Preoperative co-management of the cataract patient

1. preoperative co-management of the cataract patient Lecture 10 Liana Al-Labadi, O.D.

2. Pre-Op Co-Management YOU! Serve an essential role in the preoperative care of cataract surgery patients Must learn how to make it easier for the patient, the surgeon and you!! As the general population ages, the incidence of cataract and surgical volume will steadily increase Created an increased demand for optometric co-management in identifying cataract patients & determining which ones require surgery

3. Pre-Op Co-Management Optometrist�s Role Determining the level of visual disability the patient suffers Provide clinical evaluation of severity & educate the patient on his or her alternatives Responsible for providing our patients with: Rapid access to care Recognizing when surgical intervention is required Maximizing the visual outcomes following surgery

4. Pre-Op Co-Management Optometrist�s Role Determining the level of visual disability the patient suffers Provide clinical evaluation of severity & educate the patient on his or her alternatives Responsible for providing our patients with: Rapid access to care Recognizing when surgical intervention is required Maximizing the visual outcomes following surgery Our role begins with education Must be aware of demographics, incidence & prevalence models Must be aware of medical conditions associated- essential for co-management with internists/specialists Extensive knowledge of proper nutrition & overall systemic wellness is also essential

5. Pre-op evaluation Case History Thorough case history is necessary Determine the subjective effect of cataracts on visual function & quality of life Visual tasks: Ambulation; driving; reading & dim and bright illuminations Administer a visual function or questionnaire Best assessment to determine if visual dysfunction is affecting the patients� life Assist in determining appropriate time for surgical intervention Note all medical conditions and all the medications the patient is taking Patients may not be aware that some medications like Ibuprofen may cause cataracts to form or progress Any problems determined in the history will ultimately reveal the etiology of the cataract, suitability & prognosis of a surgical procedure

6. Pre-op evaluation Best Corrected Visual Acuity Measured in bright & dim illuminations The single most important component of overall visual function The patients VA level will generally influence the decision to proceed with cataract surgery Surgery criteria: between 20/40 and 20/50 or worse Best assessment to determine if visual dysfunction is affecting the patients� life Assist in determining appropriate time for surgical intervention Measurement of visual acuity under both low and high illumination. You may include contrast sensitivity functions and acuity testing in contrast methods using logMAR charts or glare reduction methods. Measurement of visual acuity under both low and high illumination. You may include contrast sensitivity functions and acuity testing in contrast methods using logMAR charts or glare reduction methods.

7. Pre-op evaluation Best Corrected Visual Acuity BCVA = Macular integrity + Cataract Methods performed to assess cataract level: DVA & NVA Brightness acuity Test (BAT) Methods performed to assess macular integrity: Potential Acuity Meter(PAM) Amsler Grid \ \

8. Pre-op evaluation Best Corrected Visual Acuity Brightness acuity Test (BAT) Many people with cataracts or other media opacities are disabled in bright conditions, due to the intraocular scatter The BAT test is used to test glare disability in three common bright light conditions: Direct overhead sunlight Bright cloudy day Bright overhead commercial lighting The patient�s vision can be measured using low, medium or high light settings on the instrument Low lighting condition- lighting in the workplace (driving, construction work, computer use) Strong high light sources replicate oncoming headlights or a bright sky If patient�s vision gets worse using the BAT, the patient is considered to have a glare disability Usually this is caused by a cataract