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Cataract Patients (cataract + patient)
Selected AbstractsCoping as a mediator between personality and stress outcomes: a longitudinal study with cataract surgery patientsEUROPEAN JOURNAL OF PERSONALITY, Issue 3 2005Nina Knoll Personality and coping were specified as predictors of emotional outcomes of a mildly stressful medical procedure. Situation-specific coping was examined in contrast to dispositional coping, and it was tested whether one or the other would mediate the relationship between higher-order personality factors and stress outcomes. Cataract patients (N=110) participated at four measurement points in time during a six-week period surrounding their scheduled surgery. Dispositional coping did not mediate the personality,outcome relationship. In contrast, situation-specific coping acquired a mediator status between personality and adaptational criteria and accounted for independent outcome variance once personality traits were included as predictors in the models. Thus, the data suggest that whether or not coping mediates between personality factors and affective outcomes may be related to the methodological approaches of its operationalization. Copyright © 2005 John Wiley & Sons, Ltd. [source] 3421: Straylight and visionACTA OPHTHALMOLOGICA, Issue 2010TJTP VAN DEN BERG Purpose Straylight is considered an important source of patient complaints. They can be voiced like halos, glare, hazy vision and blinding at night. With visual acuity, contrast sensitivity and slit lamp examination little may be found. Yet increased large angle light scattering in the eye media not detected by common tests, may degrade the image projected on the retina, thus decreasing the quality of vision. Aging changes to the crystalline lens and cataract are the most common causes of increased straylight. This study aimed to quantify the importance of straylight for daily life on the basis of patient complaint scores. Methods In a duocenter setting questionnaires were administered before and after cataract surgery. The 37 questions VFQ as well as a self developed 5 question straylight questionnaire were used. A comparison was made between the importance of visual acuity and of straylight to explain the questionnaire outcomes. Results A total of 214 patients were included in the study. For the comparison correlation coefficients were calculated between a weighted average of the 2 functional measures visual acuity and straylight on the one hand, and the questionnaire outcomes on the other. In all 4 cases (2 questionnaires x 2 visits) correlation was lowest for both visual acuity and straylight used in isolation. When visual acuity and straylight were combined to one combined score, correlation improved. Maximum correlation was found when visual acuity and straylight were combined 1:1 (preop) to 2:1 (postop), for both questionnaires. Conclusion For cataract patients, straylight is of about equal importance compared to visual acuity for their appreciation of daily function. In this comparison both were quantified as logarithms (logMAR and log(s)). [source] 3425: Influence of cataract morphology on retinal straylight and straylight changes due to cataract surgery using the Morcher 89A Bag in the LensTMACTA OPHTHALMOLOGICA, Issue 2010MJ TASSIGNON Purpose To evaluate straylight and contrast sensitivity (CS) in eyes with various cataract morphologies, to determine which type of cataract presents a higher impairment of visual function with respect to proposed norms car driver safety and to compare retinal straylight and CS before and after implantation of a Morcher 89A IOL. Methods BCVA, CS and straylight were measured in 97 cataractous eyes using respectively a Snellen chart, a Pelli-Robson chart and the C-Quant. Cataracts were graded using the LOCS III scale and divided into four groups: nuclear, cortical, nuclear-cortical and posterior subcapsular cataract. These results were compared to data from 38 cataract-free control subjects. A separate group of 71 eyes had their straylight measured before and after cataract surgery. Results CS was reduced and straylight increased in all cataract patients, most notably in posterior subcapsular and nuclear-cortical cataract. CS and BCVA were correlated (r=0.44), whereas straylight and BCVA were not. Applying cut-off values as proposed by European drivers studies of l.25 log CS and 1.4 log straylight as safe margins for driving, 31% would be considered unfit to drive on the basis of CS and 78% on the basis of straylight although their visual acuity was still above the current European visual acuity requirement for driving. Retinal straylight reduced significantly from 1.560.26 to 1.250.22logunits (P<0.001) after IOL implantation . Conclusion Straylight and, to a lesser extent, CS are complementary to BCVA and should be taken into account when considering driving eligibility. After IOL implantation straylight reduces significantly, resulting in a significant increase in driving eligibility. [source] Increased anterior chamber penetration of topical levofloxacin 0.5% after pulsed dosing in cataract patientsACTA OPHTHALMOLOGICA, Issue 2 2009Karin Sundelin Abstract. Purpose:, This study aimed to investigate the rise in aqueous humour (AH) levels of levofloxacin after a specific perioperative pulsed topical drop regimen. Methods:, Thirty patients undergoing phacoemulsification surgery were administered two preoperative drops of levofloxacin 0.5%, 30 mins apart, and three pulsed drops postoperatively, 5 mins apart. Aqueous humour levels of levofloxacin were measured at the start of surgery and from 5 mins to 90 mins after the last postoperative drop. Samples from individual patients were collected at the time of surgery and at one additional sampling interval by aqueous tap, and analysed using a high-performance liquid chromatography assay. Results:, Aqueous humour levels of levofloxacin continued to rise gradually, reaching a mean peak level (Cmax) of 4.4 ,g/ml (± 2.5) at 60 mins after the last postoperative drop was administered. This level exceeded the minimum inhibitory concentration of common ocular pathogens at least fourfold. At 90 mins after the last drop, mean AH levels remained > 3 ,g/ml. Conclusions:, This is the first study to measure AH levels of levofloxacin after postoperative pulsed dosing in humans. Higher AH levels were found than in previously reported studies in which only preoperative drops were given and levels were measured at the time of surgery. Levels of levofloxacin continued to rise for 60 mins after administration of the last postoperative drop, demonstrating that delivery and maintenance of effective antibiotic levels may be achievable with alternative dosing schedules. [source] Determination of uric acid concentrations in human tear fluid, aqueous humour and serumACTA OPHTHALMOLOGICA, Issue 2 2009Jutta Horwath-Winter Abstract. Purpose:, The aim of this investigation was to assess and compare levels of uric acid in human tear fluid, aqueous humour and serum in cataract patients in order to obtain information about uric acid-dependent antioxidative status. Methods:, Reflex tear fluid, aqueous humour and serum were obtained from 103 cataract patients (52 women, 51 men). Uric acid was determined by a reversed phase chromatographic method with electrochemical detection. The Randox test was used to measure the contribution of uric acid to the total antioxidative status (TAS) of these body fluids. Results:, Mean concentrations of uric acid were 20 ± 8 ,g/ml in tear fluid, 18 ± 6 ,g/ml in aqueous humour and 58 ± 15 ,g/ml in serum. Significantly less uric acid was found in tear fluid (p < 0.01) and aqueous humour (p < 0.01) in female cataract patients compared with male cataract patients. There was a significant positive correlation between uric acid content in tear fluid, aqueous humour and serum, respectively (p < 0.01). The contribution of uric acid to TAS (Randox test) amounted to 38% in tear fluid, 10% in aqueous humour and 37% in serum. Conclusions:, Uric acid was found in comparable amounts in tear fluid and aqueous humour, but these were two- to threefold lower than in serum. Female cataract patients had lower uric acid values in tear fluid and aqueous humour compared with male cataract patients. Uric acid is an important antioxidant, as proven by its contribution to TAS as determined by the Randox test. The precise role of uric acid in the antioxidative reactions in tear fluid and aqueous humour is still under debate. [source] Subjective visual sensations during cataract surgery performed under topical anaesthesiaACTA OPHTHALMOLOGICA, Issue 8 2008Zsolt Biró Abstract. Purpose:, To examine the patient's subjective visual sensations during cataract surgery performed under topical anaesthesia. Methods:, Prospective, non-randomized, cohort study. One hundred and thirty-two patients were interviewed by standard questionnaire within 1 hr of uncomplicated cataract surgery performed under topical anaesthesia. Results:, Everyone saw lights of different and changing intensity. One hundred and twenty-six (95.5%) patients saw different colours; 18 (13.6%) patients saw a rainbow-like scale of colours. Ninety-eight (74.2%) patients could see clear shapes and forms (mainly circle, square, rectangle, ellipse). Forty-nine (37.1%) patients could see instruments, and 35 (26.5%) patients saw the fingers of the surgeon during surgery. Twenty-six patients (19.7%) considered the strong light of the microscope very disturbing and uncomfortable. Forty-seven patients made drawings of the visual sensations that they experienced during surgery. Conclusion:, Consistent with our review of the literature, we found no relation between intraoperative visual sensations and patient's age, sex, preoperative visual acuity, duration of surgery or cataract severity. We found that it is helpful to inform the cataract patients of potential visual sensations before their surgery. [source] Results from the International Cataract Surgery Outcomes StudyACTA OPHTHALMOLOGICA, Issue thesis2 2007Jens Christian Norregaard MD Abstract It is widely accepted that cataract extraction with intraocular lens implantation is a highly effective and successful procedure. However, quality assessments and studies of effectiveness should still be undertaken. As with any surgical treatment modality, complications may occur, leading to suboptimal outcomes, additional health costs and deterioration in patients' functional capacity. International variation in clinical practice patterns and outcomes can serve as important pointers in the attempt to identify areas amenable to improvements in quality and cost-effectiveness. Once demonstrated, similar clinical results obtained in different health care systems can improve the level of confidence in a clinical standard against which the quality of care can be evaluated. The International Cataract Surgery Outcomes Study was established in 1992. The objective of this international comparative research project was to compare cataract management, outcomes of surgery and quality of care in four international sites. The study was conducted in the 1990s, since when many developments and refinements have emerged within cataract surgery. The actual figures reported in this thesis may no longer be of specific relevance as a decade has passed since their collection. However, the research questions and methods used in the study are still highly important and justify the publication of this report. The report deals with problems related to quality assessment, benchmarking, and the establishment and design of nationwide clinical databases , issues that are currently the focus of much attention. Moreover, the problems related to cross-national comparisons are increasingly relevant as more international databases are established. The study makes suggestions on how to report and compare objective as well as subjective criteria for surgery. The issue of how to report subjective criteria is a particular subject of current discussion. Four sites with high-quality health care systems were examined in this study: the USA, Denmark, the Province of Manitoba (Canada), and Barcelona (Spain). The design of the international research programme was based on methods developed by the US National Cataract Surgery Outcomes Study conducted by the US Cataract Patients Outcomes Research Team. The International Cataract Surgery Outcomes Study comprised three separate studies: a survey of ophthalmologists; a prospective cohort study, and a retrospective register-based cohort study. The survey study was based on data generated by a self-administered questionnaire completed by ophthalmologists in the four study areas. The questionnaire examined routine clinical practice involving patients considered for cataract surgery, and included questions on anaesthesia, monitoring and surgical techniques. The prospective cohort study was a large-scale, longitudinal observational study of patients undergoing first-eye cataract surgery in each study site. Patients were sampled consecutively from multiple clinics and followed for 4 months postoperatively. The retrospective cohort study was based on the Danish National Patient Register and claims data from the USA. This study could not be carried out in Barcelona or Manitoba as no suitable administrative databases were available. The papers based on register databases deal with retinal detachment and endophthalmitis but are not included in this thesis as the material was previously reported in my PhD thesis. The application of the studies was highly co-ordinated among the four sites and similar methods and instruments were used for data collection. The development of the data collection strategy, questionnaires, clinical data forms and data analyses were co-ordinated through weekly telephone conferences, annual in-person conferences, correspondence by mail or fax, and the exchange of sas programs and data files via the Internet. The survey study was based on responses from 1121 ophthalmologists in the four sites and results were presented in two papers. Within the previous year the participating ophthalmologists had performed a total of 212 428 cataract surgeries. With regard to preoperative ophthalmic testing, the present study reveals that refraction, fundus examination and A-scanning were performed routinely by most surgeons in all four sites. Other tests were reported to be performed routinely by some surgeons. It is unclear why any surgeon would use these other tests routinely in cataract patients with no ocular comorbidity. It appears that if this recommendation from the US Clinical Practice Guidelines Panel was broadly accepted, the use of these procedures and costs of care could be reduced, especially in Barcelona, the USA and Canada. Restricted use of medical screening tests was reported in Denmark. If this restricted screening were to be implemented in the USA, Canada and Barcelona, it would have significant resource implications. The most striking finding concerned the difference in monitoring practice between Denmark and each of the other three sites. In Denmark, monitoring equipment is seldom used and only occasionally is an anaesthesiologist present during cataract surgery. By contrast, in the other study sites, the presence of an anaesthesiologist using monitoring equipment is the norm. Adopting the Danish model in other sites would potentially yield significant cost savings. The results represent part of the background data used to inform the decision to conduct the two large-scale, multicentre Studies of Medical Testing for Cataract Surgery. The current study is an example of how surveys of clinical practice can pinpoint topics that need to be examined in randomized clinical trials. For the second study, 1422 patients were followed from prior to surgery until 4 months postoperatively. Preoperatively, a medical history was obtained and an ophthalmic examination of each patient performed. After consent had been obtained, patients were contacted for an in-depth telephone interview. The interview was repeated 4 months postoperatively. The interview included the VF-14, an index of functional impairment in patients with cataract. Perioperative data were available for 1344 patients (95%). The 4-month postoperative interview and clinical examination were completed by 1284 patients (91%). Main reasons for not re-evaluating patients were: surgery was cancelled (3%); refusal to participate (2%); lost to follow-up (1%), and death or being too sick (1%). The results have been presented in several papers, of which four are included in this thesis. One paper compared the preoperative clinical status of patients across the four sites and showed differences in both visual acuity (VA) and VF-14 measures. The VF-14 is a questionnaire scoring disability related to vision. The findings suggest that indications for surgery in comparable patients were similar in the USA and Denmark and were more liberal than in Manitoba and Barcelona. The results highlight the need to control for patient case mix when making comparisons among providers in a clinical database. This information is important when planning national databases that aim to compare quality of care. A feasible method may be to use one of the recently developed systems for case severity grading before cataract surgery. In another paper, perioperative clinical practice and rates of early complications following cataract surgery were compared across the four health care systems. Once again, the importance of controlling for case mix was demonstrated. Significant differences in clinical practice patterns were revealed, suggesting a general trend towards slower diffusion of new medical technology in Europe compared with North America. There were significant differences across sites in rates of intra- and early postoperative events. The most important differences were seen for rates of capsular rupture, hyphaema, corneal oedema and elevated pressure. Rates of these adverse events might potentially be minimized if factors responsible for the observed differences could be identified. Our results point towards the need for further research in this area. In a third paper, 4-month VA outcomes were compared across the four sites. When mean postoperative VA or crude proportions of patients with a visual outcome of <,0.67 were compared across sites, a much poorer outcome was seen in Barcelona. However, higher age, poorer general health status, lower preoperative VA and presence of ocular comorbidity were found to be significant risk factors associated with increased likelihood of poorer postoperative VA. The proportions of patients with these risk factors varied across sites. After controlling for the different distributions of these factors, no significant difference remained across the four sites regarding risk of a poor visual outcome. Once again the importance of controlling for case mix was demonstrated. In the fourth paper, we examined the postoperative VF-14 score as a measure of visual outcomes for cataract surgery in health care settings in four countries. Controlling for case mix was also necessary for this variable. After controlling for patient case mix, the odds for achieving an optimal visual function outcome were similar across the four sites. Age, gender and coexisting ocular pathology were important predictors of visual functional outcome. Despite what seemed to be an optimal surgical outcome, a third of patients still experienced visual disabilities in everyday life. A measure of the VF-14 might help to elucidate this issue, especially in any study evaluating the benefits of cataract surgery in a public health care context. [source] The cost of cataract patients awaiting surgeryACTA OPHTHALMOLOGICA, Issue 6 2000Ulf Stenevi ABSTRACT. Purpose: To describe the cost for society services caused by the patients awaiting surgery for one year in Gothenburg, 1997. Methods: From a waiting list of 1458 patients awaiting cataract surgery 250 randomly selected patients were interviewed. The structured questions focused on community services, such as home help, subsidised travel by taxi, medical treatment at home, visual aids, hospital stay and medical consultation, caused by the cataract symptoms. Results: The total cost for the community for the 1 458 patients awaiting surgery was an estimated SEK 5 200 000. Hospital stay and home help were the largest parts of this community expense. Conclusion: The direct costs for society for one year caused by 1 458 patients awaiting cataract surgery with a mean waiting time of 9.8 months was approximately the same as operating 800 patients (eyes). [source] Ascorbic acid concentration is reduced in the secondary aqueous humour of glaucomatous patientsCLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 4 2009Mauro T Leite MD Abstract Background:, We aimed to evaluate the ascorbic acid concentration in secondary aqueous humour (AH) from glaucomatous patients and to compare it with primary AH from primary open-angle glaucoma patients and non-glaucomatous patients. Methods:, Primary AH samples were prospectively obtained from clinically uncontrolled primary open-angle glaucoma patients and senile cataract patients (controls) prior to trabeculectomy and cataract surgery. Secondary AH samples were obtained from eyes with previous intraocular surgery, prior to trabeculectomy or cataract surgery. AH (0.1 mL) was aspirated by inserting a 26-gauge needle into the anterior chamber just before surgery and then immediately stored at ,80°C. The ascorbic acid concentration was determined in a masked fashion by high-pressure liquid chromatography. Results:, A total of 18 patients with senile cataract, 16 glaucomatous patients with primary AH (no previous intraocular surgery) and 11 glaucomatous patients with secondary AH (previous intraocular surgery) were included. There was no difference in mean age between groups (P = 0.15). The mean ± standard deviation concentration of ascorbic acid in the secondary AH from glaucomatous patients (504 ± 213 µmol/L [95% confidence interval {CI}, 383,624]) was significantly lower than the concentration of ascorbic acid found in the primary aqueous of primary open-angle glaucoma (919 ± 427 µmol/L [95% CI, 709,1128]) and control patients (1049 ± 433 µmol/L [95% CI, 848,1249]; P < 0.01, Kruskal-Wallis test). Conclusions:, The ascorbic acid concentration in secondary AH of glaucomatous patients was approximately twofold lower in comparison with primary AH of glaucomatous and cataract patients. The implications of a reduced concentration of ascorbic acid in the secondary AH deserve further investigation. [source] Quantitative evaluation of corneal epithelial oedema by confocal microscopyCLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 3 2009Naoyuki Morishige MD PhD Abstract Background:, To develop a novel quantitative index for evaluation of corneal epithelial oedema, the pixel intensity of confocal microscopic images was measured derived from the basal cell layer (BCL) of the corneal epithelium in normal eyes, eyes before and after cataract surgery, and eyes affected by bullous keratopathy. Methods:, Five eyes of five normal volunteers, 14 eyes of 11 cataract patients and 12 eyes of 12 bullous keratopathy patients were examined by confocal microscopy. The cataract patients underwent cataract surgery, and they were examined by confocal microscopy, corneal pachymetry, and anterior fluorometry both before and at various times after surgery. The pixel intensity of BCL images obtained by confocal microscopy was measured and expressed as the BCL index. Results:, The coefficient of variation for repeated (five times) measurement of the BCL index in each of the five normal eyes was 3.4%. The BCL index was 54.8 ± 5.3 (mean ± SD) before surgery, increased significantly to 65.2 ± 10.0 on the day after surgery, and gradually decreased thereafter in the cataract patients. The time-course of the BCL index coincided well with that of corneal thickness and anterior fluorometry value. The BCL index in eyes affected by bullous keratopathy was significantly increased at 95.0 ± 6.4. Conclusion:, The BCL index was increased after cataract surgery and in eyes affected by bullous keratopathy, conditions associated with corneal epithelial oedema. This quantitative measure obtained by confocal microscopy may prove useful in the clinical evaluation of corneal epithelial oedema. [source] | ||||||||||