Capsulotomy improves functional vision in patients with good visual acuity

This study evaluated the effect of neodymium:YAG (Nd:YAG) laser capsulotomy on functional visual acuity in patients with posterior capsule opacification (PCO) and blurred vision despite good corrected distance visual acuity (CDVA). Using the SSC-350 (Nidek, Gamagori, Japan) system to assess functional visual acuity before and after capsulotomy, the authors found that functional visual acuity improved significantly. They conclude that measurement of functional visual acuity is useful for assessing vision quality in patients who undergo Nd:YAG laser capsulotomy after cataract surgery or justifying the need for Nd:YAG laser capsulotomy in patients with good vision but visual symptoms caused by PCO.

Subjects were nine patients (10 eyes) with previous cataract surgery and central posterior PCO requiring Nd:YAG laser capsulotomy. They had postoperative visual symptoms of blur and glare and CDVA of at least 20/20.

The authors found no significant difference in CDVA before and after Nd:YAG capsulotomy among the patients. However, they measured significant improvements in mean functional visual acuity from 0.18 ± 0.11 logMAR (range, 0.03 to 0.31 logMAR) to 0.08 ± 0.07 logMAR (range, 0.04 to 0.18 logMAR) (P < 0.05) and in low-contrast visual acuity (LCVA) (P= 0.003). Higher-order aberrations (HOAs) and the root mean square of 4th-order coefficients decreased significantly after capsulotomy. These aberrations were significantly correlated with functional visual acuity and LCVA.

These results suggest that mild fibrotic PCO with no effect on conventional visual acuity has visually significant implications on dynamic vision measurement even when tear functions are normal. The authors say that PCO may have caused the increase in spherical-like and higher-order aberrations, which resulted in degradation of visual function, as evidenced by the decreases in functional visual acuity and LCVA among the subjects. They conclude that functional visual acuity testing can reflect the effect of HOAs or glare disability on visual function and provides a more thorough assessment of visual disability caused by mild PCO.

These results provide us with data to justify helping patients with good Snellen acuity but visual complaints and demonstrate the improvement in glare and contrast with Nd:YAG laser capsulotomy.