Risk of Dementia in Newly Diagnosed Glaucoma: A Nationwide Cohort Study in Korea.

PURPOSE: To investigate the risk of dementia in participants with newly diagnosed glaucoma. DESIGN: A nationwide cohort study using authorized data provided by the Korean National Health Insurance Service (NHIS). PARTICIPANTS: A total of 788 961 participants aged ≥ 45 years in 2006, who did not have dementia or glaucoma between 2002 and 2005, were included. METHODS: Data were collected from a nationwide population-based retrospective cohort study using the Korean NHIS database. From January 2006 to December 2017, participants were tracked for the diagnosis of glaucoma or dementia using claims data. The prospective association between newly diagnosed glaucoma and the risk of dementia was investigated using a multivariable Cox proportional hazard model adjusted for age, sex, behavioral factors, and systemic and ocular comorbidities. MAIN OUTCOME MEASURES: Hazard ratios (HRs) and 95% confidence intervals (CIs) for dementia development according to the parameters, including glaucoma diagnosis. RESULTS: Overall, 7.0% of the participants developed dementia after an average of 7.4 years. Newly diagnosed glaucoma was associated with a higher risk of dementia (HR, 1.89, 95% CI, 1.57-2.27) independent of age, sex, body mass index, income, smoking and drinking status, visual acuity, and other systemic comorbidities, such as diabetes, hypertension, stroke, and depression. Newly diagnosed glaucoma was associated with higher risk of AD but not VD. The risk of dementia in relation to glaucoma was higher in older participants (HR, 3.15 [≥ 65 years] vs. 1.56 [< 65 years], P < 0.0001). CONCLUSIONS: This nationwide cohort study found that individuals with newly diagnosed glaucoma were at a higher risk of developing dementia, particularly AD. This association was greater among older individuals in the studied population. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Impact of Age-Related Macular Degeneration and Related Visual Disability on the Risk of Depression: A Nationwide Cohort Study.

PURPOSE: To evaluate the prospective association of age-related macular degeneration (AMD) and related visual disability (VD) with the risk of depression. DESIGN: This nationwide population-based cohort study used authorized clinical data provided by the Korean National Health Insurance Service. PARTICIPANTS: A total of 3 599 589 individuals older than 50 years participated in the Korean National Health Screening Program in 2009. METHODS: Age-related macular degeneration diagnosis and the presence of accompanying VD were verified using diagnostic codes and disability registration data. Data on covariates, including age, sex, income level, residential area, systemic comorbidities, and behavioral factors, were collected from health screening results and claims data. Patients were followed up until December 2019, and incident cases of depression were identified using registered diagnostic codes. The prospective association of AMD and related VD with new-onset depression was investigated using the multivariable-adjusted Cox proportional hazard model. MAIN OUTCOME MEASURES: Hazard ratios and 95% confidence intervals (CIs) for depression development according to the presence of AMD and VD. RESULTS: During an average follow-up period of 8.52 years, 1 037 088 patients received new diagnoses of depression. Patients with previous diagnoses of AMD showed a greater risk of new-onset depression, with a hazard ratio of 1.15 (95% CI, 1.13-1.17) compared with the control group in the fully adjusted model. Patients with AMD and accompanying VD showed a further increased risk of depression, with a hazard ratio of 1.23 (95% CI, 1.16-1.30). CONCLUSIONS: Individuals with a diagnosis of AMD have a higher risk of depression developing in the future. The risk of depression is increased further in patients with AMD who demonstrate VD. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Increased risk of Parkinson's disease amongst patients with age-related macular degeneration and visual disability: A nationwide cohort study.

BACKGROUND AND PURPOSE: The association between Parkinson's disease (PD) and age-related macular degeneration (AMD) has been shown in previous reports. However, the association between the severity of AMD and PD development is unknown. The aim was to evaluate the association of AMD with/without visual disability (VD) with the risk of PD occurrence using the National Health Insurance data in South Korea. METHODS: A total of 4,205,520 individuals, 50 years or older and without a previous diagnosis of PD, participated in the Korean National Health Screening Program in 2009. AMD was verified using diagnostic codes, and participants with VD were defined as those with loss of vision or visual field defect as certified by the Korean Government. The participants were followed up until 31 December 2019, and incident cases of PD were identified using registered diagnostic codes. The hazard ratio was calculated for groups (control and AMD with/without VD) using multivariable adjusted Cox regression analysis. RESULTS: In total, 37,507 participants (0.89%) were diagnosed with PD. Amongst individuals with AMD, the risk of PD development was higher in individuals with VD (adjusted hazard ratio [aHR] 1.35, 95% confidence interval [CI] 1.09-1.67) than in those without (aHR 1.22, 95% CI 1.15-1.30) compared with controls. Additionally, an increased risk of PD was observed in individuals with AMD compared with controls, regardless of the presence of VD (aHR 1.23, 95% CI 1.16-1.31). CONCLUSIONS: Visual disability in AMD was associated with the development of PD. This suggests that neurodegeneration in PD and AMD may have common pathways.

FEMALE REPRODUCTIVE FACTORS AND THE RISK OF EXUDATIVE AGE-RELATED MACULAR DEGENERATION: A Nationwide Cohort Study.

PURPOSE: To evaluate the association between female reproductive factors and the incidence of exudative age-related macular degeneration (AMD). METHODS: A total of 1,297,388 postmenopausal women over 50 years of age who participated in both national health screening and cancer screening in 2009 were identified using the Korea National Health Insurance System database. Data on female reproductive factors were collected using a self-administered questionnaire. Patients were followed up until 2018, and the incident cases of exudative AMD were identified. The hazard ratios and 95% confidence intervals for exudative AMD were estimated using the multivariable-adjusted Cox proportional hazard model. RESULTS: During a mean follow-up of 7.27 years, 4,086 patients were newly diagnosed with exudative AMD. The hazard ratio (95% confidence intervals) for exudative AMD was 1.14 (1.01-1.31) for a reproductive period ≥40 years compared with a reproductive period <30 years, 1.72 (1.48-2.00) for patients with ≥5 years of hormone replacement therapy, and 1.29 (1.09-1.52) for those with 2 to 5 years of hormone replacement therapy compared with those who never underwent hormone replacement therapy. CONCLUSION: Female reproductive factors were associated with the risk of exudative AMD. Greater lifetime exposure to endogenous and exogenous estrogen was associated with a higher incidence of exudative AMD.

Chronic and Recurrent Herpes Zoster Ophthalmicus.

Background and Objectives: This study sought to investigate the natural course, the chronicity and recurrence rate, and the risk factors of chronic and recurrent herpes zoster ophthalmicus (HZO). We also evaluated the effects of long-term treatment for HZO. Materials and Methods: Patients diagnosed and treated for HZO were included in the retrospective medical chart review. Multivariable-adjusted logistic and Cox regression models were used to show risk factors for chronic and recurrent HZO along with hazard ratios (HRs) and 95% confidence intervals (CIs). Results: Among a total 130 of HZO patients, 31 patients (23.85%) had chronic disease and 19 patients (14.62%) had recurrent disease. The rate of chronic disease was higher in HZO with conjunctivitis, epithelial keratitis, and stromal keratitis. The recurrence rate increased in patients with chronic HZO (HR: 34.4, 95% CI: 3.6-324.6), epithelial keratitis (HR: 5.5, 95% CI: 1.3-30.0), stromal keratitis (HR: 18.8, 95% CI: 3.0-120.8), and increased intraocular pressure (IOP) (HR: 7.3, 95% CI: 1.6-33.2). Length of systemic antiviral therapy and anti-inflammatory eyedrop treatment were not associated with recurrent HZO (p = 0.847 and p = 0.660, respectively). The most common ocular manifestation for recurrent HZO was stromal keratitis. Conclusions: This study demonstrated a considerable frequency of chronic and recurrent HZO. Chronic HZO in the form of epithelial or stromal keratitis with increased IOP provoked a significant rise in the risk of recurrence.

Visual Acuity and Development of Parkinson's Disease: A Nationwide Cohort Study.

BACKGROUND: Visual dysfunction in Parkinson's disease (PD) is well known from previous reports, but the association of visual deficits with PD development has not yet been studied. The aim of this research was to evaluate the association of visual acuity with the risk of PD occurrence using a nationwide cohort in South Korea. METHODS: Among the population participating in the National Health Insurance Service, which is mandatory for all South Koreans, 6,055,113 individuals who had taken part in health screening programs between January 1, 2009, and December 31, 2012, were included in the cohort and followed until December 31, 2017. The hazard ratio was calculated for groups with high and low visual acuity using multivariate adjusted Cox regression analysis. RESULTS: A total of 22,872 subjects (0.38%) were diagnosed as having PD within the study period. Groups with low visual acuity showed a higher incidence of PD compared with groups with good visual acuity. Compared with the reference group (visual acuity better than 20/20), the adjusted hazard ratios and 95% confidence intervals (CIs) was 1.315 (95% CI, 1.261-1.371) for the group with visual acuity between 20/20 and 20/60, 1.357 (95% CI, 1.277-1.442) for the group with visual acuity between 20/60 and 10/100, and 1.267 (95% CI, 1.193-1.343) for the group with visual acuity less than 10/100. CONCLUSIONS: Low visual acuity was associated with the development of PD. This suggests that visual dysfunction is one of the premotor symptoms for PD development. © 2020 International Parkinson and Movement Disorder Society.

Comparison of outcomes after topography-modified refraction versus wavefront-optimized versus manifest topography-guided LASIK.

BACKGROUND: To compare the outcomes of myopia and myopic astigmatism corrected with topography-modified refraction laser in situ keratomileusis (TMR-LASIK), wavefront-optimized (WFO) LASIK, and topography-guided (TG) LASIK with a correction target based on the manifest refraction (manifest TG-LASIK). METHODS: This observational, retrospective cohort study included patients who underwent LASIK using the WaveLight® EX500 excimer laser to correct myopia and myopic astigmatism between August 2016 and July 2017. Patients who underwent TMR-LASIK (85 patients), WFO-LASIK (70 patients), or manifest TG-LASIK (40 patients) were enrolled, and only one eye from each patient was analyzed. All participants underwent measurement of the uncorrected distance visual acuity (UDVA), best-corrected distance visual acuity (BCVA), manifest refraction, vector analysis of astigmatic change, corneal topography, and corneal wavefront analysis at baseline and at every posttreatment visit. RESULTS: Three months postoperatively, a UDVA of 0.0 logMAR or better and manifest refraction spherical equivalent (MRSE) within ±0.5 diopters (D) did not differ across the TMR-, WFO-, and manifest TG-LASIK groups. However, the residual cylinder in the TMR group was significantly larger than that in the WFO and manifest TG groups. The magnitude of error in the TMR group measured using astigmatism vector analysis was significantly higher than that in the WFO and manifest TG groups. CONCLUSIONS: Although these three LASIK platforms achieved the predicted surgical outcomes, TMR-LASIK overcorrected astigmatism and showed a higher residual postoperative astigmatism compared with WFO- and manifest TG-LASIK.

Markedly increased ocular side effect causing severe vision deterioration after chemotherapy using new or investigational epidermal or fibroblast growth factor receptor inhibitors.

BACKGROUND: We sought to describe corneal epithelial changes after using epidermal (EGFR) or fibroblast growth factor receptor (FGFR) inhibitors as chemotherapy and to clarify incidence and prognosis. MATERIALS: Retrospective chart review. RESULTS: Among 6871 patients and 17 EGFR or FGFR inhibitors, 1161 patients (16.9%) referred for ophthalmologic examination. In total, 1145 patients had disease-related or unrelated ocular complications. Among 16 patients with treatment-related ocular complications, three patients had treatment-related radiation retinopathy and one patient showed treatment-related corneal ulcer. Finally the authors identified that, in 12 patients, three EGFR inhibitors and two FGFR inhibitors caused corneal epithelial lesions. Vandetanib, Osimertinib, and ABT-414 caused vortex keratopathy in nine patients, while ASP-5878 and FPA-144 caused epithelial changes resembling corneal dysmaturation in three patients. The mean interval until symptoms appeared was 246 days with vandetanib, 196 days with osimertinib, 30 days with ABT-414, 55 days with ASP-5878, and 70 days with FPA-144. The mean of the lowest logarithm of minimal angle of resolution visual acuity results of the right and left eyes after chemotherapy were 0.338 and 0.413. The incidence rates of epithelial changes were 15.79% with vandetanib, 0.5% with osimertinib, 100% with ABT-414, 50.0% with ASP-5878, and 18.2% with FPA-144. After excluding deceased patients and those who were lost to follow-up or still undergoing treatment, we confirmed the reversibility of corneal lesions after the discontinuation of each agent. Seven patients showed full recovery of their vision and corneal epithelium, while three achieved a partial level of recovery. Although patients diagnosed with glioblastoma used prophylactic topical steroids before and during ABT-414 therapy, all developed vortex keratopathy. CONCLUSIONS: EGFR and FGFR inhibitors are chemotherapy agents that could make corneal epithelial changes. Contrary to the low probability of ocular complication with old EGFR drugs, recently introduced EGFR and FGFR agents showed a high incidence of ocular complication with severe vision distortion. Doctors should forewarn patients planning chemotherapy with these agents that decreased visual acuity could develop due to corneal epithelial changes and also reassure them that the condition could be improved after the end of treatment without the use of steroid eye drops. TRIAL REGISTRATION: This study was approved by the institutional review board (IRB) of Samsung Medical Center (IRB no. 2019-04-027) and was conducted according to the principles expressed in the Declaration of Helsinki.

Refractive corneal inlay for presbyopia in emmetropic patients in Asia: 6-month clinical outcomes.

BACKGROUND: To evaluate the 6-month clinical outcomes of Flexivue Microlens refractive corneal inlay in emmetropic patients in Asia for the surgical compensation of presbyopia. METHODS: In this retrospective study, corneal inlay implantation was done using a femtosecond laser. The follow-up period was 6 months. Near/intermediate/distant visual acuities, refraction, keratometry, defocus curve, wavefront aberrations, contrast sensitivity, Scheimpflug corneal scanning, endothelial cell density, dry eye test, confocal microscopy scanning, and patient questionnaires were evaluated. RESULTS: The inlay implantation was performed in 21 eyes from June 2015 to April 2017. 6 months after surgery, the uncorrected near visual acuity of the operated eyes increased significantly from 0.55 ± 0.22 logMAR preoperatively to 0.25 ± 0.15 logMAR (p < 0.05) but mean bilateral uncorrected distant visual acuity did not change significantly (p = 0.90). Total higher-order aberration and spherical aberration increased, and the contrast sensitivity of the operated eyes decreased. Endothelial cell density and central corneal thickness did not change from preoperative values. Patient satisfaction for near vision was increased 6 months after implantation, and 50.0% of patients were independent of near spectacles. Explantation was done in 2 cases. CONCLUSION: The Flexivue Microlens refractive corneal inlay was effective for improving near visual acuity at 6 months follow-up But proportion of spectacle independency and patient satisfaction were lower in this Korean population than in previous reports. Further study with a longer follow-up period is needed.

Prospective study of bilateral mix-and-match implantation of diffractive multifocal intraocular lenses in Koreans.

BACKGROUND: To evaluate monocular and binocular visual outcomes for near, intermediate, and far distance in patients implanted with diffractive multifocal intraocular lenses (IOLs) with different add power contralaterally. METHODS: This is a prospective contralateral study. Two diffractive multifocal IOLs with different added power were implanted bilaterally in twenty patients. TECNIS® ZKB00 (+ 2.75 D) was implanted in a dominant eye, and TECNIS® ZLB00 (+ 3.25 D) was implanted in a non-dominant eye. Uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), and manifest refraction (MR) values were measured at 1 month and 3 months postoperatively. At the 3-month follow-up, defocus curve, contrast sensitivity, and reading performance were evaluated. Quality of vision, overall satisfaction, and spectacle independence were evaluated by questionnaire. RESULTS: Postoperative binocular UDVA, visual acuity at 80 cm, 60 cm, 50 cm, 43 cm, 33 cm were - 0.08 ± 0.10, 0.12 ± 0.14, 0.09 ± 0.09, 0.07 ± 0.11, 0.14 ± 0.09, 0.25 ± 0.11 logMAR. The binocular defocus curve showed an extended range of good visual acuity with sharp vision being observed from 0 D to - 2.50 D defocus (logMAR≤0.1). Reading performance was significantly improved compared to baseline. All patients were spectacle-free at distance, and 94.74% of the patients did not require glasses for near and intermediate vision. CONCLUSIONS: Mix-and-match implantation of diffractive multifocal IOLs with different add power provides an excellent wide range of vision, as well as high levels of visual quality and patient satisfaction. TRIAL REGISTRATION: ClinicalTrials.gov , NCT02556944, https://clinicaltrials.gov/show/NCT02556944.

Comparison of clinical outcomes of toric intraocular lens, Precizon vs Tecnis: a single center randomized controlled trial.

BACKGROUND: To compare the clinical outcome of Precizon toric intraocular lens (IOL) (Ophtec Inc.) to that of Tecnis toric IOL (Abbott Medical Optics Inc.). METHODS: This randomized comparative study included 40 eyes (Precizon, 20 eyes; Tecnis, 20 eyes) of 40 patients with visually significant cataract and corneal astigmatism who underwent cataract surgery. Changes in uncorrected distant visual acuity (UCDVA), best corrected distant visual acuity (BCDVA), uncorrected intermediate visual acuity (UCIVA), refraction, residual astigmatism, rotation of the IOL axis, and higher order aberrations at 3 months postoperatively were evaluated. Vector analysis was performed using the Alpins method. RESULTS: Both groups showed significant reduction in refractive astigmatism after the surgery (Precizon: - 1.06 ± 0.94 Diopter (D) to - 0.31 ± 0.29 D, p = 0.042; Tecnis: - 1.83 ± 1.29 D to - 0.41 ± 0.33 D, p = 0.015). There was no significant (p > 0.05) difference in postoperative UCDVA, BCDVA, or residual astigmatism between the two groups, although a tendency of better UCIVA was observed in the Precizon group. Vector analysis parameters showed no statistically significant difference beween groups(P > 0.05). Significant difference in rotation of toric IOL axis was found between the two groups (Precizon: 1.50° ± 0.84, Tecnis: 2.56° ± 0.68, p = 0.010). Spherical aberration in the Precizon group was significantly (p = 0.005) lower than that in the Tecnis group. CONCLUSIONS: The Precizon toric IOL group had better rotational stability at 3-month postoperatively. Both Precizon toric IOL and Tecnis toric IOL could be effectively used by cataract surgeons to correct preexisting corneal astigmatism through cataract surgery. TRIAL REGISTRATION: http://clinicaltrials.gov , NCT03085901 , retrospectively registered on 21 March 2017.

Correction to: Risk factors of presenile nuclear cataract in health screening study.

Following publication of the original article [1], the authors notified us of that due to miscommunication during proofing their given names were not presented in their full form, but only using the initials.

Risk factors of presenile nuclear cataract in health screening study.

BACKGROUND: To identify risk factors for the development of presenile nuclear cataract in health screening test. METHODS: The cross sectional study included a total of 532 eyes of 266 participants aged 30 to 49 years of Samsung Medical Center from February 2013 to April 2015. Presence of nuclear cataract was defined when the log MAR visual acuity with correction was greater than or equal to 0.2 and one or more of the following were met: Pentacam Nuclear Staging (PNS) grading score ≥ 1, average value of nuclear density ≥ 15%, maximum value of nuclear density ≥ 30%. Possible risk factors were obtained from blood tests and questionnaires of a health screening test of Samsung Medical Center. Association between nuclear cataract and risk factors was investigated using univariate and multivariate logistic regression analysis by generalized estimating equation (GEE) models. RESULTS: Five factors were significantly associated with presenile nuclear cataract: current smoking [odds ratio (OR) = 2.80, 95% confidence interval (CI), 1.10-7.12, p = 0.0310], non-exercise and high amount of daily physical exercise (OR = 3.99, 95% CI, 1.27-12.52, p = 0.0178; OR = 2.92, 95% CI, 1.38-6.22, p = 0.0053), asthma (OR = 8.93, 95% CI, 1.12-71.15, p = 0.0386), tuberculosis (OR = 4.28, 95% CI, 1.36-13.50, p = 0.0131), and higher total iron binding capacity (OR = 1.01, 95% CI, 1.00-1.02, p = 0.0059). CONCLUSIONS: Presenile nuclear cataract is related to current smoking, non-exercise or high amount of physical exercise, asthma, tuberculosis, and iron deficiency status. The association of non-exercise group and presenile nuclear cataract seems to be related to co-morbidity. Patients with asthma, tuberculosis, or iron deficiency anemia are recommended to receive frequent ophthalmic examination to detect cataract.

Association of Axial Length Growth and Topographic Change in Orthokeratology.

OBJECTIVES: To investigate the topographic factors related to axial length (AL) growth rate in orthokeratology. METHODS: Clinical data of myopic children with orthokeratology lenses from 2010 to 2016 were investigated. Corneal topography (Orbscan II) and IOLMaster-measured AL at baseline and every posttreatment visit were analyzed. Optical map topographies from baseline- and posttreatment-stabilized corneas were analyzed to calculate the refractive power difference between the apex and the periphery (apex-periphery refractive power difference [ARPD]), which estimates the change of peripheral refraction. A generalized estimating equation (GEE) was used to assess the associations between AL growth and topographic changes in both eyes. RESULTS: The mean baseline spherical equivalent (SE) was -2.40±1.12 diopters (D) and the mean AL was 24.38±0.77 mm. Over a mean follow-up period of 41.9 months, the mean AL growth rate was 0.22±0.15 mm/year. In a univariable GEE analysis, age at initial lens wear, baseline AL, baseline SE, central corneal thickness (CCT), baseline apex power, and posttreatment ARPD on optical topography maps were all significantly correlated with AL growth rate (P<0.001, 0.009, 0.024, 0.011, 0.010, and 0.006, respectively). In a multivariable GEE, CCT and posttreatment ARPD were identified as significant factors (P=0.014 and 0.016, respectively). CONCLUSIONS: The AL growth rate was significantly associated with CCT and posttreatment relative peripheral refractive power, in addition to age at initial lens wear. These associations might possibly demonstrate an effect of treatment-induced peripheral refraction changes on retardation of myopic progression, whereas younger age might significantly influence both AL growth rate and corneal deformation.

Comparison of astigmatism prediction error taken with the Pentacam measurements, Baylor nomogram, and Barrett formula for toric intraocular lens implantation.

BACKGROUND: To evaluate and compare the astigmatism prediction errors taken with the Pentacam measurements, Baylor nomogram, and Barrett formula for toric intraocular lens (IOL) implantation. METHODS: Phacoemulsification with toric Precizon IOL implantation was performed in 41 eyes with corneal astigmatism (range, 1 to 5 diopters (D)) determined by IOLMaster and SimK on Pentacam. Preoperative corneal astigmatism measurements were obtained from IOLMaster readings (IOLMaster, Baylor-IOLMaster, and Barrett-IOLMaster) and Pentacam readings (SimK, Baylor-SimK, Barrett-SimK, wavefront, true net power, total corneal refractive power, and vector derived by manual vector summation using corneal front and back astigmatism). Prediction error and intraclass correlation coefficient (ICC) between the measured (or calculated) astigmatism by IOLMaster and Pentacam and the estimated corneal astigmatism estimated by IOL toricity power and residual astigmatism were determined. RESULTS: The centroid errors in prediction error with IOLMaster, SimK, Baylor-IOLMaster, Baylor-SimK, Barrett-IOLMaster, Barrett-SimK, wavefront, true net power, total corneal refractive power, and vector were 0.59@103, 0.61 @103, 0.37@161, 0.41@162, 0.24@171, 0.36@162, 0.42@106, 0.04@8, 0.07@82, and 0.03@82, respectively, in with-the-rule (WTR) astigmatism eyes at postoperative 3-month. They were 0.22@87, 0.20@74, 0.16@21, 0.54@10, 0.43@3, 0.33@19, 0.51@25, 0.31@58, 0.29@50, and 0.14@50 in against-the-rule (ATR) astigmatism eyes. Of the ten modalities, vector showed the lowest WTR astigmatism prediction error and the highest ICC between the predicted and the estimated corneal astigmatism for both WTR and ATR eyes. CONCLUSION: Vector summation using anterior and posterior corneal surface power taken with the Pentacam yields the least astigmatism prediction error and is a promising tool for determining toric IOL cylinder power.

Buffering zone of implantable Collamer lens sizing in V4c.

BACKGROUND: The purpose of this study was to identify factors related to the unexpected vault in V4c implantable collamer lens (ICL; STAAR Surgical) implantation. METHODS: V4c ICLs were implanted in 43 eyes of 43 patients for the correction of myopia. The implanted V4c ICL sizes were determined individually with our previous V4 ICL sizing nomogram based on the sulcus-to-sulcus diameter (STS), and the V4 ICL sizes were then converted to V4c ICL sizes with a size-converting table. We defined the "normal-sizing group" as having a pre-converted ICL size larger than the STS, and the "under-sizing group" as having a pre-converted ICL size smaller than the STS. Refractive outcomes, safety and parameters related to postoperative vault were compared between the two groups. RESULTS: The value of "actual ICL size - STS" differed significantly between the normal-sizing and under-sizing groups (p < 0.001), but postoperative vault did not differ significantly (p = 0.442). The demographics, implanted ICL characteristics, effectiveness indexes, safety indexes, and parameters related to postoperative vault did not differ significantly between the two groups (p > 0.05). Two patients in the normal-sizing group exhibited over-vaulting; these patients had shallow anterior chambers and were implanted with high-dioptric-power ICLs. CONCLUSIONS: The achievement of acceptable vault in both normal-sizing and under-sizing groups indicates the existence of a buffering zone in V4c ICL sizing. The smaller size of V4c ICLs should be considered in patients susceptible to over-vaulting, such as those with shallow anterior chambers and high-dioptric-power ICLs.

Clinical Outcomes after Bilateral Implantation of a Wavefront-Shaping Extended Depth of Focus (EDOF) IOL with Mini-Monovision.

Background: To compare the visual outcomes and optical quality of patients who underwent bilateral implantation of EDOF (AcrySof® IQ Vivity IOL, DFT015) for mini-monovision, trifocal (AcrySof® IQ PanOptix, TNFT00), or monofocal (AcrySof® IQ IOL, SN60WF) IOL. Methods: The monocular-corrected and uncorrected distance visual acuities (CDVA and UDVA, respectively) were evaluated postoperatively at 1 and 3 months. The binocular visual acuity by distance, the binocular defocus curve, contrast sensitivity, and patient satisfaction were examined 3 months postoperatively. All patients were asked to complete questionnaires regarding their satisfaction, visual symptoms, and spectacle dependency. Results: This study included 178 eyes from 89 patients. The postoperative binocular UDVA did not differ significantly among the three groups. In the defocus curve, the Vivity group showed better visual acuity over a range of far and intermediate (60 cm) than the other two IOLs groups. In near-vision, the PanOptix group showed the best near-vision, and the Vivity group showed significantly better vision than the IQ group. The Vivity group showed contrast sensitivity and optical quality comparable to the IQ group. Conclusions: The bilateral implantation of AcrySof® IQ Vivity IOL with the mini-monovision approach provided excellent distance and intermediate visual acuity with good near-vision, resulting in high satisfaction.

The associations of herpes simplex virus and varicella zoster virus infection with dementia: a nationwide retrospective cohort study.

BACKGROUND: In this study, the risk of dementia in patients with a history of herpes simplex virus (HSV) or varicella zoster virus (VZV) infection was evaluated. METHODS: This nationwide cohort study used data from the Korean National Health Insurance Service collected between 2006 and 2017. A total of 752,205 subjects ≥ 45 years of age not diagnosed with dementia until 2006 were included. A multivariate Cox regression model, adjusted for age, sex, and other comorbidities, was used to assess the hazard ratio (HR) for dementia based on VZV or HSV infection. The interaction effects of both viral infections were analysed. Viral infections are classified into four categories: eye, central nervous system (CNS), simple, and complicated. The hazard ratio (HR) of viral infection was analysed based on the type of dementia. RESULTS: In multivariable analysis, both HSV and VZV infection were associated with an increased risk of dementia (HR = 1.38, 95% confidence interval, CI:1.33-1.43) and (HR = 1.41, 95% CI:1.37-1.46), respectively. Patients who experienced both HSV and VZV infections were also at an increased risk of dementia (HR = 1.57, 95% CI:1.50-1.63). The co-infection group showed the shortest time from viral infection to dementia diagnosis (4.09 ± 3.02 years). In the subgroup analysis, all types of HSV and VZV infections were associated with an increased risk of dementia compared to the non-infection group. The eye, CNS, and complicated VZV infections were associated with a significantly higher risk than simple VZV infections. There were no significant differences between the subtypes of HSV infection. Furthermore, HSV, VSV, and co-infection were associated with an increased risk of all dementia types, including Alzheimer's disease (AD) and vascular dementia (VD). CONCLUSIONS: Individual HSV and VZV infections were associated with an increased risk of all types of dementia, including AD and VD. Patients co-infected with HSV and VZV, VZV infection in the eye, CNS, or complicated type were more vulnerable to the development of dementia.

Limitations of and Solutions to Using 6 mm Corneal Spherical Aberration and Q Value after Laser Refractive Surgery.

This study aimed to evaluate the spherical aberration (SA) in different corneal areas before and after femtosecond laser-assisted in situ keratomileusis (fLASIK) and transepithelial photorefractive keratectomy (tPRK), with the goal of identifying the limitations of and potential improvements in using SA within a 6 mm area. The study included 62 patients who underwent fLASIK and tPRK. Complete eye examinations including keratometry, corneal epithelial thickness, central corneal thickness, and topography were performed preoperatively and postoperatively. Anterior, posterior, and total corneal aberrations were measured preoperatively and three months postoperatively, with pupil diameters ranging from 2 to 8 mm. In the fLASIK group, compared to the preoperative SA, the anterior and total SA increased postoperatively in the 6 and 7 mm areas. In the tPRK group, meanwhile, the anterior and total SA of the 5 mm or larger areas increased postoperatively. An area of 6 mm or larger showed an increase in correlation with the changes in Q value and refractive correction. As the corneal SA and asphericity in the 6 mm zone cannot specifically demonstrate the status of areas smaller than 6 mm or changes in the optical zone after laser refractive surgery, comparison with normal values in various areas of the cornea is necessary.