Indications for and outcomes of tertiary referrals in refractive surgery.

PURPOSE: To review the spectrum of disease, symptomatology, and management offered to patients referred for a second opinion after refractive surgery. METHODS: A prospective cohort study was done on all patients referred from October 1, 2006, to September 30, 2011, to a tertiary eye clinic after refractive surgery of any kind (ie, corneal laser surgery, conductive keratoplasty, radial keratotomy, phakic implants, refractive lens exchanges, or any combination thereof). Data analysis was performed on all demographic and clinical aspects of this cohort, including the initial complaint, type of referral, number of complaints, procedure previously performed, diagnosis at our center, type of advice given, and rate and type of surgical intervention. RESULTS: One hundred thirty-one eyes (69 patients) were included. Corneal refractive surgery was performed in 82% (108 eyes), and 11% (14 eyes) were seen after phakic intraocular lens (PIOL) implantation and 7% (9 eyes) after refractive lens exchange. The most common diagnoses were tear film dysfunction (30 eyes, 23%), residual refractive error (25 eyes, 19%), and cataract (20 eyes, 15%). Most patients (42 patients, 61%) were treated conservatively. In 27 patients (39%), 36 eyes (28%) were managed surgically. Severe visual loss was seen in 1 eye. CONCLUSIONS: No major problems were found in most second opinions after refractive surgery referral. Dry eyes, small residual refractive error, or higher-order aberrations were the most common complaints. Surgical intervention was needed in 36 eyes (28%), almost half of which were cataract extractions. Severe visual loss was seen in 1 eye with a PIOL. There was no incidence of severe visual loss in keratorefractive and refractive lens exchange procedures.

European registry for quality improvement in cataract surgery.

PURPOSE: A project aimed at creating a multi-national database for cataract and refractive surgery was initiated in 2008. The database was intended for learning and clinical improvement, not supervision. The project was co-funded by the European Union, under the Executive Agency for Health and Consumers and the European Society of Cataract and Refractive Surgeons (ESCRS) and supported by 11 national societies for cataract and refractive surgery. The purpose of this article is to describe the setup of the database and the ensuing achievements within cataract surgery after four years. DESIGN/METHODOLOGY/APPROACH: A web-based system was created for input and output of data, with a software interface to two databases, one for cataract surgery and one for refractive surgery. Data can be put in either manually through web forms or by transfer of data from existing national registries or large electronic medical record systems. Output of reports from the system or export of one's own data is available on the web. The data are anonymous to all users, with the sole exception that reporting surgeons and clinics have access to their own data. The system does not include any patient identification. FINDINGS: After four years, data from 16 countries have been entered into the system, including reports of more than 900,000 cataract extractions. The database has been used by individual clinics for benchmarking and clinical improvement work, and has also served as the basis for new clinical guidelines for cataract surgery. The ESCRS has guaranteed the sustainability of the database after the project period. ORIGINALITY/VALUE: A European quality registry with data input from surgeons and clinics in 16 European countries has been established. Close to one million surgeries have been entered into the system during the first four years. Evidence-based guidelines have been published based on data in the registry. The system is used for benchmarking by both experienced surgeons and trainees.

Evaluation of Research Productivity Among Academic Cornea, External Diseases, and Refractive Surgery Ophthalmologists Using the Relative Citation Ratio.

PURPOSE: The purpose of this study was to provide relative citation ratio (RCR) benchmark data for cornea and external diseases specialists. DESIGN: This is a cross-sectional bibliometric analysis. SUBJECTS: Subjects included were fellowship-trained cornea and external diseases faculty at Accreditation Council for Graduate Medical Education-accredited institutions in the United States. METHODS: Academic specialists were indexed using the National Institutes of Health iCite Web site. Publication count, mean RCR score, and weighted RCR score were obtained between October 2022 and January 2023 by examining PubMed-listed publications from 1980 to 2022. Data were compared by sex, career duration, academic rank, and acquisition of a Doctor of Philosophy. MAIN OUTCOME MEASURES: The main outcome measures were publication count, mean RCR value, and weighted RCR value. RESULTS: The cohort included 602 specialists from 112 Accreditation Council for Graduate Medical Education-accredited institutions. These clinician-scientists produced highly impactful research with a median publication count of 15 (interquartile ranges 4-41), median RCR of 1.4 (interquartile ranges 0.91-1.88), and median-weighted RCR of 20.28 (5.3-66.69). Both academic rank and career length were associated with greater publication count and RCR values. Male sex was also associated with greater publications counts and RCR scores compared with female faculty. Acquisition of a Doctor of Philosophy was associated with greater publication counts and weighted RCR scores but no difference in mean RCR scores. CONCLUSIONS: Academic cornea and external diseases specialists conduct high-impact research, with a median RCR of 1.4, exceeding the NIH standard value of 1. These data provide RCR benchmark data for the field to inform self, institutional, and departmental evaluations. These results also highlight a significant gender disparity in the field necessitating efforts to increase female representation and ensure equal opportunities.

[Infections after intraocular lens surgery: implications for refractive surgery]. / Infektionen nach Linsenchirurgie: Implikationen für die refraktive Chirurgie.

Apart from the classical indication of removing an opaque lens that is compromising vision, extraction of the crystalline lens is gaining increasing importance as a refractive procedure. This literature review which considers the present guidelines of various ophthalmological societies and recently published studies is intended to give an estimate of the incidence of postoperative endophthalmitis and evidence-based recommendations for its prophylaxis, diagnosis, and therapy. The incidence of endophthalmitis after cataract extraction is reported to be 0.04% to 0.3% in most sizeable studies. Immediate sequential bilateral cataract surgery is internationally gaining popularity. It remains difficult to estimate whether or not the risk of endophthalmitis is affected with this approach. A toxic anterior segment syndrome (TASS) needs to be differentiated from postoperative endophthalmitis. TASS is an acute sterile inflammation after cataract surgery. Remnants of detergents and antiseptics on the surgical instruments are supposed to be main triggers. Additionally, the inappropriate preparation of solutions and antibiotics for intracameral use is considered to be a major cause. A case of TASS was also reported after implantation of an iris-fixated anterior chamber lens in a phakic eye. The cefuroxime solution that was prophylactically used in the ESCRS study and that is recommended for routine cataract surgery is not commercially available in Germany as a ready preparation for intraoperative application. Different measures are undertaken in different countries to prevent postoperative endophthalmitis, whose values are not exactly quantifiable. Antisepsis with povidone-iodine is still considered to be the component with the best evidence. For management of acute postoperative endophthalmitis, the systemic application of antibiotics is recommended in addition to their intravitreal injection. Few case reports have been published describing an infection after the implantation of refractive intraocular lenses (IOLs) in a phakic eye. However, we could not find meaningful information regarding the incidence of endophthalmitis after implantation of refractive IOLs. Based on the fact that these IOLs are not implanted into the capsular bag but in front of the crystalline lens or into the anterior chamber, and the presumably better anti-microbial immunity of this younger population compared to cataract patients, one may assume that the infection rate is lower than after cataract surgery. Nevertheless, a prospective register to document all endophthalmitis cases is desirable.

Keeping an eye on eye care: monitoring progress towards effective coverage.

The eye care sector is well positioned to contribute to the advancement of universal health coverage within countries. Given the large unmet need for care associated with cataract and refractive error, coupled with the fact that highly cost-effective interventions exist, we propose that effective cataract surgery coverage (eCSC) and effective refractive error coverage (eREC) serve as ideal indicators to track progress in the uptake and quality of eye care services at the global level, and to monitor progress towards universal health coverage in general. Global targets for 2030 for these two indicators were endorsed by WHO Member States at the 74th World Health Assembly in May, 2021. To develop consensus on the data requirements and methods of calculating eCSC and eREC, WHO convened a series of expert consultations to make recommendations for standardising the definitions and measurement approaches for eCSC and eREC and to identify areas in which future work is required.

Recent trends of refractive surgery rate and detailed analysis of subjects with refractive surgery: The 2008-2015 Korean National Health and Nutrition Examination Survey.

The present study was conducted to investigate recent trends of refractive surgery rates and analyze subjects undergoing refractive surgery using large-scale population studies over the past 8 years. We used the dataset of the Korean National Health and Nutrition Examination Surveys, a nationwide population-based cross-sectional study which were performed from 2008 to 2015. Of the 21,415 participants aged 20 to 49 years, 1,621 had refractive surgeries. Seventy three percent of them were females and 81% of them were aged under 40 years old. Over the past 8 years, cumulative prevalence of refractive surgery rate increased more than 10%. Although young (< 40 years, odds ratio (OR) 0.31, P<0.001) women (OR 1.86, P<0.001) living in urban areas (OR 0.51, P<0.001) with high educational attainment (OR 2.67, P<0.001) and income levels (OR 3.16, P<0.001) accounted for a high proportion in refractive surgery group through all survey years, subgroup analyses revealed that gaps between genders (ORs 3.8 in 2008-2009, 2.1 in 2010-2012, and 1.5 in 2013-2015), educational level (ORs 3.0, 2.5, and 2.1, respectively), and highest/lowest quartiles of household income (ORs 5.2, 2.6, and 2.4, respectively) were decreasing over time. Overall, our study suggests that refractive surgery has reached an age where the majority accepts it, and indeed more and diverse people are undergoing refractive surgeries.

Prevalence of Keratoconus in Refractive Surgery Cases in Western India.

PURPOSE: To report the prevalence of keratoconus (KCN) in patients presenting for refractive surgery in western India. METHODS: A cross-sectional, observational, retrospective study performed at a tertiary eye care center. A total of 2902 cases, aged 18-40 years who presented in the refractive surgery department between January 2014 and December 2018 were included. Records of all the included cases were reviewed. Patients showing KCN pattern on topography were noted and divided into KCN and KCN suspects. Annual and overall 5-year prevalence were calculated at 95% confidence interval (CI). Demographic details of KCN and non-KCN participants were compared. RESULTS: Of the 2902 cases, 25 (0.86%) had clinical KCN and 22 (0.76%) were KCN suspects. The combined 5-year prevalence of all these 47 KCN cases was 1.61% (95% CI: 1.15%-2.07%), with an annual prevalence range of 0.97%-2.43%. The mean age of non-KCN cases was 24.60 ± 4.91 years and KCN cases was 24.62 ± 5.37 years (P = 0.98). Among the KCN cases, there were more females (30; 63.83%), and the gender ratio was significantly different than non-KCN cases (P = 0.004). CONCLUSION: The prevalence of KCN in refractive surgery cases was 1.61% which is higher than those found in the western population and lower than those found in the Middle East (Saudi Arabia and Iran). Furthermore, topographic examination performed during the routine screening of patients for refractive surgery can be a useful tool to diagnose new cases of KCN in asymptomatic patients.

Significance of dynamic contour tonometry in evaluation of progression of glaucoma in patients with a history of laser refractive surgery.

AIMS: In this study, we tested the hypothesis that intraocular pressure (IOP) parameters measured by dynamic contour tonometry (DCT) would be more relevant in progression of glaucoma when there is a history of laser refractive surgery (LRS) than the IOP parameters measured by Goldmann applanation tonometry (GAT) or calculated by correction formulae. METHODS: Ninety-eight eyes in 54 patients with open-angle glaucoma and a history of LRS were included in this retrospective study. IOP was measured by both GAT and DCT during follow-up. Baseline, mean, and peak IOP, IOP fluctuation, and IOP reduction were measured by each tonometry method. Corrected IOP parameters using central corneal thickness and mean keratometry values were also analysed. Clustered logistic regression was used to identify variables correlated with progression of glaucoma. Areas under the curve (AUCs) for correlated variables were also compared. RESULTS: The mean DCT value (OR 1.36, p=0.024), peak DCT value (OR 1.19, p=0.02) and pattern SD (OR 1.10, p=0.016) were significant risk factors for progression. There was a significant difference in the predictive ability of the mean DCT and GAT values (AUC 0.63 and 0.514, respectively; p=0.01) and of the peak DCT and GAT values (0.646 and 0.503, respectively, p=0.009). The AUCs for corrected IOP did not exceed those of DCT. CONCLUSIONS: IOP measurements were more associated with progression of glaucoma when measurements were obtained by DCT than by GAT or correction formulae in eyes with a history of LRS.

Analysis of optimized profiles for 'aberration-free' refractive surgery.

PURPOSE: To provide a model of an aberration-free profile and to clinically evaluate the impact of treatments based upon these theoretical profiles in the post-operative cornea. METHODS: Aberration-free profiles were deduced from the Zernike expansion of the difference between two corneal cartesian-ovals. Compensation for the focus-shift effects of removing corneal tissue were incorporated by preserving the location of the optical focus of the anterior corneal surface. Simulation of the surgical performance of the profile was performed by means of simulated ray-tracing through a cornea described by its anterior surface and pachymetry. Clinical evaluation was retrospectively analysed in terms of visual outcomes, corneal wavefront aberration and asphericity changes at 3-month follow-up compared to the baseline on 100 eyes treated for compound myopic astigmatism. RESULTS: The proposed 'aberration-free' profiles theoretically preserve aberrations, becoming more oblate asphericity after myopic treatments, and more prolate after hyperopic ones. In the clinical evaluation, 94% of eyes were within +/-0.50 D of emmetropia. BSCVA improved significantly (p < 0.001). Induced corneal aberrations at 6-mm were below clinically relevant levels: 0.123 +/- 0.129 microm for HO-RMS (p < 0.001), 0.065 +/- 0.128 microm for spherical aberration (p < 0.001) and 0.058 +/- 0.128 microm for coma (p < 0.01), whereas the rate of induced aberrations per achieved D of correction were -0.042, -0.031, and -0.030 microm D(-1) for HO-RMS, SphAb, and coma (all p < 0.001). Induction of positive asphericity correlated to achieved correction (p < 0.001) at a rate 3x theoretical prediction. CONCLUSIONS: 'Aberration-free' patterns for refractive surgery as defined here together with consideration of other sources of aberrations such as blending zones, eye-tracking, and corneal biomechanics yielded results comparable to those of customisation approaches. Having close-to-ideal profiles should improve clinical outcomes decreasing the need for nomograms, and diminishing induced aberrations after surgery.

Prevalence of Pigment Dispersion Syndrome in Patients Seeking Refractive Surgery.

PURPOSE: To determine the prevalence of pigment dispersion syndrome (PDS) in patients presenting for vision correcting refractive surgery. SETTING: Discover Vision Centers, Kansas City, MO. DESIGN: This is a prospective case series. MATERIALS AND METHODS: A total of 637 eyes of 319 serial patients who presented seeking refractive surgery were included in this prospective, observational study. Patients underwent routine ophthalmologic examination before refractive surgery. PDS was diagnosed by the presence of a deep anterior chamber, posterior bowing of the irides, Krukenberg spindles, and/or presence of mid-peripheral iris transillumination defects by the same experienced ophthalmologist. The prevalence of PDS and its associated ophthalmic and demographic characteristics were evaluated in those diagnosed. RESULTS: Of the 637 eyes, 165 (25.9%) eyes were diagnosed with PDS. Krukenberg spindles were present in 53 (8.3%) of the total eyes and in 47 (28.5%) eyes that were diagnosed with PDS. Transillumination defects were present in 153 (95%) eyes diagnosed with PDS and 161 (25.2%) total eyes. There was equal distribution between sex in those diagnosed with PDS (male vs. female: 26 vs. 25.8%; P=0.942). Blue colored eyes were most likely to have PDS (35.8% of patients). CONCLUSIONS: The prevalence of PDS within the population of patients seeking refractive surgery is likely greater than the general population as a whole. This is most likely the result of self-selection and high association between myopia and PDS. Given that not infrequent sequela can occur from untreated PDS, it is prudent that refractive surgeons be aware of this increased prevalence and perform thorough examinations to properly identify the condition.

Long-Term Outcomes of Refractive Surgery Performed During the Military.

INTRODUCTION: To evaluate the long-term refractive results of laser in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK) performed by the military in a veteran population. MATERIALS AND METHODS: Three Department of Veterans Affairs (VA) hospital sites (Puget Sound, Buffalo, and Washington D.C.) obtained IRB approval for this multi-center study. Comprehensive ophthalmologic assessment including refraction and keratometry were obtained at the time of the long-term VA examination and compared to the patients' postoperative military records. RESULTS: Eighty patients (160 eyes) enrolled in this study. At the time of treatment, patients were 21-52 years of age. Long-term post-operative data was available from 4 to 17 years post-operatively. Fifteen percent of the treatment types were LASIK and 85% PRK. At the time of their military post-operative exam (range 3-14 months, mean 4 months), 82% of patients had uncorrected visual acuity (UCVA) of 20/20 or better, and their average manifest refraction was -0.08 D (SD ± 0.48 D). At the time of the long-term ophthalmological exam at the VA medical centers (range 4-11 years, mean of 8.2 years), 49% of patients had an UCVA of 20/20 or better and an average manifest refraction was -0.64 D (SD ± 0.69 D). CONCLUSION: This is the first long-term study evaluating refractive surgery outcomes up to 17 years in a military population. Our study demonstrates safety after refractive surgery in the military with less than 0.1D increase in myopia per year and strong keratometric stability. Other changes in the eye may be the likely cause for this observed mild refractive shift.

Refractive surgery in Israel Defense Forces recruits.

PURPOSE: To determine the prevalence of refractive surgery history in recruits for military service in the Israel Defense Forces (IDF) between 1998 to 2005 and to evaluate the effect of surgery on the recruits' fitness to serve in combat units. SETTING: Surgeon General's HQ, Medical Corps, Israel Defense Forces. METHODS: The computerized medical records of all ametropic Israeli army inductees were reviewed. They included spectacle-wearing, contact lens-wearing, and post refractive-surgery individuals who were examined in the recruitment office before their compulsory military service. The extracted data from the personal files consisted of the assignment to combat units of those who had refractive surgery and those who wore corrective eyewear and the first and last military position of all ametropic recruits who were assigned to combat units. RESULTS: Five hundred ninety-seven inductees (513 men, 84 women) had refractive surgery before their military service during the study period. The prevalence of recruits who had refractive surgery increased from 0.8/1000 ametropes in 1998 to 4.9/1000 ametropes in 2005. Significantly more recruits who had surgery (73.5%) than recruits who wore corrective eyewear were assigned to combat units (P<.001). The dropout rate from combat units of the former was significantly lower than that of the latter (13.1% versus 29.2%) (P<.001). CONCLUSIONS: More corrective eyewear users had refractive surgery before their IDF military service, and relatively more of them applied for combat duty. The high percentage of recruits who had refractive surgery who serve uninterruptedly in combat units indicates that the procedure has no deleterious effect on the recruits' fitness.

[Determining factors for deciding whether or not to treat refractive errors and cataract in people with a learning disability]. / Determinanten van het al dan niet behandelen van refractieafwijkingen en cataract bij mensen met een verstandelijke beperking.

OBJECTIVE: A study into the treatment of refractive errors and cataract in a selected population with learning disabilities. Design. Retrospective. METHOD: In the years 1993-2003, 5205 people (mean age: 39 years) were referred to the visual advisory centre of Bartiméus (one of three institutes for the visually impaired in the Netherlands) by learning disability physicians and were assessed ophthalmologically. This assessment consisted of a measurement of visual acuity and refractive error, slitlamp examination and retinoscopy, and was performed at the client's accommodation. Advised treatment for spectacle prescriptions and referral for cataract surgery were registered. RESULTS: Refractive errors were found in 35% (1845/5205) of the patients with learning disabilities; 49% (905/1845) already wore spectacles; another 14% (265/1845) were prescribed spectacles for the first time. Of those with presbyopia, 12% (232/1865) had reading glasses and 10% (181/1865) were given a first prescription for spectacles. The most important determinant for not prescribing spectacles was: presence of severe learning disability (odds ratio (OR): 3.7). Cataract was present in 10% (497/5205) of the population; 399 patients were advised to be referred for surgery, 55% (219/399) were referred ofwhom 26% (57/219) had surgery. Moderately severe bilateral cataract was the only determinant of cataract surgery (OR: 7.8). CONCLUSION: Refractive errors and cataract were not always treated in this group. One of the reasons for non-treatment of refractive errors was a severe learning disability. The reason for treatment or non-treatment in patients with cataract was less clear.

[Character of refractive errors in population study performed by the Area Military Medical Commission in Lodz]. / Charakterystyka wad refrakcji u osób badanych przez Terenowa Wojskowa Komisje Lekarska w Lodzi.

PURPOSE: To determine the prevalence of refractive errors in population. MATERIAL AND METHODS: A retrospective review of medical examinations for entry to the military service from The Area Military Medical Commission in Lodz. Ophthalmic examinations were performed. We used statistic analysis to review the results. RESULTS: Statistic analysis revealed that refractive errors occurred in 21.68% of the population. The most commen refractive error was myopia. CONCLUSIONS: 1) The most commen ocular diseases are refractive errors, especially myopia (21.68% in total). 2) Refractive surgery and contact lenses should be allowed as the possible correction of refractive errors for military service.

Hospital Choice for Cataract Treatments: The Winner Takes Most.

BACKGROUND: Transparency in quality of care is an increasingly important issue in healthcare. In many international healthcare systems, transparency in quality is crucial for health insurers when purchasing care on behalf of their consumers, for providers to improve the quality of care (if necessary), and for consumers to choose their provider in case treatment is needed. Conscious consumer choices incentivize healthcare providers to deliver better quality of care. This paper studies the impact of quality on patient volume and hospital choice, and more specifically whether high quality providers are able to attract more patients. METHODS: The dataset covers the period 2006-2011 and includes all patients who underwent a cataract treatment in the Netherlands. We first estimate the impact of quality on volume using a simple ordinary least squares (OLS), second we use a mixed logit to determine how patients make trade-offs between quality, distance and waiting time in provider choice. RESULTS: At the aggregate-level we find that, a one-point quality increase, on a scale of one to a hundred, raises patient volume for the average hospital by 2-4 percent. This effect is mainly driven by the hospital with the highest quality score: the effect halves after excluding this hospital from the dataset. Also at the individual-level, all else being equal, patients have a stronger preference for the hospital with the highest quality score, and appear indifferent between the remaining hospitals. CONCLUSION: Our results suggest that the top performing hospital is able to attract significantly more patients than the remaining hospitals. We find some evidence that a small share of consumers may respond to quality differences, thereby contributing to incentives for providers to invest in quality and for insurers to take quality into account in the purchasing strategy.

Refractive error and vision correction in a general sports-playing population.

PURPOSE: To evaluate, in an amateur sports-playing population, the prevalence of refractive error, the type of vision correction used during sport and attitudes toward different kinds of vision correction used in various types of sports. METHOD: A questionnaire was used for people engaging in sport and data was collected from sport centres, gyms and universities that focused on the motor sciences. RESULTS: One thousand, five hundred and seventy-three questionnaires were collected (mean age 26.5 ± 12.9 years; 63.5 per cent male). Nearly all (93.8 per cent) subjects stated that their vision had been checked at least once. Fifty-three subjects (3.4 per cent) had undergone refractive surgery. Of the remainder who did not have refractive surgery (n = 1,519), 580 (38.2 per cent) reported a defect of vision, 474 (31.2 per cent) were myopic, 63 (4.1 per cent) hyperopic and 241 (15.9 per cent) astigmatic. Logistic regression analysis showed that the best predictors for myopia prevalence were gender (p < 0.001) and location of sport practice (p < 0.001). Sports that present higher prevalence of outdoor activity have lower prevalence of myopia. Contact lens penetration over the study sample was 18.7 per cent. Contact lenses were the favourite system of correction among people interviewed compared to spectacles and refractive surgery (p < 0.001). CONCLUSIONS: This study showed that sport was not associated with different levels of myopia prevalence in the adult population. However, subjects engaging in outdoor sports had lower rates of myopia prevalence. Penetration of contact lens use in sport was four times higher than the overall adult population. Contact lenses were the preferred system of correction in sports compared to spectacles or refractive surgery, but this preference was affected by the type of sport practised and by the age and level of sports activity for which the preference was required.

Corneal Epithelial Thickness Measured by Manual Electronic Caliper Spectral Domain Optical Coherence Tomography: Distributions and Demographic Correlations in Preoperative Refractive Surgery Patients.

PURPOSE: The aim of this study was to report the distributions and demographic correlations of corneal epithelial thickness measured by manual electronic caliper spectral domain optical coherence tomography in preoperative refractive surgery patients. DESIGN: This was a retrospective review. METHODS: The charts of 218 consecutive patients (413 eyes) who presented for refractive surgery evaluation from April 2013 through September 2013 were retrospectively reviewed. RESULTS: The mean corneal epithelial thickness was 51.0 µm with a range of 43 to 61 µm. Corneal epithelial thickness was significantly correlated with sex (P < 0.0001), corneal keratometry (P = 0.01), and underlying corneal thickness excluding the epithelium (P = 0.0268). No significant associations were identified in which corneal epithelial thickness correlated with either age (P = 0.0760) or existing refractive status of the eye (P = 0.5135). CONCLUSIONS: Corneal epithelial thickness measured by manual electronic caliper optical coherence tomography in preoperative refractive surgery patients is comparable with the findings for the general population using other measurement techniques, the awareness of which may be useful in the preoperative assessment of these patients.

Cataract surgery outcomes in corneal refractive surgery eyes: Study from the European Registry of Quality Outcomes for Cataract and Refractive Surgery.

PURPOSE: To analyze visual outcomes after cataract surgery in patients with previous corneal refractive surgery. SETTING: Cataract surgery clinics in 18 European countries and Australia. DESIGN: Database study. METHODS: Cases of cataract extraction with corneal refractive surgery eyes (corneal refractive cases) were identified from all cataract extractions reported to the European Registry of Quality Outcomes for Cataract and Refractive Surgery database over a 5-year period. Preoperative and postoperative measurements and trends over time were analyzed. RESULTS: Of 807,220 cataract extractions, 1229 (0.15%) were corneal refractive cases. There was a significant increase, over time, in the number of corneal refractive cases (P < .001). Corneal refractive patients were younger than patients without corneal refractive surgery (nonrefractive patients) (62.9 years versus 74.0 years; P < .001) but had similar mean preoperative and postoperative corrected-distance visual acuity (CDVA) (preoperative logMAR 0.44[6/16] for both [P = .286]; postoperative logMAR 0.06[6/7] for both [P = .245]). Postoperative CDVA was worse than preoperative CDVA in 35 (4%) corneal refractive and 8,999 (1.5%) nonrefractive patients (P < .001). In all, 74 (8.5%) of 873 corneal refractive versus 16,566 (2.8%) /584,496 nonrefractive patients, having cataract surgery, had preoperative CDVA of logMAR 0.0[6/6] or better (P < .001). Nineteen (54.3%) of 35 corneal refractive case patients who had worse postoperative CDVA had preoperative CDVA of logMAR 0.0(6/6) or better. CONCLUSION: Cataract surgery has been reported with increasing frequency in corneal refractive surgery patients, since 2008. These patients had preoperative CDVA similar to those of patients without previous corneal refractive surgery but were younger and were at higher risk of worse postoperative CDVA, especially if they had preoperative CDVA of logMAR 0.0(6/6) or better. FINANCIAL DISCLOSURE: No author has any financial or proprietary interest in any material, or method, mentioned.

Laser refractive surgery in the UK Biobank study: Frequency, distribution by sociodemographic factors, and general health, happiness, and social participation outcomes.

PURPOSE: To evaluate the frequency and distribution of laser refractive surgery in the United Kingdom by sociodemographic factors and outcomes of social participation and well-being. SETTING: Six regional recruitment centers in England and Wales. DESIGN: Cross-sectional epidemiological study. METHODS: Data were collected on sociodemographic factors and medical history; self-report on eyes/vision included reason for wearing optical correction, eye diseases, and treatment received (including refractive laser surgery). Mean spherical equivalent was used to categorize individuals as myopic (<-1.0 diopter) or hypertrophic (>+1.0 diopter). RESULTS: Between 2009 and 2010, 117 281 subjects recruited by UK Biobank undertook an ophthalmic assessment, including autorefraction. Of those with refractive error within a range eligible for laser refractive surgery (n = 60 352), 1892 (3.1%) reported having bilateral refractive surgery and 549 (0.9%) unilateral surgery. Frequency of bilateral surgery decreased with increasing age and was higher in women. Frequency did not vary with educational attainment or accommodation status but increased with income among working age adults. Social participation, for example, regular visits to a pub or social club, was more common among those who underwent surgery. Other eye conditions were reported by 28% of those reporting refractive surgery compared with 11% of those eligible for treatment but not reporting surgery. CONCLUSION: This study provides information not available routinely on the frequency and distribution of laser refractive surgery in an adult UK population. A high frequency of ocular conditions conventionally considered contraindications to laser refractive surgery raises the possibility that extant guidance on patient selection may not be followed.