Visual function in eyes with diffractive extended depth-of-focus and monofocal intraocular lenses: 2-year comparison.

PURPOSE: To compare long-term visual function after implantation of diffractive extended depth-of-focus (EDF) intraocular lenses (IOLs) using echelett optics and monofocal IOLs with the same platform. METHODS: In this prospective comparative case series, diffractive EDF or monofocal IOLs were implanted binocularly and followed up for 2 years. At the last visit, distance-corrected binocular visual acuities were measured at distances of 0.3, 0.5, 0.7, 1, 2, 3, and 5 m. Photopic and mesopic contrast sensitivity was also examined. Dynamic visual function was evaluated in terms of functional visual acuity (FVA), standard deviation of visual acuity (SDVA), visual maintenance ratio (VMR), mean response time, and number of blinks. The outcomes were compared between the two IOLs, and the influence of posterior capsule opacification (PCO) on contrast sensitivity and FVA was examined. RESULTS: Binocular visual acuity of eyes with EDF IOLs was better at distances of 0.5 and 0.7 m than that of eyes with monofocal IOL (P < 0.026). There were no differences in binocular visual acuity at other distances, contrast sensitivities, or dynamic visual functions. The influence of PCO on the visual functions was not found in eyes with EDF IOLs. CONCLUSION: Up to 2 years postoperatively, eyes with diffractive EDF IOLs sustained superior intermediate visual acuity together with visual function comparable to that of eyes with monofocal IOLs.

Clinical outcomes in eyes with diffractive continuous depth-of-focus intraocular lenses enhanced for near vision: comparison with trifocal intraocular lenses.

BACKGROUND: To prospectively evaluate visual functions and patient satisfaction after bilateral implantation of diffractive continuous depth-of-focus intraocular lens (CDF IOL) compared with trifocal IOLs. METHODS: This investigator-initiated study was approved by a certified local review board (registered: jRCTs032210305). CDF IOL (Synergy, J&J, group S) and trifocal IOL (AcrySof PanOptix, Alcon, group P) were implanted bilaterally in 30 patients each. Three months postoperatively, binocular outcomes of uncorrected (BUCVA) and distance-corrected (BDCVA) visual acuities at distances of 0.3, 0.4, 0.5, 0.7, and 5 m were measured. Contrast sensitivities were binocularly measured using CSV-1000 (2.5 m) and Pelli-Robson charts at distances of 0.4 and 1 m. Symptoms of glare, halo, starburst, and waxy vision, and satisfaction for near, intermediate, and far visions were assessed with questionnaires. Differences between the two groups were examined. RESULTS: Twenty-seven patients each completed the follow-up. The mean age of the group S was lower than that of the group P (P < 0.001). The BUCVA at 0.4 m was better in the S group, while the mean manifest refraction of the P group showed a significant hyperopic shift (P < 0.001). BDCVA was significantly better in the S group. The contrast sensitivity results at three distances showed no discernible differences. Although more patients in the S group reported significant glare and halo, their satisfaction with near vision was higher. CONCLUSIONS: The binocular visual function of patients with CDF IOLs was comparable to or better than that of patients with trifocal IOLs. The patients were satisfied with near vision, despite the enhanced glare and halo. Understanding the differences between the two types of presbyopia-correcting IOLs is important to ensure patient satisfaction. TRIAL REGISTRATION: This clinical trial was registered in the Japan Registry for Clinical Research (identifier: jRCTs032210305) on September 13, 2021.

Influence of implantation of diffractive trifocal intraocular lenses on standard automated perimetry.

BACKGROUND: This prospective comparative study aimed to investigate the influence of diffractive trifocal intraocular lenses (IOLs) implantation on standard automated perimetry. METHODS: Patients with no diseases affecting the visual field had undergone cataract surgery following the implantation of trifocal or monofocal IOLs from July 2019 to August 2020 were recruited. The normality of the anterior and posterior segments and absence of glaucomatous optic nerve cupping were confirmed preoperatively by slit-lamp examination. Standard automated perimetry was performed using Humphrey Visual Field 10-2 testing, 2-3 months after cataract surgery in only one eye per patient. The mean deviation (MD) and foveal sensitivity were compared between IOLs in eyes with acceptable reliability indices and best-corrected visual acuity of 20/25 or better. RESULTS: Among the 83 eyes of the 83 patients included, 39 and 29 eyes eligible for perimetry analysis had trifocal and monofocal IOLs, respectively. The mean MD and foveal sensitivity in eyes with trifocal IOLs were significantly lower than those in eyes with monofocal IOLs (P < 0.021), with mean differences of 0.77 and 1.01 dB, respectively. CONCLUSION: The comparison in nonglaucomatous eyes demonstrated that the influence of trifocal IOLs on standard automated perimetry was greater than that of monofocal IOLs.

Functional visual acuity after implantation of diffractive extended depth-of-focus intraocular lenses using an echelett optics.

BACKGROUND: The prospective comparative case series aimed to evaluate all-distance visual acuity, contrast sensitivity, and functional visual acuity (FVA) of eyes with diffractive extended depth-of-focus (EDOF) intraocular lenses (IOLs) using an echelett optics and monofocal IOLs with the same platform. METHODS: Diffractive EDOF and monofocal IOLs were implanted in 27 eyes of 27 patients each. At 3 months after implantation, all-distance visual acuities at distances of 0.3, 0.5, 0.7, 1, 2, 3, and 5 m were measured under distance-corrected. Static visual function was also examined using photopic contrast sensitivity and area under the logarithmic contrast sensitivity function (AULCSF). Dynamic visual function was examined with FVA, and mean FVA value, visual maintenance ratio (VMR), mean response time, and number of blinks were evaluated. These outcomes were compared between the two IOLs. RESULTS: The mean distance-corrected visual acuities were better at distances of 0.7 m or nearer in eyes with EDOF IOLs. There was no difference in the contrast sensitivities (P > 0.22). In the FVA results, no difference was found in mean FVA and VMR (P > 0.68). CONCLUSION: The static and dynamic evaluations of postoperative visual functions demonstrated that the visual function of eyes with EDOF IOLs under photopic and distance-corrected conditions was comparable to eyes with monofocal IOLs.

Presbyopia Correction Using Multifocal Soft Contact Lenses in Patients With Monofocal Intraocular Lenses.

OBJECTIVES: To investigate the effectiveness of presbyopia correction using multifocal soft contact lenses (MF SCLs) for pseudophakic subjects with monofocal intraocular lenses (IOLs). METHODS: In 11 subjects, after monofocal IOL implantation, disposable MF SCLs (Dailies Total 1 Multifocal, Alcon) were daily used for 3 months. Binocular visual acuity between 0.3 and 5 m was measured using an all-distance vision tester (AS-15, Kowa) at 1 and 3 months and compared before and during MF SCL wear. Binocular contrast sensitivity testing was conducted under mesopic and photopic illuminations at 1 month. RESULTS: The mean manifest refraction spherical equivalent before MF SCL wear was -0.36 D. The add powers of used MF SCLs were +1.25, +2.00, and +2.50 D in 1, 16, and 5 eyes, respectively. The mean binocular visual acuities during MF SCL wear were 20/20 or better between 0.5 and 5 m and significantly improved at 0.7 m or less (P<0.025). There was no change in the mesopic contrast sensitivity, whereas the photopic contrast sensitivity at 18 cycles per degree was degraded during MF SCL wear. CONCLUSIONS: The use of MF SCL was effective for presbyopia correction in pseudophakic subjects with monofocal IOL, and favorable binocular vision would be obtained in a range from distance to intermediate.

Influence of pterygium size on corneal higher-order aberration evaluated using anterior-segment optical coherence tomography.

BACKGROUND: The prospective observation study aimed to evaluate changes in corneal higher-order aberrations induced by advancement of pterygium using an anterior-segment optical coherence tomography (AS-OCT) and Zernike aberration analysis. METHODS: The corneal topography of 284 eyes with primary pterygia originating from the nasal region was measured using an AS-OCT (SS-1000, Tomey). With anterior corneal elevation data, Zernike polynomial coefficients were calculated in diameters of 1.0, 3.0, and 5.0 mm, and the coma, spherical, coma-like, spherical-like, and total higher-order aberrations were obtained. Pterygium size was also measured as a ratio of positions of the pterygium end with respect to the corneal diameter and categorized in eight classes: less than 15%, 15-20%, 20-25%, 25-30%, 30-35%, 35-40%, 40-45, and 45% or larger. Increases in the aberrations were analyzed with reference to those in eyes with pterygium size < 15%. RESULTS: The mean age of the participants was 69.3 years, and the pterygium size ranged from 2 to 57% (mean: 28.8%). The coma aberration significantly increased when the pterygium size was 45% or larger in 1.0 and 3.0 mm diameters and over 25-30% in 5.0 mm diameter. Similar increases were found in the pterygium sizes exceeding 45, 40, and 25%, respectively, in the coma-like, spherical-like, and total higher-order aberrations. On contrast, there was no increase in the spherical aberration. CONCLUSION: Increases in higher-order aberrations reflected the pterygium size, and significant aberrations were induced in 5.0 mm diameter when the end exceeded 25% of corneal diameter. The use of AS-OCT and Zernike analysis could enable objective grading of pterygium advancement based on changes in corneal optics.

Influence of surface light scattering in hydrophobic acrylic intraocular lenses on laser beam transmittance.

The aim of this study was to experimentally examine the changes in the transmittances of photocoagulation lasers when surface light scattering increases in AcrySof intraocular lenses (IOLs). SA60AT IOLs (Alcon) were acceleratingly aging for 0, 3, 5, and 10 years to simulate surface light scattering, and the surface light-scattering intensities of both IOL surfaces were measured using a Scheimpflug photographer. The powers of laser beams that passed from a laser photocoagulator through the aged IOLs were measured at 532, 577, and 647 nm. Changes in the laser power and transmittance with the years of aging and the intensities of surface light scattering were examined. Although the intensity of surface light scattering increased with the years of aging, the laser power did not change with the years of aging (P > 0.30, Kruskal-Wallis test). There were no significant changes in the laser transmittance with the years of aging or the laser wavelength (P > 0.30 and 0.57, respectively). The intensity of surface light scattering revealed no significant association with the laser transmittance at any wavelength (P > 0.37, liner regression). The increases in the surface light scattering of the AcrySof IOLs would not influence retinal photocoagulation treatments for up to 10 years after implantation.

Topographic changes after excision surgery of primary pterygia and the effect of pterygium size on topograpic restoration.

OBJECTIVE: To assess the effect of pterygium size on time-course change of corneal topography after excision surgery of primary pterygium. METHODS: Retrospective case series included eyes that underwent excisions of primary pterygium. Pterygium size was graded according to the advancing edge position: less than one third of corneal diameter (grade 1), outside the pupil (grade 2), and within the pupillary area (grade 3). Time-course changes in corneal refractive power, astigmatism, and irregularity (surface regularity and asymmetry indices) in corneal topographies over 12 months postoperatively were compared between the pterygium size grades. RESULTS: Pterygium excision was performed on 562 eyes, consisting of 119, 338, and 105 eyes with grades 1 to 3, respectively. Grade 1 did not change in corneal irregularity, and there was no difference between grades 1 and 2, except for corneal astigmatism at 6 months. Grade 3 showed significantly higher corneal refractive power and irregularity than grade 1 until 3 and 6 months, respectively, whereas corneal astigmatism was higher over 12 months. CONCLUSIONS: Topographic changes after primary pterygium excision were associated with pterygium size. Pterygium advancing over the pupillary area required 6 to 12 months for corneal topography restoration, resulting in slow recovery of visual acuity.

[Clinical Results of Diffractive Multifocal Intraocular Lens Implantation after Laser In Situ Keratomileusis].

PURPOSE: To evaluate the visual performance in eyes with diffractive intraocular lenses (IOLs) after laser in situ keratomileusis (LASIK). METHODS: This single-center retrospective study evaluated eyes that had diffractive multifocal IOL implantation after previous LASIK or not treated with LASIK (controls). The outcomes' measures were the visual acuities (VAs) at distance and near, spherical equivalent (SE) and contrast sensitivity at one month postoperatively. RESULTS: The study evaluated 40 eyes of 33 patients. The mean uncorrected logMAR VAs were -0.05 ± 0.13/0.00 ± 0.14 (LASIK group/control group) at distance and 0.10 ± 0.13/0.16 ± 0.18 at near. There was no statistically significant difference between the 2 groups at the VAs. The SE of the LASIK group was -0.06 ± 0.39 D, significantly lower than the control group (0.22 ± 0.45 D) (p < 0.05). The contrast sensitivity of the LASIK group at high spatial frequency was lower than the control group (p < 0.05). CONCLUSION: After LASIK, the diffractive multifocal IOL provided good uncorrected distance and near VAs. However, decrease in contrast sensitivity should be considered.

[Long-term outcomes of Boston keratoprosthesis].

PURPOSE: To evaluate the clinical efficacy and safety of am implanted Boston keratoprosthesis Type I (Boston KPro). METHODS: Six eyes of 6 patients who had experienced repeated graft failure underwent Boston KPro implantation and were followed up for over one year. The mean age of the patients was 62.7 years. There were 3 eyes with glaucoma and 1 eye with fungal keratitis preoperatively. Best-corrected visual acuity (BCVA), complications, and postoperative treatment were evaluated. RESULTS: Mean follow-up duration was 33.9 months. Preoperative BCVA of hand motion to 0.02 improved to counting fingers at 30 cm to 1.0 at 1 month postoperatively. At the last follow-up, it remained stable at counting fingers at 10 cm to 1.2. There were no intraoperative complications. Postoperative complications included 4 eyes with retroprosthetic membrane formation, one eye with elevated intraocular pressure, bacterial conjunctivitis, recurrent fungal keratitis, posterior capsular opacification, cystoids macular edema, vitreous opacity and epiretinal membranes that were all treated. No keratoprosthesis extrusion, donor cornea necrosis or progressive loss of visual field was observed. CONCLUSIONS: With continuous and appropriate postoperative management, use of the Boston KPro can produce long-term positive outcomes.

[Pterygium excision using bulbar conjunctival autograft with intraoperative mitomycin C for primary pterygium: a retrospective assessment of 1832 eyes].

PURPOSE: To retrospectively assess the efficacy of pterygium excision using bulbar conjunctival autograft with intraoperative mitomycin C (MMC) for primary pterygium. METHODS: Primary pterygium eyes of 1482 patients (1832 eyes) which had undergone excision surgery using bulbar conjunctival autograft with intraoperative MMC in Miyata Eye Hospital were studied. The patients' background and position and the size of the pterygium were reviewed. For 1188 eyes that were followed up 1 year or longer, the recurrence rate and periods were assessed. Factors such as age, occupation, sex, the size of pterygium and the skill of the surgeon were examined as risk factors for recurrence. RESULTS: Mean age was 65.0 +/- 10.0 years. The pterygium was in the nasal side in 99.0% of eyes, and the size in 55.4% of eyes was equal to the distance between one and two thirds of the radius of the cornea. The recurrence rate was 3.96% and was noted 9 months after the surgery. Significant risk factors were age of patient (p = 0.028) and the skill of the surgeon (p = 0.022). CONCLUSION: Pterygium excision using bulbar conjunctival autograft with intraoperative mitomycin C was effective in primary pterygium.

Implantation of diffractive extended depth-of-focus intraocular lenses in normal tension glaucoma eyes: A case series.

Purpose: Implantation of presbyopia-correcting intraocular lenses (IOLs) has not been advised for glaucomatous eyes because of the risk of decreased contrast sensitivity with progress of glaucoma. Extended depth-of-focus (EDF) IOLs have been reported to provide comparable postoperative visual function and influence on the visual field to monofocal IOLs. Methods: This case series was a retrospective medical record review of 16 eyes of 10 patients who had normal tension glaucoma (NTG) with no central visual field defects and underwent cataract surgery with implantation of diffractive EDF IOLs. At 3 months postoperatively, distance-corrected visual acuities (DCVAs) at distances of 5, 1, and 0.5 m and photopic contrast sensitivity were examined. Automated perimetry using the 30-2 Swedish interactive threshold algorithm was also performed, and the mean variance (MD) values, mean deviation values at the central four points (central MD), and foveal threshold were recorded. Results: The mean age of the patients (5 men, 5 women) was 66.5 years. Over 80% of eyes obtained DCVAs of 20/20, 20/20, and 20/25 at 5 m, 1 m, and 0.5 m, respectively. Whereas 5 of 16 eyes were categorized as severe by the Hodapp-Parrish-Anderson classification, postoperative contrast sensitivity was within the normal range, except for 4 eyes at 18 cycles per degree. Conclusions and importance: In this case series, the postoperative visual functions of NTG patients with EDF IOLs were almost comparable to those of normal eyes with the same IOLs, which demonstrated that the use of EDF IOLs for controlled NTG eyes would be permissible. While careful patient selection and follow-up for NTG progress are important, further investigations are necessary for confirming the safety and exploring the selection criteria.

Temperature-controlled porcine eye holder for observing intraocular temperature during cataract surgery.

During cataract surgery, the intraocular temperature changes when irrigating low-temperature fluid and ophthalmic viscosurgical devices (OVDs) are inserted in the anterior chamber, and such a temperature variation affects the unfolding of the intraocular lens (IOL). A porcine eye holder was developed for simulating temperature conditions in clinical surgery by maintaining the ocular temperature close to the body temperature. An aluminum holder was designed to fit porcine eyes and maintain the ocular temperature at approximately 36 °C, while surgery was performed at a room temperature of 20 °C. Intraocular temperature was monitored using a thermocouple sensor placed close to the posterior capsule in the vitreous cavity. Temperatures and microscopic image of the anterior chamber were simultaneously recorded. With the use of the eye holder system, the intraocular temperature unstable during surgery was observed, and there were significant reductions during hydrodissection, irrigation and aspiration, OVD insertion in the capsule, and OVD removal after IOL implantation.

Visual Function after Implantation of Diffractive Extended Depth-of-Focus Intraocular Lenses in Eyes with Primary Open-Angle Glaucoma.

INTRODUCTION: The aim of this prospective study was to compare the visual functions of extended depth-of-focus intraocular lenses (EDOF IOLs) and monofocal IOLs in eyes with mild to moderate primary open-angle glaucoma (POAG). METHODS: Cataractous eyes with POAG controlled using medical treatments, no central visual field defects, and mean deviation (MD) values of -10 dB or better on the 30-2 test grid of the Swedish Interactive Threshold Algorithm standard program were included. Twenty-two eyes of 22 patients received EDOF IOLs (ZXR00V and ZXV150-375; J&J), whereas 24 eyes of 24 patients received monofocal IOLs (ZCB00V and ZCV150-375; J&J). MD values, corrected distance visual acuity (CDVA), and photopic contrast sensitivity were measured at 3 months after surgery. Noninferiority of CDVA and contrast sensitivity in eyes with EDOF IOLs to eyes with monofocal IOLs were examined. RESULTS: The postoperative mean MDs of eyes with EDOF and monofocal IOLs were -2.76 dB and -4.21 dB with no significant difference. The CDVA of eyes with EDOF IOLs was noninferior to that of eyes with monofocal IOLs (P = 0.02). There were no inferiority in contrast sensitivity at any spatial frequency (P < 0.001). CONCLUSIONS: The visual function of EDOF IOLs in eyes with mild-to-moderate POAG was not inferior to that of monofocal IOLs. TRIAL REGISTRATION: Registered in the Japan Registry for Clinical Research (identifier: jRCTs032200218).

Utility of budgerigar/pigeon/parrot-specific IgG antibody with ImmunoCAP® in bird-related hypersensitivity pneumonitis caused by other bird species and duvet.

BACKGROUND: Bird-related hypersensitivity pneumonitis (BRHP) is an extrinsic allergic alveolitis caused by inhalation of bird antigens. Although the measurement of serum-specific IgG antibodies against budgerigar, pigeon, and parrot with ImmunoCAP® is available in Japan, the utility of the test for patients with causes by bird breeding other than these three species, including contact with wild birds/poultry/bird manure, and use of a duvet is unknown. METHODS: Of the 75 BRHP patients who participated in our previous study, 30 were included. Six cases were caused by bird breeding of species other than pigeon, budgerigar, and parrot, seven were in contact with wild birds/poultry/bird manure, and 17 were using a duvet. Bird-specific IgG antibodies were compared among the patients, 64 controls, and 147 healthy participants. RESULTS: In patients with BRHP caused by bird breeding, budgerigar and parrot-specific IgG levels were significantly higher than in disease controls. Only parrot-specific IgG was significantly higher than in disease controls in patients caused by duvet use. However, among patients with acute episodes (acute and recurrent type of chronic BRHP), IgG antibodies against all three species were significantly higher than those of disease controls caused by bird breeding and the use of a duvet. CONCLUSIONS: Bird-specific IgG antibody with ImmunoCAP® was useful for screening and diagnosing BRHP caused by other bird species and duvets.

[Effects of laser in situ keratomileusis on intraocular pressure measurements in Japanese myopic eyes].

PURPOSE: To prospectively compare preoperative and postoperative measurements of intraocular pressure (IOP) using Goldmann applanation tonometry (GAT), noncontact tonometer (NCT), and Dynamic contour tonometer (DCT) in eyes undergoing myopic laser in situ keratomileusis (LASIK) and to examine the effects of preoperative corneal curvature and IOP, and the change in central corneal thickness (CCT). METHODS: One hundred six eyes of 53 patients underwent myopic LASIK with -5.3 +/- 2.3 (mean +/- SD) diopters. Within 4 weeks before and at 1 month after LASIK, IOP using GAT, NCT and DCT and CCT were measured. RESULTS: Postoperatively, although IOP was reduced in the three measurements, IOP changes in DCT (-0.9 +/- 1.7 mmHg) were significantly lower than in the GAT (-3.6 +/- 2.1 mmHg) and in the NCT (-4.7 +/- 1.9 mmHg) measurements (p < 0.001, Tukey test). In all the measurements, the decrease in the IOP increased with the higher preoperative IOP (p < 0.001). Changes in the CCT were significantly correlated in the GAT and NCT measurements (p < 0.015). CONCLUSIONS: IOP measurements using DCT minimized the changes in IOP readings after myopic LASIK in Japanese eye. This demonstrated that the DCT was effective for IOP monitoring after LASIK.

Limbal relaxing incisions using a reference point and corneal topography for intraoperative identification of the steepest meridian.

PURPOSE: To examine the efficacy and safety of topography-based limbal relaxing incision (LRI) surgery. METHODS: Forty-four eyes of 36 consecutive patients who underwent cataract surgery more than 1 month previously, had refractive against-the-rule astigmatism of ≥2.00 diopters (D), and were scheduled to undergo LRI surgery were enrolled in the study. Patients were randomized into two groups-a topography-based LRI group (19 eyes of 14 patients) and a conventional LRI group (25 eyes of 22 patients). The topography-based LRI procedure comprised 3 steps: placing a mark on the cornea and conjunctiva, identifying this mark in the topographic image, and performing LRI based on the location of the mark. In the conventional LRI group, the horizontal meridian was marked under a slit lamp and LRIs were made based on the position of the horizontal mark. RESULTS: Corneal astigmatism in the topography-based LRI group before and 1 month after surgery was 2.03±0.92 D and 1.33±0.69 D, respectively (P=.014). Corneal astigmatism in the conventional LRI group before and 1 month after surgery was 2.36±0.77 D and 0.93±0.70 D, respectively (P<.0001). Fourier harmonic analysis of the topography data demonstrated that regular astigmatism was significantly decreased in the two groups. The mean regular astigmatism was not significantly different before and after LRI between groups, whereas the variances (mean of the deviation squared from its mean) of regular astigmatism were significantly different between groups 1 month after LRI. CONCLUSIONS: Compared with conventional LRI surgery, a topography-based procedure may reduce the deviation of the effect of LRIs.

Surface light scattering from 1-piece hydrophobic acrylic intraocular lenses with hydroxyethyl methacrylate: contralateral observation for 7 years.

PURPOSE: To quantitatively and intraindividually compare surface light scattering for 7 years after implantation of Clareon and AcrySof intraocular lenses (IOLs). SETTING: Miyata Eye Hospital, Miyazaki, Japan. DESIGN: Retrospective comparative case series. METHODS: Clinical records of eyes that had contralateral implantation of SN60WF and SY60WF IOLs were reviewed. Light scattering on the anterior surface of IOLs, corrected distance visual acuity (CDVA), and mesopic and photopic contrast sensitivities were examined at 1 year, 3 years, and 7 years postoperatively, and they were intraindividually compared. RESULTS: 34, 19, and 16 patients visited at 1 year, 3 years, and 7 years postoperatively, respectively. Surface light scattering in eyes with SY60WF IOL was significantly reduced, and the rate of increase was 2.74 computer compatible tapes per year. Although there were prominent increases in eyes with SN60WF IOL, no statistically significant difference was found in their CDVA and contrast sensitivities. CONCLUSIONS: In eyes with Clareon IOLs, the development of surface light scattering was suppressed up to 7 years. The increase rate demonstrated that the visual acuity would be least deteriorated up to 12 years postoperatively, whereas the influence of straylight induced should be investigated.

Machine learning adaptation of intraocular lens power calculation for a patient group.

BACKGROUND: To examine the effectiveness of the use of machine learning for adapting an intraocular lens (IOL) power calculation for a patient group. METHODS: In this retrospective study, the clinical records of 1,611 eyes of 1,169 Japanese patients who received a single model of monofocal IOL (SN60WF, Alcon) at Miyata Eye Hospital were reviewed and analyzed. Using biometric metrics and postoperative refractions of 1211 eyes of 769 patients, constants of the SRK/T and Haigis formulas were optimized. The SRK/T formula was adapted using a support vector regressor. Prediction errors in the use of adapted formulas as well as the SRK/T, Haigis, Hill-RBF and Barrett Universal II formulas were evaluated with data from 395 eyes of 395 distinct patients. Mean prediction errors, median absolute errors, and percentages of eyes within ± 0.25 D, ± 0.50 D, and ± 1.00 D, and over + 0.50 D of errors were compared among formulas. RESULTS: The mean prediction errors in the use of the SRT/K and adapted formulas were smaller than the use of other formulas (P < 0.001). In the absolute errors, the Hill-RBF and adapted methods were better than others. The performance of the Barrett Universal II was not better than the others for the patient group. There were the least eyes with hyperopic refractive errors (16.5%) in the use of the adapted formula. CONCLUSIONS: Adapting IOL power calculations using machine learning technology with data from a particular patient group was effective and promising.

Subjective and objective refractions in eyes with extended-depth-of-focus intraocular lenses using echelette optics: clinical and experimental study.

PURPOSE: To evaluate differences in subjective and objective refractions in eyes with extended-depth-of-focus intraocular lenses (EDOF IOLs) using echelette optics, and the effect of the light wavelength used during examinations. METHODS: In the prospective study, subjective and objective refractions of 128 eyes of 64 patients were examined 3 months after implantation of the EDOF IOLs (ZXR00V, Johnson & Johnson Surgival Vision). Objective refractions were measured using an autorefractor with a near-infrared (NIR) light source. Clinical differences in the spherical, cylindrical and spherical equivalent (SE) refractions between the subjective and objective refractions were evaluated. Then, lens powers of monofocal, EDOF and diffractive bifocal IOLs in the use of a 850-nm light source were measured experimentally for using a lensmeter, and the differences from the monofocal IOLs were calculated. RESULTS: The mean objective refractions were more myopic (p < 0.001) than the subjective refractions; the differences in the spherical, cylindrical and SE refractions were -0.71, -0.26 and -0.84 dioptre, respectively. Experimental investigation resulted that there was the mean difference of 0.83 D with the EDOF from monofocal IOLs at 850 nm, while the difference was -0.20 D with bifocal IOLs. CONCLUSIONS: The diffractive EDOF IOLs using echelette gratings inherently induced constant differences in the subjective and objective refractions, which arose from the chromatic difference in IOL powers for the visible and NIR lights.