Evidence on Importance of Follow-up Visits after Cataract Surgery

Bridging the gap in managing dry eye disease: a consensus report by the Taiwan society of cataract and refractive surgeons

BACKGROUND

An impaired ocular surface presents substantial challenges in terms of planning for cataract surgery. As a multifactorial ocular disorder, dry eye disease (DED) is common in the general population and prevalent in patients scheduled for lens replacement surgery. Cataract surgery can exacerbate DED and worsen several ocular parameters. Timely diagnosis and appropriate treatment of DED are vital to ensuring positive ophthalmic surgical outcomes. This consensus report of the Taiwan Society of Cataract and Refractive Surgeons (TSCRS) regarding the management of DED before, during, and after cataract surgery highlights the gaps between clinical guidelines and several aspects of DED, including diagnostic testing, diagnostic criteria, and clinical practice treatment.

METHODS

An expert panel of five specialists in the field of ophthalmology was recruited to develop consensus statements regarding the management of DED in both the general population and in patients undergoing cataract surgery in Taiwan. Two separate meetings of the five specialists, who were endorsed by the TSCRS, were convened for this purpose. A survey questionnaire consisting of binary or multiple-choice questions was developed through a consensus-driven formulation process. A percentage value was calculated for each statement, and a minimum of 60% agreement (equivalent to three out of five members) was required to achieve consensus. The second discussion meeting involved the presentation of the finalized consensus statements and concluded the consensus development process. Lastly, the finalized consensus statements were approved by all the experts, and the formulated recommendations for DED in the general population and prospective cataract surgery patients were accordingly presented.

RESULTS

The optimal algorithm for managing DED in the general population and in patients scheduled for cataract surgery was developed to address the unmet needs of this cohort in Taiwan.

CONCLUSION

This report provides recommendations for managing dry eye disease. It is essential to screen and confirm DED through endorsed questionnaires and tests and then diagnose it. Treatment and management of DED should follow a stepwise approach. Screening and diagnosing DED is also recommended before cataract surgery. After cataract surgery, relatively aggressive treatment strategies are recommended to manage DED effectively.

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

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.

Correlation between visual acuity at discharge and on final follow-up in patients undergoing manual small incision cataract surgery

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.

Predictors of patient compliance with follow-up visits after cataract surgery

PURPOSE

To identify patient characteristics associated with follow-up compliance and to draw implications for better cataract treatment services.

SETTING

Aravind Eye Hospital, Madurai, India.

DESIGN

Retrospective case study.

METHODS

The data of all cataract surgeries performed in 2015 were analyzed. After each surgery, patients were asked to return for follow-up after 1 month. The follow-up rates were compared between patients with different demographic characteristics, surgical factors, and preoperative and discharge visual acuities. The behaviors of patients who complied with the follow-up advice were analyzed, including the number of days from surgery to follow-up and number of follow-up visits. Multivariate regression models were used to identify predictors associated with these behaviors.

RESULTS

The overall follow-up rate for the 86 776 surgeries analyzed was 85.6%. Patients more likely to follow-up were women, younger than 70 years, and paying (versus subsidized or free) and had phacoemulsification rather than manual small-incision cataract surgery (all P < .001). Patients who had complications, reoperations, or poorer visual acuity at discharge were less likely to comply with the follow-up advice (P < .001).

CONCLUSIONS

Targeted interventions to boost follow-up rates should be directed to patients with the characteristics found in this study. Furthermore, average measures of visual outcomes at 4 weeks are likely to be overstated relative to the truth.