Mix-and-match vs bilateral trifocal and bilateral EDOF intraocular lens implantation: the spline curve battle.

PURPOSE: To compare the postoperative visual acuity curves following 3 pseudophakic presbyopic correction techniques. SETTING: Department of Ophthalmology, University Hospital of Alexandroupolis, Alexandroupolis, Greece. DESIGN: Prospective, randomized, comparative trial. METHODS: For this study, patients with stage 2 Lens Opacities Classification System III cataract were divided into 3 study groups: (1) premium monovision group, including patients who received the Panoptix intraocular lens (IOL) in the recessive eye and Vivity IOL in the dominant one; (2) bilateral trifocal group, including those who received bilaterally the Panoptix IOL; and (3) bilateral xEDOF group, including patients who received bilaterally the Vivity IOL. Postoperative bilateral uncorrected distance visual acuity was measured at 25.5, 28, 33, 40, 50, 66, 100, 200, and 300 cm distances. Spline curve fitting was attempted, and areas of the curves (AOCs) and curvature k were calculated. All patients responded to the National Eye Institute Visual Functioning Questionnaire-25 (NEI-VFQ-25). RESULTS: 90 patients were equally divided into the 3 groups. Premium monovision and bilateral trifocal implantations delivered similar visual acuity (all AOC P > .05); however, the trifocal patients suffered from drops in vision acuity in certain distance ranges as expressed by negative curvature values. Bilateral xEDOF patients demonstrated worse near vision acuity ( P < .05). Premium monovision patients reported better scores in NEI-VFQ 25 ( P = .03) and in the near activities ( P = .02) and distant activities ( P = .04) subscales. CONCLUSIONS: All surgical options provided impressive outcomes. Premium monovision appeared to deliver the best results.

Bilateral Stellate Nonhereditary Idiopathic Foveomacular Retinoschisis (SNIFR) Incidentally Identified in a Non-Myopic Female.

Stellate foveomacular retinoschisis is commonly associated with congenital X-linked retinoschisis, which is almost exclusively seen bilaterally in males. In the absence of a family history of retinoschisis and other related conditions, the term stellate nonhereditary idiopathic foveomacular retinoschisis (SNIFR) is used. SNIFR constitutes a rather rare diagnosis and is usually observed unilaterally in myopic females. Within this context, we report a case of a non-myopic female patient with bilateral SNIFR detected with optical coherence tomography (OCT).

A systematic review of reading tests.

Adequate near and intermediate visual capacity is important in performing everyday tasks, especially after the introduction of smartphones and computers in our professional and recreational activities. Primary objective of this study was to review all available reading tests both conventional and digital and explore their integrated characteristics. A systematic review of the recent literature regarding reading charts was performed based on the PubMed, Google Scholar, and Springer databases between February and March 2021. Data from 11 descriptive and 24 comparative studies were included in the present systematic review. Clinical settings are still dominated by conventional printed reading charts; however, the most prevalent of them (i.e., Jaeger type charts) are not validated. Reliable reading capacity assessment is done only by those that comply with the International Council of Ophthalmology (ICO) recommendations. Digital reading tests are gaining popularity both in clinical and research settings and are differentiated in standard computer-based applications that require installation either in a computer or a tablet (e.g., Advanced VISION Test and web-based ones e.g., Democritus Digital Acuity Reading Test requires no installation). It is evident that validated digital tests will prevail in future clinical or research settings and it is upon ophthalmologists to select the one most compatible with their examination routine.

Premium Monovision versus Bilateral Myopic Monovision, Hybrid Monovision and Bilateral Trifocal Implantation: A Comparative Study.

Purpose: Contemporary monovision techniques use premium intraocular lenses (IOLs), either in both eyes or at least in the non-dominant one. Primary objective of this study was to compare the efficacy of premium monovision (implantation of the trifocal diffractive Panoptix IOL in the non-dominant eye and the bifocal hybrid refractive-diffractive Restor IOL in the dominant eye), against bilateral myopic monovision (implantation of the monofocal SN60WF IOL targeting -0.50 D in the dominant eye and -1.25 D myopia in the non-dominant one), hybrid monovision (implantation of Panoptix in the non-dominant eye and SN60WF in the dominant eye) and bilateral trifocal implantation (with bilateral Panoptix implantation). Methods: This is a prospective, comparative, clinic-based trial. Cataract patients populated four study groups: Monovision Group (MoG), Multifocal Lens Group (MfG), Hybrid Monovision Group (HmG) and Premium Monovision Group (PmG). Binocular Uncorrected Distance Visual Acuity (UDVA), Uncorrected Reading Acuity and Critical Print Size at 60cm (UIRA, UICPS) and at 40cm (UNRA, UNCPS), contrast sensitivity, vision-related functional impairment, dysphotopsia symptoms and spectacle dependence were evaluated 6 months following the operation of the second eye. A mathematical model was constructed, which calculated the relative efficacy of each surgical intervention. Results: A total of 120 participants were recruited and populated equally the study groups. Significant improvement of preoperative UDVA was observed in all study groups. No significant differences could be detected in postoperative UDVA and UIRA (p = 0.24) among study groups, while significant differences were noticed in UICPS (p = 0.04), UNRA (p = 0.02) and UNCPS (p = 0.01). Dysphotopic phenomena (glare and shadows) were significantly more in the MfG arm followed by the PmG group (p = 0.04 and p = 0.02, respectively), while perceived difficulty and spectacle independence rates were significantly better in PmG group. PmG presented the best overall relative efficacy. Conclusion: All surgical techniques present satisfactory outcomes. Premium monovision seems to demonstrate the best outcomes. Trial Registration: ClinicalTrials.gov, NCT04618380. Registered 05 November 2020, https://clinicaltrials.gov/ct2/show/NCT04618380.

Development and Validation of a Web-Based Reading Test for Normal and Low Vision Patients.

PURPOSE: To develop and validate a web-based reading test for normal and low vision patients. METHODS: This is a prospective, comparative trial. The web-based Democritus Digital Acuity Reading Test (wDDART) was developed. wDDART introduces a series of advanced characteristics (advanced text calibration, computer-vision-based estimation of patient's distance, and automatic calculation of patient's reading times) that facilitate the overall examination procedure. wDDART's reading parameters [reading acuity (RA), maximum reading speed (MRS), critical print size (CPS) and reading accessibility index (ACC)] were compared to the corresponding ones of its conventional Windows-based reading test (DDART) in a sample of normal and low vision participants. wDDART's test-retest reliability for all reading parameters was evaluated in a 15-day time-window. RESULTS: One hundred patients (normal vision group-NVG: 70; low vision group-LVG: 30 patients) responded to DDART and wDDART. Non-significant differences between the two reading tests were found for all parameters in NVG and LVG. Intraclass correlation coefficients (ICCs) between the two tests demonstrated good or excellent correlation for RA, MRS, ACC and moderate correlation for CPS. Test-retest reliability was excellent for RA and ACC, while ICCs were 0.715-0.895 for MRS and CPS. CONCLUSION: The wDDART demonstrated sufficient validity and repeatability making it suitable for clinical and research settings. CLINICALTRIALSGOV IDENTIFIER: NCT04618224.

Α Case of Severe Thyroid Eye Disease Treated with Tocilizumab.

This is a case report describing a patient with severe thyroid eye disease complicated with dysthyroid optic neuropathy that was unresponsive to intravenous steroids and orbital radiotherapy but responded well to intravenous tocilizumab.

The Effect of Antiglaucoma Procedures (Trabeculectomy vs. Ex-PRESS Glaucoma Drainage Implant) on the Corneal Biomechanical Properties.

The aim of this study is to investigate the effect of two antiglaucoma procedures, namely trabeculectomy and Ex-PRESS mini-shunt insertion on the biomechanical properties of the cornea. This is a prospective study. Thirty patients (30 eyes) were included in the study. Nineteen eyes had an Ex-PRESS shunt inserted (Group 1) and 11 had trabeculectomy (Group 2). The examination time points for both groups were one to three weeks preoperatively and at month 1, 6, and 12 postoperatively. Corneal biomechanical properties (corneal hysteresis (CH) corneal resistance factor (CRF)) were measured with the Ocular Response Analyzer (ORA). In group 1, CH was significantly increased at 6 and 12 months compared to baseline values. Corneal hysteresis was also higher at 1 month postoperatively, but this increase did not reach statistical significance. In group 2, the CH was significantly increased at all time points compared to the preoperative values. CRF decreased at all time points postoperatively compared to the preoperative values in both groups. The difference (preoperative values to postoperative values at all time points) of the CH and CRF between the two groups was also compared and no significant differences were detected between the two surgical techniques. Trabeculectomy and the EX-PRESS mini-shunt insertion significantly alter the corneal biomechanical properties as a result of the surgical trauma and the presence of the shunt in the corneal periphery. When compared between them, they affect the corneal biomechanical properties in a similar way.

Determinants of compliance to the facemask directive in Greece: A population study.

PURPOSE: Primary objective of this study was to identify potential difficulties and/or discomfort when using a facemask. Moreover, to explore the impact of spectacles, contact lenses and visual acuity on the compliance to the facemask directive. METHODS: This is a prospective study that was conducted at the Department of Ophthalmology, University Hospital of Alexandroupolis, Greece between June 2020 and August 2020. Greek speaking citizens with permanent residency in Greece above 18 years old were included. A custom questionnaire (DeMask-20) was constructed and validated, which pertained to the perceived difficulty and discomfort when using a facemask. It contained 20 items grouped in 8 subscales (driving, near vision, distance vision, ocular discomfort, role limitation, collaboration, dependency on others, emotional stress). Perceived difficulty and discomfort when using a facemask, compliance and correlations of compliance with DeMask-20 scores, demographics, spectacle and/or contact lens use, and visual acuity were evaluated. RESULTS: The number of factors was determined through factor analysis. Cronbach's alpha ranged from 0.716 for the "Role limitation" subscale to 0.938 for "Ocular discomfort" subscale. 1,214 participants (402 men, 812 women, mean age 36.79±12.50 years) completed the DeMask-20 instrument. Mean DeMask-20 score of all study participants was 3.79±0.71. Significant differences in DeMask-20 score were detected in gender (p = 0.009), spectacle use (p = 0.034), contact lens use (p = 0.049), and binocular distance visual acuity (bDVA) (p = 0.001). Mean compliance of all participants was 4.05±0.96. Men, people <50 years and spectacle wearers showed significantly worse compliance (p<0.05). Moreover, professional workers and professional drivers demonstrated significantly better compliance (p = 0.008 and p = 0.047). Significant correlation was detected between compliance and DeMask-20 score (p<0.001, R2 = 0.471). Significant correlations were detected with driving, near vision, distance vision, collaboration, role limitation, emotional stress (p<0.05, R2: 0.386-0.493). CONCLUSIONS: Factor analysis suggested that the DeMask-20 instrument demonstrates adequate validity, while Cronbach's alpha indicated sufficient internal consistency of all subscales. This study provided the necessary methods that could evaluate compliance trends and the efficacy of healthcare interventions against COVID-19. Our outcomes suggest that young males who use spectacles should be targeted by Greek Healthcare authorities in order to improve compliance rates.

Corneal Graft Success Rates in HSV Keratitis: A Systematic Review.

Herpes Simplex Virus (HSV) has worldwide prevalence. The primary objective of this systematic review was to compare penetrating keratoplasty (PK) and deep anterior lamellar keratoplasty (DALK) regarding the efficacy and complications of the treatment of corneal scarring caused by herpes simplex keratitis. Out of the 469 articles identified during the combined search of the literature based on the PubMed and Cochrane libraries, 10 retrospective and 2 prospective studies published from January 2010 to December 2019 were included. The study outcomes indicated that both surgical approaches resulted in a comparable improvement of visual acuity (VA). However, DALK demonstrated fewer complications in the majority of studies. Higher graft survival rates were associated with higher acyclovir (ACV) doses (above 800 mg/day), topical steroid and antibiotic drops. In conclusion, in terms of postoperative VA, both PK and DALK demonstrate comparable efficacy. However, DALK, which is applied in less severe HSK cases, is associated with fewer complications and better graft survival rates. High dosages of ACV, topical steroids and antibiotics contribute significantly to improved postoperative outcomes.

Comparison of Subthreshold 532 nm Diode Micropulse Laser with Conventional Laser Photocoagulation in the Treatment of Non-Centre Involved Clinically Significant Diabetic Macular Edema.

BACKGROUND: The aim of the study was to investigate the effect of the 532 nm (green) diode subthreshold micropulse laser (SML) in the treatment of non-centre involved clinically significant macular edema (CSME) in comparison to the conventional laser photocoagulation (CLP). METHODS: A total of 60 eyes of patients diagnosed with non-centre involved CSME were randomly divided into two groups. SML photocoagulation was performed in the first group (G1), while CLP in the second one (G2). Central macular thickness (CMT) and best corrected visual acuity (BCVA) were measured prior to treatment and at 3 and 6 months after intervention. RESULTS: G1 participants had significantly better CMT at 6 months after laser application (p = 0.04) compared to G2. Additionally, CMT in both groups was significantly lower 6 months after laser application in comparison to baseline values (G1: p < 0.001, G2: p = 0.002). Moreover, significant improvement was detected 6 months after SML in G1 regarding BCVA compared to values before laser treatment (p = 0.001). CONCLUSION: SML was more effective than CLP in reducing CMT and improving BCVA in patients with non-centre involved CSME. Therefore, it seems that SML can be a good substitute for CLP in DME treatment if confirmed in future studies.

Level of agreement of intraocular lens power measurements between an image-guided system and partial coherence interferometry.

PURPOSE: To evaluate the level of agreement of partial coherence interferometry (IOLMaster) and an image-guided system (Verion) in terms of keratometric values and intraocular lens (IOL) power calculation. SETTING: Department of Ophthalmology, University Hospital of Alexandroupolis, Greece. DESIGN: Prospective comparative study. METHODS: Keratometric (K) values and IOL power calculations were compared for 3 toric IOL models (SN6ATx, TFNTx0, and SV25Tx) using 4 formulas (SRK/T, Holladay 1, Hoffer Q, and Haigis) in patients who had cataract surgery in a consecutive-if-eligible way. RESULTS: Ninety-eight eyes from 54 patients were included in the study (mean age: 60.2 ± 9.2 years). Compared with the IOLMaster, the Verion measured significantly steeper K1, K2, and Km values (P < .05), but no significant difference was observed in astigmatism power and vectors J0 and J45 (P > .05). With the SRK/T formula, the SN6ATx IOL showed significant difference in the mean IOL power calculated by the 2 devices, whereas no significant difference was observed in the TFNTx0 IOL and the SV25Tx IOL. However, with the Holladay 1, Hoffer Q, and Haigis formulas, a significant difference was found in the mean IOL power of all 3 toric IOL models. Generally, the Verion calculated a significantly lower mean IOL power for almost all formulas and IOL models. For 35 toric implantations, the mean residual astigmatism power, 6 months postoperatively, was 0.29 ± 0.24 diopter. CONCLUSIONS: The IOLMaster and the Verion seemed to present differences in IOL calculation and surgical planning that could lead to unexpected residual refractive error. When discrepancy is detected in IOL calculation, using the IOLMaster as the primary biometry and the Verion as a digital marker alone could provide excellent outcomes in terms of astigmatism correction.

Image-guided lens extraction surgery: a systematic review.

A systematic review of the recent literature regarding the current image-guided systems used for cataract surgery or refractive lens exchange was performed based on the PubMed and Google Scholar databases in March 2018. Literature review returned 21 eligible studies. These studies compared image-guided systems with other keratometric devices regarding their accuracy, repeatability and reproducibility in measurement of keratometric values, astigmatism magnitude and axis, as well as in IOL power calculation. Additionally, the image-guided systems were compared with conventional manual ink-marking techniques for the alignment of toric IOLs. In conclusion, image-guided systems seem to be an accurate and reliable technology with measurements of high repeatability and reproducibility regarding the keratometry and IOL power calculation, but not yet interchangeable with the current established and validated keratometric devices. However, they are superior over the conventional manual ink-marking techniques for toric IOL alignment.

Impact of light conditions on reading ability following multifocal pseudophakic corrections.

PURPOSE: To examine the impact of light intensity and temperature on reading performance following bilateral pseudophakic multifocal presbyopic correction. PATIENTS AND METHODS: This is a prospective clinic-based trial conducted at the Department of Ophthalmology in the University Hospital of Alexandroupolis, Greece. Three groups of patients were formed (G1: patients with bilateral bifocal implantation, G2: patients with bilateral trifocal implantation, and control group: patients with bilateral pseudophakic monofocal implantation). Reading ability was quantified with the Greek version of MNREAD chart with minimal reading speed at 80 words/min for the following light intensities (25, 50, and 75 Foot-Candles [FC]) and temperatures (3,000, 4,000, and 6,000 K). Preferred light conditions for reading were assessed, as well. ClinicalTrials.gov Identifier: NCT03226561. RESULTS: Control group demonstrated significantly lower reading ability at all light combinations with maximal ability at 75 FC and 6,000 K (0.58±0.18 logMAR). Bifocal group presented a light-dependent reading ability that ranged from 0.45±0.08 logMAR (25 FC and 3,000 K) to 0.40±0.11 logMAR (75 FC and 4,000 or 6,000 K). Trifocal participants presented the best reading ability that was light intensity-independent; however, their performance was reduced at 6,000 K. G1 and G2 preferred primarily intermediate light temperature, while control participants preferred cold light temperature. CONCLUSION: Multifocal pseudophakic corrections improve reading ability; however, they present variable efficacy according to the light conditions.

Efficacy of the travoprost/timolol fixed combination versus the concomitant use of travoprost 0.004% and timolol 0.1% gel formulation.

PURPOSE: To compare the hypotensive effect of travoprost 0.004%/timolol 0.5% fixed combination (TTFC) to the concomitant use of travoprost and timolol 0.1% gel formulation (Trav + Geltim). MATERIALS AND METHODS: Thirty-three patients (62 eyes) were enrolled and divided into two groups. Patients in group 1 (31 eyes) received the TTFC and patients in group 2 (31 eyes) received the concomitant treatment with Trav + Geltim. Patients on previous antiglaucoma treatment discontinued their drops for 2-4 weeks before starting their new treatment (TTFC or Trav + Geltim). The drops were instilled in the evening in group 1 and in group 2, the prostaglandin was installed in the evening, and timolol in the morning. IOP was measured at 1 and 3 months after the initiation of treatment at four time points during the day (09:00, 12:00, 15:00, and 18:00). RESULTS: Both groups showed significant IOP reduction from baseline at all time points at 1 and 3 months. When the two groups were compared, group 2 showed slightly better hypotensive effect that reached statistical significance only at the 18:00 time point at both 1 and 3 months. CONCLUSION: Both the TTFC and the concomitant use of the travoprost/timolol gel showed similar hypotensive effect with the latter being slightly more potent in reducing the IOP.

The Effect of Corneal Refractive Surgery on Glaucoma.

Laser-assisted refractive procedures have become very popular in the last two decades. As a result, a "generation" of patients with altered corneal properties is emerging. These patients will require both cataract extraction and glaucoma follow-up in the future. Since the glaucoma examination largely depends on the corneal properties, the reshaped postrefractive surgery cornea poses a challenge in the diagnosis, follow-up, and management of the glaucomatous patient. In order to overcome this problem, every patient who is planned to undergo corneal refractive surgery must have a thorough glaucoma examination in order for the ophthalmologist to be able to monitor their patients for possible glaucoma development and/or progression. Some examinations such as tonometry are largely affected by the corneal properties, while others such as the evaluation of the structures of the posterior pole remain unaffected. However, the new imaging modalities of the anterior segment in combination with the most recent advances in tonometry can accurately assess the risk for glaucoma and the need for treatment.

Modified deep sclerectomy combined with Ex-PRESS filtration device versus trabeculectomy for primary open angle glaucoma.

AIM: To compare the efficacy of modified deep sclerectomy combined with Ex-PRESS shunt versus trabeculectomy in primary open angle glaucoma. METHODS: This is a prospective cohort comparative single-center study. Forty-nine eyes of 49 patients were enrolled in the study. Patients were randomly divided into two groups. Group A (22 patients) underwent classic trabeculectomy and group B (27 patients) underwent modified deep sclerectomy combined with insertion of Ex-PRESS model P50 drainage device. RESULTS: Mean age was 69±7y in group A and 64±8y in group B (P=0.03). The mean reduction was 11.1±5.7 mm Hg in group A compared to 15.8±5.7 mm Hg in group B at 6mo (P=0.006), and 9.8±4.9 mm Hg and 15.4±4.7 mm Hg respectively at 1y (P=0.0001). Regarding the postoperative glaucoma medication, significant difference was observed between the two groups (in favour of group B) only at 6mo (P=0.017). At the end of the follow-up period complete success rate in group A was 68.2% compared to 92.6% in group B (χ2 test, P=0.07) and qualified success rate was 100% in both groups. CONCLUSION: Modified deep sclerectomy combined with Ex-PRESS shunt may provide comparable IOP reduction with fewer complications in management of primary open angle glaucoma.

A Simple New Technique for Treatment of Tarsal Kink Syndrome.

Congenital tarsal kink syndrome is a rare type of upper eyelid entropion associated with keratitis due to trichiasis. The authors describe a new technique for treatment of congenital horizontal tarsal kink syndrome by means of absorbable everting sutures via a posterior approach. A neonate was referred to eye clinic with right eye redness and corneal opacity since birth. Clinical examination revealed inversion of the eyelid margin with a horizontal kink in the tarsal plate and corneal ulcer. Surgical treatment resulted in successful correction of upper eyelid malpositioning, rapid resolution of the corneal ulcer with excellent anatomical outcome, visual development and cosmesis, with no evidence of recurrence after 6 years. Absorbable everting sutures via a posterior approach is a simple, minimally invasive, and effective surgical technique for treatment of congenital horizontal tarsal kink syndrome.

Comparison of dorzolamide/timolol vs brinzolamide/brimonidine fixed combination therapy in the management of primary open-angle glaucoma.

PURPOSE: To compare the efficiency of brinzolamide/brimonidine fixed combination vs the dorzolamide/timolol fixed combination. METHODS: Forty-four eyes of 44 patients were divided in 2 groups treated either with dorzolamide/timolol twice a day (group A) or with brinzolamide/brimonidine twice a day (group B). Complete ophthalmic examination including Goldmann applanation tonometry was performed before treatment administration and 1, 4, 8, and 12 weeks afterwards. The intraocular pressure (IOP) was measured twice a day (morning at 9 AM and afternoon at 4 PM). RESULTS: At the end of the follow-up period (12 weeks), mean morning IOP reduction was 7.0 ± 2.8 mm Hg in group A and 8.4 ± 1.9 mm Hg in group B. A significant difference was found (p = 0.0343). In contrast, mean afternoon IOP reduction was 8.6 ± 2.7 mm Hg in group A and 7.9 ± 1.6 mm Hg in group B and no significant difference was found (p = 0.3413). No significant adverse effects were observed in either group. CONCLUSIONS: Brinzolamide/brimonidine seems to be an effective and safe alternative ß-blocker free fixed combination, especially for patients with comorbidities, having its own antihypertensive profile.

Helicoid peripapillary chorioretinal degeneration complicated by choroidal neovascularization.

PURPOSE: Helicoid peripapillary chorioretinal degeneration (HPCD) is a hereditary disease of the fundus that is characterized by atrophic chorioretinal areas that appear early in life and expand gradually from the optic disc towards the macula and the periphery. METHODS: We describe the case of an elderly man with a known diagnosis of HPCD who developed choroidal neovascular membrane (CNV) in both eyes during the course of the disease. RESULTS: The patient was treated with intravitreal injection of ranibizumab, to which he had excellent response. The CNV subsided with 2 injections in the right eye and 1 in the left. Two years after the initial diagnosis of CNV in the right eye, visual acuity was 5/10 OD and 9/10 OS. CONCLUSIONS: Helicoid peripapillary chorioretinal degeneration is rarely complicated by CNV as the fundus lacks the trigger factors that would sustain this process. Although rare, HPCD complicated by CNV can be seen bilaterally, but responds well to few ranibizumab injections.