Patient reported outcome measures (PROMs) are essential tools for capturing the quality of life and symptom burden from the patient’s perspective, particularly relevant in cataract surgery due to its subjective impact on vision. Cataract surgery, a highly cost-effective intervention, faces a growing demand for high-quality PROMs to measure diverse patient experiences and outcomes. Contemporary studies identify 14 domains of vision-related quality of life, such as convenience, visual symptoms, and driving, which traditional PROMs may inadequately address. Additionally, the changing cataract surgery landscape, driven by advancements in intraocular lenses (IOLs) and patient populations, necessitates a re-evaluation of PROMs for cataract patients. A systematic review will examine literature on PROMs in cataract surgery, including consensus studies, instrument development, psychometric evaluations, and implementation studies. Studies will be sourced from databases including PubMed, MEDLINE, Embase, Epub, CINAHL, CENTRAL, CDSR and Northern Light. Inclusion criteria focus on adult lens removal surgery, excluding non-ophthalmic, paediatric, or non-cataract studies. Articles will be screened by multiple reviewers. PROMs will be mapped to the 14 identified domains and evaluated using the COSMIN framework for psychometric assessment. Implementation aspects, including clinical usage, digitisation, and barriers to adoption, will also be assessed. The review will address critical gaps in PROMs for cataract surgery, including domain coverage, psychometric quality, and implementation in clinical and academic settings. It will highlight the evolving needs of a diverse patient population, including refractive lens exchanges, and the impact of modern IOL technologies on PROMs. A well validated quality assessment of cataract PROMs will provide a strong platform to understand the established instruments. This comprehensive analysis will guide future research directions, including the development of new instruments or item banks, and inform best practices for PROM implementation, ensuring alignment with value-based healthcare principles. PROSPERO CRD420251007771

PURPOSE:To validate the Catquest-9SF survey in a U.S. Veteran population while assessing how cataract surgery affects quality of life from the patient's perspective. SETTING:Edward Hines Jr. VA Hospital, Hines, Illinois. DESIGN:A prospective survey study of Veteran patients undergoing cataract surgery, gauging preoperative and postoperative responses to questions regarding vision-related daily tasks. METHODS:Recruitment selected for all Veteran patients undergoing routine cataract surgery without a second simultaneous ophthalmic surgery. Patients who experienced complications during surgery were excluded. Outcomes were measured using the Catquest-9SF questionnaire and postoperative visual acuity. RESULTS:257 Veterans were included in this study. Rasch person-measure estimates improved from -1.37 to -4.22 logits (Δ 2.85 logits), indicating higher visual functioning after cataract surgery. The Catquest-9SF demonstrated satisfactory Rasch performance (ordered thresholds, person reliability 0.83, person-separation 2.25, first contrast eigenvalue 1.65). Mean logMAR visual acuity improved from 0.41 ± 0.34 to 0.18 ± 0.22 (mean change -0.23; P < .01). CONCLUSIONS:To the authors' knowledge, this is the first use of the Catquest-9SF questionnaire as a patient-reported outcomes measure tool to investigate cataract surgery outcomes among U.S. Veterans. This study found that the Catquest-9SF satisfied validation criteria in a U.S. Veteran population and found cataract surgery to improve patient-reported outcomes, regardless of comorbidity.

PURPOSE:To introduce a newly developed digital platform and compare its reliability and agreement with paper-based questionnaires for assessing quality of vision before and after cataract surgery. SETTING:University-affiliated ophthalmology department and private clinic. DESIGN:Prospective, randomized trial with parallel design of 1:1 allocation ratio without masking. METHODS:Between 11/2021 and 6/2023, patients from a preoperative cataract clinic, aged ≥21 years, with cataracts in both eyes and internet access were randomly assigned by "ALEA" software to complete Catquest-9SF and Quality-of-Vision (QoV) questionnaires before surgery and after second eye surgery via paper or a newly developed digital European Registry of Quality Outcomes in Cataract and Refractive Surgery (EUREQUO) platform. Statistical analyses evaluated agreement between methods, and validation was by Rasch analysis. RESULTS:Half (183/364, 50.3%) of the enrolled patients were allocated to digital questionnaires. After exclusion due to technical issues, missing questions, and withdrawal, 307/364 patients remained, of whom 159 (51.8%) filled in digital questionnaires. Half of all patients (n=154) underwent sequential surgeries on both eyes after a minimum one-month interval. Seventy-two (72/154, 46.8%) completed postoperative questionnaires. Comparative analysis found no significant differences between paper and digital methods. Catquest-9SF and QoV questionnaires demonstrated good precision and reliability (Rasch analysis). Postoperative vision improved at an average of 2.82 logits. CONCLUSION:The newly developed digital EUREQUO platform for patient assessment of quality of vision before and after cataract surgery with the Catquest-9SF and QoV questionnaires, offers a reliable alternative to traditional paper-based questionnaires, enhancing convenience for patients and providers.

BACKGROUND:Postcataract surgery endophthalmitis is a serious but largely preventable clinical entity. The implementation of uniform preoperative, intraoperative, and postoperative protocols is essential to reduce its incidence. METHODS:In light of emerging evidence and considerable variability in clinical practices, a panel of international experts from the Academy of Asia-Pacific Professors of Ophthalmology (AAPPO), the Asia-Pacific Vitreo-retina Society (APVRS), and the Asia-Pacific Society of Ocular Inflammation and Infection (APSOII) convened to develop evidence-based guidelines addressing all phases of cataract surgery. This consensus manuscript is the product of a systematic review of the current literature, informed by the collective experience and expertise of the panel members. The panel engaged in structured discussions, critical evaluation of clinical data, and formal voting to establish agreement across three key domains: (1) preoperative and intraoperative prophylactic strategies, (2) diagnostic approaches for early postoperative acute bacterial endophthalmitis, and (3) standardized management protocols. Voting on each proposed statement was conducted using a 5-point Likert scale (strongly agree, agree, neutral, disagree, strongly disagree). Consensus was defined as ≥75% of experts voting either "strongly agree" or "agree." RESULTS:A total of 45 consensus statements were evaluated, of which 21 (46.6%) achieved the predefined level of consensus. CONCLUSIONS:This document aims to establish standardized guidelines to improve cataract surgery outcomes by minimizing the risk of postoperative endophthalmitis. For areas where consensus was not achieved, the panel recommends further investigation and continued research to guide future updates to clinical practice.

Sex education can be described as an important part of health education in school and one way of strengthening health education could be a collaboration between different professionals in the school team. The aim of this study was to describe teachers' and school nurses' experiences and perspectives with regard to sex education among students aged 11-12 years and to explore potential influencing factors. We employed a qualitative design, and the teachers and school nurses were interviewed individually. A thematic analysis was conducted on the interviews and the results showed that the classroom was considered to be the teacher's arena. Tradition and attitudes between professionals could be obstacles that affect collaboration between teachers and nurses and the study showed that there remains much to be done before collaboration at the same level between the groups can be established.

Aims: The purpose of this study is to translate and validate a Hebrew version of the Catquest-9SF questionnaire, an efficient patient-reported outcome measure (PROM), for the assessment of cataract surgery outcome Methods: This is a prospective questionnaire validation study. The Catquest-9SFquestionnaire was translated from English to Hebrew following a standard procedure. The study population included candidates for cataract extraction surgery in both eyes. They were 21 years of age or older, Hebrew-speaking, and had Internet access. They completed the questionnaire in 2 stages, once before the surgery on the first eye and again 4-6 weeks following the surgery on the second eye. A Rasch analysis was performed to validate the Hebrew version of the questionnaire, and a sensitivity analysis was performed for the patients who completed both the preoperative and postoperative questionnaire. Results: Of the 133 patients included in the study, 125 completed the first questionnaire, and 24 also completed the second questionnaire by the time of study closure. The Hebrew translation of Catquest-9SF demonstrated 1-dimensionality, ordered response categories and good person separation. The sensitivity analysis on the 24 paired Catquest-9SF questionnaires showed good effect size (1.85). Conclusions: The Hebrew versions of the Catquest-9SF questionnaire is valid and reliable with psychometric properties of good quality and good effect size. It is applicable to Hebrew-speaking cataract patients for clinical assessment and research purposes

Abstract Purpose To study the trend of delayed sequential bilateral cataract surgery (DSBCS) in Sweden in the past decade. Methods This register-based cohort study utilized data from the Swedish National Cataract Register (NCR) from 2010 through 2019. Register files from patients who underwent cataract surgery in both eyes during the study period were linked using their social security numbers. Bilateral surgeries on different days were classified as DSBCS. The study investigated the association between DSBCS within 3 months and several variables with stratification and multivariate logistic regression. The following variables were used: operation year, region, private or public unit, age, sex, indication for surgery, type of intraocular lens (IOL), preoperative visual acuity, ocular comorbidity, posterior capsule rupture and perioperative difficulties. Results During the study period, 368,106 patients underwent DSBCS, of which 62.6% (n = 230,331) had bilateral surgery within 3 months. The median time between the surgeries was 61 days (interquartile range 26–161 days), showing regional variations. Better visual acuity in the fellow eye, presence of ocular comorbidity, various perioperative events and complications were associated with longer time to surgery of the second eye. Conversely, cataract surgery in more recent years, private clinic, increasing age, anisometropia and multifocal IOL were associated with shorter timespan between surgeries. Conclusions The majority of DSBCS were conducted within a 3-month timeframe, with the interval between surgeries decreasing throughout the study period. Several rational factors were associated with the time difference, in addition to regional variations. Many patients would probably benefit from less time between the surgeries, and we encourage a clinical practice taking the whole patient’s visual function into account.

PURPOSE:To study the incidence, predictive factors, etiology, and visual consequences of postoperative endophthalmitis (PE) in relation to 3 intracameral (IC) antibiotic regimes. SETTING:Swedish National Cataract Register entries from 2011 through 2017. DESIGN:Observational retrospective study. METHODS:PE incidence, influencing factors, bacteriology, and visual outcome were analyzed regarding the 3 major prophylactic IC protocols. RESULTS:The overall incidence of PE was 0.023% or 177 cases in 764 513 cataract procedures. Analyzed per IC regime, the rates of PE were 0.024% (126 cases in 514 916 surgeries) for cefuroxime, 0.020% (25 cases in 122 340 surgeries) for moxifloxacin, and 0.017% (20 cases in 121 045 surgeries) for combined cefuroxime-ampicillin. Incidences were not statistically significantly different from one another. Gram-positive bacteria caused 89.0% of culture positive cases. Enterococci as pathogens were significantly more frequent with IC cefuroxime than with moxifloxacin, P = .006, or cefuroxime-ampicillin, P < .001, while streptococci other than enterococci were more common with moxifloxacin than with cefuroxime, P < .001. Bacterial susceptibility to the given antibiotics was demonstrated in 21.3% of PE cases treated with cefuroxime, which was statistically significantly lower than proportions found with cefuroxime-ampicillin, 60.0%, P = .015, or with moxifloxacin, 88.2%, P < .001. Visual outcome worse than 20/200 was similar in the groups ranging from 42.0% to 53.7%. CONCLUSIONS:No statistically significant differences in PE incidence or visual outcome results between treatment groups were demonstrated. However, differences in etiology and bacterial sensitivity were found between the prophylactic IC treatments.

Purpose:To translate, validate, and evaluate the psychometric properties of the German version of Keratoconus Outcomes Research Questionnaire (KORQ).Methods:This prospective study included 3 phases. In phase 1, the KORQ was translated in a standardized way; in phase 2, Rasch validation was performed; in phase 3, the validated questionnaire was evaluated in a separate patient cohort. All patients answered the German KORQ. Scheimpflug imaging (Pentacam) and optical coherence tomography scans (MS-39) were conducted. Corneal imaging measurements were correlated with patient-reported outcome measures.Results:After standardized translation, 100 patients self-administered the German KORQ. Rasch analysis was conducted for psychometric testing of the KORQ. Based on the results of the Rasch analysis, the original German version of the KORQ was modified and any items showing a misfit were excluded. This resulted in a new shortened version of the KORQ, which was evaluated in 30 patients. The revised German KORQ met the criteria of Rasch analysis and showed excellent internal consistency reliability and convergent validity. The correlation between the KORQ score and various clinical measurements was examined using Spearman correlation. A significant moderate correlation was observed between the D (r = 0.237; P = 0.006) and Kmax (r = 0.162; P = 0.065) values of Pentacam. Inverse correlations were observed for thinnest pachymetry measured with MS-39 (r = -0.167; P = 0.058) and best corrected visual acuity (r = -0.210; P = 0.016).Conclusions:The shortened German KORQ met the assumptions of the Rasch model and displayed satisfactory psychometric properties. The German KORQ could be adopted as a powerful patient-reported outcome measures tool for German-speaking patients with keratoconus in the future.

PURPOSE:To evaluate the performance of different probabilistic classifiers to predict posterior capsule rupture (PCR) prior to cataract surgery.METHODS:Three probabilistic classifiers were constructed to estimate the probability of PCR: a Bayesian network (BN), logistic regression (LR) model, and multi-layer perceptron (MLP) network. The classifiers were trained on a sample of 2 853 376 surgeries reported to the European Registry of Quality Outcomes for Cataract and Refractive Surgery (EUREQUO) between 2008 and 2018. The performance of the classifiers was evaluated based on the area under the precision-recall curve (AUPRC) and compared to existing scoring models in the literature. Furthermore, direct risk factors for PCR were identified by analysing the independence structure of the BN.RESULTS:The MLP network predicted PCR overall the best (AUPRC 13.1 ± 0.41%), followed by the BN (AUPRC 8.05 ± 0.39%) and the LR model (AUPRC 7.31 ± 0.15%). Direct risk factors for PCR include preoperative best-corrected visual acuity (BCVA), year of surgery, operation type, anaesthesia, target refraction, other ocular comorbidities, white cataract, and corneal opacities.CONCLUSIONS:Our results suggest that the MLP network performs better than existing scoring models in the literature, despite a relatively low precision at high recall. Consequently, implementing the MLP network in clinical practice can potentially decrease the PCR rate.

Research on students’ perceptions and understanding of technology has shown that students have a narrow view of technology: for example, technology is often manifested in students’ descriptions as artefacts or objects. This study investigates the ways in which students’ understanding of how technology is manifested expands during a series of classroom activities in technology. The study was conducted at a compulsory primary school with eight-year-old students. The data (video and audio recordings) were collected in small-group interactions and in whole-class discussions. In the interactions, the students utilised self-taken photographs to visualise their understanding and perception of technology’s manifestations: object, activity, volition, and knowledge (Mitcham in Thinking through technology. The path between engineering and philosophy, The University of Chicago Press, 1994). Based on their prior knowledge, the students perceived technology as contemporary electrical artefacts. As they engage in a technology project, they develop and expand their understanding of how technology is manifested, as well as relate different manifestations to one another. The findings indicate that students achieve a more advanced understanding of technological manifestations compared to only discussing each manifestation of technology separately.

Purpose: To determine the trends in anesthesia techniques for cataract surgery over the past decade and their relationship to surgical complications. Setting: Clinics affiliated with the European Registry of Quality Outcomes for Cataract and Refractive Surgery (EUREQUO). Design: Retrospective cross-sectional register-based study. Methods: Variables include patient demographics, visual acuity, ocular comorbidities, surgery characteristics, intraoperative complications, and postoperative complications for the study period from January 2008, to December 2018. The anesthesia methods registered in the EUREQUO and included in the study are topical, combined topical and intracameral, sub-Tenon, regional, and general anesthesia. Multivariate logistic regression models for each complication were constructed to estimate the adjusted odds ratio (OR) and 95% CIs. Results: Complete data were available of 1 354 036 cataract surgeries. Topical anesthesia increased significantly over time (from 30% to 76%, P <.001). Sub-Tenon and regional anesthesia decreased (from 27% and 38% to 16% and 6%, respectively, P <.001), and general and combined topical and intracameral anesthesia remained stable (around 2%). Sub-Tenon (OR, 0.80; 95% CI, 0.71-0.91, P <.001), regional (0.74; 95% CI, 0.71-0.78, P <.001), general (0.53; 95% CI, 0.50-0.56, P <.001), and intracameral anesthesia (0.76; 95% CI, 0.64-0.90, P =.001) carried a significantly decreased risk of posterior capsule rupture (PCR), with and without dropped nucleus, compared with topical anesthesia. The risk of endophthalmitis was significantly lower with regional anesthesia compared with topical anesthesia (OR, 0.60; 95% CI, 0.44-0.82, P =.001). Conclusions: The use of topical anesthesia for cataract surgery increased over time. Topical anesthesia is associated with an increased risk of PCR with and without dropped nucleus, and endophthalmitis. Copyright (c) 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of ASCRS and ESCRS

PURPOSE:To analyse trends of ISBCS reported to the Swedish National Cataract Register (NCR) over a 10-year period.METHODS:Since 2010 the NCR contains social security number of all individuals in the list of parameters reported to NCR after each cataract procedure. Bilateral surgeries were mapped out using social security numbers. When dates of both-eye surgeries are identical for an individual it is classified as an immediate sequential bilateral cataract surgery (ISBCS). This study includes all data reported during the period 1st of January 2010 to 31st of December 2019. During the study period 113 cataract surgery clinics affiliated to the NCR reported their data on consecutive cataract cases.RESULTS:For the whole period 54 194 ISBCS were reported. The total number of bilateral cataract extractions was 422 300. There was a significant trend of increasing ISBCS over time with linear regression (Beta = 1.75, p < 0.001). In ISBCS the occurrence of an ocular comorbidity decreased over time. The use of a capsular tension ring was significantly more common in ISBCS than in delayed sequential bilateral cataract surgery (DSBCS). All other measures taken during surgery were more common in DSBCS. The use of multifocal IOL was significantly more frequent in ISBCS compared to DSBCS (p < 0.001).CONCLUSIONS:The use of ISBCS has increased over the study period. The operated eyes have less risk factors than eyes going through a DSBCS, but both ocular comorbidities and surgical complications occur in ISBCS eyes.

PURPOSE:To investigate the surgical and pharmacological management and outcomes of patients with cataract and concurrent uveitis.METHODS:Data from the Swedish National Cataract Register, 2018-2019, were collected and analysed. Uveitic eyes were identified and eyes without uveitis were used as controls. Generalized estimating equations were used to adjust for intra-individual correlation.RESULTS:The study included 719 eyes with and 256 360 without uveitis. The mean age was 66.0 ± 13.5 (standard deviation [SD]) years in the uveitis group and 74.3 ± 8.7 years in the control group (p < 0.001). Surgery was associated with more intraoperative difficulties in eyes with uveitis (27.0%) than in control eyes (7.1%; p < 0.001). Posterior capsule rupture/zonular complications were registered in nine eyes with uveitis (1.3%) and in 1464 eyes without uveitis (0.6%; p = 0.02). Hydrophilic acrylic intraocular lenses (uveitis 3.6%, controls 1.2%) and subconjunctival steroids (uveitis 17.4%, controls 6.1%) were more frequently used in eyes with uveitis (p < 0.001). post-operative best-corrected visual acuity (BCVA) was 0.16 ± 0.38 logarithm of the minimum angle of resolution (logMAR, mean ± SD) in eyes with uveitis (n = 52) and 0.08 ± 0.20 in control eyes (n = 14 489; p = 0.008).CONCLUSION:In this large registry-based Swedish cohort study, the findings demonstrate that cataract surgery in patients with uveitis poses more challenges and requires special surgical precautions. Eyes with concurrent uveitis had worse BCVA prior to and following surgery. Despite the intraoperative challenges, the visual improvement was greater in the uveitic group.

Purpose: To analyze the incidence and risk factors for posterior capsule rupture (PCR) in cataract surgery. Setting: European clinics affiliated with the European Registry of Quality Outcomes for Cataract and Refractive Surgery (EUREQUO). Design: Retrospective cross-sectional register-based study. Methods: Data were obtained from the EUREQUO. The database contains data on demographics, comorbidities, and intraoperative complications, including PCR for the study period from January 1, 2008, to December 31, 2018. Univariate and multivariate logistic regression analyses were performed to estimate the (adjusted) odds ratio (OR) and 95% confidence intervals (CIs). Results: We analyzed EUREQUO registry data of 2,853,376 patients, and 31,749 (1.1%) cataract surgeries were complicated by a PCR. Data were available of 2 853 376 patients, and 31 749 (1.1%) cataract surgeries were complicated by a PCR. The PCR rate ranged from 0.60% to 1.65% throughout the years, with a decreasing trend (P < .001). The mean age of the PCR cohort was 74.8 ± 10.5 years, and 17 29 (55.5%) patients were female. Risk factors most significantly associated with PCR were corneal opacities (OR 3.21, 95% CI, 3.02-3.41, P < .001), diabetic retinopathy (OR 2.74, 95% CI, 2.59-2.90, P < .001), poor preoperative visual acuity (OR 1.98, 95% CI, 1.88-2.07, P < .001), and white cataract (OR 1.87, 95% CI, 1.72-2.03, P < .001). Conclusions: Risk factors for PCR were identified based on the EUREQUO, and the incidence of this complication is decreasing over time.