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    Summary of The Alberta Clinical Practice Guideline, August 1996

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    malathi
    The document provides guidelines for managing cataracts through both surgical and non-surgical means. It outlines criteria for when surgery is appropriate based on subjective, objective and educational factors. It also discusses preoperative evaluation, surgical procedures, potential need for hospitalization, discharge criteria, and postoperative care requirements. The goal is to ensure cataract surgery only proceeds when it is likely to improve vision and can be performed safely.

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    Summary of The Alberta Clinical Practice Guideline, August 1996

    Uploaded by

    malathi
    23 views2 pages
    The document provides guidelines for managing cataracts through both surgical and non-surgical means. It outlines criteria for when surgery is appropriate based on subjective, objective and educational factors. It also discusses preoperative evaluation, surgical procedures, potential need for hospitalization, discharge criteria, and postoperative care requirements. The goal is to ensure cataract surgery only proceeds when it is likely to improve vision and can be performed safely.

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    Original Title

    Cataract Summary

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    The document provides guidelines for managing cataracts through both surgical and non-surgical means. It outlines criteria for when surgery is appropriate based on subjective, objective and educational factors. It also discusses preoperative evaluation, surgical procedures, potential need for hospitalization, discharge criteria, and postoperative care requirements. The goal is to ensure cataract surgery only proceeds when it is likely to improve vision and can be performed safely.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    23 views2 pages

    Summary of The Alberta Clinical Practice Guideline, August 1996

    Uploaded by

    malathi
    The document provides guidelines for managing cataracts through both surgical and non-surgical means. It outlines criteria for when surgery is appropriate based on subjective, objective and educational factors. It also discusses preoperative evaluation, surgical procedures, potential need for hospitalization, discharge criteria, and postoperative care requirements. The goal is to ensure cataract surgery only proceeds when it is likely to improve vision and can be performed safely.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
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    Guideline for Surgical & Non-Surgical Management of Cataract 2007 Update

    EW
    R EVI in the Otherwise Healthy Adult Eye
    DER
    UN Summary of the Alberta Clinical Practice Guideline, August 1996

    Diagnosis and • No single test adequately describes the effects of cataracts on visual status.
    Visual Acuity • Snellen acuity is the most universally used index of visual functioning.
    • Snellen acuity is the best predictor of appropriateness of surgery.

    Management • During early cataract development visual improvement may be achieved through:
    • Change in prescription for spectacle lenses.
    • Use of strong bifocals.
    • Magnification aids.
    • Appropriate illumination.
    • Surgery is justified when subjective, objective and educational criteria are met.
    Subjective
    • The patient’s own assessment of visual disability.
    • The patient’s perception of the impact of their disability on life-style.
    • The patient’s complaints of disabling glare.1
    Objective
    • The eye examination confirms that the cataract is the limiting factor for improving visual
    function and other factors do not preclude improvement following surgery.
    • The patient’s medical and mental health should permit surgery to be performed safely.
    Educational
    • The patient should be educated about the risks and benefits of cataract surgery and
    alternatives to treatment.2

    Other • Two other indications for cataract removal are:


    Indications for Lens Induced Diseases
    Cataract • Documented evidence of the presence of lens induced diseases (phacomorphic glaucoma,
    Removal phacolytic glaucoma, etc.) is necessary prior to cataract removal.
    Because of sight threatening complications, cataract surgery may be urgent.
    The Need to Visualize the Fundus
    • It is necessary to visualize the fundus in an eye that has the potential for sight or when other
    special investigations demonstrate intraocular pathology where further attention is important
    and requires clear media.

    One-eyed • A one-eyed patient is defined as one who has permanent legal blindness in the other eye
    Patients • The ophthalmologist has the obligation to inform and educate this patient about the risk of
    total blindness when considering the benefits of cataract surgery.
    • The worse the vision in the fellow eye, the greater the need for caution when considering
    cataract surgery in the eye to be operated.

    Contraindications • Surgery should not be performed under the following circumstances:


    to Surgery • The patient does not desire surgery.
    • Glasses or visual aids provide satisfactory functional vision.
    • Surgery will not improve visual function.
    • The patient’s life style is not compromised.
    • The patient is medically unfit.
    • The patient has had a cataract removed in one eye which has not sufficiently healed to
    warrant the surgical removal of cataract in the second eye.
    Notes:
    1. Glare testing and contrast sensitivity testing are methods designed to correlate objective findings of cataract
    formation with subjective visual loss and complaints.
    2. In patients with visual acuity that is marginally reduced, the risk of surgery relative to the expected
    benefit should be reemphasized to the patient.

    For complete guideline refer to the TOP Website: www.topalbertadoctors.org


    Administered by the Alberta
    Medical Association
    Preoperative ♦ Ensure that the criteria for cataract surgery are met
    Evaluation ♦ Ensure that the patient has a general medical history and physical examination as appropriate for
    the planned surgery and type of anesthesia
    ♦ Ensure that appropriate keratometry and A-scan measurements have been performed if an IOL is
    to be implanted
    ♦ Select appropriate IOL power when IOL implantation is planned
    ♦ Review and discuss results of pre-surgical and diagnostic evaluations with patient
    ♦ Make the patient aware of any other eye disease that may affect the prognosis for visual
    recovery.

    Surgery ♦ Phacoemulsification cataract extraction with implantation of a posterior chamber IOL is the
    current procedure of choice
    ♦ Anesthesia of the eye can be obtained with topical, peribulbar, retrobulbar, or general anesthesia

    Hospitalization ♦ Operative complications of an ocular or medical nature are possible indications for hospitalization
    • Ocular complications can include hyphema, uncontrolled elevated intraocular pressure,
    threatened or actual expulsive hemorrhage, retrobulbar hemorrhage, severe pain or other
    ocular problems requiring acute management or careful observation
    • Medical complications include cardiac instability, a cerebrovascular episode, diabetes mellitus
    requiring acute management, uncontrolled nausea or vomiting, acute urinary retention, acute
    psychiatric disorientation, or other medical conditions requiring acute management or careful
    observation
    ♦ Possible indications for planned postoperative hospitalization include:
    • Presence of medical conditions that require prolonged post operative observation by a nurse
    or skilled personnel
    • Best correctable vision in the unoperated eye is 6/60 (20/200) or worse
    • Patient is mentally debilitated or diagnosed as mentally ill
    • Patient is non ambulatory or cannot exercise self care (or responsible care is unavailable)
    during the immediate postoperative period.

    Discharge ♦ Prior to discharge, post surgical care should be discussed with patient. Written postoperative
    instructions should be provided and a follow-up appointment arranged.
    ♦ Criteria for discharge after ambulatory surgery include:
    • Stable vital signs
    • Return to preoperative mental state
    • Absence of nausea
    • Absence of significant pain

    Postoperative ♦ The ophthalmologist has responsibility for the patient’s follow-up care until the eye is healed
    Care ♦ The first postoperative visit should be within the first 24 hours
    ♦ A patient without signs or symptoms of possible complications should visit the opthalmologist
    or designate two or three times. Components of the postoperative examination include:
    • Visual acuity (each visit)
    • Intraocular pressure measurement (each visit)
    • External examination (each visit)
    • Slit lamp exam (each visit)
    • Ophthalmoscopy: if patient has any retinal symptoms during the post operative period a
    dilated fundus exam including the peripheral retina should be performed.

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