Editor,
We congratulate Hugh Taylor on his editorial in which he discusses the volume of cataract surgery which needs to be done. We were particularly interested by his calculations drawing attention to the effect of changing the visual threshold at which the decision to undertake cataract surgery is made.
We have reviewed a series of eight audits of cataract surgery to determine the visual acuities a...
Editor,
We congratulate Hugh Taylor on his editorial in which he discusses the volume of cataract surgery which needs to be done. We were particularly interested by his calculations drawing attention to the effect of changing the visual threshold at which the decision to undertake cataract surgery is made.
We have reviewed a series of eight audits of cataract surgery to determine the visual acuities at which patients were put on the waiting list for cataract extraction. The audits were designed to show surgical outcomes but they also list the visions at the point when the decision to operate
was made. They include all patients during short periods between 1982 when intracapsular extraction without lens insertion was the norm and the first six months of 2000 when practically all cases were phacoemulsification through a clear corneal incision with a foldable lens.
They are all based on the throughput of a single firm of a teaching hospital. The table shows visual acuity at listing for cataract extraction.
Audit date
No of cases in audit
Type of surgery
Percentage of patients with a given visual acuity when
decision to operate was taken
6/60 or worse
6/18 to 6/60
6/12 or better
1982
39
ICCE & no lens
76.9
20.5
2.6
1984
68
ECCE & IOL
70.6
25.0
4.4
1988
56
ECCE & PC.IOL
67.9
32.1
0.0
1989
29
ECCE & PC.IOL
62.1
34.5
3.4
1992
23
ECCE & PC.IOL
21.7
69.6
8.7
1998
56
Phaco & IOL
16.1
44.6
39.3
1999
85
Phaco & IOL
14.1
54.1
31.8
2000
41
Phaco & IOL
19.0
33.3
47.7
These results are heartening in that they show that the pool of dense cataracts resulting in visions of 6/60 or worse has decreased (from 77% in 1982 to 19% in 2000). They confirm that as surgical techniques have improved the demand for surgery at an early stage has dramatically increased. In the 1982 audit only 2.6% of cases saw 6/12 or better whereas
by 2000 this figure had risen to 47.7%.
We accept that visual acuity is far from being a comprehensive measure of visual disability but none the less it is useful as an indicator of trends. The trend is clearly towards earlier cataract surgery and it is likely to be maintained resulting in increasing surgical volumes. The answer to Hugh Taylor's question, "How much surgery do we have to do?" is more and still
more. The problem then becomes partly political in that governments decide on maximum waiting times for surgery with the effect that it becomes difficult to prioritise those patients with a serious degree of cataract
over those who are simply suffering inconvenience.
Editor
The article by Forbes et al on cheek mucosa is indeed interesting and helpful in cases of reccurent pterygia, but as they have given irradiation to cases after surgery it becomes a bias as to how much better is cheek mucosa compared with conjunctiva autograft.
Secondly, have they considered the use of buccal mucosa for the same as cheek mucosa is more difficult to harvest although I agr...
Editor
The article by Forbes et al on cheek mucosa is indeed interesting and helpful in cases of reccurent pterygia, but as they have given irradiation to cases after surgery it becomes a bias as to how much better is cheek mucosa compared with conjunctiva autograft.
Secondly, have they considered the use of buccal mucosa for the same as cheek mucosa is more difficult to harvest although I agree that the buccal mucosa is
thicker. I have tried buccal mucosa for severe symblepharons.
Editor,
We read Frau et al's report with interest and noted
that our article in Ophthalmology was not cited as
reference (Larkin G, Flaxel C, Leaver P. Phacoemulsification and silicone
oil removal through a single corneal incision.
Ophthalmology 1998;105:2023-7). In
this article, we reported our experience at Moorfields Eye Hospital with
34 eyes prospectively evaluated to l...
Editor,
We read Frau et al's report with interest and noted
that our article in Ophthalmology was not cited as
reference (Larkin G, Flaxel C, Leaver P. Phacoemulsification and silicone
oil removal through a single corneal incision.
Ophthalmology 1998;105:2023-7). In
this article, we reported our experience at Moorfields Eye Hospital with
34 eyes prospectively evaluated to look at the efficacy and potential
complications of combined cataract extraction and silicone oil removal
with posterior chamber lens implantation. We also reported the method of
Ms Maria Restori, BSc, MSc, MIPSM, Ophthalmic Ultrasound Specialist at
Moorfields Eye Hospital for calculating the IOL power in an oil filled eye
with correction for the specific gravity of silicone oil taken into
consideration.
Our findings were that the procedure was safe and effective for these eyes
that had often had many previous surgeries. The visual outcome in these
eyes was generally good with improvement in visual acuity, even with
recurrent retinal detachment or pre-existing macular pathology. We also
concluded that it was safer to place a rigid posterior chamber implant
after silicone oil removal due to potential contraction of the anterior
capsule limiting the view of the retina post-operatively. Our technique
was a passive technique but might easily be done with the I/A handpiece as
this group reported.
We feel that it would have been appropriate for them to make reference to
our study since it presents a much larger series with more detailed follow-up.
Editor,
I have visited the Kikuyu Eye Unit near Nairobi on a yearly basis since
1992, and have witnessed at first hand both there and in Somalia the
enormous burden of poverty and ill health described and quantified in the
editorial. What strikes me very forcibly is the sheer number of hugely
disadvantaged people. This, and the distressing and widening disparity in
health and income between these peopl...
Editor,
I have visited the Kikuyu Eye Unit near Nairobi on a yearly basis since
1992, and have witnessed at first hand both there and in Somalia the
enormous burden of poverty and ill health described and quantified in the
editorial. What strikes me very forcibly is the sheer number of hugely
disadvantaged people. This, and the distressing and widening disparity in
health and income between these people and those of us living in developed
countries is well made in the editorial. I have come to feel that efforts
at population control should receive a high priority, and in this regard I
was surprised and disappointed that the IHPN makes no mention of this in
their checklist of strategies to reduce the global burden of poverty and
poor health. I would be very interested to hear their response.
Your article is very interesting and indeed very promising as far the management of lymphangiomas is concerned. Do the authors think this drug has any role in the management of capillary haemangiomas or other
vascular abnormalities of the eye?
Editor,
We congratulate Hugh Taylor on his editorial in which he discusses the volume of cataract surgery which needs to be done. We were particularly interested by his calculations drawing attention to the effect of changing the visual threshold at which the decision to undertake cataract surgery is made.
We have reviewed a series of eight audits of cataract surgery to determine the visual acuities a...
Editor
The article by Forbes et al on cheek mucosa is indeed interesting and helpful in cases of reccurent pterygia, but as they have given irradiation to cases after surgery it becomes a bias as to how much better is cheek mucosa compared with conjunctiva autograft.
Secondly, have they considered the use of buccal mucosa for the same as cheek mucosa is more difficult to harvest although I agr...
Editor,
We read Frau et al's report with interest and noted that our article in Ophthalmology was not cited as reference (Larkin G, Flaxel C, Leaver P. Phacoemulsification and silicone oil removal through a single corneal incision. Ophthalmology 1998;105:2023-7). In this article, we reported our experience at Moorfields Eye Hospital with 34 eyes prospectively evaluated to l...
Editor,
I have visited the Kikuyu Eye Unit near Nairobi on a yearly basis since 1992, and have witnessed at first hand both there and in Somalia the enormous burden of poverty and ill health described and quantified in the editorial. What strikes me very forcibly is the sheer number of hugely disadvantaged people. This, and the distressing and widening disparity in health and income between these peopl...
Your article is very interesting and indeed very promising as far the management of lymphangiomas is concerned. Do the authors think this drug has any role in the management of capillary haemangiomas or other vascular abnormalities of the eye?
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