Exploring the Experience of Living with and Managing Presbyopia.

SIGNIFICANCE: Presbyopia typically occurs around 40 years of age and affects approximately one-quarter of the global population. Up to October 2021, there were no approved pharmacotherapies for presbyopia, and common treatments, such as glasses, can have disadvantages for individuals' health-related quality of life. PURPOSE: This study aimed to document the experience of living with and managing presbyopia, identify perspectives on treatment options, and determine whether there is an unmet need in the treatment landscape. METHODS: Coded transcripts of concept elicitation (CE; n = 20) and cognitive debriefing (n = 20) interviews with presbyopic individuals, originally conducted for development of patient-reported outcome instruments, were reanalyzed to identify salient concepts describing participants' experiences with presbyopia treatments. Qualitative ranking exercises assessed participants' preferences for a potential pharmacotherapy vs. existing treatments. RESULTS: Because most concepts were identified with the CE interviews, data reflect CE findings unless otherwise noted. Average age across CE/cognitive debriefing interviews was 49.4 years; a vast majority of participants used glasses for presbyopia treatment. Four themes related to treatment with glasses were identified with the interviews: inconvenience during daily activities, negative physical sensations around the eyes/head, limitations, and undesirable impacts on daily life (e.g., psychosocial). Most commonly, participants reported inconveniences related to forgetting glasses and psychosocial impacts (e.g., feeling/looking older). Strained/tired eyes and limited ability to see at varying distances were also reported. Among participants with near-vision glasses who provided data, two-thirds expressed interest in alternative treatments. In addition, almost three-quarters of the participants ranked hypothetical eye drops as their first or second preferred option, vs. reading glasses, contact lenses, magnifying glasses, and surgery. CONCLUSIONS: This study explored the experience of living with and managing presbyopia and identified limitations and negative impacts of current treatments. Pharmacological development (e.g., eye drops) may fulfill an unmet need in the presbyopia treatment landscape.

Population-based assessment of prevalence of spectacle use and effective spectacle coverage for distance vision in Andhra Pradesh, India - Akividu Visual Impairment Study.

CLINICAL RELEVANCE: Effective spectacle coverage is a useful indicator to assess the coverage of refraction services in a given region. We found a low coverage in the Akividu region suggesting a need to develop effective refraction services. BACKGROUND: To assess the prevalence of spectacle use and effective spectacle coverage for distance vision among people aged 40 years and older in the Indian state of Andhra Pradesh. METHODS: A population-based cross-sectional survey was carried out in the Akividu region in West Godavari and Krishna districts. The study teams visited selected households and conducted eye examinations in the selected clusters. A structured questionnaire was used to collect information on spectacle use. 'Met Need' was defined as unaided VA worse than 6/12 but improved to 6/12 or better with their current spectacles. 'Unmet Need' was defined as unaided VA worse than 6/12 but improved to 6/12 with pinhole, among those not using spectacles. The 'Under-met Need' was defined as aided VA worse than 6/12 but improving with pinhole to 6/12 or better. Based on these definitions, Effective Refractive Error Coverage (e-REC) is calculated as: e-REC (%) s = ((met need)/(met need + under-met need + unmet need)) X100. RESULTS: Of 3,000 enumerated from 60 clusters, 2,587 (86.2%) participants were examined. The prevalence of current spectacle use was 43.1% (95% CI:41.2-45.0). The e-REC was 37.4%. It was also lower in men compared to women and among those without any education. Participants who had cataract surgery in either eye had similar e-REC compared to those who were not operated. CONCLUSION: Though spectacle use was found to be high, there is a still large unmet need for refractive correction for distance. Effective service delivery models to provide refraction and spectacle dispensing services are needed to achieve universal eye health coverage in the region.

Spherical Aberration Customization to Extend the Depth of Focus With a Clinical Adaptive Optics Visual Simulator.

PURPOSE: To evaluate the use of the VAO adaptive optics visual simulator (Voptica SL, Murcia, Spain) for customization of spherical aberration to increase depth of focus. METHODS: Through-focus visual acuity with both high- and low-contrast letters from +1.00 to -3.00 diopters (D) was measured in 17 dilated eyes with three different induced amounts of spherical aberration for a 4.5-mm pupil diameter: control (0 µm), -0.15 µm, and -0.30 µm. RESULTS: The defocus curves followed the same behavior with both values of contrast, but the visual acuity was 0.2 logMAR lower with low contrast. The mean values of high-contrast logMAR visual acuity at far, intermediate (67 cm), and near (40 cm) were -0.10, 0.11, and 0.37 for control, 0.04, 0.00, and 0.15 for -0.15 µm, and 0.23, 0.00, and 0.06 for -0.30 µm conditions. The 95% confidence interval ranged from ±0.14 to ±0.45 logMAR and the middle 50% of the distribution was approximately 0.2 logMAR. CONCLUSIONS: Negative values of spherical aberration extend the depth of focus in different ways depending on each patient. The VAO is a new instrument that allows the visual customization of spherical aberration to enhance depth of focus. [J Refract Surg. 2020;36(4):223-229.].

[Presbyopia treatment].

Presbyopia, i.e. the loss of accommodative amplitude with age, results from increasing stiffness and thickness of the lens and leads to inability of the lens to change shape, refractive power and focus of the eye in response to the contraction of the ciliary muscle inside the eye. Multiple remedies are available, the most common being reading glasses. Alternative options include a monovision combination of monofocal lenses or the use of multifocal lenses, in the form of contact lenses or intraocular implant lenses, corneal implants or corneal refractive surgery. This review provides an update on current options and their limitations.

Presbyopia: Effectiveness of correction strategies.

Presbyopia is a global problem affecting over a billion people worldwide. The prevalence of unmanaged presbyopia is as high as 50% of those over 50 years of age in developing world populations, due to a lack of awareness and accessibility to affordable treatment, and is even as high as 34% in developed countries. Definitions of presbyopia are inconsistent and varied, so we propose a redefinition that states "presbyopia occurs when the physiologically normal age-related reduction in the eye's 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". Strategies for correcting presbyopia include separate optical devices located in front of the visual system (reading glasses) or a change in the direction of gaze to view through optical zones of different optical powers (bifocal, trifocal or progressive addition spectacle lenses), monovision (with contact lenses, intraocular lenses, laser refractive surgery and corneal collagen shrinkage), simultaneous images (with contact lenses, intraocular lenses and corneal inlays), pinhole depth of focus expansion (with intraocular lenses, corneal inlays and pharmaceuticals), crystalline lens softening (with lasers or pharmaceuticals) or restored dynamics (with 'accommodating' intraocular lenses, scleral expansion techniques and ciliary muscle electrostimulation); these strategies may be applied differently to the two eyes to optimise the range of clear focus for an individual's task requirements and minimise adverse visual effects. However, none fully overcome presbyopia in all patients. While the restoration of natural accommodation or an equivalent remains elusive, guidance is given on presbyopic correction evaluation techniques.

Intentional Undercorrection by Implantation of Posterior Chamber Phakic Intraocular Lens With A Central Hole (Hole ICL) For Early Presbyopia.

PURPOSE: To assess visual performance at near to far distances in early presbyopic patients with undercorrection by implantation of an ICL with a central hole (hole ICL). METHODS: This prospective study evaluated forty-two eyes of 21 early presbyopic patients (age, 40 to 53 years) with spherical equivalents of -7.37 ± 3.18 D [mean ± standard deviation] who underwent hole ICL implantation and whose targeted refraction was set at slight myopia (-0.61 ± 0.28 D) for both eyes. We assessed the safety, efficacy at near to far distances, predictability, and adverse events of the surgery, during the 6-month observation period. RESULTS: Corrected distance visual acuity did not improve significantly, from -0.17 ± 0.07 preoperatively to -0.19 ± 0.08 logMAR postoperatively (p=0.066, Wilcoxon signed-rank test). Uncorrected distance visual acuity was significantly improved from 1.30 ± 0.24 preoperatively to -0.03 ± 0.20 logMAR postoperatively (p<0.001). The mean binocular visual acuity was 0.02 logMAR or better at all distances (5.0, 3.0, 2.0, 1.0, 0.7, 0.5, and 0.3 m). All eyes were within ± 0.5 D of the targeted correction. Neither cataract formation, significant intraocular pressure rise, nor other vision-threatening complications occurred in any case during the 6-month observation period. CONCLUSIONS: Our pilot study showed that intentional undercorrection by hole ICL implantation for early presbyopia was safe with predictable refractive results and provided good binocular vision at near to far distances, without developing cataract, suggesting its viability as a surgical presbyopic treatment for such patients.

Perceived brightness with small apertures.

PURPOSE: To quantify the relative perceived brightness when viewing through a small aperture as that used by presbyopic patients with small-aperture corneal inlays or intraocular lenses with an embedded aperture. SETTING: Laboratorio de Óptica, Universidad de Murcia, Murcia, Spain. DESIGN: Prospective case series. METHODS: The relative perceived brightness when 2 apertures (3.0 mm and 1.6 mm diameters) were presented monocularly to the participant was determined. With equal transmittances in both apertures, a flickering effect caused by the different retinal illuminance for each condition is perceived. The participant's task was to modify the transmittance of the 3.0 mm pupil until the flickering was minimized. This transmittance value indicates the relative perceived brightness reduction. The measurements were performed under 3 average luminance levels. RESULTS: The perceived relative luminance measured ranged between 38.5% and 46.9%. This represents an increase in brightness perception with a small aperture of 1.24 and 1.51, respectively, compared with what would be expected. This trend was consistent for all the participants in the study. CONCLUSIONS: The perceived brightness with a small aperture was less pronounced than what would be predicted by the reduction in retinal illuminance. Under real visual conditions, this effect could be even more significant because binocular effects and temporal adaptation might further increase the perceived brightness with the small aperture.

Visual Performance of a New Extended Depth-of-Focus Intraocular Lens Compared to a Distance-Dominant Diffractive Multifocal Intraocular Lens.

PURPOSE: To investigate the clinical performance of a new extended depth-of-focus (EDOF) intraocular lens (IOL) and compare it to that of a distance-dominant diffractive multifocal IOL. METHODS: Patients implanted with an EDOF IOL (Mini Well; SIFI, Catania, Italy) inducing spherical aberration and with a multifocal IOL (ReSTOR SV25T; Alcon Laboratories, Inc., Fort Worth, TX) were analyzed. The following monocular parameters were investigated: corrected distance visual acuity (CDVA), distance-corrected near visual acuity (DCNVA), reading speed, defocus curve, contrast sensitivity, and halos and glare as quantified by a simulator (Halo & Glare Simulator; Eyeland-Design Network GmbH, Vreden, Germany) and questionnaire. RESULTS: Twenty patients with the EDOF IOL and 37 with the multifocal IOL were enrolled. No statistically significant difference was observed for CDVA. The defocus curve of the EDOF IOL revealed no gaps for the intermediate range. Statistically significant differences were observed at -1.00 diopter (D) (EDOF IOL: 0.08 ± 0.09 logMAR; multifocal IOL: 0.21 ± 0.12 logMAR; P < .0001) and -1.50 D defocus (EDOF IOL: 0.15 ± 0.11 logMAR; multifocal IOL: 0.24 ± 0.13 logMAR; P = .0122). The reading speed at 40 cm was similar at all print sizes. The mean DCNVA was the same (EDOF IOL: 0.35 ± 0.14 logRAD, multifocal IOL: 0.35 ± 0.13 logRAD). No differences in contrast sensitivity were detected. According to the simulator, halos had a smaller mean size (P = .0439) and a lower mean intensity (P = .0222) with the EDOF IOL. No statistically significant differences were detected for glare size. CONCLUSIONS: The new EDOF IOL performed similarly to a multifocal IOL at distance and near but was superior at intermediate distances. [J Refract Surg. 2018;34(4):228-235.].

Optimizing outcomes with multifocal intraocular lenses.

Modern day cataract surgery is evolving from a visual restorative to a refractive procedure. The advent of multifocal intraocular lenses (MFIOLs) allows greater spectacle independence and increased quality of life postoperatively. Since the inception in 1980s, MFIOLs have undergone various technical advancements including trifocal and extended depth of vision implants more recently. A thorough preoperative workup including the patients' visual needs and inherent ocular anatomy allows us to achieve superior outcomes. This review offers a comprehensive overview of the various types of MFIOLs and principles of optimizing outcomes through a comprehensive preoperative screening and management of postoperative complications.

[Refractive Lens Exchange]. / Refraktiver Linsenaustausch.

In refractive surgery the removal of the natural lens followed by implantation of an artificial intraocular lens has been an established method to treat refractive errors. The term "clear lens exchange" separates this approach from cataract surgery, where a cloudy lens has to be removed. With regard to currently available intraocular lens technologies, there is a wide range to correct myopia, hyperopia as well as astigmatism. Trifocal or extended depth-of-focus lenses (EDOF) even with a toric component offer the patients a potential benefit to further address presbyopia, respectively. Furthermore, the surgery in combination with Femtosecond laser-assistance offers more precision to this highly elective approach.This article provides an overview about currently available procedures and implants to correct presbyopia and refractive errors. A thorough evaluation of risk and benefit for each patient group is given with regard to recent guidelines of the German Commission for Refractive Surgery (KRC).

Ciliary Muscle Electrostimulation to Restore Accommodation in Patients With Early Presbyopia: Preliminary Results.

PURPOSE: To report short-term results of pulsed ciliary muscle electrostimulation to improve near vision, likely through restoring accommodation in patients with emmetropic presbyopia. METHODS: In a prospective non-randomized trial, 27 patients from 40 to 51 years old were treated and 13 age- and refraction-matched individuals served as untreated controls. All patients had emmetropia and needed near sphere add between +0.75 and +1.50 diopters. The protocol included four sessions (one every 2 weeks within a 2-month period) of bilateral pulsed (2 sec on; 6 sec off) micro-electrostimulation with 26 mA for 8 minutes, using a commercially available medical device. The uncorrected distance visual acuity (UDVA) (logMAR) for each eye, uncorrected near (40 cm) visual acuity in each eye (UNVA) and with both eyes (UNVA OU) (logMAR), and reading speed (number of words read per minute at 40 cm) were measured preoperatively and 2 weeks after each session. Overall satisfaction (0 to 4 scale) was assessed 2 weeks after the last session. RESULTS: UDVA did not change and no adverse events were noted in either group. Bilateral and monocular UNVA and reading speed were stable in the control group, whereas they continuously improved in the treated group (Friedman, P < .00001). Post-hoc significant differences were found for monocular and binocular UNVA after the second treatment and after the first treatment considering words read per minute (P < .001). One patient (3.7%) was not satisfied and 18 patients (66.7%) were very satisfied (score of 4). Average satisfaction score was 3 (satisfied). CONCLUSIONS: Ciliary muscle contraction to restore accommodation was safe and improved the short-term accommodative ability of patients with early emmetropic presbyopia. [J Refract Surg. 2017;33(9):578-583.].

[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.

[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.

Impact of Spherical Aberration Terms on Multifocal Contact Lens Performance.

PURPOSE: To investigate the impact of the primary (PSA) and secondary (SSA) spherical aberration terms on visual performance (VP) in presbyopes, as measured using multifocal (MFCL) soft contact lenses on eye. METHODS: Seventeen presbyopes (age: 55.1 ± 6.9 years) wore seven commercial lenses (four center-near (MFCL N), one center-distance (MFCL D), one bifocal, and one single vision control). Unaided and with each lens on eye, the PSA and SSA terms were obtained with an aberrometer, the BHVI-EyeMapper (low illumination, natural and 4 mm pupil diameter). High- and low-contrast distance visual acuity, contrast sensitivity, high-contrast visual acuities at near, and range of clear vision were measured. In addition, subjective VP variables included clarity of vision at distance and near, ghosting, and overall vision satisfaction. Pearson's correlation was used to determine the association between the PSA and SSA terms and the VP variables. RESULTS: PSA (natural pupil) was more negative (P < .05) with the MFCL N (mean PSA = -0.053 ± 0.080 µm) and bifocal (PSA = +0.005 ± 0.067 µm) lenses and more positive with the MFCL D lens (PSA = +0.208 ± 0.160 µm) than the control (+0.067 ± 0.072 µm). SSA (natural pupil) was significantly more positive for the MFCL N lenses (mean SSA = +0.025 ± 0.029 µm) compared to the control (SSA = -0.001 ± 0.017 µm). PSA and SSA terms were significantly (P < .05) correlated with 78% and 56% of VP variables, respectively, but the correlation coefficients were weak, ranging between |0.210| and |0.334|. Although distance variables showed improved VP with more positive PSA or negative SSA, most near variables showed improved VP with more negative PSA. Range of clear focus was greater for more negative PSA terms. CONCLUSIONS: The amount and direction of PSA and SSA terms, as measured with different MFCLs on eye, can affect VP at different distances. Results of this study may provide useful information when designing new or optimize existing MFCLs for improved VP at specific distances.

Through-focus performance with a corneal shape-changing inlay: One-year results.

PURPOSE: To evaluate improvement in the through-focus acuity and visual function provided by a corneal inlay designed to modify the surface shape of the central cornea. SETTING: Two clinical practices, United States. DESIGN: Prospective nonrandomized clinical trial. METHODS: Emmetropic patients with presbyopia who required a reading addition (add) from +1.50 to +2.00 diopters (D) had implantation of the Raindrop Near Vision Inlay in the nondominant eye. The inlay was designed to modify the anterior curvature of the central cornea with the intent to improve near and intermediate vision. At the preoperative and 1-year postoperative visits, the following visual functions were recorded: defocus curves in the nondominant eye, required add for best near vision, distance-corrected binocular contrast sensitivity, and uncorrected and corrected visual acuity at 6 m, 80 cm, and 40 cm. RESULTS: The study comprised 30 patients. One year postoperatively, on average, distance-corrected near acuity improved by more than 3 lines, with patients achieving a distance-corrected acuity of 0.3 logMAR (20/40) or better across a 3.50 D range of defocus. Binocular uncorrected visual acuity of 0.2 logMAR (20/32) or better at distance, intermediate, and near distances was obtained in 97% of patients. The mean reduction in the reading add was 1.60 D. There was no significant change in binocular contrast sensitivity. Overall patient satisfaction was high. CONCLUSION: A corneal inlay in the nondominant eye of emmetropic patients provided a significant increase in the range of functional vision at intermediate and near, with no loss in binocular distance acuity. FINANCIAL DISCLOSURE: Drs. Whitman, Hovanesian, Steinert, and Koch received compensation for participating in the study from Revision Optics, Inc. Drs. Steinert and Koch are medical monitors for Revision Optics, Inc. None of the other authors has a financial or proprietary interest in any material or method mentioned.

[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.

Comparison of conventional versus crossed monovision in pseudophakia.

AIMS: To compare the visual performances and patient satisfactions of conventional monovision, which corrects the dominant eye for distance vision, and crossed monovision, which corrects the non-dominant eye for distance vision in patients with pseudophakia. METHODS: This prospective randomised study was conducted in 59 patients who underwent implantation of different targets of monofocal intraocular lens for each eye at Konkuk University Medical Center between November 2009 and August 2012. The following were examined before bilateral cataract surgery and 2 months after the surgery: refractive error, binocular uncorrected distance visual acuity (UCDVA), uncorrected near visual acuity (UCNVA), best corrected visual acuity (BCVA) and stereopsis. Questionnaires to evaluate postoperative spectacle dependence and patient satisfaction were completed by all patients. RESULTS: The conventional monovision group and the crossed monovision group were composed of 28 and 31 patients, respectively. There were no significant differences in postoperative UCDVA, UCNVA, BCVA and stereopsis between the two groups. In addition, patient satisfaction with near and distant vision and spectacle dependence were not significantly different in the two groups. CONCLUSIONS: The clinical results of the crossed monovision were not significantly different from the results of conventional monovision. Therefore, crossed monovision can also be a valuable option for correcting postoperative presbyopia in patients considering bilateral cataract surgery. TRIAL REGISTRATION NUMBER: KCT0001065.

A prospective randomized clinical evaluation of 3 presbyopia-correcting intraocular lenses after cataract extraction.

PURPOSE: To compare contrast sensitivity, visual acuity (VA), and halos in subjects bilaterally implanted with 1 of 3 FDA-approved presbyopia-correcting intraocular lenses. DESIGN: Prospective, randomized, partially masked, multicenter clinical trial. METHODS: Seventy-eight subjects were randomized sequentially for bilateral implantation with the Crystalens AO (Bausch & Lomb Surgical), AcrySof IQ ReSTOR +3.0 (Alcon Laboratories), or Tecnis Multifocal (Abbott Medical Optics) lenses. Subjects were evaluated through visit 4 (4 to 6 months after surgery) with the following monocular and binocular assessments: high- and low-contrast VA, contrast sensitivity without glare, halos or starbursts, defocus curves, optical scatter, retinal point spread function, and safety. RESULTS: The Crystalens AO and ReSTOR +3.0 demonstrated better monocular and binocular contrast sensitivity without glare at low to mid spatial frequencies compared with the Tecnis Multifocal lens. Binocular uncorrected distance VA was not significantly different between the 3 lenses. The Crystalens AO had significantly better binocular low-contrast distance-corrected VA than the ReSTOR +3.0 and better mean monocular low-contrast DCVA than the Tecnis Multifocal lens. The Crystalens AO demonstrated significantly better monocular and binocular uncorrected and distance-corrected intermediate VA than the ReSTOR +3.0 or Tecnis Multifocal lenses. The ReSTOR+3.0 lens had significantly better monocular and binocular uncorrected and distance-corrected near VA tested at 40 cm compared with the Crystalens AO and Tecnis Multifocal lens. The Crystalens AO elicited significantly less halos than the Tecnis Multifocal lens and less optical scatter than the ReSTOR +3.0 or Tecnis Multifocal lens. CONCLUSIONS: The Crystalens AO had statistically better uncorrected intermediate VA and distance-corrected intermediate VA than the ReSTOR +3.0 or Tecnis Multifocal lenses and fewer photic phenomenon than the Tecnis Multifocal lens. Both multifocals had better distance-corrected near VA and uncorrected near VA than the Crystalens AO. These findings may guide intraocular lens selection for individual patients seeking to optimize vision at specific vergences or lighting conditions.