Using dark adaptation time to assess macular function prior to cataract surgery

Session Details

Session Title: Pseudophakic IOLs: Enlarged-Depth-of-Focus I

Session Date/Time: Monday 12/09/2016 | 14:00-15:30

Paper Time: 15:16

Venue: Hall C4

First Author: : M.McKeague USA

Co Author(s): :    M. Pyfer                    

Abstract Details

Purpose:

To establish the utility of an automated rapid dark adaptation (DA) test as a screening method for macular dysfunction in patients with a normal fundus exam undergoing cataract surgery evaluation. Such screening is needed since the symptoms of cataract are similar to early macular disease, and multifocal intraocular lenses (MFIOL) may reduce contrast sensitivity and impair visual function in patients with subclinical macular degeneration. Current standard evaluation methods, including clinical exam and ocular coherence tomography (OCT), assess structure but not function.

Setting:

Comprehensive ophthalmology practice affiliated with Wills Eye Hospital in Philadelphia, Pennsylvania, USA.

Methods:

Retrospective chart review showed that 193 eyes underwent rapid DA testing within a 13-month period for a variety of indications. In order to identify potential MFIOL candidates, we selected eyes that were pseudophakic, had best-corrected visual acuity of ≥ 20/25, had either a normal fundus exam or one revealing mild drusen or pigmentary changes, and had normal corneal topography. We analyzed the results of the rapid DA test among the final subset of 27 eyes that would be otherwise considered potential MFIOL candidates.

Results:

Among 27 eyes, 17 (63%) had normal DA time, while 10 (37%) displayed delayed dark adaptation. Logistic regression analysis showed that age was correlated with likelihood of abnormal DA (p=0.018), as seen in prior studies, but gender and central macular thickness on OCT were not (p=0.46 and p=0.789, respectively).

Conclusions:

Our results demonstrate that a substantial fraction of potential MFIOL candidates have delayed dark adaptation suggesting possible poor visual function after MFIOL implantation. While the results are limited by selection bias since our patients had various indications for DA testing, the study highlights the utility of macular function testing with dark adaptation in cataract evaluation. Abnormal dark adaptation can be used as a potential marker of subclinical macular dysfunction among patients who are otherwise deemed good candidates for MFIOL.

Financial Disclosure:

NONE