improved in children with unilateral and bilateral cataract. However, it was better 6 months following surgery in children with bilateral cataract than in children with unilateral cataract. PMID:23439722

[Analysis of the Effect of Non-phacoemulsification Cataract Operation on Corneal Endothelial Cell Nucleus Division].

PubMed

Huang, Zufeng; Miao, Xiaoqing

2015-09-01

To investigate the effect of non-phacoemulsification cataract operation in two different patterns of nucleus delivery on the quantity and morphology of corneal endothelial cells and postoperative visual acuity. Forty patients diagnosed with cataract underwent cataract surgery and were assigned into the direct nuclear delivery and semi-nuclear delivery groups. Lens density was measured and divided into the hard and soft lenses according to Emery-little lens nucleus grading system. Non-phacoemulsification cataract operation was performed. At 3 d after surgery, the quantity and morphology of corneal endothelium were counted and observed under corneal endothelial microscope. During 3-month postoperative follow-up, the endothelial cell loss rate, morphological changes and visual acuity were compared among four groups. Corneal endothelial cell loss rate in the direct delivery of hard nucleus group significantly differed from those in the other three groups before and 3 months after operation (P < 0.01), whereas no statistical significance was found among the direct delivery of soft nucleus, semi-delivery of hard nucleus and semi-delivery soft nucleus groups (all P > 0.05). Preoperative and postoperative 2-d visual acuity did not differ between the semi-delivery of hard nucleus and direct delivery of soft nucleus groups (P = 0.49), significantly differed from those in the semi-delivery of soft nucleus (P = 0.03) and direct delivery of hard nucleus groups (P = 0.14). Visual acuity at postoperative four months did not differ among four groups (P = 0.067). During non-phacoemulsification cataract surgery, direct delivery of hard nucleus caused severe injury to corneal endothelium and semi-delivery of soft nucleus yielded mild corneal endothelial injury. Slight corneal endothelial injury exerted no apparent effect upon visual acuity and corneal endothelial morphology at three months after surgery.

Functional and visual acuity outcomes of cataract surgery in Timor-Leste (East Timor).

PubMed

Naidu, Girish; Correia, Marcelino; Nirmalan, Praveen; Verma, Nitin; Thomas, Ravi

2014-12-01

To report functional outcomes following cataract surgery in Timor-Leste. Pre- and post-intervention study measuring visual function improvement following cataract surgery. Presenting visual acuity (VA) was measured and visual function documented using the Indian vision function questionnaire (IND-VFQ). All 174 persons undergoing cataract surgery from November 2009 to January 2011 in Timor-Leste were included. Mean age was 65.4 years; 113 (64.9%) were male, 143 (82.1%) were from a rural background and 151 (86.8%) were illiterate. Pre-operatively, 77 of 174 patients (44.3%, 95% confidence interval, CI, 37.0-51.7%) were blind (VA ≤3/60), 77 (44.3%, 95% CI 37.0-51.7%) were visually impaired (VA <6/18->3/60), while 20 (11.5%, 95% CI 7.4-16.9%) had presenting acuity ≥6/18 in the better eye. Following surgery, significant improvement in visual function was demonstrated by an effect size of 2.8, 3.7 and 3.9 in the domains of general functioning, psychosocial impact and visual symptoms, respectively. Four weeks following surgery, 85 patients (48.9%, 95% CI 41.5-66.3%) had a presenting VA ≥6/18, 74 (42.5%, 95% CI 35.3-45.9%) were visually impaired and 15 (8.6%, 95% CI 5.0-13.6%) were blind. IND-VFQ improvement occurred even in patients remaining visually impaired or blind following surgery. In this setting, cataract surgery led to a significant improvement in visual function but the VA results did not meet World Health Organization quality criteria. IND-VFQ results, although complementary to clinical VA outcomes did not, in isolation, reflect the need to improve program quality.

Do pattern deviation values accurately estimate glaucomatous visual field damage in eyes with glaucoma and cataract?

PubMed

Matsuda, Aya; Hara, Takeshi; Miyata, Kazunori; Matsuo, Hiroshi; Murata, Hiroshi; Mayama, Chihiro; Asaoka, Ryo

2015-09-01

To study the efficacy of pattern deviation (PD) values in the estimation of visual field compensating the influence of cataract in eyes with glaucoma. The study subjects comprised of 48 eyes of 37 glaucoma patients. Mean total deviation value (mTDs) on Humphrey Field Analyzer after cataract surgery was compared with mean PD (mPD) before the surgery. Visual field measurements were carried out ≤6 months before (VF(pre)) and following (VF(post)) successful cataract surgery. The difference between the mPD or mTD values in the VF(pre) and mTD values in the VF(post) (denoted as εmPD/ΔmTD) was calculated, and the influence of the extent of 'true' glaucomatous visual field damage or cataract (as represented by εmPD and ΔmTD, respectively) on this difference was also investigated. There was a significant difference between mTD in the VF(pre) and mTD in the VF(post) (p<0.001, repeated measures analysis of variance). There was not a significant difference between mPD in the VF(pre) and mTD in the VF(post) (p=0.06); however, εmPD was significantly correlated with the mTD in VF(post) and also ΔmTD (R(2)=0.56 and 0.27, p<0.001, Pearson's correlation). The accurate prediction of the mTD in the VF(post) can be achieved using the pattern standard deviation (PSD), mTD and also visual acuity before surgery. Clinicians should be very careful when reviewing the VF of a patient with glaucoma and cataract since PD values may underestimate glaucomatous VF damage in patients with advanced disease and also overestimate glaucomatous VF damage in patients with early to moderate cataract. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Prevalence and causes of blindness, low vision and status of cataract in 50 years and older citizen of Qatar-a community based survey.

PubMed

Al Gamra, Hamad; Al Mansouri, Fatima; Khandekar, Rajiv; Elshafei, Maha; Al Qahtani, Omar; Singh, Rajvir; Hashim, Shakeel P; Mujahed, Amjad; Makled, Alaa; Pai, Anant

2010-10-01

Rapid Assessment for the Avoidable Blindness (RAAB) was conducted in Qatar during 2009. We present the prevalence and determinants of visual disabilities and status of cataract among citizens aged 50 years and older. Residents of randomly selected houses and clusters participated in the survey. Opticians noted the presenting and the best corrected vision of participants from 49 clusters. Ophthalmologists examined participants with additional instruments like bio-microscope, digital camera, auto-perimeter and auto-refractor in a mobile van. World Health Organization recommended principal cause of blindness (Visual acuity [VA] < 3/60 in better eye), Severe visual impairment (SVI) (<6/60), low vision (VA < 6/18) and unilateral blindness (VA < 3/60) were designated. Persons with VA < 6/18 and cataract were interviewed to calculate coverage and barriers for cataract surgeries. Age sex adjusted prevalence of visual disabilities and their 95% Confidence Intervals (CI) were estimated. We examined 2,433 (97.3%) participants. The age sex adjusted prevalence of bilateral blindness was 1.28% [95% CI 1.22-1.35], SVI (1.67%), low vision (3.66%) and unilateral blindness (3.61%) in 50 years and older population. Female and older age groups were significant risk factors of visual disabilities. Cataract and glaucoma were the main causes of visual disabilities. The coverage of cataract services was 68.2%. Believing that cataract as an aging process (25) and adequate vision in the fellow eye (15) were the reasons for delay in surgery. To reduce avoidable blindness, un-operated cataract should be addressed. Primary and secondary eye care systems should be strengthened to improve the care of blinding eye diseases in Qatar.

Do older drivers with bilateral cataract self-regulate their driving while waiting for first eye cataract surgery?

PubMed Central

Agramunt, Seraina; Meuleners, Lynn B; Fraser, Michelle L; Chow, Kyle C; Ng, Jonathon Q; Raja, Vignesh; Morlet, Nigel

2017-01-01

Objectives To analyze the association between visual impairment and driver self-regulation among a cohort of older drivers waiting for first eye cataract surgery. Methods Ninety-six drivers with bilateral cataract aged 55+ years were assessed before first eye cataract surgery. Data collection consisted of a researcher-administered questionnaire, objective visual measures (visual acuity, contrast sensitivity and stereopsis), a visual attention test (the useful field of view test) and a cognitive test (the Mini-Mental State Examination). Driver self-regulation practices were collected using the Driving Habits Questionnaire and were also measured with an in-vehicle monitoring device. Characteristics of self-regulators and non-self-regulators were compared and a logistic regression model was used to examine the association between 3 objective visual measures and driver self-regulation status. Results After controlling for potential confounding factors, only binocular contrast sensitivity (p=0.01), age (p=0.03) and gender (p=0.03) were significantly associated with driver self-regulation status. The odds of participants with better contrast sensitivity scores (better vision) self-regulating their driving in at least 1 driving situation decreased (odds ratio [OR]: 0.01, 95% CI: 0.00–0.28) while those of increasing age reported an increased odds of self-regulating their driving (OR: 1.08, 95% CI: 1.01–1.15). The odds of males self-regulating their driving was decreased compared with females (OR: 0.28, 95% CI: 0.09–0.86). Conclusions Worse binocular contrast sensitivity scores, increasing age and being female were significantly associated with driver self-regulation. The study highlighted that while self-regulation was common among cataract patients, a proportion of those with poor vision did not self-regulate. Further research should determine how cataract patients could benefit from self-regulation strategies while waiting for cataract surgery. PMID:29184397

A multicenter study on the health-related quality of life of cataract patients: baseline data.

PubMed

Yamada, Masakazu; Mizuno, Yoshinobu; Miyake, Yozo

2009-09-01

This study examines the impact of cataracts on health-related quality of life (HR-QOL) and health events in the older population. The study population consisted of 439 unoperated cataract patients aged 60 years or older who visited any of the facilities affiliated with the Cataract Survey Group of the National Hospital Organization of Japan, which has been conducting a prospective multicenter cohort study on cataract patients. HR-QOL of the patients was assessed using the Japanese version of Visual Function Questionnaire-25 (VFQ-25) and the 8-Item Short-Form Health Survey (SF-8). The health condition and health events of the patients were also investigated. The average age of the 439 patients enrolled (126 men and 313 women) was 73.0 +/- 7.1 years. There were 323 patients with comorbidities (73.6%), 81 of whom (23.7%) felt it was hard to visit the hospital owing to their visual impairment. In the previous year, 74 patients (16.9%) had experienced a fall and 14 (3.2%) had been in a traffic accident. Of those, 43.2% and 8.3% respectively answered that the falls and the accident could have been triggered by their visual impairment. When the patients were classified according to visual acuity, most of the VFQ-25 subscale scores declined significantly with decreasing visual acuity, whereas the SF-8 scores showed no significant change. The participants of this study were patients with unoperated cataract, and thus the decline of HR-QOL was modest. The survey of health events, however, revealed that the visual constraint has a certain impact on the daily lives of the older population.

Outcome of in-the-bag implanted square-edge polymethyl methacrylate intraocular lenses with and without primary posterior capsulotomy in pediatric traumatic cataract

PubMed Central

Verma, Neelam; Ram, Jagat; Sukhija, Jaspreet; Pandav, Surinder S.; Gupta, Amit

2011-01-01

Purpose: To study the outcome of in-the-bag implanted square-edge polymethyl methacrylate (PMMA) intraocular lenses (IOL) with and without primary posterior capsulotomy in pediatric traumatic cataract. Materials and Methods: The study was undertaken in a tertiary care center. Thirty eyes of 30 children ranging in age from 4 to 16 years with traumatic cataract which underwent cataract extraction with capsular bag implantation of IOL were prospectively evaluated. Group A included 15 eyes of 15 children where primary posterior capsulotomy (PPC) and anterior vitrectomy with capsular bag implantation of square-edge PMMA IOL (Aurolab SQ3602, Madurai, Tamil Nadu, India) was performed. Group B comprised 15 eyes of 15 children in which the posterior capsule was left intact. Postoperative visual acuity, visual axis opacification (VAO) and possible complications were analyzed. Results: Best corrected visual acuity (BCVA) of 20/40 or better was achieved in 12 of 15 eyes in both groups. Amblyopia was the cause of no improvement in visual acuity in the remaining eyes. Visual axis opacification was significantly high in Group B as compared to Group A (P=0.001). Postoperative fibrinous uveitis occurred in most of the eyes in both groups. Pupillary capture was observed in one eye in each group. Conclusion: Primary posterior capsulotomy and anterior vitrectomy with capsular bag implantation of square-edge PMMA significantly helps to maintain a clear visual axis in children with traumatic cataract. PMID:21836338

The advanced glaucoma intervention study, 6: effect of cataract on visual field and visual acuity. The AGIS Investigators.

PubMed

2000-12-01

To investigate the effect of cataract on visual function and the role of cataract in explaining a race-treatment interaction in outcomes of glaucoma surgery. The Advanced Glaucoma Intervention Study (AGIS) enrolled 332 black patients (451 eyes) and 249 white patients (325 eyes) with advanced glaucoma. Eyes were randomly assigned to an argon laser trabeculoplasty (ALT)-trabeculectomy-trabeculectomy sequence or a trabeculectomy-ALT-trabeculectomy sequence. From the AGIS experience with cataract surgery during follow-up, we estimated the expected change in visual function scores from before cataract surgery to after cataract surgery. Then, for eyes with cataract not removed, we used these estimates of expected change to adjust visual function scores for the presumed effects of cataract. In turn, we used the adjusted scores to obtain cataract-adjusted main outcome measures. Average percent of eyes with decrease of visual field (APDVF) and average percent of eyes with decrease of visual acuity (APDVA). Within the 2 months before cataract surgery, visual acuity was better in eyes of white patients than of black patients by an average of approximately 2 lines on the visual acuity test chart. Cataract surgery improved visual acuity and visual field defect scores, with the amounts of improvement greater when preoperative visual acuity was lower. Adjustments for cataract brought about the following relative reductions: for APDVF, a relative reduction of 5% to 11% in black patients and 9% to 11% in white patients; for APDVA, a relative reduction of 45% to 49% in black patients and 31% to 38% in white patients; and for the APDVF and APDVA race-treatment interactions, relative reductions of 25% and 45%, respectively. On average, visual function scores improved after cataract surgery. The findings of reduced race-treatment interactions after adjustment for cataract do not alter our earlier conclusion that the AGIS 7-year results support use of the ALT-trabeculectomy-trabeculectomy sequence for black patients and of the trabeculectomy-ALT-trabeculectomy sequence for white patients without life-threatening health problems. The choice of treatment should take into account individual patient characteristics and needs.

Relationship between socioeconomic deprivation 
or urban/rural residence and visual acuity before cataract surgery in Northern Scotland.

PubMed

Chua, Paul Y; Mustafa, Mohammed S; Scott, Neil W; Kumarasamy, Manjula; Azuara-Blanco, Augusto

2013-01-01

To evaluate the influence of socioeconomic factors on visual acuity before cataract surgery. 
 The medical case notes of 240 consecutive patients listed for cataract surgery from January 1, 2010, at Grampian University Hospital, Aberdeen, were reviewed retrospectively. Patients with ocular comorbidity were excluded. Demographics, postal codes, and visual acuity were recorded. Scottish Index of Multiple Deprivation was used to determine the deprivation rank. Home location was classified as urban or rural. The effect of these parameters on preoperative visual acuity was investigated using chi-square tests or Fisher exact test as appropriate. 
 A total of 184 patients (mean 75 years) were included. A total of 127 (69%) patients had visual acuity of 6/12 or better. An association was found between affluence and preoperative visual acuity of 6/12 or better (χ2trend = 4.97, p = 0.03), with a significant rising trend across quintile of deprivation. There was no evidence to suggest association between geographical region and preoperative visual acuity (p = 0.63). 
 Affluence was associated with good visual acuity (6/12 or better) before cataract surgery. There was no difference in preoperative visual acuity between rural and urban populations.

Comparison of contact lens and intraocular lens correction of monocular aphakia during infancy: a randomized clinical trial of HOTV optotype acuity at age 4.5 years and clinical findings at age 5 years.

PubMed

Lambert, Scott R; Lynn, Michael J; Hartmann, E Eugenie; DuBois, Lindreth; Drews-Botsch, Carolyn; Freedman, Sharon F; Plager, David A; Buckley, Edward G; Wilson, M Edward

2014-06-01

The efficacy and safety of primary intraocular lens (IOL) implantation during early infancy is unknown. To compare the visual outcomes of patients optically corrected with contact lenses vs IOLs following unilateral cataract surgery during early infancy. The Infant Aphakia Treatment Study is a randomized clinical trial with 5 years of follow-up that involved 114 infants with unilateral congenital cataracts at 12 sites. A traveling examiner assessed visual acuity at age 4.5 years. Cataract surgery with or without primary IOL implantation. Contact lenses were used to correct aphakia in patients who did not receive IOLs. Treatment was determined through random assignment. HOTV optotype visual acuity at 4.5 years of age. The median logMAR visual acuity was not significantly different between the treated eyes in the 2 treatment groups (both, 0.90 [20/159]; P = .54). About 50% of treated eyes in both groups had visual acuity less than or equal to 20/200. Significantly more patients in the IOL group had at least 1 adverse event after cataract surgery (contact lens, 56%; IOL, 81%; P = .02). The most common adverse events in the IOL group were lens reproliferation into the visual axis, pupillary membranes, and corectopia. Glaucoma/glaucoma suspect occurred in 35% of treated eyes in the contact lens group vs 28% of eyes in the IOL group (P = .55). Since the initial cataract surgery, significantly more patients in the IOL group have had at least 1 additional intraocular surgery (contact lens, 21%; IOL, 72%; P < .001). There was no significant difference between the median visual acuity of operated eyes in children who underwent primary IOL implantation and those left aphakic. However, there were significantly more adverse events and additional intraoperative procedures in the IOL group. When operating on an infant younger than 7 months of age with a unilateral cataract, we recommend leaving the eye aphakic and focusing the eye with a contact lens. Primary IOL implantation should be reserved for those infants where, in the opinion of the surgeon, the cost and handling of a contact lens would be so burdensome as to result in significant periods of uncorrected aphakia. clinicaltrials.gov Identifier: NCT00212134

Visual field changes after cataract extraction: the AGIS experience.

PubMed

Koucheki, Behrooz; Nouri-Mahdavi, Kouros; Patel, Gitane; Gaasterland, Douglas; Caprioli, Joseph

2004-12-01

To test the hypothesis that cataract extraction in glaucomatous eyes improves overall sensitivity of visual function without affecting the size or depth of glaucomatous scotomas. Experimental study with no control group. One hundred fifty-eight eyes (of 140 patients) from the Advanced Glaucoma Intervention Study with at least two reliable visual fields within a year both before and after cataract surgery were included. Average mean deviation (MD), pattern standard deviation (PSD), and corrected pattern standard deviation (CPSD) were compared before and after cataract extraction. To evaluate changes in scotoma size, the number of abnormal points (P < .05) on the pattern deviation plot was compared before and after surgery. We described an index ("scotoma depth index") to investigate changes of scotoma depth after surgery. Mean values for MD, PSD, and CPSD were -13.2, 6.4, and 5.9 dB before and -11.9, 6.8, and 6.2 dB after cataract surgery (P < or = .001 for all comparisons). Mean (+/- SD) number of abnormal points on pattern deviation plot was 26.7 +/- 9.4 and 27.5 +/- 9.0 before and after cataract surgery, respectively (P = .02). Scotoma depth index did not change after cataract extraction (-19.3 vs -19.2 dB, P = .90). Cataract extraction caused generalized improvement of the visual field, which was most marked in eyes with less advanced glaucomatous damage. Although the enlargement of scotomas was statistically significant, it was not clinically meaningful. No improvement of sensitivity was observed in the deepest part of the scotomas.

Coverage of hospital-based cataract surgery and barriers to the uptake of surgery among cataract blind persons in nigeria: the Nigeria National Blindness and Visual Impairment Survey.

PubMed

Abubakar, Tafida; Gudlavalleti, Murthy V S; Sivasubramaniam, Selvaraj; Gilbert, Clare E; Abdull, Mohammed M; Imam, Abdullahi U

2012-04-01

To determine cataract surgical coverage, and barriers to modern cataract surgery in Nigeria. Multistage stratified cluster random sampling was used to identify a nationally representative sample of 15,027 persons aged 40+ years. All underwent visual acuity testing, frequency doubling technology visual field testing, autorefraction, and measurement of best corrected vision if <6/12 in one or both eyes. An ophthalmologist examined the anterior segment and fundus through an undilated pupil for all participants. Participants were examined by a second ophthalmologist using a slit lamp and dilated fundus examination using a 90 diopter condensing lens if vision was <6/12 in one or both eyes, there were optic disc changes suggestive of glaucoma, and 1 in 7 participants regardless of findings. All those who had undergone cataract surgery were asked where and when this had taken place. Individuals who were severely visually impaired or blind from unoperated cataract were asked to explain why they had not undergone surgery. A total of 13,591 participants were examined (response rate 89.9%). Prevalence of cataract surgery was 1.6% (95% confidence interval 1.4-1.8), significantly higher among those aged ≥70 years. Cataract surgical coverage (persons) in Nigeria was 38.3%. Coverage was 1.7 times higher among males than females. Coverage was only 9.1% among women in the South-South geopolitical zone. Over one third of those who were cataract blind said they could not afford surgery (36%). Cataract surgical coverage in Nigeria was among the lowest in the world. Urgent initiatives are necessary to improve surgical output and access to surgery.

Bilateral nanophthalmos and pigmentary retinal dystrophy--an unusual syndrome.

PubMed

Proença, Helena; Castanheira-Dinis, A; Monteiro-Grillo, M

2006-09-01

To report the clinical picture of the rare association of nanophthalmos and pigmentary retinal dystrophy and its cataract surgery outcome. We report a case of a 60-year-old female who presented with bilateral slowly progressive visual loss. The patient presented with bilateral light perception visual acuity, exotropia, brunescent cataract hindering fundus examination and hypodontia. Ultrasonography revealed bilateral nanophthalmos. A visual-evoked potential was also performed preoperatively. Cataract surgery with +40D IOL implantation was uneventful. Postoperative fundus examination revealed pigmentary retinal dystrophy, confirmed by electrophysiologic tests. Glycosaminoglycan urinary excretion was normal. Congenital bilateral nanophthalmos may rarely be associated with pigmentary retinal dystrophy. We suggest thorough preoperative evaluation in nanophthalmic eyes for the exclusion of significant features concerning visual prognosis.

Number of People Blind or Visually Impaired by Cataract Worldwide and in World Regions, 1990 to 2010.

PubMed

Khairallah, Moncef; Kahloun, Rim; Bourne, Rupert; Limburg, Hans; Flaxman, Seth R; Jonas, Jost B; Keeffe, Jill; Leasher, Janet; Naidoo, Kovin; Pesudovs, Konrad; Price, Holly; White, Richard A; Wong, Tien Y; Resnikoff, Serge; Taylor, Hugh R

2015-10-01

To estimate prevalence and number of people visually impaired or blind due to cataract. Based on the Global Burden of Diseases Study 2010 and ongoing literature research, we examined how many people were affected by moderate to severe vision impairment (MSVI; presenting visual acuity <6/18, ≥3/60) and blindness (presenting visual acuity <3/60) due to cataract. In 2010, of overall 32.4 million blind and 191 million vision impaired, 10.8 million people were blind and 35.1 million were visually impaired due to cataract. Cataract caused worldwide 33.4% of all blindness in 2010, and 18.4% of all MSVI. These figures were lower in the high-income regions (<15%) and higher (>40%) in South and Southeast Asia and Oceania. From 1990 to 2010, the number of blind or visually impaired due to cataract decreased by 11.4% and by 20.2%, respectively; the age-standardized global prevalence of cataract-related blindness and MSVI reduced by 46% and 50%, respectively, and the worldwide crude prevalence of cataract-related blindness and MSVI reduced by 32% and 39%, respectively. The percentage of global blindness and MSVI caused by cataract decreased from 38.6% to 33.4%, and from 25.6% to 18.4%, respectively. This decrease took place in almost all world regions, except East Sub-Saharan Africa. In 2010, one in three blind people was blind due to cataract, and one of six visually impaired people was visually impaired due to cataract. Despite major improvements in terms of reduction of prevalence, cataract remains a major public health problem.

Cataract Surgery Outcomes in Uveitis: The Multicenter Uveitis Steroid Treatment Trial.

PubMed

Sen, H Nida; Abreu, Francis M; Louis, Thomas A; Sugar, Elizabeth A; Altaweel, Michael M; Elner, Susan G; Holbrook, Janet T; Jabs, Douglas A; Kim, Rosa Y; Kempen, John H

2016-01-01

To assess the visual outcomes of cataract surgery in eyes that received fluocinolone acetonide implant or systemic therapy with oral corticosteroids and immunosuppression during the Multicenter Uveitis Steroid Treatment (MUST) Trial. Nested prospective cohort study of patients enrolled in a randomized clinical trial. Patients that underwent cataract surgery during the first 2 years of follow-up in the MUST Trial. Visual outcomes of cataract surgery were evaluated 3, 6, and 9 months after surgery using logarithmic visual acuity charts. Change in visual acuity over time was assessed using a mixed-effects model. Best-corrected visual acuity. After excluding eyes that underwent cataract surgery simultaneously with implant surgery, among the 479 eyes in the MUST Trial, 117 eyes (28 eyes in the systemic, 89 in the implant group) in 82 patients underwent cataract surgery during the first 2 years of follow-up. Overall, visual acuity increased by 23 letters from the preoperative visit to the 3-month visit (95% confidence interval [CI], 17-29 letters; P < 0.001) and was stable through 9 months of follow-up. Eyes presumed to have a more severe cataract, as measured by inability to grade vitreous haze, gained an additional 42 letters (95% CI, 34-56 letters; P < 0.001) beyond the 13-letter gain in eyes that had gradable vitreous haze before surgery (95% CI, 9-18 letters; P < 0.001) 3 months after surgery, making up for an initial difference of -45 letters at the preoperative visit (95% CI, -56 to -34 letters; P < 0.001). Black race, longer time from uveitis onset, and hypotony were associated with worse preoperative visual acuity (P < 0.05), but did not affect postsurgical recovery (P > 0.05, test of interaction). After adjusting for other risk factors, there was no significant difference in the improvement in visual acuity between the 2 treatment groups (implant vs. systemic therapy, 2 letters; 95% CI, -10 to 15 letters; P = 0.70). Cataract surgery resulted in substantial, sustained, and similar visual acuity improvement in the eyes of patients with uveitis treated with the fluocinolone acetonide implant or standard systemic therapy. Published by Elsevier Inc.

Association between visual impairment and patient-reported visual disability at different stages of cataract surgery.

PubMed

Acosta-Rojas, E Ruthy; Comas, Mercè; Sala, Maria; Castells, Xavier

2006-10-01

To evaluate the association between visual impairment (visual acuity, contrast sensitivity, stereopsis) and patient-reported visual disability at different stages of cataract surgery. A cohort of 104 patients aged 60 years and over with bilateral cataract was assessed preoperatively, after first-eye surgery (monocular pseudophakia) and after second-eye surgery (binocular pseudophakia). Partial correlation coefficients (PCC) and linear regression models were calculated. In patients with bilateral cataracts, visual disability was associated with visual acuity (PCC = -0.30) and, to a lesser extent, with contrast sensitivity (PCC = 0.16) and stereopsis (PCC = -0.09). In monocular and binocular pseudophakia, visual disability was more strongly associated with stereopsis (PCC = -0.26 monocular and -0.51 binocular) and contrast sensitivity (PCC = 0.18 monocular and 0.34 binocular) than with visual acuity (PCC = -0.18 monocular and -0.18 binocular). Visual acuity, contrast sensitivity and stereopsis accounted for between 17% and 42% of variance in visual disability. The association of visual impairment with patient-reported visual disability differed at each stage of cataract surgery. Measuring other forms of visual impairment independently from visual acuity, such as contrast sensitivity or stereopsis, could be important in evaluating both needs and outcomes in cataract surgery. More comprehensive assessment of the impact of cataract on patients should include measurement of both visual impairment and visual disability.

6th Yahya Cohen Lecture: visual experience during cataract surgery.

PubMed

Au Eong, K G

2002-09-01

The visual sensations many patients experience during cataract surgery under local anaesthesia have received little attention until recently. This paper reviews the recent studies on this phenomenon, discusses its clinical significance and suggests novel approaches to reduce its negative impact on the surgery. Literature review. Many patients who have cataract surgery under retrobulbar, peribulbar or topical anaesthesia experience a variety of visual sensations in their operated eye during surgery. These visual sensations include perception of light, movements, flashes, one or more colours, surgical instruments, the surgeon's hand/fingers, the surgeon and changes in light brightness. Some patients experience transient no light perception, even if the operation is performed under topical anaesthesia. The clinical significance of this phenomenon lies in the fact that approximately 7.1% to 15.4% of patients find their visual experience frightening. This fear and anxiety may cause some patients to become uncooperative during surgery and trigger a sympathetic surge, causing such undesirable effects as hypertension, tachycardia, ischaemic strain on the heart, hyperventilation and acute panic attack. Several approaches to reduce the negative impact of patients' visual experience are suggested, including appropriate preoperative counselling and reducing the ability of patients to see during surgery. The findings that some patients find their intraoperative visual experience distressing have a major impact on the way ophthalmologists manage their cataract patients. To reduce its negative impact, surgeons should consider incorporating appropriate preoperative counselling on potential intraoperative visual experience when obtaining informed consent for surgery.

Impact of cataract surgery in reducing visual impairment: a review.

PubMed

Khandekar, Rajiv; Sudhan, Anand; Jain, B K; Deshpande, Madan; Dole, Kuldeep; Shah, Mahul; Shah, Shreya

2015-01-01

The aim was to assess the impact of cataract surgeries in reducing visual disabilities and factors influencing it at three institutes of India. A retrospective chart review was performed in 2013. Data of 4 years were collected on gender, age, residence, presenting a vision in each eye, eye that underwent surgery, type of surgery and the amount the patient paid out of pocket for surgery. Visual impairment was categorized as; absolute blindness (no perception of light); blind (<3/60); severe visual impairment (SVI) (<6/60-3/60); moderate visual impairment (6/18-6/60) and; normal vision (≥6/12). Statistically analysis was performed to evaluate the association between visual disabilities and demographics or other possible barriers. The trend of visual impairment over time was also evaluated. We compared the data of 2011 to data available about cataract cases from institutions between 2002 and 2009. There were 108,238 cataract cases (50.6% were female) that underwent cataract surgery at the three institutions. In 2011, 71,615 (66.2%) cases underwent surgery. There were 45,336 (41.9%) with presenting vision < 3/60 and 75,393 (69.7%) had SVI in the fellow eye. Blindness at presentation for cataract surgery was associated to, male patients, Institution 3 (Dristi Netralaya, Dahod) surgeries after 2009, cataract surgeries without Intra ocular lens implant implantation, and patients paying <25 US $ for surgery. Predictors of SVI at time of cataract surgery were, male, Institution 3 (OM), phaco surgeries, those opting to pay 250 US $ for cataract surgeries. Patients with cataract seek eye care in late stages of visual disability. The goal of improving vision related quality of life for cataract patients during the early stages of visual impairment that is common in industrialized countries seems to be non-attainable in the rural India.

Reduced adaptability, but no fundamental disruption, of norm-based face coding following early visual deprivation from congenital cataracts.

PubMed

Rhodes, Gillian; Nishimura, Mayu; de Heering, Adelaide; Jeffery, Linda; Maurer, Daphne

2017-05-01

Faces are adaptively coded relative to visual norms that are updated by experience, and this adaptive coding is linked to face recognition ability. Here we investigated whether adaptive coding of faces is disrupted in individuals (adolescents and adults) who experience face recognition difficulties following visual deprivation from congenital cataracts in infancy. We measured adaptive coding using face identity aftereffects, where smaller aftereffects indicate less adaptive updating of face-coding mechanisms by experience. We also examined whether the aftereffects increase with adaptor identity strength, consistent with norm-based coding of identity, as in typical populations, or whether they show a different pattern indicating some more fundamental disruption of face-coding mechanisms. Cataract-reversal patients showed significantly smaller face identity aftereffects than did controls (Experiments 1 and 2). However, their aftereffects increased significantly with adaptor strength, consistent with norm-based coding (Experiment 2). Thus we found reduced adaptability but no fundamental disruption of norm-based face-coding mechanisms in cataract-reversal patients. Our results suggest that early visual experience is important for the normal development of adaptive face-coding mechanisms. © 2016 John Wiley & Sons Ltd.

Causes of blindness and visual impairment in Pakistan. The Pakistan national blindness and visual impairment survey

PubMed Central

Dineen, B; Bourne, R R A; Jadoon, Z; Shah, S P; Khan, M A; Foster, A; Gilbert, C E; Khan, M D

2007-01-01

Objective To determine the causes of blindness and visual impairment in adults (⩾30 years old) in Pakistan, and to explore socio‐demographic variations in cause. Methods A multi‐stage, stratified, cluster random sampling survey was used to select a nationally representative sample of adults. Each subject was interviewed, had their visual acuity measured and underwent autorefraction and fundus/optic disc examination. Those with a visual acuity of <6/12 in either eye underwent a more detailed ophthalmic examination. Causes of visual impairment were classified according to the accepted World Health Organization (WHO) methodology. An exploration of demographic variables was conducted using regression modeling. Results A sample of 16 507 adults (95.5% of those enumerated) was examined. Cataract was the most common cause of blindness (51.5%; defined as <3/60 in the better eye on presentation) followed by corneal opacity (11.8%), uncorrected aphakia (8.6%) and glaucoma (7.1%). Posterior capsular opacification accounted for 3.6% of blindness. Among the moderately visually impaired (<6/18 to ⩾6/60), refractive error was the most common cause (43%), followed by cataract (42%). Refractive error as a cause of severe visual impairment/blindness was significantly higher in rural dwellers than in urban dwellers (odds ratio (OR) 3.5, 95% CI 1.1 to 11.7). Significant provincial differences were also identified. Overall we estimate that 85.5% of causes were avoidable and that 904 000 adults in Pakistan have cataract (<6/60) requiring surgical intervention. Conclusions This comprehensive survey provides reliable estimates of the causes of blindness and visual impairment in Pakistan. Despite expanded surgical services, cataract still accounts for over half of the cases of blindness in Pakistan. One in eight blind adults has visual loss from sequelae of cataract surgery. Services for refractive errors need to be further expanded and integrated into eye care services, particularly those serving rural populations. PMID:17229806

Long term outcomes of bilateral congenital and developmental cataracts operated in Maharashtra, India. Miraj pediatric cataract study III.

PubMed

Gogate, Parikshit M; Sahasrabudhe, Mohini; Shah, Mitali; Patil, Shailbala; Kulkarni, Anil N; Trivedi, Rupal; Bhasa, Divya; Tamboli, Rahin; Mane, Rekha

2014-02-01

To study long term outcome of bilateral congenital and developmental cataract surgery. 258 pediatric cataract operated eyes of 129 children. Children who underwent pediatric cataract surgery in 2004-8 were traced and examined prospectively in 2010-11. Demographic and clinical factors were noted from retrospective chart readings. All children underwent visual acuity estimation and comprehensive ocular examination in a standardized manner. L. V. Prasad Child Vision Function scores (LVP-CVF) were noted for before and after surgery. Statistical analysis was done with SPSS version 16 including multi-variate analysis. Children aged 9.1 years (std dev 4.6, range 7 weeks-15 years) at the time of surgery. 74/129 (57.4%) were boys. The average duration of follow-up was 4.4 years (stddev 1.6, range 3-8 years). 177 (68.6%) eyes had vision <3/60 before surgery, while 109 (42.2%) had best corrected visual acuity (BCVA) >6/18 and 157 (60.9%) had BCVA >6/60 3-8 years after surgery. 48 (37.2%) had binocular stereoacuity <480 sec of arc by TNO test. Visual outcome depended on type of cataract (P = 0.004), type of cataract surgery (P < 0.001), type of intra-ocular lens (P = 0.05), age at surgery (P = 0.004), absence of post-operative uveitis (P = 0.01) and pre-operative vision (P < 0.001), but did not depend on delay (0.612) between diagnosis and surgery. There was a statistically significant improvement for all the 20 questions of the LVP-CVF scale (P < 0.001). Pediatric cataract surgery improved the children's visual acuity, stereo acuity and vision function. Developmental cataract, use of phacoemulsification, older children and those with better pre-operative vision had betterlong-termoutcomes.

Outcomes of and barriers to cataract surgery in Sao Paulo State, Brazil.

PubMed

de Almeida Ferreira, Gabriel; Schaal, Luisa Fioravanti; Ferro, Marcela Dadamos; Rodrigues, Antonio Carlos Lottelli; Khandekar, Rajiv; Schellini, Silvana Artioli

2017-12-22

Cataract is the leading cause of blindness in developing countries and identification of the barriers to accessing treatment is essential for developing appropriate public healthcare interventions. To evaluate the barriers to cataract surgery after diagnosis and assess the postoperative outcomes in Sao Paolo State, Brazil. This prospective study evaluated cataract patients from 13 counties in São Paulo State in 2014. Cataract was diagnosed in the community by a mobile ophthalmic unit and patients were referred to a hospital for management. Gender, age, distance to the hospital and local municipal health structure were evaluated as possible barriers. Data were analyzed for postoperative outcomes and the impact on blindness and visual impairment. Six hundred patients were diagnosed with cataract with a mean age of 68.8±10.3 years and 374 (62.3%) were females. Two hundred and fifty-four (42.3%) patients presented to the referral hospital. One hundred forty-four (56.7%) underwent surgery, 56 (22.0%) decided not to undergo surgery, 40 (15.7%) required only YAG-Laser and 14 (5.5%) required a spectacle prescription only. Visual acuity increased statistically significantly from 1.07±0.73 logMAR at presentation to 0.25±0.41 logMAR at the final visit after intraocular lens implantation (p=0.000). There was a statistically significantly decrease from 17 (11.8%) blind patients and 55 (38.2%) visually impaired patients at presentation to 2 (1.4%) and 5 (3.5%) patients respectively after treatment (p=0.000). Less than half of the individuals with cataract presented to the hospital for surgery. Among the patients who underwent treatment, there was an overall decrease in the number of blind individuals and visually impaired individuals. The barriers to cataract surgery were older age, greater distance to the hospital, municipalities with fewer inhabitants and less ophthalmic services.

Functional Visual Improvement After Cataract Surgery in Eyes With Age-Related Macular Degeneration: Results of the Ophthalmic Surgical Outcomes Data Project.

PubMed

Stock, Michael V; Vollman, David E; Baze, Elizabeth F; Chomsky, Amy S; Daly, Mary K; Lawrence, Mary G

2015-04-01

To determine if cataract surgery on eyes with AMD confers as much functional visual improvement as surgery on eyes without retinal pathology. This is a retrospective analysis of 4924 cataract surgeries from the Veterans Healthcare Administration Ophthalmic Surgical Outcomes Data Project (OSOD). We included cases of eyes with AMD that had both preoperative and postoperative NEI-VFQ-25 questionnaires submitted and compared their outcomes with controls without retinal pathology. We excluded patients with other retinal pathologies (740 patients). The analyses compared changes in visual acuity and overall functional visual improvement and its subscales using t-tests, multivariate logistic regressions, and linear regression modeling. Preoperative and postoperative questionnaires were submitted by 58.3% of AMD and 63.8% of no retinal pathology cases (controls). Analysis of overall score showed that cataract surgery on eyes with AMD led to increased visual function (13.8 ± 2.4 NEI-VFQ units, P < 0.0001); however, increases were significantly less when compared with controls (-6.4 ± 2.9 NEI-VFQ units, P < 0.0001). Preoperative best-corrected visual acuity (preBCVA) in AMD was predictive of postoperative visual function (r = -0.38, P < 0.0001). In controls, postoperative visual function was only weakly associated with preBCVA (r = -0.075, P = 0.0002). Patients with AMD with vision of 20/40 or better had overall outcomes similar to controls (-2.2 ± 4.7 NEI-VFQ units, P = 0.37). Cataract surgery on eyes with AMD offers an increase in functional visual improvement; however, the amount of benefit is associated with the eye's preBCVA. For eyes with preBCVA of 20/40 or greater, the improvement is similar to that of patients without retinal pathology. However, if preBCVA is less than 20/40, the amount of improvement was shown to be significantly less and decreased with decreasing preBCVA.

A comparison between patients with epiphora and cataract of the activity limitations they experience in daily life due to their visual disability.

PubMed

Bohman, Elin; Wyon, Maria; Lundström, Mats; Dafgård Kopp, Eva

2018-02-01

The objective of this study was to compare patients with epiphora and cataract in terms of the activity limitations they experience in daily life due to their visual disability and to validate the use of the Catquest-9SF questionnaire for epiphora patients. Seventy-two consecutively encountered adult patients with confirmed lacrimal obstruction and listed for dacryocystorhinostomy (DCR) or lacrimal intubation at the St. Erik Eye Hospital, Stockholm, Sweden, completed the Catquest-9SF questionnaire, which measures activity limitations in daily life due to visual disability. The psychometric qualities of the Catquest-9SF results obtained from this group of patients were evaluated by Rasch analysis. Rasch analysis was further employed to convert the ordinal raw data to a Rasch score for comparison with the preoperative scores of patients registered in the Swedish National Cataract Register (NCR) during March 2013. The Catquest-9SF exhibited good psychometric qualities when investigating epiphora patients, with the exception of a misfit for Item 4, the item regarding facial recognition. On the Rasch scale (-5.43 = no activity limitations to +5.01 = severe activity limitations), the mean score for epiphora patients was -0.82 while for patients listed for 1st eye and 2nd eye cataract surgery it was -0.17 and -0.76, respectively. An equivalence test confirmed that the reported visual disability of epiphora patients was not significantly different from visual disability reported by patients waiting for 2nd eye cataract surgery. The Catquest-9SF is a valid measure of visual disability in patients with epiphora. Epiphora patients experience visual disability to the same degree as patients awaiting 2nd eye cataract surgery. © 2017 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Interface Fluid Syndrome After Laser In Situ Keratomileusis (LASIK) Because of Fuchs Endothelial Dystrophy Reversed by Descemet Membrane Endothelial Keratoplasty (DMEK).

PubMed

Luceri, Salvatore; Baksoellah, Zainab; Ilyas, Abbas; Baydoun, Lamis; Melles, Gerrit R J

2016-12-01

To describe a case that developed "interface fluid syndrome" after previous laser in situ keratomileusis (LASIK) because of Fuchs endothelial dystrophy (FED), which was reversed by Descemet membrane endothelial keratoplasty (DMEK). A 58-year-old male patient presented with bilateral visual impairment owing to FED and visually significant cataract. Cataract surgery was carried out in both eyes followed by DMEK in his left eye. After cataract surgery, visual acuity did not improve sufficiently because corneal thickness increased and a fine cleft with interface fluid developed between the LASIK-flap and the residual stromal bed. After uneventful DMEK in his left eye, the fluid resolved within a week and visual acuity improved rapidly. This case demonstrates that "interface fluid syndrome" after LASIK caused by concomitant endothelial dysfunction may be reversed by DMEK allowing fast visual recovery.

Measuring outcomes of cataract surgery using the Quality of Well-Being Scale and VF-14 Visual Function Index.

PubMed

Rosen, Peter N; Kaplan, Robert M; David, Kristen

2005-02-01

To evaluate the validity and responsiveness of the self-administered Quality of Well-Being Scale (QWB-SA) and the 14-item Visual Function Index (VF-14) to assess patients having cataract surgery. Large Southern California health maintenance organization. This study comprised 233 adults who had uneventful small-incision (< 3.0 mm) phacoemulsification cataract extraction under local anesthesia. Patients were assessed before surgery as well as 4 to 6 weeks and 4 months after surgery using the QWB-SA and the VF-14. Postoperatively, patients reported significant improvements on QWB-SA (P < .005) and VF-14 (P < .001) measures. Those grouped by visual acuity in the operated eye and unoperated eye and first-eye surgery or second-eye surgery had significant changes in VF-14 results (P < .001). Improvements on the QWB-SA were significant except when the preoperative visual acuity was better than 20/40 in the operated eye or 20/50 in the unoperated eye and when patients had first-eye surgery. The vision-specific VF-14 was more sensitive to improvements after surgery than the more general QWB-SA. Both demonstrated a greater magnitude of change with lower baseline scores and correlated significantly with self-reported satisfaction and trouble with vision. Both the utility-based generic QWB-SA and disease-specific VF-14 profile were responsive to changes in quality of life after cataract surgery. The VF-14 was more sensitive to change but cannot be used for comparison across disease states or for policy analysis. The QWB-SA can be used to estimate the cost/utility of cataract surgery.

Visual function and quality of life among visually impaired and cataract operated adults. The Pakistan National Blindness and Visual Impairment Survey.

PubMed

Taylor, Amy E; Shah, Shaheen P; Gilbert, Clare E; Jadoon, Mohammad Z; Bourne, Rupert R A; Dineen, Brendan; Johnson, Gordon J; Khan, Mohammad D

2008-01-01

To assess visual functioning and quality of life in a representative sample of normally sighted, visually impaired and cataract operated individuals aged >or= 30 years in Pakistan. As part of the Pakistan National Blindness and Visual Impairment Survey, visual functioning (VF) and quality of life (QOL) questionnaires were administered to participants with presenting visual acuity less than 6/60 in either eye, aphakes/pseudophakes and a phakic sample with normal acuity (>or= 6/12 both eyes). Of 16,507 adults included in the survey, 2329 questionnaires were administered. There were strong correlations between visual acuity and VF/QOL. Mean VF and median QOL scores in normally sighted phakic individuals were 81.1 and 88.9, respectively, but were only 34.8 and 64.9 in blind unoperated individuals. In the cataract operated population overall mean VF and median QOL scores were 49.3 and 75.0. Both VF and QOL scores were lower in operated individuals than unoperated individuals (p < 0.001). Among operated individuals, rural dwelling and illiteracy were associated with lower VF and QOL scores (p all < 0.02). Although in multivariable analysis bilateral pseudophakes had similar VF scores to bilateral aphakes they had significantly better QOL scores (p = 0.001). Cataract surgery in Pakistan has not led to VF and QOL scores equivalent to those in unoperated individuals with the same levels of visual acuity. The higher proportion of intraocular lens surgery in recent years is likely to improve QOL following cataract surgery. Further focus is needed on rural and illiterate populations, to ensure that they achieve comparable VF/QOL outcomes following surgery.

Impact of Oncoming Headlight Glare With Cataracts: A Pilot Study

PubMed Central

Hwang, Alex D.; Tuccar-Burak, Merve; Goldstein, Robert; Peli, Eli

2018-01-01

Purpose: Oncoming headlight glare (HLG) reduces the visibility of objects on the road and may affect the safety of nighttime driving. With cataracts, the impact of oncoming HLG is expected to be more severe. We used our custom HLG simulator in a driving simulator to measure the impact of HLG on pedestrian detection by normal vision subjects with simulated mild cataracts and by patients with real cataracts. Methods: Five normal vision subjects drove nighttime scenarios under two HLG conditions (with and without HLG: HLGY and HLGN, respectively), and three vision conditions (with plano lens, simulated mild cataract, and optically blurred clip-on). Mild cataract was simulated by applying a 0.8 Bangerter diffusion foil to clip-on plano lenses. The visual acuity with the optically blurred lenses was individually chosen to match the visual acuity with the simulated cataract clip-ons under HLGN. Each nighttime driving scenario contains 24 pedestrian encounters, encompassing four pedestrian types; walking along the left side of the road, walking along the right side of the road, crossing the road from left to right, and crossing the road from right to left. Pedestrian detection performances of five patients with mild real cataracts were measured using the same setup. The cataract patients were tested only in HLGY and HLGN conditions. Participants’ visual acuity and contrast sensitivity were also measured in the simulator with and without stationary HLG. Results: For normal vision subjects, both the presence of oncoming HLG and wearing the simulated cataract clip-on reduced pedestrian detection performance. The subjects performed worst in events where the pedestrian crossed from the left, followed by events where the pedestrian crossed from the right. Significant interactions between HLG condition and other factors were also found: (1) the impact of oncoming HLG with the simulated cataract clip-on was larger than with the plano lens clip-on, (2) the impact of oncoming HLG was larger with the optically blurred clip-on than with the plano lens clip-on, but smaller than with the simulated cataract clip-on, and (3) the impact was larger for the pedestrians that crossed from the left than those that crossed from the right, and for the pedestrians walking along the left side of the road than walking along the right side of the road, suggesting that the pedestrian proximity to the glare source contributed to the performance reduction. Under HLGN, almost no pedestrians were missed with the plano lens or the simulated cataract clip-on (0 and 0.5%, respectively), but under HLGY, the rate of pedestrian misses increased to 0.5 and 6%, respectively. With the optically blurred clip-on, the percent of missed pedestrians under HLGN and HLGY did not change much (5% and 6%, respectively). Untimely response rate increased under HLGY with the plano lens and simulated cataract clip-ons, but the increase with the simulated cataract clip-on was significantly larger than with the plano lens clip-on. The contrast sensitivity with the simulated cataract clip-on was significantly degraded under HLGY. The visual acuity with the plano lens clip-on was significantly improved under HLGY, possibly due to pupil myosis. The impact of HLG measured for real cataract patients was similar to the impact on performance of normal vision subjects with simulated cataract clip-ons. Conclusion: Even with mild (simulated or real) cataracts, a substantial negative effect of oncoming HLG was measurable in the detection of crossing and walking-along pedestrians. The lowered pedestrian detection rates and longer response times with HLGY demonstrate a possible risk that oncoming HLG poses to patients driving with cataracts. PMID:29559933

Patient considerations in cataract surgery - the role of combined therapy using phenylephrine and ketorolac.

PubMed

Gonzalez-Salinas, Roberto; Guarnieri, Adriano; Guirao Navarro, María Concepción; Saenz-de-Viteri, Manuel

2016-01-01

Cataract, a degradation of the optical quality of the crystalline lens, progressive and age-related, is the leading cause of treatable blindness worldwide. Cataract surgery is the most common surgical procedure performed by ophthalmologists and is the only effective treatment for cataracts. Advances in the surgical techniques and better postoperative visual outcomes have progressively changed the primary concern of cataract surgery to become a procedure refined to yield the best possible refractive results. Sufficient mydriasis during cataract removal is critical to a successful surgical outcome. Poor pupil dilation can lead to serious sight-threatening complications that significantly increase the cost of surgery and decrease patients comfort. Mydriasis is obtained using anticholinergic and sympathomimetic drugs. Phenylephrine, an α1-adrenergic receptor agonist, can efficiently dilate the pupil when administered by intracameral injection. Additionally, nonsteroidal anti-inflammatory drugs (NSAIDs) like ketorolac, which inhibit the synthesis of prostaglandins, are used to decrease intraoperative miosis, control pain and inflammation associated with cataract surgery, and to prevent the development of cystoid macular edema following surgery. Recently, a new combination of phenylephrine and ketorolac (Omidria ® ) has been approved by United States Food and Drug Administration for use during cataract surgery to maintain intraoperative mydriasis, prevent miosis, and reduce postoperative pain and inflammation. Clinical trials have shown that this new combination is effective, combining the positive effects of both drugs with a good safety profile and patient tolerability. Moreover, recent reports suggest that this combination is also effective in patients with high risk of poor pupil dilation. In conclusion, cataract is a global problem that significantly affects patients' quality of life. However, they can be managed with a safe and minimally invasive surgery. Advances in surgical techniques and newer pharmacological agents such as the combination of phenylephrine and ketorolac, together with better intraocular lenses, have greatly improved visual outcomes and thus patients' expectations regarding visual recovery are also increasing.

Factors Associated with Complications and Postoperative Visual Outcomes of Cataract Surgery; a Study of 1,632 Cases

PubMed Central

Thanigasalam, Thevi; Reddy, Sagili Chandrashekara; Zaki, Rafdzah Ahmad

2015-01-01

Purpose: Cataract surgery is the most common intraocular surgery performed all over the world and has advanced technically in recent years. As in all surgeries, complications are unavoidable. Herein we report factors associated with complications and visual outcomes of cataract surgery. Methods: This retrospective cohort study included data of 1,632 cataract surgeries performed from 2007 to 2010 which was obtained from the cataract registry of the Malaysian National Eye Database. Demographic features, ocular and systemic comorbidites, grade of surgeon expertise and duration of surgery, type of anesthesia, intraoperative and postoperative complications, and the type of intraocular lens were recorded. Best corrected visual acuities were compared before and after the operation. Results: Mean patient age was 66.9 years with equal gender distribution. The majority of subjects had age related cataracts. Phacoemulsification was done faster than other surgeries, especially by specialist surgeons. History of prior ocular surgery and operations performed under general anesthesia were associated with greater complications. Phacoemulsification was associated with less complications and better visual outcomes. The age and etiology of cataract did not affect complications. Malays, absence of ocular comorbidities, left eyes and eyes operated under local anesthesia were more likely to experience more visual improvement. Gender, age, cause of cataract, systemic comorbidities and surgeon expertise as well as intra-and postoperative complications did not affect the visual outcomes. Conclusion: Phacoemulsification had good visual outcomes in cataract surgery. Duration of surgery, expertise of the surgeon and complications did not affect the visual outcomes. PMID:27051481

Cataract Surgery Visual Outcomes and Associated Risk Factors in Secondary Level Eye Care Centers of L V Prasad Eye Institute, India.

PubMed

Matta, Sumathi; Park, Jiwon; Palamaner Subash Shantha, Ghanshyam; Khanna, Rohit C; Rao, Gullapalli N

2016-01-01

To evaluate cataract surgery visual outcomes and associated risk factors in rural secondary level eye care centers of L V Prasad Eye Institute (LVPEI), India. The Eye Health pyramid of LVPEI has a network of rural secondary care centres (SCs) and attached vision centres (VCs) that provide high quality comprehensive eye care with permanent infrastructure to the most disadvantaged sections of society. The most common procedure performed at SCs is cataract surgery. We audited the outcome of a random sample of 2,049 cataract surgeries done from October 2009-March 2010 at eight rural SCs. All patients received a comprehensive ophthalmic examination, both before and after surgery. The World Health Organization recommended cataract surgical record was used for data entry. Visual outcomes were measured at discharge, 1-3 weeks and 4-11 weeks follow up visits. Poor outcome was defined as best corrected visual acuity <6/18. Mean age was 61.8 years (SD: 8.9 years) and 1,133 (55.3%) surgeries were performed on female patients. Pre-existing ocular co-morbidity was present in 165 patients (8.1%). The most common procedure was small incision cataract surgery (SICS) with intraocular lens (IOL) implantation (91.8%). Intraoperative complications were seen in 29 eyes (1.4%). At the 4-11 weeks follow-up visit, based on presenting visual acuity (PVA), 61.8% had a good outcome and based on best-corrected visual acuity (BCVA), 91.7% had a good outcome. Based on PVA and BCVA, those with less than 6/60 were only 2.9% and 1.6% respectively. Using multivariable analysis, poor visual outcomes were significantly higher in patients aged ≥70 (OR 4.63; 95% CI 1.61, 13.30), in females (OR 1.58; 95% CI 1.04, 2.41), those with preoperative comorbidities (odds ratio 4.68; 95% CI 2.90, 7.57), with intraoperative complications (OR 8.01; 95% CI 2.91, 22.04), eyes that underwent no IOL or anterior chamber-IOL (OR 12.63; 95% CI 2.65, 60.25) and those undergoing extracapsular cataract extraction (OR 9.39; 95% CI 1.18, 74.78). This study demonstrates that quality cataract surgeries can be achieved at rural SCs. The concept of the LVPEI SCs can be applied to other developing countries, allowing rural patients to attain better vision through cataract surgery. Despite improvements in quality of cataract surgery, gender discrimination in terms of outcome continues to be an issue and needs further investigation.

Prevalence of cataract surgery and visual outcomes in Indian immigrants in Singapore: the Singapore Indian eye study.

PubMed

Gupta, Preeti; Zheng, Yingfeng; Ting, Tay Wan; Lamoureux, Ecosse L; Cheng, Ching-Yu; Wong, Tien-Yin

2013-01-01

To determine the prevalence of cataract surgery and factors associated with post-surgical visual outcomes in migrant Indians living in Singapore. We conducted a population-based study in 3,400 Indian immigrants residing in Singapore-the Singapore Indian Eye Study (SINDI). All participants underwent comprehensive medical eye examination and a standardized interview. Post-operative visual impairment (VI) was defined as best-corrected or presenting visual acuity (BCVA or PVA) of 20/60 or worse. The age- and gender-standardized prevalence of cataract surgery was 9.7% (95% confidence interval [CI]: 8.9%, 10.7%) in Singapore resident Indians. Post-operative VI defined by BCVA occurred in 10.9% eyes (87/795). The main causes of post-operative VI were diabetic retinopathy (20.7%), posterior capsular opacification (18.4%), and age-related macular degeneration (12.6%). Undercorrected refractive error doubled the prevalence of post-operative VI when PVA was used. The rate of cataract surgery is about 10% in Indian residents in Singapore. Socioeconomic variables and migration had no significant impact on the prevalence of cataract surgery. Diabetic retinopathy was a major cause of post-operative VI in migrant Indians living in Singapore. Uncorrected postoperative refractive error remains an efficient way to improve vision.

The global state of cataract blindness.

PubMed

Lee, Cameron M; Afshari, Natalie A

2017-01-01

Cataracts are a significant cause of blindness and visual impairment worldwide. The present article reviews the literature and describes the current extent of cataracts globally, barriers to treatment, and recommendations for improving the treatment of cataracts. Prevalence and absolute number of blind because of cataracts remain high, although rates are declining in many areas globally. The age-standardized prevalence of blindness in adults older than 50 remains highest in western sub-Saharan Africa, with a rate of 6.0%. The greatest declines in age-standardized blindness because of cataracts in adults older than 50 between 1990 and 2010 were in East Asia, tropical Latin America, and western Europe. Recent studies have largely found higher rates of cataracts in women than in men. A new simulator for training ophthalmologists in manual small-incision cataract surgery holds promise for the future. The rates of cataract surgery are increasing and postoperative outcomes are improving worldwide, yet challenges to reducing the cataract burden further remain. Cost, an insufficient number of ophthalmologists, and low government funding remain significant barriers but investment in further eye care infrastructure and training of additional ophthalmologists would improve the current situation.

A Case-Control Study to Assess the Relationship between Poverty and Visual Impairment from Cataract in Kenya, the Philippines, and Bangladesh

PubMed Central

Kuper, Hannah; Polack, Sarah; Eusebio, Cristina; Mathenge, Wanjiku; Wadud, Zakia; Foster, Allen

2008-01-01

Background The link between poverty and health is central to the Millennium Development Goals (MDGs). Poverty can be both a cause and consequence of poor health, but there are few epidemiological studies exploring this complex relationship. The aim of this study was to examine the association between visual impairment from cataract and poverty in adults in Kenya, Bangladesh, and the Philippines. Methods and Findings A population-based case–control study was conducted in three countries during 2005–2006. Cases were persons aged 50 y or older and visually impaired due to cataract (visual acuity < 6/24 in the better eye). Controls were persons age- and sex-matched to the case participants with normal vision selected from the same cluster. Household expenditure was assessed through the collection of detailed consumption data, and asset ownership and self-rated wealth were also measured. In total, 596 cases and 535 controls were included in these analyses (Kenya 142 cases, 75 controls; Bangladesh 216 cases, 279 controls; Philippines 238 cases, 180 controls). Case participants were more likely to be in the lowest quartile of per capita expenditure (PCE) compared to controls in Kenya (odds ratio = 2.3, 95% confidence interval 0.9–5.5), Bangladesh (1.9, 1.1–3.2), and the Philippines (3.1, 1.7–5.7), and there was significant dose–response relationship across quartiles of PCE. These associations persisted after adjustment for self-rated health and social support indicators. A similar pattern was observed for the relationship between cataract visual impairment with asset ownership and self-rated wealth. There was no consistent pattern of association between PCE and level of visual impairment due to cataract, sex, or age among the three countries. Conclusions Our data show that people with visual impairment due to cataract were poorer than those with normal sight in all three low-income countries studied. The MDGs are committed to the eradication of extreme poverty and provision of health care to poor people, and this study highlights the need for increased provision of cataract surgery to poor people, as they are particularly vulnerable to visual impairment from cataract. PMID:19090614

Driver self-regulation and depressive symptoms in cataract patients awaiting surgery: a cross-sectional study

PubMed Central

2013-01-01

Background Cataract is an extremely common visual condition of ageing. Evidence suggests that visual impairment influences driving patterns and self-regulatory behavior among older drivers. However, little is known about the psychological effects of driver self-regulation among older drivers. Therefore, this study aimed to describe driver self-regulation practices among older bilateral cataract patients and to determine the association between self-regulation and depressive symptoms. Methods Ninety-nine older drivers with bilateral cataract were assessed the week before first eye cataract surgery. Driver self-regulation was measured via the Driving Habits Questionnaire. Depressive symptoms were assessed using the 20-item Center for Epidemiological Studies Depression Scale. Visual, demographic and cognitive data were also collected. Differences between self-regulators and non self-regulators were described and linear regression modeling used to determine the association between driver self-regulation and depressive symptoms score. Results Among cataract patients, 48% reported self-regulating their driving to avoid at least one challenging situation. The situations most commonly avoided were driving at night (40%), on the freeway (12%), in the rain (9%) and parallel parking (8%). Self-regulators had significantly poorer contrast sensitivity in their worse eye than non self-regulators (p = 0.027). Driver self-regulation was significantly associated with increased depressive symptoms after controlling for potential confounding factors (p = 0.002). Conclusions Driver self-regulation was associated with increased depressive symptoms among cataract patients. Further research should investigate this association among the general older population. Self-regulation programs aimed at older drivers may need to incorporate mental health elements to counteract unintended psychological effects. PMID:24016307

Prevelence and causes of visual impairment and blindness in older adults in an area of India with a high cataract surgical rate.

PubMed

Murthy, Gudlavalleti V S; Vashist, Praveen; John, Neena; Pokharel, Gopal; Ellwein, Leon B

2010-08-01

The cataract surgical rate (CSR) in Gujarat, India is reported to be above 10,000 per million population. This study was conducted to investigate the prevalence and causes of vision impairment/blindness among older adults in a high CSR area. Geographically defined cluster sampling was used in randomly selecting persons >or= 50 years of age in Navsari district. Subjects in 35 study clusters were enumerated and invited for measurement of presenting and best-corrected visual acuity and an ocular examination. The principal cause was identified for eyes with presenting visual acuity < 20/32. A total of 5158 eligible persons were enumerated and 4738 (91.9%) examined. Prevalence of presenting visual impairment < 20/63 to 20/200 in the better eye was 29.3% (95% confidence interval [CI]: 27.5-31.2) and 13.5% (95% CI: 12.0-14.9) with best correction. The prevalence of presenting bilateral blindness (< 20/200) was 6.9% (95% CI: 5.7-8.1), and 3.1% (95% CI: 2.5-3.7) with best correction. Presenting and best-corrected blindness were both associated with older age and illiteracy; gender and rural/urban residence were not significant. Cataract in one or both eyes was the main cause of bilateral blindness (82.6%), followed by retinal disorders (8.9%). Cataract (50.3%) and refractive error (35.4%) were the main causes in eyes with vision acuity < 20/63 to 20/200, and refractive error (86.6%) in eyes with acuity < 20/32 to 20/63. Visual impairment and blindness is a significant problem among the elderly in Gujarat. Despite a reportedly high CSR, cataract remains the predominant cause of blindness.

Evaluating visual function in cataract.

PubMed

Elliott, D B

1993-11-01

This paper reviews recent research on the evaluation of visual function in cataract. Visual impairment in cataract is principally caused by increased intraocular forward light scatter. It is assumed that visual acuity (VA) measurements assess the impact of narrow angle light scatter. This also makes the measurement of high spatial frequency contrast sensitivity (CS) unnecessary. However, VA measurements alone are an inadequate assessment of visual impairment in some patients with cataract. In addition, it is suggested that a measurement of wide-angle light scatter is required. This can be evaluated directly using the van den Berg Straylightmeter, or indirectly using low spatial frequency CS or disability glare (DG) tests. The following are discussed: (1) the relative usefulness of these tests; (2) how they can be incorporated into the decision as to when to extract a cataract; and (3) the importance of considering binocular visual function.

Indication for cataract surgery. Do we have evidence of who will benefit from surgery? A systematic review and meta-analysis.

PubMed

Kessel, Line; Andresen, Jens; Erngaard, Ditte; Flesner, Per; Tendal, Britta; Hjortdal, Jesper

2016-02-01

The need for cataract surgery is expected to rise dramatically in the future due to the increasing proportion of elderly citizens and increasing demands for optimum visual function. The aim of this study was to provide an evidence-based recommendation for the indication of cataract surgery based on which group of patients are most likely to benefit from surgery. A systematic literature search was performed in the MEDLINE, CINAHL, EMBASE and COCHRANE LIBRARY databases. Studies evaluating the outcome after cataract surgery according to preoperative visual acuity and visual complaints were included in a meta-analysis. We identified eight observational studies comparing outcome after cataract surgery in patients with poor (<20/40) and fair (>20/40) preoperative visual acuity. We could not find any studies that compared outcome after cataract surgery in patients with few or many preoperative visual complaints. A meta-analysis showed that the outcome of cataract surgery, evaluated as objective and subjective visual improvement, was independent on preoperative visual acuity. There is a lack of scientific evidence to guide the clinician in deciding which patients are most likely to benefit from surgery. To overcome this shortage of evidence, many systems have been developed internationally to prioritize patients on waiting lists for cataract surgery, but the Swedish NIKE (Nationell Indikationsmodell för Katarakt Ekstraktion) is the only system where an association to the preoperative scoring of a patient has been related to outcome of cataract surgery. We advise that clinicians are inspired by the NIKE system when they decide which patients to operate to ensure that surgery is only offered to patients who are expected to benefit from cataract surgery. © 2015 The Authors. Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation.

Visual outcomes of phacoemulsification cataract surgery in horses: 1990-2013.

PubMed

Brooks, Dennis E; Plummer, Caryn E; Carastro, Susan M; Utter, Mary E

2014-07-01

To evaluate the long-term visual outcome of phacoemulsification lens extraction surgery in foals and horses and identify any unique postoperative complications that affect the visual outcome. This is a retrospective medical records study of phacoemulsification cataract surgery in 95 foals and horses from 1990 to 2013. Cataracts were removed by phacoemulsification from 111 eyes of 95 horses ranging in age from 22 days to 26 years (average 8.0 ± 5.7 years). Forty-four of the 95 animals were foals (46.3%). Sixteen horses or foals had surgery bilaterally. One hundred and two eyes were blind preoperatively with 97 eyes (95.1%) having evidence of vision immediately postoperatively. Ninety of the 95 horses (94.7%) regained vision in the immediate postoperative period. Five horses did not recover vision postoperatively. Twenty-four horses had cataracts associated with equine recurrent uveitis (ERU). Trauma was noted as the cause of cataract in 10 horses, and no specific cause for the cataract identified in 61 horses. The combined visual outcome data from horses with all types of cataracts (n = 95) found 83 (87.3%) horses to be visual ≤1 month postoperatively, 47 (49.4%) horses visual for >1-6 months postoperatively, 33 (34.7%) horses visual from >6 to 12 months postoperatively, and 25 horses (26.3%) visual >24 months postoperatively. The results of phacoemulsification cataract surgery in horses indicate at least 26.3% of horses are still visual and able to continue their natural activity for 2 years or more postoperatively. © 2014 American College of Veterinary Ophthalmologists.

Visual outcome of cataract surgery; study from the European Registry of Quality Outcomes for Cataract and Refractive Surgery.

PubMed

Lundström, Mats; Barry, Peter; Henry, Ype; Rosen, Paul; Stenevi, Ulf

2013-05-01

To analyze the visual outcome after cataract surgery. Cataract surgery clinics in 15 European countries. Database study. Data were drawn from case series of cataract extractions reported to the European Registry of Quality Outcomes for Cataract and Refractive Surgery database. These data were entered into the database via the Web by surgeons or by transfer from existing national registries or electronic medical record systems. The database contains individual anonymous data on preoperative, intraoperative, and postoperative measurements. Data on 368,256 cataract extractions were available for analysis. The best visual outcome was achieved in age groups 40 to 74 years, and men showed a higher percentage of excellent vision (1.0 [20/20] or better) than women. A corrected distance visual acuity (CDVA) of 0.5 (20/40) or better and of 1.0 (20/20) or better was achieved in 94.3% and 61.3% of cases, respectively. Ocular comorbidity and postoperative complications were the strongest influences on the visual outcome; however, surgical complications and ocular changes requiring complex surgery also had a negative influence. Deterioration of visual acuity after the surgery (n= 6112 [1.7% of all cases]) was most common in patients with a good preoperative visual acuity. The visual outcomes of cataract surgery were excellent, with 61.3% of patients achieving a corrected distance visual acuity of 1.0 (20/20) or better. Age and sex influenced the visual outcomes, but the greatest influences were short-term postoperative complications, ocular comorbidity, surgical complications, and complex surgery. A weakness of the study could be that some of the data is self-reported to the registry. Copyright © 2013 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

[Cataract surgery and its impact on balance and autonomy in elderly].

PubMed

Raynal, M; Aupy, B; Jahidi, A; Ettien, D; Le Page, P; Briche, T; Kossowski, M; Pailllaud, E

2009-01-01

Cataract is a major cause of visual impairment among elderly. Cataract surgery improves visual afferencies and can have an impact on balance. The present study assessed the impact of cataract surgery upon balance and autonomy in elderly. We realized clinical examinations and objective tests the day before surgery and 2-months later. The initial cohort consisted of 66 patients that had to undergo a cataract surgery. Their mean age was 79 +/- 0.5. For logistic reasons, only 33 patients have been completely evaluated before and after surgery. Each patient underwent a history and examination that have assessed autonomy, walking, visual and then cochleo-vestibular functions including bone vibratory test and dynamic computerized posturography (Equitest). After 2 months, cataract surgery had no incidence on balance. The fear of falling has stayed the same whereas the number of falls has been noticeably reduced by surgery. The overall score of Equitest has shown an increase in visual dependence after surgery. Although cataract surgery has no incidence on autonomy, it may improve the quality of life among older people by leisure activities recovery. An early physical rehabilitation facilitated by visual improvement after surgery can also prevent visual dependence and autonomy loss. We recommend vestibular rehabilitation in elderly with major visual dependence.

Comparison of distance and near visual acuity in patients with vision loss due to cataract.

PubMed

Mercado, Carmel L; Doroslovački, Pavle; Wang, Jiangxia; Siddiqui, Aazim A; Kolker, Andrew F; Kolker, Richard J

2017-02-01

The purpose of this study was to assess whether there is a disparity in distance and near best-corrected visual acuity (BCVA) in cataract eyes. 102 patients with cataract (N = 121 eyes) were seen in clinic between January and November 2013 at the Wilmer Eye Institute Comprehensive Eye Service. An age-related macular degeneration (ARMD) group (N = 27 eyes) was also identified for comparison. Distance and near BCVA were measured as part of the standard ophthalmic evaluation. Snellen measurements were converted to their LogMAR equivalents for statistical analysis. Near was better than distance BCVA with mean difference of 1.38 lines (P < 0.001) in the cataract eyes. This disparity was not seen in the ARMD eyes. Near-distance BCVA disparity is a statistically significant finding seen with cataracts. This may have further implications in patients with both cataract and ARMD as the presence of disparity may suggest a cataract etiology playing a greater role in vision loss. This comparison may be useful for surgical prognostication and as a quick triage tool in conjunction with, or in place of, a potential acuity meter and dilated near-pinhole test.

A systematic review of phacoemulsification cataract surgery in virtual reality simulators.

PubMed

Lam, Chee Kiang; Sundaraj, Kenneth; Sulaiman, Mohd Nazri

2013-01-01

The aim of this study was to review the capability of virtual reality simulators in the application of phacoemulsification cataract surgery training. Our review included the scientific publications on cataract surgery simulators that had been developed by different groups of researchers along with commercialized surgical training products, such as EYESI® and PhacoVision®. The review covers the simulation of the main cataract surgery procedures, i.e., corneal incision, capsulorrhexis, phacosculpting, and intraocular lens implantation in various virtual reality surgery simulators. Haptics realism and visual realism of the procedures are the main elements in imitating the actual surgical environment. The involvement of ophthalmology in research on virtual reality since the early 1990s has made a great impact on the development of surgical simulators. Most of the latest cataract surgery training systems are able to offer high fidelity in visual feedback and haptics feedback, but visual realism, such as the rotational movements of an eyeball with response to the force applied by surgical instruments, is still lacking in some of them. The assessment of the surgical tasks carried out on the simulators showed a significant difference in the performance before and after the training.

Intraocular Lenses for the Treatment of Age-Related Cataracts

PubMed Central

2009-01-01

Executive Summary Objective The objective of the report is to examine the comparative effectiveness and cost-effectiveness of various intraocular lenses (IOLs) for the treatment of age-related cataracts. Clinical Need: Target Population and Condition A cataract is a hardening and clouding of the normally transparent crystalline lens that may result in a progressive loss of vision depending on its size, location and density. The condition is typically bilateral, seriously compromises visual acuity and contrast sensitivity and increases glare. Cataracts can also affect people at any age, however, they usually occur as a part of the natural aging process. The occurrence of cataracts increases with age from about 12% at age 50 years, to 60% at age 70. In general, approximately 50% of people 65 year of age or older have cataracts. Mild cataracts can be treated with a change in prescription glasses, while more serious symptoms are treated by surgical removal of the cataract and implantation of an IOL. In Ontario, the estimated prevalence of cataracts increased from 697,000 in 1992 to 947,000 in 2004 (35.9% increase, 2.4% annual increase). The number of cataract surgeries per 1,000 individuals at risk of cataract increased from 64.6 in 1992 to 140.4 in 1997 (61.9% increase, 10.1% annual increase) and continued to steadily increase to 115.7 in 2004 (10.7% increase, 5.2% increase per year). Description of Technology/Therapy IOLs are classified either as monofocal, multifocal, or accommodative. Traditionally, monofocal (i.e.. fixed focusing power) IOLs are available as replacement lenses but their implantation can cause a loss of the eye’s accommodative capability (which allows variable focusing). Patients thus usually require eyeglasses after surgery for reading and near vision tasks. Multifocal IOLs aim to improve near and distant vision and obviate the need for glasses. Potential disadvantages include reduced contrast sensitivity, halos around lights and glare. Accommodating IOLs are designed to move with ciliary body contraction during accommodation and, therefore, offer a continuous range of vision (i.e. near, intermediate and distant vision) without the need for glasses. Purported advantages over multifocal IOLs include the avoidance of haloes and no reduction in contrast sensitivity. Polymethyl methacrylate (PMMA) was the first material used in the fabrication of IOLs and has inherent ultraviolet blocking abilities. PMMA IOLs are inflexible, however, and require a larger incision for implantation compared with newer foldable silicone (hydrophobic) and acrylic (hydrophobic or hydrophilic) lenses. IOLs can be further sub-classified as being either aspheric or spheric, blue/violet filtered or non-filtered or 1- or 3-piece. Methods of Evidence-Based Analysis A literature search was conducted from January 2003 to January 2009 that included OVID MEDLINE, MEDLINE In-Process and Other Non-Indexed Citations, EMBASE, the Cumulative Index to Nursing & Allied Health Literature (CINAHL), The Cochrane Library, and the International Agency for Health Technology Assessment/Centre for Review and Dissemination. Inclusion Criteria Exclusion Criteria adult patients with age-related cataractssystematic reviews, randomized controlled trials (RCTs)primary outcomes: distance visual acuity (best corrected distance visual acuity), near visual acuity (best distance corrected near visual acuity)secondary outcomes: contrast sensitivity, depth of field, glare, quality of life, visual function, spectacle dependence, posterior capsule opacification. studies with fewer than 20 eyesIOLs for non-age related cataractsIOLs for presbyopiastudies with a mean follow-up <6monthsstudies reporting insufficient data for analysis Comparisons of Interest The primary comparison of interest was accommodative vs. multifocal vs. monofocal lenses. Secondary comparisons of interest included: tinted vs. non-tinted lenses aspheric vs. spheric lenses multipiece vs. single piece lenses biomaterial A (e.g. acrylic) vs. biomaterial B (e.g. silicone) lenses sharp vs. round edged lenses The quality of the studies was examined according to the GRADE Working Group criteria for grading quality of evidence for interventional procedures. Summary of Findings The conclusions of the systematic review of IOLs for age-related cataracts are summarized in Executive Summary Table 1. Considerations for the Ontario Health System Procedures for crystalline lens removal and IOL insertion are insured and listed in the Ontario Schedule of Benefits. If a particular lens is determined to be medically necessary for a patient, the cost of the lens is covered by the hospital budget. If the patient chooses a lens that has enhanced features, then the hospital may choose to charge an additional amount above the cost of the usual lens offered. An IOL manufacturer stated that monofocal lenses comprise approximately 95% of IOL sales in Ontario and premium lenses (e.g., multifocal/accomodative) consist of about 5% of IOL sales. A medical consultant stated that all types of lenses are currently being used in Ontario (e.g., multifocal, monofocal, accommodative, tinted, nontinted, spheric, and aspheric). Nonfoldable lenses, rarely used in routine cases, are primarily used for complicated cataract implantation situations. ES Table 1: Conclusions for the Systematic Review of IOLs for Age-Related Cataracts Comparison Conclusion GRADE Quality Multifocal vs. monofocal Objective OutcomesSignificant improvement in BDCUNVANo significant difference in BCDVAInconclusive evidence for contrast sensitivityInconclusive evidence for glareSubjective OutcomesInconclusive evidence for visual satisfactionSignificant increase in glare/halosSignificant increase in freedom from spectacles moderatemoderatelowvery lowlowlow/moderatelow/moderate Accommodative vs. multifocal/monofocal Inconclusive due to Insufficient limited evidence for any effectiveness outcome very low Hydrophilic acrylic vs. other materials (hydrophobic acrylic, silicone) Significant increase in PCO score Low Sharp edged compared to round edged Significant reduction in PCO score Low One piece compared to three piece No significant difference in PCO score low Hydrophobic acrylic compared to silicone No significant difference in PCO score moderate Aspherical modified prolate anterior surface compared to spherical No significant difference in VASignificant reduction in contrast sensitivity very lowvery low Blue light filtering compared to non blue-light filtering No significant difference in BCDVANo significant difference in contrast sensitivityNo significant difference in HRQL lowlowhigh/moderate BCDVA refers to best corrected distance visual acuity; BDCUNVA, best distance corrected unaided near visual acuity; HRQL, health related quality of life; PCO, posterior capsule opacification; VA, visual acuity. PMID:23074519

A survey on the knowledge and attitudes of anaesthesia providers in the United States of America, United Kingdom and Singapore on visual experiences during cataract surgery.

PubMed

Tan, C S H; Kumar, C M; Fanning, G L; Lai, Y C; Au Eong, K G

2006-04-01

To assess the knowledge, beliefs and attitudes of anaesthesia providers on the patients' possible intraoperative visual experiences during cataract surgery under local anaesthesia. Anaesthesia providers from the Ophthalmic Anaesthesia Society (USA); British Ophthalmic Anaesthesia Society (UK); Alexandra Hospital, National University Hospital, Tan Tock Seng Hospital, Singapore General Hospital and Changi General Hospital (Singapore) were surveyed using a structured questionnaire. A total of 146 anaesthesiologists (81.6%), 10 ophthalmologists (5.6%) and 23 nurse anaesthetists (12.8%) responded to the survey. Most respondents believed that patients would experience light perception and many also felt that patients might encounter other visual sensations such as movements, flashes, colours, surgical instruments, hands/fingers and the surgeon during the surgery. A significantly higher proportion of anaesthesia providers with previous experience of monitoring patients under topical anaesthesia believed that patients might experience the various visual sensations compared to those who have not previously monitored. For both topical and regional anaesthesia, anaesthesia providers who routinely counsel their patients are (1) more likely to believe that preoperative counselling helps or (2) were previously told by patients that they could see intraoperatively and/or that they were frightened by their visual sensations. These findings were statistically significant. The majority of anaesthesia providers in the USA, UK and Singapore are aware that patients may experience a variety of visual sensations during cataract surgery under regional or topical anaesthesia. Those who have previously managed patients undergoing cataract surgery under topical anaesthesia are more likely to believe this compared to those who have not.

Exploiting ensemble learning for automatic cataract detection and grading.

PubMed

Yang, Ji-Jiang; Li, Jianqiang; Shen, Ruifang; Zeng, Yang; He, Jian; Bi, Jing; Li, Yong; Zhang, Qinyan; Peng, Lihui; Wang, Qing

2016-02-01

Cataract is defined as a lenticular opacity presenting usually with poor visual acuity. It is one of the most common causes of visual impairment worldwide. Early diagnosis demands the expertise of trained healthcare professionals, which may present a barrier to early intervention due to underlying costs. To date, studies reported in the literature utilize a single learning model for retinal image classification in grading cataract severity. We present an ensemble learning based approach as a means to improving diagnostic accuracy. Three independent feature sets, i.e., wavelet-, sketch-, and texture-based features, are extracted from each fundus image. For each feature set, two base learning models, i.e., Support Vector Machine and Back Propagation Neural Network, are built. Then, the ensemble methods, majority voting and stacking, are investigated to combine the multiple base learning models for final fundus image classification. Empirical experiments are conducted for cataract detection (two-class task, i.e., cataract or non-cataractous) and cataract grading (four-class task, i.e., non-cataractous, mild, moderate or severe) tasks. The best performance of the ensemble classifier is 93.2% and 84.5% in terms of the correct classification rates for cataract detection and grading tasks, respectively. The results demonstrate that the ensemble classifier outperforms the single learning model significantly, which also illustrates the effectiveness of the proposed approach. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Simultaneous versus Sequential Bilateral Cataract Surgery for Infants with Congenital Cataracts: Visual Outcomes and Economic Costs

PubMed Central

Dave, Hreem; Phoenix, Vidya; Becker, Edmund R.; Lambert, Scott R.

2015-01-01

OBJECTIVES To compare the incidence of adverse events, visual outcomes and economic costs of sequential versus simultaneous bilateral cataract surgery for infants with congenital cataracts. METHODS We retrospectively reviewed the incidence of adverse events, visual outcomes and medical payments associated with simultaneous versus sequential bilateral cataract surgery for infants with congenital cataracts who underwent cataract surgery when 6 months of age or younger at our institution. RESULTS Records were available for 10 children who underwent sequential surgery at a mean age of 49 days for the first eye and 17 children who underwent simultaneous surgery at a mean age of 68 days (p=.25). We found a similar incidence of adverse events between the two treatment groups. Intraoperative or postoperative complications occurred in 14 eyes. The most common postoperative complication was glaucoma. No eyes developed endophthalmitis. The mean absolute interocular difference in logMAR visual acuities between the two treatment groups was 0.47±0.76 for the sequential group and 0.44±0.40 for the simultaneous group (p=.92). Hospital, drugs, supplies and professional payments were on average 21.9% lower per patient in the simultaneous group. CONCLUSIONS Simultaneous bilateral cataract surgery for infants with congenital cataracts was associated with a 21.9% reduction in medical payments and no discernible difference in the incidence of adverse events or visual outcome. PMID:20697007

Outcomes of Cataract Surgery in Urban and Rural Population in the South Indian State of Andhra Pradesh: Rapid Assessment of Visual Impairment (RAVI) Project.

PubMed

Marmamula, Srinivas; Khanna, Rohit C; Shekhar, Konegari; Rao, Gullapalli N

2016-01-01

To assess the visual outcomes after cataract surgery among urban and rural population aged ≥40 years in the South India state of Andhra Pradesh. A population based cross-sectional study was conducted in which 7800 subjects were sampled from two rural and one urban location. Visual Acuity was assessed and eye examination were performed by trained personnel. A questionnaire was used to collect personal and demographic information, and history of cataract surgery. Blindness and moderate Visual Impairment (MVI) was defined as presenting VA <6/60 and <6/18 to 6/60 in the better eye respectively. In total, 7378 (94.6%) were examined. Of these, 1228 eyes of 870 individuals were operated for cataract. The mean age of operated subjects was 63.7 years (SD: 10.7 years). Overall, 56.3% of those operated were women, 76% were illiterate and 42% of them were using spectacles after cataract surgery. Even after surgery, 12.2% of the operated eyes had MVI and blindness was seen in 14.7% of the eyes. A significantly higher proportion of subjects in urban area had good outcome as compared to those in the rural area (p = 0.01). Uncorrected refractive error (58.7%) was the leading cause of MVI, and posterior segment disease (34.3%) was the leading cause of blindness. On applying multiple logistic regression, risk factors for poor outcomes were age ≥ 70 years (OR: 1.9, 95% CI: 1.3-2.8), rural residence (OR: 1.3, 95% CI:1.0-1.8) and presence of aphakia (OR: 8.9, 95% CI: 5.7-13.8). Post cataract surgery, refractive errors remain an important correctable cause of MVI, in the south Indian state of Andhra Pradesh. The correction of refractive errors is required to provide good visual recovery and achieve the benefit of cataract surgery.

Cataract Surgery Visual Outcomes and Associated Risk Factors in Secondary Level Eye Care Centers of L V Prasad Eye Institute, India

PubMed Central

Matta, Sumathi; Park, Jiwon; Palamaner Subash Shantha, Ghanshyam; Khanna, Rohit C.; Rao, Gullapalli N.

2016-01-01

Purpose To evaluate cataract surgery visual outcomes and associated risk factors in rural secondary level eye care centers of L V Prasad Eye Institute (LVPEI), India. Methods The Eye Health pyramid of LVPEI has a network of rural secondary care centres (SCs) and attached vision centres (VCs) that provide high quality comprehensive eye care with permanent infrastructure to the most disadvantaged sections of society. The most common procedure performed at SCs is cataract surgery. We audited the outcome of a random sample of 2,049 cataract surgeries done from October 2009-March 2010 at eight rural SCs. All patients received a comprehensive ophthalmic examination, both before and after surgery. The World Health Organization recommended cataract surgical record was used for data entry. Visual outcomes were measured at discharge, 1–3 weeks and 4–11 weeks follow up visits. Poor outcome was defined as best corrected visual acuity <6/18. Results Mean age was 61.8 years (SD: 8.9 years) and 1,133 (55.3%) surgeries were performed on female patients. Pre-existing ocular co-morbidity was present in 165 patients (8.1%). The most common procedure was small incision cataract surgery (SICS) with intraocular lens (IOL) implantation (91.8%). Intraoperative complications were seen in 29 eyes (1.4%). At the 4–11 weeks follow-up visit, based on presenting visual acuity (PVA), 61.8% had a good outcome and based on best-corrected visual acuity (BCVA), 91.7% had a good outcome. Based on PVA and BCVA, those with less than 6/60 were only 2.9% and 1.6% respectively. Using multivariable analysis, poor visual outcomes were significantly higher in patients aged ≥70 (OR 4.63; 95% CI 1.61, 13.30), in females (OR 1.58; 95% CI 1.04, 2.41), those with preoperative comorbidities (odds ratio 4.68; 95% CI 2.90, 7.57), with intraoperative complications (OR 8.01; 95% CI 2.91, 22.04), eyes that underwent no IOL or anterior chamber-IOL (OR 12.63; 95% CI 2.65, 60.25) and those undergoing extracapsular cataract extraction (OR 9.39; 95% CI 1.18, 74.78). Conclusions This study demonstrates that quality cataract surgeries can be achieved at rural SCs. The concept of the LVPEI SCs can be applied to other developing countries, allowing rural patients to attain better vision through cataract surgery. Despite improvements in quality of cataract surgery, gender discrimination in terms of outcome continues to be an issue and needs further investigation. PMID:26741363

Influence of cataract surgery on optical coherence tomography and neurophysiology measurements in patients with retinitis pigmentosa.

PubMed

Garcia-Martin, Elena; Rodriguez-Mena, Diego; Dolz, Isabel; Almarcegui, Carmen; Gil-Arribas, Laura; Bambo, Maria P; Larrosa, Jose M; Polo, Vicente; Pablo, Luis E

2013-08-01

To evaluate the effect of uncomplicated cataract phacoemulsification on the measurements of visual evoked potentials (VEP), pattern electroretinogram (PERG), and macular and retinal nerve fiber layer (RNFL) using 2 spectral-domain optical coherence tomography (OCT) instruments, the Cirrus OCT (Carl Zeiss Meditech) and Spectralis OCT (Heidelberg Engineering), in patients with retinitis pigmentosa (RP), and to assess the reliability of the OCT measurements before and after cataract surgery. Observational cross-sectional study. Thirty-five eyes of 35 patients with RP (20 men and 15 women, 45-66 years) who underwent cataract phacoemulsification were studied. At 1 month before and 1 month after surgery, visual acuity, VEP, PERG, and 3 repetitions of scans using the RNFL and macular analysis protocols of the Cirrus and Spectralis OCT instruments were performed. The differences in measurements between the 2 visits were analyzed. Repeatability of OCT measurements was evaluated by calculating the coefficients of variation. VEP amplitude, RNFL thicknesses provided by Cirrus and Spectralis, and macular measurements provided by Cirrus OCT differed between the 2 visits. VEP latency, PERG measurements, and macular thicknesses provided by the Spectralis OCT before surgery did not differ significantly from those after surgery. The OCT repeatability was better after surgery, with lower coefficients of variation for scans performed after surgical removal of the cataract. The nuclear, cortical, and posterior subcapsular types of cataracts did not show different repeatability. The presence of cataracts affects VEP amplitude, RNFL, and macular measurements performed with OCT in eyes with RP. Image repeatability significantly improves after cataract phacoemulsification. Copyright © 2013 Elsevier Inc. All rights reserved.

[Outcome of cataract surgery in patients with pigmentary retinal degeneration].

PubMed

Grześk, Magdalena; Kałuzny, Józef; Malukiewicz-Wiśniewska, Grazyna

2007-01-01

To evaluate the results of cataract surgery in patients with RP because retinitis pigmentosa is one of the disease entities that belongs to tapeto-retinal degenerations. The occurrence of RP appearance is 1:4000 to 1:3000. Twenty patients with RP (7 women and 13 men, 33 eyes), who underwent cataract surgery were examined retrospectively. Average age in our group was 46.6 years. Visual acuity, intraocular pressure, slip lamp examination, fundus examination, cataract morphology, visual field were taken before surgery and on discharge, on the basis of medical documentation. Control examination was taken, on average, eighty one months after cataract surgery. Nine eyes were operated by phacoemulsification, 24 eyes by means of extracapsular cataract extraction. In the same way control group of 18 patients who underwent cataract surgery without RP (33 eyes) was examined. In RP group in 63.6% patients on discharge from the hospital and in 60.6% patients during the control examination, improvement of visual acuity was revealed. Deterioration was noted in 18.2% of patients on discharge from hospital and in 24.2% of patients during the control examination. In the control group improvement of visual acuity was revealed in 90.9% of patients on discharge and in 97% patients during the control examination, whereas deterioration of visual acuity occurred in 6.1% patients on discharge and in 3% patients during the check examination. In patients with retinitis pigmentosa cataract occurs earlier then in the control group. Cataract surgery for relatively minor opacities is beneficial in patients with RP, and causes improvement of visual acuity in most of eyes undergoing surgery.

Alcohol consumption and visual impairment in a rural Northern Chinese population.

PubMed

Li, Zhijian; Xu, Keke; Wu, Shubin; Sun, Ying; Song, Zhen; Jin, Di; Liu, Ping

2014-12-01

To investigate alcohol drinking status and the association between drinking patterns and visual impairment in an adult population in northern China. Cluster sampling was used to select samples. The protocol consisted of an interview, pilot study, visual acuity (VA) testing and a clinical examination. Visual impairment was defined as presenting VA worse than 20/60 in any eye. Drinking patterns included drinking quantity (standard drinks per week) and frequency (drinking days in the past week). Information on alcohol consumption was obtained from 8445 subjects, 963 (11.4%) of whom reported consuming alcohol. In multivariate analysis, alcohol consumption was significantly associated with older age (p < 0.001), male sex (p < 0.001), and higher education level (p < 0.01). Heavy intake (>14 drinks/week) was associated with higher odds of visual impairment. However, moderate intake (>1-14 drinks/week) was significantly associated with lower odds (adjusted odds ratio, OR, 0.7, 95% confidence interval, CI, 0.5-1.0) of visual impairment (p = 0.03). Higher drinking frequency was significantly associated with higher odds of visual impairment. Multivariate analysis showed that older age, male sex, and higher education level were associated with visual impairment among current drinkers. Age- and sex-adjusted ORs for the association of cataract and alcohol intake showed that higher alcohol consumption was not significantly associated with an increased prevalence of cataract (OR 1.2, 95% CI 0.4-3.6), whereas light and moderate alcohol consumption appeared to reduce incidence of cataract. Drinking patterns were associated with visual impairment. Heavy intake had negative effects on distance vision; meanwhile, moderate intake had a positive effect on distance vision.

Prevalence and causes of blindness, visual impairment, and cataract surgery in Timor-Leste

PubMed Central

Correia, Marcelino; Das, Taraprasad; Magno, Julia; Pereira, Bernadette M; Andrade, Valerio; Limburg, Hans; Trevelyan, John; Keeffe, Jill; Verma, Nitin; Sapkota, Yuddha

2017-01-01

Purpose To estimate the prevalence and causes of blindness and visual impairment, cataract surgical coverage (CSC), visual outcome of cataract surgery, and barriers to uptake cataract surgery in Timor-Leste. Method In a nationwide rapid assessment of avoidable blindness (RAAB), the latest population (1,066,409) and household data were used to create a sampling frame which consists of 2,227 population units (study clusters) from all 13 districts, with populations of 450–900 per unit. The sample size of 3,350 was calculated with the assumed prevalence of blindness at 4.5% among people aged ≥50 years with a 20% tolerable error, 95% CI, and a 90% response rate. The team was trained in the survey methodology, and inter-observer variation was measured. Door-to-door visits, led by an ophthalmologist, were made in preselected study clusters, and data were collected in line with the RAAB5 survey protocol. An Android smart phone installed with mRAAB software was used for data collection. Result The age–gender standardized prevalence of blindness, severe visual impairment, and visual impairment were 2.8%, (1.8–3.8), 1.7% (1.7–2.3), and 8.1% (6.6–9.6), respectively. Cataract was the leading cause of blindness (79.4%). Blindness was more prevalent in the older age group and in women. CSC was 41.5% in cataract blind eyes and 48.6% in cataract blind people. Good visual outcome in the cataract-operated eyes was 62% (presenting) and 75.2% (best corrected). Two important barriers to not using available cataract surgical services were accessibility (45.5%) and lack of attendants to accompany (24.8%). Conclusion The prevalence of blindness and visual impairment in Timor-Leste remains high. CSC is unacceptably low; gender inequity in blindness and CSC exists. Lack of access is the prominent barrier to cataract surgery. PMID:29238161

Ultrasonographic Findings in Patients Examined in Cataract Detection-and-Treatment Campaigns: A Retrospective Study

PubMed Central

Mendes, Marcio Henrique; Betinjane, Alberto Jorge; de Sá Cavalcante, Adhele; Te Cheng, Cheng; Kara-José, Newton

2009-01-01

INTRODUCTION: A cataract is defined as an opacity of any portion of the lens, regardless of visual acuity. In some advanced cases of cataracts, in which good fundus visualization is not possible, an ultrasound examination provides better assessment of the posterior segment of the globe. OBJECTIVES: This study aims to evaluate the ultrasonographic records of patients with advanced cataracts who were examined during cataract campaigns. METHODS: The ultrasonographic findings obtained from 215 patients examined in cataract campaigns conducted by the Hospital das Clínicas Department of Ophthalmology of the Faculdade de Medicina da Universidade de São Paulo between the years of 2005 and 2007 were evaluated, and the utility of this exam in changing the treatment procedures was studied. RESULTS: A total of 289 eyes from 215 patients were examined. Of the eyes examined, 77.5% presented with findings in the vitreous cavity and the posterior pole. A posterior vitreous detachment with no other complications was observed in 47.4% of the eyes. The remaining 30.1% presented with eye diseases that could result in a reduced visual function after surgery. The most frequent eye diseases observed were diffuse vitreous opacity (12.1% of the eyes) and detachment of the retina (9.3% of the eyes). DISCUSSION: In many cases, the ultrasonographic evaluation of the posterior segment revealed significant anomalies that changed the original treatment plan or contra-indicated surgery. At the very least, the evaluation was useful for patient counseling. CONCLUSION: The ultrasonographic examination revealed and differentiated between eyes with cataracts and eyes with ocular abnormalities other than cataracts as the cause of poor vision, thereby indicating the importance of its use during ocular evaluation. PMID:19606238

Prevalence and causes of blindness, visual impairment among different ethnical minority groups in Xinjiang Uygur autonomous region, China.

PubMed

Li, Yanping; Huang, Wenyong; Qiqige, Aoyun; Zhang, Hongwei; Jin, Ling; Ti, Pula; Yip, Jennifer; Xiao, Baixiang

2018-02-13

The aim of this cross-sectional study is to ascertain the prevalence and causes of blindness, visual impairment, uptake of cataract surgery among different ethnic groups in Xinjiang Uygur Autonomous Region, China. Four thousand one hundred fifty people at 50 years and above from different minority ethnic groups were randomly selected for an eye examination. The four trained eye teams collected data using tumbling E visual chart, torch, portable slit lamp and direct ophthalmoscope in 2015. The World Health Organization's definition of blindness and visual impairment (VI) was used to classify patients in each ethnic group. Data were analyzed by different minority groups and were compared with Han Chinese. 3977 (95.8%) out of 4150 people were examined. The prevalence of blindness from the study population was 1.7% (95% confidence interval: 1.3-2.2%).There was no significant difference in prevalence of blindness between Han Chinese and people of Khazak and other minority ethnic groups, nor, between male and female. Cataract was the leading course (65.5%) of blindness and uncorrected refractive error was the most common cause of VI (36.3%) followed by myopic retinopathy. The most common barrier to cataract surgery was lack of awareness of service availability. This study documented a low blindness prevalence among people aged 50 years and over comparing to prevalence identified through studies of other regions in China. It still indicates blindness and un-operated cataract as the significant public health issue, with no evidence of eye health inequalities, but some inequities in accessing to cataract surgery amongst ethnic minority groups in Xinjiang.

Simultaneous vs sequential bilateral cataract surgery for infants with congenital cataracts: Visual outcomes, adverse events, and economic costs.

PubMed

Dave, Hreem; Phoenix, Vidya; Becker, Edmund R; Lambert, Scott R

2010-08-01

To compare the incidence of adverse events and visual outcomes and to compare the economic costs of sequential vs simultaneous bilateral cataract surgery for infants with congenital cataracts. Retrospective review of simultaneous vs sequential bilateral cataract surgery for infants with congenital cataracts who underwent cataract surgery when 6 months or younger at our institution. Records were available for 10 children who underwent sequential surgery at a mean age of 49 days for the first eye and 17 children who underwent simultaneous surgery at a mean age of 68 days (P = .25). We found a similar incidence of adverse events between the 2 treatment groups. Intraoperative or postoperative complications occurred in 14 eyes. The most common postoperative complication was glaucoma. No eyes developed endophthalmitis. The mean (SD) absolute interocular difference in logMAR visual acuities between the 2 treatment groups was 0.47 (0.76) for the sequential group and 0.44 (0.40) for the simultaneous group (P = .92). Payments for the hospital, drugs, supplies, and professional services were on average 21.9% lower per patient in the simultaneous group. Simultaneous bilateral cataract surgery for infants with congenital cataracts is associated with a 21.9% reduction in medical payments and no discernible difference in the incidence of adverse events or visual outcomes. However, our small sample size limits our ability to make meaningful comparisons of the relative risks and visual benefits of the 2 procedures.

Medical Malpractice Claims Related to Cataract Surgery Complicated by Retained Lens Fragments (An American Ophthalmological Society Thesis)

PubMed Central

Kim, Judy E.; Weber, Paul; Szabo, Aniko

2012-01-01

Purpose: To review malpractice claims associated with retained lens fragments during cataract surgery to identify ways to improve patient outcomes. Methods: Retrospective, noncomparative, consecutive case series. Closed claims data related to cataract surgeries complicated by retained lens fragments (1989 through 2009) from an ophthalmic insurance carrier were reviewed. Factors associated with these claims and claims outcomes were analyzed. Results: During the 21-year period, 117 (12.5%) of 937 closed claims associated with cataract surgery were related to retained lens fragments with 108 unique cataract surgeries, 97% against cataract surgeon and 3% against retinal surgeon. Twelve (11%) of 108 claims were resolved by a trial, 30 (28%) were settled, and 66 (61%) were dismissed. The defendant prevailed in 83% of trials. Indemnity payments totaling more than $3,586,000 were made in 32 (30%) of the claims (median payment, $90,000). The difference between the preoperative visual acuity and the final visual acuity was predictive of an indemnity payment (odds ratio [OR], 2.28; P=.001) and going to a trial (OR, 2.93; P=.000). Development of corneal edema was associated with an indemnity payment (OR, 3.50; P=.037). Timing of referral and elevated intraocular pressure (IOP) were statistically significant in univariate analyses but not in multivariate analyses for a trial. Conclusions: Whereas the majority of claims were dismissed, claims associated with greater visual acuity decline, corneal edema, or elevated IOP were more likely to result in a trial or payment. Ways to reduce significant vision loss, including improved management of corneal edema and IOP, and timely referral to a subspecialist should be considered. PMID:23818737

Macular photostress and visual experience between microscope and intracameral illumination during cataract surgery.

PubMed

Seo, Hyejin; Nam, Dong Heun; Lee, Jong Yeon; Park, Su Jin; Kim, Yu Jeong; Kim, Seong-Woo; Chung, Tae-Young; Inoue, Makoto; Kim, Terry

2018-02-01

To evaluate macular photostress and visual experience between coaxial microscope illumination versus oblique intracameral illumination during cataract surgery. Gachon University Gil Hospital, Incheon, South Korea. Prospective case series. Consecutive patients who had cataract surgery using microscope illumination and intracameral illumination were included. The patients were asked to complete a questionnaire (seeing strong lights, feeling photophobia, feeling startled (fright) when seeing lights, seeing any colors, seeing any instruments or surgical procedures, and estimating intraoperative visual function) designed to describe their cataract surgery experience. The images projected on the retina of the model eye (rear view) with artificial opaque fragments in the anterior chamber during simulating cataract surgery were compared between the 2 illumination types. Sixty patients completed the questionnaire. Scores for strong lights, photophobia, fright, and color perception were significantly higher with microscope illumination than with intracameral illumination (all P < .001). More patients preferred the intracameral illumination (45 [75.0%]) to the microscope illumination (13 [21.7%]). In the rear-view images created in a model eye, only the bright microscope light in the center was seen without any lens image in the microscope illumination. However, in the intracameral illumination, the less bright light from the light pipe in the periphery and the lens fragments were seen more clearly. In a view of the patients' visual experience, oblique intracameral illumination caused less subjective photostress and was preferred over coaxial microscope illumination. Objective findings from the model-eye experiment correlated to the result of visual experience. Copyright © 2018 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Blindness and cataract surgical services in Atsinanana region, Madagascar.

PubMed

Randrianaivo, Jean-Baptiste; Anholt, R Michele; Tendrisoa, Diarimirindra Lazaharivony; Margiano, Nestor Jean; Courtright, Paul; Lewallen, Susan

2014-01-01

To assess the prevalence and causes of avoidable blindness in Atsinanana Region, Madagascar, with the Rapid Assessment of Avoidable Blindness (RAAB) survey. We analyzed the hospital records to supplement the findings for public health care planning. Only villages within a two-hour walk from a road, about half of the population of Atsinanana was included. Seventy-two villages were selected by population-proportional-to-size sampling. In each village, compact segment sampling was used to select 50 people over age 50 for eye examination using standard RAAB methods. Records at the two hospitals providing cataract surgery in the region were analyzed for information on patients who underwent cataract surgery in 2010. Cataract incidence rate and target cataract surgery rate (CSR) was modeled from age-specific prevalence of cataract. The participation rate was 87% and the sample prevalence of blindness was 1.96%. Cataract was responsible for 64% and 85.7% of blindness and severe visual impairment, respectively. Visual impairment was due to cataract (69.4%) and refractive error (14.1%). There was a strong positive correlation between cataract surgical rate by district and the proportion of people living within 2 hours of a road. There were marked differences in the profiles of the cataract patients at the two facilities. The estimated incidence of cataract at the 6/18 level was 2.4 eyes per 100 people over age 50 per year. Although the survey included only people with reasonable access, the main cause of visual impairment was still cataract. The incidence of cataract is such that it ought to be possible to eliminate it as a cause of visual impairment, but changes in service delivery at hospitals and strategies to improve access will be necessary for this change.

Topical versus peribulbar anaesthesia for cataract surgery.

PubMed

Sauder, Gangolf; Jonas, Jost B

2003-12-01

To assess and compare the efficacy and safety of topical versus peribulbar anaesthesia in patients undergoing routine cataract surgery. The unicentre, prospective, randomized, clinical interventional trial included 140 consecutive patients undergoing routine cataract surgery performed by one of two surgeons. The patients were randomly distributed to either peribulbar anaesthesia or topical anaesthesia. To assess intraoperative pain, each patient was asked immediately after surgery to quantitate his/her pain using a 10-point pain rating scale. The study groups did not differ significantly in pain score (p=0.54), duration of surgery (p=0.52), anaesthesia-related intraoperative difficulties (p=0.17), postoperative visual acuity (p=0.94), overall intraoperative surgical complication rate, blood pressure rise (p=0.16) or blood oxygen saturation (p=0.74) Patient comfort and surgery-related complications did not differ between topical anaesthesia and peribulbar anaesthesia. As there are no significant differences between the two techniques in terms of subjective pain experienced by patients, intraoperative complications and postoperative visual outcome, and in view of the minimally invasive character of topical anaesthesia compared to peribulbar anaesthesia, the present study suggests the use of topical anaesthesia for routine cataract surgery.

Prevalence and causes of visual impairment and blindness, cataract surgical coverage and outcomes of cataract surgery in Libya.

PubMed

Rabiu, Muhammad Mansur; Jenf, Mansour; Fituri, Suad; Choudhury, Abdulhanan; Agbabiaka, Idris; Mousa, Ahmed

2013-01-01

To assess the major causes of avoidable blindness, and outcomes and barriers to cataract services in Libya. A stratified multistage cluster random sample study was conducted in the four regions of Libya. Visual acuity and lens assessment were performed on all subjects. Those with presenting visual acuity <6/18 in either or both eyes were further investigated to determine cause(s) of impairment. Barriers to cataract surgery were investigated. Visual outcomes of subjects with surgery performed were assessed. A total of 8538 persons aged ≥50 years were examined across the four regions. The prevalence of blindness was 3.25% (3.15% with best correction), which varied across the regions (2.94-3.80%); after adjustment for age and sex, the prevalence was 2.66%. Major causes of blindness were cataract (29%), glaucoma (24%) and other corneal scars (14%). Causes were similar across all regions except in the south. Avoidable causes were responsible for 60.6% of blindness. Major causes of visual impairment were cataract (31.2%), diabetic retinopathy (16.6%) and posterior segment diseases (15.1%). Cataract surgical coverage among those with visual acuity <3/60 was 95.4%, with no sex differences. About 38% of cataract-operated eyes had poor outcome even after best correction (35%). There was poor outcome in 33% of pseudophakic eyes with best correction. The major barriers to service uptake were "waiting for maturity" (26%), "unaware of treatment" (24%) and "God's will/destiny" (17%). Libya needs to improve the quality of cataract surgery across all the regions. The southern region needs improvement in both quality and coverage of services.

Cataract: trends in surgical procedures and visual outcomes; a study in a tertiary care hospital.

PubMed

Naeem, Mohammad; Khan, Ayasha; Khan, Muhammad Zia-ul-Islam; Adil, Muhammad; Abbas, Syed Hussain; Khan, Muhammad Usman; Naz, Syeda Maria

2012-03-01

To determine the current procedures in practice and visual outcome following a cataract surgery. The study was conducted from January 7 to April 7, 2011 in the Eye Unit of the Lady Reading Hospital, Peshawar, involving 181 patients. Basic demographics of the patients as well as the type of cataract surgery were noted. Risk factors like diabetes mellitus and glaucoma were also noted for each patient. A pre-operative visual acuity was determined. The patient was examined after two months to determine the visual improvement. Out of 181 patients, 117 were males and 64 were females. Age ranged from 5 years to 83 years with a median age of 60. Most common procedure performed (60.2%) was extra capsular cataract extraction with posterior chamber intraocular lense (ECCE), followed by Phacoemulsification (24.3%). Visual outcome was good in 88.3%, borderline in 8.3% and poor in 3.3% patients. The main reasons for poor visual outcomes were diabetic retinopathy 42.8%, glaucoma-related vision loss 19.0%, history of trauma with retinal detachment 9.5%, and age-related macular degeneration 9.5%. Poor visual outcome was found in diabetic and Glaucoma patients. Surgical complications (3.8%) were rare. Overall a good visual outcome was noted in cataract surgery, which was similar to World Health Organisation guidelines. Extra capsular cataract extraction was the most common procedure followed by Phacoemulsification.

What factors influence cataract waiting list time?

PubMed Central

Churchill, A.; Vize, C.; Stewart, O.; Backhouse, O.

2000-01-01

AIMS—To determine whether there were any specific factors that influenced waiting list time (WLT) for patients undergoing cataract surgery.
METHODS—70 preoperative cataract patients were interviewed by one of the authors using a questionnaire to score visual acuity, coexisting ocular pathology and disabilities, threat to independent living/employment, and perceived visual handicap for detailed, gross, and driving vision. Individuals were analysed separately according to whether it was their first or second cataract operation.
RESULTS—The median WLT for first eye surgery was 9 months (n = 31) and 13 months for second eye surgery (n = 36). The WLT ranged from 2 to 25 months for first eyes and 0.25-18 months for second eyes. Where there was a perceived threat to independent living or employment the WLT was found to be significantly shorter than the median. A high overall score correlated with a shorter WLT. Surgical priority was also given to individuals with anisometropia >3 dioptres.
CONCLUSION—This study has demonstrated that there are specific factors that influence clinicians when prioritising patients for cataract surgery.

 PMID:10729304

Trachoma, cataracts and uncorrected refractive error are still important contributors to visual morbidity in two remote indigenous communities of the Northern Territory, Australia.

PubMed

Wright, Heathcote R; Keeffe, Jill E; Taylor, Hugh R

2009-08-01

To assess the contribution of trachoma, cataract and refractive error to visual morbidity among Indigenous adults living in two remote communities of the Northern Territory. Cross-sectional survey of all adults aged 40 and over within a desert and coastal community. Visual acuity, clinical signs of trachoma using the simplified WHO grading system and assessment of cataract through a non-dilated pupil. Two hundred and sixty individuals over the age of 40 years participated in the study. The prevalence of visual impairment (<6/12) was 17%. The prevalence of blindness (<3/60) was 2%, 40-fold higher than seen in an urban Australian population when adjusted for age. In total, 78% of adults who grew up in a desert community had trachomatous scarring compared with 26% of those who grew up in a coastal community (P < or = 0.001). In the desert community the prevalence of trachomatous trichiasis was 10% and corneal opacity was 6%. No trachomatous trichiasis or corneal opacity was seen in the coastal community. Trachoma, cataract and uncorrected refractive error remain significant contributors to visual morbidity in at least two remote indigenous communities. A wider survey is required to determine if these findings represent a more widespread pattern and existing eye care services may need to be re-assessed to determine the cause of this unmet need.

[Impact of timing of surgery on outcome in children with bilateral congenital cataract].

PubMed

Kuhli-Hattenbach, C; Fronius, M; Kohnen, T

2017-03-01

The optimal time for surgical intervention in bilateral congenital cataract is still a matter of controversy. Herein, we evaluated clinical and functional results after bilateral congenital cataract surgery and performed subgroup analysis based on the age at the time of surgery. We retrospectively reviewed the records of 52 eyes of 26 children who underwent surgery for bilateral congenital cataract without intraocular lens implantation within the first 12 months of life; 16 eyes underwent phacoaspiration within the first 10 weeks of life (group A) and 26 eyes had cataract extraction at an age of >10 weeks (group B). We defined the primary outcome measure to be the prevalence of mild, moderate, and severe amblyopia in relationship to age-dependent visual acuity norms after a mean follow-up of 59.7 ± 43.2 months. Secondary outcome measures were interocular difference of visual acuity and the presence of strabismus, nystagmus, posterior capsule opacification, and aphakic glaucoma. The prevalence of amblyopia was not statistically different between the two age groups. Of all children, 62.5 % (A) and 61.1 % (B) developed age-dependent normal visual acuity or mild amblyopia. However, the younger cohort developed significantly less strabismus than the older cohort (P = 0.03). There was a strong relationship between cataract surgery within the first 14 weeks of life and the development of aphakic glaucoma. All children developing secondary cataract formation underwent cataract surgery in the first 20 weeks of life. Our results suggest that long-term prevalence of mild, moderate, and severe amblyopia is similar between the two cohorts of bilateral congenital cataract eyes based on the age ≤ or >10 weeks at the time of surgery. Because there is a strong relationship between postoperative complications and a young age at the time of cataract surgery, close postoperative follow-up is essential. Strabismus is less likely to develop in infants after bilateral cataract surgery within the first 10 weeks of life.

A case control study of senile cataract in a hospital based population.

PubMed

Badrinath, S S; Sharma, T; Biswas, J; Srinivas, V

1996-12-01

A case-control study (244 cases and 264 controls) was done during 1986-89 on a hospital based population to evaluate the risk factors associated with the etiology of senile cataract. Patient with age between 40-60 years, visual acuity of 6/9 or less, and presence of lenticular opacity of senile origin were included as cases. Age matched individuals with absence of lenticular opacity made up the controls. Multivariate logistic regression analysis revealed that higher systolic BP and number of meals were significantly (P < or = 0.05) associated with presence of senile cataract; whereas higher weight, education and income, and utilization of cooking water had a significant protective effect against senile cataract. The present study helps the clinician to understand the possible risk factors associated with the development of senile cataract and could be helpful in designing a intervention strategy in future.

Color of intra-ocular lens and cataract type are prognostic determinants of health indices after visual and photoreceptive restoration by surgery.

PubMed

Ayaki, Masahiko; Negishi, Kazuno; Suzukamo, Yoshimi; Tsubota, Kazuo

2015-04-01

This study compared post-operative quality of life and sleep according to the type of cataract opacity and color of the implanted intra-ocular lens (IOL). This is a cohort study and participants were 206 patients (average age 74.1 years) undergoing cataract surgery with the implantation of a clear ultra-violet (UV)-blocking IOL (C) or a yellow blue-light-blocking IOL (Y). Participants were evaluated using the National Eye Institute Visual Function Questionnaire (VFQ-25) and Pittsburgh Sleep Quality Index (PSQI) before surgery and 2 and 7 months after surgery. Changes in sub-scale scores of VFQ-25 and PSQI were compared. Sub-scale analyses for improvement after surgery revealed significant differences in ocular pain scores on the VFQ-25 (Y>C; the higher the score, the better the outcome). Furthermore, there were significant differences between the two IOLs in terms of the sleep latency score (C>Y) and sleep disturbances score (C>Y). A posterior sub-capsular cataract was significantly correlated with improvements in ocular pain and sleep latency scores. These effects were successfully represented by the change in scores rather than absolute post-operative scores because individual standard of response may often change after intervention, recognized as a response shift phenomenon in patient-reported outcome study. Regarding seasonal differences, patients who had surgery in summer exhibited relatively better sleep quality than those who had surgery in winter. Analysis of sub-scales of health indices demonstrated characteristic prognoses for each IOL and cataract type. Cataract surgery may potentially contribute to systemic health in older adults.

Outcomes of cataract surgery with residents as primary surgeons in the Veterans Affairs Healthcare System.

PubMed

Payal, Abhishek R; Gonzalez-Gonzalez, Luis A; Chen, Xi; Cakiner-Egilmez, Tulay; Chomsky, Amy; Baze, Elizabeth; Vollman, David; Lawrence, Mary G; Daly, Mary K

2016-03-01

To explore visual outcomes, functional visual improvement, and events in resident-operated cataract surgery cases. Veterans Affairs Ophthalmic Surgery Outcomes Database Project across 5 Veterans Affairs Medical Centers. Retrospective data analysis of deidentified data. Cataract surgery cases with residents as primary surgeons were analyzed for logMAR corrected distance visual acuity (CDVA) and vision-related quality of life (VRQL) measured by the modified National Eye Institute Vision Function Questionnaire and 30 intraoperative and postoperative events. In some analyses, cases without events (Group A) were compared with cases with events (Group B). The study included 4221 cataract surgery cases. Preoperative to postoperative CDVA improved significantly in both groups (P < .0001), although the level of improvement was less in Group B (P = .03). A CDVA of 20/40 or better was achieved in 96.64% in Group A and 88.25% in Group B (P < .0001); however, Group B had a higher prevalence of preoperative ocular comorbidities (P < .0001). Cases with 1 or more events were associated with a higher likelihood of a postoperative CDVA worse than 20/40 (odds ratio, 3.82; 95% confidence interval, 2.92-5.05; P < .0001) than those who did not experience an event. Both groups had a significant increase in VRQL from preoperative levels (both P < .0001); however, the level of preoperative to postoperative VRQL improvement was significantly less in Group B (P < .0001). Resident-operated cases with and without events had an overall significant improvement in visual acuity and visual function compared with preoperatively, although this improvement was less marked in those that had an event. None of the authors has a financial or proprietary interest in any material or method mentioned. Copyright © 2016 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Manual small incision extracapsular cataract surgery in Australia.

PubMed

van Zyl, Lourens; Kahawita, Shyalle; Goggin, Michael

2014-11-01

Examination of the results and describing the technique of manual small incision extracapsular cataract extraction on patients with advanced cataracts in urban Australia. A descriptive case series. Thirty-eight patients at three public hospitals, one tertiary and two secondary ophthalmic units in urban Australia. Forty eyes with dense mature cataracts with hand movement vision or worse underwent a planned manual small incision extracapsular cataract extraction instead of traditional phaco-emulsification. Postoperative visual aquity, surgically induced astigmatism and complications. Seventy-eight per cent of patients had an uncorrected visual acuity of 6/12 or better on the first postoperative day. Eighty-three per cent of patients had a distance corrected visual acuity of 6/9 or better 3 months postoperatively. One case was complicated by a posterior capsule rupture. No cases of endophthalmitis were reported. The summated vector mean of the surgically induced astigmatism was 0.089D at 93°. Manual small incision extracapsular cataract extraction is an efficacious cataract surgery technique with good visual outcome and is a safe alternative to phaco-emulsification in suitable cases in a first-world setting. © 2014 Royal Australian and New Zealand College of Ophthalmologists.

Psychological distress and visual functioning in relation to vision-related disability in older individuals with cataracts.

PubMed

Walker, J G; Anstey, K J; Lord, S R

2006-05-01

To determine whether demographic, health status and psychological functioning measures, in addition to impaired visual acuity, are related to vision-related disability. Participants were 105 individuals (mean age=73.7 years) with cataracts requiring surgery and corrected visual acuity in the better eye of 6/24 to 6/36 were recruited from waiting lists at three public out-patient ophthalmology clinics. Visual disability was measured with the Visual Functioning-14 survey. Visual acuity was assessed using better and worse eye logMAR scores and the Melbourne Edge Test (MET) for edge contrast sensitivity. Data relating to demographic information, depression, anxiety and stress, health care and medication use and numbers of co-morbid conditions were obtained. Principal component analysis revealed four meaningful factors that accounted for 75% of the variance in visual disability: recreational activities, reading and fine work, activities of daily living and driving behaviour. Multiple regression analyses determined that visual acuity variables were the only significant predictors of overall vision-related functioning and difficulties with reading and fine work. For the remaining visual disability domains, non-visual factors were also significant predictors. Difficulties with recreational activities were predicted by stress, as well as worse eye visual acuity, and difficulties with activities of daily living were associated with self-reported health status, age and depression as well as MET contrast scores. Driving behaviour was associated with sex (with fewer women driving), depression, anxiety and stress scores, and MET contrast scores. Vision-related disability is common in older individuals with cataracts. In addition to visual acuity, demographic, psychological and health status factors influence the severity of vision-related disability, affecting recreational activities, activities of daily living and driving.

The results of ab interno laser thermal sclerostomy combined with cataract surgery versus trabeculectomy combined with cataract surgery 6 to 12 months postoperatively.

PubMed

Kendrick, R; Kollarits, C R; Khan, N

1996-07-01

When cataract surgery and glaucoma surgery are combined, the theoretical advantages of pressure control, removal of the visual impairment, and protection against an increase in intraocular pressure (IOP) in the immediate postoperative period are gained. The authors' objective was to determine whether ab interno laser thermal sclerostomy (LTS) combined with cataract surgery would be as effective as trabeculectomy combined with cataract surgery. Ab interno LTS was compared with trabeculectomy, retrospectively, for patients who had undergone combined cataract and glaucoma surgery. There was no significant difference in the numbers of patients using no medications or fewer medications at 6 and 12 months. There was a greater reduction in IOP in the LTS group. LTS may be better than trabeculectomy in combined cataract and glaucoma surgery because it reduces the IOP more. Compared with trabeculectomy, LTS is simpler to perform and adds less operating time to cataract surgery. Continued follow-up is recommended.

Use of cataract surgery in urban Beijing: a post screening follow-up of the elderly with visual impairment due to age-related cataract.

PubMed

Ren, Xue-tao; Snellingen, Torkel; Gu, Hong; Assanangkornchai, Sawitri; Zou, Yan-hong; Chongsuvivatwong, Virasakdi; Lim, Apiradee; Jia, Wei; Liu, Xi-pu; Liu, Ning-pu

2015-03-01

To understand the perception for the use of cataract surgical services in a population of acceptors and non-acceptors of cataract surgery in urban Beijing. From a community-based screening program a total of 158 patients with presenting visual acuity of less than 6/18 on either eye due to age-related cataract were informed about the possibility of surgical treatment. These patients were interviewed and re-examined 36 to 46 months after initial screening. The main reasons for not accepting surgery were obtained using a questionnaire. Vision function and vision-related quality of life scores were assessed in those who received and did not receive surgery. At the follow-up examination 116 of the 158 patients were available and 36 (31.0%) had undergone cataract surgery. Cases who chose surgery had higher education level than those who did not seek surgery (OR=2.64, 95% CI: 1.08-6.63, P=0.02). There were no significant differences in vision function (P=0.11) or quality of life scores (P=0.16) between the surgery group and the non-surgery group. Main reasons for not having surgery included no perceived need (50.0%), feeling of being "too old" (19.2%), and worry about the quality of surgery (9.6%). Cost was cited by 1 (1.9%) subject as the main reason for not seeking surgery. The data suggest that in China's capital urban center for patients with moderate visual impairment there is a relative low acceptance rate of cataract surgery, mainly due to people's perception of marginal benefits of surgery. Cost is not a determining factor as barrier to undergo surgery and patients with poorer education are less likely to undertake surgery.

Waiting time for cataract surgery and its influence on patient attitudes.

PubMed

Chan, Frank Wan-kin; Fan, Alex Hoi; Wong, Fiona Yan-yan; Lam, Philip Tsze-ho; Yeoh, Eng-kiong; Yam, Carrie Ho-kwan; Griffiths, Sian; Lam, Dennis Shun-chiu; Congdon, Nathan

2009-08-01

To characterize willingness to pay for private operations and preferred waiting time among patients awaiting cataract surgery in Hong Kong. This was a cross-sectional survey. Subjects randomly selected from cataract surgical waiting lists in Hong Kong (n = 467) underwent a telephone interview based on a structured, validated questionnaire. Data were collected on private insurance coverage, preferred waiting time, amount willing to pay for surgery, and self-reported visual function and health status. Among 300 subjects completing the interview, 144 (48.2%) were 76 years of age or older, 177 (59%) were women, and mean time waiting for surgery was 17 +/- 15 months. Among 220 subjects (73.3%) willing to pay anything for surgery, the mean amount was US$552 +/- 443. With adjustment for age, education, and monthly household income, subjects willing to pay anything were less willing to wait 12 months for surgery (OR = 4.34; P = 0.002), more likely to know someone having had cataract surgery (OR = 2.20; P = 0.03), and more likely to use their own savings to pay for the surgery (OR = 2.21; P = 0.04). Subjects considering private cataract surgery, knowing people who have had cataract surgery, using nongovernment sources to pay for surgery, and having lower visual function were willing to pay more. Many patients wait significant periods for cataract surgery in Hong Kong, and are willing to pay substantial amounts for private operations. These results may have implications for other countries with cataract waiting lists.

The impact of cataract surgery on visual functioning, vision-related disability and psychological distress: a randomized controlled trial.

PubMed

Walker, Janine G; Anstey, Kaarin J; Hennessy, Michael P; Lord, Stephen R; von Sanden, Chwee

2006-11-01

Determine whether there are changes in visual functioning, vision-related disability, health status and mood after cataract surgery. 45 adults (mean age = 73.7 years) with bilateral cataract needing surgery for the first eye were recruited from public ophthalmology clinics. The Visual Functioning-14 survey assessed visual disability. Minimal angle of resolution tested visual acuity, and the Melbourne Edge Test examined contrast sensitivity. Demographic, psychological, health and medication use variables were examined. Participants were randomized to either an intervention or control arm. Controls were assessed on two occasions at a 3-month interval before having surgery. The intervention group was assessed 1-2 weeks before surgery and then reassessed 3 months after surgery. Visual functioning improved for those who had cataract surgery with better visual acuity in the better (P = 0.010) and worse (P = 0.028) eye compared with controls. The intervention group reported fewer difficulties with overall vision-related disability (P = 0.0001), reading (P = 0.004) and instrumental activities of daily living (P = 0.010) post-surgery compared with controls. People with improved depression scores (P = 0.048) after surgery had less difficulty with reading compared with those with unchanged or worsened depression scores. Cataract surgery did not improve health status. First eye cataract surgery is effective in improving outcomes in visual functioning and disability. Improved mood after surgery was related to less vision-related disability compared with unchanged or worse depression.

Pediatric cataract: challenges and future directions

PubMed Central

Medsinge, Anagha; Nischal, Ken K

2015-01-01

Cataract is a significant cause of visual disability in the pediatric population worldwide and can significantly impact the neurobiological development of a child. Early diagnosis and prompt surgical intervention is critical to prevent irreversible amblyopia. Thorough ocular evaluation, including the onset, duration, and morphology of a cataract, is essential to determine the timing for surgical intervention. Detailed assessment of the general health of the child, preferably in conjunction with a pediatrician, is helpful to rule out any associated systemic condition. Although pediatric cataracts have a diverse etiology, with the majority being idiopathic, genetic counseling and molecular testing should be undertaken with the help of a genetic counselor and/or geneticist in cases of hereditary cataracts. Advancement in surgical techniques and methods of optical rehabilitation has substantially improved the functional and anatomic outcomes of pediatric cataract surgeries in recent years. However, the phenomenon of refractive growth and the process of emmetropization have continued to puzzle pediatric ophthalmologists and highlight the need for future prospective studies. Posterior capsule opacification and secondary glaucoma are still the major postoperative complications necessitating long-term surveillance in children undergoing cataract surgery early in life. Successful management of pediatric cataracts depends on individualized care and experienced teamwork. We reviewed the etiology, preoperative evaluation including biometry, choice of intraocular lens, surgical techniques, and recent developments in the field of childhood cataract. PMID:25609909

Iris-claw versus posterior chamber fixation intraocular lens implantation in pediatric traumatic cataract☆

PubMed Central

Kavitha, V; Balasubramanian, Preethi; Heralgi, Mallikarjun M.

2016-01-01

Aim: This study aims to compare visual outcomes and complications of iris-fixated (claw) intraocular lens (IFIOL) implantation with those of posterior chamber intraocular lens (PCIOL) implantation in children with traumatic cataract. Settings and design: Retrospective observational clinical audit. Materials and methods: A total of 50 pediatric traumatic cataract cases that underwent lens removal and IOL implantation (IFIOL or PCIOL) with or without corneal or corneoscleral tear repair between January 2009 and December 2013 were analyzed. After meeting the eligibility criteria, their pre- and postoperative visual outcomes and complication rates were recorded. Data were analyzed descriptively. Results: Out of 50 children, IFIOL and PCIOL implantations were performed in one eye of each of 25 children. Their mean age was 11 ± 4 years (range 4–18 years). Primary (cataract removal with lens implantation) and secondary (corneal tear repair followed by cataract removal with lens implantation) procedures were performed in 19 (76%) and six (24%) children in the IFIOL group and in 21 (84%) and four (16%) children in the PCIOL group, respectively. There was an improvement in best corrected visual acuity postimplantation in both the IFIOL and the PCIOL group, and no significant difference in the logarithm of the minimum angle of resolution of best corrected visual acuity was observed between the two groups over 36 months. Only three eyes in the IFIOL group developed complications: one eye developed secondary glaucoma, one disenclavation of IOL haptic, and one cystoid macular edema. Conclusion: Both IFIOL and PCIOL implantations have good visual outcomes and minimal postoperative complications; therefore, IFIOL can be used as an alternative to PCIOL in children with traumatic cataract with inadequate capsular support. PMID:29018714

Cost-effectiveness analysis should continually assess competing health care options especially in high volume environments like cataract surgery.

PubMed

Khan, Ashiya; Amitava, Abadan Khan; Rizvi, Syed Ali Raza; Siddiqui, Ziya; Kumari, Namita; Grover, Shivani

2015-06-01

Cost-effectiveness analysis should continually assess competing health care options especially in high volume environments like cataract surgery. To compare the cost effectiveness of phacoemulsification (PE) versus manual small-incision cataract surgery (MSICS). Prospective randomized controlled trial. Tertiary care hospital setting. A total of 52 consenting patients with age-related cataracts, were prospectively recruited, and block randomized to PE or MSICS group. Preoperative and postoperative LogMAR visual acuity (VA), visual function-14 (VF-14) score and their quality-adjusted life years (QALYs) were obtained, and the change in their values calculated. These were divided by the total cost incurred in the surgery to calculate and compare the cost effectiveness and cost utility. Surgery duration was also compared. Two group comparison with Student's t-test. Significance set at P < 0.05; 95% confidence interval (CI) quoted where appropriate. Both the MSICS and PE groups achieved comparative outcomes in terms of change (difference in mean [95% CI]) in LogMAR VA (0.03 [-0.05-0.11]), VF-14 score (7.92 [-1.03-16.86]) and QALYs (1.14 [-0.89-3.16]). However, with significantly lower costs (INR 3228 [2700-3756]), MSICS was more cost effective, with superior cost utility value. MSICS was also significantly quicker (10.58 min [6.85-14.30]) than PE. MSICS provides comparable visual and QALY improvement, yet takes less time, and is significantly more cost-effective, compared with PE. Greater push and penetration of MSICS, by the government, is justifiably warranted in our country.

Visual outcomes of bilateral congenital and developmental cataracts in young children in south India and causes of poor outcome.

PubMed

Khanna, Rohit C; Foster, Allen; Krishnaiah, Sannapaneni; Mehta, Manohar K; Gogate, Parikshit M

2013-02-01

Bilateral pediatric cataracts are important cause of visual impairment in children. To study the outcome of bilateral pediatric cataract surgery in young children. Retrospective case series in a tertiary center. Records of pediatric cataracts operated between January 2001 and December 2003, with a minimum follow-up of 3 months, were reviewed retrospectively. Independent sample t-test, Fisher's exact test, and logistic regression using SPSS (Statistical Package for Social Science, Chicago, USA) version 12. 215/257 (83.7%) patients had a minimum follow-up of 3 months. The mean age of presentation to the hospital was 53 months (range: 0-168 months). Congenital cataract was present in 107 patients (58.2%) and developmental cataract in 77 patients (41.8%). The mean age at surgery was 55.2 months (range: 1-168 months). Out of 430 eyes, 269 (62.6%) had an intraocular lens implanted. The mean duration of follow-up was 13.1 months (range: 3-38 months). Pre-operatively, 102 patients (47.3%) had visual acuity <6/60, in the better eye, compared to 37 patients (17.2%) post-operatively ( P < 0.001). Eighty-five patients (39.5%) had visual acuity >6/18. The most common early post-operative complication was fibrinous uveitis in 57 eyes (13.3%) and the most common delayed post-operative complication was posterior capsular opacification in 118 eyes (27.4%). The most important prognostic factor for poor outcome was congenital cataract (odds ratio [OR]: 26.3; 95% confidence interval [CI], 4.4-158.5) and total cataract (OR: 4.8; 95% CI, 1.3-17). Nearly half of the eyes had visual acuity >6/18. The outcome was poorer in congenital cataracts, especially those operated after >1 year of age.

Prevalence of visual impairment and outcomes of cataract surgery in Chaonan, South China

PubMed Central

Zhang, Xiujuan; Li, Emmy Y.; Leung, Christopher Kai-Shun; Musch, David C.; Tang, Xin; Zheng, Chongren; He, Mingguang; Chang, David F.

2017-01-01

Purpose To estimate the prevalence and causes of blindness and visual impairment (VI), and report the outcomes of cataract surgery in Chaonan Region, Guangdong Province, southern China Design Cross-sectional population-based survey Participants A total of 3484 participants including 1397 men (40.1%) and 2087 women (59.9%) aged ≥50 years were examined (94.2% response rate). Method A two-stage cluster sampling procedure was used to select 3700 participants aged ≥50 years from 74 clusters of Chaonan Region. Participants were examined according to the Rapid Assessment of Avoidable Blindness (RAAB) method. Blindness and visual impairment (VI) were defined by the World Health Organization criteria. Participants with visual acuity (VA) < 6/18 in either eye were examined by ophthalmologists. The primary causes of blindness and VI were reported with reference to the participant’s better eye. Main outcome measures Prevalence and main causes of blindness, severe visual impairment (SVI), VI and the outcomes of cataract surgery Results The standardized prevalence rates of blindness, SVI, and VI were 2.4% (95% confidence interval [CI], 1.9–2.9%), 1.0% (95% CI, 0.7–1.4%), and 6.4% (95% CI, 5.6%– 7.1%), respectively. The principal cause of blindness and SVI was cataract, accounting for 67.1% and 67.6% respectively, and the principal cause of VI was refractive error (46.9%). One hundred and fifty five out of 3484 (4.4%) people (211 eyes) had cataract surgery. Of the 211 eyes that had cataract surgery, 96.7% were pseudophakic. 67.2% of the 211 operated eyes had a presenting visual acuity (PVA) of 6/18 or better. Conclusions The prevalence of blindness, SVI, and VI was high among rural residents in Chaonan. Cataract remained the leading cause of avoidable blindness. Outcomes of cataract surgery performed in rural private clinics were suboptimal. Quality-control initiatives such as hands-on training program should be introduced to improve cataract surgery outcomes. PMID:28797099

Relationship of cataract symptoms of preoperative patients and vision-related quality of life.

PubMed

Lee, Jae Eun; Fos, Peter J; Sung, Jung Hye; Amy, Brian W; Zuniga, Miguel A; Lee, Won Jae; Kim, Jae Chang

2005-10-01

This study was conducted in an attempt to describe the status of cataract symptoms of preoperative cataract patients, as well as to determine the relationship between cataract symptom and vision-related quality of life measures. A cross-sectional study design was used. Study subjects were selected using non-probabilistic methods. The study sample consisted of 132 patients scheduled for cataract surgery in one eye. Information was obtained from study subjects by conducting face-to-face interviews. Study subjects were adult cataract patients at Samsung and Kunyang General Hospitals in Seoul, Korea, and Tulane University Hospital and Clinics in New Orleans, Louisiana, United States of America. Degree to which study subjects were "bothered" by cataract symptoms was measured by using the 5-item Cataract Symptom Scores (CSS). The number of symptoms, highest scored symptom among the five, number of symptoms extremely bothering, and the mean of cataract symptom score were created based on the CSS measure. Vision-related quality of life was assessed by using the Visual Function 14 Items (VF-14) and Global Measure of Vision (GMV) for trouble and satisfaction. The symptoms "blurry vision" and "worsening of vision" were most frequently reported. The symptom "colors looking different" was rarely reported among preoperative cataract patients. The degree to which study subjects were bothered by "blurry vision" and "seeing glare, halo, or rings" was highly associated with visual function, visual trouble, and visual satisfaction. Multiple regression analysis revealed that the newly developed cataract symptom-related scales, as well as total amount of degree to which study subjects were "bothered" by symptoms were highly related to vision-related quality of life measures. These relationships were persistent after controlling for major socio-demographic variables. The results indicate that cataract symptoms are highly associated with vision-related quality of life. The results also suggest that the number of symptoms, highest scored symptom among the five, number of symptoms extremely bothering, and the mean cataract symptom scores should be considered an important cataract symptom-related scale when analyzing quality of life, including cataract symptom.

Evaluation of a Public Child Eye Health Tertiary Facility for Pediatric Cataract in Southern Nigeria I: Visual Acuity Outcome

PubMed Central

Duke, Roseline E.; Adio, Adedayo; Oparah, Sidney K.; Odey, Friday; Eyo, Okon A.

2016-01-01

Purpose: A retrospective study of the outcome of congenital and developmental cataract surgery was conducted in a public child eye health tertiary facility in children <16 years of age in Southern Nigeria, as part of an evaluation. Materials and Method: Manual Small Incision Cataract Surgery with or without anterior vitrectomy was performed. The outcome measures were visual acuity (VA) and change (gain) in visual acuity. The age of the child at onset, duration of delay in presentation, ocular co-morbidity, non ocular co-morbidity, gender, and pre operative visual acuity were matched with postoperative visual acuity. A total of 66 children were studied for a period of six weeks following surgery. Results: Forty eight (72.7%) children had bilateral congenital cataracts and 18 (27.3%) children had bilateral developmental cataracts. There were 38(57.6%) males and 28 (42.4%) females in the study. Thirty Five (53%) children had good visual outcome (normal vision range 6/6/ -6/18) post-operatively. The number of children with blindness (vision <3/60) decreased from 61 (92.4%) pre-operatively to 4 (6.1%) post-operatively. Post operative complication occurred in 6.8% of cases six week after surgery. Delayed presentation had an inverse relationship with change (gain) in visual acuity (r = - 0.342; p-value = 0.005). Pre-operative visual acuity had a positive relationship with post operative change (gain) in visual acuity (r = 0.618; p-value = 0.000). Conclusion: Predictors of change in visual acuity in our study were; delayed presentation and pre-operative VA. Cataract surgery in children showed clinical benefit. PMID:27347247

Level of education associated with ophthalmic diseases. The Beijing Eye Study.

PubMed

Xu, Liang; Wang, Ya Xing; Jonas, Jost B

2010-01-01

To determine associations between educational level and ophthalmic diseases in Chinese. The population-based Beijing Eye Study, performed in 2006, enrolled 3,251 participants (age: 45+ years) out of 4,439 subjects invited to participate (response rate: 73.2%). The participants underwent an interview including questions concerning their educational level, and a detailed ophthalmic examination. Data on the level of education were available for 3,221 (99.1%) subjects, with 1,484 (46.1%) subjects living in the rural region. The mean age was 60.4 +/- 10.1 years (range: 45-89 years). In a multivariate analysis, a higher level of education was significantly associated with myopic refractive error, higher best-corrected visual acuity, lower degree of nuclear cataract, and lower prevalence of angle-closure glaucoma, and with the systemic parameters of lower age, male gender, urban region, taller body height, and lower body mass index. It was not significantly associated with intraocular pressure, amount of subcapsular cataract and cortical cataract, cataract surgery, and the prevalences of diabetes mellitus, retinal vein occlusions, chronic open-angle glaucoma, and age-related macular degeneration, and with the systemic parameters of fasting serum concentrations of glucose, high-density lipoproteins, low-density lipoproteins, cholesterol and triglycerides, systolic and diastolic blood pressure. In the Greater Beijing area, a higher level of education was associated with myopic refractive error, higher best-corrected visual acuity, and lower prevalence of nuclear cataract and angle-closure glaucoma, after adjusting for the systemic parameters of younger age, male gender, urban region, taller body height, lower body mass index less smoking and less alcohol consumption. Educational level was not significantly associated with intraocular pressure, cortical cataract, blood pressure, and frequencies of age-related macular degeneration, retinal vein occlusions and chronic open-angle glaucoma.

Glaucoma and cataract surgery: two roads merging into one.

PubMed

Shah, Manjool; Law, Geoffrey; Ahmed, Iqbal Ike K

2016-01-01

To discuss the increasing utilization of cataract extraction in the management of glaucoma and to highlight advances in surgical care that can promote synergistic treatment of these comorbid conditions. Recent years have demonstrated significant advances in the management of glaucoma through the use of novel microinvasive glaucoma devices. Furthermore, an increased understanding of the role of cataract surgery in the treatment of various glaucomas warrants review. Nevertheless, cataract surgery in the glaucoma patient warrants specific preoperative, intraoperative, and postoperative planning to optimize visual function and quality of life while mitigating potential risk factors for adverse events. Although the challenges of performing cataract extraction on glaucoma patients exist, the potential benefit to these patients is substantial. With attention to pre- and perioperative surgical planning and intraoperative technique, as well as with awareness and potential utilization of novel devices and treatment strategies, cataract extraction offers a unique platform for anatomical and functional improvement in this increasingly common cohort of patients.

Visual Results Following Implantation of a Refractive Multifocal Intraocular Lens in One Eye and a Diffractive in the Contralateral Eye

PubMed Central

Yıldırım Karabağ, Revan; Günenç, Üzeyir; Aydın, Rukiye; Arıkan, Gül; Aslankara, Hüseyin

2018-01-01

Objectives To assess the visual outcomes in patients who underwent cataract surgery with multifocal intraocular lens (IOL) implantation using a “mix and match” approach. Materials and Methods Twenty patients (40 eyes) were involved in this prospective, nonrandomized study. Refractive multifocal IOLs (ReZoom NXG1) were implanted in patients’ dominant eyes and diffractive multifocal IOLs (Tecnis ZMA00) were implanted in their non-dominant eyes. Monocular and binocular uncorrected distance, intermediate and near visual acuity (logMAR), and contrast sensitivity levels were measured at 1, 3, and 6 months after cataract surgery. Defocus curves, reading speeds, patient satisfaction, spectacle dependence, and halo and glare symptoms were also evaluated at 6 months after the surgery. Postoperative quality of life was assessed with the Turkish version of National Eye Institute Visual Function Questionnaire-25. Results The study group comprised 8 females and 12 males with a mean age of 69.45±10.76 years (range, 31-86 years). The uncorrected distance and intermediate visual acuity levels were significantly better in the ReZoom-implanted eyes at postoperative 6 months (p=0.026 and p=0.037, respectively). There was no statistically significant difference in uncorrected near visual acuity (p>0.05). There was no statistically significant difference in contrast sensitivity, reading speed, halos, or glare between the groups (p<0.05). Mild glare/halo was reported by 40% of the subjects. The mean patient satisfaction was 95% and all patients were spectacle independent. Conclusion Mixing and matching multifocal IOLs in selected cataract patients provides excellent visual outcome, a high level of patient satisfaction, and spectacle independency. PMID:29576891

Diabetic Macular Edema at the time of Cataract Surgery trial: a prospective, randomized clinical trial of intravitreous bevacizumab versus triamcinolone in patients with diabetic macular oedema at the time of cataract surgery - preliminary 6 month results.

PubMed

Lim, Lyndell L; Morrison, Julie L; Constantinou, Marios; Rogers, Sophie; Sandhu, Sukhpal S; Wickremasinghe, Sanjeewa S; Kawasaki, Ryo; Al-Qureshi, Salmaan

2016-05-01

To compare visual and anatomical outcomes between intravitreous bevacizumab (BVB, Avastin) and triamcinolone (TA, Triesence) when administered at the time of cataract surgery in patients with diabetic macular oedema (DME). Prospective, single-masked, randomized clinical trial at The Royal Victorian Eye and Ear Hospital, Melbourne. Patients with clinically significant cataract and either centre-involving DME or DME treated within the previous 24 months. Participants were randomized 1:1 to receive intravitreous BVB 1.25 mg or TA 4 mg during cataract surgery, and at subsequent review if required over 6 months. Change in central macular thickness (CMT) and best corrected visual acuity at 6 months. Forty-one patients (mean age 66.4 years, 73.2% male) were recruited. Visual acuity and CMT were similar between groups at baseline (P > 0.2).After six months, both groups gained vision (mean +21.4 letters in TA group P < 0.0001, +12.5 letters in BVB, P = 0.002), with no significant difference between groups (P = 0.085). In addition, 60.9% of eyes receiving TA achieved a VA of ≥6/12 compared to 73.3% in the BVB group (P = 0.501). However, only TA was associated with a sustained reduction in CMT (-43.8-µm reduction TA vs. +37.3-µm increase BVB, P = 0.006 over 6 months). Following surgery, additional injections were required in 70.6% of participants in the BVB group, compared to 16.7% in the TA group (P < 0.0001). Three patients in the TA group experienced a rise of IOP over 21 mmHg (12.5%) during the 6-month follow-up; BVB had no cases (P = 0.130). There were no cases of endophthalmitis in either group. When administered at the time of cataract surgery in patients with DME, at 6 months both TA and BVB improve visual acuity; however, only TA results in a sustained reduction in CMT. Further follow-up will determine whether this translates into better long-term visual outcomes in the TA group. © 2016 Royal Australian and New Zealand College of Ophthalmologists.

The Comparison between Torsional and Conventional Mode Phacoemulsification in Moderate and Hard Cataracts

PubMed Central

Kim, Dong-Hyun; Wee, Won-Ryang; Lee, Jin-Hak

2010-01-01

Purpose To compare the intraoperative performances and postoperative outcomes of cataract surgery performed with longitudinal phacoemulsification and torsional phacoemulsification in moderate and hard cataracts. Methods Of 85 patients who had senile cataracts, 102 eyes were operated on using the Infiniti Vision System. Preoperative examinations (slit lamp examination, mean central corneal thickness, and central endothelial cell counts) were performed for each patient. Cataracts were subdivided into moderate and hard, according to the Lens Opacities Classification System III grading of nucleus opalescence (NO). Eyes in each cataract group were randomly assigned to conventional and torsional phaco-mode. Intraoperative parameters, including ultrasound time (UST), cumulative dissipated energy (CDE), and the balanced salt solution plus (BSSP) volume utilized were evaluated. Best corrected visual acuity (BCVA) was checked on postoperative day 30; mean central corneal thickness and central endothelial cell counts were investigated on postoperative days 7 and 30. Results Preoperative BCVA and mean grading of NO showed no difference in both groups. Preoperative endothelial cell count and central corneal thickness also showed no significant difference in both groups. In the moderate cataract group, the CDE, UST, and BSSP volume were significantly lower in the torsional mode than the longitudinal mode, but they did not show any difference in the hard cataract group. Torsional group showed less endothelial cell loss and central corneal thickening at postoperative day seven in moderate cataracts but showed no significant differences, as compared with the longitudinal group, by postoperative day 30. Conclusions Torsional phacoemulsification showed superior efficiency for moderate cataracts, as compared with longitudinal phacoemulsification, in the early postoperative stage. PMID:21165231

The comparison between torsional and conventional mode phacoemulsification in moderate and hard cataracts.

PubMed

Kim, Dong-Hyun; Wee, Won-Ryang; Lee, Jin-Hak; Kim, Mee-Kum

2010-12-01

To compare the intraoperative performances and postoperative outcomes of cataract surgery performed with longitudinal phacoemulsification and torsional phacoemulsification in moderate and hard cataracts. Of 85 patients who had senile cataracts, 102 eyes were operated on using the Infiniti Vision System. Preoperative examinations (slit lamp examination, mean central corneal thickness, and central endothelial cell counts) were performed for each patient. Cataracts were subdivided into moderate and hard, according to the Lens Opacities Classification System III grading of nucleus opalescence (NO). Eyes in each cataract group were randomly assigned to conventional and torsional phaco-mode. Intraoperative parameters, including ultrasound time (UST), cumulative dissipated energy (CDE), and the balanced salt solution plus (BSSP) volume utilized were evaluated. Best corrected visual acuity (BCVA) was checked on postoperative day 30; mean central corneal thickness and central endothelial cell counts were investigated on postoperative days 7 and 30. Preoperative BCVA and mean grading of NO showed no difference in both groups. Preoperative endothelial cell count and central corneal thickness also showed no significant difference in both groups. In the moderate cataract group, the CDE, UST, and BSSP volume were significantly lower in the torsional mode than the longitudinal mode, but they did not show any difference in the hard cataract group. Torsional group showed less endothelial cell loss and central corneal thickening at postoperative day seven in moderate cataracts but showed no significant differences, as compared with the longitudinal group, by postoperative day 30. Torsional phacoemulsification showed superior efficiency for moderate cataracts, as compared with longitudinal phacoemulsification, in the early postoperative stage.

Immediate sequential bilateral cataract surgery: A 5-year retrospective analysis of 2470 eyes from a tertiary care eye center in South India

PubMed Central

Ganesh, Sri; Brar, Sheetal; Sreenath, Rohit

2017-01-01

Purpose: The purpose of this study is to evaluate the safety and benefits of immediate sequential bilateral cataract surgery. Patients and Methods: Retrospective data analysis of patients who underwent immediate sequential bilateral phacoemulsification with foldable intraocular lens (IOL) implantation under topical anesthesia from January 2011 to September 2016 was performed. Patients with visually significant bilateral cataract within the axial length range of 21.0–26.5 mm were included in the study. Intraoperative and postoperative complications were evaluated. Results: Two thousand four hundred and seventy eyes from 1235 patients with a mean age of 68.34 years (range: 4–90 years) were analyzed. Best-corrected visual acuity improved from 0.40 ± 0.17 to 0.08 ± 0.10 (logarithm of the minimum angle of resolution). Nearly 92.05% eyes achieved a target postoperative refraction of ± 0.5 D spherical equivalent. Main complications observed were prolonged postoperative inflammation in 25% (n = 31), posterior capsular tears in 0.45% (n = 11), and unilateral cystoid macular edema in 0.08% (n = 2) eyes. No sight-threatening complications such as endophthalmitis, retinal detachment, corneal decompensation and intraocular hemorrhage occurred in any of the eyes. Out of the 288 (23.2%) patients who underwent bilateral multifocal IOL implantation, 23 patients (46 eyes) had femtolaser-assisted cataract surgery procedure. Two pediatric and one Downs syndrome patient underwent bilateral cataract surgery under general anesthesia and intravenous sedation, respectively. Conclusion: IBSCS may be considered as a preferred practice in eligible cases considering significant patient benefits such as early visual rehabilitation, time and cost-effectiveness, and better compliance with postoperative medications. In debilitated patients and special situations, such as pediatric cataract and Downs syndrome requiring general anesthesia it may be the ideal procedure. PMID:28573990

Progressive lenticular astigmatism in the clear lens.

PubMed

Tatham, Andrew; Prydal, Jeremy

2008-03-01

We describe a case of progressive lenticular astigmatism in a 53-year-old man with a clear lens. The patient acquired 5 diopters of lenticular astigmatism in his right eye over an 18-month period. The visual acuity was reduced to 6/60. Following phacoemulsification and intraocular lens implantation, the uncorrected visual acuity was 6/5. Progressive astigmatism is usually corneal in origin and in an otherwise healthy eye, significant lenticular astigmatism is rare. When lenticular astigmatism occurs, it is usually associated with a cortical cataract; however, astigmatism may precede the development of a clinically visible cataract.

Cataract surgery audit at an Australian urban teaching hospital.

PubMed

Kahawita, Shyalle K; Goggin, Michael

2015-08-01

To provide local data on visual acuity and surgical outcomes for cataract surgery performed in an Australian teaching hospital. Continuous audit over 7 years in a public teaching hospital. A total of 3740 eyes had cataract surgery performed at The Queen Elizabeth Hospital, South Australia, from May 2006 to September 2013. Visual acuity and complication rates were recorded for cataract surgery cases operated on between May 2006 and September 2013 on a digital database with data entry contemporaneous with final follow-up. Visual acuity and surgical complications. Of the patients, 91.4% achieved postoperative best-measured vision better than preoperative best-measured vision. The rate of posterior capsular tear was 2.59%, endophthalmitis was 0.11% and the overall complication rate was 11.7%. This audit is the first to document modern cataract surgery, overwhelmingly dominated by phacoemulsification in an Australian population and can be used to benchmark cataract surgery outcome in an urban Australian population. © 2015 Royal Australian and New Zealand College of Ophthalmologists.

Impact of First Eye versus Second Eye Cataract Surgery on Visual Function and Quality of Life.

PubMed

Shekhawat, Nakul S; Stock, Michael V; Baze, Elizabeth F; Daly, Mary K; Vollman, David E; Lawrence, Mary G; Chomsky, Amy S

2017-10-01

To compare the impact of first eye versus second eye cataract surgery on visual function and quality of life. Cohort study. A total of 328 patients undergoing separate first eye and second eye phacoemulsification cataract surgeries at 5 veterans affairs centers in the United States. Patients with previous ocular surgery, postoperative endophthalmitis, postoperative retinal detachment, reoperation within 30 days, dementia, anxiety disorder, hearing difficulty, or history of drug abuse were excluded. Patients received complete preoperative and postoperative ophthalmic examinations for first eye and second eye cataract surgeries. Best-corrected visual acuity (BCVA) was measured 30 to 90 days preoperatively and postoperatively. Patients completed the National Eye Institute Visual Functioning Questionnaire (NEI-VFQ) 30 to 90 days preoperatively and postoperatively. The NEI-VFQ scores were calculated using a traditional subscale scoring algorithm and a Rasch-refined approach producing visual function and socioemotional subscale scores. Postoperative NEI-VFQ scores and improvement in NEI-VFQ scores comparing first eye versus second eye cataract surgery. Mean age was 70.4 years (±9.6 standard deviation [SD]). Compared with second eyes, first eyes had worse mean preoperative BCVA (0.55 vs. 0.36 logarithm of the minimum angle of resolution (logMAR), P < 0.001), greater mean BCVA improvement after surgery (-0.50 vs. -0.32 logMAR, P < 0.001), and slightly worse postoperative BCVA (0.06 vs. 0.03 logMAR, P = 0.039). Compared with first eye surgery, second eye surgery resulted in higher postoperative NEI-VFQ scores for nearly all traditional subscales (P < 0.001), visual function subscale (-3.85 vs. -2.91 logits, P < 0.001), and socioemotional subscale (-2.63 vs. -2.10 logits, P < 0.001). First eye surgery improved visual function scores more than second eye surgery (-2.99 vs. -2.67 logits, P = 0.021), but both first and second eye surgeries resulted in similar improvements in socioemotional scores (-1.62 vs. -1.51 logits, P = 0.255). Second eye cataract surgery improves visual function and quality of life well beyond levels achieved after first eye cataract surgery alone. For certain socioemotional aspects of quality of life, second eye cataract surgery results in comparable improvement to first eye cataract surgery. Copyright © 2017 American Academy of Ophthalmology. All rights reserved.

[Survey on avoidable blindness and visual impairment in Panama].

PubMed

López, Maritza; Brea, Ileana; Yee, Rita; Yi, Rodolfo; Carles, Víctor; Broce, Alberto; Limburg, Hans; Silva, Juan Carlos

2014-12-01

Determine prevalence of blindness and visual impairment in adults aged ≥ 50 years in Panama, identify their main causes, and characterize eye health services. Cross-sectional population study using standard Rapid Assessment of Avoidable Blindness methodology. Fifty people aged ≥ 50 years were selected from each of 84 clusters chosen through representative random sampling of the entire country. Visual acuity was assessed using a Snellen chart; lens and posterior pole status were assessed by direct ophthalmoscopy. Cataract surgery coverage was calculated and its quality assessed, along with causes of visual acuity < 20/60 and barriers to access to surgical treatment. A total of 4 125 people were examined (98.2% of the calculated sample). Age- and sex-adjusted prevalence of blindness was 3.0% (95% CI: 2.3-3.6). The main cause of blindness was cataract (66.4%), followed by glaucoma (10.2%). Cataract (69.2%) was the main cause of severe visual impairment and uncorrected refractive errors were the main cause of moderate visual impairment (60.7%). Surgical cataract coverage in individuals was 76.3%. Of all eyes operated for cataract, 58.0% achieved visual acuity ≤ 20/60 with available correction. Prevalence of blindness in Panama is in line with average prevalence found in other countries of the Region. This problem can be reduced, since 76.2% of cases of blindness and 85.0% of cases of severe visual impairment result from avoidable causes.

Refractive errors and cataract as causes of visual impairment in Brazil.

PubMed

Eduardo Leite Arieta, Carlos; Nicolini Delgado, Alzira Maria; José, Newton Kara; Temporini, Edméia Rita; Alves, Milton Ruiz; de Carvalho Moreira Filho, Djalma

2003-02-01

To identify the main causes of visual impairment (VA

Modified cataract surgery with telescopic magnification for patients with age-related macular degeneration.

PubMed

Iizuka, Megumi; Gorfinkel, John; Mandelcorn, Mark; Lam, Wai-Ching; Devenyi, Robert; Markowitz, Samuel N

2007-12-01

The most desirable effect following cataract surgery in the presence of age-related macular degeneration (AMD) is to obtain an improvement in distance resolution acuity, and the only optical solution to this is the use of telescopic magnification. The purpose of the study was to develop and verify the clinical utility of inducing low-grade telescopic magnification (<33%) at the time of cataract surgery by the choice of an appropriate intraocular lens power and spectacle glasses in patients with AMD and cataract. The design was a prospective, nonrandomized, interventional case series involving 6 patients aged 74-86 (mean 80; SD 4) years with AMD and cataract. Participants were males and females, equal in number, who had visual acuity of less than 20/400 in the weaker eye. Standard cataract surgery was performed in the weaker eye. The power of the intraocular lens was derived from the reduced Gullstrand model of the eye in such a way that at the intraocular lens plane a minus lens was created, which, together with a plus lens in matching glasses, formed a Galilean telescopic system with magnification of up to 33%. Outcome measures were visual acuity, contrast sensitivity, and activities of daily living (ADL) scores. The mean power of the implanted intraocular lenses was 6.31 (SD 2.42) diopters and, according to the theoretical derivations, achieved magnification between 20% and 30% (mean 26%; SD 4.92%). Visual acuity improved for the group from a mean of 20/525 (logMAR 1.48; SD 0.13) to a mean of 20/290 (logMAR 1.20; SD 0.21). Contrast sensitivity improved significantly (p < 0.001) only in the lower spatial frequencies. Postoperatively, ADL scores improved significantly in all patients except one. At the end of the follow-up period, 3 patients reported that they would like to proceed with similar surgery for the other eye. An optimal surgical telescopic device based on low-grade telescopic magnification may improve functional vision for usage in all tasks in AMD patients. All patients from this study were satisfied following surgery and viewed study outcomes as positive and beneficial, and some patients responded with enthusiasm. Surgeons are encouraged to use this modified technique of cataract surgery in low-vision patients with AMD and cataract.

Distance and near visual acuity improvement after implantation of multifocal intraocular lenses in cataract patients with presbyopia: a systematic review.

PubMed

Agresta, Blaise; Knorz, Michael C; Kohnen, Thomas; Donatti, Christina; Jackson, Daniel

2012-06-01

To evaluate uncorrected distance visual acuity (UDVA) as well as uncorrected near visual acuity (UNVA) as outcomes in treating presbyopic cataract patients to assist clinicians and ophthalmologists in their decision-making process regarding available interventions. Medline, Embase, and Evidence Based Medicine Reviews were systematically reviewed to identify studies reporting changes in UDVA and UNVA after cataract surgery in presbyopic patients. Strict inclusion/exclusion criteria were used to exclude any studies not reporting uncorrected visual acuity in a presbyopic population with cataracts implanted with multifocal intraocular lenses (IOLs). Relevant outcomes (UDVA and UNVA) were identified from the studies retrieved through the systematic review process. Twenty-nine studies were identified that reported uncorrected visual acuities, including one study that reported uncorrected intermediate visual acuity. Nine brands of multifocal IOLs were identified in the search. All studies identified in the literature search reported improvements in UDVA and UNVA following multifocal IOL implantation. The largest improvements in visual acuity were reported using the Rayner M-Flex lens (Rayner Intraocular Lenses Ltd) (UDVA, binocular: 1.05 logMAR, monocular: 0.92 logMAR; UNVA, binocular and monocular: 0.83 logMAR) and the smallest improvements were reported using the Acri.LISA lens (Carl Zeiss Meditec) (UDVA, 0.21 decimal; UNVA, 0.51 decimal). The results of this systematic review show the aggregate of studies reporting a beneficial increase in UDVA and UNVA with the use of multifocal IOLs in cataract patients with presbyopia, hence providing evidence to support the hypothesis that multifocal IOLs increase UDVA and UNVA in cataract patients. Copyright 2012, SLACK Incorporated.

Femtosecond laser-assisted cataract surgeries reported to the European Registry of Quality Outcomes for Cataract and Refractive Surgery: Baseline characteristics, surgical procedure, and outcomes.

PubMed

Lundström, Mats; Dickman, Mor; Henry, Ype; Manning, Sonia; Rosen, Paul; Tassignon, Marie-José; Young, David; Stenevi, Ulf

2017-12-01

To describe a large cohort of femtosecond laser-assisted cataract surgeries in terms of baseline characteristics and the related outcomes. Eighteen cataract surgery clinics in 9 European countries and Australia. Prospective multicenter case series. Data on consecutive eyes having femtosecond laser-assisted cataract surgery in the participating clinics were entered in the European Registry of Quality Outcomes for Cataract and Refractive Surgery (EUREQUO). A trained registry manager in each clinic was responsible for valid reporting to the EUREQUO. Demographics, preoperative corrected distance visual acuity (CDVA), risk factors, type of surgery, type of intraocular lens, visual outcomes, refractive outcomes, and complications were reported. Complete data were available for 3379 cases. The mean age was 64.4 years ± 10.9 (SD) and 57.8% (95% confidence interval [CI], 56.1-59.5) of the patients were women. A surgical complication was reported in 2.9% of all cases (95% CI, 2.4-3.5). The mean postoperative CDVA was 0.04 ± 0.15. logarithm of the minimum angle of resolution. A biometry prediction error (spherical equivalent) was within ±0.5 diopter in 71.8% (95% CI, 70.3-73.3) of all surgeries. Postoperative complications were reported in 3.3% (95% CI, 2.7-4.0). Patients with good preoperative CDVA had the best visual and refractive outcomes; patients with poor preoperative visual acuity had poorer outcomes. The visual and refractive outcomes of femtosecond laser-assisted cataract surgery were favorable compared with manual phacoemulsification. The outcomes were highly influenced by the preoperative visual acuity, but all preoperative CDVA groups had acceptable outcomes. Copyright © 2017 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Prospective randomized trial: outcomes of SF₆ versus C₃F₈ in macular hole surgery.

PubMed

Briand, Sophie; Chalifoux, Emmanuelle; Tourville, Eric; Bourgault, Serge; Caissie, Mathieu; Tardif, Yvon; Giasson, Marcelle; Boivin, Jocelyne; Blanchette, Caty; Cinq-Mars, Benoit

2015-04-01

To compare macular hole (MH) closure and visual acuity improvement after vitrectomy using SF6 versus C3F8 gas tamponade. The secondary purposes were to report the cumulative incidence of cataract development at 1 year after MH surgery and the proportion of complications. Prospective, randomized study. Thirty-one patients were prospectively randomized to the SF6 group and 28 patients to the C3F8 group. Preoperative data included MH minimum diameter, Early Treatment Diabetic Retinopathy Study (ETDRS) best corrected visual acuity (BCVA), cataract staging, and intraocular pressure (IOP) measurement. Postoperative data included optical coherence tomography confirmation of the closure at 6 weeks and 1 year, and ETDRS BCVA and cataract development/extraction, both 1 year after the MH surgery. Primary MH closure was achieved in 93.3% in the SF6 group and 92.9% in the C3F8 group. Mean ETDRS BCVA improved by 17.7 letters in the SF6 and 16.9 letters in the C3F8 group. The difference in cumulative incidence of cataract development and extraction between both groups was not statistically significant. Regardless of the dye used, similar results were achieved. Finally, the proportion of adverse events was similar in both groups. MH surgery with SF6 gas achieves results similar to C3F8 in terms of visual acuity improvement, MH closure, cataract development/extraction, and adverse events. Copyright © 2015 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.

The challenges in improving outcome of cataract surgery in low and middle income countries

PubMed Central

Lindfield, Robert; Vishwanath, Kalluru; Ngounou, Faustin; Khanna, Rohit C

2012-01-01

Cataract is the leading cause of blindness globally and surgery is the only known measure to deal with it effectively. Providing high quality cataract surgical services is critical if patients with cataract are to have their sight restored. A key focus of surgery is the outcome of the procedure. In cataract surgery this is measured predominantly, using visual acuity. Population- and hospital-based studies have revealed that the visual outcome of cataract surgery in many low and middle income settings is frequently sub-optimal, often failing to reach the recommended standards set by the World Health Organization (WHO). Another way of measuring outcome of cataract surgery is to ask patients for their views on whether surgery has changed the functioning of their eyes and their quality of life. There are different tools available to capture patient views and now, these patient-reported outcomes are becoming more widely used. This paper discusses the visual outcome of cataract surgery and frames the outcome of surgery within the context of the surgical service, suggesting that the process and outcome of care cannot be separated. It also discusses the components of patient-reported outcome tools and describes some available tools in more detail. Finally, it describes a hierarchy of challenges that need to be addressed before a high quality cataract surgical service can be achieved. PMID:22944761

Baseline risk factors for incidence of blindness in a South Indian population: the chennai eye disease incidence study.

PubMed

Vijaya, Lingam; Asokan, Rashima; Panday, Manish; Choudhari, Nikhil S; Ramesh, Sathyamangalam Ve; Velumuri, Lokapavani; Boddupalli, Sachi Devi; Sunil, Govindan T; George, Ronnie

2014-08-07

To report the baseline risk factors and causes for incident blindness. Six years after the baseline study, 4419 subjects from the cohort underwent a detailed examination at the base hospital. Incident blindness was defined by World Health Organization criteria as visual acuity of less than 6/120 (3/60) and/or a visual field of less than 10° in the better-seeing eye at the 6-year follow-up, provided that the eye had a visual acuity of better than or equal to 6/120 (3/60) and visual field greater than 10° at baseline. For incident monocular blindness, both eyes should have visual acuity of more than 6/120 (3/60) at baseline and developed visual acuity of less than 6/120 (3/60) in one eye at 6-year follow-up. For incident blindness, 21 participants (0.48%, 95% confidence interval [CI], 0.3-0.7) became blind; significant baseline risk factors were increasing age (P = 0.001), smokeless tobacco use (P < 0.001), and no history of cataract surgery (P = 0.02). Incident monocular blindness was found in 132 participants (3.8%, 95% CI, 3.7-3.8); it was significantly more (P < 0.001) in the rural population (5.4%, 95% CI, 5.4-5.5) than in the urban population (1.9%, 95% CI, 1.8-1.9). Baseline risk factors (P < 0.001) were increasing age and rural residence, and no history of cataract surgery was a protective factor (P = 0.03). Increasing age was a significant risk factor for blindness and monocular blindness. No history of cataract surgery was a risk factor for blindness and a protective factor for monocular blindness. Copyright 2014 The Association for Research in Vision and Ophthalmology, Inc.

Toric Intraocular Lens for Astigmatism Correction in Cataract Patients.

PubMed

Razmjoo, Hassan; Ghoreishi, Mohammad; Milasi, Azadeh Mohammadi; Peyman, Alireza; Jafarzadeh, Zahra; Mohammadinia, Mohadeseh; Kobra, Nasrollahi

2017-01-01

To assess the clinical consequences of AcrySof toric intraocular lens (IOL) and Hoya toric IOL implantation to correct preexisting corneal astigmatism in patients undergoing cataract surgery. In this study, we examined 55 eyes of 45 patients with at least 1.00 D corneal astigmatism who were scheduled for cataract surgery. After phacoemulsification, toric IOL was inserted and axis was aligned. We observed the patients, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), keratometry, manifest refraction, and IOL axis alignment 6 months after surgery. After 6 months, the UDVA was 0.17 ± 0.17 logMAR in the AcrySof group and 0.17 ± 0.18 logMar in the Hoya group. More than 78% of eyes in the AcrySof group and 80% of eyes in the Hoya toric IOL achieved a UDVA of 20/40 or better. In the AcrySof group, the mean preoperative corneal astigmatism was 2.73 ± 0.92 D. The mean postoperative refractive astigmatism was 0.84 ± 0.63 D. In the Hoya group, the preoperative corneal astigmatism was 2.58 ± 0.76 D and the postoperative refractive astigmatism was 0.87 ± 0.66 D ( P < 0.05). The mean AcrySof IOL axis rotation was 1.88° ± 3.05°. In the Hoya group, the mean axis rotation was 1.53° ± 3.66°. All changes in visual and refractive data before and after surgery were statistically significant ( P < 0.05). There was no significant difference between the two groups regarding refractive and visual outcome after surgery ( P > 0.05 for all). Implantation of AcrySof toric IOL and Hoya toric IOL was an effective way to correct preexisting corneal astigmatism in cataract surgery.

Long-term postoperative outcomes after bilateral congenital cataract surgery in eyes with microphthalmos.

PubMed

Praveen, Mamidipudi R; Vasavada, Abhay R; Shah, Sajani K; Khamar, Mayuri B; Trivedi, Rupal H

2015-09-01

To evaluate the long-term impact of bilateral cataract surgery on postoperative complications, influence of age at surgery on the pattern of axial growth and central corneal thickness (CCT), and visual and orthoptic assessment in microphthalmic eyes. Iladevi Cataract and IOL Research Centre, Ahmedabad, India. Prospective longitudinal study. This study assessed children with microphthalmos who had bilateral congenital cataract surgery. Microphthalmos was defined as an eye that has an axial length (AL) that was 2 standard deviations smaller than what is normally expected at that age. All eyes were left aphakic. One of the 2 eyes was randomly selected for analysis. Postoperative complications, AL, CCT, and visual acuity were documented. This study included 72 eys of 36 children. The mean age of the patients was 4.8 months ± 6.2 (SD) (range 0.5 to 15 months). Postoperative complications included secondary glaucoma (11/36, 30.6%), visual axis obscuration (4/36, 11.1%), and posterior synechiae (10/36, 27.8%). A significant rate of change was observed in axial growth up to 4 years and in CCT up to 3 years postoperatively. When age at the time of surgery was correlated with the profile of the rate of change in AL and CCT at 1 month and 1, 2, and 4 years, statistically significant differences in AL and CCT at all timepoints were found. Loss of vision after surgery occurred in 2 eyes. After early surgical intervention, an acceptable rate of serious postoperative complications and good visual outcomes were obtained in microphthalmic eyes. No author has a financial or proprietary interest in any material or method mentioned. Copyright © 2015 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Carbon footprint and cost-effectiveness of cataract surgery.

PubMed

Venkatesh, Rengaraj; van Landingham, Suzanne W; Khodifad, Ashish M; Haripriya, Aravind; Thiel, Cassandra L; Ramulu, Pradeep; Robin, Alan L

2016-01-01

This article raises awareness about the cost-effectiveness and carbon footprint of various cataract surgery techniques, comparing their relative carbon emissions and expenses: manual small-incision cataract surgery (MSICS), phacoemulsification, and femtosecond laser-assisted cataract surgery. As the most commonly performed surgical procedure worldwide, cataract surgery contributes significantly to global climate change. The carbon footprint of a single phacoemulsification cataract surgery is estimated to be comparable to that of a typical person's life for 1 week. Phacoemulsification has been estimated to be between 1.4 and 4.7 times more expensive than MSICS; however, given the lower degree of postoperative astigmatism and other potential complications, phacoemulsification may still be preferable to MSICS in relatively resource-rich settings requiring high levels of visual function. Limited data are currently available regarding the environmental and financial impact of femtosecond laser-assisted cataract surgery; however, in its current form, it appears to be the least cost-effective option. Cataract surgery has a high value to patients. The relative environmental impact and cost of different types of cataract surgery should be considered as this treatment becomes even more broadly available globally and as new technologies are developed and implemented.

Fitness costs of increased cataract frequency and cumulative radiation dose in natural mammalian populations from Chernobyl.

PubMed

Lehmann, Philipp; Boratyński, Zbyszek; Mappes, Tapio; Mousseau, Timothy A; Møller, Anders P

2016-01-27

A cataract is a clouding of the lens that reduces light transmission to the retina, and it decreases the visual acuity of the bearer. The prevalence of cataracts in natural populations of mammals, and their potential ecological significance, is poorly known. Cataracts have been reported to arise from high levels of oxidative stress and a major cause of oxidative stress is ionizing radiation. We investigated whether elevated frequencies of cataracts are found in eyes of bank voles Myodes glareolus collected from natural populations in areas with varying levels of background radiation in Chernobyl. We found high frequencies of cataracts in voles collected from different areas in Chernobyl. The frequency of cataracts was positively correlated with age, and in females also with the accumulated radiation dose. Furthermore, the number of offspring in female voles was negatively correlated with cataract severity. The results suggest that cataracts primarily develop as a function of ionizing background radiation, most likely as a plastic response to high levels of oxidative stress. It is therefore possible that the elevated levels of background radiation in Chernobyl affect the ecology and fitness of local mammals both directly through, for instance, reduced fertility and indirectly, through increased cataractogenesis.

Factors associated with vision-related quality of life among the adult population living in Nagorno Karabagh.

PubMed

Harutyunyan, T; Giloyan, A; Petrosyan, V

2017-12-01

Visual impairment and blindness are major public health problems causing significant suffering, disability, loss of productivity, and diminishing quality of life for millions of people. This study explored the factors associated with the overall vision-related quality of life (VRQoL) and its different domains in the adult population of Nagorno Karabakh and assessed the independent contribution of specific eye diseases to VRQoL. A cross-sectional study. We conducted interviewer-administered survey along with free eye screenings among adult residents of Hadrut and Martuni regions of Nagorno Karabakh (Artsakh) in 2014-2015. The study questionnaire included questions about sociodemographic characteristics, non-communicable diseases, use of eye care services, visual acuity, eye diseases, and VRQoL. National Eye Institute Visual Functioning Questionnaire-25 (NEI VFQ-25) was used to assess VRQoL. In total, 531 adults participated in the study. The mean age of participants was 60.1 years (standard deviation [SD] = 13.7), ranging from 18 to 90 years. The majority of participants were female (71.4%). The most frequently diagnosed eye disorder was cataract (33.8%). The prevalence of moderate and severe visual impairment was 7.0% and 0.8%, respectively. Almost 2.8% (15) of participants were blind. The mean global score of VFQ-25 in all study participants was 71.1 ± 19.28 (SD), whereas the mean global scores of VFQ-25 among not visually impaired, visually impaired, and blind participants were 74.0 ± 16.47 (SD), 51.7 ± 21.77 (SD), and 30.9 ± 20.2 (SD), respectively. In the adjusted linear regression model having moderate/severe visual impairment or blindness, age, socio-economic status, and having eye diseases such as glaucoma and cataract were significantly associated with VFQ-25 global score. The subscales of near vision, distance vision, peripheral vision, role difficulties, and mental health had significant associations with severe/moderate visual impairment in the adjusted analysis. After adjusting for visual impairment and demographic variables, participants with cataract and glaucoma were found to have statistically significant lower subscale scores than those without eye disease. Our data suggest that visual impairment was associated with lower scores of VRQoL. The strength of that association correlated with the increase in the level of visual impairment (from moderate/severe impairment to blindness). VRQoL was also shown to be affected by age, socio-economic status, and having eye diseases such as glaucoma and cataract. Further actions of remediation of visual impairment in this population are warranted. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

A comparison of patient pain and visual outcome using topical anesthesia versus regional anesthesia during cataract surgery.

PubMed

Hosoda, Yoshikatsu; Kuriyama, Shoji; Jingami, Yoko; Hattori, Hidetsugu; Hayashi, Hisako; Matsumoto, Miho

2016-01-01

The purpose of this study was to compare the level of patient pain during the phacoemulsification and implantation of foldable intraocular lenses while under topical, intracameral, or sub-Tenon lidocaine. This was a retrospective study. Three hundred and one eyes subjected to cataract surgery were included in this study. All eyes underwent phacoemulsification surgery and intraocular lens implantation using topical, sub-Tenon, or intracameral anesthesia. The topical group received 4% lidocaine drops, and the intracameral group received a 0.1-0.2 cc infusion of 1% preservative-free lidocaine into the anterior chamber through the side port combined with topical drops of lidocaine. The sub-Tenon group received 2% lidocaine. Best-corrected visual acuity, corneal endothelial cell loss, and intraoperative pain level were evaluated. Pain level was assessed on a visual analog scale (range 0-2). There were no significant differences in visual outcome and corneal endothelial cell loss between the three groups. The mean pain score in the sub-Tenon group was significantly lower than that in the topical and intracameral groups (P=0.0009 and P=0.0055, respectively). In 250 eyes without high myopia (< -6D), there were no significant differences in mean pain score between the sub-Tenon and intracameral groups (P=0.1417). No additional anesthesia was required in all groups. Intracameral lidocaine provides sufficient pain suppressive effects in eyes without high myopia, while sub-Tenon anesthesia is better for cataract surgery in eyes with high myopia.

Dizziness, but not falls rate, improves after routine cataract surgery: the role of refractive and spectacle changes.

PubMed

Supuk, Elvira; Alderson, Alison; Davey, Christopher J; Green, Clare; Litvin, Norman; Scally, Andrew J; Elliott, David B

2016-03-01

To determine whether dizziness and falls rates change due to routine cataract surgery and to determine the influence of spectacle type and refractive factors. Self-reported dizziness and falls were determined in 287 patients (mean age of 76.5 ± 6.3 years, 55% females) before and after routine cataract surgery for the first (81, 28%), second (109, 38%) and both eyes (97, 34%). Dizziness was determined using the short-form of the Dizziness Handicap Inventory. Six-month falls rates were determined using self-reported retrospective data. The number of patients with dizziness reduced significantly after cataract surgery (52% vs 38%; χ(2) = 19.14(,) p < 0.001), but the reduction in the number of patients who fell in the 6-months post surgery was not significant (23% vs 20%; χ(2) = 0.87, p = 0.35). Dizziness improved after first eye surgery (49% vs 33%, p = 0.01) and surgery on both eyes (58% vs 35%, p < 0.001), but not after second eye surgery (52% vs 45%, p = 0.68). Multivariate logistic regression analyses found significant links between post-operative falls and change in spectacle type (increased risk if switched into multifocal spectacles). Post-operative dizziness was associated with changes in best eye visual acuity and changes in oblique astigmatic correction. Dizziness is significantly reduced by first (or both) eye cataract surgery and this is linked with improvements in best eye visual acuity, although changes in oblique astigmatic correction increased dizziness. The lack of improvement in falls rate may be associated with switching into multifocal spectacle wear after surgery. © 2015 The Authors Ophthalmic and Physiological Optics published by John Wiley & Sons Ltd on behalf of College of Optometrists.

Topical anaesthesia with oxybuprocaine versus sub-Tenon's infiltration with 2% lignocaine for small incision cataract surgery.

PubMed

Chittenden, H B; Meacock, W R; Govan, J A

1997-04-01

To determine whether topical anaesthesia in small incision self-sealing phacoemulsification cataract surgery provides comparable anaesthesia to sub-Tenon's infiltration. Thirty five patients undergoing small incision self-sealing phacoemulsification cataract surgery were allocated randomly to receive topical anaesthesia with 0.4% oxybuprocaine or sub-Tenon's infiltration with 2% lignocaine. Pain experienced during the operation was assessed by asking the patient to score on a visual analogue graphic pain score chart. The median pain score for the topical group (3) was significantly higher than that of the sub-Tenon's group (0) (p = 0.004). Sub-Tenon's infiltration is superior to topical anaesthesia in ensuring patient comfort during small incision scleral tunnel self-sealing phacoemulsification cataract surgery.

Longterm visual prognosis in Usher syndrome types 1 and 2.

PubMed

Sadeghi, André M; Eriksson, Kristina; Kimberling, William J; Sjöström, Anders; Möller, Claes

2006-08-01

To estimate the age at diagnosis of retinitis pigmentosa and to determine visual acuity deterioration, visual field impairment and the frequency of cataracts in Usher syndrome types 1 and 2. We carried out a retrospective study of 328 affected subjects with Usher syndrome types 1 and 2. Study subjects were divided into seven different age groups by decade. Data were analysed using descriptive statistics, general linear model anova and survival analysis. Retinitis pigmentosa was diagnosed significantly earlier in subjects with Usher syndrome type 1 than in those with type 2. Visual acuity was significantly more impaired in affected subjects with Usher syndrome type 1 than in those with type 2 from 50 years of age onwards. Survival analysis revealed a significant difference in visual field loss (

Visual impairment and blindness in Hungary.

PubMed

Szabó, Dorottya; Sándor, Gábor László; Tóth, Gábor; Pék, Anita; Lukács, Regina; Szalai, Irén; Tóth, Georgina Zsófia; Papp, András; Nagy, Zoltán Zsolt; Limburg, Hans; Németh, János

2018-03-01

The aim of this study was to estimate the prevalence and causes of blindness, severe visual impairment (SVI), moderate visual impairment (MVI), and early visual impairment (EVI) and its causes in an established market economy of Europe. A cross-sectional population-based survey. A sample size of 3675 was calculated using the standard Rapid Assessment of Avoidable Blindness (RAAB) software in Hungary. A total of 105 clusters of 35 people aged 50 years or older were randomly selected with probability proportionate to size by the Hungarian Central Statistical Office. Households within the clusters were selected using compact segment sampling. Visual acuity (VA) was assessed with a Snellen tumbling E-chart with or without a pinhole in the households. The adjusted prevalences of bilateral blindness, SVI, MVI and EVI were 0.9% (95% CI: 0.6-1.2), 0.5% (95% CI: 0.2-0.7), 5.1% (95% CI: 4.3-5.9) and 6.9% (95% CI: 5.9-7.9), respectively. The major causes of blindness in Hungary were age-related macular degeneration (AMD; 27.3%) and other posterior segment diseases (27.3%), cataract (21.2%) and glaucoma (12.1%). Cataract was the main cause of SVI, MVI and EVI. Cataract surgical coverage (CSC) was 90.7%. Of all bilateral blindness in Hungary, 45.5% was considered avoidable. This study proved that RAAB methodology can be successfully conducted in industrialized countries, which often lack reliable epidemiologic data. The prevalence of blindness was relatively low, with AMD and other posterior segment diseases being the leading causes, and cataract is still a significant cause of visual impairment. © 2017 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Monocular oral reading after treatment of dense congenital unilateral cataract

PubMed Central

Birch, Eileen E.; Cheng, Christina; Christina, V; Stager, David R.

2010-01-01

Background Good long-term visual acuity outcomes for children with dense congenital unilateral cataracts have been reported following early surgery and good compliance with postoperative amblyopia therapy. However, treated eyes rarely achieve normal visual acuity and there has been no formal evaluation of the utility of the treated eye for reading. Methods Eighteen children previously treated for dense congenital unilateral cataract were tested monocularly with the Gray Oral Reading Test, 4th edition (GORT-4) at 7 to 13 years of age using two passages for each eye, one at grade level and one at +1 above grade level. In addition, right eyes of 55 normal children age 7 to 13 served as a control group. The GORT-4 assesses reading rate, accuracy, fluency, and comprehension. Results Visual acuity of treated eyes ranged from 0.1 to 2.0 logMAR and of fellow eyes from −0.1 to 0.2 logMAR. Treated eyes scored significantly lower than fellow and normal control eyes on all scales at grade level and at +1 above grade level. Monocular reading rate, accuracy, fluency, and comprehension were correlated with visual acuity of treated eyes (rs = −0.575 to −0.875, p < 0.005). Treated eyes with 0.1-0.3 logMAR visual acuity did not differ from fellow or normal control eyes in rate, accuracy, fluency, or comprehension when reading at grade level or at +1 above grade level. Fellow eyes did not differ from normal controls on any reading scale. Conclusions Excellent visual acuity outcomes following treatment of dense congenital unilateral cataracts are associated with normal reading ability of the treated eye in school-age children. PMID:20603057

Phacoemulsification in pseudoexfoliation syndrome.

PubMed

Akinci, Arsen; Batman, Cosar; Zilelioglu, Orhan

2008-01-01

To compare the incidence of intraoperative and early postoperative complications (IEPC), visual outcomes, and change in intraocular pressure (IOP) between eyes with and without pseudoexfoliation syndrome (PEX) having cataract extraction by phacoemulsification. 800 eyes with PEX and 1,600 eyes without PEX having cataract extraction by phacoemulsification were included in this retrospective study. Evaluated parameters were incidence of IEPC, visual outcomes and change in IOP. chi2 and Student's t test were used for statistical analysis. There were no significant differences in the incidence of IEPC and visual acuity gain between the two groups (p > 0.05). Rise in IOP in the early postoperative period was significantly higher in the PEX group (p < 0.02). Patients with PEX who have phacoemulsification can achieve results similar to patients without PEX. IOP control in the early postoperative period seems to be more important in patients with PEX. Copyright 2008 S. Karger AG, Basel.

Measuring aniseikonia using scattering filters to simulate cataract

NASA Astrophysics Data System (ADS)

Wilson, Jason

2011-12-01

The relationship between anisometropia and aniseikonia (ANK) is not well understood. Ametropic cataract patients provide a unique opportunity to study this relationship after undergoing emmetropizing lens extraction. Because light scatter may affect ANK measurement in cataract patients, its effect should also be evaluated. The Basic Aniseikonia Test (BAT) was evaluated using afocal size lenses to produce specific changes in retinal height. Several light scattering devices were then evaluated to determine which produced effects most similar to cataract. Contrast sensitivity and visual acuity (VA) losses were measured with each device and compared to those reported in cataract. After determining the most appropriate light scattering device, twenty healthy patients with normal visual function were recruited to perform the BAT using the filters to simulate cataract. Cataract patients were recruited from Vision America and the University of Alabama at Birmingham School of Optometry. Patients between 20 and 75 years of age with at least 20/80 VA in each eye, ≥ 2D ametropia, and normal binocular function were recruited. Stereopsis and ANK were tested and each patient completed a symptom questionnaire. ANK measurements using afocal size lenses indicated that the BAT underestimates ANK, although the effect was minimal for vertical targets and darkened surroundings, as previously reported. Based on VA and contrast sensitivity loss, Vistech scattering filters produced changes most similar to cataract. Results of the BAT using Vistech filters demonstrated that a moderate cataract but not a mild cataract may affect the ANK measurement. ANK measurements on cataract patients indicated that those with ≥ 2 D ametropia in each eye may suffer from induced ANK after the first cataract extraction. With upcoming healthcare reform, unilateral cataract extraction may be covered, but not necessarily bilateral, depending on patient VA in each eye. However, a questionnaire about symptoms at each visit in the current study showed that visual comfort did not improve after unilateral, but did improve after bilateral, cataract extraction. This indicates that quality of life should be better in bilateral cataract patients only if both cataracts are removed. This is supported by the findings of other studies. Keywords: Aniseikonia, Anisometropia, Cataract, Ametropia

Does cataract surgery alleviate poverty? Evidence from a multi-centre intervention study conducted in Kenya, the Philippines and Bangladesh.

PubMed

Kuper, Hannah; Polack, Sarah; Mathenge, Wanjiku; Eusebio, Cristina; Wadud, Zakia; Rashid, Mamunur; Foster, Allen

2010-11-09

Poverty and blindness are believed to be intimately linked, but empirical data supporting this purported relationship are sparse. The objective of this study is to assess whether there is a reduction in poverty after cataract surgery among visually impaired cases. A multi-centre intervention study was conducted in three countries (Kenya, Philippines, Bangladesh). Poverty data (household per capita expenditure--PCE, asset ownership and self-rated wealth) were collected from cases aged ≥50 years who were visually impaired due to cataract (visual acuity<6/24 in the better eye) and age-sex matched controls with normal vision. Cases were offered free/subsidised cataract surgery. Approximately one year later participants were re-interviewed about poverty. 466 cases and 436 controls were examined at both baseline and follow-up (Follow up rate: 78% for cases, 81% for controls), of which 263 cases had undergone cataract surgery ("operated cases"). At baseline, operated cases were poorer compared to controls in terms of PCE (Kenya: $22 versus £35 p = 0.02, Bangladesh: $16 vs $24 p = 0.004, Philippines: $24 vs 32 p = 0.0007), assets and self-rated wealth. By follow-up PCE had increased significantly among operated cases in each of the three settings to the level of controls (Kenya: $30 versus £36 p = 0.49, Bangladesh: $23 vs $23 p = 0.20, Philippines: $45 vs $36 p = 0.68). There were smaller increases in self-rated wealth and no changes in assets. Changes in PCE were apparent in different socio-demographic and ocular groups. The largest PCE increases were apparent among the cases that were poorest at baseline. This study showed that cataract surgery can contribute to poverty alleviation, particularly among the most vulnerable members of society. This study highlights the need for increased provision of cataract surgery to poor people and shows that a focus on blindness may help to alleviate poverty and achieve the Millennium Development Goals.

The long term impact of cataract surgery on quality of life, activities and poverty: results from a six year longitudinal study in Bangladesh and the Philippines.

PubMed

Danquah, Lisa; Kuper, Hannah; Eusebio, Cristina; Rashid, Mamunur Akm; Bowen, Liza; Foster, Allen; Polack, Sarah

2014-01-01

Cataract surgery has been shown to improve quality of life and household economy in the short term. However, it is unclear whether these benefits are sustained over time. This study aims to assess the six year impact of cataract surgery on health related quality of life (HRQoL), daily activities and economic poverty in Bangladesh and The Philippines. This was a longitudinal study. At baseline people aged ≥50 years with visual impairment due to cataract ('cases') and age-, sex-matched controls without visual impairment were interviewed about vision specific and generic HRQoL, daily activities and economic indicators (household per capita expenditure, assets and self-rated wealth). Cases were offered free or subsidised cataract surgery. Cases and controls were re-interviewed approximately one and six years later. At baseline across the two countries there were 455 cases and 443 controls. Fifty percent of cases attended for surgery. Response rates at six years were 47% for operated cases and 53% for controls. At baseline cases had poorer health and vision related QoL, were less likely to undertake productive activities, more likely to receive assistance with activities and were poorer compared to controls (p<0.05). One year after surgery there were significant increases in HRQoL, participation and time spent in productive activities and per capita expenditure and reduction in assistance with activities so that the operated cases were similar to controls. These increases were still evident after six years with the exception that time spent on productive activities decreased among both cases and controls. Cataract causing visual loss is associated with reduced HRQoL and economic poverty among older adults in low-income countries. Cataract surgery improves the HRQoL of the individual and economy of the household. The findings of this study suggest these benefits are sustained in the long term.

Polyphenols of Cassia tora leaves prevents lenticular apoptosis and modulates cataract pathology in Sprague-Dawley rat pups.

PubMed

Sreelakshmi, V; Abraham, Annie

2016-07-01

Cataract is a leading cause of visual impairment worldwide with multifactorial etiology and is a significant global health problem with increasing prevalence with age. Currently, no pharmacological measures are discovered to prevent and treat cataract and a significant number of epidemiological studies have suggested the potential role of antioxidants in the prevention of cataract by scavenging free radicals and preventing lens protein derangement and lenticular cell damage. The main goal of the present study is to evaluate Cassia tora leaves; an edible leafy vegetable employed in Ayurvedic and Chinese system of medicine for eye rejuvenation in preventing selenite-induced cataract in rat pups and to identify the active components that produce the effect. ECT pre-treatment effectively restored both enzymatic and metabolic antioxidant levels, membrane integrity and reduced metal accumulation and thus down-regulate epithelial cell death. Gene expression studies also confirmed these findings. ESI-MS analysis of ECT revealed the presence of chrysophanol, emodin, kaemferol, quercetin, stigmasterol and isoquercetin. The study suggests the possible role of C. tora in alleviating cataract pathology and presence of many anthraquinones and flavonoids. As it is an edible plant, the incorporation of these leaves in daily vegetables might prevent or delay the onset and maturation of cataract. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Short-term outcomes of small incision cataract surgery provided by a regional population in the Pacific.

PubMed

Bhikoo, Riyaz; Vellara, Hans; Lolokabaira, Salome; Murray, Neil; Sikivou, Biu; McGhee, Charles

2017-11-01

This study aims to describe patient demographics, visual and surgical outcomes of a cohort undergoing small incision cataract surgery at a Pacific regional ophthalmic training facility. This is a prospective, longitudinal study conducted at the Pacific Eye Institute, Fiji. One hundred fifty-six patients underwent small incision cataract surgery. Preoperatively, a complete ophthalmic examination, including pachymetry and macular optical coherence tomography performed by two independent investigators. Temporal small incision cataract surgery with intraocular lens insertion was performed by ophthalmologists, and trainee ophthalmologists. Follow-up occurred at day one, four weeks and 3 months. Patient characteristics, visual outcomes including surgically induced astigmatism and complications. Ninety-one per cent (142/156) attended 3-month follow-up with median age 63 years (range 19-82), 52% female (81/156) and 58% (90/156) Fijian ethnicity. In 37% (57/156), the contralateral eye was pseudophakic. Mean preoperative best spectacle-corrected visual acuity was logMAR 1.44 (6/165). At 3 months, 74% (105/142) achieved ≥6/18 unaided vision (94% [133/142] best spectacle-corrected visual acuity). Mean postoperative spherical equivalent was -0.78 (SD 0.95) D and mean surgically induced astigmatism 1.04 (0.57) D. Complications included posterior capsular rupture with vitreous loss (4% [6/156]), optical coherence tomography confirmed macular oedema (8% [12/152] at 4 weeks), significant posterior capsular opacity (23% [31/136]) and >5% increase in preoperative pachymetry (1% [1/142]) at 3 months. Reduction in preoperative best spectacle-corrected visual acuity occurred in 2% (3/142). No cases of endophthalmitis. Small incision cataract surgery provided to a regional population is effective with 94% achieving the World Health Organisation's definition of 'Good Vision' (≥6/18). Refinements in biometric and surgical techniques may allow a greater proportion of patients to achieve good unaided vision. © 2017 Royal Australian and New Zealand College of Ophthalmologists.

NIKE: a new clinical tool for establishing levels of indications for cataract surgery.

PubMed

Lundström, Mats; Albrecht, Susanne; Håkansson, Ingemar; Lorefors, Ragnhild; Ohlsson, Sven; Polland, Werner; Schmid, Andrea; Svensson, Göran; Wendel, Eva

2006-08-01

The purpose of this study was to construct a new clinical tool for establishing levels of indications for cataract surgery, and to validate this tool. Teams from nine eye clinics reached an agreement about the need to develop a clinical tool for setting levels of indications for cataract surgery and about the items that should be included in the tool. The tool was to be called 'NIKE' (Nationell Indikationsmodell för Kataraktextraktion). The Canadian Cataract Priority Criteria Tool served as a model for the NIKE tool, which was modified for Swedish conditions. Items included in the tool were visual acuity of both eyes, patients' perceived difficulties in day-to-day life, cataract symptoms, the ability to live independently, and medical/ophthalmic reasons for surgery. The tool was validated and tested in 343 cataract surgery patients. Validity, stability and reliability were tested and the outcome of surgery was studied in relation to the indication setting. Four indication groups (IGs) were suggested. The group with the greatest indications for surgery was named group 1 and that with the lowest, group 4. Validity was proved to be good. Surgery had the greatest impact on the group with the highest indications for surgery. Test-retest reliability test and interexaminer tests of indication settings showed statistically significant intraclass correlations (intraclass correlation coefficients [ICCs] 0.526 and 0.923, respectively). A new clinical tool for indication setting in cataract surgery is presented. This tool, the NIKE, takes into account both visual acuity and the patient's perceived problems in day-to-day life because of cataract. The tool seems to be stable and reliable and neutral towards different examiners.

Outcome of cataract surgery following simple limbal epithelial transplantation for lime injury-induced limbal stem cell deficiency

PubMed Central

Nair, Dhanyasree

2015-01-01

A 19-year-old woman presented to us after being diagnosed elsewhere with right eye total limbal stem cell deficiency resulting from a lime burn. She was advised to undergo limbal stem cell transplantation, but failed to immediately do so. Two years later, she underwent cultivated limbal epithelial transplantation (CLET). As she had severe loss of vision with persisting conjunctival nodule and symblepharon 2 years following surgery, an impression of failed CLET was formed. Subsequently, simple limbal epithelial transplantation (SLET) was performed. Nine months later, she developed a cataract in her right eye; the cataract was extracted and posterior chamber intraocular lens implanted. The unaided visual acuity improved from light perception at presentation to 20/60 at 1-week postoperatively. At 5 months follow-up, the patient continued to maintain 20/60 visual acuity in her right eye. This case describes the outcome of cataract surgery following SLET, emphasising the need to perform cataract surgery in complicated cataracts for a better visual prognosis. PMID:26698204

Correlational Analysis of Objective and Subjective Measures of Cataract Quantification.

PubMed

Cochener, Béatrice; Patel, Sunni R; Galliot, Florence

2016-02-01

To evaluate whether correlations exist between objective and subjective measures of vision quality as a consequence of cataract and whether this may qualify the Objective Scatter Index as a supplementary means of cataract assessment. A prospective multicenter, cross-sectional study was conducted in 10 centers across France in patients undergoing cataract extraction surgery (lens opacity evaluated with the Lens Opacities Classification System III). A quality of life assessment using the Visual Function Index-14 (VF-14) (14 questions scored from 0 to 4) and measurement of visual acuity and evaluation of the Objective Scatter Index (HD Analyzer, Visiometrics SL, Terrassa, Spain) to assess the alteration of light scatter were used as measures in the study. The study included 1,768 eyes of 1,768 patients (mean age: 72.5 years; range: 28 to 93 years). The average OSI score was 4.97 ± 3.13 (range: 0.4 to 20.5). There was good correlation between visual acuity and OSI (r = -0.47, P < .001) and between OSI and VF-14 (r = -0.11, P < .001). The results presented in this study confirm that the Objective Scatter Index has sufficient correlations with visual acuity and VF-14 to supplement existing cataract diagnosis in a large population encompassing a broad spectrum of cataract presentations. Copyright 2016, SLACK Incorporated.

Prevalence and causes of vision loss in Southeast Asia and Oceania: 1990-2010.

PubMed

Keeffe, J; Taylor, H R; Fotis, K; Pesudovs, K; Flaxman, S R; Jonas, J B; Leasher, J; Naidoo, K; Price, H; White, R A; Wong, T Y; Resnikoff, S; Bourne, R R A

2014-05-01

To assess prevalence and causes of vision impairment in Southeast Asia and Oceania in 1990 and 2010. Based on a systematic review of medical literature, prevalence of moderate and severe vision impairment (MSVI; presenting visual acuity <6/18 but ≥3/60 in the better eye) and blindness (presenting visual acuity <3/60) was estimated for 1990 and 2010. In Oceania, the age-standardised prevalence of blindness and MSVI did not decrease significantly (1.3% to 0.8% and 6.6% to 5.1%) respectively, but in Southeast Asia, blindness decreased significantly from 1.4% to 0.8%, a 43% decrease. There were significantly more women blind (2.18 million) compared with men (1.28 million) in the Southeast Asian population in 2010, but no significant gender differences in MSVI in either subregion. Cataract was the most frequent cause of blindness in Southeast Asia and Oceania in 1990 and 2010. Uncorrected refractive error, followed by cataract, macular degeneration, glaucoma and diabetic retinopathy were the most common causes for MSVI in 1990 and 2010. With the increasing size of the older population, there have been relatively small increases in the number of blind (2%), and with MSVI (14%) in Southeast Asia, whereas increases have been greater in Oceania of 14% for blindness and of 31% for MSVI. The prevalence of blindness has reduced significantly from 1990 to 2010, with moderate but non-significant lowering of MSVI. Cataract and uncorrected refractive error are the main causes of vision impairment and blindness; cataract continues as the main cause of blindness, but at lower proportions.

Classroom Demonstration of the Visual Effects of Eye Diseases

PubMed Central

Raphail, Ann-Marie; Bach, Emily C.; Hallock, Robert M.

2014-01-01

An understanding of the visual system is a fundamental aspect of many neuroscience and psychology courses. These classes often cover a variety of visual diseases that are correlated with the anatomy of the visual system, e.g., cataracts are caused by a clouding of the lens. Here, we describe an easy way to modify standard laboratory glasses/goggles to simulate the various perceptual deficits that accompany vision disorders such as astigmatism, cataracts, diabetic retinopathy, glaucoma, optic neuritis, posterior vitreous detachment, and retinitis pigmentosa. For example, when teaching about cataracts, students can put on glasses that mimic how severe cataracts affect one’s vision. Using the glasses will allow students to draw connections between the disorder, its perceptual deficits, and the underlying anatomy. We also discuss floaters in the eye and provide an easy method to allow students to detect their own floaters. Together, these demonstrations make for a more dynamic and interactive class on the visual system that will better link diseases of the eye to anatomy and perception, and allow undergraduate students to develop a better understanding of the visual system as a whole. PMID:24693262

Change in vision, visual disability, and health after cataract surgery.

PubMed

Helbostad, Jorunn L; Oedegaard, Maria; Lamb, Sarah E; Delbaere, Kim; Lord, Stephen R; Sletvold, Olav

2013-04-01

Cataract surgery improves vision and visual functioning; the effect on general health is not established. We investigated if vision, visual functioning, and general health follow the same trajectory of change the year after cataract surgery and if changes in vision explain changes in visual disability and general health. One-hundred forty-eight persons, with a mean (SD) age of 78.9 (5.0) years (70% bilateral surgery), were assessed before and 6 weeks and 12 months after surgery. Visual disability and general health were assessed by the CatQuest-9SF and the Short Formular-36. Corrected binocular visual acuity, visual field, stereo acuity, and contrast vision improved (P < 0.001) from before to 6 weeks after surgery, with further improvements of visual acuity evident up to 12 months (P = 0.034). Cataract surgery had an effect on visual disability 1 year later (P < 0.001). Physical and mental health improved after surgery (P < 0.01) but had returned to presurgery level after 12 months. Vision changes did not explain visual disability and general health 6 weeks after surgery. Vision improved and visual disability decreased in the year after surgery, whereas changes in general health and visual functioning were short-term effects. Lack of associations between changes in vision and self-reported disability and general health suggests that the degree of vision changes and self-reported health do not have a linear relationship.

The (lack of) relation between straylight and visual acuity. Two domains of the point-spread-function.

PubMed

van den Berg, Thomas J T P

2017-05-01

The effect of cataract and other media opacities on functional vision is typically assessed clinically using visual acuity. In both clinical and basic research, straylight (the functional result of light scattering in the eye) is commonly measured. The purpose of the present study was to determine the link between these two measures: is visual acuity in cataract and other media opacities related to straylight? Interdependence between acuity and straylight is addressed from three different points of view: (1) Methodological: can acuity differences affect the measurement value of straylight, and vice versa? (2) Basic optics: does the optical process of light scattering in the human eye affect both straylight and visual acuity? (3) Statistical: how strongly are acuity and straylight correlated in the practice of important clinical conditions? Experimental and theoretical aspects will be considered, with a focus on normal ageing and cataract formation. (1) Methodological: testing potential effects of acuity, artificially manipulated with positive trial lenses, showed no effect on measured straylight values. Since light scattering in the eye involves a low percentage of the light and has large angular spreading, contrast reduction due to straylight is limited, resulting in virtually absent acuity effects. (2) Basic optics: light scattering from the human donor eye lens is found to have virtually no effect in the centre of the point-spread-function, also for cataractous lenses, resulting in virtually absent acuity effects. (3) Statistical: literature data on straylight and visual acuity show a weak correlation for the important groups of normal ageing and cataract populations. The point-spread-function of the normal ageing and cataractous human eye is built upon two rather independent basic parts. Aberrations control the central peak. Light scattering controls the periphery from about 1° onwards. The way acuity and straylight are measured ensures no confounding between them. Statistically within the normal ageing and cataract populations, visual acuity and straylight vary quite independently from each other. Visual acuity losses with cataract and other media opacities are not due to straylight, but caused by aberrations and micro-aberrations. Straylight defines disability glare, and causes symptoms of glare, haloes, hazy vision etc. Overall, visual acuity and straylight are rather independent aspects of quality of vision. © 2017 The Author Ophthalmic & Physiological Optics © 2017 The College of Optometrists.

A Cochrane Systematic Review finds no significant difference in outcome or risk of postoperative complications between day care and in-patient cataract surgery.

PubMed

Fedorowicz, Zbigniew; Lawrence, David J; Gutierrez, Peter

2006-09-01

This review was conducted to determine reliable evidence regarding the safety, feasibility, effectiveness, and cost-effectiveness of cataract extraction performed as a day care versus in-patient procedure. The search to identify randomized controlled trials comparing day care and in-patient surgery for age-related cataract included the Cochrane Eyes and Vision Group Trials Register, the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and LILACS Latin American and Caribbean Literature on Health Sciences. Assessment of methodological quality was based on criteria defined by the Cochrane Collaboration. The primary outcome was the achievement of a satisfactory visual acuity 6 weeks after operation. Two trials, involving a total of 1284 people, are included. One trial reported statistically significant differences in early postoperative complication rates in the day care group, which had no clinical relevance to visual outcomes 4 months postoperatively. Mean change in visual acuity Snellen lines of the operated eye 4 months postoperatively was 4.1 standard deviation SD 2.3 for the day care group and 4.1 SD 2.2 for the in-patient group. Costs were 20% more for the in-patient group attributable to higher costs for overnight stay.

[Importance of occlusion therapy for amblyopia in partial unilateral congenital cataracts that are discovered late].

PubMed

Denion, E; Dedes, V; Bonne, M; Labalette, P; Berger, C; Guilbert, F; Bouckehove, S; Rouland, J-F

2004-11-01

The aim of this study is to investigate the importance of occlusion therapy for amblyopia in patients with partial unilateral congenital cataracts that were discovered after 24 months of age. A retrospective study was conducted on 11 patients, each of whom underwent a clinical examination including a cycloplegic refraction with atropine. The average age when the cataract was diagnosed was 35 months. The average distance visual acuity was 6/78 and the average near visual acuity was 35/175. Occlusion therapy using adhesive patches was started after refractive error correction. In two cases, observance was mediocre. Ametropia was found in every patient, with anisometropia in nine patients (alpha < 0.02). This anisometropia included an astigmatism that was always greater on the side with the cataract (alpha < 0.001), averaging 2.7 diopters. After occlusion therapy for amblyopia, the average visual acuity significantly improved to 6/22 in distance vision (alpha < 0.02) and 35/45 in near vision (alpha < 0.01). The average follow-up period was 28 months (5-60 months). Amblyopia is related to lens opacities as well as frequently associated anisometropia. Functional improvement is greater in near vision than in distance vision. With occlusion therapy for amblyopia, accommodation is preserved. This factor is of utmost importance as near vision is preferential in young children. This study provides an opportunity to recall the importance of refraction and occlusion therapy for amblyopia, which must be systematically attempted in cases of partial unilateral congenital cataracts before considering a surgical procedure.

Basic multisensory functions can be acquired after congenital visual pattern deprivation in humans.

PubMed

Putzar, Lisa; Gondan, Matthias; Röder, Brigitte

2012-01-01

People treated for bilateral congenital cataracts offer a model to study the influence of visual deprivation in early infancy on visual and multisensory development. We investigated cross-modal integration capabilities in cataract patients using a simple detection task that provided redundant information to two different senses. In both patients and controls, redundancy gains were consistent with coactivation models, indicating an integrated processing of modality-specific information. This finding is in contrast with recent studies showing impaired higher-level multisensory interactions in cataract patients. The present results suggest that basic cross-modal integrative processes for simple short stimuli do not depend on visual and/or crossmodal input since birth.

A study of initial therapy for glaucoma in southern India: India Glaucoma Outcomes and Treatment (INGOT) Study.

PubMed

Congdon, Nathan G; Krishnadas, R; Friedman, David S; Goggins, William; Ramakrishnan, R; Kader, M A; Gilbert, Donna; Tielsch, James; Quigley, Harry A

2012-06-01

To compare initial glaucoma therapy with medications and trabeculectomy in southern India. Patients aged ≥ 30 years newly diagnosed with glaucoma were randomized to trabeculectomy with 5-fluorouracil or medical therapy. Subjects with best-corrected vision <6/18 due to cataract underwent phacoemulsification (phaco/intraocular lens, IOL). Intraocular pressure (IOP), vision and visual function were assessed at 12 months. Patients assigned to medications and surgery received the expected therapy in 86% (172/199) and 64% (126/199) of cases, respectively. Forty patients (20%) assigned to surgery refused any treatment and 33 (17%) received medications. Among 199 patients randomized to medications, 52 (26.1%) underwent phaco/IOL, as did 89/199 (43.7%) of patients randomized to trabeculectomy. Baseline parameters of the two groups did not differ, nor did 1-year follow-up rates (medication 65%, trabeculectomy 58%, P = 0.15). Final IOP was lower with randomization to trabeculectomy (16.3 ± 5.1 mmHg) than medication (18.8 ± 6.7 mmHg, P < 0.0001). In regression models, randomization to trabeculectomy (P < 0.0001) was associated with lower IOP, and simultaneous trabeculectomy and cataract surgery was associated with higher IOP (P = 0.008) than trabeculectomy alone. Subjects receiving Phaco/IOL had significantly better final acuity (P < 0.0001) and visual function (P = 0.035), despite concurrent glaucoma treatment. Final visual acuity was worse in those receiving trabeculectomy in addition to cataract surgery, but this was of borderline significance (P = 0.06). Trabeculectomy lowered IOP significantly more than medical treatment, but with slightly greater loss of visual acuity. Combined phaco/IOL and trabeculectomy improved visual acuity with substantial IOP lowering.

Outcomes of cataract surgery in patients with exudative age-related macular degeneration and macular fluid.

PubMed

Starr, Matthew R; Mahr, Michael A; Barkmeier, Andrew J; Iezzi, Raymond; Smith, Wendy M; Bakri, Sophie J

2018-05-23

The purpose of this study was to investigate whether having macular fluid on the OCT prior to cataract surgery adversely affected vision or anatomic outcomes after cataract surgery in patients with exudative AMD. Retrospective, cohort study. We examined all patients who underwent cataract surgery and were receiving intravitreal anti-VEGF injections from January 1 st , 2012 through December 31 st , 2016. There were 81 eyes that underwent cataract surgery and had received at least one intravitreal anti-VEGF injection for a diagnosis of exudative AMD within 6 months prior to surgery. Data collected included the development of subretinal or intraretinal macular fluid, or subretinal hemorrhage in the 6 months following surgery, number of injections, best corrected visual acuity (BCVA), and central subfield thickness (CST). There was a significant improvement between pre- and post-operative BCVA when comparing all patients (p values <0.0001) and no significant difference in CST before and after surgery (p >0.05). There were 23 eyes with fluid on the pre-operative OCT. There were no differences in final BCVA or CST and no difference in the development of fluid post-operatively when compared to patients without fluid pre-operatively (all p values >0.05). These patients also saw a significant improvement in BCVA (p = 0.006). In a real world setting, patients with both cataracts and wet AMD may safely undergo cataract surgery. Patients with stable pre-operative fluid on OCT should be considered for cataract surgery as these patients did well post-operatively with no worsening of their neovascular process. Copyright © 2018. Published by Elsevier Inc.

Immediately sequential bilateral cataract surgery: advantages and disadvantages.

PubMed

Singh, Ranjodh; Dohlman, Thomas H; Sun, Grace

2017-01-01

The number of cataract surgeries performed globally will continue to rise to meet the needs of an aging population. This increased demand will require healthcare systems and providers to find new surgical efficiencies while maintaining excellent surgical outcomes. Immediately sequential bilateral cataract surgery (ISBCS) has been proposed as a solution and is increasingly being performed worldwide. The purpose of this review is to discuss the advantages and disadvantages of ISBCS. When appropriate patient selection occurs and guidelines are followed, ISBCS is comparable with delayed sequential bilateral cataract surgery in long-term patient satisfaction, visual acuity and complication rates. In addition, the risk of bilateral postoperative endophthalmitis and concerns of poorer refractive outcomes have not been supported by the literature. ISBCS is cost-effective for the patient, healthcare payors and society, but current reimbursement models in many countries create significant financial barriers for facilities and surgeons. As demand for cataract surgery rises worldwide, ISBCS will become increasingly important as an alternative to delayed sequential bilateral cataract surgery. Advantages include potentially decreased wait times for surgery, patient convenience and cost savings for healthcare payors. Although they are comparable in visual acuity and complication rates, hurdles that prevent wide adoption include liability concerns as ISBCS is not an established standard of care, economic constraints for facilities and surgeons and inability to fine-tune intraocular lens selection in the second eye. Given these considerations, an open discussion regarding the advantages and disadvantages of ISBCS is important for appropriate patient selection.

Visual outcomes of bilateral congenital and developmental cataracts in young children in south India and causes of poor outcome

PubMed Central

Khanna, Rohit C; Foster, Allen; Krishnaiah, Sannapaneni; Mehta, Manohar K; Gogate, Parikshit M

2013-01-01

Context: Bilateral pediatric cataracts are important cause of visual impairment in children. Aim: To study the outcome of bilateral pediatric cataract surgery in young children. Setting and Design: Retrospective case series in a tertiary center. Materials and Methods: Records of pediatric cataracts operated between January 2001 and December 2003, with a minimum follow-up of 3 months, were reviewed retrospectively. Statistical Methods: Independent sample t-test, Fisher's exact test, and logistic regression using SPSS (Statistical Package for Social Science, Chicago, USA) version 12. Results: 215/257 (83.7%) patients had a minimum follow-up of 3 months. The mean age of presentation to the hospital was 53 months (range: 0-168 months). Congenital cataract was present in 107 patients (58.2%) and developmental cataract in 77 patients (41.8%). The mean age at surgery was 55.2 months (range: 1-168 months). Out of 430 eyes, 269 (62.6%) had an intraocular lens implanted. The mean duration of follow-up was 13.1 months (range: 3-38 months). Pre-operatively, 102 patients (47.3%) had visual acuity <6/60, in the better eye, compared to 37 patients (17.2%) post-operatively (P < 0.001). Eighty-five patients (39.5%) had visual acuity >6/18. The most common early post-operative complication was fibrinous uveitis in 57 eyes (13.3%) and the most common delayed post-operative complication was posterior capsular opacification in 118 eyes (27.4%). The most important prognostic factor for poor outcome was congenital cataract (odds ratio [OR]: 26.3; 95% confidence interval [CI], 4.4-158.5) and total cataract (OR: 4.8; 95% CI, 1.3-17). PMID:23412523

Time-reversed ultrasonically encoded optical focusing through highly scattering ex vivo human cataractous lenses

NASA Astrophysics Data System (ADS)

Liu, Yan; Shen, Yuecheng; Ruan, Haowen; Brodie, Frank L.; Wong, Terence T. W.; Yang, Changhuei; Wang, Lihong V.

2018-01-01

Normal development of the visual system in infants relies on clear images being projected onto the retina, which can be disrupted by lens opacity caused by congenital cataract. This disruption, if uncorrected in early life, results in amblyopia (permanently decreased vision even after removal of the cataract). Doctors are able to prevent amblyopia by removing the cataract during the first several weeks of life, but this surgery risks a host of complications, which can be equally visually disabling. Here, we investigated the feasibility of focusing light noninvasively through highly scattering cataractous lenses to stimulate the retina, thereby preventing amblyopia. This approach would allow the cataractous lens removal surgery to be delayed and hence greatly reduce the risk of complications from early surgery. Employing a wavefront shaping technique named time-reversed ultrasonically encoded optical focusing in reflection mode, we focused 532-nm light through a highly scattering ex vivo adult human cataractous lens. This work demonstrates a potential clinical application of wavefront shaping techniques.

Telomere Attrition in Human Lens Epithelial Cells Associated with Oxidative Stress Provide a New Therapeutic Target for the Treatment, Dissolving and Prevention of Cataract with N-Acetylcarnosine Lubricant Eye Drops. Kinetic, Pharmacological and Activity-Dependent Separation of Therapeutic Targeting: Transcorneal Penetration and Delivery of L-Carnosine in the Aqueous Humor and Hormone-Like Hypothalamic Antiaging Effects of the Instilled Ophthalmic Drug Through a Safe Eye Medication Technique.

PubMed

Babizhayev, Mark A; Yegorov, Yegor E

2016-01-01

Visual impairment broadly impacts the ability of affected people to maintain their function and to remain independent during their daily occupations as they grow older. Visual impairment affects survival of older patients, quality of life, can affect a person's self-ranking of health, may be associated with social and functional decline, use of community support services, depression, falls, nursing home placement, and increased mortality. It has been hypothesized that senile cataract may serve as a marker for generalised tissue aging, since structural changes occurring in the proteins of the lens during cataract formation are similar to those which occur elsewhere as part of the aging process. The published analysis revealed a strong age-dependent relationship between undergoing cataract surgery and subsequent mortality. Nuclear opacity, particularly severe nuclear opacity, and mixed opacities with nuclear were significant predictors of mortality independent of body mass index, comorbid conditions, smoking, age, race, and sex. The lens opacity status is considered as an independent predictor of 2-year mortality, an association that could not be explained by potential confounders. Telomeres have become important biomarkers for aging as well as for oxidative stress-related disease. The lens epithelium is especially vulnerable to oxidative stress. Oxidative damage to the cuboidal epithelial cells on the anterior surface of the lens mediated by reactive oxygen species and phospholipid hydroperoxides can precede and contribute to human lens cataract formation. The erosion and shortening of telomeres in human lens epithelial cells in the lack of telomerase activity has been recognized as a primary cause of premature lens senescence phenotype that trigger human cataractogenesis. In this study we aimed to be focused on research defining the mechanisms that underlie linkages among telomere attrition in human lens epithelial cells associated with oxidative stress, biology of the lens response to oxidative damages, aging and health, cataract versus neuroendocrine regulation and disease. The cumulative results demonstrate that carnosine, released ophthalmically from the patented 1% Nacetylcarnosine prodrug lubricant eye drops, at physiological concentration might remarkably reduce the rate of telomere shortening in the lens cells subjected to oxidative stress in the lack of efficient antioxidant lens protection. Carnosine promotes the protection of normal cells from acquiring phenotypic characteristics of cellular senescence. The data of visual functions (visual acuity, glare sensitivity) in older adult subjects and older subjects with cataract treated with 1% N-acetylcarnosine lubricant eye drops showed significant improvement as compared, by contrast with the control group which showed generally no improvement in visual functions, with no difference from baseline in visual acuity and glare sensitivity readings. N-acetylcarnosine derived from the lubricant eye drops may be transported into the hypothalamic tuberomammillary nucleus (TMN) histamine neurons and gradually hydrolyzed. The resulting L-histidine may subsequently be converted into histamine, which could be responsible for the effects of carnosine on neurotransmission and hormone-like antiaging and anti-cataract physiological function. The research utilizing the N-acetylcarnosine lubricant eye drops powerful therapeutic platform provides the findings related to the intraocular uptake exposure sources as well as a timing dosage and duration systemic absorption of said preparation from the conjunctional sac reaching the hypothalamus with activities transfer into the hypothalamic-neuroendocrine pathways affecting across the hypothalamus metabolic pathway the telomere biology and cataract disease occurrence, reversal and prevention and the average expected lifespan of an individual. Such findings can be translated into clinical practice and may provide a basis for personalized cataract disease and aging prevention and treatment approaches.

Lutein/zeaxanthin for the treatment of age-related cataract: AREDS2 randomized trial report no. 4.

PubMed

Chew, Emily Y; SanGiovanni, John Paul; Ferris, Frederick L; Wong, Wai T; Agron, Elvira; Clemons, Traci E; Sperduto, Robert; Danis, Ronald; Chandra, Suresh R; Blodi, Barbara A; Domalpally, Amitha; Elman, Michael J; Antoszyk, Andrew N; Ruby, Alan J; Orth, David; Bressler, Susan B; Fish, Gary E; Hubbard, George B; Klein, Michael L; Friberg, Thomas R; Rosenfeld, Philip J; Toth, Cynthia A; Bernstein, Paul

2013-07-01

Age-related cataract is a leading cause of visual impairment in the United States. The prevalence of age-related cataract is increasing, with an estimated 30.1 million Americans likely to be affected by 2020. To determine whether daily oral supplementation with lutein/zeaxanthin affects the risk for cataract surgery. The Age-Related Eye Disease Study 2 (AREDS2), a multicenter, double-masked clinical trial, enrolled 4203 participants, aged 50 to 85 years, at risk for progression to advanced age-related macular degeneration. Participants were randomly assigned to daily placebo; lutein/zeaxanthin, 10mg/2mg; omega-3 long-chain polyunsaturated fatty acids, 1 g; or a combination to evaluate the effects on the primary outcome of progression to advanced age-related macular degeneration. Cataract surgery was documented at annual study examination with the presence of pseudophakia or aphakia, or reported during telephone calls at 6-month intervals between study visits. Annual best-corrected visual acuity testing was performed. A secondary outcome of AREDS2 was to evaluate the effects of lutein/zeaxanthin on the subsequent need for cataract surgery. A total of 3159 AREDS2 participants were phakic in at least 1 eye and 1389 of 6027 study eyes underwent cataract surgery during the study, with median follow-up of 4.7 years. The 5-year probability of progression to cataract surgery in the no lutein/zeaxanthin group was 24%. For lutein/zeaxanthin vs no lutein/zeaxanthin, the hazard ratios for progression to cataract surgery was 0.96 (95% CI, 0.84-1.10; P = .54). For participants in the lowest quintile of dietary intake of lutein/zeaxanthin, the hazard ratio comparing lutein/zeaxanthin vs no lutein/zeaxanthin for progression to cataract surgery was 0.68 (95% CI, 0.48-0.96; P = .03). The hazard ratio for 3 or more lines of vision loss was 1.03 (95% CI, 0.93-1.13; P = .61 for lutein/zeaxanthin vs no lutein/zeaxanthin). Daily supplementation with lutein/zeaxanthin had no statistically significant overall effect on rates of cataract surgery or vision loss. clinicaltrials.gov Identifier: NCT00345176.

Prevalence and causes of low vision and blindness in an elderly population in Nepal: the Bhaktapur retina study.

PubMed

Thapa, Raba; Bajimaya, Sanyam; Paudyal, Govinda; Khanal, Shankar; Tan, Stevie; Thapa, Suman S; van Rens, G H M B

2018-02-13

This study aims to explore the prevalence and causes of low vision and blindness focused on retinal disease in a population above 60 years in Nepal. Two thousand one hundred subjects were enrolled in a population-based cross-sectional study. History, presenting and best corrected visual acuity after subjective refraction, anterior and posterior segment examinations was obtained in detail. Among the total subjects, 1860 (88.57%) had complete information. Age varies from 60 to 95 (mean age: 69.64 ± 7.31) years. Low vision and blindness in both eyes at presentation was found in 984 (52.90%, 95% confidence interval (CI): 50.60-55.19) and 36 (1.94%, 95% CI: 1.35-2.66) subjects respectively. After best correction, bilateral low vision and blindness was found in 426 (22.92%, 95% CI: 21.01-24.88), and 30 (1.61%, 95% CI: 0.10-2.30) subjects respectively. As compared to 60-69 years old, risk of visual impairment was four times higher (95% CI:3.26-5.58) in the 70-79 year olds and 14 times higher (95% CI: 9.72-19.73) in the age group 80 years and above. Major causes of bilateral low vision were cataract (68.07%), followed by retinal disorders (28.64%), and for blindness; retinal disorders (46.66%), followed by cataract (43.33%). Illiteracy was significantly associated with visual impairment. Among the elderly population, prevalence of visual impairment was high. Refractive error, cataract and retinal disorders were the major cause of low vision. Screening the population at the age 60 years and above, focused on cataract and posterior segment diseases, providing glasses and timely referral can help reduce visual impairment.

[National survey of blindness and avoidable visual impairment in Argentina, 2013].

PubMed

Barrenechea, Rosario; de la Fuente, Inés; Plaza, Roberto Gustavo; Flores, Nadia; Segovia, Lía; Villagómez, Zaida; Camarero, Esteban Elián; Zepeda-Romero, Luz Consuelo; Lansingh, Van C; Limburg, Hans; Silva, Juan Carlos

2015-01-01

Determine the prevalence of blindness and avoidable visual impairment in Argentina, its causes, the coverage of cataract surgery, and the barriers that hinder access to these services. Cross-sectional population study conducted between May and November 2013 using the standard methodology for rapid assessment of avoidable blindness (RAAB), with a random cluster sampling of 50 people aged 50 years or more, -representative of the entire country. Participants' visual acuity (VA) was measured and the lens and posterior pole were examined by direct ophthalmoscopy. An assessment was made of the causes of having VA < 20/60, the coverage and quality of cataract surgery, and the barriers to accessing treatment. 3 770 people were assessed (92.0% of the projected number). The prevalence of blindness was 0.7% (confidence interval of 95%: 0.4-1.0%). Unoperated cataract was the main cause of blindness and severe visual impairment (44.0% and 71.1%, respectively), while the main cause of moderate visual impairment was uncorrected refractive errors (77.8%). Coverage of cataract surgery was of 97.1%, and 82.0% of operated eyes achieved VA ≥ 20/60. The main barriers to receiving this treatment were fear of the surgical procedure or of a poor result (34.9%), the cost (30.2%), and not having access to the treatment (16.3%). There is a low prevalence of blindness in the studied population and cataract is the main cause of blindness and severe visual impairment. Efforts should continue to extend coverage of cataract surgery, enhance preoperative evaluation, improve calculations of the intraocular lenses that patients need, and correct post-operative refractive errors with greater precision.

Day care versus in-patient surgery for age-related cataract.

PubMed

Fedorowicz, Zbys; Lawrence, David; Gutierrez, Peter; van Zuuren, Esther J

2011-07-06

Age-related cataract accounts for more than 40% of cases of blindness in the world with the majority of people who are blind from cataract found in the developing world. With the increased number of people with cataract there is an urgent need for cataract surgery to be made available as a day care procedure. To provide reliable evidence for the safety, feasibility, effectiveness and cost-effectiveness of cataract extraction performed as day care versus in-patient procedure. We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2011, Issue 5), MEDLINE (January 1950 to May 2011), EMBASE (January 1980 to May 2011), Latin American and Caribbean Health Sciences Literature Database (LILACS) (January 1982 to May 2011), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com) and ClinicalTrials.gov (www.clinicaltrials.gov). There were no date or language restrictions in the electronic searches for trials. The electronic databases were last searched on 23 May 2011. We included randomised controlled trials comparing day care and in-patient surgery for age-related cataract. The primary outcome was the achievement of a satisfactory visual acuity six weeks after the operation. Two authors independently assessed trial quality and extracted data. We contacted study authors for additional information. Adverse effects information was collected from the trials. We included two trials (conducted in Spain and USA), involving 1284 people. One trial reported statistically significant differences in early postoperative complication rates in the day care group, with an increased risk of increased intraocular pressure, which had no clinical relevance to visual outcomes four months postoperatively. The mean change in visual acuity (Snellen lines) of the operated eye four months postoperatively was 4.1 (standard deviation (SD) 2.3) for the day care group and 4.1 (SD 2.2) for the in-patient group and not statistically significant. The four-month postoperative mean change in quality of life score measured using the VF14 showed minimal differences between the two groups. Costs were 20% more for the in-patient group and this was attributed to higher costs for overnight stay. One study only reported hotel costs for the non-hospitalised participants making aggregation of data on costs impossible. This review provides some evidence that there is a cost saving but no significant difference in outcome or risk of postoperative complications between day care and in-patient cataract surgery. This is based on one detailed and methodologically sound trial conducted in the developed world. The success, safety and cost-effectiveness of cataract surgery as a day care procedure appear to be acceptable. Future research may well focus on evidence provided by high quality clinical databases and registers which would enable clinicians and healthcare planners to agree clinical and social indications for in-patient care and so make better use of resources, by selecting day case surgery unless these criteria are met.

[Development of a standardized evaluation system for cataracta complicata in retinitis pigmentosa].

PubMed

Auffarth, G U; Faller, U; Tetz, M R; Krastel, H; Völcker, H E

1997-07-01

Retinitis pigmentosa (RP) is associated with the formation of a posterior subcapsular cataract (PSC). As only a small part of the crystalline lens is usually affected, it is sometimes difficult to determine to what extent the visual loss is caused by the PSC alone. The methodology was developed in analogy to a scoring system for posterior capsule opacification by Tetz et al. Following dilation of the pupil, standardized photographs of the anterior segments were obtained utilizing a Zeiss photoslitlamp model 40 SL/P. The PSC was scored by evaluating retroillumination photographs. The individual PSC index was calculated by multiplying the density of the opacification (graded from 0 to 4) by the area involved in the central 4 mm zone of the pupil (calculated between 0 and 1). For testing the reliability of the evaluation system in part 1 of this study, 11 RP patients with different grades of PSC were examined by three independent observers. In part 2 of this study 37 eyes of 24 RP patients, aged 47.2 +/- 11.8 years, were evaluated and the PSC index was correlated with different parameters (visual acuity, age, visual fields, eletroretinography). RESULTS PART 1: The cataract-density grades were between 1 and 4 in the 11 patients. In relation to the central 4-mm pupillary zone between 13 and 100% of the area were opacified. Cataract indices (density x area) were between 0.13 and 4.0 (Mean values: Examiner 1:1.41 +/- 1.49; Examiner 2:1.28 +/- 1.46; Examiner 3:1.22 +/- 1.44; differences not significant: P = 0.77). PART 2: After an average duration of RP of 23 years, the average cataract index of the 24 patients was 1.72 +/- 1.35. There was no correlation between cataract index and ERG or visual fields (r < 0.2; P > 0.4); however, there was a good correlation to visual acuity (r = -0.72; P = 0.0001). Patients with early onset of RP (before 20th year of life) presented on average with an higher cataract index (2.06 +/- 1.67) compared to patients with late manifestation (0.61 +/- 0.44), but equivalent duration of RP. The evaluation system offers a reliable and reproducible method for measuring PSC density and extension in RP patients. The method can serve as a useful tool for documenting PSC development and help to define the indications for cataract surgery in RP.

Molecular Genetics of Cataract

PubMed Central

Shiels, Alan; Hejtmancik, J. Fielding

2017-01-01

Lens opacities or cataract(s) represent a universally important cause of visual impairment and blindness. Typically, cataract is acquired with aging as a complex disorder involving environmental and genetic risk factors. Cataract may also be inherited with an early onset either in association with other ocular and/or systemic abnormalities or as an isolated lens phenotype. Here we briefly review recent advances in gene discovery for inherited and age-related forms of cataract that are providing new insights into lens development and aging. PMID:26310156

Pediatric ocular trauma score as a prognostic tool in the management of pediatric traumatic cataracts.

PubMed

Shah, Mehul A; Agrawal, Rupesh; Teoh, Ryan; Shah, Shreya M; Patel, Kashyap; Gupta, Satyam; Gosai, Siddharth

2017-05-01

To introduce and validate the pediatric ocular trauma score (POTS) - a mathematical model to predict visual outcome trauma in children with traumatic cataract METHODS: In this retrospective cohort study, medical records of consecutive children with traumatic cataracts aged 18 and below were retrieved and analysed. Data collected included age, gender, visual acuity, anterior segment and posterior segment findings, nature of surgery, treatment for amblyopia, follow-up, and final outcome was recorded on a precoded data information sheet. POTS was derived based on the ocular trauma score (OTS), adjusting for age of patient and location of the injury. Visual outcome was predicted using the OTS and the POTS and using receiver operating characteristic (ROC) curves. POTS predicted outcomes were more accurate compared to that of OTS (p = 0.014). POTS is a more sensitive and specific score with more accurate predicted outcomes compared to OTS, and is a viable tool to predict visual outcomes of pediatric ocular trauma with traumatic cataract.

Visual symptoms and retinal straylight after laser peripheral iridotomy: the Zhongshan Angle-Closure Prevention Trial.

PubMed

Congdon, Nathan; Yan, Xixi; Friedman, David S; Foster, Paul J; van den Berg, Thomas J T P; Peng, Michelle; Gangwani, Rita; He, Mingguang

2012-07-01

To assess the impact of laser peripheral iridotomy (LPI) on forward-scatter of light and subjective visual symptoms and to identify LPI parameters influencing these phenomena. Cohort study derived from a randomized trial, using an external control group. Chinese subjects initially aged 50 or older and 70 years or younger with bilateral narrow angles undergoing LPI in 1 eye selected at random, and age- and gender-matched controls. Eighteen months after laser, LPI-treated subjects underwent digital iris photography and photogrammetry to characterize the size and location of the LPI, Lens Opacity Classification System III cataract grading, and measurement of retinal straylight (C-Quant; OCULUS, Wetzlar, Germany) in the treated and untreated eyes and completed a visual symptoms questionnaire. Controls answered the questionnaire and underwent straylight measurement and (in a random one-sixth sample) cataract grading. Retinal straylight levels and subjective visual symptoms. Among 230 LPI-treated subjects (121 [58.8%] with LPI totally covered by the lid, 43 [19.8%] with LPI partly covered by the lid, 53 [24.4%] with LPI uncovered by the lid), 217 (94.3%) completed all testing, as did 250 (93.3%) of 268 controls. Age, gender, and prevalence of visual symptoms did not differ between treated subjects and controls, although nuclear (P<0.01) and cortical (P = 0.03) cataract were less common among controls. Neither presenting visual acuity nor straylight score differed between the treated and untreated eyes among all treated persons, nor among those (n = 96) with LPI partially or totally uncovered. Prevalence of subjective glare did not differ significantly between participants with totally covered LPI (6.61%; 95% confidence interval [CI], 3.39%-12.5%), partially covered LPI (11.6%; 95% CI, 5.07%-24.5%), or totally uncovered LPI (9.43%; 95% CI, 4.10%-10.3%). In regression models, only worse cortical cataract grade (P = 0.01) was associated significantly with straylight score, and no predictors were associated with subjective glare. None of the LPI size or location parameters were associated with straylight or subjective symptoms. These results suggests that LPI is safe regarding measures of straylight and visual symptoms. This randomized design provides strong evidence that treatment programs for narrow angles would be unlikely to result in important medium-term visual disability. Copyright © 2012 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Outcome of cataract surgery at one year in Kenya, the Philippines and Bangladesh.

PubMed

Lindfield, R; Kuper, H; Polack, S; Eusebio, C; Mathenge, W; Wadud, Z; Rashid, A M; Foster, A

2009-07-01

To assess the change in vision following cataract surgery in Kenya, Bangladesh and the Philippines and to identify causes and predictors of poor outcome. Cases were identified through surveys, outreach and clinics. They underwent preoperative visual acuity measurement and ophthalmic examination. Cases were re-examined 8-15 months after cataract surgery. Information on age, gender, poverty and literacy was collected at baseline. 452 eyes of 346 people underwent surgery. 124 (27%) eyes had an adverse outcome. In Kenya and the Philippines, the main cause of adverse outcome was refractive error (37% and 49% respectively of all adverse outcomes) then comorbid ocular disease (26% and 27%). In Bangladesh, this was comorbid disease (58%) then surgical complications (21%). There was no significant association between adverse outcome and gender, age, literacy, poverty or preoperative visual acuity. Adverse outcomes following cataract surgery were frequent in the three countries. Main causes were refractive error and preoperative comorbidities. Many patients are not attaining the outcomes available with modern surgery. Focus should be on correcting refractive error, through operative techniques or postoperative refraction, and on a system for assessing comorbidities and communicating risk to patients. These are only achievable with a commitment to ongoing surgical audit.

Prevalence of blindness and cataract surgical outcomes in Takeo Province, Cambodia.

PubMed

Mörchen, Manfred; Langdon, Toby; Ormsby, Gail M; Meng, Ngy; Seiha, Do; Piseth, Kong; Keeffe, Jill E

2015-01-01

To estimate the prevalence of blindness and cataract surgical outcomes in persons 50 years or older above in Takeo Province, Cambodia. A population based survey. A total of 93 villages were selected through probability proportionate to size using the Rapid Assessment of Avoidable Blindness methodology. Households from 93 villages were selected using compact segment sampling. Visual acuity (VA) of 4650 people 50 years or older was tested and lens status and cause of visual impairment were assessed. The response rate was 96.2%. The age- and sex-adjusted prevalence of bilateral blindness [presenting visual acuity (PVA) <3/60 in the better eye] was 3.4% (95% confidence interval, 2.8%-4.0%), resulting in an estimated 4187 people blind in Takeo Province. The age- and sex-adjusted prevalence of low vision (PVA <6/18 to 3/60) was 21.1%, an estimated 25,900 people. Cataract surgical coverage in the bilaterally blind was 64.7% (female 59.5%, male 78.1%). Cataract surgical outcome was poor (best-corrected visual acuity <6/60) in only 7.7% and good in 88.7% (best-corrected visual acuity ≥6/18) of eyes operated in the last 5 years before the survey. The cataract surgical coverage for women is less than that for men. The increased life expectancy in Cambodia and the fact that women constitute 60.6% of the population (aged ≥50 years) at Takeo Province could have had an impact on cataract workload and high prevalence of blindness. A repeated survey using the same methodology after 8-12 years might be helpful in proving genuine change over time.

The effect of cataract surgery on sleep quality: a systematic review and Meta-analysis

PubMed Central

Zheng, Ling; Wu, Xiao-Hang; Lin, Hao-Tian

2017-01-01

AIM To evaluate the effect of cataract surgery on sleep quality and to compare the difference between ultraviolet-blocking clear intraocular lens (UVB-IOL) and blue-filtering intraocular lens (BF-IOL) implantation. METHODS Electronic search was performed of PubMed, MEDLINE, Embase and the Cochrane Library up to January 2016. Studies were eligible when they evaluated the sleep quality before and after cataract surgery by Pittsburgh sleep quality index (PSQI). A random/fixed-effects Meta-analysis was used for the pooled estimate. Heterogeneity was assessed with the I2 test. RESULTS Six studies were selected from 5623 references. Cataract surgery significantly reduced the PSQI scores at postoperative 0-3mo [mean difference (MD) =-0.62, 95%CI: -1.14 to -0.11, P=0.02, I2=66%] and 3-12mo (MD=-0.32, 95%CI: -0.62 to -0.02, P=0.04, I2=0), respectively. Considering different intraocular lens (IOL) implantations, relative post-operative PSQI reduction was found for both UVB-IOL and BF-IOL, but a significant reduction was detected only for UVB-IOL. No significant difference was found with the effect of BF-IOL vs UVB-IOL on sleep quality. CONCLUSION This study found that cataract surgery significantly improved the PSQI score-derived subjective sleep quality irrespective of the IOL type implanted. These findings highlight a substantial benefit of cataract surgery on systemic health with photoreceptive restoration in addition to visual acuity improvements. PMID:29181319

Topical anaesthesia with oxybuprocaine versus sub-Tenon's infiltration with 2% lignocaine for small incision cataract surgery

PubMed Central

Chittenden, H; Meacock, W; Govan, J

1997-01-01

AIMS—To determine whether topical anaesthesia in small incision self-sealing phacoemulsification cataract surgery provides comparable anaesthesia to sub-Tenon's infiltration.
METHODS—Thirty five patients undergoing small incision self-sealing phacoemulsification cataract surgery were allocated randomly to receive topical anaesthesia with 0.4% oxybuprocaine or sub-Tenon's infiltration with 2% lignocaine. Pain experienced during the operation was assessed by asking the patient to score on a visual analogue graphic pain score chart.
RESULTS—The median pain score for the topical group (3) was significantly higher than that of the sub-Tenon's group (0) (p = 0.004).
CONCLUSION—Sub-Tenon's infiltration is superior to topical anaesthesia in ensuring patient comfort during small incision scleral tunnel self-sealing phacoemulsification cataract surgery.

 PMID:9215056

Infectious agents in congenital cataract in a tertiary care referral center in North India.

PubMed

Singh, Mini P; Ram, Jagat; Kumar, Archit; Khurana, Jasmine; Marbaniang, Merinda; Ratho, Radha Kanta

2016-08-01

Congenital cataract has the potential for inhibiting early visual development. Intrauterine infections with Rubella virus, Herpes simplex virus (HSV) and Toxoplasma gondii plays an important role in the development of congenital cataract. The study included 120 children under the age of 6 years presenting with congenital cataract and diagnosed using serology and polymerase chain reaction (PCR). The IgM positivity for rubella, HSV, T. gondii was found to be 5.8%, 1.6% and 8.3% respectively. The overall PCR positivity was found to be 40(33.3%), 25 (20.8%) and 39 (32.5%) for rubella, HSV and T. gondii with mean copy number of 1599 copies/μL; 1716 copies/μL and 1503 copies/μL respectively. Infective etiology significantly contributes to the causation of congenital cataract particularly for rubella virus which is a potentially eradicable disease. This study provides an epidemiological data for rubella, HSV and T. gondii in children with congenital cataract and highlights the need to introduce rubella vaccine in the National Immunization Programme of India. Copyright © 2016 Elsevier Inc. All rights reserved.

Health-related quality of life of cataract patients: cross-cultural comparisons of utility and psychometric measures.

PubMed

Lee, Jae Eun; Fos, Peter J; Zuniga, Miguel A; Kastl, Peter R; Sung, Jung Hye

2003-07-01

This study was conducted to assess the presence and/or absence of cross-cultural differences or similarities between Korean and United States cataract patients. A systematic assessment was performed using utility and psychometric measures in the study population. A cross-sectional study design was used to examine the comparison of preoperative outcomes measures in cataract patients in Korea and the United States. Study subjects were selected using non-probabilistic methods and included 132 patients scheduled for cataract surgery in one eye. Subjects were adult cataract patients at Samsung and Kunyang General Hospital in Seoul, Korea, and Tulane University Hospital and Clinics in New Orleans, Louisiana. Preoperative utility was assessed using the verbal rating scale and standard reference gamble techniques. Current preoperative health status was assessed using the SF-36 and VF-14 surveys. Current preoperative Snellen visual acuity was used as a clinical measure of vision status. Korean patients were more likely to be younger (p = 0.001), less educated (p = 0.001), and to have worse Snellen visual acuity (p = 0.002) than United States patients. Multivariate analysis of variance (MANOVA) revealed that in contrast to Korean patients, United States patients were assessed to have higher scoring in general health, vitality, VF-14, and verbal rating for visual health. This higher scoring trend persisted after controlling for age, gender, education and Snellen visual acuity. The difference in health-related quality of life (HRQOL) between the two countries was quite clear, especially in the older age and highly educated group. Subjects in Korea and the United States were significantly different in quality of life, functional status and clinical outcomes. Subjects in the United States had more favorable health outcomes than those in Korea. These differences may be caused by multiple factors, including country-specific differences in economic status, health care system, cultural value system, and health policy. Cross-cultural differences should be considered when making international comparisons of quality of life.

Are blind people more likely to accept free cataract surgery? A study of vision-related quality of life and visual acuity in Kenya.

PubMed

Briesen, Sebastian; Roberts, Helen; Ilako, Dunera; Karimurio, Jefitha; Courtright, Paul

2010-01-01

To determine possible differences in visual acuity, socio-demographic factors and vision-related Quality of Life (QoL) between people accepting and people refusing sponsored cataract surgery. Three hundred and fifty seven local residents with visually impairing cataract, presenting at screening sites in Kwale District, Kenya were clinically assessed and interviewed. The World Health Organization (WHO) QoL-questionnaire WHO/Prevention of Blindness and Deafness Visual Functioning Questionnaire 20 (PBD-VFQ20) was used to determine the vision-related QoL. A standardized questionnaire asked for socio-demographic data and prior cataract surgery in one eye. After interview, patients were offered free surgery. Primary outcome was the mean QoL-score between acceptors and non-acceptors. Secondary outcomes were visual acuity and socio-demographic factors and their contribution to QoL-scores and the decision on acceptance or refusal. Fifty nine people (16.5%) refused and 298 accepted cataract surgery. Vision-related QoL was poorer in people accepting than in those refusing (mean score 51.54 and 43.12 respectively). People with poor visual acuity were only slightly more likely to accept surgery than people with better vision; the strongest predictors of acceptance were the QoL-score and gender. Men were twice as likely to accept compared to women. Of people who accepted surgery, 73.8% had best eye vision of 20/200 or better. In this population, visual acuity was of limited use to predict a person's decision to accept or refuse cataract surgery. QoL-scores provide further insight into which individuals will agree to surgery and it might be useful to adapt the QoL-questions for field use. Gender inequities remain a matter of concern with men being more likely to get sight-restoring surgery.

Global prevalence and economic and humanistic burden of astigmatism in cataract patients: a systematic literature review.

PubMed

Anderson, David F; Dhariwal, Mukesh; Bouchet, Christine; Keith, Michael S

2018-01-01

To systematically review the published evidence on the prevalence and economic and humanistic burden of astigmatism in cataract patients. For this systematic literature review, the Medline, PubMed, Embase, and Cochrane databases were searched from 1996 to September 2015 for available scientific literature that met the inclusion criteria. Studies published in the English language reporting prevalence and humanistic and economic burden in patients diagnosed with cataract and astigmatism were included. Of 3,649 papers reviewed, 31 studies from 32 publications met the inclusion criteria of this review. Preexisting astigmatism ≥1 D was present in up to 47% of cataract eyes. The cost burden of residual uncorrected astigmatism after cataract surgery was driven by the cost of spectacles, which was estimated to range from $2,151 to $3,440 in the US and $1,786 to $4,629 in Europe over a lifetime. In cataract patients, both preexisting and postoperative residual astigmatism were associated with poor vision-related patient satisfaction and quality of life, as well as higher spectacle burden. Astigmatism correction during cataract surgery appears to improve visual outcomes and results in overall lifetime cost savings compared to astigmatism correction with postoperative vision correction. There is a high prevalence of preexisting astigmatism in cataract patients. Although published data are limited, both preoperative astigmatism and postoperative residual astigmatism affect visual function and vision-related quality of life, resulting in increased humanistic burden. Suboptimal correction of astigmatism during cataract surgery drives the continuous need for vision correction with spectacles in the postoperative period. Patients must bear the out-of-pocket expenses, since payers often do not reimburse the cost of spectacles. Greater access to astigmatism correction during cataract surgery could improve visual outcomes and quality of life in patients. More research is required to gain a better understanding of the disease burden of astigmatism in cataract patients.

Global prevalence and economic and humanistic burden of astigmatism in cataract patients: a systematic literature review

PubMed Central

Anderson, David F; Dhariwal, Mukesh; Bouchet, Christine; Keith, Michael S

2018-01-01

Purpose To systematically review the published evidence on the prevalence and economic and humanistic burden of astigmatism in cataract patients. Materials and methods For this systematic literature review, the Medline, PubMed, Embase, and Cochrane databases were searched from 1996 to September 2015 for available scientific literature that met the inclusion criteria. Studies published in the English language reporting prevalence and humanistic and economic burden in patients diagnosed with cataract and astigmatism were included. Results Of 3,649 papers reviewed, 31 studies from 32 publications met the inclusion criteria of this review. Preexisting astigmatism ≥1 D was present in up to 47% of cataract eyes. The cost burden of residual uncorrected astigmatism after cataract surgery was driven by the cost of spectacles, which was estimated to range from $2,151 to $3,440 in the US and $1,786 to $4,629 in Europe over a lifetime. In cataract patients, both preexisting and postoperative residual astigmatism were associated with poor vision-related patient satisfaction and quality of life, as well as higher spectacle burden. Astigmatism correction during cataract surgery appears to improve visual outcomes and results in overall lifetime cost savings compared to astigmatism correction with postoperative vision correction. Conclusion There is a high prevalence of preexisting astigmatism in cataract patients. Although published data are limited, both preoperative astigmatism and postoperative residual astigmatism affect visual function and vision-related quality of life, resulting in increased humanistic burden. Suboptimal correction of astigmatism during cataract surgery drives the continuous need for vision correction with spectacles in the postoperative period. Patients must bear the out-of-pocket expenses, since payers often do not reimburse the cost of spectacles. Greater access to astigmatism correction during cataract surgery could improve visual outcomes and quality of life in patients. More research is required to gain a better understanding of the disease burden of astigmatism in cataract patients. PMID:29563768

Changing trends in the prevalence of blindness and visual impairment in a rural district of India: Systematic observations over a decade

PubMed Central

Khanna, Rohit C; Marmamula, Srinivas; Krishnaiah, Sannapaneni; Giridhar, Pyda; Chakrabarti, Subhabrata; Rao, Gullapalli N

2012-01-01

Context: Globally, limited data are available on changing trends of blindness from a single region. Aims: To report the changing trends in the prevalence of blindness, visual impairment (VI), and visual outcomes of cataract surgery in a rural district of Andhra Pradesh, India, over period of one decade. Settings and Design: Rural setting; cross-sectional study. Materials and Methods: Using a validated Rapid Assessment of Cataract Surgical Services (RACSS) method, population-based, cross-sectional survey was done in a rural district in the state of Andhra Pradesh, India. Two-stage sampling procedure was used to select participants ≥50 years of age. Further, a comparative analysis was done with participants ≥50 years from the previously concluded Andhra Pradesh Eye Disease Study (APEDS) study, who belonged to the same district. Statistical Analysis: Done using 11th version of Stata. Results: Using RACSS, 2160/2300 (93.9%) participants were examined as compared with the APEDS dataset (n=521). Age and sex adjusted prevalence of blindness in RACSS and APEDS was 8% (95% CI, 6.9–9.1%) and 11% (95% CI, 8.3–13.7%), while that of VI was 13.6% (95% CI, 12.2–15.1%) and 40.3% (95% CI, 36.1–44.5%), respectively. Cataract was the major cause of blindness in both the studies. There was a significant reduction in blindness following cataract surgery as observed through RACSS (17.3%; 95% CI, 13.5–21.8%) compared with APEDS (34%; 95% CI, 20.9–49.3%). Conclusion: There was a significant reduction in prevalence of blindness and VI in this rural district of India over a decade. PMID:22944766

Changing trends in the prevalence of blindness and visual impairment in a rural district of India: systematic observations over a decade.

PubMed

Khanna, Rohit C; Marmamula, Srinivas; Krishnaiah, Sannapaneni; Giridhar, Pyda; Chakrabarti, Subhabrata; Rao, Gullapalli N

2012-01-01

Context : Globally, limited data are available on changing trends of blindness from a single region. Aims : To report the changing trends in the prevalence of blindness, visual impairment (VI), and visual outcomes of cataract surgery in a rural district of Andhra Pradesh, India, over period of one decade. Settings and Design : Rural setting; cross-sectional study. Materials and Methods : Using a validated Rapid Assessment of Cataract Surgical Services (RACSS) method, population-based, cross-sectional survey was done in a rural district in the state of Andhra Pradesh, India. Two-stage sampling procedure was used to select participants ≥50 years of age. Further, a comparative analysis was done with participants ≥50 years from the previously concluded Andhra Pradesh Eye Disease Study (APEDS) study, who belonged to the same district. Statistical Analysis : Done using 11 th version of Stata. Results : Using RACSS, 2160/2300 (93.9%) participants were examined as compared with the APEDS dataset (n=521). Age and sex adjusted prevalence of blindness in RACSS and APEDS was 8% (95% CI, 6.9-9.1%) and 11% (95% CI, 8.3-13.7%), while that of VI was 13.6% (95% CI, 12.2-15.1%) and 40.3% (95% CI, 36.1-44.5%), respectively. Cataract was the major cause of blindness in both the studies. There was a significant reduction in blindness following cataract surgery as observed through RACSS (17.3%; 95% CI, 13.5-21.8%) compared with APEDS (34%; 95% CI, 20.9-49.3%). Conclusion : There was a significant reduction in prevalence of blindness and VI in this rural district of India over a decade.

Methylphenidate (Ritalin)-associated cataract and glaucoma.

PubMed

Lu, Chao-Kung; Kuang, Tung-Mei; Chou, Joe Ching-Kuang

2006-12-01

Methylphenidate hydrochloride (Ritalin) is the drug of choice for attention deficit hyperactivity disorder (ADHD). However, an association of Ritalin with glaucoma has been reported. We report a case of Ritalin-associated cataract and glaucoma. A 10-year-old boy was diagnosed with ADHD and had received methylphenidate hydrochloride, 60 mg/day for 2 years. He presented with blurred vision. Best-corrected visual acuity was 6/60 in both eyes. Ocular examinations revealed intraocular pressure (IOP) of 30 mmHg under medication, dense posterior subcapsular opacity of lens, pale disc with advanced cupping, and marked constriction of visual field. Despite maximal anti-glaucomatous medication, IOP still could not be controlled. The patient then received combined cataract and glaucoma surgery. Visual acuity improved and IOP was within normal limits in both eyes postoperatively. Large dose of methylphenidate may cause cataract and glaucoma. The mechanism remains unclear. Doctors should be aware of the possible ocular side effects of methylphenidate.

One-year outcomes of AquaLase cataract surgery.

PubMed

Yoo, Sonia H; Bhatt, Anand B

2007-01-01

The authors report surgical experience and clinical outcomes up to 1 year postoperatively in patients who underwent cataract surgery with the AquaLase liquefaction device (Alcon Laboratories, Fort Worth, TX). The device is a handpiece option for use with Alcon's Infiniti Vision System that uses heated balanced saline solution micropulses to liquefy lenticular material. Twenty-seven eyes of 23 patients underwent cataract extraction with the use of the AquaLase liquefaction device. The average age of participants was 68 years, and the average nuclear sclerotic grade was 1.96 on a 4-point scale. Outcomes were judged by metrics such as visual acuity, inflammation, endothelial cell count, and postoperative posterior capsule opacification. At 30 days postoperatively, 78% of eyes had a best-corrected visual acuity of 20/20. Visual acuity was 20/25 or better 1 year postoperatively in 88% of patients without complications except conversion to ultrasound phacoemulsification for two dense cataracts.

Postural stability changes in the elderly with cataract simulation and refractive blur.

PubMed

Anand, Vijay; Buckley, John G; Scally, Andy; Elliott, David B

2003-11-01

To determine the influence of cataractous and refractive blur on postural stability and limb-load asymmetry (LLA) and to establish how postural stability changes with the spatial frequency and contrast of the visual stimulus. Thirteen elderly subjects (mean age, 70.76 +/- 4.14 [SD] years) with no history of falls and normal vision were recruited. Postural stability was determined as the root mean square [RMS] of the center of pressure (COP) signal in the anterior-posterior (A-P) and medial-lateral directions and LLA was determined as the ratio of the average body weight placed on the more-loaded limb to the less-loaded limb, recorded during a 30-second period. Data were collected under normal standing conditions and with somatosensory system input disrupted. Measurements were repeated with four visual targets with high (8 cyc/deg) or low (2 cyc/deg) spatial frequency and high (Weber contrast, approximately 95%) or low (Weber contrast, approximately 25%) contrast. Postural stability was measured under conditions of binocular refractive blur of 0, 1, 2, 4, and 8 D and with cataract simulation. The data were analyzed in a population-averaged linear model. The cataract simulation caused significant increases in postural instability equivalent to that caused by 8-D blur conditions, and its effect was greater when the input from the somatosensory system was disrupted. High spatial frequency targets increased postural instability. Refractive blur, cataract simulation, or eye closure had no effect on LLA. Findings indicate that cataractous and refractive blur increase postural instability, and show why the elderly, many of whom have poor vision along with musculoskeletal and central nervous system degeneration, are at greater risk of falling. Findings also highlight that changes in contrast sensitivity rather than resolution changes are responsible for increasing postural instability. Providing low spatial frequency information in certain environments may be useful in maintaining postural stability. Correcting visual impairment caused by uncorrected refractive error and cataracts could be a useful intervention strategy to help prevent falls and fall-related injuries in the elderly.

Contrast-balanced binocular treatment in children with deprivation amblyopia.

PubMed

Hamm, Lisa M; Chen, Zidong; Li, Jinrong; Dai, Shuan; Black, Joanna; Yuan, Junpeng; Yu, Minbin; Thompson, Benjamin

2017-11-28

Children with deprivation amblyopia due to childhood cataract have been excluded from much of the emerging research into amblyopia treatment. An investigation was conducted to determine whether contrast-balanced binocular treatment - a strategy currently being explored for children with anisometropic and strabismic amblyopia - may be effective in children with deprivation amblyopia. An unmasked, case-series design intended to assess proof of principle was employed. Eighteen children with deprivation amblyopia due to childhood cataracts (early bilateral n = 7, early unilateral n = 7, developmental n = 4), as well as 10 children with anisometropic (n = 8) or mixed anisometropic and strabismic amblyopia (n = 2) were prescribed one hour a day of treatment over a six-week period. Supervised treatment was available. Visual acuity, contrast sensitivity, global motion perception and interocular suppression were measured pre- and post-treatment. Visual acuity improvements occurred in the anisometropic/strabismic group (0.15 ± 0.05 logMAR, p = 0.014), but contrast sensitivity did not change. As a group, children with deprivation amblyopia had a smaller but statistically significant improvement in weaker eye visual acuity (0.09 ± 0.03 logMAR, p = 0.004), as well a significant improvement in weaker eye contrast sensitivity (p = 0.004). Subgroup analysis suggested that the children with early bilateral deprivation had the largest improvements, while children with early unilateral cataract did not improve. Interestingly, binocular contrast sensitivity also improved in children with early bilateral deprivation. Global motion perception improved for both subgroups with early visual deprivation, as well as children with anisometropic or mixed anisometropic/strabismic amblyopia. Interocular suppression improved for all subgroups except children with early unilateral deprivation. These data suggest that supervised contrast-balanced binocular treatment should be further investigated as a treatment option for children with deprivation amblyopia. However, for children with more severe deprivation amblyopia due to early unilateral cataracts, supplementary or alternative options should also be explored. © 2017 Optometry Australia.

Cataract surgical outcomes from a large-scale micro-surgical campaign in China.

PubMed

Xiao, Baixiang; Guan, Chunhong; He, Yaling; Le Mesurier, Richard; Müller, Andreas; Limburg, Hans; Iezze, Beatrice

2013-10-01

To assess cataract surgical outcomes during the Jiangxi Provincial Government's "Brightness and Smile Initiative" (BSI) in South East China during May 2009 to July 2010. This cross sectional combined with retrospective study included 1157 cataract surgical patients (1254 eyes) recruited from six counties in Jiangxi during the initiative. Patient information before surgery and at discharge was obtained from hospitals' case records. Patient follow-up eye examinations were conducted during field visits in the autumn of 2010. Fifteen months after the initiative started, study subjects were examined by provincial ophthalmologists using a Snellen visual chart, portable slit lamp, torch and ophthalmoscope. The World Health Organization (WHO) cataract surgical outcome monitoring tally sheet and the outcome categories good (visual acuity, VA, ≥ 0.3 (6/18)), borderline (VA <0.3 but ≥ 0.1 (6/60)) and poor (VA < 0.1) were used for data collection and analysis. A total of 99.7% of operated patients had intraocular lenses implanted. The percentage of eyes with good outcomes (presenting VA) at follow-up was low (49.6%), while the borderline and poor outcome rates were high (34.1% and 16.3%, respectively), in comparison to WHO recommendations. There was a significant outcome difference at follow-up (p < 0.01) between eyes operated by county surgeons trained by an International Non-Government Organization and those operated on by other visiting surgeons. This study documented a low rate of good cataract surgical outcomes from the BSI in Jiangxi. The quality of cataract surgery should be improved further in the province.

Combined surgery versus cataract surgery alone for eyes with cataract and glaucoma

PubMed Central

Zhang, Mingjuan Lisa; Hirunyachote, Phenpan; Jampel, Henry

2016-01-01

Background Cataract and glaucoma are leading causes of blindness worldwide, and their co-existence is common in elderly people. Glaucoma surgery can accelerate cataract progression, and performing both surgeries may increase the rate of postoperative complications and compromise the success of either surgery. However, cataract surgery may independently lower intraocular pressure (IOP), which may allow for greater IOP control among patients with co-existing cataract and glaucoma. The decision between undergoing combined glaucoma and cataract surgery versus cataract surgery alone is complex. Therefore, it is important to compare the effectiveness of these two interventions to aid clinicians and patients in choosing the better treatment approach. Objectives To assess the relative effectiveness and safety of combined surgery versus cataract surgery (phacoemulsification) alone for co-existing cataract and glaucoma. The secondary objectives include cost analyses for different surgical techniques for co-existing cataract and glaucoma. Search methods We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (2014, Issue 10), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to October 2014), EMBASE (January 1980 to October 2014), PubMed (January 1948 to October 2014), Latin American and Caribbean Health Sciences Literature Database (LILACS) (January 1982 to October 2014), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov), and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 3 October 2014. We checked the reference lists of the included trials to identify further relevant trials. We used the Science Citation Index to search for references to publications that cited the studies included in the review. We also contacted investigators and experts in the field to identify additional trials. Selection criteria We included randomized controlled trials (RCTs) of participants who had open-angle, pseudoexfoliative, or pigmentary glaucoma and age-related cataract. The comparison of interest was combined cataract surgery (phacoemulsification) and any type of glaucoma surgery versus cataract surgery (phacoemulsification) alone. Data collection and analysis Two review authors independently assessed study eligibility, collected data, and judged risk of bias for included studies. We used standard methodological procedures expected by the Cochrane Collaboration. Main results We included nine RCTs, with a total of 655 participants (657 eyes), and follow-up periods ranging from 12 to 30 months. Seven trials were conducted in Europe, one in Canada and South Africa, and one in the United States. We graded the overall quality of the evidence as low due to observed inconsistency in study results, imprecision in effect estimates, and risks of bias in the included studies. Glaucoma surgery type varied among the studies: three studies used trabeculectomy, three studies used iStent® implants, one study used trabeculotomy, and two studies used trabecular aspiration. All of these studies found a statistically significant greater decrease in mean IOP postoperatively in the combined surgery group compared with cataract surgery alone; the mean difference (MD) was -1.62 mmHg (95% confidence interval (CI) -2.61 to -0.64; 489 eyes) among six studies with data at one year follow-up. No study reported the proportion of participants with a reduction in the number of medications used after surgery, but two studies found the mean number of medications used postoperatively at one year was about one less in the combined surgery group than the cataract surgery alone group (MD -0.69, 95% CI -1.28 to -0.10; 301 eyes). Five studies showed that participants in the combined surgery group were about 50% less likely compared with the cataract surgery alone group to use one or more IOP-lowering medications one year postoperatively (risk ratio (RR) 0.47, 95% CI 0.28 to 0.80; 453 eyes). None of the studies reported the mean change in visual acuity or visual fields. However, six studies reported no significant differences in visual acuity and two studies reported no significant differences in visual fields between the two intervention groups postoperatively (data not analyzable). The effect of combined surgery versus cataract surgery alone on the need for reoperation to control IOP at one year was uncertain (RR 1.13, 95% CI 0.15 to 8.25; 382 eyes). Also uncertain was whether eyes in the combined surgery group required more interventions for surgical complications than those in the cataract surgery alone group (RR 1.06, 95% CI 0.34 to 3.35; 382 eyes). No study reported any vision-related quality of life data or cost outcome. Complications were reported at 12 months (two studies), 12 to 18 months (one study), and two years (four studies) after surgery. Due to the small number of events reported across studies and treatment groups, the difference between groups was uncertain for all reported adverse events. Authors' conclusions There is low quality evidence that combined cataract and glaucoma surgery may result in better IOP control at one year compared with cataract surgery alone. The evidence was uncertain in terms of complications from the surgeries. Furthermore, this Cochrane review has highlighted the lack of data regarding important measures of the patient experience, such as visual field tests, quality of life measurements, and economic outcomes after surgery, and long-term outcomes (five years or more). Additional high-quality RCTs measuring clinically meaningful and patient-important outcomes are required to provide evidence to support treatment recommendations. PMID:26171900

Combining primary and piggyback intraocular lenses to treat extreme myopic astigmatism in stable keratoconus following cataract surgery.

PubMed

Goh, Yi Wei; Misra, Stuti; Patel, Dipika V; McGhee, Charles N J

2013-03-01

The majority of those with keratoconus can maximise visual acuity with spectacle or contact lens correction as they age; however, as subjects enter their sixties, cataracts may supervene and contact lens tolerance diminishes with consequent reduction in visual acuity. Following cataract extraction, the complex refractive error associated with keratoconus may not be readily corrected by an intraocular lens alone. This report highlights the planned implantation of a primary posterior chamber toric intraocular lens with a secondary piggyback, sulcus-based, intraocular lens in advanced but stable keratoconus with extreme myopic astigmatism and cataract. © 2013 The Authors. Clinical and Experimental Optometry © 2013 Optometrists Association Australia.

Catquest questionnaire for use in cataract surgery care: assessment of surgical outcomes.

PubMed

Lundström, M; Stenevi, U; Thorburn, W; Roos, P

1998-07-01

To demonstrate the outcome for patients after cataract extraction using the Catquest cataract questionnaire and discuss the models validity in assessing outcome. Thirty-five Swedish departments of ophthalmology. Patients having cataract extraction performed by surgeons from 35 Swedish departments of opthalmology participated in the study. The questionnaire was given to 2970 consecutive patients having surgery during March 1995 at the participating surgical units. The questionnaire was sent by mail to patients and completed on a voluntary basis. It focuses on visual disabilities in daily life, activity level, cataract symptoms, and degree of independence. The results form the questionnaire are interpreted using a benefit matrix that credits not only a decrease in visual disabilities and cataract symptoms but also an improvement in or maintenance of a preoperative activity level. Complete surgical outcome data and completed preoperative and postoperative questionnaires were available in 1933 cases (65.1%). Benefit from surgery according to the model was achieved by 90.9% of the patients. Patients having their second cataract extraction had the highest frequency of the greatest benefit form surgery. There was good agreement between the different levels of benefit from surgery according to the model and the patient's global rating of his or her vision or achieved visual acuity after surgery, respectively. Patients with missing data (did not return postoperative questionnaire or had missing surgical result variables) were older and had a higher frequency of other diseases and handicaps. The Catquest cataract questionnaire allowed the outcome of cataract surgery to be graded by different levels of benefit. There seemed to be good agreement between this model of assessment and the patient's global rating of his or her vision. Missing data may be a problem when a postal questionnaire is used.

Cataract in children attending schools for the blind and resource centers in eastern Africa.

PubMed

Msukwa, Gerald; Njuguna, Margaret; Tumwesigye, Cillasy; Shilio, Bernadeth; Courtright, Paul; Lewallen, Susan

2009-05-01

The aim of this study was to describe results of a representative sample of children who have undergone cataract surgery in schools for the blind in 4 African countries. Cross-sectional study. Children enrolled at schools for the blind in Kenya, Malawi, Tanzania, and Uganda. We used a population-proportional-to-size methodology to select a representative sample of schools for the blind and annexes and included all the children attending the selected schools. Trained teams using standardized examination methods and a modified World Health Organization form examined the children. The form was modified specifically to collect information on outcomes of cataract surgery. Operative status and postoperative visual acuity. Of 1062 children examined, 196 (18%) had undergone cataract surgery or had cataract as the major cause of visual impairment; 140 (71%) had bilateral surgery, 24 (12%) had unilateral surgery, and 32 (16%) had not had surgery. Of operated eyes, 118 (41%) had visual acuity > or =20/200. Intraocular lenses were implanted in 65% of the operated eyes. Eyes with intraocular lens were more likely to have better vision than those without (P for trend = 0.04). Amblyopia was the most common cause of poor visual acuity in children who had undergone cataract surgery. The number of children in the schools who receive cataract surgery has increased greatly since 1995. The high rate of amblyopia highlights the critical need for programs to find children earlier and to ensure adequate follow-up after surgery. Without such programs, the value of training pediatric surgeons will not be fully realized. The authors have no proprietary or commercial interest in any materials discussed in this article.

[Determining factors for deciding whether or not to treat refractive errors and cataract in people with a learning disability].

PubMed

van Isterdael, C E D; Stilma, J S; Bezemer, P D; Tijmes, N T

2008-05-03

A study into the treatment of refractive errors and cataract in a selected population with learning disabilities. Design. Retrospective. In the years 1993-2003, 5205 people (mean age: 39 years) were referred to the visual advisory centre of Bartiméus (one of three institutes for the visually impaired in the Netherlands) by learning disability physicians and were assessed ophthalmologically. This assessment consisted of a measurement of visual acuity and refractive error, slitlamp examination and retinoscopy, and was performed at the client's accommodation. Advised treatment for spectacle prescriptions and referral for cataract surgery were registered. Refractive errors were found in 35% (1845/5205) of the patients with learning disabilities; 49% (905/1845) already wore spectacles; another 14% (265/1845) were prescribed spectacles for the first time. Of those with presbyopia, 12% (232/1865) had reading glasses and 10% (181/1865) were given a first prescription for spectacles. The most important determinant for not prescribing spectacles was: presence of severe learning disability (odds ratio (OR): 3.7). Cataract was present in 10% (497/5205) of the population; 399 patients were advised to be referred for surgery, 55% (219/399) were referred ofwhom 26% (57/219) had surgery. Moderately severe bilateral cataract was the only determinant of cataract surgery (OR: 7.8). Refractive errors and cataract were not always treated in this group. One of the reasons for non-treatment of refractive errors was a severe learning disability. The reason for treatment or non-treatment in patients with cataract was less clear.

Prospective study of Centurion® versus Infiniti® phacoemulsification systems: surgical and visual outcomes.

PubMed

Oh, Lawrence J; Nguyen, Chu Luan; Wong, Eugene; Wang, Samuel S Y; Francis, Ian C

2017-01-01

To evaluate surgical outcomes (SOs) and visual outcomes (VOs) in cataract surgery comparing the Centurion ® phacoemulsification system (CPS) with the Infiniti ® phacoemulsification system (IPS). Prospective, consecutive study in a single-site private practice. Totally 412 patients undergoing cataract surgery with either the CPS using the 30-degree balanced ® tip ( n =207) or the IPS using the 30-degree Kelman ® tip ( n =205). Intraoperative and postoperative outcomes were documented prospectively up to one month follow-up. Nuclear sclerosis (NS) grade, cumulated dissipated energy (CDE), preoperative corrected distance visual acuity (CDVA), and CDVA at one month were recorded. CDE was 13.50% less in the whole CPS compared with the whole IPS subcohort. In eyes with NS grade III or greater, CDE was 28.87% less with CPS ( n =70) compared with IPS ( n =44) ( P =0.010). Surgical complications were not statistically different between the two subcohorts ( P =0.083), but in the one case of vitreous loss using the CPS, CDVA of 6/4 was achieved at one month. The mean CDVAs (VOs) at one month for NS grade III and above cataracts were -0.17 logMAR (6/4.5) in the CPS and -0.15 logMAR (6/4.5) in the IPS subcohort respectively ( P =0.033). CDE is 28.87% less, and VOs are significantly improved, in denser cataracts in the CPS compared with the IPS. The authors recommend the CPS for cases with denser nuclei.

[National survey of blindness and avoidable visual impairment in Honduras].

PubMed

Alvarado, Doris; Rivera, Belinda; Lagos, Luis; Ochoa, Mayra; Starkman, Ivette; Castillo, Mariela; Flores, Eduardo; Lansingh, Van C; Limburg, Hans; Silva, Juan Carlos

2014-11-01

To determine the prevalence of blindness and visual impairment in Honduras, its causes and the response by the health services to growing demand. A cross-sectional population study was conducted between June and December 2013 using the standard methodology of the Rapid Assessment of Avoidable Blindness. A random sample survey was done in 63 clusters of 50 individuals aged ≥ 50, representative of the country as a whole. Visual acuity (VA) was assessed using a Snellen eye chart, and the condition of the lens and posterior pole was examined by direct ophthalmoscopy. Cataract surgical coverage was calculated and an assessment made of its quality, the causes of VA < 20/60 and the barriers to accessing surgical treatment. A total of 2 999 people were examined (95.2% of the forecast total). Blindness prevalence was 1.9% (confidence interval of 95%: 1.4-2.4%) and 82.2% of these cases were avoidable. The main causes of blindness were unoperated cataracts (59.2%) and glaucoma (21.1%). Uncorrected refraction error was the main cause of severe (19.7%) and moderate (58.6%) visual impairment. Cataract surgical coverage was 75.2%. 62.5% of the eyes operated for cataracts achieved a VA > 20/60 with available correction. The main barriers against cataract surgery were cost (27.7%) and the lack of availability or difficulty of geographical access to the treatment (24.6%). The prevalence of blindness and visual impairment in Honduras is similar to that of other Latin American countries. 67% of cases of blindness could be resolved by improving the response capacity of the ophthalmological services, especially of cataract surgery, improving optician services and incorporating eye care in primary health care.

Relationship between macular pigment and visual function in subjects with early age-related macular degeneration.

PubMed

Akuffo, Kwadwo Owusu; Nolan, John M; Peto, Tunde; Stack, Jim; Leung, Irene; Corcoran, Laura; Beatty, Stephen

2017-02-01

To investigate the relationship between macular pigment (MP) and visual function in subjects with early age-related macular degeneration (AMD). 121 subjects with early AMD enrolled as part of the Central Retinal Enrichment Supplementation Trial (CREST; ISRCTN13894787) were assessed using a range of psychophysical measures of visual function, including best corrected visual acuity (BCVA), letter contrast sensitivity (CS), mesopic and photopic CS, mesopic and photopic glare disability (GD), photostress recovery time (PRT), reading performance and subjective visual function, using the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25). MP was measured using customised heterochromatic flicker photometry. Letter CS, mesopic and photopic CS, photopic GD and mean reading speed were each significantly (p<0.05) associated with MP across a range of retinal eccentricities, and these statistically significant relationships persisted after controlling for age, sex and cataract grade. BCVA, NEI VFQ-25 score, PRT and mesopic GD were unrelated to MP after controlling for age, sex and cataract grade (p>0.05, for all). MP relates positively to many measures of visual function in unsupplemented subjects with early AMD. The CREST trial will investigate whether enrichment of MP influences visual function among those afflicted with this condition. ISRCTN13894787. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

The Prevalence of Age-Related Eye Diseases and Visual Impairment in Aging: Current Estimates

PubMed Central

Klein, Ronald; Klein, Barbara E. K.

2013-01-01

Purpose. To examine prevalence of five age-related eye conditions (age-related cataract, AMD, open-angle glaucoma, diabetic retinopathy [DR], and visual impairment) in the United States. Methods. Review of published scientific articles and unpublished research findings. Results. Cataract, AMD, open-angle glaucoma, DR, and visual impairment prevalences are high in four different studies of these conditions, especially in people over 75 years of age. There are disparities among racial/ethnic groups with higher age-specific prevalence of DR, open-angle glaucoma, and visual impairment in Hispanics and blacks compared with whites, higher prevalence of age-related cataract in whites compared with blacks, and higher prevalence of late AMD in whites compared with Hispanics and blacks. The estimates are based on old data and do not reflect recent changes in the distribution of age and race/ethnicity in the United States population. There are no epidemiologic estimates of prevalence for many visually-impairing conditions. Conclusions. Ongoing prevalence surveys designed to provide reliable estimates of visual impairment, AMD, age-related cataract, open-angle glaucoma, and DR are needed. It is important to collect objective data on these and other conditions that affect vision and quality of life in order to plan for health care needs and identify areas for further research. PMID:24335069

[Toxicity of ethylene oxide on the crystalline lense in an occupational milieu. Difficulty of epidemiologic surveys of cataract].

PubMed

Deschamps, D; Leport, M; Cordier, S; Laurent, A M; Festy, B; Hamard, H; Renard, G; Pouliquen, Y; Conso, F

1990-01-01

Ethylene oxide is a sterilizing gas for heat-sensitive materials. Eight cases of subcapsular cataract were attributed to this compound from 1982 to 1985. This epidemiological study was conducted in 55 persons to determine the prevalence of lens opacities and cataracts in workers exposed to this gas. The 21 persons of more than 45 years of age were then compared to 16 non-exposed persons matched for age and gender. Lens opacities (independently of visual acuity) were observed in 19 of the 55 exposed. Among exposed and non-exposed persons of more than 45 years of age, there were no significantly differences with regard to the following characteristics of lens opacities: prevalence (13 in the 21 exposed; 10 in the 16 non-exposed), distribution of the localisations, morphology and importance of the cortical opacities. No link was found between the characteristics of the lens opacities and the characteristics of the exposure: habitual exposure and accidental overexposures. For cataracts, defined by the association of lens opacities and a visual acuity less than 20/25 (this loss not being attributable to another cause), their prevalence differed significantly (p less than 0.05) between the exposed (6 of 21) and the non-exposed (0 of 16). There was no relation between their existence and accidental overexposures. The risk of lens opacification by ethylene oxide, established in cases of massive exposures as previously described, could also exist during chronic exposure to low concentrations, but is to be confirmed by other studies. It could be explained by saturation of the protective mechanisms against alkylating action of this product. This study prompted us to discuss the epidemiological difficulties in studies of cataracts.

Cataract, visual impairment and long-term mortality in a rural cohort in India: the Andhra Pradesh Eye Disease Study.

PubMed

Khanna, Rohit C; Murthy, Gudlavalleti V S; Giridhar, Pyda; Krishnaiah, Sannapaneni; Pant, Hira B; Palamaner Subash Shantha, Ghanshyam; Chakrabarti, Subhabrata; Gilbert, Clare; Rao, Gullapalli N

2013-01-01

A large-scale prevalence survey of blindness and visual impairment (The Andhra Pradesh Eye Diseases Study [APEDS1]) was conducted between 1996-2000 on 10,293 individuals of all ages in three rural and one urban clusters in Andhra Pradesh, Southern India. More than a decade later (June 2009-March 2010), APEDS1 participants in rural clusters were traced (termed APEDS2) to determine ocular risk factors for mortality in this longitudinal cohort. Mortality hazard ratio (HR) analysis was performed for those aged >30 years at APEDS1, using Cox proportional hazard regression models to identify associations between ocular exposures and risk of mortality. Blindness and visual impairment (VI) were defined using Indian definitions. 799/4,188 (19.1%) participants had died and 308 (7.3%) had migrated. Mortality was higher in males than females (p<0.001). In multivariable analysis, after adjusting for age, gender, diabetes, hypertension, body mass index, smoking and education status the mortality HR was 1.9 (95% CI: 1.5-2.5) for blindness; 1.4 (95% CI: 1.2-1.7) for VI; 1.8 (95% CI: 1.4-2.3) for pure nuclear cataract, 1.5 (95% CI: 1.1-2.1) for pure cortical cataract; 1.96 (95% CI: 1.6-2.4) for mixed cataract, 2.0 (95% CI: 1.4-2.9) for history of cataract surgery, and 1.58 (95% CI: 1.3-1.9) for any cataract. When all these factors were included in the model, the HRs were attenuated, being 1.5 (95% CI: 1.1-2.0) for blindness and 1.2 (95% CI: 0.9-1.5) for VI. For lens type, the HRs were as follows: pure nuclear cataract, 1.6 (95% CI: 1.3-2.1); pure cortical cataract, 1.5 (95% CI: 1.1-2.1); mixed cataract, 1.8 (95% CI: 1.4-2.2), and history of previous cataract surgery, 1.8 (95% CI: 1.3-2.6). All types of cataract, history of cataract surgery and VI had an increased risk of mortality that further suggests that these could be potential markers of ageing.

Subjective and Quantitative Measurement of Wavefront Aberrations in Nuclear Cataracts – A Retrospective Case Controlled Study

PubMed Central

Wali, Upender K.; Bialasiewicz, Alexander A.; Al-Kharousi, Nadia; Rizvi, Syed G.; Baloushi, Habiba

2009-01-01

Purpose: To measure, quantify and compare Ocular Aberrations due to nuclear cataracts. Setting: Department of ophthalmology and school for ophthalmic technicians, college of medicine and health sciences, Sultan Qaboos University, Muscat, Oman. Design: Retrospective case controlled study. Methods: 113 eyes of 77 patients with nuclear cataract (NC) were recruited from outpatient clinic of a major tertiary referral center for Ophthalmology. Patients having NC with no co-existing ocular pathologies were selected. All patients were subjected to wavefront aberrometry (make) using Hartmann-Shack (HS) aberrometer. Consents were taken from all patients. Higher order Aberrations (HOA) were calculated with Zernike polynomials up to the fourth order. For comparison 28 eyes of 15 subjects with no lenticular opacities (control group) were recruited and evaluated in an identical manner. No pupillary mydriasis was done in both groups. Results: Total aberrations were almost six times higher in NC group compared to control (normal) subjects. The HOA were 21 times higher in NC group, and coma was significantly higher in NC eyes compared to normal (control) group. The pupillary diameter was significantly larger in control group (5.48mm ± 1.0024, p<.001) compared to NC (3.05mm ± 1.9145) subjects (probably due to younger control age group). Amongst Zernike coefficients up to fourth order, two polynomials, defocus (Z20) and spherical aberration (Z42) were found to be significantly greater amongst NC group, compared to normal control group. Conclusion: Nuclear cataracts predominantly produce increased defocus and spherical aberrations. This could explain visual symptoms like image deterioration in spite of normal Visual acuity. PMID:20142953

Bilateral phacoemulsification and intraocular lens implantation in a great horned owl.

PubMed

Carter, Renee T; Murphy, Christopher J; Stuhr, Charles M; Diehl, Kathryn A

2007-02-15

A great horned owl of estimated age < 1 year that was captured by wildlife rehabilitators was evaluated because of suspected cataracts. Nuclear and incomplete cortical cataracts were evident in both eyes. Ocular ultrasonography revealed no evidence of retinal detachment, and electroretinography revealed normal retinal function. For visual rehabilitation, cataract surgery was planned and intraocular lens design was determined on the basis of values obtained from the schematic eye, which is a mathematical model representing a normal eye for a species. Cataract surgery and intraocular lens placement were performed in both eyes. After surgery, refraction was within -0.75 diopters in the right eye and -0.25 diopters in the left eye. Visual rehabilitation was evident on the basis of improved tracking and feeding behavior, and the owl was eventually released into the wild. In raptors with substantial visual compromise, euthanasia or placement in a teaching facility is a typical outcome because release of such a bird is unacceptable. Successful intraocular lens implantation for visual rehabilitation and successful release into the wild are achievable.

Blindness and Visual Impairment Profile and Rapid Assessment of Avoidable Blindness in South East Asia: Analysis of New Data. 2017 APAO Holmes Lecture.

PubMed

Das, Taraprasad

2018-03-13

The International Agency for Prevention of Blindness (IAPB) South East Asia region (SEAR) that consists of 11 countries contains 26% of the world's population (1,761,000,000). In this region 12 million are blind and 78.5 million are visually impaired. This amounts to 30% of global blindness and 32% of global visual impairment. Rapid assessment of avoidable blindness (RAAB) survey analysis. RAAB, either a repeat or a first time survey, was completed in 8 countries in this decade (2010 onwards). These include Bangladesh, Bhutan, India, Indonesia, Maldives, Sri Lanka, Thailand, and Timor Leste. Cataract is the principal cause of blindness and severe visual impairment in all countries. Refractive error is the principal cause of moderate visual impairment in 4 countries: Bangladesh, India, Maldives, and Sri Lanka; cataract continues to be the principal cause of moderate visual impairment in 4 other countries: Bhutan, Indonesia, Thailand, and Timor Leste. Outcome of cataract surgery is suboptimal in the Maldives and Timor Leste. Rigorous focus is necessary to improve cataract surgery outcomes and correction of refractive error without neglecting the quality of care. At the same time allowances must be made for care of the emerging causes of visual impairment and blindness such as glaucoma and posterior segment disorders, particularly diabetic retinopathy. Copyright 2018 Asia-Pacific Academy of Ophthalmology.

Reducing Older Driver Motor Vehicle Collisions via Earlier Cataract Surgery

PubMed Central

Mennemeyer, Stephen T.; Owsley, Cynthia; McGwin, Gerald

2013-01-01

Older adults who undergo cataract extraction have roughly half the rate of motor vehicle collision (MVC) involvement per mile driven compared to cataract patients who do not elect cataract surgery. Currently in the U.S., most insurers do not allow payment for cataract surgery based upon the findings of a vision exam unless accompanied by an individual’s complaint of visual difficulties that seriously interfere with driving or other daily activities and individuals themselves may be slow or reluctant to complain and seek relief. As a consequence, surgery tends to occur after significant vision problems have emerged. We hypothesize that a proactive policy encouraging cataract surgery earlier for a lesser level of complaint would significantly reduce MVCs among older drivers. We used a Monte Carlo model to simulate the MVC experience of the U.S. population from age 60 to 89 under alternative protocols for the timing of cataract surgery which we call “Current Practice” (CP) and “Earlier Surgery” (ES). Our base model finds, from a societal perspective with undiscounted 2010 dollars, that switching to ES from CP reduces by about 21% the average number of MVCs, fatalities, and MVC cost per person. The net effect on total cost – all MVC costs plus cataract surgery expenditures -- is a reduction of about 16%. Quality Adjusted Life Years would increase by about 5%. From the perspective of payers for healthcare, the switch would increase cataract surgery expenditure for ages 65+ by about 8% and for ages 60 to 64 by about 47% but these expenditures are substantially offset after age 65 by reductions in the medical and emergency services component of MVC cost. Similar results occur with discounting at 3% and with various sensitivity analyses. We conclude that a policy of ES would significantly reduce MVCs and their associated consequences. PMID:23369786

Grading nuclear, cortical and posterior subcapsular cataracts using an objective scatter index measured with a double-pass system.

PubMed

Vilaseca, Meritxell; Romero, Maria José; Arjona, Montserrat; Luque, Sergio Oscar; Ondategui, Juan Carlos; Salvador, Antoni; Güell, José L; Artal, Pablo; Pujol, Jaume

2012-09-01

To evaluate objectively intraocular scattering in eyes with nuclear, cortical and posterior subcapsular cataracts by means of an objective scatter index (OSI) obtained from double-pass images. To compare the results with those obtained using clinical conventional procedures. In this prospective, observational, cross-sectional, non-consecutive case series study, 188 eyes with cataracts of 136 patients were analysed (123 eyes had nuclear, 41 eyes had cortical and 24 eyes had posterior subcapsular cataracts). The control group consisted of 117 eyes of 68 healthy patients. Patient examination included subjective refraction, best spectacle-corrected visual acuity (BSCVA), cataract grade using the lens opacities classification system III (LOCS III) and OSI. We found a decrease in the BSCVA and an increase in the OSI with increasing cataract grade. Statistically significant differences were observed when the OSI of eyes without cataracts and those with different LOCS III were compared. The comparison between the OSI and LOCS III reported good percentages of agreement regarding the number of eyes classified in equivalent levels: 72.4% (nuclear cataracts), 86.6% (cortical cataracts) and 84.3% (posterior subcapsular cataracts). A non-linear regression model was applied between OSI and BSCVA, which resulted in the following multiple correlation coefficients: r=0.878 (nuclear), r=0.843 (cortical) and r=0.844 (posterior subcapsular). The results of the study showed that OSI is a useful parameter for evaluating large amounts of intraocular scattering that can be used, in combination with other conventional procedures, as a valuable tool in clinical practice to grade cataracts objectively.

Pediatric cataract surgery in Madagascar.

PubMed

Randrianotahina, H C L; Nkumbe, H E

2014-01-01

Cataract is the main cause of blindness among children in Africa, having replaced vitamin A deficiency and measles. The management of childhood cataract in Africa, especially francophone countries, is inadequate. The objective is to study the age at presentation of children diagnosed with cataract, their visual outcomes, and follow-up patterns after surgery in Madagascar. This was a retrospective case series of children operated on for cataract in one of the busiest eye hospitals in Madagascar between September 1999 and July 2009. Data were obtained from theater logs and patient case notes and entered in a Microsoft Excel spreadsheet. Data entry was carried out using Microsoft Excel and analysis using Intercooled Stata version 9.0. Student t-test and Pearson's Chi-square were used to test associations where appropriate. A total of 60.5 percent of the 86 children operated on during the study period were boys. The mean age at presentation was 6.9 years (±SD 4.3) for congenital cataract, 13.1 years (±SD 2.9) for developmental cataract and 9.4 years (±SD 4.0) for traumatic cataract. A total of 36 children (41.9%) came back for follow-up, while 72 children (83.7%) were lost to follow-up 5 weeks after surgery. The mean follow-up period was 5 weeks (±SD 17.9). Children, who were brought back for follow-up were younger than those who were not. Although 64 (74.4%) of children had refraction during their encounters with the eye care facility, only 3 (3.5%) were provided with glasses. At last documented follow-up, 2.7% of the children had 6/18 vision or better. In Madagascar, presentation for congenital and developmental cataract is very late, visual outcome poor and follow-up inadequate. There is an urgent need for a childhood blindness program to effectively deal with pediatric cataract, an avoidable cause of blindness and visual disability in children on the island nation.

Surgery for cataracts in people with age-related macular degeneration

PubMed Central

Casparis, Heather; Lindsley, Kristina; Kuo, Irene C; Sikder, Shameema; Bressler, Neil M

2017-01-01

Background Cataract and age-related macular degeneration (AMD) are common causes of decreased vision that often occur simultaneously in people over age 50. Although cataract surgery is an effective treatment for cataract-induced visual loss, some clinicians suspect that such an intervention may increase the risk of worsening of underlying AMD and thus have deleterious effects on vision. Objectives The objective of this review was to evaluate the effectiveness and safety of cataract surgery compared with no surgery in eyes with AMD. Search methods We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) (2016, Issue 11), Ovid MEDLINE, Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE Daily (January 1946 to December 2016), Embase (January 1980 to December 2016), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982to December 2016), the ISRCTN registry (www.isrctn.com/editAdvancedSearch), ClinicalTrials.gov (www.clinicaltrials.gov), and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 2 December 2016. Selection criteria We included randomized controlled trials (RCTs) and quasi-randomized trials that enrolled participants whose eyes were affected by both cataract and AMD in which cataract surgery was compared with no surgery. Data collection and analysis Two review authors independently evaluated the search results against the inclusion and exclusion criteria. Two review authors independently extracted data, assessed risk of bias for included studies, and graded the certainty of evidence. We followed methods as recommended by Cochrane. Main results We included two RCTs with a total of 114 participants (114 study eyes) with visually significant cataract and AMD. We identified no ongoing trials. Participants in each RCT were randomized to immediate cataract surgery (within two weeks of enrollment) or delayed cataract surgery (six months after enrollment). The risk of bias was unclear for most domains in each study; one study was registered prospectively. In one study conducted in Australia outcomes were reported only at six months (before participants in the delayed-surgery group had cataract surgery). At six months, the immediate-surgery group showed mean improvement in best-corrected visual acuity (BCVA) compared with the delayed-surgery group (mean difference (MD) -0.15 LogMAR, 95% confidence interval (CI) -0.28 to -0.02; 56 participants; moderate-certainty evidence). In the other study, conducted in Austria, outcomes were reported only at 12 months (12 months after participants in the immediate-surgery group and six months after participants in the delayed-surgery group had cataract surgery). There was uncertainty as to which treatment group had better improvement in distance visual acuity at 12 months (unit of measure not reported; very low-certainty evidence). At 12 months, the mean change from baseline between groups in cumulated drusen or geographic atrophy area size was small and there was uncertainty which, if either, of the groups was favored (MD 0.76, 95% CI -8.49 to 10.00; 49 participants; low-certainty evidence). No participant in one study had exudative AMD develop in the study eye during 12 months of follow-up; in the other study, choroidal neovascularization developed in the study eye of 1 of 27 participants in the immediate-surgery group versus 0 of 29 participants in the delayed-surgery group at six months (risk ratio 3.21, 95% CI 0.14 to 75.68; 56 participants; very low-certainty evidence). Quality of life was measured using two different questionnaires. Scores on the Impact of Vision Impairment (IVI) questionnaire suggested that the immediate-surgery group fared better regarding vision-related quality of life than the delayed-surgery group at six months (MD in IVI logit scores 1.60, 95% CI 0.61 to 2.59; low-certainty evidence). However, we could not analyze scores from the Visual Function-14 (VF-14) questionnaire from the other study due to insufficient data. No postoperative complication was reported from either study. Authors' conclusions At this time, it is not possible to draw reliable conclusions from the available data as to whether cataract surgery is beneficial or harmful in people with AMD after 12 months. Although cataract surgery provides short-term (six months) improvement in BCVA in eyes with AMD compared with no surgery, it is unclear whether the timing of surgery has an effect on long-term outcomes. Physicians must make recommendations to their AMD patients regarding cataract surgery based on experience and clinical judgment until large controlled trials are conducted and their findings published. There is a need for prospective RCTs in which cataract surgery is compared with no surgery in people with AMD to better evaluate whether cataract surgery is beneficial or harmful in all or a subset of AMD patients. However, ethical considerations preclude withholding surgery, or delaying it for several years, if it may be a potentially beneficial treatment. Designers of future trials are encouraged to utilize existing standardized systems for grading cataract and AMD and for measuring key outcomes: visual acuity, change in visual acuity, worsening of AMD, quality of life measures, and adverse events. PMID:28206671

Ancestry, Socioeconomic Status, and Age-Related Cataract in Asians: The Singapore Epidemiology of Eye Diseases Study.

PubMed

Chua, Jacqueline; Koh, Jia Yu; Tan, Ava Grace; Zhao, Wanting; Lamoureux, Ecosse; Mitchell, Paul; Wang, Jie Jin; Wong, Tien Yin; Cheng, Ching-Yu

2015-11-01

To determine the prevalence of age-related cataract and its ancestral and socioeconomic risk factors in a multi-ethnic Asian population. Population-based, cross-sectional study. A total of 10 033 adults (3353 Chinese, 3280 Malays, and 3400 Indians) aged >40 years in the Singapore Epidemiology of Eye Diseases Study. Study participants were invited for a structured interview and received a standardized comprehensive eye examination. Digital lens photographs were taken from eyes of each participant and graded for nuclear, cortical, and posterior subcapsular (PSC) cataract, following the Wisconsin Cataract Grading System. Prevalence data were compared with the Blue Mountains Eye Study (BMES) in Australia. Information on medical and lifestyle factors was collected using questionnaires and blood samples. To increase the precision of racial definition, genetic ancestry was derived from genome-wide single nucleotide polymorphism markers using principal component analysis. Regression models were used to investigate the association of cataract with socioeconomic factors (education and income) and genetic ancestry. Age-related cataract. A total of 8750 participants (94.0%) had gradable lens photographs. The age-standardized prevalence of cataract surgery in Chinese (16.0%), Malays (10.6%), and Indians (20.2%) was higher than in white subjects (4.1%). We found the age-standardized cataract prevalence in Chinese (30.4%), Malays (37.8%), and Indians (33.1%) was higher than in whites (18.5%). Cataract was 1.5 to 2 times more common in Asians and began 10 years earlier than in white subjects. Malays had significantly higher age-standardized prevalence of nuclear, cortical, and PSC cataract than Chinese (P<0.001). The severity of nuclear, cortical, and PSC cataract was significantly correlated with genetic ancestry in our South East Asian population. Less education and lower income were associated with cataract for Chinese and Indians but not Malays. The presence of visual impairment associated with cataract was higher in people aged ≥60 years and Malays. We showed that people of different Asian ethnicities had a higher prevalence and earlier age of onset of cataract than Europeans. People of Malay ancestry have a greater severity for all cataract subtypes than people of Chinese ancestry. Education and income were associated with cataract for certain Asian subgroups. Copyright © 2015 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Lenticular abnormalities in children.

PubMed

Khokhar, Sudarshan; Agarwal, Tushar; Kumar, Gaurav; Kushmesh, Rakhi; Tejwani, Lalit Kumar

2012-01-01

To study the lenticular problems in children presenting at an apex institute. Retrospective analysis of records (< 14 years) of new lens clinic cases was done. Of 1,047 children, 687 were males. Mean age at presentation was 6.35 ± 4.13 years. Developmental cataract was seen in 45.6% and posttraumatic cataract in 29.7% of patients. Other abnormalities were cataract with retinal detachment, persistent hyperplastic primary vitreous, subluxated lens, micro/spherophakia, cataract secondary to uveitis, intraocular lens complications, cataract with choroidal coloboma, and visual axis opacification. Developmental and posttraumatic cataracts were the most common abnormalities. Delayed presentation is of concern. Copyright 2012, SLACK Incorporated.

Vision-related quality of life following glaucoma filtration surgery.

PubMed

Hirooka, Kazuyuki; Nitta, Eri; Ukegawa, Kaori; Tsujikawa, Akitaka

2017-05-12

To evaluate vision-related quality of life (VR-QOL) following glaucoma filtration surgery. A total of 103 glaucoma patients scheduled to undergo glaucoma filtration surgery. Prior to and at three months after glaucoma filtration surgery, trabeculectomy or EX-PRESS, all patients completed the 25-item National Eye Institute Visual Function Questionnaire (VFQ-25). A total of 48 patients underwent combined cataract and filtration surgery. The clinical data collected pre- and postoperatively included best-corrected visual acuity (BCVA) and intraocular pressure (IOP). The IOP decreased significantly from 19.0 ± 8.1 mmHg to 9.7 ± 3.9 mmHg (P < 0.001). Preoperative VFQ-25 composite score (65.8 ± 15.6) was similar to the postoperative score (67.8 ± 16.6). A significantly improved VFQ-25 composite score (pre: 63.2 ± 17.1, post: 67.7 ± 17.8; P = 0.001) was observed in the patients who underwent combined cataract and filtration surgery. There was a significant association between the BCVA changes in the operated eye and the changes in the VFQ-25 composite score (r = -0.315, P = 0.003). Although glaucoma filtration surgery by itself did not decrease the VR-QOL in glaucoma patients, there was significant improvement in the VR-QOL after the patients underwent combined cataract and glaucoma filtration surgery.

[Social marketing to increase the rate of cataract surgery in the Sava region of Madagascar].

PubMed

Nkumbe, H E; Razafinimpanana, N; Rakotondrajoa, L P

2013-01-01

Lack of information is one of the main reasons why people who are visually impaired or blind as a result of cataracts do not visit eye care centers for surgery that can restore their sight. This study was conducted to determine the best ways to inform the main target groups about the possibility of restoring sight to those whose visual impairment and blindness is due to cataracts and about outreach visits by the mobile eye clinic of FLM SALFA, Sambava, in the Sava region of Madagascar from November 2008 through October 2009. Two community eye health workers conducted awareness campaigns and delivered posters to radio stations, religious leaders, and administrative authorities of the 17 most populated municipalities in the region of Sava, two weeks before these visits. All participants who visited the mobile clinic were interviewed, and the ophthalmologist's diagnosis was noted on the questionnaire. Women accounted for 51.5% of the 955 participants. Radio was the most effective means of communication in the region overall, and specifically for reaching men (P=0.044); churches were more successful for reaching women (P = 0.000). Cataract was diagnosed in 16.2% of men and 8.1% of women (p = 0.0001). To significantly increase the number of people, especially women, having cataract surgery in the Sava region, it is essential to work closely with the leaders of all religious groups, as well as with radio stations.

Cataract surgical coverage and outcome in the Tibet Autonomous Region of China

PubMed Central

Bassett, K L; Noertjojo, K; Liu, L; Wang, F S; Tenzing, C; Wilkie, A; Santangelo, M; Courtright, P

2005-01-01

Background: A recently published, population based survey of the Tibet Autonomous Region (TAR) of China reported on low vision, blindness, and blinding conditions. This paper presents detailed findings from that survey regarding cataract, including prevalence, cataract surgical coverage, surgical outcome, and barriers to use of services. Methods: The Tibet Eye Care Assessment (TECA) was a prevalence survey of people from randomly selected households from three of the seven provinces of the TAR (Lhoka, Nakchu, and Lingzhr), representing its three main environmental regions. The survey, conducted in 1999 and 2000, assessed visual acuity, cause of vision loss, and eye care services. Results: Among the 15 900 people enumerated, 12 644 were examined (79.6%). Cataract prevalence was 5.2% and 13.8%, for the total population, and those over age 50, respectively. Cataract surgical coverage (vision <6/60) for people age 50 and older (85–90% of cataract blind) was 56% overall, 70% for men and 47% for women. The most common barriers to use of cataract surgical services were distance and cost. In the 216 eyes with cataract surgery, 60% were aphakic and 40% were pseudophakic. Pseudophakic surgery left 19% of eyes blind (<6/60) and an additional 20% of eyes with poor vision (6/24–6/60). Aphakic surgery left 24% of eyes blind and an additional 21% of eyes with poor vision. Even though more women remained blind than men, 28% versus 18% respectively, the different was not statistically significant (p = 0.25). Conclusions: Cataract surgical coverage was remarkably high despite the difficulty of providing services to such an isolated and sparse population. Cataract surgical outcome was poor for both aphakic and pseudophakic surgery. Two main priorities are improving cataract surgical quality and cataract surgical coverage, particularly for women. PMID:15615736

Folic Acid, Vitamin B6, and Vitamin B12 in Combination and Age-Related Cataract in a Randomized Trial of Women.

PubMed

Christen, William G; Glynn, Robert J; Chew, Emily Y; Albert, Christine M; Manson, JoAnn E

2016-01-01

To examine the incidence of cataract and cataract extraction in a trial of folic acid and vitamins B6 and B12. In a randomized, double-masked, placebo-controlled trial, 5442 female health professionals aged 40 years or older with preexisting cardiovascular disease (CVD) or three or more CVD risk factors were randomly assigned to receive a combination of folic acid (2.5 mg/day), vitamin B6 (50 mg/day), and vitamin B12 (1 mg/day), or placebo. A total of 3925 of these women did not have a diagnosis of cataract at baseline and were included in this analysis. The primary endpoint was age-related cataract, defined as an incident age-related lens opacity, responsible for a reduction in best-corrected visual acuity to 20/30 or worse, based on self-report confirmed by medical record review. Extraction of incident age-related cataract was a secondary endpoint of the trial. During an average of 7.3 years of treatment and follow-up, 408 cataracts and 275 cataract extractions were documented. There were 215 cataracts in the combination treatment group and 193 in the placebo group (hazard ratio, HR, 1.10, 95% confidence interval, CI, 0.90-1.33; p = 0.36). For the secondary endpoint of cataract extraction, there were 155 in the combination treatment group and 120 in the placebo group (HR 1.28, 95% CI 1.01-1.63; p = 0.04). In this large-scale randomized trial of women at high risk of CVD, daily supplementation with a combination of folic acid, vitamin B6, and vitamin B12 had no significant effect on cataract, but may have increased the risk of cataract extraction.

Evaluation of day care versus inpatient cataract surgery performed at a Jiangsu public Tertiary A hospital.

PubMed

Zhuang, Min; Cao, Juan; Cui, Minglan; Yuan, Songtao; Liu, Qinghuai; Fan, Wen

2018-06-05

High cataract incidence and low cataract surgical rate are serious public health problems in China, despite the fact that efficient day care cataract surgery has been implemented in some public Tertiary A hospitals in China. In this study, we compared not only clinical outcomes, hospitalization time and total costs but also payment manners between day care and inpatient procedures for cataract surgery in a Jiangsu public Tertiary A hospital to put forward several instructional suggestions for the improvement of government medical policies. In total, 4151 day care cases and 2509 inpatient cases underwent the same cataract surgery in the day care ward and ordinary ward respectively, and were defined as two groups. General information, complications, postoperative best corrected visual acuity (BCVA), hospitalization time, total costs and especially payment method were analyzed to compare day care versus inpatient. The general data display no significant differences (P > 0.05), and no significant difference between complications and postoperative BCVA were observed between the two groups (P > 0.05). The period of stay in hospital was significantly different (P < 0.001). The total costs were lower for day care than for inpatients (P < 0.001). To avoid sampling error, we analyzed the data of payment manner for each patient among this period. Day care patients tended to pay for the procedure using the Urban Employees Basic Medical Insurance (UEBMI) method, while inpatients tended to use the Out-of-Pocket Medical Treatment (OMT) payment method (P < 0.001). Day surgery of cataract is more cost-effective and efficient than inpatient surgery with equivalent clinical outcomes. As an efficient therapeutic regimen, day care surgery should be further promoted and supported by the government policies.

Reprint of: Relationship between cataract severity and socioeconomic status.

PubMed

Wesolosky, Jason D; Rudnisky, Christopher J

2015-06-01

To determine the relationship between cataract severity and socioeconomic status (SES). Retrospective, observational case series. A total of 1350 eyes underwent phacoemulsification cataract extraction by a single surgeon using an Alcon Infiniti system. Cataract severity was measured using phaco time in seconds. SES was measured using area-level aggregate census data: median income, education, proportion of common-law couples, and employment rate. Preoperative best corrected visual acuity was obtained and converted to logarithm of the minimum angle of resolution values. For patients undergoing bilateral surgery, the generalized estimating equation was used to account for the correlation between eyes. Univariate analyses were performed using simple regression, and multivariate analyses were performed to account for variables with significant relationships (p < 0.05) on univariate testing. Sensitivity analyses were performed to assess the effect of including patient age in the controlled analyses. Multivariate analyses demonstrated that cataracts were more severe when the median income was lower (p = 0.001) and the proportion of common-law couples living in a patient's community (p = 0.012) and the unemployment rate (p = 0.002) were higher. These associations persisted even when controlling for patient age. Patients of lower SES have more severe cataracts. Copyright © 2015. Published by Elsevier Inc.

Oxidative stress markers in patients with primary open-angle glaucoma.

PubMed

Ghanem, Asaad A; Arafa, Lamiaa F; El-Baz, Ayman

2010-04-01

To investigate the levels of antioxidant enzymes catalase (CAT), glutathione peroxidase (GPO), superoxide dismutase (SOD), and malondialdehyde (MDA) in human eyes with primary open-angle glaucoma (POAG) and to correlate their concentrations with severity of glaucoma. A prospective cases control study. Thirty patients with primary open-angle glaucoma and twenty-five patients with senile cataracts of matched age and gender were included in the study prospectively. Aqueous humor samples were obtained by paracentesis at the time of elective surgery for glaucomatous and cataractous patients. Aqueous humor were analyzed for CAT, GPO, SOD, and MDA status. GPO, SOD, and MDA enzyme levels revealed a high significant increase in aqueous humor of POAG patients with respect to the comparative group of cataract patients (P < 0.001). No significant difference in the activity of CAT enzyme in aqueous humor of POAG and cataract patient (P = 0.201). Significant correlation was found between the MDA enzyme level and severe visual field loss (P < 0.001) in POAG patients. Increased levels of aqueous humor GPO, SOD, and MDA may be associated with POAG. In addition, they may be useful antioxidant enzyme levels in aqueous humor of POAG patients as a result of glaucoma disease and not a cause.

Cataract Blindness in Osun State, Nigeria: Results of a Survey

PubMed Central

Kolawole, Olubayo U.; Ashaye, Adeyinka O.; Mahmoud, Abdulraheem O.; Adeoti, Caroline O.

2012-01-01

Purpose: To estimate the burden of blindness and visual impairment due to cataract in Egbedore Local Government Area of Osun State, Nigeria. Materials and Methods: Twenty clusters of 60 individuals who were 50 years or older were selected by systematic random sampling from the entire community. A total of 1,183 persons were examined. Results: The age- and sex-adjusted prevalence of bilateral cataract-related blindness (visual acuity (VA) < 3/60) in people of 50 years and older was 2.0% (95% confidence interval (CI): 1.6–2.4%). The Cataract Surgical Coverage (CSC) (persons) was 12.1% and Couching Coverage (persons) was 11.8%. The age- and sex-adjusted prevalence of bilateral operable cataract (VA < 6/60) in people of 50 years and older was 2.7% (95% CI: 2.3–3.1%). In this last group, the cataract intervention (surgery + couching) coverage was 22.2%. The proportion of patients who could not attain 6/60 vision after surgery were 12.5, 87.5, and 92.9%, respectively, for patients who underwent intraocular lens (IOL) implantation, cataract surgery without IOL implantation and those who underwent couching. “Lack of awareness” (30.4%), “no need for surgery” (17.6%), cost (14.6%), fear (10.2%), “waiting for cataract to mature” (8.8%), AND “surgical services not available” (5.8%) were reasons why individuals with operable cataract did not undergo cataract surgery. Conclusions: Over 600 operable cataracts exist in this region of Nigeria. There is an urgent need for an effective, affordable, and accessible cataract outreach program. Sustained efforts have to be made to increase the number of IOL surgeries, by making IOL surgery available locally at an affordable cost, if not completely free. PMID:23248537

Comparative evaluation of aspheric toric intraocular lens implantation and limbal relaxing incisions in eyes with cataracts and ≤3 dioptres of astigmatism.

PubMed

Lam, Douglas K T; Chow, Vanissa W S; Ye, Cong; Ng, Paul Ka-Fai; Wang, Zheng; Jhanji, Vishal

2016-02-01

To compare the visual outcomes of aspheric toric intraocular lens (IOL) implantation and limbal relaxing incisions (LRI) for management of coexisting age-related cataracts and astigmatism. In this prospective study, sixty eyes of 60 patients with visually significant cataract and coexisting corneal astigmatism ≤3 dioptres (D) were randomised to undergo phacoemulsification with either aspheric toric IOL or aspheric monofocal IOL with LRI. The main outcome measures were postoperative 3-month uncorrected visual acuity (UCVA), contrast sensitivity, rotational stability of the toric IOL and spectacle independence. The postoperative UCVA, contrast sensitivity and refractive astigmatism were significantly better than the baseline measurements for both groups (p≤0.001). There was no significant difference detected for these parameters between LRI and toric IOL groups postoperatively (p≥0.119). At both postoperative month 1 and 3, the percentages of eyes in need of spectacles were lower in toric group than LRI group (p≤0.030). IOL misalignment was noted in three eyes in the toric IOL group (mean misalignment 7.67±4.04°). On vector analysis, magnitude of error (ME) was negative in the LRI group indicating undercorrection, whereas the ME was close to zero for toric group. Both toric IOL implantation and LRI were effective in correcting corneal astigmatism ≤3 D during phacoemulsification, while LRI tended to undercorrect astigmatism. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Prevalence and Causes of Visual Impairment in Fundong District, North West Cameroon: Results of a Population-Based Survey.

PubMed

Oye, Joseph; Mactaggart, Islay; Polack, Sarah; Schmidt, Elena; Tamo, Violet; Okwen, Marvice; Kuper, Hannah

2017-12-01

To estimate the prevalence and causes of visual impairment in Fundong Health District, North West Cameroon. A total of 51 clusters of 80 people (all ages) were sampled with probability proportionate to size and compact segment sampling. Visual acuity (VA) was measured with a tumbling "E" chart. An ophthalmic nurse examined people with VA<6/18 in either eye. The presence of hearing and physical impairments were assessed using clinical examination, and self-reported visual problems using the Washington Group Short Set. In total, 4080 people were enumerated of whom 3567 were screened (response rate 87%). The overall prevalence of visual impairment was 2.3% (95% CI 1.8-3.0%) and blindness was 0.6% (0.3-1.0%). The prevalence of both blindness and visual impairment increased rapidly with age, so that the vast majority of cases of visual impairment (84%) and blindness (82%) were in people aged 50+. Posterior segment disease and cataract were the main causes of blindness and visual impairment, with refractive error also an important cause of visual impairment. Cataract surgical coverage (proportion of all cataracts that had received surgery) was relatively high (87% of people at VA<6/60). Post-surgery outcomes were poor, with 31% of operated eyes having VA<6/60. Among the 82 people with visual impairment, 22% had a physical impairment or epilepsy and 30% had a hearing impairment. Self-reported difficulties in vision were relatively closely related to clinical measures of visual impairment. Ophthalmic programmes in Cameroon need to incorporate control of posterior segment diseases while also working to improve outcomes after cataract surgery.

Extracapsular cataract extraction with and without intra-ocular lenses in black patients.

PubMed

Welsh, N H

1992-04-04

Cataracts are the commonest cause of blindness in Third-World countries and cataract extraction is the commonest eye operation performed anywhere. Patients require optical correction after surgery either in the form of an intra-ocular lens (IOL) or bifocal aphakic glasses. The standard operative procedure in First-World countries is an extracapsular cataract extraction with an IOL. This type of operation has been thought to be contraindicated in black patients because of the complications and lack of adequate postoperative follow-up. During 1987-1989 3,144 cataract extractions, of which 2,157 were simple extracapsular extractions and 987 had IOLs inserted, were performed at the above hospitals. The two groups were compared for complications and visual results. The complications were similar in both groups and were acceptable, therefore posterior lens implantation confers no additional risk on routine extracapsular cataract extraction. The visual results in the IOL group with and without additional glasses were compared with those patients who had correcting aphakic glasses. In the corrected IOL group, 98% of patients saw better than 6/24, whereas in the aphakic spectacle group, 87.5% saw 6/24 or better. Since the majority of black patients cannot afford costly prescribed spectacles, it was important to analyse the visual acuity in patients who had IOLs and were uncorrected; 81.6% saw 6/24 or better. IOLs in black patients are therefore indicated but the disadvantage is the cost.

Epidemiologic study of age-related cataracts among an elderly Chinese population in Shih-Pai, Taiwan.

PubMed

Tsai, Su-Ying; Hsu, Wen-Ming; Cheng, Ching-Yu; Liu, Jorn-Hon; Chou, Pesus

2003-06-01

The purpose of this study was to determine the prevalence and risk factors for age-related cataracts in a metropolitan elderly Chinese population in Shihpai, Taipei, Taiwan. Population-based cross-sectional study. A total of 2045 subjects at least 65 years of age were invited to participate, and 1361 (66.6%) participated in the survey. An eye examination, including lens opacity grading, was conducted by ophthalmologists using the Lens Opacity Classification System III (LOCS III). A structured questionnaire was used for data collection. Interviewers also collected information on subjects' blood pressure, lifestyle (cigarette smoking and alcohol intake), medical history, and waist and hip circumferences. Subjects were defined as having age-related cataracts if there was any type of lens opacity with an LOCS III grade of more than 2 in one or both eyes. When both eyes of an individual had age-related cataracts, the more affected eye was used for analysis. Among the 1361 participants, 806 were diagnosed with age-related cataracts. The prevalence was 59.2% (95% confidence interval, 56.6%-61.8%). Women had a higher prevalence of cataracts than men (64.0% vs. 56.1%, P = 0.004). The prevalence of age-related cataracts increased with age (P = 0.001). Nuclear opacity was the most prevalent type (38.9%), followed by cortical opacity (21.9%) and posterior subcapsular opacity (9.2%). On the basis of the final logistic regression model, after controlling for all other covariates, increased age and female gender were factors that were associated with an increased risk for all types of cataracts. Besides age and gender, the most significant risk factor for nuclear cataracts was current cigarette smoking; the significant predictors for cortical cataracts were higher systolic blood pressure, a history of cigarette smoking in the past, and history of diabetes; the significant predictor for posterior subcapsular cataracts was higher systolic blood pressure. The increasing prevalence of age-related cataracts with age highlights the need to seek appropriate medical services and for preventative interventions. Elderly people often ignore the importance of seeking vision services and care to prevent blindness or visual impairment. These findings suggest that the elderly need to be educated regarding the importance of eye care by physicians and hygiene authorities in Taiwan.

Correction of low corneal astigmatism in cataract surgery.

PubMed

Leon, Pia; Pastore, Marco Rocco; Zanei, Andrea; Umari, Ingrid; Messai, Meriem; Negro, Corrado; Tognetto, Daniele

2015-01-01

To evaluate and compare aspheric toric intraocular lens (IOL) implantation and aspheric monofocal IOL implantation with limbal relaxing incisions (LRI) to manage low corneal astigmatism (1.0-2.0 D) in cataract surgery. A prospective randomized comparative clinical study was performed. There were randomly recruited 102 eyes (102 patients) with cataracts associated with corneal astigmatism and divided into two groups. The first group received toric IOL implantation and the second one monofocal IOL implantation with peripheral corneal relaxing incisions. Outcomes considered were: visual acuity, postoperative residual astigmatism, endothelial cell count, the need for spectacles, and patient satisfaction. To determine the postoperative toric axis, all patients who underwent the toric IOL implantation were further evaluated using an OPD Scan III (Nidek Co, Japan). Follow-up lasted 6mo. The mean uncorrected distance visual acuity (UCVA) and the best corrected visual acuity (BCVA) demonstrated statistically significant improvement after surgery in both groups. At the end of the follow-up the UCVA was statistically better in the patients with toric IOL implants compared to those patients who underwent implantation of monofocal IOL plus LRI. The mean residual refractive astigmatism was of 0.4 D for the toric IOL group and 1.1 D for the LRI group (P<0.01). No difference was observed in the postoperative endothelial cell count between the two groups. The two surgical procedures demonstrated a significant decrease in refractive astigmatism. Toric IOL implantation was more effective and predictable compared to the limbal relaxing incision.

Correction of low corneal astigmatism in cataract surgery

PubMed Central

Leon, Pia; Pastore, Marco Rocco; Zanei, Andrea; Umari, Ingrid; Messai, Meriem; Negro, Corrado; Tognetto, Daniele

2015-01-01

AIM To evaluate and compare aspheric toric intraocular lens (IOL) implantation and aspheric monofocal IOL implantation with limbal relaxing incisions (LRI) to manage low corneal astigmatism (1.0-2.0 D) in cataract surgery. METHODS A prospective randomized comparative clinical study was performed. There were randomly recruited 102 eyes (102 patients) with cataracts associated with corneal astigmatism and divided into two groups. The first group received toric IOL implantation and the second one monofocal IOL implantation with peripheral corneal relaxing incisions. Outcomes considered were: visual acuity, postoperative residual astigmatism, endothelial cell count, the need for spectacles, and patient satisfaction. To determine the postoperative toric axis, all patients who underwent the toric IOL implantation were further evaluated using an OPD Scan III (Nidek Co, Japan). Follow-up lasted 6mo. RESULTS The mean uncorrected distance visual acuity (UCVA) and the best corrected visual acuity (BCVA) demonstrated statistically significant improvement after surgery in both groups. At the end of the follow-up the UCVA was statistically better in the patients with toric IOL implants compared to those patients who underwent implantation of monofocal IOL plus LRI. The mean residual refractive astigmatism was of 0.4 D for the toric IOL group and 1.1 D for the LRI group (P<0.01). No difference was observed in the postoperative endothelial cell count between the two groups. CONCLUSION The two surgical procedures demonstrated a significant decrease in refractive astigmatism. Toric IOL implantation was more effective and predictable compared to the limbal relaxing incision. PMID:26309869

Deprivation amblyopia and congenital hereditary cataract.

PubMed

Mansouri, Behzad; Stacy, Rebecca C; Kruger, Joshua; Cestari, Dean M

2013-01-01

Amblyopia is a neurodevelopmental disorder of vision associated with decreased visual acuity, poor or absent stereopsis, and suppression of information from one eye.(1,2) Amblyopia may be caused by strabismus (strabismic amblyopia), refractive error (anisometropic amblyopia), or deprivation from obstructed vision (deprivation amblyopia). 1 In the developed world, amblyopia is the most common cause of childhood visual impairment, 3 which reduces quality of life 4 and also almost doubles the lifetime risk of legal blindness.(5, 6) Successful treatment of amblyopia greatly depends on early detection and treatment of predisposing disorders such as congenital cataract, which is the most common cause of deprivational amblyopia. Understanding the genetic causes of congenital cataract leads to more effective screening tests, early detection and treatment of infants and children who are at high risk for hereditary congenital cataract.

Sporadic and Familial Congenital Cataracts: Mutational Spectrum and New Diagnoses Using Next‐Generation Sequencing

PubMed Central

Ma, Alan S.; Grigg, John R.; Ho, Gladys; Prokudin, Ivan; Farnsworth, Elizabeth; Holman, Katherine; Cheng, Anson; Billson, Frank A.; Martin, Frank; Fraser, Clare; Mowat, David; Smith, James; Christodoulou, John; Flaherty, Maree; Bennetts, Bruce

2016-01-01

ABSTRACT Congenital cataracts are a significant cause of lifelong visual loss. They may be isolated or associated with microcornea, microphthalmia, anterior segment dysgenesis (ASD) and glaucoma, and there can be syndromic associations. Genetic diagnosis is challenging due to marked genetic heterogeneity. In this study, next‐generation sequencing (NGS) of 32 cataract‐associated genes was undertaken in 46 apparently nonsyndromic congenital cataract probands, around half sporadic and half familial cases. We identified pathogenic variants in 70% of cases, and over 68% of these were novel. In almost two‐thirds (20/33) of these cases, this resulted in new information about the diagnosis and/or inheritance pattern. This included identification of: new syndromic diagnoses due to NHS or BCOR mutations; complex ocular phenotypes due to PAX6 mutations; de novo autosomal‐dominant or X‐linked mutations in sporadic cases; and mutations in two separate cataract genes in one family. Variants were found in the crystallin and gap junction genes, including the first report of severe microphthalmia and sclerocornea associated with a novel GJA8 mutation. Mutations were also found in rarely reported genes including MAF, VIM, MIP, and BFSP1. Targeted NGS in presumed nonsyndromic congenital cataract patients provided significant diagnostic information in both familial and sporadic cases. PMID:26694549

The effect of variably tinted spectacle lenses on visual performance in cataract subjects.

PubMed

Naidu, Srilata; Lee, Jason E; Holopigian, Karen; Seiple, William H; Greenstein, Vivienne C; Stenson, Susan M

2003-01-01

A body of clinical and laboratory evidence suggests that tinted spectacle lenses may have an effect on visual performance. The aim of this study was to quantify the effects of spectacle lens tint on the visual performance of 25 subjects with cataracts. Cataracts were scored based on best-corrected acuity and by comparison with the Lens Opacity Classification System (LOCS III) plates. Visual performance was assessed by measuring contrast sensitivity with and without glare (Morphonome software version 4.0). The effect of gray, brown, yellow, green and purple tinting was evaluated. All subjects demonstrated an increase in contrast thresholds under glare conditions regardless of lens tint. However, brown and yellow lens tints resulted in the least amount of contrast threshold increase. Gray lens tint resulted in the largest contrast threshold increase. Individuals with lenticular changes may benefit from brown or yellow spectacle lenses under glare conditions.

Generating Evidence for Program Planning: Rapid Assessment of Avoidable Blindness in Bangladesh.

PubMed

Muhit, Mohammad; Wadud, Zakia; Islam, Johurul; Khair, Zareen; Shamanna, B R; Jung, Jenny; Khandaker, Gulam

2016-06-01

There is a lack of data on the prevalence and causes of blindness in Bangladesh, which is important to plan effective eye health programs and advocate support services to achieve the goals of Vision 2020. We conducted a rapid assessment of avoidable blindness (RAAB) in 8 districts of Bangladesh (January 2010 - December 2012) to establish the prevalence and causes of blindness. People aged ≥50 years were selected, and eligible participants had visual acuity (VA) measured. Ocular examinations were performed in those with VA<6/18. Additional information was collected for those who had or had not undergone cataract surgery to understand service barriers and quality of service. In total, 21,596 people were examined, of which 471 (2.2%, 95% confidence interval, CI, 2.0-2.4%) were blind. The primary cause of blindness was cataract (75.8%). The majority of blindness (86.2%) was avoidable. Cataract and refractive error were the primary causes of severe visual impairment (73.6%) and moderate visual impairment (63.6%), respectively. Cataract surgical coverage for blind persons was 69.3% (males 76.6%, females 64.3%, P<0.001). The magnitude of blindness among people aged ≥50 years was estimated to be 563,200 people (95% CI 512,000-614,400), of whom 426,342 had un-operated cataract. In Bangladesh, the majority of blindness (86.2%) among people aged ≥50 years was avoidable, and cataract was the most important cause of avoidable blindness. Improving cataract surgical services and refraction services would be the most important step towards the elimination of avoidable blindness in Bangladesh.

Images created in a model eye during simulated cataract surgery can be the basis for images perceived by patients during cataract surgery

PubMed Central

Inoue, M; Uchida, A; Shinoda, K; Taira, Y; Noda, T; Ohnuma, K; Bissen-Miyajima, H; Hirakata, A

2014-01-01

Purpose To evaluate the images created in a model eye during simulated cataract surgery. Patients and methods This study was conducted as a laboratory investigation and interventional case series. An artificial opaque lens, a clear intraocular lens (IOL), or an irrigation/aspiration (I/A) tip was inserted into the ‘anterior chamber' of a model eye with the frosted posterior surface corresponding to the retina. Video images were recorded of the posterior surface of the model eye from the rear during simulated cataract surgery. The video clips were shown to 20 patients before cataract surgery, and the similarity of their visual perceptions to these images was evaluated postoperatively. Results The images of the moving lens fragments and I/A tip and the insertion of the IOL were seen from the rear. The image through the opaque lens and the IOL without moving objects was the light of the surgical microscope from the rear. However, when the microscope light was turned off after IOL insertion, the images of the microscope and operating room were observed by the room illumination from the rear. Seventy percent of the patients answered that the visual perceptions of moving lens fragments were similar to the video clips and 55% reported similarity with the IOL insertion. Eighty percent of the patients recommended that patients watch the video clip before their scheduled cataract surgery. Conclusions The patients' visual perceptions during cataract surgery can be reproduced in the model eye. Watching the video images preoperatively may help relax the patients during surgery. PMID:24788007

Low-Dose Radiation Cataract and Genetic Determinants of Radiosensitivity

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kleiman, Norman Jay

The lens of the eye is one of the most radiosensitive tissues in the body. Ocular ionizing radiation exposure results in characteristic, dose related, progressive lens changes leading to cataract formation. While initial, early stages of lens opacification may not cause visual disability, the severity of such changes progressively increases with dose until vision is impaired and cataract extraction surgery may be required. Because of the transparency of the eye, radiation induced lens changes can easily be followed non-invasively over time. Thus, the lens provides a unique model system in which to study the effects of low dose ionizing radiationmore » exposure in a complex, highly organized tissue. Despite this observation, considerable uncertainties remain surrounding the relationship between dose and risk of developing radiation cataract. For example, a growing number of human epidemiological findings suggest significant risk among various groups of occupationally and accidentally exposed individuals and confidence intervals that include zero dose. Nevertheless, questions remain concerning the relationship between lens opacities, visual disability, clinical cataract, threshold dose and/or the role of genetics in determining radiosensitivity. Experimentally, the response of the rodent eye to radiation is quite similar to that in humans and thus animal studies are well suited to examine the relationship between radiation exposure, genetic determinants of radiosensitivity and cataractogenesis. The current work has expanded our knowledge of the low-dose effects of X-irradiation or high-LET heavy ion exposure on timing and progression of radiation cataract and has provided new information on the genetic, molecular, biochemical and cell biological features which contribute to this pathology. Furthermore, findings have indicated that single and/or multiple haploinsufficiency for various genes involved in DNA repair and cell cycle checkpoint control, such as Atm, Brca1 or Rad9, influence cataract development and thus radiosensitivity. These observations have direct applicability to various human populations including accidentally exposed individuals, interventional medical workers, astronauts and nuclear plant workers.« less

Efficacy and safety of multifocal intraocular lenses following cataract and refractive lens exchange: Metaanalysis of peer-reviewed publications.

PubMed

Rosen, Emanuel; Alió, Jorge L; Dick, H Burkhard; Dell, Steven; Slade, Stephen

2016-02-01

We performed a metaanaysis of peer-reviewed studies involving implantation of a multifocal intraocular lens (IOL) in presbyopic patients with cataract or having refractive lens exchange (RLE). Previous reviews have considered the use of multifocal IOLs after cataract surgery but not after RLE, whereas greater insight might be gained from examining the full range of studies. Selected studies were examined to collate outcomes with monocular and binocular uncorrected distance, intermediate, and near visual acuity; spectacle independence; contrast sensitivity; visual symptoms; adverse events; and patient satisfaction. In 8797 eyes, the mean postoperative monocular uncorrected distance visual acuity (UDVA) was 0.05 logMAR ± 0.006 (SD) (Snellen equivalent 20/20(-3)). In 6334 patients, the mean binocular UDVA was 0.04 ± 0.00 logMAR (Snellen equivalent 20/20(-2)), with a mean spectacle independence of 80.1%. Monocular mean UDVA did not differ significantly between those who had a cataract procedure and those who had an RLE procedure. Neural adaptation to multifocality may vary among patients. Dr. Alió is a clinical research investigator for Hanita Lenses, Carl Zeiss Meditec AG, Topcon Medical Systems, Inc., Oculentis GmbH, and Akkolens International BV. Dr. Dell is a consultant to Bausch & Lomb and Abbott Medical Optics, Inc. Dr. Slade is a consultant to Alcon Surgical, Inc., Carl Zeiss Meditec AG, and Bausch & Lomb. None of the authors has a financial or proprietary interest in any material or method mentioned. Copyright © 2016 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Prospective study of Centurion® versus Infiniti® phacoemulsification systems: surgical and visual outcomes

PubMed Central

Oh, Lawrence J.; Nguyen, Chu Luan; Wong, Eugene; Wang, Samuel S.Y.; Francis, Ian C.

2017-01-01

AIM To evaluate surgical outcomes (SOs) and visual outcomes (VOs) in cataract surgery comparing the Centurion® phacoemulsification system (CPS) with the Infiniti® phacoemulsification system (IPS). METHODS Prospective, consecutive study in a single-site private practice. Totally 412 patients undergoing cataract surgery with either the CPS using the 30-degree balanced® tip (n=207) or the IPS using the 30-degree Kelman® tip (n=205). Intraoperative and postoperative outcomes were documented prospectively up to one month follow-up. Nuclear sclerosis (NS) grade, cumulated dissipated energy (CDE), preoperative corrected distance visual acuity (CDVA), and CDVA at one month were recorded. RESULTS CDE was 13.50% less in the whole CPS compared with the whole IPS subcohort. In eyes with NS grade III or greater, CDE was 28.87% less with CPS (n=70) compared with IPS (n=44) (P=0.010). Surgical complications were not statistically different between the two subcohorts (P=0.083), but in the one case of vitreous loss using the CPS, CDVA of 6/4 was achieved at one month. The mean CDVAs (VOs) at one month for NS grade III and above cataracts were -0.17 logMAR (6/4.5) in the CPS and -0.15 logMAR (6/4.5) in the IPS subcohort respectively (P=0.033). CONCLUSION CDE is 28.87% less, and VOs are significantly improved, in denser cataracts in the CPS compared with the IPS. The authors recommend the CPS for cases with denser nuclei. PMID:29181313

Sociodemographic status of severely disabled and visually impaired elderly people in Turkey.

PubMed

Kıvanç, Sertaç Argun; Akova-Budak, Berna; Olcaysü, Osman Okan; Çevik, Sadık Görkem

2016-02-01

To identify the prevalence of ophthalmologic diseases in elderly patients who had been classified as severely disabled and to identify the ophthalmologic conditions leading to visual impairment and blindness. The medical records of 2806 patients who had applied to the Health Board of the Erzurum Region Training and Research Hospital between January 2011 and December 2012 were reviewed. One hundred ninety-nine patients aged >64 years who were classified as severely disabled with disability rates of over 50%, and who were unable to care for themselves or to move and/or communicate without help were included in the study. The most frequently seen disabilities were neurological (47.2%) and those resulting from eye diseases (17.1%). The most common ophthalmologic diseases were cataract, glaucoma, and age-related macular degeneration. The mean right and left eye visual acuities were 1.17 ± 1.10 logMAR and 1.13 ± 1.0 logMAR, respectively. Of the 60 patients with ophthalmologic diseases or conditions, 33 were blind (visual acuity worse than 20/400) and 10 were visually impaired (visual acuity worse than 20/70 but better than 20/400). Cataracts were the main cause of blindness. The mean age of the patients who were still being followed up at the time of application to the disability board was significantly lower than that of the others (p =0.015). Seventy-nine percent of the blind patients were from rural areas, and 88% of these had no regular follow-up. Among the blind and visually impaired, significantly more patients from urban areas had social security insurance (SSI) than those from rural areas (p =0.043). Nearly 64% of the blind patients were women. The follow-up rate was significantly lower in women (p =0.025). According to multinomial logistic regression analysis, the visually impaired and blind patients were more likely to have lower follow-up rates than the other types of severely disabled patients (OR: 0.231, 95% Cl: 0.077-0.688, p=0.009). Blindness gives rise to severe disability, and the most common ophthalmologic diseases that cause severe disabilities in elderly patients are cataract, glaucoma, and age-related macular degeneration. Sociodemographic factors that may affect the accessibility of visually impaired and blind people to health services include their place of residence and gender.

Effect of preoperative counseling on fear from visual sensations during phacoemulsification under topical anesthesia.

PubMed

Haripriya, Aravind; Tan, Colin S H; Venkatesh, Rengaraj; Aravind, Srinivasan; Dev, Anand; Au Eong, Kah-Guan

2011-05-01

To determine whether preoperative counseling on possible intraoperative visual perceptions during cataract surgery helps reduce the patients' fear during surgery. Aravind Eye Hospital, Madurai, India. Randomized masked clinical trial. Patients having phacoemulsification under topical anesthesia were randomized to receive additional preoperative counseling or no additional preoperative counseling on potential intraoperative visual perceptions. After surgery, all patients were interviewed about their intraoperative experiences. Of 851 patients, 558 (65.6%) received additional preoperative counseling and 293 (34.4%) received no additional counseling. A lower proportion of patients in the counseled group were frightened than in the group not counseled for visual sensation (4.5% versus 10.6%, P<.001). Analyzed separately by specific visual sensations, similar results were found for light perception (7/558 [1.3%] versus 13/293 [4.4%], P=.007), colors (P=.001), and movement (P=.020). The mean fear score was significantly lower in the counseled group than in the not-counseled group for light perception (0.03 versus 0.12, P=.002), colors (P=.001), movement (P=.005), and flashes (P=.035). Preoperative counseling was a significant factor affecting fear after accounting for age, sex, operated eye, and duration of surgery (multivariate odds ratio, 4.3; 95% confidence interval, 1.6-11.6; P=.003). Preoperative counseling on possible visual sensations during cataract surgery under topical anesthesia significantly reduced the mean fear score and the proportion of patients reporting being frightened. Copyright © 2011 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Effect of unilateral congenital cataract surgery on ocular axial length growth and corneal flattening.

PubMed

Borghol-Kassar, R; Menezo-Rozalén, J L; Harto-Castaño, M A; Desco-Esteban, M C

2015-03-01

The aim of this article is to study the effect of unilateral congenital cataract surgery on ocular growth and corneal flattening. This is a cross-sectional study of 59 patients operated on due to a unilateral congenital cataract. The median age of the patients at the time of diagnosis was 17 months (interquartile range, 5-39 months). The median age at cataract the time of surgery was 28 months (interquartile range, 8-52 months), and the mean follow-up between cataract surgery and assessments was 149.7±69.9 months (range, 30-319 months). Axial length and corneal curvature were measured in both operated and non-operated eyes, comparing the results between them. There were no statistically significant differences for axial length growth or corneal flattening between operated and non-operated eyes: axial length (P=.327, Student t test) and corneal curvature (P=.078, Student t test). A sub-analysis was performed using the visual acuity and the age of the patient at the time of surgery. The only statistically significant data (P=.007, Student t test) was a lower axial length in operated eyes compared to non-operated eyes, in the non-deep-amblyopia group. No significant axial length growth modifications were observed between operated and non-operated eyes. Only the non-deep-amblyopia group presented with a lower axial length in the operated eyes compared to non-operated eyes. No significant differences in corneal flattening were found between groups after unilateral congenital cataract surgery. Copyright © 2011 Sociedad Española de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.

Cataract, Visual Impairment and Long-Term Mortality in a Rural Cohort in India: The Andhra Pradesh Eye Disease Study

PubMed Central

Khanna, Rohit C.; Murthy, Gudlavalleti V. S.; Giridhar, Pyda; Krishnaiah, Sannapaneni; Pant, Hira B.; Palamaner Subash Shantha, Ghanshyam; Chakrabarti, Subhabrata; Gilbert, Clare; Rao, Gullapalli N.

2013-01-01

Background A large-scale prevalence survey of blindness and visual impairment (The Andhra Pradesh Eye Diseases Study [APEDS1]) was conducted between 1996-2000 on 10,293 individuals of all ages in three rural and one urban clusters in Andhra Pradesh, Southern India. More than a decade later (June 2009-March 2010), APEDS1 participants in rural clusters were traced (termed APEDS2) to determine ocular risk factors for mortality in this longitudinal cohort. Methods and Findings Mortality hazard ratio (HR) analysis was performed for those aged >30 years at APEDS1, using Cox proportional hazard regression models to identify associations between ocular exposures and risk of mortality. Blindness and visual impairment (VI) were defined using Indian definitions. 799/4,188 (19.1%) participants had died and 308 (7.3%) had migrated. Mortality was higher in males than females (p<0.001). In multivariable analysis, after adjusting for age, gender, diabetes, hypertension, body mass index, smoking and education status the mortality HR was 1.9 (95% CI: 1.5-2.5) for blindness; 1.4 (95% CI: 1.2-1.7) for VI; 1.8 (95% CI: 1.4-2.3) for pure nuclear cataract, 1.5 (95% CI: 1.1-2.1) for pure cortical cataract; 1.96 (95% CI: 1.6-2.4) for mixed cataract, 2.0 (95% CI: 1.4-2.9) for history of cataract surgery, and 1.58 (95% CI: 1.3-1.9) for any cataract. When all these factors were included in the model, the HRs were attenuated, being 1.5 (95% CI: 1.1-2.0) for blindness and 1.2 (95% CI: 0.9-1.5) for VI. For lens type, the HRs were as follows: pure nuclear cataract, 1.6 (95% CI: 1.3-2.1); pure cortical cataract, 1.5 (95% CI: 1.1-2.1); mixed cataract, 1.8 (95% CI: 1.4-2.2), and history of previous cataract surgery, 1.8 (95% CI: 1.3-2.6). Conclusions All types of cataract, history of cataract surgery and VI had an increased risk of mortality that further suggests that these could be potential markers of ageing. PMID:24282482

The effect of early visual deprivation on the neural bases of multisensory processing.

PubMed

Guerreiro, Maria J S; Putzar, Lisa; Röder, Brigitte

2015-06-01

Developmental vision is deemed to be necessary for the maturation of multisensory cortical circuits. Thus far, this has only been investigated in animal studies, which have shown that congenital visual deprivation markedly reduces the capability of neurons to integrate cross-modal inputs. The present study investigated the effect of transient congenital visual deprivation on the neural mechanisms of multisensory processing in humans. We used functional magnetic resonance imaging to compare responses of visual and auditory cortical areas to visual, auditory and audio-visual stimulation in cataract-reversal patients and normally sighted controls. The results showed that cataract-reversal patients, unlike normally sighted controls, did not exhibit multisensory integration in auditory areas. Furthermore, cataract-reversal patients, but not normally sighted controls, exhibited lower visual cortical processing within visual cortex during audio-visual stimulation than during visual stimulation. These results indicate that congenital visual deprivation affects the capability of cortical areas to integrate cross-modal inputs in humans, possibly because visual processing is suppressed during cross-modal stimulation. Arguably, the lack of vision in the first months after birth may result in a reorganization of visual cortex, including the suppression of noisy visual input from the deprived retina in order to reduce interference during auditory processing. © The Author (2015). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Lightless cataract surgery using a near-infrared operating microscope.

PubMed

Kim, Bong-Hyun

2006-10-01

To describe the near-infrared (NIR) operating microscopy (NIOM) system using the NIR wavelength as the illumination source and to evaluate the feasibility of this system for lightless cataract surgery. HenAm Kim Eye Center, Haenam-Gun, South Korea. In this noncomparative interventional case series, cataract surgery was performed in 4 patients with bilateral cataract using the NIOM system in 1 eye and conventional microscopy in the fellow eye. The primary components of the system include an optical filter, a stereoscopic camera, head-mounted displays, and a recording system. This system uses invisible NIR (wavelength 850 to 1300 nm) illumination to facilitate cataract surgery without light. The differences between the NIOM system and conventional microscopy during cataract surgery were evaluated. The NIOM system provided excellent 3-dimensional viewing in real time. The image resolution was sufficient while performing all steps of cataract surgery. Immediately postoperatively and at 10 and 30 minutes and 1 hour, the visual acuity was better in the 4 eyes in which the NIOM system was used than in the 4 eyes in which conventional microscopy was used. However, using the NIOM system required good surgical skill. Lightless cataract surgery using the NIOM system seems useful for obtaining good visual acuity immediately postoperatively. The system may also reduce the incidence of light-induced retinal toxicity and the need for mydriatic administration and be a good educational tool.

Early light deprivation effects on human cone-driven retinal function.

PubMed

Esposito Veneruso, Paolo; Ziccardi, Lucia; Magli, Giulia; Parisi, Vincenzo; Falsini, Benedetto; Magli, Adriano

2017-03-01

To assess whether the early light deprivation induced by congenital cataract may influence the cone-driven retinal function in humans. Forty-one patients affected by congenital cataract (CC) who had undergone uncomplicated cataract extraction surgery and intraocular lens implant, and 14 healthy subjects (HS) were enrolled. All patients underwent complete ophthalmological and orthoptic evaluations and best-corrected visual acuity (BCVA) measurement; light-adapted full-field electroretinograms (ERG) and photopic negative responses (PhNR) were recorded to obtain a reliable measurement of the outer/inner retinal function and of the retinal ganglion cells' function respectively. Mean values of light-adapted ERG a- and b-wave and PhNR amplitude of CC eyes were significantly reduced and photopic ERG b-wave implicit time mean values were significantly delayed when compared to HS ones. When studying photopic ERG mean amplitudes at 5 ms, significant differences were found when comparing CC and control eyes. In CC eyes, statistically significant correlations were found between a- and b- wave amplitudes and PhNR amplitudes. No significant correlations were found between ERG parameters and BCVA, as well as between the age of CC patients at surgery and the time elapsed from lens extraction. No significant differences were found when functional parameters of bilateral and unilateral congenital cataract (uCC) eyes were compared, however uCC eyes showed significant differences when compared with contralateral healthy eyes. We found a significant impairment of cone-driven retinal responses in patients with a history of congenital cataract. These changes might result from the long-lasting effects of early light deprivation on the cone retinal pathways. Our findings support the relevance of retinal involvement in deficits induced by early light deprivation. © 2016 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Surgical outcomes after epiretinal membrane peeling combined with cataract surgery.

PubMed

Yiu, Glenn; Marra, Kyle V; Wagley, Sushant; Krishnan, Sheela; Sandhu, Harpal; Kovacs, Kyle; Kuperwaser, Mark; Arroyo, Jorge G

2013-09-01

To compare functional and anatomical outcomes after idiopathic epiretinal membrane (ERM) peeling combined with phacoemulsification and intraocular lens implantation versus ERM peeling alone. A retrospective, non-randomised comparative case series study was conducted of 81 eyes from 79 patients who underwent ERM peeling at the Beth Israel Deaconess Medical Center between 2001 and 2010. Eyes that underwent combined surgery for ERM and cataracts (group 1) were compared with those that had ERM peeling alone (group 2) with respect to best-corrected visual acuity at 6 months and 1 year after surgery, postoperative central macular thickness (CMT) as measured on optical coherence tomography, and rates of complications, including elevated intraocular pressure (IOP), ERM recurrence and need for reoperation. Mean logMAR visual acuity improved significantly in both groups at 6 months (p<0.001) and 1 year (p<0.001) after surgery. There was no statistical difference between the two groups in visual acuity improvement at 6 months (p=0.108) or 1 year (p=0.094). Mean CMT of both groups also significantly decreased after surgery (p=0.002), with no statistical difference in CMT reduction between the two groups, but a trend toward less CMT reduction in group 1 (p=0.061). The rates of complications, including IOP elevation, ERM recurrence and frequency of reoperation, were similar in the two groups, with non-statistical trends toward greater ERM recurrence (p=0.084) and need for reoperation (p=0.096) in those that had combined surgery. Combined surgery for ERMs and cataracts may potentially be as effective as membrane peeling alone with respect to visual and anatomical outcomes. Further studies are necessary to determine if there may be greater ERM recurrence or need for reoperation after combined surgery.

Femtosecond laser-assisted cataract surgery in anterior lenticonus due to Alport syndrome.

PubMed

Barnes, Alexander C; Roth, Allen S

2017-06-01

We describe a case of bilateral anterior lenticonus in a patient with Alport syndrome treated with femtosecond laser-assisted cataract surgery (FLACS). FLACS was performed without complication, and a desirable postoperative visual acuity was achieved. Femtosecond laser-assisted cataract surgery is an effective approach for managing patients with anterior lenticonus secondary to Alport syndrome.

[Ocular findings in patients older than 99 years].

PubMed

Cypel, Marcela Colussi; Palácio, Guilherme; Dantas, Paulo Elias Correa; Lottenberg, Cláudio Luis; Belfort, Rubens

2006-01-01

To determine vision conditions and ocular findings in patients older than 99 years. Patients were recruited by media advertisement and examined at the Vision Institute of UNIFESP. The following examinations were performed: visual acuity, ectoscopy, refraction, biomicroscopy, tear film break-up time, Schirmer basal test, tonometry, direct and indirect ophthalmoscopy. Complementary examinations such as optical coherence tomography were performed when indicated. Thirty patients older than 99 years were identified. Mean age of 101.5+/-1.8, 25 females and 5 males. Most common systemic disease, according to history, was arterial hypertension. In 11 patients (55%), the best corrected far visual acuity was 20/100 or better. The best corrected near visual acuity was J4 or better also in 55% (11 patients) and 63.0% (7 patients) of these were the ones that had not been submitted to cataract surgery. The most frequent visual complaint was low vision for reading (55%) and other 8 patients (40%) reported no disturbance (satisfied with their vision). Lens opacity was present in 9 patients (60%) and 8 patients (40%) had previous cataract surgery (5 aphakic eyes, 9 pseudophakic eyes). Cataract was identified as important for impairment of vision in 5 patients but only 2 of them wanted to be submitted to surgery. The main cause of visual impairment was age-related macular degeneration, present in all patients, 95% with no exudative form. Vision improved with new refractive prescription in 4 patients. Once we understand the needs we can plan specific diagnostic and treatment strategies. This sample showed that most were female (83.3%), with good general health (35%), most with systemic arterial hypertension (40%), complaining of low vision for reading (55%) because of age-related macular degeneration (100%, 95% dry form). Only 40% had been previously submitted to cataract surgery. Most of the patients with cataract said to be satisfied with their vision; of the 5 patients that could be operated only 2 decided to do it. Low vision for reading, AMD and cataract were the main findings.

Ebola Virus Persistence in Ocular Tissues and Fluids (EVICT) Study: Reverse Transcription-Polymerase Chain Reaction and Cataract Surgery Outcomes of Ebola Survivors in Sierra Leone.

PubMed

Shantha, Jessica G; Mattia, John G; Goba, Augustine; Barnes, Kayla G; Ebrahim, Faiqa K; Kraft, Colleen S; Hayek, Brent R; Hartnett, Jessica N; Shaffer, Jeffrey G; Schieffelin, John S; Sandi, John D; Momoh, Mambu; Jalloh, Simbirie; Grant, Donald S; Dierberg, Kerry; Chang, Joyce; Mishra, Sharmistha; Chan, Adrienne K; Fowler, Rob; O'Dempsey, Tim; Kaluma, Erick; Hendricks, Taylor; Reiners, Roger; Reiners, Melanie; Gess, Lowell A; ONeill, Kwame; Kamara, Sarian; Wurie, Alie; Mansaray, Mohamed; Acharya, Nisha R; Liu, William J; Bavari, Sina; Palacios, Gustavo; Teshome, Moges; Crozier, Ian; Farmer, Paul E; Uyeki, Timothy M; Bausch, Daniel G; Garry, Robert F; Vandy, Matthew J; Yeh, Steven

2018-04-01

Ebola virus disease (EVD) survivors are at risk for uveitis during convalescence. Vision loss has been observed following uveitis due to cataracts. Since Ebola virus (EBOV) may persist in the ocular fluid of EVD survivors for an unknown duration, there are questions about the safety and feasibility of vision restorative cataract surgery in EVD survivors. We conducted a cross-sectional study of EVD survivors anticipating cataract surgery and patients with active uveitis to evaluate EBOV RNA persistence in ocular fluid, as well as vision outcomes post cataract surgery. Patients with aqueous humor that tested negative for EBOV RNA were eligible to proceed with manual small incision cataract surgery (MSICS). We screened 137 EVD survivors from June 2016 - August 2017 for enrolment. We enrolled 50 EVD survivors; 46 with visually significant cataract, 1 with a subluxated lens, 2 with active uveitis and 1 with a blind painful eye due to uveitis. The median age was 24.0years (IQR 17-35) and 35 patients (70%) were female. The median logMAR visual acuity (VA) was 3.0 (Snellen VA Hand motions; Interquartile Range, IQR: 1.2-3.0, Snellen VA 20/320 - Hand motions). All patients tested negative for EBOV RNA by RT-PCR in aqueous humor/vitreous fluid and conjunctiva at a median of 19months (IQR 18-20) from EVD diagnosis in Phase 1 of ocular fluid sampling and 34months (IQR 32-36) from EVD diagnosis in Phase 2 of ocular fluid sampling. Thirty-four patients underwent MSICS, with a preoperative median VA improvement from hand motions to 20/30 at three-month postoperative follow-up (P<0.001). EBOV persistence by RT-PCR was not identified in ocular fluid or conjunctivae of fifty EVD survivors with ocular disease. Cataract surgery can be performed safely with vision restorative outcomes in patients who test negative for EBOV RNA in ocular fluid specimens. These findings impact the thousands of West African EVD survivors at-risk for ocular complications who may also require eye surgery during EVD convalescence. Copyright © 2018 The Authors. Published by Elsevier B.V. All rights reserved.

The first rapid assessment of avoidable blindness (RAAB) in Thailand.

PubMed

Isipradit, Saichin; Sirimaharaj, Maytinee; Charukamnoetkanok, Puwat; Thonginnetra, Oraorn; Wongsawad, Warapat; Sathornsumetee, Busaba; Somboonthanakij, Sudawadee; Soomsawasdi, Piriya; Jitawatanarat, Umapond; Taweebanjongsin, Wongsiri; Arayangkoon, Eakkachai; Arame, Punyawee; Kobkoonthon, Chinsuchee; Pangputhipong, Pannet

2014-01-01

The majority of vision loss is preventable or treatable. Population surveys are crucial for planning, implementation, and monitoring policies and interventions to eliminate avoidable blindness and visual impairments. This is the first rapid assessment of avoidable blindness (RAAB) study in Thailand. A cross-sectional study of a population in Thailand age 50 years old or over aimed to assess the prevalence and causes of blindness and visual impairments. Using the Thailand National Census 2010 as the sampling frame, a stratified four-stage cluster sampling based on a probability proportional to size was conducted in 176 enumeration areas from 11 provinces. Participants received comprehensive eye examination by ophthalmologists. The age and sex adjusted prevalence of blindness (presenting visual acuity (VA) <20/400), severe visual impairment (VA <20/200 but ≥20/400), and moderate visual impairment (VA <20/70 but ≥20/200) were 0.6% (95% CI: 0.5-0.8), 1.3% (95% CI: 1.0-1.6), 12.6% (95% CI: 10.8-14.5). There was no significant difference among the four regions of Thailand. Cataract was the main cause of vision loss accounted for 69.7% of blindness. Cataract surgical coverage in persons was 95.1% for cut off VA of 20/400. Refractive errors, diabetic retinopathy, glaucoma, and corneal opacities were responsible for 6.0%, 5.1%, 4.0%, and 2.0% of blindness respectively. Thailand is on track to achieve the goal of VISION 2020. However, there is still much room for improvement. Policy refinements and innovative interventions are recommended to alleviate blindness and visual impairments especially regarding the backlog of blinding cataract, management of non-communicative, chronic, age-related eye diseases such as glaucoma, age-related macular degeneration, and diabetic retinopathy, prevention of childhood blindness, and establishment of a robust eye health information system.

Microcoaxial cataract surgery outcomes: comparison of 1.8 mm system and 2.2 mm system.

PubMed

Lee, Kyung-Min; Kwon, Hyung-Goo; Joo, Choun-Ki

2009-05-01

To compare clinical outcomes of a 1.8 mm and a 2.2 mm microcoaxial cataract surgery system. Department of Ophthalmology and Visual Science, Kangnam St. Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Korea. In a prospective study, eyes were randomly selected to have phacoemulsification using a Stellaris system or an Intrepid Infiniti system. The initial incision size was 1.8 mm and 2.2 mm, respectively. Measured intraoperative parameters included phacoemulsification time, mean cumulative dissipated ultrasound energy (CDE), change in incision size at each step of surgery, and total volume of balanced salt solution (BSS) used. The best corrected visual acuity (BCVA), corneal astigmatism, corneal thickness, and endothelial cell count were evaluated preoperatively and postoperatively. The study evaluated 86 eyes of 78 patients (43 eyes in each group). There were no significant differences in postoperative BCVA, surgically induced astigmatism, or amount of BSS used between the 2 systems (P >.05). However, for high-density cataracts, the 1.8 mm group had a greater change between the initial incision size and the incision size after phacoemulsification (P = .019, nuclear opalescence [NO] NO3; P = .001, NO4), a longer phacoemulsification time (P = .013, NO3), greater mean CDE (P = .005, NO3; P = .001, NO4), and greater corneal endothelial cell loss (P = .003, NO4). Both systems were safe and effective in microcoaxial phacoemulsification. The 1.8 mm system performed better with cortical-type cataract and the 2.2 mm system, with high-density nuclear-type cataract.

Age-related Cataract in a Randomized Trial of Vitamins E and C in Men

PubMed Central

Christen, William G.; Glynn, Robert J.; Sesso, Howard D.; Kurth, Tobias; MacFadyen, Jean; Bubes, Vadim; Buring, Julie E.; Manson, JoAnn E.; Michael Gaziano, J.

2010-01-01

Objective To test whether supplementation with alternate day vitamin E or daily vitamin C affects the incidence of age-related cataract in a large-scale randomized trial of men. Design Randomized, double-masked, placebo-controlled trial. Participants Eleven thousand five hundred forty-five apparently healthy US male physicians aged 50 years or older who were without a diagnosis of cataract at baseline. Intervention Participants were randomly assigned to receive 400 IU of vitamin E or placebo on alternate days, and 500 mg of vitamin C or placebo daily. Main Outcome Measure Incident cataract responsible for a reduction in best-corrected visual acuity to 20/30 or worse based on self-report confirmed by medical record review. Results After 8 years of treatment and follow-up, a total of 1,174 incident cataracts were confirmed. There were 579 cataracts in the vitamin E treated group and 595 in the vitamin E placebo group (hazard ratio [HR], 0.99; 95 percent confidence interval [CI], 0.88 to 1.11). For vitamin C, there were 593 cataracts in the treated group and 581 in the placebo group (HR, 1.02; CI, 0.91 to 1.14). Conclusions In a large-scale randomized trial of US male physicians, long-term alternate day use of 400 IU of vitamin E and/or daily use of 500 mg of vitamin C had no significant beneficial or harmful effect on the risk of cataract. Application to Clinical Practice Long-term use of vitamin E and/or vitamin C supplements has no appreciable effect on cataract. PMID:21060040

Comparative analysis of visual outcomes with 4 intraocular lenses: Monofocal, multifocal, and extended range of vision.

PubMed

Pedrotti, Emilio; Carones, Francesco; Aiello, Francesco; Mastropasqua, Rodolfo; Bruni, Enrico; Bonacci, Erika; Talli, Pietro; Nucci, Carlo; Mariotti, Cesare; Marchini, Giorgio

2018-02-01

To compare the visual acuity, refractive outcomes, and quality of vision in patients with bilateral implantation of 4 intraocular lenses (IOLs). Department of Neurosciences, Biomedicine and Movement Sciences, Eye Clinic, University of Verona, Verona, and Carones Ophthalmology Center, Milano, Italy. Prospective case series. The study included patients who had bilateral cataract surgery with the implantation of 1 of 4 IOLs as follows: Tecnis 1-piece monofocal (monofocal IOL), Tecnis Symfony extended range of vision (extended-range-of-vision IOL), Restor +2.5 diopter (D) (+2.5 D multifocal IOL), and Restor +3.0 D (+3.0 D multifocal IOL). Visual acuity, refractive outcome, defocus curve, objective optical quality, contrast sensitivity, spectacle independence, and glare perception were evaluated 6 months after surgery. The study comprised 185 patients. The extended-range-of-vision IOL (55 patients) showed better distance visual outcomes than the monofocal IOL (30 patients) and high-addition apodized diffractive-refractive multifocal IOLs (P ≤ .002). The +3.0 D multifocal IOL (50 patients) showed the best near visual outcomes (P < .001). The +2.5 D multifocal IOL (50 patients) and extended-range-of-vision IOL provided significantly better intermediate visual outcomes than the other 2 IOLs, with significantly better vision for a defocus level of -1.5 D (P < .001). Better spectacle independence was shown for the +2.5 D multifocal IOL and extended-range-of-vision IOL (P < .001). The extended-range-of-vision IOL and +2.5 D multifocal IOL provided significantly better intermediate visual restoration after cataract surgery than the monofocal IOL and +3.0 D multifocal IOL, with significantly better quality of vision with the extended-range-of-vision IOL. Copyright © 2018 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Mutations and mechanisms in congenital and age-related cataracts

PubMed Central

Shiels, Alan; Hejtmancik, J. Fielding

2017-01-01

The crystalline lens plays an important role in the refractive vision of vertebrates by facilitating variable fine focusing of light onto the retina. Loss of lens transparency, or cataract, is a frequently acquired cause of visual impairment in adults and may also present during childhood. Genetic studies have identified mutations in over 30 causative genes for congenital or other early-onset forms of cataract as well as several gene variants associated with age-related cataract. However, the pathogenic mechanisms resulting from genetic determinants of cataract are only just beginning to be understood. Here, we briefly summarize current concepts pointing to differences in the molecular mechanisms underlying congenital and age-related forms of cataract. PMID:27334249

Identification of a Novel GJA8 (Cx50) Point Mutation Causes Human Dominant Congenital Cataracts

NASA Astrophysics Data System (ADS)

Ge, Xiang-Lian; Zhang, Yilan; Wu, Yaming; Lv, Jineng; Zhang, Wei; Jin, Zi-Bing; Qu, Jia; Gu, Feng

2014-02-01

Hereditary cataracts are clinically and genetically heterogeneous lens diseases that cause a significant proportion of visual impairment and blindness in children. Human cataracts have been linked with mutations in two genes, GJA3 and GJA8, respectively. To identify the causative mutation in a family with hereditary cataracts, family members were screened for mutations by PCR for both genes. Sequencing the coding regions of GJA8, coding for connexin 50, revealed a C > A transversion at nucleotide 264, which caused p.P88T mutation. To dissect the molecular consequences of this mutation, plasmids carrying wild-type and mutant mouse ORFs of Gja8 were generated and ectopically expressed in HEK293 cells and human lens epithelial cells, respectively. The recombinant proteins were assessed by confocal microscopy and Western blotting. The results demonstrate that the molecular consequences of the p.P88T mutation in GJA8 include changes in connexin 50 protein localization patterns, accumulation of mutant protein, and increased cell growth.

Blindness and visual impairment in Remo, Ogun State, Nigeria: a hospital-based study.

PubMed

Otulana, T O

2012-09-01

This study was conducted to determine the magnitude and causes of blindness and visual impairment in Remo, Ogun State, Nigeria. A retrospective clinic based study to analyse the cases of patients with blindness in general hospitals of Iperu and Isara areas of Ogun state between May 2005 and December 2005. The data of demographic characteristics and diagnosis were retrieved from the outpatient cards. Three hundred and sixty-nine cases registered in the eye clinic during the period of the study and were examined. 177 were males and 190 were females. The age range of patients seen was between 17 days and 89years with a mean age of 43.3 years, ± 23.62(SD). 116 patients were aged 70years and above while 13 patients were less than 10years. 29.5% of the clinic attendance were uniocularly blind, 21.1% were bilaterally blind while 25 2% were visually impaired. 55.1% of the bilateral blindness was in males. 30.8% cases of the bilaterally blind were from age related cataract, 23.1% from glaucoma, 6 cases were due to Retinitis Pigmentosa and 3 from pterygium, Cataract followed by glaucoma was the leading cause of uniocular blindness. Cataract was responsible for 66.7% of visually impairment. Blindness and visual impairment is a public health problem in Remo Ogun State, Nigeria; cataract, glaucoma and pterygium were the important causes of blindness and visual impairment. The major causes of blindness in this part of Ogun state are preventable.

Relationship between cataract severity and socioeconomic status.

PubMed

Wesolosky, Jason D; Rudnisky, Christopher J

2013-12-01

To determine the relationship between cataract severity and socioeconomic status (SES). Retrospective, observational case series. A total of 1350 eyes underwent phacoemulsification cataract extraction by a single surgeon using an Alcon Infiniti system. Cataract severity was measured using phaco time in seconds. SES was measured using area-level aggregate census data: median income, education, proportion of common-law couples, and employment rate. Preoperative best corrected visual acuity was obtained and converted to logarithm of the minimum angle of resolution values. For patients undergoing bilateral surgery, the generalized estimating equation was used to account for the correlation between eyes. Univariate analyses were performed using simple regression, and multivariate analyses were performed to account for variables with significant relationships (p < 0.05) on univariate testing. Sensitivity analyses were performed to assess the effect of including patient age in the controlled analyses. Multivariate analyses demonstrated that cataracts were more severe when the median income was lower (p = 0.001) and the proportion of common-law couples living in a patient's community (p = 0.012) and the unemployment rate (p = 0.002) were higher. These associations persisted even when controlling for patient age. Patients of lower SES have more severe cataracts. Copyright © 2013 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.

Toric vs aspherical control intraocular lenses in patients with cataract and corneal astigmatism: a randomized clinical trial.

PubMed

Visser, Nienke; Beckers, Henny J M; Bauer, Noel J C; Gast, Sacha T J M; Zijlmans, Bart L M; Berenschot, Tos T J M; Webers, Carroll A; Nuijts, Rudy M M A

2014-12-01

Spectacle independence is becoming increasingly important in cataract surgery. Not correcting corneal astigmatism at the time of cataract surgery will fail to achieve spectacle independency in 20% to 30% of patients. To compare bilateral aspherical toric with bilateral aspherical control intraocular lens (IOL) implantation in patients with cataract and corneal astigmatism. A multicenter, hospital-based, randomized clinical trial was conducted. The participants included 86 individuals with bilateral cataract and bilateral corneal astigmatism of at least 1.25 diopters (D) who were randomized to receive either bilateral toric (n = 41) or bilateral control (n = 45) IOL implantation. Bilateral implantation of an aspherical toric IOL or an aspherical control IOL. Spectacle independency for distance vision, uncorrected distance visual acuity, refractive astigmatism, contrast sensitivity, wavefront aberrations, and refractive error-related quality-of-life questionnaire. Preoperatively, mean (SD) corneal astigmatism was 2.02 (0.95) D and 2.00 (0.84) D in the toric and control groups, respectively. Four patients (5%) were lost to follow-up. At 6 months postoperatively, 26 (70%) of the patients in the toric group achieved an uncorrected distance visual acuity of 20/25 or better compared with 14 (31%) in the control group (P < .001; odds ratio, 5.23; 95% CI, 2.03-13.48). Spectacle independency for distance vision was achieved in 31 patients (84%) in the toric group compared with 14 patients (31%) in the control group (P < .001; odds ratio, 11.44; 95% CI, 3.89- 33.63). Mean refractive astigmatism was -0.77 (0.52) D and -1.89 D (1.00) D, respectively. Vector analysis of toric IOLs showed a mean magnitude of error of +0.38 D, indicative of overcorrection. No significant differences were found in contrast sensitivity, higher-order aberrations, or refractive error-related quality of life. In patients with cataract and corneal astigmatism, bilateral toric IOL implantation results in a higher spectacle independency for distance vision compared with bilateral control IOL implantation. No significant differences were identified in contrast sensitivity, higher-order aberrations, or refractive error-related quality of life following both treatments. clinicaltrials.gov Identifier: NCT01075542.

Three-Dimensional Cataract Crystalline Lens Imaging With Swept-Source Optical Coherence Tomography.

PubMed

de Castro, Alberto; Benito, Antonio; Manzanera, Silvestre; Mompeán, Juan; Cañizares, Belén; Martínez, David; Marín, Jose María; Grulkowski, Ireneusz; Artal, Pablo

2018-02-01

To image, describe, and characterize different features visible in the crystalline lens of older adults with and without cataract when imaged three-dimensionally with a swept-source optical coherence tomography (SS-OCT) system. We used a new SS-OCT laboratory prototype designed to enhance the visualization of the crystalline lens and imaged the entire anterior segment of both eyes in two groups of participants: patients scheduled to undergo cataract surgery, n = 17, age range 36 to 91 years old, and volunteers without visual complains, n = 14, age range 20 to 81 years old. Pre-cataract surgery patients were also clinically graded according to the Lens Opacification Classification System III. The three-dimensional location and shape of the visible opacities were compared with the clinical grading. Hypo- and hyperreflective features were visible in the lens of all pre-cataract surgery patients and in some of the older adults in the volunteer group. When the clinical examination revealed cortical or subcapsular cataracts, hyperreflective features were visible either in the cortex parallel to the surfaces of the lens or in the posterior pole. Other type of opacities that appeared as hyporeflective localized features were identified in the cortex of the lens. The OCT signal in the nucleus of the crystalline lens correlated with the nuclear cataract clinical grade. A dedicated OCT is a useful tool to study in vivo the subtle opacities in the cataractous crystalline lens, revealing its position and size three-dimensionally. The use of these images allows obtaining more detailed information on the age-related changes leading to cataract.

Older drivers and cataract: driving habits and crash risk.

PubMed

Owsley, C; Stalvey, B; Wells, J; Sloane, M E

1999-04-01

Cataract is a leading cause of vision impairment in older adults, affecting almost half of those over age 75 years. Driving is a highly visual task and, as with other age groups, older adults rely on the personal automobile for travel. The purpose of this study was to examine the role of cataract in driving. Older adults (aged 55-85 years) with cataract (n = 279) and those without cataract (n = 105) who were legally licensed to drive were recruited from eye clinics to participate in a driving habits interview to assess driving status, exposure, difficulty, and "space" (the distance of driving excursions from home base). Crash data over the prior 5 years were procured from state records. Visual functional tests documented the severity of vision impairment. Compared to those without cataract, older drivers with cataract were approximately two times more likely to report reductions in days driven and number of destinations per week, driving slower than the general traffic flow, and preferring someone else to drive. Those with cataract were five times more likely to have received advice about limiting their driving. Those with cataract were four times more likely to report difficulty with challenging driving situations, and those reporting driving difficulty were two times more likely to reduce their driving exposure. Drivers with cataract were 2.5 times more likely to have a history of at-fault crash involvement in the prior 5 years (adjusted for miles driven/week and days driven/week). These associations remained even after adjustments for the confounding effects of advanced age, impaired general health, mental status deficit, or depression. Older drivers with cataract experience a restriction in their driving mobility and a decrease in their safety on the road. These findings serve as a baseline for our ongoing study evaluating whether improvements in vision following cataract surgery expand driving mobility and improve driver safety.

Intraoperative retinal detachment prophylaxis in vitrectomy for retained cataract fragments.

PubMed

Morris, Robert E; Shere, Jeffrey L; Witherspoon, C Douglas; Segal, Zachary K; Tehranchi, Linda; Kuhn, Ferenc; Sapp, Mathew

2009-03-01

To assess the safety and efficacy of peripheral 360-degree laser retinopexy as prophylaxis against rhegmatogenous retinal detachment (RRD) in eyes having pars plana vitrectomy (PPV) for the removal of retained cataract fragments. Private practice, Callahan Eye Foundation Hospital, University of Alabama at Birmingham, and Helen Keller Foundation for Research and Education, Birmingham, Alabama, USA. This retrospective analysis comprised a consecutive series of patients who had PPV with 360-degree laser retinopexy for retained cataract fragment removal between January 1, 1995, and December 31, 2000. All laser treatments were applied with indirect ophthalmoscope delivery. In 78 eyes of 78 patients, the mean interval between cataract surgery and PPV with 360-degree laser retinopexy prophylaxis was 14 days. One (1.3%) of 78 eyes had postoperative RRD during a mean follow-up of 6 years. No laser-related complications occurred. The incidence of RRD after PPV with 360-degree laser retinopexy prophylaxis was 1.3%, a significant reduction from the average 8.2% RRD rate in the literature (P = .024). Although future prospective trials are indicated, the results suggest that 360-degree laser retinopexy prophylaxis could significantly reduce the incidence of this visually disabling complication.

Falls and postural control in older adults with cataracts

PubMed Central

Nodehi Moghadam, Afsun; Goudarzian, Maryam; Azadi, Farhad; Hosseini, Seide Masume; Mosallanezhad, Zahra; Karimi, Nouraddin; Larne, Yassin; Habibi, Maryam; Yaghmaei, Poorya

2015-01-01

Background: There is increasing evidence that visual impairment contribute to falling. The aim of this study was to determine the influence of vision impairment of old adult patients with cataract on the occurrence of falls and postural control. Methods: According to the results of screening ophthalmic examination, 48 cataract patients (mean±SD aged 68.5 ± 6.08 yrs.) and 50 individuals without any obvious eye disorders (mean age ± SD 70.7 ± 5.97 yrs.) were enrolled in this study. The postural control was determined using the clinical test of Sensory Interaction and Balance (CTSIB) and Timed up and Go (TUG) test. Results: The results of this study revealed that 18% (n = 9) of the normal individuals and 22.9% (n =11) of the cataract patients had at least two falls in the past 12 months. However, the result of chisquare test did not show any differences between the two groups (p= 0.36). The mean ± SD TUG times in cataract and control groups in our study were15.17 ± 3.58 and13.77 ± 4.90, respectively. However, no significant differences were found between the two groups (p= 0.12).The results of CTSIB test showed no significant differences between the two groups on standing on the floor with eyes open and eyes closed (p= 0.61, p= 0.89) and on standing on the foam with eyes open and eyes closed (p= 0.32, p= 0.74 ). Conclusion: According to the results of CTSIB and TUG tests, vision impairment of old adult patients with cataract is not associated with falls and balance disorders. Further work including assessment of postural control with advanced devices and considering other falls risk factors are also required to identify predictors of falls in cataract patients. PMID:26913274

The Prevalence and Causes of Visaual Impairment and Blindness in a Rural Population in the North of Iran

PubMed Central

HASHEMI, Hassan; REZVAN, Farhad; YEKTA, AbbasAli; OSTADIMOGHADDAM, Hadi; SOROUSH, Sara; DADBIN, Nooshin; KHABAZKHOOB, Mehdi

2015-01-01

Background: Visual impairment is a very important public health problem. In Iran, reports of visual impairment and blindness have been published from the urban population while the prevalence of visual impairment in the rural population has not been reported. The purpose of this study to determine the prevalence and causes of visual impairment, in a rural population in district of based on age and sex Methods: In a cross-sectional population-based study, using random cluster sampling, 13 of the 83 villages of Khaf County in the north east of Iran were selected. Eye examinations were performed in a Mobile Eye Clinic (Nooravaran Salamat, 2011) and included optometric examinations such as measuring uncorrected and corrected visual acuity along with non-cycloplegic refraction. Results: The prevalence of visual impairment, low vision, and blindness was 6.3% (95% CI 5.3–7.3), 3.4% (95% CI 2.6–4.1), and 3.0% (95% CI 2.3–3.6), respectively. The prevalence of visual impairment ranged from 1.8% in the participant younger than 20 years of age to 28% in the subjects aged 60 and over (P<0.001). After matching for age, the prevalence of visual impairment and low vision was significantly higher in women. The most prevalent causes of visual impairment were uncorrected refractory error (54.5%) and cataract (17.6%). Conclusion: The prevalence of visual impairment was significantly higher in the rural population of this study when compared to previous reports from Iran. It seems that provision of therapeutic facilities like cataract surgery and availability of eyeglasses in villages can considerably reduce the prevalence of visual impairment. PMID:26258099

The Prevalence and Causes of Visaual Impairment and Blindness in a Rural Population in the North of Iran.

PubMed

Hashemi, Hassan; Rezvan, Farhad; Yekta, AbbasAli; Ostadimoghaddam, Hadi; Soroush, Sara; Dadbin, Nooshin; Khabazkhoob, Mehdi

2015-06-01

Visual impairment is a very important public health problem. In Iran, reports of visual impairment and blindness have been published from the urban population while the prevalence of visual impairment in the rural population has not been reported. The purpose of this study to determine the prevalence and causes of visual impairment, in a rural population in district of based on age and sex. In a cross-sectional population-based study, using random cluster sampling, 13 of the 83 villages of Khaf County in the north east of Iran were selected. Eye examinations were performed in a Mobile Eye Clinic (Nooravaran Salamat, 2011) and included optometric examinations such as measuring uncorrected and corrected visual acuity along with non-cycloplegic refraction. The prevalence of visual impairment, low vision, and blindness was 6.3% (95% CI 5.3-7.3), 3.4% (95% CI 2.6-4.1), and 3.0% (95% CI 2.3-3.6), respectively. The prevalence of visual impairment ranged from 1.8% in the participant younger than 20 years of age to 28% in the subjects aged 60 and over (P<0.001). After matching for age, the prevalence of visual impairment and low vision was significantly higher in women. The most prevalent causes of visual impairment were uncorrected refractory error (54.5%) and cataract (17.6%). The prevalence of visual impairment was significantly higher in the rural population of this study when compared to previous reports from Iran. It seems that provision of therapeutic facilities like cataract surgery and availability of eyeglasses in villages can considerably reduce the prevalence of visual impairment.

Laser-assisted cataract surgery versus standard ultrasound phacoemulsification cataract surgery.

PubMed

Day, Alexander C; Gore, Daniel M; Bunce, Catey; Evans, Jennifer R

2016-07-08

Cataract is the leading cause of blindness in the world, and cataract surgery is one of the most commonly performed operations in the Western world. Preferred surgical techniques have changed dramatically over the past half century with associated improvements in outcomes and safety. Femtosecond laser platforms that can accurately and reproducibly perform key steps in cataract surgery, including corneal incisions, capsulotomy and lens fragmentation, are now available. The potential advantages of laser-assisted surgery are broad, and include greater safety and better visual outcomes through greater precision and reproducibility. To compare the effectiveness of laser-assisted cataract surgery with standard ultrasound phacoemulsification cataract surgery by gathering evidence on safety from randomised controlled trials (RCTs). We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) (2016, Issue 4), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to May 2016), EMBASE (January 1980 to May 2016), Latin American and Caribbean Health Sciences Literature Database (LILACS) (January 1982 to May 2016), the ISRCTN registry (www.isrctn.com/editAdvancedSearch), ClinicalTrials.gov (www.clinicaltrials.gov), the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en) and the U.S. Food and Drugs Administration (FDA) website (www.fda.gov). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 10 May 2016. We included randomised controlled trials where laser-assisted cataract surgery was compared to standard ultrasound phacoemulsification cataract surgery. We graded the certainty of the evidence using GRADE. Two review authors independently screened the search results, assessed risk of bias and extracted data using the standard methodological procedures expected by Cochrane. The primary outcome for this review was intraoperative complications in the operated eye, namely anterior capsule and posterior capsule tears. The secondary outcomes were visual acuity (corrected distance visual acuity (CDVA) and uncorrected distance visual acuity (UDVA)), refractive outcomes, quality of vision (as measured by any validated visual function score), postoperative complications and cost-effectiveness. We included 16 RCTs conducted in Germary, Hungary, Italy, India, China and Brazil that enrolled a total of 1638 eyes of 1245 adult participants. Overall, the studies were at unclear or high risk of bias. In 11 of the studies the authors reported financial links with the manufacturer of the laser platform evaluated in their studies. Five of the studies were within-person (paired-eye) studies with one eye allocated to one procedure and the other eye allocated to the other procedure. These studies were reported ignoring the paired nature of the data.The number of anterior capsule and posterior capsule tears reported in the included studies for both laser cataract surgery and manual phacoemulsification cataract surgery were low. There were four anterior capsule tears and one posterior capsule tear in 1076 eyes reported in 10 studies (2 anterior capsule tears in laser arms, 2 anterior capsule tears and 1 posterior capsule tear in standard phacoemulsification arms). We are very uncertain as to the effect of laser-assisted surgery compared to standard phacoemulsification surgery with respect to these two outcomes. For postoperative cystoid macular oedema and elevated postoperative intraocular pressures, again the evidence was inconclusive (odds ratio (OR) 0.58, 95% confidence interval (CI) 0.20 to 1.68; 957 eyes, 9 studies, low certainty evidence; and OR 0.57, 95% CI 0.11 to 2.86; 903 eyes, 8 studies, low certainty evidence).We found little evidence of any important difference in postoperative visual acuity between laser-assisted and standard phacoemulsification arms. There was a small advantage for laser-assisted cataract surgery at six months in CDVA. However, the mean difference (MD) was -0.03 logMAR (95% CI -0.05 to -0.00; 224 eyes, 3 studies, low certainty evidence) which is equivalent to 1.5 logMAR letters and is therefore, clinically insignificant. No studies reported patient-reported outcome measures such as visual function.There were no data reported on costs or resource use but three studies reported the time taken to do the surgery. There was little evidence of any major difference between the two procedures in this respect (MD 0.1 minutes, 95% CI -0.02 to 0.21; 274 eyes, low certainty evidence). The evidence from the 16 randomised controlled trials RCTs included in this review could not determine the equivalence or superiority of laser-assisted cataract surgery compared to standard manual phacoemulsification for our chosen outcomes due to the low to very low certainty of the evidence available from these studies. As complications occur rarely, large, adequately powered, well designed, independent RCTs comparing the safety and efficacy of laser-assisted cataract surgery with standard phacoemulsification cataract surgery are needed. Standardised reporting of complications and visual and refractive outcomes for cataract surgery would facilitate future synthesis. Data on patient-reported outcomes and cost-effectiveness are needed. Paired-eye studies should be analysed and reported appropriately.

Factors Predicting Visual Acuity Outcome in Intermediate, Posterior, and Panuveitis: The Multicenter Uveitis Steroid Treatment (MUST) Trial.

PubMed

Kempen, John H; Van Natta, Mark L; Altaweel, Michael M; Dunn, James P; Jabs, Douglas A; Lightman, Susan L; Thorne, Jennifer E; Holbrook, Janet T

2015-12-01

To identify factors associated with best-corrected visual acuity (BCVA) presentation and 2-year outcome in 479 intermediate, posterior, and panuveitic eyes. Cohort study using randomized controlled trial data. Multicenter Uveitis Steroid Treatment (MUST) Trial masked BCVA measurements at baseline and at 2 years follow-up used gold-standard methods. Twenty-three clinical centers documented characteristics per protocol, which were evaluated as potential predictive factors for baseline BCVA and 2-year change in BCVA. Baseline factors significantly associated with reduced BCVA included age ≥50 vs <50 years; posterior vs intermediate uveitis; uveitis duration >10 vs <6 years; anterior chamber (AC) flare >grade 0; cataract; macular thickening; and exudative retinal detachment. Over 2 years, eyes better than 20/50 and 20/50 or worse at baseline improved, on average, by 1 letter (P = .52) and 10 letters (P < .001), respectively. Both treatment groups and all sites of uveitis improved similarly. Factors associated with improved BCVA included resolution of active AC cells, resolution of macular thickening, and cataract surgery in an initially cataractous eye. Factors associated with worsening BCVA included longer duration of uveitis (6-10 or >10 vs <6 years), incident AC flare, cataract at both baseline and follow-up, pseudophakia at baseline, persistence or incidence of vitreous haze, and incidence of macular thickening. Intermediate, posterior, and panuveitis have a similarly favorable prognosis with both systemic and fluocinolone acetonide implant treatment. Eyes with more prolonged/severe inflammatory damage and/or inflammatory findings initially or during follow-up have a worse visual acuity prognosis. The results indicate the value of implementing best practices in managing inflammation. Copyright © 2015 Elsevier Inc. All rights reserved.

Outcomes after cataract surgery in eyes with pseudoexfoliation: Results from the Veterans Affairs Ophthalmic Surgery Outcomes Data Project.

PubMed

Turalba, Angela; Cakiner-Egilmez, Tulay; Payal, Abhishek R; Gonzalez-Gonzalez, Luis A; Chomsky, Amy S; Vollman, David E; Baze, Elizabeth F; Lawrence, Mary G; Daly, Mary K

2017-02-01

To compare clinical outcomes of cataract surgery in eyes with and without pseudoexfoliation (PXF). Retrospective deidentified data analysis. A total of 123 PXF and 4776 non-PXF eyes of patients who underwent cataract surgery. We compared data on visual acuity, Visual Function Questionnaire (VFQ)-based quality of life, and complications in PXF and non-PXF eyes from the Veterans Affairs (VA) Ophthalmic Surgery Outcomes Data Project across 5 VA medical centres. Pupillary expansion devices were used in 31 (25.2%) PXF cases and 398 (8.4%) non-PXF cases (p < 0.0001). Capsular tension rings were used in 6 (4.9%) PXF cases and 55 (1.2%) non-PXF cases (p < 0.004). The following complications occurred more frequently in PXF cases: zonular dehiscence without vitrectomy (4 [3.3%] PXF cases vs 40 [0.8%] non-PXF cases p = 0.02), persistent inflammation (28 [24.1%] vs 668 [14.5%]; p = 0.007), and persistent intraocular pressure elevation (5 [4.3%] vs 68 [1.5%]; p = 0.03). Best corrected visual acuity (BCVA) improved in both groups after 1 month, but 87 (83.7%) PXF cases achieved postoperative BCVA better than or equal to 20/40 compared to 3991 (93.8%) non-PXF cases (p = 0.0003). There was no significant difference in the postoperative composite VFQ scores between PXF (82.1 ± 16.9) and non-PXF cases (84.2 ± 16.8, p = 0.09). Several complications occurred more frequently in the PXF group compared to the non-PXF group, and fewer PXF cases achieved BCVA better than or equal to 20/40. Despite this, both groups experienced similar improvement in vision-related quality of life after cataract surgery. Published by Elsevier Inc.

Which factors influence patients' maximum acceptable waiting time for cataract surgery? - a questionnaire survey.

PubMed

Weingessel, Birgit; Richter-Mueksch, Sibylla; Vécsei-Marlovits, Pia V

2011-05-01

To evaluate patients’ maximum acceptable waiting time (MAWT) and to assess the determinants of patient perceptions of MAWT. A total of 500 consecutive patients with cataract were asked to fill out a preoperative questionnaire, addressing patients’ MAWT to undergo cataract surgery. Patients’ visual impairment (VF-14 score), education, profession and social status were evaluated, and an ophthalmologic examination was performed. Univariate analysis included Spearman’s correlation test, unpaired Student’s t-test and the Mann–Whitney U test. Univariate and multivariate associations were calculated using unconditional logistic regression. The mean MAWT was 3.17 ± 2.12 months. The mean VF-14 score was 72.10 ± 22.54. Between VF-14 score and MAWT, there was a significant correlation (r = 0.180, p = 0.004). Patients with higher education (high school, university) accepted significantly longer MAWT (3.92 ± 2.38 months versus 3.02 ± 2.00 months, p = 0.009). Patients who had self-noticed visual impairment were nearly four times (OR: 3.88, 95% CI = 2.07–7.28, p < 0.001) more likely to accept only MAWT of <3 months. Patients with low tolerance for waiting had greater self-reported difficulty with vision. Patients’ acceptance of waiting was not associated with clinical visual acuity measures. Education, ability to work, living independently and taking care of dependents were also strong predictors from patients’ perspective. Considering the implementation of standards for waiting lists, these facts should be taken into account. © 2010 The Authors. Journal compilation © 2010 Acta Ophthalmol.

Comparison of the Infiniti vision and the series 20,000 Legacy systems.

PubMed

Fernández de Castro, Luis E; Solomon, Kerry D; Hu, Daniel J; Vroman, David T; Sandoval, Helga P

2008-01-01

To compare the efficiency of the Infiniti vision system and the Series 20,000 Legacy system phacoemulsification units during routine cataract extraction. Thirty-nine eyes of 39 patients were randomized to have their cataract removed using either the Infiniti or the Legacy system, both using the Neosonix handpiece. System settings were standardized. Ultrasound time, amount of balanced salt solution (BSS) used intraoperatively, and postoperative visual acuity at postoperative days 1, 7 and 30 were evaluated. Preoperatively, best corrected visual acuity was significantly worse in the Infiniti group compared to the Legacy group (0.38 +/- 0.23 and 0.21 +/- 0.16, respectively; p = 0.012). The mean phacoemulsification time was 39.6 +/- 22.9 s (range 6.0-102.0) for the Legacy group and 18.3 +/-19.1 s (range 1.0-80.0) for the Infiniti group (p = 0.001). The mean amounts of intraoperative BSS used were 117 +/- 37.7 ml (range 70-195) in the Legacy group and 85.3 +/- 38.9 ml (range 40-200) in the Infiniti group (p = 0.005). No differences in postoperative visual acuity were found. The ability to use higher flow rates and vacuum settings with the Infiniti vision system allowed for cataract removal with less phacoemulsification time than when using the Legacy system. Copyright 2008 S. Karger AG, Basel.

Neurological and developmental findings in children with cataracts.

PubMed

Pike, M G; Jan, J E; Wong, P K

1989-06-01

Ninety-seven children who were born between 1954 and 1986 and presented to the Visually Impaired Program of British Columbia's Children's Hospital, Vancouver, Canada, with a primary ophthalmologic diagnosis of cataracts, were assessed neurologically, ophthalmologically, audiologically, and developmentally. Causal factors included prenatal infection (35 cases), hereditary cataracts (22 cases), various syndromes and metabolic disorders (9 cases), trauma (1 case), and unknown (30 cases). Ninety children were diagnosed to have congenital cataracts while 7 acquired them. Findings indicated that prenatal infection continues to be a cause of infantile cataracts, despite rubella immunization; that prematurity is not, as has been stated in the past, a cause of infantile cataract; and that careful neurological, audiological, and developmental examination is vital in the assessment of likely causes of this condition.

Cataract, ocular surgery, aphakia, and the chromatic expression of the painter Jovan Bijelić.

PubMed

Nikolić, Ljubiša; Jovanović, Vesna

2016-11-01

Approaching art from the standpoint of optics and the artist’s eye pathology can sometimes explain the shift of the spectral colors in the work of some artists with cataract and aphakia. This may not be obvious in the paintings of other artists with the same eye pathology. The aim of this study was to create a timeline from the recently obtained details of the cataract surgery, his best corrected aphakic visual acuity, and the last paintings of the artist Jovan Bijelić. The research included primary and secondary source material: Bijelić’s paintings from all stages of his career, interviews with Bijelić and his eye surgeon, art criticism, sources with the description of Bijelić’s symptoms, hospital archives, discussion with art historians, comparison of his palette from different periods. Jovan Bijelić was nearly blind from cataract in 1957. He underwent an unsuccessful cataract surgery in 1956, followed by enucleation of the operated eye. In 1958, 20/25–20/20 vision was regained, after the extracapsular cataract extraction and sector iridectomy in his right eye, with the posterior lens capsule discision afterwards. Xanthopsia and cyanopsia are not present in his art, which is not a representation of visualized objects. The response of Jovan Bijelić to cataract and aphakia was predominantly a change of his style.

Combined Cataract Extraction With Pars Plana Vitrectomy and Metallic Intraocular Foreign Body Removal Through Sclerocorneal Tunnel Using a Novel "Magnet Handshake" Technique.

PubMed

Dhoble, Pankaja; Khodifad, Ashish

2018-01-01

To study the outcomes of combined cataract extraction with pars plana vitrectomy (PPV) and metallic intraocular foreign body (IOFB) removal through a sclerocorneal tunnel using the "magnetic handshake" technique. A retrospective review. Retrospective review of case records of 14 patients from 2010 to 2016 with metallic IOFB and traumatic cataract was performed. Cataract extraction was combined with PPV. Two intraocular magnets (IOMs) introduced through 20-gauge vitrectomy port and sclerocorneal tunnel helped achieve safe delivery of IOFB outside the globe by the "magnetic handshake" technique. All patients were males with a mean age of 33.04 years. A final best corrected visual acuity (BCVA) of 20/60 or better was noted in 10 (71.42%) of 14 patients. Final reattachment with more than 1 surgery was achieved in 13 (92.85%) patients. Postoperative complications included retinal detachment (RD) and phthisis bulbi in 1 (14.28%) patient each. Combined cataract extraction with PPV and metallic IOFB removal through sclerocorneal tunnel using the "magnet handshake" technique gives good visual and surgical outcomes. Copyright 2017 Asia-Pacific Academy of Ophthalmology.

Measuring the impact of cataract surgery on generic and vision-specific quality of life.

PubMed

Groessl, Erik J; Liu, Lin; Sklar, Marisa; Tally, Steven R; Kaplan, Robert M; Ganiats, Theodore G

2013-08-01

Cataracts are the leading cause of blindness worldwide and cause visual impairment for millions of adults in the United States. We compared the sensitivity of a vision-specific health-related quality of life (HRQOL) measure to that of multiple generic measures of HRQOL before and at 2 time points after cataract surgery. Participants completed 1 vision-specific and 5 generic quality of life measures before cataract surgery, and again 1 and 6 months after surgery. Random effects modeling was used to measure changes over the three assessment points. The NEI-VFQ25 total score and all 11 subscales showed significant improvements during the first interval (baseline and 1 month). During the second interval (1-6 months post-surgery), significant improvements were observed on the total score and 5 of 11 NEI-VFQ25 subscales. There were significant increases in HRQOL during the first interval on some preference-based generic HRQOL measures, though changes during the second interval were mostly non-significant. None of the SF-36v2™ or SF6D scales changed significantly between any of the assessment periods. The NEI-VFQ25 was sensitive to changes in vision-specific domains of QOL. Some preference-based generic HRQOL measures were also sensitive to change and showed convergence with the NEI-VFQ25, but the effects were small. The SF-36v2™ and SF-6D did not change in a similar manner, possibly reflecting a lack of vision-related content. Studies seeking to document both the vision-specific and generic HRQOL improvements of cataract surgery should consider these results when selecting measures.

Rapid diagnosis of retina and optic nerve abnormalities in canine patients with and without cataracts using chromatic pupil light reflex testing.

PubMed

Grozdanic, Sinisa D; Kecova, Helga; Lazic, Tatjana

2013-09-01

To develop fast and reliable testing routines for diagnosing retina and optic nerve diseases in canine cataract patients based on chromatic properties of the pupillary light reflex response. Seventy-seven canine patients with a history of cataract and decreased vision (43 patients with cataracts and no evidence of retina or optic nerve disease, 21 patients with cataracts and retinal degeneration [RD], 13 patients with cataracts and retinal detachment [RDT]), 11 canine patients with optic neuritis (ON) and 23 healthy dogs were examined using chromatic pupillary light reflex (cPLR) analysis with red and blue light and electroretinography. Electroretinography analysis showed statistically significant deficits in a- and b-wave amplitudes in dogs with cataracts and RD, or cataracts and RDT, when compared to dogs with cataracts without evidence of retinal abnormalities. Evaluation of b-wave amplitudes showed that presence of 78.5-μV (or lower) amplitudes had high sensitivity of 100% (95% CI: 87.2-100%) and high specificity of 96.7% (95% CI: 88.4-100%) in RD and RDT. Evaluation of cPLR responses using red light showed that presence of the pupil end constriction diameter of 5.5 mm (or higher) had moderately high sensitivity of 76.5% (95% CI: 50.1-93.2%) and high specificity of 100% (95% CI: 91.2-100%) in detecting RD and RDT. Optic neuritis patients had absent cPLR responses, regardless of the visual status. Chromatic evaluation of the pupillary light reflex is a rapid and accurate test for diagnosing retina and optic nerve diseases in canine patients. © 2012 American College of Veterinary Ophthalmologists.

Comparison of surgically induced astigmatism in various incisions in manual small incision cataract surgery.

PubMed

Jauhari, Nidhi; Chopra, Deepak; Chaurasia, Rajan Kumar; Agarwal, Ashutosh

2014-01-01

To determine the surgically induced astigmatism (SIA) in Straight, Frown and Inverted V shape (Chevron) incisions in manual small incision cataract surgery (SICS). A prospective cross sectional study was done on a total of 75 patients aged 40y and above with senile cataract. The patients were randomly divided into three groups (25 each). Each group received a particular type of incision (Straight, Frown or Inverted V shape incisions). Manual SICS with intraocular lens (IOL) implantation was performed. The patients were compared 4wk post operatively for uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA) and SIA. All calculations were performed using the SIA calculator version 2.1, a free software program. The study was analyzed using SPSS version 15.0 statistical analysis software. The study found that 89.5% of patients in Straight incision group, 94.2% in Frown incision group and 95.7% in Inverted V group attained BCVA post-operatively in the range of 6/6 to 6/18. Mean SIA was minimum (-0.88±0.61D×90 degrees) with Inverted V incision which was statistically significant. Inverted V (Chevron) incision gives minimal SIA.

Prevalence of eye disease and visual impairment in Île de la Gonave, Haïti.

PubMed

Tousignant, B; Brûlé, J

2017-08-01

Epidemiological data describing the prevalence of blindness and visual impairment in Haiti are sparse. The Haitian National Committee for the Prevention of Blindness (CNPC) estimates the prevalence of blindness at 1 %. Other regional data estimate moderate and severe visual impairment at 5% and 22%, respectively. IRIS Mundial (IM) is a non-governmental organization collaborating with the CNPC to develop eye care infrastructure in Haiti. To estimate the prevalence and causes of blindness and visual impairment on the Haitian island of Gonâve, to assist in planning of relevant eye care infrastructure. Results from eye exams carried out by a team from IM in January 2013 have been compiled and analyzed. In all, 1724 patients were examined (38% men, 62% women). In the best eye, 87% of patients had visual acuity, 6% had moderate visual impairment, and 7% had severe visual impairment. Moreover, 1% of patients had high myopia, 1% high hyperopia, 1% high astigmatism, and 32% were presbyopic. Clinically significant binocular cataracts were found in 1.5 % of patients, while 2 % were diagnosed with probable glaucoma. Our data give a glimpse of the prevalence of visual impairment and ocular disease on Gonâve Island in Haiti. Uncorrected refractive error, cataracts, and glaucoma are confirmed as prevalent conditions in this population and their presence should guide the planning of relevant eye care interventions.

Disease and Surgery of the Equine Lens.

PubMed

Townsend, Wendy M

2017-12-01

Examination of the lens is critical, particularly when evaluating horses with visual impairment or performing prepurchase examinations. To adequately evaluate the lens, the pupil must be pharmacologically dilated. A cataract is any lens opacity. The size, density, and position of a cataract determine the impact on vision. Cataracts may be congenital or inherited or occur secondary to trauma or equine recurrent uveitis. Surgical removal is the only treatment option for vision impairing cataracts, but careful selection of surgical candidates is critical for successful outcomes. Copyright © 2017 Elsevier Inc. All rights reserved.

Delayed-onset descemet membrane detachment after uneventful cataract surgery treated by corneal venting incision with air tamponade: a case report.

PubMed

Bhatia, Harsimran Kaur; Gupta, Rakesh

2016-04-04

Descemet membrane detachment (DMD) is a significant complication noted during or early after cataract surgery. Review of literature revealed a few cases of delayed-onset DMD with presentation ranging from weeks to months after cataract surgery but most of them were treated with pneumatic descemetopexy and a few ended in penetrating keratoplasty. We report this case, to highlight the usefulness of corneal venting incision with air tamponade in late-onset DMD cases not responding to pneumatic descemetopexy. A retrospective case review of a 66 year old male who presented with diminution of vision in right eye 17 days after uneventful cataract surgery was done. Visual acuity in this eye was 20/200 at presentation. DMD was noted 3 days later (approximately 3 weeks post-operatively) and Anterior Segment Optical Coherence Tomography & Scheimpflug imaging were done in view of diffuse corneal edema. Pneumatic descemetopexy was attempted thrice (twice with SF6, once with air) over a week's span with limited success at re-attaching the DM. Finally, corneal venting incision with air tamponade was done resulting in egress of supra-descemet's fluid and DM appeared apposed to stroma. Bandage contact lens (BCL) was applied at the end of the procedure. DM was seen attached the next day. Corneal edema cleared completely in 1 week. Best corrected visual acuity (BCVA) at 6 weeks follow-up was 20/30. Delayed-onset DMD should be considered as a differential diagnosis in cases with late-onset corneal edema post-cataract surgery. Anterior segment Optical Coherence Tomography (AS-OCT) and Scheimpflug Imaging are useful tools in cases with dense corneal edema. Corneal venting incision with air tamponade is an option in cases where methods like pneumatic descemetopexy fail.

Dry Eye Symptoms, Patient-Reported Visual Functioning, and Health Anxiety Influencing Patient Satisfaction After Cataract Surgery.

PubMed

Szakáts, Ildikó; Sebestyén, Margit; Tóth, Éva; Purebl, György

2017-06-01

To evaluate how patient satisfaction after cataract surgery is associated with postoperative visual acuity, visual functioning, dry eye signs and symptoms, health anxiety, and depressive symptoms. Fifty-four patients (mean age: 68.02 years) were assessed 2 months after uneventful phacoemulsification; 27 were unsatisfied with their postoperative results and 27 were satisfied. They completed the following questionnaires: Visual Function Index-14 (VF-14), Ocular Surface Disease Index (OSDI), Shortened Health Anxiety Inventory (SHAI), and Shortened Beck Depression Inventory. Testing included logarithm of the Minimum Angle of Resolution (logMAR) uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA), dry eye tests (tear meniscus height and depth measured by spectral optical coherence tomography, tear film break-up time (TBUT), ocular surface staining, Schirmer 1 test, and meibomian gland dysfunction grading). Postoperative UCVA, BCVA, and the dry eye parameters - except TBUT - showed no statistically significant difference between the two groups (p > 0.130). However, the VF-14 scores, the OSDI scores, and the SHAI scores were significantly worse in the unsatisfied patient group (p < 0.002). No significant correlations were found between visual acuity measures and visual functioning (r < 0.170, p > 0.05). However, the VF-14 scores correlated with the OSDI scores (r = -0.436, p < 0.01) and the OSDI scores correlated with the SHAI scores (r = 0.333, p < 0.05). Multiple logistic regression revealed an adjusted association between patient satisfaction and dry eye symptoms (odds ratio = 1.46, 95% CI = 1.02-2.09, p = 0.038) and visual functioning (odds ratio = 0.78, 95% CI = 0.60-1.0, p = 0.048). Our results suggest that patient-reported visual functioning, dry eye symptoms, and health anxiety are more closely associated with patients' postoperative satisfaction than with the objective clinical measures of visual acuity or the signs of dry eye.

Demographic characteristics and visual status of patients undergoing cataract surgery at a tertiary hospital in Kano, Nigeria.

PubMed

Kurawa, Musbahu Sani; Abdu, Lawan

2017-01-01

Objective/Purpose: To describe the demographic and baseline ocular characteristics, prevalence of blindness and visual impairment among patients undergoing extracapsular cataract extraction for age related cataract at the study hospital over a one year period. Materials/Patients: All consecutive patients aged 40 years and above identified with age related cataract in one or both eyes who voluntarily agree to participate were included. The study adhered to the tenets of the Helsinki declaration. Written informed consent was obtained from all eligible patients. All patients underwent basic eye examination by the ophthalmologist. Visual impairment was determined for each eye according to the standard WHO categorizations. Information obtained also included age, sex and history of previous cataract surgery. Data were recorded in manual tally sheets and on modified computer Cataract Surgery Record forms. Analyses were done using SPSS (version 16, SPSS Inc., Chicago, USA). The participation rate was 91.2%. There were 495 eyes of 487 consecutive patients. This include 212 males and 275 females (M:F, 1:1.3). The age range was 40 to 99 years with a mean age of 62.76 ± 10.49 years (61.35 ± 9.75 years in men and 63.85±10.9 years in females). Most of the patients (n = 451; 92.6%, 95% CI: 89.9-94.6%) were aged 50 years and above. Sixty patients (12.3%, 95% CI: 9.6-15.5%) had cataract in both eyes, 427 (87.7%, 95% CI: 84.5-90.3%) were in one eye. Among these, preoperatively 16 (3.3%, 95% CI: 2.0-5.3%) had aphakia, 21 (4.3%, 95% CI: 2.8-6.5%) had uniocular pseudophakia. About 63.2% (95% CI: 58.9-67.4%) of patients had normal vision in the better eye (presenting VA ≥6/18). Overall 9.5% (95% CI: 7.3-12.7%) were bilaterally blind. About 96.8% of eyes (95% CI: 94.5-98.0%) undergoing cataract surgery were blind (presenting VAConclusion: The study highlights preponderance of females and high incidence of blinding cataract. Education and early disease awareness may play an important role in these patients and could improve cataract surgical services in our hospital..

Risk of Cataract among Subjects with the Acquired Immune Deficiency Syndrome Free of Ocular Opportunistic Infections

PubMed Central

Kempen, John H.; Sugar, Elizabeth A.; Varma, Rohit; Dunn, James P.; Heinemann, Murk-Hein; Jabs, Douglas A.; Lyon, Alice T.; Lewis, Richard A.

2014-01-01

Purpose To evaluate the risk of cataract in the setting of AIDS. Design Prospective cohort study. Participants Subjects with AIDS free of ocular opportunistic infections throughout catamnesis. Methods During 1998–2008 inclusive, subjects ≥13 years of age were enrolled. Demographic characteristics and clinical characteristics were documented at enrollment and semiannually. Main Outcome Measures Cataract was defined as high-grade lens opacity observed by biomicroscopy and judged to be the cause of a best-corrected visual acuity worse than 20/40. Eyes that underwent cataract surgery during follow-up were considered to have developed cataract prior to the first visit when pseudophakia or aphakia was observed. Results Among 1,606 participants (3,212 eyes), at enrollment 1.9% (95% confidence interval (CI): 1.3%−2.7%) were observed to have cataract or prior cataract surgery. Among the 2,812 eyes initially free of cataract, and followed longitudinally (median follow-up=4.6 years), the incidence of cataract was 0.37%/eye-year (95% CI: 0.26%– 0.53%). In addition to age, significant cataract risk factors included prior cataract in the contralateral eye (adjusted hazard ratio (aHR)=21.6, 95% CI: 10.4–44.8), anterior segment inflammation (aHR=4.40, 95% CI: 1.64–11.9), prior retinal detachment (aHR=4.94, 95% CI: 2.21–11.0), and vitreous inflammation (aHR=7.12, 95% CI: 2.02– 25.0), each studied as a time-updated characteristic. Detectable HIV RNA in peripheral blood was associated with lower risk of cataract at enrollment (adjusted odds ratio=0.32, 95% CI: 0.12–0.80) but not of incident cataract (aHR=1.58, 95% CI: 0.90–2.76). After adjustment for other factors, neither the then current absolute CD4+ T cell count nor antiretroviral therapy status showed consistent association with cataract risk, nor did an additive diagnosis of other other co-morbidities. Compared to the available population-based studies that used similar definitions of cataract, the age-specific prevalence of cataract in our cohort was higher than in one of two such studies, and the age-specific incidence of cataract surgery was higher. Conclusions Our results suggest cataract may occur earlier among patients with AIDS free of ocular opportunistic infections than in the general population. Cataract risk was associated most strongly with age and with other ocular morbidity in this population. With improved survival, the burden of cataract likely will increase for persons with HIV/AIDS. PMID:25109932

Comparison of the visual and intraocular optical performance of a refractive multifocal IOL with rotational asymmetry and an apodized diffractive multifocal IOL.

PubMed

Alió, Jorge L; Plaza-Puche, Ana B; Javaloy, Jaime; Ayala, María José

2012-02-01

To compare the visual outcomes and intraocular optical quality observed postoperatively in patients implanted with a rotationally asymmetric multifocal intraocular lens (IOL) and an apodized diffractive multifocal IOL. Seventy-four consecutive eyes of 40 cataract patients (age range: 36 to 79 years) were divided into two groups: zonal refractive group, 39 eyes implanted with a rotationally asymmetric multifocal IOL (Lentis Mplus LS-312 IOL, Oculentis GmbH); and diffractive group, 35 eyes implanted with an apodized diffractive multifocal IOL (ReSTOR SN6AD3, Alcon Laboratories Inc). Distance and near visual acuity outcomes, contrast sensitivity, intraocular optical quality, and defocus curves were evaluated during 3-month follow-up. Calculation of the intraocular aberrations was performed by subtracting corneal aberrations from total ocular aberrations. Uncorrected near visual acuity and distance-corrected near visual acuity were better in the diffractive group than in the zonal refractive group (P=.01), whereas intermediate visual acuity (defocus +1.00 and +1.50 diopters) was better in the zonal refractive group. Photopic contrast sensitivity was significantly better in the zonal refractive group (P=.04). Wavefront aberrations (total, higher order, tilt, primary coma) were significantly higher in the zonal refractive group than in the diffractive group (P=.02). Both multifocal IOLs are able to successfully restore visual function after cataract surgery. The zonal refractive multifocal IOL provides better results in contrast sensitivity and intermediate vision, whereas the diffractive multifocal IOL provides better near vision at a closer distance. Copyright 2012, SLACK Incorporated.

Rapid assessment of avoidable blindness in Bhutan.

PubMed

Lepcha, Nor Tshering; Chettri, Chandra Kumar; Getshen, Kunzang; Rai, Bhim Bahadur; Ramaswamy, Shamanna Bindiganavale; Saibaba, Saravanan; Nirmalan, Praveen Kumar; Demarchis, Emilia Hansson; Tabin, Geoffrey; Morley, Michael; Morley, Katharine

2013-08-01

To conduct a rapid assessment of avoidable blindness survey in Bhutan to obtain estimates of blindness, visual impairment, and cataract surgical coverage, outcomes and barriers among persons ≥50 years old. A total of 82 clusters of 50 people ≥50 years were selected using probability proportionate to size sampling. Eligible participants were selected from households using compact segment sampling, and underwent ophthalmic examination for visual acuity, followed by penlight and direct ophthalmoscopy. Participants with cataract were interviewed regarding surgical outcomes and barriers to surgery. Overall, 4046 of 4100 persons enumerated (98.7%) underwent ophthalmic examination. Adjusting for age and sex, the prevalence of bilaterally blind persons with available correction was 1.5% (95% confidence interval 1.09-1.89). Most blindness (67.1%) and severe visual impairment (74.1%) resulted from cataract, but 22.1% resulted from posterior segment pathology. Cataract surgical coverage for bilaterally blind persons was 72.7%. Almost 90% of patients reported moderate or good satisfaction, despite poor surgical outcomes in 23.6%. The prevalence of blindness in people aged ≥50 years in Bhutan was relatively low when compared with neighboring countries and World Health Organization sub-region estimates. Areas for improvement include community outreach, surgical outcomes, and posterior segment diseases.

Methods for assessing forward and backward light scatter in patients with cataract.

PubMed

Crnej, Alja; Hirnschall, Nino; Petsoglou, Con; Findl, Oliver

2017-08-01

To compare objective methods for assessing backward and forward light scatter and psychophysical tests in patients with cataracts. Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom. Prospective case series. This study included patients scheduled for cataract surgery. Lens opacities were grouped into predominantly nuclear sclerotic, cortical, posterior subcapsular, and mixed cataracts. Backward light scatter was assessed using a rotating Scheimpflug imaging technique (Pentacam HR), forward light scatter using a straylight meter (C-Quant), and straylight using the double-pass method (Optical Quality Analysis System, point-spread function [PSF] meter). The results were correlated with visual acuity under photopic conditions as well as photopic and mesopic contrast sensitivity. The study comprised 56 eyes of 56 patients. The mean age of the 23 men and 33 women was 71 years (range 48 to 84 years). Two patients were excluded. Of the remaining, 15 patients had predominantly nuclear sclerotic cataracts, 13 had cortical cataracts, 11 had posterior subcapsular cataracts, and 15 had mixed cataracts. Correlations between devices were low. The highest correlation was between PSF meter measurements and Scheimpflug measurements (r = 0.32). The best correlation between corrected distance visual acuity was with the PSF meter (r = 0.45). Forward and backward light-scatter measurements cannot be used interchangeably. Scatter as an aspect of quality of vision was independent of acuity. Measuring forward light scatter with the straylight meter can be a useful additional tool in preoperative decision-making. Copyright © 2017 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

High correlation between performance on a virtual-reality simulator and real-life cataract surgery.

PubMed

Thomsen, Ann Sofia Skou; Smith, Phillip; Subhi, Yousif; Cour, Morten la; Tang, Lilian; Saleh, George M; Konge, Lars

2017-05-01

To investigate the correlation in performance of cataract surgery between a virtual-reality simulator and real-life surgery using two objective assessment tools with evidence of validity. Cataract surgeons with varying levels of experience were included in the study. All participants performed and videorecorded three standard cataract surgeries before completing a proficiency-based test on the EyeSi virtual-reality simulator. Standard cataract surgeries were defined as: (1) surgery performed under local anaesthesia, (2) patient age >60 years, and (3) visual acuity >1/60 preoperatively. A motion-tracking score was calculated by multiplying average path length and average number of movements from the three real-life surgical videos of full procedures. The EyeSi test consisted of five abstract and two procedural modules: intracapsular navigation, antitremor training, intracapsular antitremor training, forceps training, bimanual training, capsulorhexis and phaco divide and conquer. Eleven surgeons were enrolled. After a designated warm-up period, the proficiency-based test on the EyeSi simulator was strongly correlated to real-life performance measured by motion-tracking software of cataract surgical videos with a Pearson correlation coefficient of -0.70 (p = 0.017). Performance on the EyeSi simulator is significantly and highly correlated to real-life surgical performance. However, it is recommended that performance assessments are made using multiple data sources. © 2016 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

[Evaluation of eye patching after cataract surgery in topical anesthesia].

PubMed

Mayer, S; Wirbelauer, C; Häberle, H; Altmeyer, M; Pham, D T

2005-01-01

Although postoperative eye patching is a common practice its background is not well known. Therefore the necessity of eye patching after cataract surgery in topical anesthesia from the medical point of view and the patients' subjective opinion was studied. In this prospective and randomized study 133 patients received after cataract surgery either no covering of the eye (group1), a transparent eye shield for four hours (group 2), an eye pad for four hours (group 3) or an eye pad until the next morning (group 4). Clinical findings were noted and local symptoms, such as pain, foreign body sensation, tearing and photophobia were documented on a visual analogue scale (0 - 10). Furthermore, a questionnaire concerning the subjective opinion was handed out to the patient. The clinical findings revealed no significant differences between the groups. The mean values for local pain were 0.94 +/- 1.56, for the foreign body sensation 1.41 +/- 2.02, for tearing 0.99 +/- 1.8 and for photophobia 1.05 +/- 1.99. Comparing the groups there was significantly more pain and foreign body sensation reported by the patients in group 3, who received eye patching for 4 hours. 91 % of the unpatched patients had no discomfort, whereas 53 % of the patients wearing an eye pad until the next morning considered it as unnecessary. After cataract surgery in topical anesthesia only mild symptoms were noted. There were no significant differences between the groups in the objective clinical findings and the subjective feeling. These results indicate that after cataract surgery eye patching could be unnecessary.

Three-dimensional microscopic tomographic imagings of the cataract in a human lens in vivo

NASA Astrophysics Data System (ADS)

Masters, Barry R.

1998-10-01

The problem of three-dimensional visualization of a human lens in vivo has been solved by a technique of volume rendering a transformed series of 60 rotated Scheimpflug (a dual slit reflected light microscope) digital images. The data set was obtained by rotating the Scheimpflug camera about the optic axis of the lens in 3 degree increments. The transformed set of optical sections were first aligned to correct for small eye movements, and then rendered into a volume reconstruction with volume rendering computer graphics techniques. To help visualize the distribution of lens opacities (cataracts) in the living, human lens the intensity of light scattering was pseudocolor coded and the cataract opacities were displayed as a movie.

[Value the correction of corneal astigmatism in cataract surgery].

PubMed

Wang, J; Cao, Y X

2018-05-11

The aim of modern micro-incision phacoemulsification combined with foldable intraocular lens implantation and femtosecond laser-assisted cataract surgery is evolving from a simple pursuit of recuperation to a refractive procedure, which involves the correction of ametropia according to preoperative and postoperative refractive conditions, especially corneal astigmatism, in order to achieve the goal of optimized postoperative uncorrected full range of vision. Nowadays, due attention to the effect of preoperative corneal astigmatism, surgery-induced astigmatism and residual astigmatism after operation is lacked, which affect postoperative visual acuity significantly. There are many effective ways to reduce corneal astigmatism after cataract surgery including selecting appropriate size and location of clear corneal incision, employing astigmatism keratotomy and the implantation of Toric intraocular lenses, which need to be appropriately applied and popularized. At the same time, surgical indications, predictability and safety should also be taken into account. (Chin J Ophthalmol, 2018, 54: 321-323) .

Cerebral visual impairment in children: Causes and associated ophthalmological problems.

PubMed

Pehere, Niranjan; Chougule, Pratik; Dutton, Gordon N

2018-06-01

The aim of this study is to identify common causes, associated ophthalmological abnormalities, and systemic comorbidities in children in Andhra Pradesh, India, with cerebral visual impairment (CVI). A retrospective review of case records of all children aged <16 years with diagnosis of CVI seen between January 2016 and December 2016 was carried out. Data were collected for their age, gender, cause of CVI, refraction, accommodation, anterior and posterior segment examination findings, and systemic problems. A total of 124 patients were identified and studied (80 boys and 44 girls, mean age 5.23 years, 44.8% aged <2 years). The most common causes of CVI were hypoxic-ischemic encephalopathy (HIE) (34.4%), undetermined etiology (32.8%), neonatal seizures, and infantile spasms (16% each). The most common presenting complaints were poor vision (76%) and squint (11.2%). Profound visual impairment was seen in 88.8%, and 11.2% had high functioning CVI. Fifty-eight (46.4%) patients had significant refractive errors, 40 (32.25%) had strabismus, 4 (3.2%) had visually significant cataract, and 40 (32%) had optic atrophy. Motor delay was observed in 39.5%, speech delay was evident in 22.4%, and cognitive delay in 16%. HIE is the most common cause (one-third) of CVI in our population, and the majority of them presented at age <2 years (44.8%) with profound visual impairment (88.8%). A significant number of them have treatable ophthalmic conditions such as refractive errors (46.4%), accommodative insufficiency (12.1%), and cataract (3.2%), and more than one-third of them also have delay in other areas of development.

Five preference-based indexes in cataract and heart failure patients were not equally responsive to change.

PubMed

Kaplan, Robert M; Tally, Steven; Hays, Ron D; Feeny, David; Ganiats, Theodore G; Palta, Mari; Fryback, Dennis G

2011-05-01

To compare the responsiveness to clinical change of five widely used preference-based health-related quality-of-life indexes in two longitudinal cohorts. Five generic instruments were simultaneously administered to 376 adults undergoing cataract surgery and 160 adults in heart failure management programs. Patients were assessed at baseline and reevaluated after 1 and 6 months. The measures were the Short Form (SF)-6D (based on responses scored from SF-36v2), Self-Administered Quality of Well-being Scale (QWB-SA), the EuroQol-5D developed by the EuroQol Group, the Health Utilities Indexes Mark 2 (HUI2) and Mark 3 (HUI3). Cataract patients completed the National Eye Institute Visual Functioning Questionnaire-25, and heart failure patients completed the Minnesota Living with Heart Failure Questionnaire. Responsiveness was estimated by the standardized response mean. For cataract patients, mean changes between baseline and 1-month follow-up for the generic indices ranged from 0.00 (SF-6D) to 0.052 (HUI3) and were statistically significant for all indexes except the SF-6D. For heart failure patients, only the SF-6D showed significant change from baseline to 1 month, whereas only the QWB-SA change was significant between 1 and 6 months. Preference-based methods for measuring health outcomes are not equally responsive to change. Copyright © 2011 Elsevier Inc. All rights reserved.

Comparison of the efficacy and patients' tolerability of Nepafenac and Ketorolac in the treatment of ocular inflammation following cataract surgery: A meta-analysis of randomized controlled trials.

PubMed

Zhao, Xinyu; Xia, Song; Wang, Erqian; Chen, Youxin

2017-01-01

As a new ophthalmic non-steroidal anti-inflammatory drug (NSAID) with prodrug structure, Nepafenac was supposed to have a better efficacy than conventional NSAIDs both in patients' tolerability and ocular inflammation associated with cataract surgery. However, many current studies reached contradictory conclusions on the superiority of Nepafenac over Ketorolac. The objective of our study is to evaluate the efficacy and patients' tolerability of Nepafenac and Ketorolac following cataract surgery. To clarify this, we conducted a meta-analysis of randomized controlled trials. Eleven articles were included in this study. The dataset consisted of 1165 patients, including 1175 cataract surgeries. Among them, 574 patients were in the Nepafenac group and 591 in the Ketorolac group. Our analysis indicated that these two drugs were equally effective in controlling post cataract surgery ocular inflammation, reducing macular edema, achieving a better visual ability and maintaining intraoperative mydriasis during cataract surgery. However, Nepafenac was more effective than Ketorolac in reducing the incidence of postoperative conjunctival hyperemia and ocular discomfort. This meta-analysis indicated that topical Nepafenac is superior to Ketorolac in patients' tolerability following cataract surgery. However, these two drugs are equally desirable in the management of anterior chamber inflammation, visual rehabilitation and intraoperative mydriasis. Given the limitations in our study, more researches with larger sample sizes and focused on more specific indicators such as peak aqueous concentrations of drugs or PEG2 levels are required to reach a firmer conclusion.

Rabbits with naturally occurring cataracts referred for phacoemulsification and intraocular lens implantation: a preliminary study of 12 cases.

PubMed

Sanchez, Rick F; Everson, Richard; Hedley, Joanna; Dawson, Charlotte; Lam, Richard; Priestnall, Simon L; Garcia de Carellan, Alejandra; de Miguel, Cristina; Seymour, Christopher

2017-12-04

To describe the presentation of 15 rabbits with naturally occurring cataracts referred for phacoemulsification surgery, the procedure in 13 cases and the follow-up in 12. Fifteen rabbits (30 eyes), nine of which stopped following visual cues in association with cataract progression. Rabbits underwent preoperative ophthalmic and ocular ultrasound examination. Thirteen rabbits (22 eyes) had mature cataracts. Ten were bilateral and three unilateral. Two rabbits had an anterior chamber abscess. The cataract in one of these was incipient. One rabbit had bilateral immature cataracts. One rabbit had a subluxated lens, and one had a retinal detachment. Thirteen rabbits (22 eyes) underwent phacoemulsification. Eighteen, 13.5-mm capsular tension rings (CTRs) and seventeen, 13-mm IOLs (Acrivet ® , Berlin, Germany) were fitted including one 41D 60V-model, and three 49D and thirteen 58D 20S-models. Intraoperative complications included one unilateral posterior-capsular tear, one lens subluxation, and one expulsive choroidal hemorrhage. One rabbit died during anesthetic recovery. Nine cases were PCR-tested for Encephalitozoon cuniculi, and only three were positive. The median follow-up time was 12 months (4-24 months). Rabbits that were not following visual cues preoperatively did so postoperatively, and surgery resulted in a clear visual axis for the follow-up period in every case except in two, due to reasons other than the surgery. Phacoemulsification with CTR and IOL implantation offers good long-term results and can improve the quality of life of pet rabbits. Retinal detachment, lens luxation, expulsive choroidal hemorrhage, and anesthetic death are potential complications. © 2017 American College of Veterinary Ophthalmologists.

Changing patterns of cataract services in North-West Nigeria: 2005–2016

PubMed Central

Muhammad, Nasiru; Adamu, Mohammed Dantani; Caleb, Mpyet; Maishanu, Nuhu Mohammed; Jabo, Aliyu Mohammed; Rabiu, Muhammad Mansur; Bascaran, Covadonga; Isiyaku, Sunday

2017-01-01

Purpose This study was conducted to assess the impact of the eye care programme on cataract blindness and cataract surgical services in Sokoto, Nigeria over a 12 year period 2005–2016. Methods Data from the 2005 population based cross-sectional study of blindness in Sokoto state was re-analysed to obtain baseline estimates of the prevalence of cataract blindness and cataract surgical coverage for persons 50 years and over in Wurno health zone. A population based survey of a representative sample of persons 50 years and over in Wurno health zone was conducted in July 2016. Data on eye health workforce, infrastructure and cataract surgical services between 2005 and 2016 were analysed from relevant documents. Results In 2005 the unadjusted prevalence of bilateral cataract blindness (<3/60) in people 50 years and over in Wurno health zone was 5.6% (95% CI: 3.1, 10.1). By 2016 this had fallen to 2.1% (95% CI 1.5%, 2.7%), with the age-sex adjusted prevalence being 1.9% (95% CI 1.3%, 2.5%). The CSC for persons with visual acuity <3/60, <6/60, <6/18 for Wurno health zone was 9.1%, 7.1% and 5.5% respectively in 2005 and this had increased to 67.3%, 62.1% and 34.7% respectively in 2016. The CSR in Sokoto state increased from 272 (1005 operations) in 2006, to 596 (2799 operations) in 2014. In the 2005 survey, couching (a procedure used by traditional practitioners to dislocate the lens into the vitreous cavity) accounted for 87.5% of all cataract interventions, compared to 45.8% in the 2016 survey participants. In 2016 18% of eyes having a cataract operation with IOL implantation had a presenting visual acuity of <6/60 (poor outcome) with the main causes being postoperative complications (53%) and uncorrected refractive error (29%). Conclusion Between 2005 and 2016 there was a doubling in cataract surgical rate, a 7 times increase in cataract surgical coverage (<3/60), and a decrease in cataract blindness and the proportion of eyes being couched. However, there remains a high prevalence of un-operated cataract in 2016 indicating a need to further improve access to affordable and good quality cataract surgical services. PMID:28817733

COMPARISON OF RECENTLY USED PHACOEMULSIFICATION SYSTEMS USING A HEALTH TECHNOLOGY ASSESSMENT METHOD.

PubMed

Huang, Jiannan; Wang, Qi; Zhao, Caimin; Ying, Xiaohua; Zou, Haidong

2017-01-01

To compare the recently used phacoemulsification systems using a health technology assessment (HTA) model. A self-administered questionnaire, which included questions to gauge on the opinions of the recently used phacoemulsification systems, was distributed to the chief cataract surgeons in the departments of ophthalmology of eighteen tertiary hospitals in Shanghai, China. A series of senile cataract patients undergoing phacoemulsification surgery were enrolled in the study. The surgical results and the average costs related to their surgeries were all recorded and compared for the recently used phacoemulsification systems. The four phacoemulsification systems currently used in Shanghai are the Infiniti Vision, Centurion Vision, WhiteStar Signature, and Stellaris Vision Enhancement systems. All of the doctors confirmed that the systems they used would help cataract patients recover vision. A total of 150 cataract patients who underwent phacoemulsification surgery were enrolled in the present study. A significant difference was found among the four groups in cumulative dissipated energy, with the lowest value found in the Centurion group. No serious complications were observed and a positive trend in visual acuity was found in all four groups after cataract surgery. The highest total cost of surgery was associated with procedures conducted using the Centurion Vision system, and significant differences between systems were mainly because of the cost of the consumables used in the different surgeries. This HTA comparison of four recently used phacoemulsification systems found that each of system offers a satisfactory vision recovery outcome, but differs in surgical efficacy and costs.

Evaluation of an interlaced triple procedure: penetrating keratoplasty, extracapsular cataract extraction, and nonopen-sky intraocular lens implantation.

PubMed

Yang, Shuo; Wang, Bin; Zhang, Yangyang; Zhai, Hualei; Wang, Junyi; Wang, Shuang; Xie, Lixin

2017-09-01

To evaluate an interlaced triple procedure that involved penetrating keratoplasty (PKP), extracapsular cataract extraction (ECCE) using diathermy capsulotomy, and nonopen-sky intraocular lens (IOL) implantation.This retrospective study involved data from 34 patients who were diagnosed with severe corneal opacities and cataracts. These patients were divided into an interlaced procedure group (21 patients) and a traditional procedure group (13 patients). In the interlaced group, the method of continuous curvilinear capsulorhexis (CCC) was completed via diathermy capsulotomy. The donor corneal button was sutured at 8 positions (at equal intervals) using 10-0 nylon sutures, and the IOL was inserted into the capsular bag using a closed anterior chamber approach at the 10:30 to 12 o'clock positions between the sutures. In the traditional group, CCC was completed using side-port capsular forceps, and the IOL was implanted using an open anterior chamber approach.In the interlaced group, the CCC, open-sky, and total operation times were significantly shorter than in the traditional group (P < .05). Neither the best-corrected visual acuity (BCVA) nor corneal endothelial cell density was significantly different between the groups at 1 and 6 months after the operation.This interlaced triple procedure for the treatment of corneal diseases with cataracts appears to be feasible and practical.

Visual impairment and blindness in Europe and their prevention.

PubMed

Kocur, I; Resnikoff, S

2002-07-01

The European region currently differs in many aspects, such as political, socioeconomic, and geographical. After substantial political changes at the beginning of the 1990s, the majority of central and eastern European countries started to rebuild their healthcare systems. It is apparent that eastern Europe represents a highly diverse region where the difference among countries broadens year after year. In highly industrialised countries of Europe, the leading causes of childhood serious visual loss are lesions of the central nervous system, congenital anomalies and retinal disorders. In the middle income countries of Europe, congenital cataract, glaucoma and, mainly, retinopathy of prematurity are highly expressed. The major cause of serious visual loss in adults in industrialised countries is age related macular degeneration. The other conditions comprise cataract, glaucoma, diabetic retinopathy, and uncorrected/uncorrectable refractive errors, along with low vision. In people of working age, diabetic retinopathy, retinopathy pigmentosa, and optic atrophy are the most frequently reported causes of serious visual loss. In the middle income countries of Europe, advanced cataract, glaucoma, and diabetic retinopathy are more frequently observed.

Visual impairment and blindness in Europe and their prevention

PubMed Central

Kocur, I; Resnikoff, S

2002-01-01

The European region currently differs in many aspects, such as political, socioeconomic, and geographical. After substantial political changes at the beginning of the 1990s, the majority of central and eastern European countries started to rebuild their healthcare systems. It is apparent that eastern Europe represents a highly diverse region where the difference among countries broadens year after year. In highly industrialised countries of Europe, the leading causes of childhood serious visual loss are lesions of the central nervous system, congenital anomalies and retinal disorders. In the middle income countries of Europe, congenital cataract, glaucoma and, mainly, retinopathy of prematurity are highly expressed. The major cause of serious visual loss in adults in industrialised countries is age related macular degeneration. The other conditions comprise cataract, glaucoma, diabetic retinopathy, and uncorrected/uncorrectable refractive errors, along with low vision. In people of working age, diabetic retinopathy, retinopathy pigmentosa, and optic atrophy are the most frequently reported causes of serious visual loss. In the middle income countries of Europe, advanced cataract, glaucoma, and diabetic retinopathy are more frequently observed. PMID:12084735

A methodological approach to identify external factors for indicator-based risk adjustment illustrated by a cataract surgery register

PubMed Central

2014-01-01

Background Risk adjustment is crucial for comparison of outcome in medical care. Knowledge of the external factors that impact measured outcome but that cannot be influenced by the physician is a prerequisite for this adjustment. To date, a universal and reproducible method for identification of the relevant external factors has not been published. The selection of external factors in current quality assurance programmes is mainly based on expert opinion. We propose and demonstrate a methodology for identification of external factors requiring risk adjustment of outcome indicators and we apply it to a cataract surgery register. Methods Defined test criteria to determine the relevance for risk adjustment are “clinical relevance” and “statistical significance”. Clinical relevance of the association is presumed when observed success rates of the indicator in the presence and absence of the external factor exceed a pre-specified range of 10%. Statistical significance of the association between the external factor and outcome indicators is assessed by univariate stratification and multivariate logistic regression adjustment. The cataract surgery register was set up as part of a German multi-centre register trial for out-patient cataract surgery in three high-volume surgical sites. A total of 14,924 patient follow-ups have been documented since 2005. Eight external factors potentially relevant for risk adjustment were related to the outcome indicators “refractive accuracy” and “visual rehabilitation” 2–5 weeks after surgery. Results The clinical relevance criterion confirmed 2 (“refractive accuracy”) and 5 (“visual rehabilitation”) external factors. The significance criterion was verified in two ways. Univariate and multivariate analyses revealed almost identical external factors: 4 were related to “refractive accuracy” and 7 (6) to “visual rehabilitation”. Two (“refractive accuracy”) and 5 (“visual rehabilitation”) factors conformed to both criteria and were therefore relevant for risk adjustment. Conclusion In a practical application, the proposed method to identify relevant external factors for risk adjustment for comparison of outcome in healthcare proved to be feasible and comprehensive. The method can also be adapted to other quality assurance programmes. However, the cut-off score for clinical relevance needs to be individually assessed when applying the proposed method to other indications or indicators. PMID:24965949

Explicit criteria for prioritization of cataract surgery

PubMed Central

Ma Quintana, José; Escobar, Antonio; Bilbao, Amaia

2006-01-01

Background Consensus techniques have been used previously to create explicit criteria to prioritize cataract extraction; however, the appropriateness of the intervention was not included explicitly in previous studies. We developed a prioritization tool for cataract extraction according to the RAND method. Methods Criteria were developed using a modified Delphi panel judgment process. A panel of 11 ophthalmologists was assembled. Ratings were analyzed regarding the level of agreement among panelists. We studied the effect of all variables on the final panel score using general linear and logistic regression models. Priority scoring systems were developed by means of optimal scaling and general linear models. The explicit criteria developed were summarized by means of regression tree analysis. Results Eight variables were considered to create the indications. Of the 310 indications that the panel evaluated, 22.6% were considered high priority, 52.3% intermediate priority, and 25.2% low priority. Agreement was reached for 31.9% of the indications and disagreement for 0.3%. Logistic regression and general linear models showed that the preoperative visual acuity of the cataractous eye, visual function, and anticipated visual acuity postoperatively were the most influential variables. Alternative and simple scoring systems were obtained by optimal scaling and general linear models where the previous variables were also the most important. The decision tree also shows the importance of the previous variables and the appropriateness of the intervention. Conclusion Our results showed acceptable validity as an evaluation and management tool for prioritizing cataract extraction. It also provides easy algorithms for use in clinical practice. PMID:16512893

New light for old eyes: comparing melanopsin-mediated non-visual benefits of blue-light and UV-blocking intraocular lenses.

PubMed

Schmoll, Conrad; Khan, Ashraf; Aspinall, Peter; Goudie, Colin; Koay, Peter; Tendo, Christelle; Cameron, James; Roe, Jenny; Deary, Ian; Dhillon, Bal

2014-01-01

Melanopsin-expressing photosensitive retinal ganglion cells form a blue-light-sensitive non-visual system mediating diverse physiological effects including circadian entrainment and cognitive alertness. Reduced blue wavelength retinal illumination through cataract formation is thought to blunt these responses while cataract surgery and intraocular lens (IOL) implantation have been shown to have beneficial effects on sleep and cognition. We aimed to use the reaction time (RT) task and the Epworth Sleepiness Score (ESS) as a validated objective platform to compare non-visual benefits of UV- and blue-blocking IOLs. Patients were prospectively randomised to receive either a UV- or blue-blocking IOL, performing an RT test and ESS questionnaire before and after surgery. Optical blurring at the second test controlled for visual improvement. Non-operative age-matched controls were recruited for comparison. 80 participants completed the study. Those undergoing first-eye phacoemulsification demonstrated significant improvements in RT over control (p=0.001) and second-eye surgery patients (p=0.03). Moreover, reduced daytime sleepiness was measured by ESS for the first-eye surgery group (p=0.008) but not for the second-eye group (p=0.09). Choice of UV- or blue-blocking IOL made no significant difference to magnitude of cognitive improvement (p=0.272). Phacoemulsification, particularly first-eye surgery, has a strong positive effect on cognition and daytime alertness, regardless of IOL type.

Pediatric cataract

PubMed Central

Khokhar, Sudarshan Kumar; Pillay, Ganesh; Dhull, Chirakshi; Agarwal, Esha; Mahabir, Manish; Aggarwal, Pulak

2017-01-01

Pediatric cataract is a leading cause of childhood blindness. Untreated cataracts in children lead to tremendous social, economical, and emotional burden to the child, family, and society. Blindness related to pediatric cataract can be treated with early identification and appropriate management. Most cases are diagnosed on routine screening whereas some may be diagnosed after the parents have noticed leukocoria or strabismus. Etiology of pediatric cataract is varied and diagnosis of specific etiology aids in prognostication and effective management. Pediatric cataract surgery has evolved over years, and with improving knowledge of myopic shift and axial length growth, outcomes of these patients have become more predictable. Favorable outcomes depend not only on effective surgery, but also on meticulous postoperative care and visual rehabilitation. Hence, it is the combined effort of parents, surgeons, anesthesiologists, pediatricians, and optometrists that can make all the difference. PMID:29208814

Posterior capsule opacification.

PubMed

Wormstone, I Michael; Wang, Lixin; Liu, Christopher S C

2009-02-01

Posterior Capsule Opacification (PCO) is the most common complication of cataract surgery. At present the only means of treating cataract is by surgical intervention, and this initially restores high visual quality. Unfortunately, PCO develops in a significant proportion of patients to such an extent that a secondary loss of vision occurs. A modern cataract operation generates a capsular bag, which comprises a proportion of the anterior and the entire posterior capsule. The bag remains in situ, partitions the aqueous and vitreous humours, and in the majority of cases, houses an intraocular lens. The production of a capsular bag following surgery permits a free passage of light along the visual axis through the transparent intraocular lens and thin acellular posterior capsule. However, on the remaining anterior capsule, lens epithelial cells stubbornly reside despite enduring the rigours of surgical trauma. This resilient group of cells then begin to re-colonise the denuded regions of the anterior capsule, encroach onto the intraocular lens surface, occupy regions of the outer anterior capsule and most importantly of all begin to colonise the previously cell-free posterior capsule. Cells continue to divide, begin to cover the posterior capsule and can ultimately encroach on the visual axis resulting in changes to the matrix and cell organization that can give rise to light scatter. This review will describe the biological mechanisms driving PCO progression and discuss the influence of IOL design, surgical techniques and putative drug therapies in regulating the rate and severity of PCO.

The First Rapid Assessment of Avoidable Blindness (RAAB) in Thailand

PubMed Central

Isipradit, Saichin; Sirimaharaj, Maytinee; Charukamnoetkanok, Puwat; Thonginnetra, Oraorn; Wongsawad, Warapat; Sathornsumetee, Busaba; Somboonthanakij, Sudawadee; Soomsawasdi, Piriya; Jitawatanarat, Umapond; Taweebanjongsin, Wongsiri; Arayangkoon, Eakkachai; Arame, Punyawee; Kobkoonthon, Chinsuchee; Pangputhipong, Pannet

2014-01-01

Background The majority of vision loss is preventable or treatable. Population surveys are crucial for planning, implementation, and monitoring policies and interventions to eliminate avoidable blindness and visual impairments. This is the first rapid assessment of avoidable blindness (RAAB) study in Thailand. Methods A cross-sectional study of a population in Thailand age 50 years old or over aimed to assess the prevalence and causes of blindness and visual impairments. Using the Thailand National Census 2010 as the sampling frame, a stratified four-stage cluster sampling based on a probability proportional to size was conducted in 176 enumeration areas from 11 provinces. Participants received comprehensive eye examination by ophthalmologists. Results The age and sex adjusted prevalence of blindness (presenting visual acuity (VA) <20/400), severe visual impairment (VA <20/200 but ≥20/400), and moderate visual impairment (VA <20/70 but ≥20/200) were 0.6% (95% CI: 0.5–0.8), 1.3% (95% CI: 1.0–1.6), 12.6% (95% CI: 10.8–14.5). There was no significant difference among the four regions of Thailand. Cataract was the main cause of vision loss accounted for 69.7% of blindness. Cataract surgical coverage in persons was 95.1% for cut off VA of 20/400. Refractive errors, diabetic retinopathy, glaucoma, and corneal opacities were responsible for 6.0%, 5.1%, 4.0%, and 2.0% of blindness respectively. Conclusion Thailand is on track to achieve the goal of VISION 2020. However, there is still much room for improvement. Policy refinements and innovative interventions are recommended to alleviate blindness and visual impairments especially regarding the backlog of blinding cataract, management of non-communicative, chronic, age-related eye diseases such as glaucoma, age-related macular degeneration, and diabetic retinopathy, prevention of childhood blindness, and establishment of a robust eye health information system. PMID:25502762

Laser-assisted corneal welding in cataract surgery: retrospective study.

PubMed

Menabuoni, Luca; Pini, Roberto; Rossi, Francesca; Lenzetti, Ivo; Yoo, Sonia H; Parel, Jean-Marie

2007-09-01

To evaluate the efficacy of laser welding to close corneal wounds in cataract surgery. Department of Ophthalmology, Hospital of Misericordia e Dolce, Prato, Italy. This retrospective nonrandomized interventional case series included 20 eyes of 20 patients. All eyes had cataract with visual acuity worse than 20/200. Ten patients had phacoemulsification surgery, and 10 had extracapsular cataract extraction (ECCE). Surgeries were followed by laser-assisted closure of the corneal wounds by diode laser welding of the stroma using a technique established in animal models. Preoperative and postoperative (1, 3, 7, 30, and 90 days) astigmatism, level of inflammation, Seidel testing, and endothelial cell counts were obtained. There were minor differences in preoperative and postoperative astigmatism except in 1 eye in the ECCE group. The Seidel test showed no wound leakage during the follow-up examinations, and endothelial cell loss was similar to that published for standard surgical cataract procedures. No collateral effects of the laser welding were detected, nor was postoperative inflammation. Astigmatism was slightly affected by the use of laser welding for corneal wound closure after phacoemulsification and ECCE. The laser-assisted corneal sealing procedure was rapid and safe and could serve as an alternative to corneal suturing, with significant potential applications for the closure of longer incisions, such as those used in penetrating keratoplasty.

Outcomes and Predictive Factors After Cataract Surgery in Patients With Neovascular Age-related Macular Degeneration. The Fight Retinal Blindness! Project.

PubMed

Daien, Vincent; Nguyen, Vuong; Morlet, Nigel; Arnold, Jennifer J; Essex, Rohan W; Young, Stephanie; Hunyor, Alex; Gillies, Mark C; Barthelmes, Daniel

2018-06-01

To evaluate outcomes and predictive factors of visual acuity (VA) change after cataract surgery in patients being treated for neovascular age-related macular degeneration (nAMD). Retrospective, matched case-control study. We studied eyes undergoing cataract surgery that had been tracked since they first started treatment for nAMD. These eyes were compared with a cohort of unoperated phakic eyes being treated for nAMD (3 per case) matched for treatment duration before cataract surgery, baseline VA, age, and length of follow-up. We included 124 patients that had cataract surgery and 372 matched controls. The mean (95% confidence interval) VA gained was 10.6 letters (7.8, 13.2; P < .001) 12 months after surgery; 26.0% had gained ≥3 lines and 1.6% had lost ≥3 lines of VA. Visual acuity (mean [standard deviation]) 12 months after surgery was higher in eyes that had cataract extraction compared with controls (65.8 [17.1] vs 61.3 [20.8] letters, respectively, P = .018). The proportion of visits where the choroidal neovascular (CNV) lesion was graded active and the mean number of injections were similar before and after surgery (P = .506 and P = .316, respectively), whereas both decreased in the control group, suggesting that surgery modestly increased the level of activity of the CNV lesion. Mean [SD] VA prior to surgery was lower in eyes that gained ≥15 letters compared with eyes that gained 0-14 letters (40.2 [21.4] vs 62.1 [15.1], P < .001). Patients undergoing cataract surgery within the first 6 months of anti-VEGF therapy were more likely to lose rather than gain vision (20.8% lost vision vs 12.8% and 4.4% gaining ≥15 or 0-14 letters respectively, P = .023). Age, receiving an injection at least 2 weeks before surgery, and the CNV lesion type had no discernible association with VA outcomes. We found evidence of a modest effect of cataract surgery on CNV lesion activity in eyes being treated for nAMD. Despite this, visual outcomes were reassuringly good. Cataract surgery within 6 months of starting treatment for nAMD should be avoided if possible. Copyright © 2018 Elsevier Inc. All rights reserved.

Prevalence and Causes of Visual Impairment and Blindness in Shanxi Province, China.

PubMed

Li, Tong; Du, Liping; Du, Lingzhen

2015-01-01

To estimate the prevalence and causes of visual impairment and blindness in Shanxi Province, China. Data were obtained from the Second National Sampling Survey of Disability conducted in 2006. Blindness and visual impairment were defined as best corrected visual acuity <3/60 and <6/18, respectively, in the better-seeing eye. Standardized ophthalmologic examinations were administered to participants aged 0-80 years in 2006. Visual acuity (VA) was measured using a Standard Logarithmic Visual Acuity E chart (Snellen) for subjects aged 7 years and older. Participants younger than 7 years were examined using special experiments or the Childhood Graphical Visual Chart. The prevalence of visual impairment and blindness in Shanxi was estimated to be 0.6% (466/75,016) among persons up to 80 years old. The prevalence in rural areas (0.7%; 351/48,137) was significantly higher than that in urban areas (0.4%; 115/26,879) and was higher in females (0.8%; 298/36,933) than in males (0.4%; 168/38,083). The most common cause of visual impairment and blindness was cataract (44.9%), followed by retinopathy and choroidopathy (12.5%), hereditary and developmental disorders (10.3%), corneal disease (5.2%), and refractive error (4.9%). Prevalences of visual impairment and blindness in women and in rural areas were higher than in men and urban areas, and increased with age. Cataract was the most prevalent cause of visual impairment and blindness. Based on the findings from this study, we suggest that provision of support and welfare services should be organized.

Comparison of a new refractive multifocal intraocular lens with an inferior segmental near add and a diffractive multifocal intraocular lens.

PubMed

Alio, Jorge L; Plaza-Puche, Ana B; Javaloy, Jaime; Ayala, María José; Moreno, Luis J; Piñero, David P

2012-03-01

To compare the visual acuity outcomes and ocular optical performance of eyes implanted with a multifocal refractive intraocular lens (IOL) with an inferior segmental near add or a diffractive multifocal IOL. Prospective, comparative, nonrandomized, consecutive case series. Eighty-three consecutive eyes of 45 patients (age range, 36-82 years) with cataract were divided into 2 groups: group A, 45 eyes implanted with Lentis Mplus LS-312 (Oculentis GmbH, Berlin, Germany); group B, 38 eyes implanted with diffractive IOL Acri.Lisa 366D (Zeiss, Oberkochen, Germany). All patients underwent phacoemulsification followed by IOL implantation in the capsular bag. Distance corrected, intermediate, and near with the distance correction visual acuity outcomes and contrast sensitivity, intraocular aberrations, and defocus curve were evaluated postoperatively during a 3-month follow-up. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected near visual acuity (UNVA), corrected distance near and intermediate visual acuity (CDNVA), contrast sensitivity, intraocular aberrations, and defocus curve. A significant improvement in UDVA, CDVA, and UNVA was observed in both groups after surgery (P ≤ 0.04). Significantly better values of UNVA (P<0.01) and CDNVA (P<0.04) were found in group B. In the defocus curve, significantly better visual acuities were present in eyes in group A for intermediate vision levels of defocus (P ≤ 0.04). Significantly higher amounts of postoperative intraocular primary coma and spherical aberrations were found in group A (P<0.01). In addition, significantly better values were observed in photopic contrast sensitivity for high spatial frequencies in group A (P ≤ 0.04). The Lentis Mplus LS-312 and Acri.Lisa 366D IOLs are able to successfully restore visual function after cataract surgery. The Lentis Mplus LS-312 provided better intermediate vision and contrast sensitivity outcomes than the Acri.Lisa 366D. However, the Acri.Lisa design provided better distance and near visual outcomes and intraocular optical performance parameters. Copyright © 2012 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

[Incidence and causes of visual impairment in the district of Mahdia, in east Tunisia: Retrospective study of 1487 cases].

PubMed

Ammari, W; Harrath, S; Mbarek, S; Mahmoud, A; Chebbi, W; Messaoud, R; Khairallah, M

2016-11-01

To study socio-demographic characteristics and main causes related to visual impairment (VI) as a function of age bracket and to analyze their trends over time in the district of Mahdia. A retrospective review was performed on 1487 cases of visual impairment registered with the social authorities in Mahdia, between 1980 and 2013. The social, demographic, vision exam findings and causes were ascertained and analyzed in an SPSS database. Incidence rates of VI and blindness due to various causes were calculated based on the demographic data from the NSI to estimate the time trends using the general linear regression model and Spearman correlation. Analyses included 1487 participants with a median age of 47 years, 40.6% of cases were aged under 45 years. Children accounted for 11.1% (165 patients), while age was between 16 and 45 years in 29.5% (439 patients), between 46 and 65 years in 31.5% (469 patients) and greater than 65 years in 27.8% (414 patients). The sex-ratio (M/F) was 1.78. Socially, 51% came from rural areas, 62% were illiterate, and 84% were unemployed. We observed blindness in 70% of participants and low vision in 30%. In children, the causes were dominated by congenital cataract and congenital glaucoma, each present in 31 children (18.8%). Between 16 and 45 years, glaucoma and hereditary dystrophies of the retina were found in 62 and 61 patients respectively (14% each). For age between 46 and 65 years, trachoma was responsible for 19.8% of cases of VI, glaucoma in 15.8% and cataract in 15.1%. Beyond 65 years, glaucoma accounted for 30.7% of the causes of VI and cataract 27.8% of cases. Trend analysis shows a significant increase in the incidence rate of visual impairment with an average of 12% per year (P=0.001). The mean age increased by 46% (P=0.003). Trachoma increased by 118% (P<0.0001) between 1980 and 1990, then declined by 42% (P=0.0013) between 1991 and 2013. Incidence of VI significantly increased by 4% for cataract (P=0.001), 23% (P=0.001) for glaucoma and 20% (P=0.02) for diabetic retinopathy, while VI related to refractive errors and AMD showed no significant change. Advanced age, lower educational and socio-economic status were associated with bilateral VI. Age related eye problems are the main causes of VI, and their incidence is tending to increase. Public health policies and procedures should be targeted to risk related populations and age-related diseases in order to control the incidence of visual impairment and avoid its consequences. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

The impact on vision of aspheric to spherical monofocal intraocular lenses in cataract surgery: a systematic review with meta-analysis.

PubMed

Schuster, Alexander K; Tesarz, Jonas; Vossmerbaeumer, Urs

2013-11-01

To provide a summary of the impact on vision of an aspheric intraocular lens (IOL) compared with a spherical IOL in cataract surgery. Systematic review with meta-analysis. Patients from published randomized controlled trials (RCTs) of cataract surgery with aspheric compared with spherical monofocal IOL implantation. We systematically searched the peer-reviewed literature in MEDLINE, EMBASE, Web of Science, BIOSIS, and the Cochrane Library according to the Cochrane Collaboration method to identify relevant RCTs. The inclusion criteria were RCTs on cataract surgery comparing the use of aspheric versus spherical IOL implantation that assessed visual acuity, contrast sensitivity, or quality of vision. The effects were calculated as mean differences or standardized mean differences (Hedges' g) and pooled using random-effect models. Best-corrected visual acuity (BCVA), contrast sensitivity, and subjective perception of the quality of vision. Forty-three studies provided data and were included, comprising 2076 eyes implanted with aspheric IOLs and 2034 eyes implanted with spherical IOLs. The BCVA showed a significant difference for aspheric IOLs (-0.01 logarithm of the minimum angle of resolution; 95% confidence interval [CI], -0.02 to -0.00). For contrast sensitivity, a significant advantage for aspheric IOLs was found under photopic and mesopic light conditions (photopic: Hedges' g 0.42, 95% CI 0.24-0.61 (3 cycles per degree [cpd]) to 0.53, 95% CI 0.33-0.73 (12 cpd); mesopic: Hedges' g 0.49, 95% CI 0.23-0.75 (1.5 cpd) to 0.76, 95% CI 0.52-1.00 (18 cpd)). Questionnaires targeting the subjective perception of quality of vision yielded less conclusive results. Overall, a patient may achieve better contrast sensitivity with an aspheric IOL than with a spherical IOL, especially under dim light. There was no clinically relevant difference in BCVA between aspheric and spherical IOL implantation. The findings on the subjective perception of visual quality were heterogeneous with no clear result favoring either option. Copyright © 2013 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

[Phacoemulsification versus manual small incision cataract surgery: Anatomic and functional results].

PubMed

Ammous, I; Bouayed, E; Mabrouk, S; Boukari, M; Erraies, K; Zhioua, R

2017-06-01

Prospective randomised study to compare the impact of phacoemusification (PHACO) and small incision cataract surgery (SICS) on endothelial structure (cell density and morphology) and refractive results (visual acuity, induced astigmatism). Prospective study of 57 patients (63 eyes) over 20 months (May 2012-January 2014) undergoing surgery by 2 experienced surgeons. We included patients with senile or presenile cataracts, LOCS III class 2, 3 and 4. Patients were randomized into 2 groups based on their birth month (group 1: PHACO [33]; group 2: SICS [30]). All pre- intra- and postoperative data were collected prospectively. The minimum follow-up was 6 months. We used the SPSS 18.0 for statistical analysis. Statistical tests used included the test-t Student, the Anova test, the Mann-Witney non-parametric test and the Khi 2 test. A threshold of significance was set at 0.05. The mean preoperative endothelial cell density was 2447.5±225 c/mm 2 with no significant difference between the two groups (P=0.207). The mean percentage of hexagonality was 55.5±8.2% in groups 1 and 2. The most significant cell loss was during the first immediate postoperative period for both groups. At Day 15 postoperative, the decrease in cell loss was significant (P<0.001) with a mean loss of 312.9±208.9 c/mm 2 (P<10 -2 ). Postoperatively, the mean best-corrected visual acuity was 0.057 log MAR for all of our patients (P=0.170); no patient had an acuity ≤1/10. The mean astigmatism at the conclusion of follow-up was 1.08±0.42 D in group 1 and 1.51±0.55 D in group 2, with a significant difference (P=0.001). Both SICS and PHACO give excellent results, both anatomical and refractive. However, SICS appears to be more advantageous than PHACO in terms of speed, cost, and independence from technology, and appears to be better suited to dense cataracts and mass surgery. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Femtosecond laser-assisted cataract surgery with bimanual technique: learning curve for an experienced cataract surgeon.

PubMed

Cavallini, Gian Maria; Verdina, Tommaso; De Maria, Michele; Fornasari, Elisa; Volpini, Elisa; Campi, Luca

2017-11-29

To describe the intraoperative complications and the learning curve of microincision cataract surgery assisted by femtosecond laser (FLACS) with bimanual technique performed by an experienced surgeon. It is a prospective, observational, comparative case series. A total of 120 eyes which underwent bimanual FLACS by the same experienced surgeon during his first experience were included in the study; we considered the first 60 cases as Group A and the second 60 cases as Group B. In both groups, only nuclear sclerosis of grade 2 or 3 was included; an intraocular lens was implanted through a 1.4-mm incision. Best-corrected visual acuity (BCVA), surgically induced astigmatism (SIA), central corneal thickness and endothelial cell loss (ECL) were evaluated before and at 1 and 3 months after surgery. Intraoperative parameters, and intra- and post-operative complications were recorded. In Group A, we had femtosecond laser-related minor complications in 11 cases (18.3%) and post-operative complications in 2 cases (3.3%); in Group B, we recorded 2 cases (3.3%) of femtosecond laser-related minor complications with no post-operative complications. Mean effective phaco time (EPT) was 5.32 ± 3.68 s in Group A and 4.34 ± 2.39 s in Group B with a significant difference (p = 0.046). We recorded a significant mean BCVA improvement at 3 months in both groups (p < 0.05) and no significant SIA nor corneal pachymetry changes in the two groups during the follow-up (p > 0.05). Finally, we found significant ECL in both groups with a significant difference between the two groups (p = 0.042). FLACS with bimanual technique and low-energy LDV Z8 is associated with a necessary initial learning curve. After the first adjustments in the surgical technique, this technology seems to be safe and effective with rapid visual recovery and it helps surgeons to standardize the crucial steps of cataract surgery.

Initial experience using a femtosecond laser cataract surgery system at a UK National Health Service cataract surgery day care centre

PubMed Central

Dhallu, Sandeep K; Maurino, Vincenzo; Wilkins, Mark R

2016-01-01

Objectives To describe the initial outcomes following installation of a cataract surgery laser system. Setting National Health Service cataract surgery day care unit in North London, UK. Participants 158 eyes of 150 patients undergoing laser-assisted cataract surgery. Interventions Laser cataract surgery using the AMO Catalys femtosecond laser platform. Primary and secondary outcome measures Primary outcome measure: intraoperative complications including anterior and posterior capsule tears. Secondary outcome measures: docking to the laser platform, successful treatment delivery, postoperative visual acuities. Results Mean case age was 67.7±10.8 years (range 29–88 years). Docking was successful in 94% (148/158 cases), and in 4% (6/148 cases) of these, the laser delivery was aborted part way during delivery due to patient movement. A total of 32 surgeons, of grades from junior trainee to consultant, performed the surgeries. Median case number per surgeon was 3 (range from 1–20). The anterior capsulotomy was complete in 99.3% of cases, there were no anterior capsule tears (0%). There were 3 cases with posterior capsule rupture requiring anterior vitrectomy, and 1 with zonular dialysis requiring anterior vitrectomy (4/148 eyes, 2.7%). These 4 cases were performed by trainee surgeons, and were either their first laser cataract surgery (2 surgeons) or their first and second laser cataract surgeries (1 surgeon). Conclusions Despite the learning curve, docking and laser delivery were successfully performed in almost all cases, and surgical complication rates and visual outcomes were similar to those expected based on national data. Complications were predominately confined to trainee surgeons, and with the exception of intraoperative pupil constriction appeared unrelated to the laser-performed steps. PMID:27466243

[A cross-sectional study on the visual disability of the residents in 2006 in Henan province, China].

PubMed

Li, Yin-yin; Zhu, Yu; Li, Zhi-gang; Chen, Ping; Yan, Shao-jun

2009-09-01

To explore the status on visual disability and the leading causes in residents in Henan Province. It was a cross-sectional study and a part of the National Epidemiological Study on the disability in 2006. Sample size 120 000 was assigned to Henan study by the protocol of the National epidemiological study on the disability. Stratified, equal interval, proportional probability; four-stage sampling was adopted. Survey teams were organized, and survey personnel was trained in the sampled counties and cities. Visual disabled persons were screened by home to home visit and confirmed by ophthalmologists. 130 415 persons in 36 923 households were studied. 1973 persons were confirmed to have the visual disability, the prevalence was 1.51%. Among them, 1376 persons just suffer from the visual disability (simple visual disability), 579 persons had multiple disability including the visual disability (multiple disability). Among them, 643 persons (0.49%) were blindness, 1330 persons (1.02%) were low vision. The age of the most of the persons with visual disability was more than 50 years old. The prevalence of the simple visual disability in male and female was 0.77% and 1.36% respectively and had significant statistical difference (chi(2) = 105.687, P < 0.01). The prevalence of the simple visual disability in urban and rural area was 0.58% and 1.15% respectively and also had significant statistical difference (chi(2) = 56.047, P < 0.01). The first five leading causes of the visual disability were cataract (54.69%), retinal and choroidal diseases (8.21%), corneal diseases (5.83%), genetic and congenital eye diseases (5.07%) and glaucoma (4.56%). Government and health organizations should pay more attention to the prevention and treatment the visual disability in Henan province, especially the prevention and treatment of cataract, retinal and choroidal diseases, corneal diseases, genetic and congenital eye diseases and glaucoma.

Microcoaxial torsional cataract surgery 1.8 mm versus 2.2 mm: functional and morphological assessment.

PubMed

Mastropasqua, Leonardo; Toto, Lisa; Vecchiarino, Luca; Di Nicola, Marta; Mastropasqua, Rodolfo

2011-01-01

To compare functional and morphological outcomes of 1.8-mm versus 2.2-mm microincision coaxial cataract surgery (MCCS). Thirty eyes of 30 patients that underwent MCCS were randomized to two groups: 1.8-mm MCCS (group 1: 15 eyes) and 2.2-mm MCCS (group 2: 15 eyes). There were no significant between-group differences in uncorrected visual acuity, best-corrected visual acuity, keratometric astigmatism, and endothelial cell count. One day postoperatively, a greater increase of corneal thickness at the incision site was observed in group 1 compared to group 2 using anterior segment optical coherence tomography with no significant differences in tunnel morphometric features and confocal microscopy showed more tunnel edema in group 1 versus group 2 that resolved in both groups. Both 1.8- and 2.2-mm torsional MCCS were safe and efficient with easy surgical maneuvers and excellent functional and morphological results; 1.8-mm MCCS induced slightly greater tunnel edema shortly after surgery that resolved in the medium term. Copyright 2011, SLACK Incorporated.

The Association of Outdoor Activity and Age-Related Cataract in a Rural Population of Taizhou Eye Study: Phase 1 Report

PubMed Central

Ye, Xiaofang; Wang, Xiaofeng; Cai, Lei; Xu, Jianming; Lu, Yi

2015-01-01

Purpose To study the relationship between outdoor activity and risk of age-related cataract (ARC) in a rural population of Taizhou Eye Study (phrase 1 report). Method A population-based, cross-sectional study of 2006 eligible rural adults (≥45 years old) from Taizhou Eye Study was conducted from Jul. to Sep. 2012. Participants underwent detailed ophthalmologic examinations including uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), intraocular pressure (IOP), slit lamp and fundus examinations as well as questionnaires about previous outdoor activity and sunlight protection methods. ARC was recorded by LOCSⅢ classification system. The prevalence of cortical, nuclear and posterior subcapsular cataract were assessed separately for the risk factors and its association with outdoor activity. Results Of all 2006 eligible participants, 883 (44.0%) adults were diagnosed with ARC. The prevalence rates of cortical, nuclear and posterior subcapsular cataract per person were 41.4%, 30.4% and 1.5%, respectively. Women had a higher tendency of nuclear and cortical cataract than men (OR = 1.559, 95% CI 1.204–2.019 and OR = 1.862, 95% CI 1.456–2.380, respectively). Adults with high myopia had a higher prevalence of nuclear cataract than adults without that (OR = 2.528, 95% CI 1.055–6.062). Multivariable logistic regression revealed that age was risk factor of nuclear (OR = 1.190, 95% CI 1.167–1.213) and cortical (OR = 1.203, 95% CI 1.181–1.226) cataract; eyes with fundus diseases was risk factor of posterior subcapsular cataract (OR = 6.529, 95% CI 2.512–16.970). Outdoor activity was an independent risk factor of cortical cataract (OR = 1.043, 95% CI 1.004–1.083). The risk of cortical cataract increased 4.3% (95% CI 0.4%-8.3%) when outdoor activity time increased every one hour. Furthermore, the risk of cortical cataract increased 1.1% (95% CI 0.1%-2.0%) when cumulative UV-B exposure time increased every one year. Conclusion Outdoor activity was an independent risk factor for cortical cataract, but was not risk factor for nuclear and posterior subcapsular cataract. The risk of cortical cataract increased 4.3% when outdoor activity time increased every one hour. In addition, the risk of cortical cataract increased 1.1% (95% CI 0.1%-2.0%) when cumulative UV-B exposure time increased every one year. PMID:26284359

Effect of the angle of the operating microscope light beam on visual recovery after phacoemulsification: Randomized trial.

PubMed

Harman, Francesca E; Corbett, Melanie C; Stevens, Julian D

2010-08-01

To evaluate differences in visual recovery after phacoemulsification with direct or tilted surgical microscope illumination using a macular photostress test. Western Eye Hospital, Imperial College Health Care National Health Service Trust, London, United Kingdom. This randomized double-masked controlled trial enrolled patients presenting to a daycare unit for single-eye cataract surgery. Inclusion criteria were no ocular pathology other than cataract, corneal keratometric astigmatism less than 1.50 diopters, intended target of emmetropia in the operated eye, and cataract grade 1 to 3 (Lens Opacification Classification System II). Exclusion criteria were an abnormal preoperative photostress test. Patients were randomized to have phacoemulsification with the operating microscope angled 15 degrees nasal to the fovea (study group) or with the operating microscope directly overhead around the optic disc region (control group). The same surgeon performed all phacoemulsification procedures using a standardized technique and topical anesthesia. Outcome measures were uncorrected (UDVA) and corrected (CDVA) distance visual acuity 10 minutes and 60 minutes postoperatively. In the 30 patients evaluated, the mean UDVA 10 minutes postoperatively was 0.40 logMAR +/- 0.26 (SD) in the study group and 0.72 +/- 0.36 logMAR in the control group (P<.01). The mean CDVA was 0.18 +/- 0.26 logMAR and 0.44 +/- 0.30 logMAR, respectively (P = .016). There was no significant between-group difference in acuity at 60 minutes. Tilting the microscope beam away from the fovea resulted in faster visual recovery and less macular photic stress. No author has a financial or proprietary interest in any material or method mentioned. Copyright 2010 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Clinical and electrophysiologic results after intracameral lidocaine 1% anesthesia: a prospective randomized study.

PubMed

Anders, N; Heuermann, T; Rüther, K; Hartmann, C

1999-10-01

To evaluate the efficacy and safety of intracameral lidocaine in cataract surgery compared to peribulbar anesthesia. A prospective, randomized, controlled study. A total of 200 consecutive cataract patients (200 eyes) participated. Eyes were randomly assigned to two groups: one group received 0.15 ml intracameral 1% unpreserved lidocaine combined with topical anesthesia (oxybuprocaine); the other group received 6 ml prilocaine peribulbar before phacoemulsification with sclerocorneal tunnel incision. Duration of surgery was measured; implicit time and amplitudes of the b-waves of the photopic electroretinogram (ERG) potentials (single-flash ERG and the 30-Hz flicker ERG) were recorded; frequencies of intraoperative problems, complications, intraoperative, and postoperative pain were evaluated. After lidocaine anesthesia combined with topical anesthesia, similar complications were found, longer operation time (P < 0.001), and significantly better visual acuity immediately after surgery (P < 0.001). The ERG amplitudes were not significantly reduced after 0.15-ml intracameral lidocaine half an hour after surgery (P > 0.05). Intracameral lidocaine 1% combined with topical anesthesia can be recommended as an alternative procedure to peribulbar anesthesia in cataract surgery with corneoscleral tunnel incision.

Rhegmatogenous retinal detachments associated to Stickler syndrome in a tertiary eye care center in Saudi Arabia.

PubMed

Alshahrani, Saeed T; Ghazi, Nicola G; Al-Rashaed, Saba

2016-01-01

To investigate the clinical findings and outcomes of rhegmatogenous retinal detachment (RRD) in Stickler syndrome on affected and fellow eyes that underwent prophylactic retinopexy. Chart review of 70 eyes (62 patients). Incidence of RRD, postoperative visual acuity, and risk factors were evaluated. Twenty-two patients (35%) had RRD in the fellow eye, 37% of the eyes had cataract, 93% had macular detachment, 50% had proliferative vitreoretinopathy, and 41% had posterior vitreous detachment. Success rates were: 60% of patients after scleral buckling; 57.1% after pars plana vitrectomy; and 75% after combined scleral buckling and pars plana vitrectomy. Sixty-one (93.8%) of patients had successful surgery (including second surgery). Silicone oil tamponade was significantly associated with final anatomic outcome, with a protective odds ratio of 0.11 (P=0.027). Visual acuity improved in 54% of eyes and decreased in 5%. Statistically significant associations were present for eyes with final visual acuity ≥20/200, and total retinal detachment (P<0.001); preoperative cataract (P=0.023); and proliferative vitreoretinopathy (P<0.001). RRD developed in 16/44 eyes despite laser prophylaxis. Prophylactic retinopexy was not beneficial for Stickler syndrome patients. Success of primary surgery for RRD remains low. The primary surgery should be vitrectomy combined with scleral buckling and silicone oil tamponade.

The Oculist's Eye: Connections between Cataract Couching, Anatomy, and Visual Theory in the Renaissance.

PubMed

Baker, Tawrin

2017-01-01

We now know that cataract couching involves depressing an occluded crystalline lens to the bottom of the vitreous chamber, but from the time of Galen until the seventeenth-century cataracts were thought to be separate concretions arising between the crystalline lens and the pupil. From Antiquity through the Renaissance, the combination of visual theory in which the crystalline humor is the author of vision, and surgical experience—that couching cataracts restored some degree of sight—resulted in anatomists depicting a large space between the crystalline lens and the pupil. In the Renaissance, oculists—surgical specialists with little higher education or connections to learned surgery or medicine—overwhelmingly performed eye surgeries. This article examines how the experience and knowledge of oculists, of barber-surgeons, and of learned surgeons influenced one another on questions of anatomy, visual theory, and surgical experience. By analyzing the writings of the oculist George Bartisch (c. 1535–1607), the barber-surgeon Ambroise Paré (1510–1590), and the learned surgeon Hieronymus Fabricius ab Aquapendente (1533–1619), we see that the oculists’ understanding of the eye—an eye constructed out of the probing, tactile experience of eye surgery—slowly lost currency among the learned toward the beginning of the seventeenth century.

Topical ketorolac tromethamine 0.5% ophthalmic solution in ocular inflammation after cataract surgery.

PubMed

Solomon, K D; Cheetham, J K; DeGryse, R; Brint, S F; Rosenthal, A

2001-02-01

To compare the efficacy and safety of ketorolac 0.5% ophthalmic solution with its vehicle in the treatment of ocular inflammation after cataract surgery and intraocular lens implantation. Multicenter clinical study. One hundred four patients were prospectively randomized, 52 patients in treatment group, 52 patients in control group. Patients received either ketorolac or vehicle four times daily in the operated eye for 14 days starting the day after surgery in a prospective, double-masked, randomized, parallel group study. Only patients with moderate or greater postoperative inflammation the day after surgery were enrolled. The main outcome measures include inflammation (cell, flare, ciliary flush), intraocular pressure and visual acuity. Ketorolac was significantly more effective than vehicle in reducing the manifestations of postoperative ocular inflammation, including: anterior chamber cells (P: = 0.002) and flare (P: = 0.009), conjunctival erythema (P: = 0.010), ciliary flush (P: = 0.022), photophobia (P: = 0.027), and pain (P: = 0.043). Five times as many patients were dropped from the study for lack of efficacy from the vehicle group (22/52) than from the ketorolac group (4/52; P: = 0.001). Ketorolac was found to be equally as safe as vehicle in terms of adverse events, changes in visual acuity, intraocular pressure, and biomicroscopic and ophthalmoscopic variables. Ketorolac tromethamine 0.5% ophthalmic solution was significantly more effective than vehicle in the treatment of moderate or greater ocular inflammation following routine cataract surgery, while being as safe as vehicle.

Surgical outcomes of 23-gauge transconjunctival pars plana vitrectomy combined with lensectomy for glaucomatous eyes with extremely shallow anterior chamber and cataract.

PubMed

Zhang, Zhaotian; Zhang, Shaochong; Jiang, Xintong; Qiu, Suo; Wei, Yantao

2016-01-04

Glaucoma combined with an extremely shallow anterior chamber and cataracts remains as a complex condition to deal with. And the emergence of microincision vitrectomy surgery (MIVS) system may provide an ideal option for the treatment of that. We report a clinical study of surgical outcomes of 23-gauge transconjunctival pars plana vitrectomy (PPV) combined with lensectomy in the treatment of glaucomatous eyes with extremely shallow anterior chamber and cataract. Prospective, nonrandomized and noncomparative case series study. Consecutive patients with secondary glaucoma, extremely shallow anterior chamber and cataract were recruited to have combined surgeries of 23-gauge transconjunctival pars plana vitrectomy and lensectomy. The main outcomes were best corrected visual acuity (BCVA), intraocular pressure (IOP), anterior chamber depth (ACD), number of anti-glaucoma medications and surgery-associated complications. Seventeen consecutive patients with secondary glaucoma, extremely shallow anterior chamber and cataract were recruited. The mean follow-up was 21.2 ± 8.8 months. Postoperatively, there was no significant improvement of BCVA (P = 0.25). The mean intraocular (IOP) decreased significantly from 43.14 ± 6.53 mmHg to 17.29 ± 1.80 mmHg (P < 0.001), and the mean depth of anterior chamber increased significantly from 0.507 ± 0.212 mm to 3.080 ± 0.313 mm (P < 0.001). The mean number of anti-glaucoma medications decreased from 4.1 ± 0.8 to 0.6 ± 0.8 (P < 0.001). No severe vision-threatening intra- or post-operative complications occurred. Glaucoma with an extremely shallow anterior chamber and cataract can be managed well with the combined surgeries of 23-gauge pars plana vitrectomy and lensectomy. The surgical procedure is an effective and safe method to resolve the pupillary block and deepen the anterior chamber.

Cost-Utility Analyses of Cataract Surgery in Advanced Age-Related Macular Degeneration

PubMed Central

Ma, Yingyan; Huang, Jiannan; Zhu, Bijun; Sun, Qian; Miao, Yuyu; Zou, Haidong

2016-01-01

ABSTRACT Purpose To explore the cost-utility of cataract surgery in patients with advanced age-related macular degeneration (AMD). Methods Patients who were diagnosed as having and treated for age-related cataract and with a history of advanced AMD at the Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, were included in the study. All of the participants underwent successful phacoemulsification with foldable posterior chamber intraocular lens implantation under retrobulbar anesthesia. Best-corrected visual acuity (BCVA) and utility value elicited by time trade-off method from patients at 3-month postoperative time were compared with those before surgery. Quality-adjusted life years (QALYs) gained in a lifetime were calculated at a 3% annual discounted rate. Costs per QALY gained were calculated using the bootstrap method, and probabilities of being cost-effective were presented using a cost-effectiveness acceptability curve. Sensitivity analyses were performed to test the robustness of the results. Results Mean logarithm of the minimum angle of resolution BCVA in the operated eye increased from 1.37 ± 0.5 (Snellen, 20/469) to 0.98 ± 0.25 (Snellen, 20/191) (p < 0.001); BCVA in the weighted average from both eyes (=75% better eye + 25% worse eye) was changed from 1.13 ± 0.22 (Snellen, 20/270) to 0.96 ± 0.17 (Snellen, 20/182) (p < 0.001). Utility values from both patients and doctors increased significantly after surgery (p < 0.001 and p = 0.007). Patients gained 1.17 QALYs by cataract surgery in their lifetime. The cost per QALY was 8835 Chinese yuan (CNY) (1400 U.S. dollars [USD]). It is cost-effective at the threshold of 115,062 CNY (18,235 USD) per QALY in China recommended by the World Health Organization. The cost per QALY varied from 7045 CNY (1116 USD) to 94,178 CNY (14,925 USD) in sensitivity analyses. Conclusions Visual acuity and quality of life assessed by utility value improved significantly after surgery. Cataract surgery was a cost-effective intervention for patients with coexistent AMD. PMID:26605501

Quality of life and visual function in Nigeria: findings from the National Survey of Blindness and Visual Impairment.

PubMed

Tran, Hang My; Mahdi, Abdull M; Sivasubramaniam, Selvaraj; Gudlavalleti, Murthy V S; Gilbert, Clare E; Shah, Shaheen P; Ezelum, C C; Abubakar, Tafida; Bankole, Olufunmilayo O

2011-12-01

To assess associations of visual function (VF) and quality of life (QOL) by visual acuity (VA), causes of blindness and types of cataract procedures in Nigeria. Multi-stage stratified cluster random sampling was used to identify a nationally representative sample of persons aged ≥ 40 years. VF/QOL questionnaires were administered to participants with VA <6/60 in one or both eyes and/or Mehra-Minassian cataract grade 2B or 3 in one or both eyes and a random sample of those with bilateral VA ≥ 6/12. VF/QOL questionnaires were administered to 2076 participants. Spearman's rank correlation showed a strong correlation between decreasing VA and VF/QOL scores (p<0.0001) with greatest impact on social (p<0.0001) and mobility-related activities (p<0.0001). People who were blind due to glaucoma had lower VF and QOL scores than those who were blind due to cataract. Mean VF and QOL scores were lower after couching compared with conventional cataract surgery (mean VF score=51.0 vs 63.0 and mean QOL score=71.3 vs 79.3). Finally, VF and QOL scores were lower among populations with specific characteristics. Populations with the following characteristics should be targeted to improve VF and QOL: people who are blind, older people, women, manual labourers, people living in rural areas, those living in the northern geopolitical zones, those practising Islamic and Traditionalism faith, those not currently married and those who have undergone couching.

Choroidal neovascularization in highly myopic eyes after cataract surgery.

PubMed

Hayashi, Kengo; Ohno-Matsui, Kyoko; Futagami, Soh; Ohno, Seiji; Tokoro, Takashi; Mochizuki, Manabu

2006-01-01

To determine the incidence and characteristics of choroidal neovascularization (CNV) in patients with high myopia (>or=8 diopters) who underwent cataract surgery in the Department of Ophthalmology, Tokyo Medical and Dental University, or the Ohno Eye Clinic, Tokyo, between September 1991 and March 2000. The medical records of 35 patients (48 eyes) who underwent cataract surgery with phacoemulsification and intraocular lens implantation were studied retrospectively. The development of CNV over a 4-year follow-up period, and its characteristics were determined. All of the eyes had received a comprehensive ophthalmological examination, including best-corrected visual acuity measurements, anterior segment biomicroscopy, and a dilated fundus examination by stereoscopic observation. CNV was found in six eyes (12.5%) of six patients. The mean interval between cataract surgery and the development of CNV was 34+/-17 months (range, 12-48 months). The CNV was subfoveal in all cases. The mean logarithm of the minimum angle of resolution (logMAR) after cataract surgery and before the appearance of CNV was 0.23+/-0.24, and 0.93+/-0.41 after the CNV appeared. This decrease was statistically significant (P=0.0008, paired Student t test). Subfoveal CNV developed more frequently in eyes when the fellow eye showed evidence of CNV preoperatively (40.0%) than in eyes when the fellow eye exhibited no evidence of CNV (9.3%). CNV developed in 12.5% of patients with high myopia after cataract surgery. CNV tended to develop more frequently when the fellow eye had CNV. Copyright (c) Japanese Ophthalmological Society 2006.

Estrogen Protects Lenses against Cataract Induced by Transforming Growth Factor-β (TGFβ)

PubMed Central

Hales, Angela M.; Chamberlain, Coral G.; Murphy, Christopher R.; McAvoy, John W.

1997-01-01

Cataract, already a major cause of visual impairment and blindness, is likely to become an increasing problem as the world population ages. In a previous study, we showed that transforming growth factor-β (TGFβ) induces rat lenses in culture to develop opacities and other changes that have many features of human subcapsular cataracts. Here we show that estrogen protects against cataract. Lenses from female rats are more resistant to TGFβ-induced cataract than those from males. Furthermore, lenses from ovariectomized females show increased sensitivity to the damaging effects of TGFβ and estrogen replacement in vivo, or exposure to estrogen in vitro, restores resistance. Sex-dependent and estrogen-related differences in susceptibility to cataract formation, consistent with a protective role for estrogen, have been noted in some epidemiological studies. The present study in the rat indicates that estrogen provides protection against cataract by countering the damaging effects of TGFβ. It also adds to an increasing body of evidence that hormone replacement therapy protects postmenopausal women against various diseases. PMID:9016876

The global burden of cataract.

PubMed

Rao, Gullapalli N; Khanna, Rohit; Payal, Abhishek

2011-01-01

To review the previous year's literature related to prevalence of blindness in general, blindness due to cataract, cataract surgical coverage (CSC) and cataract surgical rates (CSRs). Cataracts are the major cause of blindness and visual impairment in developing countries and contributes to more than 90% of the total disability adjusted life years. This review shows that coverage continues to be a problem in many countries, especially for the female population, those residing in rural areas and those who are illiterate. Although CSR is an indicator of the availability and acceptability of services, for measuring the impact of the program, we should look at combining CSR with CSC. This strategy would also enable us achieve our goal of eliminating avoidable blindness due to cataracts by the year 2020. Cataracts still continue- to be a major cause of blindness globally and with the rapidly aging population, it is a challenge to tackle. We need to plan a comprehensive strategy addressing issues related to availability, affordability, accessibility and acceptability of eye-care services.

Comparison of the efficacy and patients’ tolerability of Nepafenac and Ketorolac in the treatment of ocular inflammation following cataract surgery: A meta-analysis of randomized controlled trials

PubMed Central

Zhao, Xinyu; Xia, Song; Wang, Erqian

2017-01-01

As a new ophthalmic non-steroidal anti-inflammatory drug (NSAID) with prodrug structure, Nepafenac was supposed to have a better efficacy than conventional NSAIDs both in patients’ tolerability and ocular inflammation associated with cataract surgery. However, many current studies reached contradictory conclusions on the superiority of Nepafenac over Ketorolac. The objective of our study is to evaluate the efficacy and patients’ tolerability of Nepafenac and Ketorolac following cataract surgery. To clarify this, we conducted a meta-analysis of randomized controlled trials. Eleven articles were included in this study. The dataset consisted of 1165 patients, including 1175 cataract surgeries. Among them, 574 patients were in the Nepafenac group and 591 in the Ketorolac group. Our analysis indicated that these two drugs were equally effective in controlling post cataract surgery ocular inflammation, reducing macular edema, achieving a better visual ability and maintaining intraoperative mydriasis during cataract surgery. However, Nepafenac was more effective than Ketorolac in reducing the incidence of postoperative conjunctival hyperemia and ocular discomfort. This meta-analysis indicated that topical Nepafenac is superior to Ketorolac in patients’ tolerability following cataract surgery. However, these two drugs are equally desirable in the management of anterior chamber inflammation, visual rehabilitation and intraoperative mydriasis. Given the limitations in our study, more researches with larger sample sizes and focused on more specific indicators such as peak aqueous concentrations of drugs or PEG2 levels are required to reach a firmer conclusion. PMID:28253334

The willingness to pay for wait reduction: the disutility of queues for cataract surgery in Canada, Denmark, and Spain.

PubMed

Bishai, D M; Lang, H C

2000-03-01

We estimate demand curves for a one month reduction in waiting time for cataract surgery based on survey data collected in 1992 in Manitoba, Barcelona, and Denmark. Patients answered, "Would you be willing to pay [Bid, B] to reduce your waiting time for cataract surgery to less than one month?" Controlling for SES and visual status, Barcelonan patients have greater WTP for shortened waiting time than the Danes and Manitobans. We estimate the value (in 1992 $) of lost consumer surplus due to the cataract surgery queue at $128 per patient in Manitoba, $160 in Denmark, and $243 in Barcelona.

Rapid assessment of cataract surgical coverage in rural Zululand.

PubMed

Rotchford, A P; Johnson, G J

2000-10-01

Cataract surgical coverage (CSC) is a useful indicator of the degree of success of a cataract intervention programme. However, because previously described methods are time-consuming and labour-intensive, they are rarely performed. This study describes a simple and inexpensive assessment of CSC based on screening of pensioners at pension delivery sites in a rural district. Random cluster-based cross-sectional survey. State pension distribution sites in Hlabisa, a rural district in KwaZulu-Natal, South Africa. 562 old-age pensioners. Subjects found to be blind (visual acuity < 3/60) and those reporting a history of eye surgery were examined using a torch and direct ophthalmoscope by an ophthalmologist. Cases of blindness due to operable cataract and post-cataract surgical subjects were identified. CSC was found to be 38.5% (95% confidence interval 29.1-47.9%). Blindness prevalence was 10.3%, with 69.0% due to cataract.

Prevalence of blindness and cataract surgery in Gandaki Zone, Nepal

PubMed Central

Sapkota, Y D; Pokharel, G P; Nirmalan, P K; Dulal, S; Maharjan, I M; Prakash, K

2006-01-01

Background/aim Himalaya Eye Hospital (HEH), established in 1993, is rendering eye care services in the Gandaki and Dhaulagiri zones. The hospital has extensive community outreach activities along with services for outpatients, emergencies, and subspecialties such as vitreoretinal, paediatric, and low vision. The operation theatre is well equipped to match the surgical needs including phaco surgery for cataract. The hospital has performed more than 14 000 cataract surgeries and 250 000 treatment services during this period. The aim of this study was to estimate the prevalence of blindness, visual impairment, and cataract surgical coverage among the older adult population of three districts of Gandaki Zone, where 80% of the hospital's service recipients reside. Methods People aged 45 years and older were enrolled in the study using a stratified cluster design. Subjects in 25 randomly selected clusters from the listed 806 were recruited through door to door visits. Each recruited subject had visual acuity (VA) and clinical examination conducted by an ophthalmologist. The survey was preceded by pre‐pilot and pilot studies to refine the operational method. To assess quality assurance the interobserver variation in VA measurement was also carried out in five different clusters. Results Out of 5863 selected subjects 85.3% were examined. Blindness defined as presenting VA <6/60 in both eyes was found in 2.6% (95% confidence interval (CI): 2.2 to 3.9), whereas 16.8% individuals examined had vision <6/19 in one or both eyes. Cataract was the principal cause of blindness in 60.5%, and refractive error was the dominant cause of vision impairment (<6/19) 83.3%. Cataract surgical coverage was 59.5% among the cataract blind and associated with younger age, literacy, and male sex. Conclusion The finding suggests a positive impact of the HEH programme on the prevalence of blindness and cataract surgical services in the survey area. Strategies to further improve access and utilisation of facilities and increase cataract surgical coverage need to be developed. PMID:16547315

A longitudinal cohort study of the impact of first- and both-eye cataract surgery on falls and other injuries in Vietnam

PubMed Central

To, Kien Gia; Meuleners, Lynn; Bulsara, Max; Fraser, Michelle L; Duong, Dat Van; Do, Dung Van; Huynh, Van-Anh Ngoc; Phi, Tien Duy; Tran, Hoang Huy; Nguyen, Nguyen Do

2014-01-01

Aim Little information exists on the impact of cataract surgery on falls and other injuries in Vietnam. The aim of this study was to determine the impact of first and both eye cataract surgery on the number of falls and other injuries among bilateral cataract patients in Ho Chi Minh City, Vietnam. Materials and methods A longitudinal cohort study was conducted involving 413 bilateral cataract patients aged 50+ years. Participants were assessed at three time points: 1 week before, 1–3 months after, and 1 year after first-eye cataract surgery. Visual measures (visual acuity, contrast sensitivity and stereopsis) were taken, and self-reported falls and injury data were collected. A multilevel longitudinal Poisson regression model was used to investigate change in the number of falls after surgery. Results The risk of falls decreased by 78% (incidence-rate ratio [IRR] 0.22, 95% confidence interval [CI] 0.06–0.77; P=0.018) in the year after cataract surgery for participants who had first-eye surgery only and 83% (IRR 0.17, 95% CI 0.04–0.69; P=0.012) for participants who had the second eye operated on compared to before surgery. The risk of falls was three times higher for females than males (IRR 3.13, 95% CI 1.53–6.40; P=0.002). Improved binocular contrast sensitivity was also associated with a decrease in falls (IRR 0.40, 95% CI 0.17–0.97; P=0.042). The prevalence of other injuries also decreased after cataract surgery. Conclusion Cataract surgery reduced the number of falls and other injuries in Vietnam. Contrast sensitivity may be important for ophthalmologists to consider when prioritizing patients for surgery and assessing their fall risk. PMID:24812501

Willingness to pay for cataract surgery is much lower than actual costs in Zamfara state, northern Nigeria.

PubMed

Ibrahim, Nazaradden; Ramke, Jacqueline; Pozo-Martin, Francisco; Gilbert, Clare E

2018-06-01

Direct medical and non-medical costs incurred by those undergoing subsidised cataract surgery at Gusau eye clinic, Zamfara state, were recently determined. The aim of this study was to assess the willingness to pay for cataract surgery among adults with severe visual impairment or blindness from cataract in rural Zamfara and to compare this to actual costs. In three rural villages served by Gusau eye clinic, key informants helped identify 80 adults with bilateral severe visual impairment or blindness (<6/60), with cataract being the cause in at least one eye. The median amount participants were willing to pay for cataract surgery was determined. The proportion willing to pay actual costs of the (i) subsidised surgical fee (US$18.5), (ii) average non-medical expenses (US$25.2), and (iii) average total expenses (US$51.2) at Gusau eye clinic were calculated. Where participants would seek funds for surgery was determined. Among 80 participants (38% women), most (n = 73, 91%) were willing to pay something, ranging from

American Society of Anesthesiologists classification in cataract surgery: Results from the Ophthalmic Surgery Outcomes Data Project.

PubMed

Payal, Abhishek R; Sola-Del Valle, David; Gonzalez-Gonzalez, Luis A; Cakiner-Egilmez, Tulay; Chomsky, Amy S; Vollman, David E; Baze, Elizabeth F; Lawrence, Mary; Daly, Mary K

2016-07-01

To explore the association of American Society of Anesthesiologists (ASA) classification with cataract surgery outcomes. Five Veterans Affairs Medical Centers, United States. Retrospective observational cohort study. The study analyzed the outcomes of cataract surgery cases. Corrected distance visual acuity (CDVA), unanticipated events, and vision-related quality of life (VRQL) were assessed using the National Eye Institute Visual Function Questionnaire (NEI-VFQ), comparing ASA classes I through IV. For some analyses, ASA classes I and II were designated as Group A and ASA classes III and IV were designated Group B. Of the 4923 cases, 875 (17.8%) were in Group A, 4032 (81.9%) were in Group B, and 16 (0.3%) had missing data. The mean CDVA and mean composite NEI-VFQ score improved after cataract surgery in both groups (P < .0001); however, Group A had a better mean postoperative CDVA and postoperative VFQ composite scores than Group B (P < .0001, both outcomes). A higher ASA class was associated with an increased risk for 2 unanticipated events; that is, clinically significant macular edema (CSME) (Group A: 4 [0.47%] versus Group B: 50 [1.28%]; adjusted odds ratio [OR], 3.02; 95% confidence interval [CI], 1.02-13.05; P = 0.04) and readmission to the hospital within 30 days (2 [0.23%] versus 56 [1.41%]; OR, 8.26; 95% CI, 1.71-148.62; P = .004) CONCLUSIONS: Among United States veterans, the ASA classification could be an important predictor of VRQL and visual outcomes. In this cohort, it was associated with an increased risk for 2 serious unanticipated events-CSME and readmission to the hospital-both costly, unwanted outcomes. Dr. Vollman is a consultant to Forsight Vision5. None of the authors has a financial or proprietary interest in any material or method mentioned. Copyright © 2016 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Visual Function in Geriatric Eye Disease

ERIC Educational Resources Information Center

Faye, Eleanor E.

1971-01-01

Visual functioning, treatment, and helpful low vision aids are discussed in relation to four major eye diseases of the elderly: cataract, macular degeneration, glaucoma, and diabetic retinopathy. (KW)

Effectiveness and safety of combined cataract surgery and microhook ab interno trabeculotomy in Japanese eyes with glaucoma: report of an initial case series.

PubMed

Tanito, Masaki; Ikeda, Yoshifumi; Fujihara, Etsuko

2017-11-01

To report the early postoperative results and safety profile of ab interno microhook trabeculotomy (μLOT) combined with cataract surgery. This retrospective observational case series included 68 consecutive glaucomatous eyes of 23 Japanese men and 25 Japanese women [mean (SD) age, 76.0 ± 8.5 years] who underwent μLOT for intraocular pressure (IOP) and visually relevant cataracts. The LOT site/extent, perioperative complications, and complication treatments were collected from the medical and surgical records. The preoperative and postoperative IOP, numbers of antiglaucoma medications, logarithm of the minimum angle of resolution visual acuity (VA), anterior chamber (AC) flare, and corneal endothelial cell density (CECD) were compared. After small incisional cataract surgery, the trabecular meshwork was incised in the nasal (6 eyes, 3.6 ± 0.5 clock hours), temporal (6 eyes, 3.8 ± 0.8 clock hours), or both nasal and temporal (56 eyes, 6.5 ± 0.6 clock hours) angles. The mean preoperative IOP (16.4 ± 2.9 mmHg) and number of antiglaucoma medications (2.4 ± 1.2) decreased significantly (P < 0.0001 and P = 0.0039, respectively) to 11.8 ± 4.5 and 2.1 ± 1.0 mmHg at 9.5 months postoperatively. Compared with the preoperative conditions, the final VA improved (P = 0.0002), the AC flare increased by 6.3 pc/ms (P = 0.0157), and the CECD decreased by 6% (P = 0.0005). Hyphema with niveau formation (28 eyes, 41%) and hyphema washout (6 eyes, 9%) were the most common postoperative complication and intervention, respectively. At the final visit, 54 eyes (79%) had achieved successful IOP control of 15 mmHg or less and IOP reduction of 15% or greater. Combined μLOT and cataract surgery improves IOP and VA during the early postoperative period in patients with glaucoma and cataract.

The Effect of Early Visual Deprivation on the Neural Bases of Auditory Processing.

PubMed

Guerreiro, Maria J S; Putzar, Lisa; Röder, Brigitte

2016-02-03

Transient congenital visual deprivation affects visual and multisensory processing. In contrast, the extent to which it affects auditory processing has not been investigated systematically. Research in permanently blind individuals has revealed brain reorganization during auditory processing, involving both intramodal and crossmodal plasticity. The present study investigated the effect of transient congenital visual deprivation on the neural bases of auditory processing in humans. Cataract-reversal individuals and normally sighted controls performed a speech-in-noise task while undergoing functional magnetic resonance imaging. Although there were no behavioral group differences, groups differed in auditory cortical responses: in the normally sighted group, auditory cortex activation increased with increasing noise level, whereas in the cataract-reversal group, no activation difference was observed across noise levels. An auditory activation of visual cortex was not observed at the group level in cataract-reversal individuals. The present data suggest prevailing auditory processing advantages after transient congenital visual deprivation, even many years after sight restoration. The present study demonstrates that people whose sight was restored after a transient period of congenital blindness show more efficient cortical processing of auditory stimuli (here speech), similarly to what has been observed in congenitally permanently blind individuals. These results underscore the importance of early sensory experience in permanently shaping brain function. Copyright © 2016 the authors 0270-6474/16/361620-11$15.00/0.

The prevalence of visual impairment and blindness in underserved rural areas: a crucial issue for future.

PubMed

Hashemi, H; Yekta, A; Jafarzadehpur, E; Doostdar, A; Ostadimoghaddam, H; Khabazkhoob, M

2017-08-01

PurposeTo determine the prevalence of visual impairment and blindness in underserved Iranian villages and to identify the most common cause of visual impairment and blindness.Patients and methodsMultistage cluster sampling was used to select the participants who were then invited to undergo complete examinations. Optometric examinations including visual acuity, and refraction were performed for all individuals. Ophthalmic examinations included slit-lamp biomicroscopy and ophthalmoscopy. Visual impairment was determined according to the definitions of the WHO and presenting vision.ResultsOf 3851 selected individuals, 3314 (86.5%) participated in the study. After using the exclusion criteria, the present report was prepared based on the data of 3095 participants. The mean age of the participants was 37.6±20.7 years (3-93 years). The prevalence of visual impairment and blindness was 6.43% (95% confidence interval (CI): 3.71-9.14) and 1.18% (95% CI: 0.56-1.79), respectively. The prevalence of visual impairment varied from 0.75% in participants aged less than 5 years to 38.36% in individuals above the age of 70 years. Uncorrected refractive errors and cataract were the first and second leading causes of visual impairment; moreover, cataract and refractive errors were responsible for 35.90 and 20.51% of the cases of blindness, respectively.ConclusionThe prevalence of visual impairment was markedly high in this study. Lack of access to health services was the main reason for the high prevalence of visual impairment in this study. Cataract and refractive errors are responsible for 80% of visual impairments which can be due to poverty in underserved villages.

[Visual impairment and blindness in children in a Malawian school for the blind].

PubMed

Schulze Schwering, M; Nyrenda, M; Spitzer, M S; Kalua, K

2013-08-01

The aim of this study was to determine the anatomic sites of severe visual impairment and blindness in children in an integrated school for the blind in Malawi, and to compare the results with those of previous Malawian blind school studies. Children attending an integrated school for the blind in Malawi were examined in September 2011 using the standard WHO/PBL eye examination record for children with blindness and low vision. Visual acuity [VA] of the better eye was classified using the standardised WHO reporting form. Fifty-five pupils aged 6 to 19 years were examined, 39 (71 %) males, and 16 (29 %) females. Thirty eight (69%) were blind [BL], 8 (15 %) were severely visually impaired [SVI], 8 (15 %) visually impaired [VI], and 1 (1.8 %) was not visually impaired [NVI]. The major anatomic sites of visual loss were optic nerve (16 %) and retina (16 %), followed by lens/cataract (15 %), cornea (11 %) and lesions of the whole globe (11 %), uveal pathologies (6 %) and cortical blindness (2 %). The exact aetiology of VI or BL could not be determined in most children. Albinism accounted for 13 % (7/55) of the visual impairments. 24 % of the cases were considered to be potentially avoidable: refractive amblyopia among pseudophakic patients and corneal scaring. Optic atrophy, retinal diseases (mostly albinism) and cataracts were the major causes of severe visual impairment and blindness in children in an integrated school for the blind in Malawi. Corneal scarring was now the fourth cause of visual impairment, compared to being the commonest cause 35 years ago. Congenital cataract and its postoperative outcome were the commonest remedial causes of visual impairment. Georg Thieme Verlag KG Stuttgart · New York.

The ageing lens and cataract: a model of normal and pathological ageing

PubMed Central

Michael, R.; Bron, A. J.

2011-01-01

Cataract is a visible opacity in the lens substance, which, when located on the visual axis, leads to visual loss. Age-related cataract is a cause of blindness on a global scale involving genetic and environmental influences. With ageing, lens proteins undergo non-enzymatic, post-translational modification and the accumulation of fluorescent chromophores, increasing susceptibility to oxidation and cross-linking and increased light-scatter. Because the human lens grows throughout life, the lens core is exposed for a longer period to such influences and the risk of oxidative damage increases in the fourth decade when a barrier to the transport of glutathione forms around the lens nucleus. Consequently, as the lens ages, its transparency falls and the nucleus becomes more rigid, resisting the change in shape necessary for accommodation. This is the basis of presbyopia. In some individuals, the steady accumulation of chromophores and complex, insoluble crystallin aggregates in the lens nucleus leads to the formation of a brown nuclear cataract. The process is homogeneous and the affected lens fibres retain their gross morphology. Cortical opacities are due to changes in membrane permeability and enzyme function and shear-stress damage to lens fibres with continued accommodative effort. Unlike nuclear cataract, progression is intermittent, stepwise and non-uniform. PMID:21402586

Use of traditional cooking fuels and the risk of young adult cataract in rural Bangladesh: a hospital-based case-control study

PubMed Central

2011-01-01

Background This study aimed to investigate the independent relationship between the use of various traditional biomass cooking fuels and the occurrence of cataract in young adults in rural Bangladesh. Methods A hospital-based age- and sex-matched case-control study incorporating two control groups was conducted. Cases were cataract patients aged 18 and 49 years diagnosed on the basis of any opacity of the crystalline lens or its capsule and visual acuity poorer than 6/18 on the Log Mar Visual Acuity Chart in either eye, or who had a pseudophakic lens as a result of cataract surgery within the previous 5 years. Non-eye-disease (NE) controls were selected from patients from ENT or Orthopaedics departments and non-cataract eye-disease (NC) controls from the Ophthalmology department. Data pertaining to history of exposure to various cooking fuels and to established risk factors for cataract were obtained by face-to-face interview and analyzed using conditional logistic regression. Results Clean fuels were used by only 4% of subjects. A majority of males (64-80% depending on group) had never cooked, while the rest had used biomass cooking fuels, mainly wood/dry leaves, with only 6 having used rice straw and/or cow dung. All females of each group had used wood/dry leaves for cooking. Close to half had also used rice straw and/or cow dung. Among females, after controlling for family history of cataract and education and combining the two control groups, case status was shown to be significantly related to lifetime exposure to rice straw, fitted as a trend variable coded as never, ≤ median of all exposed, > median of all exposed (OR = 1.52, 95%CI 1.04-2.22), but not to lifetime exposure to wood/dry leaves. Case status among females showed an inverse association with ever use of cow dung as a cooking fuel (OR 0.43, 95%CI 0.22-0.81). Conclusions In this population, where cooking is almost exclusively done using biomass fuels, cases of young adult cataract among females were more likely to have had an increased lifetime exposure to cooking with rice straw fuel and not to have cooked using cow dung fuel. There is a possibility that these apparent associations could have been the result of uncontrolled founding, for instance by wealth. The nature of the associations, therefore, needs to be further investigated. PMID:21679452

The South Asian cataract management study: complications, vision outcomes, and corneal endothelial cell loss in a randomized multicenter clinical trial comparing intracapsular cataract extraction with and without anterior chamber intraocular lens implantation.

PubMed

Snellingen, T; Shrestha, J K; Huq, F; Husain, R; Koirala, S; Rao, G N; Pokhrel, R P; Kolstad, A; Upadhyay, M P; Apple, D J; Arnesen, E; Cheng, H; Olsen, E G; Vogel, M

2000-02-01

To determine clinical outcomes of primary intracapsular cataract surgery with and without implantation of anterior chamber lenses. A multicenter randomized clinical trial. One thousand two hundred twenty-nine male and female patients 40-75 years of age with senile cataract. Study patients were recruited from screening eye camps and outpatient clinics. Randomization to the two treatment groups was performed after screening for predetermined inclusion and exclusion criteria. Demographics, visual acuity, intraocular pressures, and corneal endothelial cell data were recorded before surgery and at 6 weeks, 12 months, and 24 months after surgery. Monitoring of the study was secured by a standardized image documentation procedure on all patients using the IMAGEnet digital imaging system. Analysis of corneal endothelial cell images was performed with the Cell Soft software (Topcon Corporation, Japan). Visual acuity and central corneal endothelial cell loss. The patients were randomized to intraocular lens (IOL; n = 616) and no IOL (n = 613) implantation. Surgical complications were reported in 177 (14.4%) patients (IOL = 14.8%; no IOL = 14.0%). The most frequent complication observed was vitreous loss which occurred in 10.3% of eyes (IOL = 11.2%; no IOL = 9.5%). At the final examination (2 years after surgery), 88% of the operated eyes had a best corrected vision of 6/18 or better (IOL = 88.8%; no IOL = 86.6%). Analysis of corneal endothelial cell data showed a small but significantly greater cell loss 6 weeks after surgery in eyes with IOL compared with those without IOL, but no overall difference was found between the treatment groups in the long term follow-up. The findings indicate that there is a rationale for the use of anterior chamber intraocular lenses in primary intracapsular cataract surgery.

Clinical outcomes and surgeon assessment after implantation of a new diffractive multifocal toric intraocular lens.

PubMed

Kretz, Florian T A; Bastelica, Antoine; Carreras, Humberto; Ferreira, Tiago; Müller, Matthias; Gerl, Matthias; Gerl, Ralf; Saeed, Manzar; Schmickler, Stefanie; Auffarth, Gerd U

2015-03-01

To evaluate the clinical outcome in eyes with significant corneal astigmatism after cataract surgery with implantation of a new diffractive multifocal toric intraocular lens (IOL). Prospective, non-randomised multicentre clinical study including 57 eyes of 38 consecutive patients with an age between 37 and 84 years that underwent cataract surgery with implantation of the toric multifocal IOL Tecnis ZMT (Abbott Medical Optics, Santa Ana, California, USA). Changes in uncorrected and corrected logMAR distance, intermediate and near visual acuity ((uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA) uncorrected near visual acuity (UNVA), corrected distance visual acuity (CDVA), corrected near visual acuity) and manifest refraction were evaluated during a 2-4 month follow-up. Additionally, patients were asked about photic phenomena and spectacle dependence. The surgeons subjectively assessed various aspects of the surgery. A significant improvement in CDVA was observed postoperatively (p<0.01), with a significant reduction in manifest cylinder (p<0.01). Mean postoperative binocular UDVA and UNVA were 0.04±0.10 and 0.06±0.12, respectively. Monocular UDVA and UNVA was 0.20 or better in 85.4% and 87.0% of eyes, respectively. Mean binocular logMAR UIVA was 0.21±0.20. Only 10.5% of patients required postoperative correction for near or intermediate distance. The incidence of moderate to severe photic phenomena was limited. Surgeons defined the IOL implantation in most cases as easy or very easy, with a satisfaction rate with the procedure of 84%. The implantation of the multifocal toric IOL is a safe procedure that provides a very good visual rehabilitation in eyes with corneal astigmatism. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Use of the chop hook to stabilize the capsular bag in patients with crystalline lens dislocations and cataracts.

PubMed

Zeng, Yanfeng; Fan, Licheng; Lu, Peirong

2017-04-01

Objective To observe the treatment effects of chop hook-assisted phacoemulsification surgery in patients with crystalline lens dislocation. Methods Thirty-seven eyes with cataracts and crystalline lens dislocations underwent cataract surgery. An L-shaped chop hook was introduced into the anterior chamber, and the tip was pushed or pulled to the centre of the anterior capsular edge of the zonular dialysis during the cataract operation. Postoperative follow-up was conducted for ≥ 1 month. Results All patients' postoperative visual abilities improved except one patient with glaucoma. One patient who underwent -5D intraocular lens implantation exhibited vision of 1/50. Visual acuity was less than 6/20 in 6 eyes, 6/20 to 10/20 in 7 eyes, and greater than 10/20 in 22 eyes. Conclusions L-shaped chop hooks can be used to push or pull the anterior capsular edge of the zonular dialysis for protection and avoidance of further zonular damage. This strategy provides satisfactory effects and reduces use of additional instruments.

Assessing the test-retest repeatability of the Vietnamese version of the National Eye Institute 25-item Visual Function Questionnaire among bilateral cataract patients for a Vietnamese population.

PubMed

To, Kien Gia; Meuleners, Lynn; Chen, Huei-Yang; Lee, Andy; Do, Dung Van; Duong, Dat Van; Phi, Tien Duy; Tran, Hoang Huy; Nguyen, Nguyen Do

2014-06-01

To determine the test-retest repeatability of the National Eye Institute 25-item Visual Function Questionnaire (NEI VFQ-25) for use with older Vietnamese adults with bilateral cataract. The questionnaire was translated into Vietnamese and back-translated into English by two independent translators. Patients with bilateral cataract aged 50 and older completed the questionnaire on two separate occasions, one to two weeks after first administration of the questionnaire. Test-retest repeatability was assessed using the Cronbach's α and intraclass correlation coefficients. The average age of participants was 67 ± 8 years and most participants were female (73%). Internal consistency was acceptable with the α coefficient above 0.7 for all subscales and intraclass correlation coefficients were 0.6 or greater in all subscales. The Vietnamese NEI VFQ-25 is reliable for use in studies assessing vision-related quality of life in older adults with bilateral cataract in Vietnam. We propose some modifications to the NEI-VFQ questions to reflect activities of older people in Vietnam. © 2013 ACOTA.

The Auckland Cataract Study: Assessing Preoperative Risk Stratification Systems for Phacoemulsification Surgery in a Teaching Hospital.

PubMed

Kim, Bia Z; Patel, Dipika V; Sherwin, Trevor; McGhee, Charles N J

2016-11-01

To evaluate 2 preoperative risk stratification systems for assessing the risk of complications in phacoemulsification cataract surgery, performed by residents, fellows, and attending physicians in a public teaching hospital. Cohort study. One observer assessed the clinical data of 500 consecutive cases, prior to phacoemulsification cataract surgery performed between April and June 2015 at Greenlane Clinical Centre, Auckland, New Zealand. Preoperatively 2 risk scores were calculated for each case using the Muhtaseb and Buckinghamshire risk stratification systems. Complications, intraoperative and postoperative, and visual outcomes were analyzed in relation to these risk scores. Intraoperative complication rates increased with higher risk scores using the Muhtaseb or Buckinghamshire stratification system (P = .001 and P = .003, respectively, n = 500). The odds ratios for residents and fellows were not significantly different from attending physicians after case-mix adjustment according to risk scores (P > .05). Postoperative complication rates increased with higher Buckinghamshire risk scores but not with Muhtaseb scores (P = .014 and P = .094, respectively, n = 476). Postoperative corrected-distance visual acuity was poorer with higher risk scores (P < .001 for both, n = 476). This study confirms that the risk of intraoperative complications increases with higher preoperative risk scores. Furthermore, higher risk scores correlate with poorer postoperative visual acuity and the Buckinghamshire risk score also correlates with postoperative complications. Therefore, preoperative assessment using such risk stratification systems could assist individual informed consent, preoperative surgical planning, safe allocation of cases to trainees, and more meaningful analyses of outcomes for individual surgeons and institutions. Copyright © 2016 Elsevier Inc. All rights reserved.

Liquefaction for cataract extraction

PubMed Central

Labiris, Georgios; Toli, Aspasia; Polychroni, Damaskini; Gkika, Maria; Angelonias, Dimitrios; Kozobolis, Vassilios P.

2016-01-01

A systematic review of the recent literature regarding the implementation of the liquefaction in cataract surgery and its short-term and long-term outcomes in various parameters that affect the quality of patients' life, including visual rehabilitation and possible complications was performed based on the PubMed, Medline, Nature and the American Academy of Ophthalmology databases in November 2013 and data from 14 comparative studies were included in this narrative review. Liquefaction is an innovative technology for cataract extraction that uses micropulses of balanced salt solution to liquefy the lens nucleus. Most studies reported that liquefaction is a reliable technology for mild to moderate cataracts, while fragmentation difficulties may be encountered with harder nuclei. PMID:26949656

Pros and cons of immediately sequential bilateral cataract surgery (ISBCS).

PubMed

Grzybowski, Andrzej; Wasinska-Borowiec, Weronika; Claoué, Charles

2016-01-01

Immediately sequential bilateral cataract surgery (ISBCS) is currently a "hot topic" in ophthalmology. There are well-documented advantages in terms of quicker visual rehabilitation and reduced costs. The risk of bilateral simultaneous endophthalmitis and bilateral blindness is now recognized to be minuscule with the advent of intracameral antibiotics and modern management of endophthalmitis. Refractive surprises are rare for normal eyes and with the use of optical biometry. Where a general anesthetic is indicated for cataract surgery, the risk of death from a second anesthetic is much higher than the risk of blindness. A widely recognized protocol from the International Society of Bilateral Cataract Surgeons needs to be adhered to if surgeons wish to start practicing ISBCS.

Risk of cataract in persons with cytomegalovirus retinitis and the acquired immune deficiency syndrome.

PubMed

Kempen, John H; Sugar, Elizabeth A; Lyon, Alice T; Lewis, Richard Alan; Jabs, Douglas A; Heinemann, Murk-Hein; Dunn, James P

2012-11-01

To evaluate cataract risk in eyes of patients with AIDS and cytomegalovirus (CMV) retinitis and to identify risk factors. Prospective cohort study. Patients with AIDS and CMV retinitis. Patients 13 years of age and older were enrolled between 1998 and 2008. Demographic and clinical characteristics, slit-lamp biomicroscopy findings, and dilated ophthalmoscopy results were documented at quarterly visits. Cataract status was determined at the initial visit (prevalence) and at follow-up visits (incidence). For cataract, a high grade of lens opacity by biomicroscopy to which best-corrected visual acuity worse than 20/40 was attributed. Eyes that had undergone cataract surgery before enrollment or between visits also were counted as having cataract. Seven hundred twenty-nine eyes of 489 patients diagnosed with CMV retinitis were evaluated. Higher prevalence was observed for patients with bilateral versus unilateral CMV retinitis (adjusted odds ratio [aOR], 2.74; 95% confidence interval [CI], 1.76-4.26) and, among unilateral CMV retinitis cases, for eyes with retinitis versus without retinitis (15% vs. 1.4%; P<0.0001). The age-adjusted prevalence of cataract among CMV retinitis cases was higher than that in a population-based sample (P<0.0001). Cataract prevalence increased with age (aOR, 11.77; 95% CI, 2.28-60.65 for age ≥ 60 years vs. younger than 40 years) and longer duration of retinitis (aOR, 1.36; 95% CI, 1.20-1.54 per year). Among eyes with CMV retinitis initially free of cataract, the cataract incidence was 8.1%/eye-year (95% CI, 6.7%-10.0%). Prior retinal detachment was associated with higher cataract risk (if repaired with silicone oil: adjusted hazard ratio [aHR], 10.37; 95% CI, 6.51-16.52; otherwise: aHR, 2.90; 95% CI, 1.73-4.87). Large CMV retinitis lesions also were associated with higher risk of cataract (for involvement of 25-49% retinal area: aHR, 2.30; 95% CI, 1.51-3.50; for ≥ 50% involvement: aHR, 3.63; 95% CI, 2.18-6.04), each with respect to ≤ 24% involvement, as were anterior segment inflammation (aHR, 2.27; 95% CI, 1.59-3.25) and contralateral cataract (aHR, 2.52; 95% CI, 1.74-3.66). Cytomegalovirus retinitis is associated with a high absolute and relative risk of cataract. Among several risk factors, large retinal lesion size and use of silicone oil in retinal detachment repair are potentially modifiable, albeit not in all cases. Cataract is likely to be an increasingly important cause of visual morbidity in this population. Copyright © 2012 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Risk of Cataract in Persons with Cytomegalovirus Retinitis and the Acquired Immune Deficiency Syndrome

PubMed Central

Kempen, John H.; Sugar, Elizabeth A.; Lyon, Alice T.; Lewis, Richard Alan; Jabs, Douglas A.; Heinemann, Murk-Hein; Dunn, James P.

2012-01-01

Objective To evaluate cataract risk in eyes of patients with AIDS and cytomegalovirus (CMV) retinitis and to identify risk factors. Design Prospective cohort study. Participants Patients with AIDS and CMV retinitis. Methods Patients 13 years of age and older were enrolled between 1998 and 2008. Demographic and clinical characteristics, slit-lamp biomicroscopy findings, and dilated ophthalmoscopy results were documented at quarterly visits. Cataract status was determined at the initial visit (prevalence) and at follow-up visits (incidence). Main Outcome Measures For cataract, a high grade of lens opacity by biomicroscopy to which best-corrected visual acuity worse than 20/40 was attributed. Eyes that had undergone cataract surgery before enrollment or between visits also were counted as having cataract. Results Seven hundred twenty-nine eyes of 489 patients diagnosed with CMV retinitis were evaluated. Higher prevalence was observed for patients with bilateral versus unilateral CMV retinitis (adjusted odds ratio [aOR], 2.74; 95% confidence interval [CI], 1.76–4.26) and, among unilateral CMV retinitis cases, for eyes with retinitis versus without retinitis (15% vs. 1.4%; P<0.0001). The age-adjusted prevalence of cataract among CMV retinitis cases was higher than that in a population-based sample (P<0.0001). Cataract prevalence increased with age (aOR, 11.77; 95% CI, 2.28–60.65 for age ≥60 years vs. younger than 40 years) and longer duration of retinitis (aOR, 1.36; 95% CI, 1.20–1.54 per year). Among eyes with CMV retinitis initially free of cataract, the cataract incidence was 8.1%/eye-year (95% CI, 6.7%–10.0%). Prior retinal detachment was associated with higher cataract risk (if repaired with silicone oil: adjusted hazard ratio [aHR], 10.37; 95% CI, 6.51–16.52; otherwise: aHR, 2.90; 95% CI, 1.73–4.87). Large CMV retinitis lesions also were associated with higher risk of cataract (for involvement of 25–49% retinal area: aHR, 2.30; 95% CI, 1.51–3.50; for ≥50% involvement: aHR, 3.63; 95% CI, 2.18–6.04), each with respect to ≤24% involvement, as were anterior segment inflammation (aHR, 2.27; 95% CI, 1.59–3.25) and contralateral cataract (aHR, 2.52; 95% CI, 1.74–3.66). Conclusions Cytomegalovirus retinitis is associated with a high absolute and relative risk of cataract. Among several risk factors, large retinal lesion size and use of silicone oil in retinal detachment repair are potentially modifiable, albeit not in all cases. Cataract is likely to be an increasingly important cause of visual morbidity in this population. PMID:22853972

Catquest-9SF questionnaire: validation of Malay and Chinese-language versions using Rasch analysis.

PubMed

Adnan, Tassha Hilda; Mohamed Apandi, Mokhlisoh; Kamaruddin, Haireen; Salowi, Mohamad Aziz; Law, Kian Boon; Haniff, Jamaiyah; Goh, Pik Pin

2018-01-05

Catquest questionnaire was originally developed in Swedish to measure patients' self-assessed visual function to evaluate the benefit of cataract surgery. The result of the Rasch analysis leading to the creation of the nine-item short form of Catquest, (Catquest-9SF), and it had been translated and validated in English. The aim is therefore to evaluate the translated Catquest-9SF questionnaire in Malay and Chinese (Mandarin) language version for measuring patient-reported visual function among cataract population in Malaysia. The English version of Catquest-9SF questionnaire was translated and back translated into Malay and Chinese languages. The Malay and Chinese translated versions were self-administered by 236 and 202 pre-operative patients drawn from a cataract surgery waiting list, respectively. The translated Catquest-9SF data and its four response options were assessed for fit to the Rasch model. The Catquest-9SF performed well in the Malay and Chinese translated versions fulfilling all criteria for valid measurement, as demonstrated by Rasch analysis. Both versions of questionnaire had ordered response thresholds, with a good person separation (Malay 2.84; and Chinese 2.59) and patient separation reliability (Malay 0.89; Chinese 0.87). Targeting was 0.30 and -0.11 logits in Malay and Chinese versions respectively, indicating that the item difficulty was well suited to the visual abilities of the patients. All items fit a single overall construct (Malay infit range 0.85-1.26, outfit range 0.73-1.13; Chinese infit range 0.80-1.51, outfit range 0.71-1.36), unidimensional by principal components analysis, and was free of Differential Item Functioning (DIF). These results support the good overall functioning of the Catquest-9SF in patients with cataract. The translated questionnaire to Malay and Chinese-language versions are reliable and valid in measuring visual disability outcomes in the Malaysian cataract population.

A population-based survey of visual impairment and its correlates in Mahabubnagar district, Telangana State, India.

PubMed

Mactaggart, Islay; Polack, Sarah; Murthy, Gvs; Kuper, Hannah

2018-06-01

To estimate the prevalence and correlates of visual impairment in Mahabubnagar district, Telangana, India. Fifty-one clusters of 80 people (all ages) were sampled with probability proportionate to size. Households within clusters were selected through the compact segment sampling. Visual acuity (VA) was measured with a tumbling "E" chart. An Ophthalmic Assistant or Vision Technician examined people with VA<6/12 in either eye. Other impairments (hearing, physical) were clinically assessed and self-reported functional difficulties measured using the Washington Group Extended Set. People with visual impairment and age-sex matched controls with normal vision were interviewed about poverty, employment and education. 4,125 people were enumerated and 3,574 screened (86.6%). The prevalence of visual impairment (VA<6/12) was 8.0% (95% CI = 6.9-9.4%) and blindness was 0.4% (0.2-0.9%), and both increased rapidly with age. Uncorrected refractive error was the leading cause of visual impairment, and cataract the leading cause of blindness. Cataract surgical coverage (proportion of all cataracts that had received surgery) was relatively low (41% of people at VA<6/60), while the post-surgery outcomes were good (81% of operated eyes had presenting VA≥6/18). Among the 287 people with visual impairment, 15% had a moderate/severe physical impairment or epilepsy and 25% had a moderate/severe hearing impairment. Self-reported difficulties in vision were relatively closely related to visual acuity. People with visual impairment were more likely to be in the poorest quartile (OR = 1.9, 95% CI = 1.0-3.4) or unemployed (5.0, 2.2-10.0), compared to controls. Visual impairment was common in Mahabubnagar district, was mostly avoidable, and was correlated with poverty markers.

Hereditary cataracts in Russian Blue cats.

PubMed

Nygren, Karin; Jalomäki, Sari; Karlstam, Lena; Narfström, Kristina

2018-01-01

Objectives The purpose of this study was to investigate the prevalence of cataracts in the Russian Blue breed of cats in Sweden, and to describe the clinical appearance of this presumed inherited form of cataract. Methods A total of 66 Russian Blue cats were examined in Sweden, between March and October 2014, using standard examination techniques. The examined cats were between 3 months and 14 years of age. Pedigrees were collected from all examined cats for genetic studies. Results Mild-to-severe forms of mainly bilateral cataracts were observed in 22/66 examined Russian Blue cats of both sexes. Two affected cats were <1 year of age. The most frequently observed appearance of a cataract was a small triangular, Y-shaped or circular opacity at the border of the posterior nucleus and the anterior part of the posterior cortex, which caused no observable visual impairment. More extended forms were observed in 6/22 cats, with involvement of both the nucleus and either the entire cortex or parts of the posterior and/or anterior cortex. Visual impairment or blindness was observed in the latter six cases. Pedigree analyses indicated a simple autosomal recessive mode of inheritance for the defect, although a dominant mode with incomplete penetrance could not be excluded. Conclusions and relevance This study indicates that the Russian Blue breed of cat is affected by hereditary cataracts. The high prevalence in young cats and the characteristic location of the most frequently observed defect in the study suggest an early onset type of cataract. The breeders should be aware of this defect and have their cats examined by a veterinary ophthalmologist before breeding of an individual Russian Blue cat is considered.

Simultaneous bilateral cataract surgery: economic analysis; Helsinki Simultaneous Bilateral Cataract Surgery Study Report 2.

PubMed

Leivo, Tiina; Sarikkola, Anna-Ulrika; Uusitalo, Risto J; Hellstedt, Timo; Ess, Sirje-Linda; Kivelä, Tero

2011-06-01

To present an economic-analysis comparison of simultaneous and sequential bilateral cataract surgery. Helsinki University Eye Hospital, Helsinki, Finland. Economic analysis. Effects were estimated from data in a study in which patients were randomized to have bilateral cataract surgery on the same day (study group) or sequentially (control group). The main clinical outcomes were corrected distance visual acuity, refraction, complications, Visual Function Index-7 (VF-7) scores, and patient-rated satisfaction with vision. Health-care costs of surgeries and preoperative and postoperative visits were estimated, including the cost of staff, equipment, material, floor space, overhead, and complications. The data were obtained from staff measurements, questionnaires, internal hospital records, and accountancy. Non-health-care costs of travel, home care, and time were estimated based on questionnaires from a random subset of patients. The main economic outcome measures were cost per VF-7 score unit change and cost per patient in simultaneous versus sequential surgery. The study comprised 520 patients (241 patients included non-health-care and time cost analyses). Surgical outcomes and patient satisfaction were similar in both groups. Simultaneous cataract surgery saved 449 Euros (€) per patient in health-care costs and €739 when travel and paid home-care costs were included. The savings added up to €849 per patient when the cost of lost working time was included. Compared with sequential bilateral cataract surgery, simultaneous bilateral cataract surgery provided comparable clinical outcomes with substantial savings in health-care and non-health-care-related costs. No author has a financial or proprietary interest in any material or method mentioned. Copyright © 2011 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Temporary Piggyback Intraocular Lens Implantation Versus Single Intraocular Lens Implantation in Congenital Cataracts: Long-Term Clinical Outcomes.

PubMed

Hwang, Sungsoon; Lim, Dong Hui; Lee, Soomin; Choi, Daye Diana; Chung, Eui-Sang; Chung, Tae-Young

2018-04-01

To report the long-term results of temporary piggyback IOL implantation in congenital cataract and to compare the clinical outcomes of temporary piggyback IOL with those of single IOL implantation. This is a retrospective, comparative, interventional study. The medical records of all consecutive patients who underwent cataract extraction and single or temporary piggyback IOL implantation within the first 3 years of life from 1999 to 2013 at Samsung Medical Center were reviewed. Twenty-eight eyes from 18 patients underwent single IOL implantation (monopseudophakia group), and 32 eyes of 20 patients underwent temporary piggyback IOL implantation in congenital cataract surgery (polypseudophakia group). The mean age at initial cataract surgery was 15.8 months in the monopseudophakia group and 11.1 months in the polypseudophakia group (P = 0.144). The average follow-up duration was 133 months in the monopseudophakia group and 120 months in the polypseudophakia group (P = 0.391). The best-corrected visual acuity at the last visit was 0.36 logMAR in the monopseudophakia group and 0.55 logMAR in the polypseudophakia group (P = 0.044). Four (14%) and 14 (44%) reoperations for complications within the anterior segment were performed in the monopseudophakia group and polypseudophakia group, respectively (P = 0.042). Four cases (14.3%) in the monopseudophakia group and 13 cases (40.6%) in the polypseudophakia group had a glaucoma-related adverse event (P = 0.086). Compared with primary single IOL implantation in congenital cataract, temporary piggyback IOL implantation produced worse visual acuity, higher reoperation rate, and higher risk of secondary glaucoma. Temporary piggyback IOL implantation does not have benefit in congenital cataract.

Electrophysiological evidence of altered visual processing in adults who experienced visual deprivation during infancy.

PubMed

Segalowitz, Sidney J; Sternin, Avital; Lewis, Terri L; Dywan, Jane; Maurer, Daphne

2017-04-01

We examined the role of early visual input in visual system development by testing adults who had been born with dense bilateral cataracts that blocked all patterned visual input during infancy until the cataractous lenses were removed surgically and the eyes fitted with compensatory contact lenses. Patients viewed checkerboards and textures to explore early processing regions (V1, V2), Glass patterns to examine global form processing (V4), and moving stimuli to explore global motion processing (V5). Patients' ERPs differed from those of controls in that (1) the V1 component was much smaller for all but the simplest stimuli and (2) extrastriate components did not differentiate amongst texture stimuli, Glass patterns, or motion stimuli. The results indicate that early visual deprivation contributes to permanent abnormalities at early and mid levels of visual processing, consistent with enduring behavioral deficits in the ability to process complex textures, global form, and global motion. © 2017 Wiley Periodicals, Inc.

Special Problems of People with Diabetes and Visual Impairment.

ERIC Educational Resources Information Center

Rosenthal, J. L.

1993-01-01

This article addresses the types of visual impairment caused by diabetes and the unique problems that people with diabetes and visual impairment face. Diabetic retinopathy, cataracts, glaucoma, and diabetic optic neuropathy are discussed as causes of visual impairment, and specific problems in basic living are identified, including diet,…

Efficacy and Safety of Femtosecond Laser-Assisted Cataract Surgery Compared with Manual Cataract Surgery: A Meta-Analysis of 14 567 Eyes.

PubMed

Popovic, Marko; Campos-Möller, Xavier; Schlenker, Matthew B; Ahmed, Iqbal Ike K

2016-10-01

To investigate the efficacy and safety of femtosecond laser-assisted cataract surgery (FLACS) relative to manual cataract surgery (MCS). It is unclear whether FLACS is more efficacious and safe relative to MCS. A literature search of MEDLINE, EMBASE, and Scopus from 2007 to March 2016 was conducted. Studies containing both FLACS and MCS arms that reported on relevant efficacy and/or safety parameters were included. Weighted mean differences (WMDs) and risk ratios (RRs) with 95% confidence intervals (CIs) were calculated. From 2802 screened articles, 14 567 eyes from 15 randomized controlled trials and 22 observational cohort studies were included. For primary visual and refractive outcomes, no statistically significant difference was detected between FLACS and MCS in uncorrected distance visual acuity (WMD, -0.02; 95% CI, -0.04 to 0.01; P = 0.19), corrected distance visual acuity (WMD, -0.01; 95% CI, -0.02 to 0.01; P = 0.26), and mean absolute error (WMD, -0.02; 95% CI, -0.07 to 0.04; P = 0.57). In terms of secondary surgical end points, there was a statistically significant difference in favor of FLACS over MCS for effective phacoemulsification time (WMD, -3.03; 95% CI, -3.80 to -2.25; P < 0.001), capsulotomy circularity (WMD, 0.16; 95% CI, 0.11-0.21; P < 0.001), postoperative central corneal thickness (WMD, -6.37; 95% CI, -11.88 to -0.86; P = 0.02), and corneal endothelial cell reduction (WMD, -55.43; 95% CI, -95.18 to -15.69; P = 0.006). There was no statistically significant difference between FLACS and MCS for total surgery time (WMD, 1.25; 95% CI, -0.08 to 2.59; P = 0.07), capsulotomy circularity using a second formula (WMD, 0.05; 95% CI, -0.01 to 0.12; P = 0.10), and corneal endothelial cell count (WMD, 73.39; 95% CI, -6.28 to 153.07; P = 0.07). As well, there was a significantly higher concentration of prostaglandins after FLACS relative to MCS (WMD, 198.34; 95% CI, 129.99-266.69; P < 0.001). Analysis of safety parameters revealed that there were no statistically significant differences in the incidence of overall complications between FLACS and MCS (RR, 2.15; 95% CI, 0.74 to 6.23; P = 0.16); however, posterior capsular tears were significantly more common in FLACS versus MCS (RR, 3.73; 95% CI, 1.50-9.25; P = 0.005). There were no statistically significant differences detected between FLACS and MCS in terms of patient-important visual and refractive outcomes and overall complications. Although FLACS did show a statistically significant difference for several secondary surgical outcomes, it was associated with higher prostaglandin concentrations and higher rates of posterior capsular tears. Copyright © 2016 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

The Auckland Cataract Study: 2 year postoperative assessment of aspects of clinical, visual, corneal topographic and satisfaction outcomes

PubMed Central

Thompson, A M; Sachdev, N; Wong, T; Riley, A F; Grupcheva, C N; McGhee, C N

2004-01-01

Aim: To assess clinical, visual, computerised corneal topographic, and subjective satisfaction with visual acuity, in a cohort of subjects 2 years after phacoemulsification surgery in a public hospital in New Zealand. Methods: Prospective study of a representative sample of 97 subjects (20%) randomly selected from 480 subjects in the original Auckland Cataract Study (ACS) cohort. The clinical assessment protocol was identical to the ACS and included an extensive questionnaire to enable direct comparisons to be made between the two groups. Results: The study population was predominantly female (66%) with a mean age of 76.3 (SD 9.9) years. New systemic and ocular disease affected 18.4% and 10.3% of subjects respectively, and 10.3% required referral to either a general practitioner (2.1%) or ophthalmologist (8.2%). Mean best spectacle corrected visual acuity (BSCVA) was 0.2 (0.2) logMAR units (6/9 Snellen equivalent), with mean spherical equivalent −0.37 (1.01) dioptres (D) and astigmatism −1.07 (0.70) D 2 years postoperatively, compared to mean BSCVA 0.1 (0.2) logMAR units (6/7.5 Snellen equivalent), spherical equivalent −0.59 (1.07) D, and astigmatism −1.14 (0.77) D 4 weeks after surgery. 94.9% of subjects retained a BSCVA of 6/12 or better, irrespective of pre-existing ocular disease. The overall posterior capsule opacification (PCO) rate was 20.4% and this was visually insignificant in all but 3.1% of eyes that had already undergone Nd:YAG posterior capsulotomy. Orbscan II elevation technology demonstrated corneal stability 2 years after uncomplicated phacoemulsification. Although corneal astigmatism was eliminated in approximately half of the subjects 1 month postoperatively, astigmatism showed a tendency to regress towards the preoperative level with local corneal thickening at the site of incision 2 years after cataract surgery. Of fellow eyes, 61.2% had undergone cataract surgery. Overall, 75.3% of subjects were moderately to very satisfied with their current level of visual acuity. Conclusion: Two years after cataract surgery subjects are generally satisfied with their current level of vision and distance BSCVA is 6/12 or better in the majority of eyes. Although only a minority of eyes develop sufficient PCO to require capsulotomy 10.3% of eyes develop new vision threatening ocular pathology. PMID:15258022

Brain-Derived Neurotrophic Factor in Patients with Primary Open-Angle Glaucoma and Age-related Cataract.

PubMed

Shpak, Alexander A; Guekht, Alla B; Druzhkova, Tatiana A; Kozlova, Ksenia I; Gulyaeva, Natalia V

2018-02-01

To study brain-derived neurotrophic factor (BDNF) content in aqueous humor (AH), lacrimal fluid (LF), and blood serum (BS) in patients with age-related cataract and primary open-angle glaucoma (POAG). BDNF was studied in 57 patients with age-related cataract, 55 patients with POAG combined with cataract, and 29 healthy controls (one eye in each person). AH was sampled during cataract surgery. The levels of BDNF in LF and BS did not differ in cataract patients and controls. The concentration of BDNF (pg/mL) in patients with POAG and cataract was lower than in cataract patients in AH (35.2 ± 14.2 vs. 54.6 ± 29.6, P < 0.001), LF (78.0 ± 25.1 vs. 116.2 ± 43.1, P < 0.001), and BS (19230 ± 5960 vs. 22440 ± 7580, P < 0.02), while the AH/LF ratio was similar (0.46 ± 0.18 vs. 0.48 ± 0.19). The AH level of BDNF declined in early POAG and relatively increased in the next stages of the disease, inversely correlating with visual field index (Pearson's correlation coefficient r = -0.404, P = 0.002) and average retinal nerve fiber layer thickness (r = -0.322, P = 0.018). BDNF contents in LF and BS were also the lowest in early POAG. BDNF in AH strongly correlated with its content in LF (r = 0.66, P < 0.000). A formula was suggested to calculate the AH concentration of BDNF basing on its content in LF. BDNF contents are decreased in AH, LF, and BS of patients with POAG demonstrating a significant decrease in the early POAG and relative increase in the next stages of the disease. A strong correlation exists between BDNF contents in AH and LF.

Entropic Imaging of Cataract Lens: An In Vitro Study

PubMed Central

Shung, K. Kirk; Tsui, Po-Hsiang; Fang, Jui; Ma, Hsiang-Yang; Wu, Shuicai; Lin, Chung-Chih

2014-01-01

Phacoemulsification is a common surgical method for treating advanced cataracts. Determining the optimal phacoemulsification energy depends on the hardness of the lens involved. Previous studies have shown that it is possible to evaluate lens hardness via ultrasound parametric imaging based on statistical models that require data to follow a specific distribution. To make the method more system-adaptive, nonmodel-based imaging approach may be necessary in the visualization of lens hardness. This study investigated the feasibility of applying an information theory derived parameter – Shannon entropy from ultrasound backscatter to quantify lens hardness. To determine the physical significance of entropy, we performed computer simulations to investigate the relationship between the signal-to-noise ratio (SNR) based on the Rayleigh distribution and Shannon entropy. Young's modulus was measured in porcine lenses, in which cataracts had been artificially induced by the immersion in formalin solution in vitro. A 35-MHz ultrasound transducer was used to scan the cataract lenses for entropy imaging. The results showed that the entropy is 4.8 when the backscatter data form a Rayleigh distribution corresponding to an SNR of 1.91. The Young's modulus of the lens increased from approximately 8 to 100 kPa when we increased the immersion time from 40 to 160 min (correlation coefficient r = 0.99). Furthermore, the results indicated that entropy imaging seemed to facilitate visualizing different degrees of lens hardening. The mean entropy value increased from 2.7 to 4.0 as the Young's modulus increased from 8 to 100 kPa (r = 0.85), suggesting that entropy imaging may have greater potential than that of conventional statistical parametric imaging in determining the optimal energy to apply during phacoemulsification. PMID:24760103

[Cataract surgery under topical anesthesia with oral anticoagulants].

PubMed

Wirbelauer, C; Weller, A; Häberle, H; Pham, D T

2004-09-01

Approximately 14 % of cataract surgery patients receive blood-thinning agents. In a prospective study, the influence of oral anticoagulants on intraoperative and postoperative hemorrhages in patients undergoing cataract surgery in topical anesthesia was investigated. 128 patients presenting for cataract surgery under oral anticoagulation were included. The mean preoperative prothrombin time was 39 +/- 18 %. Most patients (81 %) continued their oral anticoagulation (prothrombin time 34 +/- 13 %). All surgeries were performed in topical anesthesia. In 9 patients (7 %) an ocular hemorrhagic event was observed. These were not sight-threatening and resorbed spontaneously within a few days. Only one patient (0.8 %) had a slight hemorrhage in the anterior chamber. There were no differences (P > 0.05) between patients with or without hemorrhagic complications in the postoperative visual acuity, the intraocular pressure, the prothrombin time or the discontinuation of oral anticoagulants. Cataract surgery in topical anesthesia under oral anticoagulation did not increase the risk of sight-threatening hemorrhages. The continuation of oral anticoagulation seems particularly indicated for ambulatory cataract surgery.

Identification of a novel missense mutation of MAF in a Japanese family with congenital cataract by whole exome sequencing: a clinical report and review of literature.

PubMed

Narumi, Yoko; Nishina, Sachiko; Tokimitsu, Motoharu; Aoki, Yoko; Kosaki, Rika; Wakui, Keiko; Azuma, Noriyuki; Murata, Toshinori; Takada, Fumio; Fukushima, Yoshimitsu; Kosho, Tomoki

2014-05-01

Congenital cataracts are the most important cause of severe visual impairment in infants. Genetic factors contribute to the disease development and 29 genes are known to cause congenital cataracts. Identifying the genetic cause of congenital cataracts can be difficult because of genetic heterogeneity. V-maf avian musculoaponeurotic fibrosarcoma oncogene homolog (MAF) encodes a basic region/leucine zipper transcription factor that plays a key role as a regulator of embryonic lens fiber cell development. MAF mutations have been reported to cause juvenile-onset pulverulent cataract, microcornea, iris coloboma, and other anterior segment dysgenesis. We report on six patients in a family who have congenital cataracts were identified MAF mutation by whole exome sequencing (WES). The heterozygous MAF mutation Q303L detected in the present family occurs in a well conserved glutamine residue at the basic region of the DNA-binding domain. All affected members showed congenital cataracts. Three of the six members showed microcornea and one showed iris coloboma. Congenital cataracts with MAF mutation exhibited phenotypically variable cataracts within the family. Review of the patients with MAF mutations supports the notion that congenital cataracts caused by MAF mutations could be accompanied by microcornea and/or iris coloboma. WES is a useful tool for detecting disease-causing mutations in patients with genetically heterogeneous conditions. © 2014 Wiley Periodicals, Inc.

Relationship between socioeconomic and lifestyle factors and cataracts in Koreans: the Korea National Health and Nutrition Examination Survey 2008-2011.

PubMed

Nam, G E; Han, K; Ha, S G; Han, B-D; Kim, D H; Kim, Y-H; Cho, K H; Park, Y G; Ko, B-J

2015-07-01

Cataracts are the leading cause of visual impairment and blindness, and therefore early identification and modification of the risk factors for cataracts are meaningful. This study aimed to investigate the relationship between socioeconomic status (SES) and lifestyle factors, and age-related cataracts in South Korea. This cross-sectional study was based on data collected in the 2008-2011 Korea National Health and Nutrition Examination Survey. A total of 15 866 subjects, aged ≥40 years, were included. SES was defined using household income and education level. Sociodemographic, lifestyle, and other associated factors were assessed by health interviews and examinations. Cataracts were diagnosed via slit-lamp examination using the Lens Opacities Classification System III. The prevalence of any cataract was 38.9% in men and 42.3% in women (P<0.001). In women, the risk of cataracts increased with decreases in household income (P-value for trend=0.016 and 0.041 in any, and cortical cataract, respectively) and education level (P-value for trend=0.009, 0.027, and 0.016 in any, nuclear, and cortical cataract, respectively) after adjusting for confounding factors. Current smoking was correlated with nuclear cataracts in men (OR 1.21; 95% CI: 1.00, 1.46 in age-adjusted analysis) and cataract surgery in women (OR 2.25; 95% CI: 1.00, 5.04 in multivariate-adjusted analysis). Socioeconomic disparities in cataract prevalence were observed in women; current smoking increased the risk of nuclear cataracts in men and surgery in women. Public health interventions focusing on gender differences are warranted to prevent and treat cataracts.

Evaluation of antioxidants and argpyrimidine in normal and cataractous lenses in north Indian population

PubMed Central

Mynampati, Bharani K; Ghosh, Sujata; Muthukumarappa, Thungapathra; Ram, Jagat

2017-01-01

AIM To assess the level of glutathione, thioltransferase, and argpyrimidine in nuclear and cortical cataractous lenses as well as in the clear lenses in the north Indian population. METHODS Human cataractous lenses were collected from the patients who underwent extracapsular cataract extraction surgery; clear lenses were collected from the freshly donated eye bank eyes. Antioxidant molecules such as glutathione and thioltransferase enzyme activity were measured; simultaneously in these lenses a blue fluorophore argpyrimidine, an advanced glycation end (AGE) product level was assessed using high performance liquid chromatography (HPLC). RESULTS The protein concentration was found to be present at higher levels in the control lenses compared to cataract lenses. A significant decrease in the glutathione level was observed in the nuclear cataractous lenses compared to cortical cataractous (P=0.004) and clear lenses (P≤0.005), but no significant change in the level of antioxidant enzyme thioltransferase was observed. Further, argpyrimidine a blue fluorophore (AGE) was found to be significantly higher in the nuclear cataract (P=0.013) compared to cortical cataract lenses. CONCLUSION Antioxidants such as glutathione significantly decrease in age-related nuclear and cortical cataract and an AGE, argpyrimidine are present at significantly higher levels in nuclear cataract. PMID:28730112

Screening for Impaired Visual Acuity in Older Adults: US Preventive Services Task Force Recommendation Statement.

PubMed

Siu, Albert L; Bibbins-Domingo, Kirsten; Grossman, David C; Baumann, Linda Ciofu; Davidson, Karina W; Ebell, Mark; García, Francisco A R; Gillman, Matthew; Herzstein, Jessica; Kemper, Alex R; Krist, Alex H; Kurth, Ann E; Owens, Douglas K; Phillips, William R; Phipps, Maureen G; Pignone, Michael P

2016-03-01

Update of the US Preventive Services Task Force (USPSTF) recommendation on screening for impaired visual acuity in older adults. The USPSTF reviewed the evidence on screening for visual acuity impairment associated with uncorrected refractive error, cataracts, and age-related macular degeneration among adults 65 years or older in the primary care setting; the benefits and harms of screening; the accuracy of screening; and the benefits and harms of treatment of early vision impairment due to uncorrected refractive error, cataracts, and age-related macular degeneration. This recommendation applies to asymptomatic adults 65 years or older who do not present to their primary care clinician with vision problems. The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for impaired visual acuity in older adults. (I statement).

[Epidemiological survey of visual impairment in Funing County, Jiangsu].

PubMed

Yang, M; Zhang, J F; Zhu, R R; Kang, L H; Qin, B; Guan, H J

2017-07-11

Objective: To investigate the prevalence of visual impairment and factors associated with visual impairment among people aged 50 years and above in Funing County, Jiangsu Province. Methods: Cross-sectional study. Random cluster sampling was used in selecting individuals aged ≥50 years in 30 clusters, and 5 947 individuals received visual acuity testing and eye examination. Stata 13.0 software was used to analyze the data. Multivariate logistic regression was used to detect possible factors of visual impairment such as age, gender and education. Statistical significance was defined as P< 0.05. Results: A total of 6 145 persons aged 50 years and above were enumerated, and 5 947 (96.8%) participants were examined. Based on the criteria of World Health Organization (WHO) visual impairment classification and presenting visual acuity, 138 persons were diagnosed as blindness, and 1 405 persons were diagnosed as low vision. The prevalence of blindness and low vision was 2.32% and 23.63%, respectively. And the prevalence of visual impairment was 25.95%. Based on the criteria of WHO visual impairment classification and best-corrected visual acuity, 92 persons were diagnosed as blindness, and 383 persons were diagnosed as low vision. The prevalence of blindness and low vision was 1.55% and 6.44%, respectively. And the prevalence of visual impairment was 7.99%. Concerning presenting visual acuity and best-corrected visual acuity, the prevalence of blindness and low vision was higher in old people, females and less educated persons. Cataract (46.63%) was the leading cause of blindness. Uncorrected refractive error (36.51%) was also a main cause of visual impairment. Conclusion: The prevalence of visual impairment is higher in old people, females and less educated persons in Funing County, Jiangsu Province. Cataract is still the leading cause of visual impairment. (Chin J Ophthalmol, 2017, 53: 502-508) .

A Comparison of Three Different Thick Epinucleus Removal Techniques in Cataract Surgery.

PubMed

Hwang, Ho Sik; Lim, Byung-Su; Kim, Man Soo; Kim, Eun Chul

2017-01-01

To compare the outcomes of cataract surgery performed with three different types of the epinucleus removal techniques (safe boat, infusion/aspiration (I/A) cannulas, and phacoemulsification tip). Ninety eyes with thick adhesive epinuclei were randomly subdivided into three groups according to epinucleus removal technique: epinucleus floating (safe boat) technique, 30 patients; I/A tip, 30 patients; and phaco tip, 30 patients. Intraoperative measurements included ultrasound time (UST), mean cumulative dissipated ultrasound energy (CDE), and balanced salt solution (BSS) use. Clinical measurements were made preoperatively, and at one day, one month and two months postoperatively, including the best corrected visual acuity (BCVA), the central corneal thickness (CCT), and the endothelial cell count (ECC). Intraoperative measurements showed significantly less UST, CDE, and BSS use in the safe boat group than in the phaco tip groups (p < 0.05). The percentage of endothelial cell loss in the safe boat group was significantly lower than that in the phaco tip groups at two months post-cataract surgery (p < 0.05). The safe boat technique is a safer and more effective epinucleus removal technique than phaco tip techniques in cases with thick epinucleus.

Antioxidant vitamin supplementation for preventing and slowing the progression of age-related cataract

PubMed Central

Mathew, Milan C; Ervin, Ann-Margret; Tao, Jeremiah; Davis, Richard M

2013-01-01

Background Age-related cataract is a major cause of visual impairment in the elderly. Oxidative stress has been implicated in its formation and progression. Antioxidant vitamin supplementation has been investigated in this context. Objectives To assess the effectiveness of antioxidant vitamin supplementation in preventing and slowing the progression of age-related cataract. Search methods We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2012, Issue 2), MEDLINE (January 1950 to March 2012), EMBASE (January 1980 to March 2012), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to March 2012), Open Grey (System for Information on Grey Literature in Europe) (www.opengrey.eu/), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). There were no date or language restrictions in the electronic searches for trials. The electronic databases were last searched on 2 March 2012. We also checked the reference lists of included studies and ongoing trials and contacted investigators to identify eligible randomized trials. Selection criteria We included only randomized controlled trials in which supplementation with one or more antioxidant vitamins (beta-carotene, vitamin C and vitamin E) in any form, dosage or combination for at least one year was compared to another antioxidant vitamin or to placebo. Data collection and analysis Two authors extracted data and assessed trial quality independently. We pooled results for the primary outcomes, i.e., incidence of cataract and incidence of cataract extraction. We did not pool results of the secondary outcomes - progression of cataract and loss of visual acuity, because of differences in definitions of outcomes and data presentation. We pooled results by type of cataract when data were available. We did not perform a sensitivity analysis. Main results Nine trials involving 117,272 individuals of age 35 years or older are included in this review. The trials were conducted in Australia, Finland, India, Italy, the United Kingdom and the United States, with duration of follow-up ranging from 2.1 to 12 years. The doses of antioxidant vitamins were higher than the recommended daily allowance. There was no evidence of effect of antioxidant vitamin supplementation in reducing the risk of cataract, cataract extraction, progression of cataract or in slowing the loss of visual acuity. In the pooled analyses, there was no evidence of effect of beta-carotene supplementation in reducing the risk of cataract (two trials) (relative risk (RR) 0.99, 95% confidence interval (CI) 0.91 to 1.08; n = 57,703) or in reducing the risk of cataract extraction (three trials) (RR 1.00, 95% CI 0.91 to 1.10; n = 86,836) or of vitamin E supplementation in reducing the risk of cataract (three trials) (RR 0.97, 95% CI 0.91 to 1.04; n = 50,059) or of cataract extraction (five trials) (RR 0.98, 95% CI 0.91 to 1.05; n = 83,956). The proportion of participants developing hypercarotenodermia (yellowing of skin) while on beta-carotene ranged from 7.4% to 15.8%. Authors’ conclusions There is no evidence from RCTs that supplementation with antioxidant vitamins (beta-carotene, vitamin C or vitamin E) prevents or slows the progression of age-related cataract. We do not recommend any further studies to examine the role of antioxidant vitamins beta-carotene, vitamin C and vitamin E in preventing or slowing the progression of age-related cataract. Costs and adverse effects should be weighed carefully with unproven benefits before recommending their intake above recommended daily allowances. PMID:22696344

Antioxidant vitamin supplementation for preventing and slowing the progression of age-related cataract.

PubMed

Mathew, Milan C; Ervin, Ann-Margret; Tao, Jeremiah; Davis, Richard M

2012-06-13

Age-related cataract is a major cause of visual impairment in the elderly. Oxidative stress has been implicated in its formation and progression. Antioxidant vitamin supplementation has been investigated in this context. To assess the effectiveness of antioxidant vitamin supplementation in preventing and slowing the progression of age-related cataract. We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2012, Issue 2), MEDLINE (January 1950 to March 2012), EMBASE (January 1980 to March 2012), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to March 2012), Open Grey (System for Information on Grey Literature in Europe) (www.opengrey.eu/), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). There were no date or language restrictions in the electronic searches for trials. The electronic databases were last searched on 2 March 2012. We also checked the reference lists of included studies and ongoing trials and contacted investigators to identify eligible randomized trials. We included only randomized controlled trials in which supplementation with one or more antioxidant vitamins (beta-carotene, vitamin C and vitamin E) in any form, dosage or combination for at least one year was compared to another antioxidant vitamin or to placebo. Two authors extracted data and assessed trial quality independently. We pooled results for the primary outcomes, i.e., incidence of cataract and incidence of cataract extraction. We did not pool results of the secondary outcomes - progression of cataract and loss of visual acuity, because of differences in definitions of outcomes and data presentation. We pooled results by type of cataract when data were available. We did not perform a sensitivity analysis. Nine trials involving 117,272 individuals of age 35 years or older are included in this review. The trials were conducted in Australia, Finland, India, Italy, the United Kingdom and the United States, with duration of follow-up ranging from 2.1 to 12 years. The doses of antioxidant vitamins were higher than the recommended daily allowance. There was no evidence of effect of antioxidant vitamin supplementation in reducing the risk of cataract, cataract extraction, progression of cataract or in slowing the loss of visual acuity. In the pooled analyses, there was no evidence of effect of beta-carotene supplementation in reducing the risk of cataract (two trials) (relative risk (RR) 0.99, 95% confidence interval (CI) 0.91 to 1.08; n = 57,703) or in reducing the risk of cataract extraction (three trials) (RR 1.00, 95% CI 0.91 to 1.10; n = 86,836) or of vitamin E supplementation in reducing the risk of cataract (three trials) (RR 0.97, 95% CI 0.91 to 1.04; n = 50,059) or of cataract extraction (five trials) (RR 0.98, 95% CI 0.91 to 1.05; n = 83,956). The proportion of participants developing hypercarotenodermia (yellowing of skin) while on beta-carotene ranged from 7.4% to 15.8%. There is no evidence from RCTs that supplementation with antioxidant vitamins (beta-carotene, vitamin C or vitamin E) prevents or slows the progression of age-related cataract. We do not recommend any further studies to examine the role of antioxidant vitamins beta-carotene, vitamin C and vitamin E in preventing or slowing the progression of age-related cataract. Costs and adverse effects should be weighed carefully with unproven benefits before recommending their intake above recommended daily allowances.

[Analysis of the changes in the causes of blindness and significant vision loss among children and young adults born between 1974 and 2004].

PubMed

Seroczyńska, Małgorzata; Grałek, Mirosława; Kanigowska, Krystyna

2007-01-01

Visual impairment develops serious medical, psychological, social and economical problems. Thus, of most importance is improvement in prophylaxis, early diagnosis and treatment. THE AIM of this paper is to define the reasons of blindness and significant loss of vision in children and youths in Poland, and changes in them among children and youths under the age of 24, born between 1974-2004, with classification by age. Included in the study were the records of 2,518 children and youths under the age of 24, associates of the Polski Zwiazek Niewidomych (PZN, Polish Association of the Blind); these were analyzed for the prevalence of each cause of vision loss. There were two groups. The first group were files of 1,504 students and pupils in the institutions for blind and visually impaired children, and the archives of PZN, describing the members who joined it between year 1974 and 1998. The second, comparative group, was based on files of 1,014 children and students, who joined PZN between year 1999 and 2004. Each group was also analysed within different age groups. The most important causes of visual impairment are: optic nerve atrophy, retinopathy of prematurity (ROP), high myopia, congenital cataract and retinal degradations. Changes in them between 1998-2004 introduce a percentage growth of optic nerve atrophy from 21.66% to 25.41% and decrement in vision degrading stages of ROP from 14.14% to 10.71%, in development disorders from 8.09% to 7.10%. There is an alarming growth in congenital toxoplasmosis percentage, from 1.06% to 2.39%, and of congenital cataract, from 3.02% to 4.47%. High myopia among the visually impaired remains at the same level. There is a big growth in the percentage of heavy (bilateral) injuries, which cause significant vision loss. Less often, the cause of serious vision damage are uveitis, secondary glaucoma and toxocariasis. The study conducted between 1998-2004 revealed changes in the causes of blindness and significantly vision loss in children and youths under the age of 24, as compared to a similar study conducted between 1974-1998. There is constant increase of the optic nerve atrophy as a cause of vision loss, and decrease among vision impairments caused by vision damaging stages of ROP. Cataract and congenital abnormalities are more frequent among youngest children. Cortical blindness, formerly rarely diagnosed, is becoming a significant factor. The results of our study, describing the changes in blindness and significant vision loss factors, should provide a proper rationale for developing a strategy for control of visual impairment in children and youths.

Intracameral phenylephrine and ketorolac during cataract surgery to maintain intraoperative mydriasis and reduce postoperative ocular pain: Integrated results from 2 pivotal phase 3 studies.

PubMed

Hovanesian, John A; Sheppard, John D; Trattler, William B; Gayton, Johnny L; Malhotra, Ranjan P; Schaaf, David T; Ng, Edmund; Dunn, Steven H

2015-10-01

To evaluate the efficacy and safety of phenylephrine 1.0%-ketorolac 0.3% (Omidria) for maintenance of mydriasis during, and reduction of ocular pain after, cataract surgery. Twenty centers in the United States and the Netherlands. Prospective randomized clinical trials. Patients having cataract surgery or refractive lens exchange were enrolled in 2 clinical trials. Phenylephrine 1.0%-ketorolac 0.3% or placebo was added to irrigation solution and administered intracamerally during the procedure. Integrated analyses of primary and secondary endpoints were conducted. The clinical trials comprised 808 patients (403 treatment and 405 placebo). Phenylephrine 1.0%-ketorolac 0.3% was superior to placebo for the maintenance of mydriasis during, and reduction of ocular pain following, cataract surgery. The mean area under the curve (AUC) change from baseline in pupil diameter was 0.08 mm for treatment compared with -0.50 mm for placebo (P < .0001). The mean AUC of ocular pain visual analog scale scores within 12 hours postoperatively was 4.16 mm for the treatment group and 9.06 mm for the placebo group (P < .001). Results of all secondary efficacy analyses demonstrated a significant treatment effect associated with phenylephrine 1.0%-ketorolac 0.3%. Treatment-emergent adverse events were as expected for a population having cataract surgery; no clinically significant differences in safety measures were observed between treatment groups. In this integrated analysis, phenylephrine 1.0%-ketorolac 0.3% administered intracamerally with irrigation solution during cataract surgery was safe and effective for maintaining mydriasis during the procedure and reducing postoperative ocular pain. Dr. Schaaf is an employee and holds an equity interest in Omeros Corporation. Drs. Hovanesian, Sheppard, Trattler, Gayton, and Ng are consultants to Omeros Corporation. No other author has a financial or proprietary interest in any material or method mentioned. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

45 CFR 1308.13 - Eligibility criteria: Visual impairment including blindness.

Code of Federal Regulations, 2011 CFR

2011-10-01

.... A child is visually impaired if: (1) The vision loss meets the definition of legal blindness in the... vision such that the widest diameter of the visual field subtends an angle no greater than 20 degrees. (b..., limited field of vision, cataracts, etc. ...

45 CFR 1308.13 - Eligibility criteria: Visual impairment including blindness.

Code of Federal Regulations, 2010 CFR

2010-10-01

.... A child is visually impaired if: (1) The vision loss meets the definition of legal blindness in the... vision such that the widest diameter of the visual field subtends an angle no greater than 20 degrees. (b..., limited field of vision, cataracts, etc. ...

Advanced pigment dispersion glaucoma secondary to phakic intraocular collamer lens implant.

PubMed

Ye, Clara; Patel, Cajal K; Momont, Anna C; Liu, Yao

2018-06-01

We report a case of pigment dispersion glaucoma secondary to uncomplicated phakic intraocular collamer lens (ICL) (Visian ICL™, Staar Inc., Monrovia, CA) implant that resulted in advanced visual field loss. A 50-year-old man presented for routine follow-up status post bilateral phakic intraocular collamer lens (ICL) placement 8 years earlier. He was incidentally found to have a decline in visual acuity from an anterior subcapsular cataract and elevated intraocular pressure (IOP) in the left eye. There were signs of pigment dispersion and no evidence of angle closure. Diffuse optic nerve thinning was consistent with advanced glaucomatous visual field defects. Pigment dispersion was also present in the patient's right eye, but without elevated IOP or visual field defects. The patient was treated with topical glaucoma medications and the phakic ICL in the left eye was removed concurrently with cataract surgery to prevent further visual field loss. Pigment dispersion glaucoma is a serious adverse outcome after phakic ICL implantation and regular post-operative monitoring may prevent advanced visual field loss.

Applications in Bioastronautics and Bioinformatics: Early Radiation Cataracts Detected by Noninvasive, Quantitative, and Remote Means

NASA Technical Reports Server (NTRS)

Ansari, Rafat R.; King, James F.; Giblin, Frank J.

2000-01-01

Human exploration of Mars is a key goal in NASA's exploration planning in the next 20 years. Maintaining crew health and good vision is certainly an important aspect of achieving a successful mission. Continuous radiation exposure is a risk factor for radiation-induced cataracts in astronauts because radiation exposure in space travel has the potential of accelerating the aging process (ref. 1). A patented compact device (ref. 2) based on the technique of dynamic light scattering (DLS) was designed for monitoring an astronaut's ocular health during long-duration space travel. This capability of early diagnosis, unmatched by any other clinical technique in use today, may enable prompt initiation of preventive/curative therapy. An Internet web-based system integrating photon correlation data and controlling the hardware to monitor cataract development in vivo at a remote site in real time (teleophthalmology) is currently being developed. The new technology detects cataracts very early (at the molecular level). Cataract studies onboard the International Space Station will be helpful in quantifying any adverse effect of radiation to ocular health. The normal lens in a human eye, situated behind the cornea, is a transparent tissue. It contains 35 wt % protein and 65 wt % water. Aging, disease (e.g., diabetes), smoking, dehydration, malnutrition, and exposure to ultraviolet light and ionizing radiation can cause agglomeration of the lens proteins. Protein aggregation can take place anywhere in the lens, causing lens opacity. The aggregation and opacification could produce nuclear (central portion of the lens) or cortical (peripheral) cataracts. Nuclear and posterior subcapsular (the membrane's capsule surrounds the whole lens) cataracts, being on the visual optical axis of the eye, cause visual impairment that can finally lead to blindness. The lens proteins, in their native state, are small in size. As a cataract develops, this size grows from a few nanometers (transparent) to several micrometers (cloudy). Ansari and Datiles have shown that DLS can detect cataracts at least two to three orders of magnitude earlier noninvasively and quantitatively than the best imaging (Scheimpflug) techniques in clinical use today (ref. 3).

Prevalence of Corneal Astigmatism in an NHS Cataract Surgery Practice in Northern Ireland.

PubMed

Curragh, David S; Hassett, Patrick

2017-01-01

Post-operative corneal astigmatism following cataract surgery can leave the patient with visual impairment. Correcting it at the time of surgery with a toric intraocular lens (TIOL) can give patients a better final visual outcome. The purpose was to determine the prevalence of corneal astigmatism in a cataract population and assess the demand for TIOL. Keratometric data was collected and analyzed for all patients who attended for routine cataract surgery under the care of a single surgeon based in Altnagelvin Area Hospital, Northern Ireland (NI). All patients were included between January 2008 and December 2014. Data was collected retrospectively for this observational study. There were 2080 consecutive eyes of 1788 patients. The mean corneal astigmatism was 1.09 ± 0.83. Corneal astigmatism was 1.50D or less in 1621 eyes (78%). It was more than 2.00 D in 242 eyes (11.6%), more than 2.50 D in 127 eyes (6.1%), more than 3.00D in 68 eyes (3.27%) and more than 3.50 D in 45 eyes (2.16%). For routine cataract surgery, 41.3% of eyes had more than 1.00 D of corneal astigmatism and 11.6% had more and 2.00D. Females had more astigmatism than males. This shows the potential demand for the TIOL in this population.

Alzheimer's and Danish dementia peptides induce cataract and perturb retinal architecture in rats.

PubMed

Reddy, G Bhanuprakash; Reddy, P Yadagiri; Surolia, Avadhesha

2017-03-01

Familial Danish dementias (FDDs) are autosomal dominant neurodegenerative disorders that are associated with visual defects. In some aspects, FDD is similar to Alzheimer's disease (AD)- the amyloid deposits in FDD and AD are made of short peptides: amyloid β (Aβ) in AD and ADan in FDD. Previously, we demonstrated an interaction between the dementia peptides and α-crystallin leading to lens opacification in organ culture due to impaired chaperone activity of α-crystallin. Herein, we report the in vivo effects of ADan and Aβ on the eye. ADan [reduced (ADan-red) and oxidized (ADan-oxi)] and Aβ (Aβ1-40 and Aβ1-42) were injected intravitreally in rats. The onset of cataract was seen after injection of all the peptides, but the cataract matured by 2 weeks in the case of ADan-red, 5 weeks for ADan-oxi and 6 weeks for Aβ1-40, while Aβ1-42 had minimal effect on cataract progression. The severity of cataract is associated with insolubilization and alterations in crystallins and loss of chaperone activity of α-crystallin. Further, disruption of the architecture of the retina was evident from a loss of rhodopsin, increased gliosis, and the thinning of the retina. These results provide a basis for the dominant heredo-otoophthalmo-encephalopathy (HOOE)/FDD syndrome and indicate that ADan peptides are more potent than Aβpeptides in inflicting visual impairment.

Autosomal dominant congenital nuclear cataracts in strain 13/N guinea pigs.

PubMed

Amsbaugh, D F; Stone, S H

1984-01-01

Bilateral cataracts observed in the eyes of a 13/N guinea pig and one of her two offspring led to studies to determine the nature of this cataract and its possible heritability. The cataract was determined to be of the nuclear type, was congenital, and apparently transmitted by a single autosomal dominant gene. The cataractous condition of the mother had no effect on the percentage of litters containing stillborns. The cataractous condition of the offspring had no effect on their viability in utero, i.e., there was no greater incidence of stillborns among cataractous than among non-cataractous offspring. The birthweights of the cataractous animals were lower, but not significantly, than those of their non-cataractous littermates; however, the survivability to weaning of the cataractous offspring was reduced significantly when compared to their non-cataractous siblings.

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

PubMed Central

Day, A C; Donachie, P H J; Sparrow, J M; Johnston, R L

2015-01-01

Purpose To describe the relationships of axial length with ocular copathology, preoperative visual acuity, and posterior capsule rupture rates in patients undergoing cataract surgery. Design The Royal College of Ophthalmologists' National Ophthalmology Database (NOD) study. Methods Anonymised data on 180 114 eyes from 127 685 patients undergoing cataract surgery between August 2006 and November 2010 were collected prospectively from 28 sites. Data parameters included: demographics, biometry, ocular copathology, visual acuity measurements, and surgical complications including posterior capsule rupture, or vitreous loss or both (PCR). Results Consultant surgeons performed a higher proportion of operations on eyes whose axial length were at the extremes. Glaucoma and age related macular degeneration were more common in eyes with shorter axial lengths, whilst previous vitrectomy was associated with longer axial lengths. Eyes with brunescent or white cataracts or amblyopia were more common at both axial length extremes. Preoperative visual acuities were similar for eyes with axial length measurements up to approximately 28 mm and worse for eyes with longer axial length measurements. PCR rates showed little change with axial length (overall mean 1.95%, 95% CI: 1.89 to 2.01%), except for a borderline increase in eyes with axial length <20.0 mm where rates were 3.6% (95% CI: 2.0 to 6.3%). The likelihood of PCR in eyes with axial length <20.0 mm was 1.88 times higher than those of ≥20.0 mm (P=0.0373). Conclusion Rates of ocular comorbidities vary by axial length. PCR rates in eyes with very short or long axial lengths were lower than expected. PMID:26493034

Prevalence and Visual Outcomes of Cataract Surgery in Rural South India: A Cross-Sectional Study.

PubMed

Paul, P; Kuriakose, T; John, J; Raju, R; George, K; Amritanand, A; Doss, P A; Muliyil, J

2016-10-01

To determine the prevalence of cataract surgery and postoperative vision-related outcomes, especially with respect to sex, socioeconomic status (SES) and site of first contact with eye care, in a rural area of South India. In a population-based cross-sectional survey of 5530 individuals aged 50 years or older from 10 villages selected by cluster sampling, individuals who had undergone cataract surgery in one or both eyes were identified. Consenting participants were administered a questionnaire, underwent vision assessment and ophthalmic examination. Outcomes were classified as good if visual acuity of the operated eye was 6/18 or better, fair if worse than 6/18 but better than or equal to 6/60, and poor if worse than 6/60. Prevalence of cataract surgery in this age group (771 persons) was 13.9% (95% confidence interval, CI, 13.0-14.9%). In the 1112 eyes of 749 persons studied, at presentation, 53.1% (95% CI 50.1-56.1%) of operated eyes had good, 38.1% (95% CI 35.2-41.0%) had fair, and 8.8% (95% CI 7.1-10.5%) had poor outcomes. With pinhole, 75.2% (95% CI 72.6-77.8%) had good, 17.2% (95% CI 14.9-19.5%) had fair, and 7.4% (95% CI 5.8-9.0%) had poor outcomes. In 76.3% of eyes with fair and poor presenting outcomes we detected an avoidable cause for the suboptimal visual acuity. Place of surgery and duration since surgery of 3 years or more were risk factors for blindness, while SES, sex and site of first eye care contact were not. The high prevalence of avoidable causes of visual impairment in this rural setting indicates the scope for preventive strategies.

Femtosecond Laser-assisted Arcuate Keratotomy Versus Toric IOL Implantation for Correcting Astigmatism.

PubMed

Yoo, Aeri; Yun, Samyoung; Kim, Jae Yong; Kim, Myoung Joon; Tchah, Hungwon

2015-09-01

To evaluate the clinical efficacy and safety of femtosecond laser-assisted arcuate keratotomy (FS-AK) versus toric intraocular lens (IOL) implantation for correcting astigmatism in patients with cataract. A retrospective chart review was performed. All patients had senile cataracts with corneal astigmatism (range: +1.00 to +3.00 diopters [D]) before cataract surgery. Twenty-five patients agreed to undergo toric IOL implantation (the toric IOL group). Twenty-three patients did not agree to undergo toric IOL implantation despite astigmatism; however, these patients were not satisfied with their remaining astigmatism following cataract surgery and requested astigmatism correction using FS-AK (the FS-AK group). Visual acuity and intraocular pressure were evaluated, and automated refraction, keratometry, and slit-lamp examinations were performed at 1 day, 1 week, 1 month, and 5 months after surgery. Refractive astigmatism decreased in both groups. The mean preoperative and postoperative refractive cylinders were 1.71 ± 1.15 and 0.78 ± 1.06 D, respectively, in the FS-AK group (P < .001) and 1.67 ± 0.13 and 0.83 ± 0.097 D, respectively, in the toric IOL group (P < .001). There were no statistically significant differences between groups at any time during the follow-up period. FS-AK is a fast, customizable, adjustable, precise, and safe procedure for reducing refractive errors in patients with residual astigmatism after cataract surgery. The results of this procedure are comparable to the toric IOL. Copyright 2015, SLACK Incorporated.

Strategic issues in preventing cataract blindness in developing countries.

PubMed Central

Ellwein, L. B.; Kupfer, C.

1995-01-01

Cataract blindness is a public health problem of major proportions in developing countries. Intracapsular cataract extraction with aphakic spectacles has been the standard surgical technique for restoring sight. Because of image magnification in the operated eye, however, the result in unilaterally blind patients is less than satisfactory. Fortunately, with the availability of low-cost intraocular lenses (IOL) and ophthalmologists trained in extracapsular surgery, it is now practical to intervene successfully in the unilateral case. The need for increased attention on the quality of the visual high prevalence of cataract blindness in developing countries and an increasing cataract incidence due to an aging population require substantial increases in surgical volume. The third issue relates to cost. If significant increases in surgical volume and quality of outcomes are to be realized without an increased need for external funding, service delivery must be made more efficient. The expansion of IOL surgery for unilateral blindness is a favourable trend in ensuring financial sustainability of delivery systems; patients can be operated on while still economically productive and able to pay rather than waiting for bilateral blindness and a less favourable economic and social impact. If the quality, volume, and cost issues are to be successfully addressed, operational and structural changes to eye care delivery systems are necessary. These changes can be effected through training, technology introduction, management of facilities, social marketing, organizational partnerships, and evaluation. With improved understanding of the critical factors in successful models their widespread replication will be facilitated. PMID:8846495

Spectral analysis and comparison of mineral deposits forming in opacified intraocular lens and senile cataractous lens

NASA Astrophysics Data System (ADS)

Lin, Shan-Yang; Chen, Ko-Hwa; Lin, Chih-Cheng; Cheng, Wen-Ting; Li, Mei-Jane

2010-10-01

This preliminary report was attempted to compare the chemical components of mineral deposits on the surfaces of an opacified intraocular lens (IOL) and a calcified senile cataractous lens (SCL) by vibrational spectral diagnosis. An opacified intraocular lens (IOL) was obtained from a 65-year-old male patient who had a significant decrease in visual acuity 2-years after an ocular IOL implantation. Another SCL with grayish white calcified plaque on the subcapsular cortex was isolated from a 79-year-old male patient with complicated cataract after cataract surgery. Optical light microscope was used to observe both samples and gross pictures were taken. Fourier transform infrared (FT-IR) and Raman microspectroscopic techniques were employed to analyze the calcified deposits. The curve-fitting algorithm using the Gaussian function was also used to quantitatively estimate the chemical components in each deposit. The preliminary results of spectral diagnosis indicate that the opacified IOL mainly consisted of the poorly crystalline, immature non-stoichiometric hydroxyapatite (HA) with higher content of type B carbonated apatites. However, the calcified plaque deposited on the SCL was comprised of a mature crystalline stoichiometric HA having higher contents of type A and type B carbonate apatites. More case studies should be examined in future.

Hydropolish: a controlled trial on a technique to eradicate residual cortical lens fibers in phacoemulsification cataract surgery.

PubMed

Wang, Sarah B; Quah, Xhian M; Amjadi, Shahriar; Tong, Jessica; Francis, Ian C

2015-01-01

To assess the efficacy and safety of a noncontact, fluid-based capsular polishing technique (hydropolish) to remove residual cortical fibers (RCFs) and epithelial cells from the posterior and equatorial capsule in phacoemulsification cataract surgery. Hydropolish involved manual irrigation of the posterior and equatorial capsule after irrigation/aspiration, using a 27-G hydrodissection cannula. This prospective, consecutive, single surgeon controlled trial was conducted at a dedicated ophthalmic surgery center in Sydney, Australia, between December 20, 2006, and July 14, 2010. Single eyes of consecutive patients underwent cataract surgery without use of hydropolish (control group), while those on or after July 21, 2010, underwent hydropolish (intervention group). Corrected distance visual acuity (CDVA) up to 1 month postoperatively, surgical complications, and hydropolish time were documented. A total of 1531 eyes were included in this study (hydropolish n = 682; control n = 849). After adjusting for age, sex, and nuclear sclerosis grade, no significant difference was found between hydropolish and control groups when preoperative CDVA was compared against postoperative CDVA at 1 day, 1 week, and 1 month (p>0.05). Hydropolish is a rapid and safe technique that can remove RCFs from the posterior and equatorial capsule in phacoemulsification cataract surgery. It does not compromise postoperative CDVA.

Relationship between postoperative refractive outcomes and cataract density: multiple regression analysis.

PubMed

Ueda, Tetsuo; Ikeda, Hitoe; Ota, Takeo; Matsuura, Toyoaki; Hara, Yoshiaki

2010-05-01

To evaluate the relationship between cataract density and the deviation from the predicted refraction. Department of Ophthalmology, Nara Medical University, Kashihara, Japan. Axial length (AL) was measured in eyes with mainly nuclear cataract using partial coherence interferometry (IOLMaster). The postoperative AL was measured in pseudophakic mode. The AL difference was calculated by subtracting the postoperative AL from the preoperative AL. Cataract density was measured with the pupil dilated using anterior segment Scheimpflug imaging (EAS-1000). The predicted postoperative refraction was calculated using the SRK/T formula. The subjective refraction 3 months postoperatively was also measured. The mean absolute prediction error (MAE) (mean of absolute difference between predicted postoperative refraction and spherical equivalent of postoperative subjective refraction) was calculated. The relationship between the MAE and cataract density, age, preoperative visual acuity, anterior chamber depth, corneal radius of curvature, and AL difference was evaluated using multiple regression analysis. In the 96 eyes evaluated, the MAE was correlated with cataract density (r = 0.37, P = .001) and the AL difference (r = 0.34, P = .003) but not with the other parameters. The AL difference was correlated with cataract density (r = 0.53, P<.0001). The postoperative refractive outcome was affected by cataract density. This should be taken into consideration in eyes with a higher density cataract. (c) 2010 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Falls and health status in elderly women following first eye cataract surgery: a randomised controlled trial

PubMed Central

Harwood, R H; Foss, A J E; Osborn, F; Gregson, R M; Zaman, A; Masud, T

2005-01-01

Background/aim: A third of elderly people fall each year. Poor vision is associated with increased risk of falls. The authors aimed to determine if first eye cataract surgery reduces the risk of falling, and to measure associated health gain. Methods: 306 women aged over 70, with cataract, were randomised to expedited (approximately 4 weeks) or routine (12 months wait) surgery. Falls were ascertained by diary, with follow up every 3 months. Health status was measured after 6 months. Results: Visual function improved in the operated group (corrected binocular acuity improved by 0.25 logMAR units; 8% had acuity worse than 6/12 compared with 37% of controls). Over 12 months of follow up, 76 (49%) operated participants fell at least once, and 28 (18%) fell more than once. 69 (45%) unoperated participants fell at least once, 38 (25%) fell more than once. Rate of falling was reduced by 34% in the operated group (rate ratio 0.66, 95% confidence interval 0.45 to 0.96, p = 0.03). Activity, anxiety, depression, confidence, visual disability, and handicap all improved in the operated group compared with the control group. Four participants in the operated group had fractures (3%), compared with 12 (8%) in the control group (p = 0.04). Conclusion: First eye cataract surgery reduces the rate of falling, and risk of fractures and improves visual function and general health status. PMID:15615747

Preventable visual impairment in children 
with nonprofound intellectual disability.

PubMed

Aslan, Lokman; Aslankurt, Murat; Aksoy, Adnan; Altun, Hatice

2013-01-01

To assess the preventable visual impairment in children with nonprofound intellectual disability (ID). 
 A total of 215 children with IDs (90 Down syndrome [DS], 125 nonprofound ID) and 116 age- and sex-matched healthy subjects were enrolled in this study. All participants underwent ophthalmologic examinations including cycloplegic refraction measurements, ocular movement evaluation, screening for strabismus (Hirschberg, Krimsky, or prism cover test), slit-lamp biomicroscopy, funduscopy, and intraocular pressure measurements. All data were recorded for statistical analysis.
 Ocular findings in decreasing prevalence were as follows: refractive errors 55 (61.1%), strabismus 30 (33.2%), cataract 7 (7.8%), and nystagmus 7 (7.8%) in children with DS; refractive errors 57 (45.6%), strabismus 19 (15.2%), cataract 7 (6.4%), nystagmus 5 (4%), and glaucoma 1 (0.8%) in children with other ID; and refractive errors 13 (11.2%) and strabismus 4 (3.5%) in controls. Cataracts, glaucoma, and nystagmus were not observed in the control group. The most common ophthalmic findings in children with DS compared with other ID and controls were with hyperopia (p<0.03 and 
p<0.001, respectively) and esotropia (p<0.01 and p<0.01, respectively).
 The pediatric population with ID has a high prevalence of preventable visual impairments, refractive errors, strabismus, and cataracts. The prevalence of strabismus and refractive errors was more frequent in children with DS. The importance of further health screenings including ophthalmic examinations should be utilized to implement appropriate care management and improve quality of life.

Simultaneous Bilateral Cataract Surgery in Outreach Surgical Camps

PubMed Central

Giles, Kagmeni; Robert, Ebana Steve; Come, Ebana Mvogo; Wiedemann, Peter

2017-01-01

OBJECTIVES The aim of this study was to evaluate the safety and visual outcomes of simultaneous bilateral cataract surgery (SBCS) with intraocular lens implantation performed in outreach surgical eye camps. METHODS The medical records of 47 consecutive patients who underwent simultaneous bilateral small-incision cataract surgery between January 2010 and December 2015 in outreach surgical camps in rural Cameroon were reviewed. The measures included postoperative visual outcomes and intraoperative and postoperative complications. RESULTS Data from 94 eyes of 47 participants (30 men, 17 women; mean age: 60.93 ± 13.58 years, range: 45–80 years) were included in this study. The presented best visual acuity (VA) was less than 3/60 in 100% of the eyes. At the 4-week follow-up, 84.04% of the eyes showed increased VA of 1 line or more (P = .001). Of these, 71 (75.53%) achieved good VA (greater than 6/18). Intraoperative or postoperative complications occurred in 19 (20.21%) eyes. The most serious intraoperative complication was a posterior capsule rupture and vitreous loss (2 patients, 2 eyes). The postoperative complications included a transient elevation in the intraocular pressure (6 eyes), chronic corneal oedema (5 eyes), iris capture (3 eyes), lens decentration (2 eyes), and hyphema (1 eye). No cases of postoperative endophthalmitis were recorded. CONCLUSIONS Under the strict observation of endophthalmitis prophylaxis, SBCS is an option to reduce the cataract blindness backlog in rural areas of developing countries. PMID:28469481

Prevalence and causes of low vision and blindness in a rural Southwest Island of Japan: the Kumejima study.

PubMed

Nakamura, Yuko; Tomidokoro, Atsuo; Sawaguchi, Shoichi; Sakai, Hiroshi; Iwase, Aiko; Araie, Makoto

2010-12-01

To determine the prevalence and causes of low vision and blindness in an adult population on a rural southwest island of Japan. Population-based, cross-sectional study. All residents of Kumejima Island, Japan, 40 years of age and older. Of the 4632 residents 40 years of age and older, 3762 (response rate, 81.2%) underwent a detailed ocular examination including measurement of the best-corrected visual acuity (BCVA) with a Landolt ring chart at 5 m. The age- and gender-specific prevalence rates of low vision and blindness were estimated and causes were identified. Low vision and blindness were defined, according to the definition of the World Health Organization, as a BCVA in the better eye below 20/60 to a lower limit of 20/400 and worse than 20/400, respectively. The prevalence of bilateral low vision was 0.58% (95% confidence interval [CI], 0.38-0.89). The primary causes of low vision were cataract (0.11%), corneal opacity (0.08%), retinitis pigmentosa (RP; 0.06%), and diabetic retinopathy (0.06%). The prevalence of bilateral blindness was 0.39% (95% CI, 0.23-0.65). The primary causes of blindness were RP (0.17%) and glaucoma (0.11%). The primary causes of monocular low vision were cataract (0.65%), corneal opacity (0.16%), age-related macular degeneration (0.16%), and diabetic retinopathy (0.11%), whereas those of monocular blindness were cataract (0.29%), trauma (0.25%), and glaucoma (0.22%). Logistic analysis showed that female gender (P = 0.001; odds ratio [OR], 7.37; 95% CI, 2.20-24.71) and lower body weight (P = 0.015; OR, 0.94; 95% CI, 0.90-0.99) were associated significantly with visual impairment. The prevalences of low vision and blindness in the adult residents of an island in southwest Japan were 1.5 to 3 times higher than the prevalences reported in an urban city on the Japanese mainland. The prevalence of visual impairment caused by RP on this island was much higher than on the mainland, suggesting a genetic characteristic of the population. Furthermore, the prevalence of visual impairment resulting from cataract and corneal opacity was higher than that on the mainland. The prevalence of visual impairment resulting from myopic macular degeneration was less. Copyright © 2010 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Visual risk factors for falls in older people.

PubMed

Lord, Stephen R

2006-09-01

Poor vision reduces postural stability and significantly increases the risk of falls and fractures in older people. Most studies have found that poor visual acuity increases the risk of falls. However, studies that have included multiple visual measures have found that reduced contrast sensitivity and depth perception are the most important visual risk factors for falls. Multifocal glasses may add to this risk because their near-vision lenses impair distance contrast sensitivity and depth perception in the lower visual field. This reduces the ability of an older person to detect environmental hazards. There is now evidence that maximising vision through cataract surgery is an effective strategy for preventing falls. Further randomised controlled trials are required to determine whether individual strategies (such as restriction of use of multifocal glasses) or multi-strategy visual improvement interventions can significantly reduce falls in older people. Public health initiatives are required to raise awareness in older people and their carers of the importance of regular eye examinations and use of appropriate prescription glasses.

Quality of vision in refractive and cataract surgery, indirect measurers: review article.

PubMed

Parede, Taís Renata Ribeira; Torricelli, André Augusto Miranda; Mukai, Adriana; Vieira Netto, Marcelo; Bechara, Samir Jacob

2013-01-01

Visual acuity is the measurement of an individual's ability to recognize details of an object in a space. Visual function measurements in clinical ophthalmology are limited by factors such as maximum contrast and so it might not adequately reflect the real vision conditions at that moment as well as the subjective aspects of the world perception by the patient. The objective of a successful vision-restoring surgery lies not only in gaining visual acuity lines, but also in vision quality. Therefore, refractive and cataract surgeries have the responsibility of achieving quality results. It is difficult to define quality of vision by a single parameter, and the main functional-vision tests are: contrast sensitivity, disability glare, intraocular stray light and aberrometry. In the current review the different components of the visual function are explained and the several available methods to assess the vision quality are described.

The effect of mitomycin C trabeculectomy on the progression of visual field defect in normal-tension glaucoma.

PubMed

Hagiwara, Y; Yamamoto, T; Kitazawa, Y

2000-03-01

We investigated in a prospective fashion the visual prognosis and complications in normal-tension glaucoma following unilateral trabeculectomy with adjunctive mitomycin C. Trabeculectomy with adjunctive mitomycin C was carried out unilaterally in 21 cases of normal-tension glaucoma. Intraocular pressure (IOP), visual prognosis, and complications were compared between the operated eyes and the non-operated fellow eyes. The follow-up period ranged from 2 to 7 years. The IOP dropped significantly from 14.8+/-1.8 mmHg (mean +/- SD) to 9.6+/-3.9 mmHg in the operated eyes (P=0.0002, Wilcoxon signed-rank test), but did not drop in the non-operated eyes. The mean deviation (MD) was -12.69+/-6.41 dB preoperatively and -14.70+/-5.49 dB at the last clinic visit in the operated eyes, whereas in non-operated eyes it was -7.85+/-5.65 dB and -11.15+/-5.62 dB, respectively. The MD deteriorated significantly in both operated and non-operated eyes (operated eyes P=0.0239, non-operated eyes: P=0.0002; Wilcoxon signed-rank test). The MD slope was -0.37+/-0.60 dB/year and -0.71+/-0.89 dB/year for the operated and non-operated eyes, respectively (P=0.5243, Mann-Whitney U-test). Visual field deterioration was more frequently observed in the non-operated eyes by a pointwise definition of the progression (P<0.05, McNemar test). Visual acuity deteriorated in 6 of the operated eyes and in 5 of the non-operated eyes. Cataract developed in 6 (29%) of the 21 operated eyes, while among the non-operated eyes 4 (19%) developed cataract. Mitomycin C trabeculectomy is effective in delaying progression of visual field defect in normal-tension glaucoma, but complications may arise and cause some visual disturbance.

A rapid assessment of avoidable blindness in Southern Zambia.

PubMed

Lindfield, Robert; Griffiths, Ulla; Bozzani, Fiammetta; Mumba, Musonda; Munsanje, Joseph

2012-01-01

A rapid assessment of avoidable blindness (RAAB) was conducted in Southern Zambia to establish the prevalence and causes of blindness in order to plan effective services and advocate for support for eye care to achieve the goals of VISION 2020: the right to sight. Cluster randomisation was used to select villages in the survey area. These were further subdivided into segments. One segment was selected randomly and a survey team moved from house to house examining everyone over the age of 50 years. Each individual received a visual acuity assessment and simple ocular examination. Data was recorded on a standard proforma and entered into an established software programme for analysis. 2.29% of people over the age of 50 were found to be blind (VA <3/60 in the better eye with available correction). The major cause of blindness was cataract (47.2%) with posterior segment disease being the next main cause (18.8%). 113 eyes had received cataract surgery with 30.1% having a poor outcome (VA <6/60) following surgery. Cataract surgical coverage showed that men (72%) received more surgery than women (65%). The results from the RAAB survey in Zambia were very similar to the results from a similar survey in Malawi, where the main cause of blindness was cataract but posterior segment disease was also a significant contributor. Blindness in this part of Zambia is mainly avoidable and there is a need for comprehensive eye care services that can address both cataract and posterior segment disease in the population if the aim of VISION 2020 is to be achieved. Services should focus on quality and gender equity of cataract surgery.

Effect of intracameral carbachol given during cataract surgery on macular thickness.

PubMed

Demir, Mehmet; Oba, Ersin; Dirim, Burcu; Can, Efe; Odabasi, Mahmut; Ozdal, Erhan

2012-10-01

To evaluate the effect of intracameral carbachol on foveal thickness in patients who underwent uneventful cataract surgery. This retrospective study included two groups: the study group patients (group 1, n = 47 eyes) had uneventful cataract surgery and received only carbachol 0.01 % for miosis; the control group patients (group 2, n = 49 eyes) had uneventful cataract surgery without carbachol or any intracameral medication(s). The groups were compared for foveal thickness after cataract surgery. All phacoemulsification plus intraocular lens implantation surgeries were performed under local anesthesia via temporal clear corneal tunnel incisions. Mean values and standard deviations were calculated for preoperative and postoperative visual acuity (VA) and foveal thickness (FT) at 1 and 4 weeks. Optical coherence tomography was used for the FT measurements, with the MM6 map program. The patients in the study and control groups had a mean age of 57.78 ± 9.07 and 59.72 ± 8.96, respectively (p = 0.355). All eyes had a significant improvement in VA. In the study group, the mean FT at the visits before and 1 and 4 weeks after surgery was 216.87 ± 21.06, 228.81 ± 30.52, and 222.94 ± 29.91 μm, respectively. For the control group, the mean FT, before and 1 and 4 weeks after surgery, was 222.53 ± 17.66, 231.67 ± 23.08, and 225.41 ± 22.59 μm, respectively. Intracameral carbachol 0.01 % had no effect on foveal thickness in patients who underwent uneventful cataract surgery.

Sparing of Sensitivity to Biological Motion but Not of Global Motion after Early Visual Deprivation

ERIC Educational Resources Information Center

Hadad, Bat-Sheva; Maurer, Daphne; Lewis, Terri L.

2012-01-01

Patients deprived of visual experience during infancy by dense bilateral congenital cataracts later show marked deficits in the perception of global motion (dorsal visual stream) and global form (ventral visual stream). We expected that they would also show marked deficits in sensitivity to biological motion, which is normally processed in the…

A Single Drop of 0.5% Proparacaine Hydrochloride for Uncomplicated Clear Corneal Phacoemulsification

PubMed Central

Joshi, Rajesh Subhash

2013-01-01

Purpose: The purpose of this study was to compare the efficacy of a single drop of 0.5% proparacaine hydrochloride in uncomplicated cataract surgery with phacoemulsification. Materials and Methods: Two hundred and ninety five patients scheduled for the phacoemulsification were divided into 2 groups based on the anesthetic agents they were to receive: 146 patients who received a single drop of 0.5% proparacaine 2 min before the start of the surgery (proparacaine group) and; 149 patients who received supplementation of 0.5% intracameral preservative free xylocaine (xylocaine group). A single surgeon performed all surgeries. Intraoperative and post-operative pain scores were evaluated on a visual analog scale. The surgeon noted his subjective impression of corneal clarity, discomfort while performing the surgery any supplemental anesthesia required and intraoperative complications. An anesthetist noted vital parameters and the need for intravenous sedation. Total surgical time was noted. Comparison of parameters was performed with the Chi-square test, and A P value less than 0.05 was considered as statistically significant. Results: No statistically significant difference was seen in the intraoperative (P = 0.24) and post-operative (P = 0.164) pain scores between groups. There was no pain (0 score) in 41.8% of patients in the proparacaine group and 46.3% of patients in the xylocaine group. The average surgical time (P = 0.279) and surgeon discomfort (P = 0.07) were not statistically significantly different between groups. No patients required supplemental anesthesia. There were no surgical complications that could compromise the visual outcome. An equal number of patients in both groups preferred same type of anesthetic technique for the fellow eye cataract surgery (89.11% for the proparacaine group and 90.18% for the xylocaine group). No patients in either group had changes in vital parameters or required intravenous sedation. Conclusion: A single drop pre-operatively, of proparacaine hydrochloride was comparable to the intracameral supplementation of preservative free xylocaine for phacoemulsification in uncomplicated cataract surgery without compromising the visual outcome. However, we recommend individualizing the anesthetic technique according to the requirements of the surgeon. PMID:24014985

Safety and efficacy of loteprednol etabonate ophthalmic ointment 0.5% for the treatment of inflammation and pain following cataract surgery.

PubMed

Comstock, Timothy L; Paterno, Michael R; Singh, Angele; Erb, Tara; Davis, Elizabeth

2011-01-01

To compare the safety and efficacy of loteprednol etabonate ophthalmic ointment 0.5% (LE ointment), a new topical ointment formulation, with vehicle for the treatment of inflammation and pain following cataract surgery. Two randomized, multicenter, double-masked, parallel-group, vehicle-controlled studies were conducted. Patients aged ≥18 years with a combined postoperative anterior chamber cells and flare (ACI) ≥ Grade 3 following uncomplicated cataract surgery participated in seven study visits. Patients self-administered either topical LE ointment or vehicle four times daily for 14 days. Efficacy outcomes included the proportion of patients with complete resolution of ACI and the proportion of patients with no (Grade 0) pain at postoperative day 8. Safety outcomes included the incidence of adverse events, ocular symptoms, changes in intraocular pressure and visual acuity, and biomicroscopy and funduscopy findings. Data from the two studies were combined. The integrated intent-to-treat population consisted of 805 patients (mean [standard deviation] age 69.0 [9.2] years; 58.0% female and 89.7% white). Significantly more LE ointment-treated patients than vehicle-treated patients had complete resolution of ACI (27.7% versus 12.5%) and no pain (75.5% versus 43.1%) at day 8 (P < 0.0001 for both). Fewer LE ointment-treated patients required rescue medication (27.7% versus 63.8%), and fewer had an ocular adverse event (47.2% versus 78.0%, P < 0.0001) while on study treatment. The most common ocular adverse events with LE ointment were anterior chamber inflammation, photophobia, corneal edema, conjunctival hyperemia, eye pain, and iritis. Mean intraocular pressure decreased in both treatment groups. Four patients had increased intraocular pressure ≥10 mmHg (three LE ointment and one vehicle) prior to rescue medication. Visual acuity and dilated funduscopy results were similar between the treatment groups, with the exception of visual acuity at visits 5 and 6, which favored LE ointment. LE ointment was efficacious and well tolerated in the treatment of ocular inflammation and pain following cataract surgery.

Current status of cataract blindness and Vision 2020: the right to sight initiative in India.

PubMed

Murthy, Gvs; Gupta, Sanjeev K; John, Neena; Vashist, Praveen

2008-01-01

India is a signatory to the World Health Organization resolution on Vision 2020: The right to sight. Efforts of all stakeholders have resulted in increased number of cataract surgeries performed in India, but the impact of these efforts on the elimination of avoidable blindness is unknown. Projection of performance of cataract surgery over the next 15 years to determine whether India is likely to eliminate cataract blindness by 2020. Data from three national level blindness surveys in India over three decades, and projected age-specific population till 2020 from US Census Bureau were used to develop a model to predict the magnitude of cataract blindness and impact of Vision 2020: the right to sight initiatives. Using age-specific data for those aged 50+ years it was observed that prevalence of blindness at different age cohorts (above 50 years) reduced over three decades with a peak in 1989. Projections show that among those aged 50+ years, the quantum of cataract surgery would double (3.38 million in 2001 to 7.63 million in 2020) and cataract surgical rate would increase from 24025/million 50+ in 2001 to 27817/million 50+ in 2020. Though the prevalence of cataract blindness would decrease, the absolute number of cataract blind would increase from 7.75 million in 2001 to 8.25 million in 2020 due to a substantial increase in the population above 50 years in India over this period. Considering existing prevalence and projected incidence of cataract blindness over the period 2001-2020, visual outcomes after cataract surgery and sight restoration rate, elimination of cataract blindness may not be achieved by 2020 in India.

Partial duplication of the CRYBB1-CRYBA4 locus is associated with autosomal dominant congenital cataract

PubMed Central

Siggs, Owen M; Javadiyan, Shari; Sharma, Shiwani; Souzeau, Emmanuelle; Lower, Karen M; Taranath, Deepa A; Black, Jo; Pater, John; Willoughby, John G; Burdon, Kathryn P; Craig, Jamie E

2017-01-01

Congenital cataract is a rare but severe paediatric visual impediment, often caused by variants in one of several crystallin genes that produce the bulk of structural proteins in the lens. Here we describe a pedigree with autosomal dominant isolated congenital cataract and linkage to the crystallin gene cluster on chromosome 22. No rare single nucleotide variants or short indels were identified by exome sequencing, yet copy number variant analysis revealed a duplication spanning both CRYBB1 and CRYBA4. While the CRYBA4 duplication was complete, the CRYBB1 duplication was not, with the duplicated CRYBB1 product predicted to create a gain of function allele. This association suggests a new genetic mechanism for the development of isolated congenital cataract. PMID:28272538

Survey of childhood blindness and visual impairment in Botswana.

PubMed

Nallasamy, Sudha; Anninger, William V; Quinn, Graham E; Kroener, Brian; Zetola, Nicola M; Nkomazana, Oathokwa

2011-10-01

In terms of blind-person years, the worldwide burden of childhood blindness is second only to cataracts. In many developing countries, 30-72% of childhood blindness is avoidable. The authors conducted this study to determine the causes of childhood blindness and visual impairment (VI) in Botswana, a middle-income country with limited access to ophthalmic care. This study was conducted over 4 weeks in eight cities and villages in Botswana. Children were recruited through a radio advertisement and local outreach programmes. Those ≤ 15 years of age with visual acuity <6/18 in either eye were enrolled. The WHO/Prevention of Blindness Eye Examination Record for Children with Blindness and Low Vision was used to record data. The authors enrolled 241 children, 79 with unilateral and 162 with bilateral VI. Of unilateral cases, 89% were avoidable: 23% preventable (83% trauma-related) and 66% treatable (40% refractive error and 31% amblyopia). Of bilateral cases, 63% were avoidable: 5% preventable and 58% treatable (33% refractive error and 31% congenital cataracts). Refractive error, which is easily correctable with glasses, is the most common cause of bilateral VI, with cataracts a close second. A nationwide intervention is currently being planned to reduce the burden of avoidable childhood VI in Botswana.

The Influence of Averageness on Adults' Perceptions of Attractiveness: The Effect of Early Visual Deprivation.

PubMed

Vingilis-Jaremko, Larissa; Maurer, Daphne; Rhodes, Gillian; Jeffery, Linda

2016-08-03

Adults who missed early visual input because of congenital cataracts later have deficits in many aspects of face processing. Here we investigated whether they make normal judgments of facial attractiveness. In particular, we studied whether their perceptions are affected normally by a face's proximity to the population mean, as is true of typically developing adults, who find average faces to be more attractive than most other faces. We compared the judgments of facial attractiveness of 12 cataract-reversal patients to norms established from 36 adults with normal vision. Participants viewed pairs of adult male and adult female faces that had been transformed 50% toward and 50% away from their respective group averages, and selected which face was more attractive. Averageness influenced patients' judgments of attractiveness, but to a lesser extent than controls. The results suggest that cataract-reversal patients are able to develop a system for representing faces with a privileged position for an average face, consistent with evidence from identity aftereffects. However, early visual experience is necessary to set up the neural architecture necessary for averageness to influence perceptions of attractiveness with its normal potency. © The Author(s) 2016.

The visually impaired patient.

PubMed

Rosenberg, Eric A; Sperazza, Laura C

2008-05-15

Blindness or low vision affects more than 3 million Americans 40 years and older, and this number is projected to reach 5.5 million by 2020. In addition to treating a patient's vision loss and comorbid medical issues, physicians must be aware of the physical limitations and social issues associated with vision loss to optimize health and independent living for the visually impaired patient. In the United States, the four most prevalent etiologies of vision loss in persons 40 years and older are age-related macular degeneration, cataracts, glaucoma, and diabetic retinopathy. Exudative macular degeneration is treated with laser therapy, and progression of nonexudative macular degeneration in its advanced stages may be slowed with high-dose antioxidant and zinc regimens. The value of screening for glaucoma is uncertain; management of this condition relies on topical ocular medications. Cataract symptoms include decreased visual acuity, decreased color perception, decreased contrast sensitivity, and glare disability. Lifestyle and environmental interventions can improve function in patients with cataracts, but surgery is commonly performed if the condition worsens. Diabetic retinopathy responds to tight glucose control, and severe cases marked by macular edema are treated with laser photocoagulation. Vision-enhancing devices can help magnify objects, and nonoptical interventions include special filters and enhanced lighting.

Characteristics of Endophthalmitis after Cataract Surgery in the United States Medicare Population.

PubMed

Gower, Emily W; Keay, Lisa J; Stare, Dianne E; Arora, Pallavi; Cassard, Sandra D; Behrens, Ashley; Tielsch, James M; Schein, Oliver D

2015-08-01

Endophthalmitis is a rare but sight-threatening infection after cataract surgery. Roughly one third of eyes remain blind after treatment. We report United States population-based data on microbiological investigations and treatment patterns plus risk factors for poor outcomes. Retrospective cohort study. Medicare beneficiaries from 5 states in whom endophthalmitis developed within 6 weeks after cataract surgery in 2003 and 2004. We identified endophthalmitis cases occurring after cataract surgery using Medicare billing claims. We contacted treating physicians and requested they complete a questionnaire on clinical and microbiological data and submit relevant medical records. Two independent observers reviewed materials to confirm that cases met a standardized definition. Positive culture results, vitrectomy status, microbiology spectrum, and final visual acuity. In total, 615 cases met our case definition. Initial visual acuity was counting fingers or worse for 72%. Among 502 cases with known culture results, 291 (58%) had culture positive results. Twelve percent had positive results for streptococci. More than 99% of cases were treated with intravitreal vancomycin. Vitrectomy was performed in 279 cases (45%), including 201 cases with initial acuity better than light perception. Rates of vitrectomy varied across states, with California having the highest rate and Michigan having the lowest (56% and 19% of cases, respectively). Overall, 43% of individuals achieved visual acuity of 20/40 or better. Poor initial acuity (adjusted odds ratio [OR], 1.08; 95% confidence interval [CI], 1.04-1.12 per 0.10 logarithm of the minimum angle of resolution units), older age at diagnosis (OR, 1.22; 95% CI, 1.03-1.45 per 5-year increase), and more virulent organisms were important predictors of poor final visual acuity. Cases with streptococci infection were 10 times more likely to have poor final acuity than coagulase-negative staphylococci cases (adjusted OR, 11.28; 95% CI, 3.63-35.03). Vitrectomy was not predictive of final visual acuity (adjusted OR, 1.26; 95% CI, 0.78-2.04). Population-based data on the microbiology of acute postoperative endophthalmitis in the United States after cataract surgery are consistent with prior reports. Vitrectomy usage is higher than that recommended from the Endophthalmitis Vitrectomy Study, with no evidence of increased benefit. Copyright © 2015 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Characterization and prevalence of cataracts in Labrador Retrievers in The Netherlands.

PubMed

Kraijer-Huver, Ingrid M G; Gubbels, Ed J; Scholten, Janneke; Djajadiningrat-Laanen, Sylvia C; Boevé, Michael H; Stades, Frans C

2008-10-01

To assess the prevalence and distribution of types of cataract, investigate the effects of selective breeding on cataract development, and identify the relationship between posterior polar cataract and other types of cortical cataracts in Labrador Retrievers in The Netherlands. 9,017 Labrador Retrievers. Records of 18,283 ophthalmic examinations performed by veterinary ophthalmologists from 1977 through 2005 were reviewed. There were 522 dogs affected by hereditary cataracts in 1 or both eyes without progressive retinal atrophy (PRA) and 166 PRA-affected dogs with cataracts. These cataracts were divided into 3 groups: posterior polar (triangular) cataract, extensive immature and mature cataract, and a miscellaneous group. Dogs with PRA were analyzed separately. From 1980 through 2000, the prevalence of hereditary cataracts was stable at 8%. The prevalence of cataracts in offspring of cataract-affected dogs was significantly increased, compared with the prevalence in offspring of nonaffected dogs. The distribution of types of cataract was significantly different between dogs with primary cataracts and PRA-affected dogs. Dogs with posterior polar (triangular) cataracts produced affected offspring with the same distribution of types of cataracts as the entire population of primary cataract-affected dogs. Cataract development in the Labrador Retriever population in The Netherlands appears to be a predominantly genetic disorder. Posterior polar (triangular) cataracts appear to be related to other types of hereditary cataract. Although there is no conclusive evidence, it seems valid to continue exclusion of all Labrador Retrievers affected by any type of primary cataract from breeding.

Ultrashort-pulse lasers treating the crystalline lens: will they cause vision-threatening cataract? (An American Ophthalmological Society thesis).

PubMed

Krueger, Ronald R; Uy, Harvey; McDonald, Jared; Edwards, Keith

2012-12-01

To demonstrate that ultrashort-pulse laser treatment in the crystalline lens does not form a focal, progressive, or vision-threatening cataract. An Nd:vanadate picosecond laser (10 ps) with prototype delivery system was used. Primates: 11 rhesus monkey eyes were prospectively treated at the University of Wisconsin (energy 25-45 μJ/pulse and 2.0-11.3M pulses per lens). Analysis of lens clarity and fundus imaging was assessed postoperatively for up to 4½ years (5 eyes). Humans: 80 presbyopic patients were prospectively treated in one eye at the Asian Eye Institute in the Philippines (energy 10 μJ/pulse and 0.45-1.45M pulses per lens). Analysis of lens clarity, best-corrected visual acuity, and subjective symptoms was performed at 1 month, prior to elective lens extraction. Bubbles were immediately seen, with resolution within the first 24 to 48 hours. Afterwards, the laser pattern could be seen with faint, noncoalescing, pinpoint micro-opacities in both primate and human eyes. In primates, long-term follow-up at 4½ years showed no focal or progressive cataract, except in 2 eyes with preexisting cataract. In humans, <25% of patients with central sparing (0.75 and 1.0 mm radius) lost 2 or more lines of best spectacle-corrected visual acuity at 1 month, and >70% reported acceptable or better distance vision and no or mild symptoms. Meanwhile, >70% without sparing (0 and 0.5 mm radius) lost 2 or more lines, and most reported poor or severe vision and symptoms. Focal, progressive, and vision-threatening cataracts can be avoided by lowering the laser energy, avoiding prior cataract, and sparing the center of the lens.

Ultrashort-Pulse Lasers Treating the Crystalline Lens: Will They Cause Vision-Threatening Cataract? (An American Ophthalmological Society Thesis)

PubMed Central

Krueger, Ronald R.; Uy, Harvey; McDonald, Jared; Edwards, Keith

2012-01-01

Purpose: To demonstrate that ultrashort-pulse laser treatment in the crystalline lens does not form a focal, progressive, or vision-threatening cataract. Methods: An Nd:vanadate picosecond laser (10 ps) with prototype delivery system was used. Primates: 11 rhesus monkey eyes were prospectively treated at the University of Wisconsin (energy 25–45 μJ/pulse and 2.0–11.3M pulses per lens). Analysis of lens clarity and fundus imaging was assessed postoperatively for up to 4½ years (5 eyes). Humans: 80 presbyopic patients were prospectively treated in one eye at the Asian Eye Institute in the Philippines (energy 10 μJ/pulse and 0.45–1.45M pulses per lens). Analysis of lens clarity, best-corrected visual acuity, and subjective symptoms was performed at 1 month, prior to elective lens extraction. Results: Bubbles were immediately seen, with resolution within the first 24 to 48 hours. Afterwards, the laser pattern could be seen with faint, noncoalescing, pinpoint micro-opacities in both primate and human eyes. In primates, long-term follow-up at 4½ years showed no focal or progressive cataract, except in 2 eyes with preexisting cataract. In humans, <25% of patients with central sparing (0.75 and 1.0 mm radius) lost 2 or more lines of best spectacle-corrected visual acuity at 1 month, and >70% reported acceptable or better distance vision and no or mild symptoms. Meanwhile, >70% without sparing (0 and 0.5 mm radius) lost 2 or more lines, and most reported poor or severe vision and symptoms. Conclusions: Focal, progressive, and vision-threatening cataracts can be avoided by lowering the laser energy, avoiding prior cataract, and sparing the center of the lens. PMID:23818739

Surgical peripheral iridectomy via a clear-cornea phacoemulsification incision for pupillary block following cataract surgery in acute angle closure.

PubMed

Fang, Aiwu; Wang, Peijuan; He, Rui; Qu, Jia

2018-05-18

To describe a technique of surgical peripheral iridectomy via a clear-cornea tunnel incision to prevent or treat pupillary block following phacoemulsification. Description of technique and retrospective description results in 20 eyes of 20 patients with acute angle closure with coexisting visually significant cataract undergoing phacoemulsification considered at risk of postoperative papillary block as well as two pseudo-phakic eyes with acute postoperative pupillary-block. Following phacoemulsification and insertion of an intraocular lens, a needle with a bent tip was inserted behind the iris through the corneal tunnel incision. A blunt iris repositor was introduced through the paracentesis and placed above the iris to exert posterior pressure and create a puncture. The size of the puncture was enlarged using scissors. For postoperative pupillary block the same technique was carried out through the existing incisions created for phacoemulsification. Peripheral iridectomy was successfully created in all 22 eyes. At a mean follow-up of 18.77 ± 9.72 months, none of the iridectomies closed or required enlargement. Two eyes had mild intraoperative bleeding and one eye a small Descemet's detachment that did not require intervention. No clinically significant complications were observed. Visual acuity and IOP improved or was maintained in all patients. The incidence of pupillary block in our hospital was 0.09% overall, 0.6% in diabetics and 3.5% in those with diabetic retinopathy. This technique of peripheral iridectomy via the cornea tunnel incision can be safely used during phacoemulsification in eyes at high risk of pupillary block or in the treatment of acute postoperative pupillary-block after cataract surgery. The technique is likely to be especially useful in brown iris, or if a laser is not available.

Prevalence of blindness and cataract surgical coverage in Narayani Zone, Nepal: a rapid assessment of avoidable blindness (RAAB) study.

PubMed

Pradhan, Sangita; Deshmukh, Avnish; Giri Shrestha, Puspa; Basnet, Prajwal; Kandel, Ram Prasad; Lewallen, Susan; Sapkota, Yuddha Dhoj; Bassett, Ken; Yin, Vivian T

2018-03-01

The 1981 Nepal Blindness Survey first identified the Narayani Zone as one of the regions with the highest prevalence of blindness in the country. Subseuqently, a 2006 survey of the Rautahat District of the Narayani Zone found it to have the country's highest blindness prevalence. This study examines the impact on blind avoidable and treatable eye conditions in this region after significant increase in eye care services in the past decade. The rapid assessment of avoidable blindness (RAAB) methodology was used with mobile data collection using the mRAAB smartphone app. Data analysis was done using the standard RAAB software. Based on the 2011 census, 100 clusters of 50 participants aged 50 years or older were randomly sampled proportional to population size. Of the 5000 participants surveyed, 4771 (95.4%) were examined. The age-adjusted and sex-adjusted prevalence of bilateral blindness, severe visual impairment (SVI) and moderate visual impairment (MVI) were 1.2% (95% CI 0.9% to 1.5%), 2.5% (95% CI 2.0% to -3.0%) and 13.2% (95% CI 11.8% to 14.5%), respectively. Cataract remains the primary cause of blindness and SVI despite cataract surgery coverage (CSC) of 91.5% for VA<3/60. Women still account for two-thirds of blindness. The prevalence of blindness in people over the age of 50 years has decreased from 6.9% in 2006 to 1.2%, a level in keeping with the national average; however, significant gender inequity persists. CSC has improved but continues to favour men. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

General analysis of factors influencing cataract surgery practice in Shanghai residents.

PubMed

Xu, Yi; He, Jiangnan; Lin, Senlin; Zhang, Bo; Zhu, Jianfeng; Resnikoff, Serge; Lu, Lina; Zou, Haidong

2018-04-18

It was reported that lack of knowledge, less confidence of medical services, commute difficulties, and poor economic conditions would be the main barriers for cataract surgery practice. The influencing factors could have changed in cities with high developing speed. Shanghai is one of the biggest cities in China and the world. The purpose of the study was to explore the factors influencing cataract surgery practice in Shanghai. This was a population-based, cross-sectional study. A total of 2342 cataract patients older than 50 years old with cataract-induced visual impairment or who had undergone cataract surgery were recruited from rural and urban areas of Shanghai. Participants accepted a face-to-face structured questionnaire. Data were collected on patient demographics, education, work, income, health insurance, awareness about cataracts disease, treatment and related medical resources and deration policy, transportation and degree of satisfaction with hospitals. There were 417 patients who had received cataract surgery, 404 of them supplied complete information in the questionnaire. More female subjects (64.6%) than male subjects (35.4%) accepted cataract surgery among the 404 patients. Of the patients with cataract history, 36.4% of surgery patients were equal or older than 80. More people with urban medical insurance received surgery (p = 0.036). Patients who received surgery were more satisfied with local medical service (p = 0.032). In urban area, Lower income and difficulties with commutes were related to a higher rate of surgery. Cataract patients with the following features were more inclined to receive surgery: female, old age, better awareness. In urban areas low income and difficult commutes did not represent barriers for cataract surgery, probably because of appropriate cataract surgery promotion policies recent years in Shanghai. In rural areas, better healthcare reimbursement policies would likely lead to a higher uptake of cataract surgery. Further cohort studies with more controls could supply stronger evidence for our viewpoint.

PERIOCULAR CORTICOSTEROID INJECTIONS IN UVEITIS: EFFECTS AND COMPLICATIONS

PubMed Central

Sen, H. Nida; Vitale, Susan; Gangaputra, Sapna S.; Nussenblatt, Robert B.; Liesegang, Teresa L.; Levy-Clarke, Grace A.; Rosenbaum, James T.; Suhler, Eric B.; Thorne, Jennifer E.; Foster, C. Stephen; Jabs, Douglas A.; Kempen, John H.

2014-01-01

Purpose To evaluate the benefits and complications of periocular depot corticosteroid injections in patients with ocular inflammatory disorders. Design Multicenter retrospective cohort study. Participants A total of 914 patients (1192 eyes) who had received at least one periocular corticosteroid injection at 5 tertiary uveitis clinics in the United States. Methods Patients were identified from the Systemic Immunosuppressive Therapy for Eye Diseases (SITE) Cohort Study. Demographic and clinical characteristics were obtained at every visit via medical record review by trained reviewers. Main Outcome Measures Control of inflammation, improvement of visual acuity to 20/40 or better, improvement of visual acuity loss attributed to macular edema, incident cataract affecting visual acuity, cataract surgery, ocular hypertension and glaucoma surgery. Results Among 914 patients (1192 eyes) who received at least one periocular injection during follow-up, 286 (31.3%) were classified as having anterior uveitis, 303 (33.3%) as intermediate uveitis, 324 (35.4%) as posterior or panuveitis. Cumulatively by ≤6 months, 72.7% [95% confidence interval (95%CI): 69.1-76.3] of the eyes achieved complete control of inflammation and 49.7% [95%CI:45.5-54.1] showed an improvement in visual acuity (VA) from worse than 20/40 to 20/40 or better. Among the subset with VA worse than 20/40 attributed to macular edema, 33.1% [95%CI: 25.2-42.7] improved to 20/40 or better. By 12 months, the cumulative incidence of one or more visits with an intraocular pressure≥24 mmHg and ≥30 mmHg was 34.0% [95%CI: 24.8-45.4] and 15.0% [95%CI: 11.8-19.1] respectively; glaucoma surgery was performed in 2.4% [95%CI: 1.4-3.9] of eyes. Within 12 months, among phakic eyes initially 20/40 or better, the incidence of a reduction in VA to worse than 20/40 attributed to cataract was 20.2% [95%CI: 15.9-25.6]; cataract surgery was performed within 12 months in 13.8 % [95%CI: 11.1-17.2] of the initially phakic eyes. Conclusion Periocular injections were effective in treating active intraocular inflammation and in improving reduced visual acuity attributed to macular edema in a majority of patients. The response pattern was similar across anatomic locations of uveitis. Overall, visual acuity improved in in half of the patients at some point within six months. However, cataract and ocular hypertension occurred in a substantial minority. PMID:25017415

Cataracts induced by neodymium-yttrium-aluminium-garnet laser lysis of vitreous floaters.

PubMed

Koo, Ellen H; Haddock, Luis J; Bhardwaj, Namita; Fortun, Jorge A

2017-06-01

Neodymium-yttrium-aluminium-garnet (Nd:YAG) laser vitreolysis has been proposed as a treatment modality for symptomatic vitreous floaters. The purpose of this paper is to report two cases of cataracts associated with posterior capsular compromise, induced by Nd:YAG laser vitreolysis for symptomatic vitreous floaters. Case series. Two patients who underwent ND:YAG laser vitreolysis for symptomatic floaters, presented with decline in visual acuity in the treated eye after the laser procedure. At the slit-lamp biomicroscope, each patient was found to have a posterior subcapsular cataract in the treated eye, with obvious loss of integrity of the posterior capsule. These two patients underwent cataract extraction by the same surgeon via phacoemulsification. Both eyes were found to have a defect in the posterior capsule intraoperatively. In both cases, a three-piece acrylic intraocular lens implant was placed in the sulcus, achieving optic capture. The best-corrected visual acuity (BCVA) was 20/20 in both patients, at 1 month following the surgery. At 2 months, one patient had a BCVA of 20/15. The second patient maintained a BCVA of 20/20 at 3 months. Secondary cataract formation accompanied by loss of integrity of the posterior capsule is a potential complication of Nd:YAG laser vitreolysis for symptomatic floaters. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Thirty-two years follow-up of X-linked juvenile retinoschisis in a Chinese patient with RS1 mutation.

PubMed

Xu, Fei; Sui, Ruifang; Dong, Fangtian

2012-06-01

A Chinese family with X-linked juvenile retinoschisis (XLRS) was identified. The purpose of this study was to identify genetic defects in this family and to investigate the visual function during the progression of the disease in the proband from childhood to adulthood. The family history was collected and the proband underwent regular ophthalmologic examinations. Venous blood was collected from family members and genomic DNA was extracted. All exons and exon-intron boundaries of the RS1gene were sequenced for gene mutation in this family. The pedigree of interest was a three-generation family with 43 family members, including three affected individuals. The proband clinically diagnosed with XLRS was investigated at 7 years of age with a follow-up of 32 years. Best corrected visual acuity was stable and complications such as vitreous hemorrhage, retinal detachment, and subcapsular cataract arose during this follow-up period. The R213Q mutation in exon6 of RS1 was identified in all affected individuals. Clinical follow-up of an XLRS patient with a typical juvenile retinoschisis phenotype revealed no significant decline in visual acuity during this time period. Various complications such as vitreous hemorrhage and cataract may occur during the progression of the disease which may lead to severe vision loss.

Better Visual Outcome by Intraocular Lens Ejection in Geriatric Patients with Ruptured Ocular Injuries

PubMed Central

Sugita, Tadasu; Tsunekawa, Taichi; Matsuura, Toshiyuki; Takayama, Kei; Yamamoto, Kentaro; Kachi, Shu; Ito, Yasuki; Ueno, Shinji; Nonobe, Norie; Kataoka, Keiko; Suzumura, Ayana; Iwase, Takeshi; Terasaki, Hiroko

2017-01-01

Ocular trauma is one of the leading causes of visual impairment worldwide. Because of the popularity of cataract surgeries, aged individuals with ocular trauma commonly have a surgical wound in their eyes. The purpose of this study was to evaluate the visual outcome of cases that were coincident with intraocular lens (IOL) ejection in the eyes with ruptured open-globe ocular injuries. Consecutive patients with open-globe ocular injuries were first reviewed. Patients’ characteristics, corrected distance visual acuities (CDVAs) over 3 years after the trauma, causes of injuries, traumatic wound patterns, and coexistence of retinal detachment were examined. The relationships between poor CDVA and the other factors, including the complications of crystalline lens and IOL ejection, were examined. A total of 105 eyes/patients [43 eyes with rupture, 33 with penetrating, 28 with intraocular foreign body (IOFB), and 1 with perforating injuries] were included. Rupture injuries were common in aged patients and were mostly caused by falls, whereas penetrating and IOFB injuries were common in young male patients. CDVAs of the eyes with rupture injuries were significantly worse than those of the eyes with penetrating or IOFB injuries. CDVA from more than 50% of the ruptured eyes resulted in no light perception or light perception to 20/500. CDVA of the ruptured eyes complicated by crystalline lens ejection was significantly worse than that of those complicated by IOL ejection. The wounds of the ruptured eyes complicated by IOL ejection were mainly located at the superior corneoscleral limbus, whereas those of the eyes complicated by crystalline lens ejection were located at the posterior sclera. There were significant correlations between poor CDVA and retinal detachment and crystalline lens ejection. These results proposed a new trend in the ocular injuries that commonly occur in aged patients; history of cataract surgery might affect the final visual outcome after open-globe ocular injuries. PMID:28107485

Phacoemulsification with intravitreal bevacizumab injection in diabetic patients with macular edema and cataract.

PubMed

Akinci, Arsen; Batman, Cosar; Ozkilic, Ersel; Altinsoy, Ali

2009-01-01

The purpose of this study was to evaluate the results of phacoemulsification with intravitreal bevacizumab injection in patients with diabetic clinically significant macular edema and cataract. The records of 31 patients with diabetic clinically significant macular edema and cataract, which would interfere with macular laser photocoagulation, who have undergone phacoemulsification with intravitreal injection of 1.25 mg bevacizumab were retrospectively evaluated. All patients had undergone focal or modified grid laser photocoagulation 1 month after the surgery. All patients were evaluated by spectral optical coherence tomography/optical coherence tomography SLO before and 1 and 3 months after the surgery beyond complete ophthalmologic examination. The best-corrected visual acuity (BCVA) levels and central macular thickness (CMT) recorded at the first and third months after the surgery were compared with the initial values. Paired samples t test was used for statistical analysis. The mean initial BCVA was 0.10 +/- 0.04 (range, 0.05-0.2). The mean BCVA at the first and third months after the surgery were 0.47 +/- 0.16 (standard deviation) (range, 0.2-0.5) and 0.51 +/- 0.12 (standard deviation) (range, 0.3-0.6), respectively. The BCVA level recorded at the first and third months after the surgery were significantly higher than the initial BCVA (P = 0.004). The mean initial CMT was 387.5 +/- 109.5 microm. The mean CMT at the first and third months after the surgery were 292.7 +/- 57.2 and 275.5 +/- 40.3. The CMT recorded at the first and third months after the surgery were significantly lower than the initial CMT (P < 0.001, P < 0.001). Phacoemulsification with intravitreal injection of bevacizumab provides improvement in clinically significant macular edema with a gain in BCVA in patients with diabetes with clinically significant macular edema and cataract.

A comparable study of clinical and optical outcomes after 1.8, 2.0 mm microcoaxial and 3.0 mm coaxial cataract surgery.

PubMed

Yu, Yi-Bo; Zhu, Ya-Nan; Wang, Wei; Zhang, Yi-Dong; Yu, Yin-Hui; Yao, Ke

2016-01-01

To evaluate the clinical and optical outcomes after clear corneal incision cataract surgery (CICS) with three different incision sizes (1.8, 2.0 and 3.0 mm). Eyes of 150 patients with age-related cataract scheduled for coaxial cataract surgery were randomized to three groups: 1.8, 2.0, or 3.0 mm CICS. Intraoperative data and postoperative outcomes including surgically induced astigmatism (SIA), the corneal incision thickness, wavefront aberrations and modulation transfer function (MTF) of cornea were obtained. There were no significant differences among the three groups in demographic characteristics and intraoperative outcome. The 1.8 and 2.0 mm microincisions showed more satisfactory clinical outcomes than the 3.0 mm incision. The 1.8 mm incision showed significantly less SIA than the 2.0 mm incision until postoperative 1mo (P<0.05), but the difference was only 0.14-0.18 D. Combined with less increased incision thickness only at postoperative 1d (P=0.013), the 1.8 mm incision presented better uncorrected distance visual acuity (UCDVA) than the 2.0 mm incision only at 1d postoperatively (P=0.008). For higher-order aberrations and other Zernike coefficients, there were no significant differences between the 1.8 mm group and 2.0 mm group (P>0.05). Converting from 3.0 mm CICS to 1.8 or 2.0 mm CICS result in better clinical and optical outcomes. However, when incision is 1.8 mm, the benefits from further reduction in size compared with 2.0 mm are limited. The necessity to reduce the incision size is to be deliberated.

Infant Face Preferences after Binocular Visual Deprivation

ERIC Educational Resources Information Center

Mondloch, Catherine J.; Lewis, Terri L.; Levin, Alex V.; Maurer, Daphne

2013-01-01

Early visual deprivation impairs some, but not all, aspects of face perception. We investigated the possible developmental roots of later abnormalities by using a face detection task to test infants treated for bilateral congenital cataract within 1 hour of their first focused visual input. The seven patients were between 5 and 12 weeks old…

Rapid Cataract Progression after Nd:YAG Vitreolysis for Vitreous Floaters: A Case Report and Literature Review.

PubMed

Sun, I-Ting; Lee, Tsung-Han; Chen, Chih-Hsin

2017-01-01

We report a case of rapid cataract progression after Nd:YAG vitreolysis for vitreous floaters. A 55-year-old man presented with acute onset of blurred vision following Nd:YAG vitreolysis for symptomatic floaters in the left eye. His initial best corrected visual acuity (BCVA) was 20/1,000 in the left eye. Ocular examinations showed frost-like opacities of the lens and a suspected break of the posterior capsule in the left eye. There were no detectable retinal lesions. Cataract surgery was then arranged. Posterior capsular rupture and vitreous loss occurred during surgery, which required a subsequent pars plana vitrectomy. After the surgery, BCVA in the left eye gradually improved to 20/20 and was maintained during a 1-year follow-up period. Crystalline lens injuries and rapid cataract progression may occur following Nd:YAG vitreolysis. While dealing with this type of complicated cataract, clinicians should be aware of the possibility of posterior lens capsule rupture during surgery and the need for combined vitrectomy.

Virtual phacoemulsification surgical simulation using visual guidance and performance parameters as a feasible proficiency assessment tool.

PubMed

Lam, Chee Kiang; Sundaraj, Kenneth; Sulaiman, Mohd Nazri; Qamarruddin, Fazilawati A

2016-06-14

Computer based surgical training is believed to be capable of providing a controlled virtual environment for medical professionals to conduct standardized training or new experimental procedures on virtual human body parts, which are generated and visualised three-dimensionally on a digital display unit. The main objective of this study was to conduct virtual phacoemulsification cataract surgery to compare performance by users with different proficiency on a virtual reality platform equipped with a visual guidance system and a set of performance parameters. Ten experienced ophthalmologists and six medical residents were invited to perform the virtual surgery of the four main phacoemulsification cataract surgery procedures - 1) corneal incision (CI), 2) capsulorhexis (C), 3) phacoemulsification (P), and 4) intraocular lens implantation (IOL). Each participant was required to perform the complete phacoemulsification cataract surgery using the simulator for three consecutive trials (a standardized 30-min session). The performance of the participants during the three trials was supported using a visual guidance system and evaluated by referring to a set of parameters that was implemented in the performance evaluation system of the simulator. Subjects with greater experience obtained significantly higher scores in all four main procedures - CI1 (ρ = 0.038), CI2 (ρ = 0.041), C1 (ρ = 0.032), P2 (ρ = 0.035) and IOL1 (ρ = 0.011). It was also found that experience improved the completion times in all modules - CI4 (ρ = 0.026), C4 (ρ = 0.018), P6 (ρ = 0.028) and IOL4 (ρ = 0.029). Positive correlation was observed between experience and anti-tremor - C2 (ρ = 0.026), P3 (ρ = 0.015), P4 (ρ = 0.042) and IOL2 (ρ = 0.048) and similarly with anti-rupture - CI3 (ρ = 0.013), C3 (ρ = 0.027), P5 (ρ = 0.021) and IOL3 (ρ = 0.041). No significant difference was observed between the groups with regards to P1 (ρ = 0.077). Statistical analysis of the results obtained from repetitive trials between two groups of users reveal that augmented virtual reality (VR) simulators have the potential and capability to be used as a feasible proficiency assessment tool for the complete four main procedures of phacoemulsification cataract surgery (ρ < 0.05), indicating the construct validity of the modules simulated with augmented visual guidance and assessed through performance parameters.

Dynamic Light-Scattering Probe Used for the Very Early Detection of Cataracts and to Measure Response to Therapy (or Treatment)

NASA Technical Reports Server (NTRS)

Ansari,Rafat R.; Clark, John I.; King, James F.

2002-01-01

Half of all blindness worldwide is due to cataracts, and 34 million Americans over the age of 65 have cataracts. This figure is expected to rise to 70 million by the year 2030. Currently, no medical treatment is available to prevent or halt the progression of a cataract; nor is there any way to reverse a cataract once it has been detected by conventional methods. The only known treatment is surgical removal of the lens. It is estimated that over $5 billion will be spent this year for the treatment of cataract patients in the United States alone. According to Carl Kupfer, M.D., former Director of the National Eye Institute at the National Institutes of Health, "A delay in cataract formation of about 10 years would reduce the prevalence of visually disabling cataracts by about 45 percent." However, this vision remains a dream because of the lack of objective methods that can be used to detect cataracts very early and, hence, can be used for screening potential anticataract drugs. This is about to change. The National Eye Institute and NASA entered into a formal interagency agreement in late 1996 to develop and test a dynamic light-scattering (DLS) device to detect the earliest changes due to cataract formation. The new DLS probe developed by Dr. Ansari at the NASA Glenn Research Center is several orders of magnitude more sensitive than conventional clinical systems. This ultrahigh sensitivity enables the probe to detect the onset of a cataract before it has any effect on vision and allows researchers to test the effectiveness of anticataract drugs in reversing cataracts. This device (see the following illustration) was originally designed to study transport phenomena in microgravity fluid physics experiments onboard the space shuttle orbiters and space station. It will be very useful in testing anticataract drugs to halt or reverse the progression of cataracts during longitudinal clinical trials.

Long-Lasting Crossmodal Cortical Reorganization Triggered by Brief Postnatal Visual Deprivation.

PubMed

Collignon, Olivier; Dormal, Giulia; de Heering, Adelaide; Lepore, Franco; Lewis, Terri L; Maurer, Daphne

2015-09-21

Animal and human studies have demonstrated that transient visual deprivation early in life, even for a very short period, permanently alters the response properties of neurons in the visual cortex and leads to corresponding behavioral visual deficits. While it is acknowledged that early-onset and longstanding blindness leads the occipital cortex to respond to non-visual stimulation, it remains unknown whether a short and transient period of postnatal visual deprivation is sufficient to trigger crossmodal reorganization that persists after years of visual experience. In the present study, we characterized brain responses to auditory stimuli in 11 adults who had been deprived of all patterned vision at birth by congenital cataracts in both eyes until they were treated at 9 to 238 days of age. When compared to controls with typical visual experience, the cataract-reversal group showed enhanced auditory-driven activity in focal visual regions. A combination of dynamic causal modeling with Bayesian model selection indicated that this auditory-driven activity in the occipital cortex was better explained by direct cortico-cortical connections with the primary auditory cortex than by subcortical connections. Thus, a short and transient period of visual deprivation early in life leads to enduring large-scale crossmodal reorganization of the brain circuitry typically dedicated to vision. Copyright © 2015 Elsevier Ltd. All rights reserved.

Impact of a national system for waitlist prioritization: the experience with NIKE and cataract surgery in Sweden.

PubMed

Ng, Jonathon Q; Lundström, Mats

2014-06-01

  To evaluate waiting times for first-eye cataract surgery in Sweden following widespread adoption of the Nationell Indikationsmodell for Kataraktextraktion (NIKE) tool for prioritizing patients for cataract surgery.   Waiting times for all first-eye cataract surgeries in Sweden in 2009-2011 were identified from the Swedish National Cataract Register. Waiting times were compared according to demographic, clinical and NIKE indication group for surgery. Multivariate logistic regression modelling was used to determine factors associated with waiting times less than the 3-month Government guarantee period.   There were 141,070 first-eye cataract surgeries in 2009 to 2011; an annual increase of around 6%. Over the study period, mean waiting times decreased across all NIKE groups. The proportion waiting <3 months for surgery also increased across all NIKE groups. Surgery within 3 months of waitlisting was more likely for patients with a NIKE 1 indication classification (most need for surgery), in later years, male patients, younger patients and patients with a preoperative visual acuity in the better eye worse than 6/24.   Prioritizing patients for cataract surgery using NIKE reduces waiting times for those with the greatest need. © 2013 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

A comparison of preservative-free diclofenac and preserved diclofenac eye drops after cataract surgery in patients with diabetic retinopathy.

PubMed

Yasuda, Kanako; Miyazawa, Akiko; Shimura, Masahiko

2012-06-01

The aim of this study was to compare the anti-inflammatory efficacy of preservative-free and preserved 0.1% diclofenac eye drops for the management of postoperative inflammation after cataract surgery in patients with nonproliferative diabetic retinopathy and in normal controls. Forty-two diabetic patients and 50 normal control patients who underwent small-incision phacoemulsification cataract surgery bilaterally received topical preservative-free diclofenac in 1 eye and preserved diclofenac in the other eye. The corrected distance visual acuity (CDVA) as determined by a logarithm of the minimum angle of resolution (logMAR) chart, intraocular pressure (IOP), foveal thickness (FT) using optical coherence tomography (OCT), and the anterior chamber flare (ACF) score measured with a laser flare cell meter were monitored for 12 weeks after surgery. In the eyes with diabetic retinopathy, there were no significant differences in CDVA, IOP, FT, and ACF score between the right and left eyes at the initial exam. After cataract surgery, changes in CDVA, IOP, and FT were not influenced by the preservative in the diclofenac eye drops. In contrast, the ACF score in the eyes treated with preserved diclofenac showed slower recovery from postoperative inflammation than the eyes treated with preservative-free diclofenac. In the normal control eyes, similar but milder changes were observed in each of the clinical parameters. Because preservative suppressed the anti-inflammatory efficacy of topical diclofenac after cataract surgery, preservative-free diclofenac may have an improved safety profile during postoperative treatment, especially in patients with diabetic retinopathy.

Comparative study between a spectral domain and a high-speed single-beam swept source OCTA system for identifying choroidal neovascularization in AMD

NASA Astrophysics Data System (ADS)

Told, R.; Ginner, L.; Hecht, A.; Sacu, S.; Leitgeb, R.; Pollreisz, A.; Schmidt-Erfurth, U.

2016-12-01

This comparative study between a SD- and SS-OCTA system for visualizing neovascular patterns in AMD, also assessed the influence of cataract on OCTA imaging. 25 eyes with active CNV (AMD) were documented by FA, ICGA and SD-OCT. Two OCTA devices were used: A custom built SS-OCTA (1050 nm, 400,000 A-scans/s, 5 × 5 mm, no image segmentation); AngioVue (OptoVue, CA, USA) SD-OCTA (840 nm, 70.000 A-scans/s, 3 × 3 mm, SSADA technology). Two retina experts graded CNV types and vascular patterns. Cataract influence on OCTA image quality was reported for the superficial retinal plexus (6 eyes). The SS-OCTA prototype showed more CNV lesions compared to the SD-OCTA system (p = 0.01). Overall sensitivity of SD- and SS-OCTA systems to detect CNV lesions was.32 and.68, respectively. The SS-OCTA system was able to detect discrete lesion characteristics better than the SD-OCTA. No significant difference was found in the ability to identify CNV in treatment-naïve eyes. There was no significant influence of cataract. The SS-OCTA prototype detected CNV-associated vascular patterns more reliably than the SD-OCTA system. This is attributed to the SS-OCTA system’s longer center wavelength and higher A-scan rate yielding higher definition and contrast of small neovascular structures. The SS-OCTA system used showed no advantage regarding cataract influence.

European multicenter trial of the prevention of cystoid macular edema after cataract surgery in nondiabetics: ESCRS PREMED study report 1.

PubMed

Wielders, Laura H P; Schouten, Jan S A G; Winkens, Bjorn; van den Biggelaar, Frank J H M; Veldhuizen, Claudette A; Findl, Oliver; Murta, Joaquim C N; Goslings, Willem R O; Tassignon, Marie-José; Joosse, Maurits V; Henry, Ype P; Rulo, Alexander H F; Güell, José L; Amon, Michael; Kohnen, Thomas; Nuijts, Rudy M M A

2018-04-01

To compare the efficacy of a topical nonsteroidal antiinflammatory drug, topical corticosteroid, and a combination of both drugs to prevent the occurrence of cystoid macular edema (CME) after cataract surgery in nondiabetic patients. Twelve European study centers. Randomized clinical trial. Nondiabetic patients having uneventful cataract surgery were included in this study. Patients were randomized to receive topical bromfenac 0.09% twice daily for 2 weeks or dexamethasone 0.1% 4 times daily with 1 drop less per day every following week, or a combination of both. The primary outcome was the difference in central subfield mean macular thickness 6 weeks postoperatively. Secondary outcome measures included corrected distance visual acuity as well as the incidence of CME and clinically significant macular edema (CSME) within 6 weeks and 12 weeks postoperatively. This study comprised 914 patients. Six weeks postoperatively, the central subfield mean macular thickness was 288.3 μm, 296.0 μm, and 284.5 μm in the bromfenac group, dexamethasone group, and combination treatment group, respectively (overall P = .006). The incidence of clinically significant macular edema within 12 weeks postoperatively was 3.6%, 5.1%, and 1.5%, respectively (overall P = .043). Patients treated with a combination of topical bromfenac 0.09% and dexamethasone 0.1% had a lower risk for developing CSME after cataract surgery than patients treated with a single drug. Copyright © 2018 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Human Cataract Mutations in EPHA2 SAM Domain Alter Receptor Stability and Function

PubMed Central

Park, Jeong Eun; Son, Alexander I.; Hua, Rui; Wang, Lianqing; Zhang, Xue; Zhou, Renping

2012-01-01

The cellular and molecular mechanisms underlying the pathogenesis of cataracts leading to visual impairment remain poorly understood. In recent studies, several mutations in the cytoplasmic sterile-α-motif (SAM) domain of human EPHA2 on chromosome 1p36 have been associated with hereditary cataracts in several families. Here, we have investigated how these SAM domain mutations affect EPHA2 activity. We showed that the SAM domain mutations dramatically destabilized the EPHA2 protein in a proteasome-dependent pathway, as evidenced by the increase of EPHA2 receptor levels in the presence of the proteasome inhibitor MG132. In addition, the expression of wild-type EPHA2 promoted the migration of the mouse lens epithelial αTN4-1 cells in the absence of ligand stimulation, whereas the mutants exhibited significantly reduced activity. In contrast, stimulation of EPHA2 with its ligand ephrin-A5 eradicates the enhancement of cell migration accompanied by Akt activation. Taken together, our studies suggest that the SAM domain of the EPHA2 protein plays critical roles in enhancing the stability of EPHA2 by modulating the proteasome-dependent process. Furthermore, activation of Akt switches EPHA2 from promoting to inhibiting cell migration upon ephrin-A5 binding. Our results provide the first report of multiple EPHA2 cataract mutations contributing to the destabilization of the receptor and causing the loss of cell migration activity. PMID:22570727

Topical anesthesia with or without propofol sedation versus retrobulbar/peribulbar anesthesia for cataract extraction: prospective randomized trial.

PubMed

Kallio, H; Uusitalo, R J; Maunuksela, E L

2001-09-01

To evaluate the feasibility of intravenous sedation in addition to topical anesthesia during cataract extraction. Helsinki University Eye Hospital, Helsinki, Finland. Three hundred seventeen eyes of 291 consecutive patients having cataract surgery were prospectively randomized to receive topical (oxybuprocaine 0.4%, n = 96), combined (topical anesthesia and propofol sedation, n = 107), or retrobulbar/peribulbar (prilocaine 1.5%, n = 114) anesthesia. The intraoperative conditions were judged by the surgeon. A numerical scale (0 to 10) was used to assess the degree of pain during surgery. Outcome measures were the number of complications and adverse events registered perioperatively and 1 week postoperatively as well as Snellen visual acuity. The success of posterior chamber intraocular lens (IOL) implantation through a self-sealing clear corneal incision was 97.9%, 96.3%, and 98.2% in the topical, combined, and retrobulbar/peribulbar groups, respectively. There was no difference among the groups in pain during surgery, frequency of complications, or outcome measures. One week postoperatively, visual acuity was 20/40 or better in 81.7%, 78.5%, and 77.5% of eyes in the topical, combined, and retrobulbar/peribulbar groups, respectively. The surgeon reported significantly fewer difficulties in the retrobulbar/peribulbar group (9.8%) than in the topical (26.0%) (P =.004) or combined (21.0%) (P =.036) groups. Additional sedative/analgesic medication given intraoperatively was required significantly more often in the topical (15.6%) than in the retrobulbar/peribulbar group (2.6%) (P =.002). Patients with bilateral surgery preferred combined anesthesia over retrobulbar/peribulbar anesthesia; however, there was no significant difference in patient acceptance among groups in patients having unilateral surgery. Intravenous propofol sedation added to topical anesthesia did not improve the operative conditions or surgical outcome. Retrobulbar/peribulbar anesthesia ensured the best surgical conditions. Patients in all anesthesia groups reported high satisfaction. However, patients having bilateral surgery seemed to prefer combined anesthesia over retrobulbar/peribulbar anesthesia.

Manual small incision cataract surgery (MSICS) with posterior chamber intraocular lens versus phacoemulsification with posterior chamber intraocular lens for age-related cataract.

PubMed

Riaz, Yasmin; de Silva, Samantha R; Evans, Jennifer R

2013-10-10

Age-related cataract is a major cause of blindness and visual morbidity worldwide. It is therefore important to establish the optimal technique of lens removal in cataract surgery. To compare manual small incision cataract surgery (MSICS) and phacoemulsification techniques. We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2013, Issue 6), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to July 2013), EMBASE (January 1980 to July 2013), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to July 2013), Web of Science Conference Proceedings Citation Index - Science (CPCI-S) (January 1970 to July 2013), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 23 July 2013. We included randomised controlled trials (RCTs) for age-related cataract that compared MSICS and phacoemulsification. Two authors independently assessed all studies. We defined two primary outcomes: 'good functional vision' (presenting visual acuity of 6/12 or better) and 'poor visual outcome' (best corrected visual acuity of less than 6/60). We collected data on these outcomes at three and 12 months after surgery. Complications such as posterior capsule rupture rates and other intra- and postoperative complications were also assessed. In addition, we examined cost effectiveness of the two techniques. Where appropriate, we pooled data using a random-effects model. We included eight trials in this review with a total of 1708 participants. Trials were conducted in India, Nepal and South Africa. Follow-up ranged from one day to six months, but most trials reported at six to eight weeks after surgery. Overall the trials were judged to be at risk of bias due to unclear reporting of masking and follow-up. No studies reported presenting visual acuity so data were collected on both best-corrected (BCVA) and uncorrected (UCVA) visual acuity. Most studies reported visual acuity of 6/18 or better (rather than 6/12 or better) so this was used as an indicator of good functional vision. Seven studies (1223 participants) reported BCVA of 6/18 or better at six to eight weeks (pooled risk ratio (RR) 0.99 95% confidence interval (CI) 0.98 to 1.01) indicating no difference between the MSICS and phacoemulsification groups. Three studies (767 participants) reported UCVA of 6/18 or better at six to eight weeks, with a pooled RR indicating a more favourable outcome with phacoemulsification (0.90, 95% CI 0.84 to 0.96). One trial (96 participants) reported UCVA at six months with a RR of 1.07 (95% CI 0.91 to 1.26).Regarding BCVA of less than 6/60: there were only 11/1223 events reported. The pooled Peto odds ratio was 2.48 indicating a more favourable outcome using phacoemulsification but with wide confidence intervals (0.74 to 8.28) which means that we are uncertain as to the true effect.The number of complications reported were also low for both techniques. Again this means the review is underpowered to detect a difference between the two techniques with respect to these complications. One study reported on cost which was more than four times higher using phacoemulsification than MSICS. On the basis of this review, removing cataract by phacoemulsification may result in better UCVA in the short term (up to three months after surgery) compared to MSICS, but similar BCVA. There is a lack of data on long-term visual outcome. The review is currently underpowered to detect differences for rarer outcomes, including poor visual outcome. In view of the lower cost of MSICS, this may be a favourable technique in the patient populations examined in these studies, where high volume surgery is a priority. Further studies are required with longer-term follow-up to better assess visual outcomes and complications which may develop over time such as posterior capsule opacification.

Smoking and its association with cataract: results of the Andhra Pradesh eye disease study from India.

PubMed

Krishnaiah, Sannapaneni; Vilas, Kovai; Shamanna, Bindiganavale R; Rao, Gullapalli N; Thomas, Ravi; Balasubramanian, Dorairajan

2005-01-01

To investigate the associations between tobacco smoking and various forms of cataracts among the people of a state in India. A population-based cross-sectional epidemiologic study was conducted in the south Indian state of Andhra Pradesh (AP). A total of 10,293 subjects of all ages from one urban and three rural areas, representative of the population of AP, were interviewed, and each underwent a detailed dilated ocular evaluation by trained professionals. Data were analyzed for 7416 (72%) of the subjects aged >15 years. Increasing age was significantly associated with all cataract types and history of prior cataract surgery and/or total cataract. In multivariate analyses, after adjusting for all demographic factors and for history of smoking, females, illiterate persons, and those belonging to the extreme lower socioeconomic status group were found to have a significantly higher prevalence of any cataract, adjusted odds ratio (OR)=1.60 (95% confidence interval [CI]: 1.24-1.96), 1.46 (95% CI: 1.17-1.70), and 1.92 (95% CI: 1.14-3.24), respectively. After adjustment, cigarette and cigar smokers had a significantly higher prevalence of any cataract, adjusted OR=1.51 (95% CI: 1.10-2.06) and 1.44 (95% CI: 1.12-1.84), respectively, compared with those who had never smoked ("never-smokers"). A significantly higher prevalence of nuclear, cortical cataract, and history of prior cataract surgery and/ or total cataract was found among cigarette smokers. A dose-response relationship was seen with respect to cigarette and cigar smoking. After adjustment, compared with never-smokers, cigarette smokers who smoked heavily (>14 "pack-years" of smoking) had a significantly higher prevalence of nuclear cataract (OR=1.65; 95% CI: 1.10-2.59), cortical cataract (OR=2.11; 95% CI: 1.38-3.24), and history of prior cataract surgery and/or total cataract (OR=2.10; 95% CI: 1.05-4.22). Nuclear cataract was significantly higher in cigar smokers (adjusted OR=1.55; 95% CI: 1.16-2.01) and in cigar smokers who smoked heavily (>21 person-years of smoking; OR=1.50; 95% CI: 1.10-1.95), compared with never-smokers. Consistent with other studies, tobacco smoking was strongly associated with a higher prevalence of nuclear and cortical cataracts and history of prior cataract surgery in this population. These findings suggest yet another need to educate the community on the importance of cessation of tobacco smoking and perhaps incorporating an antismoking message into school health programs.

Primary Support Persons for Individuals Who Are Visually Impaired: Who They Are and the Support They Provide

ERIC Educational Resources Information Center

Silva-Smith, Amy L.; Theune, Thomas W.; Spaid, Penny E.

2007-01-01

As the proportion of older adults in the U.S. population grows, the prevalence of visual impairment related to cataracts, glaucoma, macular degeneration, and diabetic retinopathy will increase as well. Individuals who are visually impaired require various degrees of support and assistance in their daily activities. This assistance is frequently…

Visual outcome and rotational stability of open loop toric intraocular lens implantation in Indian eyes.

PubMed

Venkataraman, Arvind

2013-11-01

To assess the visual outcome and rotational stability of single-piece open loop toric Intra Ocular Lens (IOL) in a clinical setting. In a prospective study, 122 eyes of 77 patients were followed up for a period of 12 months after cataract surgery with toric open loop IOL implantation. The pre-operative markings for the position of incision and IOL placement were done under slit lamp by anterior stromal puncture. The visual acuity, refraction, and IOL position were assessed at day 1, 1 week, 1 month, 3 months, 6 months, and 12 months after surgery. The mean age of the cohort was 56 yrs (S.D. 13.88; range 16 to 87 years). The mean pre-operative cylinder of corneal astigmatism was 1.37 D. (SD 0.79, range 1.0 to 5.87 D). Mean post-operative refractive cylinder was 0.36 D (SD 0.57, range 0 to 1.50 D) at 12 months. Ninety-seven percent of the eyes were within 1 D of residual astigmatism. Ninety-four percent of patients had uncorrected visual acuity of 20/30 or better. Four eyes required IOL repositioning due to rotation. At 12 months, 96.7% of the IOLs were within 10 degrees of the target axis. There was no rotation seen after 6 months. Toric IOLs are very effective and consistent in correcting astigmatism during the cataract surgery. IOL rotation happens mostly within a month of surgery, and if significant, requires early repositioning.

Eighteen-year follow-up of hyperopic photorefractive keratectomy.

PubMed

Wagh, Vijay K; Dave, Reena; O'Brart, David P S; Lim, Wei S; Patel, Parul; Tam, Connan; Lee, Jennifer; Marshall, John

2016-02-01

To investigate the long-term efficacy of hyperopic photorefractive keratectomy (PRK). University Hospital, London, United Kingdom. Prospective case series. Patients with a follow-up of 18 years ± 0.7 (SD) attended for examination. All had spherical corrections with a 6.5 mm optical zone and 1.5 mm blend zone. Twenty-five patients (45 eyes) were included. The mean preoperative spherical equivalent (SE) refractive error was +4.11 ± 1.8 diopters (D) (range +1.125 to +7.25 D). Between 1 year and 18 years, in eyes that had no cataract surgery (n = 34), there was a +1.14 ± 1.48 D increase in the mean SE (P < .0002). The increase between 7.5 years and 18.0 years did not reach clinical significance (P = .1). Uncorrected distance visual acuity improved at 18 years (P < .02). Corrected distance visual acuity (CDVA) was reduced (P < .001). The efficacy index was 0.47, and the safety index was 0.83. Six eyes (18%) lost 2 lines of CDVA, of which 4 eyes had preexisting cataract. Keratometry remained stable between 1 year and 18 years (P = .2). Forty percent still had traces of peripheral haze, and 4 (9%) had Salzmann-like changes. Eleven eyes (24%) had cataract surgery and 4 (9%) had laser iridotomy. There was no evidence of ectasia. Hyperopic PRK showed an increase in hyperopic SE between 1.0 year and 7.5 years but was generally stable thereafter. The efficacy was limited. Peripheral haze was evident in 40% of cases with Salzmann-like changes in some. Ocular comorbidity in relationship to cataract was common and reduced CDVA. Dr. Marshall was a consultant to Summit Technology, Inc. No author has a financial or proprietary interest in any material or method mentioned. Copyright © 2016 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

[Rehabilitation methods for children with complicated cataract].

PubMed

Ivanov, G; Cuşnir, V; Septichina, Natalia; Cuşnir, Vitalie

2010-01-01

The work deals with the results of surgical treatment of 155 patients, who had uveal cataract, by method of facoemulsification with artificial crystalline lens transplanting. The age of the sick varied from 3 to 15 as a result of a complex treatment, involving determination of ethnic factor in the development of uveal cataract, before- and after-operation conservative medical treatment, surgical treatment of abscuration ambliopia 78.1% children and the keenness of sight 0.4 and 68.7% got binocularious sight. The study lot of posttraumatic cataract affected children included 189 patients, from them 68 with stationary cataract, 87 with intumescent cataract and 34 with postoperatorial aphakia. Age from 2 to 15 years. 76.3% cases of evolution without postoperatorial complications, in 13.7% intraoperatorial were observed different complications. The work presents the results of surgical treatment 196 of children, who had innate cataract, by the method of facoasoriation with soft intra-eyepiece lens transplanting from 133 patients who had two-sided cataract, 63 had monolateral cataract. All children underwent laser simulation and videocomputer auto-training in post-operation period. As a result of the treatment, 66.8% patients got the amelioration of sight with 0.4, and 58% got binocular sight. The children's age varied between 6 months and 15 years. This article presents a review of the treatment results of 213 children with posttraumatic, congenital and complicated cataracts. The rehabilitation of the patients with the lens pathology includes a complex of measures of early diagnosis, surgery, optimal correction, medical treatment before and after surgery, the prophilaxis and treatment of complications. This approach permits to increase the visual acuity in 83.8% and to restore the binocular vision in 71.4% patients.

Willingness to Pay for Cataract Surgery Provided by a Senior Surgeon in Urban Southern China

PubMed Central

Lin, Xianhua; Ling, Yunlan; Lin, Xiaofeng; Li, Mingge; Lamoureux, Ecosse; Zheng, Yingfeng

2015-01-01

Purpose To study willingness to pay for cataract surgery and surgical service provided by a senior cataract surgeon in urban Southern China. Methods This study was a cross-sectional willingness-to-pay (WTP) interview using bidding formats. Two-hundred eleven persons with presenting visual impairment in either eye due to cataract were enrolled at a tertiary eye hospital. Participants underwent a comprehensive eye examination and a WTP interview for both surgery and service provided by a senior surgeon. Demographic information, socioeconomic status and clinical data were recorded. Results Among 211 (98% response rate) persons completing the interview, 53.6% were women and 80.6% were retired. About 72.2% had a monthly income lower than 1000 renminbi (US $161). A total of 189 (89.6%) were willing to pay for cataract and the median amount of WTP was 6000 renminbi (US$968). And 102 (50.7%) were willing to pay additional fees for surgery performed by a senior surgeon, and the median amount of WTP was 500 renminbi (US$81). In regression models adjusting for age and gender, persons with preexisting eye diseases other than cataract, were more likely to pay for cataract surgery and service provided by a senior surgeon (P = 0.04 for both). Conclusions In urban China, cataract patients, especially those with preexisting eye conditions, are willing to pay additional fees for a senior surgeon. Moving to a system where the price of cataract surgery is proportional to the consultant’ skill and expertise is possible and may have a potential impact on waiting list and quality of eye care. Further studies are needed to examine the impact of such pricing system on attitudes and choices of cataract patients. PMID:26575284

Willingness to Pay for Cataract Surgery Provided by a Senior Surgeon in Urban Southern China.

PubMed

Wang, Mei; Zuo, Yajing; Lin, Xianhua; Ling, Yunlan; Lin, Xiaofeng; Li, Mingge; Lamoureux, Ecosse; Zheng, Yingfeng

2015-01-01

To study willingness to pay for cataract surgery and surgical service provided by a senior cataract surgeon in urban Southern China. This study was a cross-sectional willingness-to-pay (WTP) interview using bidding formats. Two-hundred eleven persons with presenting visual impairment in either eye due to cataract were enrolled at a tertiary eye hospital. Participants underwent a comprehensive eye examination and a WTP interview for both surgery and service provided by a senior surgeon. Demographic information, socioeconomic status and clinical data were recorded. Among 211 (98% response rate) persons completing the interview, 53.6% were women and 80.6% were retired. About 72.2% had a monthly income lower than 1000 renminbi (US $161). A total of 189 (89.6%) were willing to pay for cataract and the median amount of WTP was 6000 renminbi (US$968). And 102 (50.7%) were willing to pay additional fees for surgery performed by a senior surgeon, and the median amount of WTP was 500 renminbi (US$81). In regression models adjusting for age and gender, persons with preexisting eye diseases other than cataract, were more likely to pay for cataract surgery and service provided by a senior surgeon (P = 0.04 for both). In urban China, cataract patients, especially those with preexisting eye conditions, are willing to pay additional fees for a senior surgeon. Moving to a system where the price of cataract surgery is proportional to the consultant' skill and expertise is possible and may have a potential impact on waiting list and quality of eye care. Further studies are needed to examine the impact of such pricing system on attitudes and choices of cataract patients.

Aging and Visual Impairment.

ERIC Educational Resources Information Center

Morse, A. R.; And Others

1987-01-01

Eye diseases of the aged include diabetic retinopathy, senile cataracts, senile macular degeneration, and glaucoma. Environmental modifications such as better levels of illumination and reduction of glare can enhance an individual's ability to function. Programs to screen and treat visual problems in elderly persons are called for. (Author/JDD)

Management of corneal decompensation 4 decades after Sputnik intraocular lens implantation.

PubMed

Hirji, Nashila; Nanavaty, Mayank A

2015-01-01

We report an unusual case of corneal decompensation occurring four decades after complicated cataract extraction with implantation of a Sputnik intraocular lens (IOL) and highlight the clinical and practical issues faced in managing corneal decompensation with a Sputnik IOL. A 72-year-old woman presented with deterioration of the vision in her left eye, four decades after intracapsular cataract extraction with Sputnik IOL implantation. Ocular examination revealed diffuse corneal edema and thickened vitreous strands in the anterior chamber. Her best-corrected visual acuity (BCVA) worsened to 6/60 within 3 months. Anterior vitrectomy and inferior iridectomy combined with Desçemet-stripping automated endothelial keratoplasty was performed. The procedure was successful, with the patient achieving best-corrected visual acuity of 6/6 at 8 months postoperatively. Corneal decompensation after Sputnik IOL implantation can occur four decades later. When the historical preoperative visual acuity is good in such cases, careful anterior vitrectomy with Desçemet-stripping automated endothelial keratoplasty provides good visual rehabilitation.

Outbreak of multidrug-resistant acute postoperative endophthalmitis due to Enterobacter aerogenes.

PubMed

Bhat, Shailaja S; Undrakonda, Vivekanand; Mukhopadhyay, Chiranjay; Parmar, Prachi Vikramsinh

2014-04-01

To report the clinical features, management, and outcome of 7 cases of culture-proven multidrug-resistant Enterobacter postoperative endophthalmitis following cataract surgery. Medical records of 7 cases of acute postoperative endophthalmitis after uneventful cataract surgery were reviewed. Details regarding age, gender, visual acuity and clinical features at presentation, microbiological profile, treatment interventions, and visual acuity and clinical features at 1 week, 1 month, and 3 months follow-up were collected. All patients reported decreased visual acuity and pain as presenting symptoms. All patients were resistant to intravitreal antibiotics such as vancomycin (1 mg/0.1 mL) and ceftazidime (2.25 mg/0.1 mL). Culture of aqueous and vitreous sample was positive for Enterobacter aerogenes and sensitive to co-trimoxazole, cefoperazone-sulbactam, imipenem-meropenem, and piperacillin-tazobactem. Two patients with panophthalmitis and no perception of light underwent evisceration. Three patients had visual acuity of ≥6/24 at the final follow-up. Multidrug-resistant Enterobacter acute postoperative endophthalmitis has a poor prognosis if not intercepted early.

Survey of childhood blindness and visual impairment in Botswana

PubMed Central

Nallasamy, Sudha; Anninger, William V; Quinn, Graham E; Kroener, Brian; Zetola, Nicola M; Nkomazana, Oathokwa

2014-01-01

Background/aims In terms of blind-person years, the worldwide burden of childhood blindness is second only to cataracts. In many developing countries, 30–72% of childhood blindness is avoidable. The authors conducted this study to determine the causes of childhood blindness and visual impairment (VI) in Botswana, a middle-income country with limited access to ophthalmic care. Methods This study was conducted over 4 weeks in eight cities and villages in Botswana. Children were recruited through a radio advertisement and local outreach programmes. Those ≤15 years of age with visual acuity <6/18 in either eye were enrolled. The WHO/Prevention of Blindness Eye Examination Record for Children with Blindness and Low Vision was used to record data. Results The authors enrolled 241 children, 79 with unilateral and 162 with bilateral VI. Of unilateral cases, 89% were avoidable: 23% preventable (83% trauma-related) and 66% treatable (40% refractive error and 31% amblyopia). Of bilateral cases, 63% were avoidable: 5% preventable and 58% treatable (33% refractive error and 31% congenital cataracts). Conclusion Refractive error, which is easily correctable with glasses, is the most common cause of bilateral VI, with cataracts a close second. A nationwide intervention is currently being planned to reduce the burden of avoidable childhood VI in Botswana. PMID:21242581

Causes of severe visual impairment and blindness in children in the Republic of Suriname.

PubMed

Heijthuijsen, Astrid Anna Maria; Beunders, Victoria Apollonia Annemarie; Jiawan, Dinesh; de Mesquita-Voigt, Anne-Marie Bueno; Pawiroredjo, Jerrel; Mourits, Maarten; Tanck, Michael; Verhoeff, Joost; Saeed, Peerooz

2013-07-01

To determine the causes of severe visual impairment and blindness (SVI/BL) in children in Suriname (Dutch Guyana) and to identify preventable and treatable causes. 4643 children under 16 years of age were recruited from two locations: 33 children attending the only school for the blind were examined and 4610 medical records were analysed at an eye clinic. Data have been collected using the WHO Prevention of Blindness Programme eye examination record for children. 65 children were identified with SVI/BL, 58.5% were blind and 41.5% were severely visually impaired (SVI). The major anatomical site of SVI/BL was the retina in 33.8%, lens in 15.4% and normal appearing globe in 15.4%. The major underlying aetiology of SVI/BL was undetermined in 56.9% (mainly cataract and abnormality since birth) and perinatal factors 21.5% (mainly retinopathy of prematurity (ROP)). Avoidable causes of SVI/BL accounted for 40% of cases; 7.7% were preventable and 32.3% were treatable with cataracts and ROP the most common causes (15.4% and 12.3%, respectively). More than a third of the SVI/BL causes are potentially avoidable, with childhood cataract and ROP the leading causes. Corneal scarring from vitamin A deficiency does not seem to be a continuing issue in Suriname.

iStent trabecular micro-bypass stent for open-angle glaucoma

PubMed Central

Le, Kim; Saheb, Hady

2014-01-01

Trabecular micro-bypass stents, commonly known as iStents, are micro-invasive glaucoma surgery (MIGS) devices used to treat open-angle glaucoma. Like other MIGS procedures that enhance trabecular outflow, the iStent lowers intraocular pressure (IOP) by creating a direct channel between the anterior chamber and Schlemm’s canal. iStents are typically implanted at the time of phacoemulsification for patients with open-angle glaucoma and visually significant cataracts. This review summarizes the published data regarding the efficacy, safety, and cost considerations of trabecular micro-bypass stents. Most studies found statistically significant reductions in mean IOP and ocular medication use after combined phacoemulsification with single or double iStent implantation. The devices were found to be very safe, with a safety profile similar to that of cataract surgery. Complications were infrequent, with the most common complications being temporary stent obstruction or malposition, which resolved with observation or secondary procedures. Future studies are needed to evaluate long-term outcomes, patient satisfaction, cost effectiveness, and expanded indications. PMID:25284980

A Comparison of Different Operating Systems for Femtosecond Lasers in Cataract Surgery.

PubMed

Wu, B M; Williams, G P; Tan, A; Mehta, J S

2015-01-01

The introduction of femtosecond lasers is potentially a major shift in the way we approach cataract surgery. The development of increasingly sophisticated intraocular lenses (IOLs), coupled with heightened patient expectation of high quality postsurgical visual outcomes, has generated the need for a more precise, highly reproducible and standardized method to carry out cataract operations. As femtosecond laser-assisted cataract surgery (FLACS) becomes more commonplace in surgical centers, further evaluation of the potential risks and benefits needs to be established, particularly in the medium/long term effects. Healthcare administrators will also have to weigh and balance out the financial costs of these lasers relative to the advantages they put forth. In this review, we provide an operational overview of three of five femtosecond laser platforms that are currently commercially available: the Catalys (USA), the Victus (USA), and the LDV Z8 (Switzerland).

[Synthesis of the blindness situation in the countries of the Organization for Cooperation and Coordination in the Control of Major Endemic Diseases].

PubMed

Auzemery, A; Ceccon, J F; Ducousso, F; Huguet, P; Traoré, J; Audugé, A; Diallo, A; Schémann, J F

1998-01-01

The major causes of blindness in the OCCCMED states are cataracts, trachoma, glaucoma and oncocercosis. The prevalence of blindness is about 1.2% and there are about 880,000 blind individuals and 2,500,000 people with impaired vision. Cataracts were the cause of blindness in 440,000 people and the cause of visual impairment in 1,320,000 individuals. About 1,500,000 people were found to have oncocercosis, and about 24,000 were blind. The true rate of trachoma is unknown. Thirteen thousand cataracts are surgically removed in the region each year, the CSR (cataract surgery rate) being 210. In the last few years, national programs have been set up to combat blindness and equipment and training have been established. With a ratio of 1 ophthalmologist per 523,000 people, the WHO's objectives are becoming attainable.

Long term followup of cataracts in children after renal transplantation.

PubMed Central

Wilson, W A; Fine, R N

1979-01-01

In reviewing the course of 218 renal transplantation recipients 55% have developed PSC of which eleven patients have had surgery on one or both eyes; The operations in general have been uncomplicated, and the visual results have been excellent with the exception of one case that had a detached retina. The cataracts were probably induced by heavy corticosteroid therapy as the larger the dosage and the younger the recipient, the more prone were they to the development of lens changes. Phacoemulsification was preferred in this series as the more expeditious technique, leading to a clearer anterior chamber with less chance of developing a secondary cataract. Images FIGURE 1 FIGURE 2 PMID:397659

Cataract blindness in Turkmenistan: results of a national survey

PubMed Central

Amansakhatov, S; Volokhovskaya, Z P; Afanasyeva, A N; Limburg, H

2002-01-01

Aim: To present results of a rapid assessment of cataract in Turkmenistan. Methods: 6120 eligible people of 50 years and older were selected by systematic random sampling from the whole of Turkmenistan. A total of 6011 people were examined (coverage 98.2%). Results: Cataract is the major cause of bilateral blindness (54%), followed by glaucoma (25%). The age and sex adjusted prevalence of bilateral cataract blindness (VA <3/60) in people of 50 years and older was 0.6% (95% CI: 0.4 to 0.9), with a cataract surgical coverage of 75% (people). For VA <6/60 the prevalence was 2.6% (95% CI: 2.1 to 3.2) in people aged 50 and above, approximately 0.26% of the total population. In this last group the surgical coverage was 44% (people) and 32% (eyes). Of the patients operated with IOL implantation 8.2% could not see 6/60, 44.8% of those operated without IOL could not see 6/60. The main barrier to cataract surgery was indifference (“old age, no need for surgery”), followed by “waiting for maturity.” Conclusion: To increase the cataract surgical coverage in Turkmenistan the intake criteria should be lowered to VA <6/60 or less. At the same time the visual outcome of surgery can be improved by expanding the number of IOL surgeries and routine monitoring of cataract outcome. Additional investments will be required to provide all eye surgeons with appropriate equipment and skills for IOL surgery. PMID:12386068

[Refractive precision and objective quality of vision after toric lens implantation in cataract surgery].

PubMed

Debois, A; Nochez, Y; Bezo, C; Bellicaud, D; Pisella, P-J

2012-10-01

To study efficacy and predictability of toric IOL implantation for correction of preoperative corneal astigmatism by analysing spherocylindrical refractive precision and objective quality of vision. Prospective study of 13 eyes undergoing micro-incisional cataract surgery through a 1.8mm corneal incision with toric IOL implantation (Lentis L313T(®), Oculentis) to treat over one D of preoperative corneal astigmatism. Preoperative evaluation included keratometry, subjective refraction, and total and corneal aberrometry (KR-1(®), Topcon). Six months postoperatively, measurements included slit lamp photography, documenting IOL rotation, tilt or decentration, uncorrected visual acuity, best-corrected visual acuity and objective quality of vision measurement (OQAS(®) Visiometrics, Spain). Postoperatively, mean uncorrected distance visual acuity was 8.33/10 ± 1.91 (0.09 ± 0.11 LogMar). Mean postoperative refractive sphere was 0.13 ± 0.73 diopters. Mean refractive astigmatism was -0.66 ± 0.56 diopters with corneal astigmatism of 2.17 ± 0.68 diopters. Mean IOL rotation was 4.4° ± 3.6° (range 0° to 10°). Mean rotation of this IOL at 6 months was less than 5°, demonstrating stability of the optic within the capsular bag. Objective quality of vision measurements were consistent with subjective uncorrected visual acuity. Implantation of the L313T(®) IOL is safe and effective for correction of corneal astigmatism in 1.8mm micro-incisional cataract surgery. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

Results in Combined Cataract Surgery With Prosthetic Iris Implantation in Patients With Previous Iridocyclectomy for Iris Melanoma.

PubMed

Snyder, Michael E; Osher, Robert H; Wladecki, Trisha M; Perez, Mauricio A; Augsburger, James J; Corrêa, Zélia

2017-03-01

To present visual and functional results following implantation of iris prosthesis combined with cataract surgery in eyes with previous iridocyclectomy for iris melanoma or presumed iris melanoma. Retrospective noncomparative case series. Sixteen patients (16 eyes) with iris defects after iridocyclectomy for iris melanoma in 15 cases and iris adenoma in 1 case underwent prosthetic iris device implantation surgery. Prosthetic iris implantation was combined with phacoemulsification and intraocular lens (IOL) implantation. The visual acuity, subjective glare and photophobia reduction, anatomic outcome, and complications were reviewed. Best-corrected visual acuity was improved in 13 eyes (81.25%), remained stable in 2 eyes (12.25%), and decreased in 1 eye (6.25%). Photophobia and glare improved in every case except for 1 (93.75%). Notably, after surgery 12 patients (75.00%) reported no photophobia and 10 patients (62.50%) reported no glare. The median postoperative follow-up was 29.5 months, with a minimum of 5 months and a maximum of 189 months. All iris devices were in the correct position, and all eyes achieved the desired anatomic result. The IOL optic edges were covered in all areas by either residual iris or opaque portions of a prosthetic iris device. In patients who have undergone previous iridocyclectomy for presumed iris melanoma, combined cataract surgery and iris prosthesis placement, with or without iris reconstruction, can lead to visual improvement as well as reduction of both glare and photophobia. Copyright © 2016 Elsevier Inc. All rights reserved.

Combined Special Capsular Tension Ring and Toric IOL Implantation for Management of Astigmatism and High Axial Myopia with Cataracts.

PubMed

Zhao, Yang; Li, Jiaxin; Yang, Ke; Li, Xiao; Zhu, Siquan

2018-01-01

This study aimed to compare the effects of toric intraocular lens (IOL) implantation with a capsular tension ring and toric IOL implantation only in patients with axial myopic astigmatism who had undergone cataract surgery. Of 34 patients with axial myopia, 16 patients who had received IOL and capsular tension ring (CTR) implantation were included in the combined group and 18 patients who received toric IOL implantation only were included in the simple group. Uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA) were evaluated by measuring subjective refraction, residual astigmatism, and the toric IOL axis six months post-surgery. At six months postoperatively, the UCVA for the combined and simple groups was 4.6 ± 0.1 and 4.5 ± 0.2, respectively, a statistically significant difference (t = 3.531, P<0.05). The toric IOL in all of the cases was located in the capsular sac, but there were more cases with IOL rotation (12 eyes) in the simple group than in the combined group (4 eyes). The rotation angles were 20°~30° (one eye), 10°~20° (four eyes), and <10° (seven eyes) compared with 2°~5° (four eyes). The residual astigmatism was -0.50 ± 0.25 D in the combined group, not a significant difference from the predicted residual astigmatism (-0.35 ± 0.13 D). There was a significant difference in the simple group (-1.25 ± 0.33 D) when the predicted residual astigmatism was compared (-0.37 ± 0.11 D) (t = -9.511, P < 0.01). In patients with axial myopic astigmatism, CTR can effectively increase the rotational stability of a toric IOL, achieving improvement in corneal astigmatism and visual acuity.

Serum 25-hydroxyvitamin D and Age-Related Cataract.

PubMed

Park, Sangshin; Choi, Nam-Kyong

2017-10-01

Cataract and insufficient vitamin D intake are both increasing worldwide concerns, yet little is known about the relationship between serum 25-hydroxyvitamin D (25(OH)D) levels and age-related cataract. We performed this study to determine the association between serum 25(OH)D levels and age-related cataract in adults. Study participants comprised 16,086 adults aged 40 years or older who had never been diagnosed with or undergone surgery for cataract using Korean National Health and Nutrition Examination Survey data from 2008 to 2012. Participants were assessed to have cataract when diagnosed with cortical, nuclear, anterior subcapsular, posterior subcapsular, or mixed cataract. Odds ratios (ORs) and 95% confidence intervals (CIs) were used to evaluate the magnitude and significance of the association between serum 25(OH)D levels and cataract in multivariable logistic regression models. The OR for nuclear cataract with the highest quintile of serum 25(OH)D levels was 0.86 (95% CI 0.75-0.99) compared to the lowest quintile. A linear trend across quintiles was significant. Natural log-transformed serum 25(OH)D levels were also significantly associated with nuclear cataract (OR 0.84, 95% CI 0.75-0.95). The opulation-attributable fraction of nuclear cataract due to serum 25(OH)D insufficiency (<30 ng/mL) was 8.8% (p = 0.048). Serum 25(OH)D levels were inversely associated with the risk of nuclear cataract. Prospective studies investigating the effects of serum 25(OH)D levels on the development of nuclear cataract are needed to confirm our findings.

Visual and Refractive Outcomes in Manual versus Femtosecond Laser-Assisted Cataract Surgery: A Single-Center Retrospective Cohort Analysis of 1838 Eyes.

PubMed

Berk, Thomas A; Schlenker, Matthew B; Campos-Möller, Xavier; Pereira, Austin M; Ahmed, Iqbal Ike K

2018-03-06

Femtosecond laser-assisted cataract surgery (FLACS) has emerged as an alternative to manual cataract surgery (MCS) for corneal incision and capsulorhexis creation, as well as nuclear fragmentation. This study compares postoperative refractive and visual outcomes in eyes receiving MCS or FLACS. Single-center, comparative, retrospective cohort analysis. Consecutive eyes receiving FLACS and MCS from July 1, 2012, to July 31, 2015, at a single tertiary care center. Demographic data, ocular history, preoperative measurements and biometry, and postoperative surgical results were retrospectively obtained and statistically analyzed using a generalized linear mixed model adjusting for differences in baseline characteristics and within-patient correlation. A 2-tailed P value <0.05 was considered statistically significant throughout the study. Percentage of eyes achieving absolute error (AE) ≤0.5 diopters (D). Secondary outcomes included percentage of eyes with AE ≤0.25 D and ≤1.0 D, and percentage of distance-targeted eyes achieving uncorrected distance visual acuity (UDVA) of 20/20 or better, 20/25 or better, and 20/30 or better. A total of 883 eyes received MCS and 955 received FLACS among 1089 patients. Some 82.6% of FLACS eyes and 78.8% of MCS eyes had ≤0.5 D of AE at 3 weeks, representing an adjusted odds ratio (OR) of 1.28 (95% confidence interval [CI], 0.98-1.66) of FLACS relative to MCS being within target. Some 97.1% of FLACS and 97.2% of MCS eyes had ≤1.0 D of AE (OR, 0.96; 95% CI, 0.57-1.60) and 49.3% of FLACS and 46.3% of MCS eyes, ≤0.25 D of AE (OR, 1.13; 95% CI, 0.91-1.39). Factors predictive of a favorable refractive outcome included axial length between 22 and 24.8 mm, receiving a toric intraocular lens, less preoperative cylinder, and greater preoperative average keratometry. There was no significant difference in the percentage of patients targeted for distance who achieved UDVA of 20/20 or better (P = 0.30), 20/25 or better (P = 0.06), or 20/30 or better (P = 0.66) vision. Postoperatively, there was no statistically significant difference found between eyes undergoing FLACS and eyes undergoing MCS with respect to refractive and visual outcomes. Copyright © 2018 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Astigmatism Correction With Toric Intraocular Lenses in Descemet Membrane Endothelial Keratoplasty Triple Procedures.

PubMed

Yokogawa, Hideaki; Sanchez, P James; Mayko, Zachary M; Straiko, Michael D; Terry, Mark A

2017-03-01

To report the clinical efficacy of astigmatism correction with toric intraocular lenses (IOLs) in patients undergoing the Descemet membrane endothelial keratoplasty (DMEK) triple procedure and to evaluate the accuracy of the correction. Fifteen eyes of 10 patients who received cataract extraction, toric IOL placement, and DMEK surgery for Fuchs corneal dystrophy and cataracts were evaluated. The cylinder power of toric IOLs was determined by an online toric calculator with keratoscopy measurements obtained using Scheimpflug corneal imaging. Prediction errors were assessed as a difference vector between the anticipated minus postoperative residual astigmatism. At 10.1 ± 4.9 months postoperatively, 8/13 (61.5%) of eyes achieved uncorrected distance visual acuity better than 20/40. Mean best spectacle-corrected distance visual acuity (logMAR) improved from 0.21 ± 0.15 preoperatively to 0.08 ± 0.12 postoperatively (P < 0.01). The magnitude of refractive astigmatism was also significantly decreased from 2.23 ± 1.10 D (range 0.75-4.25 D) preoperatively to 0.87 ± 0.75 D (range 0.00-3.00 D) postoperatively (P < 0.01). In 1 eye with rotational misalignment by 43 degrees, we found no improvement of astigmatism. The prediction error of astigmatism at the corneal plane was 0.77 ± 0.54 D (range 0.10-1.77 D). Four eyes with preoperative "with-the-rule" corneal astigmatism had postoperative "against-the-rule" refractive astigmatism. For patients with Fuchs corneal dystrophy and cataracts, use of toric IOLs might be a valuable option in triple DMEK surgery. Additionally, care should be taken to prevent excessive IOL rotation.

Determinants of pediatric cataract program outcomes and follow-up in a large series in Mexico.

PubMed

Congdon, Nathan G; Ruiz, Sergio; Suzuki, Maki; Herrera, Veronica

2007-10-01

To report determinants of outcomes and follow-up in a large Mexican pediatric cataract project. Hospital Luis Sanchez Bulnes, Mexico City, Mexico. Data were collected prospectively from a pediatric cataract surgery program at the Hospital Luis Sanchez Bulnes, implemented by Helen Keller International. Preoperative data included age, sex, baseline visual acuity, type of cataract, laterality, and presence of conditions such as amblyopia. Surgical data included vitrectomy, capsulotomy, complications, and use of intraocular lenses (IOLs). Postoperative data included final visual acuity, refraction, number of follow-up visits, and program support for follow-up. Of 574 eyes of 415 children (mean age 7.1 years +/- 4.7 [SD]), IOLs were placed in 416 (87%). At least 1 follow-up was attended by 408 patients (98.3%) (mean total follow-up 3.5 +/- 1.8 months); 40% of eyes achieved a final visual acuity of 6/18 or better. Children living farther from the hospital had fewer postoperative visits (P = .04), while children receiving program support had more visits (P = .001). Factors predictive of better acuity included receiving an IOL during surgery (P = .04) and provision of postoperative spectacles (P = .001). Predictive of worse acuity were amblyopia (P = .003), postoperative complications (P = .0001), unilateral surgery (P = .0075), and female sex (P = .045). The results underscore the importance of surgical training in reducing complications, early intervention before amblyopia (observed in 40% of patients) can develop, and vigorous treatment if amblyopia is present. The positive impact of program support on follow-up is encouraging, although direct financial support may pose a problem for sustainability. More work is needed to understand reasons for worse outcomes in girls.

Microscope Integrated Intraoperative Spectral Domain Optical Coherence Tomography for Cataract Surgery: Uses and Applications.

PubMed

Das, Sudeep; Kummelil, Mathew Kurian; Kharbanda, Varun; Arora, Vishal; Nagappa, Somshekar; Shetty, Rohit; Shetty, Bhujang K

2016-05-01

To demonstrate the uses and applications of a microscope integrated intraoperative Optical Coherence Tomography in Micro Incision Cataract Surgery (MICS) and Femtosecond Laser Assisted Cataract Surgery (FLACS). Intraoperative real time imaging using the RESCAN™ 700 (Carl Zeiss Meditec, Oberkochen, Germany) was done for patients undergoing MICS as well as FLACS. The OCT videos were reviewed at each step of the procedure and the findings were noted and analyzed. Microscope Integrated Intraoperative Optical Coherence Tomography was found to be beneficial during all the critical steps of cataract surgery. We were able to qualitatively assess wound morphology in clear corneal incisions, in terms of subclinical Descemet's detachments, tears in the inner or outer wound lips, wound gaping at the end of surgery and in identifying the adequacy of stromal hydration, for both FLACS as well as MICS. It also enabled us to segregate true posterior polar cataracts from suspected cases intraoperatively. Deciding the adequate depth of trenching was made simpler with direct visualization. The final position of the intraocular lens in the capsular bag and the lack of bioadhesivity of hydrophobic acrylic lenses were also observed. Even though Microscope Integrated Intraoperative Optical Coherence Tomography is in its early stages for its application in cataract surgery, this initial assessment does show a very promising role for this technology in the future for cataract surgery both in intraoperative decision making as well as for training purposes.

Rapid Cataract Progression after Nd:YAG Vitreolysis for Vitreous Floaters: A Case Report and Literature Review

PubMed Central

Sun, I-Ting; Lee, Tsung-Han; Chen, Chih-Hsin

2017-01-01

Purpose We report a case of rapid cataract progression after Nd:YAG vitreolysis for vitreous floaters. Case Report A 55-year-old man presented with acute onset of blurred vision following Nd:YAG vitreolysis for symptomatic floaters in the left eye. His initial best corrected visual acuity (BCVA) was 20/1,000 in the left eye. Ocular examinations showed frost-like opacities of the lens and a suspected break of the posterior capsule in the left eye. There were no detectable retinal lesions. Cataract surgery was then arranged. Posterior capsular rupture and vitreous loss occurred during surgery, which required a subsequent pars plana vitrectomy. After the surgery, BCVA in the left eye gradually improved to 20/20 and was maintained during a 1-year follow-up period. Conclusion Crystalline lens injuries and rapid cataract progression may occur following Nd:YAG vitreolysis. While dealing with this type of complicated cataract, clinicians should be aware of the possibility of posterior lens capsule rupture during surgery and the need for combined vitrectomy. PMID:28626418

Posterior segment nucleotomy for dislocated sclerotic cataractous lens using chandelier endoilluminator and sharp tipped chopper

PubMed Central

Takkar, Brijesh; Azad, Rajvardhan; Azad, Shorya; Rathi, Anubha

2015-01-01

AIM To describe a new surgical technique for managing dislocated sclerotic cataractous lens. METHODS Six patients with advanced posteriorly dislocated cataracts were operated at a tertiary care centre and analyzed retrospectively. After standard 3 port 23 G pars plana vitrectomy and perfluorocarbon liquid (PFCL) injection, the dislocated white cataract was held with occlusion using phaco fragmatome and then chopped into smaller pieces with a sharp tipped chopper using 25 G chandelier endoilluminator. Each piece was emulsified individually. Following aspiration of PFCL, Fluid Air Exchange was done in all the cases and surgery completed uneventfully. RESULTS Best corrected visual acuity (BCVA) in all the patients was better than 6/12 after one month of follow up. No serious complications were noted till minimum 6mo of follow up. CONCLUSION Four port posterior segment nucleotomy with a chandelier endoilluminator, fragmatome and a chopper appears to be a safe, easy and effective procedure for managing dislocated sclerotic cataractous nuclei. Ultrasonic energy used and adverse thermal effects of the fragmatome on the sclera may be lesser. PMID:26309887

Antibiotic prophylaxis in cataract surgery in the setting of penicillin allergy: A decision-making algorithm.

PubMed

LaHood, Benjamin R; Andrew, Nicholas H; Goggin, Michael

Cataract surgery is the most commonly performed surgical procedure in many developed countries. Postoperative endophthalmitis is a rare complication with potentially devastating visual outcomes. Currently, there is no global consensus regarding antibiotic prophylaxis in cataract surgery despite growing evidence of the benefits of prophylactic intracameral cefuroxime at the conclusion of surgery. The decision about which antibiotic regimen to use is further complicated in patients reporting penicillin allergy. Historic statistics suggesting crossreactivity of penicillins and cephalosporins have persisted into modern surgery. It is important for ophthalmologists to consider all available antibiotic options and have an up-to-date knowledge of antibiotic crossreactivity when faced with the dilemma of choosing appropriate antibiotic prophylaxis for patients undergoing cataract surgery with a history of penicillin allergy. Each option carries risks, and the choice may have medicolegal implications in the event of an adverse outcome. We assess the options for antibiotic prophylaxis in cataract surgery in the setting of penicillin allergy and provide an algorithm to assist decision-making for individual patients. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.

An eye on nutrition: The role of vitamins, essential fatty acids, and antioxidants in age-related macular degeneration, dry eye syndrome, and cataract.

PubMed

McCusker, Meagen M; Durrani, Khayyam; Payette, Michael J; Suchecki, Jeanine

2016-01-01

Visual impairment is a global epidemic. In developing countries, nutritional deficiency and cataracts continue to be the leading cause of blindness, whereas age-related macular degeneration (AMD) and cataracts are the leading causes in developed nations. The World Health Organization has instituted VISION 2020: "The Right to Sight" as a global mission to put an end to worldwide blindness. In industrialized societies, patients, physicians, researchers, nutritionists, and biochemists have been looking toward vitamins and nutrients to prevent AMD, cataracts, and dry eye syndrome (DES). Nutrients from the AREDS2 study (lutein, zeaxanthin, vitamin C, vitamin E, zinc, copper, eicosapentanoic acid [EPA], and docosahexanoic acid [DHA]) set forth by the National Institutes of Health remain the most proven nutritional therapy for reducing the rate of advanced AMD. Omega-3 fatty acids, especially DHA, have been found to improve DES in randomized clinical trials. Conflicting results have been seen with regard to multivitamin supplementation on the prevention of cataract. Copyright © 2016. Published by Elsevier Inc.

23G pars plana vitrectomy for vitreal floaters: prospective assessment of subjective self-reported visual impairment and surgery-related risks during the course of treatment.

PubMed

Hahn, Ursula; Krummenauer, Frank; Ludwig, Klaus

2018-06-01

Quantifying the subjective impairment due to floaters based on an indication-specific questionnaire and setting its change between prior to and 3/12 months after elective vitrectomy in relation to surgical risks. Single-arm longitudinal observational multicenter study. Sixty-four floater patients underwent 23G pars plana vitrectomy; simultaneous phacoemulsification was excluded. An overall self-rated impairment index (SRI) and sub-indices SRI were calculated on the basis of a modified Visual Quality of Life questionnaire (VQoL), which addresses general vision, glare, near-sight problems and mobility of floaters. SRI ranged from 0 to 100% (maximum impairment). Secondary endpoints included corrected visual acuity and complications. Data were collected prior to and 3 (n = 64) and 12 (n = 62) months after surgery. The median overall SRI improved (44, 12, 11%) with a statistically significant median reduction of 69% (95% confidence interval 50-89%) 3 months postop. The median sub-SRIs improved for glare (50, 17, 17%), near sight problems (50, 17, 8%), and mobility of floaters (43, 5, 0%). Sixteen eyes needed cataract surgery during follow-up (10 showed cataract already prior to vitrectomy). Eight complications were reported (6 intra-operative retinal holes, 2 post-operative retinal detachments). For the majority of floater patients, subjective impairment was profoundly reduced by vitrectomy. Benefits of surgery prevailed despite complications.

Melanopsin-Mediated Acute Light Responses Measured in Winter and in Summer: Seasonal Variations in Adults with and without Cataracts.

PubMed

Münch, Mirjam; Ladaique, Myriam; Roemer, Ségolène; Hashemi, Kattayoon; Kawasaki, Aki

2017-01-01

Seasonal adaptation is a ubiquitous behavior seen in many species on both global hemispheres and is conveyed by changing photoperiods. In humans this seasonal adaptation is less apparent, in part because changes in daylength are masked by the use of electrical lighting at night. On the other hand, cataracts which reduce light transmission, may compound seasonal changes related to the reduced daylength of winter. To better understand the effects of different photoperiod lengths in healthy adults without and with cataracts, we tested their melanopsin-mediated light responses in summer vs. winter. Fifty-two participants (mean age 67.4 years; 30 with bilateral cataracts and 22 age-matched controls with clear lenses; pseudophakes) were tested twice, once in summer and once in winter. At each test session we assessed the electroretinogram and pupil responses during daytime and we determined melatonin suppression, subjective sleepiness and mood in response to light exposure in the evening. Circadian rest-activity cycles and sleep from activity recordings were also analyzed for both seasons. Both groups had similar visual function. There were no seasonal differences in the electroretinogram. For the pupil responses to bright blue light, the post-illumination pupil response (PIPR) was greater in winter than summer in pseudophakes, but not in cataract participants, whereas melatonin suppression to acute light exposure showed no differences between both groups and seasons. Overall, intra-daily variability of rest-activity was worse in winter but participants felt sleepier and reported worse mood at the laboratory in evening time in the summer. Those with cataracts had poorer sleep quality with lower sleep efficiency, and higher activity during sleep in winter than summer. In this study, the PIPR showed a seasonal variation in which a larger response was found during winter. This variation was only detected in participants with a clear intraocular lens. In the cataract group, visual function was not impaired yet these participants showed a lack of seasonal changes in the pupil response to blue light and poorer sleep in winter. These findings raise the question for tailored lighting conditions for cataract patients in order to counter potentially deleterious effects of living with chronically lower light exposure.

Melanopsin-Mediated Acute Light Responses Measured in Winter and in Summer: Seasonal Variations in Adults with and without Cataracts

PubMed Central

Münch, Mirjam; Ladaique, Myriam; Roemer, Ségolène; Hashemi, Kattayoon; Kawasaki, Aki

2017-01-01

Seasonal adaptation is a ubiquitous behavior seen in many species on both global hemispheres and is conveyed by changing photoperiods. In humans this seasonal adaptation is less apparent, in part because changes in daylength are masked by the use of electrical lighting at night. On the other hand, cataracts which reduce light transmission, may compound seasonal changes related to the reduced daylength of winter. To better understand the effects of different photoperiod lengths in healthy adults without and with cataracts, we tested their melanopsin-mediated light responses in summer vs. winter. Fifty-two participants (mean age 67.4 years; 30 with bilateral cataracts and 22 age-matched controls with clear lenses; pseudophakes) were tested twice, once in summer and once in winter. At each test session we assessed the electroretinogram and pupil responses during daytime and we determined melatonin suppression, subjective sleepiness and mood in response to light exposure in the evening. Circadian rest-activity cycles and sleep from activity recordings were also analyzed for both seasons. Both groups had similar visual function. There were no seasonal differences in the electroretinogram. For the pupil responses to bright blue light, the post-illumination pupil response (PIPR) was greater in winter than summer in pseudophakes, but not in cataract participants, whereas melatonin suppression to acute light exposure showed no differences between both groups and seasons. Overall, intra-daily variability of rest-activity was worse in winter but participants felt sleepier and reported worse mood at the laboratory in evening time in the summer. Those with cataracts had poorer sleep quality with lower sleep efficiency, and higher activity during sleep in winter than summer. In this study, the PIPR showed a seasonal variation in which a larger response was found during winter. This variation was only detected in participants with a clear intraocular lens. In the cataract group, visual function was not impaired yet these participants showed a lack of seasonal changes in the pupil response to blue light and poorer sleep in winter. These findings raise the question for tailored lighting conditions for cataract patients in order to counter potentially deleterious effects of living with chronically lower light exposure. PMID:28955293

An evaluation of intraoperative and postoperative outcomes of torsional mode versus longitudinal ultrasound mode phacoemulsification: a Meta-analysis.

PubMed

Leon, Pia; Umari, Ingrid; Mangogna, Alessandro; Zanei, Andrea; Tognetto, Daniele

2016-01-01

To evaluate and compare the intraoperative parameters and postoperative outcomes of torsional mode and longitudinal mode of phacoemulsification. Pertinent studies were identified by a computerized MEDLINE search from January 2002 to September 2013. The Meta-analysis is composed of two parts. In the first part the intraoperative parameters were considered: ultrasound time (UST) and cumulative dissipated energy (CDE). The intraoperative values were also distinctly considered for two categories (moderate and hard cataract group) depending on the nuclear opacity grade. In the second part of the study the postoperative outcomes as the best corrected visual acuity (BCVA) and the endothelial cell loss (ECL) were taken in consideration. The UST and CDE values proved statistically significant in support of torsional mode for both moderate and hard cataract group. The analysis of BCVA did not present statistically significant difference between the two surgical modalities. The ECL count was statistically significant in support of torsional mode (P<0.001). The Meta-analysis shows the superiority of the torsional mode for intraoperative parameters (UST, CDE) and postoperative ECL outcomes.

An evaluation of intraoperative and postoperative outcomes of torsional mode versus longitudinal ultrasound mode phacoemulsification: a Meta-analysis

PubMed Central

Leon, Pia; Umari, Ingrid; Mangogna, Alessandro; Zanei, Andrea; Tognetto, Daniele

2016-01-01

AIM To evaluate and compare the intraoperative parameters and postoperative outcomes of torsional mode and longitudinal mode of phacoemulsification. METHODS Pertinent studies were identified by a computerized MEDLINE search from January 2002 to September 2013. The Meta-analysis is composed of two parts. In the first part the intraoperative parameters were considered: ultrasound time (UST) and cumulative dissipated energy (CDE). The intraoperative values were also distinctly considered for two categories (moderate and hard cataract group) depending on the nuclear opacity grade. In the second part of the study the postoperative outcomes as the best corrected visual acuity (BCVA) and the endothelial cell loss (ECL) were taken in consideration. RESULTS The UST and CDE values proved statistically significant in support of torsional mode for both moderate and hard cataract group. The analysis of BCVA did not present statistically significant difference between the two surgical modalities. The ECL count was statistically significant in support of torsional mode (P<0.001). CONCLUSION The Meta-analysis shows the superiority of the torsional mode for intraoperative parameters (UST, CDE) and postoperative ECL outcomes. PMID:27366694

Sight restoration after congenital blindness does not reinstate alpha oscillatory activity in humans

PubMed Central

Bottari, Davide; Troje, Nikolaus F.; Ley, Pia; Hense, Marlene; Kekunnaya, Ramesh; Röder, Brigitte

2016-01-01

Functional brain development is characterized by sensitive periods during which experience must be available to allow for the full development of neural circuits and associated behavior. Yet, only few neural markers of sensitive period plasticity in humans are known. Here we employed electroencephalographic recordings in a unique sample of twelve humans who had been blind from birth and regained sight through cataract surgery between four months and 16 years of age. Two additional control groups were tested: a group of visually impaired individuals without a history of total congenital blindness and a group of typically sighted individuals. The EEG was recorded while participants performed a visual discrimination task involving intact and scrambled biological motion stimuli. Posterior alpha and theta oscillations were evaluated. The three groups showed indistinguishable behavioral performance and in all groups evoked theta activity varied with biological motion processing. By contrast, alpha oscillatory activity was significantly reduced only in individuals with a history of congenital cataracts. These data document on the one hand brain mechanisms of functional recovery (related to theta oscillations) and on the other hand, for the first time, a sensitive period for the development of alpha oscillatory activity in humans. PMID:27080158

Plasma catalase activity and malondialdehyde level in patients with cataract.

PubMed

Ateş, N A; Yildirim, O; Tamer, L; Unlü, A; Ercan, B; Muşlu, N; Kanik, A; Hatungil, R; Atik, U

2004-08-01

Oxidative mechanisms play a major role in the aetiology and pathogenesis of cataract, especially in age-related cataract. Our study aims to investigate systemic oxidant and antioxidant markers in cataract patients. The activity of erythrocyte catalase and the level of malondialdehyde in plasma were measured in 40 patients with cataract and 60 healthy control subjects. The malondialdehyde level, as an index of lipid peroxidation, was determined by thiobarbitüric acid reaction according to Yagi. The determination of catalase activity was measured by a method that was defined by Beutler. Catalase enzyme activity and malondialdehyde level were evaluated to find out whether there was a significant difference in these variables. Analysis of variance was used by forming a general linear model that takes age and gender as the covariate. CAT activity was found to be 13 920.2 +/- 847.9 U/l in cataract patients and 16 061.3 +/- 1126.6 U/l in control subjects. CAT activity in cataract patients was significantly lower than the control subjects (P = 0.008). Plasma MDA level is significantly higher in patients with cataract 4.47 +/- 0.35 nmol/ml compared to the control subjects 2.94 +/- 0.26 nmol/ml (P = 0.0001). There was no significant difference between different cataract subgroups when erythrocyte CAT activities and plasma MDA levels were compared (P = 0.322, 0.062). This study shows that oxidant/antioxidant balances alter in the presence of cataract.

Six-year clinical study of firework-related eye injuries in North China.

PubMed

Kong, Yichun; Tang, Xin; Kong, Baohuan; Jiang, Hao; Chen, Ying

2015-01-01

To analyse the demographic data, clinical characteristics, management and prognosis of patients with firework-related eye injuries. A retrospective review was performed of patients with eye injuries related to fireworks referred to TianJin Eye Hospital in North China from 2008 to 2013. Demographic information, clinical features, management and visual outcome were analysed and prognosis factors were evaluated. Ninety-nine patients (86 men) with 118 eye injuries were enrolled in the study. The average age of the patients was 32.0±20.5 years; 70/99 (70.7%) were aged >20 years. Eighty-one of the patients had been lighting the fireworks while the rest were bystanders. The main ophthalmic manifestations were hyphaema, vitreous haemorrhage, corneal/sclera/corneoscleral open globe injury, eyelid laceration, traumatic cataract, retinal/choroid detachment, endophthalmitis and intraocular foreign body (IOFB). Ninety patients required surgical intervention including repair of open globe injury, vitrectomy, cataract extraction and enucleation. 56/118 eyes (47.5%) received multiple operations. After treatment, final best-corrected visual acuity (BCVA) significantly improved (p=0.015). Some factors were significantly correlated with better final BCVA, including initial BCVA (p=0.036), closed globe injury (p=0.031), absence of endophthalmitis (p=0.014), absence of IOFB (p=0.024) and absence of retinal detachment (p=0.046). Firework-related eye injuries mainly occur in adult men and result in severe visual damage. The most common clinical manifestations are hyphaema and vitreous haemorrhage. Better initial BCVA and closed globe injury have a better visual result while endophthalmitis, IOFB and retinal detachment have a negative visual outcome. Improved eye protection, along with enhanced public education and legal ban on fireworks, could reduce the incidence of eye injuries. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Caffeine Eye Drops Protect Against UV-B Cataract

PubMed Central

Kronschläger, Martin; Löfgren, Stefan; Yu, Zhaohua; Talebizadeh, Nooshin; Varma, Shambhu D.; Söderberg, Per

2013-01-01

The purpose of this study was to investigate if topically applied caffeine protects against in vivo ultraviolet radiation cataract and if so, to estimate the protection factor. Three experiments were carried out. First, two groups of Sprague-Dawley rats were pre-treated with a single application of either placebo or caffeine eye drops in both eyes. All animals were then unilaterally exposed in vivo to 8 kJ/m2 UV-B radiation for 15 min. One week later, the lens GSH levels were measured and the degree of cataract was quantified by measurement of in vitro lens light scattering. In the second experiment, placebo and caffeine pre-treated rats were divided in five UV-B radiation dose groups, receiving 0.0, 2.6, 3.7, 4.5 or 5.2 kJ/m2 UV-B radiation in one eye. Lens light scattering was determined after one week. In the third experiment, placebo and caffeine pre-treated rats were UV-B-exposed and the presence of activated caspase-3 was visualized by immunohistochemistry. There was significantly less UV-B radiation cataract in the caffeine group than in the placebo group (95% confidence interval for mean difference in lens light scattering between the groups = 0.10 ± 0.05 tEDC), and the protection factor for caffeine was 1.23. There was no difference in GSH levels between the placebo- and the caffeine group. There was more caspase-3 staining in UV-B-exposed lenses from the placebo group than in UV-B-exposed lenses from the caffeine group. Topically applied caffeine protects against ultraviolet radiation cataract, reducing lens sensitivity 1.23 times. PMID:23644096

A multicenter randomized controlled fellow eye trial of pulse-dosed difluprednate 0.05% versus prednisolone acetate 1% in cataract surgery.

PubMed

Donnenfeld, Eric D; Holland, Edward J; Solomon, Kerry D; Fiore, Jay; Gobbo, Anthony; Prince, Jessica; Sandoval, Helga P; Shull, Emily R; Perry, Henry D

2011-10-01

To compare the effects of 2 corticosteroids on corneal thickness and visual acuity after cataract surgery. Multicenter, randomized, contralateral-eye, double-masked trial. Fifty-two patients (104 eyes) underwent bilateral phacoemulsification. The first eye randomly received difluprednate 0.05% or prednisolone acetate 1%; the fellow eye received the alternative. Before surgery, 7 doses were administered over 2 hours; 3 additional doses were given after surgery, before discharge. For the remainder of the day, corticosteroids were administered every 2 hours, then 4 times daily during week 1 and twice daily during week 2. Corneal pachymetry, visual acuity, and corneal edema were evaluated before surgery and at days 1, 15, and 30 after surgery. Endothelial cell counts were evaluated before surgery and at 30 days after surgery. Retinal thickness was evaluated before surgery and at 15 and 30 days after surgery. Corneal thickness at day 1 was 33 μm less in difluprednate-treated eyes (P = .026). More eyes were without corneal edema in the difluprednate group than in the prednisolone group at day 1 (62% vs 38%, respectively; P = .019). Uncorrected and best-corrected visual acuity at day 1 were significantly better with difluprednate than prednisolone by 0.093 logMAR lines (P = .041) and 0.134 logMAR lines (P < .001), respectively. Endothelial cell density was 195.52 cells/mm(2) higher in difluprednate-treated eyes at day 30 (P < .001). Retinal thickness at day 15 was 7.74 μm less in difluprednate-treated eyes (P = .011). In this high-dose pulsed-therapy regimen, difluprednate reduced inflammation more effectively than prednisolone acetate, resulting in more rapid return of vision. Difluprednate was superior at protecting the cornea and reducing macular thickening after cataract surgery. Copyright © 2011 Elsevier Inc. All rights reserved.

Morphologic features and surgically induced astigmatism of femtosecond laser versus manual clear corneal incisions.

PubMed

Zhu, Sha; Qu, Naibin; Wang, Wei; Zhu, Yanan; Shentu, Xingchao; Chen, Peiqing; Xu, Wen; Yao, Ke

2017-11-01

To compare the morphologic features and surgically induced astigmatism (SIA) between laser and manual clear corneal incisions (CCIs) after femtosecond laser-assisted cataract surgery. Eye Center, 2nd Affiliated Hospital, Medical College of Zhejiang University, Hangzhou, China. Prospective case series. Patients had femtosecond laser-assisted cataract surgery with a CCI created with the laser or manually after random allocation. The corrected distance visual acuity, corneal topography, and anterior segment optical coherence tomography were assessed at the 1-day, 1-week, 1-month, and 3-month follow-ups. The laser CCI group comprised 45 eyes and the manual CCI group, 48 eyes. The SIA was significantly lower in the manual CCI group than the laser CCI group at all visits (P < .05). At the 1-day and 1-week follow-ups, the mean CCI thickness was significantly smaller in the manual CCI group (P < .05). In the laser CCI group, the perpendicular linear distance between the external wound opening and the corneal vertex central line was statistically shorter than in the manual CCI group (P < .05). At 3 months, the SIA was correlated with the perpendicular linear distance with a Pearson correlation coefficient of -0.341 (P = .001). Femtosecond laser-created CCIs for cataract surgery caused more SIA than manually created CCIs, which could have resulted from inaccurate or uncertain corneal incision positioning of the femtosecond machine. Manual creation of CCIs is recommended in femtosecond laser-assisted cataract surgery until the locating system for the femtosecond laser incision is updated. Copyright © 2017 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Therapeutic uses of drug-carrier systems for imidazole-containing dipeptide compounds that act as pharmacological chaperones and have significant impact on the treatment of chronic diseases associated with increased oxidative stress and the formation of advanced glycation end products.

PubMed

Babizhayev, Mark A; Yegorov, Yegor E

2010-01-01

The purpose of this study was to determine how the naturally occurring molecules N-acetylcarnosine, L-carnosine, and carcinine, which are chemical or pharmacological chaperones, affect the cells and biomolecules of patients with skin diseases, cosmetic skin lesions, or underlying clinically significant visual impairment such as age-related cataracts, age-related retinal degeneration, and ocular complications of diabetes. We evaluated and characterized the effects of cited pharmacological chaperones on enzyme activity, protein structure in tissues, and other biomarkers of diseases in skin cells and tissues or in ocular tissues (human cataractous and normal lenses) derived from ophthalmic patients or age-matched donors. The samples were used to test imidazole-containing peptidomimetic chemical/pharmacological chaperones in relation to oxidative stress induced by reaction with lipid peroxides or advanced non-enzymatic glycation processes. Chaperone function is characterized by interaction with other proteins, mediating their folding, transport, and interaction with other molecules, lipid peroxidation products, and membranes. Although these therapies remain on hold pending further investigation, we present growing evidence demonstrating the ability of N-acetylcarnosine (lubricant eye drops) or carcinine pharmacological chaperone therapy to act as novel treatments for age-related cataracts, age-related macular degeneration, and ocular complications of diabetes. Finally, we examine strategies for identifying potential chaperone compounds and for experimentally demonstrating chaperone and transglycating (de-glycation) types of activity in in vitro and in vivo models of human age-related eye diseases, such as cataracts, and advanced glycation tissue protein-engineered systems.

[Femtosecond laser in cataract surgery. A critical appraisal].

PubMed

Menapace, R M; Dick, H B

2014-01-01

The use of femtosecond lasers (FSL) is increasingly spreading in cataract surgery. Potential advantages over standard manual cataract surgery are the superior precision of corneal incisions and capsular openings as well as the reduction of ultrasound energy for lens nucleus work-up. Exact positioning and dimensioning of the anterior capsular opening should help reduce decentration and tilt of the intraocular lens (IOL) optics and thus achieve better target refraction. Together with the possibility to correct low-grade corneal astigmatism by precise arcuate incision, FSL technology is expected to convert cataract surgery from a purely curative into a refractive procedure. Apart from own experiences this review article critically analyses the pertinent literature published so far as well as congress presentations and personal reports of other FSL surgeons. The advantages and disadvantages are scrutinized with regard to their impact on the surgical and refractive results and compared with those experienced by the authors with manual cataract surgery over several decades. Economic and healthcare political aspects are also addressed. The use of FSL surgery improves the precision and reproducibility of corneal incisions and the capsular opening and reduces the amount of ultrasound energy required for lens nucleus work-up. However, the clinical benefits must be put into perspective due to the subsequent surgical manipulation of the incisions (during lens emulsification, aspiration and IOL injection), the lacking possibility to visualize the crystalline lens equator as the reference for correct capsulotomy centration and the relativity of ultrasound energy consumption on the corneal endothelial trauma. This is of particular relevance against the background of the significantly higher costs. Conversely, tears of the anterior capsule edge which, apart from interfering with correct IOL positioning, may entail serious complications presently occur more frequently with all FSL instruments. From the economic and healthcare political viewpoint, thought should be given to the possible acquisition of the cataract surgical business by the industry or investors, as cataract surgery is a high-volume standardized procedure with enormous future potential. This could fundamentally change our currently decentralized and individualized structures and subsequently the steam of patient and make surgeons largely dependent or superfluous.

Epidemiological correlates of cataract cases in tertiary health care center in rural area of maharashtra.

PubMed

Avachat, Shubhada Sunil; Phalke, Vaishali; Kambale, Suchit

2014-01-01

The most recent estimates from World Health Organization (WHO) reveal that 47.8% of global blindness is due to cataract. Cataract has been documented to be the most significant cause of bilateral blindness in India. The most recent estimates from WHO reveal that 47.8% of global blindness is due to cataract and in south Asia region which includes India, 51% of blindness is due to cataract. In India cataract is the principal cause of blindness accounting for 62.6% cases of blindness. The key to the success of the Global Vision 2020: The right to sight initiative is a special effort to tackle cataract blindness which includes estimation of magnitude of the problem and understanding factors associated with it. Therefore, a study was conducted in the hospital to estimate the magnitude of cataract and study various epidemiological factors associated with it. A cross-sectional study was conducted in a tertiary health center in rural area. Total 746 patients who availed services from ophthalmology department during study period were included in the study and relevant data was collected from them. Data analysis was done by percentages, proportions, and tests of significance (Chi-square test). Out of 746 patients, 400 (53.6%) were suffering from cataract. Senile cataract was the most common cause (54%). Fifty-five percent patients were in the age group of 60-80 years and majority of them were from low socioeconomic strata. The prevalence of cataract in a medical college hospital in rural area was 53.6%. Age, sex, and educational status were significantly associated with cataract.

[The problems of cataract surgery and intraocular correction: Russian school achievements and modern trends].

PubMed

Maliugin, B E; Linnik, L F; Egorova, E V; Kopaeva, V G; Tolchinskaia, A I

2007-01-01

The development of the safest and, at the same time, efficient methods of cataract surgery, is not only a topical task of medical science and practice, but also, taking the demographic situation into account, a solution to a social problem. The article describes the main achievements of academician S. N. Fyodorov's school in the field of cataract surgery with intraocular lense (IOL) implantation. Special attention is paid to the key components of cataract extraction technique named "small incision surgery", which is based upon the use of ultrasmall surgical approaches with self-sealing ability and no need for suturing. The main advantages and disadvantages of various types of cataract lense fragmentation, including ultrasound emulsification, mechanic and hydraulic fragmentation, and laser destruction, are described. Topical issues concerning cataract extraction technique under the conditions of complicating ophthalmopathology including the weakness of ciliary zonule system, high-degree myopia, glaucoma, pseudoexfoliative syndrome, small pupil, past injuries and eye surgery, are outlined. The paper also reflects a new qualitative step in the development of intraocular aphakia correction technique under modern conditions. Basic requirements to design parameters and IOL materials are determined from the position of reestablishing the accommodative function and fine visual functions. Ways of IOL design improvement are described especially for their application in non-standard and complicated cases.

Pupil Influence on the Visual Outcomes of a New-Generation Multifocal Toric Intraocular Lens With a Surface-Embedded Near Segment.

PubMed

Wang, Mengmeng; Corpuz, Christine Carole C; Huseynova, Tukezban; Tomita, Minoru

2016-02-01

To evaluate the influences of preoperative pupil parameters on the visual outcomes of a new-generation multifocal toric intraocular lens (IOL) model with a surface-embedded near segment. In this prospective study, patients with cataract had phacoemulsification and implantation of Lentis Mplus toric LU-313 30TY IOLs (Oculentis GmbH, Berlin, Germany). The visual and optical outcomes were measured and compared preoperatively and postoperatively. The correlations between preoperative pupil parameters (diameter and decentration) and 3-month postoperative visual outcomes were evaluated using the Spearman's rank-order correlation coefficient (Rs) for the nonparametric data. A total of 27 eyes (16 patients) were enrolled into the current study. Statistically significant improvements in visual and refractive performances were found after the implantation of Lentis Mplus toric LU-313 30TY IOLs (P < .05). Statistically significant correlations were present between preoperative pupil diameters and postoperative visual acuities (Rs > 0; P < .05). Patients with a larger pupil always have better postoperative visual acuities. Meanwhile, there was no statistically significant correlation between pupil decentration and visual acuities (P > .05). Lentis Mplus toric LU-313 30TY IOLs provided excellent visual and optical performances during the 3-month follow-up. The preoperative pupil size is an important parameter when this toric multifocal IOL model is contemplated for surgery. Copyright 2016, SLACK Incorporated.

Causes of severe visual impairment and blindness in children in the Republic of Suriname

PubMed Central

Heijthuijsen, Astrid Anna Maria; Beunders, Victoria Apollonia Annemarie; Jiawan, Dinesh; de Mesquita-Voigt, Anne-Marie Bueno; Pawiroredjo, Jerrel; Mourits, Maarten; Tanck, Michael; Verhoeff, Joost; Saeed, Peerooz

2013-01-01

Aims To determine the causes of severe visual impairment and blindness (SVI/BL) in children in Suriname (Dutch Guyana) and to identify preventable and treatable causes. Methods 4643 children under 16 years of age were recruited from two locations: 33 children attending the only school for the blind were examined and 4610 medical records were analysed at an eye clinic. Data have been collected using the WHO Prevention of Blindness Programme eye examination record for children. Results 65 children were identified with SVI/BL, 58.5% were blind and 41.5% were severely visually impaired (SVI). The major anatomical site of SVI/BL was the retina in 33.8%, lens in 15.4% and normal appearing globe in 15.4%. The major underlying aetiology of SVI/BL was undetermined in 56.9% (mainly cataract and abnormality since birth) and perinatal factors 21.5% (mainly retinopathy of prematurity (ROP)). Avoidable causes of SVI/BL accounted for 40% of cases; 7.7% were preventable and 32.3% were treatable with cataracts and ROP the most common causes (15.4% and 12.3%, respectively). Conclusions More than a third of the SVI/BL causes are potentially avoidable, with childhood cataract and ROP the leading causes. Corneal scarring from vitamin A deficiency does not seem to be a continuing issue in Suriname. PMID:23603759

Prevalence of visual impairment and blindness in Upper Egypt: a gender-based perspective.

PubMed

Mousa, Ahmed; Courtright, Paul; Kazanjian, Arminee; Bassett, Ken

2014-06-01

To estimate the prevalence, causes of and risk factors for vision loss in Upper Egypt. In this cross-sectional study, four villages in Upper Egypt were randomly selected; within these four villages, households were randomly selected and within the selected households all residents aged ≥ 40 years were enumerated and enrolled. Door-to-door eye examinations of household members were conducted. Data on relevant demographic and socioeconomic characteristics were collected. The prevalence and causes of vision loss and associated risk factors were assessed. Sex differences in prevalence and determinants were also evaluated. The prevalence of best eye presenting visual impairment, severe visual impairment, and blindness were 23.9%, 6.4%, and 9.3% respectively. The prevalence of blindness among women significantly exceeded that among men (11.8% vs. 5.4%, respectively, p = 0.021). The prevalence of cataract was 22.9% (higher in women, 26.5% than men 17.2%, p = 0.018). The prevalence of trachomatous trichiasis was 9.7% (higher among women, 12.5%, than men, 5.4%, p = 0.012). The principal causes of blindness were cataract (60%), uncorrected refractive errors (16%) and corneal opacities (12%). Age, sex, family size, illiteracy, unemployment, water source and sanitation methods and living conditions were the major risk factors for vision loss. The prevalence of visual impairment remains high in Egypt, particularly among women. Risk factors for blindness may differ between men and women. There is a need for qualitative investigations to better understand the causes behind the excess in prevalence of blindness among women.

Visual outcome and rotational stability of open loop toric intraocular lens implantation in Indian eyes

PubMed Central

Venkataraman, Arvind; Kalpana

2013-01-01

Purpose: To assess the visual outcome and rotational stability of single-piece open loop toric Intra Ocular Lens (IOL) in a clinical setting. Materials and Methods: In a prospective study, 122 eyes of 77 patients were followed up for a period of 12 months after cataract surgery with toric open loop IOL implantation. The pre-operative markings for the position of incision and IOL placement were done under slit lamp by anterior stromal puncture. The visual acuity, refraction, and IOL position were assessed at day 1, 1 week, 1 month, 3 months, 6 months, and 12 months after surgery. Results: The mean age of the cohort was 56 yrs (S.D. 13.88; range 16 to 87 years). The mean pre-operative cylinder of corneal astigmatism was 1.37 D. (SD 0.79, range 1.0 to 5.87 D). Mean post-operative refractive cylinder was 0.36 D (SD 0.57, range 0 to 1.50 D) at 12 months. Ninety-seven percent of the eyes were within 1 D of residual astigmatism. Ninety-four percent of patients had uncorrected visual acuity of 20/30 or better. Four eyes required IOL repositioning due to rotation. At 12 months, 96.7% of the IOLs were within 10 degrees of the target axis. There was no rotation seen after 6 months. Conclusion: Toric IOLs are very effective and consistent in correcting astigmatism during the cataract surgery. IOL rotation happens mostly within a month of surgery, and if significant, requires early repositioning. PMID:24343593

Comparison of Visual Quality after Implantation of Big Bag and Akreos Adapt Intraocular Lenses in Patients with High Myopia.

PubMed

Ma, Shengsheng; Zheng, Dongjian; Lin, Ling; Meng, Fanjian; Yuan, Yonggang

2015-03-01

To compare vision quality following phacoemulsification cataract extraction and implantation of a Big Bag or Akreos Adapt intraocular lens (IOL) in patients diagnosed with high myopia complicated with cataract. This was a randomized prospective control study. The patients with high myopia. complicated with cataract, with axial length ≥ 28 mm, and corneal astigmatism ≤ 1D were enrolled and randomly divided into the Big Bag and Akreos Adapt IOL groups. All patients underwent phacoemulsification cataract extraction and lens implantation. At 3 months after surgery, intraocular high-order aberration was measured by a Tracey-iTrace wavefront aberrometer at a pupil diameter of 5 mm in an absolutely dark room and statistically compared between two groups. The images of the anterior segment of eyes were photographed with a Scheimpflug camera using Penta-cam three-dimensional anterior segment analyzer. The tilt and decentration of the IOL were calculated by Image-pro plus 6.0 imaging analysis software and statistically compared between two groups. In total, 127 patients (127 eyes), including 52 males and 75 females, were enrolled in this study. The total high-order aberration and coma in the Akreos Adapt group (59 eyes) were significantly higher compared with those in the Big Bag (P < 0.05). The clover and spherical aberration did not differ between the two groups (P > 0.05). The horizontal and vertical decentration were significantly smaller in the Big Bag lens group than in the Akreos Adapt group (both P < 0.05), whereas the tilt of IOL did not significantly differ between the two groups (P > 0.05). Both Big Bag and Akreos Adapt IOLs possess relatively good intraocular stability implanted in patients with high myopia. Compared with the Akreos Adapt IOL, the Big Bag IOL presents with smaller intraocular high-order aberration. Coma is the major difference between the two groups.

Oxidative stress markers in aqueous humor of patients with senile cataracts.

PubMed

Sawada, Hideko; Fukuchi, Takeo; Abe, Haruki

2009-01-01

To investigate the levels of oxidative stress markers in human eyes with senile cataracts. We conducted a retrospective, case-controlled study of 57 patients with senile cataracts. To assess oxidative stress markers in the eye, we measured the enzymatic activities of superoxide dismutase (SOD) and catalase (CAT) as well as the total protein levels in aqueous humor. In aqueous humor, SOD and CAT activity levels were 0.133 +/- 0.020 and 1.223 +/- 0.081 U/ml, respectively; protein levels were 2.372 +/- 0.166 mg/ml (means +/- SEM). We observed a significant increase in SOD activity and the protein level in progressed nuclear cataracts. No significant age-associated difference in antioxidant enzyme levels was detected. Significant increases in the levels of SOD activity and total protein correlated with the severity of the cataract but not with patient age, suggesting that progressed cataract is associated with molecules leaking from the lens capsule.

Validity of self-reported eye disease and treatment in a population-based study: the Los Angeles Latino Eye Study.

PubMed

Patty, Lauren; Wu, Cathy; Torres, Mina; Azen, Stanley; Varma, Rohit

2012-09-01

To examine the validity of self-reported eye disease, including cataract, age-related macular degeneration (AMD), glaucoma, and diabetic retinopathy (DR), and self-reported surgical treatment for cataract and DR in the Los Angeles Latino Eye Study (LALES). Population-based, cross-sectional study. A total of 6357 Latinos aged 40+ years from the LALES. Participants underwent a detailed interview, including survey questions about ocular health, diagnoses, and timing of last eye examination, and a standardized clinical examination. Self-report was compared with examination to determine sensitivity and specificity by length of time since last eye examination. Stepwise logistic regression was used to determine factors associated with inaccurate self-report. Sensitivity and specificity were calculated for 4 self-reported eye diseases (cataract, AMD, glaucoma, and DR) and for surgical treatment of cataract and DR. Odds ratios (ORs) were determined for factors associated with inaccurate self-report underestimating eye disease and treatment. For each disease, sensitivity and specificity in those who reported their last eye examination as <1 year ago were 36.8% and 92.5% for cataract, 37.7% and 96.3% for glaucoma, 5.1% and 98.9% for AMD, and 25.7% and 94.2% for DR, respectively. Self-report was less accurate with increasing time since last eye examination. Inaccurate self-report was independently associated with better visual acuity (OR, 2.4), <2 comorbidities (OR, 1.7), last eye examination/visit 1 to 5 years ago and ≥ 5 years ago (OR, 2.3 and 4.9, respectively), and less education (OR, 1.3 for 7-12 years and 1.7 for <7 years). Of 88 participants surgically treated for cataract who reported an eye examination <1 year ago, sensitivity and specificity of self-reported surgical history were 90.9% and 99.9%, respectively. Of the 31 participants treated for DR (laser/surgery) and reporting an eye examination <1 year ago, sensitivity and specificity of self-reported surgical history were 19.4% and 99.6%, respectively. Among Latinos, self-reporting of eye disease and surgical history provides a significant underestimate of the disease burden. This may lead to significant misclassification in vision research if self-report alone is used to identify persons with eye disease. Copyright © 2012 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Validity of self reported eye disease and treatment in a population-based study: The Los Angeles Latino Eye Study

PubMed Central

Patty, Lauren; Wu, Cathy; Torres, Mina; Azen, Stanley; Varma, Rohit

2012-01-01

Purpose To examine the validity of self-reported eye disease, including cataract, age-related macular degeneration (AMD), glaucoma, and diabetic retinopathy (DR), and self-reported surgical treatment for cataract and DR in the Los Angeles Latino Eye Study (LALES). Design Population-based cross-sectional study Participants 6357 Latinos age 40+ years from the LALES Methods Participants underwent a detailed interview, including survey questions about ocular health, diagnoses and timing of last eye examination, and a standardized clinical examination. Self report was compared to examination to determine sensitivity and specificity by length of time since last eye examination. Stepwise logistic regression was used to determine factors associated with inaccurate self report. Main Outcome Measures Sensitivity and specificity were calculated for four self reported eye diseases (cataract, AMD, glaucoma, DR) and for surgical treatment of cataract and DR. Odds ratios (OR) were determined for factors associated with inaccurate self report underestimating eye disease and treatment. Results For each disease, sensitivity and specificity in those who reported their last eye examination as <1 year ago were: 36.8%, 92.5% for cataract; 37.7%, 96.3% for glaucoma; 5.1%, 98.9% for AMD; and 25.7%, 94.2% for DR. Self report was less accurate with increasing time since last eye examination. Inaccurate self report was independently associated with better visual acuity (OR=2.4), <2 comorbidities (OR=1.7), last eye exam/visit 1–5 years ago and ≥5 years ago (OR=2.3 and 4.9, respectively), and less education (OR=1.3 for 7–12 years and 1.7 for <7 years). Of 88 participants surgically treated for cataract who reported an eye examination <1 year ago, sensitivity and specificity of self-reported surgical history were 90.9% and 99.9%. Of the 31 participants treated for DR (laser/surgery) and reporting an eye examination <1 year ago, sensitivity and specificity of self-reported surgical history were 19.4% and 99.6%. Conclusions Among Latinos, self reporting of eye disease and surgical history provides a significant underestimate of the disease burden. This may lead to significant misclassification in vision research if self report alone is used to identify persons with eye disease. PMID:22537615

DOE Office of Scientific and Technical Information (OSTI.GOV)

Palsamy, Periyasamy; Ayaki, Masahiko; Elanchezhian, Rajan

Highlights: Black-Right-Pointing-Pointer We found significant Keap1 promoter demethylation in diabetic cataractous lenses. Black-Right-Pointing-Pointer Demethylation of Keap1 gene upregulated the expression of Keap1 mRNA and protein. Black-Right-Pointing-Pointer Elevated levels of Keap1 are known to decrease the levels of Nrf2. Black-Right-Pointing-Pointer Thereby, the levels of antioxidant enzymes are suppressed by decreased Nrf2 level. -- Abstract: Age-related cataracts (ARCs) are the major cause of visual impairments worldwide, and diabetic adults tend to have an earlier onset of ARCs. Although age is the strongest risk factor for cataracts, little is known how age plays a role in the development of ARCs. It is knownmore » that oxidative stress in the lens increases with age and more so in the lenses of diabetics. One of the central adaptive responses against the oxidative stresses is the activation of the nuclear transcriptional factor, NF-E2-related factor 2 (Nrf2), which then activates more than 20 different antioxidative enzymes. Kelch-like ECH associated protein 1 (Keap1) targets and binds to Nrf2 for proteosomal degradation. We hypothesized that hyperglycemia will lead to a dysfunction of the Nrf2-dependent antioxidative protection in the lens of diabetics. We studied the methylation status of the CpG islands in 15 clear and 21 diabetic cataractous lenses. Our results showed significant levels of demethylated DNA in the Keap1 promoter in the cataractous lenses from diabetic patients. In contrast, highly methylated DNA was found in the clear lens and tumorized human lens epithelial cell (HLEC) lines (SRA01/04). HLECs treated with a demethylation agent, 5-aza-2 Prime deoxycytidine (5-Aza), had a 10-fold higher levels of Keap1 mRNA, 3-fold increased levels of Keap1 protein, produced higher levels of ROS, and increased cell death. Our results indicated that demethylation of the CpG islands in the Keap1 promoter will activate the expression of Keap1 protein, which then increases the targeting of Nrf2 for proteosomal degradation. Decreased Nrf2 activity represses the transcription of many antioxidant enzyme genes and alters the redox-balance towards lens oxidation. Thus, the failure of antioxidant protection due to demethylation of the CpG islands in the Keap1 promoter is linked to the diabetic cataracts and possibly ARCs.« less

The Auckland Cataract Study: co-morbidity, surgical techniques, and clinical outcomes in a public hospital service

PubMed Central

Riley, Andrew F; Malik, Tahira Y; Grupcheva, Christina N; Fisk, Michael J; Craig, Jennifer P; McGhee, Charles N

2002-01-01

Aim: To prospectively assess cataract surgery in a major New Zealand public hospital by defining presenting clinical parameters and surgical and clinical outcomes in a cohort of subjects just below threshold for treatment, based upon a points based prioritisation system. Methods: The prospective observational study comprised 488 eyes of 480 subjects undergoing consecutive cataract operations at Auckland Hospital. All subjects underwent extensive ophthalmic examination before and after surgery. Details of the surgical procedure, including any intraoperative difficulties or complications, were documented. Postoperative review was performed at 1 day and 4 weeks after surgery. Demographic data, clinical outcomes, and adverse events were correlated by an independent assessor. Results: The mean age at surgery was 74.9 (SD 9.6) years with a female predominance (62%). Significant systemic disease affected 80% of subjects, with 20% of the overall cohort exhibiting diabetes mellitus. 26% of eyes exhibited coexisting ocular disease and in 7.6% this affected best spectacle corrected visual acuity (BSCVA). A mean spherical equivalent of −0.49 (1.03) D and mean BSCVA of 0.9 (0.6) log MAR units (Snellen equivalent approximately 6/48) was noted preoperatively. Local anaesthesia was employed in 99.8% of subjects (94.9% sub-Tenon's). The majority of procedures (97.3%) were small incision phacoemulsification with foldable lens implant. Complications included: 4.9% posterior capsule tears, 3.8% cystoid macular oedema, and one case (0.2%) of endophthalmitis. Mean BSCVA after surgery was 0.1 (0.2) log MAR units (6/7.5 Snellen equivalent), with a mean spherical equivalent of −0.46 (0.89) D, and was 6/12 or better in 88% of all eyes. A drop in BSCVA, thought to be directly attributable to the surgical intervention, was recorded in a small percentage of eyes (1.5%) after surgery. Conclusion: This study provides a representative assessment of the management of cataract in the New Zealand public hospital system. A predominantly elderly, female population, frequently exhibiting significant systemic illness and coexisting ocular disease, relatively advanced cataracts, and poor BSCVA, presented for cataract surgery. The majority of subjects underwent small incision, phacoemulsification, day case surgery. While almost 90% achieved at least 6/12 BSCVA post-surgery, approximately 5% sustained an adverse intraoperative event and 1.5% of eyes exhibited a reduction in BSCVA postoperatively. PMID:11815345

Annual incidences of visual impairment during 10-year period in Mie prefecture, Japan.

PubMed

Ikesugi, Kengo; Ichio, Takako; Tsukitome, Hideyuki; Kondo, Mineo

2017-07-01

To determine the annual incidence of visual impairment in a Japanese population during a 10-year period. We examined the physical disability certificates issued yearly between 2004 and 2013 in Mie prefecture, Japan. During this period 2468 visually impaired people were registered under the newly defined Act on Welfare of the Physically Disabled Persons' criteria. The age, sex distribution, and causes of visual impairment were determined from the certificates. The major causes of visual impairment during the ten-year period were glaucoma (23.3%), diabetic retinopathy (17.3%), retinitis pigmentosa (12.2%), macular degeneration (9.0%), chorioretinal degeneration or high myopia (7.4%), optic atrophy (5.8%), stroke or brain tumor (5.4%) and cataracts (3.7%). The incidence of glaucoma was significantly higher throughout the period (2004-2013), and that of diabetic retinopathy was lower between 2007 and 2013. The incidence of retinitis pigmentosa did not change significantly during the 10-year period. The incidence of macular degeneration tended to increase between 2004 and 2007, but it decreased significantly between 2007 and 2013. The results indicate that in Japan, the rates of the major causes of visual impairment altered in the most recent 10-year period reflecting the recent changes in the social background and advances in ocular and systemic treatment.

Clinical and experimental advances in congenital and paediatric cataracts

PubMed Central

Churchill, Amanda; Graw, Jochen

2011-01-01

Cataracts (opacities of the lens) are frequent in the elderly, but rare in paediatric practice. Congenital cataracts (in industrialized countries) are mainly caused by mutations affecting lens development. Much of our knowledge about the underlying mechanisms of cataractogenesis has come from the genetic analysis of affected families: there are contributions from genes coding for transcription factors (such as FoxE3, Maf, Pitx3) and structural proteins such as crystallins or connexins. In addition, there are contributions from enzymes affecting sugar pathways (particularly the galactose pathway) and from a quite unexpected area: axon guidance molecules like ephrins and their receptors. Cataractous mouse lenses can be identified easily by visual inspection, and a remarkable number of mutant lines have now been characterized. Generally, most of the mouse mutants show a similar phenotype to their human counterparts; however, there are some remarkable differences. It should be noted that many mutations affect genes that are expressed not only in the lens, but also in tissues and organs outside the eye. There is increasing evidence for pleiotropic effects of these genes, and increasing consideration that cataracts may act as early and readily detectable biomarkers for a number of systemic syndromes. PMID:21402583

Corneal approach 20 Guage vitrectomy system for the management of congenital cataract

PubMed Central

Memon, Mariya Nazish; Bukhari, Sadia; Bhutto, Israr Ahmed

2016-01-01

Objective: To evaluate the efficacy and complications of 20 gauge vitrectomy via corneal approach for the management of congenital cataract. Method: We performed anterior capsular vitreorhexis, lens matter aspiration (LMA), primary posterior vitrectorhexis and anterior vitrectomy via corneal approach using 20 gauge vitrectomy system in children younger than two years of age with congenital cataract between January 2014 to December 2014. The intra and postoperative complications were observed. Results: Twenty nine eyes of 21 children were included in this study. Congenital cataract surgery using 20 gauge vitrectomy system via corneal approach did not reveal any intra operative complication. Post operatively all children were able to freely open their operated eyes. Conjunctival congestion at the incision site in four eyes and mild anterior chamber reaction in 8 eyes were seen on 1st daywhich resolved at one week follow up. Other major post operative complications such as inflammatory membrane, irregular pupil, posterior/anterior syneache and opacification of visual axis were not seen during follow up period. Conclusion: The 20-gauge vitrectomy system via corneal approach is easy to perform, is less time consuming, safe and effective for the management of congenital cataract in younger children. PMID:27182257

Corneal approach 20 Guage vitrectomy system for the management of congenital cataract.

PubMed

Memon, Mariya Nazish; Bukhari, Sadia; Bhutto, Israr Ahmed

2016-01-01

To evaluate the efficacy and complications of 20 gauge vitrectomy via corneal approach for the management of congenital cataract. We performed anterior capsular vitreorhexis, lens matter aspiration (LMA), primary posterior vitrectorhexis and anterior vitrectomy via corneal approach using 20 gauge vitrectomy system in children younger than two years of age with congenital cataract between January 2014 to December 2014. The intra and postoperative complications were observed. Twenty nine eyes of 21 children were included in this study. Congenital cataract surgery using 20 gauge vitrectomy system via corneal approach did not reveal any intra operative complication. Post operatively all children were able to freely open their operated eyes. Conjunctival congestion at the incision site in four eyes and mild anterior chamber reaction in 8 eyes were seen on 1(st) daywhich resolved at one week follow up. Other major post operative complications such as inflammatory membrane, irregular pupil, posterior/anterior syneache and opacification of visual axis were not seen during follow up period. The 20-gauge vitrectomy system via corneal approach is easy to perform, is less time consuming, safe and effective for the management of congenital cataract in younger children.

Blindness and Visual Impairment in an Urban West African Population: The Tema Eye Survey

PubMed Central

Budenz, Donald L.; Bandi, Jagadeesh R.; Barton, Keith; Nolan, Winifred; Herndon, Leon; Whiteside-de Vos, Julia; Hay-Smith, Graham; Kim, Hanna; Tielsch, James

2012-01-01

Objective To determine the prevalence, etiologies, and risk factors of blindness and visual impairment among persons age 40 years and older residing in an urban West African location. Design Population-based cross-sectional study. Participants Five thousand six hundred and three participants residing in Tema, Ghana. Methods Proportionate random cluster sampling was used to select participants age 40 and over living in the city of Tema. Presenting distance visual acuity was measured at 4 and 1 meters using a reduced Logarithm of the Minimum Angle of Resolution (logMAR) tumbling E chart and then with trial frame based on autorefraction. A screening examination was performed in the field on all participants. Complete clinical examination by an ophthalmologist was performed on participants with best corrected visual acuity < 20/40 or failure of any screening test. Main Outcome Measures Age- and gender-specific prevalence, causes, and risk factors for blindness (visual acuity in the better eye of < 20/400, World Health Organization definition) and visual impairment (visual acuity in the better eye of < 20/40). Results Six thousand eight hundred and six eligible participants were identified of which 5603 (82.3%) participated in the study. The mean age (±standard deviation) of participants was 52.7±10.9. The prevalence of visual impairment was 17.1% and blindness was 1.2%. After refraction and spectacle correction, the prevalence of visual impairment and blindness decreased to 6.7% and 0.75% respectively, suggesting that refractive error is the major correctable etiology of visual impairment and blindness in this population. Of 65 subjects having visual acuity < 20/400, 22 (34%) were correctable with refraction, 21 to the level of visual impairment, and one to normal. The remaining 43 (66%) had underlying pathology (19 cataract, 9 glaucoma, 3 non-glaucomatous optic neuropathy, 3 corneal opacities, 3 retinal disease, 5 undetermined) that prevented refractive correction. Increased age was a significant risk factor for blindness and visual impairment. Conclusions There is a high prevalence of blindness and visual impairment among those aged ≥40 years in Tema, Ghana, West Africa. Refractive error is a major cause of blindness and visual impairment in this population, followed by cataract, glaucoma, and corneal disease. PMID:22677425

Poverty and Blindness in Nigeria: Results from the National Survey of Blindness and Visual Impairment.

PubMed

Tafida, A; Kyari, F; Abdull, M M; Sivasubramaniam, S; Murthy, G V S; Kana, I; Gilbert, Clare E

2015-01-01

Poverty can be a cause and consequence of blindness. Some causes only affect the poorest communities (e.g. trachoma), and poor individuals are less likely to access services. In low income countries, cataract blind adults have been shown to be less economically active, indicating that blindness can exacerbate poverty. This study aims to explore associations between poverty and blindness using national survey data from Nigeria. Participants ≥40 years were examined in 305 clusters (2005-2007). Sociodemographic information, including literacy and occupation, was obtained by interview. Presenting visual acuity (PVA) was assessed using a reduced tumbling E LogMAR chart. Full ocular examination was undertaken by experienced ophthalmologists on all with PVA <6/12 in either eye. Causes of vision loss were determined using World Health Organization guidelines. Households were categorized into three levels of poverty based on literacy and occupation at household level. A total of 569/13,591 participants were blind (PVA <3/60, better eye; prevalence 4.2%, 95% confidence interval [CI] 3.8-4.6%). Prevalences of blindness were 8.5% (95% CI 7.7-9.5%), 2.5% (95% CI 2.0-3.1%), and 1.5% (95% CI 1.2-2.0%) in poorest, medium and affluent households, respectively (p = 0.001). Cause-specific prevalences of blindness from cataract, glaucoma, uncorrected aphakia and corneal opacities were significantly higher in poorer households. Cataract surgical coverage was low (37.2%), being lowest in females in poor households (25.3%). Spectacle coverage was 3 times lower in poor than affluent households (2.4% vs. 7.5%). In Nigeria, blindness is associated with poverty, in part reflecting lower access to services. Reducing avoidable causes will not be achieved unless access to services improves, particularly for the poor and women.

Prevalence of visual impairment in El Salvador: inequalities in educational level and occupational status.

PubMed

Rius, Anna; Guisasola, Laura; Sabidó, Meritxell; Leasher, Janet L; Moriña, David; Villalobos, Astrid; Lansingh, Van C; Mujica, Oscar J; Rivera-Handal, José Eduardo; Silva, Juan Casrlos

2014-11-01

To examine the prevalence of blindness, visual impairment, and related eye diseases and conditions among adults in El Salvador, and to explore socioeconomic inequalities in their prevalence by education level and occupational status, stratified by sex. Based upon the Rapid Assessment of Avoidable Blindness (RAAB) methodology, this nationwide sample comprised 3 800 participants (3 399 examined) ≥ 50 years old from 76 randomly selected clusters of 50 persons each. The prevalence of blindness, visual impairment and related eye diseases and conditions, including uncorrected refractive error (URE), was calculated for categories of education level and occupational status. Multiple logistic regression models were fitted to calculate odds ratios (ORs) and 95% confidence intervals (CIs) and stratified by sex. Age-adjusted prevalence was 2.4% (95% CI: 2.2-2.6) for blindness (men: 2.8% (95% CI: 2.5-3.1); women: 2.2% (95% CI: 1.9-2.5)) and 11.8% (95% CI: 11.6-12.0) for moderate visual impairment (men: 10.8% (95% CI: 10.5-11.1); women: 12.6% (95% CI: 12.4-12.8)). The proportion of visual impairment due to cataract was 43.8% in men and 33.5% in women. Inverse gradients of socioeconomic inequalities were observed in the prevalence of visual impairment. For example, the age-adjusted OR (AOR) was 3.4 (95% CI: 2.0-6.4) for visual impairment and 4.3 (95% CI: 2.1-10.4) for related URE in illiterate women compared to those with secondary education, and 1.9 (95% CI: 1.1-3.1) in cataract in unemployed men. Blindness and visual impairment prevalence is high in the El Salvador adult population. The main associated conditions are cataract and URE, two treatable conditions. As socioeconomic and gender inequalities in ocular health may herald discrimination and important barriers to accessing affordable, good-quality, and timely health care services, prioritization of public eye health care and disability policies should be put in place, particularly among women, the unemployed, and uneducated people.

A meta-analysis of the effect of a dexamethasone intravitreal implant versus intravitreal anti-vascular endothelial growth factor treatment for diabetic macular edema.

PubMed

He, Ye; Ren, Xin-Jun; Hu, Bo-Jie; Lam, Wai-Ching; Li, Xiao-Rong

2018-05-21

This meta-analysis evaluated the effectiveness and safety of dexamethasone (DEX) implant and intravitreal anti-vascular endothelial growth factor (VEGF) treatment for diabetic macular edema (DME). The PubMed, Embase, clinicaltrials.gov website and Cochrane Library databases were comprehensively searched for studies comparing DEX implant with anti-VEGF in patients with DME. Best-corrected visual acuity (BCVA), central subfield thickness (CST) and adverse events were extracted from the final eligible studies. Review Manager (RevMan) 5.3 for Mac was used to analyze the data and GRADE profiler were used to access the quality of outcomes. Based on four randomized clinical trials assessing a total of 521 eyes, the DEX implant can achieve visual acuity improvement for DME at rates similar to those achieved via anti-VEGF treatment (mean difference [MD] = - 0.43, P = 0.35), with superior anatomic outcomes at 6 months (MD = - 86.71 μm, P = 0.02), while requiring fewer injections, in comparison to anti-VEGF treatment. Although the mean reduction in CST did not showed significant difference at 12 months (MD = - 33.77 μm, P = 0.21), the significant in BCVA from baseline to 12 months supported the anti-VEGF treatment (MD = - 3.26, P < 0.00001). No statistically significant differences in terms of the serious adverse events. However, use of the DEX implant has higher risk of intraocular pressure elevation and cataract than anti-VEGF treatment. Compared with anti-VEGF, DEX implant improved anatomical outcomes significantly. However, this did not translate to improved visual acuity, which may be due to the progression of cataract. Therefore, the DEX implant may be recommended as a first chioce for select cases, such as for pseudophakic eyes, anti-VEGF-resistant eyes, or patients reluctant to receive intravitreal injections frequently.

Anatomic and visual outcomes of 23-G vitrectomy without scleral buckling for primary rhegmatogenous retinal detachment.

PubMed

Figueroa, Marta S; Contreras, Inés; Noval, Susana

2013-01-01

To evaluate the anatomic success rate, visual acuity (VA) changes, and complications of 23-G vitrectomy without associated scleral procedures for the treatment of primary rhegmatogenous retinal detachment (PRRD). 
 Patients diagnosed with PRRD were considered for inclusion. Patients with evidence of proliferative vitreoretinopathy or coexisting ocular pathologies were excluded. Surgery consisted of 23-G vitrectomy with endolaser photocoagulation of retinal breaks and fluid-air-gas (12% C3F8) exchange. Minimum follow-up was 3 months. 
 A total of 133 eyes of 118 patients were included. Fifty eyes were phakic and 83 pseudophakic. Mean time from diagnosis to surgery was 6.9 days (range 1-40). Mean VA improved significantly from 20/50 (range: hand movements to 20/20) to 20/30 (range: counting fingers to 20/16), with no statistically significant differences between phakic and pseudophakic eyes (p = 0.233). Visual acuity improved to 20/40 or better in 104 eyes (78.2%). A redetachment developed in 5 eyes (3.8%), so the primary anatomic success rate was 96.2%. Four eyes required a second surgical procedure and one eye a third to achieve retinal reattachment. Cataract progression in phakic eyes made cataract surgery necessary within 1 year of vitrectomy in 12/50 (24%) eyes. Subretinal perfluoro-N-octane (PFO) was detected in 6 eyes (4.5%). 
 Twenty-three--gauge vitrectomy without scleral buckling seems to be an effective technique for the treatment of PRRD without proliferative vitreoretinopathy. The high anatomic success rate was comparable to that previously described with 20 G and scleral buckling. Complications were similar to those described for 20-G vitrectomy, except for retained subretinal PFO, which has a higher rate.

Patient-reported benefit of ReSTOR® multi-focal intraocular lenses after cataract surgery: Results of Principal Component Analysis on clinical trial data

PubMed Central

Berdeaux, Gilles; Viala, Muriel; Roborel de Climens, Aude; Arnould, Benoit

2008-01-01

Background Restoration of functional distance and near vision independently of additional correction remains a goal for cataract surgery. ReSTOR®, a new multi-focal intraocular lens (IOL) addresses this issue with an improvement in both distance and near vision, often without need for glasses. This analysis attempted to discuss the patient-reported benefit of ReSTOR® using a full but organised representation of data. Methods Two non-randomised, open-label clinical trials conducted in Europe and the United-States were conducted to compare the efficacy of ReSTOR® to AcrySof® mono-focal IOLs. A total of 710 patients in need of bilateral cataract extraction were included in the pooled study. The TyPE, a patient questionnaire, was fully completed by 672 of them before and after each eye surgery. The TyPE, composed of 67 items measuring overall visual functioning in both conditions (with and without wearing glasses), evaluates limitations, troubles and satisfaction in distance and near vision. A principal component analysis (PCA) of the TyPE questionnaire was performed on pooled data from baseline and post-surgery observations in order to fully represent the change in the TyPE data over time. ReSTOR® and mono-focal groups were used as illustrative variables. The coordinates of the first 2 factors were compared between visits and between IOLs (ReSTOR® vs. mono-focal), using paired t-tests and t-tests, respectively. Results The first factor of the PCA explained 55% of the variance and represented 'visual functioning and patient satisfaction'. The second factor explained 6% of the variance and was interpreted as 'independence from glasses'. An overall difference in factorial coordinates in both factors was seen between baseline and the first eye surgery, and between the first and the second eye surgery. No difference between ReSTOR® and mono-focal IOL groups was observed at baseline. After surgery, ReSTOR® treated-patients had higher coordinates on both "visual functioning and satisfaction" and "independence from glasses" factors. Findings observed on the factorial plan were supported by statistical comparisons of factorial coordinates. Conclusion Both mono-focal and ReSTOR®-implanted patients improved their visual functioning after bilateral cataract surgery. Moreover, ReSTOR® patients reported an additional benefit in independence from glasses as well as in visual functioning and patient satisfaction. PMID:18218068

Patient-reported benefit of ReSTOR multi-focal intraocular lenses after cataract surgery: results of principal component analysis on clinical trial data.

PubMed

Berdeaux, Gilles; Viala, Muriel; Roborel de Climens, Aude; Arnould, Benoit

2008-01-24

Restoration of functional distance and near vision independently of additional correction remains a goal for cataract surgery. ReSTOR, a new multi-focal intraocular lens (IOL) addresses this issue with an improvement in both distance and near vision, often without need for glasses. This analysis attempted to discuss the patient-reported benefit of ReSTOR using a full but organised representation of data. Two non-randomised, open-label clinical trials conducted in Europe and the United-States were conducted to compare the efficacy of ReSTOR to AcrySof mono-focal IOLs. A total of 710 patients in need of bilateral cataract extraction were included in the pooled study. The TyPE, a patient questionnaire, was fully completed by 672 of them before and after each eye surgery. The TyPE, composed of 67 items measuring overall visual functioning in both conditions (with and without wearing glasses), evaluates limitations, troubles and satisfaction in distance and near vision. A principal component analysis (PCA) of the TyPE questionnaire was performed on pooled data from baseline and post-surgery observations in order to fully represent the change in the TyPE data over time. ReSTOR and mono-focal groups were used as illustrative variables. The coordinates of the first 2 factors were compared between visits and between IOLs (ReSTOR vs. mono-focal), using paired t-tests and t-tests, respectively. The first factor of the PCA explained 55% of the variance and represented 'visual functioning and patient satisfaction'. The second factor explained 6% of the variance and was interpreted as 'independence from glasses'. An overall difference in factorial coordinates in both factors was seen between baseline and the first eye surgery, and between the first and the second eye surgery. No difference between ReSTOR and mono-focal IOL groups was observed at baseline. After surgery, ReSTOR treated-patients had higher coordinates on both "visual functioning and satisfaction" and "independence from glasses" factors. Findings observed on the factorial plan were supported by statistical comparisons of factorial coordinates. Both mono-focal and ReSTOR-implanted patients improved their visual functioning after bilateral cataract surgery. Moreover, ReSTOR patients reported an additional benefit in independence from glasses as well as in visual functioning and patient satisfaction.

Effects of two antioxidants; α-lipoic acid and fisetin against diabetic cataract in mice.

PubMed

Kan, Emrah; Kiliçkan, Elif; Ayar, Ahmet; Çolak, Ramis

2015-02-01

The purpose of this study was to determine whether α-lipoic acid and fisetin have protective effects against cataract in a streptozotocin-induced experimental cataract model. Twenty-eight male BALB/C mice were made diabetic by the intraperitoneal administration of streptozotocin (200 mg/kg). Three weeks after induction of diabetes, mice were divided randomly into 4 groups in which each group contained 7 mice; fisetin-treated group (group 1), α-lipoic acid-treated group (group 2), fisetin placebo group (group 3), α-lipoic acid placebo group (group 4). Fisetin and α-lipoic acid were administered intraperitoneally weekly for 5 weeks. Cataract development was assessed at the end of 8 weeks by slit lamp examination, and cataract formation was graded using a scale. All groups developed at least grade 1 cataract formation. In the fisetin-treated group, the cataract stages were significantly lower than in the placebo group (p = 0.02). In the α-lipoic acid-treated group, the cataract stages were lower than in the placebo group but it did not reach to a significant value. Both fisetin and α-lipoic acid had a protective effect on cataract development in a streptozotocin-induced experimental cataract model. The protective effect of fisetin appears as though more effective than α-lipoic acid.

Age-related Cataract in a Randomized Trial of Selenium and Vitamin E in Men: The SELECT Eye Endpoints (SEE) Study

PubMed Central

Christen, William G.; Glynn, Robert J.; Gaziano, J. Michael; Darke, Amy K.; Crowley, John J.; Goodman, Phyllis J.; Lippman, Scott M.; Lad, Thomas E.; Bearden, James D.; Goodman, Gary E.; Minasian, Lori M.; Thompson, Ian M.; Blanke, Charles D.; Klein, Eric A.

2014-01-01

Importance Observational studies suggest a role for dietary nutrients such as vitamin E and selenium in cataract prevention. However, the results of randomized trials of vitamin E supplements and cataract have been disappointing, and are not yet available for selenium. Objective To test whether long-term supplementation with selenium and vitamin E affects the incidence of cataract in a large cohort of men. Design, Setting, and Participants The SELECT Eye Endpoints (SEE) study was an ancillary study of the SWOG-coordinated Selenium and Vitamin E Cancer Prevention Trial (SELECT), a randomized, placebo-controlled, four arm trial of selenium and vitamin E conducted among 35,533 men aged 50 years and older for African Americans and 55 and older for all other men, at 427 participating sites in the US, Canada, and Puerto Rico. A total of 11,267 SELECT participants from 128 SELECT sites participated in the SEE ancillary study. Intervention Individual supplements of selenium (200 µg/d from L-selenomethionine) and vitamin E (400 IU/d of all rac-α-tocopheryl acetate). Main Outcome Measures Incident cataract, defined as a lens opacity, age-related in origin, responsible for a reduction in best-corrected visual acuity to 20/30 or worse based on self-report confirmed by medical record review, and cataract extraction, defined as the surgical removal of an incident cataract. Results During a mean (SD) of 5.6 (1.2) years of treatment and follow-up, 389 cases of cataract were documented. There were 185 cataracts in the selenium group and 204 in the no selenium group (hazard ratio [HR], 0.91; 95 percent confidence interval [CI], 0.75 to 1.11; P=.37). For vitamin E, there were 197 cases in the treated group and 192 in the placebo group (HR, 1.02; CI, 0.84 to 1.25; P=.81). Similar results were observed for cataract extraction. Conclusions and Relevance These randomized trial data from a large cohort of apparently healthy men indicate that long-term daily supplementation with selenium and/or vitamin E is unlikely to have a large beneficial effect on age-related cataract. PMID:25232809

Short-term influence of cataract surgery on circadian biological rhythm and related health outcomes (CLOCK-IOL trial): study protocol for a randomized controlled trial.

PubMed

Saeki, Keigo; Obayashi, Kenji; Nishi, Tomo; Miyata, Kimie; Maruoka, Shinji; Ueda, Tetsuo; Okamoto, Masahiro; Hasegawa, Taiji; Matsuura, Toyoaki; Tone, Nobuhiro; Ogata, Nahoko; Kurumatani, Norio

2014-12-29

Light information is the most important cue of circadian rhythm which synchronizes biological rhythm with external environment. Circadian misalignment of biological rhythm and external environment is associated with increased risk of depression, insomnia, obesity, diabetes, cardiovascular disease, and cancer. Increased light transmission by cataract surgery may improve circadian misalignment and related health outcomes. Although some observational studies have shown improvement of depression and insomnia after cataract surgery, randomized controlled trials are lacking. We will conduct a parallel-group, assessor-blinded, simple randomized controlled study comparing a cataract surgery group at three months after surgery with a control group to determine whether cataract surgery improves depressive symptoms, sleep quality, body mass regulation, and glucose and lipid metabolism. We will recruit patients who are aged 60 years and over, scheduled to receive their first cataract surgery, and have grade 2 or higher nuclear opacification as defined by the lens opacities classification system III. Exclusion criteria will be patients with major depression, severe corneal opacity, severe glaucoma, vitreous haemorrhage, proliferative diabetic retinopathy, macular oedema, age-related macular degeneration, and patients needing immediate or combined cataract surgery. After baseline participants will be randomized to two groups. Outcomes will be measured at three months after surgery among the intervention group, and three months after baseline among the control group. We will assess depressive symptoms as a primary outcome, using the short version geriatric depression scale (GDS-15). Secondary outcomes will be subjective and actigraph-measured sleep quality, sleepiness, glycated haemoglobin, fasting plasma glucose and triglyceride, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, body mass index, abdominal circumference, circadian rhythms of physical activity and wrist skin temperature, and urinary melatonin metabolite. Chronotype and visual function will be assessed using the 'morningness-eveningness' questionnaire, the Munich chronotype questionnaire, and the National Eye Institute Visual Function Questionnaire. Although there are potential limitations due to the difference in duration from baseline survey to outcome measurements between two groups, any seasonal effect on the outcome measurement will be balanced as a result of continuous inclusion of participants through the year, and outcomes will be adjusted for day length at outcome measurements at analysis. UMIN000014559, UMIN Clinical Trials Registry, registered on 15 July 2014.

A Brief Period of Postnatal Visual Deprivation Alters the Balance between Auditory and Visual Attention.

PubMed

de Heering, Adélaïde; Dormal, Giulia; Pelland, Maxime; Lewis, Terri; Maurer, Daphne; Collignon, Olivier

2016-11-21

Is a short and transient period of visual deprivation early in life sufficient to induce lifelong changes in how we attend to, and integrate, simple visual and auditory information [1, 2]? This question is of crucial importance given the recent demonstration in both animals and humans that a period of blindness early in life permanently affects the brain networks dedicated to visual, auditory, and multisensory processing [1-16]. To address this issue, we compared a group of adults who had been treated for congenital bilateral cataracts during early infancy with a group of normally sighted controls on a task requiring simple detection of lateralized visual and auditory targets, presented alone or in combination. Redundancy gains obtained from the audiovisual conditions were similar between groups and surpassed the reaction time distribution predicted by Miller's race model. However, in comparison to controls, cataract-reversal patients were faster at processing simple auditory targets and showed differences in how they shifted attention across modalities. Specifically, they were faster at switching attention from visual to auditory inputs than in the reverse situation, while an opposite pattern was observed for controls. Overall, these results reveal that the absence of visual input during the first months of life does not prevent the development of audiovisual integration but enhances the salience of simple auditory inputs, leading to a different crossmodal distribution of attentional resources between auditory and visual stimuli. Copyright © 2016 Elsevier Ltd. All rights reserved.

[Meta-analysis of clinical randomized controlled trials comparing refractive with diffractive multifocal intraocular lenses in cataract surgery].

PubMed

Shao, Dewang; He, Shouzhi

2014-02-01

To systematic review the effectiveness of refractive multifocal intraocular lens (MIOL) versus diffractive MIOL in the treatment of cataract. Randomized controlled trials comparing refractive MIOL with diffractive MIOL were identified by searching PubMed (1966 to May, 2013), EMbase (1980 to May, 2013), Medline (1966 to May, 2013), and The Cochrane Library (Issue 1, 2013). We also hand-searched related journals. All the searches were restricted in English or Chinese. Methodological quality of randomized controlled trials (RCT) was evaluated by simple evaluate method that recommended by the Cochrane Collaboration. Data extracted by two reviewers with designed extraction form. RevMan software (release 5.2) was used for data management and analysis. A total of 11 trials (1460 eyes) were included for systematic review. Subgroup analyses were used according to different model comparison of MIOL. The results showed a significant difference in the mean of the uncorrected distance visual acuity (UCDVA) and the uncorrected intermediate visual acuity (UCIVA) in the refractive MIOL group with WMD -0.04, 95%CI -0.06 to -0.03 (P < 0.01) and WMD -0.05, 95%CI -0.09 to -0.02 (P = 0.001). It showed a significantly difference in the mean of the uncorrected near visual acuity (UCNVA), complete spectacle independent rate, halo rate and glare rate in the diffractive MIOL group with WMD 0.11, 95%CI 0.08 to 0.15 (P < 0.01), WMD 2.98, 95%CI 2.17 to 4.09 (P < 0.01), WMD 1.52, 95%CI 1.14 to 2.04 (P = 0.004) and WMD 1.27, 95%CI 1.07 to 1.50 (P = 0.005). There was no significant difference between the two groups in the mean of the best corrected distance visual acuity (BCDVA), the best distance corrected intermediate visual acuity (BDCIVA), the best distance corrected near visual acuity (BDCNVA) and the best corrected near visual acuity (BCNVA) with WMD -0.01, 95%CI -0.03 to 0.01 (P = 0.45), WMD -0.06, 95%CI -0.15 to 0.03 (P = 0.18), WMD 0.08, 95%CI -0.01 to 0.17 (P = 0.09) and WMD -0.02, 95%CI -0.26 to 0.23 (P = 0.88). Patients implanted with refractive MIOL show better uncorrected distance and intermediate visual acuity; patients implanted with diffractive MIOL show better uncorrected near visual acuity with less likely to appear light halo, glare and other visual adverse reactions. As for spectacles correction cases, patients implanted with diffractive or refractive MIOL have considerable performances in the far, middle, near visual acuity.

A Comparison of Endothelial Cell Loss in Combined Cataract and MIGS (Hydrus) Procedure to Phacoemulsification Alone: 6-Month Results

PubMed Central

Fea, Antonio M.; Consolandi, Giulia; Pignata, Giulia; Cannizzo, Paola Maria Loredana; Lavia, Carlo; Billia, Filippo; Rolle, Teresa; Grignolo, Federico M.

2015-01-01

Purpose. To compare the corneal endothelial cell loss after phacoemulsification, alone or combined with microinvasive glaucoma surgery (MIGS), in nonglaucomatous versus primary open angle glaucoma (POAG) eyes affected by age-related cataract. Methods. 62 eyes of 62 patients were divided into group 1 (n = 25, affected by age-related cataract) and group 2 (n = 37, affected by age-related cataract and POAG). All patients underwent cataract surgery. Group 2 was divided into subgroups A (n = 19, cataract surgery alone) and B (n = 18, cataract surgery and MIGS). Prior to and 6 months after surgery the patients' endothelium was studied. Main outcomes were CD (cell density), SD (standard deviation), CV (coefficient of variation), and 6A (hexagonality coefficient) variations after surgeries. Results. There were no significant differences among the groups concerning preoperative endothelial parameters. The differences in CD before and after surgery were significant in all groups: 9.1% in group 1, 17.24% in group 2A, and 11.71% in group 2B. All endothelial parameters did not significantly change after surgery. Conclusions. Phacoemulsification determined a loss of endothelial cells in all groups. After surgery the change in endothelial parameters after MIGS was comparable to the ones of patients who underwent cataract surgery alone. PMID:26664740

Growth factor restriction impedes progression of wound healing following cataract surgery: identification of VEGF as a putative therapeutic target

PubMed Central

Eldred, Julie A.; McDonald, Matthew; Wilkes, Helen S.; Spalton, David J.; Wormstone, I. Michael

2016-01-01

Secondary visual loss occurs in millions of patients due to a wound-healing response, known as posterior capsule opacification (PCO), following cataract surgery. An intraocular lens (IOL) is implanted into residual lens tissue, known as the capsular bag, following cataract removal. Standard IOLs allow the anterior and posterior capsules to become physically connected. This places pressure on the IOL and improves contact with the underlying posterior capsule. New open bag IOL designs separate the anterior capsule and posterior capsules and further reduce PCO incidence. It is hypothesised that this results from reduced cytokine availability due to greater irrigation of the bag. We therefore explored the role of growth factor restriction on PCO using human lens cell and tissue culture models. We demonstrate that cytokine dilution, by increasing medium volume, significantly reduced cell coverage in both closed and open capsular bag models. This coincided with reduced cell density and myofibroblast formation. A screen of 27 cytokines identified nine candidates whose expression profile correlated with growth. In particular, VEGF was found to regulate cell survival, growth and myofibroblast formation. VEGF provides a therapeutic target to further manage PCO development and will yield best results when used in conjunction with open bag IOL designs. PMID:27076230

Effect of neodymium:YAG laser capsulotomy on visual function in patients with posterior capsule opacification and good visual acuity.

PubMed

Yotsukura, Erisa; Torii, Hidemasa; Saiki, Megumi; Negishi, Kazuno; Tsubota, Kazuo

2016-03-01

To evaluate the effect of neodymium:YAG (Nd:YAG) laser capsulotomy on the visual function in patients with posterior capsule opacification (PCO) and good visual acuity. Keio University Hospital, Tokyo, Japan. Observational case series. Eyes were evaluated that had previous cataract surgery with a clinical diagnosis of PCO requiring Nd:YAG laser capsulotomy regardless of a good corrected distance visual acuity (CDVA) (at least 20/20). The CDVA, 10% low contrast visual acuity (LCVA), wavefront aberrations from the 3rd to 6th order, and retinal straylight were measured before and after Nd:YAG laser capsulotomy. The study included 16 eyes of 16 patients (10 men, 6 women; mean age 69.5 years ± 9.3 [SD]). The mean CDVA, LCVA, and straylight after Nd:YAG laser capsulotomy improved significantly (P < .05). The root mean square (RMS) of the 3rd Zernike coefficients (S3) and the RMS of the total higher-order aberrations (HOAs) from the 3rd to 6th order decreased significantly after capsulotomy (P < .05). The straylight correlated significantly with the total HOAs (r = 0.727, P = .002) and S3 (r = 0.748, P = .001) before capsulotomy. Subjective symptoms resolved after capsulotomy in all cases. Neodymium:YAG laser capsulotomy enabled a significant improvement in visual function even in patients with PCO with good visual acuity. Straylight measurements might be useful to determine the indications for Nd:YAG laser capsulotomy when patients report visual disturbances without decreased visual acuity. Copyright © 2016 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

[Eyeball structure changes in high myopic patients and their significance for forensic assessment].

PubMed

Liu, Yi-Chang; Xia, Wen-Tao; Zhou, Xing-Tao; Liu, Rui-Jue; Bian, Shi-Zhong; Ying, Chong-Liang; Zhu, Guang-You

2008-10-01

There are irreversible eyeball structural changes in high myopic patients. These changes include axial length, corneal radius, anterior chamber depth, fundus degeneration, macula thickness, etc. There is a close relationship between the damage degree of visual function and these changes. The incidence of complications, such as vitreous opacity, posterior vitreous detachment, cataract, glaucoma, posterior staphyloma and retina detachment, is also highly related to the myopia diopter. More and more researches have indicated that the myopia diopter and the level of visual function are affected by multiple factors. It is promising to detect all of these changes by different kinds of methods, and to assess visual function through these changes. By clarifying these changes, it is also useful to distinguish traumatic damage from disease to provide evidence for forensic assessment of eye injuries.

Microperimetric Assessment after Epiretinal Membrane Surgery: 4-Year Follow-Up

PubMed Central

Dal Vecchio, Marco; Lavia, Carlo; Nassisi, Marco; Grignolo, Federico M.; Fea, Antonio M.

2016-01-01

Purpose. To investigate retinal function using microperimetry in patients affected by idiopathic epiretinal membrane (iERM) and cataract who underwent combined surgery: 4-year follow-up. Design. Prospective, interventional case series. Methods. 30 eyes of 30 consecutive patients with iERM and age-related cataract underwent 25-gauge vitrectomy and cataract surgery. At baseline, 90 and 180 days, and 1 and 4 years, we examined retinal mean sensitivity (MS), retinal mean defect (MD), fixation stability, and frequency of microscotomas using MP1 microperimetry. Best-corrected visual acuity (BCVA) and central retinal thickness (CRT) using a spectral domain optical coherence tomography (SD-OCT) were also performed. Results. All patients completed 1-year follow-up, while 23 patients reached last follow-up. Baseline MS and MD (10.48 ± 4.17 and −9.18 ± 4.40 dB) significantly changed at one year (12.33 ± 3.66 and −7.49 ± 3.31 dB, p < 0.01), at four years (14.18 ± 3.46 and −4.66 ± 2.85, p < 0.01), and between one and four years (p < 0.01) after surgery. Compared to baseline, CRT and BCVA significantly changed at one year and remained stable at four years. No variations were observed in fixation stability and frequency of microscotomas compared to baseline. Conclusions. Long-term follow-up using microperimetry seems useful to evaluate patients after iERM surgery: retinal sensitivity changes even when BCVA and CRT remain stable. PMID:27088008

Assessing the effects of ketorolac and acetazolamide on macular thickness by optical coherence tomography following cataract surgery.

PubMed

Turan-Vural, Ece; Halili, Elvin; Serin, Didem

2014-06-01

We aimed to evaluate the efficacy of topical ketorolac 0.5 % solution and oral acetazolamide 250 mg/day delivery during the first month after uneventful phacoemulsification surgery by measuring the macular thickness using optical coherence tomography. Our nonmasked randomized prospective study comprised 87 eyes of 80 patients. Complete follow-up was achieved on 84 eyes of 77 eligible patients. Postoperatively, the patients were divided into three groups. One group received ketorolac 0.5 %, the other group received acetazolamide 250 mg/day, and the control group was given no agent. Macular thickness and volume were measured at 1 week and 1 month after surgery by optical coherence tomography. Foveal thickness, parafoveal thickness, and perifoveal thickness were determined to be significantly elevated at postoperative 1 week and 1 month in the control group. Foveal, perifoveal, and parafoveal volumes were also significantly high at postoperative week 1 and month 1 in the control group. There was no significant difference between the ketorolac and acetazolamide groups. The correlation analysis between best-corrected visual acuity, and volume and thickness revealed a negative correlation in the acetazolamide group. Use of acetazolamide after cataract surgery is as effective as ketorolac on macular thickness and volume.

[Usher syndrome: about a case].

PubMed

Daoudi, Chama; Boutimzine, Noureddine; Haouzi, Samia El; Lezrek, Omar; Tachfouti, Samira; Lezrek, Mounir; Laghmari, Mina; Daoudi, Rajae

2017-01-01

Usher syndrome is a genetic disease resulting in double sensory deprivation (auditory and visual) called deafblindness. We report the case of a 50-year old patient, born to consanguineous parents, presenting with congenital deafness associated with normal vestibular function and pigmentary retinopathy responsible for decreased bilateral visual acuity occurred at the age of 16 years. This association composes Usher syndrome type 2, a rare autosomal recessive disorder. Cataract surgery allowed visual acuity improvement in this patient.

Laser-assisted cataract surgery: benefits and barriers.

PubMed

Hatch, Kathryn M; Talamo, Jonathan H

2014-01-01

The use of the femtosecond laser (FSL) in cataract surgery may represent the largest advancement in the field since the inception of phacoemulsification. The goal of this review is to outline the benefits of and barriers to this technology. There are several significant potential benefits of the FSL in cataract surgery over conventional manual cataract surgery: precise capsulotomy formation, clear corneal and limbal relaxing incision construction, lens fragmentation, and lens softening. Evidence suggests that refractive benefits include more precise effective lens position as well as reduced effective phacoemulsification time with the use of FSL compared with manual surgery. Patients with conditions such as Fuchs' endothelial dystrophy, pseudoexfoliation, history of trauma, or brunescent cataracts may particularly benefit from this technology. There are significant financial and logistical issues to consider prior to the purchase of a FSL, including the cost of the laser, and charges to patients, and how the laser affects the patient flow in the operating room. The FSL may significantly change the current approach to cataract surgery.

The Results of Toric Intraocular Lens Implantation in Patients With Cataract and High Astigmatism After Penetrating Keratoplasty.

PubMed

Müftüoğlu, İlkay Klç; Akova, Yonca Aydn; Egrilmez, Sait; Yilmaz, Suzan Guven

2016-03-01

To evaluate the results of toric intraocular lens (IOL) implantation in patients with cataract and postpenetrating keratoplasty astigmatism. Seven eyes of 7 patients with cataract and more than 3.5 diopters (D) astigmatism following penetrating keratoplasty were included in this retrospective case series study. All of the eyes underwent phacoemulsification and Acrysof toric IOL (t5-t9) implantation at least 6 months later than the complete suture removal. Corrected visual acuity (CVA), manifest astigmatism, the keratometry measurements, and complications were assessed. The mean preoperative CVA significantly increased (0.7±0.3 [range: 0.3-1.3] logMAR to 0.1±0.04 [range: 0.05-0.15] logMAR; P<0.05) at mean 8.71±4.11 months after the surgery. The mean preoperative corneal astigmatism and the average manifest refractive astigmatism at the last visit were 5.4±0.9 D (range: 4.25-7 D) and 1.6±0.6 D (range: 0.5-2.5 D), respectively. The mean attempted cylinder correction at spectacle plane was 4.3±0.9 D (range: 2.4-4.7 D) whereas the mean cylinder correction was 4.6±0.5 D (range: 3.9-5.9 D), showing a slightly tendency for overcorrection. All eyes (100%) were within 1 D of predicted residual astigmatism. No complication occurred during the follow-up. Toric IOL implantation seems to be an effective, predictable, and safe procedure in patients with cataract formation and high astigmatism after penetrating keratoplasty.

Nepafenac 0.1% versus fluorometholone 0.1% for preventing cystoid macular edema after cataract surgery.

PubMed

Miyake, Kensaku; Ota, Ichiro; Miyake, Goichiro; Numaga, Jiro

2011-09-01

To compare a topical nonsteroidal antiinflammatory drug (nepafenac 0.1%) and a topical steroidal antiinflammatory drug (fluorometholone 0.1% ) in preventing cystoid macular edema (CME) and blood-aqueous barrier (BAB) disruption after small-incision cataract extraction with foldable intraocular lens (IOL) implantation. Shohzankai Medical Foundation, Miyake Eye Hospital, Nagoya, Japan. Randomized double-masked single-center clinical trial. Patients were randomized to receive nepafenac 0.1% eyedrops or fluorometholone 0.1% eyedrops for 5 weeks after phacoemulsification with foldable IOL implantation. The incidence and severity of CME were evaluated by fluorescein angiography, retinal foveal thickness on optical coherence tomography, and BAB disruption on laser flare-cell photometry. Thirty patients received nepafenac and 29 patients, fluorometholone. Five weeks postoperatively, the incidence of fluorescein angiographic CME was significantly lower in the nepafenac group (14.3%) than in the fluorometholone group (81.5%) (P<.0001). The fovea was thinner in the nepafenac group than in the fluorometholone group at 2 weeks (P=.0266) and 5 weeks (P=.0055). At 1, 2, and 5 weeks, anterior chamber flare was significantly less in the nepafenac group than in the fluorometholone group (P<.0001, P<.0001, and P=.0304, respectively). The visual acuity recovery from baseline was significantly greater in the nepafenac group (80.0%) than in the fluorometholone group (55.2%) (P=.0395). There were no serious side effects in either group. Nepafenac was more effective than fluorometholone in preventing angiographic CME and BAB disruption, and results indicate nepafenac leads to more rapid visual recovery. Copyright © 2011 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Cataract surgery cost utility revisited in 2012: a new economic paradigm.

PubMed

Brown, Gary C; Brown, Melissa M; Menezes, Alicia; Busbee, Brandon G; Lieske, Heidi B; Lieske, Philip A

2013-12-01

To assess the 2012 cost utility of cataract surgery in the United States and to compare 2012 cost-utility data with those from 2000. Value-Based Medicine (Flourtown, PA), patient preference-based, comparative effectiveness analysis and cost-utility analysis using 2012 real United States dollars. Previously published Patient Outcomes Research Team Study data and time tradeoff utilities obtained from patients with vision loss. Visual acuity measurements from patients wtih untreated cataract were used as controls. Thirteen-year, average, first-eye and second-eye cataract surgery cost-utility analysis using the societal and third-party insurer cost perspectives. Patient value gain in quality-adjusted life years (QALYs) and percent gain in quality of life as well as the cost-utility ratio using the dollars expended per QALY gained. Patient and financial value outcomes were discounted at 3% annually with net present value analysis. First-eye cataract surgery conferred 1.6212 QALYs over the 13-year model, a 20.8% quality-of-life gain. Bilateral cataract surgery conferred 2.8152 QALYs over 13 years, a 36.2% improvement in quality of life. The direct ophthalmic medical cost for unilateral cataract surgery in 2012 United States nominal dollars was $2653, an inflation-adjusted 34.2% less than in 2000 and 85% less than in 1985. The 2012 inflation-adjusted physician fee was 10.1% of that in 1985. The 13-year societal cost perspective, financial return on investment (ROI) for first-eye cataract surgery was $121,198, a 4567% gain. The third-party insurer cost perspective average cost-utility ratio was $2653/1.6212 = $1636/QALY for unilateral cataract surgery, whereas the societal cost perspective average cost-utility ratio was -$121,198/1.6212 = -$74,759/QALY. The net 13-year $123.4-billion financial ROI from a 1-year cohort of cataract surgery patients was accrued: Medicare, $36.4 billion; Medicaid, $3.3 billion; other insurers, $9.6 billion; patients, $48.6 billion; and increased United States national productivity, $25.4 billion. Cataract surgery in 2012 greatly improved quality of life and was highly cost effective. It was 34.4% less expensive than in 2000 and 85% less expensive than in 1985. Initial cataract surgery yielded an extraordinary 4567% financial ROI to society over the 13-year model. Copyright © 2013 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Identification and Functional Analysis of a Novel MIP Gene Mutation Associated with Congenital Cataract in a Chinese Family

PubMed Central

Shentu, Xingchao; Miao, Qi; Tang, Xiajing; Yin, Houfa; Zhao, Yingying

2015-01-01

Congenital cataracts are major cause of visual impairment and blindness in children and previous studies have shown about 1/3 of non-syndromic congenital cataracts are inherited. Major intrinsic protein of the lens (MIP), also known as AQP0, plays a critical role in transparency and development of the lens. To date, more than 10 mutations in MIP have been linked to hereditary cataracts in humans. In this study, we investigated the genetic and functional defects underlying a four-generation Chinese family affected with congenital progressive cortical punctate cataract. Mutation screening of the candidate genes revealed a missense mutation at position 448 (c.448G>C) of MIP, which resulted in the substitution of a conserved aspartic acid with histidine at codon 150 (p.D150H). By linkage and haplotype analysis, we obtained positive multipoint logarithm of odds (LOD) scores at microsatellite markers D12S1632 (Zmax = 1.804 at α = 1.000) and D12S1691 (Zmax = 1.806 at α = 1.000), which flanked the candidate locus. The prediction results of PolyPhen-2 and SIFT indicated that the p.D150H mutation was likely to damage to the structure and function of AQP0. The wild type and p.D150H mutant AQP0 were expressed in HeLa cells separately and the immunofluorescence results showed that the WT-AQP0 distributed at the plasma membrane and in cytoplasm, while AQP0-D150H failed to reach the plasma membrane and was mainly retained in the Golgi apparatus. Moreover, protein levels of AQP0-D150H were significantly lower than those of wide type AQP0 in membrane-enriched lysates when the HEK-293T cells were transfected with the same amount of wild type and mutant plasmids individually. Taken together, our data suggest the p.D150H mutation is a novel disease-causing mutation in MIP, which leads to congenital progressive cortical punctate cataract by impairing the trafficking mechanism of AQP0. PMID:25946197

SOURCES OF BINOCULAR SUPRATHRESHOLD VISUAL FIELD LOSS IN A COHORT OF OLDER WOMEN BEING FOLLOWED FOR RISK OF FALLS (AN AMERICAN OPHTHALMOLOGICAL SOCIETY THESIS)

PubMed Central

Coleman, Anne Louise

2007-01-01

Purpose To determine the sources of binocular visual field loss most strongly associated with falls in a cohort of older women. Methods In the Study of Osteoporotic Fractures, women with severe binocular visual field loss had an increased risk of two or more falls during the 12 months following the eye examination. The lens and fundus photographs of the 422 women with severe binocular visual field loss, plus a random sample of 141 white women with no, mild, or moderate binocular visual field loss—47 white women with no binocular visual field loss, 46 white women with mild binocular visual field loss, and 48 white women with moderate binocular visual field loss —were evaluated for lens opacities, glaucomatous optic nerve damage, age-related macular degeneration, and diabetic retinopathy. Results Eighty-four percent of the women with severe binocular visual field loss had ocular disease in one or both eyes. Bilateral cataracts and glaucomatous optic nerve damage were the most common sources of this severe binocular visual field loss. Approximately 15.2% of women had no evidence of lens opacities, glaucomatous optic nerve damage, age-related macular degeneration, or diabetic retinopathy. Conclusion Severe binocular visual field loss due primarily to cataracts, glaucoma, and age-related macular degeneration explains 33.3% of the falls among women who fell frequently. Because binocular visual field loss may be treatable and/or preventable, screening programs for binocular visual field loss and subsequent referral for intervention and treatment are recommended as a strategy for preventing falls among the elderly. PMID:18427619

Binocular function to increase visual outcome in patients implanted with a diffractive trifocal intraocular lens.

PubMed

Kretz, Florian T A; Müller, Matthias; Gerl, Matthias; Gerl, Ralf H; Auffarth, Gerd U

2015-08-21

To evaluate binocular visual outcome for near, intermediate and distance compared to monocular visual outcome at the same distances in patients implanted with a diffractive trifocal intraocular lens (IOL). The study comprised of 100 eyes of 50 patients that underwent bilateral refractive lens exchange or cataract surgery with implantation of a multifocal diffractive IOL (AT LISA tri 839MP, Carl Zeiss Meditech, Germany). A complete ophthalmological examination was performed preoperatively and 3 month postoperatively. The main outcome measures were monocular and binocular uncorrected distance (UDVA), corrected distance (CDVA), uncorrected intermediate (UIVA), and uncorrected near visual acuities (UNVA), keratometry, and manifest refraction. The mean age was 59.28 years ± 9.6 [SD] (range 44-79 years), repectively. There was significant improvement in UDVA, UIVA, UNVA and CDVA. Comparing the monocular results to the binocular results there was a statistical significant better binocular outcome in all distances (UDVA p = 0.036; UIVA p < 0.0001; UNVA p = 0.001). The postoperative manifest refraction was in 86 % of patients within ± 0.50 [D]. The trifocal IOL improved near, intermediate, and distance vision compared to preoperatively. In addition a statistical significant increase for binocular visual function in all distances could be found. German Clinical Trials Register (DRKS) DRKS00007837.

Evaluation of advanced glycation end-products in diabetic and inherited canine cataracts.

PubMed

Bras, I Dineli; Colitz, Carmen M H; Kusewitt, Donna F; Chandler, Heather; Lu, Ping; Gemensky-Metzler, Anne J; Wilkie, David A

2007-02-01

The receptor for advanced glycation end-products (RAGE) increases in the human cataract and should correlate with increased DNA damage and proliferation of lens epithelial cells (LECs). The purpose of this study was to measure and immunolocalize RAGE in normal and cataractous canine LECs, and to determine whether there was a correlation between RAGE and DNA damage (gadd45), cell-cycle regulation (p21), and LEC proliferation (proliferating cell nuclear antigen, PCNA). Thirty-two anterior lens capsules from 22 dogs that underwent cataract surgery and 10 lenses from dogs with normal eyes were evaluated. Eleven of the cataractous lenses were from diabetic patients (n=16), and eleven were from patients with inherited cataracts (n=16). Standard immunohistochemical staining was performed using antibodies against RAGE, gadd45, p21, PCNA, alpha-smooth muscle actin, and TGF-beta. Immunostaining intensity for each antibody was given a score of 0-4+. Standard Western blot analysis on normal and cataractous lens capsules was performed using the same antibodies as in the immunohistochemical staining. Comparisons were also made based on age and sex. Real-time reverse transcriptase-polymerase chain reaction (qRT-PCR) was performed for RAGE. There was an increase in RAGE expression with age in normal LECs, but no significant difference was seen when normal adult LECs were compared to cataractous LECs. The stage of the cataract and the presence of LIU were not associated with a significant increase in RAGE expression. There was no age-dependent difference in the normal lenses for gadd45, p21, or PCNA. Significant up-regulation of p21 (P < 0.05) and PCNA (P < 0.05) was seen in diabetic cataracts compared to inherited cataracts. RAGE and PCNA expression did not increase with cataractogenesis, possibly due to overexpression associated with normal aging and constant exposure to oxidative stress from sunlight-related ultraviolet irradiation, respectively. However, p21 and PCNA increased in diabetic cataractogenesis suggesting cell cycle and proliferation dysregulation. This may be related to the rapid onset in this type of cataract compared with the more chronic and slower-to-develop inherited cataracts.

Transverse vs torsional ultrasound: prospective randomized contralaterally controlled study comparing two phacoemulsification-system handpieces.

PubMed

Assil, Kerry K; Harris, Lindsay; Cecka, Jeannie

2015-01-01

To compare surgical efficiency and multiple early clinical outcome variables in eyes undergoing phacoemulsification using either transversal or torsional ultrasound systems. Assil Eye Institute, Beverly Hills, CA, USA. Prospective, randomized, clinician-masked, contralaterally controlled single-center evaluation. Patients seeking cataract removal in both eyes with implantation of multifocal intraocular lenses were randomly assigned to one of two treatment rooms for phacoemulsification with either a transverse ultrasound system or torsional handpiece system. The contralateral eye was treated at a later date with the alternate device. A total of 54 eyes of 27 patients having similar degrees of cataract, astigmatism, and visual potential were included. All operative data were collected for analysis, and patients were followed for 3 months after surgery. Similar visual acuity was reported at all postoperative visits between the two groups. Mean phacoemulsification time and total power required were both significantly lower with the transverse system than with the torsional technique (P<0.05 for both). Similarly, mean total balanced salt solution used was significantly less with the transverse system vs torsional (P<0.05). Postoperative safety demonstrated significantly lower endothelial cell loss at 1 day and 1 month (P<0.05) with transverse vs torsional. Macular swelling was less at 1 week, 1 month, and 3 months with transverse vs torsional, although the difference did not achieve significance (P=0.1) at any single time point. Clinically detectable corneal edema was reported less frequently at all postoperative time points with the transverse system. The transverse ultrasound system was found to be possibly associated with less balanced salt-solution use, less phacoemulsification time, and less power required than the torsional phaco system. Postoperative data suggested that improved phaco efficiency may translate to a better overall safety profile for the patient.

Endophthalmitis caused by Staphylococcus hominis and two different colonies of Staphylococcus haemolyticus after cataract surgery.

PubMed

Wong, Robert W; Rhodes, Kyle M

2015-01-01

To describe a case of endophthalmitis after cataract surgery caused by Staphylococcus hominis and two separate colony types of Staphylococcus haemolyticus. Retrospective chart review including ophthalmic examination, intraocular biopsy and cultures, and anterior segment photography. A patient presented with endophthalmitis 1 month after cataract surgery. The patient underwent pars plana vitrectomy with vitreous fluid, aqueous fluid, and lens capsule biopsy with injection of intravitreal antimicrobials with full resolution of the infection. Cultures isolated grew S. hominis and two different colonies of S. haemolyticus, all sensitive to vancomycin. To the best of the authors' knowledge, this is the first case of endophthalmitis due to lens capsule seeding from three different types of bacteria, S. hominis and two different colony types of S. haemolyticus. Prompt diagnosis and treatment can be associated with good visual outcomes.

Rehabilitation of children with cataracts.

PubMed Central

Hiatt, R L

1998-01-01

Over a period of 10 years, 160 children with cataracts underwent operation at the University of Tennessee Medical Center, Memphis. The surgical, optical, and psychosocial rehabilitation of these patients was analyzed and studied. The optical rehabilitation included patients with glasses, intraocular lens implants, epikeratophakia, and contact lenses. Seventy three of these patients were chosen at random and reevaluated as to visual outcome, and 46 were subjected to a psychosocial test to evaluate their quality of life and their rehabilitation. Eighteen of these were also given a psychosocial test to evaluate the quality of life enjoyed by these children at an older age following treatment for the cataract. Surgical, optical, and psychosocial rehabilitation of such children is also discussed. This is the first report of the psychological evaluation of such children. The further needs of these children as they approach adulthood are discussed in detail. PMID:10360302