Roberta Ferrari Marback

Emotional factors prior to cataract surgery

PURPOSE Identification of emotional factors related to daily difficulties and surgical treatment among patients with cataract at a university hospital. METHODS A cross-sectional study was carried out by means of a questionnaire, elaborated based on a previous study. The sample consisted of patients seen at the cataract unit of the ophthalmology clinic of a university hospital. RESULTS The sample consisted of 110 individuals of both sexes (34.5% men; 65.5% women) between the ages of 43 and 89 (average 69.0 +/- 10.3 years); 26.4% had never attended school, 59.1% had primary education, and 87.3% had no payed occupation. Most of the patients reported daily difficulties due to their ocular condition (82.7%), and 54.0% reported fear of visual loss. Doubt as to the outcome (32.7%), distress (26.4%), and sadness (25.5%) were reported. CONCLUSIONS Most of the patients reported difficulties in daily activities as a consequence of cataract. Fear was the predominant feeling related to undergoing surgery. The findings suggest the need for implementing intervention courses for emotional preparation for facing daily activities and cataract surgery.

Quality of life in patients with age-related macular degeneration with monocular and binocular legal blindness

OBJECTIVE To evaluate the quality of life for persons affected by age-related macular degeneration that results in monocular or binocular legal blindness. METHODS An analytic transversal study using the National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25) was performed. Inclusion criteria were persons of both genders, aged more than 50 years old, absence of cataracts, diagnosis of age-related monocular degeneration in at least one eye and the absence of other macular diseases. The control group was paired by sex, age and no ocular disease. RESULTS Group 1 (monocular legal blindness) was composed of 54 patients (72.22% females and 27.78% males, aged 51 to 87 years old, medium age 74.61 +/- 7.27 years); group 2 (binocular legal blindness ) was composed of 54 patients (46.30% females and 53.70% males aged 54 to 87 years old, medium age 75.61 +/- 6.34 years). The control group was composed of 40 patients (40% females and 60% males, aged 50 to 81 years old, medium age 65.65 +/- 7.56 years). The majority of the scores were statistically significantly higher in group 1 and the control group in relation to group 2 and higher in the control group when compared to group 1. CONCLUSIONS It was evident that the quality of life of persons with binocular blindness was more limited in relation to persons with monocular blindness. Both groups showed significant impairment in quality of life when compared to normal persons.

Avaliação oftalmológica tardia em portadores de retinopatia diabética

OBJECTIVE: To assess the delay in the ophthalmic examination of patients affected with severe diabetic retinopathy but no visual complaint. METHODS: A transversal analytical study was conducted of 44 visually asymptomatic diabetic patients. All were eligible to retinal panphotocoagulation in at least one eye. Duration and type of the disease as well as time of the first ophthalmic examination were established. RESULTS: Of the 44 patients, 6 (13.7%) had diabetes type 1 and 38 (86.3%) had diabetes type 2. Proliferative diabetic retinopathy was present in 24 (54.5%) and severe or very severe non proliferative retinopathy was present in 20 (45.5%). Best visual acuity ranged from 0.5 to 1.0 (mean 0.83 ± 0.17) according to the Snellen chart. The time interval between diagnosis of diabetes and the first ophthalmic examination ranged from 7 to 19.5 years (13.2 ± 5.12) for diabetes type 1 and from 3 months to 18 years (5.2± 4.81) for diabetes type 2. CONCLUSION: Advanced diabetic retinopathy may be detected at different times of the ophthalmic examination in both types of diabetes. Although the mean interval between the diagnosis and the first examination is 13 years for diabetes type 1 and 5 years for diabetes type 2, this severe kind of retinopathy occurred as early as three months after diagnosis of diabetes. This points to the need for an earlier ophthalmic examination in the case of this disease.

Cirurgia de catarata: características e opiniões de pacientes com visão mono versus binocular

PURPOSE To verify in two groups of patients: monocular (group 1) and binocular vision (group 2) to be submitted to cataract surgery at an University Hospital, opinions, expectances and emotional reactions related to the ocular problem, to the quality of vision and to cataract surgery. METHODS A transversal comparative and consecutive study was performed using a structured questionnaire applied by patients interview. The questionnaire was elaborated from a previous exploratory study; visual acuity and cause of the visual loss were evaluated. RESULTS The sample was constituted by 96 persons of group 1 (50.0% male; 50.0% female, ages ranging from 41 to 91 years; average 69.3 years ± 10.4 years) and 110 persons of group 2 (40.9% male; 59.1% female, ages ranging from 40 to 89 years; average 68.2 years ± 10.2 years). The majority of persons of both groups presented low educational level. There was no statistically significant difference between the groups in relation to gender (p=0.191), age (p=0.702) and educational level (p=0.245). No work activity was mentioned in 95.8% of the persons of group 1 and 83.6% of group 2 (p=0.005) and 30.4% of group 1 informed the impossibility to work due the visual impairment. Visual acuity of the eye to be operated was less than 0.05 in 40.6% (group 1) and in 33,6% (group 2), presented visual acuity ranging from 0.05 to 0.25. Almost the totality of the persons of both groups informed difficulties to perform activities of daily life and qualified as insufficient their visual acuities; 71.9% of the patients of group 1 and 71.6% of group 2 informed to know the reason of low vision; among these, 87.1% of group 1 and 83.3% of group 2 mentioned cataract as the reason of low visual acuity. CONCLUSION It was concluded that the patients of both groups were submitted to cataract surgery with visual acuities less than the visual acuity ideally indicated; the patients with monocular vision showed visual acuities significantly less in relation to the patients with binocular vision; the majority of the patients of both groups mentioned difficulties to perform daily activities as a consequence of low vision; patients with monocular vision mentioned doubts in relation to the surgical results as compared with the patients with binocular vision; many patients of both groups did not know the cause of the visual difficulty or explained the visual difficulty by other cause than the cataract.

Estabilidade visual na retinopatia diabética tratada por panfotocoagulação com laser

PURPOSE: To evaluate the effect of laser treatment in the visual acuity caused by advanced diabetic retinopathy without visual complaints. METHODS: A descriptive observational study was developed in advanced diabetic retinopathy patients not presenting visual complaints. The patients were submitted to argon laser panretinal photocoagulation after ophthalmological examination as well as retinography and retinal angiofluoresceinography. The same initial exams were repeated between third and fifth months after the treatment. The non-parametric Wilcoxon test was employed for statistical evaluation between the visual acuities before and after the treatment. RESULTS: The sample involved 67 eyes of 44 patients. Of these 67 eyes, 37 (55.2%) presented proliferative diabetic retinopathy and 30 (44.8%) showed severe and severe non proliferative diabetic retinopathy. The visual acuity before the treatment ranged from 0.5 to 1.0 (mean 0.81 ± 0.16). There was no significant statistical difference between the visual acuity (p= 0.057) before and after the treatment during the follow-up period of five months. CONCLUSION: The visual stability after panretinal argon laser photocoagulation indicated the need of this treatment in early phases of diabetic retinopathy in order to preserve the visual function.

Cataract surgery: emotional reactions of patients with monocular versus binocular vision

PURPOSE: To analyze emotional reactions related to cataract surgery in two groups of patients (monocular vision - Group 1; binocular vision - Group 2). METHODS: A transversal comparative study was performed using a structured questionnaire from a previous exploratory study before cataract surgery. RESULTS: 206 patients were enrolled in the study, 96 individuals in Group 1 (69.3 ± 10.4 years) and 110 in Group 2 (68.2 ± 10.2 years). Most patients in group 1 (40.6%) and 22.7% of group 2, reported fear of surgery (p<0.001). The most important causes of fear were: possibility of blindness, ocular complications and death during surgery. The most prevalent feelings among the groups were doubts about good results and nervousness. CONCLUSION: Patients with monocular vision reported more fear and doubts related to surgical outcomes. Thus, it is necessary that phisycians considers such emotional reactions and invest more time than usual explaining the risks and the benefits of cataract surgery.Ouvir

Percepções de oftalmologistas referentes ao modelo de ensino aplicado a lentes de contato

PURPOSE To identify perceptions regarding teaching models applied to contact lenses. METHODS A transversal study in a readily accessible sample consisting of ophthalmologists (n=39) was performed by applying a questionnaire. RESULTS The sample consisted of 39 ophthalmologists, 51.3% males and 48.7% females. Regarding frequency prior to courses on contact lenses, 28.2% reported only one course; 25.6% two courses; 5.1% three courses; 2.6% five courses and 2.6% more than 10 courses. 23.1% never attended contact lens courses and 12.8% did not answer the questionnaire. On comparison of previous knowledge with that acquired by the offered course, 59.0% declared that they increased their knowledge a lot; 33.3% reported median increase; 2.6% little increase and 5.1% did not answer. As concerns training in contact lenses, 66.7% answered that they never had any training; 30.7% answered affirmatively and 2.6% did not answer. Among those who had training, 75% declared it was good; 16.7%, very good and 8.3%, regular. CONCLUSION The offered teaching model for contact lenses was considered very valuable, increasing a great deal of knowledge in most subjects.