The Importance of Biometry to Cataract Outcomes in a Surgical Unit in Africa

Briesen, Sebastian; Roberts, Helen; Lewallen, Susan

doi:10.3109/09286586.2010.498662

Cited by 9 publications

(21 citation statements)

References 21 publications

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“…There is a marked increase in prediction error of biometry in eyes with ocular co-morbidity, and eyes with no ocular comorbidity with pre-operative VA \ 6/60 also increase the prediction error of biometry [27]. In Kenya, it was predicted that use of biometry could improve the proportion of 'good refractive outcomes' (defined as ?1-1.5D spherical equivalent) [8]. In that study, 48.8 % of men and 61.4 % of women had a good refractive outcome with standard 22D lenses without biometry.…”

Section: Discussionmentioning

confidence: 95%

“…Encouragingly, less than 2 % of surgeries had a poor visual outcome, and less than 10 % of operations resulted in a borderline outcome following pinhole correction. Although we consider 22D IOL to be the most appropriate power, in another African population, best fit of IOL is considered to be ?21D in men and ?22D in women [8].…”

Section: Discussionmentioning

confidence: 99%

“…In order to monitor the quality of cataract surgery, the World Health Organization (WHO) has set a target of at least 85 % of eyes to achieve a post-operative presenting visual acuity (VA) of 6/18 or better [7]. Although some studies suggest that use of biometry is associated with improved cataract surgical outcomes in sub-Saharan Africa [8], the findings have not been universal [9].…”

Section: Introductionmentioning

confidence: 99%

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Outcomes of manual small-incision cataract surgery using standard 22 dioptre intraocular lenses at Nkhoma Eye Hospital, Malawi

Sherwin

Dean

Schaefers³

et al. 2012

Int Ophthalmol

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The aim of this study was to investigate the outcomes of sutureless, manual small-incision cataract surgery (SICS) in rural sub-Saharan Africa using standard intraocular lenses (IOLs). In order to assess the quality of surgery, we prospectively evaluated the visual outcomes of 1455 consecutive cataract operations performed in 2006 in patients ≥40 years at Nkhoma Eye Hospital, Malawi. All operations used standard 22-dioptre IOLs without pre-operative biometry. Outcomes were categorised according to the World Health Organization criteria, and causes of a poor outcome were recorded. Mean age of patients was 71.5 ± 9.5 years, and 53 % were female. Pre-operatively, 64 % of eyes had a visual acuity (VA) <6/60, and 41.3 % of eyes were blind (VA < 3/60). Without correction (uncorrected VA), nearly eighty percent (78.7 %) achieved a 'good' outcome (VA 6/6-6/18), 19.8 % were 'borderline' (VA < 6/18-6/60), and 1.5 % had a poor (VA < 6/60) outcome. With pinhole-correction, the proportion of good outcomes increased to 89.4 %, and poor outcomes decreased to 0.9 %. Poor outcomes were most commonly due to ocular co-morbidities (54.5 %) and refractive error (36.4 %). Older age and pre-operative blindness were strongly associated with borderline or poor visual outcomes. The most common surgical complication was posterior capsule tear (without vitreous loss). In a rural African environment, using standard IOL power plus SICS can lead to a high proportion of good outcomes and a low frequency of surgical complications. A comparative study is required to determine if any additional benefit in visual outcomes can be gained by the addition of biometry.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Outcomes of manual small-incision cataract surgery using standard 22 dioptre intraocular lenses at Nkhoma Eye Hospital, Malawi

Sherwin

Dean

Schaefers³

et al. 2012

Int Ophthalmol

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“…[43] Therefore the challenge is to translate the available technology to benefit the blind and visually impaired poor populations in LMIC, at a pace that can reach the stated goals within the shortest span of time. At the time when professionals are documenting that technology like biometry and manual small incision cataract surgery/phacoemulsification can revolutionize visual outcomes after cataract surgery,[4445] there comes evidence from West Africa on high rates of couching and appalling visual outcomes as a consequence, even to this day. [46]…”

Section: Discussionmentioning

confidence: 99%

Elimination of avoidable blindness due to cataract: Where do we prioritize and how should we monitor this decade?

John¹,

Shamanna²,

Pant³

2012

Indian J Ophthalmol

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Background:In the final push toward the elimination of avoidable blindness, cataract occupies a position of eminence for the success of the Right to Sight initiative.Aims:Review existing situation and assess what monitoring indicators may be useful to chart progress towards attaining the goals of Vision 2020.Settings and Design:Review of published papers from low and middle income countries since 2000.Materials and Methods:Published population-based data on prevalence of cataract blindness/visual impairment were accessed and prevalence of cataract blindness/visual impairment computed, where not reported. Data on prevalence of cataract blindness, cataract surgical coverage at different visual acuity cut offs, surgical outcomes, and prevalence of cataract surgery were analyzed. Scatter plots were used to look at relationships of some variables, with Human Development Index (HDI) rank. Available data on Cataract Surgical Rate (CSR) was plotted against prevalence of cataract surgery reported from surveys.Results:Worse HDI Ranks were associated with higher prevalence of cataract blindness. Most studies showed that a significant proportion of the blind were covered by surgery, while a fifth showed that a significant proportion, were operated before they went blind. A good visual outcome after surgery was positively correlated with higher surgical coverage. CSR was positively correlated with cataract surgical coverage.Conclusions:Cataract surgical coverage is increasing in most countries at vision <3/60 and visual outcomes after cataract surgery are improving. Establishing population-based surveillance of cataract surgical need and performance is a strong monitoring tool and will help program planners immensely.

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“…9 Advances in technology have made biometry more portable and feasible to perform in remote locations. Briesen et al 10 predicted that using biometry in Kenyan cataract camps would increase the number of patients with a spherical equivalent between C1.00 and À1.50 D from 57.3% to 71.1%. In a national survey of Nigeria based on biometry data, Imam et al 11 found that IOL powers of 20.00 D and 21.00 D would be the most suitable for the population.…”

Section: Discussionmentioning

confidence: 98%

Intraocular lens power calculation for humanitarian missions based on partial biometry

Schmitz¹,

Davis²,

McClatchey³

2012

Journal of Cataract and Refractive Surgery

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The Importance of Biometry to Cataract Outcomes in a Surgical Unit in Africa

Cited by 9 publications

References 21 publications

Outcomes of manual small-incision cataract surgery using standard 22 dioptre intraocular lenses at Nkhoma Eye Hospital, Malawi

Outcomes of manual small-incision cataract surgery using standard 22 dioptre intraocular lenses at Nkhoma Eye Hospital, Malawi

Elimination of avoidable blindness due to cataract: Where do we prioritize and how should we monitor this decade?

Intraocular lens power calculation for humanitarian missions based on partial biometry

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