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Cioana M, Gupta RB, Tam ES, Chiu HH, Gold I, Somani S. Comparison of pain perception in patients undergoing manual cataract surgery versus refractive laser-assisted cataract surgery. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024; 59:139-145. [PMID: 37068604 DOI: 10.1016/j.jcjo.2023.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 03/19/2023] [Accepted: 03/20/2023] [Indexed: 04/19/2023]
Abstract
OBJECTIVES To assess pain perception in patients undergoing manual cataract surgery versus femtosecond laser-assisted cataract surgery (FLACS) and pain perception of patients receiving anaesthesia at 2 different time points during the FLACS procedure. We also aimed to assess the factors affecting pain perception in these different study groups. DESIGN Prospective cohort comparison of patient-selected surgical approach. PARTICIPANTS Patients undergoing delayed sequential bilateral cataract surgery at an ambulatory surgical centre in Ontario. METHODS Patients were assigned to 3 groups: a manual cataract surgery cohort (n = 30) and 2 FLACS cohorts, those who received neurolept anaesthesia just prior to draping for phacoemulsification (FLACS standard cohort; n = 38) and those who received neurolept anaesthesia prior to the femtosecond laser part of the procedure (FLACS early cohort; n = 35). Outcome metrics included pain scores on the visual analogue scale on postoperative day 0 and at postoperative week 1. Secondary outcome measures included anxiety scores, surgeon or anaesthesiologist patient cooperation scores, ocular metrics, and perioperative systemic vitals. RESULTS There were no significant differences in pain perception on postoperative day 0 and at postoperative week 1 among the manual cataract surgery and FLACS standard cohorts (p = 0.94 and p = 0.72, respectively) or FLACS early and FLACS standard cohorts (p = 0.76 and p = 0.67, respectively). Patients had higher pain scores during second-eye procedures than first-eye procedures. CONCLUSIONS Cataract surgery technique or timing of anaesthesia for FLACS procedures does not affect pain perception postoperatively. Second-eye procedures are associated with higher pain scores than first-eye procedures.
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Affiliation(s)
- Milena Cioana
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON; Uptown Eye Specialists, Toronto, ON
| | - Rishi B Gupta
- Uptown Eye Specialists, Toronto, ON; Faculty of Medicine, University of Ottawa, Ottawa, ON
| | - Eric S Tam
- Uptown Eye Specialists, Toronto, ON; William Osler Health Systems, Brampton, ON
| | - Hannah H Chiu
- Uptown Eye Specialists, Toronto, ON; William Osler Health Systems, Brampton, ON
| | - Ileana Gold
- Uptown Eye Specialists, Toronto, ON; William Osler Health Systems, Brampton, ON
| | - Sohel Somani
- Uptown Eye Specialists, Toronto, ON; William Osler Health Systems, Brampton, ON; Department of Ophthalmology and Vision Science, University of Toronto, Toronto, ON.
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Singh A, Udayakumar B, Duraisamy Ravilla T, Ponnappan V, Krishnadas R, Satyavageeswaran P. Factors Affecting Follow-Up Adherence of Glaucoma Patients. Ophthalmic Epidemiol 2024; 31:37-45. [PMID: 37122138 DOI: 10.1080/09286586.2023.2199842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 04/01/2023] [Indexed: 05/02/2023]
Abstract
PURPOSE The objective of our study is to understand the factors associated with non-adherence to the physician's follow-up advice by persons with glaucoma. METHODS We use a four-year panel dataset containing demographic, clinical, and intervention details and doctor's advised follow-up date for a random sample of 2,622 glaucoma patients from an Indian tertiary eye care hospital. We model this unique "advised follow-up date" in multivariate logistic regressions to identify factors associated with patients' coming early or late as against on-time. An OLS regression also examines an association between delayed follow-up and declining visual acuity. RESULTS Demographic variables such as age, gender, distance to hospital, IOP, and visual acuity were not associated with delayed adherence to follow-up. Patients advised to review within 2 months (p < .001), paying patients (p < .001), and those habituated to routine follow-up (diabetes patients) (p < .01) are less likely to delay care-seeking. Patients are more likely to come on-time in visits immediately after clinical interventions relative to later ones (p < .001). Our second analysis reveals the presence of cataract and the very first post-surgery visit as factors influencing patients to come early. Our third analysis reveals that a higher proportion of delayed visits had resulted in worsening of vision in the glaucoma-affected eye. CONCLUSION Our results suggest that active counselling by doctors, especially for routine follow-up visits, can help in better follow-up adherence and prevention of glaucoma-related visual impairment.
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Affiliation(s)
- Ankit Singh
- Mays Business School, Texas A&M University, College Station, Texas, USA
| | - Balakrishnan Udayakumar
- Lions Aravind Institute of Community Ophthalmology, Aravind Eye Care System, Madurai, Tamil Nadu, India
| | | | - Vedha Ponnappan
- Indian Institute of Management Udaipur, Udaipur, Rajasthan, India
| | - Ramaswamy Krishnadas
- Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
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Parajuli S, Dhakhwa P, Adhikary R. Deferring Postoperative Follow‑Up Visits up to 4 Weeks After Uneventful Cataract Surgery in a Tertiary Level Eye Hospital: Protocol for a Prospective, Quantitative, Experimental Control Study. JMIR Res Protoc 2023; 12:e48616. [PMID: 37651180 PMCID: PMC10502588 DOI: 10.2196/48616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Routine examination after cataract surgery, including a refraction test 4 to 6 weeks after surgery, is mandatory in most hospitals. In recent years, there has been growing interest in exploring alternative approaches to postoperative follow-up in cataract surgery patients due to the increasing number of cataract surgeries being performed, the limited availability of health care resources, and the need to optimize the use of health care services. OBJECTIVE We aim to compare postoperative visual outcomes after a day 0 examination in patients with 2 follow‑ups, one on day 7 and other on day 30, and patients with a single ophthalmic follow‑up between days 25 to 30. METHODS A prospective, quantitative, experimental control study will be carried out in Reiyukai Eiko Masunaga Eye Hospital, located in Banepa, Kavrepalanchok, Nepal. All patients undergoing cataract surgery meeting the inclusion and exclusion criteria irrespective of the type of surgery (small-incision cataract surgery or phacoemulsification) will be included in the study. The patients will be randomly assigned to 1 of 2 groups. Patients in group 1 will be examined on day 1, day 7, and day 30, whereas patients in group 2 will be examined on day 1 and once between days 25 to 30. The minimum clinically important difference (MCID) in our study will be set according to the improvement in the Snellen visual acuity chart. RESULTS The study is expected to be completed within 6 to 8 months from the start of the project. Data analysis and report writing will be carried out in a 2-month period. Best-corrected visual acuity will be compared between the 2 groups to determine if the MCID is achieved. The cost-effectiveness of the new approach will also be analyzed. CONCLUSIONS We aim to conclude that we can safely defer the 1-week postoperative follow-up visit in patients undergoing uncomplicated cataract surgery and that, moreover, we can reduce the patient load at the hospital and decrease patient expenses by decreasing the frequency of hospital visits. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/48616.
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Lanza M, Koprowski R, Boccia R, Ruggiero A, De Rosa L, Tortori A, Wilczyński S, Melillo P, Sbordone S, Simonelli F. Classification Tree to Analyze Factors Connected with Post Operative Complications of Cataract Surgery in a Teaching Hospital. J Clin Med 2021; 10:jcm10225399. [PMID: 34830681 PMCID: PMC8625404 DOI: 10.3390/jcm10225399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 11/18/2021] [Accepted: 11/18/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Artificial intelligence (AI) is becoming ever more frequently applied in medicine and, consequently, also in ophthalmology to improve both the quality of work for physicians and the quality of care for patients. The aim of this study is to use AI, in particular classification tree, for the evaluation of both ocular and systemic features involved in the onset of complications due to cataract surgery in a teaching hospital. Methods: The charts of 1392 eyes of 1392 patients, with a mean age of 71.3 ± 8.2 years old, were reviewed to collect the ocular and systemic data before, during and after cataract surgery, including post-operative complications. All these data were processed by a classification tree algorithm, producing more than 260 million simulations, aiming to develop a predictive model. Results: Postoperative complications were observed in 168 patients. According to the AI analysis, the pre-operative characteristics involved in the insurgence of complications were: ocular comorbidities, lower visual acuity, higher astigmatism and intra-operative complications. Conclusions: Artificial intelligence application may be an interesting tool in the physician’s hands to develop customized algorithms that can, in advance, define the post-operative complication risk. This may help in improving both the quality and the outcomes of the surgery as well as in preventing patient dissatisfaction.
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Affiliation(s)
- Michele Lanza
- Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, 80100 Napoli, Italy; (R.B.); (A.R.); (L.D.R.); (A.T.); (P.M.); (S.S.); (F.S.)
- Correspondence: ; Tel.: +39-08-1566-6778
| | - Robert Koprowski
- Institute of Biomedical Engineering, Faculty of Science and Technology, University of Silesia in Katowice, Bedzińska 39, 41-200 Sosnowiec, Poland;
| | - Rosa Boccia
- Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, 80100 Napoli, Italy; (R.B.); (A.R.); (L.D.R.); (A.T.); (P.M.); (S.S.); (F.S.)
| | - Adriano Ruggiero
- Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, 80100 Napoli, Italy; (R.B.); (A.R.); (L.D.R.); (A.T.); (P.M.); (S.S.); (F.S.)
| | - Luigi De Rosa
- Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, 80100 Napoli, Italy; (R.B.); (A.R.); (L.D.R.); (A.T.); (P.M.); (S.S.); (F.S.)
| | - Antonia Tortori
- Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, 80100 Napoli, Italy; (R.B.); (A.R.); (L.D.R.); (A.T.); (P.M.); (S.S.); (F.S.)
| | - Sławomir Wilczyński
- Department of Basic Biomedical Science, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia, Będzińska Street 39, 41-200 Sosnowiec, Poland;
| | - Paolo Melillo
- Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, 80100 Napoli, Italy; (R.B.); (A.R.); (L.D.R.); (A.T.); (P.M.); (S.S.); (F.S.)
| | - Sandro Sbordone
- Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, 80100 Napoli, Italy; (R.B.); (A.R.); (L.D.R.); (A.T.); (P.M.); (S.S.); (F.S.)
| | - Francesca Simonelli
- Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, 80100 Napoli, Italy; (R.B.); (A.R.); (L.D.R.); (A.T.); (P.M.); (S.S.); (F.S.)
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Lanza M, Koprowski R, Boccia R, Ruggiero A, De Rosa L, Tortori A, Wilczyński S, Melillo P, Sbordone S, Simonelli F. Classification Tree to Analyze Factors Connected with Post Operative Complications of Cataract Surgery in a Teaching Hospital. J Clin Med 2021; 10:jcm10225399. [PMID: 34830681 DOI: 10.3390/jcm10225399.pmid:34830681;pmcid:pmc8625404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 11/18/2021] [Accepted: 11/18/2021] [Indexed: 05/22/2023] Open
Abstract
BACKGROUND Artificial intelligence (AI) is becoming ever more frequently applied in medicine and, consequently, also in ophthalmology to improve both the quality of work for physicians and the quality of care for patients. The aim of this study is to use AI, in particular classification tree, for the evaluation of both ocular and systemic features involved in the onset of complications due to cataract surgery in a teaching hospital. METHODS The charts of 1392 eyes of 1392 patients, with a mean age of 71.3 ± 8.2 years old, were reviewed to collect the ocular and systemic data before, during and after cataract surgery, including post-operative complications. All these data were processed by a classification tree algorithm, producing more than 260 million simulations, aiming to develop a predictive model. RESULTS Postoperative complications were observed in 168 patients. According to the AI analysis, the pre-operative characteristics involved in the insurgence of complications were: ocular comorbidities, lower visual acuity, higher astigmatism and intra-operative complications. CONCLUSIONS Artificial intelligence application may be an interesting tool in the physician's hands to develop customized algorithms that can, in advance, define the post-operative complication risk. This may help in improving both the quality and the outcomes of the surgery as well as in preventing patient dissatisfaction.
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Affiliation(s)
- Michele Lanza
- Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, 80100 Napoli, Italy
| | - Robert Koprowski
- Institute of Biomedical Engineering, Faculty of Science and Technology, University of Silesia in Katowice, Bedzińska 39, 41-200 Sosnowiec, Poland
| | - Rosa Boccia
- Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, 80100 Napoli, Italy
| | - Adriano Ruggiero
- Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, 80100 Napoli, Italy
| | - Luigi De Rosa
- Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, 80100 Napoli, Italy
| | - Antonia Tortori
- Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, 80100 Napoli, Italy
| | - Sławomir Wilczyński
- Department of Basic Biomedical Science, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia, Będzińska Street 39, 41-200 Sosnowiec, Poland
| | - Paolo Melillo
- Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, 80100 Napoli, Italy
| | - Sandro Sbordone
- Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, 80100 Napoli, Italy
| | - Francesca Simonelli
- Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, 80100 Napoli, Italy
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Ravindran RD, Gupta S, Haripriya A, Ravilla T, S AV, Subburaman GBB. Seven-year trends in cataract surgery indications and quality of outcomes at Aravind Eye Hospitals, India. Eye (Lond) 2021; 35:1895-1903. [PMID: 32913291 PMCID: PMC8225659 DOI: 10.1038/s41433-020-0954-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 04/27/2020] [Accepted: 04/30/2020] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To report trends in cataract surgery indications, visual acuity outcomes, complication rates and reoperation rates at ten Aravind Eye Hospitals in Tamil Nadu, India. METHODS In this retrospective database study we analyzed seven years of data of cataract surgeries at Aravind during January 1, 2012 to December 31, 2018. Our main outcome measures were preoperative and 1-month postoperative uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA); and rates of intraoperative complications and reoperations. We performed Cochran-Armitage trend tests. RESULTS In 1.86 million eyes that underwent cataract surgery, the percentage of eyes undergoing phacoemulsification (PE) showed an increasing trend (p < 0.0001), from 26.8% in 2012 to 33.5% in 2018. The percentage of eyes undergoing manual small incision cataract surgery (SICS) showed a decreasing trend (p < 0.0001), from 70.0% in 2012 to 65.1% in 2018. For SICS, the percentages of eyes with good postoperative UCVA and BCVA showed increasing trends (p < 0.0001 for each), and the percentages of eyes with poor postoperative UCVA and BCVA showed decreasing trends (p < 0.0001 for each). Results for PE surgeries were mixed. For both PE and SICS rates of intraoperative complications showed a declining trend (p < 0.0001 for each) and a slight increasing trend for reoperations (PE p < 0.02; SICS p < 0.0001). CONCLUSIONS During this seven-year period there were noticeable trends in cataract surgeries performed at Aravind in terms of the mix of surgical procedures, preoperative vision, and cataract surgical outcomes.
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Affiliation(s)
| | - Sachin Gupta
- SC Johnson College of Business, Cornell University, Ithaca, NY, USA
| | | | | | - Ashok Vardhan S
- Cataract Services, Sri Venkateswara Aravind Eye Hospital, Tirupati, India
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Kurian DE, Amritanand A, Mathew M, Keziah M, Rebekah G. Correlation between visual acuity at discharge and on final follow-up in patients undergoing manual small incision cataract surgery. Indian J Ophthalmol 2021; 69:586-589. [PMID: 33595480 PMCID: PMC7942089 DOI: 10.4103/ijo.ijo_986_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose The aim of this study was to determine the correlation between visual acuity on discharge and at final follow-up in patients undergoing manual small incision cataract surgery (MSICS) through outreach services of a tertiary care training center. Methods A prospective observational study was done to determine the correlation between visual acuity on postoperative day 1 and final follow-up (4-8 weeks) among various categories of surgeons and surgical complications in patients who underwent MSICS between January 2018 and March 2018. Proportions of patients benefitting from refractive correction were also analyzed. Results Of the 924 patients who underwent MSICS through outreach services during the study period 841 were eligible for the study. Follow-up rate at 4-8 weeks was 91%. Mean age was 61.6 (SD 9.2) years, 63% were females and 55% were operated by trainees. There was a positive correlation between visual acuity at day one and final follow-up with a Spearman's correlation coefficient of 0.375 and 0.403 for uncorrected (UCVA) and best corrected visual acuity (BCVA) respectively (P < 0.001). The correlation coefficient, while still positive, was lower for trainees (0.287), as compared to consultants (0.492). At least two lines of improvement in visual acuity on refractive correction were found in 77% of patients. Conclusion Visual acuity on the day of discharge may be a useful quality indicator of visual outcome for monitoring cataract surgical programs. However, a follow-up at 4-8 weeks is recommended for individual patient benefit and monitoring surgical quality especially in training hospitals.
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Affiliation(s)
- Deepthi E Kurian
- Department of Ophthalmology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Anika Amritanand
- Department of Ophthalmology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Monseena Mathew
- Department of Ophthalmology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Mable Keziah
- Department of Ophthalmology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Grace Rebekah
- Department of Ophthalmology, Christian Medical College, Vellore, Tamil Nadu, India
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Moustafa GA, Borkar DS, Eton EA, Koulisis N, Kloek CE. Healthcare disparities contribute to missed follow-up visits after cataract surgery in the USA: results from the perioperative care for intraocular lens study. BMJ Open 2021; 11:e038565. [PMID: 33737416 PMCID: PMC7978071 DOI: 10.1136/bmjopen-2020-038565] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To identify factors that contribute to missed cataract surgery follow-up visits, with an emphasis on socioeconomic and demographic factors. METHODS In this retrospective cohort study, patients who underwent cataract extraction by phacoemulsification at Massachusetts Eye and Ear between 1 January and 31 December 2014 were reviewed. Second eye cases, remote and international patients, patients with foreign insurance and combined cataract cases were excluded. RESULTS A total of 1931 cases were reviewed and 1089 cases, corresponding to 3267 scheduled postoperative visits, were included. Of these visits, 157 (4.8%) were missed. Three (0.3%) postoperative day 1, 40 (3.7%) postoperative week 1 and 114 (10.5%) postoperative month 1 visits were missed. Age<30 years (adjusted OR (aOR)=8.2, 95% CI 1.9 to 35.2) and ≥90 years (aOR=5.7, 95% CI 2.0 to 15.6) compared with patients aged 70-79 years, estimated travel time of >2 hours (aOR=3.2, 95% CI 1.4 to 7.4), smokers (aOR=2.7, 95% CI 1.6 to 4.8) and complications identified up to the postoperative visit (aOR=1.4, 95% CI 1.0 to 2.1) predicted a higher rate of missed visits. Ocular comorbidities (aOR=0.7, 95% CI 0.5 to 1.0) and previous visit best-corrected visual acuity (BCVA) of 20/50-20/80 (aOR=0.4, 95% CI 0.3 to 0.7) and 20/90-20/200 (aOR=0.4, 95% CI 0.2 to 0.9), compared with BCVA at the previous visit of 20/40 or better, predicted a lower rate of missed visits. Gender, race/ethnicity, language, education, income, insurance, alcohol use and season of the year were not associated with missed visits. CONCLUSIONS Medical factors and demographic characteristics, including patient age and distance from the hospital, are associated with missed follow-up visits in cataract surgery. Additional studies are needed to identify disparities in cataract postoperative care that are population-specific. This information can contribute to the implementation of policies and interventions for addressing them.
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Affiliation(s)
- Giannis A Moustafa
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Durga S Borkar
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
- Department of Ophthalmology, Duke University Eye Center, Durham, North Carolina, USA
| | - Emily A Eton
- W K Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Nicole Koulisis
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Carolyn E Kloek
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
- Department of Ophthalmology, University of Oklahoma College of Medicine, Dean McGee Eye Institute, Oklahoma City, Oklahoma, USA
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Ayub R, Tom LM, Venkatesh R, Srinivasan K. Outcomes and Reasons for Late Presentation of Lens Induced Glaucoma: A Prospective Study. Ophthalmol Glaucoma 2021; 4:504-511. [PMID: 33548550 DOI: 10.1016/j.ogla.2021.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 01/20/2021] [Accepted: 01/25/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To determine the clinical outcomes and causes of late presentation in lens induced glaucoma (LIG). DESIGN Prospective observational study. PARTICIPANTS One hundred sixty-five patients with LIG who underwent cataract surgery. METHODS Preoperative data collection included a questionnaire about reasons for late presentation, socioeconomic status, visual acuity, intraocular pressure (IOP), and the lens and angle status of the fellow eye. All patients underwent manual small-incision cataract surgery. Postoperative vision, IOP, the anterior segment, and the fundus were evaluated at days 1, 15, and 30. MAIN OUTCOME MEASURES Reasons for late presentation, status of the fellow eyes, and surgical outcomes, including visual acuity and IOP at the 1-month postoperative visit. RESULTS Mean age at presentation was 63.8 years, and the female-to-male ratio was 1.4:1. Of the entire cohort, 70.3% were phacolytic and 29.7% had phacomorphic glaucoma. The main causes for late presentation was nonfinancial (81.2%); of these, good vision in fellow eye and lack of escort to the hospital were the major reasons. Most fellow eyes were pseudophakic (72.1%). After surgery, 75.6% gained best-corrected visual acuity of 6/18 or more. Six percent experienced poor visual recovery (≤6/60) with optic atrophy as the major cause. Only 7.9% required further glaucoma management in the form of topical medications. Delayed presentation (>15 days) was associated with poor visual outcome. CONCLUSIONS Nonfinancial causes, including good vision in the fellow eye and lack of escort, were the major determinants of late presentation. Most patients were pseudophakic in the fellow eye. After cataract extraction, only a few LIG patients required further glaucoma management.
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Affiliation(s)
- Ruksana Ayub
- Department of Glaucoma, Aravind Eye Hospital, Pondicherry, India
| | - Lisa M Tom
- Department of Glaucoma, Bascom Palmer Eye Institute, University of Miami, Miami, Florida
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Hovanesian J, Epitropoulos A, Donnenfeld ED, Holladay JT. The Effect of Lifitegrast on Refractive Accuracy and Symptoms in Dry Eye Patients Undergoing Cataract Surgery. Clin Ophthalmol 2020; 14:2709-2716. [PMID: 32982163 PMCID: PMC7502384 DOI: 10.2147/opth.s264520] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 09/03/2020] [Indexed: 01/31/2023] Open
Abstract
Purpose To determine the effect of lifitegrast ophthalmic solution 5% on improving the tear film, biometry/keratometry, and refractive accuracy for dry eye patients scheduled for cataract surgery. Patients and Methods Multicenter, prospective, open-label study of 100 eyes of 100 patients undergoing cataract surgery who had a confirmed diagnosis of dry eye. Patients underwent biometry at baseline and again after a 28-day course of lifitegrast 5% BID. Primary outcome was an improvement in the accuracy of preoperative anterior corneal power measurements at predicting postoperative spherical equivalent (SE) pre- and post-lifitegrast treatment. Secondary outcomes included changes in dry eye symptoms and corneal staining. Results The accuracy of the biometry readings for the achieved refractive SE: within 0.25 D in 47% and 50% of eyes before and after the initial lifitegrast treatment, respectively; within 0.5 D in 71% and 79% of eyes before and after the initial lifitegrast treatment; and within 0.75 D in 81% and 91% of eyes before and after the initial lifitegrast treatment (p < 0.04). Conclusion Lifitegrast 5% significantly improved preoperative corneal surface measurement accuracy in patients with confirmed dry eye who were scheduled for cataract surgery. ![]()
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