Identification of genes contributing to attenuation of rat model of galactose-induced cataract by pyruvate.

Cataracts are a disease that reduces vision due to opacity formation of the lens. Diabetic cataracts occur at young age and progress relatively quickly, so the development of effective treatment has been awaited. Several studies have shown that pyruvate inhibits oxidative stress and glycation of lens proteins, which contribute to onset of diabetic cataracts. However, detailed molecular mechanisms have not been revealed. In this study, we attempted to reduce galactose-induced opacity by pyruvate with rat ex vivo model. Rat lenses were extracted and cultured in galactose-containing medium to induce lens opacity. After opacity had developed, continued culturing with pyruvate in the medium resulted in a reduction of lens opacity. Subsequently, we conducted microarray analysis to investigate the genes that contribute to the therapeutic effect. We performed quantitative expression measurements using RT-qPCR for extracted genes that were upregulated in cataract-induced lenses and downregulated in pyruvate-treated lenses, resulting in the identification of 34 candidate genes. Functional analysis using the STRING database suggests that metallothionein-related factors (Mt1a, Mt1m, and Mt2A) and epithelial-mesenchymal transition-related factors (Acta2, Anxa1, Cd81, Mki67, Timp1, and Tyms) contribute to the therapeutic effect of cataracts.

Collaborative robot acting as scrub nurse for cataract surgery (CRASCS).

Worldwide, healthcare systems are struggling to tackle a nursing shortage. As per the data released by the American Hospital Association, the healthcare workforce could face a loss of around 5 lakh nurses by the end of the year. Consequently, it could result in those deficiencies, which will be 1.1 million instead of 0.6 million. The current nursing scenario in India as per the Indian Nursing Council (INC), which is a board under the ministry and is responsible for legally confirming and maintaining universal standardized training for nursing, is that the 1.96 nurses out of every 1000 Indians that are there are much behind the World Health Organization's (WHO) recommended figure of 3 nurses per 1000. To mitigate the nurse shortage, a collaborative robotic system was designed that can assist with surgical procedures with a collaborative robot acting as a scrub nurse for cataract surgery (CRASCS) represented in Fig. 1. Accordingly, the model has been built to empower a customized 3d printed 5-Degree of freedom robotic arm by tracking the phase of surgery in real-time and automatically supplying the clinician with the ideal equipment that is needed for the particular phase of surgery. The system is supported with one more model which can identify where the surgical equipment is located within the arm range. The system is also supported with voice commands which help in picking up the right surgical equipment in the middle of any phase of the surgery. In this way, the system could be able to potentially handle the shortage of surgical nurses around the world and benefit humanity.

Complete Blood Cell Count-Derived Inflammation Biomarkers and the Need for Laser Capsulotomy Due to Posterior Capsule Opacification Following Cataract Surgery.

Background: Inflammation plays a significant role in the proliferation, migration, and differentiation of lens epithelial cells after cataract surgery, clinically manifested as posterior capsule opacification (PCO). This condition is typically treated with neodymium: yttrium-aluminum-garnet (Nd:YAG) laser capsulotomy. Our objective is to evaluate the association between blood-derived inflammatory markers and the development of clinically significant PCO necessitating treatment with laser capsulotomy. Materials and Methods: We conducted a retrospective review of charts for all patients who underwent Nd:YAG laser capsulotomy in our department between January 2021 and December 2022. The study included 70 patients who diagnosed with clinically significant PCO requiring treatment with Nd:YAG laser capsulotomy following cataract surgery, as well as 70 pseudophakic controls with no signs of PCO. Complete blood cell count parameters were obtained from medical records and the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR) were calculated. Results: The mean age of the Nd:YAG laser capsulotomy and control group was 71.83±8.46 and 72.27±9.98 years, respectively. The preoperative NLR scores for the Nd:YAG laser capsulotomy group (mean rank = 34.43) were statistically significantly higher than those of the control group (mean rank = 25.41) (p = 0.044). However, after adjusting for preoperative measurements, no statistically significant differences were observed between the groups for the other parameters. Conclusion: Preoperative NLR scores were higher in patients who developed clinically significant PCO requiring treatment with Nd:YAG laser capsulotomy. This finding suggests that patients with elevated systemic inflammation may be at an increased risk of developing PCO following cataract surgery. Further research is needed to evaluate the role of systemic inflammation in the pathogenesis of PCO.

Comparison of iodine compounds and levofloxacin as postoperative instillation; conjunctival bacterial flora and antimicrobial susceptibility following cataract surgery.

PURPOSE: To compare the cleanliness of the conjunctival sac following the use of iodine compounds (PAI) and levofloxacin as postoperative eye drops. STUDY DESIGN: A prospective open-label study. PATIENTS AND METHODS: Either topical levofloxacin or fourfold-diluted PAI was administered for 1 week postoperatively in 128 eyes of 128 patients who underwent routine cataract surgery. Conjunctival samples were obtained at three time points: pre-surgery, 1 week postoperatively, and 1 month postoperatively. RESULTS: The respective positive bacterial culture rates for postoperative iodine and levofloxacin were 88.1% and 85.2% pre-surgery, 71.6% and 50.8% 1 week postoperatively, and 92.5% and 86.5% 1 month postoperatively. Positive bacterial culture rates in both groups significantly declined at 1 week, and the rates returned to the baseline level 1 month postoperatively. The magnitude of reduction of DNA copy number detected by polymerase chain reaction at 1 week was larger in the levofloxacin group, although no significant differences were seen at pre-surgery or 1 month postoperatively. In the levofloxacin group, only one strain was culture positive at 1 week, however, its minimum inhibitory concentration (MIC) against S. epidermidis was high (128 µg/ml). The MIC value increased from 2.31 ± 2.19 µg/ml pre-surgery to 57.14 ± 22.34 µg/ml 1 month postoperatively, while no significant change was found in the iodine group. CONCLUSION: Postoperative iodine and levofloxacin eye drops both reduced bacterial contamination in the conjunctival sac, with a superior level of disinfection in the levofloxacin group. However, postoperative levofloxacin eye drops enhanced the emergence of highly resistant bacteria, whereas no such development was seen in the iodine group.

Tear Film Hyperosmolarity is Associated with Increased Variation of Light Scatter Following Cataract Surgery.

Purpose: To study the association between tear film hyperosmolarity and ocular light scatter in a cataract surgery population. Patients and Methods: Contiguous, 20-second objective scatter index (OSI) scans were recorded in hyperosmolar (≥320 mOsm/L) and normal subjects (<308 mOsm/L) with cataract nuclear opacity ≥3. OSI was measured at screening, baseline and 90 days following surgery. Along with symptoms of ocular surface disease, slit-lamp examination included corneal staining (0-3), tear film breakup time (TBUT) and evaluation of meibomian gland disease (MGD). An additional cohort of hyperosmolar subjects were measured for OSI at screening, baseline, and 5, 10, 15 and 30 minutes following instillation of 0.18% sodium hyaluronate (HA). Results: Thirty-one eyes of 31 patients were included. There was a significant difference in post-operative OSI variation when comparing hyperosmolar (0.65±0.30, N=11) to normal subjects (0.33±0.11, N=10, p=0.005). Of note, there were no significant differences in OSI variation when subjects were sorted by staining (p=0.9), TBUT (p=0.7), symptoms (p=0.7), or MGD status (p=0.9). Instillation of 0.18% HA (N=10) did not alter OSI at 5 minutes, but significant reductions in OSI of 28.8%, 38.5% and 36.7% (all p < 0.001) were observed at 10, 15 and 30 minutes. Conclusion: Hyperosmolar patients exhibited significantly increased variation in light scatter following cataract surgery that was undifferentiated by staining or TBUT. Elevated osmolarity may be indicative of light scatter equivalent to that of a grade 2-3 cataract.

Elevated concentrations of amyloid-ß oligomers and their proapoptotic effects on age-related cataract.

Recently, amyloid-ß oligomers (AßOs) have been studied as the primary pathogenic substances in Alzheimer's disease (AD). Our previous study revealed that the Aß expression level is closely related to ARC progression. Here, we demonstrated that the accumulation of AßOs in the lens epithelium of age-related cataract (ARC) patients increased during ARC progression and that this alteration was consistent with the changes in mitochondrial function, oxidative stress, and cellular apoptosis. In vitro, human lens epithelial cells (HLECs) treated with AßOs exhibited Ca2+ dyshomeostasis, impaired mitochondrial function, elevated oxidative stress levels, and increased apoptosis. Moreover, the proapoptotic effect of AßOs was alleviated after the uptake of mitochondrial Ca2+ was inhibited. These results establish that AßOs may promote HLEC apoptosis by inducing mitochondrial Ca2+ overload, thus preliminarily revealing the possible association between the accumulation of AßOs and other pathological processes in ARC.

Eye injuries caused by high intensity macro and micro focused ultrasound treatment: a case report.

BACKGROUND: High Intensity Macro and Micro Focused Ultrasound ( HIFU) is a safe and effective method for the treatment of skin laxity. However, the application of high-intensity focused ultrasound energy on eyelids has been associated with potential ocular complications including traumatic cataract, iridocyclitis, and conjunctival hemorrhage, among others. CASE PRESENTATION: A 40-year-old female developed blurred vision in her left eye after receiving HIFU treatment on binocular eyelids, and her left far vision was 20/66. The examination revealed left eye iris depigmentation and conjunctival hemorrhage. Both eyes exhibited multiple white streaking or tadpole-shaped opacities in the lenses. CONCLUSION: Excessive ultrasonic energy generated by HIFU can cause protein denaturation, leading to conditions such as traumatic cataract, visual impairment, injuries to the iris and conjunctiva when applied to the eyes. We recommend that individuals undergoing cosmetic treatment in the periorbital region should be highly aware of the possible ocular side effects.

Hydrodissection and femtosecond laser assisted surgery in posterior polar cataract.

PURPOSE: To present our clinical experience using femtosecond laser-assisted cataract surgery (FLACS) and cortical cleavage hydrodissection in eyes with posterior polar cataract. METHODS: Medical records of consecutive10 eyes of 6 patients with clinical diagnosis of posterior polar cataract (PPC), were retrospectively reviewed. All surgeries were done by using femtosecond laser-assisted cataract surgery. In all cases careful hydrodissection was done to separate the lens material from the posterior capsule. RESULTS: There were 3 males and 3 females, ages 39-73 years (average 52.5 years), two of them were implanted with toric lenses. In all eyes hydrodissection was successfully performed and the lens material was separated from the lens capsule. The posterior capsule remained intact during nucleus removal in all cases. In one eye the posterior capsule broke during cortical cleaning and the tear was converted to posterior capsulorhexis (PCCC). No postoperative complications were recorded during follow-up in all eyes. CONCLUSIONS: Hydrodissection can be safely performed in combination (but not exclusively) with FLACS, in eyes with posterior polar cataract with no evidence of a preexisting posterior capsule rent. Hydrodissection is regarded by most surgeons as contraindicated in these eyes however apparently it is more gentile to the capsule than any other surgical maneuver and allows clean and efficient separation of the lens material from the thinned posterior capsule. Femtosecond laser capsulotomy and lens fragmentation is effective and may further assist surgery by pneumo-separation of the lens material. Anterior chamber maintainer may further aid to the stability of the chamber and safety of surgery.

A survey of intraocular lens preferences of UK refractive surgeons for cataract surgery and refractive lens exchange.

BACKGROUND: To explore intraocular lens (IOL) preferences of United Kingdom-based (UK) refractive surgeons in cataract and refractive lens exchange (RLE) surgery. METHODS: An online survey on IOL preferences (and reasons for their choice) in cataract and RLE surgery was distributed. It also enquired about implementing mini-monovision with extended depth of field (EDoF) IOLs, about utilising IOL mix-and-match (different IOL types in each eye), and at what level of corneal astigmatism they prefer toric lenses. RESULTS: Following an 81.6% response rate, thirty responses were analysed; median years of refractive surgery experience was 12.5. The most popular IOL choices for cataract surgery were EDoF lenses (30%), monofocals (20%), and trifocals (20%). The most cited reason for each was better overall visual outcomes (88.9%), fewer unwanted symptoms (66.7%) and best spectacle independence (66.7%), respectively. For RLE, EDoF remained most popular (36.7%), followed by trifocals (30%), and multifocals (16.7%) with the same reasons for choice cited above. Mini-monovision with EDoF lenses was well-regarded (83% recommend for most/select patients), unlike utilising IOL mix-and-match (60% did not recommend). 40% prefer toric IOLs for astigmatism of 1 dioptre (D) or higher, whilst 30% opt for them at < 1D. CONCLUSIONS: Experienced UK refractive surgeons prefer newer IOLs with enhanced optics; ≥50% of respondents favoured either EDoF or trifocals for a 'typical' cataract or RLE patient. Notably, respondents have a low corneal astigmatism threshold for toric lenses. Mini-monovision with EDoF IOLs was well-regarded, whilst mix-and-match of different IOL types was less recommended.

Three Patient-Reported Outcomes Questionnaires in Japanese Patients Undergoing Cataract Surgery with Trifocal IOL Implantation.

Purpose: To analyze the patient-reported-outcomes obtained after trifocal intraocular lens (IOL) bilateral implantation in Japanese patients using three different validated questionnaires. Methods: Fifty-three patients implanted with the FineVision HP IOLs (Beaver-Visitec International, Inc. USA) were enrolled in this prospective-study. At 3-months, refraction (spherical equivalent [SE] and cylinder), logMAR uncorrected distance visual acuity (UDVA), and corrected distance visual acuity (CDVA) were obtained. Specifically, patient-reported-outcomes were evaluated using the NEI VFQ-25, the Catquest-9SF, and the PRSIQ questionnaires. Results: The mean SE and refractive cylinder were 0.00±0.22D and -0.07±0.23D, respectively. A 98.11% of eyes were within ±0.50D and 100% were within ±1.00D of the SE. A 93.40% of the eyes showed equal or less than 0.50D of astigmatism and 100% of eyes equal or less than 1.00D. The mean value for monocular UDVA was -0.05±0.07 logMAR and the mean value for monocular CDVA was -0.07±0.06 logMAR. 87.74% and 92.45% of the eyes showed 20/20 or better monocular UDVA and CDVA, respectively, with 97.17% and 98.11% showing 20/25 or better for UDVA and CDVA, respectively. The NEI VFQ-25 outcomes showed very high scores across all categories, with mean general vision, distance and near activities values of 86.70±6.35, 96.23±7.72 and 92.14±10.74, respectively. The outcomes for the Catquest-9SF questionnaire showed that 90.57% of patients did not report difficulty in their everyday-life with their sight, and 100% of them were "very or quite satisfied" with their sight at present. The PRSIQ outcomes revealed that 100%, 98.11% and 98.11% of patients did not need glasses or contacts for far, intermediate and near vision, respectively. Conclusion: The results of the patient-reported-outcomes questionnaires indicated that patients implanted bilaterally with the FineVision HP IOL have high vision and health related quality-of-life scores, with a high spectacle independence rate and high patient satisfaction.

Estimation of the Economic and Environmental Impact of Single-Use Instruments in Routine Cataract Surgery.

Purpose: To estimate the economic and environmental impact of single-use instruments (SUIs) to perform standard cataract surgery in six ophthalmology centers located in Europe and in the United States. Setting: Online survey and interview. Design: Comparative cost analysis based on an online survey with follow-up questionnaire and interview. The carbon footprint calculation was made by ClimatePartner. Methods: Annual costs of reusable instruments (RUIs) were calculated based on data provided by the centers. Annual costs of SUIs were estimated based on the average-selling price of a single-use cataract set of 5 instruments and the reported annual volume of cataract surgery. The calculation carbon footprint of a cataract instrument covered the whole life cycle from production to end-of-life. Results: Annual costs for SUIs were found inferior or similar to the annual costs for RUIs for 4 out of the 6 centers included in this study. The centers where SUIs were demonstrated to be the most cost-effective were also associated with the highest costs of sterilization per instrument. The carbon footprint of 5-years usage of a cataract instrument was found to be 5478.2 kg CO2 eq for SUIs without recycling, 4639.9 kg CO2 eq for SUIs with recycling and 20.6 kg CO2 eq for RUIs. Conclusion: The study demonstrated that SUIs can be an alternative solution to using RUIs in multispecialty hospitals associated with high sterilization costs.

[Comparative assessment of the state of the cornea after YAG-laser interventions on anterior segment structures]. / Sravnitel'naya otsenka sostoyaniya rogovitsy posle YAG-lazernykh vmeshatel'stv na strukturakh perednego segmenta glaza.

YAG-laser interventions are associated with the risk of complications, including in the cornea. PURPOSE: This study evaluates the condition of the cornea after laser discission (LD) of secondary cataracts (SC) and laser iridectomy (LI) using corneal confocal microscopy (CCM). MATERIAL AND METHODS: Group 1 included patients with the diagnosis "Pseudophakia, secondary cataract", they underwent LD of SC. Patients of group 1 were divided into 2 subgroups depending on the initial state of the cornea: group 1A included patients with unaltered corneas; group 1B - with changes in the corneas. Group 2 included patients diagnosed with angle-closure glaucoma (ACG) or suspected ACG, they underwent LI. CCM was performed on the Heidelberg HRT-III system. Laser treatment was performed using the Nd:YAG-laser LPULSA SYL-9000, λ=1.064 µm. RESULTS: Immediately after treatment, subgroup 1A exhibited singular hyperreflective deposits and negligible endothelial cell loss (ECL). After 1 month, CMM findings revealed no changes in this subgroup. In subgroup 1B, a post-LD reduction in endothelial cell density led to increased polymegathism, decreased pleomorphism, heightened endothelial cell nucleus reflectivity, and moderate hyperreflective deposits after 1 month. In the second group, significant hyperreflective deposits of various sizes, increased nucleus reflectivity, and notable endothelial cell density reduction were observed immediately and 1 month after LI. CONCLUSION: The results of this study show that the possibility of developing corneal complications after photo destructive laser interventions is to a certain extent related to the initial state of the cornea. The risk of developing corneal damage increases with decreasing distance between the cornea and the irradiated structure. An increase in the level of laser radiation energy and its total values also contributes to damage to the cornea, which is possible with dense secondary cataracts and thick irises.

[Efficacy of drainage implants in combined cataract and glaucoma surgery]. / Effektivnost' primeneniya drenazhei v kombinirovannoi khirurgii katarakty i glaukomy.

The combination of glaucoma and cataract occurs in 14.6-76% of cases, according to various sources. The goal of surgical treatment for these patients is to improve visual function while simultaneously reducing intraocular pressure. Due to the wide variety of proposed surgical methods, there is no consensus on the optimal management strategy for such patients. PURPOSE: This study evaluates the hypotensive effect and visual function outcomes of combined surgery for complicated cataract and glaucoma using the mesh drain made of digeland the xenocollagen drain. MATERIAL AND METHODS: Patients in Group 1 (n=43; 48.3%) underwent combined cataract and glaucoma surgery with implantation of the digel drainage implant, while patients in Group 2 (n=46; 51.7%) underwent an identical operation with the xenocollagen implant. Preoperative tonometric pressure was 27.2±1.7 and 27.3±1.9 mm Hg; best corrected visual acuity was 0.35±0.21 and 0.33±0.18, respectively. The following surgical technique was employed. At 3.0-4.0 mm from the limbus, an intrascleral tunnel was created using a 2.2 mm sclerotome through the conjunctiva in the anteroposterior direction, exiting into the anterior chamber. Capsulorhexis and phacoaspiration were performed. The scleral tunnel was widened to 3 mm, and the intraocular lens was implanted. Penetrating basal coloboma of the iris was formed. The deep flap of the scleral tunnel was dissected from the flat part of the ciliary body and removed. The digel implant was shaped into a T-configuration, while the xenocollagen implant was used without modification. Each drainage was implanted into the intrascleral tunnel (one end directed into the anterior chamber, the other exiting the scleral tunnel). The conjunctiva was sutured with 10/0 stitches, and the paracenteses were hydrated. RESULTS: Over a 24-month follow-up period, the tonometric intraocular pressure in Groups 1 and 2 was 18.8 and 18.5 mm Hg, respectively, and the best corrected visual acuity was 0.51 and 0.58. CONCLUSION: The use of both drainages in the proposed combined surgery for complicated cataract and glaucoma results in similarly stable hypotensive outcomes and high visual function.

Preoperative OCT lens evaluation in posterior subcapsular cataract - prevention of complications from phacoemulsification.

PURPOSE: To assess the possibility of anterior segment optical coherence tomography (AS-OCT)-based preoperative evaluation of the lens in order to prevent and predict intraoperative complications of posterior subcapsular cataract (PSC) surgery. METHODS: This prospective study included 512 eyes diagnosed with PSC. AS-OCT was performed using Line, Cross Line and 3D Cornea scans to visualize the posterior capsule. The posterior capsule and opacities in the subcortical and cortical lens, their relationship and the state of the retrolenticular space were assessed. The study sample was divided into three groups while taking into account the revealed morphological changes in the lens. Groups 1, 2, and 3 comprised 312, 185 and 15 eyes, respectively, with each group characterized by a specific type (1, 2 or 3) of morphological AS-OCT changes in the PSC. Surgery consisted of ultrasound phacoemulsification with intraocular lens implantation. Well-known measures related to cataract surgery stages were performed, if required, to preserve the integrity of the posterior capsule, while taking into account the type of PSC changes. We preoperatively determined the eyes at risk for intraoperative posterior capsular rupture (PCR) and detection of posterior capsular plaque (PCP), and compared this data with the postoperative data on the state of the posterior capsule. RESULTS: The PSC cases with an expected rate of intraoperative complications of 0 to 10% were classified as those with a low risk, whereas the rest, with a high risk of complications. Only eyes with type 2 or type 3 PSC changes were expected to have a high risk of intraoperative PCP, and only eyes with type 3 PSC changes, a high risk of PCR. In groups 1, 2 and 3, the rates of intraoperative PCP were 0%, 100% and 46.7%, respectively, and the rates of intraoperative PCR, 0%, 0% and 53.3%, respectively. There was a significant positive correlation between preoperative OCT-based morphology of the lens and intraoperative complications (r = 0.88, p ≤0.001). Sensitivity and specificity for the method of AS-OCT-based evaluation of risks of intraoperative complications in PSC surgery were 98.8% and 96.5%, respectively. CONCLUSION: AS-OCT allows evaluating preoperatively posterior lens opacification morphology and posterior capsular changes, determining the risks of complications, and performing surgical planning for PSC. KEY MESSAGES: What is Known? Complications (posterior capsule (PC) rupture with or without vitreous loss and residual PC plaque) are common in, and affect the expected outcome of, posterior subcapsular cataract (PSC) surgery. What is new? PC plaque is most likely in eyes with preoperative type 2 changes in the PSC, whereas eyes with preoperative type 3 changes are likely to show PC rupture or residual PC plaque. AS-OCT enables an experienced surgeon to predict the risks of intraoperative complications in, and perform surgical planning for, PSC surgery.

The effect of adrenaline and trypan blue used during cataract surgery on anatomical and functional outcomes in pseudoexfoliation syndrome patients.

PURPOSE: To evaluate the effect of the intracameral adrenaline and trypan blue used during cataract surgery on corneal endothelial parameters in pseudoexfoliation syndrome (PEX) patients. METHODS: The patients were divided into four groups according to intraoperative use of agents during cataract surgery: intracameral adrenaline (1/10,000, 0.1 ml) (group 1), trypan blue (0.6 mg/ml, 0.1 ml) (group 2), combination of adrenaline and trypan blue (group 3) and none (group 4). RESULTS: Preoperative ECD, CV, HEX and CCT parameters were similar between the groups. A mean loss of 12.7% in ECD was observed at the postoperative third months compared to the preoperative. In group 3, ECD was found to be lower in the postoperative third months compared to the preoperative (p = 0.014). In the other groups, no statistically significant difference was found in preoperative and postoperative comparisons. CONCLUSION: In conclusion, the utilization of intracameral adrenaline or trypan blue did not cause a significant difference in corneal endothelium in PEX patients. However, their combined use may have a negative effect on endothelial cell density. In a cataract surgery performed in the presence of PEX, the increased likelihood of endothelial damage should be taken into consideration, and appropriate precautions should be taken preoperatively and intraoperatively.

A novel method to optimize personal IOL constants.

OBJECTIVE: To describe a novel method called 'three variable optimization' that entails a process of doing just one calculation to zero out the mean prediction error of an entire dataset (regardless of size), using only 3 variables: 1) the constant used, 2) the average intraocular lens (IOL) power and 3) the average PE. DESIGN: Development, evaluation, and testing of a method to optimize personal IOL constants. METHODS: A dataset of 876 eyes was used as a training set, and another dataset of 1,079 eyes was used to test the method. The Barrett Universal II, Cooke K6, Haigis, RBF 3.0, Hoffer Q, Holladay 1, Holladay 2, SRK/T and T2 were analyzed. The same dataset was also divided into 3 subgroups (short, medium and long eyes). The three variable optimization process was applied to each dataset and subset, and the obtained optimized constants were then used to obtain the mean PE of each dataset. We then compared those results with those obtained by zeroing out the mean PE in the classical method. RESULTS: The three variable optimization showed similar results to classical optimization with less data needed to optimize and no clinically significant difference. Dividing the dataset into subsets of short, medium and long eyes, also shows that the method is useful even in those situations. Finally, the method was tested in multiple formulas and it was able to reduce the PE with no clinical significant difference from classical optimization. CONCLUSION: This method could then be applied by surgeons to optimize their constants by reducing the mean prediction error to zero without prior technical knowledge and it is available online for free at http://wwww.ioloptimization.com.

Introduction and Validation of Low-Cost Ocular Biometry in Healthy and Cataractous Eyes Using a Thermally-Tunable Swept-Source Laser.

PURPOSE: To introduce and validate a novel substantially lower-priced and rapid swept-source investigational optical biometer in healthy and cataractous eyes, employing a thermally tuned laser diode used extensively in cell-phones and data communication as an alternative swept-source. DESIGN: Prospective accuracy, validity, and reliability analysis. METHODS: Sixty eyes of 59 subjects (twenty-nine eyes of 29 healthy subjects and thirty-one eyes of 30 cataract patients) were enrolled in a prospective comparative study at the Vienna General Hospital between August 2021 and April 2023. Averaged intraocular distances were acquired in 2.5 seconds from datasets consisting of 5000 consecutive A-scans at a single position by a low-cost swept-source optical biometry (SSOB) system. Instrument repeatability was assessed via standard deviations (SDs) and coefficients of variation (COVs) of parameters such as axial length (AL), anterior chamber depth (ACD), lens thickness (LT), and central corneal thickness (CCT). Healthy subjects and cataract patients were subsequently measured on the same day with the SSOB and a referential partial coherence interferometry (PCI) biometer (IOL Master 500, Zeiss, Jena, Germany) to establish AL inter-device correlation (r) for instrument calibration. AL and ACD as shared parameters between both biometers were evaluated for their limits of agreements (LoA) using Bland-Altman analysis. RESULTS: Repeated measurements of AL, ACD, LT, and CCT revealed SDs of 18 µm, 12 µm, 12 µm, and 10 µm, respectively. All parameters except for CCT had a COV < 1%. Except for 1 eye with white cataract, 59 eyes of 59 study participants with various degrees and types of cataract could be measured with both devices. AL inter-device correlation was excellent (r=>0.99). The 95 % LoAs between both biometers were -0.14 to 0.13 mm for AL and -0.28 to 0.25 mm for ACD. CONCLUSIONS: Optical biometry using a thermally-tunable VCSEL swept source light source has the potential to provide clinically relevant biometric parameters at an unprecedented 100-fold lower price point than currently employed state of the art optical biometers, paving the way for compact devices in remote care settings.

Comparison of the IOL Master and Pentacam in the measurement of anterior segment parameters in patients with high myopia and cataracts.

PURPOSE: This study aimed to compare the differences between the Zeiss IOL Master and Oculus Pentacam in keratometry and central anterior chamber depth (ACD) measurements in patients with high myopia and cataracts. METHODS: Between January 2019 and December 2020, 89 patients (103 eyes) with cataracts and high myopia who underwent preoperative cataract evaluation at Nanchang First Hospital were selected for retrospective analysis. Keratometry (K1, K2) and ACD were measured with the IOL Master and Pentacam. Paired t-tests were performed to compare the differences, while the Bland-Altman method was used to evaluate the agreement. RESULTS: The K1 value was (43.15±2.44) D for the IOL Master and (42.98±2.47) D for the Pentacam, and the difference between the two instruments was statistically significant (P<0.01). The K2 value was (44.55±2.63) D for the IOL Master and (44.32±2.55) D for the Pentacam. The ACD was (3.44±0.33)mm for the IOL Master and (3.39±0.36)mm for the Pentacam. There were statistically significant differences between the two instruments in both keratometry and ACD (P<0.01). The absolute values of the maximum difference between the two instruments for K1 and K2 were 1.1 and 1.07; thus, the consistency of the two instruments with respect to this measurement was poor. However, the absolute value of the maximum difference between the two instruments for ACD was 0.34, so the consistency of the two instruments in relation to this measurement was good. CONCLUSIONS: Both the IOL Master and the Pentacam can be used in the measurement of keratometry and ACD in patients with high myopia and cataracts, but the keratometry measurements should be compared in clinical application.

Correlations among parameters of pentacam, iTrace, and LOCS III in assessing lens opacity.

OBJECTIVES: To investigate the diagnostic value of iTrace visual function analyzer, Pentacam 3D anterior segment analysis system and Lens Opacities Classification System III (LOCS III) in assessing lens opacity in patients with age-related cataract (ARC). METHODS: A total of 129 patients with ARC admitted to Anonymized from May 2019 to April 2021 were selected as the research objects. The degree of lens opacity was evaluated by LOCS III classification, iTrace and anterior segment analysis. RESULTS: The Pentacam nucleus staging (PNS) grade was strongly correlated with nuclear color (NC) (r = 0.537, p < 0.05) and moderately correlated with nuclear opalescence (NO) (r = 0.473, p < 0.05). The integrated density (IntDen) in 3-mm nuclear region was strongly correlated with NC (r = 0.548, p < 0.05) and NO (r = 0.539, p < 0.05). The dysfunctional lens index (DLI) in 3-mm area was negatively correlated with NC (r=-0.252, p < 0.05), NO (r=-0.239, p < 0.05) and posterior subcapsular cataract (r=-0.271, p < 0.05). PNS was weakly negatively correlated with the DLI in 3-mm area (r=-0.219, p < 0.05), and IntDen in 3-mm core area was weakly negatively correlated with the DLI in 3-mm area (r=-0.291, p < 0.05). CONCLUSION: A combination of iTrace, anterior segment analysis and LOCS III may be beneficial in objectively assessing the opacity of different regions of the lens.

Prevalence and Associated Factors of Cataract, Cataract Surgery and Postoperative Outcome in an Old Population in Russia: The Ural Very Old Study.

Purpose: To assess prevalence of cataract and cataract surgery in a very old population in Russia. Design: Population-based study. Participants: The Ural Very Old Study included 1526 (81.1%) participants of 1882 eligible individuals aged >85 years. Methods: Series of ophthalmological examinations. Main Outcome Measures: Prevalence of cataract and cataract surgery. Results: The study included 1163 (76.3%) individuals with lens information. Cataract surgery had been performed in 469 right eyes (41.0%; 95% confidence interval [CI]: 38.1-43.9) (92.1% with posterior chamber intraocular lens [IOL]; 4.7% with multifocal IOL) and 479 left eyes (41.6%; 95% CI: 38.7-44.4) (92.7% with posterior chamber IOL; 4.2% with multifocal IOL). Cataract surgery had been performed in at least one eye for 610 (52.5%) individuals. Higher prevalence of previous cataract surgery correlated (multivariable analysis) with lower IOP (OR: 0.92; 95% CI: 0.88-0.95), glaucomatous optic nerve damage stage (OR: 1.20; 95% CI: 1.05-1.36), and better visual acuity (OR: 0.67; 95% CI: 0.51-0.89). Postoperative best corrected visual acuity was reduced to moderate-to-severe vision impairment (MSVI) in 202 eyes (44.6%; 95% CI: 40.0-49.2) and to blindness in 53 eyes (11.7%; 95% CI: 8.7-14.7). Causes of postoperative MSVI were age-related macular degeneration (AMD) (34.2%), glaucoma (13.9%), and secondary cataract (5.4%). Causes for blindness were AMD (24.5%), glaucoma (18.9%), corneal opacifications (15.8%) and myopic macular degeneration (11.3%). Yttrium Aluminum Garnet-laser capsulotomy had been performed in 6 (1.3%) of 469 right eyes and 12 (2.5%) of 479 left eyes. Prevalence of nuclear cataract and cortical cataract was 604/671 (90.0% in phakic eyes; 51.9% in the whole study population) and 97.9% eyes (48.4% in total study population). Cataract caused bilateral MSVI and blindness in 28.2% (95% CI: 25.6-30) and 2.9% (95% CI: 1.9-3.9), respectively, of all study participants. Conclusions: Despite a relatively high prevalence of cataract surgery, this multiethnic cohort >85 years of aged from Russia showed a high prevalence of cataract-related MSVI and blindness. Main causes for postoperative MSVI (prevalence: 44.6%) and blindness (prevalence: 11.7%) were AMD, glaucoma, corneal opacifications, and myopic macular degeneration. Almost all individuals aged 85+ years need cataract surgery, despite limited chance of postoperative good vision. Financial Disclosures: The author(s) have no proprietary or commercial interest in any materials discussed in this article.