Ten-year trends of immediate sequential bilateral cataract surgery (ISBCS) as reflected in the Swedish National Cataract Register.

PURPOSE: To analyse trends of ISBCS reported to the Swedish National Cataract Register (NCR) over a 10-year period. METHODS: Since 2010 the NCR contains social security number of all individuals in the list of parameters reported to NCR after each cataract procedure. Bilateral surgeries were mapped out using social security numbers. When dates of both-eye surgeries are identical for an individual it is classified as an immediate sequential bilateral cataract surgery (ISBCS). This study includes all data reported during the period 1st of January 2010 to 31st of December 2019. During the study period 113 cataract surgery clinics affiliated to the NCR reported their data on consecutive cataract cases. RESULTS: For the whole period 54 194 ISBCS were reported. The total number of bilateral cataract extractions was 422 300. There was a significant trend of increasing ISBCS over time with linear regression (Beta = 1.75, p < 0.001). In ISBCS the occurrence of an ocular comorbidity decreased over time. The use of a capsular tension ring was significantly more common in ISBCS than in delayed sequential bilateral cataract surgery (DSBCS). All other measures taken during surgery were more common in DSBCS. The use of multifocal IOL was significantly more frequent in ISBCS compared to DSBCS (p < 0.001). CONCLUSIONS: The use of ISBCS has increased over the study period. The operated eyes have less risk factors than eyes going through a DSBCS, but both ocular comorbidities and surgical complications occur in ISBCS eyes.

Impact of uncertainties in biometric parameters on intraocular lens power formula predicted refraction using a Monte-Carlo simulation.

PURPOSE: The purpose of this study was to investigate the uncertainty in the formula predicted refractive outcome REFU after cataract surgery resulting from measurement uncertainties in modern optical biometers using literature data for within-subject standard deviation Sw. METHODS: This Monte-Carlo simulation study used a large dataset containing 16 667 preoperative IOLMaster 700 biometric measurements. Based on literature Sw values, REFU was derived for both the Haigis and Castrop formulae using error propagation strategies. Using the Hoya Vivinex lens (IOL) as an example, REFU was calculated both with (WLT) and without (WoLT) consideration of IOL power labelling tolerances. RESULTS: WoLT the median REFU was 0.10/0.12 dpt for the Haigis/Castrop formula, and WLT it was 0.13/0.15 dpt. WoLT REFU increased systematically for short eyes (or high power IOLs), and WLT this effect was even more pronounced because of increased labelling tolerances. WoLT the uncertainty in the measurement of the corneal front surface radius showed the largest contribution to REFU, especially in long eyes (and low power IOLs). WLT the IOL power uncertainty dominated in short eyes (or high power IOLs) and the uncertainty of the corneal front surface in long eyes (or low power IOLs). CONCLUSIONS: Compared with published data on the formula prediction error of refractive outcome after cataract surgery, the uncertainty of biometric measures seems to contribute with ⅓ to ½ to the entire standard deviation. REFU systematically increases with IOL power and decreases with axial length.

Standard Clinical Outcomes, Light Distortion, Stereopsis, and a Quality-of-Life Assessment of a New Binocular System of Complementary IOLs.

PURPOSE: To evaluate the visual outcome, light distortion index (LDI), and quality of life (QoL) of patients implanted with two complementary intraocular lenses (IOLs) to treat cataract and presbyopia. METHODS: Twenty-seven consecutive patients with cataract were treated with the implantation of the Artis Symbiose Mid (Mid) IOL (Cristalens Industrie) in the distance-dominant eye and the Artis Symbiose Plus (Plus) IOL (Cristalens Industrie) in the contralateral eye following phacoemulsification. The primary objective was to ascertain the monocular and binocular defocus curves. Secondary endpoints included uncorrected distance visual acuity, corrected distance visual acuity, uncorrected intermediate visual acuity, and distance-corrected intermediate visual acuity at 90 and 70 cm, uncorrected near visual acuity and distance-corrected visual acuity at 40 cm, contrast sensitivity, LDI with a halometer, stereopsis, and patients' QoL with the validated Visual Function Index (VF-14) questionnaire. These measurements were collected in two visits, at 4.14 ± 3.13 and 10.30 ± 3.14 months postoperatively. RESULTS: Statistically significant differences in the monocular defocus curves were found at the defocus steps of -1.00, -1.25, -1.50, -1.75, -2.50, -2.75, -3.00, -3.50 diopters and the -4.00 diopters (P < .050). The mean binocular defocus curve was 0 logMAR or better from the +0.50 to the -2.50 D defocus steps. Contrast sensitivity was within normal values. The LDI was 12.57 (6.61)% for the Mid eyes, 14.99 ± 5.70% for the Plus eyes, and 10.36 ± 4.42% binocularly. The patients' stereopsis was 40.0 (12.5) arc-seconds. The QoL score was 95.99 (7.14) at 10 months. CONCLUSIONS: The implantation of the Artis Symbiose IOLs was a safe and effective treatment for presbyopia compensation in patients with cataract. Both IOLs are complementary and may produce a binocular depth-of-field of 3.00 diopters over 0 logMAR when used together. [J Refract Surg. 2023;39(10):654-661.].

Cost-effectiveness of virtual reality and wet laboratory cataract surgery simulation.

PURPOSE: To evaluate the cost-effectiveness of phacoemulsification simulation training in virtual reality simulator and wet laboratory on operating theater performance. METHODS: Residents were randomized to a combination of virtual reality and wet laboratory phacoemulsification or wet laboratory phacoemulsification. A reference control group consisted of trainees who had wet laboratory training without phacoemulsification. All trainees were assessed on operating theater performance in 3 sequential cataract patients. International Council of Ophthalmology Surgical Competency Assessment Rubric-phacoemulsification (ICO OSCAR phaco) scores by 2 masked independent graders and cost data were used to determine the incremental cost-effectiveness ratio (ICER). A decision model was constructed to indicate the most cost-effective simulation training strategy based on the willingness to pay (WTP) per ICO OSCAR phaco score gained. RESULTS: Twenty-two trainees who performed phacoemulsification in 66 patients were analyzed. Trainees who had additional virtual reality simulation achieved higher mean ICO OSCAR phaco scores compared with trainees who had wet laboratory phacoemulsification and control (49.5 ± standard deviation [SD] 9.8 vs 39.0 ± 15.8 vs 32.5 ± 12.1, P < .001). Compared with the control group, ICER per ICO OSCAR phaco of wet laboratory phacoemulsification was $13,473 for capital cost and $2209 for recurring cost. Compared with wet laboratory phacoemulsification, ICER per ICO OSCAR phaco of additional virtual reality simulator training was US $23,778 for capital cost and $1879 for recurring cost. The threshold WTP values per ICO OSCAR phaco score for combined virtual reality simulator and wet laboratory phacoemulsification to be most cost-effective was $22,500 for capital cost and $1850 for recurring cost. CONCLUSIONS: Combining virtual reality simulator with wet laboratory phacoemulsification training is effective for skills transfer in the operating theater. Despite of the high capital cost of virtual reality simulator, its relatively low recurring cost is more favorable toward cost-effectiveness.

A validated test has been developed for assessment of manual small incision cataract surgery skills using virtual reality simulation.

This study investigates the validity evidence of metrics used for the assessment of surgical skills for Manual Small Incision Cataract Surgery (MSICS) in a virtual reality simulator. MSICS surgery is a low-cost, low-technology cataract surgery technique, which is widely used in low- and middle-income countries. However, there is a lack of cataract surgeons globally, and efficient and evidence-based training of new surgeons is needed. In order to investigate the validity of simulator metrics, we included three groups of participants: (1) MSICS novices who were ophthalmologists with no cataract surgery experience, (2) MSICS novices who were experienced phacoemulsification cataract surgeons, but with no MSICS experience, and (3) experienced phacoemulsification and MSICS surgeons. The evaluation included 11 steps of the MSICS procedure, and all simulator metrics for those steps were reviewed. Of the 55 initial metrics, 30 showed high positive discriminative ability. A test passing score of 20 out of 30 was established, and one of 15 novices with no MSICS experience (mean score 15.5) and 7 out of 10 experienced MSICS surgeons (mean score 22.7) passed the test. We have developed and established validity evidence for a test for MSICS skills in a virtual reality simulator for future use in proficiency-based training and evidence-based testing of training interventions.

Cost Utility and Value of Information Analysis of Femtosecond Laser-Assisted Cataract Surgery.

Importance: The efficacy and safety of femtosecond laser-assisted cataract surgery is well documented. An important requirement for decision makers is the evaluation of the cost-effectiveness of femtosecond laser-assisted cataract surgery (FLACS) over a sufficiently long horizon. Evaluating the cost-effectiveness of this treatment was a preplanned secondary objective of the Economic Evaluation of Femtosecond Laser Assisted Cataract Surgery (FEMCAT) trial. Objective: To estimate the cost utility of FLACS compared with phacoemulsification cataract surgery (PCS) on a 12-month time horizon. Design, Setting, and Participants: This multicenter randomized clinical trial compared FLACS with PCS in parallel groups. All FLACS procedures were performed using the CATALYS precision system. Participants were recruited and treated in ambulatory surgery settings in 5 university-hospital centers in France. All consecutive patients eligible for a unilateral or bilateral cataract surgery 22 years or older with written informed consent were included. Data were collected from October 2013 to October 2018, and data were analyzed from January 2020 to June 2022. Interventions: FLACS or PCS. Main Outcomes and Measures: Utility was measured through the Health Utility Index questionnaire. Costs of cataract surgery were estimated by microcosting. All inpatient and outpatient costs were collected from the French National Health Data System. Results: Of 870 randomized patients, 543 (62.4%) were female, and the mean (SD) age at surgery was 72.3 (8.6) years. A total of 440 patients were randomized to receive FLACS and 430 to receive PCS; the rate of bilateral surgery was 63.3% (551 of 870). The mean (SD) costs of cataract surgery were €1124.0 (€162.2; US $1235) for FLACS and €565.5 (€61.4; US $621) for PCS. The total mean (SD) cost of care at 12 months was €7085 (€6700; US $7787) in participants treated with FLACS and €6502 (€7323; US $7146) in participants treated with PCS. FLACS yielded a mean (SD) of 0.788 (0.009) quality-adjusted life-years (QALYs), and PCS yielded 0.792 (0.009) QALYs. The difference in mean costs was €545.9 (95% CI, -434.1 to 1525.8; US $600), and the difference in QALYs was -0.004 (95% CI, -0.028 to 0.021). The incremental cost-effectiveness ratio (ICER) was -€136 476 (US $150 000) per QALY. The cost-effectiveness probability of FLACS compared with PCS was 15.7% for a cost-effectiveness threshold of €30 000 (US $32 973) per QALY. At this threshold, the expected value of perfect information was €246 139 079 (US $270 530 231). Conclusions and Relevance: The ICER of FLACS compared with PCS was not within the $50 000 to $100 000 per QALY range frequently cited as cost-effective. Additional research and development on FLACS is needed to improve its effectiveness and lower its price. Trial Registration: ClinicalTrials.gov Identifier: NCT01982006.

674 Cases of Late Postoperative Intraocular Lens Opacification of a Hydrophilic-Hydrophobic Acryl Intraocular Lens in Switzerland and Retrospective Opacification Risk Factor Assessment of 212 Cases.

PURPOSE: To report the prevalence of late postoperative opacification of a hydrophilic and hydrophobic acrylic intraocular lens (IOL) and to assess the risk factors in a subset of 212 eyes of patients referred to the University Eye Department in Basel, Switzerland. DESIGN: Retrospective case series. METHODS: A survey was performed at all large ophthalmological clinics in Switzerland regarding exchanged Lentis LS-502-1 lenses, and the number of affected eyes was counted. Moreover, consecutive patients who were referred to a tertiary clinic between September 2015 and November 2016 with Lentis LS-502-1 opacification were investigated. Peri- and postoperative charts, medical history, and topical and systemic medications were assessed. RESULTS: A total of 674 opacified Lentis LS-502-1 lenses have been reported in Switzerland, and 212 consecutive eyes of 182 patients were included in the study. All IOLs had a similar pattern of opacification with a yellowish, diffuse appearance, and most of them showed a small, paracentral, roundish area that was less affected or not at all. Arterial hypertension (73%), hypercholesterolemia (34%), and diabetes (21%) were the main associated systemic diseases, and statins (34%) and betablockers (34%) were the main treatments used. CONCLUSIONS: The prevalence of IOL opacification was 9.9%. No associated systemic eye disease or medications could be detected, which was implicated in the opacification process. The reason for opacification remains unclear, but it seems to be unrelated to the patient's state; therefore, it is attributed to primary calcification.

Perioperative time and economic impact of an intracameral combination of mydriatics and anaesthetics in routine cataract surgery.

PURPOSE: The aim of this study was to compare the perioperative time and economic impact of a licensed intracameral anaesthetic/mydriatic combination (Mydrane) during routine cataract surgery. METHODS: A real-life, prospective, comparative study was performed in 3 clinical centres in France. Preoperative, surgical, and post-operative times were determined for two mydriasis strategies using conventional preoperative mydriatics/anaesthetics eye drops (control regimen) or Mydrane administered at time of surgery. Staff, surgery schedules and drugs utilisation were collected over 12 surgery half-days. The total cost of each strategy was estimated based on treatment cost and nursing costs. RESULTS: The analysis included 112 routine cataract surgeries (57 surgeries using Mydrane and 55 using the topical regimen) without protocol deviations or complicated surgery. Overall, the mean time between administration of the first mydriatic eye drops or Mydrane and the end of the surgery was 27.4 ± 21.1 min in the Mydrane group vs. 90.3 ± 30.4 min in the control group (P < 0.0001). The total time of the procedure (from admission to discharge) was not significantly different between groups (P = 0.1611). On average, the extra cost of drugs per patient in the Mydrane group (€5.81) was almost balanced by the reduced nursing time (€5.57) with some variations between centres, due to different organisation including staff resource and consumable. CONCLUSIONS: The Mydrane strategy produced perioperative nursing time saving and cost reduction provided that adaptation and reorganisation of routine cataract surgery are implemented.

Assessment of Iridotrabecular Contact and Its Association With Intraocular Pressure After Phacoemulsification in Primary Angle Closure.

PURPOSE: To investigate the association between the quantitative assessment of iridotrabecular contact (ITC), measured by swept-source anterior segment optical coherence tomography (SS AS-OCT), and intraocular pressure (IOP) control after phacoemulsification in patients with primary angle closure disease (PACD). DESIGN: Retrospective, clinical cohort study. METHODS: Preoperative and postoperative anterior chamber angle parameters were measured using SS AS-OCT. IOP was measured preoperatively and until 6 months postoperatively. Percent IOP reduction and fluctuation after surgery were calculated, and their relationships with SS AS-OCT parameters were assessed by correlation analyses and locally weighted scatterplot smoothing (LOWESS) regression with change-point analysis. RESULTS: A total of 51 eyes of 51 PACD patients were included. Preoperative ITC index and area (r = 0.626, r = 0.551), as well as changes in ITC index and area (r = 0.632, r = 0.543) after surgery, were significantly correlated with postoperative IOP reduction, after adjusting for age and gender (all P <.001). Higher postoperative ITC index (r = 0.405, P = .005) and ITC area (r = 0.460, P = 0.001) were associated with greater postoperative IOP fluctuations. Change points on LOWESS curves were observed for preoperative ITC index (33.0%) and change in ITC index (27.0%) and percent IOP reductions were significantly correlated with them above (ß = 0.386, ß = 0.664, all P < .001) but not below the change points. CONCLUSIONS: Quantitative assessment of circumferential ITC can predict postoperative IOP control after phacoemulsification, and thus it may be used as a reference for determining lens extraction in PACD eyes.

Visual function assessment of Chinese cataract patients after individual aspheric intraocular lens implantation according to preoperative cornea spherical aberration.

BACKGROUND: Aspheric intraocular lens (IOLs) implantation has been widely applied in cataract surgery. However, there is no consensus on the optimal guidance for the operations in IOLs implantation. OBJECTIVE: This study evaluated the visual function of Chinese cataract patients six months after cataract surgery with two different guiding ideologies. METHODS: We evaluated 50 patients (61 eyes) with implantation of different aspheric IOLs (SN60WF IOLs, ZCB00 IOLs, PY-60AD IOLs, AO IOLs) 6 months after cataract surgery. Twenty-four patients (30 eyes) under individual implantation were ascribed to group 1 and 26 patients (31 eyes) with randomized implantation were ascribed to the control group (group 2). Postoperatively parameters included monocular best-corrected visual acuity (BCVA), contrast sensitivity (CS), total spherical aberration Z (4, 0) at 5 mm pupil size, and patient satisfaction. The quality of life after operation was assessed through the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25). RESULTS: Six months after cataract operation, the contrast sensitivity with glare of group 1 at 2.5∘ was 0.697 ± 0.027, and 0.532 ± 0.049 in group 2. Besides, there was no significant difference at any other special frequency. The mean spherical aberration Z (4, 0) at 5 mm pupil size in group 1 was 0.015 ± 0.028 um, and in group 2 was 0.043 ± 0.109 um, with a significant difference (p< 0.01). The mean scores obtained from NEI VFQ-25 were not significantly different. CONCLUSION: It is effective to implant aspheric IOLs individually according to preoperative corneal spherical aberration. Patients obtained better contrast sensitivity with glare at 2.5∘, but there was no significant difference in BCVA, contrast sensitivity at other special frequency, and subjective visual function.

Assessment of Risk Factors Affecting Refractive Outcomes after Phacovitrectomy for Epiretinal Membrane.

PURPOSE: To investigate factors associated with refractive outcomes after phacovitrectomy for epiretinal membrane (ERM). METHODS: Retrospective review of patients undergoing phacovitrectomy for ERM was done. The main outcome measure was predictive refraction error (PE), defined as observed refraction error - target refraction error, calculated by the SRK/T, Haigis, and SRK II formulae. PE was measured at postoperative 1, 3, and 6 months. Simple and multiple linear regression analysis were used to evaluate factors associated with PE. RESULTS: A total of 53 eyes of 53 patients were included. The mean PEs at postoperative 1, 3, and 6 months were all negative, implying myopic shift in all patients regardless of the intraocular lens formula used. Haigis formula showed the least myopic shift among the three formulae (p = 0.001, Friedman test). There was no significant difference in PE depending on preoperative central macular thickness (CMT) in subgroup analysis. On stepwise multiple linear regression analysis, ERM etiology (ß = 0.759, p = 0.004, SRK/T formula; ß = 0.733, p = 0.008, Haigis formula; ß = 0.933, p < 0.001, SRK II formula), preoperative anterior chamber depth (ß = -0.662, p = 0.013, Haigis formula; ß = -0.747, p = 0.003, SRK II formula), and decrease of CMT (ß = -0.003, p = 0.025, SRK/T formula) were significantly associated with PE at postoperative 6 months. CONCLUSIONS: Myopic shift in PE was observed after combined phacovitrectomy for epiretinal membrane. ERM etiology, preoperative anterior chamber depth, and decrease of CMT were significantly associated with PE at postoperative 6 months. There was no difference in PE after surgery between the two groups defined by CMT (≥500 and <500 µm).

Cost-benefit analysis of a trifocal intraocular lens versus a monofocal intraocular lens from the patient's perspective in the United States.

PURPOSE: To conduct a cost-benefit analysis of AcrySof IQ PanOptix trifocal intraocular lens (TFNT00 IOL) versus AcrySof monofocal IOL (SN60AT) from the patient perspective in the United States (US). METHODS: A de novo Markov model was developed to estimate the mean total lifetime patient costs and vision-related quality of life (measured as quality adjusted life-years (QALYs)) with each intervention (TFNT00 and SN60AT) and the incremental differences between these two treatments. The resulting incremental quality of life gain was mapped to the US patient willingness to pay threshold of $50,000 per QALY gain to estimate the lifetime net monetary value, measured as the net monetary benefit of TFNT00 IOL. Model inputs (transition probabilities, costs, discount rate, utilities, and event rates) were derived from the FDA IDE study (NCT03280108), published literature, clinical experience, and other relevant sources. RESULTS: Bilateral cataract surgery with implantation of the advanced technology IOL (AT-IOL) TFNT00 provides improved vision-related quality of life (QALY gain of 0.67) at an incremental lifetime cost of $2,783 compared to monofocal IOL. This incremental QALY gain translated into a lifetime net monetary benefit of $30,941 at the patient willingness to pay threshold of $50,000/QALY gain. Results were most sensitive to disutility due to wearing glasses, patient out of pocket costs for bilateral AT-IOL procedure, and post-operative spectacle dependence rates. CONCLUSIONS: AcrySof IQ PanOptix IOL provides greater improvement in vision related quality of life compared to no presbyopia correction with a monofocal IOL. This study shows PanOptix is a cost-beneficial treatment strategy for patients willing to pay out of pocket for cataract surgery.

Optical Assessment and Expected Visual Quality of Four Extended Range of Vision Intraocular Lenses.

PURPOSE: To assess the optical performance of four extended range of vision (ERV) intraocular lenses (IOLs) and predict the visual quality of the average pseudophakic patient. METHODS: Four ERV IOLs (LuxSmart, Bausch & Lomb; Vivity, Alcon Laboratories, Inc; Tecnis Eyhance, Johnson & Johnson Vision; and Isopure, PhysIOL) were inserted in an on-bench model eye. Their performance was assessed using through-focus modulation transfer function (MTF)-based metrics, through-focus point spread function, and halo analysis for three pupils (2.0, 3.0, and 4.5 mm). The expected visual acuity and the range of vision was estimated from the through-focus area under the MTF curve. A monofocal IOL (Tecnis ZCB00; Johnson & Johnson Vision) was included as reference. RESULTS: The Tecnis ZCB00 showed the highest image quality at far for all pupil conditions, closely followed by the Tecnis Eyhance. The LuxSmart and Vivity performed similarly in the intermediate range (-1.00 to -2.00 diopters [D]) with a 3.0-mm pupil and showed better performance than the other ERV IOLs for that range. All ERV lenses presented pupil dependent performance. All lenses reached normal expected visual acuity (0.0 logMAR) at far distance. The Tecnis ZCB00, Tecnis Eyhance, and Isopure decreased their expected visual acuity with defocus (0.1 logMAR at 66 cm) faster than the LuxSmart and Vivity (0.0 logMAR at 66 cm). The LuxSmart and Vivity produced greater halos than the Tecnis ZCB00, but they showed little change with larger pupils. The Isopure lens showed a pupil-dependent halo. CONCLUSIONS: The expected visual acuity decreased with the object distance differently, depending on the ERV design. The Vivity and LuxSmart lenses showed an expanded imaging capability (⩾ 0.50 D) with respect to a monofocal lens that may benefit intermediate vision. The Tecnis Eyhance and Isopure lenses showed more modest extensions that mainly rely on pupil constriction. [J Refract Surg. 2022;38(11):688-697.].

Health economics and manual small-incision cataract surgery: An illustrative mini review.

Cataract extraction is one of the most common surgical procedures performed worldwide. Manual small-incision cataract surgery (MSICS) is a popular technique of cataract extraction. Full economic evaluation of different techniques is of value to policy makers. This was a systematic review of published literature to present a brief overview of evidence available in respect of economic evaluation measures like cost effectiveness, cost utility, and cost parameters in cataract patients regarding MSICS. The data on these was sparse and heterogeneous. Direct costs of MSICS were lower than phacoemulsification (PE): $25.55 (PE) to $17.03 (MSICS) in India, $15 (MSICS) to $70 (PE) in Nepal, and $62.25 (MSICS) to $104.15 (PE) in Thailand. The cost utility analysis for MSICS demonstrated savings of $79.57 (INR6175) per gain in LogMAR BCVA, $8.91 (INR691) per QALY gained and $1.42 (INR110) per VF 14 score increment in India. Incremental cost-effectiveness ratio (ICER) $368.20 (13,215.50 Baht) for MSICS was better than $489.30 (17,561.70 Baht) for PE in Thailand. ICER for femto laser-assisted cataract surgery (FLACS) compared to was €10,703 in femtosecond laser-assisted versus phacoemulsification cataract surgery (FEMCAT) study. The corrected ICER for PE against MSICS is €146.50. The limited data available demonstrates that MSICS is the most cost-effective technique among FLACS, PE, and MSICS. MSICS scores over other existing alternatives of cataract extraction from cost-effectiveness and cost-minimization approaches. Further research is required in this area.

Vacuum-assisted cortex removal - A novel change to the tradition.

In developing countries, manual small-incision cataract surgery (MSICS) has surfaced as the cost-effective alternative to phacoemulsification. The Simcoe irrigation-aspiration cannula was developed nearly 40 years ago and is still the most frequently employed tool for cortex aspiration. Although it stands unsurpassed, here we attempt to introduce an addition to the existing Simcoe cannula to achieve a dynamic and controlled vacuum with the added advantage of less physical strain and an effective volume of aspiration. The vacuum-assisted cortex removal device is based on a simple spring action mechanism, where the relaxation of the spring pushes the plunger up and thereby generates a controlled vacuum.

Assessment of the influence of keratometry on intraocular lens calculation formulas in long axial length eyes.

PURPOSE: Hyperopic surprises tend to occur in axial myopic eyes and other factors including corneal curvature have rarely been analyzed in cataract surgery, especially in eyes with long axial length (≥ 26.0 mm). Thus, the purpose of our study was to evaluate the influence of keratometry on four different formulas (SRK/T, Barrett Universal II, Haigis and Olsen) in intraocular lens (IOL) power calculation for long eyes. METHODS: Retrospective case series. A total of 180 eyes with axial length (AL) ≥ 26.0 mm were divided into 3 keratometry (K) groups: K ≤ 42.0 D (Flat), K ≥ 46.0 D (Steep), 42.0 < K < 46.0 D (Average), and all the eyes were underwent phacoemulsification cataract surgery with Rayner (Hove, UK) 920H IOL implantation. Prediction errors (PE) were compared between different formulas to assess the accuracy of different formulas. Multiple regression analysis was performed to investigate factors associated with the PE. RESULTS: The mean absolute error was higher for all evaluated formulas in Steep group (ranging from 0.66 D to 1.02 D) than the Flat (0.34 D to 0.67 D) and Average groups (0.40 D to 0.74D). The median absolute errors predicted by Olsen formula were significantly lower than that predicted by Haigis formula (0.42 D versus 0.85 D in Steep and 0.29 D versus 0.69 D in Average) in Steep and Average groups (P = 0.012, P < 0.001, respectively). And the Olsen formula demonstrated equal accuracy to the Barrett II formula in Flat and Average groups. The predictability of the SRK/T formula was affected by the AL and K, while the predictability of Olsen and Haigis formulas was affected by the AL only. CONCLUSIONS: Steep cornea has more influence on the accuracy of IOL power calculation than the other corneal shape in long eyes. Overall, both the Olsen and Barrett Universal II formulas are recommended in long eyes with unusual keratometry.

Femtosecond Laser-Assisted Cataract Surgery: A Report by the American Academy of Ophthalmology.

PURPOSE: To evaluate refractive outcomes, safety, and cost-effectiveness of femtosecond laser-assisted cataract surgery (FLACS) compared with phacoemulsification cataract surgery (PCS). METHODS: A PubMed search of FLACS was conducted in August 2020. A total of 727 abstracts were reviewed and 33 were selected for full-text review. Twelve articles met inclusion criteria and were included in this assessment. The panel methodologist assigned a level of evidence rating of I to all 12 studies. RESULTS: No significant differences were found in mean uncorrected distance visual acuity, best-corrected distance visual acuity, or the percentage of eyes within ± 0.5 and ± 1 diopter of intended refractive target between FLACS and PCS. Intraoperative and postoperative complication rates were similar between the 2 groups, and most studies showed no difference in endothelial cell loss between FLACS and PCS at various time points between 1 and 6 months. In large randomized controlled studies in the United Kingdom and France, FLACS was less cost-effective than PCS. CONCLUSIONS: Both FLACS and PCS have similar excellent safety and refractive outcomes. At this time, one technique is not superior to the other, but economic analyses performed in some populations have shown that FLACS is less cost-effective.