Preoperative Cataract Research Articles

The efficacy of a nurse-led preoperative cataract assessment and postoperative care clinic

This paper describes a prospective study involving 185 public patients (221 eyes) referred to the Department of Ophthalmology at Flinders Medical Center for cataract surgery between February 2003 and August 2004. The patients were assessed in the nurse-led preoperative assessment clinic. Those deemed suitable for cataract surgery were also assessed by an ophthalmologist and underwent cataract surgery if appropriate. The nurse managed postoperative care. Measurements included concordance between nurse practitioner and ophthalmologist assessments; waiting times for first clinic appointment and surgery; visual acuity and degree of visual disability; patient satisfaction. Results showed that 114 patients (61.6%) were assigned to see the ophthalmologist for cataract surgery. The median waiting times fell from 115 days (range, 23 to 268 days) to 21 days (range, 9 to 43 days) for initial clinic appointment, and from 44 days (range, 5 to 148 days) to 29 days (range, 14 to 154 days) for surgery. All 114 patients were listed for cataract surgery, and surgery had been performed on 121 eyes by the end of the study. After surgery, visual acuity improved by a mean of 0.45 logMAR (logarithm of the minimal angle of resolution) (SD, 0.24; range, 0.08 to 1.32). All patients had improved visual ability and high levels of satisfaction. Three quality assurance evaluations demonstrated full concordance between nurse and ophthalmologist assessments. Implementing a nurse-led cataract assessment clinic improved access to care for public patients with cataracts. The safety and efficacy of the program and its excellent visual and patient-centered outcomes commend its adaptation and implementation to other ophthalmology departments.—Hans E. Grossniklaus

The efficacy of a nurse-led preoperative cataract assessment and postoperative care clinic

The purpose of this study was to describe the implementation of a nurse-led preoperative cataract assessment and postoperative care clinic and to assess the safety, efficacy, and outcomes. This was a prospective study involving 185 public patients (221 eyes) referred to the Department of Ophthalmology at Flinders Medical Centre for cataract surgery. The study was conducted between February 2003 and August 2004. Patients were assessed in the nurse-led preoperative assessment clinic. Those deemed suitable for cataract surgery were also assessed by an ophthalmologist and underwent cataract surgery if appropriate.

The efficacy of a nurse‐led preoperative cataract assessment and postoperative care clinic

The efficacy of a nurse‐led preoperative cataract assessment and postoperative care clinic

The efficacy of a nurse‐led preoperative cataract assessment and postoperative care clinic

Objective: To describe the implementation of a nurse-led preoperative cataract assessment and postoperative care clinic and to assess the safety, efficacy and outcomes.

The efficacy of a nurse‐led preoperative cataract assessment and postoperative care clinic

Objective: To describe the implementation of a nurse-led preoperative cataract assessment and postoperative care clinic and to assess the safety, efficacy and outcomes.

Ultrasonic assessment in pre-operative cataract patients

The ability to examine the posterior segment of the eye accurately in patients with opaque media is essential to good surgical care of the cataract patient. In dense cataracts, the posterior segment is inaccessible to direct and indirect ophthalmoscopy and so adequate evaluation of posterior segment to exclude abnormalities become difficult. There is a risk of poor prognosis in eyes of patients with cataracts who may also have co-existing posterior segment abnormalities. Ultrasonography provides a method of assessing the structural changes in the posterior segment of the eye in such patients. To determine the relevance and prevalence of posterior segment abnormalities in patients with dense cataracts prior to surgery by ultrasonography. A 12- month prospective study of patients with clinically diagnosed dense cataracts in either or both eyes, in which the posterior segment cannot be evaluated properly during ophthalmoscopy, and therefore were sent for ocular ultrasonography. B-scan ultrasound was done on 116 eyes of 80 patients. Eighty patients were involved in the study, 116 eyes demonstrated dense cataract. One hundred and ten eyes (94.8%) had a normal posterior segment. Total retinal detachment was noted in 3 eyes (2.59%), a left partial retinal detachment was observed in 1 eye (0.87%), 2 eyes with total retinal detachment in conjunction with vitreous haemorrhage were noted in a single patient, 1.72% Posterior segment assessment with ultrasound is advisable and important in the preoperative evaluation of patients with dense cataract prior to surgery.

EPIRETINAL MEMBRANE REMOVAL IN EYES WITH GOOD VISUAL ACUITIES

To evaluate the results of vitrectomy for epiretinal membrane in eyes with a preoperative visual acuity of 20/50 or better. The visual results and complications of vitrectomy for epiretinal membranes were analyzed in a retrospective, consecutive case series of 40 eyes of 40 patients treated by a single surgeon. The mean preoperative visual acuity was 20/50 + 2 (range 20/30 + 1 to 20/50 -3). The mean visual acuity improved to 20/40 + 2 (P = 0.02) by the final examination at a mean of 2.4 years following surgery. The status of the lens at the final examination was correlated with the visual results of surgery. Twenty-one eyes were phakic preoperatively and 14 of these eyes had cataracts removed by the final examination. The mean preoperative visual acuity in 7 eyes which were still phakic at the final examination was 20/50 and this decreased to 20/50 -2 (P = 0.82). The mean preoperative visual acuity was 20/50 + 2 in 33 eyes which were pseudophakic by the final examination and this improved to 20/32 -2 (P = 0.005). There were no other serious complications such as retinal detachment or infectious endophthalmitis. Vitrectomy for epiretinal membranes is safe in eyes with relatively good preoperative visual acuities but cataract surgery is necessary in phakic eyes to achieve long-term visual acuity improvement.

Relationship of Cataract Symptoms of Preoperative Patients and Vision-related Quality of Life

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.

Phenol red thread test vs Schirmer's test: a comparative study

To measure the agreement between Schirmer's and phenol red thread tests in detecting dry eyes. A total of 103 patients attending preoperative cataract assessment clinic who agreed to be involved in the study were recruited. Each patient had one eye examined by both tests in a random order by two different investigators who were unaware of the results of the other test. Dry eye symptoms were assessed using an interviewer-administered questionnaire. The data were collected after the study period and analysed using kappa statistics to assess the agreement between the two tests. Schirmer's test was positive in 25 patients when a cutoff point of 5 mm was used and positive in 41 patients with a cutoff point of 10 mm. Phenol red thread test was positive in four patients when a cutoff point of 10 mm was used and in 32 patients with a cutoff point of 20 mm. Kappa ranged from 0.067 to 0.3 indicating very weak agreement between the two tests. In all, 27% of the patients had symptoms of dry eyes; however, the agreement between each test and the symptoms was very poor. There is very weak agreement between Schirmer's test and phenol red thread tests and between each test and symptoms of dry eyes.

Assessment of visual satisfaction and function after cataract surgery

To examine the relationships between importance, satisfaction, visual acuity, and visual function in a sample of preoperative cataract patients and to derive and prospectively evaluate a shortened measure of visual function. Day-stay cataract surgery unit at large private hospital and consulting rooms of metropolitan ophthalmologists. Two independent samples of 111 and 121 patients were surveyed before and after surgery with regard to their visual satisfaction, trouble with vision, VF-14 visual function, overall satisfaction, and importance of factors affecting patient satisfaction. A 7-item scale of visual function derived from the first sample's results was prospectively tested against the second sample. Distance and reading acuities were recorded from the patients' charts. The 7-item measure of visual function strongly correlated with the VF-14 (r>0.9) and had predictive power equal to that of the VF-14 for satisfaction and trouble with vision. However, the 7 items differed somewhat from a version developed in Helsinki. Distance visual acuity was not significantly correlated with visual function, satisfaction, or trouble with vision, although reading acuity was significantly correlated with visual function and trouble with vision (r=0.31 and r=0.32, respectively). A shortened measure of visual function that had a predictive value equal to that of the VF-14 can more practically be used in everyday practice. Furthermore, the study showed that regional factors matter and highlights the necessity of basing measurement scales on factors important to the population in question to ensure scale validity.

Reliability and reproducibility of a Chinese-language visual function assessment

OBJECTIVE The purpose of the study was to validate a Chinese-language visual function assessment within the context of a routine cataract surgery practice and to assess the contribution of the method of questionnaire administration.DESIGN The visual function assessment (VFA) was translated into Chinese. Two groups of study subjects were recruited: Chinese who did not speak English and Chinese conversant in English. Consecutive preoperative cataract patients of Chinese ancestry presenting to an urban ophthalmology practice were recruited. The questionnaire was administered in person or by telephone interview. Pre-operative visual acuity was recorded. Visual function scores were analyzed to assess reliability and correlation with visual acuity.RESULTS Among the 186 potential study subjects, 155 patients completed the study. The Chinese-language visual function assessment had good internal consistency (Cronbach α = 0.97, inter-item correlations = 0.43 to 0.96). Reliability (with regard to the English version) and test-retest reproducibility of the Chinese questionnaire were strong with intraclass correlation coefficients greater than 0.60. The method of administration contributed to the measures of reliability and reproducibility.CONCLUSION These results show that a Chinese-language version of the VFA questionnaire is reliable and valid. In industrialized countries with large Chinese-speaking populations and newly developed countries of East and Southeast Asia, the visual function assessment may be helpful in assisting routine clinical patient evaluation and cross-cultural outcome assessment programmes. Our findings also suggest that self-administered visual function assessments may be more reliable and valid than interview-generated assessments.

Potential acuity meter results in cataract patients.

To determine the ability of the potential acuity meter (PAM) to predict potential visual acuity through lenticular opacities in a group of cataract patients without significant other ocular pathology. This prospective study undertook PAM measurements on each eye of 84 subjects during preoperative hospital visits to either A Scan or Primary Care clinics. PAM results were compared to best corrected visual acuity findings obtained at least 6 weeks post-cataract extraction. Comparison of PAM result to visual outcome showed poor correlation (rho = 0.41, P = 0.0005). Using predictive estimates, 49% of subjects' PAM results underestimated visual outcome as determined by a difference of greater than 2 Snellen acuity lines in these results. Factors such as preoperative vision level, cataract type and pupil dilation did not significantly influence the predictive power of the PAM. Preoperative pinhole results were also correlated with visual outcome (rho = 0.42, P = 0.0006). Vison in the fellow eye of subjects with 6/9 or better was correlated to the PAM result indicating a moderate to good predictive power in 'normal' eyes. PAM results were considered to be poor for a clinical test. The results of this study indicate that this instrument has only a limited usefulness as part of the standard preoperatve examination in patients undergoing cataract extraction.

Functional complaints, visual acuity,spatial contrast sensitivity, and glare disability in preoperative and postoperative cataract patients

Purpose: To quantify cataract patients' functional visual complaints and correlate them with their objective glare disability and spatial contrast sensitivity (SCS) scores. Setting: Sir Mortimer B. Davis Jewish General Hospital, Montreal, Quebec, Canada. Methods: Thirty patients scheduled for cataract surgery with a visual acuity of 20/70or better at the time of patient selection and no other ocular pathology were evaluated objectively and subjectively for visual function preoperatively and within 3 months postoperatively. Objective measures of SCS and visual acuity in the presence and absence of glare were obtained with the Optec 3000 vision tester. Subjective visual function was evaluated with the Activities of Daily Vision Scale (ADVS), a questionnaire that evaluates patients' visual function by assessing the degree of difficulty they experience in performing tasks involving distance vision, near vision, and glare conditions. Results: Preoperatively, patients had decreased visual acuity and SCS in the presence of glare. The ADVS scores were correlated with visual performance. Postoperatively, there was a statistically significant improvement in all dependent measures (i.e., visual acuity and SCS in the presence of glare) as well as in the subjective report of visual performance assessed by the ADVS. Conclusion: Spatial contrast sensitivity, glare disability, and the ADVS questionnaire should be considered as adjuncts to visual acuity testing in evaluating certain cataract patients.

Phacoemulsification and lens implantation after pars plana vitrectomy

This study aimed to describe the intraoperative and postoperative complications and visual acuity outcomes of patients undergoing Kelman phacoemulsification (KPE) and intraocular lens (IOL) implantation after pars plana vitrectomy (PPV). The study design was a retrospective review of a consecutive surgical series. Forty-four eyes of 43 patients who underwent surgery at the Jules Stein Eye Institute, Los Angeles, California, or Advanced Vision Care, West Hills, California, were studied. Office records, referring retina specialists' records, and operative reports were reviewed for demographic information, indications for PPV, preoperative cataract severity, unplanned intraoperative events and complications, early and late postoperative complications, and postoperative visual acuities. Complications and postoperative visual acuities were measured. The mean interval from PPV to KPE was 20 months. The mean interval from KPE to final examination was 19 months. Primary indications for PPV included development of a macular epiretinal membrane, macular hole, proliferative diabetic retinopathy, retinal detachment, vitreous abscess, and vitreous hemorrhage. The degree of nuclear sclerosis in postvitrectomy eyes was greater than that in typical cataract eyes (P = 0.00002). The most common intraoperative problem was the discovery of a posterior capsule plaque. In a few cases, surgery was made difficult by unusual fluctuations in anterior chamber depth and lens zonule instability. The most common early postoperative complication was corneal edema; the most common late complication was the need for neodymium:YAG (Nd:YAG) laser posterior capsulotomy. An IOL was implanted in every eye. There were no retinal detachments. Median visual acuity improved from 20/125 before cataract surgery to 20/40 6 weeks after surgery to 20/30 on final examination. Visual acuity of 20/40 or better was achieved by 63.6% of eyes at 6 weeks and by 72.7% of eyes by final examination. Kelman phacoemulsification and IOL implantation can be performed safely after PPV. Intraoperative and postoperative complications are uncommon. Pre-existing posterior segment pathology limits the ultimate improvement in visual acuity, but substantial gains in visual acuity are realized by most patients.

Glare disability and contrast sensitivity before and after cataract surgery

Purpose: To determine whether brightness-induced glare decreases spatial contrast sensitivity and visual acuity in preoperative cataract patients with functional visual complaints and to compare preoperative with postoperative results.Setting: Sir Mortimer B. Davis Jewish General Hospital, Montreal, Quebec, Canada.Methods: Twenty patients with a visual acuity of 20/70 or better at the time of chart selection and no other ocular pathology who were referred for cataract surgery were evaluated with the Optec 3000 vision tester to assess contrast sensitivity and visual acuity in the presence and absence of glare. Testing was done preoperatively and 1 and 3 months postoperatively.Results: An analysis of variance indicated that there were statistically significant double interactions between the preoperative/postoperative and glare/no-glare variables and between the preoperative/postoperative and spatial frequency variables. Postoperatively, visual acuity and contrast sensitivity improved to within normal limits. There were no statistically significant differences in visual acuity and spatial contrast sensitivity between 1 and 3 months postoperatively.Conclusion: Spatial contrast sensitivity and glare testing provided objective assessment of patients who had good visual acuity yet also had functional complaints.

Progression of Nuclear Sclerosis and Long-term Visual Results of Vitrectomy with Transforming Growth Factor Beta-2 for Macular Holes

Purpose We studied the progression of cataracts and visual acuity up to 36 months after vitrectomy and instillation of transforming growth factor beta-2 for treatment of full-thickness macular holes. Methods Sixty-four eyes with idiopathic and two with traumatic macular holes in this prospective consecutive series were divided into the following two groups: 56 phakic eyes were treated with 70, 330, or 1,330 ng of transforming growth factor beta-2 to study the progression of cataracts, and 31 phakic or pseudophakic eyes were treated with 1,330 ng of transforming growth factor beta-2 to study the long-term visual acuity after macular hole surgery. Results Eyes in the cataract progression study had a mean preoperative nuclear sclerosis grade of 0.4, which increased to 2.4 on final lens examination at a mean of 12.4 months postoperatively. The amount of nuclear sclerosis increased progressively with duration of follow-up, and 16 (76%) of 21 eyes followed up for 24 months or more required cataract extraction. The mean preoperative posterior subcapsular cataract grade was 0.0 and increased only slightly to 0.25 on final lens examination. All eyes had initial successful closure of the macular hole, but the macular hole reopened in two eyes (between six and 12 months and at 19 months) for an overall success rate of 29 (93.5%) of 31 eyes at a mean of 19.5 months. The visual acuity increased two or more Snellen lines in 29 (93.5%) of 31 eyes. The final visual acuity was 20/40 or better in 23 (74%) of 31 eyes and the visual improvement was stable in eyes followed up for three years. Conclusions Nuclear sclerotic cataracts progress substantially after macular hole surgery with a long-acting intraocular gas tamponade. The visual acuity often decreases 12 or more months after vitrectomy because of cataract progression, but the visual results of vitrectomy and transforming growth factor beta-2 for macular holes are excellent when the cataracts are removed.

Progression of Nuclear Sclerosis and Long-term Visual Results of Vitrectomy With Transforming Growth Factor Beta-2 for Macular Holes

We studied the progression of cataracts and visual acuity up to 36 months after vitrectomy and instillation of transforming growth factor beta-2 for treatment of full-thickness macular holes. Sixty-four eyes with idiopathic and two with traumatic macular holes in this prospective consecutive series were divided into the following two groups: 56 phakic eyes were treated with 70, 330, or 1,330 ng of transforming growth factor beta-2 to study the progression of cataracts, and 31 phakic or pseudophakic eyes were treated with 1,330 ng of transforming growth factor beta-2 to study the long-term visual acuity after macular hole surgery. Eyes in the cataract progression study had a mean preoperative nuclear sclerosis grade of 0.4, which increased to 2.4 on final lens examination at a mean of 12.4 months postoperatively. The amount of nuclear sclerosis increased progressively with duration of follow-up, and 16 (76%) of 21 eyes followed up for 24 months or more required cataract extraction. The mean preoperative posterior subcapsular cataract grade was 0.0 and increased only slightly to 0.25 on final lens examination. All eyes had initial successful closure of the macular hole, but the macular hole reopened in two eyes (between six and 12 months and at 19 months) for an overall success rate of 29 (93.5%) of 31 eyes at a mean of 19.5 months. The visual acuity increased two or more Snellen lines in 29 (93.5%) of 31 eyes. The final visual acuity was 20/40 or better in 23 (74%) of 31 eyes and the visual improvement was stable in eyes followed up for three years. Nuclear sclerotic cataracts progress substantially after macular hole surgery with a long-acting intraocular gas tamponade. The visual acuity often decreases 12 or more months after vitrectomy because of cataract progression, but the visual results of vitrectomy and transforming growth factor beta-2 for macular holes are excellent when the cataracts are removed.

Forward Light Scattering in Eyes with Intraocular Lens

OBJECTIVE: To measure the level of the intraocular straylight in a group of pseudophakic eyes with monofocal posterior chamber intraocular lens and clear capsule. STUDY DESIGN: The intraocular straylight, measured 1 week after lens implantation, was compared with the intraocular straylight of a cataract group and a control group. The cataract surgery was standardized with capsulorhexis, phacoemulsification of the nucleus and intracapsular implantation of monofocal lens. SETTING: Out-patient, St Erik's Eye Hospital. SUBJECTS: Ten patients with intraocular lens, 10 pre-operative cataract patients, 10 persons with clear lens. MAIN OUTCOME MEASURES: The intraocular straylight was measured with a psycho-physiologic, direct compensation method using a straylight meter. The straylight induced by a light source at three different angles was investigated. RESULTS: There was no statistically significant difference in the straylight level between the intraocular lens group and the control group. The straylight level in these two groups were significantly different from the cataract group. There was no significant difference in the level of straylight induced by the three angles. There was no linear relation between the vision and the intraocular straylight. CONCLUSIONS: The result showed that the intraocular straylight was greatly reduced after cataract operation with implantation of monofocal intraocular lens. The straylight in the pseudophakic eyes was similar to that of the eyes with clear lenses. Sampling at one angle would be enough to obtain the information on the intraocular straylight in the pseudophakic and cataract patients. The intraocular straylight can be used as a parameter to estimate the optical quality of the eye.

A Survey of Blepharitis in Pre-operative Cataract Patients

Objective: To diagnose and categorize blepharitis and associated skin diseases in preoperative cataract patients and to correlate blepharitis with the development of post-operative ocular inflammation. Design: A prospective single blind study. Setting: An ophthalmic ward in a district general hospital. Patients: One hundred consecutive patients undergoing routine cataract extraction and lens implantation. Main Outcome Measures: 1. The proportion of patients showing blepharitis of the four main clinical types - staphylococcal, seborrhoeic, demodectic and meibomian gland dysfunction. 2. The prevalence of rosacea and seborrhoeic dermatitis, skin diseases associated with blepharitis. 3. The relationship of blepharitis to the development of post-operative ocular inflammation. RESULTS: Four patients had staphylococcal blepharitis. Four patients had seborrhoeic blepharitis, one with associated seborrhoeic dermatitis. Fifty-three patients showed varying degrees of demodectic cuffing; none had demodectic blepharitis. Forty-three (43%) had evidence of meibomian gland dysfunction; 18 of these had blockage of the meibomian duct orifices, lid notching and conjunctival concretions; the remaining 25 had notching and concretions only. Three patients had seborrhoeic dermatitis. No patient had frank papulopustular rosacea. Two patients had erythema, telangiectasia and a history of flushing, suggestive of early rosacea. Three patients developed abnormal post-operative ocular inflammation. Of these, one had seborrhoeic blepharitis and two had moderate demodectic cuffing. The four patients with staphylococcal blepharitis and the remaining three with seborrhoeic blepharitis developed no post-operative ocular inflammation. Conclusions: The results indicate that hitherto undetected blepharitis occurs in patients presenting for cataract operation. The prevalence of rosacea and seborrhoeic dermatitis in the population studied was 2% and 3%, respectively. Patients being listed for cataract surgery should be screened for blepharitis and associated skin conditions, and treated well in advance of operation.

Progression of Nonproliferative Diabetic Retinopathy and Visual Outcome After Extracapsular Cataract Extraction and Intraocular Lens Implantation

Twenty-one patients with symmetric nonproliferative retinopathy who underwent extracapsular cataract extraction and intraocular lens implantation were followed up postoperatively for an average (+/- standard deviation) of 18 +/- 7 months to determine the incidence of progression of diabetic retinopathy, the final visual acuity, and factors predictive of progression of retinopathy and final visual acuity. Progression of retinopathy, defined as the development of clinically significant macular edema, an increase in intraretinal hemorrhages or hard exudate, or the development of proliferative diabetic retinopathy, was assessed in both eyes of 19 patients; in two remaining patients, dense preoperative cataract in the fellow eye precluded comparison of retinopathy progression in the operated-on eye to progression in the fellow eye. Overall, retinopathy progressed in 14 of 19 operated-on eyes (74%). Cataract extraction was highly associated with asymmetric progression of nonproliferative retinopathy; it progressed only in the operated-on eye in seven of 19 patients (37%), but in no patients did progression occur in the fellow eye alone (P = .0078). Women had a significantly increased risk of progression of retinopathy in the operated-on eye compared to men (P = .005). Visual acuity improved in 19 of 21 operated-on eyes (86%); however, only 11 eyes (52%) achieved a visual acuity of 20/50 or better and only six eyes (14%) achieved a visual acuity of 20/25 or better. In only five eyes was the final visual acuity in the operated-on eye more than two lines better than the final visual acuity in the fellow eye.(ABSTRACT TRUNCATED AT 250 WORDS)