Time Series Changes in Cataract Surgery in Korea.

PURPOSE: We analyzed time series changes in cataract surgeries in Korea, and provide basic data to enhance the efficiency of medical services for cataract surgery. METHODS: Among cataract surgery statistics registered in the Korean National Health Insurance Cooperation from 2006 to 2012, we used data regarding the number of patients and operations and the number of patients and operations per 100,000 people. We analyzed various time series changes, including differences by sex and age. RESULTS: The total numbers of patients from 2006 to 2012 by year were 207,370; 228,170; 250,289; 268,548; 289,867; 308,111; and 302,182, respectively. The total numbers of operations from 2006 to 2012 by year were 272,920; 305,807; 338,332; 365,874; 398,338; 428,158; and 420,905, respectively. The number of patients and operations per 100,000 people were highest in men 80 to 84 years old and women 75 to 79 years old. Comparing the number of operations in 2006 and after, the patient age group with the highest increase rate changed from over 85 years old to 75-79 years old since 2010 in men and from over 85 years old to 50-54 years old since 2009 in women. For each year investigated, the number of operations performed was higher than the number of patients who received operations. CONCLUSIONS: Over the study period, the number of cataract surgeries increased, while the age of cataract patients decreased. Additionally, the number of cataract-related surgeries increased in relation to the number of patients.

Wait times and volume of cataract surgery in Ontario: 2000-2012.

OBJECTIVE: To review cataract surgery trends and wait times in Ontario. DESIGN: Retrospective analysis of health records. METHODS: Ontario Health Insurance Plan billing service claims between 2000 and 2012 were analyzed for the yearly number of cataract surgeries, alone and in combination with other procedures. The number of Ontarians with cataracts was estimated by applying composite prevalence curves derived from published population data. This was then used to calculate the yearly number of procedures per 1000 Ontarians with cataracts. RESULTS: Per 1000 people with cataract, the rate of cataract extraction increased 18.9% overall from 2000 to 2012, increasing by 38.3% from 2000 to 2006 and decreasing by 14.6% from 2006 to 2012. Mean wait times for cataract surgery decreased by 45.8% from 2006 to 2009 and increased 28.5% from 2009 to 2013. The proportion of surgeries that were same-day bilateral cataract extraction increased 2.21-fold from 2000 to 2012 but represented only 0.82% of total cataract surgeries in 2012. In 2000, 3% of cataract surgeries were combined with other procedures, and this decreased to 1.8% in 2012. Of these combinations, the rates of combined glaucoma filtration procedures decreased by 44.3%, anterior vitrectomy decreased by 32.5%, posterior vitrectomy increased by 58.3%, and corneal transplantation decreased by 10.7% during this time period. CONCLUSIONS: The yearly rate of cataract surgery has decreased since 2006, and wait times have increased from 2009. Same-day bilateral cataract extraction represented less than 1% of the total cataract surgical volume. Rates of cataract combined with posterior vitrectomy have increased (58%), whereas anterior vitrectomy at the time of cataract surgery decreased (33%).

Fototoxicidad. Radiaciones ultravioleta y cataratas / Phototoxicity. Ultraviolet radiation and cataracts

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Anestesia subtenoniana en cirugía del globo ocular: revisión / Sub-Tenon block for ocular globe anesthesia: a review

La anestesia subtenoniana es una técnica efectiva y bien tolerada que permite realizar intervenciones de la cámara anterior y posterior del ojo. Ofrece similares ventajas que la anestesia peribulbar y retrobulbar al tiempo que minimiza sus complicaciones. La anestesia subtenoniana proporciona mejor analgesia que aquinesia. Frente a las anestesias tópica e intracamerular, la mayoría de estudios aboga por la anestesia subtenoniana como la técnica de elección, ya que disminuye los potenciales efectos adversos de las otras técnicas regionales y proporciona mejor analgesia y aquinesia(AU)

Sub-Tenon anesthesia is an effective, well-tolerated technique for surgery in the anterior or posterior compartments of the eye. The advantages of this block are comparable to those of peribulbar and retrobulbar anesthesia and complications are minimal. Sub-Tenon anesthesia provides better analgesia than akinesia. Most studies suggest that sub-Tenon anesthesia is a good technique to choose, given that potential adverse effects are fewer than for other regional blocks and analgesia and akinesia are superior(AU)

Reaching rural Africans with eye care services: findings from primary eye care approaches in Rubavu District, Rwanda.

OBJECTIVE: Assessment of a primary eye care programme in rural Rwanda over 2 years, with the aim of providing evidence to guide the development, training, supervision, or monitoring of primary eye care in Africa. METHOD: A comprehensive eye care programme in Rubavu District including a surgical service, health promotion, diagnostic and treatment services, training of health centre nurses and village health workers, and periodic visits by eye professionals to the health centres was implemented. Monitoring systems put in place from the beginning of the programme facilitated assessment of service use over 2 years. RESULTS: A total of 6495 people received eye care services at eight health centres (3912 from nurses and 2583 from visiting eye professionals) and 149 Rubavu residents had surgery for cataract. Increases in service use in the first few months were not maintained over the 2-year period. The number of patients receiving surgery for cataract was less than half of the number referred for surgery. CONCLUSION: In this setting, initial increases in use of services at health centres were not maintained. Reasons varied and included the observation that VHW tend to refer patients to health centres only when there was a visiting eye professional. Reductions in visits to health centres could also be traced to changing government policies on medicines provided through insurance coverage. Increasing rates of referral and uptake of cataract surgery will require revising programme activities and adopting additional strategies.

Anaesthesia for cataract surgery.

Cataract surgery is the most frequent surgical procedure requiring anaesthesia in developed countries. It is performed mainly in elderly patients, who present with many coexisting diseases that induce subsequent hazards from general anaesthesia. Cataract anaesthesia is performed following various techniques of regional anaesthesia, which are detailed in this review. Needle block carries a low but real risk of complications, mainly because of needle misplacement. Correct teaching and training are mandatory to prevent complications. The main patient risk factor for inadvertent globe perforation is the presence of a myopic staphyloma. Retrobulbar block has been progressively phased out and replaced by peribulbar block, sub-Tenon's block (STB) or topical anaesthesia (TA). The requirement for very deep block with total akinesia has greatly decreased with the use of phacoemulsification for cataract surgery, allowing for use of TA or low-volume STB. However, non-akinesia techniques may give rise to impaired surgical conditions, which have the potential to result in surgical complications. A surgical approach to accessing sub-Tenon's space avoids needle block, but does not totally prevent complications. When deep anaesthesia is required, low-volume STB, performed using either the needle technique or a surgical approach, appears to be the technique of choice in terms of efficacy. Increasing the anaesthetic volume provides reproducible akinesia. Various local anaesthetics may be used, depending on their availability and respective properties. The most useful adjuvant to local anaesthetic is hyaluronidase.

A 10-year population-based cohort analysis of cataract surgery rates in Ontario.

BACKGROUND: We studied the rates and distribution of cataract surgery throughout Ontario using population-based administrative data. METHODS: We identified patients who had had cataract surgery performed between April 1, 1994, and March 31, 2005. We calculated crude cataract surgery rates, overall and regional adjusted rates per 100,000 residents aged 65 and over, and age- and sex-specific rates. RESULTS: The number of cataract surgeries performed on patients over 65 more than doubled, from 43,818 to 90,183, over the 10-year period and accounted for approximately 81% of all cataract surgeries in Ontario. Age- and sex-adjusted rates varied considerably among health administrative geographic regions. For 2004-2005, rates including all cataract surgeries ranged from 4272 to 6563 cataract surgeries per 100,000 residents aged 65 or older. INTERPRETATION: There has been a significant increase in the number of cataract surgeries performed over the past decade in Ontario with considerable regional variation. Observed rates were higher than those reported for other countries.

Increasing cataract surgery to meet Vision 2020 targets; experience from two rural programmes in east Africa.

BACKGROUND: The numbers of cataract surgeries done in sub-Saharan Africa fall short of Vision 2020 targets. Over a few years, two programmes in rural east Africa both achieved significant increases in the number of cataract surgeries they provide, resulting in cataract surgical rates of 1583 for Kwale District in Kenya and 1165 for Kilimanjaro Region in Tanzania. Key components of success in these two programmes are described. METHODS: Data were collected on standard indicators and key personnel interviewed to describe the results and compare the methods employed to increase cataract surgical rates by the Kwale District Eye Centre programme and the Kilimanjaro regional Vision 2020 programme. RESULTS: Key components of success shared by the programmes included: (1) programmes in the community and at the hospital are closely linked so that they increase capacity together; (2) community programmes are "patient friendly," providing service in one stop; (3) the examination team includes eye workers with enough skill to provide treatment and decide who is operable so that patients are not transported needlessly or sent through a lengthy referral chain; (4) sites for visits in the community are selected according to population distribution and they are visited according to a regular schedule. CONCLUSION: The development of "bridging strategies" that create a strong link between hospitals providing clinical service and communities needing these services is a key component to realising Vision 2020 goals in sub-Saharan Africa.

Current trends in cataract and refractive surgery in Japan: 1999 survey.

PURPOSE: The eighth annual survey was carried out by mail in February 2000 to investigate the current trends in cataract and refractive surgery in Japan. RESPONDENTS: Questionnaires were sent to 930 ophthalmologist members of the Japanese Society of Cataract and Refractive Surgery. Data received from 457 (49.1%) of the recipients were cross-analyzed and compared with those from the previous surveys. RESULTS: In cataract surgery, 17% of respondents were doing 51 or more cases per month, 94% preferred phacoemulsification, 58% employed the self-sealing wound closure technique, and 26% used topical anesthesia for phacoemulsification. In refractive surgery, excimer laser surgery and astigmatic keratotomy attracted notably high interest, while less attention was directed toward radial keratotomy and intrastromal corneal ring. Laser in situ keratomileusis, photorefractive keratectomy, phakic intraocular lens, intrastromal corneal ring, and radial keratotomy were judged to be useful refractive surgical procedures by 69.0%, 40.0%, 24.6%, 14.2%, and 8.0% of the respondents, respectively. CONCLUSION: There are trends toward more surgical procedures performed by a surgeon, shorter period of hospitalization, and increasing preference for small incision cataract surgery. Refractive surgery is not yet widely performed, but laser in situ keratomileusis is viewed as the most promising procedure.

Current trends in cataract and refractive surgery in Japan: 1996 survey.

A fifth annual survey was carried out by mail in February 1997 to investigate the current trends in cataract and refractive surgery in Japan. A questionnaire was sent to 867 ophthalmologist members of the Japanese Society of Cataract and Refractive Surgery. Data received from 440 (50.7%) of the recipients were cross-analyzed and compared with those from the previous surveys. For cataract surgery, there have been trends toward more surgical procedures performed by a surgeon, shorter period of hospitalization, and increased number of outpatient surgery. Ninety percent of respondents preferred phacoemulsification, 42% employed the self-sealing wound closure technique, and 26% used topical anesthesia for phacoemulsification. As for refractive surgery, surgeons remained rather conservative, with 26% and 6% of surgeons doing astigmatic keratotomy and refractive keratotomy, respectively.

Current trends in cataract surgery in Denmark--1997 survey.

A survey of the preferred techniques and choices in cataract surgery of the members of the Danish Ophthalmological Society with address in Denmark was performed in January 1998. Only ophthalmologists performing cataract surgery were asked to return the questionnaire. Ninety-one responses were received by the cut-off day, representing 28872 cataract operations per year. The data were compared to data from previous surveys in Denmark, and similar data from the US and Japan.

Practice styles and preferences of ASCRS members--1995 survey.

A survey of the practice styles and preferences of the 1995 members of the American Society of Cataract and Refractive Surgery with a U.S. ZIP code was performed in September 1995. Approximately 27% (1500) of the 5500 questionnaires mailed were returned by the December cutoff date. Four main profile questions were used to cross-tabulate data: age of the ophthalmologist, geographic location, volume of cataract surgery per month, and volume of refractive surgery per month. Current data were compared with data in previous annual surveys.

Current trends in cataract and refractive surgery in Japan--1995 survey.

A fourth annual survey was carried out by mail in February 1996 to investigate the current trends in cataract and refractive surgery in Japan. A questionnaire was sent to 911 ophthalmologist members of the Japanese Society of Cataract and Refractive Surgery. Data received from 46.7% of the recipients were cross-analyzed and compared with those from the previous surveys.

Practice styles and preferences of ASCRS members--1989 survey.

A survey of the practice styles and preferences of 1989 ASCRS members with a U.S. zip code was performed in September 1989. More than 3,700 questionnaires were mailed and over 42% (1,543) were returned prior to the cut-off date. Three main profile questions were used to cross-analyze the results: the age of the ophthalmologist, the volume of cataract surgery per month, and the geographic location. This report also compared the data with previously published surveys of the ASCRS membership.