Visual function, spectacle independence, and patients' satisfaction after cataract surgery- a study in the Central Region of Ghana.

BACKGROUND: Reduced visual function is associated with diminished quality of life as well as decreased physical and mental health. Poor visual function related to cataracts is also a risk factor for falls and traffic accidents, which may lead to hospital admissions and limit independence. OBJECTIVE: To evaluate patients' satisfaction, visual functions and spectacle independence among patients in the Central Region of Ghana who had cataract surgery in one eye. METHODS: A hospital-based prospective cohort study was carried out on 146 patients booked for cataract surgery: 16 were lost through follow-ups whilst 130 completed the study. Visual functions including visual acuity, contrast sensitivity, stereopsis and colour vision were assessed before and after a month of cataract surgery. Objective and subjective refractions were performed to determine the post-surgery refractive status of the participants. Participants completed the NEI-VFQ 25 questionnaire and the scores obtained were used as a construct of their satisfaction. RESULTS: The NEI-VFQ 25 questionnaire scores indicated patients' satisfaction was high with an average quality of life score of 77.46. Patients satisfaction was strongly correlated with contrast sensitivity (r=0.653, p<0.001) but moderately correlated with visual acuity (r=-0.554, p<0.001), stereopsis (r=0.490, p<0.001) and colour vision (r=0.466, p<0.001). Contrast sensitivity was a better predictor of patients' satisfaction than visual acuity and stereopsis. Spectacle independence at distance was achieved in only 44.6% of the participants and 5.4% at near. There was a significant (p>0.001) association between spectacle independence and the two types of cataract surgery performed which included Small Incision Cataract Surgery (SICS) and Extracapsular Cataract Extraction (ECCE). Among those who were spectacle independent, 53.4% of them were low vision patients. CONCLUSION: Satisfaction of patients after cataract surgery was high but was greatly influenced by visual functions with contrast sensitivity being a better predictor of satisfaction than visual acuity and stereopsis. Spectacle independence after cataract surgery was low at distance and extremely low at near. The type of cataract surgery performed influenced thespectacle independence.

Bilateral cataract surgery improves neurologic brake reaction time and stopping distance in elderly drivers.

AIMS: To determine brake reaction times before and after bilateral cataract surgery in elderly drivers. METHODS: Sixty-four patients were evaluated on the day of and 4 weeks after bilateral cataract surgery. Forty-three healthy individuals with a valid driving licence served as the control group. A driving simulator was used to determine brake reaction times after receiving a visual stimulus. Total brake reaction time (BRT) as well as neurologic reaction time (NRT), foot transfer time (FTT) and brake pedal travel time (BPTT) were measured, and the measurements obtained before and after cataract surgery were compared. The correlations between NRT, best-corrected visual acuity (BCVA) and contrast sensitivity (CS) were assessed. RESULTS: Out of the 64 patients with bilateral cataract, 53 were assessed for postsurgical measurements. All time measures improved significantly after cataract surgery (BRT, 815.7(224) versus 647.9(148) ms; NRT, 364.7(91) versus 283.5(44) ms; FTT, 290.8(62) versus 248.6(58) ms; and BPTT, 160.6(96) versus 116.6(72) ms, p < 0.001). The calculated stopping distance improved significantly after surgery (22.3(6) versus 19.9(4) m at 50 km/h). Best-corrected visual acuity (BCVA) and contrast sensitivity (CS) improved significantly after surgery (0.25(0.2) versus 0.05(0.05), n = 53, p < 0.001; 1.4(0.2) versus 1.6(0.1), p < 0.001, respectively). There was a significant negative correlation between CS and NRT before surgery (r = -0.253, n = 64, p = 0.04, Pearson's correlation). CONCLUSION: Our findings show a significant effect of CS on neurological BRTs and the corresponding stopping distances. This highlights the importance of presurgical CS evaluation as a critical factor in cataract surgery decisions in elderly drivers.

Avaliação da função visual e qualidade de vida relacionada à visão em pacientes portadores de catarata senil / Evaluation of visual function and vision-related quality of life in patients with senile cataract

RESUMO Objetivo: Investigar a correlação entre qualidade de vida e diminuição da acuidade visual em idosos portadores catarata senil. Métodos: Estudo transversal e quantitativo com 53 idosos portadores de catarata senil e candidatos à facectomia em uma clínica oftalmológica particular da cidade de Montes Claros, Minas Gerais. Para investigação sociodemográfica, foi utilizado questionário elaborado pelos autores. A investigação acerca da qualidade de vida relacionada à visão foi feita por meio do questionário National Eye Institute - Visual Function Questionnaire 25 (NEI-VFQ 25). Para análise estatística, aplicou-se o coeficiente de correlação linear de Pearson e Teste de Hipóteses em que a estatística do teste segue distribuição t-Student, com nível de significância de 5% (p < 0,05). Resultados: A maioria dos pacientes entrevistados apresentava idade compreendida entre 70 a 79 anos (n.29 / 54,7%) e era do sexo feminino (n.30 / 56,6%). A relação de dependência entre o escore médio do domínio "Capacidade Visual" com o do domínio "Qualidade de Vida" obteve coeficiente de correlação de Pearson igual a 0,664, estatisticamente significante ao teste t de Student (p < 0,001). Assim, há evidências de que a qualidade de vida e a função visual estariam correlacionadas de forma que quanto maior a capacidade visual, maior seria a qualidade de vida. Conclusão: A correlação entre saúde ocular e capacidade funcional de idosos pode ser obtida pela aplicação do National Eye Institute - Visual Function Questionnaire 25 (NEI-VFQ 25), gerando dados que revelam a necessidade da garantia de acesso da população idosa à saúde ocular.

ABSTRACT Purpose: To investigate the correlation between quality of life and decreased visual acuity in elders with senile cataract. Methods: A transversal and quantitative study involving 53 elderly patients with senile cataracts and candidates for cataract surgery in a private ophthalmology clinic in Montes Claros, Minas Gerais. For sociodemographic investigation, a questionnaire elaborated by the authors was used. Research on visual-related quality of life was done through the National Eye Institute - Visual Function Questionnaire 25 (NEI-VFQ 25) questionnaire. For statistical analysis, Pearson's correlation coefficient and hypothesis testing were applied, in which the test statistic follows a Student's t distribution, with 5% significance level (p < 0,05). Results: The majority of the interviewed patients' ages were comprehended between 70 and 79 years old (n.29 / 54,7%) and were female (n.30 / 56,6%). The correlation between the mean score of the "Visual Capacity" domain and of the "Quality of Life" domain had Pearson's correlation coefficient equal to 0,664, statistically significant in Student's t-test (p < 0,001). Therefore, there are evidences that the quality of life and the visual function are correlated so that the better the visual capacity, the better the quality of life. Conclusion: The correlation between ocular health and functional capacity of the elderly can be obtained by the application the National Eye Institute - Visual Function Questionnaire 25 (NEI-VFQ 25), generating data that reveals the necessity of guaranteed access to ocular health by the elderly population.

Validation and comparison of the National Eye Institute Visual Functioning Questionnaire-25 (NEI VFQ-25) and the Visual Function Index-14 (VF-14) in patients with cataracts: a multicentre study.

PURPOSE: The present study aimed to investigate and compare the psychometric properties of the National Eye Institute Visual Functioning Questionnaire-25 (NEI VFQ-25) and the Visual Function Index-14 (VF-14) in a large sample of patients with cataracts. METHODS: A total of 1052 patients with bilateral age-related cataracts were recruited in the study. Patients with other comorbidities that severely impacted vision were excluded. Participants completed the two questionnaires in random order. Classical test theory and Rasch analyses were used to assess the psychometric properties of the questionnaires. RESULTS: Complete data were obtained from 899 patients. The mean overall index score on the NEI VFQ-25 was 76.1 ± 19.0, while that on the VF-14 was 46.5 ± 15.0. Cronbach's α-values for the NEI VFQ-25 and VF-14 were 0.89 and 0.95, respectively. Ceiling effects were observed on nine of the 12 subscales in the NEI VFQ-25. The correlation between total scores on the NEI VFQ-25 and VF-14 was moderate (r = 0.600; p < 0.001), and subscales of the NEI VFQ-25 were weakly or moderately correlated with the similar domains on the VF-14. Rasch analysis revealed ordered category thresholds and sufficient person separation for both instruments, while the two questionnaires had critical deficiencies in unidimensionality, targeting and differential item functioning. CONCLUSION: Neither the NEI VFQ-25 nor VF-14 is optimal for the assessment of vision-related quality of life in typical Chinese patients with cataracts. The potential deficiencies of the questionnaires should be taken into consideration prior to application of the instruments or interpretation of the results.

Successful Cataract Surgery Leads to an Improvement in Depressive Symptomatology.

INTRODUCTION: Cataract is the most common reversible cause of blindness worldwide, and the associated vision impairment has been associated with an adverse impact on health-related quality of life and mental health in particular. However, findings from studies on the mental health improvement of patients after cataract surgery remain inconclusive. The objective of this study is to ascertain whether the outcome on best-corrected visual acuity (BCVA) following cataract surgery is associated with depressive symptomatology. METHODS: This is an observational prospective study of a cohort of 150 consecutive patients who underwent phacoemulsification surgery and who were evaluated for changes in depressive symptomatology with Beck's Depression Inventory-II (BDI-II). RESULTS: The difference in BDI-II scores pre- and postoperatively correlated with the difference in BCVA pre- and postoperatively (p < 0.001). A paired-samples t test revealed a statistically significant difference in the preoperative and postoperative BDI-II scores (p < 0.001). A related-samples Wilcoxon signed-rank test revealed a statistically significant improvement of depression status among the patients (p = 0.004). A stepwise regression analysis concluded that the only statistically significant predictor in assessing the difference in total BDI-II score before and after the operation was the respective difference in visual acuity. DISCUSSION/CONCLUSION: The success of phacoemulsification surgery for cataract as evaluated with the change in BCVA is related to the rate of improvement in depressive symptomatology.

Avaliação da qualidade de vida em pacientes idosos antes e após a cirurgia de catarata / Quality of life assessment in elderly patients before and after cataract surgery

RESUMO Objetivo: Avaliar a qualidade de vida de pacientes idosos antes e após de se submeterem à cirurgia de catarata. Métodos: Estudo longitudinal analítico com abordagem quantitativa. A coleta de dados se deu em duas etapas (antes da cirurgia de catarata e 2 meses após o procedimento), tendo sido aplicados dois questionários, sendo um sociodemográfico e o outro o World Health Organization Quality of Life OLD. Recorreu-se à estatística descritiva e aos testes estatísticos t de Student, análise de variância, de Mann-Whitney e de Kruskal-Wallis. Resultados: Participaram da pesquisa 34 idosos, sendo 15 (44,1%) até 69 anos de idade e 19 (55,9%) com mais de 69 anos. Identificou-se decréscimo nos escores do Funcionamento do Sensório nos idosos que não tinham atividade de lazer (p=0,0006), não praticavam atividade física (p=0,0023) e não utilizavam a internet (p=0,0010). No domínio Atividades Passadas, Presentes e Futuras, identificou-se aumento do escore nos idosos que não tinham atividade de lazer (p=0,0258), não praticavam atividade física (p=0,0303), afirmaram ter outros problemas de saúde (p=0,0372) e referiram ter boa saúde (p=0,0298). Já no domínio Participação Social, houve aumento do escore nos idosos que não tinham atividade de lazer (p=0,0068), não praticavam atividade física (p=0,0033) e afirmaram ter saúde regular (p=0,0102). Conclusão: Evidenciaram-se decréscimo no Funcionamento do Sensório e aumento nas Atividades Passadas, Presentes e Futuras e na Participação Social.

ABSTRACT Objective: To evaluate quality of life of elderly patients before and after cataract surgery. Methods: A longitudinal analytical study with quantitative approach. Data collection was performed in two stages (before cataract surgery and 2 months after the procedure), when two questionnaires were used - a sociodemographic and the World Health Organization Quality of Life (WHOQLD). Descriptive statistics and Student's t test, analysis of variance, Mann-Whitney and Kruskal-Wallis tests were employed. Results: A total of 34 elderly individuals participated in the research, 15 (44.1%) aged up to 69 years and 19 (55.9%) over 69 years. A decrease in the Sensory Functioning scores was identified in those who had no leisure activity (p=0.0006), did not exercise (p=0.0023) and did not use the internet (p=0.0010). In the domain Past, Present and Future Activities, an increase in the score was observed in the elderly who had no leisure activity (p=0.0258), did not exercise (p=0.0303), reported having other health problems (p=0.0372), and in those who reported having good health status (p=0.0298). In the Social Participation domain, there was an increase in the score of the elderly who had no leisure activity (p=0.0068), did not exercise (p=0.0033), and of those who reported having regular health status (p=0.0102). Conclusion: There was a decrease in Sensory Functioning scores and an increase in the domains Past, Present and Future Activities, as well as Social Participation.

Changes in patient subjective happiness and satisfaction with cataract surgery.

The purpose of this study was to investigate the changes in patient subjective happiness and satisfaction with cataract surgery and evaluate the association between satisfaction and types of cataract. This study surveyed 247 participants (mean age, 67.9 years) and they completed questionnaires on their satisfaction with the surgery, the subjective happiness scale (SHS) and the Pittsburgh Sleep Quality Index (PSQI) before and after surgery. The SHS increased postoperatively from 4.6 ± 0.7 to 4.8 ± 0.7 (P = 0.007) and 83.4% of patients were satisfied with the surgical results and the average satisfaction score was 4.2 out of a possible 5.0. Multiple regression analysis showed that patient satisfaction was significantly associated with the postoperative SHS (ß = 0.380; P < 0.001), the postoperative PSQI (ß = -0.041; P = 0.035) and the presence of a posterior subcapsular cataract (PSC) (ß = 0.277; P = 0.026). This study clarified that cataract surgery may improve both visual function and patient happiness and that patient satisfaction was affected by postoperative sleep quality and the disappearance of a PSC.

Association of Glaucoma and Cataract with Incident Dementia: A 5-Year Follow-Up in the Shanghai Aging Study.

BACKGROUND: Growing evidence has shown the association between ophthalmic disorders and the risk of cognitive decline, but the conclusions were inconsistent. OBJECTIVE: This study aimed to verify the hypothesis that glaucoma or cataract or their combination is associated with incident dementia in Chinese older adults. METHODS: We followed up 1,659 non-demented community residents aged ≥60 years for an average of 5.2 years in the Shanghai Aging Study. Histories of glaucoma and cataract were collected based on self-report and medical record confirmation. Consensus diagnoses of incident dementia and Alzheimer's disease (AD) were made based on neurological and neuropsychological assessments. RESULTS: During the follow-up, 168 cases (10.1%) of incident dementia and 124 cases (7.5%) of incident AD were identified. Participants with glaucoma at baseline had a significant risk of incident dementia (hazard ratio [HR] = 2.38, 95% confidence interval [CI] 1.08-5.23) and incident AD (HR = 2.77, 95% CI 1.17-6.56) after adjusting for confounders. There was no association between cataract and incident dementia (HR = 1.23, 95% CI 0.85-1.79) or AD (HR = 1.14, 95% CI 0.73-1.77). Those who had both glaucoma and cataract were more likely to develop dementia (HR = 3.08, 95% CI 1.29-7.37) and AD (HR = 3.72, 95% CI 1.52-9.14), compared to those without ophthalmic conditions. CONCLUSION: Glaucoma is an independent risk factor of incident dementia and AD. The comorbidity of glaucoma and cataract may significantly increase the risk of dementia and AD.

Social impact indicators in patient diagnosed of senile cataract treated with phacoemulsification plus intraocular lens implantation.

PURPOSE: To analyze indicators of social impact in patients with senile cataract treated with phacoemulsification and intraocular lens (IOL) implant. MATERIAL AND METHODS: Patients ≥ 60 years, better corrected visual acuity (BCVA) ≥ 0.6 logarithm of the minimum angle of resolution (LogMAR) and senile cataract treated with PHACO + IOL for cases and incipient senile cataract without surgical treatment with MVCA < 0.6 LogMAR for controls. Exclusion criteria; pathologies that modify the quality of life. The WHOQOL-OLD test was applied: presurgical, one postoperative month and three postoperative months. RESULTS: 54 controls and 56 cases were included. The preoperative BCVA was 1.57 ± 1.041, third month was 0.68 ± 0.7817 (p < 0.001). The results of the preoperative WHOQOL-OLD survey vs the third month: INT 12.96 versus 11.06 (p < 0001); DAD, 10.48 versus 6.389 (p < 0.00001); SOP 12.07 versus 13.76 (p < 0.0007) and SAB, 13.02 versus 8.648 (p < 0.0001). The survey of the 3rd month versus the controls: INT 9.66 versus 11.06 (p < 0.001); PPF, 13.89 versus 12.39 (p < 0.001) and AUT 12.47 versus 10.15 (p < 0.001). CONCLUSION: Patients, present an improvement in the BCVA that is reflected in the quality of life, this can be interpreted as positive results and should be taken into account to support the surgical indication.

OBJETIVO: Analizar indicadores de calidad de vida en pacientes con catarata senil tratados con facoemulsificación más implante de lente intraocular. MÉTODO: Pacientes a partir de 60 años de edad, con agudeza visual mejor corregida (AVMC) ≥ 0.6 LogMAR y catarata senil tratada con facoemulsificación más implante de lente intraocular para casos y catarata senil incipiente sin tratamiento quirúrgico con AVMC < 0.6 LogMAR para controles. Criterios de exclusión: patologías que modificaran la calidad de vida. Se aplicó la encuesta WHOQOL-OLD en el preoperatorio y a 1 y 3 meses posquirúrgicos. RESULTADOS: 54 controles y 56 casos. La AVMC preoperatoria fue 1.57 ± 1.041, y al tercer mes 0.68 ± 0.7817 (p < 0.001). Los resultados de la encuesta preoperatoria en comparación con el tercer mes fueron: dominio de intimidad 12.96 vs. 11.06 (p < 0.0001); dominio de muerte y agonía 10.48 vs. 6.389 (p <0.00001); dominio de participación social 12.07 vs. 13.76 (p < 0.0007); y dominio de capacidad sensorial 13.02 vs. 8.648 (p < 0.0001). Los resultados de la encuesta del tercer mes en comparación con los controles fueron: dominio de intimidad 9.66 vs. 11.06 (p < 0.001); dominio de actividades pasadas, presentes y futuras 13.89 vs. 12.39 (p < 0.001) y dominio de autonomía 12.47 vs. 10.15 (p < 0.001). CONCLUSIÓN: Los pacientes presentan una mejora en la AVMC y en los resultados de la WHOQOL-OLD, por lo que deben ser tomados en cuenta para apoyar la indicación quirúrgica.

A Randomized Prospective Placebo-Controlled Study of the Effects of Lavender Aromatherapy on Preoperative Anxiety in Cataract Surgery Patients.

PURPOSE: To determine if lavender aromatherapy can reduce preoperative anxiety in cataract surgery patients. DESIGN: Single-center prospective randomized placebo-controlled trial. METHODS: Seventy-five patients awaiting cataract surgery were randomized to lavender essential oil or grape seed oil (control) and administered the State-Trait Anxiety Inventory. Vital signs were also recorded. FINDINGS: Patients in the lavender group showed greater improvements in self-reported anxiety using the State-Trait Anxiety Inventory (P = .023, two-sample t test). Compared with the control group, the effects of lavender on the reduction of anxiety were statistically significant when adjusting for age, gender, and baseline scores (P = .012, analysis of covariance). CONCLUSIONS: Lavender aromatherapy reduced anxiety in preoperative cataract surgery patients.

A comparative study of depressive symptomatology among cataract and age-related macular degeneration patients with impaired vision.

Vision impairment remains an important cause of disability with the leading being age-related cataract (ARC) and age-related macular degeneration (ARMD) with depression symptoms often reported in vision impairment. This is a cross-sectional survey of two groups of fifty patients with ARC and ARMD and no prior psychiatric history on depressive symptomatology. Results indicate that ARMD patients scored higher on the BDI-II than ARC patients, in line with their poorer prognosis. Female patients with ARMD, living alone, with a higher number of other comorbid health issues, are more likely to have more depressive symptomatology. ARMD patients scored higher in the items related to pessimism for the future, feelings of past failure and feelings of self-dislike. There is a need for liaison psychiatry services to be readily available in patients with suspected ARC and ARMD coming forward with substantial vision loss. ARMD patients in particular tend to be more pessimistic and blame themselves for the progression of their disease. This should be taken into consideration with patient education on the causes of the disease and more effort should be undertaken to instill hope. The impact of vision loss on psychic status is related to disease prognosis and not only current state.

Quality of life in children suffering from juvenile idiopathic arthritis-associated uveitis.

Uveitis (JIA-U), the most common extra-articular manifestation in juvenile idiopathic arthritis (JIA), may cause severe impairment of vision in children and affect their quality of life (QoL). Considering the lack of uveitis-related QoL assessment questionnaire, and multidimensional nature of the Juvenile Arthritis Multidimensional Assessment Report (JAMAR), commonly used for monitoring and assessing the health status of children with JIA, we performed a cross-sectional study to investigate the potential of the JAMAR in estimation of QoL in children suffering from JIA-U. The study included 42 children with JIA, 21 of whom had JIA-U. Both children and their parents completed the JAMAR. We compared two groups of children (JIA-U and JIA without uveitis) and their parents against five extracted questionnaires items (QoL, functional ability, pain level, disease activity estimation, and current emotional state of the child) using the independent-samples t test to verify the differences and the Pearson correlation coefficient to measure the strength of a linear association between variables. No significant statistical difference in any of the examined variables was found between the two groups of children. In the groups of parents, current emotional state of children with JIA-U was assessed to be significantly worse (t = 2.05, p < 0.05) and the overall level of functioning significantly lower (t = 2.03, p < 0.05) than children without uveitis. Our results suggest the need for adding the uveitis-specific questionnaires items to JAMAR to improve its sensitivity and specificity in the assessment of QoL in children suffering from JIA-U, as well as designing a second assessment tool such as uveitis-specific questionnaires.

Assessing the construct validity and responsiveness of Preference-Based Measures (PBMs) in cataract surgery patients.

PURPOSE: The validity and responsiveness of the EQ-5D-3L in visual conditions has been questioned, inspiring development of a vision 'bolt-on' domain (EQ-5D-3L + VIS). Developments in preference-based measures (PBM) also includes the EQ-5D-5L and the ICECAP-O capability wellbeing measure. This study aimed to examine the construct validity and responsiveness of the EQ-5D-3L, EQ-5D-5L, EQ-5D-3L + VIS and ICECAP-O in cataract surgery patients for the first time, to inform choice of PBM for economic evaluation in this population. METHODS: The analyses used data from the UK Predict-CAT cataract surgery cohort study. PBMs and the Cat-PROM5 [a validated measure of cataract quality of life (QOL)] were completed before surgery and 4-8 weeks after. Construct validity was assessed using correlations and known-group differences evaluated using regression. Responsiveness was evaluated using effect sizes and analysis of variance to compare change scores between groups, defined by patient-reported and clinical outcomes. RESULTS: The sample comprised 1315 patients at baseline. No PBMs were associated with visual acuity and only the ICECAP-O (Spearman's rs = - 0.35), EQ-5D-3L + VIS (rs = - 0.42) and EQ-5D-5L (Value Set for England rs = - 0.31) correlated at least moderately with the Cat-PROM5. Effect sizes of change were consistently largest for the EQ-5D-3L + VIS (range 0.34-0.41), followed by the ICECAP-O (range 0.20-0.34). Results indicated no improvement in responsiveness using the EQ-5D-5L (range 0.13-0.16) compared to the EQ-5D-3L (range 0.17-0.20). CONCLUSIONS: Whilst no PBMs comprehensively demonstrated evidence of construct validity and responsiveness in cataract surgery patients, the ICECAP-O was the most responsive generic PBM to improvements in QOL. Surprisingly the EQ-5D-5L was not more responsive than the EQ-5D-3L in this setting.

The impact of an interactive, multifaceted education approach for congenital cataract on parental anxiety, knowledge and satisfaction: A randomized, controlled trial.

OBJECTIVE: The aim of our research was to examine the impact of a patient education program for parents of children with congenital cataract on parental stress, comprehension of disease information and parental satisfaction. METHODS: This prospective study included 177 parents of children with congenital cataract. The children were randomized into the following groups: the health education program with a multifaceted, interactive approach and conventional follow-up. Self-administered questionnaires were used for parental evaluation before and after the education program. The anxiety level, parental satisfaction and comprehension of the information were evaluated at each time point. RESULTS: A multifaceted, interactive approach to education significantly reduced parental levels of anxiety compared with the conventional group (effect sizes: Parenting Stress Index, ƞ2 = 0.285; Ocular Treatment Index, ƞ2 = 0.346). This approach also improved comprehension-memorization scores (effect sizes: ƞ2 = 0.303) and parental satisfaction (p < 0.001). The impact of this new intervention was maintained for 6 and 12 months after the course. CONCLUSION: The interactive, multifaceted education approach could efficiently improve the comprehension of disease-related information and parental satisfaction, resulting in significantly decreased parental anxiety. PRACTICE IMPLICATIONS: This new patient education approach had a significant impact on congenital cataracts and may be generalized to other pediatric diseases.

Monovision with a Bifocal Diffractive Multifocal Intraocular Lens in Presbyopic Patients: A Prospective, Observational Case Series.

PURPOSE: We report the visual outcomes and patient satisfaction after bilateral implantation of a bifocal diffractive intraocular lens with monovision. DESIGN: Prospective, observational case series. METHODS: Twenty-one subjects underwent cataract surgery or refractive lens exchange with bilateral implantation of the ZMB00 intraocular lens, with the dominant eye and nondominant eye targeted for plano and -1.25 to -1.00 diopters, respectively. Postoperative assessments included visual acuity (VA) at various distances under photopic and mesopic conditions; defocus curve, contrast sensitivity, and stereopsis; and Visual Function Questionnaire-25 and supplementary questionnaire. RESULTS: Mean binocular uncorrected VA at distance, intermediate (67 cm), and near (30 cm) were -0.03 ± 0.06, 0.12 ± 0.18, and 0.11 ± 0.05, respectively. No eyes lost >1 line of corrected distance VA. Binocular intermediate VA was significantly better in the uncorrected condition (P = .004) whereas binocular distance VA was better in the distance-corrected condition (P = .014). Near VA was similar in both conditions (P > .05). Stereoacuity and contrast sensitivity were within normal limits. All subjects had a composite score of ≥90 for vision-targeted items in the National Eye Institute Visual Function Questionnaire-25. Halos, glare, and starbursts occurred in 52%, 29%, and 24% of subjects, respectively. All subjects reported a satisfaction score of ≥3.5 of 5 and required no spectacles postoperatively. No intraocular lens exchange was required. CONCLUSIONS: Monovision with bilateral bifocal multifocal intraocular lens was safe and provided satisfactory vision at various distances, with good stereopsis and contrast sensitivity. Complete spectacle independence and high satisfaction score were achieved. In comparison with bilateral emmetropic bifocal multifocal intraocular lens, it provided better vision at intermediate and at very near distances without inducing more dysphotopsia.

Psychometric Properties of an Indian Translation of the Vision-related Activity Limitation Item Bank in Cataract.

SIGNIFICANCE: The Indian translated and culturally adapted version of the vision-related activity limitation (VRAL) item bank is a validated instrument to assess the difficulty in performing daily activities by cataract patients and can also be used to capture self-reported changes in ability to perform daily activities after cataract surgery. PURPOSE: The purpose of this study was to document (a) translation, cross-cultural adaptation of VRAL item bank into an Indian language, and (b) its validation using Rasch analysis in a South Indian cataract population. METHODS: At the first stage, a translated Indian version of VRAL item bank was produced using recommended procedures. At the second stage, Rasch analysis was performed to investigate its psychometric properties in 787 cataract patients (mean age, 58.2 years; mean ± SD visual acuity [logMAR], 1.19 ± 0.96 at baseline in eye for surgery) including comparison with the original version. RESULTS: Post-translation equivalence of meaning was achieved, but some English phrases required cross-cultural adaptation. Subsequently, all items were appropriate for the Indian culture, and VRAL item bank demonstrated excellent measurement precision (7.39). Dimensionality assessment suggested that VRAL construct may contain other dimensions such as self-care and visual search, and mobility. Self-care and visual search formed a unidimensional measure but was highly correlated with main VRAL dimension, and the removal of its items weakened precision of the main VRAL dimension measurement. Taken together, evidence favored retaining self-care and visual search items in a larger VRAL item bank. Mobility subscale lacked adequate measurement precision, so it was not examined further; again, items were retained in VRAL scale because they strengthened its measurement properties. Majority of items (99%) did not demonstrate notable differential item functioning (>1.0 logit) by presenting visual acuity (median, 0.20 logMAR) in the better-seeing eye. CONCLUSIONS: Items in the translated Indian VRAL item bank measure the same construct as the English version and fulfilled the psychometric requirements for use in cataract patients.

Psychometric properties of the Portuguese version of the National Eye Institute Visual Function Questionnaire-25.

BACKGROUND: To investigate the psychometric properties of the Brazilian Portuguese version of the National Eye Institute Visual Function Questionnaire (NEI VFQ-25) questionnaire in a group of patients with different eye diseases. METHODS: Cross-sectional study. All subjects completed the Portuguese version of the NEI VFQ-25 questionnaire. Another questionnaire containing a survey about clinical and demographics data was also applied. Rasch analysis was used to evaluate the psychometric properties of the NEI VFQ-25. RESULTS: The study included 104 patients with cataract, 65 with glaucoma and 83 with age macular degeneration. Mean age was 70.7 ± 9.9 years, with 143 female (56.7%) and 109 male patients (43.2%). Mean visual acuity was 0.47 and 1.17 logMAR in the better and worse eye, respectively. According to Rasch analysis, seven items were found to misfit. Those items belonged to the following subscales: general health, social function, mental health, ocular pain and role limitations. The principal component analysis of the residuals showed that 55.5% of the variance was explained by the principal component. Eight items loaded positively onto the first contrast with a correlation higher than 0.4. These items belonged to the following subscales: near vision, distance vision, mental health and dependency. After excluding those items, we were able to isolate items from the NEI VFQ-25, related only to a visual functioning component. Finally, the principal component analysis from residuals of this revised version of the NEI VFQ-25 (items related to visual function) showed that the principal component explained 61.2% of the variance, showing no evidence of multidimensionality. CONCLUSIONS: The Portuguese version of the NEI VFQ-25 is not a unidimensional instrument. We were able to find items that belong to a different trait, possible related to a socio-emotional component. Thus, in order to obtain psychometrically valid constructs, both the visual functioning and socio-emotional components should be analyzed separately.