Indications for cataract surgery.

This review article will attempt to guide ophthalmologists in deciding the indications for cataract surgery. It will consider this year's visual function questionnaires, ancillary vision tests, and postoperative outcome measures to assess visual function. Cultural factors, age, and gender are a few of the confounding variables in trying to assess visual function. The indications for cataract surgery in the 21st century have evolved dramatically since cataract surgery was first performed in the 1700s. The physicians' dictum in the Hippocratic oath of "do no harm" has determined the indications for cataract surgery over time. Today, doing no harm means operating on cataracts earlier than previously, as this is technically easier than in previous years, when poorer surgical techniques prevailed. However, are we operating on cataracts too early? This review will attempt to highlight the relevant factors that will help to determine the indications for cataract surgery.

Prevalence of ocular hemorrhage in patients receiving warfarin therapy.

BACKGROUND: Warfarin, the drug most commonly used for outpatient anticoagulation therapy, has bleeding as its main side effect. The objective of this study was to determine the prevalence of ocular hemorrhage in patients receiving warfarin and to compare it to the prevalence in the general population. METHODS: Patients receiving warfarin therapy who were attending the anticoagulation clinic at a tertiary care hospital in Montreal between October and December 1996 received a flyer inviting them to have their eyes examined to look for "ocular bleeding." Consenting patients were examined for subconjunctival hemorrhage, gross hyphema, and vitreous and retinal hemorrhages through external ocular examination and funduscopic examination with the pupils dilated using direct and indirect ophthalmoscopy. RESULTS: Of the 1225 patients seen at the clinic 126 (10%) agreed to participate. Four patients (3%) were found to have intraretinal hemorrhage at the time of examination. All hemorrhages were visually insignificant. INTERPRETATION: The risk of retinal hemorrhage in patients without preexisting ocular disease, such as retinal neovascularization or choroidal vasculopathy, who are receiving warfarin therapy is so small that it should not deter physicians from prescribing this drug when indicated.

Anterior dislocation of a posterior chamber intraocular lens after blunt trauma.

An 85-year-old man developed an anterior dislocation of a posterior chamber intraocular lens (IOL) after blunt trauma. The dislocated IOL was exchanged for an anterior chamber IOL. Visual acuity was 20/40 at the 6 month follow-up. This case presents an unusual sequela of trauma to a pseudophakic eye and discusses management issues that should be considered.

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 20/70 or 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.

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.