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111 EW RESIDENTS March 2016 Perhaps the greatest takeaway from this article is that we are currently unable to quantify subtle visual changes that occur in patients with early PCO using only best corrected Snellen visual acuity. This study pointed out the possibility of using newer technologies in the future to better assess symptomatic changes in vision. EW References 1. Apple DJ, et al. Posterior capsule opacifica- tion. Surv Ophthalmol. 1992; 37:73–116. 2. Awasthi N, et al. Posterior capsular opacification: a problem reduced but not yet eradicated. Arch Ophthal. 2009; 127:555–562. 3. Corcoran S. Coding and reimbursement: Continuing questions about YAG. Ophthalmolo- gy Management. December 2010. 4. Elliott DB et al. Assessing the reliability, discriminative ability, and validity of disability glare tests. Invest Ophthalmol Vis Sci. 1993; 34:108–119. 5. van Bree MC, et al. Effect of neodymium: YAG laser capsulotomy on retinal straylight values in patients with posterior capsule opacification. J Cataract Refract Surg. 2008; 34:1681–1686. Contact information Chow: jessica.chow@yale.edu and whether the correlation changes after capsulotomy. In summary, this study serves as a good pilot study, which suggests a possible use of retinal straylight as a way to quantify changes in vision. However, a larger, prospective, controlled study is needed in order to further elucidate the relationships suggested in this paper. Areas that need to be addressed more carefully in another study are comparison of only the same models of IOLs (as all IOLs have different optical aber- rations), having the same surgeon with the same YAG capsulotomy technique performed every time (in this study the surgeons varied and the only criteria was a minimum 3 mm opening), specifying a range limit of anterior capsulotomy size, and having a separate arm for toric and multifocal IOLs as this group of patients would be the most rele- vant population that would need or benefit from an early YAG capsu- lotomy. While the idea of retinal straylight is an interesting concept, it may not be practical to obtain a straylight meter for the sole purpose of measuring vision in patients with PCO. More applications of straylight measurement should be investigated as well. the readers is how much of a change in retinal straylight is noticed by patients. While the measured value may differ before and after YAG capsu- lotomy with statistical significance, it is difficult to ascertain how much change in straylight is translated into a notable improvement in vi- sion. Did any patients have worsen- ing of straylight or HOA values after YAG capsulotomy? The data does not specify this point, although it does mention that all patients had an improvement in symptoms. The major weaknesses of this study are the small number of eyes included and a lack of a control group. It would be useful for statis- tical analysis as well as for compar- ison purposes to show how mea- surements of retinal straylight and HOA compare in eyes without PCO, eyes without symptomatic change in vision, or eyes with symptomatic PCO and sham YAG capsulotomy procedure. Interestingly, despite the reason for doing the YAG capsuloto- my on these patients being the pres- ence of PCO and symptoms, there is no analysis of the possible correla- tion between retinal straylight and PCO grades or patient symptoms, ophthalmologist decide that a laser procedure, one that has the poten- tial to damage the lens and worsen the symptoms, is the appropriate treatment? How do we attribute the symptoms to a PCO as opposed to other ocular pathology? This study attempts to investigate the use of retinal straylight as a way to quan- tify visual deterioration from mild PCO. While it is unclear whether the authors did an observational case series or a retrospective chart review (both were mentioned in the article), all the included patients did have CDVA, LCVA, straylight, and HOAs measured pre- and post-YAG capsulotomy. As in all studies that evaluate correlation between 2 or more measured variables, the results show a mathematical correlation of 2 variables without proving causation. While it is interesting to see that retinal straylight and LCVA both correlated with THOA and S3, there is no definitive conclusion that can be made regarding what this correla- tion means clinically. Furthermore, when certain correlations are shown to be present prior to YAG capsulo- tomy and lost after the procedure, it is unclear what the implications are. One fact that is not known to on visual function and good visual acuity" EyeWorld Blog Focusing on Refractive • Advances in technology • Refractive advice • Surgical techniques • Ask a question • Post a comment • Recommend a topic Visit: Blog.EyeWorld.org

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