Bilateral Cataract Surgery

By Andrew Doan, MD, PhD

Should cataract surgeons operate on both eyes on the same day? A study in the Journal of Cataract & Refractive Surgery reports data that show bilateral cataract surgery performed simultaneously or sequentially yielded similar refractive outcomes, rates of complications, and patient-rated satisfaction.

Researchers at the Helsinki University Eye Hospital in Finland conducted a study of 491 patients undergoing bilateral cataract surgery. Participants were randomized surgery in one session (study group) or sequentially (control group) 4 to 6 weeks apart. 247 patients had bilateral cataract surgery in one session and 257 patients had bilateral cataract surgery in separate sessions.

Overall, 240 patients (96.0%) in the study group and 250 patients (97.3%) in the control group were treated per protocol. The refraction was within ±0.5 D of the target in 67.2% of eyes in the study group and in 69.2% of eyes in the control group and within ±1.0 D of the target in 91.0% of eyes in the study group and 90.3% of eyes in the control group (P = 0.92). The only complication that affected postoperative visual acuity was chronic cystoid macular edema, which occurred in one eye in the study group (0.2%) and in two eyes (0.4%) of one patient in the control group (P = 0.57). Ninety-five percent of patients in both groups reported being very satisfied with the surgery.

The study, however, fails to address the risk of endophthalmitis, or severe eye infection, after cataract surgery in patients with bilateral cataract surgery. Published rates of eye infection following cataract surgery is approximately 1 in 1000-1500 cases, depending on the study. The number of patients receiving bilateral cataract surgery in the Helsinki study was not adequate enough to assess manifestations of eye infection in patients with bilateral surgery. In other words, are patients at risk of bilateral eye infections when both eyes undergo cataract surgery on the same day? Although the risk of eye infection following cataract surgery is low, the consequence of bilateral eye infection and possible loss of vision in both eyes may be too great to take the risk of bilateral cataract surgery in most patients.

On the other hand, there may be circumstances that justify the risk of bilateral cataract surgery; such as medical necessity or when patients require general anesthesia and the risk of having general anesthesia a second time may place patients in significant harm.

Reference

1. Sarikkola AU, Uusitalo RJ, Hellstedt T, et al. Simultaneous bilateral versus sequential bilateral cataract surgery: Helsinki simultaneous bilateral cataract surgery report study 1 [published online ahead of print]. J Cataract Refract Surg. doi:10.1016/j.jcrs.2011.01.019.

Comparison of AMD Treatment Trials (CATT)

By Andrew Doan, MD, PhD

The National Eye Institute released the results of the Comparison of AMD Treatment Trials (CATT), comparing bevacizumab (Avastin™) and ranibizumab (Lucentis™). When administered similarly for age-related macular degeneration (AMD), the two drugs have equivalent effects on visual acuity. In the study, both provided beneficial outcomes to patients, with between 25 percent and 34 percent of affected eyes improving substantially and more than 90 percent of affected eyes avoiding any further loss of vision. Results were published in the New England Journal of Medicine.

American Academy of Ophthalmology CEO David W. Parke II, MD, provides a perspective on the groundbreaking Comparison of AMD Treatment Trials (CATT), the initial results of which were released on Thursday. Dr. Parke notes that the Academy played an important role in facilitating this research, and he remarks on CATT’s potential influence on ophthalmologists, patients and clinical research.

We should not underestimate the importance of CATT as a touchstone for future comparative effectiveness research…The impact of this trial will go far beyond AMD, beyond retina and beyond ophthalmology. It will impact how future clinical trials research is conducted in all of medicine. As ophthalmologists, we should be proud to have blazed this new trail and continued the rich history of seminal clinical trials design begun by Dr. [Arnall] Patz and his co-workers.

How do I fall asleep faster?

By Brooke Strickland
Writer for FEP International

The phone’s ringing, the dog’s barking, your baby’s crying, and your boss is yelling at you. These are just some of the things that happen during our hectic lives. With our days jam-packed with meetings, work to finish, kids to take care of, commutes to make, and meals to cook, it is no wonder we are tired by the end of the night. Yet, when we lie down to sleep, many of us have difficulty finding rest quickly. Insomnia plagues millions of Americans, so what are some ways to fall asleep village of slumber faster.

* Start a bedtime routine: It’s no secret that kids benefit from nightly bedtime routines, so why can’t you too? Take a warm, soaking bath, drink a cup of hot chamomile tea, put on some soothing music, or read a book. All of these things can help you relax.

* Exercise: This will not only keep you healthy in general, but will also wear your body out.

* Create a relaxing environment: Put in earplugs to drown out unnecessary noise, and make sure your room is cool and dark.

* Clear your mind: Stress can negatively impact you in a lot of areas, including your sleep. So to avoid tossing and turning, try to shut your brain off by writing things down before bed instead of mulling them over in your head all night.

* Massage: Massage is a proven effective tool to relax those aching, tensed muscles. It not only feels great, but can help you relax enough to unwind and fall into a deep sleep.

* Scents: Try using aromatherapy to relax your senses and reduce stress. There are lots of different scents on the market today, such as lavender or sandalwood oil, that are marketed as beneficial aromatherapy products.

* Snacks: A light snack (maybe some toast with peanut butter?) can help you feel full and comfortable before going to sleep. But remember, eating a full meal before bed isn’t a good idea.

* Turn off the television and computer: Don’t stimulate your brain too much with computer games or television shows. Turn them off well before bed time.

We spend a lot of our time sleeping. With a little work, you can get deep, meaningful sleep, and enjoy it during the process.

References

[1] 15 Tips to Fall Asleep more Quickly. Sixwise.com. Accessed on the Web November 7, 2009. http://www.sixwise.com/newsletters/08/04/02/15-tips-to-fall-asleep-more-quickly.htm

[2] How to Fall Asleep Quickly. Associated Content. Accessed on the Web November 7, 2009. http://www.associatedcontent.com/article/2096739/how_to_fall_asleep_quickly_pg2_pg2.html?cat=5