Eyeworld

EW CATARACT 42 October 2016 by Vanessa Caceres EyeWorld Contributing Writer with increasing ASA class, and this trend was significant (p=.0017). Patients in higher ASA classes with more systemic disease had lower vision-related quality of life com- pared to healthier patients with less systemic disease (P<.001). Group B patients were also more likely to be at risk for two unantic- ipated events: clinically significant edema (Group A, 0.47% versus Group B, 1.28%) and readmission to the hospital within 30 days (Group A, 0.23% versus Group B, 1.41%). There were eight deaths with- in 30 days of surgery, all of which occurred in Group B. Researchers found that patients with a history of COPD were at significantly higher risk of all-cause death after cataract surgery. The authors concluded that ASA classification was useful in estimat- ing visual acuity outcomes, periop- erative events, and vision-related quality of life after surgery. Practical implications This kind of research could help sur- geons better estimate the risks of sur- gery and set reasonable visual out- come expectations for the patients. "It might also provide an opportu- nity for improved informed consent processes and decision making and better optimization of patients with comorbidities before elective surgery, and it could potentially decrease the risk for poor surgical outcomes," the authors wrote. "Though cataract surgery is often referred to as a low-risk proce- dure, it appears there is an import- ant relationship between ASA class and outcomes of this surgery," Dr. Daly said. Based on the study, Anita Shukla, MD, assistant in ophthal- mology, Massachusetts Eye and Ear Infirmary, Boston, said she will broaden her informed consent dis- cussion to include the importance of optimizing systemic illness prior to routine cataract surgery. "The study demonstrates that best correct- ed visual acuity and vision-related quality of life results are lower in higher ASA classes. Patients should be aware of these facts so that their postop expectations are clear," she said. The significant association of ASA class and clinically significant published in the Journal of Cataract & Refractive Surgery. 1 The study's findings shed light on the relation- ship between preop assessments and ophthalmic outcomes after cataract surgery, said study author Mary Daly, MD, ophthalmology department, Veterans Affairs Boston HealthCare System, Boston. Data review The ASA system evaluates physi- cal status with regard to systemic disease and is a predictor of mor- tality and morbidity after major non-cardiac and cardiac operations, the study reported. "Less is known, however, for cataract surgery spe- cifically regarding the relationship between ASA class with ophthalmic outcomes," Dr. Daly said. Authors of the retrospective observational cohort study includ- ed 4,923 cases from five Veterans Affairs Medical Centers across the U.S. Patients in ASA classes I and II (875 patients)—considered healthier patients—were designated as Group A. Patients in ASA classes III and IV (4,032 patients)—generally not as healthy—were designated as Group B. Although the ASA system has two other classes, I through IV are the only ones relevant to ophthalmic surgery, the authors wrote. Researchers analyzed corrected distance visual acuity (CDVA), unan- ticipated events, and vision-related quality of life using the National Eye Institute Visual Function Question- naire (NEI-VFQ). The data reviewed were from the Veterans Health Ad- ministration's Ophthalmic Surgery Outcomes Database Pilot Project, a quality-improvement program. The mean patient age in Group A was 66 years old versus 71 years old in Group B. Most patients were men. "As ASA class increased, so did the proportion of those with diabe- tes mellitus, hypertension, peripher- al vascular disease, chronic pulmo- nary disease (COPD), and congestive heart failure," the authors wrote. The only comorbidity without a ma- jor difference among the groups was a history of hearing impairment. Although the mean CDVA and NEI-VFQ scores improved in both groups after surgery, Group A had a better mean postop CDVA and better postop VFQ composite scores. The proportion of patients with postop CDVA of 20/40 or better decreased increased risk of clinically significant macular edema and readmission to the hospital within 30 days after surgery compared with healthi- er patients, according to a study P atients with a higher Amer- ican Society of Anesthesi- ologists (ASA) classification before cataract surgery had worse visual outcomes and ASA classifications correlate with cataract surgery outcomes NEW Our Family of Pre-Loaded CTRs Has Expanded Malyugin/Cionni & Henderson Capsular Tension Rings Now Pre-Loaded in Morcher EyeJets Malyugin/Cionni CTR • Eyelet at curved end is sutured to sclera • Unique design facilitates smooth introduction into capsule • The only injectable Cionni type CTR Henderson CTR • Scalloped design facilitates cortical removal • Maintains the desired stretch of the capsular bag Standard CTRs • Stabilize the capsule during surgery • Available in three sizes to accommodate various capsule bags Henderson CTR TYPE 10C Standard CTRs TYPES 14, 14A, 14C Malyugin/Cionni CTR TYPE 10G 800.932.4202 Visit FCI-Ophthalmics.com to watch the EyeJet informational video. 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