Preoperative and Postoperative Glarometer Preoperative and Postoperative Glarometer Measurements in Patients Having Cataract Measurements in Patients Having Cataract
Extraction with Placement of Posterior Chamber and Extraction with Placement of Posterior Chamber and Accommodating IOLs Accommodating IOLs
Michael Ehrlich, MDMichael Ehrlich, MD11 Steven Siepser MD, FACS Steven Siepser MD, FACS22
1- Wills Eye Institute, Philadelphia, PA. No financial 1- Wills Eye Institute, Philadelphia, PA. No financial interest.interest.2 - Siepser Laser Eyecare, Wayne, PA. Receives a 2 - Siepser Laser Eyecare, Wayne, PA. Receives a royalty from Gulden Ophthalmics for the Glarometerroyalty from Gulden Ophthalmics for the Glarometer
Background•Patients often present in the perioperative
period with glare symptoms
•Usually attributed to cataracts
•AAO preferred practice pattern states that glare testing “...can help to better assess and quantify functional visual impairment due to a cataract.”1
•But no consensus on how to test and quantify glare
AAO Cataract and Anterior Segment Panel, “Preferred Practice Pattern: Cataract Surgery in the Adult Eye” January 2008, 11
Background
•Many devices measure impact of glare on visual acuity or contrast sensitivity
•Decision to operate often hinges on results of these glare tests, which can be expensive and time consuming
•Therefore additional need to directly quantify glare symptoms and to show improvement with surgery
Patients who complain of glare may have reduced visual acuity or
contrast sensitivity, but many note glare halos and starbursts
Glare Halos
Glare Starburst
s
Glarometer• Simulates and
quantifies patient glare experience
• Patient measures glare halos and starbursts on scale from 1-5
• Non-mydriatic measurements
• Monocular
• Distance 5 feet
• Exam door closed, lights fully dimmed
Study Design
•Hypothesis:
•Glarometer measurements of halos are starbursts are statistically reliable
•Cataract surgery with a monofocal lens (Alcon sn60wf) and an accommodative lens (Bausch and Lomb Cyrstalens) results in a statistically significant decrease in measurements of glare halos and starburts
Study Design• Patient population:
• Monofocal lens: 50 patients from the Cataract and Primary Eye Care Service at Wills Eye Institute undergoing non-complex, non-complicated surgery by Michael Ehrlich, MD
• Accommodative lens: 25 patient from Siepser Laser Eyecare undergoing non-complex, non-complicated surgery by Steven Siepser, MD, FACS
• Age-matched controls for each study arm
• Data points:
• Collected pre-operative, post-op day #1 and post-op month #1
• BCVA (LogMAR)
• Glare Halos
• Glare Starbursts
Study Results
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GlarometerHalos
GlarometerStarburts
BAT Vistech MCT Berkeley Straylightmeter
Device
Reliability
Correlation
Coefficient
Multiple measurements of the control group show the Glarometer to be reliable compared
to other devicesElliott DB, Bullimore MA. Assessing the reliability, discriminative ability, and validity of disability glare tests. IOVS: 1993 (34)1: 108-19
Study ResultsCorrelation between control data points
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Halos vs Starbrusts Halos vs LogMAR VA Starbursts vs LogMAR VA
Correlation
Coefficient
There is a limited relationship between halos and starbursts in the control group. The
relationship between glare and visual acuity was stronger.
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Study Results
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Halos vs Starbrusts ControlHalos vs Starbursts sn60wfHalos vs Starbursts Crystalens
Halos vs LogMAR VA ControlHalos vs LogMAR VA sn60wfHalos vs LogMAR VA Crystalens
Starbursts vs LogMAR VA Control Starbursts vs LogMAR VA sn60wfStarbursts vs LogMAR VA Crystalens
Pre-op
Post-op Day 1
Post-op Month 1
Correlation between data points
The relationship between all variables decreased with intervention in all groups
Study ResultsImprovements in Glarometer Score with
Surgery
Conclusions• Reliability measurements of the Glarometer are consistent with other adjunctive glare tests
• There was a statistically significant improvement in both glare halos and starbursts with cataract surgery in both monofocal and accommodative lenses
• The Glarometer can be a useful tool for clinicians in evaluating and documenting glare in cataract evaluations.
• Further studies:
• Glarometer measurements pre and post-operative for Lasik patients
• Correlate Glareometer measurements with VF-14 quality of life survey
