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Lying down looking down test: Evaluating patient suitability for small incision cataract surgery using assisted

Vimal K Rajput¹, Shweta Bhalsing², Snehal Bhalsing³

¹Department of Pediatric Ophthalmology and Strabismus, Prime Vision Superspeciality Eye Care, Ahmednagar, Maharashtra, India.

Indian Journal of Ophthalmology

|January 19, 2021

Summary

The Lying down looking down (LDLD) test accurately identifies patients suitable for assisted topical anesthesia (ATA) during cataract surgery. This simple, outpatient department-based test shows high specificity and positive predictive value for successful ATA.

Keywords:

LDLD Objective test topical MSICS

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Area of Science:

Ophthalmology
Surgical Anesthesia Techniques
Patient Assessment

Background:

Manual small incision cataract surgery (MSICS) can be performed under assisted topical anesthesia (ATA).
Accurate patient selection is crucial for the success of ATA.
A reliable preoperative assessment tool is needed to determine suitability for ATA.

Purpose of the Study:

To evaluate the Lying down looking down (LDLD) test for assessing patient suitability for ATA during MSICS.
To compare the outcomes of ATA with assisted local anesthesia (ALA).

Main Methods:

The LDLD test was performed preoperatively on 250 patients.
The test involves assessing downward gaze, eye squeezing, and withdrawal reflexes with the patient lying down.
Statistical analyses (Chi-square, Fisher's exact tests) were used to determine the association between LDLD results and ATA suitability, calculating positive predictive value and specificity.

Main Results:

A positive LDLD test was significantly associated with successful ATA (P=0.002).
The LDLD test demonstrated high positive predictive value (92.56%) and specificity (93.48%) for ATA suitability.
Fewer complications, such as congestion and corneal edema, were observed in the ATA group compared to the ALA group.

Conclusions:

The LDLD test is a simple, highly specific, outpatient department-based method for determining patient suitability for MSICS under ATA.
The LDLD test can aid in optimizing patient selection for ATA, potentially improving surgical outcomes and patient comfort.