In The Journal Of Cataract & Refractive Surgery January 2012

Patient understanding of informed consent

Anita N. Shukla, M.D., Mary K. Daly, M.D., Paul Legutko, Ph.D.
Investigators in this study considered whether patients understood the risks and benefits of cataract treatment options better when receiving this information in verbal, written, or videotaped format. Using a randomized protocol, investigators slated cataract patients into one of four arms of the informed consent process. Those in group 1 received their information verbally. Patients in group 2 likewise were verbally told the risks as they would be conventionally and also given a brochure at the second-grade reading level. Those in group 3 likewise were verbally told the risks conventionally plus given a brochure written at an eighth-grade reading level. Patients slated for group 4 were shown a patient education DVD in addition to conventional verbal warnings. All patients were then given a questionnaire. Investigators found that those in group 2 scored the highest with a mean score of 10.8 out of 12 and those in group 1 the lowest with a score of 7.68. Those in group 4 who watched the video had the second highest score at 10.56. Investigators concluded that the best way to optimize the informed consent process was to offer patients easy-to-understand information at early reading grade levels and videotaped presentations. The payoff for practitioners here may come in the form of better protection from claims of inadequate informed consent with less risk of related indemnity payments.

Effect of blue light filtering on multifocal VEP
Michael B. Hoffmann, Ph.D., Wolfgang Behrens-Baumann, M.D., Achim Langenbucher, Ph.D., Juliane Reupsch, Arne Viestenz, M.D.
The aim of this cohort study of 20 patients was to consider how cortical processing was affected by blue light filters and to determine whether higher visual functions were neurally degraded as a result. Investigators here compared multifocal pattern reversal visual-evoked potentials (VEPs) recorded in pseudophakic patients with a clear IOL with filter characteristics akin to a blue light-filtering lens and also through a neutral filter. Measurements were recorded for 60 visual field locations for six stimulus eccentricities. Investigators found that at all stimulus levels for blue light filtering typical multifocal VEPs were obtained. They concluded that neural activity in the primary visual cortex was largely unaffected by induced visual stimulus.

Comparison of single and double femtosecond pass

Gonzalo Muñoz, M.D., Ph.D., F.E.B.O., César Albarrán-Diego, M.Sc., Teresa Ferrer-Blasco, Ph.D., Jaime Javaloy, M.D., Ph.D., Santiago García-Lázaro, M.Sc.
In this study of 42 eyes, investigators considered the effect on the eye of a single pass of femtosecond laser versus a double pass needed after intraoperative suction loss on outcomes after myopic LASIK. At the 12-month mark investigators found that there were no significant differences between the two in any of the parameters studied here. With single pass femtosecond there was residual spherical equivalent of –0.05 D versus double pass where this was just –0.03 D. With a single pass femtosecond flap uncorrected distance visual acuity (UDVA) was a mean of 0.008 D and corrected distance visual acuity (CDVA) was –0.010 D. The UDVA was 0.011 D and –0.007 D CDVA for double pass. Higher-order aberrations were likewise comparable. The conclusion reached was that after uneventful femtosecond LASIK, use of a single or a double pass after suction loss were comparable with regard to acuity, refractive outcomes, or higher-order aberrations. They determined that good visual outcomes could be attained if after intraoperative suction loss with the femtosecond laser a new pass was immediately performed.