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Current Opinion in Ophthalmology Jan 2024The aim of this study to provide an overview of recent publications and opinions in refractive cataract surgery. (Review)
Review
PURPOSE OF REVIEW
The aim of this study to provide an overview of recent publications and opinions in refractive cataract surgery.
RECENT FINDINGS
With the advent of intraocular lenses (IOLs) on different platforms, the surgeon has a wide arena of types of IOL to choose, depending on the patient's visual requirement. Optimization of the tear film, integrating tomography and topography devices for appropriate keratometry values, biometry, use of advanced formulas for IOL power calculation and application of newer IOLs can help achieve target refraction in cases scheduled for cataract surgery. Intraoperative aberrometry can be a useful aid for cataract surgery in postrefractive cases and can help minimize residual postoperative astigmatism.
SUMMARY
Evolvement and rapid advancement of technology allows to impart desired refractive outcomes in most of the cases postcataract surgery. Appropriate preoperative and intraoperative factors should be considered to achieve the desired postoperative outcome.
Topics: Humans; Lens Implantation, Intraocular; Refraction, Ocular; Lenses, Intraocular; Cataract Extraction; Cataract; Astigmatism; Biometry; Phacoemulsification
PubMed: 37962881
DOI: 10.1097/ICU.0000000000001005 -
Arquivos Brasileiros de Oftalmologia 2023
Topics: Humans; Phacoemulsification; Cataract Extraction; Internship and Residency; Teaching
PubMed: 37878952
DOI: 10.5935/0004-2749.2023-1005 -
Current Opinion in Ophthalmology Jan 2024To showcase the majority of online intraocular lens (IOL) calculation tools and highlight some of their characteristics. (Review)
Review
PURPOSE OF REVIEW
To showcase the majority of online intraocular lens (IOL) calculation tools and highlight some of their characteristics.
RECENT FINDINGS
Online tools are available for preoperative and postoperative IOL-related calculations, including IOL power and toricity selection for standard patients, patients who underwent prior refractive surgery, keratoconus, limbal relaxing incisions for astigmatism management, realignment of a misplaced or rotated toric IOL, surgical induced astigmatism (SIA), formulae comparison, and other tools.
SUMMARY
As there are new online developments and technology is advancing rapidly, we hope that this review will assist ophthalmologists in becoming acquainted with a large variety of online tools.
Topics: Humans; Lens Implantation, Intraocular; Astigmatism; Phacoemulsification; Lenses, Intraocular; Refractive Surgical Procedures; Refraction, Ocular; Retrospective Studies
PubMed: 37922421
DOI: 10.1097/ICU.0000000000001014 -
Klinische Monatsblatter Fur... Jan 2024Cataract is among the leading causes of visual impairment worldwide. Innovations in treatment have drastically improved patient outcomes, but to be properly implemented,... (Review)
Review
Cataract is among the leading causes of visual impairment worldwide. Innovations in treatment have drastically improved patient outcomes, but to be properly implemented, it is necessary to have the right diagnostic tools. This review explores the cataract grading systems developed by researchers in recent decades and provides insight into both merits and limitations. To this day, the gold standard for cataract classification is the Lens Opacity Classification System III. Different cataract features are graded according to standard photographs during slit lamp examination. Although widely used in research, its clinical application is rare, and it is limited by its subjective nature. Meanwhile, recent advancements in imaging technology, notably Scheimpflug imaging and optical coherence tomography, have opened the possibility of objective assessment of lens structure. With the use of automatic lens anatomy detection software, researchers demonstrated a good correlation to functional and surgical metrics such as visual acuity, phacoemulsification energy, and surgical time. The development of deep learning networks has further increased the capability of these grading systems by improving interpretability and increasing robustness when applied to norm-deviating cases. These classification systems, which can be used for both screening and preoperative diagnostics, are of value for targeted prospective studies, but still require implementation and validation in everyday clinical practice.
Topics: Humans; Prospective Studies; Photography; Cataract; Lens, Crystalline; Visual Acuity; Phacoemulsification
PubMed: 38242135
DOI: 10.1055/a-2003-2369 -
European Journal of Ophthalmology Mar 2024Practical advancements in phacoemulsification techniques and intraocular lenses and the wide availability of phacoemulsification machines have led refractive lens...
Practical advancements in phacoemulsification techniques and intraocular lenses and the wide availability of phacoemulsification machines have led refractive lens exchange (RLE) to increase in popularity. Ethical boundaries in RLE have subsequently been pushed to include patients at higher risk of complications. In this editorial, we consider RLE outcomes and complications per type of refractive error, together with preoperative, intraoperative and postoperative ethical obligations for refractive surgeons. In the conclusions section, we propose an algorithm for ethics-guided indications to RLE.
Topics: Humans; Visual Acuity; Astigmatism; Lens Implantation, Intraocular; Refraction, Ocular; Lenses, Intraocular; Phacoemulsification
PubMed: 38062638
DOI: 10.1177/11206721231218909 -
European Journal of Ophthalmology Sep 2023The purpose of this report is to summarize the visual and refractive outcomes of patients with trifocal toric intraocular lens (IOL) implants. A peer-reviewed literature... (Review)
Review
The purpose of this report is to summarize the visual and refractive outcomes of patients with trifocal toric intraocular lens (IOL) implants. A peer-reviewed literature search in different databases was carried out to identify clinical publications reporting outcomes of patients with this type of implant. The analysis considered information on the sample of eyes, type and power of the trifocal toric IOLs, biometric preoperative data, postoperative refraction, rotational stability, visual acuity at different distances and other analyses undertaken, such as contrast sensitivity or quality of vision questionnaires. 20 clinical studies, encompassing a total of 1404 eyes implanted with three commercially available trifocal toric IOLs, were included in this review. The analysis assessed the outcomes reported for the AT LISA tri toric 939MP IOL, involving 3 articles and 313 eyes; the FineVision toric POD FT IOL, with 7 articles studying 370 eyes, and the AcrySof IQ PanOptix toric IOL, involving 11 articles and 721 eyes. Our assessment of the outcomes of the various studies indicates that the efficacy of the refractive correction (both sphere and cylinder) and visual acuity at different distances was similar between the IOL models. The same was found for the patients' quality of vision and satisfaction levels, in addition to photic phenomena reported. The outcomes summarized in this report lead us to conclude that the use of trifocal toric IOLs allows complete visual restoration over a wide range of distances.
Topics: Humans; Pseudophakia; Patient Satisfaction; Phacoemulsification; Prosthesis Design; Prospective Studies; Lenses, Intraocular; Refraction, Ocular
PubMed: 36788496
DOI: 10.1177/11206721231155047 -
Current Opinion in Ophthalmology Jan 2024This review aims to clarify the advantages and disadvantages of immediately sequential bilateral cataract surgery (ISBCS) based on recent studies, illustrate the safety... (Review)
Review
PURPOSE OF REVIEW
This review aims to clarify the advantages and disadvantages of immediately sequential bilateral cataract surgery (ISBCS) based on recent studies, illustrate the safety of this approach, the cost-effectiveness, and present the importance of inclusion protocols for the best results.
RECENT FINDINGS
In recent studies, the authors found no evidence of an increased risk of bilateral devastating complications such as endophthalmitis with ISBCS based on descriptive evidence compared to delayed sequential bilateral cataract surgery (DSBCS). Furthermore, recent studies on cost analyses showed that ISBCS resulted in fewer costs and significant cost savings to third-party payers, patients, and society compared to DSBCS.
SUMMARY
The ISBCS surgical approach decreases hospital visits, reduces costs, and provides rapid visual rehabilitation and neuro adaptation. The risk of bilateral simultaneous complications is now recognized to be very rare with intracameral antibiotics and compliance with correct protocols. With new generations of optical biometry and lens calculation formulas, refractive surprises are occasional for normal eyes. However, refractive surprise is controversial, especially in the implantation of presbyopia correction intra-ocular lenses, which must be evaluated carefully in the ISBCS approach.
Topics: Humans; Phacoemulsification; Lens Implantation, Intraocular; Cataract Extraction; Visual Acuity; Cataract
PubMed: 38390776
DOI: 10.1097/ICU.0000000000001003 -
Frontiers in Medicine 2024
PubMed: 38323036
DOI: 10.3389/fmed.2024.1367577 -
Medicine Oct 2023To evaluate the cost-effectiveness of phacoemulsification simulation training in virtual reality simulator and wet laboratory on operating theater performance. (Randomized Controlled Trial)
Randomized Controlled Trial
PURPOSE
To evaluate the cost-effectiveness of phacoemulsification simulation training in virtual reality simulator and wet laboratory on operating theater performance.
METHODS
Residents were randomized to a combination of virtual reality and wet laboratory phacoemulsification or wet laboratory phacoemulsification. A reference control group consisted of trainees who had wet laboratory training without phacoemulsification. All trainees were assessed on operating theater performance in 3 sequential cataract patients. International Council of Ophthalmology Surgical Competency Assessment Rubric-phacoemulsification (ICO OSCAR phaco) scores by 2 masked independent graders and cost data were used to determine the incremental cost-effectiveness ratio (ICER). A decision model was constructed to indicate the most cost-effective simulation training strategy based on the willingness to pay (WTP) per ICO OSCAR phaco score gained.
RESULTS
Twenty-two trainees who performed phacoemulsification in 66 patients were analyzed. Trainees who had additional virtual reality simulation achieved higher mean ICO OSCAR phaco scores compared with trainees who had wet laboratory phacoemulsification and control (49.5 ± standard deviation [SD] 9.8 vs 39.0 ± 15.8 vs 32.5 ± 12.1, P < .001). Compared with the control group, ICER per ICO OSCAR phaco of wet laboratory phacoemulsification was $13,473 for capital cost and $2209 for recurring cost. Compared with wet laboratory phacoemulsification, ICER per ICO OSCAR phaco of additional virtual reality simulator training was US $23,778 for capital cost and $1879 for recurring cost. The threshold WTP values per ICO OSCAR phaco score for combined virtual reality simulator and wet laboratory phacoemulsification to be most cost-effective was $22,500 for capital cost and $1850 for recurring cost.
CONCLUSIONS
Combining virtual reality simulator with wet laboratory phacoemulsification training is effective for skills transfer in the operating theater. Despite of the high capital cost of virtual reality simulator, its relatively low recurring cost is more favorable toward cost-effectiveness.
Topics: Humans; Ophthalmology; Cost-Benefit Analysis; Internship and Residency; Clinical Competence; Phacoemulsification; Computer Simulation; Virtual Reality; Cataract; Simulation Training
PubMed: 37800761
DOI: 10.1097/MD.0000000000035067