Aniseikonia Associated with Cataract Surgery and Its Impact on Post-Surgical Binocular Vision
Qingqing Tan1, Xuan Liao1, Changjun Lan1, James Lewis2,3, Mitchell Scheiman2
1Department of Ophthalmology, Affiliated Hospital of North Sichuan Medical College, Medical School of Ophthalmology & Optometry, North Sichuan Medical College, Nanchong 637000, China 2Pennsylvania College of Optometry at Salus University, Elkins Park 19027, USA 3LewisLASIK Eye Clinic, Elkins Park 19027, USA
Abstract：Objective: To investigate the change in the aniseikonia after cataract surgery and its effect on postsurgical binocular vision status. Methods: A prospective, clinical study of 73 patients ( ≥ 50 years) who elected to undergo bilateral cataract surgery at Pennsylvania College of Optometry at Salus University and LewisLASIK Eye Clinic from January 2019 to November 2019 was implemented. All subjects underwent aniseikonia test before surgery of the first eye. Aniseikonia and comprehensive binocular vision test battery were performed for all subjects after surgery of the second eye. A comprehensive binocular vision test battery including stereopsis, ocular alignment, fusional vergence, vergence facility and near point of convergence. A detailed diagnostic classification protocol was applied to identify the presence of binocular vision anormalies after surgery. McNemar Chi-square test was used to compare the proportion of significant aniseikonia before and after surgery. Spearman test was used to detect the correlations between aniseikonia and anisometropia, interocular difference in intraocular lens (IOL) power or stereopsis. Logistic regression was used to test the effects of aniseikonia on post-surgical binocular vision status.The receiver operating characteristic (ROC) curve was used to determine the cut-off values of aniseikonia that can predict the presence of post-surgical binocular vision anormalies. Results: The mean follow-up interval was 2 months. A total of 51 subjects were included, of which 13 cases (25%) were diagnosed with non-strabismic binocular vision anormalies after surgery, mainly with convergence insufficiency (11 cases, 22%). There were no statistically significant changes in the changes in proportions of clinically significant aniseikonia (≥3%) after surgery (x2 =1.14, P=0.286). There were no statistically significant correlations between aniseikonia and anisometropia, interocular difference in IOL power or stereopsis either at baseline or after surgery. Logistic regression results showed significant associations between the presence of post-surgical binocular vision anormalies and pre-surgical (OR=1.46, P=0.047), post-surgical (OR=1.67, P=0.031) aniseikonia, and surgically induced (OR=1.48, P=0.021) aniseikonia. ROC curve indicated that the best area under curve (AUC) was shown for surgically induced aniseikonia (AUC=0.74), and a cut-off value of 2.4% provides the optimal sensitivity and specificity for whether predicting a post-surgical binocular vision anormaly. Before and after surgical aniseikonia had similar AUC values (0.68 vs. 0.66), and the cutoff values of 3.3% and 2.9% showing the best combination of sensitivity and specificity. Conclusions: Bilateral cataract surgery does not appear to significantly change aniseikonia. However, this study found a significant predictive effect of aniseikonia for the occurrence of binocular vision disorders after surgery.
谭青青,廖萱,兰长骏,等. 白内障手术相关的不等像及其对术后双眼视觉的影响[J]. 中华眼视光学与视觉科学杂志, 2022, 24(11): 820-826.
Qingqing Tan1,Xuan Liao1,Changjun Lan1,et al. Aniseikonia Associated with Cataract Surgery and Its Impact on Post-Surgical Binocular Vision. Chinese Journal of Optometry Ophthalmology and Visual science, 2022, 24(11): 820-826. DOI: 10.3760/cma.j.cn115909-20220318-00102
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