Assessing visual quality with the point spread function using the NIDEK OPD-Scan II.

PURPOSE: To present the use of the point spread function (PSF) metric pre- and postoperatively for the assessment of visual quality in cataract and refractive surgery. METHODS: Case examples of cataract and refractive surgery and the effect of accommodation are presented. All PSF measurements were obtained using the NIDEK OPD-Scan II, and corneal internal and total aberrations were simulated using the NIDEK OPD-Station software. All eyes underwent corneal topography, wavefront aberrometry, autorefraction, keratometry, and pupillometry measurements pre- and postoperatively using the OPD-Scan II. The PSF was used to assess visual quality. RESULTS: Four case examples including refractive surgery, aspheric multifocal intraocular lens (IOL) implantation, toric IOL implantation, and the difference in PSF due to accommodation are presented. CONCLUSIONS: The PSF in refractive and cataract surgery is a clinically valuable metric to evaluate the patient's visual quality pre- and postoperatively. The OPD-Scan II can measure the effect of accommodation and distant fixation providing an assessment of changes in visual quality.

Interpretation of aberrometry measurements in cataract surgery.

PURPOSE: To discuss the use of wavefront measurements generated from the NIDEK OPD-Scan II and OPD-Station for cataract surgery. METHODS: Case examples are presented along with information and relevant clinical data obtained from the OPD-Scan II aberrometer and OPD-Station software. All eyes underwent corneal topography, wavefront aberrometry, autorefraction, keratometry, and pupillometry measurements pre- and postoperatively using the OPD-Scan II. Optical and visual quality simulations, including modulation transfer functions, and visual quality attributable to corneal and internal aberrations, were performed using OPD-Station software. RESULTS: Twelve case examples from cataract surgery, including aspheric intraocular lens (IOL) implantation, diffractive IOLs, and toric IOL implantation, are presented. CONCLUSIONS: The wavefront analysis in cataract surgery was shown to be a fundamental tool in evaluating visual quality after IOL implantation. The OPD-Scan II distinguished between corneal and lenticular aberrations, allowing for evaluation of actual optical and visual performance attributable to the IOL. Our review of case examples also showed that for multifocal IOL implantation, a thorough investigation is necessary to correlate subjective and objective visual quality and for patient selection.

PermaVision intracorneal lens for the correction of hyperopia.

PURPOSE: To evaluate the safety, predictability, and efficacy of sutureless synthetic keratophakia (SSK) with PermaVision intracorneal lens (Anamed) implantation. SETTING: Ophthalmic Hospital, Rome, Italy. METHODS: This retrospective study analyzed the refractive outcomes in 10 eyes of 6 patients who had SSK with PermaVision lens implantation for spherical hyperopia (cylinder less than 1.0 diopter [D]). Preoperatively, the mean spherical equivalent (SE) refraction was +4.33 D +/- 1.52 (SD) (range +3.00 to +6.37 D). All procedures were performed using the Hansatome microkeratome (Bausch & Lomb) with a superior hinge except in 1 eye in which the flap was cut using the Amadeus microkeratome (Allergan) with a nasal hinge. RESULTS: Six months after PermaVision lens insertion, the mean SE refraction was +0.03 +/- 0.36 D (range -0.50 to +0.38 D), the mean uncorrected visual acuity was 0.85 +/- 0.13 (range 0.63 to 1.00), and the mean best corrected visual acuity was 0.99 +/- 0.19 (range 0.63 to 1.25). No eye lost lines of visual acuity. In 1 eye, the lens was acutely decentered and had to be explanted. CONCLUSIONS: Sutureless synthetic keratophakia with the PermaVision intracorneal lens is a new technique for the correction of hyperopia. It is easy to perform as well as reversible, and the learning curve of the experienced laser in situ keratomileusis surgeon is short. The technique was safe and effective for spherical hyperopia, but longer follow-up and additional cases are needed to draw conclusions about the efficacy of the technique.

Safety and effectiveness of a single-piece hydrophobic acrylic intraocular lens (enVista®) - results of a European and Asian-Pacific study.

PURPOSE: To evaluate the safety and effectiveness of a single-piece hydrophobic acrylic intraocular lens (IOL) (enVista® MX60; Bausch and Lomb Incorporated, Rochester, NY, USA) following implantation to correct aphakia subsequent to extracapsular cataract extraction in adults. SUBJECTS AND METHODS: This was an open-label, non-interventional, observational study conducted in 19 university and private-practice settings in Europe and the Asia-Pacific region to investigate clinical outcomes of the MX60 IOL in standard practice. Eligible subjects were at least 18 years of age and had undergone standard phacoemulsification and extracapsular cataract extraction with implantation of the MX60 IOL. The primary safety endpoint was the occurrence of adverse events, and the primary effectiveness endpoints included visual and refractive outcomes and stability, with data collected up to 2 years post-procedure. RESULTS: In this multicenter study, pooled data of 255 eyes were collected and analyzed. Excellent visual and refractive outcomes and stability were demonstrated. At postoperative visit 4 (61-180 days postoperative), 62.2% of subjects achieved a Snellen best-corrected distance visual acuity (CDVA) of 20/20 (decimal 1.00), and 97.8% of subjects achieved a CDVA of 20/40 (decimal 0.50) or better. One eye (1.0%) underwent neodymium:yttrium aluminum garnet capsulotomy at 12 months post-procedure. No glistenings of any grade were reported for any subject at any visit. Adverse events were infrequent and were consistent with incidences generally reported with cataract surgery. CONCLUSION: This study, which enrolled all comers, provided evidence of the excellent safety and effectiveness of the MX60 IOL in standard practice. Favorable clinical outcomes included outstanding visual and refractive outcomes and stability. No glistenings were reported at any postoperative visit.

Clinical properties of a novel, glistening-free, single-piece, hydrophobic acrylic IOL.

A new, single-piece, hydrophobic acrylic lens - the first constructed with a lens optic and haptics comprised of a hydroxyethyl methacrylate-polyethylene glycol phenyl ether acrylate-styrene copolymer, cross-linked with ethylene glycol dimethacrylate, and labeled as "glistening-free" - was recently introduced globally. Glistenings have been a significant source of clinical concern with previous hydrophobic lens designs. This new monofocal lens provides enhanced, clear optics for lens-based surgery. The superior optical clarity of this lens is achieved through the elimination of glistenings, enhanced surface durability, high refractive index, a high Abbe number, and an aspheric design. Additionally, the lens design reduces the risk of developing posterior capsule opacification.