Secondary outcomes of lens and cataract surgery: More than just “best-corrected visual acuity”

IF 18.6 1区 医学 Q1 OPHTHALMOLOGY Progress in Retinal and Eye Research Pub Date : 2023-07-01 DOI:10.1016/j.preteyeres.2022.101150
Idan Hecht , Piotr Kanclerz , Raimo Tuuminen
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引用次数: 7

Abstract

Most studies evaluating cataract surgery focus on the primary outcome of early, central, best-corrected visual acuity. However, cataract surgery and intraocular lens (IOL) design have other secondary visual outcomes as well as impacts on various ocular tissues, the visual function, and quality of life. Some of these aspects are more difficult to quantify, or are historically neglected, but might be extremely important to patients. One important development was the addition of blue-light filtering to IOL design. Whether these IOLs truly have the retinal protective qualities they were designed for is disputed, yet other inadvertent desirable and possibly detrimental influences are being examined. Risk of falls, driving accidents, and other injuries decrease following cataract surgery, especially in the elderly, the importance of which cannot be overemphasized. Cataract formation contributes to social isolation and decreases cognitive stimulation in the elderly population, while cataract extraction can reduce the risk of dementia and cognitive decline. Diffractive multifocal and extended depth-of-focus IOLs improve spectacle independence and patient reported outcomes, but positive and negative dysphotopsia may be persistent. Future directions such as using the IOL enabling clear spectacle-free vision at all distances, or intraoperative drug delivery systems show promising preliminary results. It seems inevitable that a higher focus on the secondary outcomes of surgery will increase. We believe that these aspects will become more and more relevant when considering new IOL designs and surgical techniques, a fact that will benefit both the patients and the surgeons.

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晶状体和白内障手术的次要结果:不仅仅是“最佳矫正视力”
大多数评估白内障手术的研究都集中在早期、中心、最佳矫正视力的主要结果上。然而,白内障手术和人工晶状体(IOL)设计还有其他的次要视觉结果,以及对各种眼组织、视觉功能和生活质量的影响。其中一些方面更难量化,或者在历史上被忽视,但对患者来说可能极其重要。一个重要的发展是在IOL设计中增加了蓝光过滤。这些人工晶状体是否真的具有其设计的视网膜保护质量尚存在争议,但其他无意中产生的可取且可能有害的影响正在研究中。白内障手术后,跌倒、驾驶事故和其他伤害的风险降低,尤其是老年人,其重要性再怎么强调也不为过。白内障的形成有助于老年人的社会孤立和减少认知刺激,而白内障摘除可以降低患痴呆症和认知能力下降的风险。衍射性多焦和扩大焦深人工晶状体可改善眼镜的独立性和患者报告的结果,但阳性和阴性的听力障碍可能持续存在。未来的方向,如使用IOL在所有距离实现清晰的无眼镜视觉,或术中给药系统,显示出有希望的初步结果。似乎不可避免的是,人们会更加关注手术的次要结果。我们相信,在考虑新的IOL设计和手术技术时,这些方面将变得越来越重要,这一事实将使患者和外科医生都受益。
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来源期刊
CiteScore
34.10
自引率
5.10%
发文量
78
期刊介绍: Progress in Retinal and Eye Research is a Reviews-only journal. By invitation, leading experts write on basic and clinical aspects of the eye in a style appealing to molecular biologists, neuroscientists and physiologists, as well as to vision researchers and ophthalmologists. The journal covers all aspects of eye research, including topics pertaining to the retina and pigment epithelial layer, cornea, tears, lacrimal glands, aqueous humour, iris, ciliary body, trabeculum, lens, vitreous humour and diseases such as dry-eye, inflammation, keratoconus, corneal dystrophy, glaucoma and cataract.
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