Complication rates of resident-performed cataract surgery: Impact of early introduction of cataract surgery training.

PURPOSE: To determine the effect of the early introduction of cataract surgery training on the complication rates of resident-performed cataract surgery. SETTING: University of California San Diego, San Diego, California, USA. DESIGN: Retrospective case series. METHODS: Two classes of ophthalmology residents were examined, one class with a late introduction of cataract surgery and one with an early introduction of cataract surgery. All cataract cases in which residents acted as primary surgeon were included. Patient charts were reviewed to collect data on patient characteristics, surgical details, and intraoperative and postoperative complications. RESULTS: The late-introduction cohort comprised 3 residents who performed 540 cataract cases, all during their final year of residency. The early-introduction cohort comprised 4 residents who performed 780 cataract cases beginning in the first year of residency. The late-introduction cohort had higher rates of major intraoperative complications than the early-introduction cohort (8.5% versus 3.1%) and of anterior vitrectomy (7.6% versus 2.1%) (both P < .001). Examination of the anterior vitrectomy rate as a function of experience showed the early-introduction cohort had a stable anterior vitrectomy rate of 1% to 2% throughout training, while the late-introduction cohort had a peak anterior vitrectomy rate of 12% at approximately case 20. Multivariable regression analysis showed the early-introduction cohort was independently associated with a lower rate of anterior vitrectomy (hazard ratio, 0.49; 95% confidence interval, 0.36-0.66) after adjusting for differences in patient characteristics and surgical complexity. CONCLUSIONS: Early introduction of cataract surgery training significantly decreased the rate of major intraoperative complications, specifically anterior vitrectomy, in resident-performed cataract surgeries.

A qualitative investigation of visual tasks with which to assess distance-specific visual function.

BACKGROUND: The ability to perform many daily tasks relies on good visual acuity at various distances. A review of existing measures of visual function revealed gaps in task content, particularly tasks that rely on intermediate vision. PURPOSE: This research sought to extend the content base and visual range coverage of tasks used to assess visual function. METHODS: Ophthalmology patients (n = 72) with myopia, hyperopia, presbyopia, astigmatism, cataracts, and/or glaucoma were involved in various qualitative sub-studies, including life event journaling, telephone interviews, and both on-line and face-to-face focus groups. The resulting journal entries and transcripts were thematically analyzed to identify visual tasks that rely on visual acuity in the near, intermediate, and distant visual ranges. RESULTS: A wide variety of distance-specific visual tasks were identified. Certain types of tasks relied on distance vision, such as; ambulation, driving, leisure and sports, and social functions. Other task groupings such as technology use and activities of daily living relied primarily on near and intermediate vision. Two new content areas were identified, technology use and safe task performance. CONCLUSIONS: This thematic analysis provides a rich body of information about tasks that affect daily life and are made more difficult by poor visual acuity at various distance ranges.

Morphologic and volumetric studies of the meibomian glands in elderly human eyelids.

PURPOSE: To study the microscopic structure of postmortem human Meibomian glands (MGs) in the elderly. METHODS: Human MG samples from left lower eyelids were obtained at autopsy from 5 men and 4 women with a mean age of 63.1 +/- 7.67 years. The tissues were fixed and embedded in paraffin. Serial transverse sections 5 mum thick were stained with hematoxylin and eosin (H&E), van Gieson, and Masson blue stains. Computer-assisted 3-dimensional reconstructions of MGs were performed, and morphologic and volumetric data were analyzed. RESULTS: The average length of human MGs in the nasal, central, and temporal areas was 1.551 +/- 0.43, 1.654 +/- 0.47, and 1.594 +/- 0.57 mm, respectively. The average surface area of the glands in the nasal, central, and temporal areas was 0.029 +/- 0.03, 0.033 +/- 0.01, and 0.056 +/- 0.03 mm, respectively. The average volume of glands in the nasal, central, and temporal areas was 0.054 +/- 00.4, 0.056 +/- 0.03, and 0.053 +/- 0.03 mm, respectively. A circular, floral arrangement of acini, surrounding the terminal duct just deep to the skin, is probably responsible for the circular arrangement seen clinically around each healthy orifice. We confirmed that most glands are embedded within a cylindrical, connective tissue matrix. CONCLUSIONS: We report the dimensions of normal Meibomian acini in an older population. Some structural features observed may explain normal physiologic landmarks or contribute to glandular pathophysiology.