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PubMed2002

The relationship between nuclear colour and opalescence on the LOCSIII scale and physical characteristics of cataract nuclei.

PURPOSE: To evaluate the compression characteristics of the human lens nucleocortex in relation to its LOCSIII clinical grading. METHODS: Sixteen subjects undergoing planned extracapsular cataract surgery had pre-operative slit-lamp examination and assessment of cataract LOCSIII grade followed by postoperative in vitro evaluation of the nucleus with measurement of 'linear compressibility' by a purpose-designed caliper incorporating a strain gauge, enabling the derivation of a graph of nuclear compression (D (mm) against applied force (F (N)). RESULTS: Nuclear colour correlates with the force required to compress a lens to 75% of its original depth (F75) (R = 0.625, P = 0.017). Nuclear opalescence correlates with the force required to compress a lens to 75% of its original depth (R = 0.651, P = 0.012) and inversely with linear compressibility (DeltaD/DeltaF, the slope of the graph of nuclear compression against applied force) (R = -0.610, P = 0.014). F75 is a direct and linear compressibility is an inverse related parameter of lens nucleus 'hardness'. CONCLUSION: A new instrument is described which allows measurement of 'hardness'-related compression characteristics of the human cataract in vitro. There is a relationship between the LOCSIII clinical classification of nuclear cataracts and mechanical compression characteristics of the cataractous lens. LOCSIII classification may aid the preoperative planning of an appropriate surgical approach to an individual cataract.

Aged↗
PubMed2004

Referrals for cataract surgery: variations between different geographic areas within a Welsh Health Authority.

AIM: The aim of the study was to identify variations in cataract presentation within three different eye units in a single health authority and to identify any correlation between cataract presentation and social deprivation indices. We also compared our patient profile and results with the UK National Cataract Audit Statistics. METHODS: It was a prospective multicentre questionnaire-based project involving three hospitals: Cardiff Eye Unit--University Hospital of Wales (UHW), Royal Glamorgan Hospital--Llantristant (RGH), and Prince Charles Hospital--Merthyr Tydfil (PCH). Demographic, clinical, and socioeconomic data were collected in patients undergoing cataract surgery. Patients were also asked to fill in the questionnaire based on Berth-Petersen Visual Function Index (VF-14) indicating difficulty in performing daily living activities. RESULTS: A total of 112 patients were recruited in the study. Demographics were similar to National Cataract Audit. However, the percentage of patients with poor visual acuity (less than 6/60) at the time of surgery was greater at all the three hospitals compared to the national statistics. Among the three hospitals at South Wales, PCH had the lowest visual acuity in both listed and fellow eye and the lowest VF-index. Both the outpatient and surgery waiting times were longest at PCH. The population at PCH also visited their optician least frequently. CONCLUSION: Our results show significant variation in cataract presentation between the three eye units within a single Health Authority. These variations correlate well with social deprivation indices and poor use of Optometric services. Local policies are needed to redress these inequalities and raise public and professional awareness of causes of poor sight in the elderly population.

Age Distribution↗
PubMed2001

Intraocular pressure before and after cataract surgery in participants of the Melbourne Visual Impairment Project.

The purpose of this study was to investigate the effect of cataract surgery on intraocular pressure (IOP) in a cluster-stratified random sample of the population of Victoria, Australia. A total of 3271 participants aged 40 years or older were examined at baseline for the Visual Impairment Project. The baseline study (1992-1994) was followed by a 5-year incidence study The IOP data were compared between participants who had cataract surgery between the two stages of the study and participants with and without cataract at follow up. The IOP was also compared before and after cataract extraction in glaucoma participants. An eligible 89 non-glaucoma and 24 glaucoma participants had cataract surgery between the two time points. The analyses showed that IOP increases with age in non-operated eyes in both glaucoma and non-glaucoma groups. However IOP decreased significantly after cataract surgery in eyes with glaucoma but did not change significantly in non-glaucoma participants.

Adult↗
PubMed2001

Optimal reading speed in simulated cataract: development of a potential vision test.

Previous studies suggest that optimal reading speed is unaffected by cataract, yet is significantly reduced in age-related macular disease. This raises the question of whether a reading speed test could be developed to assess potential vision after cataract surgery. In this study, 20 young subjects, with and without a simulation of dense cataract, read aloud Bailey-Lovie word charts. From the results, critical print size, optimal reading speed and word acuity were calculated. The simulated cataract reduced word acuity and increased the critical print size, yet optimal reading speed remained unchanged. Measurements were also taken with the charts in reversed contrast polarity. Reversing the contrast polarity of the charts improved the word acuity and optimal reading speed with the cataract simulation. The results suggest that optimal reading speed could be used as a potential vision test. Further investigations using patients with cataract and ARMD are required.

Adult↗
PubMed2000

Traditional couching is not an effective alternative procedure for cataract surgery in Mali.

INTRODUCTION: In Mali, more cataract patients receive sight-restoring surgery using a traditional "couching" procedure (the lens inside the vitreous body) than by modern cataract surgery. In order to evaluate the relative effectiveness and other outcomes of the traditional procedure compared to the modern surgical intervention, we conducted a population-based survey in a rural district of Mali in 1996. METHOD: A total of 99,800 persons from 160 villages were eligible to be included in the sample. All individuals operated for cataract by a modern procedure were checked for visual acuity and questioned regarding their clinical history, the cost of the surgery and their satisfaction with the surgery immediately following the operation and presently. Each patient was paired with one person operated by a traditional cataract surgical procedure. RESULTS: From a total population of 99,800 we found 85 individuals (0.085%) who had been operated by intracapsular extraction (ICCE) without lens implantation and we paired these with 82 individuals operated by the traditional method and by a local healer. In both groups, males were predominant (74.4% in the modern group and 61.3% in the traditional) and the median age was 65 and 68 years, respectively. Men with a higher social status (defined as administrative or religious authority) were slightly more common among those operated by ICCE (18.9%) than among those operated by the traditional healer (4.4%). Nearly half (47.6%) of the patients operated by couching did not know that a modern alternative existed. The mean cost to the patient of the two procedures was similar; with traditional couching costing on average US$ 42.10 and modern surgery (including transport and drugs) costing US$ 52.40. The traditional healer was often paid partially in kind and the price paid varied according to the patient's ability to pay. The clinical results differed greatly between the two methods. After aphakic correction of eyes operated by ICCE, 5.3% had good vision (33/18), 76.8% had low vision (33/60 and <3/18) and 17.9% were still blind (<3/60). Of eyes operated by traditional couching, none had good vision, 29.1% had low vision and 70.9% were blind. The level of satisfaction was high (89.7%) among persons operated in an ophthalmic center by the modern method, and relatively low (22.6%) among persons operated traditionally. DISCUSSION: In Mali, two types of providers offer two different interventions to treat cataract-blind persons. This study suggests that the couching method used by traditional healers is relatively expensive and ineffective. It is also potentially dangerous although this study did not address this question specifically. It is important that health policy makers and medical authorities do what they can to prevent traditional healers from performing the couching procedure, as well as informing the population about the existence of a more-effective and safer alternative. However, while more effective and safer, the results obtained by ICCE are not excellent either. Further, it is important to improve the quality of ophthalmic services in order to provide cataract patients with the best, most accessible and least expensive services possible.

Aged↗
PubMedDate not supplied

Cataract extraction and age-related macular degeneration: associations, diagnosis and management.

Both cataract and age-related macular degeneration (ARMD) are common findings in our aging population. At issue is the progression of ARMD following cataract extraction. The purpose of this paper is to review the data relevant to this subject and to offer suggestions as to the management of cataract associated with macular degeneration. Published data are reviewed and an attempt is made to interpret the results. Topics discussed include the epidemiology and association between the incidence of cataract and ARMD, the role of photo-oxidative damage and inflammation in the pathogenesis of ARMD, and the possible contribution of cataract extraction to the exacerbation and acceleration of ARMD through increased photo-oxidative damage and intraocular inflammation. Recommendations for the cataract surgeon and specialist are formulated on the basis of existing literature.

Cataract↗
PubMed2005

Cataract in the Kingdom of Morocco: indications for surgery and functional results.

AIM: To investigate the results of cataract surgery in different settings in the Kingdom of Morocco. METHOD: At four separate health facilities, 100 consecutive patients undergoing ECCE cataract extraction for age-related cataract were examined pre-operatively and 6-8 weeks post-operative for changes in visual acuity. RESULTS: Thirty-four percent of patients (better eye acuity) and 95.5% of operated eyes had a visual acuity of less than 3/60 pre-operatively. Six to eight weeks post-operatively 84.0% of patients (better eye acuity) and 74.7% of operated eyes achieved a visual acuity of 6/18 or better. Of 198 eyes having an intraocular lens (IOL) implanted, 87.9% achieved 6/18 and 3.0% were less than 6/60 post-operatively. Of 202 eyes having cataract surgery without an IOL, 61.7% achieved 6/18 and 4.5% were less than 3/60. The proportion of eyes receiving an IOL in the 4 centres ranged from 29% to 74%. CONCLUSION: Monitoring the pre and post-operative acuity of cataract patients can give useful information on the indications for surgery in different settings, the use of IOLs and the visual outcome. Implantation of an IOL should be encouraged in all people having cataract surgery unless contra-indicated.

Cataract↗
PubMed2006

Predictors of poor follow-up in children that had cataract surgery.

BACKGROUND: Centers for high quality cataract surgery for children have been developed in a number of sub-Saharan African countries. Surgery, however, is only the first stage of a long, often complex, rehabilitation program. There are indications that follow-up in these settings is poor. In a setting with a high quality surgical service an active program to identify and manage children with cataract and a newly developed low vision program, we sought to measure routine follow-up and to determine the factors associated with good or poor follow-up. METHODS: This prospective study included all children (under the age of 16 years) having surgery for congenital, developmental, or traumatic cataract at KCMC Hospital between March 2003 and October 2004. Standardized data was collected pre-, intra-, and postoperation. Follow-up was assessed at two weeks and ten weeks. RESULTS: Among the 154 children included 35.1% had congenital cataract, 32.5% had developmental cataract, and 31.8% had traumatic cataract. Overall, 66.9% attended two-week follow-up and 42.9% attended ten-week follow-up. Multivariate analysis revealed that sex (being a boy), close proximity to a hospital, and minimal delay in presentation for surgery all independently predicted good follow-up at two weeks. Only distance from a hospital and preoperative vision (not blind in operative eye) predicted good ten-week follow up. DISCUSSION: Current follow-up practices are inadequate. Significant investment in surgical interventions may not lead to improved visual rehabilitation or quality of life, if investments in follow-up are not increased. Linking individual children, their families, and the hospital needs to be approached systematically, if follow-up is to be improved. Improved hospital-based counseling should focus on families who bring their child late for surgery and with girls.

Cataract↗
PubMed2006

Association between visual impairment and patient-reported visual disability at different stages of cataract surgery.

PURPOSE: To evaluate the association between visual impairment (visual acuity, contrast sensitivity, stereopsis) and patient-reported visual disability at different stages of cataract surgery. METHODS: A cohort of 104 patients aged 60 years and over with bilateral cataract was assessed preoperatively, after first-eye surgery (monocular pseudophakia) and after second-eye surgery (binocular pseudophakia). Partial correlation coefficients (PCC) and linear regression models were calculated. RESULTS: In patients with bilateral cataracts, visual disability was associated with visual acuity (PCC = -0.30) and, to a lesser extent, with contrast sensitivity (PCC = 0.16) and stereopsis (PCC = -0.09). In monocular and binocular pseudophakia, visual disability was more strongly associated with stereopsis (PCC = -0.26 monocular and -0.51 binocular) and contrast sensitivity (PCC = 0.18 monocular and 0.34 binocular) than with visual acuity (PCC = -0.18 monocular and -0.18 binocular). Visual acuity, contrast sensitivity and stereopsis accounted for between 17% and 42% of variance in visual disability. CONCLUSIONS: The association of visual impairment with patient-reported visual disability differed at each stage of cataract surgery. Measuring other forms of visual impairment independently from visual acuity, such as contrast sensitivity or stereopsis, could be important in evaluating both needs and outcomes in cataract surgery. More comprehensive assessment of the impact of cataract on patients should include measurement of both visual impairment and visual disability.

Aged↗
PubMed2001

Prospective study of cataract extraction and risk of coronary heart disease in women.

Oxidative damage to proteins in the human lens is believed to be important in the etiology of age-related cataract. Because free radical-mediated oxidative damage to lipoproteins may accelerate atherosclerosis, the authors hypothesized that the development of cataract might be a marker for such damage and therefore might be associated with future risk of coronary heart disease (CHD). The authors followed 60,657 women aged 45--63 years and without known coronary disease, stroke, or cancer in 1984. During 10 years of follow-up (674,283 person-years), the authors documented 887 incident cases of CHD and 2,322 deaths. After adjustment for age, smoking, and other coronary risk factors, cataract extraction was significantly associated with higher risk of CHD (relative risk (RR) = 1.88, 95% confidence interval (CI): 1.41, 2.50) for total CHD, 2.44 (95% CI: 1.54, 3.89) for fatal CHD, and 1.63 (95% CI: 1.14, 2.34) for nonfatal myocardial infarction). The positive association between cataract extraction and total CHD was stronger among women with a history of diabetes (RR = 2.80, 95% CI: 1.77, 4.42) than among those without reported diabetes (RR = 1.51, 95 percent CI: 1.04, 2.18). In multivariate analyses, cataract extraction was associated with significantly increased overall mortality (RR = 1.37, 95 percent CI: 1.13, 1.66), which was entirely explained by the increased mortality from cardiovascular disease (RR = 1.84, 95% CI: 1.29, 2.64). These findings are compatible with current hypotheses relating oxidative damage and tissue aging to the development of cataract and CHD.

Cataract↗
PubMed1993

Cataract surgical techniques.

Cataract surgery continues to evolve as modifications in techniques are introduced. Extracapsular surgery, whether by phacoemulsification or planned extracapsular cataract extraction, is a very safe and effective technique. Maintaining versatility in operative techniques, depending on the clinical situation, is a distinct challenge for the cataract surgeon. Adequate surgical planning, coupled with meticulous surgical technique, gives optimal results. Innovations in wound architecture provide intraoperative and postoperative advantages to the surgeon and to the patient. Capsulorhexis is the preferred method of capsulotomy in phacoemulsification and planned extracapsular cataract extraction. Hydrodissection and related techniques are useful in all types of extracapsular cataract extraction. This article reviews techniques in cataract surgery with an emphasis on the recent literature.

Cataract↗
PubMed2002

Cataracts associated with systemic disorders and syndromes.

This review article examines the ophthalmic literature published on cataracts and systemic disease during the past year. Epidemiologically, the association between alcohol consumption and lens opacification is reviewed. Cataracts continue to be strongly associated with systemic diseases such as diabetes mellitus. Clinical, basic science reports and the results of the Blue Mountains Eye Study group on the morphology of diabetes-related cataracts are presented. Patients with neurologic disorders such as Wilson disease may first present with decreased vision and cataracts. Cataracts are now associated with syndromes such as Cohen syndrome, Degos disease, and Dubowitz syndrome. A recent study suggests earlier mortality in middle-age patients undergoing cataract surgery.

Cataract↗
PubMed1989

Prediction of visual function behind cataract using displacement threshold hyperacuity.

Visual acuity and displacement threshold hyperacuity were measured in a group of patients awaiting cataract extraction, and this was repeated several weeks subsequent to surgery. In addition, measurements were made on a group of patients with various ocular pathologies but without the presence of cataract. Displacement thresholds in the cataract group increased only slightly with the severity of the opacity. On the other hand, displacement thresholds for the pathology group showed a marked dependence upon visual acuity--the worse the acuity, the higher the threshold. This results in a clear distinction between vision loss due to optical factors (cataract) and retinal/neural factors. There was a good correlation between pre- and post-operative displacement thresholds in the cataract group, with post-operative thresholds being slightly better than pre-operative thresholds. The results suggest that this technique may offer patients a good indication of the likely quality of vision achieved following cataract extraction.

Aged↗
PubMed2006

Effect of cataract surgery on falls and mobility in independently living older adults.

OBJECTIVES: To determine the effect of cataract surgery on the occurrence of falls and mobility and balance problems in older adults with cataract. DESIGN: Longitudinal follow-up study. SETTING: Clinical Research Unit, University of Alabama at Birmingham. PARTICIPANTS: Persons aged 55 and older with a cataract were recruited from 12 eye clinics in Alabama from October 1994 through March 1996. Participants were classified into two groups: those who had cataract surgery (surgery group, n=122) and those who had not (no-surgery group, n=92). MEASUREMENTS: At baseline and 1-year follow-up visits, information on the occurrence of falls and mobility and balance problems was collected based on subjects' recall of events during the prior 12 months. RESULTS: After adjusting for demographic, behavioral, medical, and visual characteristics, there was no difference between the two groups in the likelihood of falling (risk ratio (RR)=0.96, 95% confidence interval (CI)=0.64-1.42) or in having mobility (RR=0.81, 95% CI=0.55-1.18) or balance difficulties (RR=0.71, 95% CI=0.37-1.39). CONCLUSION: Cataract surgery had no association with the occurrence of falls or mobility or balance problems in independently living older adults with a cataract.

Accidental Falls↗
PubMed1996

Cataract extraction in Behçet's disease.

Cataract is one of the most common complications of ocular inflammation due to Behçet's disease. A retrospective clinical trial was performed to review the management and discuss the outcome of cataract extraction in patients with Behçet's disease in order to find the best method of treatment. Fifty-five eyes of 40 patients were included into the study group. The surgical methods used were intracapsular cataract extraction (ICCE), extracapsular cataract extraction (ECCE), extracapsular cataract extraction+intraocular lens (ECCE+IOL), and extracapsular cataract extraction+trabeculectomy (ECCE+T). The postoperative visual prognosis was not satisfactory with any of the surgical methods because of the severe posterior segment complications of ocular Behçet's disease, particularly optic atrophy.

Adolescent↗
PubMed2004

Exfoliation syndrome in Estonian patients scheduled for cataract surgery.

PURPOSE: To examine the frequency of exfoliation syndrome (XFS) in Estonian patients scheduled for cataract surgery. METHODS: A series of 305 patients (mean age 71.5 +/- 8.6 years) scheduled for cataract surgery were examined for the presence of exfoliation syndrome, predominant type of lens opacification and intraocular pressure (IOP). RESULTS: Exfoliation material was detected in 108 (35.4%) patients, of whom 51 (47.2%) were bilaterally and 57 (52.8%) were unilaterally affected. In the bilaterally phakic patients exfoliation material was detected in 92 (30.2%) patients, of whom 51 (55.4%) were bilaterally and 41 (44.6%) were unilaterally affected. Intraocular pressure was higher in eyes with exfoliation than in eyes without it (19.2 +/- 6.5 mmHg and 17.1 +/- 3.8 mmHg, respectively; p = 0.006). Nuclear sclerosis predominated in eyes with XFS compared to those without XFS (57.6% and 36.9%, respectively). Cortical (7.6%) and subcapsular (7.6%) cataracts were less common in eyes with XFS than in eyes without XFS (16.9% and 20.2%, respectively). Mature cataract was found in 41.3% of all mixed types of cataracts. CONCLUSION: Exfoliation syndrome is common in Estonian patients. It was detected in 35.4% of the patients scheduled for cataract surgery.

Adult↗
PubMed1981

A change in indications for cataract surgery? A 10 year comparative epidemiologic study.

A change in the indications for cataract surgery might be one of the many reasons for the steady increasing number of cataract extractions. A comparison between the indications for surgery in a group of cataract patients from 1970 and a similar group from 1980 was done. In bilateral cataracts, evaluated on basis of visual acuity in both eyes, no widening of the indications for cataract surgery could be found. In monaphakics, going to be operated on the second eye, visual acuity in both eyes revealed no change, but we do operate more second eye cataracts now, 41% against 25% in 1970, which means that monaphakia is in itself considered a stronger indication for surgery in the second eye than it was 10 years ago. Acknowledgment of the difficulties of being monaphakic, refinements of extraction techniques and increased requirements for better vision among the elderly population might explain this altered attitude towards monaphakia.

Adult↗
PubMed1989

Idiopathic presenile cataract formation and galactosaemia.

Five hundred patients undergoing cataract surgery were prospectively examined, and 46 Caucasian patients were found to have strictly idiopathic cataracts severe enough to warrant surgery on or before age 55. In a masked fashion we determined the activity of galactokinase (GK) and galactose-1-phosphate uridyl transferase (GPUT) in these patients as well as on 53 age matched controls. With respect to GK no cataract patient had an enzyme level of less than 2 standard deviations below the control mean. However, 3 of 45 (6.7%) patients in the cataract group had a GPUT level less than 2 standard deviations below the mean for controls, and were presumably heterozygotes for this enzyme. In comparison with the expected population rate of 0.8% this is highly significant (p = 0.006). Abnormalities in galactose pathway enzymes may therefore predispose to development of presenile cataracts. In affected people there is a possibility of treating these patients clinically by dietary restriction of dairy products or by using aldose reductase inhibitors to prevent or reverse cataract formation.

Adult↗