Rural pre-operative cataract assessment on the Lions Outback Vision Van.

The Lions Outback Vision Van was launched in March 2016 and is a mobile eye clinic providing ophthalmology care to regional and remote Western Australia. For the first time, we have been able to bring essential equipment to regional and remote towns to improve the delivery of our ophthalmology service (Figs 1,2). Equipment available on the Vision Van include 3D OCT-1 Maestro Optical Coherence Tomographer (Topcon Corporation, Tokyo, Japan), OCTOPUS 600 Perimeter (Haag-Streit AG, Köniz, Switzerland), Pentacam (Oculus, Wetzlar, Germany), IOLMaster 500 (Carl Zeiss, Jena, Germany), California ultrawidefield retinal imaging (Optos, Dunfermline, UK) and Compact Touch A/B Scanner (Quantel Medical Inc., Cournon d’Auvergne Cedex, France). We present two cases that highlight the benefits of this equipment during pre-operative assessment, which were previously unavailable at rural locations. A 63-year-old man was seen in an ophthalmology clinic on the Vision Van for pre-operative assessment for left eye cataract surgery to be performed the next day at the regional hospital. The patient had a longstanding cataract and poor visual acuity following blunt trauma to his left eye as a teenager. The patient had a history of diet-controlled diabetes mellitus and hypertension, and no other significant ocular history. He had been seen 6 months prior at a rural outreach ophthalmology clinic where he was waitlisted for left cataract surgery. On assessment, visual acuity measured 6/9 in the right eye and hand movements at 1 metre in the left eye. On anterior segment examination, inferotemporal iridodialysis was noted, and a posterior subcapsular cataract (1+) with inferior cortical spokes (2+). Bilateral dilated fundal exam noted peripapillary atrophy, inferior retinal scarring and the optic disc appeared tilted. Intraocular pressures were normal. To complete the pre-operative assessment, biometry using the IOLMaster 500 was performed and noted an axial length of 25.66 mm in the left eye, compared with 22.48 mm in the right. This discrepancy was verified on B-scan ultrasonography where a posterior staphyloma was imaged as shown in Figure 3. Given the likelihood of post-operative aniseikonia, surgery was cancelled, and the patient conservatively managed.