Social impact indicators in patient diagnosed of senile cataract treated with phacoemulsification plus intraocular lens implantation.

PURPOSE: To analyze indicators of social impact in patients with senile cataract treated with phacoemulsification and intraocular lens (IOL) implant. MATERIAL AND METHODS: Patients ≥ 60 years, better corrected visual acuity (BCVA) ≥ 0.6 logarithm of the minimum angle of resolution (LogMAR) and senile cataract treated with PHACO + IOL for cases and incipient senile cataract without surgical treatment with MVCA < 0.6 LogMAR for controls. Exclusion criteria; pathologies that modify the quality of life. The WHOQOL-OLD test was applied: presurgical, one postoperative month and three postoperative months. RESULTS: 54 controls and 56 cases were included. The preoperative BCVA was 1.57 ± 1.041, third month was 0.68 ± 0.7817 (p < 0.001). The results of the preoperative WHOQOL-OLD survey vs the third month: INT 12.96 versus 11.06 (p < 0001); DAD, 10.48 versus 6.389 (p < 0.00001); SOP 12.07 versus 13.76 (p < 0.0007) and SAB, 13.02 versus 8.648 (p < 0.0001). The survey of the 3rd month versus the controls: INT 9.66 versus 11.06 (p < 0.001); PPF, 13.89 versus 12.39 (p < 0.001) and AUT 12.47 versus 10.15 (p < 0.001). CONCLUSION: Patients, present an improvement in the BCVA that is reflected in the quality of life, this can be interpreted as positive results and should be taken into account to support the surgical indication.

OBJETIVO: Analizar indicadores de calidad de vida en pacientes con catarata senil tratados con facoemulsificación más implante de lente intraocular. MÉTODO: Pacientes a partir de 60 años de edad, con agudeza visual mejor corregida (AVMC) ≥ 0.6 LogMAR y catarata senil tratada con facoemulsificación más implante de lente intraocular para casos y catarata senil incipiente sin tratamiento quirúrgico con AVMC < 0.6 LogMAR para controles. Criterios de exclusión: patologías que modificaran la calidad de vida. Se aplicó la encuesta WHOQOL-OLD en el preoperatorio y a 1 y 3 meses posquirúrgicos. RESULTADOS: 54 controles y 56 casos. La AVMC preoperatoria fue 1.57 ± 1.041, y al tercer mes 0.68 ± 0.7817 (p < 0.001). Los resultados de la encuesta preoperatoria en comparación con el tercer mes fueron: dominio de intimidad 12.96 vs. 11.06 (p < 0.0001); dominio de muerte y agonía 10.48 vs. 6.389 (p <0.00001); dominio de participación social 12.07 vs. 13.76 (p < 0.0007); y dominio de capacidad sensorial 13.02 vs. 8.648 (p < 0.0001). Los resultados de la encuesta del tercer mes en comparación con los controles fueron: dominio de intimidad 9.66 vs. 11.06 (p < 0.001); dominio de actividades pasadas, presentes y futuras 13.89 vs. 12.39 (p < 0.001) y dominio de autonomía 12.47 vs. 10.15 (p < 0.001). CONCLUSIÓN: Los pacientes presentan una mejora en la AVMC y en los resultados de la WHOQOL-OLD, por lo que deben ser tomados en cuenta para apoyar la indicación quirúrgica.

Effect of music tempo on operating room preparation time.

Most operating rooms around the world play music, both during the surgeries and in between cases. We investigated whether music tempo (fast or slow) can affect the operating room preparation time in between surgeries (turnover time) in an ambulatory outpatient surgical centre setting. We compiled two playlists, one with fast upbeat tempo and the other with slow relaxing tempo. Each of the playlists was played throughout the workday in the operating room for one week with the same surgeon and nursing staff. The turnover times for each case were analysed. Inclusion criteria were standard cataract extraction with intraocular lens implant surgery. Exclusion criteria were any external reasons causing delays in the turnover time (such as anaesthesia team break time, computer system down, etc.). The turnover time from 32 cases in the slow group and 26 cases in the fast group were compared with Student's t test. The turnover time was significantly faster in the fast group versus the slow group (17.0 ± 0.60 vs. 20.1 ± 0.96, p < 0.03). Our study demonstrated that fast music tempo in the operating room can significantly reduce turnover time. This improved efficiency could potentially lead to significant cost savings in the healthcare sector.

Monovision with a Bifocal Diffractive Multifocal Intraocular Lens in Presbyopic Patients: A Prospective, Observational Case Series.

PURPOSE: We report the visual outcomes and patient satisfaction after bilateral implantation of a bifocal diffractive intraocular lens with monovision. DESIGN: Prospective, observational case series. METHODS: Twenty-one subjects underwent cataract surgery or refractive lens exchange with bilateral implantation of the ZMB00 intraocular lens, with the dominant eye and nondominant eye targeted for plano and -1.25 to -1.00 diopters, respectively. Postoperative assessments included visual acuity (VA) at various distances under photopic and mesopic conditions; defocus curve, contrast sensitivity, and stereopsis; and Visual Function Questionnaire-25 and supplementary questionnaire. RESULTS: Mean binocular uncorrected VA at distance, intermediate (67 cm), and near (30 cm) were -0.03 ± 0.06, 0.12 ± 0.18, and 0.11 ± 0.05, respectively. No eyes lost >1 line of corrected distance VA. Binocular intermediate VA was significantly better in the uncorrected condition (P = .004) whereas binocular distance VA was better in the distance-corrected condition (P = .014). Near VA was similar in both conditions (P > .05). Stereoacuity and contrast sensitivity were within normal limits. All subjects had a composite score of ≥90 for vision-targeted items in the National Eye Institute Visual Function Questionnaire-25. Halos, glare, and starbursts occurred in 52%, 29%, and 24% of subjects, respectively. All subjects reported a satisfaction score of ≥3.5 of 5 and required no spectacles postoperatively. No intraocular lens exchange was required. CONCLUSIONS: Monovision with bilateral bifocal multifocal intraocular lens was safe and provided satisfactory vision at various distances, with good stereopsis and contrast sensitivity. Complete spectacle independence and high satisfaction score were achieved. In comparison with bilateral emmetropic bifocal multifocal intraocular lens, it provided better vision at intermediate and at very near distances without inducing more dysphotopsia.

Qualidade de vida e visão pós-facectomia / Quality of life and vision post-facectomy

Resumo Objetivo: A catarata é a principal causa de cegueira reversível no mundo e seu tratamento é baseado em cirurgia, facectomia. A evolução do procedimento tem se baseado em vários pilares, mas é no desenvolvimento de novos tipos de lentes intraoculares que vem mostrando inovações consideráveis. As lentes atuais são capazes, além de tratar a catarata, de corrigir erros refracionais. O objetivo deste estudo foi avaliar a qualidade de vida e de visão pós-facectomia, comparando as lentes multifocais (Restor), tóricas, monofocais esféricas (SN60AT) e monofocais asféricas. Métodos: A pesquisa abrangeu 54 pacientes submetidos a facectomia com implantação de uma das lentes há, pelo menos, 3 meses. Os pacientes responderam questionário de qualidade de vida Cataract TyPE Specification sobre satisfação de visão, dependência de óculos para diversas atividades diárias e presença de fenômenos disfóticos. Para análise dos dados foram utilizados os testes de Kolmogorov-Smirnov, quanto a normalidade e ANOVA com teste de Tukey, quanta parametria. Em comparações não paramétricas, utilizou-se o teste de Mann-Whitney. Em todas as análises foi usado o mesmo nível de significância (p<0,05). Resultados: Numa escala de 0 a 10, a pesquisa mostrou que as lentes SN60AT, esféricas monofocais, foram as que obtiveram menor nível de satisfação entre as 4 lentes, obtendo média de 8,7 (DP= 1,30; IC ± 0,655), seguido das esféricas monofocais (média= 8,3 - DP= 1,83; IC ± 0,927), das esféricas multifocais (Restor) (média = 8,9 - DP = 1,42; IC ± 0,721) e as tóricas (média = 9,1 - DP = 1,67; IC ± 0,844) como a de maior nível de satisfação. Em relação à dependência dos óculos, a lente Restor foi a que mostrou melhor desempenho, com menor dependência dos óculos. Fenômenos disfóticos foram mais frequentes nos pacientes que tiveram implantada a lente SN60AT seguida de lente Restor. Conclusão: Conclui-se que as lentes SN60AT foram as lentes que causaram menor grau de satisfação, tendo os fenômenos disfóticos umas das principais queixas, associada a dependência dos óculos pós-cirurgia. Os pacientes que tiveram as lentes Restor implantadas, apesar dos sintomas disfóticos mais presentes do que as lentes monofocais tóricas e monofocais esféricas, tem o mesmo nível de satisfação, e ainda proporciona maior independência dos óculos.

Abstract Objective: Cataract is the leading cause of reversible blindness in the world and its treatment is based on surgery, facectomy. The evolution of the procedure has been based on several pillars, but it is in the development of new types of intraocular lenses that has been showing considerable innovations. Current lenses are capable, in addition to treating cataracts, of correcting refractive errors. The aim of this study was to evaluate the quality of life and post-facectomy vision, comparing multifocal lenses (Restor), toric, spherical monofocals (SN60AT) and aspheric monofocals. Methods: The study included 54 patients undergoing a facectomy with implantation of one of the lenses for at least 3 months. The patients answered questionnaire quality of life Cataract TyPE Specification on vision satisfaction, glasses dependence for various daily activities and presence of dysphothetic phenomena. For the analysis of the data, the Kolmogorov-Smirnov tests were used, regarding normality and ANOVA with Tukey's test, how much parametric. In non-parametric comparisons, the Mann-Whitney test was used. In all analyzes, the same level of significance was used (p <0.05). Results: On a scale of 0 to 10, the research showed that single-spherical spherical SN60AT lenses were the ones that obtained the lowest level of satisfaction among the four lenses, obtaining an average of 8.7 (SD = 1.30, CI ± 0.655), followed (mean = 8.9 - SD = 1.42, CI ± 0.721) and the toric (mean = 8.3 - SD = 1.83, CI ± 0.927), multifocal spherical (Restor) 9.1 - SD = 1.67, CI ± 0.844) as the highest level of satisfaction. Regarding the dependence of the glasses, the Restor lens showed the best performance, with less dependence on the glasses. Dysphasic phenomena were more frequent in patients who had implanted the SN60AT lens followed by Restor lens. Conclusion: It is concluded that the SN60AT lenses were the lenses that caused less satisfaction, and the dysphothetic phenomena were one of the main complaints, associated with the postoperative glasses dependence. Patients who had restored Restor lenses, despite the more present dysphoric symptoms than spherical monofocal and single-focal lenses, have the same level of satisfaction, and still provide greater independence of the glasses.

[Evaluation of quality of life of patients after phacoemulsification with accommodating lens implantation]. / Ocena jakosci zycia pacjentów po fakoemulsyfikacji z wszczepieniem akomodacyjnej soczewki wewnatrzgalkowej.

INTRODUCTION: Intraocular lens implantation is an important part of cataract surgery, as it has a significant influence on the final result. Accommodative intraocular lenses (IOLs) are the latest solution for the lack of accommodation in pseudophakic eyes. PURPOSE: To evaluate the quality of life of patients who underwent cataract surgery with accommodating IOL implantation and to compare the data with results of patients after standard monofocal IOL implantation. MATERIAL AND METHODS: The study group consisted of 20 patients (40 eyes), aged from 48 to 73 years old, who underwent phacoemulsification through a 2.75 mm clear corneal incision followed by the implantation of an accommodating IOL Crystalens HD (Bausch & Lomb, USA). The control group consisted of 20 patients (40 eyes), aged from 63 to 83 years old, who underwent phacoemulsification through a 2.75 mm clear corneal incision followed by the implantation of a standard monofocal single-piece acrylic intraocular lens AcrySof (Alcon, USA). All enrolled patients had no coexisting ocular diseases which could influence the final visual acuity. All surgeries were uneventful. At one month postoperatively, the patients were requested to answer 36 questions included in the questionnaire in order to evaluate the quality of visual function. RESULTS: There was a significant improvement in the quality of life in both groups after cataract surgery. The study group tended to assess their own eyesight higher than the control group. Patients from the study group use spectacle correction for a lower number of activities, they find it easier to use fine motor skills when performing activities without spectacle correction in comparison with patients from the control group. Patients from the study group use spectacle correction for reading significantly less frequently, they also find it easier to read the normal size and small print without spectacle correction, in comparison with patients from the control group. CONCLUSIONS: Patients with accommodating IOLs self-evaluate their own eyesight highly, use spectacle correction for a lower number of activities and find it significantly easier to perform precise activities without spectacle correction, in comparison with patients after the standard monofocal intraocular lens implantation.

Parenting stress in the infant aphakia treatment study.

OBJECTIVE: To evaluate parenting stress following infants' cataract extraction surgery, and to determine if levels of stress differ between 2 treatments for unilateral congenital cataract in a randomized clinical trial. METHODS: At surgery, an intraocular lens (IOL) was implanted or children were left aphakic, treated with contact lens (CL). Stress measures were administered 3 months after surgery and at the first visit after the visual acuity (VA) assessment done at 12 months of age. RESULTS: Caregivers in the IOL group reported higher levels of stress than those in the CL group 3 months after surgery, but there were no group differences in stress scores at the post-VA assessment. Stress scores did not change differentially for participants assigned to IOL versus CL treatments. CONCLUSIONS: Treatment assignment did not have a significant impact on caregiver stress during infancy or on the change in stress during the child's first 2 years of life.

Quality-of-life and visual function after manual small incision cataract Surgery in South Western Nigeria.

BACKGROUND: Outcome studies after cataract surgery should focus on functional status and quality of life instead of visual acuity measurement alone. OBJECTIVE: To assess patients' quality of life (QoL) and overall visual function (VF) after manual small incision cataract surgery (SICS) with intraocular lens (IOL) implantation. METHODS: A prospective hospital based study which evaluated the preoperative and postoperative visual function and vision related QoL among patients presenting with first eye cataract at an eye hospital in South Western Nigeria using the VF-14 questionnaire and the vision related QoL questionnaire. RESULTS: One hundred and eighty two patients were enrolled for the study with a mean age of 66.5 ± 10.46. The mean preoperative visual function (VF) score was 40.17 ± 33.59 (range 0 to 82.14) and postoperatively it was 88.79 ± 20.15 (range 0 to 100) p value <0.001. Prior to surgery, 50 (27.6%) patients had visual function score. 75% however after surgery 161 (88.2%) patients had a visual function score of over 75%. (p value <0.001). Using the vision related QoL questionnaire, the highest impact of visual recovery after cataract surgery was improvement with mobility in almost 80% of the patients. CONCLUSION: This study has demonstrated improvement in vision related quality of life and visual function, resulting in rapid recovery of the patient's functional independence and health status following manual SICS. Small incision cataract surgery should therefore be offered to more patients in the African sub-region.

[Predictors of quality of life in refractive surgery]. / Les prédicteurs de qualité de vie en chirurgie réfractive.

PURPOSE: To investigate predictors of quality of life in refractive surgery: psychological status, quality of vision, visual acuity, and patient satisfaction. METHODS: In a prospective study, 143 patients were evaluated preoperatively and after the third postoperative month using the same questionnaire. Quality of vision, visual acuity, well-being, self-esteem, coping, and patient satisfaction were analyzed with 47 parameters. Refractive procedures included PRK, LASIK, and phakic IOL. Four groups of low (G1), medium (G2), and high myopia (G3) and hyperopia (G4) were individualized to compare the results. RESULTS: We noted a mean postoperative best corrected visual acuity (BCVA) of 20/25 or more for the G1, G2, and G4 groups. For the G3 group, the mean BCVA was increased, with a gain of two Snellen Lines from 20/50 to 20/32. Postoperative patient satisfaction improved, with a significant difference (p<0.05) in all groups. We noted no significant difference in all myopic groups in well-being and no significant decrease in G4. Concerning self-esteem and coping, scores improved, with a significant difference in G3 group (p<0.05). Quality of vision was directly correlated with improvement of quality of life (psychological status), satisfaction scores, and BCVA preoperatively and postoperatively in all patients, but no correlation was noted between visual acuity and patient satisfaction. CONCLUSION: In spite of good refractive results, modification of patient satisfaction depends on quality of vision and quality of life (psychological status) scores. These results give us a new tool that provides useful additional information in refractive surgery.

Intraocular lens implantation during infancy: perceptions of parents and the American Association for Pediatric Ophthalmology and Strabismus members.

BACKGROUND: To determine whether a randomized clinical trial, the Infant Aphakia Treatment Study, comparing intraocular lens (IOL) implantation with contact lens (CL) correction for infants with a unilateral congenital cataract (UCC), is feasible by (1) ascertaining whether American Association for Pediatric Ophthalmology and Strabismus (AAPOS) members have equipoise regarding these two treatments and (2) evaluating the willingness of parents to agree to randomization. METHODS: All AAPOS members were surveyed in August 1997 and again in June 2001 regarding their use of CLs and IOL implants to correct infants vision after unilateral cataract surgery. In addition, a pilot study was begun in March 2002 to evaluate the safety of IOL implantation during infancy and the willingness of parents to randomize their children with a UCC to either IOL implantation or CL correction. RESULTS: In 1997, 89% of the 260 respondents reported that in the previous year they had treated at least one infant with a UCC, but only 4% had implanted an IOL in an infant <7 months old. Silsoft (Bausch & Lomb, Rochester, NY) CL correction was the preferred treatment choice for 84% of the respondents. In 2001, 21% of the 279 respondents had implanted an IOL in an infant. On a scale from 1 to 10 with 1 strongly favoring an IOL implant and 10 strongly favoring a CL, the median score was 7.5. Sixty-one percent of the respondents indicated that they would be willing to randomize children with a UCC to one of these two treatments. The main concerns about IOL implantation were poor predictability of power changes, postoperative complications, inflammation, and technical difficulty of surgery. The main concerns about CL correction were poor compliance, high lens loss rate, high cost, and keratitis. In our pilot study, 30 infants <7 months of age were evaluated at nine clinical centers for a visually significant UCC. Of 24 infants eligible for randomization, the parents of 17 (71%) agreed to randomization. CONCLUSIONS: Although most AAPOS members still favor CL correction after cataract surgery for a UCC, five times as many had implanted an IOL in an infant in 2001 compared with the number in 1997. Parents were almost equally divided in their preference for IOL implant versus CL correction. Given the relative equipoise of AAPOS members regarding these treatments and the willingness of more than two thirds of parents to agree to randomization, it seems likely that a randomized clinical trial comparing these two treatments could indeed be conducted.

Cataract extraction with multifocal intraocular lens implantation: clinical, functional, and quality-of-life outcomes. Multicenter clinical trial in Germany and Austria.

PURPOSE: To compare bilateral implantation of a multifocal intraocular lens (IOL) versus a monofocal lens with respect to visual function, patient satisfaction, and quality of life. SETTING: Seven clinical sites in Germany and 1 site in Austria. METHODS: A prospective randomized masked clinical trial included 124 randomly assigned bilateral pseudophakic individuals, 64 of whom had bilateral implantation of an Array(R) foldable multifocal IOL (model SA-40N, Allergan) and 60 of whom had bilateral implantation of an AMO(R)PhacoFlex II(R) silicone monofocal IOL (model SI-40NB). Clinical data included binocular uncorrected and corrected distance and near visual acuities, complications, adverse events, and reports of halos and glare. Quality-of-life data were collected on 3 occasions using the modified Cataract TyPE Specification instrument. The functional status of the 2 groups was compared from baseline to final postoperative interview. RESULTS: Three months after surgery, a higher proportion in the Array group achieved a Jaeger value of J3 (20/40 Snellen) or better uncorrected binocular near visual acuity and 0.5 (20/40) or better distance-corrected binocular near visual acuity than in the monofocal groups (97% versus 68% and 95% versus 59%, respectively; P <.001). A higher proportion in the multifocal group achieved both 0.5 (20/40) and J3 or better uncorrected binocular distance and near visual acuities (97% versus 66%; P <.001). Those in the Array group were more likely than those in the monofocal group to never wear glasses overall (41% versus 12%; P <.001). Multifocal patients rated their vision without glasses better overall, at near and at intermediate distances (P <.05), and demonstrated better visual function for near tasks and social activities. CONCLUSIONS: Those who had bilateral implantation of the Array multifocal IOL obtained better uncorrected and distance-corrected near visual acuities and reported better overall vision, less limitation in visual function, and less spectacle dependency than patients with bilateral monofocal IOLs.

[Scale for evaluating desirable ametropia or eumetropia]. / Echelle d'évaluation de l'amétropie désirée ou eumétropie.

GOAL: The purpose of this study is to assess the degree of desirable ametropia in cataract surgery. MATERIAL AND METHODS: A scale for evaluation was created. It allows to measure the desired distance for a neat uncorrected vision (desired ametropia) after cataract surgery that presbyopic patients (monocular vision) would like to obtain. This scale helps to calculate the power of the intraocular lens to be implanted. The scale was shown to a series of 50 consecutive presbyopic patients. Refraction was the same in both eyes. The interest of patients in the evaluation of their desirable ametropia was measured on a scale from 0 to 5. RESULTS: Interest was good for 50% of patients (grade > or = 3). Mean distance desired by patients for a neat uncorrected vision was 1 meter. Preoperative myopia and hyperopia have no significantive influence upon the distance desired for a neat uncorrected vision. CONCLUSION: The choice of the power of the lens implanted during cataract surgery should take into account the patients' desires. An evaluation of the postoperative desirable ametropia should be systematic.

Refractive cataract surgery: office systems to improve results.

As we approach the second millennium, state-of-the-art cataract surgery means not only improved corrected vision, but also the opportunity to create better uncorrected distance and near visual acuity for patients by taking advantage of new technology and techniques. Patient satisfaction will ultimately depend on our ability and success in effectively meeting the challenge to reduce the need for spectacles after cataract surgery. A systemic and coordinated effort by various members of the office staff and the surgeon to monitor the results of IOL calculations will enhance the overall success for good uncorrected distance and near acuity after IOL implantation. Newer IOL theoretic formulas, better A-scan biometers, and the use of more reproducible A-scan techniques, such as immersion, can help to achieve greater accuracy. Newer computer software programs now offer database options to help in tracking results after surgery. As we carefully monitor postoperative results and troubleshoot those eyes that do not fall into the expected spherical target refraction after surgery, our IOL power accuracy improves and our patient's desire for less spectacle dependency will be satisfied.