Study compares M-SICS, phaco in charity camp population

Manual small-incision cataract surgery (M-SICS) can be performed at a much lower cost compared with phacoemulsification, but to answer the question of whether quality-specifically, uncorrected vision, astigmatism, visual rehabilitation, and safety-is sacrificed when M-SICS is performed instead of phaco, Sanduk Ruit, MD, Geoffrey Tabin, MD, David F. Chang, MD, and colleagues conducted the first prospective, randomized trial of phaco versus M-SICS in a charity camp population (Am J Ophthalmol. 2007;143:32–38).

During the study in Nepal, Dr. Ruit performed M-SICS and Dr. Chang performed phaco in more than 100 randomly assigned subjects.

The authors concluded that both procedures offer excellent visual outcomes with low complication rates. Because M-SICS could be performed significantly more quickly and was less expensive and less technology-dependent than phaco, it may be more appropriate for the treatment of advanced cataracts in developing nations, they said.

Of note, Dr. Chang said in his Binkhorst Lecture at the annual meeting of the American Society of Cataract and Refractive Surgery, “With these brunescent nuclei on postop day one, the acuities were much better in the M-SICS group due to less corneal edema. This is actually important in this unsophisticated population, which doesn’t really understand that you may have to wait a little bit for your eye to recover. Sometimes, someone will decide not to have surgery because their friend from the day before’s surgery still isn’t seeing very well.”

By 6 weeks, astigmatism rates were similar in both groups, and the numbers of patients with uncorrected visual acuity of at least 20/60 (the World Health Organization definition of functional vision) were similar at 6 weeks, 6 months, and 1 year.

“Uncorrected acuity, of course, is very important in this population, many of whom will never get or wear spectacles,” Dr. Chang said.

At 6 months, more patients in the phaco group than in the M-SICS group had best-corrected visual acuity of at least 20/20, he said, “but if you define your goal as restoring 20/60 functional vision to a poor, charitable population that’s blind, that doesn’t need to drive on the freeway, use a computer, and in most cases cannot even read, then what the study did show is that M-SICS can do as well as phaco at a fraction of the cost, and with much higher efficiency.”

To read more about ways in which cataract is being addressed in the developing world, visit www.ophthalmologytimes.com/cataractprograms