In standard cataract surgery with IOL implantation, preoperative refraction is not very useful for calculating the performance of an implant, because when the lens is removed, the dioptric force is also removed and then replaced. In cases where performance in the eye is not reduced (e.g. secondary implant in aphakia, ferrouted IOL in pseudophakia or less IOL in the anterior chamber of a myopic phakic eye), the IOL power required for the desired postoperative refraction can be calculated from corneal strength and preoperative refraction. A measurement of axial length is not required. First, the age-specific prevalence of pseudophacia and aphakia was calculated. To estimate the standardised overall prevalence, the age and sex distribution of the German population from 2014 onwards was used [42]. Associated anthropometric and cardiovascular factors were assessed using multivariate logistic regression models. Models comparing #1 people with pseudophacia with people without lens replacement, #2 people with unilateral pseudophacia (and phacia in the other eye) with those with bilateral phakia (i.e. without lens replacement), #3 people with bilateral pseudophacia with people with bilateral phacia were analyzed. The covariates included were sex, age (as a continuous variable), ESS, body weight, height, diabetes, smoking and lipid concentration (high-density lipoprotein, low-density lipoprotein, triglycerides).
The prevalence of pseudophadisease in our cohort is similar to that observed in other regions of the world: for example, the Singapore Malay Eye Study (4.7%) [4], the Beaver Dam Eye Study in Wisconsin (3.1%) [16], the Australian Blue Mountains Eye Study (6.0%) [17], the Barbados Eye Study (3.0%) [18] and the Central India Eye and Medical Study (5.0%) [7]; However, other Indian studies on urban areas have reported figures as high as 9.4% [9.19]. In China, the prevalence of pseudophakia is lower, as reported in the Beijing Eye Study 2006 [20] and 2009 [5] and the Chinese survey of the nine provinces [10]. Since these prevalence data are not standardized for the same age and sex distribution, they are not directly comparable. In addition, most studies did not distinguish between unilateral and bilateral pseudophakia. Comparing changes in lens extractions over time, the Beaver Dam Eye Study found a remarkably 6.5-fold higher incidence between 1990 and 2010 [21]. For the first time, we report in a population-based study on the prevalence of pseudophadisease and aphakia in Germany and investigate the causes of aphakia after the introduction of phacoemulsification and implantation of a posterior chamber intraocular lens. We found that 1.55% of the population aged 35 to 74 years had unilateral pseudophakia and about 3% bilateral pseudophakia. These people are more likely to be older, have diabetes and smoke. Gender is not associated with pseudophakia status.
In patients with pseudophakia, the incidence of increased IOP decreased with the advent of extracapsular cataract extraction (ECCE) and posterior intraocular lens implantation (PCIOL). Transient increases in intraocular pressure are observed on the first postoperative day in eyes without pre-existing glaucoma at rates of 29-50%. The prevalence of chronic glaucoma in pseudophakic eyes after surgery was noted to be between 2.1 and 4% after standard extracapsular extraction[5]. Cataracts have been identified worldwide as the leading cause of visual impairment and blindness [1]. Cataract surgery is the most commonly performed surgical procedure in the world. The opaque lens is removed and replaced with an artificial intraocular lens (pseudophakie), or the resulting refractive error is corrected in aphakia with glasses or contact lenses. The Gutenberg Health Study (GHS) is a prospective population-based observational cohort study conducted in the Rhine-Main region. Our sample of 15,010 participants was randomly drawn from local state registrars. The cohort was stratified uniformly by sex, urban and rural residence over each decade. Further details on the study design can be found in Höhn et al. described [31]. A complete ophthalmological examination was performed for each participant.
Objective refraction (Humphrey Automated Refractor/Keratometer (HARK) 599, Carl Zeiss Meditec AG, Jena, Germany) and distance-corrected visual acuity, non-contact tonometry (Nidek NT-2000, Nidek Co, Japan), anterior segment slit lamp examination and funduscopy were performed and ophthalmic conditions (e.g. phakie, pseudophakia and aphakia) were documented using standardized documentation sheets. These variables (aphakia, pseudophakia) have been validated by refraction and ophthalmological history. After age- and sex-standardized for vision-related quality of life in those aged 60 years and older, the quality of life of people with bilateral pseudophacia was comparable to that of people with bilateral phacia on the visual function scale, while people with unilateral pseudophakia had reduced vision-related quality of life measures (Table 44). Logistic regression analyses showed that older age, higher body weight, shorter height, diabetes and smoking were independently associated with the presence of pseudophadisease (unilateral or bilateral; Table 22). Visual function differed between participants with bilateral phakie, unilateral pseudophacia and bilateral pseudophakia. Distance corrected visual acuity was normal in bilateral phakic participants and almost normal in subjects with bilateral pseudophakia. In subjects with unilateral pseudophakia, visual acuity did not differ between the phakic eye and the pseudophakic eye, but was lower than in subjects with phakic subjects or in subjects with bilateral pseudophakia. The wink of this patient is the result of pseudophakia with a normal Purkinje 1 (P1) reflex and prominent images of Purkinje 3 and 4 (P3 and P4) (reflexes) (Figure 2). Pseudophakia refers to an eye in which the natural lens has been replaced by an implanted artificial intraocular lens (IOL).
Among patients with unilateral pseudophakia, 10.5% reported having glaucoma, compared with 7.3% of people with bilateral pseudophakia and 2.0% of phakic people. While the presence of age-related macular degeneration was similar in all three groups, corneal disease was more common in people with unilateral pseudophacia (Table (table).1). Cataracts were observed in 31% of bilateral phakic participants on the slit lamp examination, while 71% of patients with unilateral pseudophacia had cataracts in the other eye In unilateral pseudophakia, advanced age and lower height were independently associated, while in bilateral pseudophakia, older age and smoking were associated independently (Table (Table 22). In the Gutenberg Health study, we had the opportunity to study the prevalence of pseudophadisease and aphakia in Germany and to assess the associated factors. In addition, we investigated vision-related quality of life and tested whether vision-related quality of life differs from bilateral phakic quality of life in people with pseudophakia. Self-reported eye diseases were more common in people with unilateral pseudophadisease than in patients with bilateral pseudophadisease or phakic people. As part of the Gutenberg Health Study, a population-based cross-sectional study was conducted in Germany. An ophthalmological examination including a slit lamp examination was performed. Prevalence including 95% confidential intervals was calculated and analyses of systemic and ocular factors associated with pseudophadisease were performed using multivariate logistic regression models.
Vision-related quality of life was recorded using a standardized questionnaire and Rasch`s transformation. 14,696 people were trapped. Of these, 1.55% [1.36%-1.77%] had unilateral pseudophacia and 3.08% [2.81%-3.37%] had bilateral pseudophakia. Unilateral aphagia was present in 21 people and bilateral aphagia in 2 people. Pseudophakia was independently associated with age, higher body weight and shorter height, diabetes and smoking. Vision-related quality of life scores were similar for those with bilateral phacia and pseudophakia, but lower for those with unilateral pseudophakia. Schuster AK, Pfeiffer N, Schulz A, et al. The impact of pseudophadisease on visual quality of life in the general population – The Gutenberg Health Study.
Age. 2017;9(3):1030-1040. doi:10.18632%2Faging.101208 Of the 452 people with bilateral pseudophakia, one had secondary implantation of an anterior chamber intraocular lens attached to the iris after endophthalmitis and another had an anterior chamber intraocular lens attached to the iris in addition to a posterior ventricular intraocular lens.