Functional visual outcomes of cataract surgery in patients with 20/20 or better preoperative visual acuity.

PURPOSE: To measure the visual outcomes after cataract surgery in patients with 20/20 or better preoperative visual acuity. SETTING: University-based cataract referral practice. METHODS: In this retrospective case review, 2 groups of patients with a corrected distance visual acuity (CDVA) of 20/20 or better in both eyes before cataract surgery were identified. Patients in the first group had a cataract in 1 eye and an intraocular lens (IOL) in the other eye. Patients in the second group had cataracts in both eyes. Each patient completed a Visual Function 14 (VF-14) questionnaire before and after cataract surgery. Changes in VF-14 scores were analyzed. RESULTS: The VF-14 scores improved significantly after cataract surgery in both groups. Patients with cataract in 1 eye and an IOL in the other eye before surgery (n = 28) had a mean improvement of 12.2 in the VF-14 score (P = .029). Patients with cataract in both eyes (n = 31) had a mean improvement of 14.5 in the VF-14 score (P<.0001). CONCLUSIONS: The functional vision of patients with 20/20 or better preoperative CDVA improved significantly after cataract surgery. This finding shows that arbitrary CDVA thresholds of worse than 20/20 cannot always be used to determine who will benefit from cataract surgery.

Correction of astigmatism at the time of cataract surgery.

PURPOSE OF REVIEW: There are several options for correcting astigmatism at the time of cataract surgery. They include incision placement on the steep axis of corneal astigmatism, single or paired peripheral corneal relaxing incisions, and toric intraocular lens implantation. The aim of this review is to update readers on advances reported during the last year. RECENT FINDINGS: Phacoemulsification incision placement on the steep corneal axis corrects small amounts of astigmatism and is sufficient for most eyes. Peripheral corneal relaxing incisions correct greater amounts of astigmatism. They may be necessary when implanting multifocal intraocular lenses in eyes with more than 1 diopter of astigmatism. Toric intraocular lenses are also safe and effective for treating more than 1 diopter of astigmatism, and they now have excellent rotational stability. SUMMARY: Good uncorrected postoperative distance visual acuity can be obtained for a high percentage of cataract patients with preexisting corneal astigmatism. Postoperative keratorefractive surgery is available to enhance the condition of patients who achieve less-than-optimal astigmatic results.

Avoidance, recognition, and management of LASIK complications.

PURPOSE: To provide important concepts of the latest developments in laser in situ keratomileusis (LASIK) complication avoidance, recognition, and management. DESIGN: A perspective. METHODS: A comprehensive literature search and review of a total of 816 publications that discussed LASIK complications from 1992 to 2005 was conducted. RESULTS: The risk of visually threatening complications is inherent in any ophthalmologic surgical procedure. Not only does LASIK require the use of several complex medical devices, but there can be significant human variation in response to this surgical intervention. As a result, many potential complications can occur after LASIK. The risk of many complications can be mitigated by appropriate patient selection and preoperative, surgical, and postoperative care. Unforeseen complications will occur, despite meticulous planning, and must be managed. Important current developments in the avoidance, recognition, and management of LASIK complications are reviewed. CONCLUSIONS: Complications as a result of LASIK can threaten vision and may cause debilitating symptoms in an otherwise healthy eye. Advancing our understanding of the prevention and management of the complications of LASIK is an endeavor that must be continued as long as refractive surgery is performed.