Effect of smartphone application assisted medical service on follow-up adherence improvement in pediatric cataract patients.

PURPOSE: To evaluate the potential of the smartphone application assisted medical service to increase patient compliance in attendance of follow-up after pediatric cataract treatment. METHODS: This prospective study enrolled a total of 163 pediatric cataract patients with uneventful surgery. According to their follow-up intervention method, patients were divided into the smartphone application assisted medical service group (WeChat group, 75 patients) or control group (88 patients). Attendance at five follow-up appointments after surgery was recorded. The percentage of patients that attend each follow-up appointment and the compliance of refractive correction were assessed. RESULTS: Although no significant difference was observed in the first appointment comparing the two groups (98.7% vs. 94.3%, p = 0.293), the attendance rates at the other appointments of the WeChat group were significantly higher than the control group (second: 98.7% vs. 89.8%, third: 97.3% vs. 83%, fourth: 93.3% vs. 78.4%, fifth: 80% vs. 56.8%, total: 93.6% vs. 80.5%, respectively). Compared with the control group, the odd ratios for adherence improvement were 4.4 for males (95% confidence index [CI] 2.54-7.65), 4.75 for patients more than 2 years old (95% CI 2.41-9.36), 4.19 for intraocular lens implantation (2.29-7.66), 6.93 for unilateral cataract (2.9-16.52), 4.87 for undeveloped cities (2.74-8.65), and 3.49 for cities far away (2.04-5.96), with all the p < 0.0001. CONCLUSIONS: This study demonstrates that the use of smartphone application assisted medical service can significantly improve follow-up attendance after pediatric cataract treatment.

The impact of age-related cataract on measures of frailty in an aging global population.

PURPOSE OF REVIEW: To review the associations among age-related cataract, frailty, and frailty outcomes (e.g., disabilities). RECENT FINDINGS: It is predicted that the proportion of the population aged 65 and older, in developed and developing nations alike, will rise until at least 2050. The proportion of patients suffering from cataracts and frailty is expected to increase, as are age-related diseases. Although there are many papers reporting on the association between frailty outcomes, cataract, and visual impairment, there is a relative paucity of papers describing associations between frailty markers, cataract, and visual impairment. SUMMARY: Reports regarding the relationship between frailty, visual impairment, cataract, and cataract surgery are limited, but gradually increasing. Further research is expected to clarify the mechanism of visual function or the impact of restored vision on frailty. Evidence for the effect of cataract on frailty and frailty outcomes after restoring vision by cataract surgery remains limited.

The global state of cataract blindness.

PURPOSE OF REVIEW: Cataracts are a significant cause of blindness and visual impairment worldwide. The present article reviews the literature and describes the current extent of cataracts globally, barriers to treatment, and recommendations for improving the treatment of cataracts. RECENT FINDINGS: Prevalence and absolute number of blind because of cataracts remain high, although rates are declining in many areas globally. The age-standardized prevalence of blindness in adults older than 50 remains highest in western sub-Saharan Africa, with a rate of 6.0%. The greatest declines in age-standardized blindness because of cataracts in adults older than 50 between 1990 and 2010 were in East Asia, tropical Latin America, and western Europe. Recent studies have largely found higher rates of cataracts in women than in men. A new simulator for training ophthalmologists in manual small-incision cataract surgery holds promise for the future. SUMMARY: The rates of cataract surgery are increasing and postoperative outcomes are improving worldwide, yet challenges to reducing the cataract burden further remain. Cost, an insufficient number of ophthalmologists, and low government funding remain significant barriers but investment in further eye care infrastructure and training of additional ophthalmologists would improve the current situation.

[Long-term clinical observation of aspheric multifocal intraocular lens implantation].

Objective: To observe the clinical effect of long term visual quality after the implantation of the aspheric diffractive multifocal intraocular lens. Methods: This was a retrospective cohort study.One hundred and thirty cases of age-related cataract (170 eyes) after phacoemulsification cataract extraction combined with IOL implantation were collected from September of 2009 to January of 2011 in the First Affiliated Hospital of Zhengzhou University.There were 42 patients (57 eyes) with aspheric multifocal group, 43 patients (57 eyes) in the aspheric group and 45 patients (56 eyes) in the spherical group according to the different types of IOL implanted.At 1 year, 3 years and 5 years after operation, the following parameters were assessed: uncorrected and best corrected distance, medium and near vision acuity, contrast sensitivity, wavefront aberrations, modulation transfer functions (MTF), stereopsis, visual function and quality of life (VF/QOL) questionnaire survey. Results: At 1 year, 3 years and 5 years after operation, the uncorrected medium visual acuity in aspheric diffractive multifocal IOL group(0.30(0.10, 0.50), 0.30(0.10, 1.00), 0.30(0.10, 0.50)) was better than that of eyes in aspheric IOL group(0.40 (0.10, 0.0), 0.40 (0.20, 1.00), 0.40 (0.20, 0.50)) (Z(1)=-3.32,-1.73,-3.01, P(1)=0.00, 0.01, 0.00) and spherical IOL group (0.40(0.30, 1.00), 0.40(0.20, 1.00), 0.40(0.20, 1.00)) (Z(2)=-5.77,-3.19,-4.49, P(2)=0.00, 0.00, 0.00).And the near vision in aspheric diffractive multifocal IOL group(0.25(0.00, 1.00), 0.30(0.00, 1.00), 0.30(0.00, 1.00)) was also obviously better than that of eyes in aspheric IOL group (0.50(0.18, 1.00), 0.50(0.18, 1.00), 0.50(0.18, 1.00)) (Z(1)=-5.57,-5.37,-4.93, P(1)=0.00, 0.00, 0.00) and spherical IOL group(0.60(0.18, 1.00), 0.60(0.18, 1.00), 0.60(0.18, 1.00)) (Z(2)=-7.00,-6.91,-6.53, P(2)=0.00, 0.00, 0.00). At 5 years after operation, the mean higher-order aberration for 3.0mm and 5.0mm optical zone in aspheric diffractive multifocal IOL group (0.21(0.03, 0.46), 0.37(0.12, 2.01)) were significantly lower than that in spherical IOL group (0.43(0.10, 1.91), 0.46 (0.10, 1.91) ) (Z(2)=-4.81,-1.97, P(2)=0.00, 0.01).But there was no statistical difference between the aspheric diffractive multifocal and aspheric IOL group (0.21(0.03, 1.17), 0.34(0.06, 1.74)) (Z(1)=-0.10,-1.81, P(1)=0.92, 0.07).The mean spherical aberration for 3.0mm and 5.0mm optical zone in aspheric diffractive multifocal IOL group (0.01(-0.01, 0.20), 0.03(-0.10, 0.20)) were significantly lower than that in spherical IOL group (0.29(0.10, 0.99), 0.32(0.10, 0.99)) (Z(2)=-8.48,-8.54, P(2)=0.00, 0.01).But there was no statistical differences between the aspheric diffractive multifocal and aspheric IOL group (0.02(-0.09, 0.37), 0.04(-0.09, 0.37)) (Z(1)=-0.60,-0.73, P(1)=0.55, 0.46).About 86% of patients in aspheric diffractive multifocal IOL group do not need to wear glasses, it was better than the other two groups (χ(2)=17.83, 24.45, P=0.00, 0.00).The incidence of night glare and halo in aspheric diffractive multifocal IOL group 16/50(32%) was higher than that of aspherical IOL group 5/50(10%) and spherical IOL group 3/50(6%), and the difference was statistically significant (χ(2)=7.29, 10.98, P=0.00, 0.00).The overall satisfaction in aspheric diffractive multifocal IOL group was 45/50 (90%), better than that of aspherical IOL group 29/50(58%) and spherical IOL group 20/50(40%), and the difference was statistically significant (χ(2)=13.31, 27.47, P=0.00, 0.00). Conclusions: The aspheric diffractive multifocal IOL can provide patients with good and stable far, medium and near vision, to meet the needs of patients without glasses.At the same time, it can effectively reduce the high order aberrations and spherical aberration, improve visual quality.But due to night glare and glow, it does not apply to professional drivers and nighttime drivers. (Chin J Ophthalmol, 2017, 53: 599-609).

Disaster in Cosmetic Surgery: Inadvertent Formalin Injection During Blepharoplasty.

The authors report a case where formalin was accidentally injected into the eyelids of a 71-year-old woman undergoing blepharoplasty, causing full thickness necrosis of both upper eyelids and ocular complications that required multiple reconstructive surgical procedures.

Development of a postoperative visual function rehabilitation compliance assessment scale for children with congenital cataract: a reliability and validity study.

OBJECTIVE: To develop a comprehensive compliance assessment scale for postoperative visual function rehabilitation in children with congenital cataracts and to assess its reliability and validity. METHOD: Drawing on the Interactive Model of Health Behavior, we conducted a literature review and semi-structured interviews to create a pool of 36 items. The items underwent rigorous evaluation through the Delphi method, face validity checks, and item analysis, leading to a reduction to 18 items. To assess the scale's reliability and validity, we collected data from 225 parents of children with congenital cataracts. We employed SPSS version 25.0 for data analysis and evaluated construct validity using exploratory factor analysis, content validity, internal consistency reliability, and test-retest reliability. RESULTS: The compliance scale for postoperative visual function rehabilitation in children with congenital cataracts comprises 5 dimensions and 18 items. Exploratory factor analysis extracted 5 common factors, with a cumulative variance contribution rate of 68.178%. Item-level content validity index ranged from 0.730 to 1.000, and the content validity index of the scale was 0.963. The total Cronbach's alpha coefficient, split-half reliability, and test-retest reliability of the scale were 0.855, 0.778, and 0.859, respectively. CONCLUSIONS: The compliance assessment scale for postoperative visual function rehabilitation in children with congenital cataracts demonstrates acceptable reliability and validity. It serves as a valuable reference for developing standardized nursing programs for these children in clinical practice.

A randomized, single-center study of equivalence of 2 intraocular lenses used in cataract surgery.

PURPOSE: To compare the outcomes of 2 intraocular lenses (IOLs) for the treatment of age-related cataracts. DESIGN: Prospective, randomized trial. PARTICIPANTS: Patients with age-related cataracts were recruited and randomized to receive phacoemulsification and implantation of either the AcrySof SA60AT lens (Alcon, Inc, Fort Worth, TX) or the low-cost Tecsoft Flex lens (Fred Hollows Foundation, Tilganga, Nepal). A total of 300 patients were available for description and analysis (148 in the AcrySof group and 152 in the Tecsoft group). METHODS: Patients underwent phacoemulsification and implantation of the AcrySof SA60AT lens or the Tecsoft Flex lens. They were followed up and examined at baseline, 1 week, 1 month, 6 months, and 12 months after cataract surgery. MAIN OUTCOME MEASURES: Uncorrected distance visual acuity (UDVA), best-corrected distance visual acuity (BDVA), incidence of posterior capsule opacification (PCO), Visual Function Index questionnaire results, and safety of the implanted IOLs. RESULTS: No significant difference (P>0.05) was found in UDVA and BDVA after surgery between the 2 groups. The equivalence test of the 95% confidence intervals showed that both lenses had an equal improvement of UDVA and BDVA as well as similar rates of PCO after cataract surgery. There was no significant difference between the 2 groups with regard to visual functioning or the incidence of adverse surgical events during (P>0.05) or after (P>0.05) the surgery. CONCLUSIONS: The Tecsoft Flex IOL is a low-cost suitable alternative that is similar to the AcrySof IOL in terms of safety and visual outcomes.

Change in vision, visual disability, and health after cataract surgery.

PURPOSE: Cataract surgery improves vision and visual functioning; the effect on general health is not established. We investigated if vision, visual functioning, and general health follow the same trajectory of change the year after cataract surgery and if changes in vision explain changes in visual disability and general health. METHODS: One-hundred forty-eight persons, with a mean (SD) age of 78.9 (5.0) years (70% bilateral surgery), were assessed before and 6 weeks and 12 months after surgery. Visual disability and general health were assessed by the CatQuest-9SF and the Short Formular-36. RESULTS: Corrected binocular visual acuity, visual field, stereo acuity, and contrast vision improved (P < 0.001) from before to 6 weeks after surgery, with further improvements of visual acuity evident up to 12 months (P = 0.034). Cataract surgery had an effect on visual disability 1 year later (P < 0.001). Physical and mental health improved after surgery (P < 0.01) but had returned to presurgery level after 12 months. Vision changes did not explain visual disability and general health 6 weeks after surgery. CONCLUSIONS: Vision improved and visual disability decreased in the year after surgery, whereas changes in general health and visual functioning were short-term effects. Lack of associations between changes in vision and self-reported disability and general health suggests that the degree of vision changes and self-reported health do not have a linear relationship.

Phacoemulsification versus manual small-incision cataract surgery for age-related cataract: meta-analysis of randomized controlled trials.

BACKGROUND: To compare outcomes of phacoemulsification (PE) with manual small-incision cataract surgery (MSICS) for age-related cataract. DESIGN: Meta-analysis. PARTICIPANTS: Patients from previously reported randomized controlled trials (RCTs) of PE and MSICS with clinical outcomes. METHODS: A comprehensive literature search of Cochrane Library, PubMed and EMBASE to identify relevant RCTs comparing PE and MSICS. A meta-analysis was performed on the results and a RevMan 5.0 software (version 5.0; Cochrane Collaboration, Oxford, UK) was used for data analysis. MAIN OUTCOME MEASURES: Primary outcome measures included best corrected vision acuity (BCVA), uncorrected visual acuity (UCVA). Secondary outcome measures included surgically induced astigmatism (SIA), percentage of endothelial cell count (ECC) loss and complications. RESULTS: Six RCTs describing a total of 1315 eyes were identified. There were no significant differences between the techniques regarding the BCVA 6/9 or better (P = 0.69) and less than 6/18 (P = 0.68), percent of ECC loss (P = 0.45), intraoperative or postoperative complications (P = 0.44 and P = 0.87, respectively). However, a greater proportion of patients in the PE group had final UCVA ≥ 6/9 (P = 0.03), whereas a greater proportion of patients in the MSICS group had final UCVA < 6/18 (P = 0.03). Moreover, PE group induced less SIA (P < 0.00001). CONCLUSIONS: PE is superior to MSICS in UCVA and causes less SIA, but there were no significant differences in visual rehabilitation, ECC loss and complication rates between the two techniques.

Preoperative visual acuity of people undergoing cataract surgery in rural and urban Nepal.

BACKGROUND: Preoperative presenting visual acuity (PPVA) is not a commonly reported indicator for the delivery of cataract services. This study aimed to evaluate the PPVA of patients undergoing cataract surgery in rural and urban areas of Nepal. DESIGN: A prospective, non-interventional study conducted from October 2007 to March 2008 in a tertiary hospital and outreach clinics of Nepal. PARTICIPANTS: A total of 3023 consecutive subjects from urban and rural settings (1323 from the tertiary hospital and 1700 from outreach clinics) with cataract were included. METHODS: Visual acuity was tested with a Snellen E-chart at 6 m by ophthalmic assistants. All Outreach Microsurgical Eye Clinic patients were examined by either ophthalmologists or senior ophthalmic assistants. Patients at the Tertiary Eye Care Centre were examined only by ophthalmologists. MAIN OUTCOME MEASURES: Preoperative presenting visual acuity of patients undergoing cataract surgery was measured in both the settings. RESULTS: The sex ratio was 0.96 (male/female). Based on PPVA, 11.5% of patients operated were blind (PPVA < 3/60 in the better eye). The proportion of blind people operated was similar in rural (11.4%) to urban (11.6%) areas. The proportion of blind eyes operated was higher in rural (50.7%) compared to urban (38.9%) areas. CONCLUSION: Despite a comparatively high volume of cataract surgery carried out in Nepal every year, only about one in eight patients operated for cataract in the sample population was blind. PPVA is an important indicator for the progress towards eliminating cataract blindness.

Item banking: a generational change in patient-reported outcome measurement.

PURPOSE: Patient-reported outcomes are traditionally measured with questionnaires and many have been developed to measure Vision-Related Activity Limitation (VRAL; visual disability or visual functioning), Symptoms, and Quality Of Life (QOL). These vary in quality and can be classified as First or Second Generation instruments. First generation instruments are characterized by simple summary scoring of ordinal responses, which precludes interval measurement. This problem is solved in second generation instruments where Rasch analysis is used to optimize psychometric properties. However, second generation instruments retain limitations; difficulties in comparing scores across instruments, limited applicability to populations and inability to adapt to change. A third generation approach to patient-reported outcomes measurement, item banking, can solve these problems. The aim of this project was to use Rasch analysis to calibrate all items from all instruments to form VRAL, Symptoms, and QOL Item Banks. METHODS: Six hundred twenty-four people on the waiting list for cataract surgery were recruited. Each participant completed, by self-administration, a number of the 19 instruments. A total of 353 items were calibrated using Rasch analysis (Winsteps v3.67). The psychometric properties of each item bank were optimized; items fitting the Rasch model were retained (Infit and Outfit range, 0.50 to 1.50). RESULTS: Items were sorted into the three traits; 226 tapped VRAL, 22 symptoms, and 60 QOL. Satisfactory measurement of each latent trait occurred with person separation of 8.11 for VRAL, 2.33 for Symptoms, and 3.20 for QOL. Rasch estimates of item difficulty were highly stable with an average standard error of 0.11 logits. CONCLUSIONS: Item banks for the measurement of the latent traits of VRAL, symptoms, and QOL have been formed. New items can be added to enable evolution of measurement. Item banking facilitates accurate and precise measurement through computer adaptive testing. This approach provides common measurement scales, facilitating worldwide comparison of results.

[Rehabilitation methods for children with complicated cataract]. / Metode de reabilitare a copiilor cu cataracta complicata.

The work deals with the results of surgical treatment of 155 patients, who had uveal cataract, by method of facoemulsification with artificial crystalline lens transplanting. The age of the sick varied from 3 to 15 as a result of a complex treatment, involving determination of ethnic factor in the development of uveal cataract, before- and after-operation conservative medical treatment, surgical treatment of abscuration ambliopia 78.1% children and the keenness of sight 0.4 and 68.7% got binocularious sight. The study lot of posttraumatic cataract affected children included 189 patients, from them 68 with stationary cataract, 87 with intumescent cataract and 34 with postoperatorial aphakia. Age from 2 to 15 years. 76.3% cases of evolution without postoperatorial complications, in 13.7% intraoperatorial were observed different complications. The work presents the results of surgical treatment 196 of children, who had innate cataract, by the method of facoasoriation with soft intra-eyepiece lens transplanting from 133 patients who had two-sided cataract, 63 had monolateral cataract. All children underwent laser simulation and videocomputer auto-training in post-operation period. As a result of the treatment, 66.8% patients got the amelioration of sight with 0.4, and 58% got binocular sight. The children's age varied between 6 months and 15 years. This article presents a review of the treatment results of 213 children with posttraumatic, congenital and complicated cataracts. The rehabilitation of the patients with the lens pathology includes a complex of measures of early diagnosis, surgery, optimal correction, medical treatment before and after surgery, the prophilaxis and treatment of complications. This approach permits to increase the visual acuity in 83.8% and to restore the binocular vision in 71.4% patients.

A comparative study of lens management in the United Kingdom and India with regard to rhegmatogenous retinal detachment surgery.

INTRODUCTION: Lens management in phakic patients with rhegmatogenous retinal detachments undergoing para plana vitrectomy surgery remains controversial among vitreoretinal surgeons. When combined phacovitrectomy is performed, the biometry decisions can be challenging both in the face of macula-off rhegmatogenous retinal detachments and previous refractive surgery. This study analyses current trends in practise. METHODS: A scenario-related survey was sent to all members of the British and Eire Association of Vitreoretinal Surgeons and to vitreoretinal surgeons in the northern Indian state of Punjab. RESULTS: In post-laser-assisted in situ keratomileusis patients with a visually significant cataract and a macula-on rhegmatogenous retinal detachment, the majority of British and Eire Association of Vitreoretinal Surgeons members (67.3%) and surgeons in Punjab (91.4%) would perform a stand-alone para plana vitrectomy and defer cataract surgery. When a combined phacovitrectomy is performed in this scenario, the majority of British and Eire Association of Vitreoretinal Surgeons (68%) would implant an intraocular lens (using either Haigis-L or European Society of Cataract and Refractive Surgeons/American Society of Cataract and Refractive Surgeons calculators), whereas the majority of Punjab surgeons (79.3%) would leave the patient aphakic. In a patient with a cataract and macula-off rhegmatogenous retinal detachment undergoing combined phacovitrectomy surgery, without any previous refractive surgery, the majority of British and Eire Association of Vitreoretinal Surgeons members (47.3%) would use the opposite eye biometry, whereas most Punjab surgeons (62.7%) would leave the patient aphakic. DISCUSSION: Vitreoretinal surgeons in both the United Kingdom and Punjab predominantly avoid combined surgery in rhegmatogenous retinal detachment cases, even when faced with a visually significant cataract. When combined phacovitrectomy is performed, most vitreoretinal surgeons preference using the opposite eye biometry for macula-off cases and Haigis-L (myope) or online calculators for post-laser-assisted in situ keratomileusis cases.

[The management of cataract in childhood]. / Die Behandlung der Katarakt im Kindesalter.

Congenital and juvenile cataracts are one of the leading causes of childhood blindness. About one out of 3000 children has or develops optically significant lens opacities that need surgery early in life. Up to the age of two years, the eyes remain aphacic and are corrected with contact lenses and bifocal glasses following surgery. Beyond the age of two years, IOL implanation is safe and sufficiently precise, but requires surgical measures to prevent secondary cataract. In congenital cases, surgery should be performed early enough to prevent amblyopia, but not too early in order to reduce the likelihood of secondary glaucoma. Hence, unilateral cataracts should be operated on in the sixth week of life, bilateral ones in the tenth week. Optimal interaction between surgeons, orthoptists and parents are prerequisites for good functional outcomes. This review covers the most important aspects of the timing of surgery, surgical techniques, visual outcomes, complications and postsurgical visual rehabilitation.

Quality of life assessment for nuclear, cortical, posterior subcapsular patients before and after cataract surgery / Evaluación de la calidad de vida de pacientes nucleares, corticales y subcapsulares posteriores antes y después de la cirugía de cataratas

Purpose: The impact of visual outcomes of cataract surgery can be measured using a questionnaire. The aim of our study was to evaluate how patient quality of life changes after cataract surgery and if there are differences between the responses of patients with nuclear, cortical, and posterior subcapsular cataracts, which has not been studied before. Method: We studied 210 cataract patients who were divided into 3 cataract groups based on their cataract type: nuclear (n = 80), cortical (n = 70), and posterior subcapsular (PSC) (n = 60). The patients completed the Visual Function Index (VF-14) questionnaire before, 2 weeks and 1 month after bilateral cataract surgery. The results were analysed using one-way ANOVA (significance level 5 %) and were compared over time and between the cataract groups. Results: Before the cataract surgery, cortical cataract patients had the lowest questionnaire score compared to nuclear and posterior subcapsular cataract groups (p = 0.08). After cataract surgery, cortical cataract patients experienced the greatest improvement in near distance daily activities, while PSC cataract patients experienced the greatest improvement in far distance daily activities (p = 0.38). Before surgery, nuclear cataract patients had the highest questionnaire scores compared to the other cataract groups (p = 0.08). Conclusion: At the 1 month follow-up, there were no statistically significant differences in questionnaire scores between the cataract groups for any of the questions. Overall, cortical cataract patients showed a trend to experience the greatest subjective improvement in quality of life after cataract removal, followed by nuclear and posterior subcapsular patients.(AU)

Validation of Catquest-9SF in Danish: developing a revised form of the Catquest-9SF - the Danish Catquest-7SF.

PURPOSE: The primary goal was to validate a Danish translated version of the Catquest-9SF by Rasch analysis. The secondary goal was to investigate whether preoperative Catquest-9SF scores, best-corrected visual acuity, comorbidity, gender, age or corneal astigmatism could predict improvements in subjective outcome. METHODS: In a prospective trial, 250 patients eligible for cataract surgery were included. Patients filled out the translated Catquest-9SF questionnaire before surgery and again 3 months after surgery. Both preoperative and postoperative questionnaires were included in the Rasch analysis. A multiple reverse stepwise regression model was used to investigate the correlation between preoperative measurements and subjective improvement. RESULTS: The preliminary Rasch analysis showed misfit of items 4 and 6. These items were removed, and the remaining seven items demonstrated a measurement precision of 2.78, a person reliability coefficient of 0.89, ordered response categories, infit of 0.69-1.22, outfit of 0.73-1.14, observed raw variance explained by measures of 70.4% and an eigenvalue of 1.7. Item 7 showed a mild DIF for gender (0.54 logits), and person mean Rasch score targeting was -1.69 logits. Preoperative Catquest score was the only parameter with a significant correlation to a gain in subjective outcome (p < 0.001). A preoperative Catquest-9SF score of 0.5 carried a 95% likelihood of an increase in subjective outcome. CONCLUSION: The Danish version of the Catquest-9SF fit the Rasch model. Only preoperative Catquest-9SF score was correlated to subjective improvement, and a cut-off value of 0.5 predicted an improvement in subjective outcome with 95% probability.

[Combined implantation of monofocal and multifocal intraocular lenses for presbyopia correction in cataract patients]. / Kombinierte Implantation einer Mono- und einer Multifokallinse zur Presbyopiekorrektur bei Kataraktpatienten.

BACKGROUND: The purpose of this study was to assess uncorrected far and near vision after implantation of a multifocal intraocular lens (IOL) in the second eye in patients with a unilateral monofocal IOL. PATIENTS AND METHODS: 13 cataract patients with a monofocal intraocular lens in one eye (SA60AT, Alcon) and postoperative emmetropia received a multifocal lens in the second eye (ReSTOR, Alcon). Two and six months postoperatively the clinical examination, far and near vision, near aniseikonia (AWAYA-New Aniseikonia Test), stereo vision (Lang I test) and the mesopic contrast sensitivity (F. A. C.T) were tested. In addition, the grade of satisfaction without glasses in general, and with far and near vision were noted on a visual analogue scale (0 - 10). Furthermore, independence from glasses and the presence of optical phenomena were assessed. RESULTS: The mean uncorrected far visual acuity 6 months postoperatively was 1.06 +/- 0.28 for the monofocal lens, 0.88 +/- 0.23 for the multifocal lens, and 1.16 +/- 0.24 binocularly. The uncorrected near visual acuity was Nieden 1 binocularly for all patients and ranged from Nieden 1 - 3 for the multifocal lens to Nieden 2 - 11 for the monofocal lens. 77% of the patients received the multifocal lens in their far dominant eye. The mean uncorrected near aniseikonia was < 1%. The mesopic contrast sensitivity showed no significant differences between the two IOL types and compared to binocular values. The satisfaction with the uncorrected visual acuity was in general 8.88 +/- 1.21, with the far visual acuity 9.42 +/- 1.24, and 7.33 +/- 1.72 with the near visual acuity. After 6 months 67% of the patients used glasses only for periods of prolonged reading. Halos and a low degree of glare were noted by 38.5% of patients 2 months postoperatively. At the 6 months visit 33.3% still had halos and only 8% glare. CONCLUSIONS: This first experience with the combined implantation of a monofocal and a multifocal lens revealed a marked improvement of the uncorrected near visual acuity compared to bilateral monofocal IOL implantation along with a high patient satisfaction.

Effect of active evaluation on the detection of negative dysphotopsia after sequential cataract surgery: discrepancy between incidences of unsolicited and solicited complaints.

PURPOSE: To evaluate the incidence of negative dysphotopsia after sequential cataract surgery. METHODS: Retrospective cohort study. The incidence of negative dysphotopsia was assessed by retrospective reviewing of medical records and interviews with patients between 2 and 4 months after sequential cataract surgery. Inclusion criteria were uncomplicated surgery, postoperative corrected distance visual acuity (CDVA) ≥20/25 Snellen and the absence of ocular comorbidity. The majority of intra-ocular lens (IOL) implants were one-piece AcrySof SN60WF (161 eyes). Other IOLs (29 eyes) were toric (SN6AT3-6), spherical (SN60AT), three-piece (MN60MA) and multifocal (ReSTOR SN6AD1, PanOptix TFNT00 and Finevision Micro F trifocal). RESULTS: The study population was comprised of 95 patients with a mean age of 72 ± 10 years. Unsolicited complaints of negative dysphotopsia were reported by eight patients (8%), and two of them had a resolution of symptoms within 1 month of follow-up. Eighteen patients (19%) reported negative dysphotopsia at the time of the interview. Two patients reported bothersome negative dysphotopsia, and one of them was successfully treated with implantation of a supplementary IOL in the ciliary sulcus. Patients with negative dysphotopsia were younger than patients without dysphotopsia (p = 0.045) and had shorter axial eye length (p = 0.04), a tendency for higher IOL power (p = 0.09) and a higher CDVA (p = 0.001). CONCLUSION: The incidence of unsolicited negative dysphotopsia after sequential cataract surgery appears to be a substantial underestimation of complaints identified in active interviewing. Although symptoms are not bothersome in the majority of cases, some patients with undiagnosed severe negative dysphotopsia may benefit from reassurance or secondary treatment.