DOCSLIB.ORG

Preoperative Steps in Presbyopic Cataract

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Preoperative Steps in Presbyopic Cataract s FUNDAMENTALS IN FIVE PREOPERATIVE STEPS IN PRESBYOPIC CATARACT SURGERY Five fundamentals to match the right IOL technology to the right patient. BY FLORIAN T.A. KRETZ, MD, FEBO; AND IMANE TARIB, MD ecent advances in premium cataract surgery allow sur- geons to achieve better visual outcomes for patients than was possible in the past. Due to expanding indications for surgery and rising expectations of patients, preoperative screening is a crucial step in the process of determining Rthe right IOL for the right patient. In the June Fundamentals in Five column, we discussed five important factors in choosing the right IOL. In this issue, we discuss five key factors that every surgeon and staff member must master in preoperative patient screen- ing, evaluation, and counseling to ensure that patients are Figure 1. Corneal tomography maps showing regular (left) and irregular (right) astigmatism. happy with our decisions in presbyopia-correcting surgery. Analysis of axial power maps and the front:back cor- FUNDAMENTAL CORNEAL EVALUATION neal surface ratio in the sagittal plane allow detection of Corneal tomography is an effective tool to abnormalities in corneal shape. This is especially pertinent 1 assess corneal optical quality. It provides an in patients with a history of refractive surgical procedures exhaustive examination of the corneal surface and thickness, because it significantly influences IOL power calculation. and it can display Scheimpflug images for visualization of Moreover, measurements of corneal spherical aberration anterior segment structures.1 These images help to document provided by corneal tomography are essential for IOL selec- lens opacification and make it easier to explain to patients tion and patient counseling. These measurements can help the need for surgical intervention. The data gathered include make the choice between a monofocal and an extended information such as the presence of irregular astigmatism depth of focus (EDOF) IOL, depending on pupil size and (Figure 1), corneal shape, spherical aberration, and cylinder. spherical aberration. Irregular astigmatism greatly affects visual outcomes and It is also important to analyze cylinder measurements, is challenging to treat after surgery. Therefore, preoperative especially if the use of toric IOLs is being considered. screening for this condition is important. Corneal tomogra- Measuring regular corneal astigmatism with a manual or phy provides quantitative assessment of irregular astigma- automated keratometer is not enough. It is now mandato- tism with analysis of total higher-order aberrations (HOAs), ry to assess total HOAs in order to make the right decision. along with qualitative assessment with a refractive power Patients with severe irregular corneal astigmatism are not map. Studies have found that patients with moderate eligible for toric IOL implantation. The reproducibility of amounts of HOAs—values greater than 0.3 µm in mild tomographic cylinder measurements can be confirmed by irregular astigmatism and 0.4 µm in moderate irregular comparing the magnitude and axis of regular astigmatism astigmatism for a 4-mm pupil—are likely to experience between manual keratometry and the wavefront-derived a major decrease in visual quality postoperatively.2,3 This value. Several studies have shown the effect of poste- matters for quality of vision with presbyopia-correcting rior corneal curvature on visual outcomes, making these IOLs but also for asphericity and the aspheric optical pro- measurements important for toric IOL planning.2,4 file of monofocal IOLs. (Continued on page 79) 82 CATARACT & REFRACTIVE SURGERY TODAY EUROPE | JULY/AUGUST 2018 FUNDAMENTALS IN FIVE s (Continued from page 82) FUNDAMENTAL OCT EVALUATION FUNDAMENTAL SETTING PATIENT Cataract patients EXPECTATIONS 3 generally belong to 2 To determine the the senior population, which means best IOL technology for patients who that they have a relatively high rate desire presbyopic cataract surgery, of associated pathologies, some of it is key to focus on each patient’s which can compromise the outcomes individual lifestyle and needs. Patient of presbyopia-correcting IOL surgery.7 education and counseling helps the Chronic pathologies such as diabetic surgeon to decide which approach retinopathy and glaucoma are well would be best. During this chair time, documented on OCT. Other disor- patients are informed about potential ders that are not clinically visible can outcomes with an emphasis on the also be observed with OCT, such as degree of spectacle independence mild macular edema or a transparent that may be expected, the possibil- epiretinal membrane—either of which ity of dysphotopic phenomena, and can negatively impact the outcomes of the potential need for postoperative presbyopia-correcting surgery. refinements. Additionally, early stages of age- It is important to impress upon related macular degeneration (AMD) patients that presbyopia-correcting can be detected on OCT. When early IOLs offer a wider range of vision com- AMD is detected, patients should be pared to monofocal IOLs because they counseled about possible chronic loss provide multiple foci.5 It is important of vision in their later years after IOL to discuss with patients how their lens implantation (Figure 4). choices will affect their reading habits and the visual tasks required in their FUNDAMENTAL DEALING WITH Figure 2. Halo and glare strength analysis with the profession and daily activities. DYSPHOTOPIC AT LARA 829 EDOF IOL (Carl Zeiss Meditec). Photic phenomena are a possible 4 PHENOMENA side effect with presbyopia-correcting Photic phenomena induced by the promising with regard to the reduction lenses, and patients must be edu- optical designs of presbyopia-correcting of dysphotopic phenomena.6 cated about this risk by showing IOLs are often the first dissatisfaction There are also so-called mix-and- them images that illustrate halos and reported by patients after premium match approaches, in which two differ- glare around light sources in differ- cataract surgery.6,8 These phenomena ent types of IOL are used. These have ent scenarios, such as driving a car at should be discussed before surgery. been reported to result in remarkable night (Figure 2). Fortunately, this side Explain to patients that each optical rates of satisfaction, with significantly effect is rare and often disappears design has a different pattern of photic reduced frequency of dysphotopsia after a period of neural adaptation. In phenomena, and show patients images complaints by patients.9 In a small case worst-case scenarios, surgery can be from simulators to gauge their tolerance series of older cataract patients, we reversed and a multifocal IOL can be in the event these phenomena occur found that the rate of photic phenom- exchanged for a monofocal. However, after surgery (Figure 2). Although it is ena in patients binocularly implanted it is important to remember that not often discussed, monofocal IOLs can with a rotationally asymmetric EDOF monofocal IOLs can also cause halos also cause dysphotopsia, depending on IOL with 1.50 D depth of focus at the and glare.6 Patients must understand their aspheric optical profiles and espe- IOL plane resulted in rates of halos and these possibilities preoperatively so cially if corneal aberrations are not taken glare comparable to those in patients that they have realistic expectations. into account.6 implanted with a monofocal IOL.10 In our practice we have learned that, In bilateral presbyopia-correcting IOL with diffractive IOLs, patients need to surgery, when patients are motivated FUNDAMENTAL TAKING ACCOUNT know that they could experience halos but undecided about their tolerance of OF ASSOCIATED as a result of the optical profile of the dysphotopsia, the surgeon can implant 5 DISORDERS lens (Figure 3). A simple explanation one IOL in the nondominant eye and In order to avoid pitfalls in pre- can result in a happy doctor with let the patient decide if he or she mium cataract surgery, it is important a functional outcome and a happy still wants the same IOL in the other to conduct an exhaustive ophthal- patient who knew what to expect. eye. The latest generation of IOLs is mic examination to determine the JULY/AUGUST 2018 | CATARACT & REFRACTIVE SURGERY TODAY EUROPE 79 s FUNDAMENTALS IN FIVE right candidates for presbyopia-correcting surgery, elimi- to strengthen the cornea and making the incision on the nate those who have contraindications, and fine-tune steep axis to help reduce astigmatism. preoperative measurements. Finally, a history of previous infection or inflammation Dry eye disease (DED) is one of the most frequently may call for prophylactic measures. For example, patients encountered conditions in candidates for premium cataract with a history of herpes simplex virus infection must take surgery.11 In severe forms, DED can cause serious ocular sur- valaciclovir pre- and postoperatively in order to prevent face damage, significant topographic errors, and, if not well recurrence of the infection, which would compromise the treated, poor visual outcomes that can be falsely blamed on surgical outcomes. the surgery. Therefore, proper diagnosis and management of DED is mandatory prior to surgery to ensure patients’ post- CONCLUSION operative satisfaction and good outcomes. Premium IOL surgery, and especially presbyopia correc- A history of previous refractive surgery may require adapta- tion, is truly one of the most amazing opportunities in our tion of IOL power calculation methods,
Load more

Recommended publications
  • Visual Outcomes of Combined Cataract Surgery and Minimally Invasive Glaucoma Surgery
    1422 REVIEW/UPDATE Visual outcomes of combined cataract surgery and minimally invasive glaucoma surgery Steven R. Sarkisian Jr, MD, Nathan Radcliffe, MD, Paul Harasymowycz, MD, Steven Vold, MD, Thomas Patrianakos, MD, Amy Zhang, MD, Leon Herndon, MD, Jacob Brubaker, MD, Marlene Moster, MD, Brian Francis, MD, for the ASCRS Glaucoma Clinical Committee Minimally invasive glaucoma surgery (MIGS) has become a reliable on visual outcomes based on the literature and the experience of standard of care for the treatment of glaucoma when combined the ASCRS Glaucoma Clinical Committee. with cataract surgery. This review describes the MIGS procedures J Cataract Refract Surg 2020; 46:1422–1432 Copyright © 2020 Published currently combined with and without cataract surgery with a focus by Wolters Kluwer on behalf of ASCRS and ESCRS inimally invasive (sometimes referred to as mi- and thereby lower IOP. The endoscope consists of a fiber- croinvasive) glaucoma surgery (MIGS) is a pro- optic camera, light source, and laser aiming beam with an Mcedure that lowers intraocular pressure (IOP) 832 nm diode laser. The endoscope probe is introduced into without significantly altering the tissue, allows for rapid the globe via a limbal corneal or pars plana incision. The visual recovery, is moderately effective, and can be com- anterior approach requires inflation of the ciliary sulcus with bined with cataract surgery in a safe and efficient manner.1,2 an ophthalmic viscosurgical device, whereas the posterior This is in contrast to more conventional glaucoma surgery approach uses a pars plana or anterior chamber irrigation (eg, trabeculectomy or large glaucoma drainage device port. Although the anterior approach can be used in a phakic implantation), which requires conjunctival and scleral eye, it is typically performed with cataract extraction as a incisions as well as suturing.
    [Show full text]
  • Ocular Surface Disease: Supplement April 2018 Accurately Diagnose & Effectively Treat Your Surgical Patients
    Ocular Surface Disease: Supplement April 2018 Accurately Diagnose & Effectively Treat Your Surgical Patients Supported by an unrestricted educational grant from Ocular Surface Disease: Accurately Diagnose & Effectively Treat Your Surgical Patients Prevalence of Ocular Surface Disease and Its Impact on Surgical Outcomes Accurate diagnosis of dry eye disease is critical before cataract or refractive surgery By Elisabeth M. Messmer, MD ry eye is a common disease, but it may remain EPIDEMIOLOGY OF DRY EYE SYNDROME undetected. If it is not treated before cataract or 1-4 refractive surgery, patients may have suboptimal visual AFTER CATARACT SURGERY outcomes from their procedures. D l Very limited data available, mostly small descriptive/ IMPACT ON CATARACT SURGERY non-randomised studies There are a number of triggering factors for dry eye (Figure 1). l 10-20% of patients: DED induced or worsened after Cataract surgery worsens or causes dry eye in approximately uncomplicated cataract surgery 10% to 20% of patients (Figure 2).1-4 l In all studies: Signs and symptoms of dry eye In a study of 136 patients with a mean age of 71 years who increase after surgery were having cataract surgery, 22% had a prior diagnosis of dry eye that was not treated.5 Thirty-one percent complained l In most studies: gradual improvement of signs and of stinging, burning or other symptoms of dry eye when asked symptoms of dry eye within 3 months about their symptoms, and 41% reported a foreign body l In some studies: signs and symptoms persist > 3 months sensation. When the patients were examined, 77% had corneal staining and 50% had central staining.
    [Show full text]
  • CAUSES, COMPLICATIONS &TREATMENT of A“RED EYE”
    CAUSES, COMPLICATIONS & TREATMENT of a “RED EYE” 8 Most cases of “red eye” seen in general practice are likely to be conjunctivitis or a superficial corneal injury, however, red eye can also indicate a serious eye condition such as acute angle glaucoma, iritis, keratitis or scleritis. Features such as significant pain, photophobia, reduced visual acuity and a unilateral presentation are “red flags” that a sight-threatening condition may be present. In the absence of specialised eye examination equipment, such as a slit lamp, General Practitioners must rely on identifying these key features to know which patients require referral to an Ophthalmologist for further assessment. Is it conjunctivitis or is it something more Iritis is also known as anterior uveitis; posterior uveitis is serious? inflammation of the choroid (choroiditis). Complications include glaucoma, cataract and macular oedema. The most likely cause of a red eye in patients who present to 4. Scleritis is inflammation of the sclera. This is a very rare general practice is conjunctivitis. However, red eye can also be presentation, usually associated with autoimmune a feature of a more serious eye condition, in which a delay in disease, e.g. rheumatoid arthritis. treatment due to a missed diagnosis can result in permanent 5. Penetrating eye injury or embedded foreign body; red visual loss. In addition, the inappropriate use of antibacterial eye is not always a feature topical eye preparations contributes to antimicrobial 6. Acid or alkali burn to the eye resistance. The patient history will usually identify a penetrating eye injury Most general practice clinics will not have access to specialised or chemical burn to the eye, but further assessment may be equipment for eye examination, e.g.
    [Show full text]
  • Contacts Vs. Iols for Congenital Cataract
    in Review News commentary and perspectives Contacts vs. IOLs for Congenital Cataract he verdict is in on the issue of optical correction in children who undergo unilateral cataract surgery before age 7 months: Aphakia, corrected with a contact lens, is a better option than an T CONTACT LENS PATIENT. Dr. Lambert examines a 6-year-old intraocular lens (IOL) for 55 others who received an aphakic girl in the IATS trial. This child was prescribed a most of these babies. IOL implant (median VA in contact lens in one eye at 1 month of age and could insert “Primary IOL implan- both groups, 0.90 logMAR her own contact lens by the age 4 years. tation should be reserved [20/159]). for those infants where, in More complications. pillary membranes occurred one normal eye. But the the opinion of the surgeon, However, a significantly 10 times more often in the thing about children is that the cost and handling of greater number of the pseu- pseudophakic eyes. they’re going to live for a a contact lens would be so dophakic eyes required one Scott R. Lambert, MD, very long time, and it is burdensome as to result in or more additional intra- a professor of ophthalmol- important for them to have significant periods of uncor- operative procedures over ogy at Emory University in the best possible visual acu- rected aphakia,” stated the the course of the study (41 Atlanta and the lead inves- ity in their problem eye,” investigators in the Infant patients compared with tigator in the trial, credited he said, particularly in case Aphakia Treatment Study.1 12 in the aphakic group; advocacy by the pediatric anything should happen to Comparable VA.
    [Show full text]
  • Treatment of Stable Keratoconus by Cataract Surgery with Toric IOL Implantation
    10.5005/jp-journals-10025-1024 JaimeCASE Levy REPORT et al Treatment of Stable Keratoconus by Cataract Surgery with Toric IOL Implantation Jaime Levy, Anry Pitchkhadze, Tova Lifshitz ABSTRACT implantation in the right eye. On presentation, uncorrected We present the case of a 73-year-old patient who underwent visual acuity (UCVA) was 6/60 OU. Refraction was –0.75 successful phacoemulsification and toric intraocular lens (IOL) –5.0 × 65° OD and –3.25 –4.0 × 98° OS. Nuclear sclerosis implantation to correct high stable astigmatism due to and posterior subcapsular cataract +2 was observed in the keratoconus and cataract. Preoperative refraction was –3.25 – left eye. The posterior segments were unremarkable. 4.0 × 98°. A toric IOL (Acrysof SN60T6) with a spherical power of 16.5 D and a cylinder power of 3.75 D at the IOL plane and Corneal topography performed with Orbscan (Bausch 2.57 D at the corneal plane was implanted and aligned at an and Lomb, Rochester, NY) showed central thinning of 457 axis of 0°. Uncorrected visual acuity improved from 6/60 to microns and positive islands of elevation typical for 6/10. Postoperative best corrected visual acuity was 6/6, 6 months after the operation. In conclusion, phacoemulsification keratoconus in the right eye (Fig. 1). In the left eye a less with toric IOL implantation can be performed in eyes with pronounced inferior cone was observed (Fig. 2), without keratoconus and cataract. any area of significant thinning near the limbus typical for Keywords: Intraocular lens, Toric IOL, Keratoconus, Cataract pellucid marginal degeneration.2 Keratometry (K)-values surgery.
    [Show full text]
  • Incidence of Posterior Vitreous Detachment After Cataract Surgery
    ARTICLE Incidence of posterior vitreous detachment after cataract surgery Alireza Mirshahi, MD, FEBO, Fabian Hoehn, MD, FEBO, Katrin Lorenz, MD, Lars-Olof Hattenbach, MD PURPOSE: To report the incidence of posterior vitreous detachment (PVD) after uneventful state- of-the-art small-incision phacoemulsification with implantation of a posterior chamber intraocular lens (PC IOL). SETTING: Department of Ophthalmology, Ludwigshafen Hospital, Ludwigshafen, Germany. METHODS: This prospective study evaluated the vitreous status of eyes by biomicroscopic exam- ination, indirect binocular ophthalmoscopy, and B-scan ultrasonography before planned cataract surgery. Patients with the posterior vitreous attached were included for follow-up and examined 1 week, 1 month, and 1 year after uneventful phacoemulsification with PC IOL implantation. The preoperative prevalence and postoperative incidence of PVD were determined by ultrasonography. RESULTS: The study included 188 eyes of 188 patients (131 women, 57 men) with a mean age of 77.2 years. The mean spherical equivalent was À0.78 diopter (D) (range À8.75 to C6.25 D) and the mean axial length (AL), 23.22 mm (range 20.50 to 26.04 mm). Preoperatively, 130 eyes (69.1%) had PVD and 58 eyes (30.9%) had no PVD. Postoperatively, 12 eyes (20.7%) developed PVD at 1 week, 18 eyes (31%) at 1 month, and 4 eyes (6.9%) at 1 year. The vitreous body remained at- tached to the retina in 24 eyes (41.4%) 1 year after surgery. No preoperatively measured parameter (eg, age, refraction, AL, effective phacoemulsification time) was predictive of the occurrence of PVD after cataract surgery. CONCLUSION: The occurrence of PVD after modern cataract surgery was frequent in cases in which the posterior hyaloid was attached to the retinal surface preoperatively.
    [Show full text]
  • Florida Board of Medicine and Florida Board Of
    FLORIDA BOARD OF MEDICINE AND FLORIDA BOARD OF OSTEOPATHIC MEDICINE APPROVED INFORMED CONSENT FORM FOR CATARACT OPERATION WITH OR WITHOUT IMPLANTATION OF INTRAOCULAR LENS DOES THE PATIENT NEED OR WANT A TRANSLATOR, INTERPRETOR OR READER? YES _____ NO_____ TO THE PATIENT: You have the right, as a patient, to be informed about your cataract condition and the recommended surgical procedure to be used, so that you may make the decision whether or not to undergo the cataract surgery, after knowing the risks, possible complications, and alternatives involved. This disclosure is not meant to scare or alarm you; it is simply an effort to make you better informed so that you may give or withhold your consent to cataract surgery and should reflect the information provided by your eye surgeon. If you have any questions or do not understand the information, please discuss the procedure with your eye surgeon prior to signing. WHAT IS A CATARACT, AND HOW IS IT TREATED? The lens in the eye can become cloudy and hard, a condition known as a cataract. Cataracts can develop from normal aging, from an eye injury, various medical conditions or if you have taken certain medications such as steroids. Cataracts may cause blurred vision, dulled vision, sensitivity to light and glare, and/or ghost images. If the cataract changes vision so much that it interferes with your daily life, the cataract may need to be removed to try to improve your vision. Surgery is the only way to remove a cataract. You can decide to postpone surgery or not to have the cataract removed.
    [Show full text]
  • Cataract Surgery a Cataract Is Any Opacity Within the Lens of the Eye
    The Ohio State University Veterinary Medical Center Cataract Surgery A cataract is any opacity within the lens of the eye. The lens sits within the eye and helps to focus images onto the retina. Cataracts can be caused by genetics, diabetes, aging, and other diseases of the eye, such as retinal disease or inflammation. If cataracts are severe enough, visual deficits can be noted at home or in unfamiliar environments (e.g. bumping into things, missing treats or stairs). Diagrammatic cross section of the eye What do I need to do for my pet prior to cataract surgery? In order to ensure the best chance of vision after cataract surgery, the health of both eyes and the animal are evaluated. Vitreous This includes: Health of the Eye Lens Retina • Complete ophthalmic exam by an ophthalmologist, including Cornea tests to evaluate tear production and intraocular pressure • Electroretinogram (ERG) – this is an electrical test used to evaluate the health of the retina behind the lens, usually performed without general anesthesia • Ultrasound of the eye to evaluate the structural integrity of the lens, retina and fluid behind the lens (the vitreous) Health of the Animal • Physical exam, including listening to the heart and lungs • Basic blood and urine tests to evaluate the overall health of the animal Diabetic animals should receive additional diagnostics • Fructosamine and/or glucose curve should be performed by your referring veterinarian to evaluate for adequate diabetic Mature cataract in a dog with diabetes mellitus. control (occasional spot-checks at home are not adequate prior to surgery) • Urine culture collected sterilely directly from the bladder, to ensure there is no active urinary tract infection present These evaluations should be performed within one month of the planned surgery to ensure we have the most up-to-date picture of your pet’s health.
    [Show full text]
  • Tips and Techniques for Cataract Surgery in Glaucoma Patients
    Tips and Techniques for Cataract Surgery in Glaucoma Patients Joey Yen-Cheng Hsia, MD Assistant Professor of Ophthalmology Glaucoma Service University of California, San Francisco No Financial Disclosures Introduction • Visually significant cataract often co-exist with glaucoma in the elderly population. • Glaucoma incisional surgery can lead to accelerated cataract formation. • Glaucoma patients are at risk for perioperative complications • Set realistic expectation preoperatively Preoperative Evaluation – Is the cataract or glaucoma causing the decreased vision? – PAP or PAM – Set realistic expectation – Is the IOP at target? – Role of combined surgery? – No. of medications – Anticoagulation – ⍺-1 blocker – Prior incisional surgeries Examination – angle grading, trab ostium - Prior incisional surgery - endothelial dysfunction – shallowing – dilation, prior LPI, iridectomy – PXE, phacodynesis – cupping, pallor, retinal pathology Postoperative IOP Spike • Note the of glaucoma – Foveal involving scotoma – At risk for progression with IOP spike : – Advanced glaucoma, IFIS, No. of gtts, long AXL, PXE • IOP spike occurs after surgery – Same day check up for high risk patients History of Trabeculectomy – Modify incisions accordingly – Avoid suction / fixation ring – High function bleb may lead to chemosis / chamber instability – Age<50, Preop IOP > 10, iris manipulation, postop IOP spike, and short interval time between trabeculectomy and cataract – Longer steroid +/- anti- metabolite Grover-Fellman spatula; Epislon History of Tube Shunt –
    [Show full text]
  • History of Cataract Surgery
    History of Cataract Surgery A cataract is a clouding of the normally clear lens of the eye and can be addressed through a procedure that removes the affected lens and replaces it with a manmade lens known as an intraocular lens or IOL.1 Associated with improvements in vision, overall health, and cognitive and emotional well-being,2 cataract surgery is a safe and effective procedure1 and is the most commonly performed surgery in the world.3 One of the oldest surgical procedures known, cataract surgery was first documented in the fifth century BC.4 1747 French ophthalmologist Jacques Daviel is credited 1998 Toric IOLs are rolled out to correct astigmatism. Toric with the first Extracapsular Cataract Extraction, a IOLs have different powers in different meridians of the technique that uses a small incision to remove the lens and lens to correct the asymmetric power of the eye that is minimize the wound.5,6 characteristic of astigmatism.10 1753 London surgeon Samuel Sharp performs the first 2004 Aspheric IOLs, which closely match the shape and optical Intracapsular Cataract Extraction, a technique that quality of the eye’s natural lens, are introduced for sharper uses a large incision to remove the entire natural vision — especially in low light conditions and when the lens and capsule.7 pupil is dilated.11 1949 Intraocular lenses, manmade lenses made of 2010 Femtosecond laser is cleared by the FDA for cataract polymethylmethacrylate, are introduced by Sir Harold surgery.12 The femtosecond laser replaces or supports Ridley in London.8 Previously,
    [Show full text]
  • Cataract Surgery and Retinal Detachment: Cause and Effect? Br J Ophthalmol: First Published As 10.1136/Bjo.80.8.683 on 1 August 1996
    British Journal of Ophthalmology 1996;80:683-684 683 Cataract surgery and retinal detachment: cause and effect? Br J Ophthalmol: first published as 10.1136/bjo.80.8.683 on 1 August 1996. Downloaded from Retinal detachment following cataract surgery is a serious Measures of effect, such as relative risk, provide some and potentially sight threatening event that will often assessment of the magnitude of an association between an necessitate further surgical intervention. Because of the exposure (cataract surgery) and the condition (retinal temporal sequence of events, any retinal detachment detachment), indicating the likelihood of developing the following cataract surgery is often assumed to be causally condition in the exposed group relative to those who are related to the cataract extraction. The evidence for this not exposed. The identification of a control group by Nor- relation has been based on the observed frequency of such regaard and colleagues permits this kind of assessment of events following cataract surgery, particularly the excess the risk of retinal detachment associated with cataract sur- frequency observed after intracapsular cataract extraction gery. Taking the standardised incidence ratios that are pre- (ICCE) compared with extracapsular cataract extraction sented in this study (as estimates of relative risk), it would (ECCE). All these observations relate to surgical practice appear that the risk 4 years after surgery, for the ECCE and at least a decade ago and are characterised by the absence IOL group, is over 4.4 times that of the control group. of a control group of patients who did not have cataract The relative risk indicates the strength of an aetiological surgery and their experience of retinal detachment for (or causal) association between cataract surgery and retinal comparison.
    [Show full text]
  • Cataract Surgery Will Improve Your Vision
    What is a Cataract? We all have a natural lens inside of our eyes. This lens helps to focus our vision. As our eyes age or other diseases affect the eyes, the natural lens becomes cloudy and disturbs good vision. This is called a cataract. The Initial Cataract Evaluation An initial evaluation is performed to determine if you have a cataract, and whether it can be safely removed. A full eye exam is performed during this visit, which involves dilating the eyes. Furthermore, we determine if cataract surgery will improve your vision. With cuts to Medicare and health insurance, we are now only allowed to perform the most basic diagnostic testing during this evaluation. In the past, we were able to perform these advanced preoperative tests during the initial cataract evaluation. The Preoperative Refractive Evaluation (PRE) After your initial evaluation, a PRE is scheduled on a separate day sometime shortly before your Cataract Surgery. During this evaluation, your eyes are typically not dilated and we perform a multitude of advanced diagnostic tests. The results of these tests are vital to the success of your cataract surgery. To schedule cataract surgery with Dr. McGarity, this evaluation is highly recommended. Cataract Surgery At our vision correction center, Dr. McGarity performs surgery using phacoemulsification. Using ultrasound technology, phacoemulsification gently dissolves and aspirates the cataract from the eye. Then a biocompatible, customized, prescription lens, known as an intraocular lens (IOL), is permanently inserted in your eye. The PRE is essential in providing the most accurate measurements to select the best IOL prescription for your eye.
    [Show full text]