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Lee P. Challenging Considerations Regarding Waste and Potential Environmental Effects in Cataract Surgery. JAMA Ophthalmol 2019; 137:1163-1164. [PMID: 31369050 DOI: 10.1001/jamaophthalmol.2019.2936] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Paul Lee
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor
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An objective scatter index cutoff point as a powerful objective criterion for preoperative nuclear cataract decision-making based on ROC analysis. J Cataract Refract Surg 2019; 45:1452-1457. [DOI: 10.1016/j.jcrs.2019.05.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 04/16/2019] [Accepted: 05/26/2019] [Indexed: 11/20/2022]
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Kahook MY, Serle JB, Mah FS, Kim T, Raizman MB, Heah T, Ramirez-Davis N, Kopczynski CC, Usner DW, Novack GD. Long-term Safety and Ocular Hypotensive Efficacy Evaluation of Netarsudil Ophthalmic Solution: Rho Kinase Elevated IOP Treatment Trial (ROCKET-2). Am J Ophthalmol 2019; 200:130-137. [PMID: 30653957 DOI: 10.1016/j.ajo.2019.01.003] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 01/03/2019] [Accepted: 01/05/2019] [Indexed: 12/21/2022]
Abstract
PURPOSE To evaluate netarsudil 0.02% ophthalmic solution in patients with open-angle glaucoma (OAG) and ocular hypertension (OHT). DESIGN Double-masked, randomized, multicenter, parallel-group, noninferiority clinical study. METHODS After a washout of all prestudy ocular hypotensive medications, 756 eligible patients with elevated IOP were randomized to receive netarsudil 0.02% once a day (q.d.) (251); netarsudil 0.02% twice a day (b.i.d.) (254); or timolol 0.5% b.i.d. (251) for 12 months, as well as a noninterventional Corneal Observation Study (COS) for patients manifesting cornea verticillata. RESULTS On treatment, mean IOP at 8:00 AM decreased from a baseline IOP of 22.5-22.6 mm Hg to 17.9-18.8 mm Hg, 17.2-18.0 mm Hg, and 17.5-17.9 mm Hg for netarsudil q.d., netarsudil b.i.d., and timolol, respectively, over 12 months. The most frequently reported adverse events (AEs) were ocular, with the most frequent ocular AE being conjunctival hyperemia, with an incidence of 61%, 66%, and 14%, respectively. The next most frequent AEs were corneal deposits (corneal verticillata), with an incidence of 26%, 25%, and 1%, respectively, and conjunctival hemorrhage (typically petechial), with an incidence of 20%, 19%, and 1%, respectively. All 3 AEs were generally scored as mild, with conjunctival hyperemia and/or hemorrhage appearing sporadically during the study. In the observational follow-up component of this study, there was no clinically meaningful impact of corneal verticillata on visual function in affected patients. CONCLUSIONS In this randomized, double-masked trial, once-daily dosing of netarsudil 0.02% was effective, consistently lowering IOP through 12 months, and was tolerated by the majority of patients.
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Affiliation(s)
- Malik Y Kahook
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Janet B Serle
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Terry Kim
- Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Theresa Heah
- Aerie Pharmaceuticals, Inc, Bedminster, New Jersey, USA; Durham, North Carolina, USA
| | - Nancy Ramirez-Davis
- Aerie Pharmaceuticals, Inc, Bedminster, New Jersey, USA; Durham, North Carolina, USA
| | - Casey C Kopczynski
- Aerie Pharmaceuticals, Inc, Bedminster, New Jersey, USA; Durham, North Carolina, USA
| | | | - Gary D Novack
- PharmaLogic Development, Inc, San Rafael, California, USA; Department of Ophthalmology, University of California Davis School of Medicine, Sacramento, California, USA.
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Constantinou M, Jhanji V, Jing X, Lamoureux EL, Boffa U, Taylor HR, Vajpayee RB. A randomized, single-center study of equivalence of 2 intraocular lenses used in cataract surgery. Ophthalmology 2012. [PMID: 23207175 DOI: 10.1016/j.ophtha.2012.08.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To compare the outcomes of 2 intraocular lenses (IOLs) for the treatment of age-related cataracts. DESIGN Prospective, randomized trial. PARTICIPANTS Patients with age-related cataracts were recruited and randomized to receive phacoemulsification and implantation of either the AcrySof SA60AT lens (Alcon, Inc, Fort Worth, TX) or the low-cost Tecsoft Flex lens (Fred Hollows Foundation, Tilganga, Nepal). A total of 300 patients were available for description and analysis (148 in the AcrySof group and 152 in the Tecsoft group). METHODS Patients underwent phacoemulsification and implantation of the AcrySof SA60AT lens or the Tecsoft Flex lens. They were followed up and examined at baseline, 1 week, 1 month, 6 months, and 12 months after cataract surgery. MAIN OUTCOME MEASURES Uncorrected distance visual acuity (UDVA), best-corrected distance visual acuity (BDVA), incidence of posterior capsule opacification (PCO), Visual Function Index questionnaire results, and safety of the implanted IOLs. RESULTS No significant difference (P>0.05) was found in UDVA and BDVA after surgery between the 2 groups. The equivalence test of the 95% confidence intervals showed that both lenses had an equal improvement of UDVA and BDVA as well as similar rates of PCO after cataract surgery. There was no significant difference between the 2 groups with regard to visual functioning or the incidence of adverse surgical events during (P>0.05) or after (P>0.05) the surgery. CONCLUSIONS The Tecsoft Flex IOL is a low-cost suitable alternative that is similar to the AcrySof IOL in terms of safety and visual outcomes.
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Affiliation(s)
- Marios Constantinou
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Victoria, Australia
| | - Vishal Jhanji
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Victoria, Australia; Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Xie Jing
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Victoria, Australia
| | - Ecosse L Lamoureux
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Victoria, Australia; Singapore Eye Research Institute, National University of Singapore, Singapore, Republic of Singapore
| | | | - Hugh R Taylor
- Melbourne School of Population Health, University of Melbourne, Melbourne, Australia
| | - Rasik B Vajpayee
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Victoria, Australia; Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
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Abstract
BACKGROUND Long-term evolution of congenital toxoplasmosis is not documented. We assessed the outcome of treated congenital toxoplasmosis in a cohort of adult individuals who had undergone ante- and postnatal treatment to provide information for pediatricians and parents on the evolution of the disease. METHODS We conducted a questionnaire study on 126 adults with congenital toxoplasmosis (mean age: 22.2 years; age range: 18-31 years) monitored regularly until the time of inclusion. The main outcome measures were quality of life (Psychological General Well-Being Index) and visual function (VF14 questionnaire), and the outcomes were correlated with disease-specific factors. RESULTS Of the 102 patients (80.9%) who were finally included in the study, 12 (11.8%) presented neurologic effects and 60 (58.8%) manifested ocular lesions; in the latter category, 13 individuals (12.7%) had reduced visual function. The overall global quality-of-life score (74.7 ± 14.2) was close to the expected normal range for the general population (73.7 ± 15.3). Overall, visual function was only slightly impaired (M = 97.3; 95% confidence interval, 95.8-98.8). Although disease-independent critical life circumstances were associated with a reduced Psychological General Well-Being Index, this index was not influenced by any of the clinical characteristics of congenital toxoplasmosis. Neurologic pathologies, reduced visual acuity, foveal location of the retinal lesion, and squinting contributed to decreased visual function at follow-up. CONCLUSIONS Our data reveal that treated congenital toxoplasmosis has little effect on the quality of life and visual function of the affected individuals. These encouraging findings may help to alleviate the anxiety of affected individuals and their parents.
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An objective scatter index based on double-pass retinal images of a point source to classify cataracts. PLoS One 2011; 6:e16823. [PMID: 21326868 PMCID: PMC3033912 DOI: 10.1371/journal.pone.0016823] [Citation(s) in RCA: 154] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Accepted: 01/11/2011] [Indexed: 11/19/2022] Open
Abstract
Purpose To propose a new objective scatter index (OSI) based in the analysis of double-pass images of a point source to rank and classify cataract patients. This classification scheme is compared with a current subjective system. Methods We selected a population including a group of normal young eyes as control and patients diagnosed with cataract (grades NO2, NO3 and NO4) according to the Lens Opacities Classification System (LOCS III). For each eye, we recorded double-pass retinal images of a point source. In each patient, we determined an objective scatter index (OSI) as the ratio of the intensity at an eccentric location in the image and the central part. This index provides information on the relevant forward scatter affecting vision. Since the double-pass retinal images are affected by both ocular aberrations and intraocular scattering, an analysis was performed to show the ranges of contributions of aberrations to the OSI. Results We used the OSI values to classify each eye according to the degree of scatter. The young normal eyes of the control group had OSI values below 1, while the OSI for subjects in LOCS grade II were around 1 to 2. The use of the objective index showed some of the weakness of subjective classification schemes. In particular, several subjects initially classified independently as grade NO2 or NO3 had similar OSI values, and in some cases even higher than subjects classified as grade NO4. A new classification scheme based in OSI is proposed. Conclusions We introduced an objective index based in the analysis of double-pass retinal images to classify cataract patients. The method is robust and fully based in objective measurements; i.e., not depending on subjective decisions. This procedure could be used in combination with standard current methods to improve cataract patient surgery scheduling.
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Sommer A, Abbott RL, Lum F, Hoskins HD. PPPs--twenty years and counting. Ophthalmology 2008; 115:2125-6. [PMID: 19041472 DOI: 10.1016/j.ophtha.2008.09.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2008] [Accepted: 09/17/2008] [Indexed: 11/27/2022] Open
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Lebensqualität – methodologische und klinisch-praktische Aspekte mit einem Fokus auf die Augenheilkunde. Ophthalmologe 2008; 105:727-34. [DOI: 10.1007/s00347-008-1805-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Aslam TM, Haider D, Murray IJ. Principles of disability glare measurement: an ophthalmological perspective. ACTA ACUST UNITED AC 2007; 85:354-60. [PMID: 17313443 DOI: 10.1111/j.1600-0420.2006.00860.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Disability glare describes the loss of retinal image contrast as a result of intraocular light scatter, or straylight. It has increasingly important modern implications such as with cataract and refractive surgery or high-intensity lighting. However, its measurement has proven difficult despite many varying approaches. This article aims to explain the principles and problems associated with glare testing that are important for assessment and use of glare measures. After defining disability glare, this article discusses the importance of its measurement to current clinical practice. It explains the principles and mechanisms that underlie disability glare and its measurement. Finally, some examples of available glare tests are described to illustrate the principles discussed.
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Vianya-Estopà M, Douthwaite WA, Noble BA, Elliott DB. Capabilities of potential vision test measurements. J Cataract Refract Surg 2006; 32:1151-60. [PMID: 16857502 DOI: 10.1016/j.jcrs.2006.01.111] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2005] [Accepted: 01/29/2006] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine the usefulness of a battery of potential vision tests (PVTs) including potential acuity meter (PAM), laser interferometer (LI), critical flicker/fusion frequency (CFF), superilluminated pinhole at distance (SPH(d)) and near (SPH(n)), and optimal reading speed (ORS) by their independence of the effects of cataracts and sensitivity to macular disease (MD). SETTING Department of Optometry, University of Bradford, Bradford and Leeds General Infirmary, Leeds, United Kingdom. METHODS Potential vision test measurements were determined in 76 patients with age-related cataract and no other eye disease, 52 patients with MD and clear ocular media, and 28 patients with normal, healthy eyes. RESULTS Potential vision tests were independent of the degrading effects of cataract up to a visual acuity (VA) level of 20/200 or worse (CFF), 20/125 (ORS and SPH), and 20/40 (PAM and LI). A high degree of association was found between PVT scores and distance VA in the MD group for SPH(d) (r2 = 0.93), SPH(n) (r2 = 0.89), and PAM (r2 = 0.71). A moderate correlation was found for LI (r2 = 0.55), CFF (r2 = 0.50), and ORS (r2 = 0.45). CONCLUSIONS Potential acuity meter and LI showed very limited independence to moderate/dense cataracts and inaccurate predictions in patients with MD. Superilluminated pinhole was relatively unaffected by moderate/dense cataract and yet provided accurate predictions in the presence of MD and clear ocular media. Critical flicker/fusion frequency showed the greatest ability to bypass cataracts, although its ability to predict VA in patients with early MD was limited. The ORS was relatively unaffected by moderate/dense cataract, but its poor ability to predict VA in MD may limit its clinical suitability as a PVT.
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Affiliation(s)
- Marta Vianya-Estopà
- Department of Optometry, University of Bradford, Bradford, West Yorkshire, United Kingdom
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Chua BE, Mitchell P, Cumming RG. Effects of cataract type and location on visual function: the Blue Mountains Eye Study. Eye (Lond) 2004; 18:765-72. [PMID: 15044934 DOI: 10.1038/sj.eye.6701366] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To measure the effect of cataract type, severity and location on presenting, and best-corrected visual acuity, contrast sensitivity, and glare disability. METHODS In all, 3654 (82.4% participation rate) eligible noninstitutionalised residents aged 49 years or older, living in two postcode areas of the Blue Mountains, Australia, received detailed eye examinations including visual acuity, contrast sensitivity, and glare disability testing. Data from right eyes were analysed using multiple regression modelling. RESULTS The effect of age on visual acuity and contrast sensitivity only became evident in persons aged at least 60 years. Cataract severity was inversely related to visual acuity and contrast sensitivity. Late posterior subcapsular cataract caused the greatest reduction in visual acuity. Early grade cataract caused significant reduction in contrast sensitivity at intermediate and high spatial frequencies, but late grade cataract reduced contrast sensitivity across all spatial frequencies. There was insufficient study power to detect consistent significant effect of cataract on glare disability tests or cortical cataract location on visual function. CONCLUSIONS Age at least 60 years, cataract type, and cataract severity were principal determinants of visual acuity and contrast sensitivity in this study. Axial and superotemporally located cortical cataract had the greatest effect on visual function tests.
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Affiliation(s)
- B E Chua
- Department of Public Health and Community Medicine, The University of Sydney, Australia
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Stifter E, Sacu S, Weghaupt H, König F, Richter-Müksch S, Thaler A, Velikay-Parel M, Radner W. Reading performance depending on the type of cataract and its predictability on the visual outcome. J Cataract Refract Surg 2004; 30:1259-67. [PMID: 15177601 DOI: 10.1016/j.jcrs.2003.11.051] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2003] [Indexed: 10/26/2022]
Abstract
PURPOSE To investigate the influence of various types of cataract on reading performance in a standardized reading test setting. SETTING Department of Ophthalmology, University of Vienna, Vienna, Austria. METHODS The reading performance of 94 eyes with age-related cataract and normal macular function was evaluated with the Radner Reading Charts preoperatively and 4 weeks after cataract surgery. Distance visual acuity was tested with the ETDRS charts. Cataracts were graded using the Lens Opacities Classification System (LOCS) III, on which NO is nuclear opalescence and NC is nuclear color. RESULTS Patients with pure nuclear cataracts (LOCS III: NO/NC 2.1-5) achieved a normally high MRS (99.84% +/- 7.65% of their postoperative MRS): preoperative MRS(1): 190.6 +/- 30.74 words per minute (wpm); postoperative MRS(2): 191.21 +/- 29.36 wpm. Patients with mixed nuclear-cortical cataracts (LOCS III: NO/NC 2.1-5; C>2) preoperatively achieved 96.96% +/- 5.6% of their postoperative MRS (MRS(1): 175.77 +/- 31.54 wpm; MRS(2): 181.34 +/- 30.56 wpm). In dense nuclear cataracts (LOCS III: NO/NC>5), the MRS was significantly reduced, achieving only 72.64 +/- 19.19% of the postoperative MRS (MRS(1): 133.06 +/- 39.43 wpm; MRS(2): 185.76 +/- 40.18 wpm). In posterior subcapsular cataracts, the preoperative MRS (134.1 +/- 33.72 wpm) was significantly lower than postoperatively (191.14 +/- 27.08 wpm). CONCLUSIONS In contrast to dense nuclear cataracts and posterior subcapsular cataracts, the preoperative reading speed of patients with pure nuclear or nuclear-cortical cataracts was normal at large print sizes. The preoperative evaluation of reading acuity and speed with standardized reading tests can therefore be used to estimate the postoperative reading performance in the latter 2 types of cataract.
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Affiliation(s)
- Eva Stifter
- Departments of Ophthalmology and Optometry, University of Vienna, Vienna, Austria
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Abstract
Goals of the quality-of-care initiative are to improve the structure, process, and outcome of health care. The effectiveness of methods to improve quality have been largely unverified. Most methods are costly to implement and time-consuming to perform; some threaten professional autonomy. The characteristic feature of modern medicine that fuels the debate over quality is the variation in the delivery of health care. This review examines the "variation phenomenon" in medicine and the roles that practice guidelines and physician profiling have in improving health care, in general, and for adult cataract, in particular.
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Affiliation(s)
- Curtis E Margo
- Department of Ophthalmology, Watson Clinic, LLP, Lakeland, Florida 33805, USA
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Abstract
PURPOSE To determine the ability of the potential acuity meter (PAM) to predict potential visual acuity through lenticular opacities in a group of cataract patients without significant other ocular pathology. METHODS This prospective study undertook PAM measurements on each eye of 84 subjects during preoperative hospital visits to either A Scan or Primary Care clinics. PAM results were compared to best corrected visual acuity findings obtained at least 6 weeks post-cataract extraction. RESULTS Comparison of PAM result to visual outcome showed poor correlation (rho = 0.41, P = 0.0005). Using predictive estimates, 49% of subjects' PAM results underestimated visual outcome as determined by a difference of greater than 2 Snellen acuity lines in these results. Factors such as preoperative vision level, cataract type and pupil dilation did not significantly influence the predictive power of the PAM. Preoperative pinhole results were also correlated with visual outcome (rho = 0.42, P = 0.0006). Vison in the fellow eye of subjects with 6/9 or better was correlated to the PAM result indicating a moderate to good predictive power in 'normal' eyes. CONCLUSIONS PAM results were considered to be poor for a clinical test. The results of this study indicate that this instrument has only a limited usefulness as part of the standard preoperatve examination in patients undergoing cataract extraction.
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Affiliation(s)
- C J Devereux
- School of Orthoptics, La Trobe University, Bundoora, Victoria, Australia.
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Frost NA, Sparrow JM. Use of vision tests in clinical decision making about cataract surgery: results of a national survey. Br J Ophthalmol 2000; 84:432-4. [PMID: 10729305 PMCID: PMC1723432 DOI: 10.1136/bjo.84.4.432] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIM To provide information on the use of vision tests in clinical decision making about cataract surgery in the UK. METHOD A questionnaire survey was mailed to 703 consultant ophthalmologists. RESULTS A response rate of 70% was obtained. Monocular distance visual acuity was the only visual function that was tested routinely by all surgeons. Supplementary use of contrast sensitivity and glare testing was low. Many surgeons (35%) were willing to consider surgery at acuity levels better than 6/9 and a small but substantial number (12%) indicated that they did not use an acuity criterion. Being prepared to consider surgery at relatively good levels of acuity was not associated with more common use of other tests of vision. CONCLUSION Many UK surgeons are prepared to consider cataract extraction at relatively good levels of visual acuity and use other vision tests infrequently.
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Affiliation(s)
- N A Frost
- Department of Ophthalmology, University of Bristol, UK
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Sommer A. Health, medicine, and ophthalmology: facing the facts and paying the piper LVI Edward Jackson Memorial Lecture. Am J Ophthalmol 1999; 128:673-9. [PMID: 10612501 DOI: 10.1016/s0002-9394(99)00312-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To describe the sources of tension within the health care system and methods for pursuing their solution. METHODS Presentation of observations pertinent to patient, provider, and payer perspectives relevant to the cost, delivery, and quality of care and their impact on health. RESULTS Societal forces, not just wealth, are major determinants of both health and the costs of health care. CONCLUSIONS Tensions created by rising health care costs in the face of finite societal resources will increase in the years ahead. These can be resolved only by realizing new efficiencies in care, and prioritizing, through an explicit process, the care that is to be provided.
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Affiliation(s)
- A Sommer
- School of Hygiene and Public Health, Johns Hopkins University, Baltimore, Maryland 21205-2179, USA.
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Kogure S, Iijima H, Tsukahara S. Assessment of potential macular function using a color saturation discrimination test in eyes with cataract. J Cataract Refract Surg 1999; 25:569-74. [PMID: 10198866 DOI: 10.1016/s0886-3350(99)80058-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To study the efficacy of a color saturation discrimination test (CSDT) in assessing potential macular function in eyes with cataract. SETTING Yamanashi Medical University and Nirasaki City Hospital, Yamanashi, Japan. METHODS In this prospective study of 200 consecutive eyes with cataract, the thresholds of color saturation discrimination on 6 hues were measured with the CSDT. The CSDT program was run on a personal computer and cathode-ray tube color monitor. The preoperative CSDT scores and postoperative visual acuities were compared. In addition, preoperative laser interferometry (LI) and postoperative CSDT were performed on selected patients and the results compared with their preoperative CSDT results. RESULTS Patients who had a CSDT score of 11 or more had a significantly lower postoperative visual acuity (P < .0001). The prevalence of neuroretinal abnormality postoperatively increased with the preoperative CSDT score. The CSDT score was not correlated with preoperative visual acuity (P = 1409). Cataract severity had little influence on the CSDT score. The preoperative results of the CSDT and Ll were correlated with the postoperative acuity, with the correlation coefficient being stronger with the CSDT (r = -0.338 and 0.276 for CSDT and Ll, respectively). CONCLUSION The CSDT was effective in evaluating neuroretinal pathology and predicting postoperative acuity.
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Affiliation(s)
- S Kogure
- Department of Ophthalmology, Yamanashi Medical University, Japan
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Superstein R, Boyaner D, Overbury O. Functional complaints, visual acuity, spatial contrast sensitivity, and glare disability in preoperative and postoperative cataract patients. J Cataract Refract Surg 1999; 25:575-81. [PMID: 10198867 DOI: 10.1016/s0886-3350(99)80059-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To quantify cataract patients' functional visual complaints and correlate them with their objective glare disability and spatial contrast sensitivity (SCS) scores. SETTING Sir Mortimer B. Davis Jewish General Hospital. Montreal, Quebec, Canada. METHODS Thirty patients scheduled for cataract surgery with a visual acuity of 20/70 or better at the time of patient selection and no other ocular pathology were evaluated objectively and subjectively for visual function preoperatively and within 3 months postoperatively. Objective measures of SCS and visual acuity in the presence and absence of glare were obtained with the Optec 3000 vision tester. Subjective visual function was evaluated with the Activities of Daily Vision Scale (ADVS), a questionnaire that evaluates patients' visual function by assessing the degree of difficulty they experience in performing tasks involving distance vision, near vision, and glare conditions. RESULTS Preoperatively, patients had decreased visual acuity and SCS in the presence of glare. The ADVS scores were correlated with visual performance. Postoperatively, there was a statistically significant improvement in all dependent measures (i.e., visual acuity and SCS in the presence of glare) as well as in the subjective report of visual performance assessed by the ADVS. CONCLUSION Spatial contrast sensitivity, glare disability, and the ADVS questionnaire should be considered as adjuncts to visual acuity testing in evaluating certain cataract patients.
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Affiliation(s)
- R Superstein
- Department of Ophthalmology, Sir Mortimer B. Davis Jewish General Hospital, McGill University, Montreal, Quebec, Canada
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Espallargues M, Alonso J. Effectiveness of cataract surgery in Barcelona, Spain site results of an international study. Barcelona I-PORT investigators. International Patient Outcomes Research Team. J Clin Epidemiol 1998; 51:843-52. [PMID: 9762877 DOI: 10.1016/s0895-4356(98)00067-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To describe the impact of cataract surgery on visual function and health status in terms of clinical indicators as well as perceived health and functional capacity, and to identify patient characteristics and differences in clinical management that might affect outcomes. SUBJECTS AND METHODS Observational longitudinal study of a cohort of 218 patients aged 50 or older undergoing first eye cataract surgery. Patients were evaluated pre- and postoperatively by clinical examinations (visual acuity [VA], ocular and medical comorbidity) and standardized telephone interviews. Main outcome measures included: the VF-14 Visual Function Index, the Cataract Symptom Score (CSS), the Sickness Impact Profile (SIP), and global measures of patients' trouble and satisfaction with vision. RESULTS Significant improvement in all outcomes measures were observed at 4 months postoperatively (P < 0.001). However, the proportion of improved patients varied according to the outcome considered: VA (87%), CSS (72%), VF-14 (62%), and SIP (38%). Patient characteristics associated with higher a level of improvement were: worse preoperative visual function (VA, CSS, VF-14) (P < 0.001), less ocular comorbidity (P < 0.05), less postoperative complications (P < 0.05) and better preoperative general health status (SIP) (P < 0.01). The differences in clinical management were not associated with the outcomes (effectiveness) of surgery. CONCLUSIONS A large proportion of patients benefit from cataract surgery, the greatest gain corresponding to visual function rather than to general health status. Since effectiveness of surgery is unrelated to operative procedures, less costly practices (i.e., day case surgery and loco-regional anesthesia) should be promoted.
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Affiliation(s)
- M Espallargues
- Health Services Research Unit, Institut Municipal d'Investigació Mèdica, Barcelona, Spain
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Espallargues M, Castells X, Castilla M, Alonso J. Evaluación de la práctica clínica en cirugía de cataratas: resultados de una encuesta a oftalmólogos de la provincia de Barcelona. GACETA SANITARIA 1998. [DOI: 10.1016/s0213-9111(98)76449-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Superstein R, Boyaner D, Overbury O, Collin C. Glare disability and contrast sensitivity before and after cataract surgery. J Cataract Refract Surg 1997; 23:248-53. [PMID: 9113577 DOI: 10.1016/s0886-3350(97)80349-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE To determine whether brightness-induced glare decreases spatial contrast sensitivity and visual acuity in preoperative cataract patients with functional visual complaints and to compare preoperative with postoperative results. SETTING Sir Mortimer B. Davis Jewish General Hospital, Montreal, Quebec, Canada. METHODS Twenty patients with a visual acuity of 20/70 or better at the time of chart selection and no other ocular pathology who were referred for cataract surgery were evaluated with the Optec 3000 vision tester to assess contrast sensitivity and visual acuity in the presence and absence of glare. Testing was done preoperatively and 1 and 3 months postoperatively. RESULTS An analysis of variance indicated that there were statistically significant double interactions between the preoperative/postoperative and glare/no-glare variables and between the preoperative/postoperative and spatial frequency variables. Postoperatively, visual acuity and contrast sensitivity improved to within normal limits. There were no statistically significant differences in visual acuity and spatial contrast sensitivity between 1 and 3 months postoperatively. CONCLUSION Spatial contrast sensitivity and glare testing provided objective assessment of patients who had good visual acuity yet also had functional complaints.
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Affiliation(s)
- R Superstein
- Department of Ophthalmology, Sir Mortimer B. Davis Jewish General Hospital, McGill University, Quebec, Canada
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Bartamian M, Meyer DR. Site of service, anesthesia, and postoperative practice patterns for oculoplastic and orbital surgeries. Ophthalmology 1996; 103:1628-33. [PMID: 8874436 DOI: 10.1016/s0161-6420(96)30453-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
PURPOSE Variations in physician practice patterns, particularly with reference to cost-intensive resource utilization, are increasingly being scrutinized. However, little information is currently available regarding physician practice patterns for oculoplastic surgery. METHODS The authors surveyed members of the American Society of Ophthalmic Plastic and Reconstructive Surgery regarding their most common site of service, type of anesthesia, and first postoperative week of follow-up for 15 selected eyelid, lacrimal, and orbital procedures. RESULTS The majority of eyelid and lacrimal surgeries are currently performed on an out-patient basis (hospital out-patient, ambulatory surgery center, or office), typically using local anesthesia, with or without sedation. Regional differences were noted. Physicians in western states showed a greater tendency toward office-based surgery for procedures such as blepharoplasty and ptosis repair. Orbital procedures were performed more frequently as a hospital inpatient surgery, under general anesthesia. Patterns of follow-up within the first postoperative week varied considerably for most procedures. Compared with admitting practices in 1987, an obvious trend toward out-patient surgery was noted. CONCLUSION Variations in practice patterns will assume greater importance as the pressure for cost-containment increases. Total costs are affected by physician choices for site of service and type of anesthesia. This study allows surgeons who perform oculoplastic procedures to compare their practices with a national group specializing in such surgery. Further outcome-oriented studies are needed to develop practice guidelines for "preferred patterns" of care.
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Affiliation(s)
- M Bartamian
- Division of Oculoplastic and Orbital Surgery, Lions Eye Institute, Albany, NY 12208, USA
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Javitt JC, Steinberg EP, Sharkey P, Schein OD, Tielsch JM, Diener M, Legro M, Sommer A. Cataract surgery in one eye or both. A billion dollar per year issue. Ophthalmology 1995; 102:1583-92; discussion 1592-3. [PMID: 9098247 DOI: 10.1016/s0161-6420(95)30824-x] [Citation(s) in RCA: 85] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To measure the relative effect of cataract surgery in the second eye compared with the first eye on functional impairment, satisfaction, and vision problems. METHODS Seventy-five randomly selected ophthalmologists in three cities in the United States were enrolled in a National Study of Cataract Outcomes. They, in turn, referred eligible, sequential patients scheduled for first-eye cataract surgery. Interviews were conducted at enrollment, 4 months after first-eye surgery, and 12 months after first-eye surgery. An attempt was made to conduct a special, preoperative interview of those patients scheduled to undergo second-eye surgery before the 4-month interview. Each interview included administration of the VF-14 (a 14-item questionnaire that assessed visual function), as well as questions about symptoms possibly related to cataract, "trouble with vision," and satisfaction with vision. RESULTS Seven hundred seventy-two patients were enrolled in the study, and interview data to 12 months were obtained from 669 (86%) patients. Of these patients, 243 (36%) underwent cataract extraction in the second eye during the 12-month period of observation. Overall, subjects who underwent cataract surgery in both eyes during the 12-month period had 61% greater improvement in VF-14 score (P < 0.001), 27% more decline in trouble with vision (P < 0.001), and 24% greater improvement in satisfaction with vision (P < 0.001) compared with those who underwent surgery in only one eye. CONCLUSIONS Cataract surgery in the second eye of patients with bilateral cataract is associated with clinical and statistically significant improvement in functional impairment, trouble with vision, and satisfaction with vision.
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Affiliation(s)
- J C Javitt
- Worthen Center for Eye Care Research, Department of Ophthalmology, Georgetown University Medical Center, Washington, DC 20007, USA
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