Light as a drug: prospective randomized evaluation and comparison of the effect of decreased illumination on visual recovery after cataract surgery

Abstract

Purpose: To compare the effect of decreased illumination on the rate of postoperative visual recovery, and the incidence of cystoid macular edema with surgical visualization achieved with a traditional analog operating microscope compared to a three-dimensional (3-D) digital visualization system. Setting: Ambulatory Surgery Center, New York Design: Prospective, randomized, consecutive, single surgeon series. Methods: Patients undergoing routine cataract surgery were randomized into either: (1) visualization via the binoculars of a standard operating microscope (“traditional group”), or (2) visualization via a 3-D digital visualization system affixed to the same operating microscope (“digital group”). Note was made in each case of light intensity utilized, light exposure time, cumulative dissipated energy (CDE), femtosecond laser use, preoperative medical and ocular conditions, intraoperative and/or postoperative complications, and pre- and postoperative visual acuities and optical coherence tomography confirmed cystoid macular edema (CME). Results: The study comprised 118 eyes in the traditional group and 96 eyes in the digital group. There were no differences in preoperative visual acuity, light exposure time, CDE, or femtosecond laser use between groups, but the light intensity utilized in the digital group was significantly less (19.5%±0.5%) than in the traditional group (48.6%±0.6%; p<0.001). Furthermore, the digital group achieved a better decimal postoperative day 1 visual acuity (0.60±0.03) with less rates of CME (2.1%) when compared to that of the traditional group (0.51±0.02,p=0.03; and 9.2%, p=0.03) respectively. Conclusions: Visual recovery and CME rates were significantly better in patients who underwent cataract surgery assisted by the 3-D digital visualization platform without an increase in complications or surgical time.