Visual acuity and quality of life in heavy visual workload patients with bilateral cataract before and after phacoemulsification

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BACKGROUND

Cataract is one of the most urgent forms of eye pathologies, with an overall prevalence in the Russian Federation of 3.36% for the urban population and 3.63% for the rural population. According to a mathematical model, the prognosis of the prevalence of patients with mature cataract in different age groups will account for 11%–13% of the general population in the coming years. Cataract is also one of the major causes of reversible ablepsia and impaired vision [1–3]. The gold standard of cataract surgery is phacoemulsification (PE), and its practical application has been widely tested and regulated in the practice of both Russian [4] and international ophthalmologists [5, 6]. To date, several aspects of PE are debatable in the literature [7–10], one of which is the study of the surgical characteristics in patients with heavy visual workload (HVW) [11]. In addition, the inclusion of the quality of life (QoL) assessment in the complex of standard clinical and functional methods for examining the eyes of a patient with cataracts is highly efficient [12–14].

This work aimed to analyze the dynamics of visual acuity and QoL in patients HVW and bilateral cataract before and after PE.

MATERIALS AND METHODS

We monitored 32 patients (26 men, 6 women) aged 37–65 (mean age, 54.7 ± 1.4) years who met the following inclusion criteria:

• Daily activities were characterized as HVW using a personal computer, such as financial and scientific workers, proofreaders, etc.
• Binocular cataract with a visual acuity in the “best” eye of no more than 0.6, which corresponded to the recommendations justifying surgical treatment of cataracts in patients with HVW at an earlier stage [11].
• Absence of other eye pathologies and systemic somatic diseases.
• Surgery on the fellow eye three weeks after the first surgery (for paramedical reasons).

All patients underwent standard PE using Infiniti (Alcon, TX, USA) or Constellation (Alcon) devices according to the standard technique through a 2.2-mm corneal incision with a meridional direction according to the refractive map of the cornea; in all patients, procedures were performed by the same surgeon (D. F. Pokrovsky). For aphakia correction, monofocal intraocular lenses Acrysof Natural IQ (Alcon), Akreos AO (Bausch + Lomb, Bridgewater, NJ, USA), and Biflex (Medicontur, Hungary) were implanted. Biometrics and calculation of intraocular lenses were performed using an optical biometer IOL Master (Carl Zeiss, Germany).

The best-corrected distance visual acuity (BCVA) was evaluated according to the standard method using a SC-1700 chart panel and a phoropter (Nidek, Japan). Refraction was assessed using an HRK-7000 instrument (Huvitz, South Korea) before and after surgery. In this case, the “target” refraction was ±0.5 diopters. QoL was assessed using the “QoL-25” questionnaire widely tested in refractive surgery, which includes 25 questions in the main areas of professional and everyday visual activity; this tool can be used as a quantitative integral indicator based on the weight coefficients of each of the patient’s answers. The total test indicator was estimated [15]. This questionnaire was selected given that, at present, cataract surgery, in terms of the quality of vision of the patient after PE, can be referred to as a refractive intervention, which is associated with the implementation of new technologies in ophthalmic surgery and development of high-quality intraocular lenses [16]. Patients were examined before the first surgery; 7, 14, and 21 days after the first surgery; and 7 and 14 days after the second surgery.

Statistical analysis of the study results was performed using the Statistica 8.0 software application (StatSoft, Inc., USA) based on the use of standard parametric methods for estimating the mean and error of the mean value of the indicator (M ± m), as well as Student’s t-test.

RESULTS

In the analysis of the clinical findings of patients after PE, no postoperative infectious complications were noted. Tables 1 and 2 and Figure 1 present the research results.

 

Table 1. Results of the best corrected distance visual acuity (BCVA) dynamics before and after phacoemulsification, M ± m / Таблица 1. Результаты исследования динамики максимально корригируемой остроты зрения вдаль (МКОЗ) у пациентов до и после проведения факоэмульсификации катаракты, M ± m

BCVA, rel. units	“Worst” eye	“Best” eye	p*
Before surgery	0.18 ± 0.04	0.56± 0.04	0.0008
After surgery 1
Day 7	0.78 ± 0.06	0.56 ± 0.04	0.006
Day 14	0.89 ± 0.06	0.56 ± 0.04	0.004
Day 21	0.94 ± 0.06	0.56 ± 0.04	0.0006
After surgery 2
Day 7	0.95 ± 0.05	0.80 ± 0.05	0.02
Day 14	0.95 ± 0.05	0.92 ± 0.05	0.25

* р — level of confidence between the “worst” and “best” eye.

 

Table 2. Results of refraction testing before surgery and deviations from target refraction in patients after phacoemulsification, M ± m / Таблица 2. Результаты исследования рефракции до операции и отклонения от целевой рефракции у пациентов после проведения факоэмульсификации катаракты, M ± m

Parameter	“Worst” eye	“Best” eye
Refraction before surgery, diopter	–2.41 ± 0.21	–1.95 ± 0.26
Deviation from the target refraction after the first surgery, diopter
Day 7	0.22 ± 0.05	–
Day 14	0.25 ± 0.04	–
Day 21	0.27 ± 0.04
Deviation from the target refraction after the second surgery, diopter
Day 7	0.26 ± 0.04	0.22 ± 0.05
Day 14	0.26 ± 0.05	0.27 ± 0.04

 

Figure. The results of the investigation of the quality of life dynamics in a patient before and after phacoemulsification / Рисунок. Результаты исследования динамики качества жизни пациента до и после проведения факоэмульсификации катаракты

 

DISCUSSION

PE demonstrated a high clinical efficiency, which is confirmed (14 days after the second surgery) by an increase in BCVA, with an average of 0.92–0.95 rel. units and QoL up to 201.4 points, which represent maximum values. In all cases, a minimum deviation of 0.22–0.27 diopters was noted from the “target” refraction. Moreover, data indicated a certain dynamics of QoL, which is manifested by its significant deterioration after 14 and 21 days from the first surgery (by 2.3%–4.7%, p = 0.02–0.008) compared with data obtained within 7 days. The changes can be due to a pronounced difference in the visual acuity of both eyes, which at this period averaged from 0.33 to 0.38 rel. units.

In the analysis of the literature, targeted studies indicated the negative effect of anisometropia and aniseikonia in patients with binocular cataract after surgery on the “worst” eye [17–19]. In addition, the results of optical modeling [11] and basic studies of the psychophysiology of vision indicate the maximum allowable value in the difference in the visual acuity of both eyes (0.2–0.3 rel. units) [20].

From the current situation to the practice of cataract surgery, sequential surgical intervention with a time interval between surgeries of 7–10 days appears appropriate in patients with HVW and binocular cataract. Moreover, in our opinion, one-stage binocular phacoemulsification should be considered an alternative option [21–23] compared with the traditional monocular one, when surgery on the fellow eye is performed after certain periods, often quite long due to various reasons, which, according to the results presented, may be a risk factor for a decrease in QoL and visual performance.

CONCLUSION

Surgical treatment of patients with HVW and binocular cataract is based on an earlier (7–10 days) surgery on the fellow eye or simultaneous binocular PE, taking into account the QoL, particularly in patients with HVW.

ADDITIONAL INFORMATION

Author contributions. All authors confirm that their authorship complies with the ICMJE criteria. All of them have made a significant contribution to the development of the concept, as well as research, and preparation of the article. They have read and approved the final version before its publication. Specific contributions were as follows: D.F. Pokrovsky developed the concept and design of the study and prepared the final draft of the article for publication. N.I. Ovechkin developed the concept and design of the study and collected the data.

Conflict of interest. The authors declare no conflict of interest.

Funding. The study had no external funding.

About the authors

Dmitry F. Pokrovsky

N.I. Pirogov Russian National Research Medical University

Email: dfpokrovskiy@gmail.com
ORCID iD: 0000-0002-5475-0398
SPIN-code: 6487-5793

Cand. Sci. (Med.), MD, Ophthalmologist, Assistant Professor

Russian Federation, 1, Ostrovityanova st., Moscow, 1117997

Nikolay I. Ovechkin

Helmholtz National Medical Research Center of Eye Diseases

Author for correspondence.
Email: n.ovechkin@gmail.com
SPIN-code: 3248-2607

Cand. Sci. (Med.), MD, Head of operation unit

Russian Federation, Moscow

References

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