Optician India

ABSTRACT

BACKGROUND:-Cataract is one of the most frequently occurring visual impairments among the ocular disease in the world. Cataract in very elderly patients can cause progressive painless vision loss.

AIM:-The aim of this study was to retrospectively evaluate the effect of cataract surgery on visual acuity (VA) and daily living activities in participants aged over 80 years.

METHOD:-In this retrospective study involved a total number of 100 patients. Patients were divided into two age group 80 to 84 years old and 85 to 90 years old. Preoperative and postoperative details, best corrected visual acuity (BCVA), intraocular pressure, systemic Illness, ocular comorbidities and surgical complication were analyzed on the 1 month after cataract surgery. Data were recorded from the patient's medical file.

RESULTS:-In all, 150 patients 90 patients male and 60 patients female. In total, 92/150 eyes had phacoemulsification and 58 patients has SICS ( small incision cataract surgery).Best corrected visual acuity (BCVA) improved in 115 of 150 eyes (76%). BCVA remained the same in 20 of the 150 eyes (13%) and decreased in 15 of the 150 eyes (10%), mainly because of coexisting glaucoma and age related macular degeneration (AMD). Postoperative scores for the daily living activities scale were significantly better to preoperative levels.

CONCLUSION:-Advanced age is not a contraindication for cataract surgery. Our result showed that better VA levels for daily living activities can be obtained after cataract surgery in elderly patients aged over 80 years old, thereby suggesting that cataract removal in this populations.

INTRODUCTION

Cataract is one of the most frequently occurring visual impairments among the ocular disease in the world. Cataract in very elderly patients can cause progressive painless vision loss. Because of the demographic shift in developed countries toward old age ,the prevalence over the whole population has increased. The major indication for cataract surgery is to improve as contrast sensitivity, disability glare and even visual field. The goal is not only to improve performance in daily living activities.

Cataract surgery in very elderly patients is challenging, as the majority of these patients have very dense nuclear cataract. As age advances there is gradual reduction in corneal endothelial cell density, thus possibly predisposing to higher complication rates. In addition to these, cataract surgery in very elderly patients could be fraught with difficulties, as they may not be able to lie flat because of neck or back problems. Uncooperative patients and those who are hard of hearing could make matter worse.

Cataract are one of the conditions responsible for impaired vision in very elderly. The decrease of vision is a serious risk factor for loss of balance, perhaps leading to falls and injury. Many risk factors for falling among elderly people have been identified in epidemiological studies, including poor vision. Hip fractures in the elderly are commonly caused by falls.

In this study, we aim to evaluate the clinical outcomes of cataract surgery in very elderly subjects. Accordingly, we analyzed retrospectively the postoperative VA, the effect of VA on the patient's ability to participate in their daily living activities, and frequency of surgical complications.

LITERATURE REVIEW

1. Applegate et al has shown improved VA in a majority of thepatient's (88%) above 70 years old following cataract surgery.

2. Lundstrom et al have shown improvement in VA in 84.3% of patients greater then 85 years.

3. Berler et al, found that in patients under 88 years, 90.5% of eyes with complicated cataract surgery achieved a VA>6/12, compared with only 40% of complicated cataract cases when patients were >88 years old.

4. Westcott et al found that age is a significant determinant of visual outcomes, with the odds of a patients with no comorbidity achieving acuity VA of greater then 6/12 being 4.6 times higher in the 60-69 year old age group than in those greater then 80 years old.

METHODOLOGY

This is a retrospective study done on 150 patients of age group between 80 to 90 years old, who underwent cataract surgery at Sitapur Eye Hospital, Sitapur, Uttar Pradesh between 1 January 2022 to 21 August 2022.

The record from cataract patients were retrospectively evaluated and data from 150 eyes of 150 eligible patients who had no previous ocular surgery and who had been followed up for 1 month postoperatively were included. Preoperative and postoperative details, Snellen chart was used to evaluate best corrected visual acuity, intraocular pressure and systemic Illness, ocular comorbidities and postoperative complication were assessed. Data were collected from medical record files. Patients had significant bilateral cataracts causing impairment of visual functions or with unacceptable glare or reduced quality of vision attributable to cataract..

EXCLUSION CRITERIA- Exclusion criteria were age under 80 years.

                                           Patients with both eye operated.

INCLUSION CRITERIA- Inclusion criteria were age above 80 years.

                                        Patients with unilateral eye operated for cataract.

RESULT

The overall study population consisted of 150 eyes from 150 patients eligible for cataract surgery patients.
Group 1 included 105 patients between age group 80 to 84 years old (45 female and 70 male ) and
Group 2 included 35 patients of age group 85 to 90 years old (20 male and 15 female).
In this study, it was found that male ratio is greater than the female ratio.

Pre Operative Visual Acuity

It was found that 42 patients( 28% ) had visual acuity between 6/60 to 6/18 ; 73 patients(48%) had visual acuity between 1/60 to 5/60 and rest 35 patients(23.3%) had visual acuity between PL+ to CFFC Preoperatively.

Post Operative Visual Acuity

It was found that 52 patients (34.6%) had visual acuity between 6/12 to 6/9 ,79 patients (52.6%) had visual acuity between 6/60 to 6/18 and rest 19 patients (12.6%) had visual acuity between 5/60 to CFFC Postoperatively.

It was found that there was no significant changes of IOP before and after cataract surgery.

The surgical technique performed was either phacoemulsification 92 cases (61.3%) and SICS (small incision cataract surgery) 58 cases (38.6%). The majority of these patients (115 cases) were operated under local anesthesia.

Co-morbidities decreased the level of postoperative visual acuity were glaucoma 20 patients (13%),age related macular degeneration 17 patients (11.3),Corneal opacity 15 patients (10%), CRVO ( Central Retinal Vein Occlusion) 4 patients (2.6), CRAO (Central Retinal Artery Occlusion) 4 patients (2.6%), Retinal Atrophy 3 patients (2%) and CNVM (Choroidal Neovascular Membrane) 2 patients (1.3%).

The patients undergoing cataract surgery had some associated systemic diseases. 30 (20%)patients were Hypertensive. 12 (8%) patients were Diabetic. 10 (6.6%) patients had cardiac abnormalities, 6 (4%) were Asthmatic, 2 (1.3%) had Arthritis and rest 1 had Tuberculosis.

Some patients were found to be with surgical complications like macular edema 2 patients (1.3%), Iridodialysis 1 patient (0.6%), and Postoperative Uveitis 3 patients (2%).

DISCUSSION

Cataract is the most frequent disease causing visual loss in elderly people worldwide. Age is the most important risk factor for developing a cataract, but increasing age is also know to influence the visual acuity achieved after cataract surgery. It is difficult to perform cataract surgery on an elderly patients owing to additional difficulties like coexisting systemic disorder, the difficulty of patients cooperation during surgery, higher incidence of hard nucleus, smaller pupil size. We found little evidence to support the hypothesis that age alone is a risk factor for the intraoperative complication of phaco cataract surgery.

In the study of Berler et al, he reported that in patients under 88 years, 90.5% of eyes with complicated cataract surgery achieved a VA >6/12,compared with only 40% of complicated cataract cases when patients were >88 years old. In a previous study, Westcott et al found that age is a significant determinant of visual outcome, with the odds of a patient with no co-morbidity achieving acuity VA of >6/12 being 4.6 times higher in the 60- 69 year old age group than in those >80 years old.

In my study, it was found that improvement in VA in 82% of patients >80 years. Our study supports these observations and others. Lundstrom et al shown improvement in VA in 84.3% of patients >85 years. Similarly, a study carried out by Applegate et al shown improved VA in a majority of the patients (88%) above 70 years old following cataract surgery.

Lundstrom and colleagues suggested that the outcome of cataract surgery in the very elderly should be considered to be very good. Their finding indicate that visual outcomes after cataract surgery are worse in older patients compared with that achieved by younger ones, but that certain subgroup s of elderly patients may attain an excellent outcome. Some studies reported that poor VA level were obtained in elderly patients because postoperative complications are more common among this population segment.. In the present study, only a few patients (4%) did not have expected VA level because of macular edema in 2 patients (1.3%), Iridodialysis 1 patient (0.6%),postoperative Uveitis in 3 patients (2%).

This study has some limit actions also. First, a Snellen chart was used to asses preoperative and postoperative VA in all patients. However, Snellen visual acuity is a poor way of measuring visual acuity in clinical research, a fact that might have affected the measured outcomes. Second, we havenot used a validated questionnaires such as the ADVS or VF-14 to assess functional vision. This might have been a source of bias.

CONCLUSION

According to my study, it is concluded that when systemic conditions are stable both phaco and SICS with IOL implantation for very elderly patients are effective and safe.The result of the study showed that, functional outcomes of cataract surgery in very elderly patients are beneficial. Based on these findings, we believe that restoring vision with cataract surgery is helpful even in patients with advanced age, as it maintains their ability and extend life expectancy.

REFRENCES

1. . Lundstorm M, Stenevi U, Thorburn W . Cataract surgery in very elderly patients. J Cataract Refract Surg 2000; 26: 408–41
2. Berler DK. Intraoperative complications during cataract surgery in thevery old. Trans Am Ophthalmol Soc. 2000;98:127–130
3. Syam PP, Eleftheriadis H, Casswell AG, Brittain GP, McLeod BK, Liu CS. Clinical outcome following cataract surgery in very elderly patients. Eye (Lond). 2004;18(1):59–62.
4. Lundstorm M, Stenevi U, Thorburn W. Cataract surgery in very elderly patients. J Cataract Refract Surg 2000; 26:408–414.
5. Applegate WB, Miller ST, Elam JT, Freeman JM, Wood TO, Gettlefinger TC. Impact of cataract surgery with lensimplantation on vision and physical function in elderlypatients. JAMA 1987; 257: 1064–1066.
6. Westcott MC, Tuft SJ, Minassian DC. Effect of age on visual outcome following cataract extraction. Br J Ophthalmol 2000; 84: 1380–1382.