Recurring themes during cataract assessment and surgery

Abstract

The aim of this review was to discuss frequently encountered themes such as cataract surgery in presence of age-related macular degeneration (AMD), dementia, Immediate Sequential Bilateral Cataract Surgery (ISBCS), discussing non-standard intraocular lens (IOL) options during consultation in the National Health Services (NHS) and the choice of the biometric formulae based on axial length. Individual groups of authors worked independently on each topic. We found that cataract surgery does improve visual acuity in AMD patients but the need for cataract surgery should be individualised. In patients with dementia, cataract surgery should be considered 'sooner rather than later' as progression may prevent individuals presenting for surgery. This should be planned after discussion of patients' best interests with any carers; multifocal IOLs are not proven to be the best option in these patients. ISBCS gives comparable outcomes to delayed sequential surgeries with a low risk of bilateral endophthalmitis and it can be cost-saving and efficient. Patients are entitled to know all suitable IOL options that can improve their quality of life. Deliberately withholding this information or pressuring patients to choose a non-standard IOL is inappropriate. However, one should be mindful of the not spending inappropriate amounts of time discussing these in the NHS setting which may affect care of other NHS patients. Evidence suggests Hoffer Q, Haigis, Hill-RBF and Kane formulae for shorter eyes; Barrett Universal II (BU II), Holladay II, Haigis and Kane formulae for longer eyes and BU II, Hill-RBF and Kane formulae for medium axial length eyes.

Axial Length Distributions in Patients With Genetically Confirmed Inherited Retinal Diseases

“…The mean ± SD AL for all patients was 24.03 ± 2.00 mm. Taking the broadly normal range for AL as ∼22 to 26 mm, 19 – 25 , 27 there were no conditions in this cohort with mean AL below the lower limit of this range, but for four conditions the mean AL was above the upper limit of this range.…”

“…The particular cut-offs were chosen as these are frequently used to define short and long eyes, particularly in clinical contexts, such as in the planning of cataract surgery and lens replacement. 19 – 25 …”

Practice of immediate sequential bilateral cataract surgery (ISBCS): A teaching hospital experience in United Kingdom

“…Our experience in Sheffield promoted routine listing of ISBCS in an NHS public teaching hospital in the UK and showed that in the one-year period following the reopening of cataract service from the initial COVID-19 pandemic wave, 6.1% (208/3402 eyes) of cataract operations performed were ISBCS with the vast majority of cases performed under LA (89%) in contrast to 11% under GA. A recent review by Chandra et al confirmed ISBCS is a sustainable alternative to DSBCS with comparable clinical and refractive outcomes as well as extremely low rates of bilateral endophthalmitis. 13 ISBCS has been increasingly favoured by patients demonstrated on a patient survey in NHS. 14 From patients' perspective, it helps to improve patient and family convenience and to reduce required hospital visits for preoperative and post-operative assessments.…”

“…A recent review by Chandra et al confirmed ISBCS is a sustainable alternative to DSBCS with comparable clinical and refractive outcomes as well as extremely low rates of bilateral endophthalmitis. 13 ISBCS has been increasingly favoured by patients demonstrated on a patient survey in NHS. 14 From patients’ perspective, it helps to improve patient and family convenience and to reduce required hospital visits for pre-operative and post-operative assessments.…”