Clinical Evaluation of a New Spectral-Domain Optical Coherence Tomography-Based Biometer.

The VEMoS-AXL system is a new optical biometer based on spectral domain optical coherence tomography (SD-OCT) that has been tested in terms of intrasession repeatability and compared with a swept-source optical coherence tomography biometer (SS-OCT), which is recognized as the gold standard for the performance of an agreement analysis. A biometric analysis was performed three consecutive times in 120 healthy eyes of 120 patients aged between 18 and 40 years with the SD-OCT system, and afterwards, a single measurement was obtained with the SS-OCT system. Within-subject standard deviations were 0.004 mm, 4.394 µm, and 0.017 mm for axial length (AL), central corneal thickness (CCT), and anterior chamber depth (ACD) measures obtained with the SD-OCT biometer, respectively. The agreement between devices was good for AL (limits of agreement, LoA: -0.04 to 0.03 mm) and CCT (LoA: -4.36 to 14.38 µm), whereas differences between devices were clinically relevant for ACD (LoA: 0.03 to 0.21 mm). In conclusion, the VEMoS-AXL system provides consistent measures of anatomical parameters, being most of them interchangeable with those provided by the SS-OCT-based gold standard.

Perioperative intense pulsed light to prevent and improve symptoms of post-laser corneal refractive surgery dry eye. A randomized clinical trial.

PURPOSE: To evaluate the efficacy of perioperative IPL therapy in preventing postoperative ocular surface disorders in patients undergoing corneal laser refractive surgery. DESIGN: randomized, controlled, clinical trial with triple-blinding. METHODS: Setting: Vissum Miranza - Alicante; Study population: 61 patients randomized in two groups: 31 study patients (perioperative IPL + laser refractive surgery) and 30 control patients (perioperative placebo + laser refractive surgery). Follow-up was conducted over a 6-month period; Intervention: Each participants underwent three IPL sessions with a two-week interval between each session (pre-surgery, post-surgery week-one, and post-surgery week-three). For controls, placebo was administered following the same protocol. MAIN OUTCOMES MEASURES: visual outcomes and refraction, slit-lamp examination, corneal topography, visual analogue scale questionnaire and Oculus Keratograph 5 M including tear meniscus height, non-invasive tear break- up time, ocular redness, infrared meibography and Ocular Surface Disease Index (OSDI) questionnaire. RESULTS: 61 randomized eyes were included. No significant differences were observed in terms of uncorrected and corrected distance visual acuity (UDVA, CDVA), refractive error or corneal aberrations. A statistically significant improvement in OSDI score (change -8.47, p = 0.043), tear meniscus (change 0.05 mm, p = 0.004) and Meibography (change -0.42, p = 0.012) was observed at the third postoperative month in the study group. Additionally, at the sixth postoperative month, there were statistically significant improvements in tear meniscus (change 0.06 mm, p = 0.018), tear break-up-time (change 1.68 s, p = 0.039) and Meibography (change -0.37, p = 0.030). CONCLUSIONS: Results suggest that perioperative IPL therapy applied to laser corneal refractive surgery improves objective and subjective ocular surface parameters over non-IPL-treated control patients and early postoperative dry eye symptoms.

Clinical Retinal Image Quality of a Non-diffractive Wavefront-Shaping Extended Depth of Focus (Vivity) Intraocular Lens.

PURPOSE: To evaluate clinical retinal optical image quality following implantation of an extended depth of focus intraocular lens (EDOF IOL) (Vivity; Alcon Laboratories, Inc), and to compare it with a monofocal and a trifocal IOL. METHODS: This prospective, comparative, case-control study included 88 eyes implanted with: (1) 19 monofocal IOLs (AcrySof SA60AT; Alcon Laboratories, Inc); (2) 38 EDOF IOLs (AcrySof IQ Vivity); and (3) 31 trifocal IOLs (AT LISA tri 839MP; Carl Zeiss Meditec AG). Total root mean square, ocular lower (LOA) and higher (HOA) order aberrations, point spread function (PSF) Strehl ratio (PSF with LOA), and PSF Strehl ratio excluding LOA (PSF without LOA) were analyzed using a Pyramidal WaveFront-based sensor aberrometer Osiris (Costruzione Strumenti Oftalmici) at two different pupil sizes (3 and 4 mm). RESULTS: The trifocal IOL showed the highest PSF without LOA at both pupil sizes (0.52 ± 0.12 and 0.31 ± 0.07, respectively), followed by the AcrySof SA60AT (0.39 ± 0.10 and 0.27 ± 0.07) and AcrySof IQ Vivity (0.34 ± 0.11 and 0.24 ± 0.09) (P < .001). The AcrySof IQ Vivity and monofocal IOLs were comparable (P > .05). Despite the comparable postoperative low spherical equivalent among the IOL groups, the AT LISA tri 839MP retinal image quality (PSF with LOA) was the most severely affected by such residual refractive errors (dropped to 0.26 ± 0.06 at 3 mm; P < .001) compared to the monofocal AcrySof SA60AT (0.24 ± 0.07 at 3 mm) and EDOF Acrysof IQ Vivity (0.23 ± 0.06 at 3 mm) groups. The PSF with LOA was comparable (P > .05) among the three groups at both the 3-and 4-mm pupil size. CONCLUSIONS: Although trifocal IOLs provided significantly better retinal image quality if influence of LOA is excluded, they also demonstrated to be the most sensitive to residual refractive errors. Both the EDOF Acrysof IQ Vivity and mono-focal AcrySof SA60AT IOLs showed a comparable retinal image quality, and they are also comparable with trifocal IOLs when considering the clinically real PSF (PSF with LOA). [J Refract Surg. 2023;39(2):103-110.].

Stability of corneal topography and aberrometry after hyperopic laser in situ keratomileusis with a 500-Hz excimer laser platform: A 3-year follow-up study.

PURPOSE: The aim of this study is to analyze the long-term stability of the corneal topography, the functional optical zone, and the refractive stability throughout 3 years following laser in situ keratomileusis surgery for hyperopia using a 500-Hz excimer laser system. METHODS: This retrospective consecutive observational case series study comprised 66 eyes that underwent laser in situ keratomileusis to correct hyperopia with a postoperative follow-up of 3 years. Laser in situ keratomileusis procedures were performed using the SCHWIND Amaris 500-Hz excimer laser. Main outcomes measured were stability of the functional optical zone at corneal topography and corneal aberrometry. RESULTS: Statistically significant differences were found in simulated keratometry (K2 (steep meridian) and Km (mean keratometry)) between 3 and 36 months postoperatively (p ⩽ 0.01); these differences disappeared at 12 and 36 months (p ⩾ 0.18). No statistically significant changes were observed in the horizontal and vertical diameter of the functional optical zone throughout the whole follow-up (p ⩾ 0.07). A statistically significant difference was found in the spherical aberration between 3 and 36 months (p = 0.02); this difference disappeared when compared between 12 and 36 months (p = 0.72). Statistically significant correlations were detected between the vertical functional optical zone and coma root mean square (r = -0.510, p < 0.01) and between the vertical functional optical zone and spherical aberration (r = 0.441, p = 0.02) 36 months after surgery. CONCLUSION: Following 3 years of hyperopic laser in situ keratomileusis with a 500-Hz Amaris excimer laser, keratometry, functional optical zone, and corneal aberrations remain stable from 1 year after surgery. Topographical regression is not observed in hyperopic laser in situ keratomileusis with this excimer laser technology from 1 year after surgery.

Clinical evaluation of the repeatability of ocular aberrometry obtained with a new pyramid wavefront sensor.

PURPOSE: To evaluate the intrasubject repeatability of the ocular aberrometry obtained with a new ocular pyramidal aberrometer technology in a sample of normal eyes. METHODS: A total of 53 healthy eyes of 53 subjects with ages ranging from 18 to 45 years were included in this study. In all cases, three consecutive acquisitions were obtained. Intrasubject repeatability of the measurements with a pyramidal aberrometer was calculated. Intrasubject repeatability for 4.0- and 6.0-mm pupils was evaluated within the subject standard deviation (Sw) and intraclass correlation coefficient. RESULTS: Low values of the Sw and intraclass correlation coefficient outcomes close to 1 were observed for the sphere and cylinder at 3.0-mm pupil size. Most low Sw and intraclass correlation coefficient values close to 1 were observed for total, low-order aberrations and higher-order aberrations root mean square and for each Zernike coefficient analysis (intraclass correlation coefficient ⩾0.798) at 4.0-mm pupil size, with more limited outcomes for the aberrometric coefficient of Z(4, 4) with an intraclass correlation coefficient of 0.683. For a 6.0 mm pupil diameter, low Sw and intraclass correlation coefficient values close to 1 were observed for all aberrometric parameters or Zernike coefficients analyzed (intraclass correlation coefficient ⩾0.850). CONCLUSION: The new pyramidal aberrometer Osiris provides repeatable and consistent measurements of ocular aberrometry measurements in normal eyes.

Clinical outcomes with a diffractive trifocal intraocular lens.

PURPOSE: To evaluate clinical and visual outcomes, quality of near vision, and intraocular optical quality of patients bilaterally implanted with a trifocal PanOptix intraocular lens. METHODS: In this prospective consecutive case-series study, 52 eyes of 26 bilateral patients (mean age, 60.2 ± 7.4 years) were implanted with the AcrySof IQ Panoptix intraocular lens. Visual acuity, defocus curve, contrast sensitivity (Pelli-Robson test), near activity visual questionnaire, and internal aberrations with Osiris were evaluated. A prototype light-distortion analyzer was used to quantify the postoperative light-distortion indices. The follow-up was 6 months after surgery. RESULTS: Uncorrected, corrected distance, and uncorrected near visual acuities improved with the surgery (p ≤ 0.02). Distance corrected near visual acuity was 0.13 ± 0.10, 0.13 ± 0.13, and 0.13 ± 0.08 at 1, 3, and 6 months after surgery, respectively (p = 0.82). Distance corrected intermediate visual acuities were 0.09 ± 0.13, 0.13 ± 0.15, and 0.12 ± 0.12 at 1, 3, and 6 months, postoperatively. Binocular contrast sensitivity was 1.86 ± 0.15 Log Units. Defocus curve provided a visual acuity equal or better to 0.30 LogMAR between defocus levels of +0.50 to -3.00 D. The near activity visual questionnaire scores improved significantly with the surgery (p < 0.01). CONCLUSION: The AcrySof IQ Panoptix intraocular lens is able to restore visual function with an acceptable intermediate and near vision after cataract surgery with good contrast sensitivity and an improvement in the near activity visual questionnaire.

Quality of life related variables measured for three multifocal diffractive intraocular lenses: a prospective randomised clinical trial.

IMPORTANCE: Quality of vision after multifocal intraocular lens (IOLs) implantation in relation to patient satisfaction. It is important to include the evaluation of visual quality and patient satisfaction in clinical practice. BACKGROUND: To evaluate and compare quality of life and patient satisfaction after implantation of three types of diffractive-refractive and apodized-diffractive bifocal and trifocal multifocal IOLs. DESIGN: Comparative, prospective, case series and randomized. PARTICIPANTS: Hundred and four eyes of 52 patients. METHODS: Three multifocal IOLs: AT LISA 809 M (Carl Zeiss Meditec) (AT LISA group, 38 eyes), AT LISAtri 839MP (Carl Zeiss Meditec) (AT LISAtri group, 32 eyes), and ReSTOR SN6AD1 (Alcon) (ReSTOR group, 34 eyes) were implanted after cataract surgery. MAIN OUTCOME MEASURES: Contrast sensitivity, photopic phenomena, patient satisfaction and quality of life criteria were evaluated. RESULTS: Patient of ≥ 88% were satisfied with near and intermediate visual outcomes. Better distance-corrected intermediate visual acuity at 90 cm was detected for AT LISA tri group (P < 0.04). No statistically significant differences were found among groups in postoperative contrast sensitivity (P ≥ 0.053). There were no significant differences in spectacle dependence scores among the groups (P ≥ 0.180). The addition of an intermediate focus did not statistically affect halo and glare size and intensity (P ≥ 0.256) or subjective impact (P ≥ 0.077). Patient satisfaction was consistently high for all groups (P ≥ 0.154). CONCLUSIONS AND RELEVANCE: Contrast sensitivity outcomes and patient satisfaction remained high in the trifocal group when compared to the bifocal IOL groups.

Laser-Assisted in Situ Keratomileusis with Optimized, Fast-Repetition, and Cyclotorsion Control Excimer Laser to Treat Hyperopic Astigmatism with High Cylinder.

PURPOSE: To evaluate the visual outcomes after femtosecond laser-assisted laser in situ keratomileusis (LASIK) surgery to correct primary compound hyperopic astigmatism with high cylinder using a fast repetition rate excimer laser platform with optimized aspheric profiles and cyclotorsion control. METHODS: Eyes with primary simple or compound hyperopic astigmatism and a cylinder power ≥3.00 D had uneventful femtosecond laser-assisted LASIK with a fast repetition rate excimer laser ablation, aspheric profiles, and cyclotorsion control. Visual, refractive, and aberrometric results were evaluated at the 3- and 6-month follow-up. The astigmatic outcome was evaluated using the Alpins method and ASSORT software. RESULTS: This study enrolled 80 eyes at 3 months and 50 eyes at 6 months. The significant reduction in refractive sphere and cylinder 3 and 6 months postoperatively (p<0.01) was associated with an improved uncorrected distance visual acuity (p<0.01). A total of 23.75% required retreatment 3 months after surgery. Efficacy and safety indices at 6 months were 0.90 and 1.00, respectively. At 6 months, 80% of eyes had an SE within ±0.50 D and 96% within ±1.00 D. No significant differences were detected between the third and the sixth postoperative months in refractive parameters. A significant increase in the spherical aberration was detected, but not in coma. The correction index was 0.94 at 3 months. CONCLUSIONS: Laser in situ keratomileusis for primary compound hyperopic astigmatism with high cylinder (>3.00 D) using the latest excimer platforms with cyclotorsion control, fast repetition rate, and optimized aspheric profiles is safe, moderately effective, and predictable.

Multifocal intraocular lenses: An overview.

Multifocal intraocular lenses are increasingly used in the management of pseudophakic presbyopia. After multifocal intraocular lens implantation, most patients do not need spectacles or contact lenses and are pleased with the result. Complications, however, may affect the patient's quality of life and level of satisfaction. Common problems with multifocal lenses are blurred vision and photic phenomena associated with residual ametropia, posterior capsule opacification, large pupil size, wavefront anomalies, dry eye, and lens decentration. The main reasons for these are failure to neuroadapt, lens dislocation, residual refractive error, and lens opacification. To avoid patient dissatisfaction after multifocal intraocular lens implantation, it is important to consider preoperatively the patient's lifestyle; perform an exhaustive examination including biometry, topography, and pupil reactivity; and explain the visual expectations and possible postoperative complications.

Impact of low mesopic contrast sensitivity outcomes in different types of modern multifocal intraocular lenses.

PURPOSE: To investigate the low mesopic contrast sensitivity function (LMCSF) of patients implanted with different modern optical bifocal and trifocal designs of multifocal intraocular lenses (mfIOLs). METHODS: This prospective, comparative, nonrandomized consecutive case series included 180 eyes that underwent cataract surgery. Six groups of eyes were differentiated: group A, eyes with the diffractive AT LISA tri 839MP; group B, eyes with diffractive FineVision; group C, eyes with the bifocal Lentis Mplus-LS313; group D, eyes with the diffractive bifocal Acri.Lisa 366D; group E, eyes with the diffractive apodized Acrysof ReSTOR SN6AD1; group F, as the control group, implanted with a monofocal spherical intraocular lens. The LMCSF was evaluated with the OPTEC® 6500 device at 3 months postoperatively using a luminance of 3 cd/m2. RESULTS: No significant differences among groups were detected in LMCSF for the spatial frequencies of 1.5, 3.0, 6.0, and 12.0 cpd (1.5 cpd: F = 1.81, p = 0.13; 3.0 cpd: F = 1.14, p = 0.14; 6.0 cpd: F = 1.87, p = 0.11; 12.0 cpd: F = 1.26, p = 0.29), but significant differences were found among groups for the spatial frequency of 18 cpd (F = 2.62, p = 0.03). When comparing the groups in pairs, only statistically significant differences were observed between groups E and F for the spatial frequency of 18.0 cpd (t = 3.27, p = 0.03) with better values for group F. CONCLUSION: No significant differences were observed in LMCSF among the different mfIOLs studied. The third focus of trifocal IOL models did not adversely affect the LMCSF. The ReSTOR SN6AD1 showed the poorest LMCSF for the highest spatial frequency analyzed when compared with the control group.

Analysis of defocus curves of different modern multifocal intraocular lenses.

PURPOSE: To compare the visual performance in patients implanted with different modern multifocal intraocular lens (mfIOL) models using defocus curves. METHODS: This prospective, interventional, comparative, nonrandomized consecutive series of cases included 60 patients (45-87 years) who underwent binocular cataract surgery. Patients were divided into 4 groups depending on the intraocular lens (IOL) implanted after cataract surgery: group A, 15 patients with AT LISA tri 839MP IOL (Carl Zeiss Meditec); group B, 15 patients with FineVision trifocal IOL (PhysIOL); group C, 15 patients with ReSTOR SN6AD1 bifocal IOL (Alcon); and group D, 15 patients with Acri.Smart 48S monofocal IOL (Carl Zeiss Meditec). Distance and near visual acuity outcomes and defocus curve of each one of the mfIOLs were evaluated postoperatively during a 3-month follow-up. RESULTS: Statistically significant differences in distance and near vision were found among groups (p<0.01). Statistically significant differences were found among groups (p<0.01) for defocus levels ranging from -4.00 D to +0.50 D. Statistically significant differences were found between trifocal IOL groups for defocus levels ranging from -2.00 to +1.00 D (p<0.01), with better values of visual acuity for group A. Statistically significant differences were detected between groups A and C for defocus levels of -1.50 and -1.00 D with better visual acuity for group A. CONCLUSIONS: Multifocal IOLs provide good distance, near, and intermediate visual acuity. The AT LISA tri MP839 showed better outcomes for intermediate vision than the FineVision and AcrySof ReSTOR SN6AD1 IOLs. By knowing the defocus curve profile of each lens, the surgeon can select the best IOL.

Optical Profile Following High Hyperopia Correction With a 500-Hz Excimer Laser System.

PURPOSE: To evaluate corneal higher order aberrations after LASIK for the correction of high hyperopia using a 500-Hz excimer laser and optimized ablation profile. METHODS: Retrospective consecutive study including 51 eyes of 28 patients (age range: 21 to 54 years) with high hyperopia or hyperopic astigmatism (sphere ≥ 5.00 diopters). All cases underwent LASIK using the sixth generation Amaris excimer laser (SCHWIND eye-tech-solutions, Kleinostheim, Germany) and a femtosecond laser platform for flap creation. Postoperative changes in corneal higher order aberrations for the 4-, 5-, and 6-mm pupil diameters and corneal asphericity for 4.5 and 8 mm were represented at the end of the 6-month follow-up. RESULTS: A significant increase in corneal root mean square higher order, spherical, and coma aberrations was observed 6 months after surgery (P < .01). Corneal asphericity for the 4.5-mm (Q45) and 8-mm (Q8) corneal diameter also changed significantly during the postoperative period (P < .01). Strehl ratio change was not statistically significant (P = .77). CONCLUSIONS: Correction of high hyperopia with LASIK significantly induces corneal higher order aberrations regardless of the physiologic level of photopic and mesopic pupil conditions.

Clinical outcomes with a new microincisional diffractive multifocal IOL.

BACKGROUND: To evaluate the refractive outcomes and the optical performance as well as the quality of life in patients implanted with a new diffractive multifocal intraocular lens (IOL). METHODS: Prospective, clinical study including 41 cases of patients who underwent cataract surgery and were divided in two groups: group 1, including 20 eyes implanted with the multifocal IOL SeeLens MF (Hanita Lenses, Israel); group 2, 21 eyes implanted with the Acrysof SA60AT IOL. Visual acuity, defocus curve, intraocular aberrations, contrast sensitivity function and quality of life were assessed during a follow up period of 6 months. RESULTS: Significant improvement was observed in the uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA) in both groups (p < 0.02). The multifocal group showed better results in terms of uncorrected near visual acuity (UNVA) and distance-corrected near visual acuity (DCNVA) (p < 0.01). Comparison of both groups showed better visual acuities for the multifocal IOL group in defocus levels from -3.0 D to -1.50 D (p ≤ 0.01). At 6 months, there was a significant reduction of the internal higher order aberrations (p ≤ 0.04). A significant increase in scotopic contrast sensitivity was detected for 6 cycles/° spatial frequency during follow up (p = 0.04), but no significant changes were observed for the rest of spatial frequencies (p ≥ 0.06). Visual Functioning Index (VF-14) questionnaire showed that patients reported high levels of satisfaction when performing daily tasks. CONCLUSIONS: The SeeLens MF IOL is able to successfully restore distance, near and intermediate visions after cataract surgery. It also provides functional intermediate vision with optimal intraocular optical quality.

Three-Year Follow-up of Hyperopic LASIK Using a 500-Hz Excimer Laser System.

PURPOSE: To evaluate the long-term visual, refractive, and corneal aberrometric outcomes and regression of the achieved correction of hyperopia with a sixth-generation excimer laser. METHODS: This retrospective, consecutive, observational case series study comprised 86 eyes of 44 patients who underwent LASIK to correct hyperopia with a postoperative follow-up of 3 years. LASIK procedures were performed using the sixth-generation Amaris excimer laser (Schwind eye-tech-solutions GmbH and Co., Kleinostheim, Germany). Visual acuity, manifest refraction, corneal topography, and aberrometry were evaluated in the follow-up. RESULTS: Three years postoperatively, 65 eyes (76%) had an uncorrected distance visual acuity of 20/20 or better. Five eyes (6.2%) lost one or more lines of corrected distance visual acuity. Sixty eyes (70%) had a spherical equivalent within ± 0.50 diopters (D). There was regression of 0.47 D between 3 and 36 months postoperatively. Statistically significant differences were found in spherical equivalent between 3 and 36 months (P < .01), but no differences were observed between 12 and 36 months (P = .08). A flattening of 0.16 D was observed between 3 and 36 months after surgery in the mean simulated keratometry. A significant increase of root mean square spherical-like, coma-like, and higher-order aberrations (P < .01) were observed postoperatively. Twenty-five eyes (29%) required re-treatment. CONCLUSIONS: Treatment of hyperopia using the sixth-generation Amaris excimer laser provides good results in terms of efficacy, safety, predictability, and visual outcomes after 3 years. The refractive stability shows a significant regression in the first 12 months after surgery with more stable results from 12 months postoperatively.

Keratoconus progression after intrastromal corneal ring segment implantation in young patients: Five-year follow-up.

PURPOSE: To analyze whether implantation of intrastromal corneal ring segments (ICRS) influences the progression of keratoconus in young patients. SETTING: Vissum Corporation, Alicante, Spain. DESIGN: Retrospective case series. METHODS: Eyes with confirmed progressive keratoconus and ICRS (Intacs or Keraring) were evaluated. The visual, refractive, topographic, and aberrometric outcomes were assessed at 2 preoperative examinations to confirm the progressive nature of each case. The postoperative follow-up was 5 years. RESULTS: The study evaluated 18 eyes in 15 patients with a mean age of 25.75 years ± 3.59 (SD). All the visual, refractive, and topographic measurements worsened between the 2 preoperative examinations, confirming the progressive nature of the cases. Six months postoperatively, there was improvement in the uncorrected and corrected distance visual acuities (P > .05) and all refractive measurements (P < .05) and the mean keratometry (K) was reduced by 4.48 diopters (D) (P < .01). Immediately after the procedure, the visual and refractive variables improved but then worsened. From 6 months postoperatively to 5 years, the mean K value regressed 3.36 D. CONCLUSION: Implantation of ICRS significantly improved the visual, refractive, and topographic parameters in the short term; however, the regression at 5 years suggests that implantation of ICRS does not significantly influence progressive keratoconus in young patients with confirmed progression of the disease. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Correlating optical bench performance with clinical defocus curves in varifocal and trifocal intraocular lenses.

PURPOSE: To investigate the correlations existing between a trifocal intraocular lens (IOL) and a varifocal IOL using the "ex vivo" optical bench through-focus image quality analysis and the clinical visual performance in real patients by study of the defocus curves. METHODS: This prospective, consecutive, nonrandomized, comparative study included a total of 64 eyes of 42 patients. Three groups of eyes were differentiated according to the IOL implanted: 22 eyes implanted with the varifocal Lentis Mplus LS-313 IOL (Oculentis GmbH, Berlin, Germany); 22 eyes implanted with the trifocal FineVision IOL (Physiol, Liege, Belgium), and 20 eyes implanted with the monofocal Acrysof SA60AT IOL (Alcon Laboratories, Inc., Fort Worth, TX). Visual outcomes and defocus curve were evaluated postoperatively. Optical bench through-focus performance was quantified by computing an image quality metric and the cross-correlation coefficient between an unaberrated reference image and captured retinal images from a model eye with a 3.0-mm artificial pupil. RESULTS: Statistically significant differences among defocus curves of different IOLs were detected for the levels of defocus from -4.00 to -1.00 diopters (D) (P < .01). Significant correlations were found between the optical bench image quality metric results and logMAR visual acuity scale in all groups (Lentis Mplus group: r = -0.97, P < .01; FineVision group: r = -0.82, P < .01; Acrys of group: r = -0.99, P < .01). Linear predicting models were obtained. CONCLUSIONS: Significant correlations were found between logMAR visual acuity and image quality metric for the multifocal and monofocal IOLs analyzed. This finding enables surgeons to predict visual outcomes from the optical bench analysis.

Vector analysis of astigmatism correction after toric intraocular lens implantation.

PURPOSE: To determine astigmatic changes by vector analysis and postoperative refractive and visual outcomes after implantation of the monofocal aspheric bitoric AT Torbi 709M toric intraocular lens (IOL). SETTING: Three centers in Salzburg, Austria, and Alicante and San Sebastián, Spain. DESIGN: Prospective interventional case series. METHODS: Preoperative and postoperative visual acuity, subjective and objective refractions, and corneal radii using a topographer were examined in all patients. All patients had postoperative examinations within the first week and at 6 to 12 weeks. Astigmatic changes were evaluated using the Alpins vector method based on 3 fundamental vectors as follows: target induced astigmatism (TIA), surgically induced astigmatism (SIA), and difference vector. The various relationships between these 3 vectors were calculated, providing an extensive description of the astigmatic correction achieved. RESULTS: Eighty-eight eyes (71 patients) were included. Postoperatively, refractive cylinder was reduced significantly (P < .001), concurrent with visual improvement. The mean magnitude of the SIA vector (2.54 diopters [D] ± 1.21 [SD]) was slightly higher than the mean magnitude of the TIA vector (2.37 ± 1.15 D) at the last follow-up. The mean difference vector was 0.46 ± 0.46 D, the mean magnitude of error was 0.16 ± 0.46 D, and the mean correction index was 1.09 ± 0.21, all indicating minimal overcorrection at 3 months that remained stable during the follow-up. CONCLUSION: Implantation of the toric IOL was safe and effective for the treatment of eyes with cataract in combination with preexisting regular corneal astigmatism over a short-term follow-up. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Geometrical custom modeling of human cornea in vivo and its use for the diagnosis of corneal ectasia.

AIM: To establish a new procedure for 3D geometric reconstruction of the human cornea to obtain a solid model that represents a personalized and in vivo morphology of both the anterior and posterior corneal surfaces. This model is later analyzed to obtain geometric variables enabling the characterization of the corneal geometry and establishing a new clinical diagnostic criterion in order to distinguish between healthy corneas and corneas with keratoconus. METHOD: The method for the geometric reconstruction of the cornea consists of the following steps: capture and preprocessing of the spatial point clouds provided by the Sirius topographer that represent both anterior and posterior corneal surfaces, reconstruction of the corneal geometric surfaces and generation of the solid model. Later, geometric variables are extracted from the model obtained and statistically analyzed to detect deformations of the cornea. RESULTS: The variables that achieved the best results in the diagnosis of keratoconus were anterior corneal surface area (ROC area: 0.847, p<0.000, std. error: 0.038, 95% CI: 0.777 to 0.925), posterior corneal surface area (ROC area: 0.807, p<0.000, std. error: 0.042, 95% CI: 0,726 to 0,889), anterior apex deviation (ROC area: 0.735, p<0.000, std. error: 0.053, 95% CI: 0.630 to 0.840) and posterior apex deviation (ROC area: 0.891, p<0.000, std. error: 0.039, 95% CI: 0.8146 to 0.9672). CONCLUSION: Geometric modeling enables accurate characterization of the human cornea. Also, from a clinical point of view, the procedure described has established a new approach for the study of eye-related diseases.

Clinical and optical intraocular performance of rotationally asymmetric multifocal IOL plate-haptic design versus C-loop haptic design.

PURPOSE: To compare the visual and intraocular optical quality outcomes with different designs of the refractive rotationally asymmetric multifocal intraocular lens (MFIOL) (Lentis Mplus; Oculentis GmbH, Berlin, Germany) with or without capsular tension ring (CTR) implantation. METHODS: One hundred thirty-five consecutive eyes of 78 patients with cataract (ages 36 to 82 years) were divided into three groups: 43 eyes implanted with the C-Loop haptic design without CTR (C-Loop haptic only group); 47 eyes implanted with the C-Loop haptic design with CTR (C-Loop haptic with CTR group); and 45 eyes implanted with the plate-haptic design (plate-haptic group). Visual acuity, contrast sensitivity, defocus curve, and ocular and intraocular optical quality were evaluated at 3 months postoperatively. RESULTS: Significant differences in the postoperative sphere were found (P = .01), with a more myopic postoperative refraction for the C-Loop haptic only group. No significant differences were detected in photopic and scotopic contrast sensitivity among groups (P ⩾ .05). Significantly better visual acuities were present in the C-Loop haptic with CTR group for the defocus levels of -2.0, -1.5, -1.0, and -0.50 D (P ⩽.03). Statistically significant differences among groups were found in total intraocular root mean square (RMS), high-order intraocular RMS, and intraocular coma-like RMS aberrations (P ⩽.04), with lower values from the plate-haptic group. CONCLUSIONS: The plate-haptic design and the C-Loop haptic design with CTR implantation both allow good visual rehabilitation. However, better refractive predictability and intraocular optical quality was obtained with the plate-haptic design without CTR implantation. The plate-haptic design seems to be a better design to support rotational asymmetric MFIOL optics.

Laser in situ keratomileusis using optimized aspheric profiles and cyclotorsion control to treat compound myopic astigmatism with high cylinder.

PURPOSE: To evaluate the visual outcomes after laser in situ keratomileusis (LASIK) surgery to correct primary compound myopic astigmatism with high cylinder performed using a fast-repetition-rate excimer laser platform with optimized aspheric profiles and cyclotorsion control. SETTING: Vissum Corporation and Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain. DESIGN: Retrospective consecutive observational nonrandomized noncomparative case series. METHODS: Eyes with primary compound myopic astigmatism and a cylinder power over 3.00 diopters (D) had uneventful LASIK with femtosecond flap creation and fast-repetition-rate excimer laser ablation with aspheric profiles and cyclotorsion control. Visual, refractive, and aberrometric outcomes were evaluated at the 6-month follow-up. The astigmatic correction was evaluated using the Alpins method and Assort software. RESULTS: The study enrolled 37 eyes (29 patients; age range 19 to 55 years). The significant reduction in refractive sphere and cylinder 3 months and 6 months postoperatively (P<.01) was associated with improved uncorrected distance visual acuity (P<.01). Eighty-seven percent of eyes had a spherical equivalent within ±0.50 D; 7.5% of eyes were retreated. There was no significant induction of higher-order aberrations (HOAs). The targeted and surgically induced astigmatism magnitudes were 3.23 D and 2.96 D, respectively, and the correction index was 0.91. The safety and efficacy indices were 1.05 and 0.95, respectively. CONCLUSIONS: Laser in situ keratomileusis for primary compound myopic astigmatism with high cylinder (>3.00 D) performed using a fast-repetition-rate excimer laser with optimized aspheric profiles and cyclotorsion control was safe, effective, and predictable and did not cause significant induction of HOAs.