Scientists assessed risk factors for worse visual acuity outcomes after intraocular lens exchange and common post-surgical complications, as part of a retrospective cohort study.

Eyes from patients ages 18 years and older in the American Academy of Ophthalmology’s IRIS Registry that underwent intraocular lens exchange in the United States between 2013 and 2019, were included.

Scientists determined VA improvement compared to baseline at one-year postoperatively. A multivariable general estimating equation model adjusting for demographic factors and baseline vision was used to identify factors associated with VA worse than 20/40 at one-year postoperatively.

Main outcome measures included VA outcomes and postoperative complications following lens exchange.

A total of 46,063 procedures (n=41,925 unique patients) were included in the researchers’ analysis of the registry. Here are some of the findings:

• Overall VA improved from mean logMAR 0.53 ±0.58 (Snellen 20/70) preoperatively to mean logMAR 0.31 ±0.40 (20/40) at one-year postoperatively. 

• Among eyes with VA recorded at baseline and at one-year postoperatively, 60.5 percent achieved VA of 20/40 or better at one year. 

• VA of worse than 20/40 at one year was associated with: 

o greater age (OR: 1.16 per five-year increase; CI, 1.14 to 1.18); 

o higher logMAR baseline VA (OR: 1.14 per 0.1 increase; CI, 1.14 to 1.15); 

o black vs. white race (OR: 1.96; CI, 1.68 to 2.28); 

o Hispanic ethnicity (OR: 1.82; CI, 1.59 to 2.08); and 

o Asian vs. white race (OR: 1.48; CI, 1.21 to 1.81); 

o Medicaid (OR: 1.78; CI, 1.40 to 2.25) vs. private insurance; 

o smoking (OR: 1.22; CI, 1.11 to 1.35); 

o concurrent anterior vitrectomy (OR: 1.65; CI, 1.51 to 1.81) and posterior vitrectomy (OR: 1.53; CI, 1.41 to 1.66) vs. no vitrectomy. 

• Female sex (OR: 0.93; CI, 0.87 to 0.99) was associated with 20/40 or better VA at one year. 

• At one year, epiretinal membrane (10.9 percent), mechanical lens complication (9.4 percent) and dislocation of the replacement lens (7.1 percent) were the most common complications.

Scientists found the annual number of intraocular lens exchanges rose steadily over time. Vision improved in more than half of patients, and worse visual outcomes were associated with greater age, worse baseline vision, black race, Hispanic ethnicity, Medicaid insurance, smoking and concurrent vitrectomy. Scientists added that epiretinal membrane was the most common complication.

Ophthalmology 2023; Oct 17. [Epub ahead of print]

Son HS, Chang DF, Li C, et al. 

The Effect of 15 Years of CXL On Transplantation

Scientists looked at the long-term effects of corneal collagen crosslinking on the frequency of corneal transplants among patients with keratoconus in the same region.

Before the introduction of cross-linking in 2007, 55 primary corneal transplants had been conducted in patients with keratoconus (2005 and 2006) at the Department of Ophthalmology, Oslo University Hospital, Norway. Scientists collected data from the department’s corneal transplant registry for 2021 and 2022. The primary outcome was the number of corneal transplants performed in patients with keratoconus. Age, sex, visual acuity (recorded in logMAR notation), keratoconus stage according to the Amsler–Krumeich classification system and steepest keratometry reading (maximum keratometry by Pentacam HR, Oculus) were recorded. In addition, scientists analyzed the annual number of corneal cross-linking treatments conducted from 2007 to 2022.

Here are some of the findings from the researchers’ review:

• A total of 352 corneal transplants were performed between 2021 and 2022. 

• Among the transplants, 11 (3.1 percent) were for patients with keratoconus. 

• All included patients were male; 90.1 percent of patients were graded stage 4, and 9.1 percent were graded stage 3. 

• The mean maximum keratometry was 79 D (range: 61.0 to 109 D). 

• The mean best-corrected visual acuity (logMAR) was 1.3 (range: 0.2 to 3.0). 

• Between 2021 and 2022, 431 CXL treatments were performed.

Scientists uncovered a significant decrease in the number of corneal transplants performed in patients with keratoconus 15 years after the introduction of corneal cross-linking. They concluded that the availability of the procedure may considerably reduce the need for keratoplasties in this group of patients.


Cornea 2023; Oct 18. [Epub ahead of print].

Hagem AM, Thorsrud A, Sæthre M, et al. 


Less-frequent Recall in Diabetic Patients

In the U.K., the English Diabetic Eye Screening Programme offers people living with diabetes annual screening. Less frequent screening has been advocated among people living with diabetes without diabetic retinopathy, but evidence for individual ethnic groups is limited. Investigators examined the potential effect of biennial vs. annual screening on the detection of sight-threatening DR (and proliferative diabetic retinopathy among people living with diabetes without DR) from a large urban multi-ethnic English Diabetic Eye Screening Programme.

Diabetic patients taking part of the North-East London English Diabetic Eye Screening Programme (January 2012 to December 2021) with no DR with up to eight years of follow-up were examined. The researchers determined what effect delays in identification of sight-threatening DR and proliferative diabetic retinopathy events if two-year screening intervals been used.

Here are some of the findings: 

• Among 82,782 people living with diabetes (37 percent white, 36 percent South Asian and 16 percent black), there were 1,788 incident sight-threatening DR cases over mean 4.3 ±2.4 years (sight-threatening DR rate 0.51; CI, 0.47 to 0.55 per 100-person-years). 

• Sight-threatening DR incidence rates per 100-person-years by ethnicity were: 0.55 (CI, 0.48 to 0.62) for South Asian patients, 0.34 (CI, 0.29 to 0.40) for white patients, and 0.77 (CI, 0.65 to 0.90) for black patients. 

• Biennial screening would have delayed diagnosis by one year for 56.3 percent (1,007/1,788) with sight-threatening DR and 43.6 percent (45/103) with proliferative diabetic retinopathy. 

• Standardized cumulative rates of delayed sight-threatening DR per 100,000 persons for each ethnic group were: 1,904 (CI, 1,683 to 2,154) for black patients, 1,276 (CI, 1,153 to 1,412) for South Asian patients and 844 (CI, 745 to 955) for white patients.

Investigators determined that biennial screening would have delayed detection of some sight-threatening diabetic retinopathy and proliferative diabetic retinopathy by one year, especially among black patients. 

Br J Ophthalmol 2023; Oct 24. [Epub ahead of print].

Olvera-Barrios A, Rudnicka AR, Anderson J, et al; ARIAS Research Group.