Modulation transfer function of implantable phakic intraocular contact lens (IPCL) for myopia and presbyopia.

PURPOSE: This study aimed to assess the optical quality of myopic and presbyopic IPCLs with different additional powers, and to investigate the effects of pupil size on the optical quality of these IPCLs using an in-vitro modulation transfer function (MTF) measurement system. METHODS: Linear scatter functions (LSFs) were recorded using the OPAL Vector system and an eye phantom consisting of wet cells filled with a balanced salt solution. A myopic IPCL or a presbyopic IPCL was placed in the posterior chamber of this model. The MTF was calculated from the LSF using the fast Fourier transform techniques. The effective apertures were set at 2.0 to 5.0 mm in 1.0 mm steps. RESULTS: The in-focus MTF values of the myopic IPCL and presbyopic IPCL with additional powers of + 2.0 and + 4.0 diopters at 100 cycles/mm for an effective aperture of 3.0 mm were 43%, 27%, and 24%, respectively. The in-focus MTF value of both myopic and presbyopic IPCLs was the highest when the effective aperture was set at 3.0 mm, and it gradually worsened when the effective aperture became larger than 3.0 mm at 20, 60, and 100 cycles/mm. CONCLUSIONS: Both myopic and presbyopic IPCLs provided excellent MTF values, but the additional power profile can deteriorate optical performance in presbyopic IPCL-implanted eyes, even with a low additional power. Pupil size can influence visual quality in IPCL-implanted eyes for both myopia and presbyopia.

Accuracy of intraocular lens power formulas in eyes with keratoconus: Multi-center study in Japan.

PURPOSE: To assess the accuracy of intraocular lens (IOL) power formulas, namely, SRK/T, Haigis, Barrett Universal II, Barrett True-K for keratoconus, Kane formula, and Kane formula for keratoconus, for cataract with keratoconus in Japanese eyes. SETTING: Five surgical sites in Japan. DESIGN: A retrospective case series. METHODS: Eyes with keratoconus undergoing cataract surgery were included. Postoperative refraction was compared with the prediction by the formulas. Visual acuity, manifest spherical equivalent, prediction error (PE), and mean absolute errors (MAEs) were determined 1 month postoperatively. The PE within 0.50 diopter (D), 1.00 D, and 2.00 D were compared between IOL formulas. Subgroup analysis based on the steepest keratometry (stage 1, ≤ 48 D; stage 2, > 48 D and ≤ 53 D; and stage 3, > 53 D) was performed. The relationship between PE and preoperative biometric data were assessed. RESULTS: Fifty eyes were included. The MAE of the Barrett True-K for keratoconus, Kane keratoconus, and Kane formulas were significantly lower than that of Haigis. A statistically significant difference in the prediction accuracy within ± 0.50 D was found between Kane keratoconus and Haigis. The prediction accuracy of the Barrett True-K for keratoconus, SRK/T, and Kane within ± 1.00 D was statistically significant compared with that of Haigis. In stage 3, the Barrett True-K for keratoconus had a significantly lower MAE than SRK/T and Haigis. CONCLUSION: Keratoconus-specific formulas were more accurate than existing formulas in Japanese eyes. The Barrett True-K formula for keratoconus had higher prediction accuracy in severe keratoconus.

Effect of corneal cross-linking on endothelial cell density and morphology in the peripheral cornea.

BACKGROUND: To compare the endothelial cell density and morphology in the peripheral cornea before and after corneal cross-linking (CXL). METHODS: This study evaluated thirty-one eyes of 31 patients who were treated with standard CXL for progressive keratoconus. Preoperatively and 6 months postoperatively, we compared the corneal endothelial cell density (ECD), the coefficient of variation in cell size (CV), and the percentage of hexagonal cells (HEX), in the peripheral regions of the cornea, using a non-contact specular microscope (EM-3000, Tomey). RESULTS: All keratoconic eyes in this series were measurable in the peripheral regions. No significant differences were found in the peripheral ECD preoperatively and 6 months postoperatively at each point (Wilcoxon signed-rank test, superior, p = 0.16, nasal superior, p = 0.12, temporal superior, p = 0.17, inferior, p = 0.37, nasal inferior, p = 0.28, temporal inferior, p = 0.17). The mean percentage of the ECD loss was 1.3, 1.3, 1.0, 1.4, 0.7, and 1.4%, respectively. No significant differences in the peripheral CV or HEX were found preoperatively and 6 months postoperatively at each point. CONCLUSIONS: Standard CXL does not cause significant changes in endothelial cell density, polymegethism, or polymorphism, in the peripheral regions of the cornea. It is suggested that CXL is a minimally invasive surgical approach for progressive keratoconus, even in terms of peripheral endothelial cells. TRIAL REGISTRATION: University Hospital Medical Information Network Clinical Trial Registry (000031162).

Regional comparison of preoperative biometry for cataract surgery between two domestic institutions.

PURPOSE: Regional variations of the preoperative biometry can affect the refractive accuracy of cataract surgery. We aimed to compare the preoperative biometric data for cataract surgery between two domestic institutions. METHODS: We retrospectively reviewed the preoperative biometric data of 673 consecutive eyes undergoing standard cataract surgery at Miyata Eye Hospital (Miyazaki; M group) and Kitasato University Hospital (Kanagawa; K group), and compared these data between the two groups. RESULTS: We found significant differences in the mean keratometric readings (44.39 ± 1.56 D vs. 44.09 ± 1.74 D) (unpaired t test, p = 0.034), the anterior chamber depth (3.14 ± 0.43 mm vs. 3.46 ± 0.62 mm) (p < 0.001), the axial length (23.98 ± 1.62 mm vs. 24.59 ± 1.82 mm) (p < 0.001), and the lens thickness (4.64 ± 0.48 mm vs. 4.37 ± 0.62 mm) (p < 0.001), in the M and K groups, respectively. Otherwise, we found no significant differences in corneal astigmatism (p = 0.104), or central corneal thickness (p = 0.480) between the two groups. For subgroup analysis, the prediction error (0.06 ± 0.47 D) in the M group was significantly more hyperopic than that (- 0.09 ± 0.54 D) in the K group (p = 0.006). CONCLUSIONS: There were significant differences in the mean keratometric readings, the anterior chamber depth, the axial length, and the lens thickness, by approximately 0.3 D, 0.3 mm, 0.6 mm, and 0.3 mm, respectively. Regional variations of the preoperative biometry did exist to some extent, and were not clinically negligible, in consideration of the precise IOL power calculation and the subsequent refractive accuracy of cataract surgery. TRIAL REGISTRATION: University Hospital Medical Information Network Clinical Trial Registry (000037994).

Factors Influencing Visual Acuity in Fuchs' Endothelial Corneal Dystrophy.

SIGNIFICANCE: In eyes with mild Fuchs' endothelial corneal dystrophy without significant corneal edema, objective scattering index has the strongest influence on distance visual acuity, followed by the anterior corneal densitometry. Our findings suggest that distance visual acuity deteriorates in eyes with higher forward light scatter. PURPOSE: To evaluate the factors affecting distance visual acuity in patients with Fuchs' endothelial corneal dystrophy. METHODS: This retrospective study comprised 31 eyes of 31 patients with mild Fuchs' dystrophy without corneal edema and 25 eyes of 25 age-matched healthy subjects. Stepwise multiple regression analysis was used to assess the relationship between distance acuity with age, sex, forward light scatter, corneal backward scatter, anterior and posterior corneal higher-order aberrations, endothelial cell density, central corneal thickness, and corneal astigmatism. RESULTS: The forward light scatter, corneal backward scatter, and corneal higher-order aberrations were significantly larger in the Fuchs' dystrophy group than those in the control group (P ≤ .004). In a univariate analysis, with higher forward light scatter, anterior corneal backward scatter, corneal higher-order aberrations, and age, the distance acuity significantly deteriorated in eyes with Fuchs' dystrophy. In a multiple linear regression analysis, explanatory variables relevant to the distance acuity were the forward light scatter (P < .001, partial regression coefficient B = 0.035) and anterior corneal backward scatter (P = 0.2, B = 0.008) (adjusted R = 0.694). CONCLUSIONS: Eyes with higher light scatter, especially forward light scattering, showed deteriorated visual acuity. Results suggest that forward light scatter and corneal backward scatter play a more important role in visual performance than corneal higher-order aberrations in Fuchs' endothelial corneal dystrophy.

Etiology and outcomes of secondary surgical intervention for dissatisfied patients after pseudophakic monovision.

PURPOSE: To evaluate the etiology and the clinical outcomes of secondary surgical interventions for dissatisfied patients after pseudophakic monovision. SETTING: Department of Ophthalmology, Kitasato University Hospital, Kanagawa, Japan. DESIGN: Retrospective case series. METHODS: This study comprised 12 eyes in 12 patients (age 66.2 ± 5.6 years) who underwent photorefractive keratectomy (PRK) enhancement to improve their dissatisfaction after pseudophakic monovision. We quantitatively assessed the visual and refractive outcomes and the subjective satisfaction measured using a visual analog scale, that ranged from 0 (very dissatisfied) to 10 (very satisfied), before and 3 months after PRK enhancement. RESULTS: Six (50%) of the 12 patients were dissatisfied with their various distance visions because of a large amount of anisometropia (≥2.50 D). Two (16.7%) were dissatisfied with their distance vision after conventional monovision because of residual cylindrical errors (≥0.75 D) in the dominant eye. Three (25%) was an unknown origin. The remaining one of the 12 patients was dissatisfied due to the unadaptability to crossed monovision. Eleven (91.7%) eyes were within ±0.5 D of the targeted correction after PRK enhancement. The overall satisfaction score was significantly improved, from 3.7 ± 2.4 (range 0-7) preoperatively to 6.0 ± 2.4 (range 2-9) postoperatively (p = 0.02). No vision-threatening complications were seen throughout the observation period. CONCLUSIONS: PRK enhancement was effective with predictable refractive results and thus improved patient satisfaction for dissatisfied patients after pseudophakic monovision. These findings also suggest that the accurate correction of refractive errors plays a key role in successful pseudophakic monovision.

Effect of Scattering and Aberrations on Visual Acuity for Band Keratopathy.

SIGNIFICANCE: The progressive accumulation of the calcification may deteriorate corneal transparency, especially in the interpalpebral area, and subsequent visual performance for patients with band keratopathy. However, the detailed quantitative analysis of light scattering or higher-order aberrations on visual performance for these patients so far has not been elucidated. PURPOSE: The aim of this study was to assess the relationship of intraocular forward scattering, corneal backward scattering, and corneal higher-order aberrations with visual acuity in eyes with band keratopathy. METHODS: This prospective study comprised 27 eyes of 27 consecutive patients who were diagnosed as having band keratopathy and age-matched 27 eyes of 27 healthy subjects. We quantitatively assessed objective scattering index using the double-pass instrument (Optical Quality Analysis System II; Visiometrics, Terrassa, Spain), corneal densitometry using the Scheimpflug rotating camera (Pentacam HR; Oculus, Wetzlar, Germany), and corneal higher-order aberrations using the Hartmann-Shack aberrometry (KR-9000; Topcon, Tokyo, Japan). RESULTS: The mean objective scattering index, corneal densitometry, corneal higher-order aberrations, and logarithm of the minimal angle of resolution (logMAR) visual acuity in eyes with band keratopathy were 5.14 ± 3.11, 36.42 ± 10.55 gray-scale units, 0.33 ± 0.10 µm, and 0.03 ± 0.11 logMAR, respectively. These parameters were significantly larger in the band keratopathy group than in those in the control group (Mann-Whitney U test, P < .001). We found significant correlations of visual acuity with the objective scattering index (Spearman correlation coefficient, r = 0.465, P = .015), but no significant association with the corneal densitometry (r = 0.082, P = .683) or with corneal higher-order aberrations (r = -0.073, P = .718), in eyes having band keratopathy. CONCLUSIONS: Intraocular forward scattering, corneal backward scattering, and corneal higher-order aberrations in eyes with band keratopathy were significantly higher than those in normal eyes. Visual acuity was significantly correlated with intraocular forward scattering, but not with corneal backward scattering or corneal aberrations in the band keratopathy group, suggesting that intraocular forward scattering plays a vital role in visual performance in eyes with band keratopathy.

Two Cases of Severe Infectious Keratitis Treated with Corneal Collagen Crosslinking.

Purpose: Corneal collagen crosslinking (CXL) is effective not only in halting the progression of keratoconus but also in management of infectious keratitis. However, as far as we can ascertain, there are no reports of CXL for the treatment of severe infectious keratitis in Japan. Thus, we report 2 cases in which CXL was effective for infectious corneal ulcer. Cases: A 82-year old man and 76-year-old woman. Both of which were treated with local antibiotic therapy; however, the therapy was not empirically effective. Thus, we performed CXL following the standard Dresden protocol after obtaining informed consent from each case. Two weeks after CXL, slit-lamp examinations revealed improvements of corneal transparency and keratitis in each case. No serious complications such as corneal perforations and infectious recurrences occurred after the treatments. Conclusion: Two cases of infectious keratitis improved in corneal opacity and had showed inhibitory effect on infected cornea. CXL seems to be an effective therapeutic alternative in resistant cases of infectious keratitis, although the exact etiology of this effective treatment remains unclear.

Influence of femtosecond lenticule extraction and small incision lenticule extraction on corneal nerve density and ocular surface: a 1-year prospective, confocal, microscopic study.

PURPOSE: To compare the influence of femtosecond lenticule extraction (FLEx) and small incision lenticule extraction (SMILE) on corneal nerve density and the ocular surface for equivalent degrees of correction of myopia. METHODS: Sixty eyes of 30 patients (8 males and 22 females, mean age: 31.0 ± 6.0 years) were included in the study. The patients underwent FLEx in 1 eye and SMILE in the other eye by random assignment. Subbasal nerve density was measured using confocal microscopy preoperatively and at 1 week, 1 and 3 months, and 1 year postoperatively. Ocular surface parameters such as Schirmer's test results, tear film break-up time, and corneal sensation were performed preoperatively and at 1 and 3 months postoperatively. RESULTS: In the FLEx group, subbasal nerve density was 18,390 ± 6,090 µm/mm(2) preoperatively and 5,770 ± 3,490 µm/mm(2) at 1 year postoperatively (P < .001, Dunnett's test). In the SMILE group, subbasal nerve density was 16,810 ± 6,220 µm/mm(2) preoperatively and 11,870 ± 8,200 µm/mm(2) at 1 year postoperatively (P = .21). The decrease in corneal nerve density was significantly less after SMILE than after FLEx at all postoperative visits (Mann-Whitney U test, P < .05). FLEx resulted in a significant decrease in Schirmer's test results, tear film break-up time, and corneal sensation at all postoperative visits, whereas SMILE induced no significant changes in these parameters (P > .05). CONCLUSIONS: There was less damage to the sub-basal nerve plexus of the cornea and less effect on the ocular surface parameters after SMILE than after FLEx.

Intraocular Scattering after Instillation of Diquafosol Ophthalmic Solution.

PURPOSE: To assess the changes in intraocular scattering before and after instillation of diquafosol ophthalmic solution in patients with short tear breakup time (TBUT) dry eye. METHODS: We prospectively examined 20 eyes of 20 short TBUT dry eye patients (study group) and age-matched 20 eyes of 20 healthy subjects (control group). Intraocular scattering was measured as the objective scattering index (OSI) at 0.5-second intervals over 10 seconds without blinking. Patients were instructed to start topical administration of 3% diquafosol ophthalmic solution six times daily for 4 weeks. RESULTS: The OSI significantly deteriorated after 7.0 seconds compared with the initial value of OSI after the blinking in the study group. The OSI was also significantly higher in the study group than in the control group at 4.5 to 10.0 seconds after the blinking (p < 0.05). We found significant improvements 2 weeks after treatment not only in TBUT (p < 0.001) but also in the mean OSI, the OSI change rate, and the slope of the linear regression line of the OSI within 10 seconds (p < 0.001, p = 0.003, and p = 0.002, respectively). We also found significant improvements 4 weeks after treatment in these variables. CONCLUSIONS: Intraocular scattering deteriorates significantly with time in patients with short TBUT dry eye. Diquafosol ophthalmic solution exhibits an improvement not only in TBUT but also in intraocular scattering, indicating that diquafosol is also effective for improving the optical quality of the eye.

Comparison of astigmatic correction after femtosecond lenticule extraction and wavefront-guided LASIK for myopic astigmatism.

PURPOSE: To compare postoperative astigmatic correction between femtosecond lenticule extraction (FLEx) and wavefront-guided LASIK in eyes with myopic astigmatism. METHODS: Fifty-eight eyes of 41 patients undergoing FLEx and 49 eyes of 29 patients undergoing wavefront-guided LASIK to correct myopic astigmatism were examined. Visual acuity, cylindrical refraction, predictability of the astigmatic correction, and astigmatic vector components were compared between groups 6 months after surgery. RESULTS: There was no statistically significant difference in manifest cylindrical refraction (P = .08) or percentage of eyes within ± 0.50 diopter (D) of its refraction (P = .11) between the surgical procedures. The index of success in FLEx was statistically significantly better than that of wavefront-guided LASIK (P = .02), although there was no significant difference between the groups in other indices (eg, surgically induced astigmatism, target-induced astigmatism, astigmatic correction index, angle of error, difference vector, and flattening index). Subgroup analysis showed that FLEx had a better index of success (P = .02) and difference vector (P = .04) than wavefront-guided LASIK in the low cylinder subgroup; the angle of error in FLEx was significantly smaller than that of wavefront-guided LASIK in the moderate cylinder subgroup (P = .03). CONCLUSIONS: Both FLEx and wavefront-guided LASIK worked well for the correction of myopic astigmatism by the 6-month follow-up visit. Although FLEx had a better index of success than wavefront-guided LASIK when using vector analysis, it appears equivalent to wavefront-guided LASIK in terms of visual acuity and the correction of astigmatism.

Evaluation of the Accuracy of Intraocular Lens Power Calculation Formulas in Phacovitrectomy.

INTRODUCTION: The aim of this study was to evaluate the refractive error in patients undergoing combined phacovitrectomy with and without gas tamponade. METHODS: This was a retrospective chart review including patients undergoing phacoemulsification alone (Group 1), combined phacovitrectomy for epiretinal membrane (Group 2), and combined phacovitrectomy with gas tamponade for rhegmatogenous retinal detachment (RRD) (Group 3). Axial length and keratometry were measured using an optical biometric system (Argos, Alcon Laboratories. Inc.), and a three-piece intraocular lens (IOL; NX-70S) was implanted in all groups. In each group, the prediction error at 3 months was calculated using IOL power calculation formulas (SRK/T, Hill-RBF, Kane, and Barrett Universal II) for each eye. Outcome measures included the mean prediction error (MPE), its standard deviation (SD), and the mean absolute error (MAE). The change in IOL position at 3 months was also assessed using anterior segment optical coherence tomography. RESULTS: A total of 104 eyes were included (Group 1: 30; Group 2: 34; Group 3: 40 eyes). The MPE was -0.08 ± 0.37 diopters (D), -0.26 ± 0.32 D, and -0.59 ± 0.34 D in Group 1, Group 2, and Group 3, respectively, using the Barrett Universal II formula (P < 0.01, ANOVA). The movement forward in the IOL position was 0.95 ± 0.16 mm, 0.94 ± 0.12 mm, and 1.07 ± 0.20 mm in Group 1, Group 2, and Group 3, respectively (P < 0.01). No significant difference was shown in MPE among the four formulas after combined phacovitrectomy with gas (P = 0.531). CONCLUSIONS: Phacovitrectomy in RRD induced a significant myopic shift using any of the clinically available formulas. This suggests that myopic shift should be taken into consideration for better refractive outcomes in phacovitrectomy with gas tamponade in RRD.

Changes in cataract and refractive surgery practice patterns among JSCRS members over the past 20 years.

PURPOSE: To evaluate changes in cataract and refractive surgery practice patterns among members of the Japanese Society of Cataract and Refractive Surgery (JSCRS) over the past 20 years. STUDY DESIGN: Questionnaire survey study. SUBJECTS AND METHODS: Clinical surveys were conducted annually between February and April from 2004 to 2023. Survey questions covered various areas, including cataract surgical techniques, anesthesia, endophthalmitis prophylaxis, toric and presbyopia-correcting intraocular lenses (IOLs), complications, and refractive surgery. RESULTS: The highest (n=554 [36.8%]) and lowest (n=316 [19.1%]) numbers of responses were collected in 2012 and 2016, respectively. In perioperative management, the intraoperative use of polyvinyl alcohol-iodine solution and topical antibiotic prescription 3 days before surgery has increased. The use of intracameral injection at the end of surgery has also significantly increased, although it has not been established as common practice. In anesthesia, there is a clear polarization between the use of topical drops and tenon injection. The use of toric IOLs and presbyopia-correcting IOLs has significantly increased from 2010 to 2023. In the latter, the use of trifocal IOLs has particularly increased. Regarding IOL power calculations, the Barrett True K and the Barrett Universal II formulas are rapidly gaining popularity for application with and without post-laser vision correction, respectively. In refractive surgery, phakic IOLs and corneal refractive therapy have attracted considerable interest, followed by laser in situ keratomileusis. CONCLUSIONS: Evaluation of annual clinical survey data over the past two decades provided valuable insights into the shifting practice patterns and clinical opinions among JSCRS members.

Clinical evaluation of accuracy of horizontal meridian limbal marking.

PURPOSE: To assess the horizontal meridian misalignment of limbal marking under a slit lamp microscope by means of anterior segmental image assessment. METHODS: A consecutive series of the 32 eyes of 16 subjects (7 males and 9 females) aged 29 ± 6 years (range, 23-44 years), who had refractive errors but were otherwise healthy, were used in this study. With each subject seated at the slit lamp and a coaxial slit turned to the horizontal meridian, we aligned the subject's head vertically and placed two reference marks aligned with the 3- and 9-o'clock positions on the limbal conjunctiva, using a marker pen or a toric marker. We quantitatively evaluated the accuracy of axis aliment by determining deviation from the horizontal reference line using a corneal topographer with an anterior segment image. RESULTS: The amount of the axis misalignment was 3.4° ± 2.2° (range, 0°-8°) when the marker pen was used, and 6.9° ± 5.0° (range, 0-24°) when the toric marker was used. Location identification using the toric marker showed a significantly larger deviation in axis alignment than that using the marker pen (Wilcoxon sign rank test, p < 0.001). CONCLUSIONS: Horizontal limbal marking using a slit lamp microscope showed the axis misalignment by an average of 3.4° to 6.9°. These alignment errors led to a reduction of the effectiveness of astigmatism correction by an average of 10% to 20%, which was not necessarily negligible when we aim to correct astigmatism completely, if possible. For successful astigmatic surgical procedures, increased accuracy of preoperative limbal marking by decreased misalignment of the astigmatism axis is essential.

[Long-term outcomes of Boston keratoprosthesis].

PURPOSE: To evaluate the clinical efficacy and safety of am implanted Boston keratoprosthesis Type I (Boston KPro). METHODS: Six eyes of 6 patients who had experienced repeated graft failure underwent Boston KPro implantation and were followed up for over one year. The mean age of the patients was 62.7 years. There were 3 eyes with glaucoma and 1 eye with fungal keratitis preoperatively. Best-corrected visual acuity (BCVA), complications, and postoperative treatment were evaluated. RESULTS: Mean follow-up duration was 33.9 months. Preoperative BCVA of hand motion to 0.02 improved to counting fingers at 30 cm to 1.0 at 1 month postoperatively. At the last follow-up, it remained stable at counting fingers at 10 cm to 1.2. There were no intraoperative complications. Postoperative complications included 4 eyes with retroprosthetic membrane formation, one eye with elevated intraocular pressure, bacterial conjunctivitis, recurrent fungal keratitis, posterior capsular opacification, cystoids macular edema, vitreous opacity and epiretinal membranes that were all treated. No keratoprosthesis extrusion, donor cornea necrosis or progressive loss of visual field was observed. CONCLUSIONS: With continuous and appropriate postoperative management, use of the Boston KPro can produce long-term positive outcomes.

Wavelength Characteristics and Visual Function of Photochromic Contact Lenses in Indoor and Outdoor Conditions.

PURPOSE: To examine the wavelength characteristics of photochromic contact lenses (CL) and evaluate the impact of tinting on visual function in indoor, outdoor, and glare environments. METHODS: A total of 33 healthy individuals with refractive errors were recruited and fully corrected for refractive errors. Three groups were established, including non-activated photochromic CL, activated photochromic CL, and lenses without photochromic properties, which replicated the dimming characteristics of CL. Visual acuity and contrast sensitivity were measured and compared among the three groups. RESULTS: Statistically significant differences were observed in the spatial frequency (6, 12 cpd) and contrast sensitivity outdoors, with improved values recorded in the activated photochromic-CL group. In subsequent comparisons, the activated-photochromic-CL group demonstrated significantly better contrast-sensitivity values than the non-photochromic-CL group, as well as significant improvement in contrast sensitivity compared to the non-activated-photochromic-CL group. No significant differences were observed in the indoor or outdoor visual acuity. CONCLUSION: Our results suggest that photochromic CL enhances visual function in outdoor environments, while maintaining visual function indoors and under glare, thereby improving the quality of vision (QOV) in severe light conditions where exposure to sunlight and ultraviolet light is anticipated.

Prevalence of Accommodative Microfluctuations in Eyes after Cataract Surgery.

BACKGROUND: We aimed to evaluate the existence of accommodative microfluctuations in eyes after cataract surgery. METHODS: This retrospective observational cohort study included 1160 eyes of 713 patients (mean age: 72.5 ± 8.3 years) who underwent phacoemulsification, intraocular lens insertion, and an evaluation of accommodative microfluctuations with an autorefractometer. Patients with posterior segment disorders resulting in visual acuity impairment and those with unavailable medical information were excluded. High-frequency components (HFCs), between 1.0-2.3 Hz, based on fast Fourier transform analysis of the accommodative microfluctuation data were examined at postoperative 2-3 (2 M) and 6 months (6 M). The relationships between the HFCs and patient age, manifest refraction, and axial length were analyzed. RESULTS: Increased HFC values (>65) were observed at a constant rate after cataract surgery, with prevalence rates of 33.4% at 2 M and 34.7% at 6 M. Postoperatively, at 2 M, increased HFC values were significantly more common for eyes with axial length ≥26 mm than for those with axial length <26 mm (p = 0.0056). However, they were not significantly correlated to age or postoperative manifest refraction. CONCLUSIONS: At 2 M postoperatively, increased HFC values presented more frequently in eyes with a greater axial length; hence, the precise detection and understanding of postoperative accommodative spasms in high myopia patients is important.

Effect of astigmatism on apparent accommodation in pseudophakic eyes.

PURPOSE: To investigate the factors affecting apparent accommodation in pseudophakic eyes from a clinical viewpoint and the effects of corneal and refractive astigmatism on this accommodation from an optical viewpoint. METHODS: We retrospectively examined 62 eyes of 33 patients who had undergone phacoemulsification with monofocal intraocular lens implantation. We quantitatively assessed the amplitude of apparent accommodation using an accommodometer 3 months after surgery. Multiple regression analysis was used to assess the factors affecting apparent accommodation. We also estimated the accommodation in eyes with corneal astigmatism by optical simulation. RESULTS: The mean amplitude of apparent accommodation was 1.58 = 0.65 D. Explanatory variables relevant to this accommodation were in order of influence, pupil diameter (partial regression coefficient B = 0.293, p = 0.008), and corneal multifocality (B = 0.101, p = 0.03). Other explanatory variables such as age, gender, axial length, corneal astigmatism, and refractive astigmatism showed no significant relationship with this accommodation. The estimated apparent accommodations for a 3.0 mm pupil by optical simulation were 1.25, 1.25, 1.25, 0.75, and 0 D, in eyes with corneal astigmatism of 0, 0.5, 1.0, 1.5, and 2.0 D, respectively. Similar results were obtained for a 4.0 mm pupil. CONCLUSIONS: Eyes with smaller pupil diameter and eyes with greater corneal multifocality are more predisposed to have greater apparent accommodation. However, from clinical and optical viewpoints, corneal or refractive astigmatism does not significantly contribute to apparent accommodation after cataract surgery, suggesting that it may be of less significance that the astigmatism is consciously retained in consideration of this accommodation in astigmatic eyes.

Daytime variations in pupil size under photopic conditions.

PURPOSE: To assess the daytime variations in pupil size when far and near targets are viewed under photopic conditions. METHODS: We prospectively examined 20 eyes of 20 healthy subjects [27.3 years ± 4.1 (SD)]. Using an open view-type infrared video pupillometer, pupil sizes were measured in subjects looking at targets 5 m or 1/3 m away under photopic conditions (400 lux). The first measurement was performed at 8.00 h, with following measurements at 3-h intervals until 20.00 h. The average pupil size for 5 s consecutive measurements was used for analysis. RESULTS: The respective pupil sizes during far and near viewing were 3.80 ± 0.72 and 3.15 ± 0.62 (mean ± SD); 3.73 ± 0.78 and 3.08 ± 0.70; 3.74 ± 0.82 and 3.06 ± 0.68; 3.79 ± 0.67 and 3.17 ± 0.71; and 3.91 ± 0.76 and 3.13 ± 0.70 mm, at 8.00, 11.00, 14.00, 17.00, and 20.00 h. The pupil sizes did not differ significantly with time over the course of the day [far (p 0.94) and near (p 0.98) (one-way analysis of variance)]. The daytime variations of pupil size were 0.64 ± 0.33, and 0.41 ± 0.29 mm, respectively. Two eyes (10%) and one eye (5%) showed differences of more than 1.0 mm during daytime hours in pupil sizes while viewing far and near target, respectively. CONCLUSIONS: In this study, young adults show no significant variations in photopic pupil size throughout daytime hours. However, a single pupil size measurement appears to be insufficient for clinical use in some eyes.

Comparison of Laser Iridotomy and Lensectomy Outcomes for Acute Primary Angle Closure.

Purpose: To compare the clinical outcomes of the different treatments for acute primary angle closure (APAC). Methods: We retrospectively reviewed the clinical charts of 87 eyes of 87 patients undergoing treatment for APAC. We investigated the best spectacle-corrected visual acuity (BSCVA), intraocular pressure (IOP), corneal endothelial cell density (ECD), and secondary interventions after each treatment. Results: The pretreated IOP was 56.4 ± 9.0 mmHg. As the first treatment for APAC, all eyes underwent topical 2% pilocarpine and systemic mannitol administration. Subsequent laser iridotomy (LI) and lensectomy were necessary in 29 eyes (33%) and 35 eyes (40%), respectively. Bullous keratopathy developed in 1 eye (1%), and following glaucoma surgery was required in 7 eyes (8%). The BSCVA at the final follow-up was 0.16 ± 0.53 and 0.01 ± 0.20 logMAR (Mann-Whitney U test, p=0.149), the IOP was 12.8 ± 2.6, and 12.6 ± 2.9 mmHg (p=0.860), and the ECD was 2295.9 ± 658.2 and 2244.1 ± 622.0 cells/mm2 (p=0.735) in the LI and lensectomy groups, respectively. Conclusions: Approximately 26% of eyes with APAC were resolved after the initial medical treatment, and subsequent surgical treatments, such as LI and lensectomy, were required in 33% and 40% of eyes, respectively. We found no significant differences in the BSCVA, the IOP, or the ECD among LI and lensectomy treatment groups.