Performance on clinical outcomes, activities of daily living and user experience on head-mounted displays for people with vision impairment.

PURPOSE: To compare the objective performance, acceptance and usability of head-mounted displays (HMDs) to provide evidence-based data that could be used to increase the efficiency of device referrals based upon a person's vision loss and functional needs. METHODS: A cross-sectional, counterbalanced, individually controlled crossover study was performed on 15 adults with various eye conditions. Performance was measured when using four HMDs: eSight4, Eyedaptic EYE3, Eyedaptic EYE4 and IrisVision Inspire. Performance on clinical visual acuity tests and contrast were assessed, as well as vision-related activities of daily living (ADL) which were divided into three categories: Reading, Searching & Identifying and Eye-hand Coordination. User-experience was also assessed. Logistic regression analyses, Friedman one-way repeated measure analyses of variance by ranks and multivariate permutation testing were used for analysis. RESULTS: There was a significant improvement in visual acuity when using all devices. For contrast tasks, only the eSight4 and Eyedaptic EYE3 improved performance relative to baseline. For most Reading and Searching & Identifying tasks, the odds of being able to perform the tasks were significantly higher while using the devices. However, the actual performance with most devices (e.g., number of words read or reading speed) did not improve significantly over baseline for most tasks. For the Eye-hand Coordination tasks, participants performed equivalent to or significantly poorer than baseline when using the devices. No demographic or clinical predictors of outcomes were identified. Participants expressed dissatisfaction with the devices' effectiveness, acceptability and usability. CONCLUSIONS: While performance on clinical tests was better when using the devices, performance on most real-world ADLs was equal to or worse than baseline. No single device improved performance on all tasks, and performance on any one task was not improved with all the devices. The overall dissatisfaction with the devices paralleled the lack of objective improvement in the performance of real-world tasks.

Cyclosporine 0.05% to improve visual outcomes after multifocal intraocular lens implantation.

PURPOSE: To evaluate the efficacy of cyclosporine 0.05% in alleviating dry-eye signs and improving visual quality after multifocal intraocular lens (IOL) implantation. SETTING: Private practice and university medical center, New York, New York, USA. METHODS: This randomized prospective contralaterally controlled double-masked trial comprised patients scheduled to have bilateral phacoemulsification with implantation of a refractive multifocal IOL (ReZoom). Patients received twice-daily cyclosporine 0.05% in 1 eye and an artificial tear in the other eye from 1 month before to 2 months after second-eye surgery. Outcomes were evaluated at baseline and 2 months after second-eye surgery. RESULTS: The study enrolled 28 eyes of 14 patients. At baseline, there were no statistically significant between-group differences in outcome measures. Two months postoperatively, the cyclosporine group had significantly lower mean uncorrected distance visual acuity than the artificial tear group (0.11 logMAR +/- 0.03 [SD] [20/25 Snellen equivalent] versus 0.19 +/- 0.05 logMAR [20/30]; P = .045) as well as significantly lower mean corrected distance visual acuity (0.0 +/- 0.02 logMAR [20/20] versus 0.1 +/- 0.02 logMAR [20/25]; P = .005) and corneal staining scores (0.210 +/- 0.07 versus 0.645 +/- 0.18; P = .034). Treatment with cyclosporine 0.05% also improved contrast sensitivity, conjunctival staining, and tear breakup time. Significantly more patients preferred the eye treated with cyclosporine 0.05% to the eye treated with artificial tears (57.1% versus 14.3%; P = .007). CONCLUSION: Cyclosporine 0.05% therapy reduced dry-eye signs and improved visual quality after multifocal IOL implantation. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned. Additional disclosures are found in the footnotes.

Comparison of topical cyclosporine, punctal occlusion, and a combination for the treatment of dry eye.

PURPOSE: To compare the efficacy of topical cyclosporine, punctal occlusion, and a combination for the treatment of dry eye. METHODS: Patients with dry eye (N = 30) seen in a university-affiliated private practice were randomized to 1 of 3 treatments: cyclosporine 0.05% ophthalmic emulsion (RESTASIS) twice daily, lower-lid punctal plugs (PARASOL), or a plugs-cyclosporine combination. Tear volume, ocular surface staining, and artificial tear use were assessed at baseline and 1, 3, and 6 months. RESULTS: All treatments improved Schirmer scores by 6 months (P < or = 0.005 vs. baseline), with plug-containing regimens favored at 1 and 3 months (P < 0.001 vs. cyclosporine alone). Cyclosporine-containing regimens, but not plugs alone, improved rose bengal staining at 3 and 6 months (P < or = 0.010 vs. baseline). Artificial tear use decreased with plug-containing regimens at 1 month and with all treatments at 3 and 6 months (P < or = 0.005 vs. baseline). Combination therapy produced the greatest overall improvements and was superior to plugs alone in decreasing artificial tear use at 6 months (P = 0.012). CONCLUSIONS: All 3 regimens effectively treated dry eye. Plug-containing regimens increased wetness initially; cyclosporine appeared to promote long-term ocular surface health. The effects may be additive. Patients with punctal occlusion may benefit from adjunctive cyclosporine.

Dry eye symptoms following cataract surgery.

This randomized, controlled clinical study demonstrates the development of dry eye-type symptoms after routine cataract extraction, and shows that topical cyclosporine ophthalmic emulsion can reduce the occurrence of these symptoms after cataract surgery. Based on these results, a regimen of pre- and postoperative topical cyclosporine should be considered for cataract patients who have dry eyes or who are at risk of developing dry eye. This paper presents the study methodology and results, and discusses implications for care of cataract patients so as to improve the quality of vision after surgery and to maximize patient satisfaction with the procedure.

Comparative analysis of prednisolone acetate suspensions.

PURPOSE: The aim of this study was to determine differences in particle size between three prednisolone acetate suspensions: Pred Forte, EconoPred Plus, and generic prednisolone acetate 1%. SETTING: This study employed the setting of a laboratory evaluation. METHODS: Qualitative assessment of sedimentation rate as a function of particle size was the method employed for this study. Samples of the three products were taken from the top of the suspensions at 0 and 6 h and then at 12-h intervals from 12 to 72 h. At 72 h, a sample was pulled from the bottom of each suspension. RESULTS: Particle size in aliquots removed from the top of the suspensions steadily decreased over time. In the Pred Forte sample, results for 72 h (bottom) were consistent with T = 0 h results. In the generic and EconoPred Plus lots, the T = 72 h (bottom) results exceeded the T = 0 h results, suggesting a tendency for these particles to agglomerate more readily. CONCLUSIONS: The prednisolone particles in Pred Forte were smaller and more uniform at all time points, allowing them to stay in suspension longer. This may result in greater homogeneity between doses and increased ocular bioavailability.

Topical NSAIDS to control pain in clear corneal cataract extraction.

This study was conducted to assess the additive efficacy of ophthalmic topical nonsteroidal anti-inflammatory drugs (NSAIDs) with topical anesthesia in the control of pain associated with clear corneal cataract extraction. The patients who received three days of preoperative topical NSAIDs had a statistically significant decrease in their level of discomfort. We have previously shown that three days of preoperative NSAIDs can reduce postoperative inflammation after cataract surgery. This study demonstrates that ophthalmic topical NSAIDs also decrease discomfort during surgery.