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Introduction: The aims of this study were to study ocular biometric data and their association with age and sex in a population of cataract surgery candidates and to assess the proportion of inhomogeneous eyes and the ratio anterior segment (AS) to axial length (AL). Multicentric cross-sectional analysis was conducted between April 2008 and May 2021 in public and private ophthalmic institutions in Montpellier, France. Individuals ≥40 years old who underwent ocular biometry before cataract surgery were included., Methods: Right phakic eyes were included. Ocular biometrics were measured by using the Lenstar LS900 device. We defined AS as anterior chamber depth (ACD) plus lens thickness (LT) and calculated the ratio of AS to AL. We defined inhomogeneous eyes as those with deep AS (≥4th quartile) and short AL (≤1st quartile) (AS+) or with short AS and high AL (AL+)., Results: We included 11,650 individuals (11,650 eyes) (mean [SD] age 71.64 [10.50] years; 54.51% women). Older age was associated with shorter AL (p < 0.01), shallower ACD (p < 0.01), thinner central corneal thickness (p < 0.01), and larger LT (p < 0.001). Women had shorter AL, shallower ACD, and thinner central corneal thickness than men (p < 0.001). In total, 778 (6.68%) eyes were inhomogeneous (3.22% AS+ and 3.46% AL+), for a mean (SD) AS/AL ratio of 0.36 (0.01) and 0.28 (0.01), respectively, as compared with 0.32 (0.02) for homogeneous eyes (p < 0.001)., Conclusion: The AS/AL ratio could be useful to screen inhomogeneous eyes before cataract surgery and justify the use of new generation formulas in these eyes to avoid the risk of refractive error., (© 2023 The Author(s). Published by S. Karger AG, Basel.)

Purpose: Cataract and glaucoma are among the leading causes of blindness worldwide in older people, and they are often concomitant. To assess topical intraocular (IOP)-lowering agents delivery changes after cataract extraction., Material and Methods: Longitudinal matched exposed-unexposed study from the French national healthcare database from January 1, 2005 to January 1, 2017. We compared individuals using topical IOP-lowering agents who underwent bilateral cataract extraction with individuals matched on IOP-lowering agents load, age, and sex who did not undergo cataract extraction. IOP-lowering agents number of drops was assessed 12 months before the first cataract extraction and compared with number of drops 12 months after the second cataract extraction., Results: About 1194 individuals treated with IOP-lowering agents were included, 597 exposed to bilateral cataract extraction and 597 unexposed to any surgery (total mean age 74.8 ± 8.3 years; 69.0% women). Mean IOP-lowering agents delivery at baseline was 1.4 daily drops in both groups. The mean number of drops decreased greater in the exposed than unexposed group (-25.5% vs -3.5%; p < 0.0001). Overall, 159 (26.6%) and 48 (8.0%) individuals in the exposed and unexposed groups interrupted medication ( p < 0.0001)., Conclusions: A decrease of around one quarter of IOP-lowering agents delivery was observed after cataract extraction in the present real-life study with a longstanding interruption observed in one quarter of patients. Phacoemulsification as a standalone procedure reduces IOP-lowering agents delivery in ocular hypertension and glaucoma.

Objective: To report the outcomes of cataract surgery performed by non-physician cataract surgeons due to lack of ophthalmologists in remote areas of North Cameroon., Design: Prospective cohort study., Setting: The main centre of the non-governmental organisation Ophtalmo Sans Frontières in Lagdo., Participants and Interventions: Age-related cataract surgery performed between 28 November 2016 and 17 May 2017., Main Outcomes Measures: The main outcome measure was presenting visual acuity (PVA) 1-4 weeks after surgery, classified according to the WHO as good (PVA ≥6/18), borderline (PVA 6/60-6/18) and poor (PVA <6/60). The WHO definition of blindness (visual acuity <3/60) and severe visual acuity (visual acuity 3/60-6/60) was used to assess the proportion of patients with a change in WHO category., Results: We included 474 eyes of 474 patients; the mean (SD) age was 63.9 (15) years (42.2% female). At 1-4 weeks after surgery, the surgical outcome was good for 170 patients (41.1%), borderline for 213 (51.5%) and poor for 31 (7.5%). In all, 224 patients (47.2%) had blindness or severe visual impairment before cataract surgery and 22 (5.3%) at 1-4 weeks after surgery. Poor visual outcome was associated with older age (p=0.018), preoperative blindness or severe impairment (p=0.012) and surgical complications (p=0.019)., Conclusion: Blindness and severe visual impairment were significantly decreased in the early postoperative period. Poor outcomes were associated with older age, low preoperative binocular visual acuity and intraoperative complications. Non-physician cataract surgeons may compensate for the lack of ophthalmologists in remote areas of low-income and middle-income countries., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: To evaluate the preoperative clinical and biometric determinants associated with the actual lens position after cataract surgery., Setting: Department of Ophthalmology, University Hospital of Montpellier, France., Design: Prospective longitudinal cohort study., Methods: The data collected included clinical factors (age, sex, history of vitrectomy) and biometry factors (axial length [AL], anterior chamber depth [ACD], lens thickness, white-to-white [WTW] distance) that might affect actual lens position. Each patient had optical low-coherence reflectometry biometry (Lenstar) preoperatively and 1 month postoperatively. The actual lens position was measured as the postoperative position of the center of the intraocular lens (IOL). Patients were stratified into 3 groups by type of IOL: Acrysof SN60WF or SN6AT (Group 1), Tecnis ZCB00 or ZCT (Group 2), and Asphina 409 MV (Group 3)., Results: The study comprised 168 eyes (mean age 73.3 years ± 9.8 [SD]). The mean actual lens position was 4.88 ± 0.29 mm, 5.01 ± 0.29 mm, and 5.05 ± 0.32 mm in Group 1 (n = 67 eyes), Group 2 (n = 52 eyes), and Group 3 (n = 49 eyes), respectively. In the overall population, AL, ACD, anterior segment depth, and WTW distance were correlated with actual lens position (r = 0.48, P < .0001; r = 0.64, P < .001; r = 0.58, P < .0001; r = 0.39, P < .001, respectively)., Conclusions: The AL, ACD, anterior segment depth, and WTW distance correlated with actual lens position after cataract surgery. The integration of these data in IOL formulas could help improve refractive outcomes after the surgery., (Copyright © 2017 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Introduction: Prevention of visual impairment due to congenital cataract is an international priority as part of VISION 2020 - The Right to Sight, the joint initiative of the World Health Organization and the International Agency for the Prevention of Blindness. The present study is part of the Epidemiology and Safety (EPISAFE) collaborative program aiming at assessing the epidemiology and safety of interventions in ophthalmology., Methods: All children who underwent cataract surgery before the age of 1 year in France between January 2010 and December 2012 were identified by using the Programme de Médicalisation des Systèmes d'Information., Results: In 3 years, 532 children (699 eyes; 46.6% girls) had cataract surgery before the age of 1 year; 31.4% had bilateral surgery. During the first year of life, the incidence of cataract surgery was 2.15/10,000 births. The median (interquartile range) age at surgery was 3.5 (2.2-4.8) months for children with unilateral cataract and 4.0 (2.2-7.2) months for children with bilateral cataract. Of the 699 operated eyes, 76.49% received intraocular lens implantation during the cataract surgery., Conclusions: The incidence of congenital cataract surgery observed in France is close to that in the literature in the industrialized world, which is estimated at 1-3/10,000 births. The timing of surgery is critical for visual development. Surgery was performed younger in children with monocular cataracts than in those with bilateral cataracts., (© 2017 S. Karger AG, Basel.)

Medical-administrative databases are an important source of big data to assess the epidemiology of diseases and interventions, compare drugs, and investigate rare adverse events. We describe the French national health insurance system databases and the Epidemiology and Safety (EPISAFE) collaboration program in ophthalmology and illustrate the paper with recent studies that used the databases to investigate cataract surgery. The Système national d'information inter-régime de l'assurance maladie (SNIIR-AM) is one of the largest databases of medical and administrative data for a general population, covering nearly 65 million people. The SNIIR-AM database links data for all outpatient-reimbursed health expenditures, hospitalization in all 1,546 French private or public healthcare facilities, and date of death. The use of this database provides information at the scale of the entire country, allowing measurement of the impact of changes in practices and new guidelines. Between 2009 and 2012, a total of 2,717,203 eyes in 1,817,865 patients underwent cataract surgery in France, and the incidence of cataract surgery increased from 9.86 to 11.08/1,000 person-years. The 4-year cumulative risk of retinal detachment was 0.99%, and patients <60 years of age were at higher risk of retinal detachment. The incidence of pseudophakic cystoid macular edema was 0.95%. From 2005 to 2014, from data including more than 6 million procedures, the incidence of endophthalmitis after cataract surgery decreased from 0.15 to 0.05%. The EPISAFE collaboration program encompasses the key issues facing ophthalmology, including public health and public policy concerning disease incidence and prevalence, safety and adverse event monitoring, and clinical guidelines., (© 2017 S. Karger AG, Basel.)

Purpose: To report age- and sex-specific incidence rates of cataract surgery in France and evaluate the trends of cataract surgery from 2009 to 2012., Design: Cohort study., Subjects: Data for all patients who underwent primary cataract surgery in France between January 2009 and December 2012 were collected from the national database., Methods: Annual incidence rates were calculated and adjusted to the corresponding-year national population data from the French National Institute of Statistics. Kaplan-Meier analysis was used to assess the time between surgeries for both eyes., Main Outcome Measures: Age- and sex-specific incidence of cataract surgery., Results: Over the 4 years, 2 717 203 eyes in 1 817 865 patients (59.1% were women; mean age, 73.5±0.015 years) underwent cataract surgery. Between 2009 and 2012, the total number of operated eyes per year increased, from 634 070 to 723 172 (+14.0%), and the number of patients with 1 or both eyes undergoing cataract surgery decreased, from 475 301 to 449 318 (-5.5%). The incidence of cataract surgery increased from 9.86 to 11.08/1000 person-years and that of operated patients (1 or both eyes) decreased from 7.39 to 6.89/1000 person-years. The incidence of cataract surgery ranged from 1.06/1000 person-years for patients aged 40 to 49 years to 65.94/1000 person-years for those aged 80 to 89 years. Between 2009 and 2012, the probability of second-eye surgery 12 months after the first-eye surgery increased from 40.6% to 51.2% (P < 0.0001). The median interval for surgery between eyes was 29 (interquartile range, 14-86) days. The rate of posterior capsular tear was 0.20%, with a higher proportion from extracapsular extraction than phacoemulsification (7.9% vs. 0.15%; P < 0.0001). The proportion of patients who underwent cataract surgery with a history of high myopia, eye trauma, or retinal detachment was 0.49%, 0.21%, and 0.80%, respectively., Conclusions: This study documented the incidence and trends in cataract surgery in the overall population in France. Between 2009 and 2012, the number of people undergoing cataract surgery slightly decreased, but the total number of operated eyes increased because the proportion of surgeries on the second eye increased., (Copyright © 2015 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)