Depressive and generalized anxiety symptoms in adults awaiting cataract surgery in India.

Background Systematic data on mental health issues among adults awaiting cataract treatment are not readily available in India. We explored the prevalence and predictors of depressive and generalized anxiety (GA) symptoms in a cohort of adults awaiting cataract surgery. Methods Our study is based on data from baseline assessments which were conducted as part of a multicentre prospective, longitudinal cohort study. Subjects were recruited from four eye hospitals to assess depression and GA and associated risk factors using standardized scales, i.e. Center for Epidemiologic Studies-Depression Scale (CES-D) and Generalised Anxiety Disorder (GAD-7). Variation in the intensity of depression and GA was assessed using multiple classification analysis (MCA). Results A total of 813 adults awaiting cataract surgery participated, of whom 456 (56.1%) were men. The mean (SD) CES-D and GAD-7 scores were 24.6 (7.8) and 6.3 (SD 4.2) for men and 25.8 (8.9) and 6.9 (4.4) for women, respectively. The overall prevalence of depression score of >16 was 87.4% (95% confidence interval [CI] 84.7%- 89.6%), and GA score of >10 was 57.1% (95% CI 53.5%-60.7%). The prevalence of comorbid depressive and anxiety symptoms was 56.6% (95% CI 52.9%- 60.2%). MCA showed that being neglected and mistreated by family/friends because of vision condition and facing difficulty and requiring help with daily tasks had the highest effect on the intensity of both depression (beta=0.254 and 0.238, respectively) and GA (beta=0.219 and 0.211, respectively). Conclusion The majority of adults with untreated cataract had both depressive and GA symptoms. These findings could be used for planning mental health interventions for adults awaiting cataract surgery.

Improvement in general health after cataract surgery is not limited to vision-specific function.

Cataract surgery is known to have a beneficial impact on quality of life. Recent studies claimed that disease-specific measures of functional impairment are more sensitive to preoperative functional impairment and gains from surgery than are generic measures of general health and quality of life. The purpose of this study is to ascertain whether measures of general health provide additional information on the improvement of patients following cataract surgery over measures of visual function. This is an observational prospective study of a cohort of 150 consecutive patients who underwent phacoemulsification surgery and were evaluated for changes in health-related quality of life with the Medical Outcomes Study Short-Form 36 (SF-36) and improvement in visual-related functioning with the 14-item Visual Function test (VF-14). All of the SF-36 subscales improved post operatively with the magnitude of improvement in VF-14 significantly affecting all subscales except for the Vitality subscale. Treatment effects were significant for the SF-36 subscales 'Role limitations due to physical health', 'Role limitations due to emotional problems', 'Social Functioning' and 'General Health', while taking into account the difference in VF-14 scores pre and postoperatively (p < 0.001). The outcome of phacoemulsification surgery for cataract cannot be completely ascertained solely by the measurement of improvement on tasks related to visual functioning, leaving unaccounted a component related to self-appraisal of ability in everyday and social function, as well as the general feeling of subjective health. The concurrent use of general health measures with visual functioning measures to account for the general improvement on health status following cataract surgery is thus justified.

Ambulatory cataract surgery centre without perioperative anaesthesia care: a prospective cohort study.

This study aims to evaluate the safety and patient satisfaction of a fast-track procedure for cataract surgery under topical anaesthesia without perioperative anaesthesia care. This is a prospective single-centre study including all cataract procedures in the Centre Ambulatoire de la Chirurgie de la Cataracte at the Hospital of Bourges between May and August 2018. Procedures were performed under topical anaesthesia without the presence of a nurse anaesthesiologist or anaesthesiologist, the patient had not fasted, and no peripheral venous line was placed. Only heart rate and oxygen saturation were monitored intraoperatively with pulse oximetry. Incidence and nature of intraoperative adverse events and surgical complications were recorded. Patient satisfaction was assessed using the Iowa Satisfaction with Anaesthesia Scale (ISAS). In total, 651 cataract surgeries were performed among which 614 (94.3%) were uneventful. Thirty (4.6%) intraoperative adverse events and 8 (1.2%) surgical complications were recorded. All surgeries were successfully completed. No medical emergency team intervention or hospital admittance was encountered. The mean ISAS score was 5.7/6, indicating high patient satisfaction. Cataract surgery in an ambulatory cataract surgery centre without perioperative anaesthesia care is a safe procedure with high patient satisfaction for screened patients. Anaesthesia ressources are scarce and may be more beneficial to more complex ophthalmic or non-ophthalmic surgeries.

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.

Analysis of the influence of clinical and demographic factors on the understanding of cataract informed consent / Análisis de la influencia de factores clínicos y demográficos en la comprensión del consentimiento informado de cataratas / Análise da influência de fatores clínicos e demográficos na compreensão do consentimento informado para cirurgia de catarata

PURPOSE: To estimate the influence of clinical and demographical information in the understanding of cataract surgery informed consent, identifying less understandable areas. To assess informed consent document concept. METHODS: Multiple-choice questionnaire was designed to collect information and to evaluate the understanding of cataract surgery and informed consent. An ordinary regression model was adjusted to express the effect of clinical and demographic variables to the questionnaire score. RESULTS: The study comprised 180 patients. Sex (female, p=0.404), non-ophthalmologist source of information (p=0.397), previous surgical history (p=0.571), not having a companion (p=0.396) nor the days since the signing of informed consent form (p=0.535) had no influence in the understanding of cataract surgery informed consent. Age (r=-0.083, p<0.001) and educational level (secondary studies r=1.845, p<0.001; tertiary studies r=4.289, p<0.001) showed statistical significance with greater strength of association educational level (OR secondary studies = 6.33, OR tertiary studies = 72.86) than age had (OR = 0.92). CONCLUSION: Patient's knowledge about cataract informed consent is influenced by age and educational level. The purpose and the risks, consequences of not performing surgery and postoperative indications are the least understood topics. Informed consent is seen as a forced legal obligation.

OBJETIVOS: estimar la influencia de la información clínica y demográfica en la comprensión del consentimiento informado de la cirugía de cataratas, identificando áreas menos comprensibles. Evaluar el concepto de "documento de consentimiento informad". MÉTODOS: el cuestionario de opción múltiple se diseñó para reunir información y evaluar la comprensión de la cirugía de cataratas y el consentimiento informado. Se ajustó un modelo de regresión ordinario para expresar el efecto de las variables clínicas y demográficas en la puntuación del cuestionario. RESULTADOS: El estudio abarcó 180 pacientes. Sexo (femenino, p = 0.404); fuente de información no oftalmológica (p = 0.397); historial quirúrgico previo (p = 0.571); no tener acompañante (p = 0.396), y los días desde la firma del formulario de consentimiento informado (p = 0,535), que no tuvo influencia en la comprensión del consentimiento informado en la cirugía de cataratas. La edad (r = -0.083, p <0.001) y el nivel educativo (estudios secundarios r = 1.845, p <0.001; estudios terciarios r = 4.289, p <0.001) mostraron significación estadística con una mayor fuerza del nivel educativo de asociación (OR estudios secundarios = 6.33, OR estudios terciarios = 72.86) que la edad (OR = 0.92). CONCLUSIÓN: El conocimiento del paciente sobre el consentimiento informado en cirugía de cataratas está influenciado por la edad y el nivel educativo. Los temas menos entendidos son el propósito y los riesgos, las consecuencias de no realizar la cirugía y las indicaciones postoperatorias. El consentimiento informado se considera una obligación legal forzada.

OBJETIVO: Estimar a influência de informações clínicas e demográficas na compreensão do consentimento informado para cirurgia de catarata, identificando áreas menos compreensíveis. Avaliar o conceito do documento de consentimento informado. MÉTODOS: Um questionário de múltipla escolha foi desenvolvido para coletar informações e avaliar a compreensão sobre cirurgia de catarata e de consentimento informado. Um modelo de regressão ordinária foi ajustado para expressar o efeito das variáveis clínicas e demográficas no escore do questionário. RESULTADOS: O estudo envolveu 180 pacientes. Sexo (feminino, p=0,404), fonte de informações não oftalmológica (p=0,397), história cirúrgica prévia (p=0,571), não ter um/a companheiro/a (p=0,396) nem os dias desde a assinatura do formulário de consentimento informado (p=0,535) tiveram influência na compreensão do consentimento informado para cirurgia de catarata. Idade (r=-0,083, p<0,001) e nível educacional (estudos secundários r=1,845, p<0,001; estudos terciários r=4,289, p<0,001) mostraram significância estatística, com maior força de associação para o nível educacional (OR estudos secundários = 6,33, OR estudos terciários = 72,86) que para a idade (OR = 0,92). CONCLUSÃO: O conhecimento do paciente sobre o consentimento informado para cirurgia de catarata é influenciado pela idade e nível educacional. O objetivo e os riscos, consequências, de não fazer a cirurgia e as indicações pós-operatórias são os tópicos menos compreensíveis. O consentimento informado é visto como uma obrigação legal compulsória.

Congenital cataract in newborns: A qualitative study on parents' experiences of the surgery and subsequent care.

PURPOSE: Having a child with congenital cataract that requires surgery, contact lens treatment, and frequent medication is a life-altering experience. The aim of this study was to provide more in-depth knowledge of parents' experiences of diagnosis, surgery, and subsequent care, in order to find the areas for improvement. METHODS: Data were collected via semi-structured interviews with parents recruited from St. Erik Eye Hospital, Sweden. The children were operated for congenital cataract before 3 months of age and were aged 12-24 months at the time of the interviews. The interviews were analysed using qualitative content analysis with an inductive approach. RESULTS: Three themes emerged from the data: living in a turbulent time before the diagnosis, coping during the time of initial treatment, and managing the responsibility of their child's visual development. All parents expressed confidence in the operating unit. However, there was a clear need for reliable information on the condition, the surgery, and likely the long-term outcome in the time between receiving the preliminary diagnosis at the maternity ward and getting it confirmed by a paediatric ophthalmologist. CONCLUSION: Much of the parents' concern in this turbulent time is linked to poor information before the visit to the eye hospital. We, therefore, recommend earlier contact with the eye hospital, preferably at the time of writing the referral. Moreover, the possibility of providing up-to-date information via alternative information channels such as smartphone apps should be investigated.

Effect of music tempo on operating room preparation time.

Most operating rooms around the world play music, both during the surgeries and in between cases. We investigated whether music tempo (fast or slow) can affect the operating room preparation time in between surgeries (turnover time) in an ambulatory outpatient surgical centre setting. We compiled two playlists, one with fast upbeat tempo and the other with slow relaxing tempo. Each of the playlists was played throughout the workday in the operating room for one week with the same surgeon and nursing staff. The turnover times for each case were analysed. Inclusion criteria were standard cataract extraction with intraocular lens implant surgery. Exclusion criteria were any external reasons causing delays in the turnover time (such as anaesthesia team break time, computer system down, etc.). The turnover time from 32 cases in the slow group and 26 cases in the fast group were compared with Student's t test. The turnover time was significantly faster in the fast group versus the slow group (17.0 ± 0.60 vs. 20.1 ± 0.96, p < 0.03). Our study demonstrated that fast music tempo in the operating room can significantly reduce turnover time. This improved efficiency could potentially lead to significant cost savings in the healthcare sector.

Lack of recall after sedation for cataract surgery and its effect on the validity of measuring patient satisfaction.

BACKGROUND: We evaluated the validity of assessing patient satisfaction with the sedation regimen among patients being discharged 45 min after receiving midazolam. If most patients do not have recall, then the sedation cannot be considered complete at the time of evaluation. METHODS: In this prospective cohort study, 20 patients underwent cataract surgery with nurse-administered midazolam and fentanyl. The 11-item Iowa Satisfaction with Anesthesia Scale was administered  30 min after sedation in the recovery room. Recalled items were evaluated the next morning. RESULTS: Eleven patients recalled 0 themes, 4 recalled 1, 4 recalled 2, and 1 recalled 3 themes. Thus, 15/20 patients (75%) recalled 0 or 1 of the 11 themes (P = 0.021 versus half the patients). The 95% one-sided lower confidence limit for 0, 1, or 2 themes was 80% of patients (P < 0.001 versus half). Patients who received less midazolam recalled more themes (Kendall's τb = 0.43, P = 0.039). CONCLUSIONS: Evaluating patient satisfaction with sedation shortly after admission to the post-anesthesia care unit is invalid because of a lack of recall; the sedation/amnesia is ongoing. Patient comfort may be assessed, but comfort is not synonymous with satisfaction; 'satisfaction' implies presence of recall. Because we studied sedation with low doses of midazolam and fentanyl, the same conclusion reliably would apply to larger doses of anxiolytics administered intraoperatively. The results match previous findings that when patients receive preoperative midazolam prior to meeting the anesthesiologist, even if the patient fully answers questions, they may have negligible recall of having met the anesthesiologist.

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.

Patient-reported quality of life for cataract surgery: prospective validation of the 'Impact on Life' and Catquest-9SF questionnaires in New Zealand.

AIMS: The 'Impact on Life' (IoL) questionnaire is used to prioritise publicly funded cataract surgery in New Zealand, however, it has not been formally validated for ophthalmic use. The Catquest-9SF questionnaire is widely used to assess vision-related quality of life (VRQoL) but has not been validated in New Zealand. This study evaluates the validity of the IoL and Catquest-9SF questionnaires for measuring VRQoL in New Zealand. METHOD: Formal ethics approval was obtained. Participants completed the IoL and Catquest-9SF questionnaires before and three months after routine cataract surgery. Rasch analysis was used to investigate all qualitative questionnaire responses. Results were correlated with the change in patient visual acuity. RESULTS: There was a 100% response rate at follow-up (41 participants). Disordered probability thresholds were observed for all IoL questions but no Catquest-9SF questions. All IoL questions demonstrated unsatisfactory mean-square fit statistics. Differences in visual acuity following surgery correlated with the change in total F-score for the Catquest-9SF (P=0.04), but not IoL responses (P=0.17). CONCLUSIONS: Disordered probability thresholds, poor question-model fit and correlation with visual acuity changes indicate the current IoL questionnaire is poorly suited for assessment of VRQoL. In contrast, the Catquest-9SF demonstrated credible results for assessment of VRQoL in New Zealand.

Evaluating the effect of massage based on slow stroke back massage on the anxiety of candidates for cataract surgery.

Purpose: Preoperative anxiety over cataract surgery affects a large number of patients. This study aims to evaluate the effect of slow-stroke back massage on the anxiety of candidates for cataract surgery. Design: Quasi-experimental study. Methods: This study was a quasi-experimental study, which involved 60 candidates for cataract surgery referred to Amiralmomenin Hospital, Zabol in Iran between August 1, 2015, and March 30, 2016. These patients were randomly divided into two groups of slow-stroke back massage group (n=30) and control group (n=30). After obtaining an informed consent, the anxiety levels were measured by the Spielberger state trait anxiety questionnaire in the slow-stroke back massage group and the control group on the morning of the surgery before and immediately after the massage. SPSS software version 22 was used for data analysis. Independent t-test and chi-square test were used to compare the data. Findings: According to the results, there was a significant difference between the anxiety levels of the patients in the intervention group before and after the massage (p < 0.001). Conclusions: Based on the results of this study, Slow-stroke-back massage, which is a low-cost and safe method, significantly reduces anxiety in patients who are candidates for cataract surgery.

A randomized, controlled trial of video supplementation on the cataract surgery informed consent process.

PURPOSE: To assess the effects of the American Academy of Ophthalmology's 2015 patient education video on patient information retention and anxiety preoperatively, on the day of surgery and postoperatively. METHODS: This is a prospective, surgeon-blinded randomized controlled trial at the University of Chicago Medical Center. Ninety-one patients with a diagnosis of first-eye cataract were randomized into either a video or control group. Subjects in both groups received face-to-face discussion with the surgeon and an informational brochure at the preoperative evaluation. Participants in the video group then viewed a four-minute educational video at the preoperative evaluation and on the day of surgery. Both groups completed an information retention quiz and a state anxiety assessment at the preoperative visit, on the day of surgery, and on the postoperative week one visit. Subject understanding of cataract surgery was measured using a twelve-question multiple choice quiz. State anxiety was measured by State Trait Anxiety Inventory-Y1 survey score. RESULTS: Participants in the video group did not score significantly higher on the information retention quiz compared with the control group at the preoperative evaluation (8.7 ± 2.4 vs 7.7 ± 2.5, P = 0.07), but did so on the day of surgery (11.2 ± 0.8 vs 8.4 ± 1.7, P < 0.001) and postoperative week 1 visit (10.8 ± 1.5 vs 9.0 ± 2.0, P < 0.001). Subjects in the video group were significantly less anxious on the day of surgery (26.4 ± 5.1 vs 41.1 ± 10.3, P < 0.001). CONCLUSIONS: Video supplementation to the traditional informed consent process demonstrated an improvement in patient understanding of cataract surgery at multiple timepoints and decreased anxiety on the day of surgery.

The effect of nursing intervention on preoperative cataract.

This retrospective study investigated the effect of nursing intervention (NIV) in Chinese patients under preoperative cataract (PC). A total of 70 eligible patients with PC were included. Thirty-five patients in an intervention group received regular clinical treatment and NIV before the surgery, while the other 35 patients received regular clinical treatment only. The NIV was applied 4 sessions, 1 week before the surgery. The primary outcome of satisfaction was measured by 11-points visual analog scale. The secondary outcomes were measured by the functional impairment caused by cataract (the VF-14), cooperativeness during the surgery period, and sleep quality. All the outcome measurements were assessed before and after the surgery. After NIV, patients in the intervention group exerted better outcomes in decreasing anxiety (P < .01), increasing current experience with satisfaction (P < .01), and enhancing the cooperativeness during the surgery period (P < .01), compared to those outcomes in the control group. The results of this study showed that NIV may help increase satisfaction in experience and cooperation, and decrease anxiety in Chinese patients with PC.

Validity and time course of surgical fear as measured with the Surgical Fear Questionnaire in patients undergoing cataract surgery.

OBJECTIVES: The primary aim of the study was to assess the convergent validity of the Surgical Fear Questionnaire (SFQ) with other self-report instruments and biological indices of stress. Secondary aims were the examination of predictors of the level and time course of fear and preferences for fear treatment. METHODS: In a prospective observational cohort study SFQ short-term (SFQ-s) and long-term (SFQ-l) scores were assessed one week, one day, and the morning before cataract surgery, together with salivary cortisol and alpha-amylase (sAA) levels, and numeric rating scale (NRS) fear score. SFQ-scores were also assessed before second eye surgery. Expected pain and recovery, and sociodemographic and medico-psychological predictors of fear were assessed at baseline. RESULTS: Data of 98 patients were analyzed. Scores of both SFQ-subscales (range 0-40) were generally low, all mean ≤ 9.0. SFQ-s and SFQ-l correlated significantly with the other self-report instruments: NRS fear .83 and .89, expected pain .49 and .54, expected recovery -.27 and -.44. No association was found between SFQ-scores and cortisol or sAA level. Predictors of the level of fear were baseline pain and stress. Additional effects of time were found for subgroups based on educational level, antidepressant use, and presurgical stress (SFQ-l). SFQ-scores were significantly lower before the second cataract surgery than before the first, and higher in patients who would have appreciated treatment of fear. DISCUSSION: Convergent validity of the SFQ with other self-report measures is shown. The sensitivity of the SFQ permits the detection of small variations in fear caused by time or other factors.

Re-engineering the Hong Kong Quality of Life Questionnaire to Assess Cataract Surgery Outcomes.

PURPOSE: To assess psychometric properties of the Hong Kong Quality of Life Questionnaire (HKQ) using Rasch analysis and use it to assess cataract surgery outcomes. METHODS: The HKQ was interviewer administered to participants at baseline (preoperative) and 12 months of follow-up (postoperative). Rasch analysis was used to assess and improve psychometric properties of the HKQ using the preoperative data. The responsiveness of the HKQ was assessed on the stacked preoperative and postoperative data, reported with the effect size. RESULTS: One hundred ninety-nine participants (median age: 72 years; interquartile range: 65 to 78 years) with cataract completed the HKQ at the preoperative assessment. There were more women (58%) and most of the participants had bilateral cataract (83.9%). Nearly half of the participants had undergone surgery in one eye (45.2%) followed by bilateral surgery (38.7%). Psychometric assessment guided by Rasch analysis resulted into a 15-item HKQ with promising psychometric properties including adequate measurement precision (2.09), no misfitting items, near perfect targeting (-0.05), unidimensionality, and with no evidence of item bias. For those who completed the HKQ (n = 82, 41.2%) at the 12-month follow-up visit, all groups demonstrated statistically significant gains in the HKQ scores, with the highest gain in participants who had undergone bilateral surgery (effect size: 2.61). CONCLUSIONS: The 15-item HKQ was valid and psychometrically sound and might be a highly responsive instrument to measure cataract surgery outcomes in China. This study demonstrated that cataract surgery significantly improves quality of life in the Chinese population. [J Refract Surg. 2018;34(6):413-418.].

Qualidade de vida e visão pós-facectomia / Quality of life and vision post-facectomy

Resumo Objetivo: A catarata é a principal causa de cegueira reversível no mundo e seu tratamento é baseado em cirurgia, facectomia. A evolução do procedimento tem se baseado em vários pilares, mas é no desenvolvimento de novos tipos de lentes intraoculares que vem mostrando inovações consideráveis. As lentes atuais são capazes, além de tratar a catarata, de corrigir erros refracionais. O objetivo deste estudo foi avaliar a qualidade de vida e de visão pós-facectomia, comparando as lentes multifocais (Restor), tóricas, monofocais esféricas (SN60AT) e monofocais asféricas. Métodos: A pesquisa abrangeu 54 pacientes submetidos a facectomia com implantação de uma das lentes há, pelo menos, 3 meses. Os pacientes responderam questionário de qualidade de vida Cataract TyPE Specification sobre satisfação de visão, dependência de óculos para diversas atividades diárias e presença de fenômenos disfóticos. Para análise dos dados foram utilizados os testes de Kolmogorov-Smirnov, quanto a normalidade e ANOVA com teste de Tukey, quanta parametria. Em comparações não paramétricas, utilizou-se o teste de Mann-Whitney. Em todas as análises foi usado o mesmo nível de significância (p<0,05). Resultados: Numa escala de 0 a 10, a pesquisa mostrou que as lentes SN60AT, esféricas monofocais, foram as que obtiveram menor nível de satisfação entre as 4 lentes, obtendo média de 8,7 (DP= 1,30; IC ± 0,655), seguido das esféricas monofocais (média= 8,3 - DP= 1,83; IC ± 0,927), das esféricas multifocais (Restor) (média = 8,9 - DP = 1,42; IC ± 0,721) e as tóricas (média = 9,1 - DP = 1,67; IC ± 0,844) como a de maior nível de satisfação. Em relação à dependência dos óculos, a lente Restor foi a que mostrou melhor desempenho, com menor dependência dos óculos. Fenômenos disfóticos foram mais frequentes nos pacientes que tiveram implantada a lente SN60AT seguida de lente Restor. Conclusão: Conclui-se que as lentes SN60AT foram as lentes que causaram menor grau de satisfação, tendo os fenômenos disfóticos umas das principais queixas, associada a dependência dos óculos pós-cirurgia. Os pacientes que tiveram as lentes Restor implantadas, apesar dos sintomas disfóticos mais presentes do que as lentes monofocais tóricas e monofocais esféricas, tem o mesmo nível de satisfação, e ainda proporciona maior independência dos óculos.

Abstract Objective: Cataract is the leading cause of reversible blindness in the world and its treatment is based on surgery, facectomy. The evolution of the procedure has been based on several pillars, but it is in the development of new types of intraocular lenses that has been showing considerable innovations. Current lenses are capable, in addition to treating cataracts, of correcting refractive errors. The aim of this study was to evaluate the quality of life and post-facectomy vision, comparing multifocal lenses (Restor), toric, spherical monofocals (SN60AT) and aspheric monofocals. Methods: The study included 54 patients undergoing a facectomy with implantation of one of the lenses for at least 3 months. The patients answered questionnaire quality of life Cataract TyPE Specification on vision satisfaction, glasses dependence for various daily activities and presence of dysphothetic phenomena. For the analysis of the data, the Kolmogorov-Smirnov tests were used, regarding normality and ANOVA with Tukey's test, how much parametric. In non-parametric comparisons, the Mann-Whitney test was used. In all analyzes, the same level of significance was used (p <0.05). Results: On a scale of 0 to 10, the research showed that single-spherical spherical SN60AT lenses were the ones that obtained the lowest level of satisfaction among the four lenses, obtaining an average of 8.7 (SD = 1.30, CI ± 0.655), followed (mean = 8.9 - SD = 1.42, CI ± 0.721) and the toric (mean = 8.3 - SD = 1.83, CI ± 0.927), multifocal spherical (Restor) 9.1 - SD = 1.67, CI ± 0.844) as the highest level of satisfaction. Regarding the dependence of the glasses, the Restor lens showed the best performance, with less dependence on the glasses. Dysphasic phenomena were more frequent in patients who had implanted the SN60AT lens followed by Restor lens. Conclusion: It is concluded that the SN60AT lenses were the lenses that caused less satisfaction, and the dysphothetic phenomena were one of the main complaints, associated with the postoperative glasses dependence. Patients who had restored Restor lenses, despite the more present dysphoric symptoms than spherical monofocal and single-focal lenses, have the same level of satisfaction, and still provide greater independence of the glasses.