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  • Preoperative and Postoperative Glarometer Measurements in Patients Having Cataract Extraction with Placement of Posterior Chamber and Accommodating IOLs Michael Ehrlich, MD1 Steven Siepser MD, FACS2

    1- Wills Eye Institute, Philadelphia, PA. No financial interest.2 - Siepser Laser Eyecare, Wayne, PA. Receives a royalty from Gulden Ophthalmics for the Glarometer

  • BackgroundPatients often present in the perioperative period with glare symptomsUsually attributed to cataractsAAO preferred practice pattern states that glare testing ...can help to better assess and quantify functional visual impairment due to a cataract.1But 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

  • BackgroundMany devices measure impact of glare on visual acuity or contrast sensitivityDecision to operate often hinges on results of these glare tests, which can be expensive and time consumingTherefore additional need to directly quantify glare symptoms and to show improvement with surgery

  • GlarometerSimulates and quantifies patient glare experiencePatient measures glare halos and starbursts on scale from 1-5Non-mydriatic measurementsMonocularDistance 5 feetExam door closed, lights fully dimmed

  • Study DesignHypothesis: Glarometer measurements of halos are starbursts are statistically reliableCataract 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 DesignPatient 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, MDAccommodative lens: 25 patient from Siepser Laser Eyecare undergoing non-complex, non-complicated surgery by Steven Siepser, MD, FACSAge-matched controls for each study armData points:Collected pre-operative, post-op day #1 and post-op month #1BCVA (LogMAR)Glare HalosGlare Starbursts

  • Study ResultsReliabilityCorrelation CoefficientMultiple 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 pointsCorrelation CoefficientThere is a limited relationship between halos and starbursts in the control group. The relationship between glare and visual acuity was stronger.

  • Study ResultsCorrelation between data pointsThe relationship between all variables decreased with intervention in all groups

    ascrs data

    0.462Halos vs Starbrusts ControlHalos vs Starbrusts Control

    0.6130.150.143

    0.40.050.05

    0.597Halos vs LogMAR VA ControlHalos vs LogMAR VA Control

    0.5650.10.1

    0.60.10.1

    0.772Starbursts vs LogMAR VA ControlStarbursts vs LogMAR VA Control

    0.5590.0110.05

    0.50.10.1

    Pre-op

    Post-op Day 1

    Post-op Month 1

    ascrs change

    1.722.02

    1.581.82

    0.81

    0.50.8

    Post-op Day 1

    Post-op Month 1

    ASCRS baseline to final

    42.282

    31.41.2

    2.51.71.5

    1.510.7

    Baseline Score

    Post-op Day 1 Score

    Post-op Month 1 Score

    Sheet1

    DeviceCorrelation Coefficient

    Glarometer Halos0.921

    Glarometer Starburts0.804Post-op Day 1Post-op Month 1

    BAT0.9Halos SN60WF1.722.02

    Vistech MCT0.57Starbursts SN60WF1.581.82

    Berkeley0.87

    Straylightmeter0.91Halos Crystalens0.81

    Starbursts Crystalens0.50.8

    Change with surgeryPost-op Day 1Post-op Month 1

    Halos1.722.02

    Starbursts1.581.82

    Crystalens

    Halos0.20.3

    Starbursts0.81.4

    Lasik

    Halos0.07

    Starbursts1.07ControlPre-opPost-op Day 1Post-op Month 1

    Halos vs Starbrusts Control0.462

    Halos vs Starbursts sn60wf0.6130.150.143

    Corelation between groupsCorrelation CoefficientHalos vs Starbursts Crystalens0.40.050.05

    ControlBaselineHalos vs LogMAR VA Control0.597

    Halos vs Starbrusts0.462Halos vs LogMAR VA sn60wf0.5650.10.1

    Halos vs LogMAR VA0.597Halos vs LogMAR VA Crystalens0.60.10.1

    Starbursts vs LogMAR VA0.772Starbursts vs LogMAR VA Control0.772

    Starbursts vs LogMAR VA sn60wf0.5590.0110.05

    Starbursts vs LogMAR VA Crystalens0.50.10.1

    InterventionBaselinePost-op Day 1Post-op Month 1

    Halos vs Starbrusts0.6130.150.143

    Halos vs LogMAR VA0.565-0.185-0.178

    Starbursts vs LogMAR VA0.5590.011-0.05

    CrystalensBaselinePost-op Day 1Post-op Month 1

    Halos vs Starbrusts-0.0530.0190.071

    Halos vs LogMAR VA0.1480.0090.233

    Starbursts vs LogMAR VA-0.1310.0050.029ControlBaselinePost-op Day 1Post-op Month 1

    Halos vs Starbursts0.4620.6130.150.143

    Halos vs LogMAR VA0.5970.565-0.185-0.178

    LasikBaselinePost-op Day 1Starbursts vs LogMAR VA0.7720.5590.011-0.05

    Halos vs Starbrusts0.1630.048

    Halos vs LogMAR VA0.624-0.028

    Starbursts vs LogMAR VA-0.4580.096

    Change scores

    InterventionPost-op Day 1Post-op Month 1Post-op Day 1Post-op Month 1

    Change LogMAR VA vs Halos0.2230.471

    Change LogMAR VA vs Starburts0.2730.526

    LasikPost-op Day 1Post-op Month 1

    Change LogMAR VA vs Halos0.0090.624

    Change LogMAR VA vs Starburts-0.369-0.458

    CrystalensPost-op Day 1Post-op Month 1Post-op Day 1Post-op Month 1

    Change LogMAR VA vs Halos-0.0010.115Halos SN60WF1.722.02

    Change LogMAR VA vs Starburts0.1990.139Starbursts SN60WF1.581.82

    Halos Crystalens0.81

    Starbursts Crystalens0.50.8

    Baseline ScorePost-op Day 1 ScorePost-op Month 1 Score

    Halos SN60WF42.282

    Starbursts SN60WF31.41.2

    Halos Crystalens2.51.71.5

    Starbursts Crystalens1.510.7

    Sheet2

    Sheet3

  • Study ResultsImprovements in Glarometer Score with Surgery

    ascrs data

    0.462Halos vs Starbrusts ControlHalos vs Starbrusts Control

    0.6130.150.143

    0.40.050.05

    0.597Halos vs LogMAR VA ControlHalos vs LogMAR VA Control

    0.5650.10.1

    0.60.10.1

    0.772Starbursts vs LogMAR VA ControlStarbursts vs LogMAR VA Control

    0.5590.0110.05

    0.50.10.1

    Pre-op

    Post-op Day 1

    Post-op Month 1

    ascrs change

    1.722.02

    1.581.82

    0.81

    0.50.8

    Post-op Day 1

    Post-op Month 1

    ASCRS baseline to final

    42.282

    31.41.2

    2.51.71.5

    1.510.7

    Baseline Score

    Post-op Day 1 Score

    Post-op Month 1 Score

    Sheet1

    DeviceCorrelation Coefficient

    Glarometer Halos0.921

    Glarometer Starburts0.804Post-op Day 1Post-op Month 1

    BAT0.9Halos SN60WF1.722.02

    Vistech MCT0.57Starbursts SN60WF1.581.82

    Berkeley0.87

    Straylightmeter0.91Halos Crystalens0.81

    Starbursts Crystalens0.50.8

    Change with surgeryPost-op Day 1Post-op Month 1

    Halos1.722.02

    Starbursts1.581.82

    Crystalens

    Halos0.20.3

    Starbursts0.81.4

    Lasik

    Halos0.07

    Starbursts1.07ControlPre-opPost-op Day 1Post-op Month 1

    Halos vs Starbrusts Control0.462

    Halos vs Starbursts sn60wf0.6130.150.143

    Corelation between groupsCorrelation CoefficientHalos vs Starbursts Crystalens0.40.050.05

    ControlBaselineHalos vs LogMAR VA Control0.597

    Halos vs Starbrusts0.462Halos vs LogMAR VA sn60wf0.5650.10.1

    Halos vs LogMAR VA0.597Halos vs LogMAR VA Crystalens0.60.10.1

    Starbursts vs LogMAR VA0.772Starbursts vs LogMAR VA Control0.772

    Starbursts vs LogMAR VA sn60wf0.5590.0110.05

    Starbursts vs LogMAR VA Crystalens0.50.10.1

    InterventionBaselinePost-op Day 1Post-op Month 1

    Halos vs Starbrusts0.6130.150.143

    Halos vs LogMAR VA0.565-0.185-0.178

    Starbursts vs LogMAR VA0.5590.011-0.05

    CrystalensBaselinePost-op Day 1Post-op Month 1

    Halos vs Starbrusts-0.0530.0190.071

    Halos vs LogMAR VA0.1480.0090.233

    Starbursts vs LogMAR VA-0.1310.0050.029ControlBaselinePost-op Day 1Post-op Month 1

    Halos vs Starbursts0.4620.6130.150.143

    Halos vs LogMAR VA0.5970.565-0.185-0.178

    LasikBaselinePost-op Day 1Starbursts vs LogMAR VA0.7720.5590.011-0.05

    Halos vs Starbrusts0.1630.048

    Halos vs LogMAR VA0.624-0.028

    Starbursts vs LogMAR VA-0.4580.096

    Change scores

    InterventionPost-op Day 1Post-op Month 1Post-op Day 1Post-op Month 1

    Change LogMAR VA vs Halos0.2230.471

    Change LogMAR VA vs Starburts0.2730.526

    LasikPost-op Day 1Post-op Month 1

    Change LogMAR VA vs Halos0.0090.624

    Change LogMAR VA vs Starburts-0.369-0.458

    CrystalensPost-op Day 1Post-op Month 1Post-op Day 1Post-op Month 1

    Change LogMAR VA vs Halos-0.0010.115Halos SN60WF1.722.02

    Change LogMAR VA vs Starburts0.1990.139Starbursts SN60WF1.581.82

    Halos Crystalens0.81

    Starbursts Crystalens0.50.8

    Baseline ScorePost-op Day 1 ScorePost-op Month 1 Score

    Halos SN60WF42.282

    Starbursts SN60WF31.41.2

    Halos Crystalens2.51.71.5

    Starbursts Crystalens1.510.7

    Sheet2

    Sheet3

  • ConclusionsReliability measurements of the Glarometer are consistent with other adjunctive glare testsThere was a statistically significant improvement in both glare halos and starbursts with cataract surgery in both monofocal and accommodative lensesThe 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 patientsCorrelate Glareometer measurements with VF-14 quality of life survey