The association between cataract surgery and mental health in older adults: a review

BACKGROUND

Although cataract surgery has been proposed as a potentially modifiable protective factor for enhancing emotional well-being in cataract patients, studies examining the relationship between anxiety or depression and cataract surgery have yielded inconsistent findings. This review summarizes existing evidence to establish whether cataract surgery is associated with depression and anxiety in older adults.

METHODS

A literature search was conducted across PubMed, Medline, Web of Science, and Embase databases. An initial screening by abstracts and titles was performed, followed by a review and assessment of the methodological quality of the relevant full papers, and final inclusion of 44 studies were deemed eligible for inclusion in this review.

RESULTS

Among 44 included studies, 36 studies (81.8%) were observational studies concerning the association of cataract surgery or cataracts with anxiety or depression, four studies (9.1%) were interventional studies, and four studies (9.1%) were reviews. Cataract surgery notably enhances the mental health of individuals with impaired vision. However, the multifaceted nature of psychological well-being, influenced by various factors, suggests that cataract surgery may not address all aspects comprehensively. Additionally, preoperative anxiety and depression significantly impact cataract surgery outcomes.

CONCLUSION

Vision impairment in older adults is closely associated with increased symptoms of depression and anxiety. While surgical intervention for cataracts improves these symptoms, it might be less effective for mental disorders with multifactorial causes. Notably, anxiety or depression poses challenges to successful preoperative and intraoperative cataract surgeries.

Bilateral cataract surgery improves neurologic brake reaction time and stopping distance in elderly drivers

AIMS

To determine brake reaction times before and after bilateral cataract surgery in elderly drivers.

METHODS

Sixty-four patients were evaluated on the day of and 4 weeks after bilateral cataract surgery. Forty-three healthy individuals with a valid driving licence served as the control group. A driving simulator was used to determine brake reaction times after receiving a visual stimulus. Total brake reaction time (BRT) as well as neurologic reaction time (NRT), foot transfer time (FTT) and brake pedal travel time (BPTT) were measured, and the measurements obtained before and after cataract surgery were compared. The correlations between NRT, best-corrected visual acuity (BCVA) and contrast sensitivity (CS) were assessed.

RESULTS

Out of the 64 patients with bilateral cataract, 53 were assessed for postsurgical measurements. All time measures improved significantly after cataract surgery (BRT, 815.7(224) versus 647.9(148) ms; NRT, 364.7(91) versus 283.5(44) ms; FTT, 290.8(62) versus 248.6(58) ms; and BPTT, 160.6(96) versus 116.6(72) ms, p < 0.001). The calculated stopping distance improved significantly after surgery (22.3(6) versus 19.9(4) m at 50 km/h). Best-corrected visual acuity (BCVA) and contrast sensitivity (CS) improved significantly after surgery (0.25(0.2) versus 0.05(0.05), n = 53, p < 0.001; 1.4(0.2) versus 1.6(0.1), p < 0.001, respectively). There was a significant negative correlation between CS and NRT before surgery (r = -0.253, n = 64, p = 0.04, Pearson's correlation).

CONCLUSION

Our findings show a significant effect of CS on neurological BRTs and the corresponding stopping distances. This highlights the importance of presurgical CS evaluation as a critical factor in cataract surgery decisions in elderly drivers.

Visual function, spectacle independence, and patients' satisfaction after cataract surgery- a study in the Central Region of Ghana

Background

Reduced visual function is associated with diminished quality of life as well as decreased physical and mental health. Poor visual function related to cataracts is also a risk factor for falls and traffic accidents, which may lead to hospital admissions and limit independence.

Objective

To evaluate patients' satisfaction, visual functions and spectacle independence among patients in the Central Region of Ghana who had cataract surgery in one eye.

Methods

A hospital-based prospective cohort study was carried out on 146 patients booked for cataract surgery: 16 were lost through follow-ups whilst 130 completed the study. Visual functions including visual acuity, contrast sensitivity, stereopsis and colour vision were assessed before and after a month of cataract surgery. Objective and subjective refractions were performed to determine the post-surgery refractive status of the participants. Participants completed the NEI-VFQ 25 questionnaire and the scores obtained were used as a construct of their satisfaction.

Results

The NEI-VFQ 25 questionnaire scores indicated patients' satisfaction was high with an average quality of life score of 77.46. Patients satisfaction was strongly correlated with contrast sensitivity (r=0.653, p<0.001) but moderately correlated with visual acuity (r=-0.554, p<0.001), stereopsis (r=0.490, p<0.001) and colour vision (r=0.466, p<0.001). Contrast sensitivity was a better predictor of patients' satisfaction than visual acuity and stereopsis. Spectacle independence at distance was achieved in only 44.6% of the participants and 5.4% at near. There was a significant (p>0.001) association between spectacle independence and the two types of cataract surgery performed which included Small Incision Cataract Surgery (SICS) and Extracapsular Cataract Extraction (ECCE). Among those who were spectacle independent, 53.4% of them were low vision patients.

Conclusion

Satisfaction of patients after cataract surgery was high but was greatly influenced by visual functions with contrast sensitivity being a better predictor of satisfaction than visual acuity and stereopsis. Spectacle independence after cataract surgery was low at distance and extremely low at near. The type of cataract surgery performed influenced thespectacle independence.

The impact of an interactive, multifaceted education approach for congenital cataract on parental anxiety, knowledge and satisfaction: A randomized, controlled trial

OBJECTIVE

The aim of our research was to examine the impact of a patient education program for parents of children with congenital cataract on parental stress, comprehension of disease information and parental satisfaction.

METHODS

This prospective study included 177 parents of children with congenital cataract. The children were randomized into the following groups: the health education program with a multifaceted, interactive approach and conventional follow-up. Self-administered questionnaires were used for parental evaluation before and after the education program. The anxiety level, parental satisfaction and comprehension of the information were evaluated at each time point.

RESULTS

A multifaceted, interactive approach to education significantly reduced parental levels of anxiety compared with the conventional group (effect sizes: Parenting Stress Index, ƞ2 = 0.285; Ocular Treatment Index, ƞ2 = 0.346). This approach also improved comprehension-memorization scores (effect sizes: ƞ2 = 0.303) and parental satisfaction (p < 0.001). The impact of this new intervention was maintained for 6 and 12 months after the course.

CONCLUSION

The interactive, multifaceted education approach could efficiently improve the comprehension of disease-related information and parental satisfaction, resulting in significantly decreased parental anxiety.

PRACTICE IMPLICATIONS

This new patient education approach had a significant impact on congenital cataracts and may be generalized to other pediatric diseases.

Psychometric properties of the Portuguese version of the National Eye Institute Visual Function Questionnaire-25

BACKGROUND

To investigate the psychometric properties of the Brazilian Portuguese version of the National Eye Institute Visual Function Questionnaire (NEI VFQ-25) questionnaire in a group of patients with different eye diseases.

METHODS

Cross-sectional study. All subjects completed the Portuguese version of the NEI VFQ-25 questionnaire. Another questionnaire containing a survey about clinical and demographics data was also applied. Rasch analysis was used to evaluate the psychometric properties of the NEI VFQ-25.

RESULTS

The study included 104 patients with cataract, 65 with glaucoma and 83 with age macular degeneration. Mean age was 70.7 ± 9.9 years, with 143 female (56.7%) and 109 male patients (43.2%). Mean visual acuity was 0.47 and 1.17 logMAR in the better and worse eye, respectively. According to Rasch analysis, seven items were found to misfit. Those items belonged to the following subscales: general health, social function, mental health, ocular pain and role limitations. The principal component analysis of the residuals showed that 55.5% of the variance was explained by the principal component. Eight items loaded positively onto the first contrast with a correlation higher than 0.4. These items belonged to the following subscales: near vision, distance vision, mental health and dependency. After excluding those items, we were able to isolate items from the NEI VFQ-25, related only to a visual functioning component. Finally, the principal component analysis from residuals of this revised version of the NEI VFQ-25 (items related to visual function) showed that the principal component explained 61.2% of the variance, showing no evidence of multidimensionality.

CONCLUSIONS

The Portuguese version of the NEI VFQ-25 is not a unidimensional instrument. We were able to find items that belong to a different trait, possible related to a socio-emotional component. Thus, in order to obtain psychometrically valid constructs, both the visual functioning and socio-emotional components should be analyzed separately.

Patient-reported quality of life for cataract surgery: prospective validation of the 'Impact on Life' and Catquest-9SF questionnaires in New Zealand

AIMS

The 'Impact on Life' (IoL) questionnaire is used to prioritise publicly funded cataract surgery in New Zealand, however, it has not been formally validated for ophthalmic use. The Catquest-9SF questionnaire is widely used to assess vision-related quality of life (VRQoL) but has not been validated in New Zealand. This study evaluates the validity of the IoL and Catquest-9SF questionnaires for measuring VRQoL in New Zealand.

METHOD

Formal ethics approval was obtained. Participants completed the IoL and Catquest-9SF questionnaires before and three months after routine cataract surgery. Rasch analysis was used to investigate all qualitative questionnaire responses. Results were correlated with the change in patient visual acuity.

RESULTS

There was a 100% response rate at follow-up (41 participants). Disordered probability thresholds were observed for all IoL questions but no Catquest-9SF questions. All IoL questions demonstrated unsatisfactory mean-square fit statistics. Differences in visual acuity following surgery correlated with the change in total F-score for the Catquest-9SF (P=0.04), but not IoL responses (P=0.17).

CONCLUSIONS

Disordered probability thresholds, poor question-model fit and correlation with visual acuity changes indicate the current IoL questionnaire is poorly suited for assessment of VRQoL. In contrast, the Catquest-9SF demonstrated credible results for assessment of VRQoL in New Zealand.

Differences in Cataract Surgery Rates Based on Dementia Status

BACKGROUND

Cataract surgery substantially improves patient quality of life. Despite the rising prevalence of dementia in the US, little is known about use of cataract surgery among this group.

OBJECTIVE

To evaluate the relationship between dementia status and cataract surgery.

METHODS

Using administrative insurance claims for a representative sample of 1,125,387 US Medicare beneficiaries who received eye care between 2006 and 2015, we compared cataract surgery rates between patients with and without dementia via multivariable regression models to adjust for patient characteristics. Main outcome measures were annual rates of cataract surgery and hazard ratio and 95% confidence interval (CI) for receiving cataract surgery.

RESULTS

Cataract surgery was performed in 457,128 patients, 23,331 with a prior diagnosis of dementia. 16.7% of dementia patients underwent cataract surgery, compared to 43.8% of patients without dementia. 59 cataract surgeries were performed per 1000 dementia patients annually, versus 105 surgeries per 1000 nondementia patients. After adjusting for patient characteristics, dementia patients were approximately half as likely to receive cataract surgery compared to nondementia patients (adjusted HR = 0.53, 95% CI 0.53-0.54). Among the subset of patients who received a first cataract surgery, those with dementia were also less likely to receive second-eye cataract surgery (adjusted HR = 0.87, 95% CI 0.86-0.88).

CONCLUSION

US Medicare patients with dementia are less likely to undergo cataract surgery than those without dementia. This finding has implications for quality of care and dementia progression. More information is necessary to understand why rates of cataract surgery are lower for these patients, and to identify conditions where benefits of surgery may outweigh risks.

The effect of nursing intervention on preoperative cataract

This retrospective study investigated the effect of nursing intervention (NIV) in Chinese patients under preoperative cataract (PC). A total of 70 eligible patients with PC were included. Thirty-five patients in an intervention group received regular clinical treatment and NIV before the surgery, while the other 35 patients received regular clinical treatment only. The NIV was applied 4 sessions, 1 week before the surgery. The primary outcome of satisfaction was measured by 11-points visual analog scale. The secondary outcomes were measured by the functional impairment caused by cataract (the VF-14), cooperativeness during the surgery period, and sleep quality. All the outcome measurements were assessed before and after the surgery. After NIV, patients in the intervention group exerted better outcomes in decreasing anxiety (P < .01), increasing current experience with satisfaction (P < .01), and enhancing the cooperativeness during the surgery period (P < .01), compared to those outcomes in the control group. The results of this study showed that NIV may help increase satisfaction in experience and cooperation, and decrease anxiety in Chinese patients with PC.

Primary care barriers to cataract surgery in the eastern zone of Peninsular Malaysia: an interpretative phenomenological analysis

OBJECTIVE

Cataract is the leading cause of blindness in Malaysia. There is an alarming backlog of cataract extraction surgery as the majority believes they did not require surgery. This study aimed to explore the barriers at the primary care level to cataract surgery from the perspective of patients with severe cataract blindness.

METHODS

Eleven participants were involved in this qualitative research which utilised the interpretative phenomenological analysis approach more renowned in health psychology research. All interviews conducted at their home. The interviews were recorded, typed verbatim, and the transcripts were analysed using NVivo software version 8.0.

RESULTS

The main barriers identified at the primary care level were 1) nondisclosure of their visual problems originated from their belated needs for better sight, delayed awareness of their visual status and social stigma and 2) patient-provider-related issues namely miscommunication and delayed referral. The first main theme explains their belief for not requiring surgery. This has led to their delayed awareness and impeded disclosure of their visual problems to family members or primary care providers. The second main theme reflects the provider-patient-related issues which retarded cataract detection and referral process required for earlier cataract extraction surgery.

CONCLUSION

Thus, the appropriate approach targeting these specific barriers at primary care level will be able to detect, motivate and assist patients for early uptake of cataract extraction surgery to improve their vision and prevent severe blindness.

Prevalence of fear of falling and associated factors among Japanese community-dwelling older adults

To determine the prevalence of fear of falling and associated factors among Japanese community-dwelling older adults.Cross-sectional study between 2011 and 2013.Community in which residents voluntarily attended a health examination.We recruited 844 older adults (male, n = 350; female, n = 494) aged 60 to 92 years from among those who presented at the health examination.We assessed fear of falling, falls in the previous year, pain, comorbidity, and cataracts. Five times chair stand time was applied as an indicator of physical performance.The prevalence of fear of falling was 26.9% and 43.3% among the men and women, respectively. Men and women who feared falling were older (P < .01), had longer 5 times chair stand time (P < .01), and more falls in the previous year (P < .05), pain (P < .01), and comorbidity (P < .05). Multivariate logistic regression analysis identified advanced age (odds ratios [OR], 1.57; 95% confidence interval [CI], 1.03-2.39), falls in the previous year (OR, 2.44; 95%CI, 1.29-4.64), and pain (OR, 1.82; 95%CI, 1.03-3.22) in men, and advanced age (OR, 1.59; 95%CI, 1.13-2.24), longer 5 times chair stand times (OR, 1.28; 95%CI, 1.04-1.59), falls in the previous year (OR, 2.59; 95%CI, 1.54-4.34), and pain (OR, 1.65; 95%CI, 1.06-2.55) in women as being independently associated with fear of falling.The prevalence of fear of falling was similar to previous reports. Advanced age, falls in previous year, and pain were associated with fear of falling in men. A longer 5 times chair stand time was also associated with fear of falling among older adult women. Maintenance of physical function and pain management might be important for older adults with fear of falling.

Proteomic analysis of the glutathione-deficient LEGSKO mouse lens reveals activation of EMT signaling, loss of lens specific markers, and changes in stress response proteins

PURPOSE

To determine global protein expression changes in the lens of the GSH-deficient LEGSKO mouse model of age-related cataract for comparison with recently published gene expression data obtained by RNA-Seq transcriptome analysis.

METHODS

Lenses were separated into epithelial and cortical fiber sections, digested with trypsin, and labeled with isobaric tags (10-plex TMT^TM). Peptides were analyzed by LC-MS/MS (Orbitrap Fusion) and mapped to the mouse proteome for relative protein quantification.

RESULTS

1871 proteins in lens epithelia and 870 proteins in lens fiber cells were quantified. 40 proteins in LEGSKO epithelia, 14 proteins in LEGSKO fiber cells, 22 proteins in buthionine sulfoximine (BSO)-treated LEGSKO epithelia, and 55 proteins in BSO-treated LEGSKO fiber cells had significantly (p<0.05, FDR<0.1) altered protein expression compared to WT controls. HSF4 and MAF transcription factors were the most common upstream regulators of the response to GSH-deficiency. Many detoxification proteins, including aldehyde dehydrogenases, peroxiredoxins, and quinone oxidoreductase, were upregulated but several glutathione S-transferases were downregulated. Several cellular stress response proteins showed regulation changes, including an upregulation of HERPUD1, downregulation of heme oxygenase, and mixed changes in heat shock proteins. NRF2-regulated proteins showed broad upregulation in BSO-treated LEGSKO fiber cells, but not in other groups. Strong trends were seen in downregulation of lens specific proteins, including β- and γ-crystallins, lengsin, and phakinin, and in epithelial-mesenchymal transition (EMT)-related changes. Western blot analysis of LEGSKO lens epithelia confirmed expression changes in several proteins.

CONCLUSIONS

This dataset confirms at the proteomic level many findings from the recently determined GSH-deficient lens transcriptome and provides new insight into the roles of GSH in the lens, how the lens adapts to oxidative stress, and how GSH affects EMT in the lens.

Rasch analysis of the hospital anxiety and depression scale among Chinese cataract patients

Purpose

To analyze the validity of the Hospital Anxiety and Depression Scale (HADS) among Chinese cataract population.

Methods

A total of 275 participants with unilateral or bilateral cataract were recruited to complete the Chinese version of HADS. The patients' demographic and ophthalmic characteristics were documented. Rasch analysis was conducted to examine the model fit statistics, the thresholds ordering of the polytomous items, targeting, person separation index and reliability, local dependency, unidimentionality, differential item functioning (DIF) and construct validity of the HADS individual and summary measures.

Results

Rasch analysis was performed on anxiety and depression subscales as well as HADS-Total score respectively. The items of original HADS-Anxiety, HADS-Depression and HADS-Total demonstrated evidence of misfit of the Rasch model. Removing items A7 for anxiety subscale and rescoring items D14 for depression subscale significantly improved Rasch model fit. A 12-item higher order total scale with further removal of D12 was found to fit the Rasch model. The modified items had ordered response thresholds. No uniform DIF was detected, whereas notable non-uniform DIF in high-ability group was found. The revised cut-off points were given for the modified anxiety and depression subscales.

Conclusion

The modified version of HADS with HADS-A and HADS-D as subscale and HADS-T as a higher-order measure is a reliable and valid instrument that may be useful for assessing anxiety and depression states in Chinese cataract population.

A validation study comparing self-reported travel diaries and objective data obtained from in-vehicle monitoring devices in older drivers with bilateral cataract

BACKGROUND

Advances in technology have made it possible to examine real-world driving using naturalistic data obtained from in-vehicle monitoring devices. These devices overcome the weaknesses of self-report methods and can provide comprehensive insights into driving exposure, habits and practices of older drivers.

AIM

The aim of this study is to compare self-reported and objectively measured driving exposure, habits and practices using a travel diary and an in-vehicle driver monitoring device in older drivers with bilateral cataract.

METHODS

A cross-sectional study was undertaken. Forty seven participants aged 58-89 years old (mean=74.1; S.D.=7.73) were recruited from three eye clinics over a one year period. Data collection consisted of a cognitive test, a researcher-administered questionnaire, a travel diary and an in-vehicle monitoring device. Participants' driving exposure and patterns were recorded for one week using in-vehicle monitoring devices. They also completed a travel diary each time they drove a motor vehicle as the driver. Paired t-tests were used to examine differences/agreement between the two instruments under different driving circumstances.

RESULTS

The data from the older drivers' travel diaries significantly underestimated the number of overall trips (p<0.001), weekend trips (p=0.002) and trips during peak hour (p=0.004). The travel diaries also significantly overestimated overall driving duration (p<0.001) and weekend driving duration (p=0.003), compared to the data obtained from the in-vehicle monitoring devices. No significant differences were found between instruments for kilometres travelled under any of the driving circumstances.

CONCLUSIONS

The results of this study found that relying solely on self-reported travel diaries to assess driving outcomes may not be accurate, particularly for estimates of the number of trips made and duration of trips. The clear advantages of using in-vehicle monitoring devices over travel diaries to monitor driving habits and exposure among an older population are evident.

Objective Scatter Index: Working Toward a New Quantification of Cataract?

PURPOSE

To investigate the associations between clinical cataract classifications, quality of life (QOL), and the objective loss of ocular transparency in patients presenting with clinical cataracts.

METHODS

In this prospective, multicenter, cross-sectional study, 1,768 eyes of 1,768 patients (mean age: 72.5 years; range: 28 to 93 years) referred for cataract assessment were enrolled. Visual acuity was measured before slit-lamp examination to determine the severity of lens opacification using the Lens Opacities Classification System III. Patients were asked to complete the Visual Function Index (VF-14) questionnaire. Ocular transparency was quantified by Objective Scatter Index (OSI) and was measured by the HD Analyzer (Visiometrics SL, Terrassa, Spain). Association and categorical data analysis were performed between each measured parameter alongside cross-tabulation analyses to determine sensitivity and efficiency of the HD Analyzer.

RESULTS

High OSI levels corresponded slightly with a lower visual acuity value and corresponded better with lower VF-14 scores. OSI scores were strongly associated with cataract classification and severity. Cross-tabulation analysis revealed a high sensitivity and efficiency index for the OSI with these clinically validated parameters illustrating good agreement overall for the OSI in determining cataract.

CONCLUSIONS

The OSI measured by the HD Analyzer is a sensitive and efficient tool to be considered in the early detection of cataract in patients.

Correlational Analysis of Objective and Subjective Measures of Cataract Quantification

PURPOSE

To evaluate whether correlations exist between objective and subjective measures of vision quality as a consequence of cataract and whether this may qualify the Objective Scatter Index as a supplementary means of cataract assessment.

METHODS

A prospective multicenter, cross-sectional study was conducted in 10 centers across France in patients undergoing cataract extraction surgery (lens opacity evaluated with the Lens Opacities Classification System III). A quality of life assessment using the Visual Function Index-14 (VF-14) (14 questions scored from 0 to 4) and measurement of visual acuity and evaluation of the Objective Scatter Index (HD Analyzer, Visiometrics SL, Terrassa, Spain) to assess the alteration of light scatter were used as measures in the study.

RESULTS

The study included 1,768 eyes of 1,768 patients (mean age: 72.5 years; range: 28 to 93 years). The average OSI score was 4.97 ± 3.13 (range: 0.4 to 20.5). There was good correlation between visual acuity and OSI (r = -0.47, P < .001) and between OSI and VF-14 (r = -0.11, P < .001).

CONCLUSIONS

The results presented in this study confirm that the Objective Scatter Index has sufficient correlations with visual acuity and VF-14 to supplement existing cataract diagnosis in a large population encompassing a broad spectrum of cataract presentations.

Quality of life and functional vision concerns of children with cataracts and their parents

PurposeTo identify specific health-related quality of life (HRQOL) and functional vision concerns affecting children with cataracts and common associated conditions as expressed by children or one of their parents (proxy), and HRQOL concerns affecting the parents themselves.MethodsIndividual semi-structured interviews were conducted with parents of children with cataracts (N=31) and with the children themselves (ages 5-17 years; N=16). Transcripts of recorded interviews were evaluated using NVivo software. Specific concerns were identified and coded, and broad themes were identified. The frequency of each theme was calculated, with the frequency of specific concerns within each theme.ResultsRegarding the child's experience, 6 themes were identified: Visual Function (mentioned by 16 of 16 children (100%) and by 26 of 31 parents (84%), Social (94 and 65%), Treatment (81 and 90%), Worry (75 and 10%), Emotions (63 and 68%), and Physical Discomfort (63 and 26%). Worry showed the largest discrepancy between child and their parent; although 75% children reported Worry, only 6% of parents reported that their child experienced Worry (P=0.0009). Regarding the parents' own experience, 5 themes were identified: Worry (100%), Compensation for Condition (100%), Treatment (94%), Emotions (90%), and Affects Family (52%).ConclusionsA wide range of concerns were identified from interviews of children with cataracts and their parents. Concerns reflect the impact of cataracts in physical, emotional, and social domains, and specific concerns will be used for the development of questionnaires to quantify the quality of life and functional vision effects of cataracts.

Trifocal Intraocular Lens Implantation to Treat Visual Demands in Various Distances Following Lens Removal

PURPOSE

To evaluate visual and refractive outcomes after implantation of a trifocal intraocular lens (IOL).

DESIGN

Prospective, nonrandomized noncomparative case series.

METHODS

setting: Department of Ophthalmology, Goethe University, Frankfurt/Germany. patient or study population: Twenty-seven patients (54 eyes) who had bilateral implantation of the AT LISA trifocal IOL (AT LISA tri839MP; Carl Zeiss Meditec, Jena, Germany) pre-enrollment. Exclusion criteria were previous ocular surgeries excluding cataract surgery and refractive lens exchange, irregular corneal astigmatism of >1.5 diopter, and ocular pathologies or corneal abnormalities. Intervention or Observation Procedure(s): Postoperative examination at 1 and 3 months included manifest refraction; monocular and binocular uncorrected (UCVA) and distance-corrected (DCVA) visual acuity in 4 m, 80 cm, and 40 cm; slit-lamp examination; and tomography. At 3 months defocus testing, binocular contrast sensitivity (CS) under photopic and mesopic conditions, and a questionnaire on subjective quality of vision, optical phenomena, and spectacle independence were performed.

MAIN OUTCOME MEASURE(S)

Three-months-postoperative monocular and binocular UCVA and DCVA in 4 m, 80 cm, and 40 cm (logMAR); defocus curve; CS; and quality-of-vision questionnaire results.

RESULTS

Mean spherical equivalent was 0.05 ± 0.32 D 3 months postoperatively. Binocular UCVA at distance, intermediate, and near was -0.1 ± 0.1 logMAR, 0.0 ± 0.1 logMAR, and 0.0 ± 0.1 logMAR, respectively. Despite some optical phenomena, 92% of patients would choose the same IOL again.

CONCLUSION

Evaluation of a trifocal IOL showed good VA (0.1 logMAR or better) at far, intermediate, and near distance; high patient satisfaction despite some optical phenomena; and high spectacle independence 3 months postoperatively.

Willingness to Pay for Cataract Surgery Provided by a Senior Surgeon in Urban Southern China

Purpose

To study willingness to pay for cataract surgery and surgical service provided by a senior cataract surgeon in urban Southern China.

Methods

This study was a cross-sectional willingness-to-pay (WTP) interview using bidding formats. Two-hundred eleven persons with presenting visual impairment in either eye due to cataract were enrolled at a tertiary eye hospital. Participants underwent a comprehensive eye examination and a WTP interview for both surgery and service provided by a senior surgeon. Demographic information, socioeconomic status and clinical data were recorded.

Results

Among 211 (98% response rate) persons completing the interview, 53.6% were women and 80.6% were retired. About 72.2% had a monthly income lower than 1000 renminbi (US $161). A total of 189 (89.6%) were willing to pay for cataract and the median amount of WTP was 6000 renminbi (US$968). And 102 (50.7%) were willing to pay additional fees for surgery performed by a senior surgeon, and the median amount of WTP was 500 renminbi (US$81). In regression models adjusting for age and gender, persons with preexisting eye diseases other than cataract, were more likely to pay for cataract surgery and service provided by a senior surgeon (P = 0.04 for both).

Conclusions

In urban China, cataract patients, especially those with preexisting eye conditions, are willing to pay additional fees for a senior surgeon. Moving to a system where the price of cataract surgery is proportional to the consultant’ skill and expertise is possible and may have a potential impact on waiting list and quality of eye care. Further studies are needed to examine the impact of such pricing system on attitudes and choices of cataract patients.

Quality of life in adults with strabismus

PURPOSE

To assess relative quality of life in patients with strabismus.

DESIGN

Retrospective cohort study.

METHODS

The 25-item National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25) was performed in 42 strabismic adults over the age of 50 years at a single institution. Subscale scores were compared with those of patients with other ocular diseases, including diabetic retinopathy, age-related macular degeneration (AMD), glaucoma, cataract, cytomegalovirus (CMV) retinitis, and low vision.

RESULTS

Median visual acuity was 20/20 (range 20/12.5-20/50), and 34 patients (81%) reported diplopia. Strabismic patients performed the same or worse on nearly all vision-related subscales than did patients with diabetic retinopathy, age-related macular degeneration, glaucoma, cataract, and CMV retinitis. Additionally, strabismic patients reported significantly worse ocular pain than all comparison groups before any surgery was performed.

CONCLUSIONS

Strabismus impacts quality of life through both functional and psychosocial factors. Physicians treating strabismic patients should recognize these quality-of-life issues and address them accordingly.

Cataract management: effect on patients' quality of life

This article summarises the epidemiology of cataract, the normal and altered physiology of the eye's lens, and the causes of and risk factors associated with the condition. It outlines the aims of modern cataract surgery and discusses the main surgical approaches. The effects of 'cataract blindness' on the patient's quality of life are addressed, with particular reference to the negative effect of the onset of depression. The role of the nurse in promoting quality of life is explored with reference to the value of psychosocial theory in the care of and promotion of health to older patients with cataracts.

Effects of patient education and therapeutic suggestions on cataract surgery patients: a randomized controlled clinical trial

OBJECTIVE

This paper describes a randomized controlled single blind study testing the effects of a patient education intervention combined with positive therapeutic suggestions on anxiety for cataract surgery patients.

METHODS

84 patients participated in the study. Physiological and behavioral indicators of anxiety were compared between a regularly treated control and an intervention group receiving an audio CD containing information, relaxation, and positive imagery.

RESULTS

We found that the intervention group was calmer throughout the four measurement points of the study (p=.004; d=0.71) and they were more cooperative (p=.01; d=0.60) during the operation. The groups did not differ in sleep quality before the day of the operation, heart rate during the procedure, and subjective Well-being.

CONCLUSION

Findings indicate that preoperative information combined with positive suggestions and anxiety management techniques might reduce patient anxiety in the perioperative period of cataract surgery, but further research is needed to investigate the benefits of such interventions and to uncover the underlying mechanisms.

PRACTICE IMPLICATIONS

Patient education interventions providing additional anxiety management techniques are recommended for use prior to cataract surgery.

Measuring the impact of cataract surgery on generic and vision-specific quality of life

PURPOSE

Cataracts are the leading cause of blindness worldwide and cause visual impairment for millions of adults in the United States. We compared the sensitivity of a vision-specific health-related quality of life (HRQOL) measure to that of multiple generic measures of HRQOL before and at 2 time points after cataract surgery.

METHODS

Participants completed 1 vision-specific and 5 generic quality of life measures before cataract surgery, and again 1 and 6 months after surgery. Random effects modeling was used to measure changes over the three assessment points.

RESULTS

The NEI-VFQ25 total score and all 11 subscales showed significant improvements during the first interval (baseline and 1 month). During the second interval (1-6 months post-surgery), significant improvements were observed on the total score and 5 of 11 NEI-VFQ25 subscales. There were significant increases in HRQOL during the first interval on some preference-based generic HRQOL measures, though changes during the second interval were mostly non-significant. None of the SF-36v2™ or SF6D scales changed significantly between any of the assessment periods.

CONCLUSIONS

The NEI-VFQ25 was sensitive to changes in vision-specific domains of QOL. Some preference-based generic HRQOL measures were also sensitive to change and showed convergence with the NEI-VFQ25, but the effects were small. The SF-36v2™ and SF-6D did not change in a similar manner, possibly reflecting a lack of vision-related content. Studies seeking to document both the vision-specific and generic HRQOL improvements of cataract surgery should consider these results when selecting measures.

Patient reported evaluation of functional symptoms (PREFS): a simple method of ascertaining patient satisfaction post cataract surgery

No abstract available.DOI: http://dx.doi.org/10.3126/nepjoph.v4i2.6562 Nepal J Ophthalmol 2012; 4 (2): 346-347  

The impact of cataract surgery questionnaire: re-evaluation using Rasch analysis

PURPOSE

The Impact of Cataract Surgery (ICS) questionnaire was designed to assess cataract surgery outcomes. The aim of this study was to describe the psychometric properties of the ICS questionnaire using the Rasch model in a cataract population.

METHODS

Ninety-one patients waiting to undergo cataract surgery in the first or second eye at the Flinders Medical Centre, Adelaide, South Australia self-administered the four-item ICS questionnaire. Rasch analysis was performed to assess behaviour of response categories, ability to differentiate between participants' visual abilities (person separation; minimum acceptable 2.0), if items measure a single underlying construct [i.e. unidimensionality assessed by fit statistics and further by principal components analysis (PCA)] and matching of item difficulty to participant ability (targeting; ideal < 0.5 logits). Adequate person separation was defined as basic requirement for a measure, failing which further assessment such as PCA was not performed.

RESULTS

The four-item ICS questionnaire did not meet the required measurement properties (person separation zero). Response categories did not behave as intended, requiring the collapsing of categories for one item (read ordinary newspaper-size print). One item misfit (estimating distance) indicating that it was not measuring the same construct as other items. However, person separation failed to improve following the deletion of this item. Targeting was -0.46 logits, indicating that the item difficulty was well suited to the visual abilities of the participants.

CONCLUSION

In its present form, the ICS is unsuitable for visual disability assessment in patients awaiting cataract surgery. Other, better visual function questionnaires are available and preferred.

Which factors influence patients' maximum acceptable waiting time for cataract surgery? - a questionnaire survey

PURPOSE

To evaluate patients’ maximum acceptable waiting time (MAWT) and to assess the determinants of patient perceptions of MAWT.

METHODS

A total of 500 consecutive patients with cataract were asked to fill out a preoperative questionnaire, addressing patients’ MAWT to undergo cataract surgery. Patients’ visual impairment (VF-14 score), education, profession and social status were evaluated, and an ophthalmologic examination was performed. Univariate analysis included Spearman’s correlation test, unpaired Student’s t-test and the Mann–Whitney U test. Univariate and multivariate associations were calculated using unconditional logistic regression.

RESULTS

The mean MAWT was 3.17 ± 2.12 months. The mean VF-14 score was 72.10 ± 22.54. Between VF-14 score and MAWT, there was a significant correlation (r = 0.180, p = 0.004). Patients with higher education (high school, university) accepted significantly longer MAWT (3.92 ± 2.38 months versus 3.02 ± 2.00 months, p = 0.009). Patients who had self-noticed visual impairment were nearly four times (OR: 3.88, 95% CI = 2.07–7.28, p < 0.001) more likely to accept only MAWT of <3 months.

CONCLUSIONS

Patients with low tolerance for waiting had greater self-reported difficulty with vision. Patients’ acceptance of waiting was not associated with clinical visual acuity measures. Education, ability to work, living independently and taking care of dependents were also strong predictors from patients’ perspective. Considering the implementation of standards for waiting lists, these facts should be taken into account.

Psychological distress and visual functioning in relation to vision-related disability in older individuals with cataracts

OBJECTIVE

To determine whether demographic, health status and psychological functioning measures, in addition to impaired visual acuity, are related to vision-related disability.

METHODS

Participants were 105 individuals (mean age=73.7 years) with cataracts requiring surgery and corrected visual acuity in the better eye of 6/24 to 6/36 were recruited from waiting lists at three public out-patient ophthalmology clinics. Visual disability was measured with the Visual Functioning-14 survey. Visual acuity was assessed using better and worse eye logMAR scores and the Melbourne Edge Test (MET) for edge contrast sensitivity. Data relating to demographic information, depression, anxiety and stress, health care and medication use and numbers of co-morbid conditions were obtained.

RESULTS

Principal component analysis revealed four meaningful factors that accounted for 75% of the variance in visual disability: recreational activities, reading and fine work, activities of daily living and driving behaviour. Multiple regression analyses determined that visual acuity variables were the only significant predictors of overall vision-related functioning and difficulties with reading and fine work. For the remaining visual disability domains, non-visual factors were also significant predictors. Difficulties with recreational activities were predicted by stress, as well as worse eye visual acuity, and difficulties with activities of daily living were associated with self-reported health status, age and depression as well as MET contrast scores. Driving behaviour was associated with sex (with fewer women driving), depression, anxiety and stress scores, and MET contrast scores.

CONCLUSION

Vision-related disability is common in older individuals with cataracts. In addition to visual acuity, demographic, psychological and health status factors influence the severity of vision-related disability, affecting recreational activities, activities of daily living and driving.

Supporting patients undergoing cataract extraction surgery

A cataract is an opacification, or clouding, of the lens of the eye, causing a deterioration in the clarity and brightness of vision, which may reduce quality of life. Surgical removal and artificial replacement of the opacified lens is the only treatment option available. This article discusses the patient's experience of treatment and highlights the role of the nurse in pre and post-operative care. A review of the anatomy of the eye is included and, as nurses have a vital role in supporting patients undergoing surgery, the cataract extraction operation and its potential risks and complications are described briefly.

Holistic approach to pre-operative assessment for cataract patients

When patients agree to have cataract surgery it is important that they are fully assessed to determine their fitness for surgery. This article discusses the benefits of a nurse-led holistic approach to patient assessment, which, in practice, should be more than simply a 'tick-box exercise'. Essential components of the assessment include obtaining valid informed consent and performing biometry - the process by which the required dioptric power of an intraocular lens (IOL) implant is calculated prior to cataract surgery. It is a highly skilled procedure, which involves the measurement of corneal curvature and the axial length of the eye using either ultrasound or optical methods of biometry. This article examines the vital nursing roles aimed at improving the quality and efficiency of the patient's 'journey'.

How consistent are health utility values?

The use of preference-based generic instruments to measure the health-related quality of life of a general population or of individuals suffering from a specific disease has been increasing. However, there are several discrepancies between instruments in terms of utility results. This study compares SF-6D and EQ-5D when administered to patients with cataracts and aims at explaining the differences. Agreement between EQ-5D and SF-6D health state classifications was assessed by correlation coefficients. Simple correspondence analysis was used to assess the agreement among the instrument's descriptive systems and to investigate similarities between dimensions' levels. Cluster analysis was used to classify SF-6D and EQ-5D levels into homogeneous groups. There was evidence of floor effects in SF-6D and ceiling effects in EQ-5D. Comparisons of means showed that SF-6D values exceeded EQ-5D values. Agreement between both instruments was high, especially between similar dimensions. However, different valuation methods and scoring algorithms contributed to the main differences found. We suggest that one or both instruments should be revised, in terms of their descriptive systems or their scoring algorithms, in order to overcome the weakness found.

Vision-related quality of life in patients with diabetic macular oedema

AIMS

The aim of this study was to determine the impact of diabetic macular oedema (DME) on the quality of life (QOL) in patients with type 2 diabetes mellitus.

METHODS

The study was a prospective, consecutive, non-comparative case series. An observational study evaluated the quality of vision and vision-specific QOL using the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25). Mean VFQ-25 subscale scores in type 2 diabetic study patients were compared with mean VFQ-25 subscale score in groups of patients with type 1 diabetic retinopathy (T1DR) and varying degrees of age-related macular degeneration (ARMD), glaucoma and cataracts and in reference populations.

RESULTS

Thirty-three patients completed the NEI VFQ-25. The mean age of the study population was 64 years. When performing a comparison of those patients with DME versus those with isolated T1DR we found that for the general health subscale, the DME versus T1DR group means were 42+/-4.4 versus 61+/-1.0 respectively. The DME versus T1DR quality of vision categorical mean scores were 69+/-4.1 versus 93+/-3.9. The DME versus T1DR VR-QOL categorical mean scores were 62+/-5.0 versus 93+/-1.0. The DME group was significantly worse in each of these three categories compared with the T1DR group (p<0.01). An additional analysis was performed to examine the differences in VR-QOL in the DME group versus varying common ocular diseases, including age-related macular degeneration (ARMD), glaucoma, cataracts and disease-free reference groups. The mean values of VFQ-25 subscale in the DME group were significantly lower then the glaucoma group in ten of 12 subscales, the cataract group in 11 of 12 subscales, and the reference group in 12 of 12 subscales. However, the mean values of VFQ-25 subscale in the DME group were only significantly different from the ARMD group in three of 12 subscales.

CONCLUSIONS

Type 2 diabetes patients with macular oedema experience a decreased VR-QOL compared with type 1 diabetic patients with diabetic retinopathy, glaucoma or cataracts. However, VR-QOL in type 2 diabetic patients with macular oedema was similar to those individuals with ARMD.

Using scotopic and photopic flicker to measure lens optical density

Many applications require knowledge of lens absorption. Measuring lens optical density (OD), however, is often difficult and time-consuming. For example, psychophysical measurement typically requires a long period of dark adaptation (e.g. about 40 min) and assessment of absolute scotopic thresholds. In this study, we examined efficient scotopic and photopic methods for measuring lens OD. In Experiment 1, 30 subjects were tested using a Maxwellian-view optical system. Relative scotopic thresholds were obtained after 15 min of dark adaptation using slow-rate (2 Hz) flicker photometry. A 3 degrees test stimulus, presented at 10 degrees nasal, was used that alternated between measuring wavelengths (420 and 460 nm) and a reference field (540 nm). The results showed that the relative scotopic method produces values that are consistent with published lens spectral curves. In Experiment 2, relative photopic measures (i.e. no dark adaptation period) were also obtained at 406 nm in natural view and compared with lens data obtained in Maxwellian view at 407 nm using the absolute scotopic method. The photopic method compared well with the absolute scotopic values obtained on the same subjects. Taken together, the two experiments showed that a relative method can yield valid lens density estimates. Using a relative rather than an absolute method reduces the time needed for dark adaptation and is an easier task for subjects to perform and may therefore be preferable when expeditious measures are desirable.

The impact of anchor point on utilities for 5 common ophthalmic diseases

PURPOSE

To elicit utilities on a perfect health and perfect vision scale for 5 common eye diseases.

DESIGN

Cross-sectional observational preference study.

PARTICIPANTS

We included 434 patients: 58 with diabetic retinopathy, 99 with glaucoma, 44 with age-related macular degeneration (AMD), 124 with cataract; 109 with refractive error.

TESTING

Standard gamble utilities were estimated using a computer-based preference assessment interview platform.

MAIN OUTCOME MEASURES

Standard gamble utilities, a quality-of-life measure that examines the willingness to accept a risk of death or unilateral blindness in return for perfect health or perfect vision.

RESULTS

Using the standard policy scale, where health equivalent to death is 0 and perfect health is 1, participants with asymptomatic diabetic retinopathy had a utility of 0.93. By comparison, symptomatic diabetics had a further utility loss of 0.14. Asymptomatic glaucoma participants had a utility of 0.92 with a decrease of 0.03 for early field loss and a further decrease of 0.03 with central field loss. Participants with AMD who had > or =20/100 better-eye visual acuity reported a utility of 0.89, whereas those with more severe AMD reported 0.76. However, neither clinical cataract opacity score nor refractive error correlated with utility. Adjustment for age and comorbidity did not alter these relationships. For the same participants, utilities measured with different anchor points-monocular blindness as 0 and perfect vision as 1-were lower, especially among participants with increased disease severity. The difference between utility assessed on this perfect vision-blindness scale and the perfect health-death scale ranged from 0.04 for those with severe refractive error to 0.19 for symptomatic diabetics and 0.37 for those with severe AMD.

CONCLUSIONS

This paper elicits utilities with different anchor points from a previously unreported sample of 434 patients. Lower utility scores normally imply greater benefit with successful treatment or prevention of disease, but switching from the conventional policy scale to the perfect vision scale also consistently results in lower scores. Because most previous ophthalmic studies have used perfect vision as the upper anchor, the resulting utilities may not have been accurate.

The development of visual feature binding processes after visual deprivation in early infancy

Higher visual functions were investigated in patients treated for bilateral congenital cataracts in two experiments. Participants were asked to detect either real or illusory contours (Kanizsa squares in Experiment 1 or one of four different Kanizsa contours in Experiment 2) among distractor items. Compared to normally sighted participants matched for age, gender and education, cataract patients treated after the age of 5-6 months took relatively longer to detect Kanizsa figures (Experiments 1 and 2) and they had higher miss rates (Experiment 2). The present results suggest that the ability of visual feature binding depends on early visual input and is permanently impaired if patterned vision is prevented in early infancy for 5 months or more.

Comparison of visual outcomes, photopic contrast sensitivity, wavefront analysis, and patient satisfaction following cataract extraction and IOL implantation: aspheric vs spherical acrylic lenses

PURPOSE

To determine vision quality when testing two acrylic intraocular lenses (IOLs), AcrysofIQ and AcrysofSingle-Piece, after routine cataract extraction and IOL implantation.SettingStorm Eye Institute and Magill Research Center for Vision Correction, Medical University of South Carolina, Charleston, SC, USA.

METHODS

Prospective, randomized, double-masked study that included 53 eyes of 27 patients who underwent bilateral cataract extraction and IOL implantation. Patients were randomly divided into two groups depending on the type of IOL implanted: AcrysofIQ or AcrysofSingle-Piece. Preoperative, 1- and 3-month postoperative evaluations included ETDRS visual acuity, photopic contrast sensitivity, pupil size, wavefront testing, and a subjective questionnaire. Comparisons between the two groups and comparisons to baseline were made at each visit. P<0.05 was considered statistically significant.

RESULTS

Preoperative, statistically significant differences were evident in response to the subjective questionnaire (near activities, driving dimensions, and overall score) between the two groups. Postoperatively there was a greater increase in contrast sensitivity at 1 and 3 months in the AcrysofIQ group when compared to baseline. Patients with AcrysofIQ IOL had a significant reduction in total high-order aberrations (HOA) and spherical aberration (SA) when compared to those patients with AcrysofSingle-Piece at 1 and 3 months and to baseline. Postoperative patient satisfaction showed no difference among the groups.

CONCLUSION

The use of a new aspheric acrylic IOL may improve the quality of vision as a result of the reduction of total HOA and SA.

Long-term outcomes after allogeneic stem cell transplantation for children with hematological malignancies

We analyzed long-term outcomes and psycho-social aspects in 112 children with malignancies surviving 1 year after hematopoietic stem cell transplantation. At 10 years, overall survival was 75+/-5%, TRM 18+/-4% and relapse 14+/-3%; 10-year cumulative incidence of infections was 31+/-4%, cataract 44+/-4%, pulmonary dysfunction 20+/-4%, bone and joint complications 29+/-5%, hypothyroidism 36+/-4%, cardiac complications 11+/-3% and secondary malignancies 7+/-3%. Total body irradiation (TBI) was the most significant risk factor associated with cataract, pulmonary impairment, osteoarticular complications and hypothyroidism. Chronic graft-versus-host disease was associated with higher incidence of pulmonary dysfunction. The number of complications per patient increased with time. Half of the patients had psychological disturbance, 13 signs of depression and 16 a history of eating behavior disorders; 54% of patients with one or more long-term complications had psychological problems. Sixty-nine patients had learning difficulties and 36 achieved normal scholarship. With increased follow-up, development of late effects and of psycho-social disturbance are of major concern. While the use of single-dose TBI has now been abandoned, other risk factors are still of concern in the early 2000s.

Waiting times for cataract surgery in ten European countries: an analysis using data from the SHARE survey

AIMS

To assess waiting times for cataract surgery and their acceptance in European countries, and to find explanatory, country-specific health indicators.

METHODS

Using data from the survey of health, ageing and retirement in Europe (SHARE), waiting times for cataract surgery of 245 respondents in ten countries were analysed with the help of linear regression. The influence of four country specific health indicators on waiting times was studied by multiple linear regression. The influence of waiting time and country on the wish to have surgery performed earlier was determined through logistic regression. Additional information was obtained for each country from opinion leaders in the field of cataract surgery.

RESULTS

Waiting times differed significantly (p<0.001) between the ten analysed European countries. The length of wait was significantly influenced by the total expenditure on health (p<0.01) but not by the other country specific health indicators. The wish to have surgery performed earlier was determined by the length of wait (p<0.001) but not by the country where surgery was performed.

CONCLUSION

The length of wait is influenced by the total expenditure on health, but not by the rate of public expenditure on health, by the physician density or by the acute bed density. The wish to have surgery performed earlier depends on the length of wait for surgery and is not influenced by the country.

Acceptance of cataract surgery in a cohort of Tanzanians with operable cataract

BACKGROUND

In spite of recent increases in the number of surgeries carried out within some hospitals and programmes in sub-Saharan Africa, there are indications that the acceptance of cataract surgery remains quite low.

METHODS

We conducted a population-based prospective (cohort) study of cataract patients from 12 villages in Hai district of Kilimanjaro region, Tanzania. Those identified with operable cataract were informed of the regular community programmes (within 5 km) in place providing transportation and high-quality surgery. At years 1 and 2 after the survey, we traced the patients to determine uptake of cataract surgery.

RESULTS

Among patients eligible for surgery (128), 31 could not be followed up after 1 year due to deaths, moving, and refusal. Among the remaining patients, 18 accepted surgery in the first year and four accepted in the second year. Among these 22 patients, only five were blind or with severe visual impairment. The most elderly were those least likely to accept surgery.

DISCUSSION

Even with bridging strategies in place to make cataract surgery accessible and affordable, the uptake of cataract surgery remains low. Strategies aimed to identifying and referring all patients recognizing vision loss as a personal disability rather than using predefined vision cutoffs will likely be most successful in reducing the burden of vision loss due to cataract.

Cataract visual impairment and quality of life in a Kenyan population

AIMS

To evaluate the World Health Organization Prevention of Blindness and Deafness 20-item Visual Functioning Questionnaire (WHO/PBD VF20), a vision-related quality of life scale, and to describe the relationship between cataract visual impairment and vision- and generic health-related quality of life, in people >or=50 years of age in Nakuru district, Kenya.

METHODS

The WHO/PBD VF20 was pilot tested and modified. 196 patients with visual impairment from cataract and 128 population-based controls without visual impairment from cataract were identified through a district-wide survey. Additional cases were identified through case finding. Vision- and health-related quality of life were assessed using the WHO/PBD VF20 scale and EuroQol generic health index (European Quality of Life Questionnaire (EQ-5D)), respectively. WHO/PBD VF20 was evaluated using standard psychometric tests, including factor analysis to determine item grouping for summary scores.

RESULTS

The modified WHO/PBD VF20 demonstrated good psychometric properties. Two subscales (general functioning and psychosocial) and one overall eyesight-rating item were appropriate for these data. Increased severity of visual impairment in cases was associated with worsening general functioning, psychosocial and overall eyesight scores (p for trend <0.001). Cases were more likely to report problems with EQ-5D descriptive dimensions than controls (p<0.001), and, among cases, increased severity of visual impairment was associated with worsening self-rated health score.

CONCLUSION

The modified WHO/PBD VF20 is a valid and reliable scale to assess vision-related quality of life associated with cataract visual impairment in this Kenyan population. The association between health-related quality of life and visual impairment reflects the wider implications of cataract for health and well-being, beyond visual acuity alone.

The health-related quality of life of children with congenital cataract: findings of the British Congenital Cataract Study

BACKGROUND

There is increasing emphasis on patient-based assessment of healthcare outcomes, but evaluation of the impact of ophthalmic disorders on quality of life is undertaken infrequently.

AIM

To report on the health-related quality of life (HRQOL) of children with congenital cataract.

METHODS

At least 6 years after diagnosis, 41 children (representative of a national cohort) and their parents completed the child and proxy (parental) versions of PedsQL 4.0, a generic multidimensional paediatric HRQOL instrument, independently. This provided a physical health summary score, a psychosocial health summary score and an overall score (range 0-100, higher scores indicating better HRQOL).

RESULTS

Questionnaires were completed by 33 parent-child pairs and by 8 parents alone. The mean (SD) total score self-reported by children was 75.85 (15.56) and that reported by parents was 75.91(16.79). The mean (SD) physical health score self-reported by children was 80.76 (8.61), which was higher than the psychosocial health score of 72.93 (16.06). There was considerable variation in agreement of scores reported by individual child-parent pairs (the largest difference was 56.3 points). Notably, the PedsQL scores of children with congenital cataract were comparable with those reported for some children with severe systemic diseases such as rheumatological disease and some cancers.

CONCLUSIONS

These findings serve to characterise the significant broader impact of congenital cataract on patients and their families. The PedsQL 4.0 proved to be an acceptable instrument for assessing generic HRQOL, permitting valuable reporting by children and their parents. However, to capture the subjective experience of ophthalmic disease in childhood fully, specific vision-related quality of life measures for children are needed.

A comparison of patient-reported outcomes from an apodized diffractive intraocular lens and a conventional monofocal intraocular lens

OBJECTIVE

The primary objective of this research was to compare cataract patient-reported outcomes of subjects bilaterally implanted with apodized diffractive intraocular lenses (AD-IOL) to subjects bilaterally implanted with conventional monofocal intraocular lenses (CM-IOL). A secondary objective was to establish the relationship between uncorrected visual acuity and patient-reported outcomes.

METHODS

This was a prospective non-randomized, open-label clinical trial consisting of 339 patients bilaterally implanted with the AD-IOL and 156 bilaterally implanted with the CM-IOL. The outcomes of both groups were assessed 6 months postoperatively after second eye implantation. Assessed endpoints included patient-reported outcomes and visual acuity. Limitations of this study include the lack of random assignment to treatment groups and lack of masking of both the physicians and patients.

RESULTS

AD-IOL patients demonstrated significantly better uncorrected near visual acuity (UCNVA) compared to CM-IOL patients (0.02 versus 0.41 log MAR [logarithm of the minimum angle of resolution], respectively; p < 0.0001). UCNVA was significantly correlated with nine patient-reported outcomes in the AD-IOL group and two patient-reported outcomes in the CM-IOL group. Significantly more AD-IOL patients reported spectacle independence compared to CM patients (80% versus 8% respectively; p < 0.0001). AD-IOL patients reported their vision quality as better than CM-IOL patients (p < 0.0001). AD-IOL patients were more satisfied with their daytime (p < 0.0001), nighttime (p < 0.0001), and overall (p < 0.0001) vision than CM-IOL patients. AD-IOL patients reported less trouble with their daytime (p < 0.0001) and nighttime (p = 0.0238) vision compared to CM-IOL patients. Furthermore, AD-IOL patients reported less distance vision limitation (p = 0.0282), less near vision limitation (p < 0.0001), and less social limitation (p < 0.0001) than CM-IOL patients.

CONCLUSIONS

The patient reported near vision benefits of the AD-IOL coupled with its high rate of spectacle independence significantly improved cataract patients' health-related quality-of-life, compared to a CM-IOL.

Refractive outcomes after cataract surgery with primary lens implantation in infants

AIMS

To show the refractive outcomes, accuracy of intraocular lens power selection, and visual outcomes and complications in infants undergoing cataract surgery.

METHODS

The refraction (spherical equivalent) of 14 operated eyes in 8 children aged <1 year was plotted over time. Preoperative and final recorded visual acuities were assessed.

RESULTS

The median follow-up was 37.25 months. The median initial postoperative refraction was (+)6.75 dioptres.

CONCLUSIONS

Refractive outcomes for each eye were not entirely predictable and were variable between infants. However, there was a consistent pattern in each infant who underwent bilateral surgery, with both eyes following a similar pattern of refractive change with time: a decreasing myopic shift was seen in 8 eyes, possibly demonstrating emmetropisation. The two unilateral cases appeared to show a linear myopic shift. 4 eyes in 2 patients did not follow a myopic shift curve and one of these patients showed an early trend towards increased hyperopia. Definite causes for this erratic refractive change were not identified. A postoperative refraction >4.5 dioptres avoided early onset myopia. The range of difference between postoperative and predicted refraction using SRK-T was (-)2.85 to 2.97 dioptres. Most of the visual results are encouraging compared with historical data in older children.

Bilateral cataract surgery and driving performance

BACKGROUND

Cataract surgery is one of the most common medical procedures undertaken worldwide.

AIMS

To investigate whether cataract surgery can improve driving performance and whether this can be predicted by changes in visual function.

METHODS

29 older patients with bilateral cataracts and 18 controls with normal vision were tested. All were licensed drivers. Driving and vision performance were measured before cataract surgery and after second eye surgery for the patients with cataract and on two separate occasions for the controls. Driving performance was assessed on a closed-road circuit. Visual acuity, contrast sensitivity, glare sensitivity and kinetic visual fields were measured at each test session.

RESULTS

Patients with cataract had significantly poorer (p<0.05) driving performance at the first visit than the controls for a range of measures of driving performance, which significantly improved to the level of the controls after extraction of both cataracts. The change in contrast sensitivity after surgery was the best predictor of the improvements in driving performance in patients with cataract.

CONCLUSIONS

Cataract surgery results in marked improvements in driving performance, which are related to concurrent improvements in contrast sensitivity.