New insights in presbyopia: impact of correction strategies.

Presbyopia occurs when the physiologically normal age-related reduction in the eyes focusing range reaches a point, when optimally corrected for distance vision, that the clarity of vision at near is insufficient to satisfy an individual's requirements. Hence, it is more about the impact it has on an individual's visual ability to function in their environment to maintain their lifestyle than a measured loss of focusing ability. Presbyopia has a significant impact on an individual's quality of life and emotional state. While a range of amelioration strategies exist, they are often difficult to access in the developing world and prescribing is generally not optimal even in developed countries. This review identified the need for a standardised definition of presbyopia to be adopted. An appropriate battery of tests should be applied in evaluating presbyopic management options and the results of clinical trials should be published (even if unsuccessful) to accelerate the provision of better outcomes for presbyopes.

A new trifocal corneal inlay for presbyopia.

Corneal inlays (CIs) are the most recent surgical procedure for the treatment of presbyopia in patients who want complete independence from the use of glasses or contact lenses. Although refractive surgery in presbyopic patients is mostly performed in combination with cataract surgery, when the implantation of an intraocular lens is not necessary, the option of CIs has the advantage of being minimally invasive. Current designs of CIs are, either: small aperture devices, or refractive devices, however, both methods do not have good performance simultaneously at intermediate and near distances in eyes that are unable to accommodate. In the present study, we propose the first design of a trifocal CI, allowing good vision, at the same time, at far, intermediate and near vision in presbyopic eyes. We first demonstrate the good performance of the new inlay in comparison with a commercially available CI by using optical design software. We next confirm experimentally the image forming capabilities of our proposal employing an adaptive optics based optical simulator. This new design also has a number of parameters that can be varied to make personalized trifocal CI, opening up a new avenue for the treatment of presbyopia.

Social Media Listening to Understand the Lived Experience of Presbyopia: Systematic Search and Content Analysis Study.

BACKGROUND: Presbyopia is defined as the age-related deterioration of near vision over time which is experienced in over 80% of people aged 40 years or older. Individuals with presbyopia have difficulty with tasks that rely on near vision. It is not currently possible to stop or reverse the aging process that causes presbyopia; generally, it is corrected with glasses, contact lenses, surgery, or the use of a magnifying glass. OBJECTIVE: This study aimed to explore how individuals used social media to describe their experience of presbyopia with regard to the symptoms experienced and the impacts of presbyopia on their quality of life. METHODS: Social media sources including Twitter, forums, blogs, and news outlets were searched using a predefined search string relating to symptoms and impacts of presbyopia. The data that were downloaded, based on the keywords, underwent manual review to identify relevant data points. Relevant posts were further manually analyzed through a process of data tagging, categorization, and clustering. Key themes relating to symptoms, impacts, treatment, and lived experiences were identified. RESULTS: A total of 4456 social media posts related to presbyopia were identified between May 2017 and August 2017. Using a random sampling methodology, we selected 2229 (50.0%) posts for manual review, with 1470 (65.9%) of these 2229 posts identified as relevant to the study objectives. Twitter was the most commonly used channel for discussions on presbyopia compared to forums and blogs. The majority of relevant posts originated in Spain (559/1470, 38.0%) and the United States (426/1470, 29.0%). Of the relevant posts, 270/1470 (18.4%) were categorized as posts written by individuals who have presbyopia, of which 37 of the 270 posts (13.7%) discussed symptoms. On social media, individuals with presbyopia most frequently reported experiencing difficulty reading small print (24/37, 64.9%), difficulty focusing on near objects (15/37, 40.5%), eye strain (12/37, 32.4%), headaches (9/37, 24.3%), and blurred vision (8/37, 21.6%). 81 of the 270 posts (30.0%) discussed impacts of presbyopia-emotional burden (57/81, 70.4%), functional or daily living impacts (46/81, 56.8%), such as difficulty reading (46/81, 56.8%) and using electronic devices (21/81, 25.9%), and impacts on work (3/81, 3.7%). CONCLUSIONS: Findings from this social media listening study provided insight into how people with presbyopia discuss their condition online and highlight the impact of presbyopia on individuals' quality of life. The social media listening methodology can be used to generate insights into the lived experience of a condition, but it is recommended that this research be combined with prospective qualitative research for added rigor and for confirmation of the relevance of the findings.

Normative patterns and factors associated with presbyopia progression in a multiethnic Asian population: the Singapore Epidemiology of Eye Diseases Study.

BACKGROUND/AIM: To investigate normative patterns and factors associated with presbyopia progression in a multiethnic Asian population. METHODS: Malay, Indian and Chinese participants aged 40-80 years who had baseline and 6-year follow-up examinations with subjective refraction data were recruited from the Singapore Epidemiology of Eye Diseases Study. Presbyopia progression was defined as an increase in near addition power of ≥+0.50 dioptre (D) from baseline to follow-up visit. Modified Poisson regression analyses were used to determine baseline factors associated with presbyopia progression. RESULTS: From the eligible 3974 eyes, 2608 eyes were included for final analysis after excluding eyes with a history of cataract surgery (929 eyes) and best-corrected distance visual acuity worse than 20/40 (342 eyes). Overall the mean near addition power change over 6 years was +0.25 D; Malays showed greater change (+0.37 D) compared with Indians (+0.23 D) and Chinese (+0.16 D). After adjusting for baseline age, gender, body mass index, hypertension, cataract, refractive error and daily hours of reading and writing, Malays were more likely to have presbyopia progression compared with Chinese (RR (relative risk)=1.67; 95% CI 1.43 to 1.95; p<0.001) and Indians (RR=1.45; 95% CI 1.25 to 1.68; p<0.001). Individuals aged 60-69 years (RR=0.77; p=0.006) and ≥70 years (RR=0.51; p<0.001) were less likely to progress in presbyopia compared with those aged 40-49. CONCLUSION: In this Asian population, the near addition power change over 6 years was lower than the current near addition prescription guidelines (+0.25 D vs +0.60 D). Our findings may help update near addition prescription guidelines that can be more tailored to Asians.

Clinical experience after tetrafocal intraocular lens implantation "PANOPTIX" / Experiência clínica após implantação de lentes intraoculares tetrafocais "PANOPTIX"

Abstract Purpose: To assess long, intermediate and near uncorrected visual acuity after a tetrafocal diffractive intraocular lens implantation, presence of dystopic phenomenon and patient satisfaction after surgery. Methods: Retrospective, observational study performed in Puerta de Hierro Specialties Hospital, in Jalisco, México. That included 100 eyes after phacoemulsification surgery by femtosecond assistance, followed by tetrafocal diffractive intraocular lens implantation due to cataract. Long, intermediate and near visual acuity without correction was measured, and presence or absence of dystopic phenomenon, plus patient satisfaction after surgery. Results: A total of 100 eyes in 50 patients who underwent cataract surgery with phacoemulsification by femtosecond assistance were evaluated. 100% underwent bilateral phacoemulsification. Long, intermediate, and near visual acuity after three months was in the most patients 20/20 (46%), 20/15 (44%) and Jaeger 1 (48%) respectively. The percentage or patients who refers halos was 7%; and other associated symptoms in 18%, being astenopia the most prevalent. The removal of the lens was not required in any case. Conclusion: Tetrafocal diffractive intraocular lenses provides excellent intermediate vision (at 60 centimeters) and satisfactory near (30 centimeters) and long (6 meters) visual acuity.

Resumo Objetivo: Avaliar a acuidade visual de longe, intermediária e de perto após o implante de lente intra-ocular difrativa tetrafocal, presença de fenômenos distópicos e satisfação do paciente após a cirurgia. Métodos: Estudo retrospectivo, observacional, realizado em Puerta de Hierro Hospital de Especialidades, em Jalisco, México. Isso incluiu 100 olhos após a cirurgia de facoemulsificação pela presença de laser de femtosegundo, seguida por implante de lente intra-ocular difrativa tetrafocal devido à catarata ou cirurgia facorrefractiva. Foi medida a acuidade visual de longe, intermediária e de perto, e a presença ou ausência de fenômenos distópicos, além da satisfação do paciente após a cirurgia. Resultados: Um total de 100 olhos em 50 pacientes submetidos à cirurgia de catarata com facoemulsificação por femtosegundo foram avaliados. 100% foram submetidos a facoemulsificação bilateral. A acuidade visual para longe, intermediária e de perto após três meses foi na maioria dos pacientes 20/20 (46%), 20/15 (44%) e Jaeger 1 (48%) respectivamente. A porcentagem ou pacientes que se referem a halos foi de 7%; e outros sintomas associados em 18%, sendo a astenopia a mais prevalente. A remoção da lente não foi necessária em nenhum caso. Conclusão: A lente intra-ocular difrativa tetrafocal fornece excelente visão intermediária (a 60 centímetros) e acuidade visual satisfatória de perto a (30 centímetros) e de longe (6 metros).

[Presbyopia and refractive surgery]. / Presbytie et chirurgie réfractive.

Presbyopia is the progressive loss of accommodation. Accommodation is a quick, precise and involuntary action which enables the eye to change the power of the young crystalline lens to see clearly at all distances. Presbyopia is and age-linked physiologic phenomenon: it results from aging of the lens, which loses its elasticity, gradually becomes rigid and loses the ability to accommodate. Presbyopia has attained a prevalence of 80% in Europe and is increasing regularly due to the aging of the population. Various surgical techniques can be proposed. Indications depend on age, ophthalmological exam, and any associated ametropia. The main techniques act by either changing the curvature of the cornea with laser or with an intrastromal inlay to create pseudoaccomodation, or by intraocular lens surgery with a multifocal or accommodating IOL. Once the surgical choice has been made, the information must be clearly conveyed and consent obtained.

Late-onset refractive shift after small-aperture corneal inlay implantation.

We present a series of 5 consecutive cases in which a small-aperture corneal inlay (Kamra ACI7000PDT) was uneventfully implanted in a corneal pocket created at a depth between 200 µm and 250 µm. Three months after surgery, all patients had good visual results, normal corneal surfaces, and adequate stromal healing. Between 6 months and 19 months after surgery, visually significant refractive changes appeared in the form of a hyperopic shift in 4 cases and a myopic shift in 1 case. Topical steroids were ineffective. In 2 cases, the inlay was explanted. Among the adverse events reported in the 2015 approval of the small-aperture corneal inlay was a low incidence of late refractive changes. Recently, we have encountered a relatively higher frequency of these adverse events. Thus, we evaluated the hypothesis that a relationship between these late refractive changes and the decreased diffusivity of nutritional fluid to the anterior stroma accentuated by a lower depth of implantation is the cause.

Satisfação de pacientes após cirurgia refrativa de monovisão avançada / Satisfaction of patients after advanced mono-refractive surgery

Resumo Objetivo: Monovisão é um conceito que descreve a correção propositadamente desigual da visão de em um olho para longe e outro olho para perto, sendo utilizada principalmente para correção da presbiopia. O objetivo principal foi avaliar a satisfação dos pacientes com a cirurgia refrativa de monovisão avançada. Os objetivos secundários foram avaliar a necessidade de uso de óculos após a cirurgia, e analise do perfil dos participantes. Métodos: Foi realizado um estudo transversal observacional de série de casos baseado na revisão de prontuários de participantes submetidos a cirurgia refrativa de monovisão em uma clínica oftalmológica privada. A população estudada foi do tipo não-probabilistica com n de 50 participantes. A amostragem foi por conveniência, sendo selecionados os prontuários dos últimos 50 participantes que retornaram para consulta de revisão após a cirurgia refrativa realizada até novembro de 2016. Resultados: Foram analisados 50 prontuários. Quando questionados sobre a satisfação com o procedimento, a nota média atribuída foi 9,4 ± 0,6 dentro de uma escala de 0 a 10. Sobre a necessidade do uso de óculos após o procedimento, 92% dos pacientes referiram não necessitar. Os demais 8% que referiram utilizar eventualmente óculos para perto eram hipermetropes antes da cirurgia Conclusão: Concluímos que o índice de satisfação com a cirurgia de monovisão na amostra estudada foi alto e a maioria dos participantes referiu não necessitar de óculos após o procedimento. A amostra foi composta majoritariamente por mulheres com média de idade de 52 anos, hipermetropes, que realizaram a cirurgia em ambos os olhos. Nossa amostra foi distinta de outros estudos devido ao fato de incluirmos maior parte de participantes hipermetropes.

Abstract Objective: Monovision is a concept that describes the purposely unequal correction of vision from one eye to the other and eye to eye, and is mainly used to correct presbyopia. The main objective was to evaluate patients' satisfaction with advanced monovision refractive surgery. The secondary objectives were to evaluate the need for glasses after surgery, and to analyze the profile of the participants. Methods: A cross-sectional observational study of a series of cases was carried out based on the review of medical records of participants submitted to refractive surgery of monovision in a private ophthalmologic clinic. The population studied was of the non-probabilistic type with n of 50 participants. Sampling was for convenience, and the medical records of the last 50 participants who returned for revision consultation after refractive surgery performed until November 2016 were selected. Results: Fifty patients were analyzed. When questioned about satisfaction with the procedure, the mean score assigned was 9.4 ± 0.6 on a scale of 0 to 10. Regarding the need for glasses after the procedure, 92% of the patients reported not needing it. Conclusion: We concluded that the satisfaction index with monovision surgery in the sample studied was high and most of the participants reported that they did not require glasses after the procedure. The sample consisted mainly of women with mean age of 52 years, hypermetropes, who underwent surgery in both eyes. Our sample was different from other studies due to the fact that we included most participants with hypermetropes.

[The search for electrophysiological predictors of visual comfort after presbyopia correction with contact lenses]. / Recherche d'indices électrophysiologiques de confort visuel après correction de la presbytie par lentilles de contact.

Starting at 40 years of age, prespyopia affects a quarter of the world population. Many techniques of presbyopia surgery have emerged in recent years. The purpose of this study was to compare monovision and multifocality and to identify clinical and electrophysiological predictive markers of visual comfort for each correction available in clinical practice. Ten presbyopic patients participated in this study. Patients received monovision and multifocal correction using contact lenses for three weeks each in a random order. A clinical evaluation (visual acuity, TNO test, binocular contrast sensitivity and quality of vision questionnaires) and an electrophysiological evaluation (monocular and binocular pattern VEP with multiple spatial frequencies: 60, 30 and 15') were performed before and after each correction modality. The P100 was significantly wider and slightly earlier after binocular compared to monocular stimulation at T0. The TNO stereopsis score decreased significantly after correction. No other significant differences, either on clinical or electrophysiological criteria, were found between the two modes of correction. Several significant correlations were found between the stereoacuity difference depending upon correction and evoked potentials by binocular pattern at T0. The larger the stereoacuity difference (better stereoacuity with multifocal compensation), the longer the latency of the P100 using 60' checks (R=0.82; P=0.004) and the greater the amplitude of the N75 using 30' (R=0.652; P=0.04). Our study found no differences between the 2 types of correction, but it highlights a benefit of VEP used in current practice and measurement of the P100 wave, the best indicator of stereopsis and the most consistent, to predict visual comfort after compensation presbyopia.

Effect of the Femtosecond Laser on an Intracorneal Inlay for Surgical Compensation of Presbyopia during Cataract Surgery: Scanning Electron Microscope Imaging.

PURPOSE: To investigate the effect of the femtosecond laser-assisted cataract surgery (FLACS) on porcine eyes implanted with a Kamra corneal inlay and to describe how the inlay may change the effect of the femtosecond laser on the lens. METHODS: FLACS was performed on six porcine eyes and a Kamra corneal inlay had been implanted, exploring the lens under the surgical microscope. Another Kamra corneal inlay was attached to the upper part of the transparent hemisphere used for calibration of the femtosecond laser. Capsulorhexis, arcuate incisions, and phacofragmentation were carried out. The Kamra corneal inlay was compared with a nontreated one using a scanning electron microscope (SEM), and the hemisphere was analyzed with a surgical microscope. RESULTS: Capsulorhexis and phacofragmentation were completed in all the porcine eyes, although accuracy to determine the exact effect on the lens was not possible to achieve. The effect of the femtosecond laser on the PMMA hemisphere through the Kamra corneal inlay showed the capsulorhexis was placed outside the outer margin of the inlay and a sharply sculpted fragmentation pattern with a three-dimensional (donut-shaped) annulus untreated beneath it. SEM images of the nontreated and the treated inlays were comparable. No ultrastructural changes were found in the treated Kamra corneal inlay. CONCLUSIONS: FLACS can be performed with a Kamra corneal inlay for surgical compensation of presbyopia without the risk of damaging the inlay. The Kamra corneal inlay acts as a screen that avoids the laser to reach the areas beneath its shadow, but not the exposed areas of the lens.

[The KAMRA™ inlay : A realistic approach?] / Das KAMRA™-Inlay : Ein realistischer Ansatz?

BACKGROUND AND PURPOSE: The KAMRA™ inlay (AcuFocus, Irvine, California, USA) is an additional option for correcting presbyopia that has been used for many years in refractive surgery. Our objective is to report our three-month postoperative results of KAMRA™ inlay implantation in terms of near, intermediate and distance vision. PATIENTS AND METHODS: All 24 patients (average age 54.1 ± 6.0 years) were treated with the KAMRA™ inlay in the non-dominant eye (75 % in the left eye) by the same surgeon (MEH). The KAMRA™ inlay was implanted under a 200 µm-thick femtosecond laser-assisted LASIK flap in 2 emmetropic presbyopic patients, 13 hyperopic presbyopic patients and 9 myopic presbyopic patients, without ocular pathologies. The uncorrected distance, intermediate, and near vision were assessed. The central corneal thickness (CCT), endothelial cell density (ECD) and visual field were assessed both pre- and post-operatively. In addition, patients were asked to complete a patient satisfaction questionnaire. Follow-ups were carried out one day, one week, and 1, 3, 6, 9 and 12 months postoperatively. RESULTS: After three months, all 24 eyes revealed an increase in the mean uncorrected distant visual acuity in the non-dominant eye from 0.4 ± 0.2 to 0.9 ± 0.1, an increase in the mean uncorrected intermediate visual acuity (logMAR, Jaeger 75 cm) from 0.6 ± 0.3 (J 11) to 0.0 ± 0.0 (J 1) and an increase in the mean uncorrected near visual acuity (logMAR, Jaeger 45 cm) from 0.6 ± 0.2 (J 9) to 0.0 ± 0.0 (J 1) monocularly. The visual acuity did not change over the time. The CCT and ECD remained unchanged compared with the findings before surgery. Subjectively, the questionnaire showed high patient satisfaction. CONCLUSION: Femtosecond laser-assisted KAMRA™ inlay implantation can be used in post-LASIK emmetropic patients and patients with a monofocal intraocular lens. It can also be combined with LASIK (for ametropic patients). The potential reversibility, low impairment of psychophysical investigations and the high degree of patient satisfaction makes this novel technique designed to increase depth of focus a reliable method for the surgical correction of presbyopia. Patient selection and centration of the KAMRA™ inlay is crucial.

A comparison of small aperture implants providing increased depth of focus in pseudophakic eyes.

BACKGROUND AND PURPOSE: Presbyopia is characterized by a decreasing ability of accommodation - the eye's ability to alter the focus between far and near distance objects. After cataract surgery, accommodation is completely lost. Several years ago, small aperture (pinhole) implants have been presented in order to increase the depth of focus providing functional vision at far and near distance without the need for spectacles. We simulated the theoretical depth of focus with three different pseudophakic eye models in order to investigate the potential benefit arising from the implantation of small aperture optical (SAO) implants. The purpose was to compare the achievable defocus range of a SAO intraocular lens with a SAO corneal inlay. MATERIAL AND METHODS: We created three pseudophakic eye models with an aberration correcting intraocular lens (IOL): one with a corneal SAO implant (M1), a second one with a SAO intraocular lens (M2) and a third one with a conventional intraocular lens of the same optical design but without SAO (M0). Defocus curves were created by varying the focal length of a thin lens in front of the eye - which mimics the clinical assessment of defocus curves. RESULTS: With a Strehl ratio threshold of 0.05, the reference design M0 provided a maximum defocus range of approximately 1.7D (with a 2.0mm pupil) whereas both pinhole implants (M1 and M2) showed a defocus range up to 3.0 and 3.3D, respectively. With large natural pupil diameter, where light passes outside the SAO aperture, the defocus range drops to 0.8D/0.7D for M1 and M2 compared to 0.7D with M0. CONCLUSIONS: The SAO intraocular lens showed a similar defocus range as the SAO corneal inlay. Both concepts have the potential of increasing depth of focus compared to a conventional intraocular lens. In case of large physiological pupil diameters these advantages of SAO implants may be lost.

Long-term outcomes of intrastromal femtosecond laser presbyopia correction: 3-year results.

BACKGROUND/AIMS: To analyse visual outcomes and corneal changes 3 years after intrastromal femtosecond laser presbyopia treatment. METHODS: In a prospective, unicentric clinical trial, 25 presbyopic patients received INTRACOR treatment (Technolas femtosecond laser) on their non-dominant eye. Examinations were performed preoperatively as well as 1, 24 and 36 months postoperatively and included refraction, near, intermediate and distance visual acuity tests, reading speed, corneal topography, stray light measurement, endothelial cell count and slit-lamp examination. RESULTS: Comparison of preoperative versus 36 months postoperative values showed in median an improvement of uncorrected near visual acuity (UNVA) from 0.70 logMAR to 0.10 logMAR (p<0.001). Corrected distance visual acuity (CDVA) was reduced from -0.10 logMAR to 0.00 logMAR (p<0.001). The spherical equivalent preoperatively was 0.625 D and after an initial myopic shift after 1 month (0.125 D) and 24 months (0.25 D), the 36 months value (0.50 D) returned to resemble the preoperative value in statistical terms (p=0.123). A significant corneal steepening of 1.50 D in the treated area was measured. Pachymetry (thinnest point) revealed a statistically significant, but clinically insignificant corneal thickening from 535 to 549 µm (p=0.033). Endothelial cell count did not change. 92.86% of patients felt comfortable with the surgery result. CONCLUSION: INTRACOR treatment after 36 months improved UNVA to varying degrees. The effect can be explained by a corneal steepening. An initial myopic shift was reversible. Reductions especially in CDVA have to be taken into account and therefore careful patient selection and information is obligatory. TRIAL REGISTRATION NUMBER: NCT01164358 and NCT01025050, Results.

Distância interpupilar e convergência na população présbita / Interpupillary distance and convergence in the presbyopic population

Objetivo:Determinar as medidas da distância interpupilar (DIP) e convergência ocular na população présbita com pupilômetro de reflexo corneano.Métodos:Cento e sessenta pacientes, com idades entre 41 e 85 anos, sendo 66 do sexo masculino e 94 do sexo feminino, foram avaliados com medida da DIP longe e de perto com PRC.Resultados:A média da idade foi de 55,9 ± 11,5 anos, com DIP média de 65,02 ± 2,78 e 62,47 ± 3,15mm para o sexo masculino e feminino, respectivamente. A média da convergência foi de 5,00 ± 0,5mm. Houve forte correlação direta entre o aumento da DIP e a convergência.Conclusão:Este estudo sugere que a DIP média é pouco menor na população présbita feminina e que existe variação da convergência de acordo com a DIP do paciente.

Objective:To determine the measurements of interpupillary distance (IPD) and ocular convergence in the presbyopic population with corneal reflex pupillometer.Methods:160 subjects (66 males and 94 females) aged 41 to 85 years have their measurements of IPD done - far and near - by CRP method.Results:The mean age was 55.9 ± 11.5 years; the average IPD was 65.02 ± 2.78 and 62.47 ± 3.15 mm for male and female respectively. Also, the average convergence was 5.00 ± 0.5 mm. There was a strong direct correlation between the increase in IPD and convergence.Conclusions:This study suggests that the average IPD is slightly smaller in presbyopic female population, and there is variation in the convergence according to the IPD of the subject.

Location of achromatizing pupil position and first Purkinje reflection in a normal population.

PURPOSE: Quality of vision in patients who have undergone corneal refractive surgery depends upon the optimal centration of the procedures used. The center of the pupil is used as a reference point in some corneal ablation procedures. The achromatic axis would be a more sensible option from an optical point of view, but it is not as readily detectable. As an alternative, other refractive techniques, like the small aperture corneal inlay for presbyopia correction, use the corneal reflex (first Purkinje image). To assess the relative position of these two marks, we developed a new instrument to simultaneously measure both the first Purkinje image (PI) and the intersection of the achromatic axis with the pupil plane. METHODS: The apparatus records images of the pupil and the PI when illuminated with a circle of infrared light-emitting diodes. A second optical path allows determination of the achromatic axis by using a subjective method. Both the positions of the PI and the achromatic axis intersection are determined simultaneously. RESULTS: A series of data were obtained in 48 eyes. The mean location of the achromatic point relative to the PI was [x = -0.05 ± 0.15 mm; y = 0.09 ± 0.18 mm]. Considered individually, in 55% of eyes, the distance between locations is less than 0.2 mm, and in 95% of eyes, distances are less than 0.4 mm. CONCLUSIONS: On average, achromatic axis crossing of the pupil and PI locations coincides within measurement errors. Although there was some intersubject variability, differences in location were less than 0.6 mm in all measured eyes.

[Clinical results of a multifocal pseudophakic additional lens]. / Klinische Ergebnisse einer multifokalen pseudophaken Zusatzlinse.

BACKGROUND: In order to meet the patients wish for compensation of presbyopia in a flexible way, even in cases of an already pseudophacic eye, sulcus-fixated additional intraocular lenses (IOL) have been developed as an alternative to multifocal IOLs (MIOL) in the capsular bag. This allows subsequent application of multifocal optics. Furthermore, these additional lenses offer a relatively simple opportunity for postoperative refractive fine tuning or, in cases of incompatibility, a minimally invasive explantation of the multifocal part of the optical system. PURPOSE: The objective of our work was the examination of a diffractive multifocal additional IOL and its functional characteristics. MATERIAL AND METHODS: In a prospective, monocentric trial 32 eyes of 21 patients had cataract surgery with implantation of a monofocal IOL into the capsular bag and simultaneous implantation of a multifocal additional IOL into the sulcus. The visual acuity was tested at different distances 6 weeks and 3 months postoperatively. At the 3 month follow-up contrast sensitivity and defocus curves were additionally assessed. Patients with bilateral implantation filled in a questionnaire to assess their subjective satisfaction of postoperative visual quality. RESULTS: All eyes had an uneventful postoperative course. At both follow-ups an uncorrected distance and near visual acuity (VA) of 0.2 LogMAR or better was achieved. In intermediate vision 29 out of 32 eyes after 6 weeks and 31 out of 32 eyes after 3 months reached an uncorrected VA of 0.2 LogMAR or better. The defocus curves showed a typical two-peaked shape. At intermediate distance (-1.5 D of defocus) the median VA was 0.35 LogMAR. Contrast sensitivity testing showed results in the upper region of the standard range of age-matched, healthy patients. DISCUSSION: The examined type of diffractive additional IOL achieved good to very good functional results, which are comparable to corresponding IOLs in the capsular bag. Multifocal additional IOLs can be considered as a useful extension of refractive surgical alternatives for the compensation of presbyopia. The possibility to implant the multifocal optic part independently of the primary surgery, the minimal invasivity of the procedure and the likewise time-independent reversibility can be pointed out as special qualities of these IOL.

Evaluating the short-term results of KAMRA inlay implantation using real-time optical coherence tomography-guided femtosecond laser technology.

PURPOSE: To evaluate the outcomes from using real-time optical coherence tomography (OCT)-guided femtosecond laser technology for pocket creation for KAMRA inlay (Acufocus, Inc., Irvine, CA) implantation surgery. METHODS: One hundred fifty-one eyes underwent KAMRA inlay implantation using the real-time OCT-guided femtosecond laser for pocket creation. All patients had a history of prior LASIK. Uncorrected distance visual acuity, corrected distance visual acuity, uncorrected near visual acuity, corrected near visual acuity, and manifest refraction spherical equivalent were evaluated preoperatively and postoperatively. The follow-up period was 3 months. RESULTS: Mean manifest refraction spherical equivalent, uncorrected distance visual acuity, and uncorrected near visual acuity changed from -0.18 ± 0.33 to -0.95 ± 0.64, 20/16 to 20/20, and J8 to J2, respectively. Corrected distance visual acuity and corrected near visual acuity remained stable before and after KAMRA inlay implantation, 20/12 and J1, respectively. CONCLUSIONS: Using real-time OCT-guided femtosecond laser technology increases the safety and accuracy of corneal KAMRA inlay implantation surgery with a history of prior LASIK with excellent visual and refractive outcomes.

Piggyback multifocal IOLs for a hyperopic-presbyopic surprise after cataract surgery in high myopic patients.

PURPOSE: To demonstrate the utility of piggyback multifocal intraocular lenses (IOLs) for a hyperopic-presbyopic surprise after cataract surgery in highly myopic patients. METHODS: Case report. RESULTS: A 43-year-old woman with high myopia presented with dense subcapsular cataracts. The IOL power calculated with the Haigis formula gave a lens of -7D for emmetropia in the right eye. The refractive result was a spherical equivalent refractive error of +2.25. To overcome refractive surprise, a refractive multifocal +3D Sulcoflex 653F with an additional 3.5D for near vision was implanted, achieving a best-corrected visual acuity of 20/40. The lens offered her good intermediate vision for computer work. CONCLUSIONS: With a Sulcoflex IOL, it is possible to achieve good near-intermediate visual acuity and spectacle independence, especially in highly myopic eyes with good near visual acuity. In addition, the implantation of these IOLs might correct residual refractive errors following previous implantation of a monofocal IOL.