Abstract
Purpose :
Despite advances in surgical technique and intraocular lens (IOL) design, posterior capsular opacification (PCO) leads to decreased visual performance in at least 20% of patients after cataract surgery. This study is a retrospective analysis of whether visual acuity (VA) can be used as a surrogate marker to predict the need for Nd:YAG laser capsulotomy, and analyzes factors that may impact timing of the need for YAG.
Methods :
Eyes undergoing cataract phacoemulsification surgery at the University of Colorado Hospital from 1/1/2014 through 12/31/2016 who required Nd:YAG laser capsulotomy prior to 04/2018 were identified. Uncorrected and corrected distance visual acuities (UDVA and CDVA) at the clinic visit prior to cataract surgery, the time of capsulotomy, and all clinic visits in between were collected. The type of IOL (monofocal, monofocal toric, and multifocal) and demographic information (age, gender) were also recorded. Exclusion criteria included patients under age 55, history of or combined surgery with vitrectomy, and history of uveitis.
Results :
Four hundred and thirty-seven eyes were identified for the study. Most received monofocal lenses (88.5%), while 6.9% received toric lenses and 4.6% received multifocal lenses. The mean interval between surgery and capsulotomy was 527 days (SD 364).. There was no significant difference in time from cataract surgery to YAG analyzed by age or gender. The most common CDVA at the visit prior to YAG was 20/20 (33%); however, the most common UDVAs at this same time were 20/30 (17%) and 20/40 (17%) and only 11% of patients had 20/20 UDVA prior to YAG (Figure 1). There was a trend towards earlier YAG (Figure 2) and superior UDVA at time of YAG for multifocal lenses (70% were 20/30 or better) compared to monofocal lenses (42.7% were 20/30 or better); however, this difference did not reach statistical significance.
Conclusions :
This study suggests that CDVA is not a reliable predictor of the need for YAG; however, a decrease in UDVA may be a more predictive metric. Patients that receive multifocal lenses may be getting capsulotomy sooner than patients with monofocal or toric lenses, but our sample size of eyes receiving multifocal lens was too small for this difference to reach statistical significance. This data will help physicians and researchers better understand the most common time for intervention with capsulotomy and help direct timing of future pharmacologic therapies.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.