By the American Academy of Ophthalmology Preferred Practice Pattern Cataract/Anterior Segment Panel: Randall J. Olson, MD,1 Rosa Braga-Mele, MD, MEd, FRCSC,2 Sherleen Huang Chen, MD,3 Kevin M. Miller, MD,4 Roberto Pineda, II, MD,5 James P. Tweeten, MD,6 David C. Musch, PhD, MPH7
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1 Department of Ophthalmology and Visual Science, John A. Moran Eye Center, University of Utah Health Care, Salt Lake City, Utah
2 Kensington Eye Institute and Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
3 Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
4 Stein Eye Institute and Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California
5 Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
6 Intermountain Eye Clinic, Boise, Idaho
7 Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
HIGHLIGHTED FINDINGS AND RECOMMENDATIONS FOR CARE
Symptomatic cataract is a surgical disease. Dietary intake and nutritional supplements have demonstrated minimal to no effect in the prevention or treatment of cataract. (III, good quality, strong recommendation)
The standard of care in cataract surgery in the United States is a small-incision phacoemulsification with foldable intraocular lens (IOL) implantation. It is a standard of care that has withstood the test of time.
Refractive cataract surgery has the potential to reduce a patient’s dependence on eyeglasses and contact lenses for distance, intermediate, and near vision.
Intraocular lens technologies and surgical approaches to implanting lenses continue to improve.
Femtosecond laser-assisted cataract surgery (FLACS) increases the circularity and centration of the capsulorrhexis and reduces the amount of ultrasonic energy required to remove a cataract. However, the technology may not yet be cost-effective, and the overall risk profile has not yet been shown to be superior to that of standard phacoemulsification.
The use of topical nonsteroidal anti-inflammatory drugs (NSAIDs) is controversial, with evidence suggesting that NSAIDS only be used for the prevention of cystoid macular edema (CME) in patients with diabetic retinopathy or other high-risk ocular comorbidities.
Increasing evidence demonstrates that intracameral antibiotics reduce the risk of postoperative bacterial endophthalmitis.
Surgeons should recognize and prepare to manage high-risk characteristics that may complicate cataract surgery. New risks may become apparent as new technologies come to market. One example is capsular damage with rapid development of a complicated cataract associated with intravitreal injections.
Toxic anterior segment syndrome (TASS) may be confused with infectious endophthalmitis. However, TASS has an earlier onset, is associated with limbus-to-limbus corneal edema, and responds to corticosteroids.
Cochrane Eyes and Vision Supplements
We thank our partners, the Cochrane Eyes and Vision US Satellite (CEV@US), for identifying reliable systematic reviews and for developing the evidence tables that we cite and discuss in support of the PPP recommendations.