Postoperative stability of refraction after cataract surgery
The first extracapsular cataract extraction was performed by the French ophthalmologist Jacques Daviel in the middle of the 18th century. To remove the crystalline lens from the posterior chamber, he made a suitable corneal incision.1 Today, an estimated 700,000 to 800,000 cataract surgeries are performed in Germany every year.2 However, there is still some uncertainty among optometrists and ophthalmologists regarding the timing of postoperative stability of refraction after cataract surgery and about the most appropriate time to prescribe a new visual aid after complication free cataract surgery. Postoperative astigmatism in particular is a key factor in the stability of the cornea after cataract surgery. Responsible for this is primarily the size, position and healing process of the incision through which the foldable IOL is positioned into the capsular bag.
While some older publications still refer to 3 months as the appropriate time for a postoperative prescription of visual aids,3 more recent studies suggest that refractive stabilization can already be expected after 1 or 2 weeks postoperatively.4,5,6
This means that visual aids can be prescribed relatively safely 1 to 3 weeks after cataract surgery without complications. The main reasons for cataract surgery are reduced visual acuity and increased photophobia due to the opacification of the lens. Today's high mobility of older people leads to significantly earlier lens replacement than years ago. In this respect, the timing of cataract surgery must always be considered depending on the individual life situation of the person affected.
Today, almost 87 per cent of all prescriptions for visual aids in Germany are prescribed by ophthalmic opticians or optometrists,7 who are often the first eye care provider to diagnose cataracts and refer patients to an ophthalmologist. This means that patients after cataract surgery often return to their previous eye care provider for a postoperative prescription for a new visual aid.
In the context a good cooperation between members of both eye care professions up-to-date knowledge about the right time to prescribe spectacles after uncomplicated cataract surgery is therefore of great benefit for the patients.
Today, older patients are more mobile than ever. Therefore, timely prescription of visual aids after cataract surgery should be also in the interest of both eye care professions. The significant time difference between the older publication by Baranyovits from 1988 and the current time data is certainly due to the actual cataract surgery technology.
[1] Koelbing, H. M. (1985). Kühnheit und Umsicht: Jacques Daviels Weg zur Star Extraktion (1745 – 1752). Klin. Monbl. Augenheilkd., 186, 235-238.
[2] Berufsverband der Augenärzte Deutschlands (BVA) . Katarakt (Grauer Star), https://www.augeninfo.de.
Referencing: 28 February 2024.
[3] Baranyovits, P. R. (1988). Stabilisation
of refraction following cataract surgery. Br. J. Ophthalmol., 72, 815-819.
[4] Feng, R., Wang, M., Tao, S., Liang, F., Liu, X.,
He, C., Fan, S. (2024). Refractive stability and timing of spectacle prescription following cataract surgery in myopic eyes. Ophthalmic Physiol. Opt., doi: 10.1111/opo.13285. Epub ahead of print. PMID: 38351864.
[5] Pattanayak, S., Patra, S. H. S., Nanda, A. K., Subudhi, P. (2022). Stabilization of refraction and timing of spectacle prescription following manual small-incision cataract surgery. Indian J. Ophthalmol., 70,
3938-3941.
[6] Dietze, H., Kruse, M. (2021). Postoperative Stabilität der Refraktion nach Katarakt-Operation. Optom. Contact Lenses, 1, 14-20.
[7] Zentralverband der Augenoptiker und Optometristen (ZVA) (2023). Branchenbericht Augenoptik in Zahlen 2022-2023, https://www.zva.de/branchenberichte.Referencing: 28 February 2024.