Moderator
Arun C. Gulani, MD, ABO
Panelists
Leela Raju, MD, ABO
Ken D. Novak, MD, ABO
Viewing Papers
Expand a paper title to the right to view the paper abstract and authors. Use the video link to jump to that poster in the session.
Presenting Author
Kerem Tahmaz, MD
Co-Authors
Robert Hoerster MD
Purpose
To evaluate the effectiveness of cataract surgery in improving visual acuity in patients with a concomitant neovascular AMD over a period of 24 months. Furthermore, evaluate anti-VEGF efficacy with regards to specific OCT biomarkers in preserving the post-operative visual improvement.
Methods
Two-year, non-randomized, retrospective study of 131 eyes of 120 subjects from rural Niederrhein (Germany). Patients underwent phacoemulsification + monofocal lens implantation for cataract, and anti-VEGF therapy for nAMD. Visual acuity (logMAR), SD-OCT for nAMD assessment, intraocular pressure, anti-VEGF application frequency (Bevacizumab, Ranibizumab, Aflibercept) were assessed. Patients were categorized by vision improvement (gainers), loss (losers), or stabilization (stabilizers) based on a 1-line change on Snellen chart after 24mo. Exclusion criteria included any retinal comorbidity such as diabetic retinopathy, corneal diseases, other factors that hamper cataract surgery.
Results
BCVA baseline pre-operatively (0,54 logMAR) showed peak improvement at 3months post-operatively (0,42 logMAR) and returned to baseline at 24 months (0,54 logMAR). �Gainers� had highest BCVA (0,50 logMAR) and �losers� lowest (0,562 logMAR) at baseline. �Gainers� showed most frequently fibrotic pigment epithelial detachment (41%) �Stabilizers� intraretinal fluid (38%) and �Losers� subretinal fluid most (42%). Intravitreal injections were on average preoperatively n=9, postoperatively n=11, while no significant difference among visual outcome categories were seen. The treatment regimen was PRN, while the most common medication was Bevacizumab.
Conclusion
Cataract surgery led to temporary BCVA improvement, which diminished after 24 months. The threshold to initiate an early treatment of neovascular AMD OCT changes should remain low, as it might secure the BCVA gain. Specific OCT characteristics might assist the ophthalmologist to guide treatment decisions and accurately stipulate a prognosis.
Presenting Author
Ayah A Marrie, MD
Co-Authors
Mohamed Hosny FRCOphth, FRCSEd, PhD, Ahmed Ashor MD, PhD, Marwa Abdelaal MSc
Purpose
To evaluate CE changes and function after uneventful phacoemulsification in relation to the level of HbA1c.
Methods
A prospective interventional case-control study was conducted on 76 eyes, divided into two groups; group 1: included 38 eyes of diabetic patients, which was further divided into 3 subgroups according to the level of HbA1c; group A (strict control HbA1c < 7mg/dl), group B (moderate control HbA1c 7- 9mg/dl) and group C (poorly controlled HbA1c > 9mg/dl), and group 2: included 38 eyes of non-diabetic patients. All participants had full ophthalmological examination, assessment of level of HbA1c, preoperative evaluation of CE by specular microscopy, uneventful phacoemulsification and reassessment of CE by specular microscopy 3 weeks after surgery.
Results
Three weeks after surgery, statistically significant changes in CE parameters regarding ECD, ACG and SD in both groups were found, with greater changes in diabetics. The poorer the control of diabetes (higher preoperative HbA1c) the greater the impact on postoperative CE changes, but the changes were of no statistical significance.
Conclusion
Diabetics are more vulnerable to CE damage during phacoemulsification and the higher preoperative HbA1c the more the damage. So, strict preoperative diabetic control, is advisable before phacoemulsification.
Presenting Author
Lindsay Ong-Tone, FRCSEd, FRCOphth, FRCSC
Purpose
This was the sixteenth annual survey on the practice patterns of Canadian Ophthalmological Society (COS) members in cataract surgery.
Methods
In January 2024, the COS office sent an email with a link to the survey on Red Cap to its 241 members whose primary focus was cataract surgery. Two reminders were sent at 2 weeks interval. The response rate was 19.9%. All responses were collected anonymously.
Results
Most respondents (80.4%) corrected astigmatism at the time of cataract surgery. Most (90.2%) used a Toric IOL. 51% of the respondents aimed for monovision. The difference aimed for between the two eyes following cataract surgery ranged from 0.75D to 2 D. Presbyopia correcting lenses were used by 72.5% of the respondents. Intracameral antibiotics was used by 62.7% of the respondents in 2024 while only 42.9% did so in 2020. Immediately Sequential Bilateral Cataract Surgery (ISBCS) was performed by 58.8% of the respondents in 2024 while only 26% did so in 2020. Also of note, only 7.6% of the respondents performed ISBCS more than 50% of the time in 2020 while 23.3% did so in 2023.
Conclusion
There was a marked increase in respondents performing ISBCS and using intracameral antibiotics since the beginning of the COVID pandemic. The latter is probably because of the former. The COS leadership has been encouraging its members to perform ISBCS to reduce patient interaction during the pandemic.
Presenting Author
Xiteng Chen, MD
Purpose
Diabetes significantly increases the risk of cataract formation, making it essential to understand the pathogenesis of diabetic cataracts.
Methods
We conducted transcriptomic analysis on peripheral blood mononuclear cells from diabetic patients to identify key genes. Immune infiltration analysis was performed to identify differential immune cells. Additionally, we analyzed single-cell transcriptomic data to investigate changes in immune cell differentiation and regulatory pathways. We also carried out rat lens transcriptomic analysis to assess gene and pathway-level changes in the lens. Finally, experimental studies were conducted to validate the analytical results.
Results
In the transcriptomic analysis, BCL6 was identified as a key gene in diabetes. Immune infiltration analysis indicated increased levels of follicular helper T cells and non-classical monocytes in diabetic patients. Single-cell transcriptomic analysis confirmed that BCL6 plays a role in the differentiation process from classical monocytes to non-classical monocytes. Additionally, TNF and IFNG signaling pathways were significantly upregulated in monocyte clusters in the diabetic group. In diabetic rats, inflammatory and apoptotic pathways were increased in the lens. Experimental studies confirmed elevated inflammation in the diabetic group.
Conclusion
Diabetes alters the peripheral blood immune environment, leading to increased intraocular inflammation and apoptosis of lens epithelial cells. These changes exacerbate the formation of cataracts in diabetic patients.
Presenting Author
Marianna Hollaender, MD
Co-Authors
Laura Cyrino MD, Jaime Guedes PhD, Marcela Bastos MD, Maria Ant�nia Arteche MS, Amanda Nascimento MS
Purpose
The potential benefits and risks of the use of perioperative subconjunctival steroid injection(PSSI) in dropless cataract surgery are controversial. To address this knowledge gap, we conducted a systematic review and meta-analysis,consolidating findings from multiple studies to assess it.
Methods
We searched PubMed, EMBASE, and Cochrane Central for observational and randomized controlled trials (RCT), comparing the potential benefits and risks of using perioperative subconjunctival steroid injection in dropless cataract surgery. Statistical analysis was performed using the Cochrane Collaboration tool to assess the risk of bias in randomized trials (RoB 2). Heterogeneity was assessed with I2 statistics. The initial search yielded 2431 results.After removing duplicate records and ineligible studies, thirty remained and were thoroughly reviewed based on the inclusion criteria.Of these, 4 RCTs and 1 observational study were included, encompassing a total of 70.751 eyes.
Results
Of these patients, 12.319(17,4%)underwent the perioperative conjunctional steroid injection approach,while 58.432(82,6%)received the prednisolone acetate plus NSAIDs approach.There was no statistically significant difference in terms of macular edema (OR 0.74; 95% CI 0.44 to 1.23; p=0.249; I�=52%)when compared with the control group.The same is true for visual acuity(MD 0.00; 95% CI -0.03 to 0.03; p=0.73; I�=0%;),laser flare counting(MD -0.05; 95% CI -0.19 to 0.09; p=0.45; I�=0%;),intraocular pressure after 7 days (MD -0.91; 95% CI -2.01 to 0.18; p=0.10; I�=0%) and intraocular pressure after 1 month (MD -0.91; 95% CI -2.01 to 0.18; p=0.10; I�=0%).
Conclusion
Both subconjunctival steroid injections and traditional topical steroids are similarly effective in managing postoperative inflammation following cataract surgery, showing no statistically significant differences across several key outcomes.
Presenting Author
Inder P. Singh, MD
Purpose
A novel 27 gauge needle vitrector, recently approved in the US, has been used to remove a limited amount of vitreous without the need for trocars or posterior infusion. We wanted to assess the safety and efficacy of this new device in pseudophakic patients who had symptomatic floaters.
Methods
This was an IRB approved prospective trial. 78 eyes of 56 patients had a limited vitreous removal procedure performed using the 1 Step 27 gauge needle vitrector. No trocars were used and an AC maintainer, included in the kit, was used to maintain the stability of the eye. The 27 gauge needle attached the Stellaris phaco machine with 5,000 cuts/min was used to enter 3.5 mm behind the limbus. Initially high vacuum was used for the first 10 eyes, but then low vacuum (less than 100) was adopted. Once no vitreous opacities were seen coming to the tip, the needle was removed. Immediate post, POD1. POW1, POM1, and POM3 iTrace, IOP, DFE, and subjective assessments (questionnaire) were performed.
Results
At 3 mos, All 78 eyes demonstrated symptomatic improvement with 86% of the patients reporting compete resolution of symptoms. The other 14% reported improvement averaging 85%. A scale from 0-4 was used to document severity of the vitreous opacities pre and post op. The average improvement was 3.2 (from 3.6 down to 0.4). Internal HOA improved from 2.6 down to 0.8. Visual acuity returned to baseline in 100% of patients by 1 week. Visual acuity improved on average by 0.6 lines post op. 2 eyes developed an IOP spike of > 10 mmHg from baseline which resolved by 1 month. 1 eye developed a retinal tear which was found and treated without sequelae. This eye (3rd) underwent surgery with high vacuum
Conclusion
Limited vitreous removal with the 1 step 27 gauge needle vitrector appears to be a safe and effective treatment option for patients suffering from symptomatic vitreous opacities.
Presenting Author
George H. Beiko, BM BCh, FRCSC
Co-Authors
Samantha Orr MD
Purpose
To present a technique for repositioning and stabilizing dislocated in-the-bag IOLs
Methods
The technique involves using 9-0 polene to create a loose loop or belt loop, to encircle the haptics at the haptic optic junction. These loops are sutured to the scleral in two locations, 180 degrees apart so as to centre the optic on the pupil. The sutures are not tightened but left loose. The technique will be demonstrated using photos and video.
Results
This technique has been used for one piece and 3 piece IOLs for the past 3 years, with success.
Conclusion
The belt loop technique for scleral suture fixation of dislocated in the bag IOLs is a viable alternative for managing these rare cases
Presenting Author
Won Seok Song, MD
Co-Authors
Dong Hui Lim MD, PhD, Yeokyoung Won PhD
Purpose
This study aims to propose a method for classifying the severity of cortical cataracts using deep learning techniques with retroillumination images, a type of anterior segment imaging that allows direct visualization of the lens.
Methods
Two experts classified cortical cataracts into four grades�normal,mild,moderate,and severe �based on LOCSIII criteria using retroillumination images taken with a slit-lamp microscope. The performance of the cataract severity classification model was evaluated using precision, sensitivity, F1 score, and accuracy. ROC curves were analyzed for a more detailed performance assessment. Data preprocessing included image refinement, lesion masking, and application of a CNN model with multiple kernel sizes for severity classification. The model was trained using 222 retroillumination images collected between January 2017 and December 2020, with 59 normal, 44 mild, 72 moderate, and 48 severe images.
Results
The model achieved an overall accuracy of 82.5% on the test set. ROC curve analysis revealed a high performance for identifying cataracts. For the 'Normal' grade, the model recorded an AUC (Area Under the Curve) of 100%. 'Mild' and 'Moderate' grades showed 90% and 88% AUC respectively. In case of 'Severe' grades, the result was 96% AUC.
Conclusion
We successfully classified cortical cataracts into four detailed severity grades using deep learning techniques, demonstrating high accuracy particularly for all grades. Future research should focus on improving classification performance accuracy by using more balanced datasets and refined model training methods.
Presenting Author
Muhammad J Khan, MBBS
Co-Authors
Muhammad Ali MBBS, Fasika Woreta MD, Joshua Stein MD, MS, Ahmed Sabit MS, Sidra Zafar MBBS
Purpose
To assess the impact of social determinants of health (SDoH) and clinical factors on visual impairment (VI) at initial presentation in cataract patients.
Methods
A retrospective analysis of the Sight Outcomes Research Collaborative (SOURCE) Ophthalmology Data Repository identified patients aged ?40 with a cataract diagnosis using ICD-9 and 10 codes. SOURCE is a large multicenter repository that has data from 19 sites in the US. Best-recorded vision (BRV) at the initial presentation, demographics, Charlson comorbidity index (CCI), cigarette smoking status, and Distressed Community Index (DCI) were recorded. VI was categorized as none/mild (BRV ? 20/40), moderate (20/40 < BRV < 20/200), and severe (BRV ? 20/200). Multivariable logistic regression assessed the impact of clinical and sociodemographic factors on moderate and severe VI.
Results
Among 137,847 patients with a mean (SD) age of 67.4 (9.1), 58.6% (N=77,425) were White, 22.5% (N=29,725) were Black, and 8.8% (N=11,562) were Hispanic/Latino. In an adjusted logistic regression, males (OR: 1.27; p < 0.001), Black patients (OR: 1.25; p < 0.001), Native American patients (OR: 1.47; p = 0.02), non-English speaking patients (OR: 1.64; p < 0.001), and those with a cigarette smoking history (OR: 1.47; p < 0.001) had higher odds of severe VI. Higher DCI quintiles (more economically distressed) were associated with severe VI; OR (p < 0.001) of 1.33 in the 2nd, 1.34 in the 3rd, 1.44 in the 4th, and 1.64 in the 5th quintile.
Conclusion
This study has been conducted on a diverse population. It is the first study examining the impact of DCI on cataract-related VI highlighting the need for interventions to improve access to healthcare and prevent vision impairment in these communities.
Presenting Author
Elad Ziv-On, MD, MPH
Purpose
Our research aims to examine both subjectively and objectively the impact of listening to preferred music during cataract surgery on patients' stress, anxiety, and pain levels. This study seeks to provide insights into music's potential benefits as a non-invasive intervention in ophthalmic surgical settings.
Methods
This randomized study involved patients undergoing uncomplicated cataract surgery. Participants rated their stress, anxiety, and pain levels using questionnaires before and after surgery. Blood pressure, heart rate, and oxygen saturation were measured before, during, and after the procedure. Half of the patients listened to their chosen music upon entering the operating room and during the surgery, while the other half did not. All operations were performed by four experienced cataract surgeons.The study design and methodology allowed for direct comparison of music's impact on both subjective patient experiences and objective physiological responses during cataract surgery.
Results
A total of 106 patients were recruited, with 62 (58.5%) being female. The average age was 72.3 (SD=8.2) years. 55 patients (51.9%) listened to their chosen music during surgery. The music group showed a greater decrease in heart rate during the surgery compared to waiting times. Additionally, this group exhibited a lower increase in mean arterial pressure during the procedure compared to the non-music group. Subjectively, the music group reported a greater reduction in perceived stress and anxiety levels during surgery compared to their pre-operative state. However, it should be noted that these observed differences, did not reach statistical significance in the current sample size.
Conclusion
Trends indicate a reduction in stress and anxiety when patients listen to self-selected music during cataract surgery. While differences weren't statistically significant, they suggest potential benefits. Further research with larger sample sizes is needed. This could provide more definitive evidence for its use in ophthalmic surgical settings.
Presenting Author
Amr K. Hassan, MD
Co-Authors
Philip Dockery MPH, MD, Reem ElSheikh MD, Abdelrahman Elhusseiny MD
Purpose
To evaluate the impact of music on patient vital signs during cataract surgery.
Methods
A systematic review and meta-analysis were conducted in July 2024 through comprehensive searches of PubMed, Scopus, and Google Scholar, using the keywords ((Cataract) OR (Phacoemulsification)) AND (Music). We included peer-reviewed randomized controlled trials comparing cataract surgery with relaxing music to surgeries without music. Statistical analyses were performed using the Statistical Package for Social Sciences (SPSS) and Review Manager (RevMan) version 5.4, with meta-analyses conducted using a random effects model.
Results
A total of 8 studies encompassing 1199 cataract surgeries were included, with 622 in the music group (M group) and 532 in the no music group (NM group). Comparing postoperative to preoperative values, the M group exhibited reductions that were observed in systolic blood pressure (SBP) (135.3 vs 138.9 mmHg, p < .001), heart rate (HR) (71.4 vs 77.4 beats per minute, p < .001), and respiratory rate (RR) (19.3 vs 20.1 breaths per minute, p = .003). In the NM group, there was an increase in diastolic blood pressure (DBP) (78 vs 74.3 mmHg, p < .001). Compared to the NM group, the M group showed a decrease in HR (MD = -1.81, p = .007) and RR (MD = -0.82, p < .001).
Conclusion
The introduction of music during cataract surgery significantly improves patient heart rate and respiratory rate.
Presenting Author
Geoffrey Nguyen, MD
Co-Authors
Paul Kang MD
Purpose
The expansion of VR headsets, haptic technology, and virtual education has provided educational innovators a high-fidelity alternative to traditional surgical training approaches. This study aims to characterize ophthalmology faculty perspectives regarding the use of virtual reality simulator training for ophthalmological surgical education.
Methods
An anonymous online survey hosted by Qualtrics was emailed to ophthalmology faculty through the AUPO listservs. They were asked if virtual reality simulators were used in their program, and depending on if they answered "Yes" or "No", the questionnaire branched into two distinct pathways of questions. Participants that answered �Yes� were asked questions regarding the specific virtual reality simulators used, hours spent on virtual reality simulator training by residents, and strategies to improve integration of virtual reality simulator training into their program. Participants that answered �No� were asked questions regarding barriers to integration of virtual reality simulator training.
Results
57 ophthalmology faculty responded. The majority of participants indicated "Yes� to using VR simulators (n= 43, 75%), with EyeSi being the most popular (n = 40, 93%), followed by HelpMeSee (n = 1, 2%). Most participants agreed that the number of resident complications has decreased in their program (n = 26, 60%) and the mean time for a resident to complete a cataract procedure has decreased as well (n = 25, 58%). For the participants without VR simulators at their program, most said that the simulators being too expensive was the biggest barrier (n = 12, 86%), followed by lack of familiarity with VR simulator training (n = 6, 43%) and lack of time for residents and faculty (n = 2, 14%).
Conclusion
Most participants surveyed agreed that VR simulator training is a helpful tool for ophthalmological surgical education. When integrated into surgical curriculums, it has increased resident confidence during live surgery and has led to better surgical outcomes. However, financial and time constraints continue to be a barrier for integration of VR.
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