Depressive symptoms in older adults awaiting cataract surgery

Pushing the envelope: the feasibility of using a mailed contrast sensitivity test to prioritise cataract waiting lists

BACKGROUND

Cataract waiting lists are growing globally. Pragmatic, cost-effective methods are required to prioritise the most urgent cases. Here we investigate the feasibility of using a third-party pen-and-paper contrast sensitivity, CS, test (SpotChecksTM), delivered by mail, and performed by patients at home unsupervised, to flag eyes requiring surgery.

METHODS

Pen-and-paper CS tests were mailed to 233 people waiting for a cataract assessment, along with a prepaid return envelope (cross-sectional study). Response rates were tabulated (stratified by age, sex and socioeconomic status), and test scores analysed to see how well the home tests predicted which eyes were listed subsequently for surgery. A subset of patients (N = 39) also underwent in-person follow-up testing, to confirm the accuracy of the home data.

RESULTS

Forty-six percent of patients responded (216 eyes). No gross differences were observed between respondents and non-respondents, either in terms of age, sex, socioeconomic status, or geographic location (all P > 0.05). The home-test CS scores predicted which eyes were subsequently listed for surgery, with an AUROC {±CI95%} of 0.69 {0.61-0.76}. Predictive performance was further-improved when machine learning was used to combine CS scores with letter acuity, extracted from patients' medical records (AUROC {±CI95%} = 0.77 {0.70-0.83}). Among 39 patients who underwent follow-up testing, home CS scores were correlated with various measures made in clinic: biometry signal-to-noise (P = 0.032), LogMAR acuity, Pelli-Robson CS and SpotChecks CS (all P < 0.001).

CONCLUSIONS

Mailing patients pen-and-paper CS tests may be a feasible, 'low-tech' way of prioritising patients on cataract waiting lists.

Depression and Eye Disease-A Narrative Review of Common Underlying Pathophysiological Mechanisms and their Potential Applications

Background: Depression has been shown to be associated with eye diseases, including dry eye disease (DED), cataracts, glaucoma, age-related macular degeneration (AMD), and diabetic retinopathy (DR). This narrative review explores potential pathophysiological connections between depression and eye disease, as well as its potential correlations with ocular parameters. Methods: A literature search was conducted in August 2022 in PUBMED, EMBASE, and PsycINFO. Published articles related to the subject were consolidated and classified according to respective eye diseases and pathophysiological mechanisms. Results: The literature reviewed suggests that common pathophysiological states like inflammation and neurodegeneration may contribute to both depression and certain eye diseases, while somatic symptoms and altered physiology, such as disruptions in circadian rhythm due to eye diseases, can also influence patients' mood states. Grounded in the shared embryological, anatomical, and physiological features between the eye and the brain, depression is also correlated to changes observed in non-invasive ophthalmological imaging modalities, such as changes in the retinal nerve fibre layer and retinal microvasculature. Conclusions: There is substantial evidence of a close association between depression and eye diseases. Understanding the underlying concepts can inform further research on treatment options and monitoring of depression based on ocular parameters.

The association between cataract surgery and mental health in older adults: a review

BACKGROUND

Although cataract surgery has been proposed as a potentially modifiable protective factor for enhancing emotional well-being in cataract patients, studies examining the relationship between anxiety or depression and cataract surgery have yielded inconsistent findings. This review summarizes existing evidence to establish whether cataract surgery is associated with depression and anxiety in older adults.

METHODS

A literature search was conducted across PubMed, Medline, Web of Science, and Embase databases. An initial screening by abstracts and titles was performed, followed by a review and assessment of the methodological quality of the relevant full papers, and final inclusion of 44 studies were deemed eligible for inclusion in this review.

RESULTS

Among 44 included studies, 36 studies (81.8%) were observational studies concerning the association of cataract surgery or cataracts with anxiety or depression, four studies (9.1%) were interventional studies, and four studies (9.1%) were reviews. Cataract surgery notably enhances the mental health of individuals with impaired vision. However, the multifaceted nature of psychological well-being, influenced by various factors, suggests that cataract surgery may not address all aspects comprehensively. Additionally, preoperative anxiety and depression significantly impact cataract surgery outcomes.

CONCLUSION

Vision impairment in older adults is closely associated with increased symptoms of depression and anxiety. While surgical intervention for cataracts improves these symptoms, it might be less effective for mental disorders with multifactorial causes. Notably, anxiety or depression poses challenges to successful preoperative and intraoperative cataract surgeries.

Depressive and generalized anxiety symptoms in adults awaiting cataract surgery in India

Background Systematic data on mental health issues among adults awaiting cataract treatment are not readily available in India. We explored the prevalence and predictors of depressive and generalized anxiety (GA) symptoms in a cohort of adults awaiting cataract surgery. Methods Our study is based on data from baseline assessments which were conducted as part of a multicentre prospective, longitudinal cohort study. Subjects were recruited from four eye hospitals to assess depression and GA and associated risk factors using standardized scales, i.e. Center for Epidemiologic Studies-Depression Scale (CES-D) and Generalised Anxiety Disorder (GAD-7). Variation in the intensity of depression and GA was assessed using multiple classification analysis (MCA). Results A total of 813 adults awaiting cataract surgery participated, of whom 456 (56.1%) were men. The mean (SD) CES-D and GAD-7 scores were 24.6 (7.8) and 6.3 (SD 4.2) for men and 25.8 (8.9) and 6.9 (4.4) for women, respectively. The overall prevalence of depression score of >16 was 87.4% (95% confidence interval [CI] 84.7%- 89.6%), and GA score of >10 was 57.1% (95% CI 53.5%-60.7%). The prevalence of comorbid depressive and anxiety symptoms was 56.6% (95% CI 52.9%- 60.2%). MCA showed that being neglected and mistreated by family/friends because of vision condition and facing difficulty and requiring help with daily tasks had the highest effect on the intensity of both depression (beta=0.254 and 0.238, respectively) and GA (beta=0.219 and 0.211, respectively). Conclusion The majority of adults with untreated cataract had both depressive and GA symptoms. These findings could be used for planning mental health interventions for adults awaiting cataract surgery.

Perioperative Anxiety and Depression in Older Adults: Epidemiology and Treatment

The intervals before and after major surgery is a high-risk period for older adults; in this setting, anxiety and depression are common and serious problems. We comprehensively reviewed current evidence on perioperative anxiety and depression in older adults, focusing on epidemiology, impact, correlates, medication risks, and treatment. Principles of perioperative mental healthcare are proposed based on the findings. Prevalence estimates of clinically significant anxiety and depression range from 5% to 45% for anxiety and 6% to 52% for depression, depending on surgical populations and measurement tools. Anxiety and depression may increase risk for surgical complications and reduce patient participation during rehabilitation. Medical comorbidities, pain, insomnia, cognitive impairment, and delirium are common co-occurring problems. Concomitant uses of central nervous system acting medications (benzodiazepines, anticholinergics, and opioids) amplify the risks of delirium and falls. Based on these findings, we propose that anxiety and depression care should be part of perioperative management in older adults; components include education, psychological support, opioid-sparing pain management, sleep management, deprescribing central nervous system active medications, and continuation and optimization of existing antidepressants. More research is needed to test and improve these care strategies.

Impact of COVID-19 on Depressive Symptoms Among Patients with Low Vision and Blindness

Background

Disability is globally recognized as a key cause of depression. Likewise, the COVID-19 pandemic has significantly increased the vulnerability of patients with low vision to health and health-related issues, especially mental health. This study aimed to examine the association between the impact of COVID-19 and depressive symptoms in patients with low vision and blindness.

Methods

This cross-sectional study was conducted between February and July 2022 and involved face-to-face interviews. Patients with low vision and blindness diagnosed with depression were excluded. The following items were included in the questionnaire: sociodemographic information, Multi-Dimensional Scale of Perceived Social Support (MSPSS), the impact of COVID-19, and The Center for Epidemiological Studies-Depression (CES-D). Hierarchical linear regression analysis was used to examine the association between the impact of COVID-19 and depression.

Results

The prevalence of depression among patients with low vision and blindness was 43.0%. Three factors were associated with depressive symptoms: compliance with COVID-19 prevention strategies (β = 0.16, p<0.01), anxiety during COVID-19 (β = 0.24, p<0.001), and social support (β = -0.16, p<0.01).

Conclusion

The findings indicated that COVID-19 significantly increased depressive symptoms among patients with low vision and blindness. The psychological effects of the COVID-19 pandemic have been considered critical and emergent public health issues. Stakeholders, particularly public health organizations, need to urgently implement preventive and protective measures to help patients with physical and mental disabilities.

Impact and Determinants of COVID-19 Pandemic on the Cataract Surgery Rate at a Tertiary Referral Center

PURPOSE

Preventive measures to mitigate the spread of coronavirus, minimized workload on health-care systems and redirected resources to COVID-19 patients resulting in a reduction of elective procedures such as cataract surgery. We report the changes in monthly cataract surgery rate and its associated determinants at a tertiary eye hospital during different periods of the pandemic. Studying the impact of COVID-19 pandemic on cataract surgery rate will help health-care policymakers to better understand the barriers to overcome the expected surgical backlog.

METHODS

A retrospective review of medical records was performed for cataract surgeries from November 2018 to January 2022, five thousand and ninety-two eyes that underwent cataract surgery during different phases of the COVID-19 pandemic were included. The monthly cataract surgery rate (MCSR) was calculated and compared before (Phase 1), during (Phase 2) and after the COVID-19 pandemic (Phase 3 and 4). Changes in monthly cataract surgery rate during and after the pandemic were presented as ratios and compared pre- to post-pandemic levels to evaluate the impact of different determinants.

RESULTS

Of 9701 cataract patients, 5092 (52.5%) were operated in P1, 71 (0.73%) in P2, 116 (1.2%) in P3 and 4422 (45.6%) in P4. The MCSR varied significantly based on the degree of visual impairment in the operated and fellow eyes, and by the type of operating surgeon (P < 0.05). Age, gender, laterality, and place of residence were not significantly different throughout the study period. During phase 1135 (2.6%) eyes had rupture of the posterior capsule (PCR), while 6 eyes (8.4%) had PCR in phase 2.

CONCLUSION

The monthly cataract surgery rate declined during the pandemic and has not recovered to pre-pandemic levels. This should alert the key stakeholders to address the identified barriers to surpassing the baseline monthly surgical rate as this is crucial to eliminate the surgical backlog after the pandemic.

Modeling the Recovery of Elective Waiting Lists Following COVID-19: Scenario Projections for England

OBJECTIVES

A significant indirect impact of COVID-19 has been the increasing elective waiting times observed in many countries. In England's National Health Service, the waiting list has grown from 4.4 million in February 2020 to 5.7 million by August 2021. The objective of this study was to estimate the trajectory of future waiting list size and waiting times up to December 2025.

METHODS

A scenario analysis was performed using computer simulation and publicly available data as of November 2021. Future demand assumed a phased return of various proportions (0%, 25%, 50%, and 75%) of the estimated 7.1 million referrals "missed" during the pandemic. Future capacity assumed 90%, 100%, and 110% of that provided in the 12 months immediately before the pandemic.

RESULTS

As a worst-case scenario, the waiting list would reach 13.6 million (95% confidence interval 12.4-15.6 million) by Autumn 2022, if 75% of missed referrals returned and only 90% of prepandemic capacity could be achieved. The proportion of patients waiting under 18 weeks would reduce from 67.6% in August 2021 to 42.2% (37.4%-46.2%) with the number waiting over 52 weeks reaching 1.6 million (0.8-3.1 million) by Summer 2023. At this time, 29.0% (21.3%-36.8%) of patients would be leaving the waiting list before treatment. Waiting lists would remain pressured under even the most optimistic of scenarios considered, with 18-week performance struggling to maintain 60%.

CONCLUSIONS

This study reveals the long-term challenge for the National Health Service in recovering elective waiting lists and potential implications for patient outcomes and experience.

Supporting COVID-19 elective recovery through scalable wait list modelling: Specialty-level application to all hospitals in England

The recovery of elective waiting lists represents a major challenge and priority for the health services of many countries. In England’s National Health Service (NHS), the waiting list has increased by 45% in the two years since the COVID-19 pandemic was declared in March 2020. Long waits associate with worse patient outcomes and can deepen inequalities and lead to additional demands on healthcare resources. Modelling the waiting list can be valuable for both estimating future trajectories and considering alternative capacity allocation strategies. However, there is a deficit within the current literature of scalable solutions that can provide managers and clinicians with hospital and specialty level projections on a routine basis. In this paper, a model representing the key dynamics of the waiting list problem is presented alongside its differential equation based solution. Versatility of the model is demonstrated through its calibration to routine publicly available NHS data. The model has since been used to produce regular monthly projections of the waiting list for every hospital trust and specialty in England.

The incidence of falls after first and second eye cataract surgery: a longitudinal cohort study

OBJECTIVE

To compare fall incidence, and visual acuity and refractive status, before surgery and after first and second eye cataract surgery.

DESIGN, SETTING

Prospective observational study in eight tertiary referral ophthalmology clinics in public hospitals in Sydney, Melbourne, and Perth.

PARTICIPANTS

People aged 65 years or more referred for bilateral age-related cataract surgery during 2013-16, followed for maximum of 24 months after study entry or until six months after second eye surgery, whichever was shorter.

MAIN OUTCOME MEASURES

Primary outcome: age- and sex-adjusted incidence of falls.

SECONDARY OUTCOMES

visual acuity and refractive error.

RESULTS

The mean age of the 409 included participants was 75.4 years (SD, 5.4 years); 220 were women (54%). Age- and sex-adjusted fall incidence prior to surgery was 1.17 (95% CI, 0.95-1.43) per year, 0.81 (95% CI, 0.63-1.04) per year after first eye surgery, and 0.41 (95% CI, 0.29-0.57) per year after second eye surgery. For the 118 participants who underwent second eye surgery and participated in all follow-up visits, age- and sex-adjusted incidence before (0.80 [95% CI, 0.55-1.15] falls per year) and after first eye surgery (0.81 [95% CI, 0.57-1.15] falls per year) was similar, but was lower after second eye surgery (0.32 [95% CI 0.21-0.50] falls per year). Mean habitual binocular visual acuity (logMAR) was 0.32 (SD, 0.21) before surgery, 0.15 (SD, 0.17) after first eye surgery, and 0.07 (SD, 0.15) after second eye surgery.

CONCLUSIONS

First eye surgery substantially improves vision in older people with cataract, but second eye surgery is required to minimise fall incidence. Timely cataract surgery for both eyes not only optimises vision in older people with cataract, but also reduces their risk of injury from falls.

Safety and Efficacy of Cataract Surgery Under a Local Infection Control Protocol Before and During a COVID-19 Wave in Thailand for Healthcare Workers and Patients: A Prospective Cohort from a Secondary Center

Purpose

To assess the effectiveness of a local infection control protocol for cataract surgery (CS) during the coronavirus disease (COVID-19) pandemic and determine the trend of CSs and visual outcomes during this period, as compared to the pre-COVID-19 pandemic period.

Methods

This study was conducted at Suddhavej Hospital, Mahasarakham University, Mahasarakham, Thailand, between July 1, 2020, and March 31, 2021. In this two-phase study, we used only a COVID-19-screening questionnaire during the first phase and preoperative nasopharyngeal swab severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing for real-time reverse transcriptase-polymerase chain reaction in the second phase, during Thailand's second COVID-19 wave. Nasopharyngeal swab SARS-CoV-2 nucleic acid testing, SARS-CoV-2 IgG/IgM, or anti-SARS-CoV-2 spike antibody seroconversion was used to detect COVID-19 infection among healthcare workers. We also compared cataract surgical volume and postoperative visual acuity of CS patients between the pre-COVID-19 period and during the COVID-19 pandemic period.

Results

A total of 947 patients underwent CS. Thirty-two healthcare workers and 275 patients tested negative for SARS-CoV-2 in the second study phase. CSs increased on average by 50.09% month-to-month when the surgery was resumed. The mean postoperative logMAR best-corrected visual acuity was significantly better in the COVID-19 pandemic period than in the pre-pandemic period (difference, 0.1 [95% CI: 0.00-0.12], p < 0.0001).

Conclusion

CS could be safely performed under an infection control protocol during the COVID-19 pandemic. The cataract surgical volume, with favorable visual outcomes, has an increasing trend after resuming elective surgeries.

The Impact of Cataract Surgery on Vision-Related Quality of Life and Psychological Distress in Monocular Patients

Purpose

To determine the changes in vision-related quality of life and psychological distress after cataract surgery in monocular patients and to compared these with a control group of age- and gender-matched binocular patients.

Methods

We enrolled 40 monocular patients and 40 binocular patients who underwent cataract surgery from August 2017 to December 2018. All participants undertook eye examinations and answered questionnaires (the National Eye Institute Visual Function Questionnaire, Self-rating Anxiety Scale, and Self-rating Depression Scale) before and after cataract surgery.

Result

The monocular patients had significantly worse mean CDVA than the binocular patients before and after surgery. However, there was no significant difference between the increases gained by the two groups. Mean composite VFQ-25 scores of the monocular group were significantly lower than those of the binocular group before and after surgery, but the improvement experienced by the monocular group was statistically larger than the binocular group (37.20 ± 12.84 vs. 19.11 ± 5.13, P < 0.001). Mean standard SAS scores of monocular patients were significantly higher than those of binocular controls before and after surgery, while monocular patients experienced a significant greater decline of SAS scores (−9.41 ± 5.39 VS −3.84 ± 1.61, P < 0.001). Mean standard SDS scores of the monocular group were significantly higher than those of the control group before and after surgery, but the monocular group experienced a significantly greater decline of SDS scores following cataract surgery (−11.91 ± 6.38 VS −4.78 ± 1.79, P < 0.001). There was a significant correlation between the preoperative logMAR CDVA and both the postoperative logMAR CDVA (r = 0.63, P < 0.001) and the changes in the logMAR CDVA (r = −0.881, P < 0.001) for monocular patients. Linear regression analyses suggested that higher postoperative VFQ-25 scores had significant associations with better preoperative CDVA and the absence of systemic comorbidity (both P < 0.05). Age and ocular comorbidity were significantly associated with postoperative SAS scores (both P < 0.05). Age and systemic comorbidity remained significant impact factors for SDS scores (both P < 0.05).

Conclusion

Monocular patients reported greater improvement in vision-related quality of life and greater decline in the level of anxiety and depression than binocular control subjects, despite having similar CDVA gains after cataract surgery. We argue that it is not a better choice for monocular patients to delay cataract surgery until the cataract is very advanced. A clear understanding of the impact of cataract surgery on vision-related quality of life and psychological distress in monocular patients is needed by ophthalmologists when making surgery decision.

How can we improve the quality of cataract services for all? A global scoping review

BACKGROUND

Cataract is a leading cause of blindness and vision impairment globally. Cataract surgery is one of the most frequently performed operations worldwide, but good quality services are not universally available. This scoping review aims to summarise the nature and extent of published literature on interventions to improve the quality of services for age-related cataract globally.

METHODS

We used the dimensions of quality adopted by WHO-effectiveness, safety, people-centredness, timeliness, equity, integration and efficiency-to which we added planetary health. On 17 November 2019, we searched MEDLINE, Embase and Global Health for manuscripts published since 1990, without language or geographic restrictions. We included studies that reported quality-relevant interventions and excluded studies focused on technical aspects of surgery or that only involved children (younger than 18 years). Screening of titles/abstracts, full-text review and data extraction were performed by two reviewers independently. Studies were grouped thematically and results synthesised narratively.

RESULTS

Most of the 143 included studies were undertaken in high-income countries (n = 93, 65%); 29 intervention groups were identified, most commonly preoperative education (n = 17, 12%) and pain/anxiety management (n = 16, 11%). Efficiency was the quality element most often assessed (n = 58, 41%) followed by people-centredness (n = 40, 28%), while integration (n = 4) and timeliness (n = 3) were infrequently reported, and no study reported outcomes related to planetary health.

CONCLUSION

Evidence on interventions to improve quality of cataract services shows unequal regional distribution. There is an urgent need for more evidence relevant to low- and middle-income countries as well as across all quality elements, including planetary health.

Factors associated with the occurrence of falls among older people with and without cataracts: Structural equation modelling analysis

AIMS AND OBJECTIVES

To identify the frequency of falls among older people with and without cataracts and to verify the association of sociodemographic, clinical and behavioural variables with the number of falls among community-dwelling older adults according to self-reported cataracts.

BACKGROUND

Although the literature on the topic is vast, no studies were found that described the explanatory factors for the relationship between sociodemographic, clinical and behavioural variables with the occurrence of falls in older people, with and without cataracts, through models previously tested in mediation analysis.

DESIGN AND METHOD

This is a cross-sectional and quantitative study guided by the STROBE, conducted with two groups: older people with (268) and without cataracts (689). For analysing the data, the path analysis was performed.

RESULTS

The occurrence of falls among the older people with cataracts was higher than in the group without cataracts. In both groups, frailty and depressive symptoms were directly associated with a higher occurrence of falls. Among older people with cataracts, the lowest physical performance score and the highest sedentary behaviour were directly associated with the highest number of falls. Among the older people without cataract, the youngest age, the highest number of morbidities and functional disability for instrumental activities of daily living were directly associated with the occurrence of falls.

CONCLUSION

The older people with cataracts have a higher frequency of falls. The factors associated with the occurrence of falls differ between the older people with and without cataracts.

RELEVANCE TO CLINICAL PRACTICE

The expanded understanding of the factors associated with falls among community-dwelling older adults, differentiating those with and without cataracts, guides the health professional in the development and implementation of measures to reduce the occurrence of these events.

COVID-19 and cataract surgery backlog in Medicare beneficiaries

Suspension of elective surgical care during COVID-19 will result in a large backlog of cataract surgeries in Medicare beneficiaries. It is necessary to start planning proactively to reduce the backlog.

Purpose:

To forecast the volume of cataract surgery in Medicare beneficiaries in the United States in 2020 and to estimate the surgical backlog that may be created due to COVID-19.

Design:

Epidemiologic modeling.

Methods:

Baseline trends in cataract surgery among Medicare beneficiaries were assessed by querying the Medicare Part B Provider Utilization National Summary data. It was assumed that once the surgical deferment is over, there will be a ramp-up period; this was modeled using a stochastic Monte Carlo simulation. Total surgical backlog 2 years postsuspension was estimated. Sensitivity analyses were used to test model assumptions.

Results:

Assuming cataract surgeries were to resume in May 2020, it would take 4 months under an optimistic scenario to revert to 90% of the expected pre-COVID forecasted volume. At 2-year postsuspension, the resulting backlog would be between 1.1 and 1.6 million cases. Sensitivity analyses revealed that a substantial surgical backlog would remain despite potentially lower surgical demand in the future.

Conclusions:

Suspension of elective cataract surgical care during the COVID-19 surge might have a lasting impact on ophthalmology and will likely result in a cataract surgical patient backlog. These data may aid physicians, payers, and policymakers in planning for postpandemic recovery.

Prevalence and correlates of depressive symptoms among Chinese patients with cataracts treated in tertiary general hospitals

Background

Previous studies recruited unrepresentative samples of Chinese patients with cataract and reported a wide range of prevalence of depressive symptoms in this patient population (18.0–89.7%). The present study determined the prevalence and correlates of depressive symptoms among a consecutive sample of Chinese patients with cataract treated in tertiary general hospitals.

Methods

A total of 339 patients with cataract were consecutively selected from ophthalmology departments of two large general hospitals in Wuhan, China. Depressive symptoms were assessed with the Chinese Hospital Anxiety and Depression Scale. Logistic regression was used to identify factors that were associated with depression.

Results

The prevalence of depressive symptoms was 23.9% (95% CI [19.4–28.4]%) among patients with cataract. Correlates for depressive symptoms include an education level of primary school and below (OR = 1.93, P = 0.038), marital status of “others” (OR =3.15, P < 0.001), poor family economic status (OR = 2.26, P = 0.010), nuclear cataract (OR =4.32, P < 0.001), and mixed cataract (OR = 2.76, P = 0.017).

Conclusions

Depressive symptoms are common among Chinese patients with cataract treated in large general hospitals. Patients who are poorly educated, have a marital status other than “married”, have poor family economic status, and suffer from nuclear and mixed cataracts are at greater risk for depressive symptoms.

Advanced ophthalmic nurse practitioners: the potential to improve outcomes for older people with cataracts

An ageing population has led to a substantial increase in the prevalence of visual impairments, which can compromise lifestyle, health and general physical and psychological well-being. Age-related cataracts can have a negative effect on older people's quality of life but can be corrected by surgery. It is imperative that older people have access to cataract surgery and, given government objectives of NHS efficiency gains, advanced level nurse practitioners have the potential to increase capacity for and access to cataract surgery. This article outlines the aetiology of cataracts, developments in ophthalmic nursing and the broadened scope of practice of advanced ophthalmic nurse practitioners (AONPs). It explores how the AONP is well-placed to provide high quality care to the older person who requires cataract surgery. Professional drivers for role development are explored in relation to older people.

Associations between cataract and multimorbidity: a cross-sectional study of 23,089 adults from Spain

BACKGROUND

Little is known about the association between cataract and multimorbidity. Therefore, the aim of the present study was to examine the relationship between cataract and chronic conditions and multimorbidity in a large representative sample of Spanish adults.

METHODS

This study used data from the Spanish National Health Survey 2017, a cross-sectional sample of 23,089 adults aged ≥15 years from Spain [54.1% female; mean (standard deviation) age 53.4 (18.9) years]. Cataract and 30 other physical and mental chronic conditions were self-reported. Multimorbidity was defined as the presence of at least two physical and/or mental chronic conditions (excluding cataract). Control variables included sex, age, marital status, education, smoking, and alcohol consumption. Multivariable logistic and negative binomial regression analyzes were conducted to assess associations.

RESULTS

The prevalence of cataract and multimorbidity was 12.5% and 56.5%, respectively. All chronic conditions were significantly more frequent in individuals with than in those without cataract. Overall, there was a positive relationship between cataract and multimorbidity [odds ratio (OR) = 2.77; 95% confidence interval (CI): 2.39-3.21]. In addition, cataract was significantly associated with the number of chronic conditions in the whole population [incidence rate ratio (IRR) = 1.34; 95% CI: 1.29-1.38].

CONCLUSIONS

Cataract is positively associated with chronic conditions and multimorbidity in adults. Interventions specifically designed for those with cataract to reduce or manage co-occurring chronic conditions and multimorbidity are urgently required.

Prevalence of depressive symptoms and associated factors in an urban, ophthalmic population

OBJECTIVE

To determine the prevalence of depressive symptoms in an adult ophthalmic patient population and to delineate correlates.

DESIGN

Cross-sectional study.

PARTICIPANTS

Adult patients (⩾18 years) were approached in general and sub-specialty cornea, retina, and glaucoma ophthalmic clinics. A total of 367 patients from the four clinics were enrolled.

METHODS

Depressive symptoms were assessed using the Patient Health Questionnaire-9. A cut-off score of ⩾10 was used to indicate clinically significant depressive symptoms. Patient Health Questionnaire-9 scores were used to evaluate bivariate relationships between depressive symptoms and distance visual acuity, ocular diagnosis, diabetes status, smoking status, demographic information, and medications.

RESULTS

The majority of patients were female (52.9%) and Caucasian (48.6%). The mean age was 52.0 years (standard deviation: 16.7). Clinically significant depressive symptoms were present in 19.9% of patients overall; this rate varied slightly by clinic. Patients with low vision and blindness (visual acuity worse than 20/60) were more likely to have depressive symptoms (odds ratio = 2.82; 95% confidence interval: 1.90-4.21). Smoking and diabetes were also associated with depressive symptoms (odds ratio = 3.11 (2.66-3.64) and 3.42 (1.90-6.16), respectively).

CONCLUSION

In a sample of urban ophthalmic adult patients, depressive symptoms were highly associated with low vision, smoking, and diabetes. This information can be used to target interventions to those at greatest risk of depressive symptoms.

The Interface Between Psychiatry and Ophthalmology

OBJECTIVE

The aim of this article is to review the interface between psychiatry and ophthalmology at several levels, such as the influence of psychopharmacology on eye disorders, the occurrence of psychiatric symptoms in eye diseases, and the neuroophthalmological examination methods supporting the validity of psychiatric diagnoses.

MATERIALS AND METHODS

We searched the PubMed computer database for the key words "Psychiatry" and "Ophthalmology" on the 28th of August, 2018 to obtain relevant articles which were consequently summarized.

RESULTS

The results showed that most patients with ocular disease simultaneously have one or more psychiatric symptoms. We also found a prevalence of eye-related side effects in patients who use psychiatric drugs. At the same time, we observed that some ophthalmology methods of diagnostics can be used as diagnostic tools in psychiatry.

CONCLUSIONS

Most studies showed a significant relation between psychiatry and ophthalmology, such as eye symptoms and diseases following long-term use of psychotropics as well as psychiatric symptoms and syndromes in patients with eye disorders. Our review may be beneficial to psychiatrists, ophthalmologists, and, last but not least, the patients themselves.

Should every candidate for cataract extraction be scheduled to the preoperative clinic? The Rabin Medical Center experience

BACKGROUND

Cataract surgery is one of the most common elective surgeries. We present a novel approach of preoperative triage using community-based ophthalmologist referral letters for scheduling surgery, thus reducing both patient and physician time prior to surgery. Since most patients are not routinely examined in a preoperative clinic, day of surgery cancelations are a possibility. The aim of this study is to evaluate the efficiency of our triage system.

METHODS

Historical prospective study in which the end point was day-of-surgery cancelation. The main outcome measure of this study was the rate of cancelations which could have been prevented by a preoperative visit. Patients' records were reviewed for reasons for cancelation and demographics.

RESULTS

During the study period, 1030 patients underwent cataract surgery, 171 patients (16.6%) were examined in the preoperative clinic. Forty-five patients (4.4%) were canceled on the day of surgery due to various reasons. The main reason for cancelation (13 cases, 28.9%) was non-availability of operating theater. In 20 cases (1.9% of total patients, 44.4% of cancelations), the cancelations could have been prevented by a preoperative clinic visit.

CONCLUSION

Our results suggests that most cataract patients do not require preoperative visit prior to the day of surgery. The cooperation of community-based ophthalmologists and the availability of senior surgeons in the operating theater allows for the proper implementation of our system. Direct referral to surgery could shorten both costs and time to surgery and provide timely treatment for cataracts in a cost-aware environment.

Illness uncertainty, anxiety and depression in Chinese patients with glaucoma or cataract

This study evaluated illness uncertainty, anxiety and depression among glaucoma patients and cataract patients in China. 263 patients with primary glaucoma and 100 patients with age-related cataract were recruited sequentially from Zhongshan Ophthalmic Center between October 2013 and March 2016. All the participants completed questionnaires for socio-demographic information, Mishel Uncertainty in Illness Scale (MUIS) and Hospital Anxiety and Depression Scale (HADS). 25 of the 263 glaucoma patients and 21 of the100 cataract patients finished two copies of the same questionnaires before and after surgery. Statistics were analyzed using SPSS17.0 software. We observed that glaucoma patients had higher MUIS and HADS score than did cataract patients. Multivariate logistic regression analysis indicated risk factors for illness uncertainty, anxiety and depression for glaucoma patients were high HADS score, poor visual acuity (VA) in the better eye and education level respectively. Risk factors for the same parameters of cataract patients were high HADS-A score, poor VA in the better eye and high illness uncertainty respectively. Scores of MUIS and HADS both decreased after surgery, but the change in HADS score among glaucoma patients was not significant. Clinical workers should take these factors into account to improve therapy, especially for glaucoma patients who undergo surgery.

Re-engineering the Hong Kong Quality of Life Questionnaire to Assess Cataract Surgery Outcomes

PURPOSE

To assess psychometric properties of the Hong Kong Quality of Life Questionnaire (HKQ) using Rasch analysis and use it to assess cataract surgery outcomes.

METHODS

The HKQ was interviewer administered to participants at baseline (preoperative) and 12 months of follow-up (postoperative). Rasch analysis was used to assess and improve psychometric properties of the HKQ using the preoperative data. The responsiveness of the HKQ was assessed on the stacked preoperative and postoperative data, reported with the effect size.

RESULTS

One hundred ninety-nine participants (median age: 72 years; interquartile range: 65 to 78 years) with cataract completed the HKQ at the preoperative assessment. There were more women (58%) and most of the participants had bilateral cataract (83.9%). Nearly half of the participants had undergone surgery in one eye (45.2%) followed by bilateral surgery (38.7%). Psychometric assessment guided by Rasch analysis resulted into a 15-item HKQ with promising psychometric properties including adequate measurement precision (2.09), no misfitting items, near perfect targeting (-0.05), unidimensionality, and with no evidence of item bias. For those who completed the HKQ (n = 82, 41.2%) at the 12-month follow-up visit, all groups demonstrated statistically significant gains in the HKQ scores, with the highest gain in participants who had undergone bilateral surgery (effect size: 2.61).

CONCLUSIONS

The 15-item HKQ was valid and psychometrically sound and might be a highly responsive instrument to measure cataract surgery outcomes in China. This study demonstrated that cataract surgery significantly improves quality of life in the Chinese population. [J Refract Surg. 2018;34(6):413-418.].

Patient perspectives of cataract surgery: protocol and baseline findings of a cohort study

BACKGROUND

Patient-reported outcome measures (PROMs) are becoming increasingly recognised as a key component in assessing the relative effectiveness of cataract surgery. This manuscript presents the protocol methodology and baseline characteristics of a prospective cohort study investigating patient-centred predictors of cataract surgery outcomes.

METHODS

Patients with bilateral cataract (aged ≥ 50 years) scheduled for their first eye cataract surgery were recruited at four public hospitals and three private ophthalmology clinics in Sydney, Australia. Participants underwent a comprehensive assessment of clinical measures of vision (for example, visual acuity, contrast sensitivity) and PROMs prior to first eye surgery and three months after first and second eye surgery. The PROMs of interest included health-related quality of life, visual disability and satisfaction with vision.

RESULTS

The characteristics of the baseline cohort of 359 participants are reported in this manuscript. Enrolment occurred over a two-year period with the majority recruited from urban public hospitals (96 per cent, n = 345). Health-related quality of life was scored highly (80 out of 100). Self-reported visual disability was considered within normal ranges compared to cataract populations in other high-income countries (-0.94 logits). Three-quarters of participants (n = 263/351) were dissatisfied with their pre-operative vision.

CONCLUSIONS

There is a complex and wide range of patient-centred experiences prior to first eye cataract surgery in the public hospital setting. Gaining further insight into the patient perspective may allow eye health professionals to more appropriately time surgery, better manage patient expectations and provide direction for future prioritisation initiatives of cataract wait lists. Companion papers will follow, detailing results of surgery in terms of PROMs.

Are cataract surgery referrals to public hospitals in Australia poorly targeted?

IMPORTANCE

Referral letters constitute the first step on the pathway to cataract surgery; however, little is known on how effective referral letters are in providing adequate information to triage patients and inform surgical prioritization.

BACKGROUND

Benchmarking exercises are important to document referral processes and to identify areas where improvements can be made.

DESIGN

Cross-sectional study with longitudinal follow-up conducted at two metropolitan public hospitals in New South Wales, Australia.

PARTICIPANTS

A total of 400 sequential cataract referral letters.

METHODS

An audit of cataract referral letters was performed and content benchmarked against international prioritization tools. Medical records were reviewed 1 year following referral.

MAIN OUTCOME MEASURES

Referral quality and waiting times.

RESULTS

Two-thirds of patients referred for cataract surgery were yet to have their initial hospital appointment in the year following referral (65%, 245/376). One half of referrals seen in clinic (49%, 64/113) were not listed for cataract surgery. Multivariate analysis revealed referral letter content was not indicative of surgical booking, with the major predictors being hospital-recorded visual acuity and grading of cataract (P < 0.0001). Referral content lacked sufficient detail to apply prioritization tools developed in other settings.

CONCLUSION AND RELEVANCE

This audit highlights a disconnect between referral letter content and hospital assessment of patients. Current referrals to public hospitals are poorly targeted, with high numbers of referred patients not proceeding to surgery. Patients commonly waited over 1 year to have their ophthalmic assessment at these public hospital eye clinics, revealing lengthy 'wait-for-waits' as a barrier to care. Standardized referral templates may facilitate improvement of referral pathways and shorten waiting times.

Rasch analysis of the hospital anxiety and depression scale among Chinese cataract patients

Purpose

To analyze the validity of the Hospital Anxiety and Depression Scale (HADS) among Chinese cataract population.

Methods

A total of 275 participants with unilateral or bilateral cataract were recruited to complete the Chinese version of HADS. The patients' demographic and ophthalmic characteristics were documented. Rasch analysis was conducted to examine the model fit statistics, the thresholds ordering of the polytomous items, targeting, person separation index and reliability, local dependency, unidimentionality, differential item functioning (DIF) and construct validity of the HADS individual and summary measures.

Results

Rasch analysis was performed on anxiety and depression subscales as well as HADS-Total score respectively. The items of original HADS-Anxiety, HADS-Depression and HADS-Total demonstrated evidence of misfit of the Rasch model. Removing items A7 for anxiety subscale and rescoring items D14 for depression subscale significantly improved Rasch model fit. A 12-item higher order total scale with further removal of D12 was found to fit the Rasch model. The modified items had ordered response thresholds. No uniform DIF was detected, whereas notable non-uniform DIF in high-ability group was found. The revised cut-off points were given for the modified anxiety and depression subscales.

Conclusion

The modified version of HADS with HADS-A and HADS-D as subscale and HADS-T as a higher-order measure is a reliable and valid instrument that may be useful for assessing anxiety and depression states in Chinese cataract population.

Incidence and Predictors of Complications due to Urethral Stricture in Patients Awaiting Urethroplasty

PURPOSE

We examined the incidence and predictors of complications due to urethral stricture in patients awaiting urethroplasty.

MATERIALS AND METHODS

We retrospectively reviewed the charts of patients who underwent urethroplasty from 2009 to 2013. The primary outcome was complications, defined as any unplanned interaction with the health care system due to urethral stricture during the period between the decision to perform surgery and urethroplasty.

RESULTS

A total of 276 patients were identified for analysis. Median stricture length was 4.0 cm and 67.4% of strictures were in the bulbar urethra. The most common stricture etiologies were idiopathic in 47.8% of cases and traumatic in 15.9%. Overall 15.9% of patients presented with a complication with a median time to complication of 43 days. Median surgical wait time was 151 days. Complications included urinary tract infections in 56.8% of patients, acute urinary retention in 20.5%, genitourinary pain in 5.8% and catheter related issues in 15.9%. Univariate analysis suggested that catheter dependent status, number of prior endoscopic treatments, a hypospadias and/or trauma etiology, and prior urethroplasty were potential significant predictors of complications. Multivariate analysis yielded only catheter dependent status (HR 5.2, 95% CI 2.4-11.3, p <0.0001) and prior failed urethroplasty (HR 1.6, 95% CI 1.1-2.3, p = 0.03) as significantly associated with complications.

CONCLUSIONS

To our knowledge our study is the first to examine and quantify the morbidity of urethroplasty wait time. Approximately 16% of patients experienced a complication while awaiting urethroplasty. The optimal wait time should be less than 43 days. Patients with prior urethroplasty and catheters at the time of the surgical decision should be prioritized as they may be more likely to experience complications.