Optical power profiles and aberrations of a non-diffractive wavefront-shaping extended depth of focus intraocular lens.

PURPOSE: This study is to evaluate the optical characteristics of a non-diffractive wavefront-shaping intraocular lens which incorporates surface refractive modifications for shaping the wavefront in order to achieve extended depth of focus (EDoF) and to assess whether the nominal power of this IOL influences the attainable add power. METHODS: A commercially available optical bench NIMO TR1504 device (LAMBDA-X, Nivelles, Belgium) was employed to obtain full optical characterization of three non-diffractive EDoF intraocular lenses with + 10 D, + 20 D, and + 30 D powers. After NIMO measurements, data were computed using a custom-made MATLAB program (Mathworks, Inc., Natick, MA, USA) to evaluate the optical quality functions, such as the point spread function (PSF), wavefront profiles, and modulation transfer function (MTF) for two pupil sizes: 3 mm and 4.0 mm. RESULTS: The non-diffractive EDoF intraocular lens showed a central serrated power profile behavior with additions of + 2.00 to + 2.50 D over the nominal power. Higher order aberrations were found to be driven mainly by the spherical aberration, with almost null comatic influence. Optical quality metrics showed good values, better for a 3 mm pupil compared to a 4.5 mm one, as expected. The three IOL powers tested showed a very similar behavior in terms of power and aberrometric profiles, with minimal to null differences related to the nominal power. CONCLUSION: The non-diffractive wavefront-shaping EDoF intraocular lens achieves a near addition up to + 2.50 D aiming for an extended range of vision, almost independently of the base power.

Visual and refractive outcomes after bilateral implantation of an enhanced monofocal intraocular lens: prospective study.

PURPOSE: To evaluate visual and refractive outcomes, as well as patient satisfaction after bilateral implantation of an enhanced monofocal intraocular lens (IOL) with emmetropia as a target refraction. SETTING: San Carlos Hospital, Madrid, Spain. DESIGN: Prospective, monocentric, noncomparative study. METHODS: Adults 21 years or older suitable for cataract surgery and with corneal astigmatism <1.50 diopters (D) were bilaterally implanted with the RayOne EMV IOL and followed up for 3 months. Outcomes measures included refraction, monocular and binocular uncorrected distance visual acuity, corrected distance visual acuity (CDVA), uncorrected intermediate visual acuity, distance-corrected intermediate visual acuity (DCIVA), and defocus curve, aberrometry, and satisfaction. Visual symptoms were assessed using the CatQuest-9SF questionnaire. RESULTS: 50 eyes of 25 patients were included. At month 3, the mean manifest spherical equivalent was -0.39 ± 0.28 D, with all eyes within 1.00 D. Binocularly, uncorrected, at distance, 68% of patients could read ≤0.0 logMAR and 95% ≤0.2 logMAR; at intermediate 59% of patients could read ≤0.1 and 100% ≤0.2 logMAR. Mean monocular CDVA was -0.03 ± 0.06 logMAR and mean monocular DCIVA was 0.28 ± 0.07 logMAR. Binocular defocus curve demonstrated a visual acuity ≤0.2 logMAR over a 2 D range from +1.00 D to -1.25 D. Satisfaction was good in 96% of patients. CONCLUSIONS: Bilateral implantation of an enhanced monofocal IOL with emmetropia as a target provided excellent binocular CDVA and good DCIVA, with a high level of satisfaction.

Optical and aberrometric evaluation of a new enhanced monofocal intraocular lens with isofocal optic design.

PURPOSE: To evaluate the optical and aberrometric outcomes of an enhanced monofocal intraocular lens (ISOPure) compared with those of a standard monofocal lens (MicroPure) having the same platform and material. METHODS: A prospective, comparative and randomised clinical study. A total of 28 eyes of 28 patients were randomly assigned to either group. Monocular visual acuity (VA) was measured at distance and intermediate under photopic and mesopic conditions. Aberrometry was analysed for 3.0-, 4.0-, 4.5- and 5.0 mm pupils. The contrast sensitivity defocus curve was measured for 3.0- and 4.5-mm pupils, while the modulation transfer function (MTF) and Strehl ratio (SR) were assessed with a double-pass system. All measurements were performed monocularly 3 months after surgery. RESULTS: No significant differences were found for distance VA. Under photopic conditions, intermediate VA was better with the ISOPure lens, while no significant differences were found between the lenses under mesopic conditions. Internal and total aberrations were higher for the ISOPure lens. No significant differences were found for corneal aberrations. Additionally, both the contrast sensitivity defocus curve and optical quality showed similar behaviour for each lens, with the MTF cut-off frequency exceeding 30 c/deg in both cases. CONCLUSION: The isofocal ISOPure lens enhanced intermediate VA without affecting distance VA under photopic conditions. Moreover, there were no significant differences in visual quality between the ISOPure and MicroPure lenses, despite the former exhibiting higher internal and total aberrations than the monofocal model.

Tolerance to residual astigmatism of an isofocal intraocular lens.

PURPOSE: To evaluate the impact of residual astigmatism on the optical and visual performance of an enhanced-monofocal isofocal intraocular lens (EM Isopure, BVI medical, Belgium) compared to a monofocal one (Micropure, BVI medical, Belgium). METHODS: Laboratory investigation and prospective, comparative and randomized clinical study. Optical quality was assessed on an optical bench for 2.0, 3.0, and 4.5 mm pupils. The effect of residual astigmatism was investigated from through-focus images recorded with increasing amounts of regular positive astigmatism induced with a deformable mirror. To evaluate the impact of residual astigmatism, 28 eyes of 28 patients were randomly assigned to either group. Residual astigmatism was induced with positive and negative cylinder lenses at 90 and 180°. Visual acuity (VA) was measured at each step. RESULTS: The optical performance of both IOLs was quite similar for 2.0 and 3.0 mm pupils. For 4.5-mm pupil, the EM Isopure showed a significant reduction of its optical quality in comparison with the monofocal IOL. When visual performance was evaluated, no statistically significant differences were found for any power of induced astigmatism. More differences were found when positive induced astigmatism was compared within each group, and VA was better when the astigmatism was induced at 180° vs. 90°. The greatest differences were found for and induced positive astigmatism of + 1.50D (p = 0.009 for Isopure and p = 0.023 for Micropure). CONCLUSIONS: The tolerance to residual astigmatism of the EM Isopure lens is similar to that of a reference monofocal lens with pupils up to 3.5 mm.

Revisiting Javal's rule: a fresh and improved power vector approach according to age.

PURPOSE: The scientific community has established Javal's rule as a model linking refractive (RA) and keratometric (KA) astigmatism since its appearance more than 100 years ago. The aim was to improve the accuracy of this relationship according to subject's age by applying the power vector analysis. Posterior corneal curvature has also been studied. METHODS: The IOLMaster 700 optical biometer was used to measure the corneal thickness and the radius of curvature of the anterior and posterior corneal surfaces. Refractive error was determined by a non-cycloplegic subjective refraction process with trial lenses. Linear regression analyses were applied using J0 and J45 power vector components. An evaluation was carried out according to the subject's age resulting into eight regression relationships for each astigmatic vector component for each relationship. RESULTS: A total of 2254 right eyes from 2254 healthy subjects were evaluated. A trend towards against-the-rule astigmatism (ATR) was found with aging, both for refractive astigmatism (RA) and keratometric astigmatism (KA), with 95.2% of subjects under 20 years old having with-the-rule (WTR) KA, and only 22.8% above 79 years old. The following regression equations were found between RA and KA: [Formula: see text] = 0.73 × [Formula: see text] - 0.18 (R = 0.78) and [Formula: see text] = 0.70 × [Formula: see text] + 0.04 (R = 0.69) and between RA and total corneal astigmatism (TCA): [Formula: see text] = 0.73 × [Formula: see text] + 0.13 (R=0.78) and [Formula: see text] = 0.70 × [Formula: see text] - 0.06 (R = 0.68) for the whole sample, but with sensible differences among age groups, both in the slope and in the intercept. CONCLUSION: Ignoring the age of the subject when using Javal's rule could lead to an error in the final cylinder calculation that would increase in high astigmatisms. Applying this new power vector approach based on subject's age could improve the accuracy of the astigmatism prediction.

Optical and Clinical Outcomes of an Isofocal Intraocular Lens vs. a Monofocal Standard Lens.

The aim of this study is to evaluate the results obtained on the optical bench and clinically with an isofocal lens (ISOPure, BVI medical, Belgium) to compare them to a standard monofocal one (MicroPure, BVI medical, Belgium). To do so, we have combined laboratory investigation and a prospective, comparative, and randomized clinical study. First, we have measured the wavefront of the two models studied using a NIMO TR1504 (Lambda-X, Belgium) deflectometer for three nominal powers: +10.00, +20.00 and +30.00 D. In the randomized study with 48 patients, half of them implanted with ISOPure and the other with MicroPure, we have measured visual acuities and contrast sensitivity under photopic and mesopic conditions. The optical bench results show that the isofocal lens presented higher power than the monofocal one, at the lens center, due to the spherical aberration (coefficients Z(4,0), Z(6,0) and Z(8,0)) induced by the greater asphericity of its design. The addition obtained depended on the nominal power, from +1.00 to +1.50 D. The results of the clinical study showed that the ISOPure lens presented better visual outcomes, which were statistically significant, at intermediate distance compared to the MicroPure lens (p-values of 0.014 and 0.022 for 80 and 60 cm, respectively) without decreasing the contrast sensitivity. Clinical outcomes were not affected by pupillary size. In conclusion, due to the increase in power at the lens center due to its highly aspherical design, the isofocal lens evaluated showed better intermediate vision than the monofocal one.

Influence of isofocal intraocular lenses on objective refraction based on autorefraction and aberrometry.

PURPOSE: To evaluate and compare the objective refractions obtained by autorefraction and aberrometry under different lighting conditions with an isofocal intraocular lens (Isopure, BVI medical, Liége, Belgium) compared to a monofocal control lens (Micropure, BVI medical, Liége, Belgium) with the same platform and material. METHODS: Prospective, comparative and randomized study on patients undergoing cataract surgery and bilateral isofocal or monofocal IOL implantation. A total of 44 subjects were randomly assigned to either the isofocal group (n = 22) or the Micropure (n = 22). Manifest refraction (MR) was always performed under the same lighting conditions for all the patients. For objective refraction the autorefractor KR8800 and the aberrometer OPD-Scan III (Nidek Inc., Tokyo, Japan.) were used. For each eye included in the study, six result sets were collected: MR, AR (autorefraction measured with the autorefractor), WF-P and WF-M (Zernike-coefficients-based objective refraction, photopic and mesopic pupil size), OPD-C and OPD-M (autorefraction measured with the aberrometer in photopic and mesopic conditions). RESULTS: The mean sphere for MR was 0.03 ± 0.32D for the Isopure group and 0.24 ± 0.22D for the monofocal group (p = 0.013). For the Isopure group, Friedman analysis showed statistically significant differences for sphere measured with WF-P (p = 0.035), WF-M (p = 0.018) and OPD-M (p = 0.000), and SE measured with OPD-M (p = 0.004). In the Micropure lens group, the Friedman analysis showed differences for all values studied (p < 0.05). Correlation coefficients showed that AR is the objective method with the strongest correlation values for all components of refraction for both groups. CONCLUSION: The modification of the surfaces of the isofocal lens does not have a negative impact on the refraction obtained by AR compared to a standard monofocal intraocular lens.

Forward-scattered and backward-scattered light in moderate keratoconus.

INTRODUCTION: To evaluate the backscattered light, objective scatter index (OSI) and retinal straylight in patients with moderate keratoconus and healthy control subjects. METHODS: A prospective observational study was developed with 33 patients in the moderate-keratoconus group (KC) and 34 in the non-keratoconus group (NKC). Corneal densitometry was obtained using Scheimpflug corneal tomography and measurements were expressed in grayscale units (GSU) over four zones within a 12.00 mm diameter around the corneal apex. A straylight meter was used to determine the amount of intraocular straylight under scotopic conditions, and the straylight parameter (LOG(s)) and test duration were recorded. The Optical Quality Analysis System based on the double-pass technique determined the OSI value. RESULTS: Significant differences were observed between the KC and NKC groups for corneal densitometry (except in the 6-10 mm zone), OSI and retinal straylight. A moderate and significant correlation was found between OSI and retinal straylight LOG(s) (r = 0.52, p = 0.002). Weaker and non-significant correlations were found between corneal densitometry and the other parameters analysed (i.e., OSI, retinal straylight LOG(s) and retinal straylight times). CONCLUSIONS: Backscattered light, retinal straylight and the OSI show clear differences between healthy eyes and those with moderate KC. The changes present in the stages of KC evaluated in the current study (stages II and III according to the Amsler-Krumeich classification) might alter the scattering of the light entering the eye.

Comparison of visual performance between two aspheric monofocal intraocular lens models.

CLINICAL RELEVANCE: It is important to distinguish between visual acuity, optical quality and quality of vision when outcomes obtained with intraocular lenses are evaluated. These parameters, that includeobjective and subjective tests, should be assessed to obtain results that are not biased. BACKGROUND: To assess the difference in visual and optical quality between two monofocal intraocular lens models. METHODS: : This was a prospective, parallel and randomised clinical study conducted at Miranza IOA, a private clinic in Madrid, Spain. Sixty patients were implanted bilaterally, 30 per group, with two aspheric IOLs with induced spherical aberration of -0.27 µm for Group A and -0.20 µm for Group B. Visual outcomes obtained at 1 and 3 months after surgery included both uncorrected (UCVA) and corrected monocular distance visual acuity (DCVA), objective scattering index (OSI), modulation transfer function (MTF) cut-off, Strehl Ratio (SR), contrast sensitivity defocus curve (CSDC), intraocular lens spherical aberration (SA), and longitudinal chromatic aberration of the eye. Activity limitations in daily life were assessed using CatQuest-9SF questionnaire. RESULTS: There were statistically significant differences for DCVA (0.04 LogMAR; p = .008) and SR (0.03; p = .003) between groups. Outcomes related to CSDC showed statistically significant differences for vergences between -0.50 D and +1.00 D (3 mm pupil) and for vergences of 0.00 D and +0.50 D (4.5 mm pupil) between groups. Overall, Group A showed better results regarding visual and optical quality, including a lower longitudinal chromatic aberration result in comparison to Group B. Patient satisfaction evaluated with CatQuest-9SF showed that Group A achieved better outcomes, although the differences were statistically significant only for the 'Reading text on television' item (p = 0.027). CONCLUSIONS: Both intraocular lens models showed excellent quantity of vision, optical and visual quality as well as high patient satisfaction. Despite this, the the Group A model provided slightly better outcomes than the Group B model.

Changes in Accommodative and Binocular Function following Phakic Intraocular Lens for High and Low-to-Moderate Myopia.

The aim was to evaluate accommodative and binocular function of phakic intraocular lens implantable collamer lens (ICL) in high and low-to-moderate myopia. Prospective comparative cohort study with 38 myopic patients who underwent ICL implantation were divided into two groups of 19 patients, each one based on the spherical equivalent (SE): high-power (SE ≤ −6 D) and low-to-moderate (SE > −6 D). The push-up amplitude of accommodation (AA), monocular accommodative facility (MAF), distance and near ocular deviation, near convergence amplitude, near point convergence (NPC), stereopsis, and accommodative convergence/accommodation (AC/A) ratio were assessed before surgery and 1 week and 1 month postoperatively. The mean residual refractive error at 1 month after surgery improved in both groups, 0.18 ± 0.34 D and 0.09 ± 0.26 D, respectively (p < 0.001). There was a significant decrease in AA in both groups between preoperatively and at 1-week (p = 0.001; p = 0.008, respectively) and 1-month follow-up (p = 0.001; p = 0.008). For the rest of the binocular measurements, no statistically significant postoperative changes were found in any group. This finding suggests follow-up studies on amplitude of accommodation in phakic intraocular lens ICL implantation.

Visual and optical quality of enhanced intermediate monofocal versus standard monofocal intraocular lens.

PURPOSE: Intraocular lens designs are constantly evolving, trying to obtain more spectacle independence after cataract surgery. This advantage can be linked to some disadvantages, such as optical quality decrease. For that reason, it is important to assess, not only the amount of vision provided but also the quality of vision once they are implanted. The purpose of the present work was to compare the visual performance between two monofocal intraocular models: a standard model and a monofocal with enhanced intermediate vision lens. METHODS: Prospective, randomized, comparative study. Sixty adult subjects scheduled to undergo bilateral cataract surgery and IOL implantation were randomized to receive one of the two IOLs in both eyes at Miranza IOA, Madrid, Spain (group A: monofocal with enhanced intermediate vision lens and group B: standard monofocal lens). Monocular outcomes (right eyes) determined 1 and 3 months postoperatively were photopic corrected distance visual acuity (CDVA), uncorrected distance visual acuity (UDVA), perceived halo, corrected intermediate-distance contrast sensitivity, and higher-order aberrations. The impact of the new IOL in the postoperative management with autorefraction devices was also evaluated. RESULTS: No differences were found in CDVA between the two groups. Significant differences were detected between the two lenses evaluated in both total HOA (p = 0.028) and internal HOA (p = 0.037). Contrast sensitivity and halometry results obtained at 1 month were similar across the two IOL groups. CONCLUSION: In patients undergoing cataract surgery, monofocal with enhanced intermediate vision IOL offered similar distance performance and contrast sensitivity along with perceived HOA and halos compared with the standard monofocal IOLs tested.

Agreement between the biometric measurements used to calculate the size of the implantable collamer lenses measured with four different technologies.

Purpose: To evaluate the agreement between the biometric measurements used to calculate the size of the implantable collamer lenses (ICL) with different technologies: swept-source optical coherence tomography, spectral domain optical coherence tomography, and Scheimpflug tomography. Methods: This retrospective observational study included subjects undergoing refractive surgery with posterior chamber phakic IOL implantation to correct their myopia. The anterior chamber depth (ACD) and the horizontal white to white (WTW) or the angle to angle (ATA) distance were measured with the following four devices: the IOLMaster 700 biometer (Carl Zeiss Meditec, Jena, Germany), based on swept-source optical coherence tomography; the Cirrus and Visante optical coherence tomographs (Carl Zeiss Meditec) based on low-coherence interferometry; and the Pentacam rotating Scheimpflug camera (Oculus, Wetzlar, Germany). Results: In the horizontal corneal diameter measurements, there were statistically significant differences between Pentacam-IOLMaster 700 pair (P < 0.001) and Pentacam-Visante pair (P < 0.001). WTW from CIRRUS showed the lowest correlation when paired with Pentacam and IOLMaster 700 (R2 = 0.452 and 0.385 for Visante and R2 = 0.494 and 0.426 for Cirrus). Regarding the linear correlation of the ACD measurements, all pairs of devices were statistically significant and all of them showed a very good correlation index. Conclusion: There is a good agreement between the different devices under evaluation for ACD measurements. As for WTW, the values measured with the different devices showed large discrepancies with low correlation levels, especially when comparing the tomographs with the other devices under evaluation.

Pseudomyopia: A Review.

This review has identified evidence about pseudomyopia as the result of an increase in ocular refractive power due to an overstimulation of the eye's accommodative mechanism. It cannot be confused with the term "secondary myopia", which includes transient myopic shifts caused by lenticular refractive index changes and myopia associated with systemic syndromes. The aim was to synthesize the literature on qualitative evidence about pseudomyopia in terms that clarify its pathophysiology, clinical presentation, assessment and diagnosis and treatment. A comprehensive literature search of PubMed and the Scopus database was carried out for articles published up to November 2021, without a data limit. This review was reported following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Following inclusion and exclusion criteria, a total of 54 studies were included in the qualitative synthesis. The terms pseudomyopia and accommodation spasm have been found in most of the studies reviewed. The review has warned that although there is agreement on the assessment and diagnosis of the condition, there is no consensus on its management, and the literature describes a range of treatment.

Interocular biometric parameters comparison measured with swept-source technology.

PURPOSE: In the event that any ocular parameter involved in the calculation of intraocular lens power could not be properly measured in one eye, it is important to know whether clinically relevant differences between both eyes can be expected. The aim of this work is to evaluate the symmetry of interocular biometric parameters. METHODS: This was a prospective, cross-sectional study involving 4090 subjects. Patients underwent consecutive swept-source optical biometry performed with an IOLMaster 700 (Carl Zeiss Meditec AG, Jena, Germany). The biometric parameters that were evaluated were: axial length (AL), mean anterior curvature (Rm), anterior chamber depth (ACD), crystalline lens thickness (LT), central corneal thickness (CCT) and white-to-white (WTW). The Chang-Waring chord distance (CWC-D) and the Chang-Waring chord angle (CWC-A) were also evaluated. RESULTS: There is an excellent correlation between both eyes for almost all the biometric parameters under study, with the exception of the CWC. Agreement for AL was better for eyes shorter than 24 mm. The linearity of the OD-vs-OS relationship can be correctly assumed for all parameters (Cusum test: p > 0.05 in all cases). CONCLUSION: There are no clinically significant interocular differences for the biometric parameters under study, although for all of them, except the LT, statistically significant differences did arise. In the case of AL, moderate differences can be expected in eyes larger than 24 mm.

Impact of Lens Material on Objective Refraction in Eyes with Trifocal Diffractive Intraocular Lenses.

PURPOSE: Compare subjective (Rx) and objective (ObjRx) refractions outcomes with two autorefractors models and an aberrometer in eyes implanted with a hydrophobic trifocal IOL (FineVision POD F GF, Physiol, Liége, Belgium) and a hydrophilic one (FineVision POD F, Physiol, Liége, Belgium). METHODS: Prospective comparative cohort study, with 100 subjects randomly assigned to either the POD F group (n = 50) or the POD F-GF group (n = 50). Postoperative eye examinations at 1-month visit included seven result sets, one for each assessment method: Rx, AR (automated refraction measured with the autorefractor KR8800), WF-P (Zernike-coefficients-based objective refraction, photopic pupil size), WF-M (Zernike-coefficients-based objective refraction, mesopic pupil size), WF-4 (Zernike-coefficients-based objective refraction, 4 mm pupil), OPD-C (automated refraction measured with the aberrometer OPD in the central pupil/photopic conditions), and OPD-M (automated refraction measured with the aberrometer OPD under mesopic conditions). RESULTS: Mean differences between ObjRx and Rx reached statistical significance for sphere and spherical equivalent (M) only with OPD-C in the POD F-GF group. All ObjRx methods showed significant differences with Rx in the POD F group, with some values differing by more than 0.50 D (-0.58 D in M for the WF-P). Bland Altman plots showed better agreement for the astigmatic components, and for sphere and spherical equivalents in both IOL groups measured with AR and OPD-M. CONCLUSIONS: None of the objective methods of refraction evaluated in this study were as reliable as the subjective refraction, irrespective of the lens material, but POD F-GF ObjRx seems to differ less with Rx than POD F ObjRx values.

First Results after Implantation of Hydrophilic and Hydrophobic Trifocal Intraocular Lenses: Visual and Optical Performance.

PURPOSE: To compare postcataract surgery visual and optical performance between two trifocal intraocular lenses (IOLs) with the same optical design: a hydrophobic acrylic glistening-free IOL and a hydrophilic acrylic IOL. METHODS: Patients were bilaterally implanted with either the hydrophobic or the hydrophilic IOL. The data of the patients' right eyes were evaluated. Visual quality assessments included refractive outcomes, monocular visual acuity (VA) at far, intermediate, and near distances, defocus curve, aberrations (spherical aberration (SA)), root mean square (RMS) of corneal, internal, and total higher-order aberrations (HOAs)), and tilt of IOL. RESULTS: Fifty-one patients were included in the analysis: 26 patients implanted with the hydrophobic IOL and 25 patients implanted with the hydrophilic IOL. At 1 month, no statistically significant differences were found for monocular uncorrected and corrected VA at distance, distance-corrected VA at intermediate and near, defocus curve, manifest spherical equivalent, total SA, and RMS of the total, internal, and corneal HOA. The defocus curve of both groups showed a visual acuity of 0.3 logMAR or better in the intermediate range from 0.5 to -2.5 D of vergence level with no significant differences between the groups. Compared to the hydrophilic group, y-direction tilt was significantly higher in the hydrophobic group (p=0.027). The total tilt and x-axis tilt did not differ between the groups. CONCLUSION: Both IOLs demonstrated an excellent quality of vision and provided the patient with a wide range of vision.

Feasibility of optical quality analysis system for the objective assessment of accommodation insufficiency: a phase 1 study

Purpose: To assess differences in a new objective metric obtained with a double-pass technique between a group with accommodation insufficiency (AI) and a control group and to explore the diagnostic capabilities of this new tool in comparison to conventional procedures. Methods: Retrospective cross-sectional case-control phase 1 study. Two groups with ages ranging from 8 to 18 years were recruited: AI and control group. The diagnostic criterion of AI was based on monocular accommodative amplitude (AA), 2 D below Hofstetter’s calculation for minimum AA, and monocular accommodative facility (MAF), failing with minus lens and cut-off at ≤ 6 cycles per minute. Accommodative response with a double pass device (HD Analyzer, Visiometrics) was measured, performing an evaluation from +1.00 D to −3.50D (−0.5D steps), offering the width of the profile at 50% (WP) in minutes of arc. Results: Differences were found between groups for the AA, MAF and MEM retinoscopy (p < 0.0001, p < 0.001, p = 0.037). The discriminative capacity of MEM retinoscopy for AI diagnosis was significant and the cut-off that maximized the sensitivity and specificity was > 0.5 D. Considering WP 50% in different points, the discriminative AI diagnosis capacities for the points of 2.0 D and 2.50 D were significant (ROC-AUC 0.78; p = 0.03 and p = 0.02). Conclusions: Double-pass system metric differed between patients with AI and control group, therefore the aim of a Phase I study was achieved. Further steps with higher sample sizes are required to evidence if the system really provides any advantage versus conventional methods in the diagnosis of AI. (AU)

Time-efficiency assessment of guided toric intraocular lens cataract surgery: pilot study.

PURPOSE: To compare the time spent on toric intraocular lens (IOL) implantation during cataract surgery using a manual-marking vs a digital image-guided system (t Verion) for toric IOL alignment. SETTING: Instituto Oftalmológico Quirónsalud ophthalmology clinic, A Coruña, Spain. DESIGN: Experimental and longitudinal study. METHODS: A total of 98 eyes of 65 participants (68.2 ± 12.2 years) were divided into 2 groups: 49 eyes operated with toric IOL alignment using a manual-marking technique (manual group) and another 49 eyes operated using image-guided marking (Verion group). The primary variable for comparison between both groups was cataract surgery time. Other outcomes such as toric IOL misalignment, spherical equivalent, astigmatism, uncorrected distance visual acuity, and corrected distance visual acuity were also measured. RESULTS: The total cataract surgery time was 2:09 minutes shorter (P < .001) with the Verion system (12:12 ± 2:20 in 49 eyes operated) compared with the surgical procedure performed using manual marking (15:27 ± 3:04 in 49 eyes operated). One month after surgery, there were no statistical differences in terms of toric IOL misalignment between the Verion (3.38 ± 2.95 degrees) and the manual group (4.66 ± 3.95 degrees). No statistical differences were observed between groups for refractive and visual outcomes (P ≥ .05). CONCLUSIONS: The cataract surgery time was reduced when the procedure was assisted using the Verion system to align the IOL compared with manual marking, maintaining the same efficacy in terms of toric IOL misalignment, residual refraction, and visual acuity.

Feasibility of optical quality analysis system for the objective assessment of accommodation insufficiency: a phase 1 study.

PURPOSE: To assess differences in a new objective metric obtained with a double-pass technique between a group with accommodation insufficiency (AI) and a control group and to explore the diagnostic capabilities of this new tool in comparison to conventional procedures. METHODS: Retrospective cross-sectional case-control phase 1 study. Two groups with ages ranging from 8 to 18 years were recruited: AI and control group. The diagnostic criterion of AI was based on monocular accommodative amplitude (AA), 2 D below Hofstetter's calculation for minimum AA, and monocular accommodative facility (MAF), failing with minus lens and cut-off at ≤ 6 cycles per minute. Accommodative response with a double pass device (HD Analyzer, Visiometrics) was measured, performing an evaluation from +1.00 D to -3.50D (-0.5D steps), offering the width of the profile at 50% (WP) in minutes of arc. RESULTS: Differences were found between groups for the AA, MAF and MEM retinoscopy (p < 0.0001, p < 0.001, p = 0.037). The discriminative capacity of MEM retinoscopy for AI diagnosis was significant and the cut-off that maximized the sensitivity and specificity was > 0.5 D. Considering WP 50% in different points, the discriminative AI diagnosis capacities for the points of 2.0 D and 2.50 D were significant (ROC-AUC 0.78; p = 0.03 and p = 0.02). CONCLUSIONS: Double-pass system metric differed between patients with AI and control group, therefore the aim of a Phase I study was achieved. Further steps with higher sample sizes are required to evidence if the system really provides any advantage versus conventional methods in the diagnosis of AI.

Longitudinal Chromatic Aberration in Patients Implanted With Trifocal Diffractive Hydrophobic IOLs.

PURPOSE: To measure the in vivo longitudinal chromatic aberration (LCA) from the chromatic difference of focus (480 to 700 nm) using psychophysical methods in patients bilaterally implanted with a hydrophobic trifocal intraocular lens (IOL). METHODS: Psychophysical best focus was measured in both eyes at different wavelengths (480 to 700 nm) and at three different viewing distances (0.00, +1.75, and +3.50 diopters [D]) using a custom-developed polychromatic adaptive optics set-up provided with a supercontinuum laser, a Hartmann-Shack wavefront sensor, a deformable mirror, a motorized Badal system, a pupil monitoring system, and a psychophysical channel with monochromatically illuminated stimuli. Measurements were performed on 10 patients (20 eyes) bilaterally implanted with hydrophobic trifocal diffractive IOLs (FineVisionHP POD F GF; PhysIOL). LCA was computed from the chromatic difference of focus curves as the difference between 480 and 700 nm at near, intermediate, and far. RESULTS: The LCA from psychophysical measurements was significantly higher for far vision (0.99 ± 0.06 diopters [D]), than for intermediate (0.67 ± 0.10 D) and near (0.23 ± 0.08 D) vision (one-way analysis of variance, P < .05). CONCLUSIONS: LCA for far vision was significantly higher than for intermediate and near vision in hydrophobic trifocal diffractive IOLs, in agreement with a previous study with the same optical design but hydrophilic material IOLs. The LCA for the hydro-phobic IOL is slightly higher than for the hydrophilic IOL at far. Different combinations of refractive and diffractive LCA will allow optimizing IOL designs to improve polychromatic image quality. [J Refract Surg. 2020;36(12):804-810.].