Functional and neuroadaptive effects in cataract and clear lens extraction characterised via a quality of vision questionnaire

Session Details

Session Title: Pseudophakic IOLs: Multifocal & Accommodative

Session Date/Time: Monday 07/09/2015 | 08:00-10:30

Paper Time: 09:24

Venue: Room 1

First Author: : R.McNeely UK

Co Author(s): :    E. Pazo   A. Spence   O. Richoz   T. Moore   J. Moore   A. Nesbit     

Abstract Details

Purpose:

A Quality of Vision (QOV) questionnaire previously designed by us was modified to enhance its predictive capabilities. To determine its sensitivity and specificity to the presence of cataract, QOV was assessed in patients with and without cataract undergoing phacoemulsification with subsequent multifocal intraocular lens (MIOL) implantation.

Setting:

Cathedral Eye Clinic, Belfast, Northern Ireland, UK

Methods:

This study comprised of patients implanted with asymmetric MIOLs after phacoemulsification. The study enrolled 92 patients (182 eyes) with clear lens extraction (CLE) with a mean age of 66.9 years and 36 patients (70 eyes) with cataract extraction, mean age 59.9 years. Refraction, uncorrected (UDVA) and corrected distance visual acuity (CDVA), uncorrected near visual acuity (UNVA), uncorrected intermediate (UIVA) and a QOV questionnaire were evaluated preoperatively and at two postoperative follow-ups. Two groups were categorized based upon whether they had preoperative CLE or cataract extraction. Categorical statistical analysis was carried out on all measured indices based upon these two groups.

Results:

The CLE group showed a statistically significant higher median QOV score preoperatively (P≤ 0.05). Those patients who had preoperative cataract had a higher median QOV score at the first postoperative assessment (P≤ 0.05). At the later postoperative assessment the two groups showed the same median QOV score (P=0.314). The mean UDVA in the cataract group at the first postoperative was 0 logMAR ± 0.13 and -0.02 logMAR ± 0.13 at the subsequent postoperative assessment. The mean UDVA in the non-cataract group at the first postoperative assessment was -0.03 logMAR ± 0.12 and -0.18 logMAR ± 0.12 at the succeeding assessment.

Conclusions:

The QOV questionnaire demonstrated significant evidence of reduced QOV indices in the preoperative cataract group consistent with other objective clinical tests. In the early postoperative period despite similar objective visual function tests patients with cataract preoperatively demonstrated enhanced subjective QOV findings, what we have described as a ‘euphoria' effect due to removal of the cloudy crystalline lens. This type of ‘functional neural overlay' reduces with time and is usually lost between 3months to 1year postoperatively. This QOV questionnaire therefore appears to be sensitive to both objective visual differences induced by cataract preoperatively and to early functional neural overlay and neuroadaptation.

Financial Interest:

NONE