Session 534 Cataract_ Prevalence and Predictors

Transcription

ARVO 2016 Annual Meeting Abstracts
534 Cataract: Prevalence and Predictors
Thursday, May 05, 2016 11:00 AM–12:45 PM
Exhibit/Poster Hall Poster Session
Program #/Board # Range: 6220–6234/A0148–A0162
Organizing Section: Clinical/Epidemiologic Research
Program Number: 6220 Poster Board Number: A0148
Presentation Time: 11:00 AM–12:45 PM
American Major Dietary Patterns and Age-related Cataract
Chung-Jung Chiu1, 2, Gary Gensler3, Allen Taylor1, 2. 1United
States Department of Agriculture Human Nutrition Research
Center on Aging at Tufts University, Boston, MA; 2Department of
Ophthalmology School of Medicine, Tufts University, Boston, MA;
3
Age-Related Eye Disease Study Coordinating Center, The Emmes
Corporation, Rockville, MD.
Purpose: We aimed to evaluate the associations between major
American dietary patterns and risk for cortical and nuclear cataract.
Methods: Dietary consumption data of 37 food groups were
collected by a 90-item Block food frequency questionnaire
administered at the baseline Age-Related Eye Disease Study
(AREDS). Using the AREDS System for Classifying Cataracts, 2007
eyes with pure nuclear lens opacity, 1281 eyes with pure cortical
opacity, and 2491 eyes without lens opacity were identified from
7,575 eligible eyes. Associations between dietary patterns and pure
lens opacities were examined by using the generalized estimating
approach to logistic regression.
Results: Two major dietary patterns were identified by principle
component analysis and named Oriental and Western patterns. The
Oriental pattern was characterized by higher intake of vegetables,
legumes, fruit, whole grains, tomatoes, and seafood. The Western
pattern was characterized by higher intake of red meat, processed
meat, high-fat dairy products, French fries, refined grains, and eggs.
We ranked our participants according to how closely their diets line
up with the two patterns by calculating the two pattern scores for
each participant. For all nuclear opacity (grade >2; approximately
equivalent to LOCS III grades 3.0-3.9), the multivariate-adjusted
odds ratio (OR) comparing the highest to lowest tertile of the
Western pattern score was 1.36 (95% confidence interval (CI):
1.06-1.76; Ptrend=0.03), and for mild nuclear opacity (grade <4 but
>2; approximately equivalent to LOCS III grades <5.0-6.4 but >3.03.9) the OR was 1.45 (1.12-1.89; Ptrend=0.01). No other significant
associations were noted.
Conclusions: Our data indicate that consuming a Western dietary
pattern is significantly associated with increased odds of early nuclear
opacity.
Commercial Relationships: Chung-Jung Chiu, None;
Gary Gensler, None; Allen Taylor, None
Support: NIH RO1EY021826, RO1EY013250, RO1EY021212, and
USDA 1950-5100-060-01A
Clinical Trial: NCT00001312
In Situ Deposition of Heavy Metals in the Lens of the Human Eye
Bruce I. Gaynes, Susanne Tidow-Kebritchi, Cossette Joy, Peter Filip,
Laura Burke, Neelam Balasubramanian, Martina Schmeling.
Ophthalmology, Loyola University Chicago, Maywood, IL.
Purpose: Environmental heavy metal exposure plays a role in many
disease processes. However, quantifying cumulative exposure over
one’s lifetime is exceedingly difficult. Heavy metals are readily
adsorbed to tissue protein, thus as lens epithelial cells infoliate with
growth the lens may sequester and store xenobiotics over a lifetime.
Here, we describe both in qualitative and quantitative terms the
content of heavy metals in the crystalline lens at the time of cataract
surgery.
Methods: Study design was a cross sectional analysis of lens
specimens taken at the time of cataract surgery. Following collection,
lens samples were centrifuged and the supernatant used as a blank
for subsequent spectroscopy by Total Reflection X-Ray Fluorescence
(TXRF). Lens tissue and supernatant were subjected to a 1:1 dilution
with both water and concentrated high purity nitric acid before being
analyzed by TXRF. Relevant data such as concomitant diseases and
patient demographics were also collected from electronic records
(EPIC).
Results: A total of 84 individuals were enrolled for study, 66% were
female. Mean age was 70 yrs, mean body mass index 30.25. Among
all subjects 5.2% were current smokers, 46% former smokers.
Statistical analysis revealed four common heavy metals in the lens at
time of cataract surgery. These included iron (mean=32.68 μg/L range
0-500 μg/L); rubidium (mean=6.71 μg/L, range 0-22.6 μL), zinc
(mean=5.43 μg/L, range 0-114 μL) and copper (mean=0.51 μg/L,
range 0-19.10 μL). Additional metals found in lens bulk included lead
and strontium. Although not statistically significant, zinc appeared
to be protective against posterior subcapsular cataract while lens Rb
appears to be inversely related to rates of heart failure.
Conclusions: Heavy metals are found in small but measurable
quantities in the aged human lens and include forms that are
associated with both detrimental and beneficial biologic action. The
consequence of rubidium in the human lens is currently unknown
however there is evidence of some degree of toxicity of rubidium for
humans including neuromuscular hyperirritability. Copper, iron and
zinc were found in quantities far below that typical of human serum.
Further study is required to define the association between heavy
metal deposition in the lens and various forms of ocular and systemic
disease as noted by the interesting finding regarding lens Rb and
heart failure.
Commercial Relationships: Bruce I. Gaynes, None;
Susanne Tidow-Kebritchi, None; Cossette Joy, None; Peter Filip,
None; Laura Burke, None; Neelam Balasubramanian;
Martina Schmeling, None
Support: Richard Perritt Charitable Foundation
Effects of ferritin on the prevalence of cataracts
Philip Kurochkin, Sana Qureshi, Roy S. Chuck, Jimmy K. Lee. Dept
of Ophthalmology, Albert Einstein college of medicine, Bronx, NY.
Purpose: Markedly elevated ferritin levels found in hereditary
hyperferritinemia-cataract
syndrome (HHCS) have been linked to the early development of
cataracts in these patients. Studies have shown that HHCS patients
have 15 times the normal L-ferritin levels in their lenses. However,
HHCS accounts for a very small percentage of patients with elevated
ferritin levels. We explored the effects of chronically elevated ferritin
levels in any disease process to see how it affects the prevalence of
cataract formation and age of onset.
Methods: We conducted a retrospective epidemiological study of
Montefiore Medical Center’s
1.5 million patient population from 6/1997 - 6/2015. We selected
patients with 4 documented ferritin tests, each at least 1 year apart
and assembled three cohorts: 1) males, ferritin levels >300 ng/
mL (N=589, avg. age 58.6), 2) females, ferritin levels >200 ng/mL
(N=1026, avg. age 64.6), 3) cataract surgery patients (N=9,356, avg.
age M 68.9, avg. age F 71.0 total avg. 70.2). 38 males (avg. age 68.3)
and 59 females (avg. age 70.7) with hyperferritinemia underwent
cataract surgery.
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to access the versions of record.
Results: The overall prevalence of cataract surgery in the Montefiore
population was 0.53% in
males, 0.72% in females, and 0.64% collectively. The prevalence
of cataract surgery in males and females with hyperferritinemia
was 6.45% and 5.75% respectively, and 6.01% collectively. The
prevalence of cataract surgery in the total population compared to the
prevalence in the single sex and collective hyperferritinemia groups
was found to be statistically significant with p-values < 0.0001.
Age stratified analysis was significant for increased cataracts in
hyperferritinemia groups at decades 40-49 to 90-99.
Conclusions: Chronically high levels of ferritin may increase
a patient’s risk of cataract development relative to the general
population. As the underlying pathophysiology remains unclear
future studies that measure the levels of L-ferritin in the cataracts of
patients with chronically elevated ferritin caused by other disease
processes can help elucidate whether increased cataract susceptibility
stems from accumulation in the lens secondary to increased serum
ferritin levels or direct production by lens epithelium.
Commercial Relationships: Philip Kurochkin, None;
Sana Qureshi, None; Roy S. Chuck, None; Jimmy K. Lee, None
Support: Research to Prevent Blindness
Functional autonomy assessment in older patients with cataract
using the Lawton and Barthel scales in a specialized hospital in
Mexico City
Jesus Guerrero1, Enrique O. Graue-Hernandez4, Alvaro Garcia
Perez1, Jesus Arrieta2, Sandra Evelin Cardenas-Gonzalez1,
Aida Jimenez-Corona1, 3. 1Ocular Epidemiology and Visual Health,
Instituto de Oftalmologia Fundacion Conde de Valenciana, Mexico
City, Mexico; 2Department of Anterior Segment, Instituto de
Oftalmologia Fundacion Conde de Valenciana, Mexico City, Mexico;
3
General Directorate of Epidemiology, Health Secretariat, Mexico
City, Mexico; 4Department of Cornea and Refractive Surgery,
Instituto de Oftalmologia Fundacion Conde de Valenciana, Mexico
City, Mexico.
Purpose: Lack of autonomy related to disability in older people is
widely recognized; however, less information is available about this
condition and visual impairment. This study aimed to determine
the level of functional autonomy in patients ≥50 years of age with
clinically significant cataract.
Methods: Cross-sectional study carried out from November 2014
to July 2015, comprising 391 patients age ≥50 years with clinically
significant cataract. Functional autonomy was evaluated through
the Lawton questionnaire that examines instrumental activities of
daily living (IADL), including the following 8 items: ability to use
telephone, shopping, food preparation, housekeeping, laundry, mode
of transportation, responsibility of own medication, and ability to
handle finances. The score range from 0 (total) to 8 (without) and
the level of dependency is classified as follows: without, mild,
moderate, and total. The Barthel questionnaire was also applied,
which evaluates the following 10 basic activities in daily living
(BADL): feeding, bathing, grooming, dressing, bowels, bladder, toilet
use, transfer (bed to chair and back), mobility, and stairs. The score
range from 0 (total) to 100 (without) and the level of dependency is
classified as follows: without, mild, moderate, severe, and total (score
<20). All analyses were performed using Stata 13.
Results: Of 391 patients (242 women and 149 men; average age
71.6 years, S.D. 10.2), 227 had moderate/severe visual impairment
and 164 were blind. With respect to IADL, 20.9% had mild, 9.7%
moderate, and 4.2% total dependency. As for BADL, 18.7% had
mild, 3.0% moderate, and 2.5% total dependency. In multiple logistic
regression analyses, after adjustment for sex, hypertension, and
diabetes, dependency on IADL and BADL were associated with age
≥70 years (OR=3.44 [95%CI 1.71-6.90] and OR=7.65 [95%CI 1.7233.9], respectively) and blindness (OR=1.55 [95%CI 0.86-2.80] and
OR=2.19 [95%CI 0.88-5.45], respectively).
Conclusions: Adult patients with blindness caused by cataract are
at higher risk of having lower functional autonomy; therefore, a
multidisciplinary management to improve the autonomy of these
patients should be implemented.
Commercial Relationships: Jesus Guerrero, None;
Enrique O. Graue-Hernandez, None; Alvaro Garcia Perez, None;
Jesus Arrieta, None; Sandra Evelin Cardenas-Gonzalez, None;
Aida Jimenez-Corona, None
Patient Self-Reported Questionnaire for Eye Complaints To
Identify Anterior Segment Pathology
Nita Valikodath2, Paula Anne Newman-Casey1, Leslie Niziol1,
Maria A. Woodward1. 1Department of Ophthalmology and Visual
Sciences, University of Michigan, Ann Arbor, MI; 2University of
Michigan, Ann Arbor, MI.
Purpose: To validate a questionnaire to assess eye complaints that
can detect the presence of anterior segment (AS) pathology and
facilitate patient self-triage.
Methods: The content of the Patient Ocular Symptom Telemedicine
Questionnaire (POST) was created using existing validated
questionnaires (NEI-VFQ, OSDI). Content validity was assessed
by expert review (10 MDs) and evaluated with 40 patients prior
to this study. The questionnaire included 9 eye symptom items.
Patients from the comprehensive and cornea clinics were recruited
to complete the POST. An ophthalmologist performed a complete
exam on all participants. Presence of AS disease was analyzed by
logistic regression and the number of reported symptoms by Poisson
regression.
Results: 74 subjects (148 eyes) were enrolled. In normal eyes (n=28),
79% reported no symptoms on the POST. In eyes with AS diagnoses
(n=120), 72% reported ≥1 symptom on the POST. The predicted
number of reported symptoms in eyes with an AS diagnosis was 3.3
times higher than that of normal eyes (relative risk, RR=3.29, 95%
confidence interval, CI=1.34-8.08, p=0.01). Eyes with symptoms of
pain, glare, sensitivity to light, and blurred vision were associated
with increased odds of AS disease, compared to eyes without these
symptoms (unadjusted odds ratio, OR=8.85, 10.18, 3.58, 10.15,
respectively; all p<0.05) but symptoms of burning, itching, gritty
feeling, redness, or headache were not (all p≥0.05). In a multivariable
model, symptoms of glare (adjusted OR=5.78, CI=1.64-20.36,
p<0.01) and blurred vision (adjusted OR=5.42, CI=1.56-18.84,
p<0.01) were independently predictive of increased odds of AS
disease, compared to eyes without these symptoms. In eyes with
infectious keratitis (INFK) (n=24), 83% were reported to have ≥ 1
symptom and 58% with ≥ 5 symptoms. The predicted number of
reported symptoms in eyes with INFK was 8 times higher than that
of normal eyes (RR=8.34, CI=3.00-23.20, p<0.001). INFK eyes had
between 8-45 times increased odds of a reported symptom compared
to normal eyes (all p<0.02).
Conclusions: Patients whose eyes have AS problems can self-report
ocular symptoms accurately compared with normal eyes. Symptoms
of pain, glare, sensitivity to light, and blurred vision predict the
presence of AS pathology. The POST could serve as a screening
tool to enhance remote evaluation of ophthalmic complaints in a
telemedicine setting.
Commercial Relationships: Nita Valikodath, None;
Paula Anne Newman-Casey, None; Leslie Niziol, None;
Maria A. Woodward
Support: NIH Grant K12EY022299, NIH Grant K23EY023596-01
Evaluation of longitudinal chromatic aberration with a
multiwavelength wavefront sensor in pseudophakic eyes
Seiu Takagi1, Masashi Nakajima2, 3, Toshiya Yamamoto4,
Yoko Hirohara3, Toshifumi Mihashi2, Takahiro Hiraoka1,
Tetsuro Oshika1. 1University of Tsukuba, Tsukuba, Japan;
2
Tokyo Institute of Technology, Yokohama, Japan; 3TOPCON
CORPORATION, Itabashi, Japan; 4Ushiku Aiwa General Hospital,
Ushiku, Japan.
Purpose: To evaluate the longitudinal chromatic aberration (LCA)
using a multiwavelength wavefront sensor in pseudophakic eyes after
implantation of various intraocular lenses (IOLs).
Methods: Forty-three eyes of 36 pseudophakic patients were
examined. Patents’ age ranged from 29 to 86 years (70.8 ± 9.5 years,
mean ± SD). IOLs implanted included SN60WF or SN60AT (Alcon)
in 11 eyes, NY60 (HOYA) in 5 eyes, XY1 (HOYA) in 11 eyes, and
ZCB00V (AMO) in 16 eyes. Wavefront sensing was conducted using
a newly developed multiwavelength wavefront sensor with three
different light sources (561, 690, 840 nm), and LCA in diopters were
calculated between 561 and 840 nm lights. The obtained data were
compared among IOLs.
Results: LCA (840 - 561) was 0.96 ± 0.11 D in eyes with SN60WF
and SN60AT, 0.80 ± 0.06 D in eyes with NY60, 1.01 ± 0.09 D in eyes
with XY1, and 0.66 ± 0.06 D in eyes with ZCB00V. LCA was similar
between SN60WF/SN60AT and XY1. LCA was significantly smaller
with NY60 and ZCB00V than with SN60WF/SN60AT and XY1 (P
< 0.05, Kruskal - Wallis with Bonferroni test). ZCB00V showed the
smallest LCA value among the IOLs (P < 0.05). LCA had positive
correlation with IOL power in eyes with SN60WF/SN60AT and XY1,
but not in those with NY60 and ZCB00V.
Conclusions: Using multiwavelength wavefront sensor, LCA could
be quantitated in pseudophakic eyes. Our results indicate that LCA
varies depending on the IOL material and power, and ZCB00V
showed the smallest LCA which did not increase even with higher
IOL diopters.
Commercial Relationships: Seiu Takagi, None;
Masashi Nakajima, TOPCON CORPORATION (F);
Toshiya Yamamoto, None; Yoko Hirohara, TOPCON
CORPORATION (F); Toshifumi Mihashi, None;
Takahiro Hiraoka, None; Tetsuro Oshika, None
Cataract prevalence in Brazil demonstrated in ten years
Thiago Hayashida Teles de Carvalho, Annah Rachel R. Graciano,
Cristine A. Póvoa, Daniel Silva Lôbo, Andreza Araújo Costa Rios,
Múcio de Melo Canedo, Luiza Ferreira Rocha. Medicine, Centro
Universitário de Anápolis - UniEvangélica, Goiânia, Brazil.
Purpose: Cataract is the leading cause of reversible blindness in the
world, which stands for 47.8% of all blindness cases. Even though it
is a disease with great functional, physic and socioeconomic impacts,
there are few epidemiologic studies about cataracts in Brazil. This
transversal quantitative study, therefore, aims to evaluate the cataracts
prevalence in Brazil according to the informatics department of the
unique health system (DATASUS).
Methods: The cataract cases in Brazil were analyzed over a 10 years
period (2004-2014), using as source DATASUS. All patients at the
age range of 0 to 85 assisted by ambulatory service and registered
by DATASUS were included, totaling 182.242.824 registries in a
population of 182.060.108 to 202.768.562 inhabitants (2004 – 2014).
There were also used data about a population of 182.060.108 to
202.768.562 inhabitants (2004-2014) available in the informatics
department of Brazilian institute of geography and statistics (IBGE).
The data were analyzed using descriptive statistics with the software
SPSS (Statistical Package for the Social Sciences) version 2.0 and
Excel.
Results: The cataract rate analysis notified by DATASUS and from
general population supplied by IBGE between the years 2004 and
2014 has shown few variation of frequency among the years. During
the analyzed years the highest prevalence rate was of 14.72% of
the Brazilian population, related to the year 2014. Taking sex into
account, the relative risk (RR) calculated in 2014 was 0.731 (IC95%
0.731 to 0.732) woman to every man. In regards to age, the highest
prevalence was between 70 to 79 years old (1.005%) and the least
affected group was between 10 to 19 years old (0.004%).
Conclusions: This study verified that the prevalence of cataracts
notified cases in Brazil, during the analysis period, was rather stable,
with maximum rates of 0.16% of the population. There were higher
occurrences rates for females and ages between 70 and 79 years old.
Although the DATASUS information system needs to be improved,
it’s a very important tool to collect data in order to develop better
health policies, specially in regards to cataracts.
Commercial Relationships: Thiago Hayashida Teles de Carvalho,
None; Annah Rachel R. Graciano, None; Cristine A. Póvoa, None;
Daniel Silva Lôbo, None; Andreza Araújo Costa Rios, None;
Múcio de Melo Canedo, None; Luiza Ferreira Rocha, None
Cataract formation and progression in patients less than 50 years
following pars plana vitrectomy (PPV)
Amandeep Kataria1, 2, John T. Thompson2. 1Johns Hopkins School of
Public Health, Baltimore, MD; 2Retina Specialists, Greater Baltimore
Medical Center, Baltimore, MD.
Purpose: To measure the rate of cataract development and
progression of nuclear sclerotic (NSC), posterior subcapsular (PSC)
and cortical spoking (CS) cataracts in non-diabetic patients younger
than 50 years of age following a pars plana vitrectomy.
Methods: Clinical records of 27 eyes of 27 patients that had
undergone a pars plana vitrectomy younger than 50 years of age were
retrospectively reviewed. NSC, PSC and CS scores were recorded
preoperatively, 1, 3, 6, 9, 12 months following surgery and at final
examination. Twenty-seven eyes were graded on a scale of 0 to 4.0
using the lens opacities classification system LOCS II prior and
subsequent to pars plana vitrectomy for macular hole, epiretinal
membranes and vitreous hemorrhage. Linear regression analysis was
performed to compare the rate of change in cataract score over time.
Results: The mean age at surgery was 29.8 ± 13.5 years in 27 eyes
with a median follow-up of 12 months. We observed no difference in
NSC and PSC progression between baseline and final examination
for 85% of patients and 100% of patients for CS. Two patients
developed NSC, two developed PSC and another two developed
both within 12 months. The mean progression between baseline and
final examination while still phakic for NSC, PSC and CS were 0.24
± 0.64, 0.21 ± 0.63, and 0, respectively. Linear regression analysis
shows minimal increase in NSC (+0.09/year, p<0.001, R2 =+0.350),
a slight increase in PSC (+0.16/year, p<0.001, R2 =+0.861), and a
minimal decrease in CS (-0.02/year, p<0.05, R2=-0.09). PSC scores
show a strong correlation with elapsed time since surgery, NSC
scores show moderate correlation and CS scores show no correlation.
Prior studies of nuclear sclerosis following vitrectomy in patients
older than 50 years show an increase of +0.812/year. Younger patients
are relatively protected against lens oxidation, which is an important
factor in nuclear sclerosis progression following vitrectomy.
Conclusions: Our findings suggest there is a minimal increase in
NSC and PSC scores for patients younger than 50 years following
pars plana vitrectomy with no change in CS. Cataract progression
is not a significant factor in the first few years following vitrectomy
in patients younger than 50 years. This may have implications in
the development of therapies to try to prevent nuclear sclerosis
progression in patients over 50 years of age.
Commercial Relationships: Amandeep Kataria, None;
John T. Thompson, None
Anxiety and depression in older patients with clinically significant
cataract
Maria J. Salgado-Canseco1, Alvaro Garcia Perez1,
Enrique O. Graue-Hernandez4, Jesus Arrieta2,
Aida Jimenez-Corona1, 3. 1Ocular Epidemiology and Vision Health,
Instituto de Oftalmología Conde de Valenciana, Mexico City,
Mexico; 2Department of Anterior Segment, Instituto de Oftalmología
Conde de Valenciana, Mexico City, Mexico; 3General Directorate of
Epidemiology, Health Secretariat, Mexico City, Mexico; 4Cornea and
Refractive Surgery, Instituto de Oftalmología Conde de Valenciana,
Mexico City, Mexico.
Purpose: Several studies have shown a negative impact of cataract
on the psychological health of older people, which predispose to
lack of autonomy of these subjects. This study aimed to evaluate the
anxiety and depression status in patients age ≥50 years with clinically
significant cataract.
Methods: Cross-sectional study carried out from November
2014 to July 2015, including 391 patients ≥50 years of age with
clinically significant cataract. The Hospital Anxiety and Depression
Scale (HADS) that includes 14 items and 2 subscales (anxiety and
depression) was used to assess these conditions. The score ranges
from 0 to 21 for each subscale, and anxiety and depression symptoms
(independently) were classified as follows:without (score, 0-7 and
0-8, respectively), borderline (score, 8-10 and 7-10, respectively),
and presence of each condition (score for both, 11-21). Additionally,
information about health self-perception and chronic conditions
such as diabetes and hypertension was obtained. All analyses were
performed using Stata 13.
Results: Of 391 patients (242 women and 149 men; average age
71.6 years, S.D. 10.2),227 had moderate/severe visual impairment
and 164 were blind. Borderline anxiety was present in 8.5% of
patients and anxiety in 5%, whereas borderline depression was
present in 10.9% of patients and depression in 3.0%. Anxiety and
depression were more frequent in patients age ≥70 years than in
younger ones (27.7% and 20.4%, respectively) and in patients
with blindness compared with those with moderate/severe visual
impairment (30.5% and 20.3%, respectively). In multiple logistic
regression analyses, separately, anxiety (OR=1.79, 95%IC 1.05-3.07,
p=0.033) but not depression was associated with blindness (OR=1.53,
95%IC 0.88-2.66, p=0.129) after adjustment for age, sex, and health
self-perception. Finally, the presence of anxiety or depression was
significantly associated with age (OR=1.03, 95%IC 1.00-1.05,
p=0.009), sex (OR=1.92, IC95% 1.13–3.26, p=0.016), poor health
self-perception (OR=2.00, 95%IC95% 1.42–2.82, p=0.0001), and
blindness (OR=1.68, 95%IC 1.03-2.74, p=0.036).
Conclusions: The main factors for both anxiety and depression in
subjects with cataract were age, sex, health self-perception, and
blindness. Visual impairment and blindness in patients with cataract
is preventable; therefore, earlier psychotherapeutic interventions
should be implemented to prevent or reverse symptoms of anxiety
and depression in these patients.
Commercial Relationships: Maria J. Salgado-Canseco, None;
Alvaro Garcia Perez, None; Enrique O. Graue-Hernandez, None;
Jesus Arrieta, None; Aida Jimenez-Corona, None
Discrepancy in eye treatment options across the province of
Guangdong, China: A Retrospective Study
Sumit PARIKH, Mingguang He. University of Melbourne,
Melbourne, VIC, Australia.
Purpose: The Universal Eye Health Program define a 25% reduction
on the avoidable blindness from 2010 – 2019. The hypothesis is
to understand the geographical distribution of ophthalmologist
per population, service output per population, efficiency of
ophthalmologists (number of eye surgery per ophthalmologist) and
their association in the province of Guangdong, China with 2007 –
2009 data serving as a good baseline.
Methods: Data was collated retrospectively from various hospital
datasets and the census register with the geographical unit being
COUNTY. SPSS statistical software (Version 21, SPSS Science,
Chicago, IL) was used to analyze the data. Descriptive statistical
analyses were performed to characterize the data stratified by
COUNTY using ANOVA. We used an advanced license version of
ArcGIS 10.3 Software (Copyright @ ESRI Inc) for geographical
mapping of the data. Prior to mapping, the geographical location data
of COUNTY was cross-linked with equivalent Ophthalmologist and
service output data using Python 2.7 to create categories and map
multiple attributes of the data.
Results: Guangdong is a province situated at the southernmost
tip of Mainland China adjacent to Hongkong and Macau with 21
prefecture-level divisions subdivided into 119 county-level divisions.
It topped the total GDP rankings among all provincial-level divisions
making its economy roughly the same size as The Netherlands.
Maximum Ophthalmologists resided in Shenzhen (N=67) with
average being 13 (Standard Deviation SD=23) across the province.
ANOVA of Ophthalmologists per million population was significant
(p=0.031) and lead by Xinhui (1:2642). Outpatient visits per annum
increased by atleast 3.8% each year while eye surgery rate per annum
quadrupled from 2008 to 2009. The average cataract surgery rate
per annum per COUNTY was 1122 (SD=977) in 2009. Maximum
cataract surgery per annum was in Shenzhen (N=4725), however
cataract per million population was lead by Xinhui (1:16, p=0.045).
In this study we have also demonstrated how Ophthalmologists are
unequally distributed geographically, its impact on treatment options
and efficiency across the province. Our findings emphasize the need
for improving quality of life.
Conclusions: Further studies need to establish the extent of the
problem and then develop better health service delivery models to
close the existing treatment gap in accordance with the Universal Eye
Health Program.
First-Day Intraocular Pressure Spikes after Phacoemulsification
Cataract Surgery Among Patients Taking Tamsulosin
Levi N. Bonnell1, Jeffrey R. Soohoo1, Leonard Seibold1,
Richard Davidson1, Naresh Mandava1, Ashlee M. Cerda1,
Anne Lynch1, Brandie D. Wagner2, 1, Michael Taravella1. 1Department
of Ophthalmology, University of Colorado School of Medicine,
Aurora, CO; 2Department of Biostatistics and Informatics, Colorado
School of Public Health, Aurora, CO.
Purpose: Transient intraocular pressure (IOP) spikes after cataract
surgery are well documented; however, subgroups of patients
predisposed to first-day IOP spikes need to be identified. Transient
IOP spikes can cause intraocular pain, ischemic optic neuropathy
and, in patients with glaucoma, progressive visual field loss. A
retrospective, observational clinical study was performed to assess
first-day intraocular pressure after phacoemulsification cataract
surgery in patients taking tamsulosin hydrochloride at the time of
surgery.
Methods: Using registry data from the University of Colorado Health
Eye Center, data from patients who underwent phacoemulsification
cataract surgery with intraocular lens implantation between January
and August 2014 (n=630 patients) were analyzed. Patients taking
tamsulosin at the time of surgery were included as cases, while
patients with no history of Flomax use were used as controls. The
primary outcome measure was a first-day postoperative IOP spike,
defined as either 1) an IOP increase ≥ 10 mmHg compared to baseline
or 2) a first-day postoperative IOP > 30 mmHg. A multivariable
generalized linear model with repeated measures was used for
analysis. Patients who underwent cataract surgery combined with
another procedure, had a traumatic cataract or did not have IOP
measured on postoperative day one were excluded. Analysis was
performed in SAS 9.4.
Results: Of the 926 (n=630 patients) eyes included in the analysis,
there were 52 eyes in the tamsulosin group and 874 control eyes. The
mean ± standard deviation first-day postoperative IOP was 19.2 ± 9.4
mmHg in the tamsulosin group and 15.6 ± 4.8 mmHg in the control
group (p<0.0001). An IOP increase ≥ 10 mmHg or IOP spike > 30
mmHg after cataract surgery occurred in 17.3% and 9.6% of eyes
in the tamsulosin group versus 3.3% and 1.4% in the control group,
respectively. After adjusting for a history of glaucoma and the use of
a Malyugin Ring®, suture, and Iopidine® during surgery, patients
on tamsulosin were 4.4 [95% CI: 1.5-12.7, p=0.007] and 5.7 [95%
CI: 1.5-21.9, p=0.01] times more likely to have an IOP increase ≥10
mmHg or IOP spike > 30 mmHg, respectively.
Conclusions: Patients on tamsulosin have an increased risk of a
first-day IOP spike after phacoemulsification cataract surgery. Future
studies are needed to identify ways to mitigate this risk in order to
prevent complications related to an increased IOP.
Commercial Relationships: Levi N. Bonnell; Jeffrey R. Soohoo,
None; Leonard Seibold, None; Richard Davidson, None;
Naresh Mandava, None; Ashlee M. Cerda, None; Anne Lynch,
None; Brandie D. Wagner, None; Michael Taravella, None
Commercial Relationships: Sumit PARIKH, None;
Mingguang He, None
Predictors of patient satisfaction following cataract surgery
Vu Q. Do1, 2, Lisa J. Keay1, Anna Palagyi1, Fiona Stapleton2,
Jan Steen3, Andrew J. White4, 5, Peter J. McCluskey4. 1Injury, The
George Institute for Global Health, Sydney, NSW, Australia; 2School
of Optometry and Vision Science, University of New South Wales,
Sydney, NSW, Australia; 3Ophthalmology Network, Agency for
Clinical Innovation, Sydney, NSW, Australia; 4Save Sight Institute,
Sydney Medical School, University of Sydney, Sydney, NSW,
Australia; 5Westmead hospital, Department of Ophthalmology,
Sydney, NSW, Australia.
Purpose: The patient’s perspective on vision following cataract
surgery is important in defining surgical success, however little is
known about the relationship between satisfaction with post-operative
vision and preoperative vision status. A prospective cohort study was
performed to determine whether preoperative factors were predictive
of dissatisfaction with vision following cataract surgery.
Methods: Bilateral cataract patients (aged 50 years and older)
scheduled for their first-eye cataract surgery were recruited at
four metropolitan NSW public hospitals. Patients with significant
comorbidities that were considered to impact surgical outcome, such
as advanced glaucoma, amblyopia, dementia, stroke or Parkinson’s
disease, were excluded. Participants were assessed prior to first-eye
surgery and 3-months after surgery. We used logistic regression
to investigate the impact of pre-operative visual acuity, contrast
sensitivity, stereopsis, spherical ametropia, astigmatism, distance
spectacle dependence, residual refractive error, driving status and
self-reported visual disability (Catquest 9SF, rescaled 0-100) on
dissatisfaction with postoperative vision.
Results: The mean age of participants was 72 ±8 years (mean ± SD),
with the majority were female (53%, n=78/147). Mean bilateral visual
acuity was 0.24 ±0.2 logMAR (mean ± SD) and median bilateral
log contrast sensitivity was 1.56 (IQR: 1.40-1.68) prior to cataract
extraction. One in every five participants (n=30) were dissatisfied with
their first-eye cataract surgery. Pre-operative patient-reported visual
disability (χ2= 8.20, 1 DF, p=0.004) and 2 dioptres of more astigmatism
(χ2=4.05, 1 DF, p=0.044) were found to be independently predictive of
postoperative vision dissatisfaction. For every 10 units increase in visual
disability, the risk of dissatisfaction with postoperative vision increased
by 64% (OR=1.64, 95%CI: 1.17 to 2.3). Those with high astigmatism
were 2.6 times more likely to be dissatisfied with vision postoperatively
(OR=2.6, 95%CI: 1.03 to 6.63).
Conclusions: This study suggests that patients with complex
pre-operative refractive errors such as high astigmatism may be
more likely to be dissatisfied with their vision post-operatively.
Patient-reported visual disability, rather than more commonly used
objective measures of vision was associated with post-operative
dissatisfaction with vision.
Commercial Relationships: Vu Q. Do, None; Lisa J. Keay, None;
Anna Palagyi, None; Fiona Stapleton, None; Jan Steen, None;
Andrew J. White, None; Peter J. McCluskey, None
Support: NSW ACI Project Grant
The Effect of Mandatory On-Site Pre-Admission Testing on
Resident-Performed Cataract Surgery Cancellation Rates
Eileen Mayro1, Douglas Wisner2, Robert Bailey2, Anish Koka3,
Adedoyin Okulate1, Benjamin Leiby4, Nooreen S. Dabbish4,
Laura Pizzi5, Ann P. Murchison1, 6, Samantha Parker1, Lisa Hark1, 6.
1
Department of Research, Wills Eye Hospital, Philadelphia, PA;
2
Cataract and Primary Eye Care Service, Wills Eye Hospital,
Philadelphia, PA; 3Koka Cardiology, Thomas Jefferson University,
Philadelphia, PA; 4Department of Pharmacology and Experimental
Theraputics, Thomas Jefferson University, Philadelphia, PA;
5
College of Pharmacy, Thomas Jefferson University, Philadelphia,
PA; 6Department of Ophthalmology, Thomas Jefferson University,
Philadelphia, PA.
Purpose: To evaluate the effect of mandatory on-site pre-admission
testing in decreasing resident-performed cataract surgery cancellation
rates.
Methods: Patients scheduled for cataract surgery in the resident
clinic between January 5, 2015 and October 31, 2015 were
randomized by week into two groups: usual care or intervention.
Nursing home, dialysis, and incarcerated patients, and patients
younger than age 18 were excluded. Patients randomized to the
usual care group were provided with pre-admission testing (PAT)
requirements at the time of cataract surgery scheduling and instructed
to complete PAT at their own primary care physician. Patients
randomized to the intervention group were required to complete
same-day, on-site PAT at an affiliated cardiology practice and
escorted by a research assistant. Patients in both groups received a
reminder call by the ophthalmology resident or operating room staff
1-2 days prior to surgery. Statistical analysis consisted of univariate
GEE model regression to account for clustering by week.
Results: A total of 413 patients were enrolled in the study with
185 patients randomized to the intervention group and 228 patients
randomized to the usual care group. Mean ages in the intervention
and usual care groups were 66.1 ± 12.2 years and 64.6 ± 12.4 years,
respectively. Patients were predominately female in both groups
representing 54% of the intervention group and 58% of the usual care
group. In the total sample (n=413), 229 patients (55%) were African
American, 120 (29%) were Caucasian, 19 (5%) were Asian, and 19
(5%) were Hispanic/Latino. Pre-admission testing was completed in
95% of the intervention group compared to 92% of the usual care group
(p=0.22). The cataract surgery cancellation rate in the intervention group
was 12% compared to 15% in the usual care group (p=0.34).
Conclusions: No statistically significant difference was observed in
resident-performed cataract surgery cancellation rates between the
mandatory same-day, on-site PAT group and the usual care group.
Pre-admission testing was completed by the majority of patients and
low cancellations rates, 15% and 12%, were observed in both groups.
Commercial Relationships: Eileen Mayro, None;
Douglas Wisner, None; Robert Bailey, None; Anish Koka,
None; Adedoyin Okulate, None; Benjamin Leiby, None;
Nooreen S. Dabbish, None; Laura Pizzi, None; Ann P. Murchison,
None; Samantha Parker, None; Lisa Hark
Support: Wills Eye Hospital Innovation Grant 15072
Clinical Trial: NCT02621840
Improvement on the quality of life after cataract surgery in
patients older than 50 years of age
Yolanda Beatriz Ortiz-Figueroa1, Alvaro Garcia Perez1,
Roberto Castrejon Perez2, Enrique O. Graue-Hernandez3,
Jesus Arrieta4, Aida Jimenez-Corona1, 5. 1Ocular epidemiology and
vision health, Instituto de Oftalmologia Conde de Valenciana, Mexico
City, Mexico; 2National Institute of Geriatry Health Secretariat,
Mexico, Mexico; 3Department of Cornea and Refractive Surgery,
Instituto de Oftalmologia Conde de Valenciana, Mexico, Mexico;
4
Department of Anterior Segment, Instituto de Oftalmologia
Conde de Valenciana, Mexico, Mexico; 5General Directorate of
Epidemiology, Health Secretariat, Mexico, Mexico.
Purpose: Age-related cataract is one of the main causes of visual
impairment and blindness that affects the quality of life of patients.
Our aim was to assess the quality of life before and after cataract
surgery using the SF-36 questionnaire.
Methods: Longitudinal study carried out from November 2014
to July 2015, including 402 patients aged ≥50 years with cataract.
Patients were evaluated one month after cataract surgery. The SF36
questionnaire, which assesses quality of life according to selfreported health status, includes 36 items for 8 domains (physical
functioning, physical performance, corporal pain, general health,
vitality, social functioning, emotional performance and mental
health). The score per domain ranges from 0 (worse status) to 100
(best status).
Results: Of 391 patients (66.7%); average age 71.6 years, S.D.10.2),
46.3% had diabetes and 50% had hypertension. Moderate/severe
visual impairment was present in 86.3% of patients, and blindness
in 13.7%. At baseline, the SF36-score was lower in women than in
men for physical functioning (66.3 vs 72.3 respectively, p=0.002),
emotional performance (64.3 vs 87.2, respectively, p=0.0001), and
mental health (69.8 vs 79.1, respectively, p=0.0001). Subjects with
blindness had a lower SF36-score compared with subjects with
moderate/severe impairment for physical functioning (70.2 vs 75.9,
respectively, p=0.037) and physical performance (45.7 vs 55.1,
respectively, p=0.034). The SF36-score was lower in hypertensive
compared with non-hypertensive subjects for general health, and
physical functioning, and vitality. The SF36-score was also lower
in diabetic compared with non-diabetic subjects for general health.
In a subsample of 186 patients, using multiple linear regression,
after adjustment for age, sex, diabetes, hypertension, blindness and
depression, after one month of cataract surgery, an improvement on
the quality of life for physical functioning dimension (per each 10
points on the score at baseline, the increment on the score was 6.67
points [IC95% 5.2-8.0]); and for mental health dimension (per each
10 points on the score at baseline, the increment on the score was
4.66 points [IC95% 3.0-6.2]) was observed.
Conclusions: This study shows a positive impact of cataract surgery
on some dimensions of quality of life related to health, particularly
physical functioning and mental health, which is a necessary
condition for resuming daily life activities
Commercial Relationships: Yolanda Beatriz Ortiz-Figueroa,
None; Alvaro Garcia Perez, None; Roberto Castrejon Perez,
None; Enrique O. Graue-Hernandez, None; Jesus Arrieta, None;
Aida Jimenez-Corona, None
Cataract Surgery in Hospice Patients: Pros, Cons and
Cost-Effectiveness
Joshua Nunn1, Seth Pantanelli1, Ingrid U. Scott1, Scott Shreve2.
1
Ophthalmology, Penn State Hershey Medical Center, Harrisburg, PA;
2
Lebanon VA Medical Center, Lebanon, PA.
Purpose: Hospice care focuses on improving quality of life (QOL)
rather than prolonging life. The purpose of this study is to investigate
the pros, cons, and cost-effectiveness of performing cataract surgery
in hospice patients.
Methods: The pros and cons of cataract surgery in hospice patients
are described. To assess cost effectiveness, the cost per quality
adjusted life year (QALY) was calculated and compared to the cost
per QALY of hemodialysis. Many previous studies have used the
annual cost of hemodialysis as the benchmark to define societal
willingness to pay for a QALY, arguing that the federal entitlement to
Medicare insurance coverage for patients with chronic renal failure
implies a societal judgment that the program’s benefits are worth its
cost. To calculate the cost per QALY of cataract extraction, CMS.
gov was queried to determine the average Medicare reimbursement
for uncomplicated cataract extraction. This was combined with
previously published calculations of the QALY gained from cataract
extraction. The cost per QALY of hemodialysis was determined using
previously published calculations.
Results: Cataract surgery in hospice patients is a relatively safe
intervention that can improve QOL. However, risks include
complications requiring more surgery, a small risk of intraoperative
death, and the stigmata surgeons face if post-surgical patients expire
within 30 days. The average cost of cataract extraction is $650.40
per procedure. Previous work has shown the total Medicare cost
of hemodialysis per person per year is $84,550. It has been shown
that the utility gain for cataract surgery is 0.148 QALY/year and
hemodialysis confers a benefit of 0.66 QALY/year. The average
length of hospice service is 72.6 days. Based on this information,
the average cost per QALY of performing cataract extraction in a
hospice patient is $22,100/QALY, and the average cost per QALY of
hemodialysis is $128,000/QALY.
Conclusions: Performing cataract surgery in a person with limited
life expectancy is controversial. It improves QOL by allowing
individuals to see loved ones and enjoy activities otherwise
impossible, such as reading or watching television. However, the
intervention comes with risks including possible complications
or intraoperative death. Cost-effectiveness analysis suggests
cataract surgery in hospice patients is acceptable in those with life
expectancies of as little as 12-13 days.
Commercial Relationships: Joshua Nunn, None; Seth Pantanelli,
Alcon (R); Ingrid U. Scott, None; Scott Shreve, None

Session 534 Cataract_ Prevalence and Predictors

Transcription

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