Original Article
Subjective
Quality of Vision before and after Cataract Surgery at Holy Family Hospital,
Rawalpindi
Muhammad
Imran Janjua, Ali Raza
Pak J Ophthalmol 2018, Vol. 34, No. 2
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See end of article for authors affiliations …..……………………….. Correspondence to: Muhammad
Imran Janjua Department
of Ophthalmology, Holy Family Hospital, Rawalpindi Email: janjua.doc@gmail.com |
Objective:
To determine mean change in subjective quality of vision in
patients undergoing cataract surgery at Holy Family Hospital, Rawalpindi. Study
Design: Quasi experimental. Place
and Duration of Study: Department of Ophthalmology,
Holy Family Hospital, Rawalpindi, over a period of six months, from April,
2015 to October, 2015. Materials
and Methods: 60 patients, between the age of 30 to 70
years with bilateral cataract diagnosed by slit lamp examination, undergoing
cataract surgery with Phacoemulsification + IOL at Holy Family Hospital,
Rawalpindi were included in this study. Patients were interviewed one day
before surgery and their responses filled in the questionnaire. They were
operated the next day by consultant Ophthalmologist and then followed up for
one month for uneventful recovery after cataract surgery. The patients were
interviewed again using the same questionnaire. The mean pre-operative and
post-operative scores were compared. Results:
A total of 60 patients were included in the study. Out of these
25 (41.7%) were males and 35 (58.3%) were females. The mean age was 56.15 ± 4.90
years (mean ± S.D). The right eye was operated in 32 (53.3%) patients and the
left eye in 28 (46.7%). The average pre-operative score was 19.60 ± 2.12
(mean ± S.D). At one month, post-operatively the mean score was 29.68 ± 2.66
(mean ± S.D). There was an average difference of 10.08 ± 2.16
(mean ± S.D) between the pre and post-operative scores which was
statistically significant (p = 0.00). Conclusion:
Cataract surgery is an extremely effective procedure, in
improving the subjective quality of vision in patients and has far greater
implications for the lives of patients that cannot be measured on a visual
acuity chart. Key Words: Cataract, Phacoemulsification, Subjective visual recovery. |
Cataract
is one of the important causes of reversible blindness in the world1.
Cataract surgery is amongst the most frequently performed surgeries worldwide2.
Cataract causes impairment in visual function of patients, which has a negative
impact on daily activities3. It also negatively affects patient’s
physical and mental health2.
Visual improvement is by far the most common indication for
cataract surgery. Operation is indicated when the opacity develops to a degree
sufficient to cause difficulty in performing essential daily activities4.
Advances in the methods to perform cataract surgery in the last two decades
have improved the visual outcome post operatively4.
Phacoemulsification with placement of posterior chamber intraocular lens has
become the procedure of choice for cataract extraction4. The
subjective quality of vision and patient satisfaction is a very important indicator
for measuring the outcome of cataract surgery5.
Patients
ask for treatment not because of the result of any objective measurement but
for their subjectively experienced problems 6. A previous study
showed that there is significant improvement in visual function after cataract
surgery as measured by the Catquest-9SF questionnaire7. The purpose
of cataract surgery should not only be to improve the visual acuity of patients
but also, and more importantly, to enhance the subjective quality of vision. This
study was conducted to determine the change in quality of vision before and
after cataract surgery at Holy Family Hospital, Rawalpindi, so that
deficiencies could be addressed in future and the patient morbidity is
decreased.
MATERIAL AND METHODS
This quasi-experimental
study was conducted from April 2015 to October 2015 at the Department of
Ophthalmology, Holy Family Hospital, Rawalpindi. Non-probability consecutive
sampling was done to recruit the patients. All patients, both male and female,
between the age of 30 to 70 years with bilateral cataract diagnosed by slit
lamp examination, undergoing cataract surgery with Phacoemulsification + IOL at
Holy Family Hospital, Rawalpindi were included in the study. Patients with post
traumatic cataract, those suffering from any other eye disease that causes
decrease in visual function e.g. any macular pathology, glaucoma or moderate or
severe diabetic or hypertensive retinopathy and patients having any
complication during or after surgery e.g. posterior capsular rupture with
vitreous loss, IOL placed at any site other than the capsular bag or post-surgical
infection were excluded.
After taking informed consent, demographic data and contact number
was taken to ensure follow up. Patients were interviewed one day before surgery
and their responses filled in the questionnaire. They were operated the next
day and then followed-up for one month for uneventful recovery after cataract
surgery. Consultant ophthalmologist performed operation. After one month of
surgery the patients were interviewed again using the same questionnaire. The
mean pre-operative and post-operative scores were compared.
All the
data was entered and analyzed in Statistical Package for the Social Sciences
(SPSS). For the categorical variables like gender, frequencies along with
percentages were calculated. For the continuous variables like age and pre and post-operative
scores, means and standard deviations were calculated. To determine any
statistical difference between the pre op and post op mean scores, paired t-test
was applied at 5% level of significance. Effect modifiers like age, gender etc.
were controlled by stratification. Post stratification paired sample t- test
was applied.
RESULTS
A total of 60 patients were
included in the study. 25 (41.7%) were males and 35 (58.3%) were females (Fig. 1). The mean age was 56.15 ± 4.90
years (mean ± S.D). (Table-1).The
right eye was operated in 32 (53.3%) patients and the left eye was operated in
28 (46.7%) patients.
Gender
Fig.
1: Gender Distribution of Study
Patients (n = 60).
Table 1: Age of Patients (n = 60).
Minimum
Age (Years) |
Maximum
Age (Years) |
Mean
Age (Years) |
S.D. |
45 |
65 |
56.15 |
4.90 |
The minimum pre-operative score was 14
and maximum score was 23. The average score was 19.60 ± 2.12 (mean ± S.D).
At one-month post operatively the minimum score was 27 and maximum score was
33. The mean post-operative score was 29.68 ± 2.66 (mean ± S.D).
The difference between post op and pre op
Table 2: Scores of Patients (n = 60).
|
Pre
op Score |
Post
op Score |
Difference
in Score (Post
op – Pre op) |
p-value |
Minimum |
14 |
27 |
5 |
0.00 |
Maximum |
23 |
33 |
15 |
|
Mean |
19.60 |
29.68 |
10.08 |
|
S.D. |
2.12 |
2.66 |
2.16 |
Table 3: Score of Patients According to Gender (n = 60).
Gender (n) |
Pre op score |
Post op score |
P value |
||
Mean |
S.D. |
Mean |
S.D. |
||
Males (25) |
19.56 |
2.00 |
30.04 |
2.70 |
0.00 |
Females (35) |
19.63 |
2.22 |
29.43 |
2.64 |
0.00 |
Table 4: Score of Patients According to Age (n = 60).
Age (n) |
Pre
op score |
Post
op score |
P
value |
||
Mean |
S.D. |
Mean |
S.D. |
||
45 – 55 (23) |
20.30 |
2.24 |
30.43 |
2.76 |
0.00 |
56 – 65 (37) |
19.16 |
1.93 |
29.22 |
2.52 |
0.00 |
score
was calculated and the minimum difference was 5 and maximum difference was 15.
There was an average difference of score of 10.08 ± 2.16 (mean ± S.D).
This difference between the post op and pre op score was statistically
significant (p = 0.00) (Table 2). The patients’ age and gender did not have any
significant effect on the results. After stratification according to age and
gender, paired sample t-test was applied and there was significant difference
between pre op and post op scores of patients (p = 0.00) (Table 3 & 4).
This shows that cataract surgery resulted in a significant improvement of
subjective quality of vision in cataract patients.
DISCUSSION
Cataract
surgery in the developed world has undergone a revolution over the last 20
years. An operation, which used to require a stay in hospital and long visual rehabilitation,
is now a quick day-case procedure with immediate benefits. There is now the
potential to provide cataract surgery at an earlier stage of cataract
maturation and save patients from a period of severe visual impairment8.
Lens
opacities in the eye are inevitable in later life. The word ‘‘cataract’’ is
originally translated from Greek “down rush” or Latin “waterfall”9.
A cataract is a symptomatic lens opacity that obstructs the passage of light
and causes a reduction of vision. Poor vision has a great impact on patient’s
lives. Decreased visual function, regardless of cause, is associated with
diminished quality of life and general functional living activities.
Although
visual acuity is used as an objective measure when considering cataract
surgery, it is standard practice to select patients on their symptoms of visual
function and quality of life rather than purely on their visual acuity10,11.
Patients have widely differing visual demands and it is vital to take these
into account when considering surgery.
This
study consisted of 60 cataract patients. All had visual symptoms and
subjectively decreased quality of vision. They had difficulties in performing
routine activities of daily life. When they were operated and after removal of cataract,
the intraocular lens was implanted, they all had improvement in their visual
quality and were able to carry out their everyday activities without
difficulty.
The
overall benefits of cataract surgery on visual function have been demonstrated
by many studies. Previous studies showed that visual function and patient’s
quality of life were significantly improved by cataract surgery12. A
study from the UK showed that even in patients with unilateral cataract, who
had previously undergone uncomplicated contralateral cataract extraction with
posterior chamber lens implantation, there was a significant improvement in the
quality of vision after second eye cataract extraction with intraocular lens
implant 13,14.
A study
from India showed that the long-term visual outcome of cataract surgery largely
depends on the intra and post-operative complications like vitreous loss, post-operative
corneal decompensation, retinal detachment etc. and other associated ocular
diseases like optic atrophy, glaucoma, age related macular degeneration etc.
Another significant factor of surgical outcome is the experience of the
operating surgeon15. Keeping this in mind, the complicated cases and
those with pre-existing ocular pathologies other than cataract were excluded
from this study and only those patients were interviewed who had uneventful
cataract surgery and post op recovery. Consultant ophthalmologists performed
the surgeries.
Cataract surgery can benefit
older age groups in improving their quality of life as shown by a study from
the USA16. Majority of patients in my study belonged to middle and
old age, and by offering them a quick and effective remedy for their cataracts,
their visual quality was significantly improved. Another study showed that even
in early cataracts the patients can have significant subjective visual symptoms
like glare and decreased contrast sensitivity and these can be effectively
overcome by offering them early cataract surgery with implantation of posterior
chamber intraocular lens17. Another study from Australia showed that
patients’ satisfaction and perceived improvement in their symptoms largely
depends on their expectations18. Cataract surgery is one of those
procedures where patients can have immediate results and their visual symptoms
and quality of life can be significantly improved19, 20.
CONCLUSION
Cataract surgery is an
extremely effective and economical procedure, which has far greater
implications for the lives of patients that cannot be measured on a visual
acuity chart. The continuing false assumption by many patients and physicians
that a cataract should not be extracted until “ripe” is depriving many people of
an enhanced quality of life. Efforts should be made to educate people about the
effectiveness and success of cataract surgery and that cataract surgery not
only provides functional benefit in terms of improved vision but also
significantly improves the subjective quality of life of patients.
Author’s
Affiliation
Dr.
Muhammad Imran Janjua
FCPS,
Senior Registrar, Ophthalmology
Shifa
College of Medicine
Shifa
Tameer-e-Millat University
Islamabad
Prof.
Dr. Ali Raza
MCPS, FCPS,
Professor and Head of Department
Department
of Ophthalmology
RMC and
Allied Hospitals
Rawalpindi
Role of
Authors
Dr. Muhammad Imran Janjua
Study conception, Data collection and analysis, Article
drafting and formatting
Prof.
Dr. Ali Raza
Critical
analysis, Data review, Overall supervision.
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