Bilateral Cataract Surgery Research Articles

Comparison of Mean and Centroid of Surgically Induced Astigmatism After Standard Cataract Surgery.

Purpose: To compare the arithmetic mean of surgically induced astigmatism (M-SIA) and the centroid of surgically induced astigmatism (C-SIA) after standard cataract surgery.Methods: We retrospectively examined 200 eyes of 100 consecutive patients undergoing bilateral cataract surgery through a 2.8 mm temporal clear corneal incision. We quantitatively measured the magnitude and axis of corneal astigmatism preoperatively and 3 months postoperatively using an automated keratometer (TONOREFF-II, Nidek). We assessed the M-SIA, the C-SIA, and the double angle plots for the display of the individual SIA distributions.Results: For bilateral data analysis, the magnitude of corneal astigmatism significantly increased from 0.66 ± 0.39 D preoperatively to 0.74 ± 0.46 D postoperatively (paired t-test, p = 0.012). The M-SIA was 0.50 ± 0.36 D. On the other hand, the C-SIA was 0.18 ± 0.60 D at an axis of 97°. For unilateral analysis, we obtained similar outcomes between the right and left eye groups.Conclusions: According to our experience, standard cataract surgery induces the M-SIA by approximately 0.5 D. The magnitude of the C-SIA largely decreased to approximately 40% of the M-SIA, and the direction of the C-SIA showed a tendency toward with-the-rule astigmatism. It should be noted that the M-SIA was considerably different from the C-SIA, especially when selecting the appropriate toric IOL model and power.

Bilateral cataract surgery improves neurologic brake reaction time and stopping distance in elderly drivers.

AimsTo determine brake reaction times before and after bilateral cataract surgery in elderly drivers.MethodsSixty‐four patients were evaluated on the day of and 4 weeks after bilateral cataract surgery. Forty‐three healthy individuals with a valid driving licence served as the control group. A driving simulator was used to determine brake reaction times after receiving a visual stimulus. Total brake reaction time (BRT) as well as neurologic reaction time (NRT), foot transfer time (FTT) and brake pedal travel time (BPTT) were measured, and the measurements obtained before and after cataract surgery were compared. The correlations between NRT, best‐corrected visual acuity (BCVA) and contrast sensitivity (CS) were assessed.ResultsOut of the 64 patients with bilateral cataract, 53 were assessed for postsurgical measurements. All time measures improved significantly after cataract surgery (BRT, 815.7(224) versus 647.9(148) ms; NRT, 364.7(91) versus 283.5(44) ms; FTT, 290.8(62) versus 248.6(58) ms; and BPTT, 160.6(96) versus 116.6(72) ms, p < 0.001). The calculated stopping distance improved significantly after surgery (22.3(6) versus 19.9(4) m at 50 km/h). Best‐corrected visual acuity (BCVA) and contrast sensitivity (CS) improved significantly after surgery (0.25(0.2) versus 0.05(0.05), n = 53, p < 0.001; 1.4(0.2) versus 1.6(0.1), p < 0.001, respectively). There was a significant negative correlation between CS and NRT before surgery (r = −0.253, n = 64, p = 0.04, Pearson’s correlation).ConclusionOur findings show a significant effect of CS on neurological BRTs and the corresponding stopping distances. This highlights the importance of presurgical CS evaluation as a critical factor in cataract surgery decisions in elderly drivers.

Resident-performed immediate sequential bilateral cataract surgery during the COVID-19 pandemic.

Purpose:To assess visual outcomes and patient satisfaction for senior resident-performed immediate sequential bilateral cataract surgery (ISBCS) versus delayed sequential bilateral cataract surgery (DSBCS) during the COVID-19 pandemic, when minimizing healthcare-related exposures for patients and providers are paramount.Methods:This was a pilot retrospective cohort study of all ISBCS and DSBCS patients who underwent senior resident-performed cataract surgery from May to September 2020 at a single academic institution. Outcome measures were final corrected distance visual acuity (CDVA), final manifest refraction (MRx), intraoperative and postoperative complications rates, total number of visits, and patient satisfaction assessed postoperatively by telephone questionnaire.Results:Twenty-two eyes of 14 patients and 56 eyes of 28 patients underwent senior resident-performed ISBCS and DSBCS, respectively. Final CDVA was 20/25 or better in 21 (95%) ISBCS and 51 (91%) DSBCS eyes (P = 0.670). Deviation of final MRx from target refraction was within 0.50 D in 17 (77%) ISBCS and 47 (84%) DSBCS eyes (P = 0.522). There was no significant difference in intraoperative (P = 1.000) or postoperative (P = 1.000) complications. ISBCS patients averaged 3.5 fewer visits than DSBCS patients (5.9 vs 9.5, P < 0.001). All ISBCS and 20 DSBCS patients (87%) reported they were “very satisfied” or “satisfied” with their experience (P = 0.701). Five of six senior residents responded that they preferred performing ISBCS over DSBCS.Conclusion:This early experience suggests that senior resident-performed ISBCS is as safe and effective as DSBCS, with the added benefit of averaging fewer in-person visits. Residency programs should consider offering senior resident-performed ISBCS to select patients during the COVID-19 pandemic.

Anaesthetic Management of a Child with Congenital Rubella Syndrome Posted for Cochlear Implant - A Case Report

Congenital Rubella Syndrome (CRS) is a constellation of multi-system abnormalities and each problem has significant anaesthetic implications. These patients pose various challenge to anesthesiologists like unanticipated difficult airway, uncorrected cardiac lesions, etc. Anesthetic for cochlear implant in child with CRS has not been reported. Anaesthetic management in an infant with PS should be based on decrease in pulmonary vascular resistance (PVR), avoidance of tachycardia with sinus rhythm, myocardial depression, systemic hypotension and adequate intra vascular volume. Here we report the anaesthetic management of a 5 year aged child with congenital rubella syndrome - post device closure of Patent ductus arteriosus, bilateral cataract surgery with moderate branch pulmonary artery stenosis and mental retardation posted for cochlear implant. Keywords: Congenital rubella syndrome, pulmonary artery stenosis, difficult airway, cochlear implant, patent ductus arteriosus.

537 Implications of Covid-19 on Vitreoretinal and Cataract Surgery

IntroductionThe coronavirus pandemic (COVID-19) has greatly impacted ophthalmic surgery, including changes to surgical protocols and training. We explored the effects on vitreoretinal and cataract surgeries, which constitute the commonest areas of ophthalmic surgery.MethodLiterature searches were performed for the terms “vitreoretinal”, and “cataract”, each in combination with “surgery” and “Covid-19”. Relevant results were assessed to determine perceived impact on ophthalmic theatres.Results36 search results were analysed; 25 and 11 for cataract and vitreoretinal surgery respectively. Efforts to reduce infection rates have significantly reduced non-urgent operations, with reports of just 5.7% of ophthalmologists in certain areas performing cataract surgeries. Furthermore, surgeons have been advised to perform bilateral cataract surgery, and to combine phacoemulsification with vitreoretinal surgery, thereby avoiding deferred operations and further exposure. Other recommended changes in surgical strategies to enhance safety include three-dimensional heads-up displays for vitreoretinal surgeries, novel microscope drapes, and virtual consultations for surgery follow-up. Various reports indicate a negative impact on junior surgeon training and mental well-being; indeed, The Royal College of Ophthalmology has recommended assigning operations to experienced surgeons.ConclusionsOphthalmic surgery rates and protocols have been impacted in the effort to reduce Covid-19 spread. Trainee surgeon education and well-being warrant further attention.

Visual and Refractive Outcomes and Patient Satisfaction Following Implantation of Monofocal IOL in One Eye and ERV IOL in the Contralateral Eye with Mini-Monovision.

TitleVisual and refractive outcomes and patient satisfaction following implantation of monofocal intraocular lens in one eye and ERV intraocular lens in the contralateral eye with mini-monovision.PurposeTo evaluate the outcomes following implantation of monofocal intraocular lens in one eye and ERV intraocular lens in the contralateral eye with mini-monovision.MethodsTwenty-five subjects underwent bilateral cataract surgery, wherein the dominant eye received monofocal Tecnis-1 IOL, while in the contralateral eye received the Tecnis Symphony ERV IOL. The dominant eye was targeted for emmetropia and the non-dominant eye for myopia of −0.50 to −0.75D. Binocular uncorrected and corrected distance (UDVA, CDVA), intermediate (UIVA, CIVA), and near (UNVA, DCNVA) visual acuity; reading speeds, defocus curve and contrast sensitivity were studied at 6 months post-operatively.ResultsAt 6 months post-operatively the mean binocular UDVA, CDVA, UNVA and DCNVA were 0.007±0.07, −0.13±0.06, 0.26±0.09 and 0.44±0.10 LogMAR, respectively. Binocular UIVA and DCIVA at 60 cm were 0.22±0.10 and 0.18±0.08 LogMAR and at 80 cm was 0.16±0.11 and 0.15±0.10 LogMAR, respectively. Mean uncorrected reading speeds evaluated with SRD at 40, 60 and 80 cm were 114.4±6.9, 126.4±7.9 and 123.16±5.8 words per minute. Contrast sensitivity values did not show significant difference for any spatial frequency tested. At 6 months, only 12% (3 patients) reported mild halos. Spectacle independence satisfaction scores were 96%, 100% and 88% for distance, intermediate and near.ConclusionImplantation of monofocal intraocular lens in one eye and ERV intraocular lens in the contralateral with mini-monovision resulted in good outcomes for far and intermediate, and satisfactory outcomes for near vision, with good tolerance to mini-monovision at the end of 6 months.

Recurring themes during cataract assessment and surgery.

The aim of this review was to discuss frequently encountered themes such as cataract surgery in presence of age-related macular degeneration (AMD), dementia, Immediate Sequential Bilateral Cataract Surgery (ISBCS), discussing non-standard intraocular lens (IOL) options during consultation in the National Health Services (NHS) and the choice of the biometric formulae based on axial length. Individual groups of authors worked independently on each topic. We found that cataract surgery does improve visual acuity in AMD patients but the need for cataract surgery should be individualised. In patients with dementia, cataract surgery should be considered 'sooner rather than later' as progression may prevent individuals presenting for surgery. This should be planned after discussion of patients' best interests with any carers; multifocal IOLs are not proven to be the best option in these patients. ISBCS gives comparable outcomes to delayed sequential surgeries with a low risk of bilateral endophthalmitis and it can be cost-saving and efficient. Patients are entitled to know all suitable IOL options that can improve their quality of life. Deliberately withholding this information or pressuring patients to choose a non-standard IOL is inappropriate. However, one should be mindful of the not spending inappropriate amounts of time discussing these in the NHS setting which may affect care of other NHS patients. Evidence suggests Hoffer Q, Haigis, Hill-RBF and Kane formulae for shorter eyes; Barrett Universal II (BU II), Holladay II, Haigis and Kane formulae for longer eyes and BU II, Hill-RBF and Kane formulae for medium axial length eyes.

Clinical Outcomes With a New Continuous Range of Vision Presbyopia-Correcting Intraocular Lens.

To evaluate the clinical outcomes including patient-reported outcome measures in a sample of eyes undergoing bilateral cataract surgery with implantation of a new model of presbyopia-correcting intraocular lens (IOL). This non-randomized prospective case series enrolled 206 eyes of 103 patients undergoing phacoemulsification cataract surgery with bilateral implantation of the TECNIS Synergy IOL (Johnson & Johnson Vision). High and low contrast visual acuity, refractive, defocus curve, and patient-reported visual performance (Catquest-9SF questionnaire) outcomes were evaluated during a 3-month follow-up. A total of 96.1% (99 of 103) and 91.3% (94 of 103) of patients achieved binocular postoperative uncorrected distance (UDVA) and near visual acuity (UNVA) of 0.00 logMAR (20/20), respectively. Mean postoperative mesopic UNVA for both eyes was 0.14 ± 0.03 logMAR. Likewise, mean binocular UDVA and UNVA were 0.00 ± 0.03 and 0.04 ± 0.02 logMAR. An almost flat mean defocus curve was obtained, with visual acuities between 0.00 and 0.10 logMAR for most defocus levels in both eyes. A reduction of contrast led to a limited but statistically significant change in UNVA in both eyes (P < .001). The Rasch calibrated scoring of item 2 and the Rasch calibrated mean score of the Catquest-9SF questionnaire increased significantly with surgery (P < .001). This new presbyopia-correcting IOL provides a continuous range of functional focus, with a limited deterioration under mesopic conditions, which is perceived as a satisfactory outcome by the patient if proper patient selection is performed. [J Refract Surg. 2021;37(4):256-262.].

Effect of Cataract Surgery on Frequency of Falls among Older Persons: A Systematic Review and Meta-Analysis.

Background Falls are a significant public health problem among older people worldwide. The aim was to perform a new systematic review and meta-analysis to assess whether cataract surgery is effective in reducing the rate of falls in older persons. Methods The systematic review was performed following the recommendations by the Cochrane Collaboration. Original papers were included with RCT or quasi-experimental design, which described the effect on uni- or bilateral cataract surgery on the rate of falls among people aged 60 or older. Titles and abstracts were reviewed, full-text versions were retrieved, and two independent examiners reviewed them to assess inclusion criteria. All relevant variables were synthesised in an evidence table. Random-effects meta-analyses were performed pooling the trials, and results were expressed as relative risk (RR) and 95% confidence intervals. Results The initial search reported 99 potential abstracts, and 41 full-text versions were examined. In the end, eight studies were included. Five included patients 65 years of age and older, two patients 55 years and older, and one included patients 50 years or older. Phacoemulsification and intraocular lens implant were performed in all studies. Two were RCT, and six were quasi-experimental. Falls was the main outcome. The six quasi-experimental studies reported that a reduction in the frequency of falls was observed (RR 0.68, 95% CI 0.48–0.96), although heterogeneity was significant (I2 = 74%). Only one RCT reported risk reduction of 34% (RR 0.66, 95% CI 0.45–0.96). Conclusions This meta-analysis provides evidence that the first cataract surgery reduces the frequency of falls in older people with bilateral cataracts, but a second surgery does not have significant impact.

Effect of First Eye Prediction Error on Refractive Adjustment of Second Eye in Delayed Sequential Bilateral Cataract Surgery

Effect of First Eye Prediction Error on Refractive Adjustment of Second Eye in Delayed Sequential Bilateral Cataract Surgery

Comparative evaluation of visual outcomes after bilateral implantation of an advanced or conventional monofocal intraocular lens.

To assess the clinical outcomes and patient satisfaction of the Tecnis Eyhance, an advanced monofocal intraocular lens (IOL), compared to a conventional monofocal IOL. Retrospective case-control study. This study included 120 eyes of 60 patients (30 patients in each group) who underwent bilateral cataract surgery either with the implantation of conventional monofocal IOLs (Tecnis PCB00), as a control group, or advanced monofocal IOLs (Tecnis Eyhance ICB00). Ophthalmological evaluation included the measurement of binocular corrected distance visual acuity (CDVA), monocular and binocular uncorrected distance visual acuity (UDVA), and uncorrected intermediate VA (UIVA). In addition the binocular defocus curve was analyzed. Furthermore a subjective questionnaire (Catquest-9SF) was used to assess vision and life quality. The average binocular UDVA was 20/22 in the ICB00 group and 20/20 in the PCB00 model (p = 0.62). The average monocular UIVA was 20/32 in the ICB00 group and 20/40 in the control group (p < 0.001). We found the binocular UIVA, had a mean value of 20/30 in the ICB00, compared to 20/40 in the control group (p < 0.001). The reported dysphotopsia was not significantly different between both groups (p = 0.56). Regarding the life quality questionnaire, the ICB00 group showed less difficulty in activities requiring intermediate vision. Our results demonstrated a significant improvement in visual acuity for intermediate distance in the ICB00 group compared to the control group, without compromising distance visual acuity. We also found a greater capability for intermediate distance activities (namely for computer use and reading price tags) when comparing ICB00 patients with the control group.

Dynamic changes of axial length, corneal refractive power, and refractive state after cataract surgery in infants

Objective: To investigate the changes of axial length, corneal refractive power, and refractive state in infants with congenital cataract surgery. Methods: Retrospective cohort study. Medical records of 103 patients who underwent congenital cataract surgery in the Eye Hospital of Wenzhou Medical University Hangzhou Branch from January 1, 2015 to December 31, 2018 were reviewed. There were 61 boys and 42 girls in the study. The mean age at the surgery of 103 congenital cataract patients was (3.95±1.94) months. In patients receiving bilateral cataract surgery, only the left eye was selected for analysis. The patients were followed up for at least 1 year. The patients were divided into the groups of <4 months old and 4-12 months old according to the age at cataract surgery. The change in the axial length, corneal refractive power, and refractive state of each patient at 1 year after surgery was analyzed. Independent sample t-test, one way variance analysis and simple linear regression were used for statistical analysis. Results: There were 71 cases of bilateral cataract, including 33 in the group of <4 months old and 38 in the group of 4-12 months old, and 32 cases of unilateral cataract, including 17 in the group of <4 months old and 15 in the group of 4-12 months old. The change in the axial length of bilateral cataract children in the <4-month-old group was (2.46±1.33) mm at 1 year after surgery, which was greater than (1.52± 1.00) mm in the group of 4-12 months old (t=3.21; P<0.01). In the same surgery age group, there was no significant difference in the change of axial length among bilateral cataract eyes, unilateral cataract eyes and the contralateral eyes at 1 year after surgery (both P>0.05). One year after surgery, the axial length of the eyes in patients with bilateral cataract, the affected eyes and the fellow eyes in patients with unilateral cataract all was highly correlated with the logarithm of the actual age (r=0.68, 0.52, 0.73; all P<0.01). The corneal refractive power showed a decreased trend with the increase of age. The change in the corneal refractive power of the bilateral cataract children in the <4-month-old group at 1 year after surgery was (1.43±2.87) D, and in the group of 4-12 months old was (0.68±2.10) D, but the difference was not statistically significant (P>0.05). The chang in spherical equivalent of bilateral cataract children was (2.02±2.60) D in the <4-month-old group, greater than that in the group of 4-12 months old [(0.69±1.89) D; t=2.15; P<0.05]. The change of spherical equivalent one year after surgery in 4-12 months group, unilateral cataract eyes was significantly greater than that of bilateral cataract eyes [(2.05±0.95) D vs. (0.69±1.89) D; t=2.49; P<0.05]. The spherical equivalent of both bilateral and unilateral cataract children was highly correlated with the actual age (r=-0.51, -0.54; both P<0.01). Conclusions: The axial length is increased, the corneal refractive power is decreased, and the spherical equivalent is decreased at 1 year after surgery for congenital cataract in infants. The younger the age at cataract surgery, the greater the change in the axial length, myopia drift, and corneal refractive power. (Chin J Ophthalmol, 2021, 57: 34-40).

Commentary: Pediatric cataract management during the COVID-19 era.

Commentary: Pediatric cataract management during the COVID-19 era.

Unilateral deposit of exfoliative material on the surface of intraocular lens after phacoemulsification

We report a case of a 78-year old man who consults for blurred vision 5 years after bilateral cataract surgery with pliable intraocular lens (IOL) implanted in the capsular bag. The best corrected visual acuity was 20/20 in the right eye and 20/25 in the left eye. Slit lamp examination found unilateral left sided pseudo-exfoliative deposits on the surface of the IOL (A,B) with a slight opacification of the posterior capsule (B). Intraocular pressure was normal. The examination of the angle found Sampaolesi line with open angle in both eyes. The excavation of the optic nerve head was normal. Pseudo-exfoliation syndrome (PEX) is common. The origin of the exfoliative material is not yet clearly defined. The exfoliative material can have a target pattern on the surface of the lens with a two rings of deposits separated by a clear area. In cases with material on the surface of the IOL, we can find the opposite pattern with presence of the exfoliative deposits in the intermediate zone, like in our case. The presence of this material on the surface of the IOL after cataract surgery suggests that the anterior capsular lens wouldn´t be necessary for its production. Follow-up is necessary due to the risk of pseudo-exfoliative glaucoma.

Visual Performance of a Polynomial Extended Depth of Focus Intraocular Lens

Purpose: To clinically evaluate a new extended depth of focus intraocular lens (ISOPURE, PhysIOL) with optic design modification based on a unique polynomial concept to improve intermediate vision while keeping the quality of distance vision equal to a monofocal lens. Methods: 18 patients (11 female, 7 male, mean age of 69.4 years) with bilateral cataract and regular corneal astigmatism ≤ 1.0 D underwent bilateral cataract surgery with ISOPURE implantation. Patients were followed for up to 6 months. Measured parameters were uncorrected (UDVA) and corrected distance visual acuity (CDVA), uncorrected (UIVA) and distance-corrected intermediate visual acuity at 80 cm and 66 cm (DCI80VA, DCI66VA) subjective refraction, defocus curve, tolerance of cylinder induction, and contrast sensitivity. The data from all implanted eyes (all-eyes) and a subset only including the first eye implanted for each patient were analysed. Results: The mean manifest refraction spherical equivalent (MRSE) decreased from 1.05 D pre-operatively to ?0.15 D at the 4 - 6 month assessment, with 80.6% of eyes within ±0.50 D of emmetropia. At the final follow-up, mean (SD) monocular CDVA was ?0.06 (0.04) logMAR, DCI80VA was 0.18 (0.08) logMAR and DCI66VA was 0.27 (0.13) logMAR. Despite a cylinder induction of ?0.50 D, uncorrected distance visual acuity of 0.02 logMAR was still achieved. Conclusion: The ISOPURE intraocular lens provides excellent distance corrected visual acuity for far and intermediate distances along with high contrast sensitivity and good tolerance of residual refractive cylinder.

Commentary - Should immediate sequential bilateral cataract surgery be the norm in the COVID-19 era?

Commentary - Should immediate sequential bilateral cataract surgery be the norm in the COVID-19 era?

Immediate sequential bilateral cataract surgery and its relevance in COVID-19 era.

Immediately sequential bilateral cataract surgery (ISBCS) involves performing phacoemulsification with intraocular lens implantation in both the eyes of a patient, sequentially in the same operative sitting. 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. As a result of the COVID-19 pandemic, all elective surgeries were stopped. This has resulted in a large backlog of deferred cataract surgeries. Now more than ever before, we should consider ISBCS as an excellent alternative to delayed sequential bilateral cataract surgery in the right hospital or surgical setting. In the age of COVID-19, it can help to decrease surgical scheduling and follow-up visits. The one change in practice that could have the most significant benefit in reducing infection exposure risk is ISBCS.

Commentary: Improving the cataract surgery efficiency and clearing the cataract surgery backlog due to COVID-19 pandemic.

Commentary: Improving the cataract surgery efficiency and clearing the cataract surgery backlog due to COVID-19 pandemic.

Commentary: Immediate sequential bilateral cataract surgery during the COVID-19 pandemic.

Commentary: Immediate sequential bilateral cataract surgery during the COVID-19 pandemic.

Patient preference and pain-reported outcomes for topical versus subtenon anesthetic for cataract surgery.

PURPOSE:Cataract extraction and lens implantation is the most common surgical procedure performed worldwide, with surgeons opting for either a topical or a subtenon anesthetic in majority of cases. While complication rates and pain scores have been previously examined in a bid to determine which modality was better, patients who have had both eyes operated upon under different techniques have never previously been asked which method they prefer. We undertook this study to fill in this crucial gap in our knowledge.METHODS:This is a retrospective study of patients who have undergone bilateral cataract surgery with one eye operated on with topical anesthesia and the other eye with subtenon anesthesia. Patients were identified who had had surgery undertaken in the previous 6 months at Singleton Hospital, Swansea, where both eyes had been operated upon using different anesthetic techniques. Telephone interviews with these patients were performed and their pain scores recorded on a scale from 0 (no pain) to 10 (severe pain) for both eyes, with the patients then being asked which the method of anesthetic they preferred. Statistical analysis of pain scores was compared using Wilcoxon rank-sum testing.RESULTS:One hundred and fifty-two patients in total were identified. One hundred and forty-one of the applicable patients participated in the study. Of these, 78 patients received topical anesthesia for their first operation and 63 had subtenon block for their first operation. The mean pain scores reported for surgery with topical anesthesia and subtenon block were 2.30 and 1.38, respectively. The pain data were analyzed using a Wilcoxon signed-rank test, returning a z-score of 4.038. This result therefore suggests that patients experience statistically significantly less pain from cataract surgery when given a subtenon block. Patients expressed a preference for subtenon anesthesia, with 70% preferring subtenon block, 23% preferring topical anesthesia, and 7% having no preference.CONCLUSIONS:Patients report less pain with subtenon anesthesia compared with topical anesthesia in cataract surgery, where both eyes were operated upon with different anesthetic techniques. This is the first study in which patients who have had both anesthetic techniques performed independently for cataract surgery have had their pain scores reported and statistically analyzed.