Comparison of visual performance with an aspheric intraocular lens and a spherical intraocular lens.

PURPOSE: To compare the visual performance after implantation of the Akreos Adapt Advanced Optics aspheric intraocular lens (IOL) and the Sensar AR40e spherical acrylic IOL. SETTING: Eye Department, Southampton University Hospital, United Kingdom. DESIGN: Randomized masked single-center clinical trial. METHODS: Patients with bilateral cataract who were older than 50 years with a biometry-predicted IOL power between 10.0 diopters (D) and 30.0 D were recruited. Outcome measures included corrected distance visual acuity (CDVA) using a high-contrast logMAR chart, contrast sensitivity measured with the Pelli-Robson chart, range of accommodation using the Royal Air Force (RAF) rule, pseudoaccommodation and mesopic and scotopic pupil diameters measured with a power refractor, and patient satisfaction evaluated using a previously validated questionnaire 3 months after second-eye surgery. RESULTS: The difference in the mean value between the 2 IOLs (40 patients) was 0.015 (95% confidence interval [CI], 0.0009 to 0.070) for CDVA in favor of the spherical IOL, 0.02 (95% CI, -0.0534 to 0.0159) for contrast sensitivity, and 0.05 (95% CI, -1.90 to +2.90) for range of accommodation. Questionnaire results showed no difference in dysphotopsia or patient satisfaction between the 2 IOLs. CONCLUSIONS: Although there were no statistically significant differences in contrast sensitivity, range of accommodation, dysphotopsia, or subjective patient satisfaction or preference between the 2 IOLs, the difference in CDVA was statistically significant, but not clinically important (relative difference 1.5%), in favor of the spherical IOL. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Intraocular pressure outcome in primary 5FU phacotrabeculectomies compared with 5FU trabeculectomies.

PURPOSE: Combined surgery for glaucoma and cataract may not achieve as low intraocular pressure (IOP) as compared with trabeculectomy alone. The aim of this study was to assess the IOP control of 5-fluorouracil (5FU) phacotrabeculectomies compared with 5-fluorouracil trabeculectomies. METHODS: A retrospective, nonrandomized study of consecutive primary 5FU phacotrabeculectomies and primary 5FU trabeculectomies. The main outcome measures were preoperative and postoperative IOP, number of medications, visual acuity, and complications. RESULTS: Forty-five 5FU phacotrabeculectomies and 47 5FU trabeculectomies were performed with a mean follow-up of 43.1 and 36.6 months, respectively. The absolute success rate as defined as an IOP equal to or less than 16 mm Hg on no glaucoma drops was 62.2% for the phacotrabeculectomy group and 63.8% for the trabeculectomy group. These success rates were not statistically significantly different (log-rank test P = 0.81 for absolute success and P = 0.29 for relative success). The magnitude of the treatment effect was found to be significantly greater in the T group compared with the PT group (a 44.6% reduction in IOP in the T group compared with a 31.2% reduction in the PT group). The phacotrabectomy group underwent significantly more postoperative 5FU injections compared with the trabeculectomy group (P = 0.008). CONCLUSIONS: 5FU phacotrabeculectomy seems to be a safe and effective treatment option in terms of IOP control. Patients with both coexistent glaucoma and cataract could be considered for combined surgery.

Cause-specific visual impairment and mortality: results from a population-based study of older people in the United Kingdom.

OBJECTIVE: To assess the association between mortality and cause-specific visual impairment in older people. METHODS: Visual acuity and causes of visual impairment were collected in 13 569 participants 75 years and older participating in a randomized trial of health screening. Participants were followed up for mortality for a median of 6.1 years. RESULTS: Compared with those with 6/6 (or 20/20 Snellen) or better visual acuity, the age- and sex-adjusted rate ratio for visually impaired people (binocular visual acuity <6/18 or <20/60 Snellen) was 1.60 (95% confidence interval, 1.47-1.74), which was markedly attenuated (rate ratio, 1.17; 95% confidence interval, 1.07-1.27) after adjustment for confounding factors. People whose visual impairment was due to cataract or age-related macular degeneration had excess risks of all-cause and cardiovascular mortality, which disappeared after adjustment. People with refractive error remained at small risk, despite adjustment, probably owing to residual confounding from factors associated with minimal use of eye services rather than underlying eye disease. There were no associations with cancer mortality. CONCLUSION: Associations reported for visual impairment and mortality or for specific causes of visual impairment reflect confounding by comorbidities, risk factors, and other factors related to susceptibility to death rather than an independent biological association of vision problems or specific eye diseases.

Needle revision of failing and failed trabeculectomy blebs with adjunctive 5-fluorouracil: survival analysis.

PURPOSE: To report the outcome of 5-fluorouracil (5-FU)-augmented bleb needling revision of failed and failing filtration blebs and to identify risk factors for failure, indicators for success, and any complications of the procedure. DESIGN: Prospective, observational, noncomparative, interventional case series with survival analysis. METHODS: The results of 101 bleb needling procedures augmented with subconjunctival 5-FU injection were determined after a minimum follow-up of 9 months. Kaplan-Meier plots were constructed and a Cox proportional hazards regression analysis was performed to assess the association between study factors and time to failure. MAIN OUTCOME MEASURES: Reduction in intraocular pressure (IOP) by 2 criteria (<22 mmHg, >30%), glaucoma medications, complications, and factors associated with outcome. RESULTS: At the time of their last follow-up visit, 60 eyes had an IOP <22 mmHg, mean IOP being reduced from 26.5 mmHg to 15 mmHg [corrected] after a median of 1 needling procedure (mean, 1.6). The median interval between the "index" filtration surgery and the first (or only) needling procedure was 3.1 months, with a range of 10 days to 11 years. There was a reduction in mean number of topical antiglaucoma agents from 0.7 to 0.2 per successful eye and a median follow-up duration of 18.7 months (range, 9.3-52.8 months [corrected]). Thus, the overall cross-sectional success rate of the procedure at the time of the last visit was 59.4%. Strong evidence was found for an association between the immediate attainment of a low IOP (<11 mmHg) and longer survival times. None of the other proposed factors that may have affected outcome were identified as having a statistically significant effect; however, this may have been the result of the low statistical power for some of the factors in this study. CONCLUSIONS: These data suggest that bleb needling augmented with 5-FU is a safe and effective method by which a significant number of failed or failing filtration blebs can be rescued from failure. Attaining an immediate reduction in IOP to <11 mmHg seems to be a favorable factor with respect to reasonably long-term efficacy .