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  • Refractive Error After Cataract Surgery: New Risk Factors Identified

    By Lynda Seminara
    Selected By: Deepak P. Edward, MD
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    Journal Highlights

    Journal of Cataract & Refractive Surgery
    Published online April 20, 2018

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    In a large multicenter study, Lundström et al. documented risk factors for refractive error after cataract surgery. In addition to previously reported risk factors, they identified several new indicators, including poor preoperative visual acuity, corneal opacities, and surgical complications such as vitreous loss and capsular break.

    The authors gathered data from consecutive cases of cataract extraction reported to the European Registry of Quality Outcomes for Cataract and Refractive Surgery (EUREQUO) in 2014 and 2015. All told, 100 clinics and 12 countries were represented. Collected information included demographics, preoperative corrected distance visual acuity (CDVA), target refraction, coexisting eye disease, previous eye sur­gery, type of surgery and any surgical difficulties, and type of intraocular lens (IOL) implanted.

    Of the 548,392 reported cases, fol­low-up data were available for 282,811 (mean age of patients, 74 years). The absolute mean biometry prediction error was 0.42 D. The prediction error was within 1.0 D for 93% of eyes and within 0.50 D for 72%. Strong indica­tors of poor refractive outcome were target refraction (negative or absolute), poorer preoperative CDVA, coexisting eye disease, and surgical difficulty and complications. The odds ratios of refractive error in the presence of a surgical complication were 2.55, 5.57, and 13.8 for >0.5 D, >1.0 D, and >2.0 D, respectively.

    The authors found that older age (>60 years) was associated with biom­etry prediction errors >0.5 D, while younger age was linked to prediction errors >2.0 D. There were no signifi­cant differences in refractive outcomes between men and women. The absolute mean biometry prediction error was 0.43 ± 0.55 D in 2014 and 0.41 ± 0.48 D in 2015 (p < .001).

    The number of risk factors for re­fractive error is larger than expected. Results of this study may aid in up­dating evidence-based guidelines. The authors suggest lowering the absolute biometry prediction error from ≤0.6 D (as stated in 2012 guidelines based on the EUREQUO data) to ≤0.45 D, to more closely resemble their find­ings. They also propose increasing the benchmark percentage of error within 1.0 D from ≥87% (per the 2012 guidelines) to at least 90%. Moreover, the authors recommend that all risk factors be considered during preopera­tive planning, including selection of the most appropriate IOL.

    The original article can be found here.