Objectives To evaluate the 3-and 5-year incidence of posterior capsule opacification (PCO) and neodymium-doped yttrium aluminium garnet (Nd:YAG) capsulotomy in patients following cataract surgery, comparing results for different single-piece acrylic hydrophilic and hydrophobic monofocal intraocular lens (IOL) models and other patient factors. Patients and methods Electronic medical record data collected from seven United Kingdom (UK) National Health Service (NHS) ophthalmology clinics for routine, age-related (≥65 years) cataract surgeries that implanted single-piece acrylic monofocal IOLs during 2010-2013 were used to calculate 3-and 5-year incidence of Nd:YAG and PCO. IOL models of Alcon Acrysof, AMO Tecnis, Bausch & Lomb (B & L) Akreos, LenStec Softec, and Rayner Flex were analyzed. Pairwise comparisons were conducted between AcrySof IOLs and other IOLs using Bonferroni adjustment for multiplicity. Multivariate analyses were conducted adjusting for known confounders. Results The incidence of Nd:YAG capsulotomy ranged between 2.4-12.6% at 3 years and 5.8-19.3% at 5 years postcataract surgery. Similarly, the incidence of PCO ranged between 4.7-18.6% at 3 years and 7.1-22.6% at 5 years. When comparing all of the single-piece IOLs, AcrySof demonstrated the lowest incidence rates for both PCO and Nd:YAG (P < 0.001 for each comparison). From adjusted logistic regression analysis, AcrySof were associated with lower 3-and 5-year odds of Nd:YAG and PCO incidence. Conclusions Following cataract surgery with single-piece monofocal IOLs different incidence rates of PCO were observed with different IOLs. AcrySof IOLs were associated with significantly lower incidence of PCO requiring Nd:YAG treatment over periods of 3 and 5 years.

PurposeTo evaluate 3-year incidence of Nd:YAG capsulotomy and PCO and compare the effect of different IOL materials.MethodsData were retrospectively collected from seven UK ophthalmology clinics using Medisoft electronic medical records. Eyes from patients ≥65 years undergoing cataract surgery with implantation of acrylic monofocal IOLs during 2010–2013 and 3-year follow-up were analysed. Nd:YAG capsulotomy and PCO incidence proportions were reported for 3 IOL cohorts: AcrySof, other hydrophobic and hydrophilic acrylic IOLs. Unadjusted/adjusted odds ratios (OR) of Nd:YAG capsulotomy were calculated through logistic regression for non-AcrySof cohorts versus AcrySof. A sub-group analysis in single-piece IOLs (>90% of sample eyes) was also performed.ResultsThe AcrySof cohort included 13,329 eyes, non-AcrySof hydrophobic 19,025 and non-AcrySof hydrophilic 19,808. The 3-year Nd:YAG capsulotomy incidence (95% CI) for AcrySof (2.4%, 2.2–2.7%) was approximately two times lower than non-AcrySof hydrophobic IOLs (4.4%, 4.1–4.7%) and approximately fourfold lower than non-AcrySof hydrophilic IOLs (10.9%, 10.5–11.3%). Trends were similar in PCO incidence (AcrySof: 4.7%; non-AcrySof hydrophobic: 6.3%; non-AcrySof hydrophilic: 14.8%). Also in the analysis restricted to single-piece IOLs, the pattern remained (2.4% vs 5.1% vs. 10.9%, respectively). Adjusted regression analysis showed a approximately two and fivefold increased odds of Nd:YAG for non-AcrySof hydrophobic and hydrophilic acrylic IOLs respectively vs. AcrySof IOLs. Nd:YAG capsulotomy ORs were similar and remained statistically significant in the single-piece IOL sub-group.ConclusionsReal-world evidence shows that within 3 years following implantation, AcrySof IOLs are significantly superior in reducing Nd:YAG capsulotomy and PCO incidence compared to other hydrophilic and hydrophobic acrylic IOLs.

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There is a significant burden of preoperative astigmatism in the UK cataract population. The available refraction data indicate that this burden is not reduced after surgery with implantation of standard monofocal IOLs. Measures should be taken to improve visual outcomes of patients with astigmatic cataract by simultaneously correcting astigmatism during cataract surgery.

PurposeTo systematically review the published evidence on the prevalence and economic and humanistic burden of astigmatism in cataract patients.Materials and methodsFor this systematic literature review, the Medline, PubMed, Embase, and Cochrane databases were searched from 1996 to September 2015 for available scientific literature that met the inclusion criteria. Studies published in the English language reporting prevalence and humanistic and economic burden in patients diagnosed with cataract and astigmatism were included.ResultsOf 3,649 papers reviewed, 31 studies from 32 publications met the inclusion criteria of this review. Preexisting astigmatism ≥1 D was present in up to 47% of cataract eyes. The cost burden of residual uncorrected astigmatism after cataract surgery was driven by the cost of spectacles, which was estimated to range from $2,151 to $3,440 in the US and $1,786 to $4,629 in Europe over a lifetime. In cataract patients, both preexisting and postoperative residual astigmatism were associated with poor vision-related patient satisfaction and quality of life, as well as higher spectacle burden. Astigmatism correction during cataract surgery appears to improve visual outcomes and results in overall lifetime cost savings compared to astigmatism correction with postoperative vision correction.ConclusionThere is a high prevalence of preexisting astigmatism in cataract patients. Although published data are limited, both preoperative astigmatism and postoperative residual astigmatism affect visual function and vision-related quality of life, resulting in increased humanistic burden. Suboptimal correction of astigmatism during cataract surgery drives the continuous need for vision correction with spectacles in the postoperative period. Patients must bear the out-of-pocket expenses, since payers often do not reimburse the cost of spectacles. Greater access to astigmatism correction during cataract surgery could improve visual outcomes and quality of life in patients. More research is required to gain a better understanding of the disease burden of astigmatism in cataract patients.

Objective The purpose of this study was to evaluate the impact of different intraocular lens materials (IOL) and optic edge designs on the incidence of Nd:YAG laser capsulotomy. Methods Randomized controlled trials (RCTs) reporting incidence of Nd:YAG capsulotomy in patients with monofocal IOLs were identified for systematic literature review (SLR) using Cochrane methodology. A network meta-analysis was conducted under a Bayesian framework. Mean hazard ratios (HRs), 95% credible intervals, and one-sided p-values were estimated for Nd:YAG capsulotomy incidence by comparing AcrySof IOLs with a group of non-AcrySof hydrophobic acrylic, hydrophilic acrylic, silicone, and PMMA IOLs. Sensitivity analysis was conducted comparing the risk of Nd:YAG capsulotomy between sharp- and round-edged designs of the above IOLs. Results AcrySof IOLs had a lower risk of Nd:YAG capsulotomy compared to hydrophobic acrylic (HR: 2.68; 95% CrI: 1.41, 4.77; p < 0.01), hydrophilic acrylic (HR: 7.54; 95% CrI: 4.24, 14.06; p < 0.001), PMMA (HR: 3.64, 95% CrI: 1.87, 6.33; p < 0.001), and silicone (HR: 1.13; 95% CrI: 0.59, 1.91; p <0.1) IOLs. The risk for Nd:YAG was highest among sharp-edged IOLs for hydrophilic acrylic IOLs (HR: 9.32; 95% CrI: 4.32, 19.29; p < 0.01), followed by other hydrophobic acrylic (HR: 2.91; 95% CrI: 1.27, 5.88; p < 0.01), silicone (HR: 0.838; 95% CrI: 0.328, 1.74; p = 0.69), and PMMA (HR: 0.39; 95% CrI: 0.042, 1.49; p = 0.93) IOLs, compared to AcrySof. Acrysof IOLs had a lower risk of Nd:YAG compared to PMMA (HR: 3.25; 95% CrI: 1.21, 7.37; p < 0.01) and silicone, round edge IOLs (HR: 3.84; 95% CrI: 1.08, 10.64; p = 0.015). Conclusion The risk of Nd:YAG capsulotomy is lower in eyes implanted with AcrySof IOLs compared to non-AcrySof hydrophobic or hydrophilic acrylic IOLs. Sharp-edged AcrySof, PMMA, and silicone IOLs are comparable in terms of reducing the risk of Nd:YAG laser capsulotomy.

Purpose: This study compared real-world safety and efficacy outcomes of cataract surgery performed with LenSx femtosecond laser-assisted cataract surgery or manual phacoemulsification cataract surgery procedures. Methods: A retrospective observational study used data from anonymised electronic medical records to compare mean cumulative dissipated energy, the proportion of eyes reaching emmetropia, mean change in best-corrected distance visual acuity and the proportion of eyes with post-surgical complications, including corneal oedema and posterior capsule opacification. Results were adjusted for multiple comparisons for primary and secondary objectives. Results: Data from 811 phacoemulsification cataract surgery and 496 femtosecond laser-assisted cataract surgery procedures were analysed. Mean cumulative dissipated energy was significantly lower for femtosecond laser-assisted cataract surgery (6.5 percent-seconds) than for phacoemulsification cataract surgery (14.3 percent-seconds; p < 0.0001) procedures. More femtosecond laser-assisted cataract surgery (81.2%) procedures achieved emmetropia (⩽ 0.5 dioptre) than did phacoemulsification cataract surgery (73.5%) procedures, although this difference was not statistically significant. Mean change in best-corrected distance visual acuity and the proportion of eyes with corneal oedema, posterior capsule opacification or other complications were not significantly different between cohorts when adjusted for multiple comparisons. Conclusions: In this single-centre, single-surgeon retrospective electronic medical record database study using divide and conquer technique, femtosecond laser-assisted cataract surgery was associated with significantly lower cumulative dissipated energy when compared to manual phacoemulsification cataract surgery. This supports the hypothesis that femtosecond laser-assisted cataract surgery involves less mechanical trauma, which might lead to more consistent refractive and safety outcomes than manual phacoemulsification cataract surgery, though such outcomes were found to be comparable in this study.

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