Comparative efficacy and safety of all kinds of intraocular lenses in presbyopia-correcting cataract surgery: a systematic review and meta-analysis.

PURPOSE: To assess the efficacy and safety of various intraocular lenses (IOLs), including standard monofocal, bifocal, trifocal, extended depth of focus (EDOF), and enhanced monofocal IOLs, post-cataract surgery through a network meta-analysis. METHODS: A systematic search of PubMed, Cochrane Library, and Web of Science was conducted to identify relevant studies from the past 5 years. Parameters such as binocular visual acuities, spectacle independence, contrast sensitivity (CS), and optical quality were used to evaluate efficacy and safety. Data from the selected studies were analyzed using Review Manager 5.4 and STATA 17.0 software. RESULTS: Twenty-eight Randomized Controlled Trials (RCTs) comprising 2465 subjects were included. Trifocal IOLs exhibited superior uncorrected near visual acuity (UNVA) compared to monofocal IOLs (MD: -0.35; 95% CI: -0.48, -0.22). Both trifocal (AcrySof IQ PanOptix IOLs group MD: -0.13; 95% CI: -0.21, -0.06) and EDOF IOLs (MD: -0.13; 95% CI: -0.17, -0.09) showed better uncorrected intermediate visual acuity (UIVA) than monofocal IOLs. Trifocal IOLs ranked highest in spectacle independence at various distances (AT LISAtri 839MP group: SUCRA 97.5% for distance, 80.7% for intermediate; AcrySof IQ PanOptix group: SUCRA 83.0% for near). CONCLUSIONS: For cataract patients who want to treat presbyopia, trifocal IOLs demonstrated better visual acuity and spectacle independence at near distances. Different types of trifocal IOL characteristics differ. EDOF and enhanced monofocal IOLs have improved visual quality at intermediate distances.Therefore, It is very important to select the appropriate IOLs based on the lens characteristics and patient needs.

Association between Fundus Tessellation and Contrast Sensitivity in Myopic Eyes.

PURPOSE: To assess the association of fundus tessellation with contrast sensitivity, Quality of Vision questionnaire, and other factors at five years postcorneal refractive surgery. METHODS: This is a cross-sectional study. Both eyes of 98 subjects (196 eyes) who received femtosecond laser in situ keratomileusis (FS-LASIK) or small incision lenticular extraction (SMILE) five years prior were enrolled in this study. Fundus tessellation was imaged using wide-angle fundus photographs and graded into four categories with the assistance of the ETDRS grid. Photopic and mesopic contrast sensitivity were measured under the best correction. The Quality of Vision (QoV) questionnaire was used to assess visual symptoms. RESULTS: Fundus tessellation was classified as follows: 19 eyes were grade 0 (9.7%), 28 eyes were grade 1 (14.3%), 59 eyes were grade 2 (30.1%), and 90 eyes were grade 3 (45.9%). Higher degrees of fundus tessellation were associated with lower photopic contrast sensitivity, a significant difference was observed at spatial frequencies of 6cpd (p = 0.030, grade 1 >grade 3 p = 0.011). Higher degrees of fundus tessellation were also associated with lower mesopic contrast sensitivity, a significant difference was observed at spatial frequencies of 18cpd (p = 0.011, grade 0 >grade 3 p = 0.012). The preoperative degree of myopia was positively associated with fundus tessellation grade (p < 0.001). However, in linear mixed-effect model analysis, no significant influence of parameters (contrast sensitivity, preoperative myopia, and QoV scores) upon different tessellation grades was found (p > 0.05). CONCLUSIONS: Patients with moderate and high myopia were more likely to have higher grades of fundus tessellation. Higher degree of fundus tessellation associates with lower contrast sensitivity. Patients with moderate and high myopia should be concerned with retinal-choroidal changes. Contrast sensitivity could be a clinical sign for progression of tessellation and used to screen for early retinal-choroidal changes to prevent pathologic myopia.

Optimising a landscape visual quality protocol. A Method for reducing respondent fatigue and obtaining site-specific indicators.

Evaluation of landscape visual quality is crucial for policymaking and planning but is still challenging. A wide range of visual assessment protocols is available, but there is still no consensus on appropriate indicators or approaches. Also, evaluation protocols can encompass many indicators, being exhaustive and complex and making the evaluation lengthy. Furthermore, protocols tend to be catered to a particular type of landscape or site-specific, and it can be tricky to ensure the protocol developed is adequate for the landscape under study. This paper proposes a methodology to optimise the selection of indicators for landscape visual assessments. There are two main goals: i) reduce the evaluation time to avoid respondent fatigue, and ii) make the protocol site-specific, choosing indicators that perform better and avoiding redundant indicators. •The presented method optimises the selection of indicators in expert visual assessments;•Indicators are rated in situ on a 5-point scale and go through a performance and redundancy test;•It helps to adapt complex evaluation protocols to the study landscape and to choose robust indicators in a supported and scientific way.

Optimal Bowel Preparation Method to Visualize the Distal Ileum via Small Bowel Capsule Endoscopy.

Small bowel capsule endoscopy (SBCE) is a convenient and minimally invasive method widely used to evaluate the small intestine. However, especially in the distal ileum, visualization of the intestinal mucosa is frequently hampered by the remaining intestinal contents, making it difficult to detect critical lesions. Although several studies have reported on the efficacy of bowel preparation before SBCE, no standardized protocol has been established. Herein, we determined the optimal preparation method for better visualization of the distal ileum using SBCE. We retrospectively analyzed 259 consecutive patients who had undergone SBCE between July 2009 and December 2019, divided into three groups: Group A (no preparation except overnight fasting), Group B (ingestion of 1-2 L polyethylene glycol 4 h before colonoscopy after overnight fasting and performing SBCE immediately after colonoscopy), and Group C (ingestion of 0.9 L magnesium citrate [MC] before SBCE after overnight fasting). The visibility of the intestinal mucosa in the first 10 min and at the last 10 min during the period of observation of the distal ileum was examined using a scoring system and compared. The visibility of the images captured by SBCE was assessed based on the scoring of the degree of bile/chyme staining, residual fluid and debris, brightness, bubble reduction, and visualized mucosa. The status of intestinal collapse was also assessed. In the first 10 min of observation of the distal ileum, no significant differences were detected among the groups. In the last 10 min, significantly better images were acquired in Group C in terms of bile/chyme staining, brightness, bubble reduction, and visualized mucosa. Bowel preparation using a low-dose MC solution 2 h before SBCE provided significantly higher-quality images of the distal ileum. Further optimization, such as the timing of initiating the preparation, is necessary to determine the optimal regimen for bowel preparation prior to SBCE.

Comparison of cataract patients with regular corneal astigmatism after implantation of extended range-of-vision and bifocal toric intraocular lenses.

Purpose: To compare the postoperative visual acuity and visual quality between extended range-of-vision and multifocal toric intraocular lens (IOLs) after implantation in cataract patients with regular corneal astigmatism. Setting: Department of Ophthalmology, the Second Hospital of Jilin University, Changchun, Jilin Province, China. Design: Retrospective and single-center study. Methods: The study involved implanting the Tecnis Symphony (ZXR00IOL) or the bifocal toric (ZMTIOL) in patients undergoing cataract surgery. Three months after surgery, lens performance was evaluated using distance, intermediate, and near visual acuity tests, defocus curves, the modulation transfer function (MTF), a visual function index questionnaire (VF-14), and the adverse optical interference phenomena. Results: The 3-month postoperative follow-up found that both groups had good corrected distance vision. The ZMT group had better-uncorrected distance visual acuity and near visual acuity (p < 0.05). However, the ZXR group showed better uncorrected intermediate visual acuity (p < 0.05) and visual continuity. Overall astigmatism in the postoperative ZMT group was significantly lower than that in the pre-operative group (p < 0.05). The ZMT group had lower total high-order aberrations (tHOs), higher MTF values, and higher VF-14 scores (p < 0.05). Finally, the ZXR group exhibited reduced halo and glare phenomena (p < 0.05). Conclusion: We found that ZMT can effectively correct a corneal astigmatism of 1.0-1.5 D and ZXR can improve patient outcomes regarding subjective optical quality and range of vision. These findings have the potential to improve future astigmatism treatment options.

Effect of Aloe vera gel coating on organoleptic and nutritional quality of minimally processed carrot.

Demand for fresh vegetables has led to development studies in postharvest area mainly focused on minimizing and look for alternatives to chemical additives for food preservation. The use of natural derived edible coatings emerges as a promising alternative for maintaining quality of vegetables. The objective of this study was to evaluate the effect of Aloe vera gel in minimally processed carrot during postharvest storage. Samples with different degrees of processing were immersed in Aloe vera gel, packaged polyolefin bags, and stored in refrigerated chambers at 5 °C for 12 days. Different organoleptic and quality parameters were evaluated. In general, the samples treated with Aloe vera gel showed less quality loss and a lower increment in the bleaching index. Moreover, sensory analysis allowed to establish that carrots processed in slices and shredded and coated with the gel had a more flavorful taste and higher moisture content. Aloe vera treatment did not influence the microbiological growth of bacteria and fungi during storage. Regarding nutritional quality, the treated samples showed a higher accumulation or lower degradation of phenols, flavonoids, and carotenoids, probably generating in this way, a higher antioxidant capacity in these samples. Finally, Aloe vera gel treatment did not influence sugar dynamics in any of the samples. It can be concluded that the treatment with Aloe vera gel allows maintaining a better organoleptic and nutritional quality of carrots with different degrees of processing during refrigerated storage.

Therapeutic effect of a new implantation method of rotationally asymmetric multifocal intraocular lenses on visual quality.

PURPOSE: To assess the visual quality after implantation of a rotationally asymmetric multifocal intraocular lens (IOL) using a new method according to the angle kappa. SETTING: Qingdao Eye Hospital, Qingdao, China. DESIGN: Prospective case series. METHODS: Patients with the implantation of SBL-3 IOLs for age-related cataract from September to December 2019 had the distance-horizontal zone of the IOL placed at the center of the optic axis using the Callisto Eye System. Postoperative visual acuities and defocus curves were recorded. Modulation transfer function cutoff frequency, Strehl ratio, and objective scatter index were measured using the Optical Quality Analysis System. The decentration and tilt of IOLs were analyzed by iTrace aberrometry and anterior segment optical coherence tomography. A questionnaire of patient satisfaction was also collected. RESULTS: Thirty patients (60 eyes) were involved, with a balanced sex ratio. Their average age was 56.04 ± 10.83 years. The average angle kappa distance was 0.23 ± 0.121 mm. At 3 months after surgery, the mean uncorrected and corrected distance visual acuities were 0.01 ± 0.07 logMAR and 0.01 ± 0.06 logMAR. The uncorrected intermediate and near visual acuities were 0.09 ± 0.11 logMAR and 0.09 ± 0.11 logMAR. The mean horizontal and vertical tilts of IOLs were 0.67 ± 0.52 degrees and 0.47 ± 0.32 degrees. The mean decentration of IOLs was 0.17 ± 0.08 mm. Most patients were satisfied with their distance, intermediate, and near vision. There was mild glare in 58.3% of the eyes. CONCLUSIONS: Locating the center of the optic axis in the distance-horizontal zone during the implantation of SBL-3 IOLs could provide satisfactory visual acuity and quality.

Comparison of binocular visual quality in six treatment protocols for bilateral cataract surgery with presbyopia correction: a prospective two-center single-blinded cohort study.

OBJECTIVE: To compare the postoperative binocular visual quality in six treatment protocols for bilateral age-related cataract surgery with presbyopia correction for clinical decisions. MATERIALS AND METHODS: In this prospective two-center single-blinded cohort study, participants from North or South China who underwent bilateral phacoemulsification and intraocular lens implantation were divided into six protocols: monovision, diffractive bifocal, mixed, refractive bifocal, trifocal, and micro-monovision extended range of vision (EROV). Binocular visual quality was evaluated at 3 months postoperatively, including binocular uncorrected full-range visual acuity, binocular defocus curves (depth of focus [DoF] and area under the curve [AUC]), binocular visual function (fusion function and stereopsis), binocular subjective spectacle independence rates, visual analog scale (VAS) of overall satisfaction, 25-item visual function questionnaire (VFQ-25), and binocular dysphotopsia symptoms. RESULTS: Of the 300 enrolled patients, 272 (90.7%; 544 eyes) were analyzed. The trifocal protocol showed excellent binocular full-range visual acuity and the best performance for most DoFs and AUCs. The monovision protocol presented the worst binocular visual quality in most perspectives, especially in convergence, distance, and near stereopsis (p < 0.001). The full-range subjective spectacle independence rates were sorted from highest to lowest as follows: trifocal (84.8%), refractive bifocal (80.9%), EROV (80.0%), mixed (73.3%), diffractive bifocal (65.2%), and monovision (32.6%) protocols, with no statistically significant differences between the former five protocols (p > 0.05). The EROV protocol achieved the highest VAS and VFQ-25 scores. The incidence of postoperative binocular dysphotopsia symptoms was comparable in all protocols. CONCLUSIONS: The trifocal protocol showed the best performance, and the monovision protocol presented the worst performance in most perspectives of binocular visual quality for presbyopia correction. The refractive bifocal, mixed, or EROV protocols can provide an approximate performance as a trifocal protocol. Ophthalmologists can customize therapies using different protocols.

Assessment of Visual Quality Improvement as a Result of Spectacle Personalization.

Personalized spectacles customized according to an individual's facial anatomy were developed to provide enhanced visual performance and overall comfort when compared to standard spectacles. In this comparative crossover trial, each subject was randomly assigned to wear either personalized spectacles or standard spectacles for two weeks and then tried the second pair for another two weeks. Visual acuity and reading speed were measured, and visual quality and comfort were assessed using specific questionnaires. The correlation of the wearing parameters with the subjects' satisfaction was calculated. According to our results, the subjects wearing personalized glasses reported significantly less experience of swaying and significantly higher overall satisfaction compared to those wearing the control spectacles. At the end of the study, 62% of subjects preferred the personalized spectacles, and visual quality was the primary reason for their spectacle preference followed by wearing comfort. The difference from the ideal cornea-vertex distance was significantly lower when wearing the personalized spectacles compared to the control frames. In addition, the absolute value of the difference from the ideal cornea-vertex distance was significantly correlated with patient satisfaction. These results suggest that personalized spectacles, customized according to an individual's facial anatomy for the ideal wearing parameters, result in both visual and comfort advantages for wearers.

Visual Quality, Motility Behavior, and Retinal Changes Associated with Reading Tasks Performed on Electronic Devices.

BACKGROUND: The purpose of this study was to objectively evaluate visual discomfort using an eye tracker and aberrometer after a 21-min reading session on an iPad and an Ebook. Additionally, retinal changes were analyzed using optical coherence tomography (OCT). METHODS: A total of 31 young subjects (24 ± 4 years) participated in this study. They read for 21 min on an Ebook and for another 21 min on an iPad under controlled lighting conditions while their eye movements were monitored using an eye tracker. Aberrometry and retinal OCT measurements were taken before and after each reading session. Parameters such as pupil diameter, fixations, saccades, blinks, total aberration, high-order aberration, low-order aberration, and central and peripheral retinal thickness in the nine early treatment diabetic retinopathy study (ETDRS) areas were measured for each reading situation. Statistical analysis was performed on the collected data. RESULTS: No statistically significant differences (p > 0.05) between the two devices were observed in terms of the different types of eye movements or the changes in retinal thickness. However, the aberrometric analysis showed variations in post-reading situations depending on the device used. CONCLUSION: Reading speed and visual discomfort resulting from electronic device usage can be objectively assessed using an eye tracker and aberrometer. Additionally, changes found in central and peripheral retinal thickness between the two devices and the baseline measurements were not significant and remained relatively stable.

Visual-quality-driven unsupervised image dehazing.

Most of the existing learning-based dehazing methods require a diverse and large collection of paired hazy/clean images, which is intractable to obtain. Therefore, existing dehazing methods resort to training on synthetic images. This may result in a possible domain shift when treating real scenes. In this paper, we propose a novel unsupervised dehazing (lightweight) network without any reference images to directly predict clear images from the original hazy images, which consists of an interactive fusion module (IFM) and an iterative optimization module (IOM). Specifically, IFM interactively fuses multi-level features to make up for the missing information among deep and shallow features while IOM iteratively optimizes dehazed results to obtain pleasing visual effects. Particularly, based on the observation that hazy images usually suffer from quality degradation, four non-reference visual-quality-driven loss functions are designed to enable the network trained in an unsupervised way, including dark channel loss, contrast loss, saturation loss, and edge sharpness loss. Extensive experiments on two synthetic datasets and one real-world dataset demonstrate that our method performs favorably against the state-of-the-art unsupervised dehazing methods and even matches some supervised methods in terms of metrics such as PSNR, SSIM, and UQI.

Long-term observation on safety and visual quality of implantable collamer lens V4c implantation for myopia correction: a 5-year follow-up.

AIM: To elucidate the safety and visual quality of implantable collamer lens with central hole (ICL V4c) implantation for correcting moderate and high myopia for at least 5y. METHODS: This retrospective study was conducted on 58 patients (114 eyes) who were followed up for at least 5y after ICL V4c implantation. The observation was done before and on 1d, 1mo, 1 and 5y or more after the surgical procedure. The visual acuity, subjective refraction, intraocular pressure, vault, axial length, central hole position, pupil diameter, visual quality, and adverse events were analyzed. The visual quality includes aberration, the modulation transfer function cutoff frequency (MTF cutoff), objective scattering index (OSI), Stroller's ratio (SR), and visual quality questionnaire. RESULTS: The average follow-up period was 69.25±3.80mo (range 60-82mo) and the preoperative spherical equivalent (SE) was -8.66±1.97 D. At 5y after operation, the safety index was 1.01±0.02 and the efficacy index was 0.99±0.42 and SE was -0.65±0.63 D. The 59.6% of the eyes achieved an uncorrected distance visual acuity of 20/20, 76.3% of the eyes had SE within ±1.0 D at the last visit. The axial length increased by 0.29±0.71 mm 5y after the surgery (t=-3.843, P<0.001). The mean vault at the last follow-up was 510.59±245.61 µm. The central hole was on the temporal side in 80 eyes (84.2%). The visual quality questionnaire showed that 98.2% patients were satisfied with the surgical procedure. Adverse events occurred in 4 eyes (3.5%), including the posttraumatic toric ICL rotation (2 eyes), iris incarceration (1 eye), and posttraumatic ICL displacement (1 eye) at the last follow-up. CONCLUSION: Long-term ICL V4c implantation is safe, effective, and stable for correcting moderate and to high myopia, and the visual quality with patients is excellent and satisfactory, but the progression of axial length still needs attention after surgery.

Subjective patient-reported visual quality after small-incision lenticule extraction and its correlation to the objective one.

PURPOSE: The purpose of the study was to characterize the subjective visual quality and satisfaction following small-incision lenticule extraction (SMILE) and to identify its influential factors. SETTING: Peking University Third Hospital, Beijing, China. DESIGN: This was a retrospective observational study. METHODS: Patients who had simultaneous binocular SMILE for myopia and myopic astigmatism were included 6 months postoperatively, and the patient-reported outcome questionnaire was employed for the assessment of visual quality in real-life situations. Examinations with SIRIUS combined corneal topography and tomography were performed including the parameters of Strehl ratio (SR), corneal higher-order aberrations (HOAs) within 6.0-mm area, kappa angel, and thinnest corneal thickness. Decentration and effective optical zone (EOZ) were measured based on a tangential pre-post-operation difference map. Binary logistic regression analysis was performed for predictors of patient-reported visual quality. RESULTS: Clinical data from 97 cases were analyzed retrospectively. Overall satisfaction was 96.91% (94/97). Fluctuation in vision and glare is the most frequent and dominant visual symptoms. SR value increased non-significantly compared with preoperative (P> 0.05). A statistically significant (P < 0.05) increase in total HOAs, spherical aberration, and coma was noted. SR and HOAs were not correlated with the degree of visual symptoms (P > 0.05). No objective parameter was found to be associated with patient-reported visual quality after SMILE (P> 0.05). CONCLUSION: The high patient-reported satisfaction confirmed the ideal effect on visual quality following SMILE in real-life situations, though some objective optical performances were not satisfying. It is very tolerant toward patients' conditions and mild deviations, and this study did not find factors affecting visual performances.

Four-year visual outcomes and optical quality of SMILE and implantable collamer lens V4c (EVO-ICL) implantation for high myopia: a retrospective study.

BACKGROUND: To compare the 4-year visual outcomes of implantable collamer lens V4c (EVO-ICL) implantation and small incision lenticule extraction (SMILE) for high myopia and astigmatism. METHODS: This retrospective case study included 64 eyes of 40 patients. These patients with preoperative manifest refraction spherical equivalent (SE) between - 6.00 and - 10.00 diopters (D) were screened from the database of SMILE and EVO-ICL implantation procedures in 2015. The ICL group [32 eyes of 19 patients (mean age, 29.6 ± 6.3 years); mean SE, -8.71 ± 1.06 D] and SMILE group [32 eyes of 21 patients (mean age, 27.7 ± 5.6 years); mean SE, -8.35 ± 0.65D] were compared. All patients were then prospectively examined at a four-year follow-up for routine postoperative examinations, higher-order ocular aberrations, retinal image quality and a questionnaire. RESULTS: The safety indexes were 1.15 ± 0.14 and 1.22 ± 0.21 (P = 0.36) for the SMILE and ICL groups, respectively. No eyes lost two or more lines of CDVA in either group. The efficacy indexes were 0.97 ± 0.16 and 0.96 ± 0.19 (P = 0.87), respectively. Twenty-three eyes (72%) in ICL and 26 eyes (81%) in SMILE groups were within ± 0.5 D of the attempted SE (P < 0.01). ICL-treated eyes had significantly less spherical aberration and coma (P < 0.01 and < 0.05, respectively) postoperatively. Halos were the prevalent visual disturbance in both groups. CONCLUSION: SMILE and EVO-ICL implantation provided safe and effective correction of high myopia. SMILE showed slightly better long-term predictability. Mild postoperative visual disturbances were observed after ICL and SMILE at 4-year follow-up.

Comparison of visual quality after SMILE correction of low-to-moderate myopia in different optical zones.

OBJECTIVE: To compare the effects of different optical zones for small-incision lenticule extraction (SMILE) on postoperative visual quality in low-to-moderate myopia. METHODS: This retrospective case-control study involved patients who underwent SMILE using two optical-zone diameters: 6.5 mm (50 patients, 100 eyes) and 6.8 mm (50 patients, 100 eyes). Uncorrected visual acuity (UCVA), best corrected visual acuity, spherical equivalent (SE), corneal higher-order aberrations (HOAs), and subjective visual-quality questionnaire scores were assessed. RESULTS: Postoperatively, UCVA and SE did not differ between the two groups (P > 0.05). In both groups, corneal HOAs, spherical aberration, and coma significantly increased at 1 and 3 months postoperatively (P < 0.05), while trefoil was unchanged after surgery (P > 0.05). Corneal HOAs, spherical aberration, and coma significantly differed between the groups at 1 and 3 months (P < 0.05), while trefoil did not (P > 0.05). Visual-quality scores were higher in the 6.8 mm group than in the 6.5 mm group at 1 month (P = 0.058), but not at 3 months (P > 0.05). In both groups, subjective scores significantly decreased at 1 month (P < 0.05) and gradually returned to the preoperative level at 3 months (P > 0.05). The subjective visual-quality scores were negatively and positively correlated with pupillary and optical-zone diameter, respectively (P < 0.05 for both). Objective visual-quality indicators (HOAs, spherical aberration, and coma) were negatively correlated with optical-zone diameter (P < 0.05) but not pupillary diameter (P > 0.05). CONCLUSION: SMILE in different optical zones effectively corrected low-to-moderate myopia. The larger the optical-zone diameter, the better the early postoperative visual quality.

Influence of decentration of plate-haptic toric intraocular lens on postoperative visual quality.

BACKGROUND: To evaluate the influence of decentration of plate-haptic toric intraocular lens (IOLs) on visual quality. METHODS: This study enrolled 78 eyes of 78 patients. Patients in group A were implanted with toric IOLs, and patients in group B were implanted with monofocal IOLs. All patients were divided into group A1 and B1 (decentration below 0.3 mm) and group A2 and B2 (decentration above 0.3 mm). The uncorrected distance visual acuity (UDVA), best corrected visual acuity (BCVA), modulation transfer function cutoff (MTF cutoff), objective scatter index (OSI), strehl ratio (SR), optical interference and patients' satisfaction were measured in different pupils at three months postoperatively. The associations between decentration and visual quality were analyzed by Spearman correlation. RESULTS: There were no significant differences in UDVA, BCVA, MTF cutoff, OSI, SR, optical interference and patients' satisfaction among subgroups. The differences in decentration between groups A and B were not statistically significant. In group A2, the total higher order aberrations (tHOAs) at pupil sizes of 3 mm (P = 0.046), 5 mm (P = 0.014), spherical aberrations at pupil sizes of 3 mm (P = 0.011), 4 mm (P = 0.014), 5 mm (P = 0.000), secondary astigmatism at pupil sizes of 3 mm (P = 0.002), 4 mm (P = 0.005) were higher than in group B2. Compared to group A1, group A2 had higher spherical aberrations at pupil sizes of 4 mm (P = 0.042), 5 mm (P = 0.001), 6 mm (P = 0.038), secondary astigmatism at pupil sizes of 3 mm (P = 0.013), 4 mm (P = 0.005), 6 mm (P = 0.013). Group B2 has higher coma and secondary astigmatism than group B1 at 6-mm pupil (P = 0.014, P = 0.045). Significant positive correlations were found between spherical aberrations and the decentration of group A1 and A2 at 6-mm pupils. CONCLUSION: The decentration above 0.3 mm negatively affected visual quality due to increased tHOAs, spherical aberrations, coma and secondary astigmatism aberrations, the influence become larger with increasing pupil diameter. And toric IOLs are more affected by decentration than monofocal IOLs.

Comparison of visual outcomes in adult patients with different types of developmental cataracts after toric multifocal intraocular lenses implantation.

PURPOSE:  To analyze and compare the visual performance and patient satisfaction following the implantation of toric multifocal intraocular lenses (TMIOLs) in adult patients with different types of developmental cataracts (DC) accompanied by corneal astigmatism (CA). METHODS:  This is a prospective observational cohort study. Patients diagnosed with DC aged 18-30 years were divided into three groups according to the anatomic location of the lens opacity: cortical, nuclear, and posterior subcapsular (PSC) groups, and implanted with TMIOLs. Visual acuity (VA), postoperative refractive astigmatism (RA), intraocular lens (IOL) rotation, high-order aberrations (HOAs), modulation transfer function (MTF) curve, and Strehl ratio were compared. The functional vision and incidence of photic phenomena were surveyed using questionnaires. RESULTS:  Fifty-five eyes of 37 patients were enrolled and completed a 1-year follow-up. The mean CA was 2.06 ± 0.79 D preoperatively, and the mean RA was 0.29 ± 0.30 D 3-month postoperatively. The IOL rotation was 2.48° ± 1.89°, with no deviation > 10°. At 12 months, mean uncorrected distance VA improved from 0.93 ± 0.41 preoperatively to 0.08 ± 0.08 logarithm of the minimum angle of resolution (logMAR), mean uncorrected near VA increased from 0.45 ± 0.30 preoperatively to 0.12 ± 0.11 logMAR, and mean uncorrected intermediate VA was 0.14 ± 0.08 logMAR. The cortical and nuclear groups displayed better improvements in uncorrected near and intermediate VA than that in the PSC group. Similar results were observed in the 3-month defocus curves, HOAs, MTF curve, halo incidence, and near vision satisfaction. CONCLUSION: In adult patients with DC accompanied by CA, TMIOLs implantation achieved good postoperative visual outcomes and significantly reduced glasses dependency. Patients with cortical or nuclear lens opacity showed better whole-course VA and quality of vision, while patients with PSC opacity showed unsatisfactory near vision and suffered more photic phenomena.

Analysis of visual quality after multifocal intraocular lens implantation in post-LASIK cataract patients.

With the development of refractive corneal surgery, excimer laser in situ keratomileusis (LASIK) has become a common refractive surgery procedure. However, post-LASIK patients are at increased risk of developing cataracts as they age and often require IOL implantation. The choice of IOLs is particularly important for these patients, who have smaller residual refractive error and have higher requirements for post-cataract vision recovery and visual quality than the general population. Multifocal IOLs are widely used in clinical practice for patients with high visual acuity needs, such as cataract patients after refractive keratomileusis, due to their advantages of providing excellent near and distance visual acuity; however, compared to monofocal IOLs, multifocal IOLs can lead to postoperative problems related to visual quality such as increased higher order aberrations and decreased contrast sensitivity. Therefore, whether multifocal IOLs have advantages for post-LASIK cataract patients, such as improving the visual quality of such patients, has attracted attention. In this paper, we analyze the current status of research on the implantation of multifocal IOLs in post-LASIK cataract patients by domestic and foreign experts, review and summarize the relevant literature, and propose further discussion in the context of the actual situation of postoperative visual quality and vision recovery.

Effects of brimonidine tartrate 0.2 and 0.15% ophthalmic solution on the static and dynamic pupil characteristics.

Aims: To investigate the differences between 0.2 and 0.15% brimonidine tartrate eye drops for anti-mydriatic effects and the optical quality under different light conditions. Methods: This prospective study involved 80 consecutive high myopia patients undergoing implantation of a V4c ICL. The patients were randomly instilled with brimonidine 0.2 and 0.15% 2 weeks postoperatively. Visual quality, pupil center, pupil size, and refraction under different light conditions were measured before and 0.5 h after brimonidine administration. A symptom questionnaire was also evaluated. Results: There was no statistical difference in the static and dynamic pupil diameters and velocity after LS between the two groups (p > 0.05). The 0.2% group had significant changes in pupil center before and after treatment, while there was no obvious movement of the 0.15% group under all illumination condition (p > 0.05). The OSI after treatment of the 0.15% group was lower than that of 0.2% group (p = 0.012). The PVA9% and PVA100% of the 0.15% group was higher than that of 0.2% group in the dark (p = 0.009, p = 0.012). The HOA RMS of the 0.15% group was lower than that of 0.2% group (p = 0.016). The QIRC score in the 0.15% group was significantly higher than that in the 0.2% group (p = 0.043). Conclusion: 0.15 and 0.2% brimonidine tartrate eye drops had similar anti-mydriatic ability, while 0.15% group had better visual quality than 0.2% concentration, and hardly introduced pupil shift. 0.15% brimonidine tartrate eye drops may be more suitable for patients with nocturnal glare symptoms in the early postoperative period after ICL implantation.

The dynamic changes and influencing factors of visual symptoms after small incision lenticule extraction.

BACKGROUND: To investigate the dynamic changes and influencing factors of visual symptoms after small incision lenticule extraction (SMILE). METHODS: This was a prospective observational study. Visual symptoms including glare, haloes, starbursts, hazy vision, fluctuation, blurred vision, double vision and focusing difficulties were evaluated before and 1, 3, 6 months after SMILE using a questionnaire. Generalized linear mixed models were used to assess the effects of preoperative characteristics and objective visual quality parameters on postoperative visual symptoms. RESULTS: 73 patients/146 eyes were enrolled. Preoperatively, the most common symptoms were glare (55% of eyes), haloes (48%), starbursts (44%) and blurred vision (37%). At 1 month postoperatively, the incidence and extent scores of glare, haloes, hazy vision and fluctuation rose significantly. At 3 months, the incidence and extent scores of glare, haloes and hazy vision restored to baseline. And at 6 months, the extent scores of fluctuation returned to baseline. Other symptoms (e.g., starbursts) did not change before and 1, 3, 6 months after SMILE. Preoperative visual symptoms were associated with postoperative symptoms, as patients with a symptom preoperatively had higher postoperative scores for that symptom. Age was related to postoperative extent of double vision (coefficient = 0.12, P = 0.046). There were no significant associations between postoperative visual symptoms and preoperative SE, scotopic pupil size, angle kappa (with intraoperative adjustment), postoperative HOAs or scattering indexes. CONCLUSIONS: The incidence and extent scores of hazy vision, glare, haloes and fluctuation increased at the first month after SMILE, and recovered to baseline at 3 or 6 months. Preoperative visual symptoms were associated with the postoperative symptoms and should be fully considered before SMILE.