The Pyhäjärvi Cataract Study II. Criteria for cataract surgery

Purpose: It is necessary to develop tools for patient selection to target cataract surgery to patients with the best expected outcomes. We used visual acuity, visual functioning 14 (VF‐14) test, the 15‐dimension health‐related quality‐of‐life questionnaire (15D) and the New Zealand priority criteria to evaluate the criteria for cataract surgery in a post hoc setting. Material and methods: Ninety‐three consecutive patients living in a defined rural area in Finland had cataract surgery as a part of the Pyhäjärvi Cataract Study in 2003. Success of cataract surgery was defined as improvement of visual acuity by at least 2 lines and/or improvement of visual function measured by questionnaires. Results: The patients with a visual acuity of 0.30 logMAR (0.5 Snellen decimal) or worse in the better eye and/or 0.52 logMAR (0.3 Snellen decimal) in the worse eye had successful surgery in 59–83% of cases depending on the definition of success. When subjective judgement was added, the success rates varied between 63% and 91%. Conclusion: Setting indication criteria, it seems sufficient to use two global questions in addition to visual acuity: one on the subjective view on disability, and one on a more neutral view on visual function, such as the 15D item on vision. The VF‐14 did not perform any better than the single item counterparts.     

Extended long‐term outcomes of cataract surgery

Purpose: To longitudinally report the changes in visual acuity (VA) and subjective visual function, 10 years after cataract surgery. Methods: This population‐based prospective study reviewed 335 patients (85% of survivors) who underwent cataract surgery during a 1‐year period in 1997–98, 289 of whom were also re‐examined. The patients underwent a routine eye examination and answered the same visual function questionnaire (VF‐14), preoperatively, 4 months postoperatively, 5 years and 10 years after surgery. Results: Ten years after surgery, the best corrected VA (BCVA) of the operated eye had deteriorated to a median of 0.06 (logMAR) (Snellen acuity: 20/23) from 0.046 (logMAR) (20/22) postoperatively (p = 0.001). More than two‐thirds of the patients had <0.1 logMAR units worsening of BCVA compared with postoperatively. Approximately half of the patients had no deterioration in subjective visual function, and 77% had 10 points decline or less. Twelve per cent of the patients (42/335) had a worsening of more than 30 points. Effect size was calculated for the VF‐14 total score at all three occasions of follow‐up after surgery and was largest approximately 4 months postoperatively. Long‐time follow‐up of 10 years shows still moderate effect size. Conclusion: These results confirm the effectiveness of cataract extraction, offering good long‐term visual rehabilitation for the majority of the patients. The most common cause for large functional loss after 10 years is age‐related macular degeneration.     

Gender‐related differences in cataract surgery outcome: a 5‐year follow‐up

Purpose: A prospective, longitudinal, population‐based cohort study was performed to analyse gender‐related differences in subjective and objective visual function 5 years after cataract surgery. Methods: All patients (n = 810) who underwent cataract surgery during a 1‐year period (1997–98) at Norrlands University Hospital in Umeå, Sweden, were studied with visual acuity (VA) data and questionnaires (VF‐14) before and after surgery, as well as 5 years later. Five hundred and thirty patients (177 men, 353 women) answered the questionnaire, constituting 90% (530/590) of the survivors. Four hundred and sixty‐seven (156 men, 311 women) also underwent an eye examination. Results: The women were significantly older (P = 0.009) and were more often operated on both eyes (P = 0.005). Before surgery and postoperatively, the women had a significantly lower age‐ and VA‐adjusted VF‐14 score (P = 0.000 and P = 0.036, respectively). This difference was not significant 5 years after surgery (P = 0.16). Five years after surgery, a significantly larger proportion of women had a decline of more than 0.1 logarithm of the minimum angle of resolution of the better‐seeing eye (P = 0.013). There were no significant gender‐related differences in the operated eye. Conclusion: Female cataract surgery patients assess their visual function worse than males after adjustment for age and VA preoperatively and postoperatively. These differences were not significant 5 years after surgery although the men had better best‐corrected visual acuity (BCVA) of their better eye. It is important to be aware of gender‐related differences in perception when performing questionnaire‐based outcome studies.     

Which factors influence patients’ maximum acceptable waiting time for cataract surgery? – a questionnaire survey

Purpose: To evaluate patients’ maximum acceptable waiting time (MAWT) and to assess the determinants of patient perceptions of MAWT. Methods: A total of 500 consecutive patients with cataract were asked to fill out a preoperative questionnaire, addressing patients’ MAWT to undergo cataract surgery. Patients’ visual impairment (VF‐14 score), education, profession and social status were evaluated, and an ophthalmologic examination was performed. Univariate analysis included Spearman’s correlation test, unpaired Student’s t‐test and the Mann–Whitney U test. Univariate and multivariate associations were calculated using unconditional logistic regression. Results: The mean MAWT was 3.17 ± 2.12 months. The mean VF‐14 score was 72.10 ± 22.54. Between VF‐14 score and MAWT, there was a significant correlation (r = 0.180, p = 0.004). Patients with higher education (high school, university) accepted significantly longer MAWT (3.92 ± 2.38 months versus 3.02 ± 2.00 months, p = 0.009). Patients who had self‐noticed visual impairment were nearly four times (OR: 3.88, 95% CI = 2.07–7.28, p < 0.001) more likely to accept only MAWT of <3 months. Conclusions: Patients with low tolerance for waiting had greater self‐reported difficulty with vision. Patients’ acceptance of waiting was not associated with clinical visual acuity measures. Education, ability to work, living independently and taking care of dependents were also strong predictors from patients’ perspective. Considering the implementation of standards for waiting lists, these facts should be taken into account.     

Longitudinal changes in subjective and objective visual function in diabetics 5 years after cataract surgery

Purpose: To investigate and compare the long‐term subjective and objective visual functional results of phacoemulsification in diabetics and non‐diabetics. Methods: A prospective, longitudinal, population‐based study comprising 57 diabetics and 473 non‐diabetics, who had cataract surgery during a 1‐year period at Norrlands University Hospital, Umeå, Sweden. Visual acuity data, visual function questionnaire (VF‐14) responses, and level of diabetic retinopathy were recorded pre‐ and postoperatively as well as 5 years after surgery. Results: Four months postoperatively, the median VF‐14 total score for both the diabetics and the non‐diabetics was 100; at 5 years, the score decreased to 96.4 and 97.2, respectively (p = 0.81). The median best corrected visual acuity (BCVA) of the operated eye was logMAR 0.046 (Q1:Q3 = 0:0.15) for both the diabetics and the non‐diabetics 4–8 weeks postoperatively. Five years later, the BCVA for the diabetics was logMAR 0.14 (Q1:Q3 = 0.02:0.34) and for the non‐diabetics 0.1 (Q1:Q3 = 0.02:0.3), (p = 0.34). Five years after surgery, 26% of the diabetics and 22% of the non‐diabetics had a reduction in VF14‐score of 10 points or more (p = 0.64) compared with 4 months postoperatively. One‐third of both the diabetics (18/57) and the non‐diabetics (149/473) had lost more than 0.1 log MAR unit in BCVA of the operated eye (p = 0.86). Conclusion: Subjective and objective visual function 5 years after cataract surgery remained stable in most surviving diabetics and non‐diabetics. The longitudinal visual function in diabetics was not significantly worse compared with non‐diabetics.     

Changes in visual acuity of patients undergoing cataract surgery during the last two decades

PURPOSE: To compare preoperative visual acuities in patients who underwent cataract surgery between 1982 and 2000. METHODS: Information on visual acuity (VA), ocular disease and general disease was obtained from records relating to samples of consecutive cataract operations in 1982, 1985, 1990, 1995 and 2000 in two hospitals in the Vaasa region of Finland. RESULTS: Between 1982 and 2000, the average preoperative VA in the operated eye increased by 0.85 logMAR units (from logMAR 1.56 to logMAR 0.71) or 8.5 log lines. Corresponding decimal values are 0.03 and 0.2, respectively. In the better eye, VA increased from logMAR 0.64 to logMAR 0.37. Corresponding decimal values are 0.23 and 0.43, respectively. The incidence of cataract surgery increased from 1.0 to 7.2 operations per 1000 of the population per year over the period. For an annual increase of one operation per 1000 inhabitants, the increase in average VA before surgery is 1.3 log lines in the operated eye and 0.4 log lines in the better eye. The number of patients with visual impairment (WHO definition: VA < 0.3) before surgery fell from 47% to 15%, and the number of patients with profound visual handicaps (VA < 0.1) before surgery fell from 15% to 4%. CONCLUSION: The preoperative vision of patients undergoing cataract surgery during the last two decades has improved significantly. Preoperative VA has increased linearly in line with the incidence of surgery. Only a small proportion of the increase in incidence of cataract surgery can be explained by the increasing average age of the population.     

Interim clinical outcomes in the Collaborative Initial Glaucoma Treatment Study comparing initial treatment randomized to medications or surgery.

PURPOSE: To report interim outcome data, using all available follow-up through 5 years after treatment initiation, in the Collaborative Initial Glaucoma Treatment Study (CIGTS). DESIGN: Randomized clinical trial. PARTICIPANTS: Six hundred seven newly diagnosed glaucoma patients. METHODS: In a randomized clinical trial, 607 patients with newly diagnosed open-angle glaucoma were initially treated with either medication or trabeculectomy (with or without 5-fluorouracil). After treatment onset and early follow-up, patients were evaluated clinically at 6-month intervals. In addition, quality of life telephone interviews were conducted at similar frequency to the clinical visits. Patients in both arms of CIGTS were treated aggressively in an effort to reduce intraocular pressure (IOP) to a level at or below a predetermined target pressure specific for each individual eye. Visual field (VF) scores were analyzed by time-specific comparisons and by repeated measures models. MAIN OUTCOME MEASURES: VF loss was the primary outcome variable in CIGTS. Secondary outcomes of visual acuity (VA), IOP, and cataract were also studied. RESULTS: On the basis of completed follow-up through 4 years and partially completed through 5 years, VF loss did not differ significantly by initial treatment. Over the entire period of follow-up, surgical patients had a greater risk of substantial VA loss compared with medical patients. However, by 4 years after treatment, the average VA in the two groups was about equal. Over the course of follow-up, IOP in the medicine group has averaged 17 to 18 mmHg, whereas that in the surgery group averaged 14 to 15 mmHg. The rate of cataract requiring removal was greater in the surgically treated group. CONCLUSIONS: Both initial medical or initial surgical therapy result in about the same VF outcome after up to 5 years of follow-up. VA loss was greater in the surgery group, but the differences between groups seem to be converging as follow-up continues. When aggressive treatment aimed at substantial reduction in IOP from baseline is used, loss of VF can be seen to be minimal in general. Because 4 to 5 years of follow-up in a chronic disease is not adequate to draw treatment conclusions, these interim CIGTS outcomes do not support altering current treatment approaches to open-angle glaucoma.     

The waiting game: natural history of a cataract waiting list in New Zealand

Aims : To identify the demographic and visual function of patients on the reserve waiting list for cataract surgery at a large public hospital within New Zealand and to determine the ultimate outcome of those on a priority‐based, rationed, health‐care waiting list. Methods : Patients from a defined geographical population, placed on a reserve waiting list for possible cataract surgery, during the period January 1997 to March 2000, were invited to attend for further clinical assessment and asked to complete a visual assessment questionnaire. Results : Of 193 patients in the pilot study group who had been on the reserve waiting list for a mean of 18.2 ± 11.6 months (range 0.1–62.7 months), only 94 (49%) were deemed suitable for, and subsequently underwent, surgery in the public sector. Forty‐nine (25%) had undergone surgery earlier, the majority of these (84%) in the private sector. A further 23 (12%) patients were deceased, four (2%) declined surgery and in six (3%) cataract surgery was no longer indicated. The remaining 11 (6%) patients could not be traced. Patients still awaiting surgery had a mean age of 77.2 years (range 48–95 years). Fifty‐four were women. Vision had deteriorated by a mean of 0.05 LogMAR units, from Snellen equivalent 6/30 at listing to 6/36, over this time. Conclusions : Current methods of prioritization for cataract surgery are imperfect, as are the resources for performing adequate levels of cataract surgery. Analysis of a residual waiting list for cataract surgery highlights that the majority (51%) do not ultimately progress to cataract surgery in the public sector for a variety of reasons. During a mean waiting time of 1.5 years vision further deteriorates in this predominantly older population.     

Cataract blindness in Turkmenistan: results of a national survey

AIM: To present results of a rapid assessment of cataract in Turkmenistan. METHODS: 6120 eligible people of 50 years and older were selected by systematic random sampling from the whole of Turkmenistan. A total of 6011 people were examined (coverage 98.2%). RESULTS: Cataract is the major cause of bilateral blindness (54%), followed by glaucoma (25%). The age and sex adjusted prevalence of bilateral cataract blindness (VA <3/60) in people of 50 years and older was 0.6% (95% CI: 0.4 to 0.9), with a cataract surgical coverage of 75% (people). For VA <6/60 the prevalence was 2.6% (95% CI: 2.1 to 3.2) in people aged 50 and above, approximately 0.26% of the total population. In this last group the surgical coverage was 44% (people) and 32% (eyes). Of the patients operated with IOL implantation 8.2% could not see 6/60, 44.8% of those operated without IOL could not see 6/60. The main barrier to cataract surgery was indifference ("old age, no need for surgery"), followed by "waiting for maturity." CONCLUSION: To increase the cataract surgical coverage in Turkmenistan the intake criteria should be lowered to VA <6/60 or less. At the same time the visual outcome of surgery can be improved by expanding the number of IOL surgeries and routine monitoring of cataract outcome. Additional investments will be required to provide all eye surgeons with appropriate equipment and skills for IOL surgery.     

Prevalence of major eye diseases and causes of visual impairment in the adult Finnish population: a nationwide population‐based survey

Purpose: To estimate the prevalence of cataract, glaucoma, age‐related maculopathy (ARM) and diabetic retinopathy (DR) in the adult Finnish population. Methods: A representative cross‐sectional sample of the Finnish population aged 30 years and older. Of the 7979 eligible people, 7413 (93%) were interviewed and/or examined. The interview included self‐reported doctor‐made diagnoses of cataract, glaucoma, degenerative fundus changes (mainly ARM) or DR. Information on self‐reported eye diseases was complemented with data from national registers, and case records were gathered for non‐participants and persons with visual acuity (VA) < 0.5 or reporting difficulties in vision or eye diseases without assessed VA. Results: Based on self‐reported and/or register‐based data the estimated total prevalences of cataract, glaucoma, ARM and DR in the study population were 10%, 5%, 4% and 1%, respectively. All these chronic eye diseases increased with age (p < 0.001). The corresponding prevalences for persons aged 65 and older were 34%, 13%, 12% and 2%, respectively. Cataract and glaucoma were more common in women than in men [odds ratio (OR) 1.55, 95% confidence interval (CI) 1.26–1.91; OR 1.57, 95% CI 1.24–1.98, respectively]. The most prevalent eye diseases in people with visual impairment (VA ≤ 0.25) were ARM (37%), unoperated cataract (27%), glaucoma (22%) and DR (7%). Conclusion: The high prevalence of these mainly age‐related eye diseases, together with increasing life expectancy, mean that continuous efforts are needed to identify and treat eye diseases in order to maintain patients’ quality of life and to alleviate the social and economic burden of serious eye diseases.     

白内障伴血液系统疾病行超声乳化术临床分析

目的:评价超声乳化技术在伴有血液系统疾病的白内障患者手术的临床效果。方法:伴有血液系统疾病的白内障患者14例19眼,行白内障超声乳化联合人工晶状体植入手术,观察术前术后视力变化。结果:所有术眼视力均有不同程度的提高。最佳矫正视力≥0.3者15眼占79%,最佳矫正视力≥0.5者10眼占53%。结论:伴有血液系统疾病的白内障患者在一定程度上可以行白内障超声乳化合并人工晶状体植入术。     

Why are patients with no visual symptoms on cataract waiting lists?

BACKGROUND: Some patients waiting for cataract surgery report limited or no visual symptoms when responding to standardized visual function questions. This has led some to argue that too many patients are undergoing cataract surgery. METHODS: One hundred and forty-nine consecutive patients who reported no symptoms on the Visual Function Index questionnaire (VF-14) were asked if they had any visual symptoms not included in the VF-14, why they thought they were on the waiting list, and what they expected to gain from surgery. They were interviewed after their surgery to see if they were satisfied with the procedure and if their vision had improved. RESULTS: Of 149 patients, 108 described some degree of visual impairment, 28 stated they were undergoing surgery at their doctor's suggestion, and 13 did not describe any reason for their surgery. By the second interview, 105 patients had had surgery, of whom 85% were very or extremely satisfied and 75% felt their vision was markedly improved. There was no statistically significant difference in satisfaction rates between the symptomatic, asymptomatic, or doctor's suggestion groups, or between patients undergoing first or second eye surgery. INTERPRETATION: Patients on cataract waiting lists who scored 100 (no complaints) on the VF-14 are likely to have some visual complaints not identified by the test and are likely to experience significant visual gain after undergoing cataract surgery. The adoption of the VF-14 questionnaire to determine the threshold for cataract surgery would be detrimental, because many patients who clearly could benefit from surgery would be denied appropriate health care.     

Apolipoprotein E genotype and risk for development of cataract and age‐related macular degeneration

Purpose: To study whether apolipoprotein E (APOE) genotypes are associated with risk for developing cataract and age‐related macular degeneration (AMD). Methods: A sample of 88 healthy adults (50–75 years) genotyped for polymorphisms of APOE underwent an eye examination which included visual acuity (VA) testing, slit‐lamp cataract evaluation, optical coherence tomography (OCT) and fundus photography, the last of which was analysed and graded for macular pathology at the Reading Centre, Moorfields Eye Hospital, London. Two‐by‐two cross tables were analysed using the Fisher–Boschloo unconditional full multinomial test. Two‐sample t‐tests were used for comparing means of scale variables. Results: Thirty‐two participants were diagnosed with cataract or had undergone cataract surgery in one or both eyes, and 56 participants demonstrated no signs of cataract. We found that APOE4 carriers were less likely to have cataract than non‐APOE4 carriers (p = 0.039). No correlation between APOE genotypes and morphologic changes in the macular region was revealed. However, APOE3 carriers disclosed significantly higher average macular thickness in both eyes than non‐APOE3 carriers (p = 0.012), and APOE3 carriers also had significantly better VA than non‐APOE3 carriers (p = 0.041). Conclusions: We found no association between AMD and APOE polymorphism in a population of 96 individuals aged 50?75 years. A weak negative association between APOE4 and cataract was uncovered in the same population. Apolipoprotein E3 may be a protective factor against the loss of nerve fibres in the macular region.     

Visual recovery after vitrectomy for macular hole using 25‐gauge instruments

Purpose: To determine whether vitrectomy with 25‐gauge instruments contributes to better postoperative visual recovery after macular hole (MH) surgery. Methods: The medical records for 46 consecutive eyes operated for MH by a single surgeon were retrospectively examined. Vitrectomy had been performed with a 25‐gauge instrument in 23 eyes (25‐G group) and with a 20‐gauge instrument in 23 eyes (20‐G group). Postoperative visual acuity (VA) in logMAR (logarithm of the minimum angle of resolution) units after 1 week and 1, 3, 6, 9 and 12 months, operating time, and volume of intraocular irrigating fluid were compared between the two groups. Results: Mean preoperative logMAR VA was 0.72 in the 25‐G group and 0.68 in the 20‐G group (p = 0.282, unpaired t‐test). One week after surgery, VA was significantly better in the 25‐G group (0.40 ± 0.34) than in the 20‐G group (0.58 ± 0.30) (p = 0.020). This significant difference was maintained until 9 months after surgery, but was no longer evident at 12 months (p = 0.182). Operating time was significantly shorter in the 25‐G group (56 ± 16 mins) than in the 20‐G group (85 ± 28 mins) (p = 0.003, unpaired t‐test). The volume of intraocular irrigating fluid was significantly less in the 25‐G group (244 ± 72 ml) than in the 20‐G group (416 ± 113 ml) (p < 0.0001). Conclusions: The use of 25‐gauge vitrectomy instruments leads to better postoperative visual recovery following surgery for MH during the first 9 months, probably as a result of shorter surgical time and a lower volume of intraocular irrigating fluid.     

Comparison of adapted Vryghem macular function test and Lotmar‐light interferometer in predicting visual acuity after cataract surgery

Purpose: To assess the accuracy of a newly described macular function test (Vryghem macular function test) adapted to our examination equipment and to compare it to the Lotmar‐light interferometer for the preoperative evaluation of cataract patients at the University Eye Clinic, Geneva, Switzerland. Methods: This prospective study included 71 consecutive patients (72 eyes) who were undergoing uneventful cataract surgery. Testing with the Lotmar‐light interferometer and an adapted form of Vryghem macular function test (AVMFT) using a Birkhauser reading chart, a hyperaddition of +8 D and halogen illumination were performed to assess macular function and to predict postoperative visual acuity (VA). The duration of each test and the density and location of lens opacities were also noted. Best‐corrected postoperative VA was compared to the predicted values of each test. Results: The positive predictive value was 94.2% for AVMFT compared to 92.2% for the Lotmar‐light interferometer. The negative predictive value was 50% for AVMFT compared to 42.9% for the Lotmar‐light interferometer. The sensitivity was 83.1% for AVMFT and 79.7% for the Lotmar‐light interferometer. The specificity was 76.9% for AVMFT and 69.2% for the Lotmar‐light interferometer. The correlation coefficient for AVMFT and preoperative Lotmar results (both in LogMAR) with postoperative best‐corrected VA (poBCVA; LogMAR) were similar (0.74 and 0.77 respectively). Conclusion: The results of this study suggest that AVMFT is as reliable as the Lotmar‐light interferometer in predicting postoperative VA after uneventful cataract surgery. The correlation coefficients with postoperative VA were 0.74 and 0.77, respectively. Both tests showed a high positive (94.2% and 92.2%, respectively) but a low negative (50.0% and 42.9%, respectively) predictive value.     

早期白内障超声乳化吸除术及人工晶状体植入术后视觉质量评价

目的:评价早期白内障超声乳化吸除术及人工晶状体植入术后的视觉质量。方法:连续选取入院治疗的白内障患者120例,按照术前最佳矫正视力分为三组(A组:最佳矫正视力<4.0;B组:最佳矫正视力4.0～<4.5;C组:最佳矫正视力≥4.5,分别记录手术前及手术后1mo的矫正视力,并于手术前后分别进行VF-14问卷调查,记录VF-14评分。结果:三组患者的术前及术后矫正视力和VF-14评分差异均有明显的统计学意义(P<0.01),A组和B组,A组和C组的术前及术后VF-14评分差异有明显统计学意义,B组和C组的术前及术后VF-14评分差异无明显统计学意义。三组患者的术前矫正视力与VF-14评分呈明显正相关(rs=0.703,P<0.01);三组患者的术后矫正视力与VF-14评分呈明显正相关(rs=0.878,P<0.01)。结论:早期行白内障超声乳化吸除术及人工晶状体植入术能够明显提高术后视觉质量,从而改善生活质量。     

麻风病患者白内障手术治疗效果的追踪观察

目的:追踪观察麻风病患者白内障手术后的临床疗效。方法:与负责治疗麻风病患者的皮肤科医生一起,筛选出适合白内障手术的患者28例(28眼),在局麻下行小切口非超声乳化摘除联合人工晶状体植入术,术后8mo追踪其临床效果,并与同期的老年性白内障患者63例(63眼)的手术效果相比较。结果:麻风病组术后最好的视力≥0.4者为21%,视力在0.1～0.3者为68%,<0.1者为11%,而老年性白内障组的术后视力≥0.4者为90%,视力在0.1～0.3者为8%,<0.1者为2%,两组差异有显著性(P<0.05)。在麻风病组的22例≤0.3的患者中,15例由于术前存在慢性葡萄膜炎,是术后低视力原因的首位。结论:麻风病患者白内障手术效果比一般老年人的手术效果差,其原因主要是术前合并慢性葡萄膜炎。     

Comparison of the results of first and second cataract eye surgery

OBJECTIVE: To compare the outcomes of second eye cataract surgery with those of first eye surgery. In particular, to evaluate changes in visual acuity (VA), visual function, and health status after the first and second eye surgeries. DESIGN: A cohort (case series) analysis of patients recruited in a clinical trial. PARTICIPANTS: A total of 403 consecutive patients with indication of noncombined first eye or second eye cataract surgery were recruited in 3 public hospitals in Barcelona, Spain. First eye surgery patients are compared to second eye surgery patients. INTERVENTION: Patients were evaluated both before surgery and 4 months after surgery by a standardized telephone interview and clinical examination. MAIN OUTCOME MEASURES: Visual acuity, visual function index (VF-14), a 14-item instrument designed to measure visual function, and the Sickness Impact Profile (SIP), a generic measure of health status. RESULTS: Full data were obtained from 315 (78%) patients: 249 who underwent first eye surgery only and 66 different patients who underwent second eye surgery. Significant improvement was found in both groups of patients for best-corrected VA in the operated eye (4.4 Snellen lines, P < 0.001; 4.2 Snellen lines, P < 0.001, respectively), VA in the better eye (2.8 Snellen lines, P < 0.001; 1.4 Snellen lines, P < 0.001), and visual function (26.3 Snellen lines, P < 0.001; 17.0 Snellen lines; P < 0.001). Four months after the operation, the VF-14 of the second eye group was slightly better (93.4 vs. 88.5; P = 0.09; score range: 0, worst, to 100, best). Psycho-social SIP scores improved in both groups (4.8, P < 0.001; 3.1, P = 0.016). Physical SIP score improved only in the first eye surgery group (1.8, P = 0.003) but not in the second eye surgery group (-1.0, P = 0.338; score range: 0, best, to 100, worst). CONCLUSIONS: The results of our study suggest that patients undergoing second eye cataract surgery show significant improvements in VA, visual function, and psycho-social health status. However, global and physical health status does not change after second eye cataract surgery.     

Decision-making in second-eye cataract surgery: can presence of Pulfrich phenomenon help?

PURPOSE: To determine whether testing for the Pulfrich phenomenon (PP) can be used as a tool to assess the need for and optimal timing of second-eye cataract surgery. METHODS: A total of 61 patients with logMAR 0 visual acuity (VA) after cataract surgery in one eye and logMAR 0.2-0.7 VA in the other eye were tested for PP using a computer-generated oscillating target at Baskent University Hospital. Only patients who had no ophthalmologic or systemic problem that could cause PP were included. In all, 15 normal patients with logMAR 0 VA in both eyes served as controls. The main outcome measures were presence and magnitude (measured by neutral density filters) of PP and presence of complaints related to binocular vision. RESULTS: Of the 61 patients, 36 (59%) and none of the controls were PP (+) (P<0.001). A total of 27 (75%) of the PP (+) patients had logMAR 0.7-0.4 VA, and nine (25%) had logMAR 0.3-0.2 VA (P=0.01). In all, 16 patients (all PP (+)) had developed binocular vision-related complaints since cataract surgery. The mean PP magnitude in these cases was significantly greater than the mean for the 20 patients without complaints (1.2+/-0.5 vs0.6+/-0.4 log units, respectively; P<0.001). There was no significant difference between the mean VA in the complaint (+) and complaint (-) subgroups (P=0.213). CONCLUSION: PP testing may detect binocular visual dysfunction after first-eye cataract surgery; thus, it could help assess the need for second-eye cataract surgery on this basis.     

Outcome and number of cataract surgeries in India: policy issues for blindness control

Purpose: To assess what impact attention to quality of cataract surgery and postoperative follow up can have on cataract blindness in India, and to estimate the number of surgeries needed to eliminate cataract blindness in India. Methods: In a population‐based sample of 5268 persons in two rural areas in the state of Andhra Pradesh, India, data on the visual outcome of cataract surgery were obtained on 129 eyes of 106 persons operated previously. These were compared with the visual outcome of cataract surgery performed during 1999 in 2394 eyes of 2213 persons at two new rural eye centres set up in these areas that pay particular attention to the quality of eye care. Blindness in an eye was defined as presenting distance visual acuity less than 6/60, and in a person as this acuity level in the better eye. These data were extrapolated to India. Results: In the population‐based sample, of the 129 operated eyes, 51 (39.5%) were blind after surgery, which included 41 (31.8%) from cataract surgery‐related causes. Of the 106 persons in the population sample who had had cataract surgery in one or both eyes, 26 (24.5%) were still blind. In contrast, for the cataract surgery at the two rural eye centres paying attention to quality, 3.1% of the eyes and 1.8% of the persons were blind soon after surgery, but these figures could increase 2.6 times over the lifetime of these persons. The 3.5 million cataract surgeries in India in 2000 are estimated to result in 0.32 million persons having blindness averted over their lifetime. To eliminate cataract blindness in India, an estimated 9 million good‐quality cataract surgeries are needed every year during 2001?2005, increasing to over 14 million surgeries needed every year during 2016?2020 on persons most likely to go blind from cataract. Conclusions: The number of persons in whom blindness is being averted due to cataract surgery in India is currently a very small fraction of the number blind from cataract. If adequate attention is given to the quality of eye care, for the current number of cataract surgeries in India it should be possible to increase by threefold the number in whom blindness can be averted with cataract surgery. In addition to improving quality, the annual number of cataract surgeries has to be at least threefold the current number during 2006?2010 if cataract blindness in India is to be eliminated.