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    <recommendedItem id="20090101_19_1028"
                     title="Most Lasik Patients Happy with Results"
                     score="-0.006"
                     href="http://www.medpagetoday.com/Ophthalmology/LaserSurgery/tb/13573?impressionId=1265787309211"
                     
      TORONTO, April 2 -- The vast majority of patients who have Lasik eye surgery are happy with the results, according to a review of world scientific literature that spanned a decade.
              &lt;p&gt; 
              &lt;p&gt;In studies reported from 1988 to 2008, some 95.4% of patients were satisfied with the results of laser-assisted in situ keratomileusis, according to Kerry Solomon, M.D., of the Medical University of South Carolina, and colleagues.
              &lt;p&gt; 
              &lt;p&gt;In the 19 studies that reported on patient satisfaction, the rates ranged from 87.2% to 100%, Dr. Solomon and colleagues said in the April issue of &lt;em&gt;Ophthalmology&lt;/em&gt;.
              &lt;p&gt; 
              &lt;p&gt;&quot;This places Lasik among the most successful of all elective surgeries, comparing very favorably with other elective procedures,&quot; Dr. Solomon said in a statement. 
              &lt;p&gt; 
              &lt;p&gt;For elective procedures, patient satisfaction is an important &quot;litmus test&quot; to evaluate success, Dr. Solomon and colleagues said. But until now there has been no systematic look at how patients feel about Lasik surgery.
              &lt;p&gt; 
              &lt;p&gt;To fill the gap, the researchers reviewed published articles covering procedures performed between 1995 and 2003. All told, the literature review found 309 peer-reviewed, well-designed, properly conducted, randomized clinical trials or case-control and cohort studies.
              &lt;p&gt; 
              &lt;p&gt;However, the vast majority focused on visual outcomes, leaving only the 19 -- or 6.2% -- that reported on patient satisfaction, Dr. Solomon and colleagues found.
              &lt;p&gt; 
              &lt;p&gt;Of those, the researchers said, 12 were prospective and seven were retrospective. They were conducted in Egypt, France, India, Iran, Ireland, The Netherlands, Scotland, South Africa, Spain, Turkey, the United Arab Emirates, the U.K., and the U.S. 
              &lt;p&gt; 
              &lt;p&gt;Most of the studies focused on treatment of myopia and in those, 1,811 of 1,901 patients (93.5%) said they were satisfied. In studies of treatment for hyperopia, 286 of 297 patients (96.3%) said they were happy with the results. The difference was not significant.
              &lt;p&gt; 
              &lt;p&gt;Results were similar whether or not the study used validated questionnaires, the researchers found.
              &lt;p&gt; 
              &lt;p&gt;Dr. Solomon and colleagues also asked whether patient satisfaction has changed over time. Eight studies, with 1,112 patients who underwent surgeries 1995 to 2000, found an overall satisfaction rate was 96.0%.
              &lt;p&gt; 
              &lt;p&gt;Five studies, with 511 patients, reported surgeries that took place from 2001 to 2003, where the rate was 94.6% -- not significantly different form the earlier period.
              &lt;p&gt; 
              &lt;p&gt;&quot;Lasik has provided consistently high rates of patient satisfaction, regardless of when the surgery was performed,&quot; the researchers said.
              &lt;p&gt; 
              &lt;p&gt;There was also no significant difference in patient satisfaction inside or outside the U.S. Among the 1,261 patients who had surgery in the U.S., the satisfaction rate was 95.2%, while among the 937 who had surgery outside the U.S., the rate was 95.6%. 
              &lt;p&gt; 
              &lt;p&gt;The most common reasons for dissatisfaction were residual refractive error, dry eyes, older age, or night vision symptoms, such as halo or glare.
              &lt;p&gt; 
              &lt;p&gt;&quot;Because this review process was systematic, transparent, and based on carefully vetted international and U.S. research, the findings are highly reliable,&quot; Dr. Solomon said.
              &lt;p&gt; 
              &lt;p&gt;But he and colleagues noted that -- like all such reviews -- the study has limitations, including heterogeneity of data that makes it difficult to combine results. 
              &lt;p&gt; 
              &lt;p&gt;&lt;table cellspacing=&quot;0&quot; hspace=&quot;1&quot; style=&quot;border-style:solid; border-width:1px; border-color:#8dabbc; font-family:arial; font-size:12px; background-color:#DBE9F2; padding:5px 5px 5px 5px;&quot;&gt;
&lt;tr&gt;&lt;td&gt;The study was supported by the American Society of Cataract and Refractive Surgery Foundation, the NIH, and Research to Prevent Blindness. 
              &lt;p&gt; 
              &lt;p&gt;Dr. Solomon reported financial links with Alcon Laboratories, Allergan, Advanced Medical Optics, Advanced Vision Research, Bausch &amp;amp; Lomb, Eyemaginations, and QLT.&lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;
           
    </recommendedItem>
    <recommendedItem id="20090101_19_2415"
                     title="Common Cataract Surgery Accelerates Diabetic Retina Deterioration"
                     score="-0.006"
                     href="http://www.medpagetoday.com/Ophthalmology/GeneralOphthalmology/tb/15313?impressionId=1265787309211"
                     
      PRINCETON, N.J., July 31 -- Diabetics who undergo phacoemulsification cataract surgery risk doubling the rate at which their vision deteriorates because of damage to the capillaries that nourish the retina, a new study shows.
              &lt;p&gt; 
              &lt;p&gt;However, phacoemulsification results in less progression of retinopathy than older methods of intracapsular and extracapsular cataract surgery, according to a report in the Aug. 1 edition of &lt;em&gt;Ophthalmology&lt;/em&gt;.
              &lt;p&gt; 
              &lt;p&gt;The older methods require larger incisions than phacoemulsification, Jie Jin Wang, MMed, PhD, of the University of Sydney, and colleagues noted.
              &lt;p&gt; 
              &lt;p&gt;A year after phacoemulsification surgery, 28.2% of the eyes that were operated on developed diabetic retinopathy, compared to only 13.8% of the nonsurgical eyes (95% CI 1.06 to 6.61).
              &lt;p&gt; 
              &lt;p&gt;In patients who had the surgery in only one eye, 35.6% of the eyes operated on showed signs of diabetic retinopathy progression compared to only 20% of the eyes that weren&apos;t surgically altered (95% CI 0.85 to 5.71).
              &lt;p&gt; 
              &lt;p&gt;&quot;We found that phacoemulsification surgery may still exacerbate the development and progression of diabetic retinopathy in older patients with diabetes, compared with fellow eyes of the same patients that had not undergone phacoemulsification surgery during a 12-month period.&quot;
              &lt;p&gt; 
              &lt;p&gt;Even so, they concluded, &quot;the risk magnitude for diabetic retinopathy progression after phacoemulsification surgery was found to be substantially lower than the progression rates previously documented after surgery using older surgical techniques.&quot;
              &lt;p&gt; 
              &lt;p&gt;The researchers followed a subset of 190 patients ages 65 years or older with type 1 or 2 diabetes who underwent phacoemulsification cataract surgery at Westmead Hospital in Sydney, Australia, between 2004 and 2006. The participants included 90 women and 100 men, with a mean age of 74.
              &lt;p&gt; 
              &lt;p&gt;During the surgery an ultrasound or laser probe is used to break apart the cloudy lens of the eye, and the lens fragments are removed. A foldable synthetic lens is then inserted through a small incision, which requires no sutures.
              &lt;p&gt; 
              &lt;p&gt;Of the patients, 56 had previously undergone cataract surgery on one eye.
              &lt;p&gt; 
              &lt;p&gt;The researchers found that the prevalence of diabetic retinopathy was higher at the beginning of the study in these 56 eyes than in the 324 eyes that had not been operated on (71.4% versus 48.2%, respectively, adjusted OR 2.16, 95% CI 1.16 to 4.03).
              &lt;p&gt; 
              &lt;p&gt;The researchers followed 169 of the patients for 12 months after their operations, tracking the condition of 278 eyes that had undergone surgery and 60 eyes that retained their original lenses.
              &lt;p&gt; 
              &lt;p&gt;They assessed the condition of the patients&apos; eyes prior to surgery and at one, six, and 12 months after surgery by taking digital photographs of their retinas. They also determined the progression of their vision deterioration using the Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity test.
              &lt;p&gt; 
              &lt;p&gt;Diabetic retinopathy developed or progressed in about one-third of the surgically altered eyes and about one-fifth of nonoperated eyes.
              &lt;p&gt; 
              &lt;p&gt;While the findings suggest that surgery accelerates the deterioration of the patients&apos; vision, Wang and colleagues cautioned that patients who require cataract surgery may simply be at higher risk of diabetic retinopathy.
              &lt;p&gt; 
              &lt;p&gt;&quot;One possibility that this study cannot easily address is the concern that both diabetic retinopathy and cataract are complications of diabetes, and therefore the presence of cataract may be a marker for greater severity or increased likelihood of progression of diabetic retinopathy,&quot; they wrote.
              &lt;p&gt; 
              &lt;p&gt;They called for physicians to closely monitor at-risk eyes and consider preoperative laser treatment to adequately control macular edema and other problems related to diabetic retinopathy.
              &lt;p&gt; 
              &lt;p&gt;&quot;Although these findings should not argue against performing cataract surgery in older people with diabetes, it is important for clinicians to recognize this residual risk and to take appropriate precautions,&quot; they wrote.
              &lt;p&gt; 
              &lt;p&gt;&lt;table cellspacing=&quot;0&quot; hspace=&quot;1&quot; style=&quot;border-style:solid; border-width:1px; border-color:#8dabbc; font-family:arial; font-size:12px; background-color:#DBE9F2; padding:5px 5px 5px 5px;&quot;&gt;
&lt;tr&gt;&lt;td&gt;The study was supported by the Australian National Health and Medical Research Council.
              &lt;p&gt; 
              &lt;p&gt;The authors reported no financial conflicts of interest.&lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;
       
    </recommendedItem>
    <recommendedItem id="20090101_2_279"
                     title="Laser Surgery for Myopia Effective Over a Decade"
                     score="-0.007"
                     href="