Institute of Nursing 2nd Semester SY 11-12

Pain and Surgery - INP

vidence

B N
ased
Submitted by:

ursing

Tanglao, Jeffrey B.

BSN215 GROUP 60B

Submitted to:

Prof. Rosalie R. Villanueva RN, MAN

Clinical Instructor

I. Clinical Question:
Can specific type of Intra Ocular Lens (IOL) provide a better post operative outcome and functioning after a Cataract extraction procedure?

II. Citation:
COMPARISON OF VISUAL OUTCOMES, PHOTOPIC CONTRAST SENSITIVITY, WAVEFRONT ANALYSIS, AND PATIENT SATISFACTION FOLLOWING CATARACT EXTRACTION AND IOL IMPLANTATION: ASPHERIC VS SPHERICAL ACRYLIC LENSES HP Sandoval, LE Fernandez de Castro, DT Vroman and KD Solomon
Magill Research Center for Vision Correction, Storm Eye Institute, Medical University of South Carolina, Charleston, SC, USA

III. Study Characteristics

1. Patients Included (Population and Sample) The study included 30 patients aging 50 years old and above who had undergone bilateral cataract extraction and IOL placement. From the number of patients, 3 of them withdrew giving a final sample of 27 patients with a total of 53 eyes from the said patients included in the assessment for this research study. The patients were randomly divided into 2 groups depending on the type of lens implanted to them; 14 patients under AcrysofIQ group and 13 under the AcrysofSingle- Piece group. 2. Interventions Compared The study compared the quality of vision provided by two different acrylic IOLs, an ASPHERIC IOL (AcrysofIQ SN60WF) and a SPHERICAL IOL (AcrysofSingle- Piece SA60AT) both distributed by Alcon Laboratories, Ft. Worth, TX, USA, implanted after routine cataract extraction. Both studied lenses are hydrophobic, acrylic, monofocal, and single piece IOLs. 3. Outcomes Monitored Several outcomes that were monitored for the effects of the IOL implantation includes ETDRS (early treatment of diabetic retinopathy study) best-corrected visual acuity (BCVA), best distance-corrected photopic contrast sensitivity testing, and determination of determining differences in spherical aberration (SA) and other highorder aberrations (HOA), establishing differences in photopic contrast sensitivity, and evaluating a subjective questionnaire.

4. Does the study focus on a significant problem in the clinical practice? Yes, the study focuses on a significant problem in the clinical practice especially in the field of Ophthalmology and nursing care for patients who undergo cataract surgeries. However, despite of different enhancements in cataract surgeries, a lot of patients still complain of post operative side effects and discomfort which are attributed to the design, dimensions and other mechanical characteristics of the implants.

IV. Methodology / Design

1. Methodology Used Prospective, randomized, double-masked study that included 53 eyes of 27 patients who underwent bilateral cataract extraction and IOL implantation was implemented for this study. 2. Design The research study utilized an experimental design wherein the patients are randomly assigned to the type of lens that they received. Assessment parameters were established before and after the surgical procedure and the differences where compared for both the lenses. 3. Setting The study was conducted in the Storm Eye Institute and Magill Research Center for Vision Correction, Medical University of South Carolina, Charleston, SC, USA. 4. Data Sources The researchers data came only from the patients records in the said institution. The Medical University of South Carolina, Institutional Review Board approved this study. Informed consent was obtained from all patients after a thorough explanation of the procedure and its potential benefits and risks. 5. Subject Selection a) Inclusion Criteria: Randomization was done and the study included patients 50 years of age and above, undergoing bilateral phacoemulsification with primary implantation of a posterior-chamber IOL with a naturally dilated pupil(in dim light) 4.0mm in both the eyes.

b) Exclusion Criteria: Exclusion criteria included any preoperative ocular pathology potentially affecting visual outcome, previous intraocular or corneal surgery, keratometric astigmatism exceeding 1.5 diopters (D), planned postoperative refraction for monovision, and/or other ocular surgery at the time of the cataract extraction. Intraoperative exclusion criteria included significant anterior chamber bleeding, iris damage, detached Descemets membrane, posterior capsule rupture, vitreous loss, and zonular rupture. Postoperative exclusion criteria included IOL decentration of more than 1.0mm (evaluated by retro illumination and digital photograph), use of corneal sutures for more than 1 week, and ocular pathologies, potentially affecting visual acuity that were not evident before surgery. 6. Has the study been replicated? Yes. Previous studies have already been made by Maia-Rocha and co-workers comparing in their study comparing the AcrysofIQ to the AcrysofNatural and Sensar using 4 and 5mm pupil sizes. Significant findings on their studies showed that SA were significantly lower in the AcrysofIQ group. Another study by Kasper et al also reported significantly lower SA comparing Tecnis and Sensar for physiological mesopic pupil of 3.84 and 3.76 mm, respectively 7. What are the risk and benefits of the nursing action / intervention tested in the study? The study is very beneficial both for the physicians / surgeons and the patients themselves especially in selecting the type on IOL to be implanted in their eyes after the extraction. As nurses, the knowledge about this subject matter will enable us to help our patients in choosing the type of lens they prefer to use. By sharing them information about this study, we can help them in making the right decision for their treatment. Risk factors include the risk factors following the cataract surgery. Regardless of the type of lens they select, anterior chamber bleeding, iris damage, posterior capsule rupture, vitreous loss, zonular rupture, IOL decentration may still follow if not properly managed.

V. Results of the Study

Postoperatively there was a greater increase in contrast sensitivity at 1 and 3 months in the AcrysofIQ group when compared to baseline. Patients with AcrysofIQ IOL had a significant reduction in total high-order aberrations (HOA) and spherical aberration (SA) when compared to those patients with AcrysofSingle-Piece. Postoperative patient satisfaction showed no difference among the groups. Change in contrast sensitivity showed a significantly greater increase in the AcrysofIQ group than in the AcrysofSingle-Piece group at 1 month in spatial frequencies. However, no statistical differences among the groups at 1 and 3 months postoperatively were found at any spatial frequency. There were no significant differences in total astigmatism, total coma and other terms among the groups, or compared to preoperative values.

VI. Authors Conclusion / Recommendation

Advances in IOL technology using wavefront analysis include modifications on its surface to improve visual outcomes. It has been reported that aspheric IOLs compensate the SA of the cornea and improve contrast sensitivity providing patients with better quality of vision. However, centration and tilting of the lens are important factors to control to obtain such results. The asphericity of the AcrysofIQ IOL has been created by reducing the posterior center thickness without increasing the lens-edge thickness and introduces 0.20 mm of SA compensating for the SA of the normal cornea. Similar to previous studies we did not find significant differences in photopic contrast sensitivity among the groups; however, there was a greater increase in the change of contrast sensitivity preoperative to 1 and 3 months in the AcrysofIQ group compared to the AcrysofSingle-piece. In summary, use of the aspheric acrylic AcrysofIQ lens, designed to compensate for the SA of the cornea and the lens, may improve the quality of vision of pseudophakic patients by reducing the total HOA and SA.

VII. Applicability
1. Does the study provide a direct enough answer to your clinical question in terms of the type of patients, intervention and outcomes? Yes. The study gave a direct answer to the clinical question. The study suggests that there is a specific type of IOL that offers better outcomes among post cataract extraction surgeries in terms of reduced adverse effects and discomforts brought about by various factors that reduces the effectivity of its placement.

2. Is it feasible to carry out the nursing action in the real world? Yes, it may be feasible to perform the said intervention however; the availability of the said lenses may be of question when it is to be done here in the Philippines. Optimistically, maybe there are IOL products that are available here in the Philippines that possess the same characteristics of AcrysofIQ that makes it a better option of IOL implantation.

VIII. Reviewers Conclusion / Recommendation

I believe that this study should be replicated here in our country making use of available IOL products that we have for Filipino patients. Making a replication of this study will not only validate the results that the previous researchers have found out but also, it will enable us to identify which specific IOL will produce the same results as that of the Aspheric IOL. This study can also be a basis for improvement for Local IOL manufacturers in the Philippines, if there are, to make revisions into the designs of the IOLs that they have so that it would suit the needs of the eyes that those Aspheric IOls gives those patients in America. IX. Reference : Eye (2008) 22, 14691475 & 2008 Macmillan Publishers Limited All rights reserved DOI: 0950-222X/08