Perception of difficulties with vision-related activities of daily living among patients undergoing unilateral posterior capsulotomy

Nd:YAG Laser Capsulotomy: Efficacy and Outcomes Performed by Optometrists

SIGNIFICANCE

An increasing number of optometrists are performing Nd:YAG laser capsulotomy procedures; however, there is limited published information on the outcomes of these procedures.

PURPOSE

This study aimed to assess the efficacy and safety of capsulotomy procedures performed by optometrists.

METHODS

Subjects diagnosed with posterior capsule opacification causing reduced vision and subjective visual complaints were recruited for this study. A baseline examination was performed to ensure that the subjects met all the necessary criteria. The procedure was performed by a licensed doctor of optometry at six different clinics, and each subject was monitored for visual outcome and any potential complications.

RESULTS

Subjects' Snellen visual acuity improved from an average of 20/40 to 20/23 ( P < .001) with no complications of increased intraocular pressure, inflammation, visually significant lens pitting, macular edema, or retinal detachment. Of 78 subjects who responded to a post-procedure survey, 77 (99%) reported subjective improvement in vision after capsulotomy.

CONCLUSIONS

Based on the outcomes of this study, YAG laser capsulotomies are effective treatments to improve patient vision that can be safely and effectively performed by optometrists.

Stress and vision-related quality of life in acute and chronic central serous chorioretinopathy

BACKGROUND

To compare vision-related quality of life (VRQOL) between acute and chronic Central serous chorioretinopathy (CSC) and correlate this with Cohen's Perceived Stress Scale (PSS) questionnaire.

METHODS

Patients who were diagnosed with both acute and chronic CSC were recruited in this study. Vision-related quality of life (VRQOL) was assessed with Rasch revised National Eye Institute Visual Functioning Questionnaire 25 (NEI-VFQ25) and perceived stress with Cohen's PSS questionnaire in 118 subjects with either acute or chronic CSC. The quality of life score was compared between patients with acute and chronic CSC. Correlations between the functional score and visual acuity (VA), stage of CSC, and stress were studied.

RESULTS

There was no significant difference in VRQOL between Acute and Chronic CSC. In Acute CSC, affected eye VA correlated significantly with near vision question of the visual function subscale. Better eye VA correlated significantly with distance vision, social function, role limitation and dependency of the socioeconomic subscale. In chronic CSC, affected eye VA correlated with social function question of the socioemotional subscale and the better eye VA correlated with driving and distance vision of the visual function subscale. No other significant correlations with VA were noted. No correlations were observed between outcome of Cohen's PSS questionnaire and NEI-VFQ25 scores of acute and chronic CSC.

CONCLUSION

The VRQOL is similar between acute and chronic CSC. Perceived stress was not found to influence the VRQOL in CSC.

Further Enhancement of Intraocular Open-Capsule Devices for Prevention of Posterior Capsule Opacification

Purpose

We improve the intraocular open-capsule devices (IOCD) for the prevention of posterior capsule opacification (PCO).

Methods

A total of 45 New Zealand rabbit eyes were divided into six similar groups after crystalline lens evacuation. Each group was implanted with a hydrophilic intraocular lens (IOL) and a hydrophilic IOCD of different designs. In the first experiment (Part A), a square design ring with and without large apertures was compared to a round design ring without apertures. In the second experiment (Part B), a square design ring with large apertures was compared to square design IOCDs with small apertures of high and low density. PCO and Soemmering's ring were evaluated clinically, by the Miyake Apple view, and histologically. The results were compared to a control group of eyes implanted with a hydrophilic IOL only.

Results

All devices showed significant prevention of PCO and Soemmering's ring compared to the control group. Part A: the square design with apertures had the lowest level of peripheral lens epithelial cells proliferation (protrusions). Part B: modifying the size and density of the apertures had no influence on those protrusions.

Conclusions

The IOCD significantly reduced the rate of PCO and its precursor, Soemmering's ring. The rings with the square edges and apertures produced the best results. The study was underpowered to determine the influence of the apertures design.

Translational Relevance

The IOCD has the potential to prevent up to 80% of the PCO cases; the most common complication after cataract surgery. The design of the ring is important for its success.

Improvement of visual acuity in diabetic and nondiabetic patients after Nd:YAG laser capsulotomy

Purpose

The aim of the study reported here was to compare the improvement of visual acuity (VA) of diabetic and nondiabetic patients after neodymium-doped yttrium-aluminum-garnet (Nd:YAG) laser capsulotomy.

Methods

In this prospective cohort study, 50 age- and sex-matched patients, comprising 25 nondiabetics and 25 diabetics (referred to as Group A and B, respectively), with posterior chamber poly(methyl methacrylate) non-foldable intraocular lens implants attending our clinic at Karachi for capsulotomy had pre- and postoperative measures of VA, posterior pole visibility, and grading of posterior capsular opacity as seen on slit-lamp examination. VA was recorded before and after performing standard capsulotomy.

Results

The postoperative (mean) VA in nondiabetics was 0.25, 0.23, and 0.21 logMAR as compared with 0.25, 0.25, and 0.24 logMAR in diabetics at 1 week, 1 month, and 6 months, respectively. P-values of 0.47, 0.47, and 0.24, respectively, were determined, which were not significant. Preoperative VA improvement was recorded in 92% of diabetics in Group B and 96% of nondiabetics in Group A. Two (8%) diabetic patients developed glaucoma and did not participate in the study further.

Conclusion

Remarkable improvement in VA was achieved in both Group A and B, but the Group A nondiabetics showed more improvement in best-corrected VA after Nd:YAG laser capsulotomy.

Visual function and quality of life in pseudophakic patients before and after capsulotomy

PURPOSE

To assess the correlation between visual acuity, visual function, and health-related quality of life before and after neodymium:YAG laser posterior capsulotomy.

METHODS

A total of 150 patients with posterior capsule opacification (PCO) were examined before and after capsulotomy. Ocular examination, visual acuity, patient reports of satisfaction with vision, and disease-specific (VF-14 Index of Visual Functions) and generic (EuroQol: EQ-5D) outcomes were measured at baseline and 3 weeks after treatment.

RESULTS

After capsulotomy, patients showed significant improvements in binocular visual acuity, VF-14 index, satisfaction with vision, and EQ-5D measures. The average gains in visual function and quality of life were apparent in groups with good visual outcome and poor visual outcome. The VF-14 score improvement was moderately correlated with the EuroQol Visual Analogue Scale score improvement, showing stronger correlations with changes in self-reported satisfaction with vision than did gains in binocular visual acuity.

CONCLUSIONS

Measuring of the outcomes of capsulotomy by clinical indicators alone may underestimate the overall benefits of treatment. Visual acuity in conjunction with visual function and health-related quality of life questionnaires will likely prove to be better indicators of the need for and outcome of capsulotomy.