Visual outcomes comparing emmetropia vs mini-monovision after bilateral implantation of a nondiffractive extended vision intraocular lens: randomized trial.

PURPOSE: To compare visual outcomes and patient satisfaction after bilateral implantation of a nondiffractive extended vision intraocular lens (IOL) when targeting emmetropia vs mini-monovision. SETTING: Iladevi Cataract & IOL Research Centre, Ahmedabad, India. DESIGN: Prospective, randomized controlled trial. METHODS: Patients undergoing bilateral cataract surgery with an extended vision IOL (Vivity) randomized to group I-IOL implantation with emmetropic target in both eyes or group II-IOL implantation with mini-monovision of -0.5 diopters (D) were included in this study. Outcome measures evaluated 6 months postoperatively were unaided and corrected near visual acuity (UNVA, CNVA) at 40 cm and unaided and corrected distance (UDVA, CDVA) and intermediate (UIVA, CIVA) visual acuity at 66 cm. Mesopic contrast sensitivity, binocular defocus curve, Patient-Reported Spectacle Independence Questionnaire, and satisfaction on the McAlinden questionnaire were also assessed. RESULTS: 70 patients enrolled in this study. 34 and 33 patients in groups I and II, respectively, completed follow-up. Binocular UNVA was significantly better in group II (0.26 ± 0.05 vs 0.22 ± 0.08 logMAR, P = .03). Reading add required in group II was significantly lower. UIVA (0.09 ± 0.06 vs 0.07 ± 0.08 logMAR, P = .15) and UDVA (0.02 ± 0.04 vs 0.02 ± 0.05 logMAR, P = .78) were not significantly different between groups. Mesopic contrast sensitivity was not significantly different between the groups. Binocular defocus curve showed significantly better mean visual acuities between -2.0 D and -3.0 D in group II. Patients in both groups had high levels of spectacle independence, with no patient reporting dysphotopsia. CONCLUSIONS: Binocular UNVA was significantly better, with comparable UDVA and mesopic contrast sensitivity when targeting mini-monovision with the nondiffractive extended vision IOL as compared with targeting binocular emmetropia.

Visual and refractive outcomes after bilateral implantation of an enhanced monofocal intraocular lens: prospective study.

PURPOSE: To evaluate visual and refractive outcomes, as well as patient satisfaction after bilateral implantation of an enhanced monofocal intraocular lens (IOL) with emmetropia as a target refraction. SETTING: San Carlos Hospital, Madrid, Spain. DESIGN: Prospective, monocentric, noncomparative study. METHODS: Adults 21 years or older suitable for cataract surgery and with corneal astigmatism <1.50 diopters (D) were bilaterally implanted with the RayOne EMV IOL and followed up for 3 months. Outcomes measures included refraction, monocular and binocular uncorrected distance visual acuity, corrected distance visual acuity (CDVA), uncorrected intermediate visual acuity, distance-corrected intermediate visual acuity (DCIVA), and defocus curve, aberrometry, and satisfaction. Visual symptoms were assessed using the CatQuest-9SF questionnaire. RESULTS: 50 eyes of 25 patients were included. At month 3, the mean manifest spherical equivalent was -0.39 ± 0.28 D, with all eyes within 1.00 D. Binocularly, uncorrected, at distance, 68% of patients could read ≤0.0 logMAR and 95% ≤0.2 logMAR; at intermediate 59% of patients could read ≤0.1 and 100% ≤0.2 logMAR. Mean monocular CDVA was -0.03 ± 0.06 logMAR and mean monocular DCIVA was 0.28 ± 0.07 logMAR. Binocular defocus curve demonstrated a visual acuity ≤0.2 logMAR over a 2 D range from +1.00 D to -1.25 D. Satisfaction was good in 96% of patients. CONCLUSIONS: Bilateral implantation of an enhanced monofocal IOL with emmetropia as a target provided excellent binocular CDVA and good DCIVA, with a high level of satisfaction.

Influence of Lens Thickness on Accuracy of Kane, Hill-RBF 3.0, Barrett Universal II, Emmetropia Verifying Optical, and Pearl-DGS Formulas in Eyes with Nonhigh Myopia and High Myopia.

PURPOSE: To investigate the influence of lens thickness (LT) on accuracy of Kane, Hill-RBF 3.0 Barrett Universal II (BUII), Emmetropia Verifying Optical (EVO), and Pearl-DGS formulas in eyes with different axial lengths (AL). METHODS: The prospective cohort study was conducted at Eye and ENT Hospital of Fudan University. Patients who had uneventful cataract surgery between March 2021 and July 2023 were recruited. Manifest refraction was conducted two-month post-surgery. Eyes were divided into 4 groups based on AL: short (<22mm), medium (22-24.5 mm), medium long (24.5-26mm) and very long (≥26mm). In each AL group, eyes were then divided into 3 subgroups based on the LT measured with IOLmaster700: thin (<4.5 mm), medium (4.5-5.0 mm), and thick (≥ 5 mm). The influence of LT on accuracy of Kane, Hill-RBF 3.0, BUII, EVO, and Pearl-DGS formulas were investigated in each AL group. RESULTS: A total of 327 eyes from 327 patients were analyzed, with 64, 102, 73 and 88 eyes in each AL group, respectively. In eyes with AL < 24.5 mm, myopic PE was significantly associated with greater LT using all the 5 formulas (all p < 0.05). Backward stepwise multivariate regression analyses revealed that LT was an important influencing factor for PE in all 5 formulas, particularly in eyes with AL <24.5 mm. In eyes with AL <24.5 mm and LT > 5.0 mm, PE of all 5 formulas calculated with the optional parameter LT were more myopic than those calculated without LT. CONCLUSIONS: Thicker LT was associated with more myopic PE among eyes with AL <24.5 mm when using all 5 formulas. Further optimization of current formulas is necessary, especially for eyes with short AL and thick LT.

Ablation of mpeg+ Macrophages Exacerbates mfrp-Related Hyperopia.

Purpose: Proper refractive development of the eye, termed emmetropization, is critical for focused vision and is impacted by both genetic determinants and several visual environment factors. Improper emmetropization caused by genetic variants can lead to congenital hyperopia, which is characterized by small eyes and relatively short ocular axial length. To date, variants in only four genes have been firmly associated with human hyperopia, one of which is MFRP. Zebrafish mfrp mutants also have hyperopia and, similar to reports in mice, exhibit increased macrophage recruitment to the retina. The goal of this research was to examine the effects of macrophage ablation on emmetropization and mfrp-related hyperopia. Methods: We utilized a chemically inducible, cell-specific ablation system to deplete macrophages in both wild-type and mfrp mutant zebrafish. Spectral-domain optical coherence tomography was then used to measure components of the eye and determine relative refractive state. Histology, immunohistochemistry, and transmission electron microscopy were used to further study the eyes. Results: Although macrophage ablation does not cause significant changes to the relative refractive state of wild-type zebrafish, macrophage ablation in mfrp mutants significantly exacerbates their hyperopic phenotype, resulting in a relative refractive error 1.3 times higher than that of non-ablated mfrp siblings. Conclusions: Genetic inactivation of mfrp leads to hyperopia, as well as abnormal accumulation of macrophages in the retina. Ablation of the mpeg1-positive macrophage population exacerbates the hyperopia, suggesting that macrophages may be recruited in an effort help preserve emmetropization and ameliorate hyperopia.

Topically instilled caffeine selectively alters emmetropizing responses in infant rhesus monkeys.

Oral administration of the adenosine receptor (ADOR) antagonist, 7-methylxanthine (7-MX), reduces both form-deprivation and lens-induced myopia in mammalian animal models. We investigated whether topically instilled caffeine, another non-selective ADOR antagonist, retards vision-induced axial elongation in monkeys. Beginning at 24 days of age, a 1.4% caffeine solution was instilled in both eyes of 14 rhesus monkeys twice each day until the age of 135 days. Concurrent with the caffeine regimen, the monkeys were fitted with helmets that held either -3 D (-3D/pl caffeine, n = 8) or +3 D spectacle lenses (+3D/pl caffeine, n = 6) in front of their lens-treated eyes and zero-powered lenses in front of their fellow-control eyes. Refractive errors and ocular dimensions were measured at baseline and periodically throughout the lens-rearing period. Control data were obtained from 8 vehicle-treated animals also reared with monocular -3 D spectacles (-3D/pl vehicle). In addition, historical comparison data were available for otherwise untreated lens-reared controls (-3D/pl controls, n = 20; +3D/pl controls, n = 9) and 41 normal monkeys. The vehicle controls and the untreated lens-reared controls consistently developed compensating axial anisometropias (-3D/pl vehicle = -1.44 ± 1.04 D; -3D/pl controls = -1.85 ± 1.20 D; +3D/pl controls = +1.92 ± 0.56 D). The caffeine regime did not interfere with hyperopic compensation in response to +3 D of anisometropia (+1.93 ± 0.82 D), however, it reduced the likelihood that animals would compensate for -3 D of anisometropia (+0.58 ± 1.82 D). The caffeine regimen also promoted hyperopic shifts in both the lens-treated and fellow-control eyes; 26 of the 28 caffeine-treated eyes became more hyperopic than the median normal monkey (mean (±SD) relative hyperopia = +2.27 ± 1.65 D; range = +0.31 to +6.37 D). The effects of topical caffeine on refractive development, which were qualitatively similar to those produced by oral administration of 7-MX, indicate that ADOR antagonists have potential in treatment strategies for preventing and/or reducing myopia progression.

Unilateral Versus Bilateral Refractive Lens Exchange With a Trifocal Intraocular Lens in Emmetropic Presbyopic Patients.

PURPOSE: To compare visual outcomes and patient satisfaction between unilateral and bilateral trifocal diffractive intraocular lens (IOL) implantation in emmetropic patients with presbyopia. DESIGN: Retrospective observational case series. METHODS: This is a multicenter, multisurgeon study of emmetropic presbyopes who underwent refractive lens exchange (RLE) followed by an implantation of FineVision IOL (PhysIOL). Inclusion criteria were emmetropic eyes, with a sphere between -0.25 and +0.50 diopters (D), cylinder of less than 0.75 D and spherical equivalent (SE) between -0.25 and +0.25 D. In addition, uncorrected distance visual acuity (UDVA) had to be Snellen >0.9 in each eye. A total of 171 eyes of 122 patients were evaluated. This sample was divided into 2 groups depending on whether they have been operated monocularly or binocularly. Visual and refractive performance, patient satisfaction, and spectacle independence were evaluated. RESULTS: UDVA and corrected distance visual acuity (CDVA) remained almost unchanged after monocular and binocular surgery. Binocular uncorrected intermediate (UIVA) and near visual acuity (UNVA) were better in those operated binocularly (0.3±0.12 vs 0.22±0.06, P < .063, and 0.09±0.08 vs 0.04±0.05, P < .027, respectively). Predictability and efficacy were higher in the binocular group, whereas safety was better in the monocular group. Visual dysphotopsia was worse and spectacle independence for all distances was higher in binocular group. CONCLUSIONS: Our research shows that RLE with binocular implantation of a trifocal diffractive IOL in presbyopic emmetropic patients is more successful in UNVA than monocular implantation. However, no significant differences were observed in UDVA, UIVA, and patient satisfaction.

Three-dimensional data capture and analysis of intact eye lenses evidences emmetropia-associated changes in epithelial cell organization.

Organ and tissue development are highly coordinated processes; lens growth and functional integration into the eye (emmetropia) is a robust example. An epithelial monolayer covers the anterior hemisphere of the lens, and its organization is the key to lens formation and its optical properties throughout all life stages. To better understand how the epithelium supports lens function, we have developed a novel whole tissue imaging system using conventional confocal light microscopy and a specialized analysis software to produce three-dimensional maps for the epithelium of intact mouse lenses. The open source software package geometrically determines the anterior pole position, the equatorial diameter, and three-dimensional coordinates for each detected cell in the epithelium. The user-friendly cell maps, which retain global lens geometry, allow us to document age-dependent changes in the C57/BL6J mouse lens cell distribution characteristics. We evidence changes in epithelial cell density and distribution in C57/BL6J mice during the establishment of emmetropia between postnatal weeks 4-6. These epithelial changes accompany a previously unknown spheroid to lentoid shape transition of the lens as detected by our analyses. When combined with key findings from previous mouse genetic and cell biological studies, we suggest a cytoskeleton-based mechanism likely underpins these observations.

Resultados del cálculo de la lente intraocular con la fórmula Holladay 2 en pacientes con catarata / Results of intraocular lens calculation with the Holladay 2 formula in cataract patients

RESUMEN Objetivo: Determinar los resultados refractivos en pacientes operados de catarata, según el cálculo del poder dióptrico de la lente intraocular con la fórmula Holladay 2. Métodos: Se realizó un estudio descriptivo prospectivo y longitudinal en 222 ojos de 173 pacientes operados de catarata mediante la técnica de facoemulsificación. Se empleó para el cálculo de la lente el IOL Master 700 y la fórmula Holladay 2. Resultados: Predominó el sexo femenino y el grupo etario mayor de 60 años. En el posoperatorio se observó una mejoría en la agudeza visual sin corrección y corregida de más de 4 líneas en la cartilla de Snellen, independiente de la longitud axial, sin cambios significativos en el cilindro queratométrico. En 69,0 por ciento de los casos el resultado refractivo final estuvo en el rango de la emetropía. Los ojos mayores de 26 mm presentaron una disminución del equivalente esférico superior a 6 dioptrías en el posoperatorio; los menores de 22 mm mostraron la mayor diferencia entre el poder dióptrico de la lente intraocular que se implantó y el que sugiere la fórmula convencional. Conclusiones: La fórmula Holladay 2 resulta útil para el cálculo de la lente intraocular en todos los rangos de longitud axial(AU)

ABSTRACT Objective: Determine refractive results in patients undergoing cataract surgery based on intraocular lens dioptric power calculation with the Holladay 2 formula. Methods: A prospective longitudinal descriptive study was conducted of 222 eyes of 173 patients undergoing cataract surgery by phacoemulsification technique. IOL Master 700 and the Holladay 2 formula were used for lens calculation. Results: There was a predominance of the female sex and the over-60 years age group. The postoperative period was characterized by improvement in visual acuity without correction and corrected of more than 4 lines on the Snellen chart, regardless of axial length, with no significant changes in the keratometric cylinder. In 69.0 percent of the cases, the final refractive result was within the range of emmetropia. Eyes larger than 26 mm displayed a spherical equivalent reduction above 6 diopters postoperative, whereas eyes smaller than 22 mm showed the greatest difference between the dioptric power of the intraocular lens implanted and the one suggested by the conventional formula. Conclusion: The Holladay 2 formula is useful for intraocular lens calculation in all axial length ranges(AU)

Retinal Pigment Epithelium Cell Density and Bruch's Membrane Thickness in Secondary versus Primary High Myopia and Emmetropia.

To assess differences between secondary high myopia (SHM) due to congenital glaucoma and primary high myopia (PHM) and non-highly myopic eyes (NHM) in the relationships between axial length and Bruch's membrane (BM) thickness and retinal pigment epithelium (RPE) density. The histomorphometric study included human globes enucleated for reasons such as malignant uveal melanoma, end-stage painful secondary angle-closure glaucoma and congenital glaucoma. BM thickness and RPE cell density were measured upon light microscopy. The investigation included 122 eyes (mean axial length: 26.7 ± 3.7 mm; range: 20.0-37.0 mm): 7 eyes with SHM (axial length: 33.7 ± 2.1 mm; range: 31.0-37.0 mm), 56 eyes with PHM (mean axial length: 29.1 ± 2.4 mm; range: 26.0-36.0 mm) and 59 eyes in the NHM-group (axial length: 23.5 ± 1.3 mm; range: 20.0-25.5 mm). In the SHM group, longer axial length was associated with lower RPE cell density at the posterior pole (standardized regression coefficient beta: 0.92; non- standardized regression coefficient B: -2.76; 95% confidence interval (CI): -4.41, -1.10;P = 0.01), at the midpoint posterior pole/equator (beta: -0.87; B: -3.60; 95% CI: -6.48, -0.73;P = 0.03), and at the equator (beta: -0.88; B: -0.95; 95% CI: -1.68, -0.23; P = 0.02), but not at the ora serrata (P = 0.88). In the PHM-group and NHM group, RPE cell density at the posterior pole (P = 0.08) and ora serrata (P = 0.88) was statistically independent of axial length, while at the midpoint posterior pole/equator (P = 0.01) and equator (P < 0.001), RPE cell density decreased with longer axis. BM thickness in the SHM group decreased with longer axial length at the posterior pole (beta: -0.93;B: -0.29; 95% CI: -0.39, -0.14; P = 0.003), midpoint posterior pole/equator (beta: -0.79; B: -0.22; 95% CI: -0.42, -0.02; P = 0.035) and equator (beta: -0.84; B: -0.21; 95% CI: -0.37, -0.06; P = 0.017), while in the PHM-group and NHM-group, BM thickness at any ocular region was not statistically significantly correlated with axial length (all P > 0.05). In the SHM-group, but not in the PHM-group or NHM-group (P = 0.98), lower BM thickness was associated with lower RPE cell density (beta: 0.93; B: 0.09; 95% CI: 0.04, 0.14; P = 0.007), while in the eyes without congenital glaucoma the relationship was not statistically significant. In SHM in contrast to PHM, BM thickness and RPE cell density decrease in a parallel manner with longer axial length. The findings fit with the notion of BM being a primary driver in the process of axial elongation in PHM as compared to SHM.

Extended depth-of-focus toric intraocular lens targeted for binocular emmetropia or slight myopia in the nondominant eye: Visual and refractive clinical outcomes.

PURPOSE: To compare the visual and refractive outcomes with a diffractive toric extended depth-of-focus (EDOF) intraocular lens (IOL) when both eyes are targeted for emmetropia and the nondominant eye is targeted for slight myopia. SETTING: Three clinical practices, United States. DESIGN: Prospective case series. METHODS: Patients having routine cataract surgery with bilateral Tecnis Symfony toric EDOF IOL implantation were assigned to 1 of 2 groups. In 1 group, the nondominant eye was targeted for -0.50 diopter (D) (mini-monovision). Assessments included uncorrected monocular and binocular visual acuities (logarithm of the minimum angle of resolution) at distance (4 m), intermediate (66 cm), and near (40 cm) and the postoperative residual refractive error. RESULTS: Forty patients were enrolled in each group, with 1 dropout. The mean postoperative residual refractive astigmatism was 0.25 D in both groups, with no statistically significant difference. The mean residual refractive astigmatism was 0.50 D or lower in 92% of eyes (72/78) in the mini-monovision group and 95% of eyes (74/78) in the emmetropia group 3 months postoperatively. The mini-monovision group had slightly worse uncorrected visual acuity at 4 m than the emmetropia group (0.16 versus 0.09; P = .002) but better uncorrected acuity at 40 cm (0.25 versus 0.34; P < .001). Binocular uncorrected acuity was not statistically significantly different between groups at 4 m (-0.03 versus -0.01; P = .33) or 66 cm (0.06 versus 0.04; P = .34) but was statistically significant at 40 cm (0.25 versus 0.19; P = .03). CONCLUSIONS: The EDOF toric IOL provided functional distance, intermediate, and near vision. A slight monovision approach appears to improve near visual acuity.

Initial Clinical Outcomes of a New Extended Depth of Focus Intraocular Lens.

PURPOSE: To evaluate clinical and patient-reported outcomes of a new extended depth of focus intraocular lens (IOL). METHODS: Data of patients treated between September 2017 and September 2018 who underwent a refractive lens exchange/cataract surgery with an implantation of the AT LARA 829MP IOL (Carl Zeiss Meditec AG, Jena, Germany) and attended the 1-week, 1-month, and 3-month follow-up visit were reviewed. RESULTS: At 3 months, the percentage of eyes within ±0.50 diopters (D) of emmetropia was 86.7%. The mean binocular uncorrected distance visual acuity was -0.05 ± 0.09 logMAR and the mean binocular unaided near vision was 0.26 ± 0.14 logMAR. Of all patients, 90.3% were satisfied with their vision. The percentage of patients spectacle-free for near and distance vision was 83.6% and 95.4%, respectively. On a scale from 1 (no difficulty) to 7 (severe difficulty), there was an average 1.2 to 1.4 units increase in glare, halo, and starburst between the preoperative and 1-month visit, and a decrease of 0.2 to 0.3 units between the 1- and 3-month visit. CONCLUSIONS: The new extended depth of focus IOL provided reasonable unaided near and distance vision, as well as spectacle independence and patient satisfaction. Some optical side effects were reported in the early postoperative period. [J Refract Surg. 2019;35(7):426-433.].

Unilateral Refractive Lens Exchange with a Multifocal Intraocular Lens in Emmetropic Presbyopic Patients.

Purpose: To evaluate the visual outcome and patient satisfaction after a unilateral multifocal IOL implantation in the non-dominant eye of emmetropic patients with presbyopia. Methods: An interventional case series of consecutive patients who underwent unilateral phacoemulsification with femto-laser assisted cataract surgery (FLACS) and refractive lens exchange (RLE), followed by an implantation of a trifocal diffractive IOL (FineVision Micro F), was performed in the non-dominant eyes of emmetropic patients with presbyopia. After 6 months of follow-up, the main outcome measures were uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), and uncorrected near visual acuity (UNVA). Secondary outcomes included spherical equivalent (SE), refraction, contrast sensitivity, patient questionnaire and presence of visual side effects. Results: A total of 26 eyes of 26 patients, with an average age of 53.8 ± 4.1 years, were included in this study. Preoperative mean UDVA was 0.13 ± 0.04 logMAR (Snellen 20/27), UIVA was 0.46 ± 0.12 logMAR (Snellen 20/58), and UNVA was 0.66 ± 0.17 logMAR (Snellen 20/91), in comparison to postoperative mean UDVA of 0.18 ± 0.32 logMAR (Snellen 20/30) (p = 0.32), UIVA of 0.17 ± 0.21 logMAR (Snellen 20/30) (p < 0.005), and UNVA of 0.02 ± 0.10 logMAR (Snellen 20/21) (p < 0.005). Monocular UNVA of 20/25 or better in the operated eye was achieved in 23 (88%) patients. Twenty-four (96%) patients said they would recommend this procedure to family and friends. There were no intraoperative complications and no IOL exchange was required. Conclusions: A unilateral RLE of the non-dominant eye with FLACS and a trifocal diffractive IOL (FineVision Micro F) implantation in emmetropic, presbyopic patients is provides satisfactory distance, intermediate, and near visual outcomes with no complications reported in this preliminary case series.

Cortical Cataract and Refractive Error.

PURPOSE: To evaluate the relationship between the presence of cortical cataract and accommodation effort, using refractive error as a proxy. METHODS: Patients between 50 and 90 years, scheduled for cataract surgery, were selected with the help of a photographic database. Nuclear and cortical cataract were graded and patients grouped having no cataract, pure cortical, mixed or pure nuclear cataract. Refraction data at the time of the photograph was converted to estimated spherical equivalent refractive error each patient would have had at the age of 45 years. RESULTS: From the initial 239 eyes from 239 patients, cases with myopia below -6.5 dpt and hyperopia above 6.5 dpt were excluded, resulting in 199 cases for final analysis. Eyes with no cataract showed the lowest median refractive error (-3.65 dpt), followed by the pure nuclear group (-2.69 dpt). The median refractive error for pure cortical (-0.23 dpt) and mixed cataracts (-0.87 dpt) were close to emmetropia. Cortical cataracts were found in 37% of myopes, 82% of emmetropes, and 85% of hyperopes. CONCLUSION: Emmetropes and hyperopes tend to develop more cortical cataract than myopes. These cortical cataracts might be caused by shear stress inside the crystalline lens due to accommodation efforts at the time of onset of presbyopia.

Changes of intraocular pressure after cataract surgery in myopic and emmetropic patients.

To investigate the intraocular pressure (IOP) changes after cataract surgery, and its relationship with refractive conditions.IOP after phacoemulsification with intraocular lens (IOL) implantation was retrospectively reviewed. Patients were classified into 3 groups by refractive conditions: emmetropia, mild to moderate myopia, and high myopia. Basic information was collected including age, sex, place of IOL, and operating surgeon, with IOP and refractive conditions measured before surgery, and 1, 7, 30, and 90 days after surgery.The study comprised 353 eyes from 353 patients, of which 175 were emmetropia, 130 were mild to moderate myopia, and 48 were high myopia. A lower IOP than baseline was observed at 7, 30, and 90 days after surgery in emmetropic and mild to moderate myopia, while in high myopia, IOP was instable from 1 to 30 days, and reduced only in 90 days after surgery. Changes of IOP was more significant from 1 to 7 days in emmetropic and mild to moderate myopic patients, but from 30 to 90 days in high myopia. Patients over 75 showed a lower IOP at each follow-up than patients younger and female showed a higher baseline IOP than male. Different surgeons might influence the IOP fluctuation at first 90 days but not the final IOP.All patients with different refractive conditions showed a remarkably lower IOP at 90 days after cataract surgery. However, high myopia lowered the speed of IOP reduction, which might be explained by the anatomical changes of eye structure.

The Adenosine Receptor Antagonist, 7-Methylxanthine, Alters Emmetropizing Responses in Infant Macaques.

Purpose: Previous studies suggest that the adenosine receptor antagonist, 7-methylxanthine (7-MX), retards myopia progression. Our aim was to determine whether 7-MX alters the compensating refractive changes produced by defocus in rhesus monkeys. Methods: Starting at age 3 weeks, monkeys were reared with -3 diopter (D; n = 10; 7-MX -3D/pl) or +3D (n = 6; 7-MX +3D/pl) spectacles over their treated eyes and zero-powered lenses over their fellow eyes. In addition, they were given 100 mg/kg of 7-MX orally twice daily throughout the lens-rearing period (age 147 ± 4 days). Comparison data were obtained from lens-reared controls (-3D/pl, n = 17; +3D/pl, n = 9) and normal monkeys (n = 37) maintained on a standard diet. Refractive status, corneal power, and axial dimensions were assessed biweekly. Results: The -3D/pl and +3D/pl lens-reared controls developed compensating myopic (-2.10 ± 1.07 D) and hyperopic anisometropias (+1.86 ± 0.54 D), respectively. While the 7-MX +3D/pl monkeys developed hyperopic anisometropias (+1.79 ± 1.11 D) that were similar to those observed in +3D/pl controls, the 7-MX -3D/pl animals did not consistently exhibit compensating myopia in their treated eyes and were on average isometropic (+0.35 ± 1.96 D). The median refractive errors for both eyes of the 7-MX -3D/pl (+5.47 D and +4.38 D) and 7-MX +3D/pl (+5.28 and +3.84 D) monkeys were significantly more hyperopic than that for normal monkeys (+2.47 D). These 7-MX-induced hyperopic ametropias were associated with shorter vitreous chambers and thicker choroids. Conclusions: In primates, 7-MX reduced the axial myopia produced by hyperopic defocus, augmented hyperopic shifts in response to myopic defocus, and induced hyperopia in control eyes. The results suggest that 7-MX has therapeutic potential in efforts to slow myopia progression.

Preliminary Evidence of Successful Near Vision Enhancement With a New Technique: PrEsbyopic Allogenic Refractive Lenticule (PEARL) Corneal Inlay Using a SMILE Lenticule.

PURPOSE: To describe a new technique (PrEsbyopic Allogenic Refractive Lenticule [PEARL] inlay) using an allogenic corneal inlay prepared from a small incision lenticule extraction (SMILE) lenticule. METHODS: A SMILE lenticule of specified thickness (mean: 61.5 ± 3.32 µm) was trephined at the center to 1-mm diameter and implanted in the cornea on the coaxially sighted light reflex under a femtosecond laser-created cap of 120 µm in the nondominant eye of presbyopic patients. RESULTS: Four emmetropic presbyopic patients underwent PEARL inlay implantation in the nondominant eye. In the operated eye, uncorrected near visual acuity at 33 cm improved from J8 to J2 in one and from J5, J6, and J7, respectively, to J2 in three operated eyes with improvement between three and five lines in all eyes. Uncorrected intermediate visual acuity ranged between J3 and J5 at 67 cm and uncorrected distance visual acuity remained 20/20 in the operated eye and binocularly. The patients were comfortable and reported independence from glasses for near, intermediate, and distance for all of their routine visual tasks for the 6-month follow-up period. There were no complaints of dysphotopsia or troublesome night glare/halos. All lenticules remained well centered during the follow-up and no lenticule-induced complications were seen. All patients reported satisfaction with the surgical procedure. Topography showed a central area of prolateness corresponding to the PEARL inlay. The inlay was not visible on naked eye examination. CONCLUSIONS: This preliminary study demonstrates the safety and efficacy of a PEARL corneal inlay for presbyopic correction. Further studies are recommended to determine long-term outcomes. [J Refract Surg. 2017;33(4):224-229.].

Contrast Sensitivity in Patients With Emmetropic Presbyopia Before and After Small-Aperture Inlay Implantation.

PURPOSE: To develop a normative contrast sensitivity function and examine the postoperative contrast sensitivity outcomes for emmetropic patients with presbyopia implanted with a KAMRA intracorneal inlay (AcuFocus Inc., Irvine, CA) in their non-dominant eyes. METHODS: A prospective, non-randomized, multicenter clinical trial was conducted on 507 patients between 45 and 60 years of age who were monocularly implanted with the KAMRA inlay. A predetermined subgroup of 335 patients in the contrast sensitivity substudy were measured preoperatively and postoperatively with the Functional Acuity Contrast Test (FACT) chart in the Optec 6500 Vision Tester (Stereo Optical Co., Chicago, IL) under monocular and binocular, photopic and mesopic without glare, and binocular mesopic with glare conditions each over four spatial frequencies (3, 6, 12, and 18 cycles per degree for photopic conditions and 1.5, 3, 6, and 12 cycles per degree for mesopic conditions). Normative ranges were developed using 1.96 standard deviations from the preoperative mean logCS (log10 unit of contrast sensitivity). RESULTS: The preoperative contrast sensitivity measurements were used to develop the normative contrast sensitivity curves. Postoperatively, contrast sensitivity was stable both monocularly and binocularly and average contrast sensitivity remained within the normative ranges. Postoperative contrast sensitivity was mildly reduced monocularly but not binocularly, and the ratio of area under logCS function comparing postoperative to preoperative values was above 90% for all but one condition. CONCLUSIONS: Normative contrast sensitivity curves for a presbyopic population are established to provide a referent in the investigation of the impact of other presbyopia-correcting ophthalmic procedures on contrast sensitivity. [J Refract Surg. 2016;32(6):386-393.].

Influence of the effective lens position, as predicted by axial length and keratometry, on the near add power of multifocal intraocular lenses.

PURPOSE: To calculate the near focal distance of different multifocal intraocular lenses (IOLs) as a function of the 2 parameters that are measured before cataract surgery; that is, axial length (AL) and refractive corneal power (keratometry [K]). SETTING: GB Bietti Foundation IRCCS, Rome, Italy. DESIGN: Noninterventional theoretical study. METHODS: The IOL power for emmetropia was first calculated in an eye model with the AL ranging from 20 to 30 mm and K from 38 to 48 diopters (D). Then, the predicted myopic refraction for any given IOL add power (from +1.5 to +4.0 D) was calculated, and from this value the near focal distance was obtained. Calculations were also performed for the average eye (K = 43.81 D; AL = 23.65 mm). RESULTS: The near focal distance increased with increasing values of K and AL for each near power add. The near focal distance ranged between 53 cm and 72 cm (21 inches and 28 inches) for a multifocal IOL with +2.50 D, between 44 cm and 60 cm (17 inches and 24 inches) for a multifocal IOL with +3.00 D add, and between 33 cm and 44 cm (13 inches and 18 inches) for a multifocal IOL with +4.00 D add. In the average eye, the near focal distance ranges between 36 cm (near add power = 4.00 D) and 99 cm (near add power = 1.5 D). CONCLUSIONS: Longer eyes with steeper corneas showed the longest near focal distance and could experience more difficulties in focusing near objects after surgery. The opposite was true for short hyperopic eyes. FINANCIAL DISCLOSURE: Dr. Hoffer receives licensing fees for the commercial use of the registered trademark Hoffer from all biometry manufacturers using the Hoffer Q formula to ensure that it is programmed correctly and book royalties from Slack, Inc., for the textbook IOL Power. None of the authors has a financial or proprietary interest in any material or method mentioned.

Treatment of Presbyopia in Emmetropes Using a Shape-Changing Corneal Inlay: One-Year Clinical Outcomes.

PURPOSE: To report 1-year safety and efficacy clinical outcomes of a shape-changing corneal inlay for the treatment of presbyopia. DESIGN: Prospective, nonrandomized, multicenter United States Food and Drug Administration Investigational Device Exemption clinical trial (clinicaltrials.gov identifier, NCT01373580). PARTICIPANTS: Nondominant eyes (N = 373) of emmetropic presbyopic subjects were implanted at 11 sites with the Raindrop Near Vision Inlay (ReVision Optics, Lake Forest, CA); 340 eyes underwent the 1-year follow-up visit. METHODS: The corneal inlay was implanted under a corneal flap at the center of the light-constricted pupil created with a femtosecond laser. MAIN OUTCOME MEASURES: For subjects completing the 1-year follow-up, monocular and binocular uncorrected and corrected visual acuity, refractive stability, contrast sensitivity (CS; photopic and mesopic), symptom and satisfaction questionnaire results, and adverse events. RESULTS: At 1 year in the treated eye, on average, uncorrected near visual acuity (UNVA) improved by 5.1 lines, uncorrected intermediate visual acuity (UIVA) improved by 2.5 lines, and uncorrected distance visual acuity (UDVA) decreased by 1.2 lines. From 3 months through 1 year, 93% of subjects achieved UNVA of 20/25 or better, 97% achieve UIVA of 20/32 or better, and 95% achieved UDVA of 20/40 or better. Binocularly, the mean UDVA exceeded 20/20 from 3 months through 1 year. Contrast sensitivity loss occurred only at the highest spatial frequencies, with no loss binocularly. Absent or mild scores were reported in 96% of subjects for visual symptoms (glare, halos, double vision, and fluctuations in vision), in 99% for ocular symptoms (pain, light sensitivity, and discomfort), and in 95% for dryness. Adverse events were treatable and resolved. Eighteen inlays were replaced, usually soon after implantation because of decentration, but UNVA was little affected in this group thereafter. In the 11 cases requiring inlay explantations, 100% achieved a corrected distance visual acuity of 20/25 or better by 3 months after explant. CONCLUSIONS: The Raindrop Near Vision Inlay provides significant improvement in near and intermediate visual performance, with no significant change in binocular distance vision or CS. Subject satisfaction is improved significantly with minimal ocular or visual symptoms.

Bifocal refractive corneal inlay implantation to improve near vision in emmetropic presbyopic patients.

PURPOSE: To evaluate the safety and effectiveness of the Flexivue Microlens corneal inlay for the improvement of near vision in emmetropic presbyopic patients. SETTING: Ophthalmology Department, Misericordia e Dolce Hospital, Prato, Italy. DESIGN: Prospective interventional case series. METHODS: Corneal inlay implantation was performed in nondominant eyes using a 150 kHz femtosecond laser (iFS). Refraction, uncorrected (UNVA) and corrected (CNVA) near visual acuities, uncorrected (UDVA) and corrected (CDVA) distance visual acuities, slitlamp evaluation, wavefront aberrometry, photopic and mesopic contrast sensitivity, anterior segment optical coherence tomography, endothelial cell density, and central corneal thickness measurements were assessed preoperatively and at each postoperative visit. RESULTS: The study evaluated 81 eyes. In 26 eyes, the mean preoperative UNVA and UDVA were 0.76 logMAR and 0.00 logMAR, respectively, compared with 0.10 logMAR and 0.15 logMAR, respectively, 36 months postoperatively. Sixteen (62%) of 26 treated eyes lost more than 1 line of UDVA, and 5 (19%) lost more than 2 lines of UDVA. Two eyes (8%) lost more than 1 line of CDVA at 36 months. The mean binocular UDVA was 0.00 logMAR preoperatively and 0.02 logMAR at 36 months. The mean spherical aberration increased after surgery. Statistically significant differences in the mean mesopic and photopic contrast sensitivities at higher spatial frequencies were found between treated eyes and nontreated eyes. Explantation was performed in 6 treated eyes because of halos, glare, and a reduced UDVA. CONCLUSION: The corneal inlay might be a safe and effective method of improving UNVA in emmetropic presbyopic patients. FINANCIAL DISCLOSURE: Dr. Fantozzi is a member of the Presbia medical advisory board. No other author has a financial or proprietary interest in any material or method mentioned.