Real-World Clinical Results with the Hoya Vivinex Impress Intraocular Lens with Enhanced Depth of Focus.

BACKGROUND: In cataract surgery, intraocular lenses (IOLs) with enhanced depth of focus are an option to correct presbyopia. The purpose of this quality assurance analysis was to evaluate visual acuity and patient satisfaction after implantation of the Hoya Vivinex Impress IOL. METHODS: The Hoya Vivinex Impress IOL was implanted in patients undergoing cataract surgery at the Pallas Klinik, Olten, Switzerland. Five weeks postoperatively, a clinical examination and a survey on patient satisfaction were conducted. RESULTS: A total of 17 eyes (9 patients; mean age 64 years) underwent cataract surgery with implantation of a Hoya Vivinex Impress IOL. Five weeks postoperatively, mean uncorrected distance visual acuity (UDVA) was 0.2 logMAR, uncorrected intermediate visual acuity (UIVA) was 0.0 logMAR, and uncorrected near visual acuity (UNVA) was 0.2 logMAR. The mean distance-corrected visual acuity results were 0.0 logMAR, 0.1 logMAR, and 0.3 logMAR, respectively. Reading the newspaper without glasses was possible for 33.4% of patients. Visual disturbances such as halos and glares were not reported. CONCLUSION: Cataract surgery with Hoya Vivinex Impress IOL implantation revealed good distance and intermediate vision and, in some patients, functional near vision as well as a high patient satisfaction.

Extended depth of focus IOL in eyes with different axial myopia and targeted refraction.

AIM: To evaluate the objective visual outcomes following implantation of extended depth of focus intraocular lens (EDOF IOL) in individuals with varying axial lengths (AL) and targeted refraction. METHODS: This retrospective study comprised age-matched eyes that underwent implantation of the EDOF IOL. Eyes were categorized based on AL into groups: control group with AL < 26 mm; high myopia group with AL ≥ 26 mm. Each group was then subdivided based on postoperative spherical equivalent (SE). Follow-up at three months included assessment of uncorrected visual acuity at different distances, contrast sensitivity (CS), refractive outcomes, and spectacle independence. RESULTS: Overall, this study included 100 eyes from 100 patients, comprising 50 males (50.00%) and 50 females (50.00%), with 20 eyes in each group. In the control group, the uncorrected distance visual acuity (UDVA) at 5 and 3 m (m) in the - 1.50 to -0.75 group was inferior to that of the - 0.75 to 0.00 group (P = 0.004). Conversely, the uncorrected near visual acuity (UNVA) at 33 cm in the - 1.50 to -0.75 group was superior to that of the - 0.75 to 0.00 group (P = 0.005). Within the high myopia group, the UDVA at 5 and 3 m in the - 2.25 to -1.50 group was worse than in the - 0.75 to 0.00 group (P = 0.009 and 0.008, respectively). However, the UNVA at 33 cm in the - 2.25 to -1.50 group was better than in the - 0.75 to 0.00 group (P = 0.020). No significant differences were observed among the groups for corrected distance visual acuity (CDVA) (P > 0.05). Additionally, in the high myopia group, the CS of the - 2.25 to -1.50 group was lower compared to that of the - 0.75 to 0.00 group (P = 0.017). Among high myopia patients, 90.00% with refraction ranging from - 1.50 to -0.75 reported achieving overall spectacle independence. CONCLUSIONS: Implantation of extended depth of focus intraocular lenses (IOLs) yields satisfactory visual and refractive outcomes in eyes with axial myopia. Among high myopia patients, a refraction ranging from - 1.50 to -0.75 diopters achieves superior visual quality compared to other postoperative myopic diopters.

Patient-Reported Outcome Measures (PROMs) with Refractive and Diffractive Extended Depth of Focus (EDOF) Intraocular Lenses.

BACKGROUND: Extended depth of focus intraocular lenses (EDOF-IOLs) provide unaided far- and mid-range vision. Refractive IOLs, in contrast to diffractive designs, are associated with a lower depth of focus and absence of dysphotopsia. The aim of this study was to assess spectacle independence for far-range, mid-range, and near-vision activities in patients after implantation of refractive or diffractive EDOF-IOLs using patient-reported outcome measures (PROMs) in a real-world setting. PATIENTS AND METHODS: In 2021 and 2022, all patients in a single center referred for bilateral cataract surgery were assigned to 7 experienced cataract surgeons who either bilaterally implanted only a diffractive EDOF-IOL (Carl Zeiss Meditec AG, AT LARA Jena, Germany, three surgeons) or refractive EDOF-IOL (Johnson & Johnson Vision Inc., Tecnis Eyhance Irvine, California, USA, four surgeons) at the surgeon's discretion, with the aim of bilateral emmetropia. Six months after both cataract surgeries, all patients were contacted by telephone and asked to report their outcomes using a structured questionnaire investigating their spectacle usage for various daily activities and their experience with night glare or halos. Inclusion criteria were a normal postoperative visual potential based on the preoperative examination and completion of the questionnaire regarding postoperative visual experience. RESULTS: Of the patients, 514 underwent bilateral cataract surgery aiming for bilateral emmetropia with the implantation of EDOF-IOLs (422 with Tecnis Eyhance and 92 with AT LARA). A complete questionnaire was obtained from 472 (92%) patients, who were included in the study (393 vs. 79). Comparing Tecnis Eyhance with AT LARA IOL, 54 vs. 57% patients were able to perform most of their daily activities without spectacles, 9 vs. 19% reported not being dependent on spectacles at all, 25 vs. 29% reported using their smartphones without spectacles, 15 vs. 49% patients reported experiencing glares or halos at night, and 1 vs.15% with driving disturbance. Overall, 95 vs. 93% patients described themselves as "satisfied" or "highly satisfied" with their IOL. CONCLUSIONS: With both types of EDOF-IOLs, the majority of patients could perform most of their daily activities without spectacles, except reading, and were highly satisfied with their IOLs. Patients with diffractive Zeiss AT LARA EDOF-IOLs were more likely to accomplish unaided near-range visual tasks; however, they were also at a higher risk of experiencing glares or halos at night.

Six-month binocular stereopsis recovery and its influencing factors in children with intermittent exotropia.

OBJECTIVE: To investigate the recovery of binocular stereopsis recovery and its influencing factors in children with intermittent exotropia after successful correction of eye position. METHODS: Prospective clinical study. A total of 178 patients, aged 9 ∼ 14 (10.8 ± 1.7) years, who were successfully corrected after intermittent exotropia surgery at the Beijing Tongren Hospital Affiliated to Capital Medical University from October 2023 to September 2023 were collected, the follow-up duration was six-month or longer. Paired t test, Pearson correlation analysis and multivariable linear regression analysis were used to probe preoperative clinical features that may predict the stereopsis six months after surgery. RESULTS: Six months after surgery, the angle of deviation of the patients met the orthotopic standard, and there was significant difference compared with that before surgery (distant: -2.7△±3.2△ vs. -30.5△±8.4△, t=-25.3, P < 0.001. Near:-3.7△±4.1△ vs. -33.7△±8.0△, t=-26.1, P < 0.001). Distant stereopsis (3.0 ± 0.6 vs. 3.9 ± 0.4, t = 4.9, P < 0.05) and near stereopsis (2.3 ± 0.5 vs. 2.6 ± 0.4, t = 3.8, P < 0.05) were both significantly improved compared with that of before surgery. 17% and 22% patients rebuilt normal distant stereopsis and normal near stereopsis, respectively. Preoperative distant stereopsis (r=-0.26, P = 0.004) and near stereopsis (r=-0.23, P = 0.011) was significantly negatively correlated with convergence reserve. Multivariable analysis showed that patients' age (ß = 0.003, p = 0.037), anisometropia (ß = 0.015, p = 0.043), and preoperative distant stereopsis (ß = 0.456, p < 0.001) were significantly associated with postoperative distant stereopsis. Patients' age (ß = 0.005, p = 0.044), anisometropia (ß = 0.127, p = 0.034), angle of deviation (ß=-0.230, p = 0.020), and preoperative near stereopsis (ß = 0.136, p < 0.001) were significantly associated with postoperative near stereopsis. CONCLUSION: IXT patients could get eye position fixed after surgery, about 20% patients benefited from stereopsis improvement. Patient's age, binocular anisometropia, angle of deviation and preoperative stereopsis were independent factors influencing postoperative stereopsis.

Optical coherence tomography parameters as prognostic factors for stereopsis after vitrectomy for unilateral epiretinal membrane: a cohort study.

This retrospective cohort study explored the relationship between monocular and interocular optical coherence tomography (OCT) parameters and stereopsis in 56 patients undergoing pars plana vitrectomy (PPV) for unilateral idiopathic epiretinal membrane (IERM). IERM impairs visual functions, with symptoms ranging from asymptomatic to severe impairment. Despite established surgical interventions, including PPV with membrane peeling, the impact on advanced three-dimensional visual functions such as stereopsis remains inadequately investigated. All subjects were assessed for stereopsis, visual acuity, and metamorphopsia, alongside spectral domain OCT parameters. These visual functions significantly improved 3-month postoperatively. Central retinal thickness at the fovea, parafovea, and perifovea (CFT, CRT-3 mm, and CRT-6 mm), ectopic inner foveal layer thickness, and retinal layer thickness notably decreased 1 week to 3 months after surgery. The interocular difference in OCT parameters between bilateral eyes was included as a parameter. Baseline CRT-3 mm difference and inner nuclear layer (INL) thickness were independently correlated with postoperative stereopsis on the Titmus Stereo Test, while baseline CRT-6 mm difference and INL thickness were independently related to stereopsis on the TNO stereotest. This study highlights the substantial enhancement in stereopsis post-IERM surgery, with both interocular and monocular OCT parameters independently influencing postoperative stereopsis. These findings underscore the importance of retinal microstructures in assessing and predicting stereopsis in IERM patients after vitrectomy.

Clinical performance after implantation of an EDOF intraocular lens in the dominant eye and a presbyopia-correcting intraocular lens in the nondominant eye.

PURPOSE: To evaluate subjective and objective outcomes after combined implantation of an extended depth-of-focus (EDOF) intraocular lens (IOL) and a combined technology multifocal lens (CT-IOL). SETTING: 2 clinical practices (Carolina Eyecare Physicians, Center For Sight) in the United States. DESIGN: Prospective, unmasked, multicenter, nonrandomized bilateral eye study. METHODS: Patients interested in reducing their dependence on spectacles were implanted with an EDOF IOL in the dominant eye and a CT-IOL in the nondominant eye. Refractive and visual acuity (VA) data at various distances (4 m, 66 cm, 40 cm, and 33 cm) were collected 3 months postsurgery, along with the distance-corrected binocular defocus curve and responses to questionnaires related to spectacle independence, visual disturbances, and overall visual function. RESULTS: Data from 37 participants were analyzed. The distance-corrected binocular defocus curve showed a mean VA better than 0.1 logMAR (20/25) at all vergences from +1.00 to -2.50 diopters (D). 36 participants (97%) had an uncorrected binocular VA of 0.3 logMAR or better, at all test distances. 70% of participants (26/37) reported never wearing spectacles at any distance, and 84% (31/37) were "completely" or "mostly" satisfied with their overall vision after surgery. Halos were the disturbance reported most frequently and reported as most bothersome, with difficulty driving at night the most common visual function issue. Difficulty reading was the next most reported issue. Overall eyesight was rated as "excellent" or "good" by 92% (34/37) of participants. CONCLUSIONS: This combined EDOF/CT-IOL approach was well-tolerated by participants and provided some potential benefits relative to bilateral implantation of either lens.

Using adaptive optics to optimize the spherical aberration of eyes implanted with EDOF and enhanced monofocal intraocular lenses.

PURPOSE: To assess the effect of change in ocular spherical aberration (SA) with adaptive optics on visual acuity (VA) at different defocus after implantation of extended depth-of-focus (EDOF) and enhanced monofocal intraocular lenses (IOLs). SETTINGS: Narayana Nethralaya Eye Hospital, Bangalore, India. DESIGN: Prospective, longitudinal, observational. METHODS: 80 eyes (40 patients) that had cataract surgery were included in the study. 40 eyes were implanted with Eyhance EDOF IOLs and the remaining with Vivity EDOF IOLs. Baseline ocular aberrations were measured with a visual adaptive optics aberrometer, then the optimal SA was determined by increasing it in steps of -0.01 µm up to -0.1 µm until the maximum improvement in near distance VA was observed for a given eye. Then the defocus curve for each eye was measured after modifying the ocular SA by magnitude equal to optimal SA. RESULTS: Most of the eyes accepted a negative induced SA of -0.05 µm (Eyhance group: 67.6%; Vivity group, 45.2%). In the Eyhance group (dominant eyes), VA improved at -2 diopters (D) ( P < .02) only and degraded at 0 D, +0.5 D, and +1 D defocus ( P < .05). In the Vivity group, the VA remained unchanged at all defocus ( P > .05). In the Eyhance group (nondominant eyes), VA improved at -3.5 D defocus only and degraded at +1.5 D and +2 D defocus ( P < .05). In the Vivity group, VA improved at -2.5 D defocus ( P < .05) only. CONCLUSIONS: A negative induced SA of -0.05 µm in implanted eyes was optimal for a slight improvement in distance-corrected near and intermediate VA without any significant decrease in baseline distance-corrected VA.

Standard Clinical Outcomes, Light Distortion, Stereopsis, and a Quality-of-Life Assessment of a New Binocular System of Complementary IOLs.

PURPOSE: To evaluate the visual outcome, light distortion index (LDI), and quality of life (QoL) of patients implanted with two complementary intraocular lenses (IOLs) to treat cataract and presbyopia. METHODS: Twenty-seven consecutive patients with cataract were treated with the implantation of the Artis Symbiose Mid (Mid) IOL (Cristalens Industrie) in the distance-dominant eye and the Artis Symbiose Plus (Plus) IOL (Cristalens Industrie) in the contralateral eye following phacoemulsification. The primary objective was to ascertain the monocular and binocular defocus curves. Secondary endpoints included uncorrected distance visual acuity, corrected distance visual acuity, uncorrected intermediate visual acuity, and distance-corrected intermediate visual acuity at 90 and 70 cm, uncorrected near visual acuity and distance-corrected visual acuity at 40 cm, contrast sensitivity, LDI with a halometer, stereopsis, and patients' QoL with the validated Visual Function Index (VF-14) questionnaire. These measurements were collected in two visits, at 4.14 ± 3.13 and 10.30 ± 3.14 months postoperatively. RESULTS: Statistically significant differences in the monocular defocus curves were found at the defocus steps of -1.00, -1.25, -1.50, -1.75, -2.50, -2.75, -3.00, -3.50 diopters and the -4.00 diopters (P < .050). The mean binocular defocus curve was 0 logMAR or better from the +0.50 to the -2.50 D defocus steps. Contrast sensitivity was within normal values. The LDI was 12.57 (6.61)% for the Mid eyes, 14.99 ± 5.70% for the Plus eyes, and 10.36 ± 4.42% binocularly. The patients' stereopsis was 40.0 (12.5) arc-seconds. The QoL score was 95.99 (7.14) at 10 months. CONCLUSIONS: The implantation of the Artis Symbiose IOLs was a safe and effective treatment for presbyopia compensation in patients with cataract. Both IOLs are complementary and may produce a binocular depth-of-field of 3.00 diopters over 0 logMAR when used together. [J Refract Surg. 2023;39(10):654-661.].

Initial postoperative plasticity as a predictor of mid-term stereoacuity outcome after surgery for intermittent exotropia.

BACKGROUND: Intermittent exotropia (IXT) would cause different degrees of damage to stereopsis. We aimed to introduce a visual perception plasticity score (VPPS) that reflects initial postoperative plasticity and evaluate its effectiveness in predicting the mid-term surgical outcome in IXT patients. METHODS: A total of 149 patients with intermittent exotropia who underwent surgery in November 2018 and October 2019 were recruited. All subjects underwent detailed ocular examinations before and after surgery. VPPS were calculated based on visual perception examination system at one week postoperatively. Demographic, angle of deviation and stereopsis were collected and analyzed with regard to the VPPSs preoperatively and at one week, one month, three months, six months postoperatively. Predictive performances of VPPS were assessed using receiver operating characteristic (ROC) curves, the area under the curve (AUC) and cut-offs were obtained. RESULTS: Of the 149 patients, the average deviation was 43Δ at distance and 46Δ at near. The average rate of normal stereopsis before surgery was 22.81% at distance and 29.53% at near. Higher VPPS was associated with preoperative better near stereoacuity (r = 0.362, p = 0.000), less angle of deviation at distance (r=-0.164, p = 0.046), and better near (r = 0.400, p = 0.000) and distant stereoacuity (r = 0.321, p = 0.000) during the early postoperative period (1 week). The areas under the curves suggested that VPPS could be an effective predictor of sensory outcome(AUC>0.6). Cut-off values of 50 and 80 were calculated for VPPS using ROC curve analysis. CONCLUSION: Higher VPPSs were associated with a greater possibility of stereopsis improvement in patients with IXT. VPPS is a potentially promising indicator to predict the mid-term surgical outcome of intermittent exotropia.

Visualisation ergonomics and robotic surgery.

Stereopsis may be an advantage of robotic surgery. Perceived robotic ergonomic advantages in visualisation include better exposure, three-dimensional vision, surgeon camera control, and line of sight screen location. Other ergonomic factors relating to visualisation include stereo-acuity, vergence-accommodation mismatch, visual-perception mismatch, visual-vestibular mismatch, visuospatial ability, visual fatigue, and visual feedback to compensate for lack of haptic feedback. Visual fatigue symptoms may be related to dry eye or accommodative/binocular vision stress. Digital eye strain can be measured by questionnaires and objective tests. Management options include treatment of dry eye, correction of refractive error, and management of accommodation and vergence anomalies. Experienced robotic surgeons can use visual cues like tissue deformation and surgical tool information as surrogates for haptic feedback.

Beam-Shaping Extended Depth of Focus Intraocular Lens: Optical Assessment With Corneas of Increasing Spherical Aberration.

PURPOSE: To assess the optical quality and halo formation of a beam-shaping extended depth-of-focus (EDOF) intraocular lens (IOL) (AcrySof IQ Vivity; Alcon Laboratories, Inc) with corneas of long-range spherical aberration (SA) such as those resulting from myopic laser ablations. METHODS: The optical quality of the EDOF IOL and a reference monofocal IOL was evaluated with three corneas (A, B, and C, with SA =+0.135, +0.290, +0.540 µm, respectively, for a 5.15-mm pupil at the IOL plane). The through-focus modulation transfer function area (MTFa) curves were obtained between -5.00 and +2.00 diopters (D) defocus range. The halo was also assessed with the three corneas. RESULTS: Through-focus MTFa curves for a 4.5-mm IOL pupil showed a slight decrease in the maximum MTFa value provided by the EDOF IOL compared to the monofocal IOL in the three corneal situations (A: 45.9 vs 38.6 units; B: 41.1 vs 33.1 units, and C: 26.9 vs 23.8 units). For the 3.0-mm pupil, the EDOF IOL also had lower maximum MTFa than the monofocal IOL; however, the depth-of-focus increased to -2.20 D. With corneas A and B, the halo induced was of low energy with both IOLs. With cornea C, the EDOF IOL created a much larger and intense halo. CONCLUSIONS: The EDOF IOL provided a good distance optical performance and an extended range of focus of approximately 2.00 D, with a halo of low intensity when evaluated with a corneal SA similar to the one induced by a low to moderate myopic ablation. With a high myopic ablation, the halo induced would be of considerable size and energy. [J Refact Surg. 2023;39(2):95-102.].

The effects of torsion on horizontal motor fusion and stereopsis.

To investigate the effects of ocular torsion on horizontal motor fusion and stereopsis in normal adults and to probe the effects of torsion on peripheral fusion, macular fusion and foveal fusion. Twenty-five normal adults aged 30-38 were enrolled in this study. During the synoptophore assessment, the break points (BP) and recovery points (RP) of convergent fusion (CF) and divergent fusion (DF) and random-dots stereopsis were measured and analyzed at intorsion and extorsion of 3°, 5°, 7°, and 9°. According to the different sizes of the retinal areas stimulated by the synoptophore slides, fusion was classified into three categories: peripheral fusion (p-F), macular fusion (m-F) and foveal fusion (f-F). The p-F, m-F and f-F were analyzed and compared at the same torsional angle. There were significant differences in BPCF, RPCF, BPDF and RPDF among different torsion angles (ANOVA, P < 0.05). The Tukey's multiple comparison test showed that BPCF and RPCF of p-F, m-F and f-F decreased significantly at extorsion and intorsion ≥ 5°, compared with baseline (0° torsion) (P < 0.05). Compared with the baseline, BP of DF decreased significantly at torsion angles ≥ 3°, ≥ 5° and ≥ 7° for p-F, m-F, and f-F, respectively (P < 0.05), and RP of DF decreased significantly at torsion angles ≥ 5°, ≥ 9° and ≥ 7° for p-F, m-F, and f-F, respectively (P < 0.05). Comparison among p-F, m-F and f-F revealed significant differences only in BPCF at an intorsion of 3°, extorsion of 3° and the baseline (ANOVA, P < 0.05). There was a significant difference in the proportion of subjects with different sizes of RDS at different torsional angles (Fisher's exact test, P = 0.000). Fine stereopsis was damaged with increasing torsion. Torsion within the normal range of cyclofusion affects the horizontal motor fusion of convergent and divergent fusion and stereopsis. Torsion ≥ 5° should be considered during strabismus surgery for regaining fine binocular vision.

Cortical Deficits are Correlated with Impaired Stereopsis in Patients with Strabismus.

In this study, we explored the neural mechanism underlying impaired stereopsis and possible functional plasticity after strabismus surgery. We enrolled 18 stereo-deficient patients with intermittent exotropia before and after surgery, along with 18 healthy controls. Functional magnetic resonance imaging data were collected when participants viewed three-dimensional stimuli. Compared with controls, preoperative patients showed hypoactivation in higher-level dorsal (visual and parietal) areas and ventral visual areas. Pre- and postoperative activation did not significantly differ in patients overall; patients with improved stereopsis showed stronger postoperative activation than preoperative activation in the right V3A and left intraparietal sulcus. Worse stereopsis and fusional control were correlated with preoperative hypoactivation, suggesting that cortical deficits along the two streams might reflect impaired stereopsis in intermittent exotropia. The correlation between improved stereopsis and activation in the right V3A after surgery indicates that functional plasticity may underlie the improvement of stereopsis. Thus, additional postoperative strategies are needed to promote functional plasticity and enhance the recovery of stereopsis.

Stereopsis following surgery in children with congenital and developmental cataracts: A systematic review and meta-analysis.

We estimated the proportion of children with stereopsis following surgery in congenital and developmental cataracts by systematic review and meta-analysis and also considered the factors influencing stereopsis, such as intervention age and presence of strabismus. Stereopsis is directly related to quality of life, and investigating its levels following cataract surgery in children may help decide the right time to intervene, particularly in the context of brain plasticity. We conducted a systematic literature search using Scopus, PubMed, and Web of Science and found 25 case series, 3 cohorts, and 3 clinical trial studies from 1/1/1995 to 31/12/2020. Study-specific proportions of stereopsis from 923 children were pooled using a random-effects model, and stratified analyses were conducted based on intervention age and pre-existing strabismus as a confounder. We appraised the risk of bias using tools published by National Institutes of Health and evaluated publication bias with funnel plots and the Egger test. The pooled proportions of stereopsis based on 8 unilateral and 6 bilateral congenital cataract studies were 0.37 (95% CIs: [0.24, 0.53]) and 0.45 (95% CIs: [0.24,0.68]) when patients with preexisting strabismus were excluded as a confounder. When the intervention age was ≤6 months, proportions in unilateral congenital cataract group significantly increased to 0.52 (95% CIs: [0.37, 0.66]; P = 0.49) compared to 0.26 (95% CIs: [0.14, 0.44]; P = 0.16) otherwise. A similar increase in proportions was found when intervention age ≤4 months. In both unilateral and bilateral congenital cataract groups, proportions increased significantly when the confounder was excluded. Overall, proportions in bilateral congenital cataracts were significantly greater than unilateral cases (irrespective of confounder). Eight unilateral and 5 bilateral developmental cataract studies resulted in pooled proportions of 0.62 (95% CIs: [0.27, 0.88] and 0.82 (95% CIs: [0.4, 0.97]), respectively. Although proportions for bilateral developmental cataracts were greater than unilateral cataracts (irrespective of confounder), results were not statistically significant. Finally, proportions in unilateral developmental cataracts were significantly greater than unilateral congenital cataracts (Z = 7.413, P = 6.173694e-14). We conclude that surgical intervention within first 4-6 months can significantly affect postoperative outcomes in unilateral congenital cataracts. Analysis of existing data does not show a significant effect of intervention age on stereopsis outcomes for developmental cataracts.

Sensory eye dominance following surgically correction for acute acquired concomitant esotropia of adulthood.

BACKGROUND: Acute acquired concomitant esotropia (AACE) is an unusual presentation characterized by acute onset of esotropia after infancy. For patients with AACE of adulthood, the outcome of surgery, which is a common treatment, often shows successful recovery of stereopsis. However, whether surgically corrected patients with AACE of adulthood achieved balanced eyes is yet unclear. METHODS: Here, we used a binocular phase combination paradigm to quantitatively assess the ocular dominance of 22 surgically aligned patients with AACE of adulthood, which all had regained normal stereopsis after the surgery and 14 adult controls with normal vision. The sensory eye dominance was quantified as the interocular contrast ratio, termed balance point, at which each eye contributed equally to the perception of cyclopean grating. RESULTS: We found that, normal controls had a mean balance point value close to unity (0.96 ± 0.01), whereas adult AACE patients exhibited apparent interocular imbalance (0.76 ± 0.04), which was significantly different from control group (Mann-Whitney U = 135, P < 0.001, two tailed). In addition, the balance point of adults with AACE didn't correlate with the interval between onset of esotropia and the surgery (r = - 0.262, p = 0.239), or the length of postoperative follow-up period (r = 0.127, p = 0.575). CONCLUSION: Our results suggest that, for patients with AACE of adulthood whose eyes had been straightened, there is still residual sensory imbalance which may be a potential risk factor for AACE of adulthood.

Clinical features, etiological reasons, and treatment results in patients who developed acute acquired nonaccomodative esotropia.

PURPOSE: To evaluate the clinical features, possible etiological reasons, and treatment results in children who developed acute acquired comitant esotropia (AACE) without strabismus in previous years. METHODS: Medical records of the patients who were diagnosed with AACE between July 2017 and June 2021 were retrospectively reviewed. The children with ocular and orbital pathology, hypermetropia > 2.00 diopters, and anisometropia > 1.00 diopters were not included in the study. Possible etiological factors that could cause esotropia, treatment results, motor, and sensory functions were investigated. RESULTS: The mean age at first admission, and the onset of AACE, was 8.8 ± 2.9 (4-13) years of three female (23.1%) and 10 male (76.9%) cases. The causes of AACE were determined to be occlusion of the eye due to corneal foreign body removal in one (7.7%), emotional stress in one case (7.7%), and excessive close work, on computer and smartphone screens in the other 11 cases (84.6%). Orthotropia was achieved in cases who underwent strabismus surgery (n = 10) and in cases using the prism (n = 2); except for one case, all (92.3%) achieved binocular single vision (100 s/arc stereopsis and fusion) after treatment, while there was no binocular single vision in any of the cases before treatment. CONCLUSIONS: Acute acquired comitant esotropia is a rare clinical entity. Successful motor and sensory outcomes can be achieved by strabismus surgery or by prism therapy. It is critical to investigate the patients with AACE in terms of intracranial pathologies, although rarely seen.

Through-Focus Response of Extended Depth of Focus Intraocular Lenses.

PURPOSE: To investigate extended depth of focus intraocular lenses (EDOF IOLs), intended to extend the depth of field after cataract surgery in a comparative study at the optical bench. METHODS: An optical bench with either green or white light was used for this study. The artificial cornea used exhibited a spherical aberration of 0.2 µm. Examinations of the following lenses with a pupil opening of 3 and 4.5 mm were carried out: AcrySof IQ Vivity (Alcon Laboratories, Inc), Isopure (PhysIOL), Tecnis Eyhance (Johnson & Johnson), Vivinex Impress (Hoya Surgical Optics), and xact (Santen). RESULTS: Using green light and a pupil aperture of 3 mm, the AcrySof IQ Vivity showed the highest light energy for the intermediate area, whereas the Isopure and Vivinex Impress provided the highest energy for distance vision. Under the same examination conditions with a pupil opening of 4.5 mm, all lenses showed a low light distribution for the intermediate range. Regarding light distribution for distance, the Tecnis Eyhance had the highest light intensity. Using white light, the curves became much wider and more similar to each other. CONCLUSIONS: The five EDOF lenses investigated differ mainly by their different weighting of energy between the far and intermediate ranges. [J Refract Surg. 2022;38(8):497-501.].

Using the White Disk Test to Predict Fusional Potential.

INTRODUCTION: Fusional potential in patients experiencing binocular torsional diplopia may be challenging for the clinician to assess, particularly when accompanied by vertical and horizontal diplopia. OBJECTIVE: To demonstrate a clinical test that may help predict if binocular fusion can be achieved once cyclotorsion is alleviated. DESIGN: Video recording demonstrating how to perform the white disk test and retrospective chart review of patients tested with the white disk test. RESULTS: Twelve patients with binocular torsional diplopia were included. All subjects had excyclotorsion, 11 (91.7%) had combined vertical and horizontal strabismus and 1 patient (8.3%) had vertical strabismus. Eleven patients (91.7%) were able to achieve single binocular vision with the white disk test and 1 patient (8.3%) demonstrated brittle fusion. The white disk test successfully predicted postoperative fusion in 10 of 11 patients (90.9%). Eight patients (66.7%) demonstrated improved stereopsis after surgery. CONCLUSION: The white disk test was found to be very useful in predicting fusional potential in patients that experience binocular torsional diplopia.

Comparison of sensory outcomes in patients with successful motor outcome versus recurrent exotropia after surgery for intermittent exotropia.

Here, we compared sensory outcomes between patients with successful motor outcomes and recurrent exotropia after intermittent exotropia surgery. We retrospectively analyzed 303 patients who underwent surgery for intermittent exotropia, divided into two groups: successful motor outcome defined as an alignment between 10 prism diopters (PD) exodeviation and 5PD esodeviation at the final follow-up (Group A, n = 177) and residual or recurrent exotropia defined as exodeviation > 10 PD (Group B, n = 126). Preoperative and postoperative (at final visit) sensory outcomes were compared using the Titmus stereotest and distance Worth 4-dot test. Stereoacuity significantly improved postoperatively in both successful motor outcome group (Group A) and residual or recurrent exotropia group (Group B). However, stereoacuity did not differ between groups preoperatively and postoperatively. On the other hand, fusion rates for the Worth 4-dot test were significantly higher in group A than in group B, preoperatively and postoperatively, and significantly increased postoperatively only in group A. Therefore, the distance Worth 4-dot test may be useful for evaluating postoperative prognosis and preoperative sensory status.