Preoperative and Postoperative Glarometer Measurements in Patients Having Cataract Extraction with Placement of Posterior Chamber and Accommodating IOLs Michael Ehrlich, MD 1 Steven Siepser MD, FACS 2 1- Wills Eye Institute, Philadelphia, PA. No financial interest. 2 - Siepser Laser Eyecare, Wayne, PA. Receives a royalty from Gulden Ophthalmics for the Glarometer

Background Patients often present in the perioperative period with glare symptoms Usually attributed to cataracts AAO preferred practice pattern states that glare testing “...can help to better assess and quantify functional visual impairment due to a cataract.” 1 But no consensus on how to test and quantify glare AAO Cataract and Anterior Segment Panel, “Preferred Practice Pattern: Cataract Surgery in the Adult Eye” January 2008, 11

Background Many devices measure impact of glare on visual acuity or contrast sensitivity Decision to operate often hinges on results of these glare tests, which can be expensive and time consuming Therefore additional need to directly quantify glare symptoms and to show improvement with surgery

Patients who complain of glare may have reduced visual acuity or contrast sensitivity, but many note glare halos and starbursts Glare Halos Glare Starbursts

Glarometer Simulates and quantifies patient glare experience Patient measures glare halos and starbursts on scale from 1-5 Non-mydriatic measurements Monocular Distance 5 feet Exam door closed, lights fully dimmed

Study Design Hypothesis: Glarometer measurements of halos are starbursts are statistically reliable Cataract surgery with a monofocal lens (Alcon sn60wf) and an accommodative lens (Bausch and Lomb Cyrstalens) results in a statistically significant decrease in measurements of glare halos and starburts

Study Design Patient population: Monofocal lens: 50 patients from the Cataract and Primary Eye Care Service at Wills Eye Institute undergoing non-complex, non-complicated surgery by Michael Ehrlich, MD Accommodative lens: 25 patient from Siepser Laser Eyecare undergoing non-complex, non-complicated surgery by Steven Siepser, MD, FACS Age-matched controls for each study arm Data points: Collected pre-operative, post-op day #1 and post-op month #1 BCVA (LogMAR) Glare Halos Glare Starbursts

Study Results Reliability Correlation Coefficient Multiple measurements of the control group show the Glarometer to be reliable compared to other devices Elliott DB, Bullimore MA. Assessing the reliability, discriminative ability, and validity of disability glare tests. IOVS: 1993 (34)1:

Study Results Correlation between control data points Correlation Coefficient There is a limited relationship between halos and starbursts in the control group. The relationship between glare and visual acuity was stronger.

Study Results Correlation between data points The relationship between all variables decreased with intervention in all groups

Study Results Improvements in Glarometer Score with Surgery

Conclusions Reliability measurements of the Glarometer are consistent with other adjunctive glare tests There was a statistically significant improvement in both glare halos and starbursts with cataract surgery in both monofocal and accommodative lenses The Glarometer can be a useful tool for clinicians in evaluating and documenting glare in cataract evaluations. Further studies: Glarometer measurements pre and post-operative for Lasik patients Correlate Glareometer measurements with VF-14 quality of life survey