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  5. FP36 : Quality of Life after SICS and Phacoemulsification

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Dr. Nidhi Pandey, P07183, Dr. Vijaya Sahu

BACKGROUND

Manual small incision cataract surgery (SICS) is a safe and cost-effective technique for tackling the huge backlog of cataract blindness in the developing world. It has been proven to be as effective as phacoemulsification in terms of
visual outcomes and safety of procedure and might be even superior to phacoemulsification in terms of tackling hard brown cataracts, surgical time required and cost-effectiveness. Visual outcomes with SICS are good, surgical times short, sutures are required rarely and complication rates are comparable with those of phacoemulsification. [1, 2]

To evaluate the outcome of interventions, the impact on Visual Function (VF) related to patient- perceived outcomes is a significant factor, for which visual acuity alone may be an inadequate measure.  Thus, assessment of patient satisfaction and quality of life (QoL) following intervention is also important in evaluation of surgical outcome. Though widely compared with phacoemulsification in varied aspects in previous studies, this study compares the change in QoL after the two surgical procedures.

Purpose:

To compare the improvement in QoL in adult patients undergoing SICS versus those undergoing phacoemulsification using the INDIAN Vision Function Questionnaire (IND-VFQ-33)

METHODS
DESIGN: Prospective comparative study

  1. PARTICIPANTS- 60 consecutive patients between 20-70 years of age with visually significant cataract presenting to Department of Ophthalmology, Pt. J.N.M.Medical College, Raipur. 30 patients underwent SICS and 30 patients were operated by phacoemulsification
    Inclusion criteria–
    Patients aged 20-70years having NSII to NS IV grade cataract in both eyes
    Exclusion criteria–
    Vision threatening ocular co morbidity
    2. Chronic systemic diseases that could significantly affect QoL (e.g. arthritis, coronary artery diseases, cerebro-vascular diseases, collagen vascular disorders, deaf or communication impaired and physically disabled individuals)
    3. Patients not willing to be interviewed

ASSESSMENT-
All patients were assessed using the IND -VFQ-33. The questionnaire has been   developed by Murthy et al to elicit problem statements describing the consequences of vision impairment in the Indian population. It has been previously validated and tested for reliability. [3,4] The Hindi version of the questionnaire,  which has been previously used by the developers  by translating and back translating was used in the study.[5]
The questionnaire comprises  of 33 items in three domains, the general functioning domain,(Domain 1, 21 items) the psychosocial impact domain(Domain 2, 5items) and the visual symptoms domain(Domain 3, 7 items). The responses were calibrated quantitatively by giving a score to each of the responses from 1 to 5 for domain 1, and 1 to 4 for domain 2 and 3. VF was graded from excellent to poor according to the score. The summary scores from each domain were added to give a total QoL score with a minimum score of 33 and maximum 153. The higher the score, the worse is the QoL.

The questionnaire was administered before surgery in all participants after obtaining consent. Participants underwent either SICS with implantation of a rigid PMMA lens (Appalens, single piece biconvex Mod C Step Vault, manufactured by Appasamy ocular Devices (P) Ltd.) or phacoemulsification with implantation of a foldable IOL (Spectrafold, hydrophilic acrylic IOL manufactured by Spectra Vision). All surgeries were performed under peribulbar anaesthesia. The QoL was reassessed at approximately 15 days to one month after surgery before spectacle prescription, based on the fact that for everyday ambulatory vision most patients do not use their spectacles and rely on their uncorrected vision. The change in QOL after SICS was compared to the change in QOL after phacoemulsification.

Results

Baseline demographics
60 patients presenting for cataract surgery were recruited for the study, 30 were operated by phacoemulsification and 30 by SICS.  The mean age of the patients in the phacoemulsification group was 54± 8.2years, while in the SICS group it was 63 ± 11.2 years. 16 patients (53.33%) in the phacoemusification group were females while in the SICS group, 21(70%) were females.

The data was analysed for normality as shown below. The Shapiro -Wilk test for normality was not significant for both phacoemulsification and SICS groups (Phaco   .960, p = 0.345; and SICS   0.936, p = 0.086), indicating normal distribution of data.

Test  of Normality
                                                    Shapiro- Wilk

Statistic Df Sig
Prephaco total .960 28 .345
PreSICS  total .936 28 .086

QoL Comparisons

  1. Within Group Analysis: (Paired t-test)

Pre- to post – operative Differences in SICS group

t-test Df p-value 95% CI
Domain 1 8.406 28 <.001 23.314 to 38.340
Domain 2 7.648 28 <.001 4.721 to 8.172
Domain 3 10.356 28 <.001 7.717 to 11.523
Total  score 9.631 28 <.001 36.623 to 56.411

Pre and post-operative Differences in Phacoemulsification group

t-test Df p-value 95% CI
Domain 1 7.874 27 <.001 18.168 to 30.974
Domain 2 8.710 27 <.001 4.777 to 7.722
Domain 3 10.220 27 <.001 8.020 to 12.050
Total score 9.694 27 <.001 32.209 to 49.505

The mean total pre-Phacoemulsification score was 76.46 (SD 4.69) and mean SICS pre-score was 81.14 (SD 5.35). The QOL scores in each domain as well as combined total QOL scores demonstrated a statistically significant decrease from pre-to post SICS (p ˂ 0.001)

Similarly, the QOL scores demonstrated a statistically significant decrease from pre-to post phacoemulsification procedure (p ˂ 0.001) for all three QOL domains as well as total scores. 

  1. Between Group Analysis: (Independent t-test) 

Difference between phacoemulsification and SICS groups in the change of QOL scores-

     Independent Samples Test

DIFFERENCE
PHACO vs. SICS		 t-test Df p-value 95% CI
Domain 1 -1.145 54 .201 -15.328 to 4.185
Domain 2 .099 54 .733 -2.069 to 2.283
Domain 3 .312 54 .969 -2.328 to 3.185
Total score -.719 54 .476 -17.591 to 8.305

The difference in QOL post intervention was not statistically different between groups neither in any of the domains nor in the total score (p >0.05).

Discussion
Herein we present our results of comparing the change in QoL scores following SICS and phacoemulsification. QoL scores decreased significantly following both interventions. However, no difference was found in the pre-to-post change scores between phaco and SICS groups in any of the domains, nor in the total scores. Both intervention techniques could thus significantly improve QoL with no one technique better than the other in their ability to affect QoL scores.

Previous studies have shown significant improvement in QoL after cataract surgery. [6,7] Better  outcome in terms of patient quality of life following phacoemulsification compared to Extra capsular cataract extraction (ECCE) has also been previously demonstrated.[8]This study is the first of its kind comparing QoL following phacoemulsification  and  SICS, and as with other comparisons, SICS has proved itself to be equivalent to phacoemulsification in terms of improving QoL also.

Conclusion

Both phacoemulsification and SICS significantly improved the quality of life postoperatively to a similar extent.

Bibliography

  1. Gogate PM, Kulkarni SR, Krishnaiah S, et al. Safety and efficacy of phacoemulsification compared with manual small incision cataract surgery by a randomized controlled clinical trial. Ophthalmology 2005; 112:869–74.
  2. Muralikrishnan R, Venkatesh R, Prajna NV, Frick KD. Economic cost of cataract surgery procedures in an established eye care centre in southern India. Ophthalmic Epidemiol 2004; 11:369–80.
  3. Murthy GV, Gupta SK, Thulasiraj RD, Viswanath K, Donoghue EM, Fletcher AE. The development of the Indian vision function questionnaire: Questionnaire content. Br J Ophthalmol 2005; 89:498‑
  4. Gupta SK, Viswanath K, Thulasiraj RD, Murthy GV, Lamping DL, Smith SC, et al. The development of the Indian vision function questionnaire: Field testing and psychometric evaluation. Br J Ophthalmol 2005; 89:621‑
  5. Arora V, Bali SJ, Gupta SK, Vashisht P, Agarwal T, Sreenivas V, et al. Impact of initial topical medical therapy on short-term quality of life in newly diagnosed patients with primary glaucoma. Indian J Ophthalmol 2015; 63:511-5.
  6. AlhassanMB, BabalolaOE.The impact of cataract surgery on subjective visual functions and quality of life in patients with cataract in North-western Nigeria. NigerJOphthalmol 2016; 24:57-61.
  7. Bandhu SD, Vabale YG, Sambarey PP, Walke AB, Raje S. Impact of cataract on the quality of life of rural patients in India. J Clin Ophthalmol Res 2016; 4:75-81.
  8. Paula Teixeira de Mendonça, leonardo Teixeira de Mendonça, alexandre Antonio Marques Rosa, Luiz Carlos de lima Silveira. Life quality assessment of patients after phacoemulsification or extracapsular cataract extraction. Arq Bras Oftalmol. 2014;77(1):12-6

 

 

 

 

 

 

 

 

 

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