Wikipedia:Peer review/Cataract surgery/archive1

Cataract surgery

I've listed this article for peer review because it has just been promoted to GA and I would like comment and suggestions to prepare it for FAC. I am mainly looking for gaps to fill, i.e. what have I missed? Also are there things that are not clear enough that need to be explained better without bogging down on excessive detail - there are several supporting articles linked which can carry much of that load. I am aware that the regional sections and history sections could be expanded, and will do so if and when I find suitable sources, so those would also be useful.

Cheers, · · · Peter Southwood ^(talk): 05:13, 22 August 2023 (UTC)

STANDARD NOTE: I have added this PR to the Template:FAC peer review sidebar to get quicker and more responses. When this PR is closed, please remove it from the list. Also, consider adding the sidebar to your userpage to help others discover pre-FAC PRs, and please review other articles in that template. Thanks, Z1720 (talk) 00:51, 26 August 2023 (UTC)

@Pbsouthwood: This has been open for over a month without comment. Are you still interested in receiving feedback? Z1720 (talk) 14:42, 26 September 2023 (UTC)

Useful feedback is always welcome, but waiting delays nomination for FA. Do you think it is worth waiting longer? There is no great rush. · · · Peter Southwood ^(talk): 05:08, 27 September 2023 (UTC)

@Pbsouthwood: I would suggest either asking for feedback on Wikiprojects attached to this article, or just closing this and nominating it at FAC. Z1720 (talk) 01:02, 12 October 2023 (UTC)

@Pbsouthwood: It has been another month without comments. Any thoughts about closing this and nominating it to FAC? You can also post a note at WP:MEDICINE and see if someone is willing to PR this. Z1720 (talk) 21:15, 14 November 2023 (UTC)

I'm very sorry to be so late to this, but I'm happy to have a look and give comments. No need to keep the PR open just on my behalf; I'm happy to post at the talk page if this shuts down. It'll take me around a week to get to this, so please ping me if you haven't heard from me by then. Looking forward to the read. Thanks for taking some time to update an article on such a major topic. Ajpolino (talk) 02:34, 1 December 2023 (UTC)

No apologies expected, your attention is appreciated. I felt the need to improve the article as it did not answer my questions at the time I had the procedure, so I stepped up and fixed what seemed necessary and possible, and it just sort of went on from there. As it is such a common procedure I thought it would be useful to a wide audience. Cheers, · · · Peter Southwood ^(talk): 04:46, 5 December 2023 (UTC)

Ajpolino

Some thoughts as I read through the article. All gentle suggestions that can be taken or left freely.

First round of comments

Lead Cataract surgery, which is also called lens replacement surgery, is the removal of the natural lens (also called the "crystalline lens") of the human eye that has developed a cataract, an opaque or cloudy area.  Done Over time, metabolic... acuity at low light levels. - This information is all about cataracts rather than the surgery. I suspect this could be removed and the prime real estate at the top of the article could be instead used to summarize cataract surgery info. You have a point, I will look into this more carefully. Most of the section is a summarised description of the condition, so I have renamed it accordingly, and removed the duplicated content of the first paragraph. The next section is "Technique" which describes the procedure in moderate detail, and links to more detailed descriptions of the component sub-procedures. I think this is an overall improvement to the structure. causes little or no pain and minor discomfort to the patient - The context makes it obvious who you're referring to.  Done Well over 90% of operations... - "Well over" and "Over" mean the same thing to a reader. I feel that the emphasis is appropriate, so will leave it for FAC for second opinion. Description Cataract surgery, also... or cloudy area - It's somewhat jarring to read the sentence that's exactly the same as the lead's first sentence. Could we vary it up a bit? the paragraph has been removed as redundant. I think this section could use refocusing. I expected to find a description of cataract surgery (since I'm at Cataract surgery#Description). Instead it mostly described cataracts. I'd encourage you to consider which information needs to be hosted/duplicated where. Cataract surgery is a big topic, that surely we can fill an article summarizing. A reader seeking background is just a click away from cataract. I think the article flows more smoothly if we keep it focused on cataract surgery here, providing only the necessary context on the condition (and convenient wikilinking where needed to point interested folks towards more dedicated content). Good points. I have removed the duplication, and renamed the section to make it clear that it is a summary description of the condition. The description of the surgical procedure follows in the section "Technique", and even this is mostly summaries of more detailed descriptions of the component procedures, and covers the broader topic. Contraindications medical conditions that predict a high risk of unsatisfactory surgical outcomes. - Intriguingly vague. Do we know what these conditions might be? Unfortunately I do not. I would like to be more specific, and I think that it mostly refers to pre-existing conditions that may lead to complications during the procedure, like high blood pressure, or infections, but I will have a look and see if I can find something more specific. I found a few. They are not astonishing. The source I have cited is not great but probably good enough, and similar can be found on a bunch of websites of clinics offering the procedure, so I am not concerned that they are fringe opinions. The usefulness and effectiveness of the implantation of a posterior chamber intraocular lens (PCIOL) in infants younger... This sentence comes as a surprise here because as a reader I have no idea what a posterior chamber intraocular lens is or why anyone would want to put one in an infant. I have tried to clarify briefly. I did not want to overdo it. Let me know if it is sufficient. The rest of the paragraph also feels a bit abrupt. The only thing you've described so far is what cataracts are, so a list of uncommon contraindications is hard to contextualize. Perhaps you could consider re-ordering things to improve the flow of the article? I'm not sure the (optional) section order at MEDMOS will be very helpful here. The most recent medical procedure article to go through FAC was Complete blood count, where you can see the major editor landed on a non-standard section order that seems to flow fairly nicely for that topic. Perhaps with that in mind you could come up with something that flows to the reader's benefit? I will give this some thought. Perhaps it could be combined with Pre-operative evaluation? I have done that, it seems to work for me, as pre-operative evaluation is when the contraindications would be assessed. Technique this requirement led to a variation of ECCE... which does not usually need stitches - I'm left wondering why it doesn't require stitches... The wound is designed to be self sealing under internal pressure. this is described in detail elsewhere, so I will see if I can clarify suitably. Cataract surgery using intracapsular cataract extraction (ICCE) has been superseded by phacoemulsification and MSICS over time and is now rarely performed.[2] ECCE has largely become a contingency procedure to deal with complications during surgery - This is all a bit confusing. The first paragraph makes it seem there are two major surgical strategies: phaco and ECCE (and a minor variant MSICS that doesn't merit explanation). But then immediately in the next paragraph we're told there is a third, ICCE, which has been superseded by phaco and MSICS (didn't expect that, thought we'd be talking about ECCE). And then, to my surprise, we learn ECCE is only for contingencies... Perhaps this all could be reframed to read more clearly. If it confuses you it should be clarified. I will see what I can do. (MSICS is currently the most used form of ECCE, but is still a form of ECCE) There's a citation needed tag in the second paragraph. Reference found and cited and there is evidence that day surgery - Classic science literature filler words to look out for.  Done Some of the content in "Types of surgery" is repetitive to the two paragraphs above. Can things be rearranged to flow more smoothly? I have made some changes to the structure with this purpose in mind. Probably more to come. More came. I think I have reduced redundancy a fair amount. second instrument, which is sometimes called  Done What is meant by "a side port"? rewritten to clarify. making emulsification and the aspiration of cortical material (the soft part of the lens around the nucleus) easier. perhaps you could just say "making emulsification and removal easier" to lose a bit of jargon? I have rephrased but not entirely eliminated mention of cortical material. Management differs significantly from nuclear material. or a bimanual I-A system is this distinction necessary for the reader to understand? Simplified. The detailed description is in one or more of the linked articles and is not really necessary at this level. Is "Femtosecond laser-assisted cataract surgery" a type of surgery or an alternative tool for emulsification during phaco? Also the paragraph is a bit confusing. It opens may have fewer adverse effects and closes has not been shown to have significant... safety benefits Type of surgery. An expensive and precise cutting tool as I understand it. It seems that the jury is still out. Some claim it is better, others say not proven, no-one seems to think it is worse. Also has been reported to be safe this is the only method you write is reported to be safe, which leaves the reader wondering about the others. I think you can just cut the wording and we'll assume all surgical techniques are safe, except in the ways you tell us they aren't.  Done It is bleeding edge tech, so possibly more in question than methods that have decades of use. Not obvious why ECCE may be preferable for those with hard cataracts. Tried to clarify. Too much heating can injure the eye. Not really clear how Refractive lens exchange fits into this. It's another surgical method for cataract removal? The first sentence is effectively the same procedure used to replace a lens with high refractive error when other methods are not effective isn't really helpful because we don't know what procedure you're referring to or in what situations other methods aren't effective. Tried to clarify. Sometimes an implanted IOL does not work well, and must be swapped out. to provide refractive compensation for the lack of the damaged natural lens would it mean the same thing to just say "to replace the damaged natural lens"? Close enough, so  Done it is folded using a holder/folder or a proprietary insertion device, which is provided with the lens itself this sentence doesn't seem to be doing much for my understanding of the topic and can probably be cut. Simplified.

I'm going to stop here and make a few general comments:

1. The flow of the article is pretty choppy. I'd advise you to think about who your audience is, and imagine you're telling them this story. What context do they need to understand and care about each chunk of information? The article should be smoothly readable top-to-bottom. Sometimes rearranging material can do wonders; sometimes adding context is the solution; sometimes cutting material can ease the reader's burden.
2. As a consequence of the choppy flow, there's often material that's repeated in several places. If you do some reorganizing, I think you'll find repetition is no longer necessary. I'm particularly looking at the Technique subsections, but you may find the same phenomenon elsewhere. If you find yourself repeating a fact, consider whether it needs to be in there twice, or if a gentle reorganization can make the content flow better.
3. You've often included jargon that would be meaningless to an uninitiated reader. A few examples as I'm skimming: execute the capsulotomy, scleral tunnel wound (a wound in the "scleral tunnel", or a "tunnel wound" in the sclera?), ciliary sulcus, subluxated lenses, capsular bag, zonulodialysis, or the whole next sentence This requires a modification of refractive power because of the more-anterior placement on the optical axis. There's nothing wrong with teaching the reader new and essential words. But a worthy goal is that the reader should be able to understand the article without clicking out to each wikilink. You can typically help them along by putting new words into a supportive context, or if needed adding a very brief parenthetical explanation.

These are fair criticisms, as before I started editing the article I was also unfamiliar with them and had to look up a lot and find links, in some cases I had to write the links too. My problem is that I may think I understand a term, but not necessarily well enough to explain it reliably in a few non-technical words. Some of those terms may need a fair sized paragraph for an accurate description. I will probably put in a few more explanatory footnotes.

I'm happy to return to the article after you've done some reorganizing if you'd like. If you need more specific examples and suggestions, just let me know and I'll do my best. If you think I'm just dead wrong, you're welcome to say so -- certainly I won't be offended. You can ask at WT:MED for another set of eyes. Or I might recommend asking help of one of the other medicine FAC-experienced editors particularly Spicy (who ushered Complete blood count through FAC), Colin, Graham Beards, or Vaticidalprophet. Best of luck with this project! Ajpolino (talk) 18:18, 3 December 2023 (UTC)

Thanks for the review Ajpolino, I will consider your suggestions and get back to you where I need clarification. Cheers, · · · Peter Southwood ^(talk): 04:37, 5 December 2023 (UTC)

@Ajpolino:, I have done some reorganising. mainly of section "Techniques" which has somewhat reduced duplication of content as you suggested. I expect to tinker with it more in the hope of a smoother product, but it would be helpful if you could take a quick look to see if I understood your intention correctly. Cheers, · · · Peter Southwood ^(talk): 16:34, 5 December 2023 (UTC)

Yep, just give me a few days. If you haven't heard from me by the end of the weekend please ping me. Ajpolino (talk) 17:48, 6 December 2023 (UTC)

If any of the others mentioned by Ajpolino have any constructive comments, I would welcome them. · · · Peter Southwood ^(talk): 16:34, 5 December 2023 (UTC)

temporary break

Alright, I'm back at it:

Lead/Cataract

• Now that this is relabeled I guess I'll reiterate my opinion that the article would be better without the cataract-focused lead paragraph and subsequent section. Here we should only include the background necessary for a reader to understand this article. Knowing how one gets cataracts and how many people have them doesn't make the cut to me.
  • Thinking about this, will get back.

Techniques

• I think we're moving in the right direction here, but still some unclarities to iron out. First, in the opening sentence of the section we're told there are two main classes of techniques. From the next two sentences I assume the two classes are phaco and femtosecond laser-assisted phaco. But I think the intended meaning is that the two classes are phaco and ECCE. Could you clarify? (Maybe as simple as "Two main classes of cataract surgical...the world: phaco and ECCE" would be plenty to orient the reader).
  • Done
• I'm left unsure from the prior version and this if the femtosecond laser version of phaco is common or is flashy new tech.
  • The femtosecond laser is the expensive tech. What is obvious to me is not always obvious to someone else, so I will look into making this more clear.
    • Now explicitly stated.
• and its variation MSICS you define the acronym a couple sentences later.
  • Changed. Is it better?
• as the incision geometry is self sealing under internal pressure I get what you're saying, but is there a shorter/clearer way to say this?
  • "the incision is self sealing under internal pressure due to its geometry" is probably clearer, but a little longer. "the incision is self sealing" is shorter, but does not say why. Both the geometry and internal pressure in combination are why. I can't think of a way to make it shorter without leaving out information that would make it less clear. I prefer clarity to brevity in this case, and will use the first option unless something better comes up. I have also mentioned that the geometry should make it self sealing as sometimes a stitch is needed, and the sources do not specify that this is always a consequence of a geometrical error.
• Just a thought, perhaps you should describe phaco and MSICS together first, then in another paragraph describe ECCE and ICCE as former techniques that are now only employed in exceptional circumstances. Currently you describe MSICS and ECCE together, then ICCE separately. Seems from your description the latter two have more in common?
  • MSICS is a form of ECCE, main difference is the smaller incision, ICCE is significantly different in that the capsule is also removed, which has a range of possible consequences avoided in ECCE. The retention of an intact barrier between vitreous and aqueous can prevent several complications. Do I need to make this clearer in the article?
• Any idea why we don't use a cryoprobe for MSICS? Not clear why it'd be ICCE specific.
  • The sources do not mention a reason. Possibly the techniques for dissection and expression using the simple instruments needed for MSICS make the cryoprobe redundant, or maybe it is not compatible with the scleral tunnel incision. I cannot suggest these as they are not even OR, just guesswork by an engineer with no surgical qualifications, and it could be something else entirely. If I come across something by accident I might be able to clarify, but not even sure how to search for that sort of detail.
• Cataract surgery using intracapsular... is now rarely performed. repeats info in the prior paragraph and can be removed.
  • Done.
• Fiddly grammar but I think high... costs... has made should be "have made".
  • Agree, fixed.
• I think it might be nice and orienting to have Phacoemulsification is the most commonly performed cataract procedure in the developed world mentioned right up at the top of the section as you introduce phaco.
  • I am concerned that this would be undue weight considering the popularity of MSICS in India, and the sheer number of operations in India every year. It would not surprise me to find that MSICS significantly outnumbers phaco, or that it is the single most common procedure, but have not seen any comparative estimates.
• It seems like maybe Refractive lens exchange... high refractive errors. could be cut as its not about cataract surgery?
  • Removed and added to "See also" section as annotated links

Pre-operative evaluation

• is necessary to → "can"?
  • The sources seem to consider it necessary, though I would think the presence of a cataract is fairly obvious, and most of the screening looks like it could be done by a competent person with a checklist. My guess is a lot of the screening, maybe all, is done by someone other than the surgeon in the clinics for production line procedures, like in India, but I have not seen this written anywhere. My personal experience was a pretty thorough screening by the optometrist and an almost identical repeat with a few extra questions relating to contraindications by the surgeon. Also a brief interview by the anaesthetist and further checks by the nurse in pre-op on the day. I have edited to be less specific about who does what.
• It's not a law of encyclopedic writing, but we typically avoid using "patient" to describe those with diseases as we aren't writing our articles for healthcare workers (codified here). That said, this is an article about a type of surgery, so I get that the people undergoing cataract surgery are someone's patients. Just caught my eye and thought I'd flag it...
  • Yes, I am aware of the preference, and generally agree with the style recommendation, but how else should the people undergoing surgery be referred to?
• I didn't click through to them, but are the three references after the first sentence really all necessary to support that relatively straightforward claim?
  • No, they are appropriate at the other places they are used, but redundant at that place. Kept the one that mentions the largest number of conditions, removed the others which each refer to one.
• prospective studies have shown the risk is greatly reduced if the surgeon is informed that the person is taking the drug before the operation and has easy access to appropriate alternative techniques Not to be annoying, but this has kind of a "well duh" vibe and I think it can be cut.
  • I agree. I think someone else put that bit in but I was hesitant to remove without some consensus.
• "must" and "should" smack of medical textbook language, where the authors have an authority to recommend based on their (we assume) scholarly eminence. Typically we avoid that in encyclopedia articles. Easy workarounds are to be more clear with where the instruction comes from (e.g. "The International Association of Ophthalmologists recommends people with cataracts be screened for X, Y, and Z before surgery") or to phrase it in more generic descriptive terms (e.g. "Before undergoing surgery, people with cataracts are typically examined to ensure they don't have any of various medical conditions that can make cataract surgery more dangerous. Those with uncontrolled glaucoma can...").
  • Agreed, though to me there is a difference between testing and evaluation. I have removed "must" and "should" where I think appropriate, but have left a few uses where they simply state a logical consequence, and are not an instruction from authority.
• Actioning the above so that we're not commanding people in Wikipedia's voice will hopefully also make it less abrupt to the reader when we then follow by saying a Cochrane study found all of the pre-screening we just described makes no difference.
  • Good catch, but I don't think the Cochrane study is an exact match with the process above.
• Perhaps Contraindications and the opening Pre-operative evaluation paragraph/list can be merged even further? They're a bit repetitive now.
  • I will look into it.
    • I am not noticing much repetition. The contraindications are additional to the other screening points, which are more an indication of circumstances in which variations to the standard procedure would be expected. It may be possible to merge the contraindications subsection into the containing subsection.
      • The first pre-op bullet is getting at the same thing as several of the contra bullets, namely "if the cataracts aren't what's obscuring your vision, no need to get cataract surgery". I'm not sure the second list adds a lot of value after reading the first (more complete and clearly worded) list.
        • (to be revisited)
• The usefulness... child is older A brief topic sentence might help orient the reader on this paragraph. Maybe just rearranging the paragraph to "infants with congenital cataracts can have inflammation problems", "their eyes grow rapidly and unpredictably, making it challenging to fit an IOL", "a second later surgery is often required" would suffice?
  • Modified accordingly.
• intraocular lens is usually implanted into the eye to replace obvious from context.
  • Done
• Is capsular bag within the posterior chamber referring to a location in the eye? Perhaps "usually into a part of the eye called the capsular bag" gets across enough detail and orients the reader who (like me) is dumb enough to wonder if the bag is part of the eye or something an IOL is packaged in?
  • Clarified, I hope.

  Pulled away from the computer. Will continue tomorrow. Best, Ajpolino (talk) 03:06, 10 December 2023 (UTC)

  Thanks, · · · Peter Southwood ^(talk): 07:54, 10 December 2023 (UTC)

temporary break 2

• The list of formula names seems unhelpful to me unless you think a brief explanation of each formula is merited. Without context they're just names that don't really add to my understanding of the topic.
  • Agree. Too much information more relevant to Intraocular lens, which is hatlinked, so will move it there and trim down the detail. (Done)
• Refractive results...in 85% of cases. should this be in the Outcomes section? Or am I misunderstanding its meaning?
  • The stats refer specifically to the accuracy of estimating the refractive strength of the IOL, so are relevant to choosing the IOL, but on the other hand, they are outcomes, so could go there.
  • I moved them and prefer the new arrangement.
• Developments in intra-operative wavefront technology... or better). Not clear if you're describing a mainstream technology currently used in surgeries, or fancy new tech that might be used going forward...
  • It appears to be new tech that is not available everywhere, and probably costs a lot, so may take some time to penetrate the market, as the gains are real but not huge. I don't understand the technology, so difficult to clarify reliably.
• One model of accommodating ...implant, instead. I didn't really understand this paragraph. Is this a common style of lens or just something that exists? Is "accommodating lens" a term of art, or is this a lens that is accommodating? The consequences of its force responsiveness are not obvious -- are they what allow it to be focused by the ciliary body's contractions?
  • Not common, does not work with all people, costs more. The force responsiveness allows them to be focused by the same muscles and reflexes that previously focused the natural lens. I have partly rewritten in the hope of clarifying.
• Monofocal IOLs provide... spherical curvature maybe this should be moved before the discussion of bi/trifocal IOLs?
  • Done.
• Cataract surgery may be... a variation of monovision. this material should probably also be alongside the discussion of bi/trifocal IOLs since it's all about available lens types to correct for near/distance/both visions (or I'm misunderstanding it).
  • I have moved it, but some more clarification may be desirable.
• Monovision redirects to contact lenses. Is that desired?
  • Yes but it should have redirected to the relevant section. Fixed.
• The flow in the bunch of short paragraphs here is really choppy. Some material feels like it's dropped there at random. Is there any way you can reorganize this so that like material is all together and the topic flows smoothly like you're telling a story? I'm not sure I have a super useful answer here, but I can try to think of some example fixes if I'm not being clear.
  • I will make the basic changes then see if I can improve this.
• Are light-absorbing and light-adjustable lenses commonly being implanted? Or are these future tech?
  • Available in the US, not sure about elsewhere, but not commonly used. Possibly still considered a bit experimental.

Operation procedures

• Antibiotics may be administered pre-operatively, intra-operatively, or post-operatively. Frequently, a topical corticosteroid or nonsteroidal anti-inflammatory drug (NSAID) is used in combination with topical antibiotics in the post-operative phase is repetitive to the prior paragraph
  • The previous paragraph is preparation, whch is the subtopic of the section, Much of this paragraph is off topic post-op, so will move.
    • Moved and merged.
• sclerocorneal tunnel incision could you just say "the incision"? Or is this a particular subtype of incision?
  • It is the type of incision that is self sealing, and when done in the superior position requires the eyeball to be held still while rolled forward as much as possible to get the scalpel at the correct angle. Other types of incision are not made at such a low angle with the eyebrow in the way. It is, however probably better placed in the MSICS section and I will move it there.
  • Moved, and it now directly follows a more detailed explanation of the term. Serendipity.
• in the United States, 99.9% of lens and cataract procedures in 2012 were done in an out-patient setting over a decade ago (time flies). Any chance you can find something more recent? If not, perhaps the prior Lens and cataract procedures are commonly performed in an out-patient setting will suffice to get the meaning across without a statistic.
  • The trend is towards out-patient, and there will always be exceptions, so I think the stats are probably still valid, and have rephrased to that effect.
• Local anaesthetic nerve blocking has been recommended to facilitate surgery.[8] Topical anaesthetics may be used at the same time as an intracameral lidocaine injection to reduce pain during the operation I'm not clear on how this information differs from what I was told in the prior paragraph. Should they be merged?
  • They have been merged.
• The phacoemulsifiation description here is largely redundant to the description in the Techniques section. I get that it feels like a description should go in the "Operation procedures" section. But I think you should consider how you'd like to layout the article, and whether you'd like to be describing techniques in the Techniques section or in the Operation procedures section (and in either case, what use should the remaining section have?).
  • Noted, will consider after completing other fixes.
  • I think techniques => concepts and comparisons, operation procedures => practical aspects of the specific procedure is probably a good split.
• A more-posterior incision I assume here "more posterior" would mean closer to edge of the eye? If that's so, maybe it'd be clearer to just say "an incision closer to the edge of the eye..."
  • Edge of the eye is a bit ambiguous to me, (where is the "edge of the eye"? the eyelid has an edge, but it moves relative to the eye, and may or may not cover the are of the incision at any time. The globe has no edge.) while more posterior is well defined in comparison, as being in the dorsal direction. "Further back from the front of the eye/cornea" would be accurate and clear, but maybe a bit awkward-looking? The incision is usually close to the limbus, and I do not know what the limits in anterior/posterior positioning are, so must go with the sources.
• although they do not flow and retain their shape under low shear stress can this be rephrased or cut? I have a general sense of what shear stress is, but I don't understand from reading this why it would matter that OVDs don't retain their shape in such conditions...
  • It is important as it is the basic reason why they are used. Should I give a more detailed explanation? The linked page Ophthalmic viscosurgical device has a reasonably comprehensive explanation of how they work and why they are used, but it is slightly technical and I thought a bit much for this article.
• Capsulorhexis is the process of tearing ... I think you could orient the reader a bit better with a few gentle extra words; something like "After cutting through the cornea, a circular incision is made in the lens capsule allowing access to the lens within." I had to reread this paragraph at first thinking "wait didn't we already cut a small incision in the eye?" (because I'm too ignorant to know and remember my eye layers without help).
  • Done. A bit differently, but should work. Incidentally, capsulorhexis is specifically tearing the membrane, which apparently leaves an edge less susceptible to further tearing than cutting it, which is more likely to leave stress-raising notches.
• Comparative trials of MSICS...applicable to almost all types of cataract.[8] doesn't really fit in with your step-by-step account of how the surgery unfolds. Should it go up to the Techniques section (where there's similar discussion)? Down to Outcomes?
  • Good catch, I moved it into techniques.
• The precise geometry of the ... faces of the incision you describe the incision itself, which is helpful. Does this only apply to MSICS or does all the same apply to the smaller phaco incision as well?
  • Yes, but possibly to a lesser degree, so will look into it
• The depth of the anterior chamber and position... internal pressure is this MSICS specific? Or does this apply to phaco as well. Also you use the acronym BSS here but it's not defined until later.
  • Also applies to phaco, but in phaco OVD is used almost exclusively as far as I can make out, so I have not mentioned the possibility of anterior chamber maintainer there as I have not seen it in the literature. Phaco has much more intensive internal detail work and greater risk of bits of lens drifting around and getting lost.
  • First use of BSS has moved around a bit. It is now expanded and linked at first use again.
• A posterior capsulotomy... it has opacified you make it sound like this isn't done for cataract surgery (unless what has opacified?). Should it be removed?
  • Only done if the posterior membrane of the capsule has opacified on the visual axis. The membrane prevents vitreous leakage into the anterior chamber, which caused complications, so is left intact if possible. Sometimes it ruptures accidentally.
• Is the short iridectomy subsection necessary? It seems peripheral to our topic at hand.
  • It is done to prevent a relatively common complication, but maybe can be moved to another section (complications) or trimmed down to a mention. (both done)
• A general comment, I pasted this into MS Word which tells me that the article is currently at 11,733 words. You can see rules of thumb at WP:SIZERULE which recommends over 9,000 words Probably should be divided or trimmed. On the one hand, it's not a hard-and-fast rule; people come here to learn, and learning requires words. On the other hand, I think it can be helpful to know that this article is unusually long. My observation/opinion is that long articles are typically long because they're repetitive and overly detailed (though sometimes they're just covering enormous topics that require length to do them justice). Consider what can be done to tighten up this article. It's harder for me to see the line between "critical information" and "unnecessary detail" because I don't know the topic well; you're doubtless better suited to make that judgment.
  • Alright, out of curiosity I gathered a bit of context. There are currently a neat 30 articles at FAC. Their average prose length (excluding references and notes) is 4581 words. They range from a short 1864 (John B. Creeden) to a long 11184 (Pierre Boulez). That long one is an outlier. Second longest is Education at 9300 words. I haven't bothered to look at more recent FAs, but suffice to say this would likely be an unusually long entry at FAC. Something to consider... Ajpolino (talk) 06:10, 11 December 2023 (UTC)
    • I know the feeling. My only FA to date is Underwater diving, which was also unusually large, probably much the same size.
      • By my count that one was 8441 words at the time of promotion, making this article ~40% longer. Ajpolino (talk) 19:17, 12 December 2023 (UTC)
        • Fair enough, it has grown since promotion, and there is no reason to assume Cataract surgery would not also grow after promotion, as more missing content is noticed and added over time.
  • The sections most likely to expand over time and most suitable for splitting out are "History" and "Regional practice and statistics", which is a sort of Society and culture thing, particularly as history is already the largest single section. I am thinking about summarising these sections, then splitting them out, so there may be some additional repetition in those areas for a while as I put the summaries together.
  • I have split out and summarised History of cataract surgery, which was relatively straightforward, but have hit a bit of a block with the regional practice section as I cannot think of an appropriate title. Do you have any ideas? · · · Peter Southwood ^(talk): 08:02, 15 December 2023 (UTC)
    • Maybe "Global access to cataract surgery"? · · · Peter Southwood ^(talk):
    • Global access to cataract surgery now exists. Still need to summarise existing content. · · · Peter Southwood ^(talk): 10:11, 18 December 2023 (UTC)

  Made it through Post-operative care. Will be back for my daily dose (hopefully) tomorrow. Ajpolino (talk) 05:26, 11 December 2023 (UTC)

temporary break 3

• Pardon the delay, I'm back at last. Beginning with:

Complications

• Not a big deal but ... can cause lens fragments to be retained, corneal oedema, and cystoid macular oedema is a classic confusing list. My brain read this as three things that can happen to lens fragments ("they can be retained, corneal oedema, and CMO") and I had to re-read to get it right. You can make it flow easier by reordering list items "... can cause corneal oedema, CMO, or lens fragments to be retained."
  • Changed.
• ... mus be treated immediately and effectively in order to preserve - all treatments discussed in the article must be delivered effectively to have the intended effect
  • True, changed.
• In the event of a posterior capsule... a vitreoretinal specialist. Should this be discussed in the first paragraph with the other posterior capsule rupture material?
  • Yes, done.
• but its cases are monitored with increasing interest, since the interaction between the vitreous body and the retina might play a decisive role in the development of major pathological vitreoretinal conditions. I'm not sure what you're trying to get across here. Would "but may increase the risk of future vitreoretinal conditions" get the same thing across?
  • Not one of mine, so I looked at the source, and I think your wording expresses the findings better, so changed.
• has an incidence of about 0.3% to 28.4% That's an awfully broad range. Any context as to why it go from very rare to exceedingly common? Does it depend on surgeon, location, age of patient, etc.?
  • I tracked it down to a Lancet article which clarifies a bit and amended accordingly.
• Cataract surgery increases the rate of vitreous humour liquefaction, which leads to increased rates of RRD any context or anything you can add to make this more understandable? I guess I thought the vitreous humour was... already liquid...
  • Apparently vitreous starts off as a fairly stable gel, (vitreous=glass-like) and gets sloppier with age. Added link.
• a non-infectious inflammatory Given the context here, we wouldn't assume it's infectious.
  • Would the average reader make the same assumption? I really have no idea. I would not even know if the average reader would know the difference between infectious and inflammatory. Someone thought it was worth mentioning.
• but there is some concern that the clear cornea incision might predispose mean the same thing with or without.
  • I think the intended implication is that it is a minority concern.
• Sorry stepping away again. Back soon. Ajpolino (talk) 20:07, 15 December 2023 (UTC)
  • Back again, pardon the delay.
• vitreous' communication is the appostraphe a typo or is there a grammar intended that I'm missing.
  • Probably a typo, fixed.
• Common infective agents include coagulase-negative staphylococci and Staphylococcus aureus in about 80% of infections is redundant. Could rephrase to "Around 80% of infections are caused by..." or something like that.
  • Done.
• Notes 11, 12, and 13 seem unnecessary. The way you're using "exchange", "remove", and "reposition" fits with their normally understood definitions (I think).
  • I also thought so at first, but the source puts some emphasis on the distinctions, and "remove" in this context is a little non-intuitive, as it includes replace with a different model, whereas replace here refers only to the same model, so I put in all three in case the reader wonders about the others.
• which consists in the hyper-distention of the lens capsular bag I think there's a typo in here, but I'm not sure I understand the clause well enough to correct it.
  • I have attempted clarification, does it help?
• The list at the end is a bit weird. It's not clear what differentiates these items from the 10 paragraphs before them. Surely those other complications might also be reasons to exchange, remove, or reposition an IOL.
  • They could indeed be reasons to exchange, remove, or (less likely) reposition an IOL.
• Statistically, cataract surgery...
  • Redundant, removed.
• As of 2011, cataract surgery... Now 12 years ago. Can you find anything more recent?
  • Not really in scope for the section, so I just removed it.
• with the rate decreasing by about 20% over the study period. This is interesting. If procedures are generally getting safer, that would be nice to include in the article. That said, the fact that this study is from 2004-2006 makes me wonder if we should continue to include it in the article in 2023.
  • I will update if I can find anything more recent, but a 20% improvement over a short period seems worthy of mention.

Recovery and rehabilitation

• Is "grittiness" a term of art for eye care, or does it mean the sensation that there's grit in your eye (or something else)?
  • It is what the source used, without explanation. I assume it is the sensation of grit in the eye, as that ties in with personal experience. The source (NHS) targets the potential patient, so I doubt it is a term of art.

Outcomes

• This section doesn't flow well; the paragraphs don't seem to connect to each other and so each transition feels abrupt. The third and fourth paragraphs read as just a list of three studies. The second feels related to the first, but not quite blended with it. The sixth feels like it doesn't fit in with the rest of the section at all.
  • I agree about the flow, but do not know what to do about it. Sometimes reality does not lend itself to flowing prose. Maybe someone else will come up with a solution at FAC.

History

• It is one of the most common... self-sealing incisions feels unnecessary here. You just told us it has a long history, then jump to the present day. Slightly jarring.
  • That was in the lead to the original, much larger history section which was split out. I guess it is no longer useful, so removed it.
• Is there a wikilink that could explain "Couching"?
  • Yes, there was a linked article. The link was removed when I split the section out, so I have replaced it.
• In 1884... - 1884 is repeated.
  • Fixed.
• Can you lump some of these one-sentence paragraphs into proper paragraphs?
  • Done. I hope it is an improvement.
• In 2009... is this technique widely used? I don't recall it being mentioned above.
  • It is one of the techniques which can be used in MSICS to reduce the size of incision needed. I have no idea of how widely it is used. There may be a source somewhere out there discussing this but I have not seen it. I will take a look.
  • There seem to be a few other options for breaking up the lens. It is not clear which are most commonly used, so just removed mention.

Accessibility

• surgery is very variable Mean the same thing to a reader.
  • Variability occurs within bounds. In this case they are very widely spread relative to the possible range. Some readers may find the distinction meaningful, others may not.
• The global health situation of cataracts is improving vague. Do fewer people have cataracts? Or newer management strategies mean vision loss isn't as severe?
  • The management strategy is surgery. Surgery rates are getting closer to the requirements in most countries.
• Asia - it's a bit confusing that the first sentence is about South Asia only, while the second is presumably about all of Asia. Might flow a bit smoother with broader material first, more specific material next.
  • Rearranged.
• Africa - "According to... while..." maybe split into two sentences? The two halves seem distinct.
  • They are related: 6% of 1 million is 60000. A lot of cataracts per surgeon.

Social and economic relevance

• Visual outcomes are variable... availability of care. This could probably be cut; we know both these things from the earlier sections.
  • Removed.
• a figure of 1,000 new cases per million population per year is used for planning purposes I'm not sure I understand what you're trying to tell us here.
  • When estimating the requirements for future surgery, the existing cases plus 1000 assumed new cases per million population is used.
• As of 1998, the rate... may be sufficient in the short term This material is so old now that I really don't think it should be included. Surely several of these country's CSRs have changed dramatically in the last 25 years.
  • Most CSRs have increased significantly, but not many by enough to be bringing the backlog down. It is mainly growing more slowly. I will update if I can find more recent data. A change in CSR will not necessarily significantly change the rate needed to stabilise or reduce the numbers. Death is probably the main limiter to backlog growth, as the people with the highest proportion of cataracts is also the group that are dying off the fastest. Note also that the source for that paragraph is from 2022, so it is unlikely that there will be much available that is more recent.
• Vision 2020: The Right to Sight - Maybe this should be moved to the History section?
  • Moved to history section.
• It has been estimated... leading cause of blindness in 2020 Perhaps this should be at the top of this section?
  • Moved to top of section.
• Cataract is globally the most common cause of blindness in people older than 50 years. It impairs vision and lowers quality of life. Improvements in vision help with daily activities, including work productivity and education. Redundant to prior material/sections.
  • Removed
• In addition to the direct costs, associated surgical complications may require further intervention. Doesn't really have much meaning in this context and can probably be cut.
  • When considering the overall costs and social impact, indirect costs are also important.

Special populations

• I think the first paragraph could be cut here, since it's not essential to the topic at hand. The subsection could start with the next paragraph and still be perfectly clear.
  • Done.
• The "Developing world" subsection repeats material that's already elsewhere and can probably be cut (or expanded, it's certainly a topic that's typically undercovered in the medical literature and in our articles. But you've already done a much better-than-average job of covering it above).
  • Fair comment, removed.

Other animals

• sub-Tenons?
  • Was linked in earlier version, but trimmed out so have put in a new link.

Ok, that's my first pass through, mainly focusing on prose. I'm sorry it took me so long to make it through. It's an interesting topic and an informative article. I appreciate your responsiveness to the points above, though I haven't had a chance to read all your changes and responses. At this point, I'm afraid we may have different ideas of the best path forward. My thinking is that the article will need additional prose massaging to bring it up to a level that pleases the FAC crowd. I'd also take a second pass through with an eye to easing medical jargon, then a third pass through with a critical eye to the sourcing. My impression based on your comments above, and the fact that you opened the peer review 4 months ago, is that you feel the article is just about FA quality, and you'd like to start an FAC sooner, rather than later. If so, perhaps it'd be best if you just go for it and launch the FAC when you feel ready. If it's well received there, you'll know that I'm just overcritical and uneducated about the topic (second part is definitely true); if it's poorly received at FAC, I'm more than happy to help give more feedback to guide the article's further improvement. I'm around (if slow) if you'd like a hand, but I don't want to wear you down with endless lists of suggestions. Hope that helps? Let me know if there's any other way I can be useful. Otherwise, best of luck and happy editing! Ajpolino (talk) 19:07, 20 December 2023 (UTC)

Ajpolino, Your help so far is greatly appreciated, and I think the article is much improved already. I am in no great rush at present, and expect to be busy or even away for a while in the new year, so no rush and no obligation. I have not put a medical article through FA, and expect more changes will be required, some good. Cheers · · · Peter Southwood ^(talk): 09:44, 21 December 2023 (UTC)

Hi @Pbsouthwood, apologies for barging into this discussion uninvited. If you believe this PR has been completed, you should close it, as it is one of the longest open PRs and also has been inactive for 2 months. Cheers. Matarisvan (talk) 07:29, 10 February 2024 (UTC)

OK, will do.· · · Peter Southwood ^(talk): 08:09, 10 February 2024 (UTC)