Prevalence of cataract and cataract surgery in urban and rural Chinese populations over 50 years old: a systematic review and Meta-analysis

AIM: To summarize the data of epidemiological studies on cataract prevalence over 50 years old in urban and rural areas of China from 2000 to 2020, and to analyze the prevalence of cataract and operation rate in China. METHODS: By searching PubMed, EMBASE, Web of Science, Wanfang Data and CNKI, Chinese and English literatures on the prevalence of cataract in China were retrieved, and the relevant characteristic data were extracted. Then, Stata v15SE software was used for Meta-analysis and heterogeneity test. According to the results of heterogeneity, the corresponding effect models were selected to combine the extracted data. RESULTS: A total of 20 studies were included in this study, with a total of 111 434 cases. Meta-analysis showed heterogeneity. According to the random effect model, the overall prevalence of cataract in Chinese people over 50 years old was 27.45%, that in rural was 28.79%, and that in urban was 26.66%. The overall coverage rate of cataract surgery was 9.19%. CONCLUSION: The prevalence of cataract is high in China, and there is still room for improvement in surgical coverage, so it is very important to promote cataract screening and prevention.

Preoperative Biometry and Uncorrected Visual Outcome Following Cataract Surgery at a Teaching Hospital at Western Part of Nepal

Introduction: Proper preoperative biometry in cataract surgery provides expected postoperative uncorrected visual outcome. Astigmatism is one of the major problems to achieve best postoperative unaided visual acuity. Aims: To determine the distribution of biometric parameter and unaided visual outcome in the cataract patients operated at Nepalgunj medical college, Banke, Nepal. Methods: The patients who underwent cataract surgery between January 2019 and December 2020 at Nepalgunj medical college were studied. Patient’s demographic parameter, keratometric value, anterior chamber depth, lens thickness and axial length data, type of surgery, preoperative and post-operative visual acuity and other clinical details were collected and analyzed. Results: This study enrolled 261 eyes of 261 patients who had undergone cataract surgery. The mean age of patients was 60.8 ± 14.62 years. The mean corneal astigmatism was 1.30±1.43 D. Corneal astigmatism was higher than 1.00 D in almost 40% of cases. With-therule astigmatism was the most common type (46.4%) of astigmatism observed in this study. The mean average keratometry was 44.83±2.05 D. The mean preoperative LogMAR VA of 1.52±0.83 improved to 0.48 ± 0.48 postoperatively without statistically significant differences between manual small incision cataract surgery and phacoemulsification technique (p=0.496). Conclusion: The biometric data helps to improve surgical procedure and select most appropriate intraocular lens to attain maximal postoperative uncorrected visual acuity following cataract surgery. This study found superior convention incision is better for cataract surgery with equivalent visual outcome following manual small incision cataract surgery and phacoemulsification.

Triad of rubric assessment, constructive feedback and video recorded surgeries key assessment for competent ophthalmic surgeon

Ophthalmic surgery involves very precise surgical skill, which is difficult to teach and even more cumbersome in assessment of resident’s surgical skill. Hence it’s a need of time to adopt newer tool for transferring as well as assessing surgical skill. With this concept in mind International Council of Ophthalmology (ICO) has developed various tools for assessing surgical skills. If we use this tool not only as learning tool but also to give constructive feedback on the surgical skills of resident doctors it will help in creating a competent ophthalmic surgeon and eventually help society in general. 1To develop more standardized surgical training; 2. To assess efficacy and feasibility of new tool in improving surgical skills of Post Graduate(PG) student; 3. To know the effect of constructive feedback on surgical performance. Small incision cataract surgery training is done by Rubric designed by ICO- OSCAR. The same tool was used to assess video recorded cataract surgery of residents by different faculties and assess their surgical skill. The assessor simply circled the observed performance description at each step of the procedure. The ICO-OSCAR score was completed. At the end of the case assessor immediately discussed operated case with student to provide timely, structured, specific performance feedback. Oscar score was recorded and analysed with inter rater agreement. OSCAR TOOL has very good inter rater agreement i.e.(0.96). Analysis of student & Observer feedback infers that OSCAR Tool is best tool for learning as well as assessment tool and is easy to use. Recorded surgeries & constructive feedback from assessor helped Post Graduate students to improve surgically. This resulted in best outcome for patient in terms of good visual acuity post operatively. The formative assessment of surgical skills becomes an integral part of our formal residency, training framework, it would be in the interest of our trainees and trainers that we should adopt the OSCAR tools to train and assess. These tools can add immense value to our residency as well fellowship surgical training and possibly help create a generation of competent trainee.Formative Assessment and constructive feedback in surgical training will improve the competency of new ophthalmic surgeons.Structured surgical training will be relatively easy to observe and perform, as trainee learns what is required to be competent.This will ultimately improve the overall quality of patient care.

Accuracy and predictability of novel MS Excel-based surgically induced astigmatism calculator

Study of steepening, flattening, clockwise, and counter-clockwise torque effect is indispensable to understand and design surgical induced astigmatism calculator. Hence, in this study by constructing a novel Microsoft Office Excel 2007 based astigmatic calculator following cataract surgery, analysis on the accuracy and predictability evaluated for the performance. Post-cataract surgery patients from May 2019 to January 2020 at a tertiary medical institution recruited for this present study. Based on Pythagoras principle, MS Excel calculator designed and the law of cousins for calculating the vector magnitude and axis respectively. Manual keratometry measurements for pre and postoperative horizontal (Kh) and vertical (Kv) curvatures established, and statistical analysis for the resultant SIA magnitude and axis deduced with Medcalc software comparing with the existing SIA 2.1 version calculator. A total of 29 eyes of 25 patients studied with a mean age of 62.55 (±8.08) years, males contributing to 14 (56%), and right laterally in 17 (58%) eyes. MS Excel and SIA 2.1 versions calculated a mean SIA magnitude of 0.66 (±0.47) D and 0.64 (±0.55) D respectively. Pearson coefficient correlation (r=-0.16, p=0.40), paired-two sample test (t value= 0.11, p= 0.91) and ROC curve analysis (AUC = 0.75, p= 0.34, 95% CI= 0.25 to 0.99) calculated. Regression equation (y = 0.75 + -0.14 x) and limits of agreements (95% CI -0.29 to 0.31) analyzed, and, 95% of data points distributed within ±1.96 SD of the line of equality on Bland-Altman difference plots.The present calculator proclaimed an acceptable accuracy and agreement with a prediction of 0.61 Diopter for every unit change in the magnitude of SIA 2.1 software in addition to consideration of interchangeability.

To determine functional visual improvement after cataract surgery in eyes with age related macular degeneration

To determine whether patients with Age related macular degeneration (ARMD) benefit from cataract surgery in terms of best corrected visual acuity (BCVA) and to assess impact of surgery on progression of ARMD.: A prospective study was carried out of patients with and without ARMD undergoing cataract surgery at our department. Patients were divided into two groups- Group A (cases) with ARMD and Group B (controls) without ARMD and other retinal pathology. BCVA of cases was recorded on day 1, day 14, 1 month and 1/month and compared to that of controls.: BCVA significantly improved but markedly less than that experienced by control eyes. No increased incidence in progression to wet form of ARMD. Cataract surgery is safe in ARMD patients with no evidence of increased complications or rates of disease advancement.

Changes in macular thickness post uncomplicated MSICS & phacoemulsification surgery

To evaluate changes in macular thickness via-a-vis visual acuity post uncomplicated manual small incision cataract surgery (MSICS) & phacoemulsification surgery Prospective clinical study on 160 patients of uncomplicated immature senile cataract, aged 40-70yrs, patients were randomised into two groups, MSICS & phacoemulsification, by simple 1:1 randomization, who underwent uncomplicated cataract surgery with posterior chamber intraocular lens (PCIOL). Post-operatively, the patients were evaluated for best corrected visual acuity (BCVA) and changes in macular thickness by optical coherence tomography (OCT) at post-op Day 1, 7, 21, 48, and 12 weeks. Paired t-test was used for comparison across follow up. : At 12 weeks post-operative, mean logMAR BCVA was 0.01±0.02 for MSICS group and 0±0.02 for Phacoemulsification group. Macular thickness was not statistically significant (p=0.342) between MSICS group (219.19±17.88µm) and Phacoemlusification group (215.61±16.21µm), at the end of 12 weeks post-operative. Clinically significant macular oedema was not diagnosed in any of the patients at the follow-ups.: Both procedures achieved good post-operative Best Corrected visual acuity without significant differences in BCVA between both the groups at the end of 12 weeks.

Effect of heparin sodium on postoperative inflammation after adult cataract surgery

To evaluate the effect of use of ringer lactate solution supplemented with heparin sodium in patients undergoing cataract surgery.In a prospective, double-blind, interventional study, 200 patients were included and were randomized to undergo cataract surgery using ringer lactate solution with or without 10 IU/ml heparin. All patients underwent phacoemulsification with hydrophobic acrylic foldable intraocular lens (IOL) implantation. The severity of anterior chamber inflammation and amount of pigment deposition of IOL was assessed by slit lamp biomicroscopy on day 1, 7, 28 and after 8 weeks postoperatively. Mean age in treatment and control group was 63.0± 11.5 years and 65.1±12.7 years respectively. A significant reduction in the severity of inflammatory cellular activity (p=0.001), flare (p=0.001) and pigment deposition on IOL (p=0.001) was noted on day 1 in the heparin treated group compared to the control group. However, no significant difference was observed in the amount of inflammatory activity as well as IOL pigment deposition beyond 1 week postoperatively. The inflammatory activity resolved almost completely in both the groups by the end of 8 weeks postoperatively. : Our study showed the beneficial effect of addition of heparin to irrigating solution during cataract surgery. Heparin treated eyes demonstrated a reduction in the early postoperative inflammation and IOL pigment deposition. The anti-inflammatory effect was observed in the early postoperative period.

Visual outcomes in pediatric traumatic cataract

To study epidemiology, biometry and visual outcomes (with or without posterior capsulorhexis) in cases of pediatric traumatic cataract. This was a prospective observational study conducted on 30 children of traumatic cataract belonging to an age group of less than 16 years. All patients were subjected to detailed history and ocular examination. Patients underwent cataract surgery with or without intraocular lens (IOL) implantation. Posterior capsulorhexis with posterior optic capture was done in all patients presenting with primary posterior capsular opacity. All patients were followed up till 6 months and surgical outcomes in terms of Best Corrected Visual Acuity (BCVA), and visual axis opacification (VAO) were observed. Firecracker injury was found to be the most common causal agent, followed by arrow and ball injuries. Males were more commonly injured than females (70%:30%). Open-globe injury was more frequent than closed globe injury (CGI) (53.3%:46.7%). Anterior capsular rupture was the most frequent preoperative complication. Mean axial length was 22.53 which was not significantly different from the fellow eye. 3 patients were left aphakic, 10 patients underwent single piece IOL implantation and 16 patients underwent multipiece IOL implantation. Anterior chamber IOL (ACIOL) was implanted in one case. Intraoperatively 6 patients were found to have posterior capsular plaque and were implanted with multipiece IOL with posterior optic capture. Visual acuity significantly improved in 21 out of 30 eyes from baseline after cataract surgery (p<0.001). 9 patients (30%) had posterior capsular opacification (PCO) on follow up. Posterior capsular opacity in pediatric traumatic cataracts can be effectively managed with posterior capsulorhexis and posterior optic capture.

National trends in surgical subspecialisation in ophthalmology in the USA

Background/aimsTo assess surgical patterns in ophthalmology by subspecialty in the USA.MethodsOphthalmic surgeons were categorised as comprehensive/subspecialist based on billed procedures in the 2017–2018 Medicare Provider Utilization and Payment Data. Poisson regression models assessed factors associated with physicians performing surgeries in the core domain (eg, cataract extractions) and subspecialty domain. Models were adjusted for provider gender, time since graduation, geographical region, practice setting and hospital affiliation.ResultsThere were 10 346 ophthalmic surgeons, 74.7% comprehensive and 25.3% subspecialists. Cataract extractions were performed by 6.0%, 9.9%, 21.0%, 88.1% and 95.3% of specialists in surgical retina, neuro-ophthalmology/paediatrics, oculoplastics, glaucoma and cornea, respectively. Retina specialists were more likely to perform cataract surgery if they were 20–30 or>30 years in practice (relative risk: 2.20 (95% CI: 1.17 to 4.12) and 3.74 (95% CI: 1.80 to 7.76), respectively) or in a non-metropolitan setting (3.78 (95% CI: 1.71 to 8.38)). Among oculoplastics specialists, male surgeons (2.71 (95% CI: 1.36 to 5.42)), those in practice 10–20 years or 20–30 years (1.93 (95% CI: 1.15 to 3.26) and 1.91 (95% CI: 1.11 to 3.27), respectively) and in non-metropolitan settings (3.07 (95% CI: 1.88 to 5.02)) were more likely to perform cataract surgery. Only 26 of the 2620 subspecialists performed surgeries in two or more subspecialty domains.ConclusionsThere is a trend towards surgical subspecialisation in ophthalmology in the USA whereby some surgeons focus their surgical practice on subspecialty procedures and rarely perform surgeries in the core domain.