Evaluating the accuracy of a cataract surgery simulation video in depicting patient experiences under conscious anesthesia.

PURPOSE: To evaluate the accuracy of a point-of-view cataract surgery simulation video in representing different subjective experiences of patients undergoing the procedure. METHODS: One hundred consecutive post-cataract-surgery patients were shown a short simulation video of the surgery obtained through a porcine eye model during the first postoperative week. Patients then answered a multiple-choice questionnaire regarding their visual and tactile intraoperative experiences and how those experiences matched the simulation. RESULTS: Of the patients surveyed (n = 100), 78% (n = 78) recalled visual experiences during surgery, 11% recalled pain (n = 11), and 6.4% (n = 5) recalled frightening experiences. Thirty-six percent of patients (n = 36) were interviewed after their second cataract surgery; there was no statistically significant difference between anxiety scores reported before the first eye surgery and second eye surgery (p = 0.147). Among all patients who recalled visual experiences (n = 78), nearly half (47.4%) reported that the video was the same/similar to their experience. Forty-eight percent of the patients recommended future patients to watch the video before their procedures, and more than a third (36%) agreed that watching the video before surgery would have helped them to relax. CONCLUSIONS: Our model reflects the wide range of subjective patient experiences during and after surgery. The high percentage of patients who found the video accurate in different ways suggests that, with more development, point-of-view cataract simulation videos could prove useful for educational or clinical use. Further research may be done to confirm the simulation's utility, by screening the video for subjects before operations.

Five-Year Cost-Effectiveness Modeling of Primary Care-Based, Nonmydriatic Automated Retinal Image Analysis Screening Among Low-Income Patients With Diabetes.

BACKGROUND: Artificial intelligence-based technology systems offer an alternative solution for diabetic retinopathy (DR) screening compared with standard, in-office dilated eye examinations. We performed a cost-effectiveness analysis of Automated Retinal Image Analysis System (ARIAS)-based DR screening in a primary care medicine clinic that serves a low-income patient population. METHODS: A model-based, cost-effectiveness analysis of two DR screening systems was created utilizing data from a recent study comparing adherence rates to follow-up eye care among adults ages 18 or older with a clinical diagnosis of diabetes. In the study, the patients were prescreened with an ARIAS-based, nonmydriatic (undilated), point-of-care tool in the primary care setting and were compared with patients with diabetes who were referred for dilated retinal screening without prescreening, as is the current standard of care. Using a Markov model with microsimulation resulting in a total of 600 000 simulated patient experiences, we calculated the incremental cost-utility ratio (ICUR) of the two screening approaches, with regard to five-year cost-effectiveness of DR screening and treatment of vision-threatening DR. RESULTS: At five years, ARIAS-based screening showed similar utility as the standard of care screening systems. However, ARIAS reduced costs by 23.3%, with an ICUR of $258 721.81 comparing the current practice to ARIAS. CONCLUSIONS: Primary care-based ARIAS DR screening is cost-effective when compared with standard of care screening methods.

Video recording and light intensity change analysis during cataract surgery using an animal model.

PURPOSE: To estimate light exposure changes during cataract surgery through intraoperative images simulated from the "patient's perspective" using an animal model. METHODS: In this experimental study, a 3-mm maculostomy was performed through the posterior globe's surface of 15 porcine eyes. Eyes were fixated to a glass slide and placed over an iPad camera. Video footage of a cataract surgery was obtained through the maculostomy for each eye, keeping light exposure parameters and focus constant. Seventy-five images, five from each eye, were extracted at pre-determined points, and mean gray value (MGV), a light intensity measure, was calculated. Differences in MGV between discrete surgical steps were evaluated using multiple one-sample t-tests. RESULTS: This technique allowed for the capture of a full-length cataract surgery through a 3-mm maculostomy. MGV range was 14.21-132.51. Light intensity was similar across surgeries and varied greatly through each procedure. A 24% decrease in MGV between post-hydrodissection and post-phacoemulsification stages was noted (difference - 18.36; 95% CI - 30.50 to - 6.22; p value = 0.006). A 22.4% decrease in light intensity was noted after phacoemulsification in comparison to the starting image (MGV difference - 16.78; 95% CI - 32.45 to - 1.12; p value: 0.0375). Light intensity was similar at the start and end of surgery (difference - 7.15; 95% CI - 19.35 to + 5.05; p value = 0.229). CONCLUSIONS: Light intensity changes through different steps of cataract surgery and may be minimal after phacoemulsification completion. This video and data may serve as informational and educational tools for surgeons and patients.

Nationwide Prevalence of Self-Reported Serious Sensory Impairments and Their Associations with Self-Reported Cognitive and Functional Difficulties.

PURPOSE: To estimate the nationwide prevalence of self-reported serious vision impairment (SVI), serious hearing impairment (SHI), and serious dual sensory impairment (DSI; i.e., concomitant SVI and SHI) and to characterize their associations with self-reported cognitive, independent living, self-care, and ambulatory difficulties. DESIGN: The American Community Survey (ACS) is a nationwide cross-sectional survey administered by the United States Census Bureau. PARTICIPANTS: The 2011-2015 ACS sample contains data on 7 210 535 individuals 45 years of age or older. METHODS: Descriptive statistics for each of the 4 mutually exclusive sensory impairment categories no sensory impairment (NSI), SVI, SHI, and serious DSI were calculated using the weighted sample. Adjusted odds ratios using several logistic regressions were calculated using the unweighted sample to measure the magnitude of associations between sensory impairment status and the outcome difficulties. MAIN OUTCOME MEASURES: Self-reported cognitive, independent living, self-care, and ambulatory difficulty. RESULTS: Among individuals 45 years of age or older, the estimated nationwide prevalence of self-reported SVI alone is 2.8%, that of SHI alone is 6.0%, and that of serious DSI is 1.6%. The prevalence of each sensory impairment increases with age. A greater proportion of American Indians or Alaskan Natives experience SVI (4.8%), SHI (8.5%), and serious DSI (3.7%) than any other race or ethnic group (P < 0.001). Individuals reporting serious DSI are more likely to report cognitive impairment, independent living difficulty, self-care difficulty, and difficulty ambulating than individuals with NSI across all age groups (all P < 0.001). Furthermore, serious DSI is associated with greater cognitive and functional difficulties than SVI or SHI alone, and SVI alone has a greater association with cognitive and functional difficulties than SHI alone. CONCLUSIONS: The nationwide prevalence of self-reported serious sensory impairment increases with age and is distributed unequally among different racial and ethnic groups. Any sensory impairment is associated with greater cognitive and functional difficulties than NSI. Additionally, serious DSI is associated with greater difficulties than SVI or SHI alone, and SVI alone is more serious than SHI alone in each of the 4 cognitive and functional difficulties.