Purchase this article with an account.
Jonathan Hyer, Andrew Coombes, Mark C Westcott; A 10 year prospective study of cataract surgery in an ethnically diverse population: Is the language barrier a risk factor for posterior capsule rupture?. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):1924.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
The UK Cataract National Dataset has allowed the identification and quantification of risks for posterior capsule rupture (PCR) but data were not collected on patients’ proficiency in English language or whether patients moved whilst operating. A large proportion of our patients are Bangladeshi with multiple co-morbidities for whom English is not their first language. We performed a prospective perioperative survey to identify risk factors for PCR, with particular attention to this subgroup.
Data were collected prospectively at a single NHS site from January 2005. Operations were performed by surgeons of all grades. Risk indicators for variations in the rate of PCR were identified by univariate analyses using SPSSv22.
Overall PCR rate was 3.7% from a total of 2912 operations analysed. The majority were performed under local anaesthetic (96.3%). Statistically significant risk indicators for PCR were small pupil (p=0.003), dense nuclear sclerosis (p=0.003), patient movement (p=0.003) and the use of vision blue (p=0.001). Mean pre-operative best corrected LogMAR visual acuity was significantly worse in the PCR group (p=0.01). Patient movement correlated significantly with inability to speak English (p < 0.001) and could represent a surrogate risk factor. 23% of subjects were non-English speaking, and these eyes had statistically worse pre-operative vision, higher prevalence of diabetes and retinopathy, dense cataracts, and intraoperative use of vision blue (p= 0.001).
Our data confirm previously established risk factors for PCR, and rates of these are higher in the non-English speaking subgroup. Unsurprisingly, but previously unreported, is the correlation of patient movement with PCR. Whilst this is difficult to assess pre-operatively, it appears to be strongly associated with patients who don’t speak English. This has implications for operations performed under local anaesthetic and may suggest the need for intraoperative interpreters in these eyes already at higher risk of PCR.
This PDF is available to Subscribers Only