It's All About Function: Improving Vision
Vision improvement is the primary reason for cataract surgery as defined by the American Academy of Ophthalmology in their 2011 edition of Cataract in the Adult Eye, Preferred Practice Pattern. Best practice guidelines are given with positive outcome and patient consent being factors in their recommendations, as stipulated in the Preferred Practice Pattern statement, "Perform cataract surgery when there is the expectation that it will benefit the patient's function and when the patient elects this option."
Enhancing the quality of life through improving visual function is a recurring theme in the Preferred Practice Pattern’s following guidelines : (1) "The decision to recommend cataract surgery should be based on consideration of the following factors: visual acuity, visual impairment, and potential for functional benefits. (2) Outcome criteria include, Improvement in visual function. (3) Perform cataract surgery when there is the expectation that it will benefit the patient's function."
The Preferred Practice Pattern teaches us that (1)“Many comorbid conditions are associated with the potential for reduced improvement in visual function or BCVA, and the patient should be adequately informed and counseled during the care process. (2) Biomicroscopic and ophthalmoscopic examinations of the macular region do not necessarily predict macular function when the macula is abnormal. (3) The presence and extent of AMD may be defined preoperatively through the use of diagnostic instrumentation such as OCT, fluorescein angiography, and potential acuity instruments, which can assist in establishing realistic expectations. (4) Optical coherence tomography (OCT) and diagnostic and fluorescein angiography may be helpful prior to cataract surgery for confirming normal foveal architecture or for identifying the presence of comorbid disease, even when the foveal center and immediately surrounding areas appear normal on direct examination. (5) When the preoperative distance acuity is 20/100 or better, the Retinal Acuity Meter may be more likely to predict the postoperative visual acuity in the presence of ocular comorbidity correctly."
It is important to recognize that biomicroscopic and ophthalmoscopic examinations, OCT and fluorescein angiography evaluate the structural architecture but not function. It therefore follows that the only possible measurement of the functional capacity of the eye is vision measured through the cataract by potential acuity instruments. Realistic expectations can be fulfilled when the functional capacity of the eye is measured and shared with the patient.Excerpts from The Preferred Practice Pattern are listed below to expedite the review of key features related to measuring the function of the macula prior to recommending surgery. To study the complete The Preferred Practice Pattern for Cataract in the Adult Eye ..CLICK
Links to Excerpts..CLICK:
Objective: Expectation that it will benefit the patient's function
Outcome criteria includes: Improvement in Function
