Patients' preoperative expectation for the outcome of cataract surgery

Patient preoperative expectation for the outcome of cataract surgery and the actual postoperative experience

in judoAuthors- Zelalem Addisu - berhan solomon

Presented OSE in 2008

Outline of the study report Introduction Literature review significance of the study Objectives Methodology Result and Discussion Conclusion and recommendations

Introduction cataract is the leading cause of blindness in

the world an estimated of 25 million people were blind

due to cataract ie 50 or more of the global burden of blindness

Annually at least 25 million eyes develop visual acuity lt660 due to cataract

around 1 of Africans are blind

around 71 of the worlds 38 million blind people live in sub-Saharan Africa

Around 60 of Africas blind are women Around 50 of blindness in sub-Saharan

Africa is due to cataract The number of people blind from cataract in

the world is increasing by approximately 1 million per year and the number of lsquooperablersquo cataract eyes with a visual acuity of less than 660 is increasing by 4ndash5 million per year

In NBS prevalence of BL and LV was 16 and 37 [50 and 41 ]

Globally the need for cataract operations is at least 30 million per year but only around 10 million cataract operations are performed annually

For this reason intervention against cataract blindness has received priority

attention in Vision 2020

Global causes of blindness as a percentage of total blindness in 2002 cataract 478Source WHO 04138

Outcome of cataract surgery is

the change in functional disability as a result of cataract operation

usually expressed as visual acuity Purpose of monitoring cataract surgical outcome Encourage eye surgeons to monitor their own results over time Identify causes of poor outcome

bullSelection

bullSurgery

bullSpectacles

bullSequelae

1048766Address causes to improve future outcome

Outcome depends on

1048766skills and knowledge of eye surgeon

1048766surgical technique used

1048766surgical facilities and environment

1048766post-operative care

1048766optical correction provided

1048766patient-related risk factors like ocular comorbidity (glaucoma age-related macula degeneration

Patient satisfaction is an increasingly important objective for health services

with satisfied patients reporting greater compliance well-being and treatment outcomes

with satisfied patients both remaining with and recommending their provider and that a satisfied patient is the best defense against

malpractice lawsuits patient satisfaction with surgery is an

important outcome measure to include in the assessment of surgical outcomes

Monitoring outcomes could therefore be applied in a clinical settingwhere the visua l outcome of cataract surgery(post-operative visual acuity) is primarily measured

In addition studies based on activities of daily living(ADL) patient well being quality of life and patient satisfaction may be instituted as a routine or more commonly on randomly selected post-operative patient groups

Literature Review

In USA to assess the functional expectations and postoperative outcomes revealed very high and were unrelated to their demographic or ocular characteristics The preoperative VF-12 score however

was positively correlated with expected postoperative VF-12 score Only 61 of patients achieved or surpassed their expected level of postoperative functioning

In Australia to assess expectations and outcomes in cataract surgery showed that the median va was 618 with a mean (SD) preoperative VF-14 score of 847 (148) and postoperative VF-14 score of 898 (164)

The most unrealistic expectations involved driving at night reading small print and doing fine handiwork

In British Columbia to assess VF post cataract surgery ndashof 47 people 28 (596) had a perfect score postoperatively 13 (276) had a score of 90 or better 5 (106) had a score of 87 to 90 and 1 (21) had a score of 67Among the 200 people with a preoperative VFA score of 90 to 99 postoperatively the VFA score improved for 146 (730) remained the same for 43 (215) and worsened for 11 (55)

In Indonesia to evaluate cataract surgical outcomes reported a total of 443 patients were operated and at one month after surgery 7608 was seen gt 618

248 lt 360

Intra amp post-operative cxns were seen in 1084 of all cases mainly due to vitreous loss (6667) Intra-operative complications

systemic diseases present before the operation and associated eye diseases were significant risk factors for poor outcome

The results of hospital based prospective studies of cataract surgery in developing countries have usually reported good outcomes In the Madurai intraocular lens study 1yr after ECCE + PC IOL 06 of patients had a BCVA of lt 660 and 981 had a BCVA of 618 or better

In a study from Kenya 15 of eyes had a visual acuity of lt 660 postoperatively and 943 were 618 or better after ECCE and PC-IOL These studies demonstrate that good outcomes can be obtained in the settings of developing countries This has led to calls for the quality of cataract surgery to receive at least as much attention as the quantity of surgery

At Kikuyu Eye Unit to assess the visual outcome of patient undergoing cataract surgery and the result were BCVA of 618 or better was obtained in 943 of eyes and an uncorrected vision of 618 or better in 782 of eyes Six eyes (15) had BCVA of lt 660

At Menelik II Hospital revealed that out of the 214-study population 174 (813) were followed up to the 8th week and also completed the entire interview and examination The uncorrected VA of the 174 patients was 618 or better in 74 (425) while 100(575) patients had low vision (lt618) However the final corrected post-operative visual acuity (VA) was 618 or better in 109 (630) of the patients and in 65(37) patients it was found to be low (lt618)

Study done in Jimma zone showed that out of 617pts operated 77 eyes (184) had final visual acuity (VA) of gt618 388 eyes (926) had VA of gt660 and 395 eyes (943) had VA gt 360

Significance of the study Calculates the visual outcome and assesses the

quality of cataract surgery encouraging eye surgeons to monitor their own

results over time in itself will lead to better outcomes of cataract surgery

Provide base line data for the eye unit to design appropriate strategies in order to provide the highest level of satisfaction and improve results of cataract surgery as improved outcome will motivate more patients to come forward for surgery

OBJECTIVES

GENERAL OBJECTIVIES To describe the relationship between

patients preoperative expectations regarding the outcome of cataract surgery and actual postoperative experience

To evaluate post operative visual outcome of cataract surgery

SPECIFIC OBJECTIVES

To assess patients preoperative expectations for postoperative outcomes and actual postoperative experience

To evaluate post operative outcome of cataract surgery at first day postoperative and at 4 weeks after the operation

To identify the cause of poor outcome

Methods and Materials

Study area and period Ham 161999- Hed 1000 Study Design Population

Source Population Study Population

Sample size PROCEDURE AND MEASURES

- Structured questionnaire

- Preop assessment VA slit lamp bio microscopy

amp dilated funduscopy Keratometry and A-scan

biometry

VF were measured using a 15-item visual function assessment with final score ranging from 0 (no visual ability) to 100 (no visual disability) Patients were then asked to rate their expected postoperative functional

outcome for each of the 15 items on the VF-15 scale The visual status was classified using the World Health

Organization (WHO) category of Visual Impairment and Blindness

Data collections were conducted Validity and reliability Data analysis Ethical consideration Limitation of the study

RESULTS amp DISCUSSION

200 patients were approached Of these 179 (895) were followed up to the 5th

week follow up Table 1patient characterstics Jimma University

ophthalmology department 2007

Characteristics preoperative 5th wks

Post operative

No of patients 200 179

Age mean (SD) 587(146)

No of women () 60 (40 )

VF-15 score mean (SD) 5419 (341) 941 (159)

Overall satisfaction

Very much improved 132(737)

Table 2preoperative visual acuity of patients Jimma University Ophthalmology Department 2007

VA No

624-660 1 05

lt660-360 9 45

lt360-LP 190 950

Total 200 100

Fig1 cataract type (N=200) Jimma University ophthalmology department 2007

Table 4Surgeon that did the surgery amptype of IOL inserted Jimma University Ophthalmology Department 2007 Surgeon PC IOL AC IOL aphakic Total

Ophthalmologist 139 4 0 143

Resident trainee 12 0 0 12

Cataract Surgeon

trainer 42 1 2 45

Total 193 5 2 200

Table 5 Intraoperative complications in operated eye Jimma University Ophthalmology Department

2007 Intraoperative complication No

None 181 905Capsular rupture with vitreous loss 8 40Iris damage(inadverteal PIiridodialysis 4 20Retrobulbar hemorrhage 4 20Capsular rupture without vitreous loss 2 10Zonular dehiscence 1 5 Total 200 1000

NB at Kikuyu OF 388 PCR 27 (70) Z 2(05) V 16(41)

at Kaduna PCR10 eyes (57) v 3 NZ PCR 445 FINLAND 54 Aravind 17 of 898 eyes

10 in Ghana and 114 in Sierra Leone

Table 6 Immediate postoperative surgical events of cataract surgery Jimma University Ophthalmology Department 2007

Immediate postoperative Total No of Patients()

complication

Striate keratopathy 143 ( 715)

Ac reaction 82 (410 )

Ac hemorrhaged 9 (45 )

retained lens matter 8 (40 )

Wound leak 1 (05 )

SK amp retained lens matter 2 (10 )

AC shallow 2 (10 )

Kaduna 78 (446) Sk corticalAC remnant 14 (8)1 eye (06) endophthalmitis

New Zealand increase IOP

Table 7 Postoperative visual acuity of patients (after 4wks) Jimma University Ophthalmology department 2007

Post operative VA without correction with pin hole

No No

Good gt618 102 570 126 704

Borderline lt618-660 55 307 39 218

Poor lt660 22 123 14 78

Total 179 100 179 100

In Nepal ndash uncorrected 479 of cases

- corrected 774 of cases at Kikuyu 731 had uncorrected 2 m In Menelik Without correction 74(425) With pin hole 110(632) (1999) 174

Best corrected vision after 1 year in clinical trials

LAHAN ARAVIND

Visual Acuity ICCE + ICCE + ICCE + ECCE + PC-IOL

specs AC-IOL specs

66 - 618 932 899 955 966

lt 618 - 660 46 75 29 11

lt 660 22 26 16 23

n= 914 906 1401 1474

follow-up 91 85 WHO guideline for evaluating the outcome of cataract surgery

Post-operative Available correction Best correction

visual acuityGood 66ndash618 gt80 (704) gt90

Borderline lt618ndash660 lt15 (218) lt5

Poor lt660 lt5 (78) lt5

Table 8 Postoperative complications following cataract surgery in 179 pts at Jimma University Ophthalmology DepartmentPost operative complications No No () Me-II 1999

None 135 754

Missed shaped pupil 21 117 PCO 9 50 9 (52)

Cortical remanants 3 17 16(92)

IOL decenteration 2 11 10(57)

Bullus keratopathyCorneal opacity 2 11 3(17)

Uvieitis 2 11 13(75)

Postoperative glaucoma 1 6 2(11)

Wound gap 1 6 2(11)

Vitreous opacity 1 6

RD 1 6

Pupillary fibrinous material Vit in AC amp Iridocorneal touch 1 6 5(03)

Total 179 1000

Table 9 Causes of poor outcome (best corrected acuity lt660) in 200 pts seen at 2 month follow up

Factors No

Pre-existing ocular comorbidity 7(50)

Central corneal opacity 1

Pseudoexfolation and Glaucoma 2

Pseudoexfolation and ARMD 2

Others 3

Surgical events 3(214)

PC tear 2

Iris damage(inadverteal PIiridodialysis 1

Post-surgical conditions 4(286)

PCO 3

RD 1

Total 14

Table 10 Mean of pt Expectation and outcome for visual function index (VF-15) items Jimma University ophthalmology department 2007

VF-15 Item Expectation Outcome

Mean (SD) Mean (SD) P-value

1 Performing manual tasks 876(214) 931(1793) 012

2 Going out by your self 945(131) 945(1702) lt 0001

3 Reading small print 917(1489) 915(2265) 0026

4 Reading large print such as posters

numbers on a Telephone 978(809) 961(1554) 07

5 Recognizing people 963(1055) 943(1713) lt 0001

6 Doing fine hand works like sewing

knitting or wood working 896(1829) 831(3000) lt 0001

7 Cooking dressing or other

self-care activities 954(1177) 934(1879) 007

8 Participating in social activities 959(1086) 930(2018) 0001

9 Going to shopsMarkets 949(1356) 922(2189) lt 0001

10 Working just like you did before 94(1331) 930(1911) lt 0021

11 Choosing clothes to wear 98(844) 982(992) lt 0001

12 Taking a bath by yourself 98(844) 982(992) lt 0001

13 Getting dressed by yourself 984(795) 984(977) lt 0001

14 Visiting your friends 969(1000) 937(1908) 018

15 Watching Television 947(1395) 980(866) 017

In Sydney Private Hospital Sydney of 121pts 80 patients (66) failing to equal or exceed their expectations at 1-month follow-up

Table 11 Sperman rank correlation with patient satisfaction for visual function Index (VF-15) items Jimma University Ophthalmology department 2007 Correlation with satisfaction

VF-15 Item Preoperative post operative

Expectation outcome

1 Performing manual tasks NS 084

2 Going out by your self NS 088

3 Reading small print NS 053


numbers on a Telephone NS 088

5 Recognizing people 026(0002) 088


knitting or wood working 026(0002) 063


self-care activities NS 089

8 Participating in social activities 016(0048) 092

9 Going to shopsMarkets NS 092

10 Working just like you did before NS 082

11 Choosing clothes to wear NS 037

12 Taking a bath by yourself NS 037

13 Getting dressed by yourself NS 037

14 Visiting your friends NS 076

15 Watching Television NS 070

Abbreviations NS not significant

P values (outcome) lt0001

Table 12Sperman correlation with patient satisfaction for composite measures Jimma University ophthalmology department 2007 Measure Correlation p-value

With satisfaction

Expected VF -15 score improvement 0004 NS

Actual VF -15 score improvement 019 NS

Actual post operative VF -15 score 038 010

NB Expected VF -15 score improvement 021 002



CONCLUSION

Expectations regarding visual functioning after cataract surgery were very high and in most cases such expectations are fulfilled

The visual outcome of cataract surgery performed during the sample period was satisfied the patients by the results achieved and very encouraging to consider it in the future

With adequate surgical skills ECCE with PC IOL implantation offers good visual rehabilitation even with training conditions

The need for measuring outcomes preferably over a wider spectrum than the mere visual outcome is a critical element in measuring and tracking our achievements towards the goal of eliminating avoidable blindness by 2020

RECOMMONDATIONS Prospective standardized monitoring of cataract surgical

outcomes with regular analysis of the causes of poor outcome is an important tool in which the ophthalmic surgical teams can use to improve the results of their cataract surgery

Surgeons have to emphasize the importance of controlling their patientsrsquo expectations (Bc controlling patient expectations may be more effective than improving patientsrsquo postoperative outcome in terms of maximizing patient satisfaction)

Reference1 Bull World Health Organ 1995 73 115-212 ELLWEIN LB amp KUPFER C - Strategic issues in preventing cataract blindness

in developing countries Bul World Health Org 1995 73681-6903 PCON super site Microsoft internet co management results in lsquoexcellentrsquo patient outcomes Yorston D Foster A Audit of extracapsular cataract extraction and posterior chamber lens implantation as a routine treatment for

age related cataract in east Africa Br J Ophthalmol 99983897-9015 Monitoring cataract surgical outcome Text for presentation on monitoring cataract surgical outcome Community eye health CD 20076 Mangione CM Lee PP Gutierrez PR et al Development of the 25-item National Eye Institute Visual Function Questionnaire Arch Ophthalmol 20011191050-1058 7 Scott A Sjjnjmith RD Keeping the customer satisfied issues in the interpretation and use of patient satisfaction surveys Int J Qual Health Care

19946353-359

8 Epstein AM The outcomes movement will it get us where we want to go

N Engl J Med 1990323266-270

9 Cleary PD McNeil BJ Patient satisfaction as an indicator of quality of care

Inquiry19882525-36

10 Padberg RM Padberg LF Strengthening the effectiveness of patient

education applied principles of adult education Oncol Nurs Forum

19901765-69

11 Williams B Patient satisfaction a valid concept Soc Sci Med 199438509-516

12 Yucelt U An investigation of causes of patient satisfactiondissatisfaction with physician services Health Mark Q 19941211-28

13 Ware JE Davies AR Behavioral consequences of consumer dissatisfaction

with medical care Eval Program Plann 19836291-297

14 Espallargues M Alonso J Effectiveness of cataract surgery in Barcelona

Spain site results of an international study Barcelona I-PORT investigators International Patient Outcomes Research Team J Clin Epidemiol 199851843ndash52

15Steinberg EP Tielsch JM Schein OD et al National study of cataract Surgery outcomes Variation in 4-month postoperative outcomes as reflected

in multiple outcome measures Ophthalmology 19941011131ndash40 16 MacCormick AD Collecutt WG Parry BR Prioritizing patients for elective surgery a systematic review ANZ J Surg 200373633ndash4217 LeBlanc RP Evaluating elective surgery CMAJ 2003168397ndash400 18 Rubin HR Gandek B Rogers WH Kosinski M McHorney CA Ware JE Patients ratings of outpatient visits in different practice settings results from the Medical Outcomes Study JAMA 1993 270835-840 19 Rubin HR Can patients evaluate the quality of hospital care Med Care

Rev 199047267-32620 Zeithaml VA Parasuraman A Berry LL Delivering Quality Service Balancing Customer Perceptions and Expectations New York NYT Free Press 199021 Messner RL Lewis SJ Increasing Patient Satisfaction A Guide for Nurses New York 22 Carr-Hill RA The measurement of patient satisfaction J Public Health Med 199214236-249 NY Springer 1996

23 Thompson AG Sunol R Expectations as determinants of patient

Satisfaction concepts theory and evidence Int J Qual Health Care

19957127-141

24 Flood AB Lorence DP Ding J McPherson K Black NA The role of

expectations in patients reports of post-operative outcomes and

improvement following therapy Med Care 1993 311043-1056

25 Scott A Smith RD Keeping the customer satisfied issues in the

interpretation and use of patient satisfaction surveys Int J Qual Health Care 19946353-359


N Engl J Med 1990 323266-270

27 Community eye health journal 2002 15(44) 51-53

28 Aharony L Strasser S Patient satisfaction what we know about and what we still need to explore Med Care Rev 19935049ndash79

29 American Academy of Ophthalmology Basic and Clinical Sciences Course

Section 11 (Lens and Cataract)160

30 Limburg HbAc Foster A Murthy GVS Monitoring visual outcome of cataract surgery in India Bull World Health Org 1999 77 (6)455-60

31Duaen clinical ophthalmology CD 200532 Tielsch JM Steinberg EP Cassard SD Schein OD Javitt JC Legro MW Bass EB Sharkey P Preoperative functional expectations and postoperative outcomes among patients undergoing first eye cataract surgery Arch Ophthalmol 1995 Oct 113(10)1312-833 Chet K Pager BMed (Hons) DipEd MA Expectations and Outcomes in

Cataract Surgery Arch Ophthalmol 20041221788-1792 34 Ms Linda Santamaria Dr Marcel Favilla Southern Health Quality Surgical

Audit Ophthalmology Unit Monash University 2005 35 Ken Bassett Kukuh Noertjojo Praveen Nirmalan Paul Courtright Duncan Anderson visual function assessment and cataract surgery in British Columbia CAN J OPHTHALMOLmdashVOL 40 NO 1 200536 Mayang Rini Evaluation of cataract surgical outcomes in Cicendo Eye Hospital Bandung West Java Indonesia Community Eye Health J 200720(61) 7-15 37 Reeta Gurung Cataract surgical outcome and gender specific barriers to cataract services in Tilganga Eye Centre and its outreach microsurgical eye

clinics in Nepal Community Eye Health J 200720(61) 7-15

38 Dandona L Dandona R Naduvilath et al Population-based assessment of

the outcome of cataract surgery in an urban population in southern India Am J Ophthalmol 1999 127650ndash8

39 Limburg H Kumar R Follow-up study of blindness attributed to cataract in

Karnataka State India Ophthalmic Epidemiol 1998 5211ndash23

40 Zhao J Sui R Jia L et al Visual acuity and quality of life outcomes in

patients with cataract in Shunyi County China Am J Ophthalmol

1998126515ndash23

41Yorston D Are intraocular lenses the solution to cataract blindness inAfrica

Br J Ophthalmol 199882469ndash71

42 Singh AJ Garner P Floyd K Cost-effectiveness of public-funded options for cataract surgery in Mysore India Lancet 2000355180ndash4

43 McCarty CA Nanjan MB Taylor HR Operated and unoperated cataract in

Australia Clin Exp Ophthalmol 20002877ndash82

44 Desai P Minassian DC Reidy A National cataract surgery survey 1997ndash8 a report of the results of the clinical outcomes Br J Ophthalmol

1999831336ndash40

45 Prajna NV Chandrakanth KS Kim R et al The Madurai intraocular lens

study II Clinical outcomes Am J Ophthalmol 199812514ndash25

46 Yorston D Foster A Audit of extracapsular cataract extraction and posterior

chamber lens implantation as a routine treatment for age related cataract in

east Africa Br J Ophthalmol 199983897ndash901

47 Johnson GJ Improving outcome of cataract surgery in developing countries

Lancet 2000 355158ndash9

48 Limburg H Foster A Vaidyanathan K et al Monitoring visual outcome of

cataract surgery in India Bull World Health Organ 199977455ndash60

49 Courtright PKanjaloti S Barriers to acceptance of cataract surgery among

patients presenting to district hospitals in rural malawi Trop Geogr Med

1995 4718-18

50 David Yorston Allen FosterAudit of extracapsular cataract extraction and

posterior chamber lens implantation as a routine treatment for age related

cataract in east Africa Br J Ophthalmol 199983897ndash901

51 D Yorston S Gichuhi M Wood A Foster Does prospective monitoring

improve cataract surgery outcomes in AfricaBr J Ophthalmol 200286543ndash7

52 Dr Uma Pradhan Dr Shrirang Deshpande Dr P S Grewal and Dr Museret

Awave Intercontinental Medicare Project in Ethiopia Community Eye

Health200316(47)42-43

53 Tesfaye Haileselassie Yared Asefa Samson Bayu Abebe BejigaOutcome

of extra-capsular cataract extraction with posterior chamber intraocular lens

implantation performed at a cataract surgical campaign Ethiop

J Health Dev 200216(1)77- 83

54 Zerihun N Visual outcome of the first 500 cataract extractions done in the

field JimmaEthiopia Int Ophthalmol 200124(5)291-5

55 Egbert PR Buchanan MResults of extracapsular cataract surgery and

intraocular lens inplantation in Gana Arch Ophthalmol 1991 109 1764-

1768 [Abstract]

56 Cook NJ Evaluation of high volume extracapsular cataract cataract

extraction extraction with posterior lens implantation in sierra leoneWest

Africa Br J Ophthalmology 1996 80 698-701[AbstractFree Full Text ]

57 Mahmoud B Alhassan Fatima Kyari Ibrahim B Achi Chinenyem P Ozemela Adenike Abiose Audit of outcome of an extracapsular cataract extraction and posterior chamber intraocular lens training course (Br J Ophthalmol 2000 84848- 851

58 Lumme P Laatikainen LT Risk factors for intraoperative and early

postoperative complications in extracapsular cataract surgery Eur J

ophthalmol 19944151-158[Medline]

59 Natchiar G Robin ALNalgirkar ARet al posterior capsule tears during

extracapsular cataract surgery in India Arch Ophthalmol19931993 111706- 708[Abstract]

60 Welsh NH Extracapsular cataract extraction with and without intra-ocular

lenses in black patientsS AfrMed J 199281357ndash60

61 Apple DJ Solomon KD Tetz MR et al Posterior capsule opacification Surv Ophthalmol 19923773ndash116

62 Argento C Nunez EWainsztein R Incidence of postoperative posterior

capsular opacification with types of senile cataracts J Cataract Refract Surg 199218586ndash8

63 Isenberg SJ Apt L Yoshimori R et alOutpatient topical use of povidone-

iodine in preparing the eye for surgeryOphthalmology 1989981769ndash75

64 Ruit S Robin AL Pokhrel RP Sharma A DeFellar J Extracapsular cataract extraction in Nepal 2-Year outcome Arch Ophthalmol Vol 109 December 1991

65 World Health Organization Informal consultation on analysis of blindness

prevention outcomes WHOPBL9868 Geneva WHO 1998

Outline of the study report Introduction Literature review significance of the study Objectives Methodology Result and Discussion Conclusion and recommendations


















bullSelection

bullSurgery

bullSpectacles

bullSequelae


Outcome depends on














Literature Review







248 lt 360












OBJECTIVES




SPECIFIC OBJECTIVES











biometry










Post operative



No of women () 60 (40 )

VF-15 score mean (SD) 5419 (341) 941 (159)




VA No

624-660 1 05

lt660-360 9 45

lt360-LP 190 950

Total 200 100





Cataract Surgeon

trainer 42 1 2 45

Total 193 5 2 200









complication





Wound leak 1 (05 )


AC shallow 2 (10 )





No No

Good gt618 102 570 126 704

Borderline lt618-660 55 307 39 218

Poor lt660 22 123 14 78

Total 179 100 179 100




LAHAN ARAVIND


specs AC-IOL specs

66 - 618 932 899 955 966

lt 618 - 660 46 75 29 11

lt 660 22 26 16 23

n= 914 906 1401 1474







None 135 754







Wound gap 1 6 2(11)


RD 1 6


Total 179 1000


Factors No





Others 3


PC tear 2



PCO 3

RD 1

Total 14

























Expectation outcome






















With satisfaction







CONCLUSION











19946353-359


N Engl J Med 1990323266-270


Inquiry19882525-36



19901765-69












19957127-141







N Engl J Med 1990 323266-270
















1998126515ndash23







1999831336ndash40












1995 4718-18








Health200316(47)42-43




J Health Dev 200216(1)77- 83





1768 [Abstract]





































bullSelection

bullSurgery

bullSpectacles

bullSequelae


Outcome depends on














Literature Review







248 lt 360












OBJECTIVES




SPECIFIC OBJECTIVES











biometry










Post operative



No of women () 60 (40 )

VF-15 score mean (SD) 5419 (341) 941 (159)




VA No

624-660 1 05

lt660-360 9 45

lt360-LP 190 950

Total 200 100





Cataract Surgeon

trainer 42 1 2 45

Total 193 5 2 200









complication





Wound leak 1 (05 )


AC shallow 2 (10 )





No No

Good gt618 102 570 126 704

Borderline lt618-660 55 307 39 218

Poor lt660 22 123 14 78

Total 179 100 179 100




LAHAN ARAVIND


specs AC-IOL specs

66 - 618 932 899 955 966

lt 618 - 660 46 75 29 11

lt 660 22 26 16 23

n= 914 906 1401 1474







None 135 754







Wound gap 1 6 2(11)


RD 1 6


Total 179 1000


Factors No





Others 3


PC tear 2



PCO 3

RD 1

Total 14

























Expectation outcome






















With satisfaction







CONCLUSION











19946353-359


N Engl J Med 1990323266-270


Inquiry19882525-36



19901765-69












19957127-141







N Engl J Med 1990 323266-270
















1998126515ndash23







1999831336ndash40












1995 4718-18








Health200316(47)42-43




J Health Dev 200216(1)77- 83





1768 [Abstract]




















Outcome depends on














Literature Review







248 lt 360












OBJECTIVES




SPECIFIC OBJECTIVES











biometry










Post operative



No of women () 60 (40 )

VF-15 score mean (SD) 5419 (341) 941 (159)




VA No

624-660 1 05

lt660-360 9 45

lt360-LP 190 950

Total 200 100





Cataract Surgeon

trainer 42 1 2 45

Total 193 5 2 200









complication





Wound leak 1 (05 )


AC shallow 2 (10 )





No No

Good gt618 102 570 126 704

Borderline lt618-660 55 307 39 218

Poor lt660 22 123 14 78

Total 179 100 179 100




LAHAN ARAVIND


specs AC-IOL specs

66 - 618 932 899 955 966

lt 618 - 660 46 75 29 11

lt 660 22 26 16 23

n= 914 906 1401 1474







None 135 754







Wound gap 1 6 2(11)


RD 1 6


Total 179 1000


Factors No





Others 3


PC tear 2



PCO 3

RD 1

Total 14

























Expectation outcome






















With satisfaction







CONCLUSION











19946353-359


N Engl J Med 1990323266-270


Inquiry19882525-36



19901765-69












19957127-141







N Engl J Med 1990 323266-270
















1998126515ndash23







1999831336ndash40












1995 4718-18








Health200316(47)42-43




J Health Dev 200216(1)77- 83





1768 [Abstract]



























Literature Review







248 lt 360












OBJECTIVES




SPECIFIC OBJECTIVES











biometry










Post operative



No of women () 60 (40 )

VF-15 score mean (SD) 5419 (341) 941 (159)




VA No

624-660 1 05

lt660-360 9 45

lt360-LP 190 950

Total 200 100





Cataract Surgeon

trainer 42 1 2 45

Total 193 5 2 200









complication





Wound leak 1 (05 )


AC shallow 2 (10 )





No No

Good gt618 102 570 126 704

Borderline lt618-660 55 307 39 218

Poor lt660 22 123 14 78

Total 179 100 179 100




LAHAN ARAVIND


specs AC-IOL specs

66 - 618 932 899 955 966

lt 618 - 660 46 75 29 11

lt 660 22 26 16 23

n= 914 906 1401 1474







None 135 754







Wound gap 1 6 2(11)


RD 1 6


Total 179 1000


Factors No





Others 3


PC tear 2



PCO 3

RD 1

Total 14

























Expectation outcome






















With satisfaction







CONCLUSION











19946353-359


N Engl J Med 1990323266-270


Inquiry19882525-36



19901765-69












19957127-141







N Engl J Med 1990 323266-270
















1998126515ndash23







1999831336ndash40












1995 4718-18








Health200316(47)42-43




J Health Dev 200216(1)77- 83





1768 [Abstract]


























248 lt 360












OBJECTIVES




SPECIFIC OBJECTIVES











biometry










Post operative



No of women () 60 (40 )

VF-15 score mean (SD) 5419 (341) 941 (159)




VA No

624-660 1 05

lt660-360 9 45

lt360-LP 190 950

Total 200 100





Cataract Surgeon

trainer 42 1 2 45

Total 193 5 2 200









complication





Wound leak 1 (05 )


AC shallow 2 (10 )





No No

Good gt618 102 570 126 704

Borderline lt618-660 55 307 39 218

Poor lt660 22 123 14 78

Total 179 100 179 100




LAHAN ARAVIND


specs AC-IOL specs

66 - 618 932 899 955 966

lt 618 - 660 46 75 29 11

lt 660 22 26 16 23

n= 914 906 1401 1474







None 135 754







Wound gap 1 6 2(11)


RD 1 6


Total 179 1000


Factors No





Others 3


PC tear 2



PCO 3

RD 1

Total 14

























Expectation outcome






















With satisfaction







CONCLUSION











19946353-359


N Engl J Med 1990323266-270


Inquiry19882525-36



19901765-69












19957127-141







N Engl J Med 1990 323266-270
















1998126515ndash23







1999831336ndash40












1995 4718-18








Health200316(47)42-43




J Health Dev 200216(1)77- 83





1768 [Abstract]





























OBJECTIVES




SPECIFIC OBJECTIVES











biometry










Post operative



No of women () 60 (40 )

VF-15 score mean (SD) 5419 (341) 941 (159)




VA No

624-660 1 05

lt660-360 9 45

lt360-LP 190 950

Total 200 100





Cataract Surgeon

trainer 42 1 2 45

Total 193 5 2 200









complication





Wound leak 1 (05 )


AC shallow 2 (10 )





No No

Good gt618 102 570 126 704

Borderline lt618-660 55 307 39 218

Poor lt660 22 123 14 78

Total 179 100 179 100




LAHAN ARAVIND


specs AC-IOL specs

66 - 618 932 899 955 966

lt 618 - 660 46 75 29 11

lt 660 22 26 16 23

n= 914 906 1401 1474







None 135 754







Wound gap 1 6 2(11)


RD 1 6


Total 179 1000


Factors No





Others 3


PC tear 2



PCO 3

RD 1

Total 14

























Expectation outcome






















With satisfaction







CONCLUSION











19946353-359


N Engl J Med 1990323266-270


Inquiry19882525-36



19901765-69












19957127-141







N Engl J Med 1990 323266-270
















1998126515ndash23







1999831336ndash40












1995 4718-18








Health200316(47)42-43




J Health Dev 200216(1)77- 83





1768 [Abstract]




















SPECIFIC OBJECTIVES











biometry










Post operative



No of women () 60 (40 )

VF-15 score mean (SD) 5419 (341) 941 (159)




VA No

624-660 1 05

lt660-360 9 45

lt360-LP 190 950

Total 200 100





Cataract Surgeon

trainer 42 1 2 45

Total 193 5 2 200









complication





Wound leak 1 (05 )


AC shallow 2 (10 )





No No

Good gt618 102 570 126 704

Borderline lt618-660 55 307 39 218

Poor lt660 22 123 14 78

Total 179 100 179 100




LAHAN ARAVIND


specs AC-IOL specs

66 - 618 932 899 955 966

lt 618 - 660 46 75 29 11

lt 660 22 26 16 23

n= 914 906 1401 1474







None 135 754







Wound gap 1 6 2(11)


RD 1 6


Total 179 1000


Factors No





Others 3


PC tear 2



PCO 3

RD 1

Total 14

























Expectation outcome






















With satisfaction







CONCLUSION











19946353-359


N Engl J Med 1990323266-270


Inquiry19882525-36



19901765-69












19957127-141







N Engl J Med 1990 323266-270
















1998126515ndash23







1999831336ndash40












1995 4718-18








Health200316(47)42-43




J Health Dev 200216(1)77- 83





1768 [Abstract]



























biometry










Post operative



No of women () 60 (40 )

VF-15 score mean (SD) 5419 (341) 941 (159)




VA No

624-660 1 05

lt660-360 9 45

lt360-LP 190 950

Total 200 100





Cataract Surgeon

trainer 42 1 2 45

Total 193 5 2 200









complication





Wound leak 1 (05 )


AC shallow 2 (10 )





No No

Good gt618 102 570 126 704

Borderline lt618-660 55 307 39 218

Poor lt660 22 123 14 78

Total 179 100 179 100




LAHAN ARAVIND


specs AC-IOL specs

66 - 618 932 899 955 966

lt 618 - 660 46 75 29 11

lt 660 22 26 16 23

n= 914 906 1401 1474







None 135 754







Wound gap 1 6 2(11)


RD 1 6


Total 179 1000


Factors No





Others 3


PC tear 2



PCO 3

RD 1

Total 14

























Expectation outcome






















With satisfaction







CONCLUSION











19946353-359


N Engl J Med 1990323266-270


Inquiry19882525-36



19901765-69












19957127-141







N Engl J Med 1990 323266-270
















1998126515ndash23







1999831336ndash40












1995 4718-18








Health200316(47)42-43




J Health Dev 200216(1)77- 83





1768 [Abstract]





























Post operative



No of women () 60 (40 )

VF-15 score mean (SD) 5419 (341) 941 (159)




VA No

624-660 1 05

lt660-360 9 45

lt360-LP 190 950

Total 200 100





Cataract Surgeon

trainer 42 1 2 45

Total 193 5 2 200









complication





Wound leak 1 (05 )


AC shallow 2 (10 )





No No

Good gt618 102 570 126 704

Borderline lt618-660 55 307 39 218

Poor lt660 22 123 14 78

Total 179 100 179 100




LAHAN ARAVIND


specs AC-IOL specs

66 - 618 932 899 955 966

lt 618 - 660 46 75 29 11

lt 660 22 26 16 23

n= 914 906 1401 1474







None 135 754







Wound gap 1 6 2(11)


RD 1 6


Total 179 1000


Factors No





Others 3


PC tear 2



PCO 3

RD 1

Total 14

























Expectation outcome






















With satisfaction







CONCLUSION











19946353-359


N Engl J Med 1990323266-270


Inquiry19882525-36



19901765-69












19957127-141







N Engl J Med 1990 323266-270
















1998126515ndash23







1999831336ndash40












1995 4718-18








Health200316(47)42-43




J Health Dev 200216(1)77- 83





1768 [Abstract]





















VA No

624-660 1 05

lt660-360 9 45

lt360-LP 190 950

Total 200 100





Cataract Surgeon

trainer 42 1 2 45

Total 193 5 2 200









complication





Wound leak 1 (05 )


AC shallow 2 (10 )





No No

Good gt618 102 570 126 704

Borderline lt618-660 55 307 39 218

Poor lt660 22 123 14 78

Total 179 100 179 100




LAHAN ARAVIND


specs AC-IOL specs

66 - 618 932 899 955 966

lt 618 - 660 46 75 29 11

lt 660 22 26 16 23

n= 914 906 1401 1474







None 135 754







Wound gap 1 6 2(11)


RD 1 6


Total 179 1000


Factors No





Others 3


PC tear 2



PCO 3

RD 1

Total 14

























Expectation outcome






















With satisfaction







CONCLUSION











19946353-359


N Engl J Med 1990323266-270


Inquiry19882525-36



19901765-69












19957127-141







N Engl J Med 1990 323266-270
















1998126515ndash23







1999831336ndash40












1995 4718-18








Health200316(47)42-43




J Health Dev 200216(1)77- 83





1768 [Abstract]
























Cataract Surgeon

trainer 42 1 2 45

Total 193 5 2 200









complication





Wound leak 1 (05 )


AC shallow 2 (10 )





No No

Good gt618 102 570 126 704

Borderline lt618-660 55 307 39 218

Poor lt660 22 123 14 78

Total 179 100 179 100




LAHAN ARAVIND


specs AC-IOL specs

66 - 618 932 899 955 966

lt 618 - 660 46 75 29 11

lt 660 22 26 16 23

n= 914 906 1401 1474







None 135 754







Wound gap 1 6 2(11)


RD 1 6


Total 179 1000


Factors No





Others 3


PC tear 2



PCO 3

RD 1

Total 14

























Expectation outcome






















With satisfaction







CONCLUSION











19946353-359


N Engl J Med 1990323266-270


Inquiry19882525-36



19901765-69












19957127-141







N Engl J Med 1990 323266-270
















1998126515ndash23







1999831336ndash40












1995 4718-18








Health200316(47)42-43




J Health Dev 200216(1)77- 83





1768 [Abstract]




























complication





Wound leak 1 (05 )


AC shallow 2 (10 )





No No

Good gt618 102 570 126 704

Borderline lt618-660 55 307 39 218

Poor lt660 22 123 14 78

Total 179 100 179 100




LAHAN ARAVIND


specs AC-IOL specs

66 - 618 932 899 955 966

lt 618 - 660 46 75 29 11

lt 660 22 26 16 23

n= 914 906 1401 1474







None 135 754







Wound gap 1 6 2(11)


RD 1 6


Total 179 1000


Factors No





Others 3


PC tear 2



PCO 3

RD 1

Total 14

























Expectation outcome






















With satisfaction







CONCLUSION











19946353-359


N Engl J Med 1990323266-270


Inquiry19882525-36



19901765-69












19957127-141







N Engl J Med 1990 323266-270
















1998126515ndash23







1999831336ndash40












1995 4718-18








Health200316(47)42-43




J Health Dev 200216(1)77- 83





1768 [Abstract]






















No No

Good gt618 102 570 126 704

Borderline lt618-660 55 307 39 218

Poor lt660 22 123 14 78

Total 179 100 179 100




LAHAN ARAVIND


specs AC-IOL specs

66 - 618 932 899 955 966

lt 618 - 660 46 75 29 11

lt 660 22 26 16 23

n= 914 906 1401 1474







None 135 754







Wound gap 1 6 2(11)


RD 1 6


Total 179 1000


Factors No





Others 3


PC tear 2



PCO 3

RD 1

Total 14

























Expectation outcome






















With satisfaction







CONCLUSION











19946353-359


N Engl J Med 1990323266-270


Inquiry19882525-36



19901765-69












19957127-141







N Engl J Med 1990 323266-270
















1998126515ndash23







1999831336ndash40












1995 4718-18








Health200316(47)42-43




J Health Dev 200216(1)77- 83





1768 [Abstract]





















LAHAN ARAVIND


specs AC-IOL specs

66 - 618 932 899 955 966

lt 618 - 660 46 75 29 11

lt 660 22 26 16 23

n= 914 906 1401 1474







None 135 754







Wound gap 1 6 2(11)


RD 1 6


Total 179 1000


Factors No





Others 3


PC tear 2



PCO 3

RD 1

Total 14

























Expectation outcome






















With satisfaction







CONCLUSION











19946353-359


N Engl J Med 1990323266-270


Inquiry19882525-36



19901765-69












19957127-141







N Engl J Med 1990 323266-270
















1998126515ndash23







1999831336ndash40












1995 4718-18








Health200316(47)42-43




J Health Dev 200216(1)77- 83





1768 [Abstract]





















None 135 754







Wound gap 1 6 2(11)


RD 1 6


Total 179 1000


Factors No





Others 3


PC tear 2



PCO 3

RD 1

Total 14

























Expectation outcome






















With satisfaction







CONCLUSION











19946353-359


N Engl J Med 1990323266-270


Inquiry19882525-36



19901765-69












19957127-141







N Engl J Med 1990 323266-270
















1998126515ndash23







1999831336ndash40












1995 4718-18








Health200316(47)42-43




J Health Dev 200216(1)77- 83





1768 [Abstract]





















Factors No





Others 3


PC tear 2



PCO 3

RD 1

Total 14

























Expectation outcome






















With satisfaction







CONCLUSION











19946353-359


N Engl J Med 1990323266-270


Inquiry19882525-36



19901765-69












19957127-141







N Engl J Med 1990 323266-270
















1998126515ndash23







1999831336ndash40












1995 4718-18








Health200316(47)42-43




J Health Dev 200216(1)77- 83





1768 [Abstract]












































Expectation outcome






















With satisfaction







CONCLUSION











19946353-359


N Engl J Med 1990323266-270


Inquiry19882525-36



19901765-69












19957127-141







N Engl J Med 1990 323266-270
















1998126515ndash23







1999831336ndash40












1995 4718-18








Health200316(47)42-43




J Health Dev 200216(1)77- 83





1768 [Abstract]































With satisfaction







CONCLUSION











19946353-359


N Engl J Med 1990323266-270


Inquiry19882525-36



19901765-69












19957127-141







N Engl J Med 1990 323266-270
















1998126515ndash23







1999831336ndash40












1995 4718-18








Health200316(47)42-43




J Health Dev 200216(1)77- 83





1768 [Abstract]




















CONCLUSION











19946353-359


N Engl J Med 1990323266-270


Inquiry19882525-36



19901765-69












19957127-141







N Engl J Med 1990 323266-270
















1998126515ndash23







1999831336ndash40












1995 4718-18








Health200316(47)42-43




J Health Dev 200216(1)77- 83





1768 [Abstract]


























19946353-359


N Engl J Med 1990323266-270


Inquiry19882525-36



19901765-69












19957127-141







N Engl J Med 1990 323266-270
















1998126515ndash23







1999831336ndash40












1995 4718-18








Health200316(47)42-43




J Health Dev 200216(1)77- 83





1768 [Abstract]





















N Engl J Med 1990323266-270


Inquiry19882525-36



19901765-69












19957127-141







N Engl J Med 1990 323266-270
















1998126515ndash23







1999831336ndash40












1995 4718-18








Health200316(47)42-43




J Health Dev 200216(1)77- 83





1768 [Abstract]

























19957127-141







N Engl J Med 1990 323266-270
















1998126515ndash23







1999831336ndash40












1995 4718-18








Health200316(47)42-43




J Health Dev 200216(1)77- 83





1768 [Abstract]






























1998126515ndash23







1999831336ndash40












1995 4718-18








Health200316(47)42-43




J Health Dev 200216(1)77- 83





1768 [Abstract]































1995 4718-18








Health200316(47)42-43




J Health Dev 200216(1)77- 83





1768 [Abstract]






















Health200316(47)42-43




J Health Dev 200216(1)77- 83





1768 [Abstract]




















Patients' preoperative expectation for the outcome of cataract surgery

Health & Medicine

Transcript of Patients' preoperative expectation for the outcome of cataract surgery