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Biomedical subjects

E Mönestam

Publications and source records attributed to E Mönestam.

11 recordsLinked to original sources
PubMed2005

Visual function and car driving: longitudinal results 5 years after cataract surgery in a population.

AIMS: To determine visual function in drivers who had cataract surgery 5 years previously, and to analyse longitudinal data, by comparing preoperative and postoperative changes in subjective driving ability and objective visual function. METHODS: All patients (810) who underwent cataract surgery, during a 1 year period, were prospectively studied. Data regarding present driving status were collected from self administered questionnaires and visual acuity (VA) data were measured before and after surgery. All patients who were alive 5 years later were invited to participate with a new eye examination and questionnaire. RESULTS: Before surgery 36 active drivers (16%) did not fulfil the visual requirements for driving; with improved glasses this number could be reduced to 24 (11%). 5 years after surgery, the corresponding figures were 5% and 3% (5/174), respectively. Before surgery 50% stated visual difficulties while driving in daylight and 79% in darkness. A few months and 5 years after surgery the corresponding figures were 6% and 5%, respectively, for daytime driving and 34% and 44%, respectively, for night-time driving. CONCLUSIONS: Long term results regarding cataract surgery in car drivers are beneficial. 5 years after surgery only a few patients drove not fulfilling the requirements, but there were a larger proportion of patients with problems driving in darkness compared with a few months after surgery.

Aged↗
PubMed2003

Nitrous oxide anesthesia and intravitreal gastamponade.

The right eye of a 66-year-old man was operated with vitrectomy and peeling of an epiretinal membrane. Perioperatively, the eye was filled with 20% SF6 gas to tamponade retinal breaks. Five days later the patient underwent prostatectomy under general anesthesia using nitrous oxide. Postoperatively the eye had no light perception as a result of ischemic retinopathy. The movement of nitrous oxide into gas-containing spaces in the body has been known for a long time. The use of nitrous oxide in patients with intravitreal gas will elevate the intraocular pressure with risk for closure of the central retinal artery. The present case report highlights the problems that can occur when preoperative assessment is carried out a long time before surgery.

Aged↗
PubMed2002

Analysis of mean retinal transit time from fluorescein angiography in human eyes: normal values and reproducibility.

OBJECTIVE: To evaluate three different techniques to quantify retinal blood flow transit times in normal human eyes from fluorescein angiograms. SUBJECTS AND METHODS: Fluorescein angiograms were recorded on two different occasions in 18 normal individuals with a scanning laser ophthalmoscope. The angiograms were digitized (5 frames per second) and the images were aligned. Mean transit times (MTT) were analysed with a newly developed technique based on an impulse-response analysis (MTTIR) and again with the conventional technique (MTTSLOPE). Arterio-venous passage times (AVP) were also calculated. RESULTS: At the first determination, mean values (SD) for MTTIR, MTTSLOPE, and AVP were 3.22 (0.78), 4.88 (1.86), and 1.46 (0.57) seconds, respectively. Detection of an increase of 25% with a power of 80% requires groups of 12, 86 and 17 individuals for the three techniques, respectively. CONCLUSIONS: Mean transit time is a well-defined physiological parameter. The technique based on impulse-response analysis allows for analysis of even badly defined dye curves. We found this technique to be superior to the conventional technique in terms of reproducibility.

Adult↗
PubMed2001

Topical anesthesia for cataract surgery: a population-based perspective.

PURPOSE: To analyze the anesthetic regimen and sedation in a population-based cohort of unselected cataract surgery cases operated on with the goal of maximizing the percentage of patients with topical anesthesia and no sedation. SETTING: Department of Ophthalmology, Norrlands University Hospital, Umeå, Sweden. METHODS: This prospective observational population-based study comprised all patients having cataract surgery during a 1 year period at 1 institution. Data were collected from the patients' records, which were standardized. Outcome measures were use of preoperative sedation, type of anesthesia, intraoperative complications, and adverse events. RESULTS: The study comprised 890 cases performed by 4 surgeons. Seventy-two percent of patients had no sedation and topical anesthesia only. All patients except 1 who had previous cataract surgery with topical anesthesia chose the same method for their second-eye surgery. The rate of posterior capsule rupture was in the expected range for a population with high incidences of pseudoexfoliation and mature cataract. CONCLUSIONS: It is possible to achieve a high percentage of effective topical anesthesia for cataract surgery in a population-based setting. The findings have implications for cost-containment in health services.

Administration, Oral↗
PubMed1999

Dissatisfaction with cataract surgery in relation to visual results in a population-based study in Sweden.

PURPOSE: To evaluate dissatisfied patients and those with subjectively worse visual ability after cataract surgery and to analyze how these factors relate to poor visual acuity results (worse than 20/40). SETTING: Department of Ophthalmology, Norrlands University Hospital, Umeå, Sweden. METHODS: A prospective, population-based study of cataract surgery outcome was conducted. All patients (459 surgeries) who had cataract surgery during a 1 year period were studied using self-administered questionnaires and data from patient records. Outcome measures were (1) patient degree of satisfaction with the result, (2) subjective visual ability after surgery of visually demanding tasks such as reading, television viewing, orientation in unfamiliar surroundings, and distance estimation far and near, and (3) visual acuity results. RESULTS: After surgery, 37 of the 459 cases (8%) were dissatisfied. These patients had a significantly lower age-corrected visual acuity in the operated eye than the satisfied patients (P < .0001). Ten percent said 1 or more visual ability was worse after their cataract surgery. Logistic regression analysis revealed that the visual acuity in the better eye before surgery and age-related maculopathy were the most significant risk factors. Poor visual acuity after surgery in the operated eye was found in 22%, mostly as a result of concurrent age-related maculopathy, diabetes, or glaucoma. Four percent had no improvement in visual acuity in the operated eye. CONCLUSIONS: Dissatisfaction seemed to rely mostly on visual acuity in the operated eye. Low visual acuity in the better eye before surgery and age-related maculopathy were the most significant risk factors for subjectively worse visual ability after surgery. The degree of satisfaction after cataract surgery and changes in visual ability differed in important ways from visual acuity as a measure of visual function.

Activities of Daily Living↗
PubMed1999

Impact of cataract surgery on visual acuity and subjective functional outcomes: a population-based study in Sweden.

PURPOSE: First, to determine the effects of cataract surgery on subjectively experienced visual function and visual acuity in a defined population, at a specific frequency of surgery. Secondly, to validate questionnaire data regarding the visual function of cataract patients. METHODS: A prospective population-based investigation of the subjective visual functional and visual acuity outcomes of cataract surgery over a 1 year time interval at one institution was conducted. All operated cases (n = 459) were grouped into three levels of visual impairment, according to the preoperative visual acuities of their better eyes. Subjective reading, TV watching, distance estimation and ability to orientate in unfamiliar surroundings, before and after surgery, were assessed using self-administered questionnaires. The subjective outcomes were related to the subjects' post-operative visual acuities. The statistical evaluations comprised analyses of variance, Yates'-corrected chi-squared tests, weighted kappa and correlation statistics. RESULTS: The pre-operative subjective visual disabilities of the patients were significantly correlated with the pre-operative visual acuities of the patients' better eyes. There was an improvement in subjective reading ability, distance estimation and ability to orientate in unfamiliar surroundings for most patients at all three pre-operative visual acuity levels. After surgery there was a stronger correlation between the subjective functional improvement and the increase in visual acuity for the operated eye than for the better eye. CONCLUSIONS: An incidence of cataract surgery of 3.3 per 1000 population for the year the present study was conducted seems not to be an over-utilisation of resources. Irrespective of the visual acuity level before cataract surgery, the vast majority of patients gain better subjective visual function and better acuity after surgery. It is possible to gain valid information from cataract surgery patients using a short questionnaire.

Activities of Daily Living↗
PubMed1998

Cataract surgery from a gender perspective--a population based study in Sweden.

PURPOSE: To determine the presence of any gender-related differences of preoperative subjective visual functional problems that may explain the higher frequency of cataract surgery found in women. METHODS: All patients (n=453) who, during a one-year period, underwent cataract surgery at Norrlands University Hospital, Umeå, Sweden, were included in the study. Incidence, age-distribution, visual acuity, self-estimated ability to perform vision dependent tasks as well as subjective symptoms from the cataractous eyes preoperatively and visual acuity after surgery were analyzed separately in males and females. RESULTS: Before surgery there were no statistically significant differences between men and women in visual acuity of the eyes to be operated on and the fellow eyes. Preoperatively women had significantly more subjective problems with distance-estimation for near and far (57% and 60%, respectively) compared to males (45% and 43%, respectively). Women had significantly larger problems orientating in unfamiliar surroundings. CONCLUSION: There are gender-related differences in self-assessed visual function before surgery that might contribute to the higher incidence of cataract surgery in women. Preoperatively women experience a higher degree of visual functional problems than men. Women were not found to demand cataract surgery earlier than men when preoperative visual acuities were compared.

Adult↗
PubMed1997

The impact of cataract surgery on low vision patients. A population based study.

PURPOSE: To assess the impact of cataract surgery on low vision patients. METHODS: Self-estimated ability to perform visually demanding tasks before and after cataract surgery and expectations and satisfaction with the surgery were analysed in all low-vision patients (n = 52), who during a one-year period underwent surgery at Norrlands University Hospital in Umeå, Sweden. Self-administered questionnaires were used and the records of the patients were studied. RESULTS: The majority (81%) of the low vision patients reported an improved ability to perform visually demanding tasks after surgery. The number of patients who were unable to read newspaper-size print decreased significantly, from 44% to 21% after surgery. The subjectively improved visual ability as well as the augmentation of VA of the operated eye were both significantly related to satisfaction with the outcome of surgery. CONCLUSION: Most low-vision patients with significant cataract benefit from surgery, both subjectively by increased ability to perform visually demanding tasks as well as by an improved visual acuity. Particularly patients with loss of peripheral visual fields subjectively gain in orientation ability. It is important to reduce unreasonable expectations about the outcome of the surgery.

Activities of Daily Living↗
PubMed1997

Impact of cataract surgery on car driving: a population based study in Sweden.

AIMS: To investigate the outcome of cataract surgery on the patients' self estimation of visual function while driving. Furthermore, the benefit of surgery to the car driving population was determined. METHODS: A total of 208 consecutive patients (211 cases) with driving licences, who underwent cataract surgery with intraocular lenses, were studied prospectively using self administered questionnaires. Their self estimated degree of visual functional problems while driving were analysed before and after surgery. RESULTS: Visual problems while driving declined from 82% preoperatively to 5% after surgery. Remaining visual problems with the operated eye were present in only seven patients. Problems in estimating distance while driving decreased from 37% before surgery to 6% after surgery. Twenty three per cent of the patients drove with a visual acuity below the requirements for driving in Sweden before surgery and only 4% after surgery. There was no correlation between the degree of visual problems while driving and visual acuity before surgery. CONCLUSION: The car driving population greatly benefited from cataract surgery in terms of subjectively improved visual function and distance estimation while driving. Functional visual problems while driving should be considered as an indication for cataract surgery. These findings also indicated that the second eye should be operated on, if necessary, to achieve optimal ability to estimate distance and give best possible road safety.

Adult↗
PubMed1991

Eye injuries in northern Sweden.

An analysis of 927 eye injuries treated at the University Hospital of Umeå, Northern Sweden, during a one-year period has been made. The estimated incidence was 8.1 per 1000 population. 86% of the injured were men. An overrepresentation of severe injuries were found in children and young adults, aged 10-19 years. 94.5% of the injuries were minor. The most common diagnosis was foreign body adherent to cornea or conjunctiva (40%). All chemical injuries were superficial. One-third of the sports injuries were caused by hockey-bockey and indoor bandy. Most of these were major injuries. The total cost of the injuries was assessed at SEK 1300,000. More information to the public concerning use of safety glasses and potential risks of eye trauma could reduce eye injury incidence.

Adolescent↗