The Importance of Acuity, Stereopsis, and Contrast Sensitivity for Health-Related Quality of Life in Elderly Women with Cataracts

Datta, Sayan; Foss, Alexander; Grainge, Matthew J.; Gregson, R; Zaman, Anwar; Masud, Tahir; Osborn, F. David; Harwood, Rowan H.

doi:10.1167/iovs.06-1073

Cited by 75 publications

(83 citation statements)

References 29 publications

(26 reference statements)

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“…38 Binocular contrast sensitivity in cataract patients has been shown to correlate strongly with perceived visual disability. 35,39,40 Stereopsis Stereopsis (also referred to as stereoacuity or depth perception) refers to a person's ability to perceive the three-dimensional structure of the environment based on the different two-dimensional images captured by each eye. In normal vision, the brain is capable of measuring the disparity of vision between the two eyes and 'fusing' these into a single image to produce the sensation of depth.…”

Section: Contrast Sensitivitymentioning

confidence: 99%

“…Cataract in one or both eyes may therefore compromise a person's stereopsis. Suboptimal stereopsis has been shown to adversely affect motor skills, 42 performance with everyday tasks, 35 driving ability 40 and risk of falls in the elderly. 43 Stereopsis is assessed by measuring the smallest lateral displacement (or 'disparity') of target images presented to each eye that can be perceived by a patient in a 'stereotest'.…”

Section: Contrast Sensitivitymentioning

confidence: 99%

“…40,86,90,91,94,[101][102][103][104][105][106] The included studies were diverse in terms of their aims, comparisons made, study designs, patient characteristics and locations. The full data extraction forms for all included studies are provided (see Appendix 9).…”

Section: Systematic Review Of Health-related Quality-of-life Studiesmentioning

confidence: 99%

“…Half of the studies (Table 14) were conducted in Europe, 40,90,91,101,106 of which two were from the UK. 40,91 One of the UK studies, by Sach and colleagues, 91 was a cost-effectiveness study conducted alongside a RCT and was included in our systematic review of cost-effectiveness (see Systematic review of cost-effectiveness evidence), with the RCT itself (Foss and colleagues 83 ) included in our systematic review of clinical effectiveness (see Chapter 4).…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

“…40,91 One of the UK studies, by Sach and colleagues, 91 was a cost-effectiveness study conducted alongside a RCT and was included in our systematic review of cost-effectiveness (see Systematic review of cost-effectiveness evidence), with the RCT itself (Foss and colleagues 83 ) included in our systematic review of clinical effectiveness (see Chapter 4). Of the remaining studies, two were from the USA, 102 Mean ages, in years, in the studies were generally in the early 70s, but ranged from 69 to 81 years.…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

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The clinical effectiveness and cost-effectiveness of second-eye cataract surgery: a systematic review and economic evaluation

Frampton

Harris

Cooper

et al. 2014

Health Technology Assessment

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BackgroundElective cataract surgery is the most commonly performed surgical procedure in the NHS. In bilateral cataracts, the eye with greatest vision impairment from cataract is operated on first. First-eye surgery can improve vision and quality of life. However, it is unclear whether or not cataract surgery on the second eye provides enough incremental benefit to be considered clinically effective and cost-effective.ObjectiveTo conduct a systematic review of clinical effectiveness and analysis of cost-effectiveness of second-eye cataract surgery in England and Wales, based on an economic model informed by systematic reviews of cost-effectiveness and quality of life.Data sourcesTwelve electronic bibliographic databases, including MEDLINE, EMBASE, Web of Science, The Cochrane Library and the Centre for Reviews and Dissemination databases were searched from database inception to April 2013, with searches updated in July 2013. Reference lists of relevant publications were also checked and experts consulted.Review methodsTwo reviewers independently screened references, extracted and checked data from the included studies and appraised their risk of bias. Based on the review of cost-effectiveness, a de novo economic model was developed to estimate the cost-effectiveness of second-eye surgery in bilateral cataract patients. The model is based on changes in quality of life following second-eye surgery and includes post-surgical complications.ResultsThree randomised controlled trials (RCTs) of clinical effectiveness, three studies of cost-effectiveness and 10 studies of health-related quality of life (HRQoL) met the inclusion criteria for the systematic reviews and, where possible, were used to inform the economic analysis. Heterogeneity of studies precluded meta-analyses, and instead data were synthesised narratively. The RCTs assessed visual acuity, contrast sensitivity, stereopsis and several measures of HRQoL. Improvements in binocular visual acuity and contrast sensitivity were small and unlikely to be of clinical significance, but stereopsis was improved to a clinically meaningful extent following second-eye surgery. Studies did not provide evidence that second-eye surgery significantly affected HRQoL, apart from an improvement in the mental health component of HRQoL in one RCT. In the model, second-eye surgery generated 0.68 incremental quality-adjusted life-years with an incremental cost-effectiveness ratio of £1964. Model results were most sensitive to changes in the utility gain associated with second-eye surgery, but otherwise robust to changes in parameter values. The probability that second-eye surgery is cost-effective at willingness-to-pay thresholds of £10,000 and £20,000 is 100%.LimitationsClinical effectiveness studies were all conducted more than 9 years ago. Patients had good vision pre surgery which may not represent all patients eligible for second-eye surgery. For some vision-related patient-reported outcomes and HRQoL measures, thresholds for determining important clinical effects are either unclear or have not been determined.ConclusionsSecond-eye cataract surgery is generally cost-effective based on the best available data and under most assumptions. However, more up-to-date data are needed. A well-conducted RCT that reflects current populations and enables the estimation of health state utility values would be appropriate. Guidance is required on which vision-related, patient-reported outcomes are suitable for assessing effects of cataract surgery in the NHS and how these measures should be interpreted clinically.Study registrationThis project is registered as PROSPERO CRD42013004211.FundingThis project was funded by the National Institute for Health Research Health Technology Assessment programme.

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Section: Contrast Sensitivitymentioning

confidence: 99%