Eyeworld

EW RESIDENTS May 2014 53 lens optical aberrations. Given the broad range of preoperative spheri- cal equivalent refraction (–8.88 D to +10.13 D), which was largely corrected after cataract surgery (postoperative refraction ranged from –1.38 D to +1.5 D), an evalua- tion of the contribution of refractive error to straylight measurement would have aided in the interpreta- tion of the study results. Second, halos and glare are known side ef- fects that patients experience after implantation of multifocal intraocu- lar lenses (IOLs). 7 The authors have utilized a variety of IOLs, including diffractive multifocal IOLs, toric IOLs, and monofocal IOLs, which further confounds the interpretation of results. A selection of one IOL or a subgroup analysis may have helped with the interpretation of the post- operative straylight data, particularly if one subset of patients had a greater proportion of a particular type of IOL. In addition, there is lit- tle information about the statistical analysis used in the study. Was non- parametrical or parametrical testing used? Finally, the patient population studied is relatively small and young (160 eyes total with mean age of 59.4 +/–8.1 years), which could limit the generalizability of the outcomes of the study. Broadening the size and diversity of the patient popula- tion would be helpful in subsequent studies. As mentioned in the authors' discussion, a weakness of the study is the lack of visual function ques- tionnaires (VFQs) to measure the patients' subjective improvement in the quality of vision following surgi- cal intervention. The use of VFQs has been validated in previous studies in the setting of cataract surgery. 8 It is unknown whether the measured decrease in ocular straylight following lens extraction is associated with an overall improvement in the patients' subjective quality of vision postop. This becomes extremely important in the new era of the Affordable Care Act, which necessitates in- creased physician accountability aspects on justifying when cataract surgery is indicated. As VFQs will be implemented in many ambulatory surgery centers as part of a federal quality reporting program, it is im- portant that any evaluation of new technologies such as straylight meas- urement consider incorporating measurement of patients' subjective visual function in their assessment. With the technological advances in modern cataract surgery there will be an increasing focus and interest in the field of redefining "success" in the cataract patient. Since the introduction of phacoemulsification by Charles Kelman, MD, in the late 1960s, the definition of a successful cataract surgery has continued to evolve. It is no longer defined as the atraumatic removal of a cataractous lens, but in- stead is characterized by a patient's visual experience, where visual acu- ity is only one important parameter. It is clear that we need better meas- ures of visual function and patient satisfaction before and after surgery to help evaluate and quantify the surgical outcome. Devices measuring ocular straylight are important tools in our armamentarium that, in the correct setting, can aid in the peri- operative evaluation of the patient with a visually significant cataract. EW References 1. Koch DD. Glare and contrast sensitivity testing in cataract patients. J Cataract Refract Surg. 1989;15(2):158–164. 2. Van Den Berg TJ, Franssen L, Kruijt B, Coppens JE. History of ocular straylight measurement: A review. Zeitschrift fur Medizinische Physik. 2013;23(1):6–20. 3. Van Den Berg TJ, Franssen L, Coppens JE. Straylight in the human eye: testing objec- tivity and optical character of the psy- chophysical measurement. Ophthalmic Physiol Opt. 2009;29(3):345–350. 4. Van Den Berg TJ, Van Rijn LJ, Michael R, et al. Straylight Effects with Aging and Lens Extraction. Am J Ophthalmol. 2007;144(3): 358–363. 5. Cerviño A, Montes-Mico R, Hosking SL. Per- formance of the compensation comparison method for retinal straylight measurement: effect of patient's age on repeatability. Br J Ophthalmol. 2008;92(6):788–791. 6. van der Meulen IJ, Gjertsen J, Kruijt B, Witmer JP, Rulo A, Schlingemann RO, van den Berg TJ. Straylight measurements as an indication for cataract surgery. J Cataract Refract Surg. 2012;38(5): 840–848. 7. Calladine D, Evans JR, Shah S, Leyland M. Multifocal versus monofocal intraocular lenses after cataract extraction. Cochrane Database Syst Rev. 2012;9:CD003169. 8. Amesbury EC, Grossberg AL, Hong DM, Miller KM. Functional visual outcomes of cataract surgery in patients with 20/20 or better preoperative visual acuity. J Cataract Refract Surg. 2009;35(9):1505–1508. Contact information Kloek: Carolyn_Kloek@meei.harvard.edu phacoemulsification better than 0.1 logMAR" Harvard Medical School ophthalmology residents (from left to right) Katherine Talcott, MD, and Aristomenis Thanos, MD (second year residents), Seanna Grob, MD, MAS (first year resident), and Yewlin Chee, MD (chief resident) contributed to this journal article review. Source: Carolyn Kloek, MD

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