Type of publication:

Conference abstract

Author(s):

*Nayak D.; *Yadav S.; *Owoniyi M.; *Sanjana E.; Makwana T.

Citation:

Eye (Basingstoke). Conference: The Royal College of Ophthalmologists Annual Congress 2025. Liverpool United Kingdom. 39 (pp 191-192), 2025. Date of Publication: 01 Jun 2025.

Abstract:

Introduction: The current cataract surgery consent form primarily focuses on the surgeon's perspective of potential complications, often neglecting the patient's emotional and visual experiences during the procedure. This audit aimed to explore the importance of informing patients about the potential visual experiences they might encounter during cataract surgery. By incorporating this information into the consent process, the goal was to enhance patient understanding, alleviate anxiety, and reduce distress during the surgery. This study was discussed with a patient focus group to understand their concerns about cataract surgery, particularly regarding anxiety and the unknown aspects of the procedure. Patients emphasised the lack of information about potential visual phenomena, like flashes of light and shimmer, which contributed to their anxiety. Method(s): To evaluate the impact of preoperative information about potential intraoperative visual phenomena on patient anxiety during cataract surgery and to compare outcomes between patients who were informed about these visual disturbances and those who were not Study Design: A prospective audit was conducted involving two groups of patients undergoing cataract surgery at a single surgical centre over a defined period (6months). One group received preoperative information about the possibility of visual phenomena during surgery, while the other group was not informed. Group Classification: Group 1 (Informed group): This information was included in the preoperative counselling session and added to the consent forms. Group 2 (Non-informed group) Data Collection: Patient Survey: The survey included questions about their emotional state, whether they were surprised or distressed by any visual phenomena, and how well they felt prepared for the surgery. Apprehension Scoring: Likert scale (non continuous) along with open-ended questions to gather qualitative feedback on patient experiences and Visual Analogue Score (continuous) was also used. Result(s): Preliminary data suggests that a significant number of patients experience distress due to the visual phenomena during cataract surgery. Incorporating this information into the consent forms is expected to better prepare patients for the procedure, thereby improving their overall experience and reducing unnecessary anxiety. Informed Group: The group that was informed about potential visual disturbances prior to surgery reported significantly lower levels of anxiety during the procedure. The mean apprehension score for this group was 2.1 +/- 0.8, with 72% of patients rating their apprehension as mild or minimal (scores 1-2). Statistical analysis revealed a significant difference in apprehension scores between the informed and non-informed groups (p < 0.01). Non-informed Group: The non-informed group showed a higher level of distress, with a mean apprehension score of 3.8 +/- 1.2. A larger proportion of patients in this group (43%) reported moderate to high distress (scores 4-5). The difference in distress between the two groups was statistically significant (p < 0.001). Chi-Square Test Results: The chi-square test indicated a significant difference in the frequency of patients reporting surprise or discomfort related to visual phenomena, with 55% of the non-informed group expressing surprise, compared to just 20% in the informed group (chi2 =14.68, p < 0.01). Confidence Interval: The 95% confidence interval for the mean difference in apprehension scores between the informed and non-informed groups was (1.3, 2.4), suggesting a moderate -large effect size in the reduction of patient anxiety when preoperative information was provided. Conclusion(s): Statistical analysis substantiated that reduction in anxiety was clinically and statistically significant(p < 0.01). Cataract surgery remains a common procedure in ophthalmology in elderly patients, many with diverse co-morbidities. A proposal is advanced to revise the informed consent documents and preoperative counselling protocols to include comprehensive details about the potential visual phenomena that patients may encounter postoperatively. An enhanced cataract consent framework should be regarded as an integral aspect of evidence-based, patient-centred care, ensuring patients are thoroughly educated and psychologically prepared for surgery.

DOI: 10.1038/s41433-025-03831-0

Type of publication:

Conference abstract

Author(s):

*Rao P.; *Perera L.; Garikapati N.; *Godbole K.; *Zaw S.-N.; *Mathew N.M.; Veeramani P.

Citation:

Eye (Basingstoke). Conference: The Royal College of Ophthalmologists Annual Congress 2025. Liverpool United Kingdom. 39 (pp 271), 2025. Date of Publication: 01 Jun 2025.

Abstract:

Introduction: Intravitreal injections of anti-VEGF drugs have revolutionised the management of wet age related macular degeneration (ARMD), retinal vein occlusion (RVO) and diabetic maculopathy over the last 18 years in the UK. In the year 2022 over 677,000 intravitreal injections were performed in England alone (4796 per 100,000 population). In the UK over 75% of intravitreal injections are performed by allied health professionals such as nurses, optometrists and orthoptists. Although anti-VEGF injections are only NICE approved for 4 main conditions (wet ARMD, retinal vein occlusion, diabetic maculopathy and myopic choroidal neovascular membrane(CNV))often clinicians are faced with clinical presentations that mimic the 4 main indications thereby making the clinical decision to treat or not treat a particular patient with anti-VEGF injections difficult. Method(s): We have retrospectively reviewed the case records of patients attending rapid access clinics and intravitreal injection clinics over a 4 year period to identify macular and retinal conditions that mimic the four major NICE approved indications for intravitreal anti-VEGF injections. Result(s): We identified 12 such clinical conditions: 1) Adult vitelliform macular degeneration 2) Peripapillary pachychoroid syndromes 3) Central serous retinopathy 4) Intraretinal fluid overlying the old disciform macular scars 5) Retinal pigment epithelial rips involving the fovea 6) Old BRVO/ CRVO with extrafoveal macular oedema/ thickening 7) Macular oedema/ haemorrhage secondary to a macroaneurysm 8) Peripapillary CNV without involvement of the macula 9) Macular oedema secondary to epiretinal membrane 10) Inactive CNV: slow growing lesion with minimal fluid leakage and stable vision. 11) Transient foveal oedema due to microaneurysms close to foveola 12) Macular oedema mistaken for vein occlusions and Diabetic maculopathy a) Post operative cystoid macular oedema (CMO) b) CMO in hereditary dystrophies c) Drug (toxic) related macular oedema. Conclusion(s): We have identified the most common macular / retinal conditions for which anti-VEGF therapies are not necessarily of benefit. In a large cohort of injection patients it is not unusual to find some patients with other varied pathologies receiving anti-VEGF injections with limited or no benefit. We believe that it is important to highlight these varied pathologies to all clinicians to avoid inappropriate treatments. We demonstrate each category of patients with evidence on multimodal imaging to support the diagnosis and also of suboptimal outcomes.

DOI: 10.1038/s41433-025-03831-0

Type of publication:

Conference abstract

Author(s):

*Rao P.; *Zaw S.-N.; Garikapati N.; *Godbole K.; Veeramani P.; *Perera L.

Citation:

Eye (Basingstoke). Conference: The Royal College of Ophthalmologists Annual Congress 2025. Liverpool United Kingdom. 39 (pp 244-245), 2025. Date of Publication: 01 Jun 2025.

Abstract:

Introduction: With emergence of new imaging technology adult vitelliform macular degeneration (AVMD) is being diagnosed with increasing frequency over the last two decades. The condition is often mistaken for wet age-related macular degeneration (ARMD) when the vitelliform material starts scrambling showing pseudo fluid in optical coherence tomography (OCT) scans. In addition, in some AVMD patients the vitelliform lesions in fact do develop choroidal neovascularisation (CNV) requiring urgent intravitreal injections. We aim to highlight the prevalence, natural progression and treatment options for patients presenting with AVMD. Method(s): We have retrospectively analysed 123 eyes of 82 patients of AVMD presented to this department over the last 4 years. Result(s): We identified 44 females and 38 males, 41 patients with bilateral involvement at presentation. The clinical findings varied from a classical sub foveal yellow lesion to partial empty spaces within the lesion, to complete atrophic scar following resorption of all the colloid material. The presenting Visual acuity in the worse eye also varied from 6/9 to HM according to the stage of degeneration they presented with. Thirty-nine patients were asymptomatic and AVND was an incidental finding in one of their eyes. We have obtained serial optical coherence tomography (OCT) scan to monitor the progress whenever possible. All patients had OCT, optical coherence tomographic angiography (OCTA), and fundus autofluorescence (FAF). Some patients in addition underwent fundus fluorescein angiography (FFA) and indocyanine green angiography (ICG) when a choroidal neovascular membrane (CNVM) was suspected. Sixty nine of 82 patients did not need any active interventions. Fourteen patients were already taking antioxidant supplementations. Thirteen patients have developed significant subretinal fluid (SRF) and were treated with intravitreal anti-vascular endothelial growth factor (VEGF) injections. On further reviewing of the OCTA scans and FFA only 10 of 13 showed active CNVM. The other 3 patients only had passive subretinal fluid with no evidence of CNVM. Therefore only 12 % of AVMD patients seem to have developed wet ARMD in our series. Response to the anti-VEGF injections was suboptimal in AVMD patients with CNV compared to a case of conventional wet ARMD. This unfavourable response was most likely due to pre-existing long standing atrophic and degenerative changes. Contrary to earlier publications, based on family history alone we did not find any strong evidence of autosomal dominance inheritance therefore we prefer to call it a degenerative rather than dystrophic condition. Conclusion(s): With increasing use of OCT imaging by optometrists and primary care physicians more patients are being diagnosed with macular pathology, AVMD is one such condition. Most of these patients do not need any active interventions or long term follow ups in hospital clinics. Our study shows only 12% of AVMD patients go on to develop CNV requiring intravitreal anti-VEGF injections. As our cohort shows it may not be unusual to mistake passive fluid lakes within vitelliform lesions for active wet ARMD. It is important for clinicians to be aware of the possibility of AVMD with passive subretinal fluid and not to resort to unnecessary long term intravitreal anti-VEGF injections. As we have shown even in cases of AVMD with secondary CNV the prognosis is poor for long term retention of central vision.

DOI: 10.1038/s41433-025-03831-0

Type of publication:

Conference abstract

Author(s):

Nayak D.; Iqbal N.; Makwana T.; Sathiaraj S.; Olagunju A.; Yadav S.

Citation:

Eye (Basingstoke). Conference: The Royal College of Ophthalmologists Annual Congress 2025. Liverpool United Kingdom. 39 (pp 208-209), 2025. Date of Publication: 01 Jun 2025.

Abstract:

Introduction: To evaluate the accuracy of IOL power determination using new generation super formulas in IOL-cal.com in comparison to traditional formulas such as SRK/T, Hoffer Q, and Holladay 1 for cataract surgery patients, particularly those with challenging biometric characteristics to optimise visual outcome. Method(s): Study Design: Prospective study involving 100 patients undergoing cataract surgery. Preoperative Measurements: Axial length (AL) measured using optical biometry. Corneal curvature (K) measured using keratometry or corneal topography. Anterior chamber depth (ACD) measured to assess proper IOL power. IOL Power Calculation: IOL-cal.com: Integrated tool using multiple formulas (Ladas/ Kane, SRK/T, Hoffer Q, Holladay 1) based on patient-specific measurements. Traditional formulas for comparison: SRK/T, Hoffer Q, and Holladay 1. Surgical Procedure: Phacoemulsification with monofocal IOL implantation in the capsular bag. Primary Outcome Measure: Mean Absolute Prediction Error (MAE) of postoperative refractive outcomes at 6 weeks. Secondary Outcome Measures: Proportion of patients achieving postoperative refraction within +/-0.5 D of target refraction. Rate of residual astigmatism at 6 weeks post-surgery. Statistical Analysis: Descriptive statistics, paired t-tests or ANOVA, chi-square tests for categorical variables, significance set at p < 0.05. Result(s): Mean Absolute Prediction Error (MAE): IOL-cal.com demonstrated a significantly lower**Mean Absolute Prediction Error (MAE)**when compared to traditional IOL power calculation formulas, with a p-value < 0.05. This indicates that IOL-cal.com provided more accurate predictions of postoperative refractive outcomes. The tool particularly excelled in predicting refractive outcomes for patients with**short eyes**(<22 mm) and**long eyes**(>26 mm), showing improved precision in both these challenging biometric categories. Refractive Outcomes: A higher percentage of patients in the IOL-cal.com group achieved a refractive outcome within +/-0.5 dioptres (D) of the target refraction (82%) compared to the traditional formula group. The percentage of patients achieving this target refraction was 75% for the SRK/T formula, 71% for the HofferQ formula, and 73% for the Holladay 1 formula. These results suggest that IOL-cal.com is more effective at helping patients achieve a closer match to their target refractive outcome. Residual Astigmatism: The incidence of significant residual astigmatism (greater than 0.75 D) was lower in the IOL-cal.com group, with only 12% of patients showing significant astigmatism after surgery. In contrast, the SRK/T formula showed a residual astigmatism rate of 18%, the Hoffer Q formula had a rate of 20%, and the Holladay 1 formula had a residual astigmatism rate of 19%. These findings indicate that IOL-cal.com was more effective in minimizing postoperative astigmatism, particularly in comparison to traditional formulas. Conclusion(s): The use of IOL-cal.com for intraocular lens (IOL) power determination offers significant advantages over traditional formulas like SRK/T, Hoffer Q, and Holladay 1 by providing more accurate and consistent results. This online tool integrates multiple advanced IOL power calculation formulas and tailors them to individual biometric parameters, such as axial length, corneal curvature, and anterior chamber depth. By adjusting for these factors, IOL-cal.com enhances the likelihood of achieving a refractive outcome that closely matches the target refraction, significantly reducing the Mean Absolute Prediction Error (MAE) and minimizing residual astigmatism after cataract surgery. IOL-cal.com proves especially useful in challenging cases, such as patients with extreme axial lengths, irregular corneal curvature, or those who have previously undergone refractive surgery. These situations often complicate traditional IOL power calculations, but IOLcal.com's ability to account for such complexities ensures more precise outcomes. Its user-friendly interface, combined with its ability to integrate multiple formulas, makes it a highly valuable tool for cataract surgeons. The tool's enhanced accuracy and ability to improve refractive outcomes position it as an essential resource for optimizing cataract surgery, particularly for complex or high-risk cases.

DOI: 10.1038/s41433-025-03831-0

Type of publication:

Conference abstract

Author(s):

*Iqbal N.; *Jenyon T.

Citation:

Eye (Basingstoke). Conference: The Royal College of Ophthalmologists Annual Congress 2025. Liverpool United Kingdom. 39 (pp 215), 2025. Date of Publication: 01 Jun 2025.

Abstract:

Introduction: Airbag systems are integral to passenger safety during road traffic accidents (RTAs), yet their deployment can also result in significant ocular trauma. The cornea, a vital structure responsible for focusing light onto the retina, relies on its endothelial layer to maintain transparency through fluid regulation. Damage to these endothelial cells can lead to corneal oedema and visual impairment. This report describes a unique case of bilateral endothelial decompensation following airbag-induced blunt trauma, highlighting the need for vigilance in recognising potential ocular complications in such scenarios. Method(s): We present a case of an 89-year-old male who presented with bilateral corneal decompensation following airbag deployment during a road traffic accident. Result(s): Ocular examination revealed multi-level ocular injury with severe bilateral corneal oedema. This was managed with topical steroids, mydriatics and, antibiotic therapy. At one month follow up the left eye had persistent corneal oedema. Specular microscopy was performed which confirmed endothelial cell loss making the patient a candidate for a corneal endothelial graft. We observed blunt trauma from airbag deployment causing endothelial cell loss and subsequent corneal decompensation. Conclusion(s): Common ocular traumas, such as corneal abrasions, hyphaema, and subconjunctival haemorrhage, are often readily identifiable. In contrast, endothelial damage can be subtle, leading to delayed symptoms such as blurred vision and corneal oedema. Clinicians should maintain a high index of suspicion for endothelial damage in patients presenting with post-accident ocular trauma and consider early referral to specialist services in such cases.

DOI: 10.1038/s41433-025-03831-0