Accuracy of intraocular lens power formulas in eyes with keratoconus: Multi-center study in Japan.

PURPOSE: To assess the accuracy of intraocular lens (IOL) power formulas, namely, SRK/T, Haigis, Barrett Universal II, Barrett True-K for keratoconus, Kane formula, and Kane formula for keratoconus, for cataract with keratoconus in Japanese eyes. SETTING: Five surgical sites in Japan. DESIGN: A retrospective case series. METHODS: Eyes with keratoconus undergoing cataract surgery were included. Postoperative refraction was compared with the prediction by the formulas. Visual acuity, manifest spherical equivalent, prediction error (PE), and mean absolute errors (MAEs) were determined 1 month postoperatively. The PE within 0.50 diopter (D), 1.00 D, and 2.00 D were compared between IOL formulas. Subgroup analysis based on the steepest keratometry (stage 1, ≤ 48 D; stage 2, > 48 D and ≤ 53 D; and stage 3, > 53 D) was performed. The relationship between PE and preoperative biometric data were assessed. RESULTS: Fifty eyes were included. The MAE of the Barrett True-K for keratoconus, Kane keratoconus, and Kane formulas were significantly lower than that of Haigis. A statistically significant difference in the prediction accuracy within ± 0.50 D was found between Kane keratoconus and Haigis. The prediction accuracy of the Barrett True-K for keratoconus, SRK/T, and Kane within ± 1.00 D was statistically significant compared with that of Haigis. In stage 3, the Barrett True-K for keratoconus had a significantly lower MAE than SRK/T and Haigis. CONCLUSION: Keratoconus-specific formulas were more accurate than existing formulas in Japanese eyes. The Barrett True-K formula for keratoconus had higher prediction accuracy in severe keratoconus.

Violet light suppresses lens-induced myopia via neuropsin (OPN5) in mice.

Myopia has become a major public health concern, particularly across much of Asia. It has been shown in multiple studies that outdoor activity has a protective effect on myopia. Recent reports have shown that short-wavelength visible violet light is the component of sunlight that appears to play an important role in preventing myopia progression in mice, chicks, and humans. The mechanism underlying this effect has not been understood. Here, we show that violet light prevents lens defocus-induced myopia in mice. This violet light effect was dependent on both time of day and retinal expression of the violet light sensitive atypical opsin, neuropsin (OPN5). These findings identify Opn5-expressing retinal ganglion cells as crucial for emmetropization in mice and suggest a strategy for myopia prevention in humans.

Suppressive effects of violet light transmission on myopia progression in a mouse model of lens-induced myopia.

The prevalence of myopia has been steadily increasing for several decades, and this condition can cause extensive medical and economic issues in society. Exposure to violet light (VL), a short wavelength (360-400 nm) of visible light from sunlight, has been suggested as an effective preventive and suppressive treatments for the development and progression of myopia. However, the clinical application of VL remains unclear. In this study, we aimed to investigate the preventive and suppressive effects of VL on myopia progression. Various transmittances of VL (40%, 70%, and 100%) were tested in C57BL/6J mice with lens-induced myopia (LIM). Changes in the refractive error, axial length, and choroid thickness during the 3-week LIM were measured. The myopic shift in refractive error and difference in axial length between the 0 and -30 diopter lens was lessened in a transmission-dependent manner. Choroidal thinning, which was observed in myopic conditions, was suppressed by VL exposure and affected by its transmission. The results suggest that myopia progression can be managed using VL transmittance. Therefore, these factors should be considered for the prevention and treatment of myopia.

Lipidomic analysis revealed n-3 polyunsaturated fatty acids suppressed choroidal thinning and myopia progression in mice.

Myopia is increasing worldwide and its preventable measure should urgently be pursued. N-3 polyunsaturated fatty acids (PUFAs) have been reported to have various effects such as vasodilative and anti-inflammatory, which myopia may be involved in. This study is to investigate the inhibitory effect of PUFAs on myopia progression. A lens-induced myopia (LIM) model was prepared using C57B L6/J 3-week-old mice, which were equipped with a -30 diopter lens to the right eye. Chows containing two different ratios of n-3/n-6 PUFA were administered to the mice, and myopic shifts were confirmed in choroidal thickness, refraction, and axial length in the n-3 PUFA-enriched chow group after 5 weeks. To exclude the possibility that the other ingredients in the chow may have taken the suppressive effect, fat-1 transgenic mice, which can produce n-3 PUFAs endogenously, demonstrated significant suppression of myopia. To identify what elements in n-3 PUFAs took effects on myopia suppression, enucleated eyes were used for targeted lipidomic analysis, and eicosapentaenoic acid (EPA) were characteristically distributed. Administration of EPA to the LIM model confirmed the inhibitory effect on choroidal thinning and myopia progression. Subsequently, to identify the elements and the metabolites of fatty acids effective on myopia suppression, targeted lipidomic analysis was performed and it demonstrated that metabolites of EPA were involved in myopia suppression, whereas prostaglandin E2 and 14,15-dihydrotestosterone were associated with progression of myopia. In conclusion, EPA and its metabolites are related to myopia suppression and inhibition of choroidal thinning.

Effects of Hyperoxia on the Refraction in Murine Neonatal and Adult Models.

Whether hyperoxia affects the refraction in neonatal and adult mice is unknown. The mice exposed to 85% oxygen at postnatal 8 days (P8d) for 3 days and the mice exposed to normal air were assigned to the neonatal hyperoxia and normoxia groups, respectively. The refraction, the corneal curvature radius (CR) and the axial length (AL) were measured at P30d and P47d. Postnatal 6 weeks (P6w) adult mice were divided into the adult hyperoxia and normoxia groups. These parameters were measured before oxygen exposure, after 1 and 6 weeks, and every 7 weeks. The lens elasticity was measured at P7w and P26w by enucleation. The neonatal hyperoxia group showed a significantly larger myopic change than the neonatal normoxia group (P47d -6.56 ± 5.89 D, +4.11 ± 2.02 D, p < 0.001), whereas the changes in AL were not significantly different (P47d, 3.31 ± 0.04 mm, 3.31 ± 0.05 mm, p = 0.852). The adult hyperoxia group also showed a significantly larger myopic change (P12w, -7.20 ± 4.09 D, +7.52 ± 2.54 D, p < 0.001). The AL did not show significant difference (P12w, 3.44 ± 0.03 mm, 3.43 ± 0.01 mm, p = 0.545); however, the CR in the adult hyperoxia group was significantly smaller than the adult normoxia group (P12w, 1.44 ± 0.03 mm, 1.50 ± 0.03 mm, p = 0.003). In conclusion, hyperoxia was demonstrated to induce myopic shift both in neonatal and adult mice, which was attributed to the change in the CR rather than the AL. Elucidation of the mechanisms of hyperoxia and the application of this result to humans should be carried out in future studies.

Ocular-Component-Specific miRNA Expression in a Murine Model of Lens-Induced Myopia.

To identify tissues and molecules involved in refractive myopic shift and axial length elongation in a murine lens-induced myopia model, we performed a comprehensive analysis of microRNA (miRNA) expression. Three weeks after negative 30 diopter lens fixation on three-week-old C57BL/6J mice, total RNA was extracted from individual ocular components including cornea, iris, lens, retina, retinal pigment epithelium (RPE)/choroid, and sclera tissue. The miRNA expression analysis was pooled from three samples and carried out using Agilent Mouse miRNA Microarray (8 × 60 K) miRBase21.0. The expression ratio was calculated, and differentially expressed miRNAs were extracted, using GeneSpring GX 14.5. Myopic induction showed a significant myopic refractive change, axial elongation, and choroidal thinning. Through the comprehensive miRNA analysis, several upregulated miRNAs (56 in cornea tissue, 13 in iris tissue, 6 in lens tissue, 0 in retina tissue, 29 in RPE/choroid tissue, and 30 in sclera tissue) and downregulated miRNAs (7 in cornea tissue, 28 in iris tissue, 17 in lens tissue, 9 in retina tissue, 7 in RPE/choroid tissue, and 40 in sclera tissue) were observed. Overlapping expression changes in miRNAs were also found in different ocular components. Some of this miRNA dysregulation may be functionally involved in refractive myopia shift and axial length elongation.

Progress and Control of Myopia by Light Environments.

During the past 30 years, the prevalence rate of myopia has been increased dramatically. Myopia has become one of the leading causes of vision loss in some countries, whereas the mechanism of the main pathological change in myopia is still largely unknown. Although several studies showed genetic background influences the phenotype of myopia to some extent, the sudden increase of morbidity cannot be explained by genetics only. The change in lifestyle results in tremendous change in the light environment, which can be considered to play an important role in the onset and progression of myopia. The difference between indoor and outdoor light environments such as intensity and wavelength of modern electronic lighting equipment may be a cue for myopia control as environmental factors. In this review, we discuss the relationship between myopia and light environment focusing on the basic and clinical studies.

Myopic regression after phakic intraocular lens implantation and LASIK.

PURPOSE: In myopia, biometry including the axial length is important, along with the refractive data. We compared the rates of myopic regression 3 years after phakic intraocular lens (pIOL) implantation and laser in situ keratomileusis (LASIK) after matching the preoperative axial length in highly myopic eyes of Japanese patients. METHODS: This retrospective nonrandomized study included 133 eyes of 84 patients with myopia exceeding -6.00 diopters (D) who underwent implantation of two iris-fixated pIOLs (pIOL group, 66 eyes/46 patients) or myopic LASIK (LASIK group, 67 eyes/38 patients) who were followed for more than 3 years postoperatively. The patient age, preoperative refraction, and preoperative axial length were matched between the study groups. RESULTS: There were no significant differences preoperatively between the groups in age, intraocular pressure, refraction, keratometry, or axial length. The mean regression values after 3 years compared with the 1-month postoperative refractions were -0.12 ± 0.47 (SD) D in the pIOL group and -0.82 ± 0.69 D in the LASIK group (p < 0.001). The differences in the mean regression rates between 1 and 12 months, 12 and 24 months, and 24 and 36 months of follow-up were, respectively, 0.09 ± 0.38 D, -0.11 ± 0.35 D, and -0.11 ± 0.30 D in the pIOL group and -0.57 ± 0.84 D, -0.24 ± 0.47 D, and 0.00 ± 0.53 D in the LASIK group (p < 0.001, p = 0.07, p = 0.15, respectively). CONCLUSIONS: There was a significant difference in myopic regression 3 years postoperatively between the groups matched for preoperative axial length in Japanese patients. This result has the potential to elucidate myopia in the future.

A Possible Reciprocal Relationship Between Myopia and Dry Eye Disease in Japanese Teenagers.

Purpose: To investigate the relationship between dry eye disease (DED) and myopia in Japanese teenagers. Methods: This clinic-based, retrospective, cross-sectional study assessed DED condition in 10- to 19-year-old teenagers presenting at Japanese eye clinics. They included 106 high myopic patients (HM; mean age, 16.4 ± 2.2 years), 494 mild myopic patients (15.0 ± 2.6 years) and 82 non-myopic teenagers (NM; 13.8 ± 2.6 years). Subjective refraction and anisometropia were measured. Myopia grade was classified as HM (≤ -6.00 D), MM (> -6.00 D, < -0.50 D), or NM (≥ -0.5 D). The presence of DED-related symptoms including dryness, irritation, pain, fatigue, blurring and photophobia were assessed through a questionnaire. Tear film break-up time (BUT) and fluorescein corneal staining were investigated. Comparison among three groups and regression analysis of myopic error and other variables were conducted. Results: Anisometropia and astigmatic error were greatest in the HM group compared with the other groups (p < 0.001). The HM group reported less photophobia (p < 0.001) and less pain (p = 0.039) compared with the NM group. Regression analysis revealed that myopic error was correlated with astigmatic error (ß = -0.231, p <0.001), anisometropia (ß = -0.191, p <0.001), short BUT (ß = -0.086, p = 0.028) and the presence of diagnosed DED (ß = -0.112, p = 0.003). Dryness (ß = -0.127 p = 0.004), photophobia (ß = 0.117, p = 0.002) and pain (ß = 0.084, p = 0.034) correlated with myopic error. Conclusion: This study associated clinical findings of DED in HM teenagers. The present results suggest DED might be associated with myopia, possibly in a reciprocal relationship.

Effect of Eyelid Hygiene on Functional Visual Acuity After Cataract Surgery: A Randomized Controlled Study.

Purpose: To evaluate the effect of eyelid hygiene after cataract surgery on eyelid and ocular surface findings, subjective symptoms and visual function, including functional visual acuity (FVA) and higher order aberration, in a randomized controlled study. Methods: Fifty patients who underwent cataract surgery at a single institution were involved. Twenty-five patients were instructed to wipe their eyelids twice a day from one to four weeks postoperatively, whereas the other 25 patients did not perform any eyelid hygiene. Optical measurement, FVA, meibomian glands, the grade of meibum, lid margin findings, fluorescein corneal staining findings, dry eye-related subjective symptoms and surgical satisfaction were assessed both preoperatively and one month postoperatively. Results: In the eyelid hygiene group, the visual maintenance ratio of FVA improved significantly (p = 0.048) and the higher order aberration of the 4th + 6th order deteriorated less (p = 0.027) compared with the control group. Multiple regression analyses showed that the change in visual maintenance ratio was associated with surgical satisfaction (p = 0.003), change in corneal staining score (p = 0.007), history of eye diseases (p = 0.029) and eyelid hygiene (p = 0.048). Conclusions: Eyelid hygiene after cataract surgery may be effective for visual function measured with an FVA test.

Slowing of Greater Axial Length Elongation Stemming from the Coronavirus Disease 2019 Pandemic with Increasing Time Outdoors: The Tokyo Myopia Study.

Purpose: To investigate the changes in axial length (AL) elongation and other ocular parameters before and during the coronavirus disease 2019 pandemic. Design: A longitudinal school-based study. Participants: Public elementary schoolchildren in Tokyo (grades 1-6; age, 6-12 years) participated in this study from 2018 to 2021. Methods: All participants underwent eye examinations and provided written consent to measurements of the noncycloplegic refraction and ocular biometry including AL, among others. The students' parents also completed a questionnaire about the students' lifestyles. We included the right eye in our analysis and compared the changes in the ocular parameters among the periods using a linear mixed-effects model for repeated measures and examined the univariate and step-wise multiple regression analyses to evaluate the associations between myopia and other covariates. Main Outcome Measures: Changes in AL elongation and other ocular parameters from 2018 to 2019 (prepandemic), that of 2019 to 2020 (immediately after the pandemic onset), and that of 2020 to 2021 (during the pandemic). Results: A total of 578 students before the pandemic period, 432 immediately after the pandemic onset, and 457 during the pandemic period were evaluated. The changes in the ALs and spherical equivalents (SEs) a year before, immediately after onset, and during the pandemic were 0.31 mm/-0.20 diopter, 0.38 mm/-0.27 diopter, and 0.28 mm/-0.47 diopter, respectively (ALs, P < 0.001; SEs, P = 0.014). The results of the questionnaire showed that time spent outdoors daily had changed during the 3 years to 79, 63, and 77 minutes/day, respectively (P < 0.001). Time spent using smartphones or tablets increased year by year to 41, 52, and 62 minutes/day (P < 0.001). The greatest AL elongation occurred during the period when the shortest amount of time was spent outdoors during the 3 years. Conclusions: These results suggested that the school closures and decreasing time spent outdoors might have caused greater AL elongation among schoolchildren in Tokyo; however, it is possible that, although the time spent in near work still increased, the return to the time spent outdoors to the prepandemic levels may have affected the slowing of AL elongation after lockdown. Financial Disclosures: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Myopia Is an Ischemic Eye Condition: A Review from the Perspective of Choroidal Blood Flow.

Myopia is a common refractive error that affects a large proportion of the population. Recent studies have revealed that alterations in choroidal thickness (ChT) and choroidal blood flow (ChBF) play important roles in the progression of myopia. Reduced ChBF could affect scleral cellular matrix remodeling, which leads to axial elongation and further myopia progression. As ChT and ChBF could be used as potential biomarkers for the progression of myopia, several recent myopia treatments have targeted alterations in ChT and ChBF. Our review provides a comprehensive overview of the recent literature review on the relationship between ChBF and myopia. We also highlight the importance of ChT and ChBF in the progression of myopia and the potential of ChT as an important biomarker for myopia progression. This summary has significant implications for the development of novel strategies for preventing and treating myopia.

Changes in cataract and refractive surgery practice patterns among JSCRS members over the past 20 years.

PURPOSE: To evaluate changes in cataract and refractive surgery practice patterns among members of the Japanese Society of Cataract and Refractive Surgery (JSCRS) over the past 20 years. STUDY DESIGN: Questionnaire survey study. SUBJECTS AND METHODS: Clinical surveys were conducted annually between February and April from 2004 to 2023. Survey questions covered various areas, including cataract surgical techniques, anesthesia, endophthalmitis prophylaxis, toric and presbyopia-correcting intraocular lenses (IOLs), complications, and refractive surgery. RESULTS: The highest (n=554 [36.8%]) and lowest (n=316 [19.1%]) numbers of responses were collected in 2012 and 2016, respectively. In perioperative management, the intraoperative use of polyvinyl alcohol-iodine solution and topical antibiotic prescription 3 days before surgery has increased. The use of intracameral injection at the end of surgery has also significantly increased, although it has not been established as common practice. In anesthesia, there is a clear polarization between the use of topical drops and tenon injection. The use of toric IOLs and presbyopia-correcting IOLs has significantly increased from 2010 to 2023. In the latter, the use of trifocal IOLs has particularly increased. Regarding IOL power calculations, the Barrett True K and the Barrett Universal II formulas are rapidly gaining popularity for application with and without post-laser vision correction, respectively. In refractive surgery, phakic IOLs and corneal refractive therapy have attracted considerable interest, followed by laser in situ keratomileusis. CONCLUSIONS: Evaluation of annual clinical survey data over the past two decades provided valuable insights into the shifting practice patterns and clinical opinions among JSCRS members.

Effect of pupil size on uncorrected visual acuity in pseudophakic eyes with astigmatism.

PURPOSE: To study the effect of pupil size on the relationship between refractive astigmatism and uncorrected distance visual acuity (UDVA) and pseudoaccommodation in pseudophakic eyes. METHODS: Thirty-six eyes from 36 patients who underwent phacoemulsification and intraocular lens (IOL) implantation were included. All eyes were divided into two groups based on the presence of postoperative-with-the-rule astigmatism or against-the-rule astigmatism. Uncorrected and corrected distance visual acuity (CDVA), refractive astigmatism, subjective accommodation amplitude, and pupil sizes under photopic and mesopic conditions were measured 1 month postoperatively. The effects of pupil size on the relationship between refractive astigmatism and UDVA were investigated. RESULTS: Against-the-rule astigmatism had a moderate but significant negative linear correlation with UDVA irrespective of the pupil size (R(2)=0.60, P<.01). A moderate but significant negative linear correlation was found when the pupil diameter exceeded 2.9 mm in eyes with with-the-rule astigmatism (R(2)=0.46, P=.04). Refractive astigmatism was not significantly correlated with pseudoaccommodation regardless of the pupil diameter in either group. CONCLUSIONS: The results of the current study suggest that pupil size may have an impact on postoperative UDVA in eyes having against-the-rule astigmatism and in eyes with a large pupil diameter and with-the-rule astigmatism.

Effect of experimentally induced astigmatism on functional, conventional, and low-contrast visual acuity.

PURPOSE: To report the changes in functional visual acuity (FVA) in eyes with experimentally induced astigmatism. METHODS: This study included 26 right eyes from 26 healthy participants (mean age: 27.0±4.4 years). After confirming best correction under cycloplegia, the cylinder power ×90° and ×180° (against-the-rule [ATR] and with-the-rule [WTR] astigmatism, respectively) were added with 0.50-diopter (D) steps, from 0.50 to 2.50 D. Conventional visual acuity (VA), FVA as measured by the FVA Measurement System (NIDEK Co Ltd), and 10% low-contrast visual acuity (LCVA) were measured with 3-mm artificial pupil under each condition. RESULTS: The mean corrected logMAR VA, FVA, LCVA were -0.18±0.00 (20/13), -0.10±0.08 (20/16), and 0.06±0.06 (20/23), respectively. The VA, FVA, and LCVA had a significant linear negative correlation with the addition of cylinder irrespective of the axes. A significant decrease in FVA was noted on addition of ⩾0.50 D WTR astigmatism and ⩾1.00 D ATR astigmatism. With the addition of 1.00 D of cylindrical lens, 96% of eyes with WTR and ATR astigmatism could maintain 20/20 in VA testing, whereas only 50% and 62% of eyes with WTR and ATR astigmatism, respectively, could maintain 20/20 in FVA testing. CONCLUSIONS: Astigmatism may be associated with deterioration of visual function even when conventional VA of 20/20 is attained. Functional VA testing seems to be useful in evaluating the masked astigmatic visual impairment that cannot be detected by conventional VA testing.

Changes in higher-order aberrations after iris-fixated phakic intraocular lens implantation.

PURPOSE: To evaluate surgically induced changes in corneal, internal, and ocular higher-order aberrations (HOAs) after phakic intraocular lens (PIOL) implantation and compare them between two PIOLs with different pupillary diameters. METHODS: Twenty-three eyes with an Artisan PIOL (Ophtec BV, Groningen, The Netherlands) (Artisan group) and 30 eyes with an Artiflex PIOL (Ophtec BV) (Artiflex group) were retrospectively evaluated. The corneal, internal, and ocular HOAs and refractive data were recorded preoperatively and 6 months postoperatively. The root mean squares (RMSs) of the total HOAs from the third- to sixth-order Zernike coefficients were calculated. The RMSs of the third- and fourth-order coefficients represented coma-like aberrations (S3) and spherical-like aberrations (S4), respectively. The main outcome measures were the differences in the parameters among the groups with different pupillary diameters. RESULTS: The mean postoperative spherical equivalents decreased from -11.84 ± 4.90 to -0.16 ± 0.40 diopters and -9.78 ± 3.20 to -0.09 ± 0.26 diopters in the Artisan and Artiflex groups, respectively. With the 4- and 5-mm pupillary diameters, the postoperative internal and ocular spherical aberrations (Z4(0)) were significantly lower in the Artiflex group than in the Artisan group (4 mm, P = .002, .024; 5 mm, P = .004, .022, respectively). With the 6-mm pupillary diameter, there were no significant postoperative differences in any parameter measured between groups; both groups had positive spherical aberration values. CONCLUSIONS: The postoperative ocular spherical aberrations were positive after Artisan and Artiflex implantation. The postoperative ocular spherical aberration was greater in the Artisan group, possibly due to differences in the SAs of both PIOLs.

Sex differences in the relationship between axial length and dry eye in elderly patients.

Purpose: The aim of this study was to explore the association between myopia and dry eye (DE)-related ocular parameters. Methods: We recruited a total of 460 patients (mean age, 73.6 years; 40.2% men) and performed DE-related, axial length (AL) and retinal examinations. Statistical analysis revealed a significant sex difference in AL, strip meniscometry value, corneal staining score, corneal endothelial cell density, ganglion cell complex (GCC) thickness, and full macular thickness. AL was strongly age- and sex-dependent, so subsequent analyses were stratified by sex. Results: Among DE-related parameters, strip meniscometry value (ß = -0.167, p = 0.033) and corneal endothelial cell density (ß = -0.139, p = 0.023) were correlated with AL in women but not in men. Regarding retinal parameters, GCC thickness and full macular thickness were correlated with AL in women but not in men. Conclusion: The current results suggest a relationship between tear production and AL in elderly women and support the hypothesis that there may be a common upstream factor including the parasympathetic nervous system in the association between tear production and AL or DE and myopia.

Implantation of a toric intraocular lens after repeated radial keratotomy procedures: A case report.

Corneal alterations due to radial keratotomy (RK) complicate intraocular lens calculations, which may explain why there have been few reports of toric intraocular lens (TIOL) implantation after excessive or multiple operations. A 71-year-old male with a history of repeated RKs and at least 30 corneal incisions in each eye was referred for cataract surgery. Preoperatively, the best-corrected distance visual acuity was 0.7 decimal (0.15 logMAR) in the right eye and 0.9 decimal (0.05 logMAR) in the left eye. The refractive errors were -8.00 -3.00 × 80 and -6.00 -3.50 × 80, respectively. The total corneal cylindrical powers (real power; anterior and posterior) were, respectively, -0.90 D and -3.60 D at 9 a.m., compared to -1.60 D and -3.80 D at 1 p.m. Corneal astigmatism in the left eye was considered symmetric and diurnally stable; therefore, an XY1AT6 TIOL (Hoya, Tokyo, Japan; cylindrical power at the plane, +3.75 D) was implanted. A non-toric intraocular lens, the XY1 (Hoya), was implanted in the right eye. Six-month postoperative best-corrected distance visual acuities were 1.2 decimal (-0.08 logMAR) and 1.0 decimal (0.00 logMAR) in the right and left eyes, respectively. Post-operative manifest refractions were +0.00 -3.00 × 70 and -1.00 -2.00 × 85, respectively. The TIOL reduced refractive astigmatism in the left eye; therefore, we believe that even after multiple RKs, the TIOL can be a suitable candidate to correct astigmatism if the corneal astigmatism is diurnally stable and symmetric.

Clinical Results and Factors Affecting Visual Function in Eyes Implanted with an Enhanced Monofocal Intraocular Lens.

Purpose: To compare the clinical results achieved with the enhanced monofocal intraocular lenses (IOLs) with those of the monofocal IOL and investigate factors affecting the distance, intermediate, and near vision. Patients and Methods: Patients were included who underwent bilateral consecutive cataract surgeries using the same IOLs with follow-up to 1 month postoperatively. Refractions, monocular UDVA and CDVA, and binocular distance-corrected functional visual acuity at 5 meters (BDCFVA), at 66 centimeters (BDCIFVA) and at 40 centimeters (DCNVA) were assessed. Multiple regression analysis was used to assess the factors affecting binocular BDCFVA, BDCIFVA, and BDCNFVA. Subjective symptoms were assessed using the Near Activity Visual Questionnaire (NAVQ) and visual analogue scale (VAS). Results: Sixty patients (120 eyes) implanted with the Tecnis Eyhance IOL (30 patients, 60 eyes) or the Tecnis monofocal IOL (30 patients, 60 eyes) were included. The Tecnis Eyhance IOL provided significantly better binocular BDCIFVA than the Tecnis monofocal IOL in patients under 70 years of age. Multiple regression analysis showed that age was the only factor affecting distance and intermediate visual function in eyes with the Tecnis Eyhance IOL; gender, pupillary diameter, axial length, and average keratometry were not significant. There were no significant differences in subjective symptoms. Conclusion: The comprehensive cohort analysis did not confirm the advantage on the intermediate vision of the Tecnis Eyhance IOL. Younger age may be an important factor to benefit from the unique optical characteristics of this IOL.

Ginkgo biloba extracts improve choroidal circulation leading to suppression of myopia in mice.

Myopia is becoming more common across the world, necessitating the development of preventive methods. We investigated the activity of early growth response 1 (EGR-1) protein and discovered that Ginkgo biloba extracts (GBEs) activated EGR-1 in vitro. In vivo, C57BL/6 J mice were fed either normal or 0.0667% GBEs (200 mg/kg) mixed chow (n = 6 each), and myopia was induced with - 30 diopter (D) lenses from 3 to 6 weeks of age. Refraction and axial length were measured by an infrared photorefractor and an SD-OCT system, respectively. In lens-induced myopia mice, oral GBEs significantly improved refractive errors (- 9.92 ± 1.53 D vs. - 1.67 ± 3.51 D, p < 0.001) and axial elongation (0.22 ± 0.02 mm vs. 0.19 ± 0.02 mm, p < 0.05). To confirm the mechanism of GBEs in preventing myopia progression, the 3-week-old mice were divided into normally fed with either myopic-induced or non-myopic-induced groups and GBEs fed with either myopic-induced or non-myopic-induced groups (n = 10 each). Choroidal blood perfusion was measured with optical coherence tomography angiography (OCTA). In both non-myopic induced groups, compared to normal chow, oral GBEs significantly improved choroidal blood perfusion (8.48 ± 15.75%Area vs. 21.74 ± 10.54%Area, p < 0.05) and expression of Egr-1 and endothelial nitric oxide synthase (eNOS) in the choroid. In both myopic-induced groups, compared to normal chow, oral GBEs also improved choroidal blood perfusion (- 9.82 ± 9.47%Area vs. 2.29 ± 11.84%Area, p < 0.05) and was positively correlated with the change in choroidal thickness. These findings suggest that GBEs may inhibit the progression of myopia by improving choroidal blood perfusion.