When is refraction stable following routine cataract surgery? A systematic review and meta-analysis.

PURPOSE: We systematically reviewed the literature to investigate when refraction is stable following routine cataract surgery implanting monofocal intraocular lenses. Current advice recommends obtaining new spectacles 4-6 weeks following surgery. Due to advancements in surgical techniques, we hypothesised that refractive stability would be achieved earlier, which could have major short-term improvements in quality of life for patients. METHODS: Medline, CINAHL, AMED, Embase, Web of Science and the Cochrane Library were searched with key words chosen to find articles, which assessed refraction following uncomplicated cataract surgery. Citation chains and the reference lists of all included papers were searched. Unpublished literature was identified using OpenGrey (www.opengrey.eu). The review considered studies that measured refraction at regular intervals following surgery until stability was achieved. RESULTS: The search identified 6,680 papers. Two reviewers independently screened the abstracts and nine papers were found to fit the criteria, of which five were included in the meta-analysis. The quality of the papers was evaluated using the Methodological Index for Non-Randomised Studies (MINORS) instrument. Meta-analysis of 301 patients' data of spherical, cylindrical and spherical equivalent correction were performed using Review Manager 5 (RevMan 5.3) (https://revman.cochrane.org/). Refraction at 1-week versus the gold standard of 4-weeks showed no significant difference for sphere data (effect size and 95% confidence interval of; ES = 0.00, 95% CI: -0.17, 0.17; p = 1.00), cylindrical data (ES = +0.06; 95% CI: -0.05, 0.17; p = 0.31), and spherical equivalent (ES = -0.01; 95% CI: -0.12, 0.10; p = 0.90). Heterogeneity was non-significant (I2  < 25%) for all refractive elements. Data were similar for 2- versus 4-weeks post-surgery. Acquired data from one study highlighted a small number of patients with very unstable cylindrical corrections at 1-week post-operatively. CONCLUSIONS: No statistical difference was found when comparing sphere, cylindrical and spherical equivalent values at 1- and 4-weeks post cataract surgery. This suggests that new glasses could be provided 1-week after surgery. However, from a clinical perspective, a small number of patients (~7%) from an acquired dataset (N = 72) showed very unstable cylindrical corrections at 1-week. Further work is needed to determine why this is the case and how these patients can be detected.

Reduced Peripapillary and Macular Vessel Density in Unilateral Postgeniculate Lesions With Retrograde Transsynaptic Degeneration.

BACKGROUND: Retrograde transsynaptic degeneration (RTSD) of the retinal ganglion cells and retinal nerve fiber layer after postgeniculate injury has been well documented, but to the best of our knowledge, associated retinal microvascular changes have not been examined. The purpose of our study was to assess vessel density (VD) at macular and peripapillary regions in patients with RTSD. METHODS: Cross-sectional study including 16 patients with homonymous visual field defects secondary to unilateral postgeniculate visual pathway injury and 18 age-matched controls. All participants were examined with AngioVue optical coherence tomography angiography to measure the peripapillary vessel density and macular vessel density (pVD/mVD) as well as the peripapillary retinal nerve fiber layer (pRNFL) and macular ganglion cell complex (GCC) thicknesses. The pRNFL and macular ganglion cell-inner plexiform layer (GCIPL) thicknesses also were evaluated using Cirrus OCT. A normalized asymmetry score (NAS) was calculated for GCIPL and GCC thickness, and mVD. RESULTS: Average pRNFL and macular GCIPL/GCC thicknesses were significantly thinner in both eyes of patients compared with control eyes (all P ≤ 0.05). Eight patients (50%), who showed a RTSD of the GCIPL map, had a relative thinning of the GCIPL/GCC ipsilateral to the brain lesion in both eyes (represented by a positive GCIPL-NAS/GCC-NAS). The mean pVD and mVD also were significantly reduced in patients (all P ≤ 0.05). There was a strong correlation between GCIPL-NAS/GCC-NAS and mVD-NAS index in both eyes (all r > 0.7, P = 0.001). Furthermore, there was a similar spatial pattern of damage for the macular GCC thickness and VD values. CONCLUSIONS: We demonstrated a significant VD decrease in peripapillary and macular areas of patients with RTSD because of postgeniculate lesions. The structural and microvascular asymmetry indexes were significantly correlated. These findings provide new insights regarding transsynaptic degeneration of the visual system.

Gas permeable contact lens fitting in keratoconus: Comparison of different guidelines to back optic zone radius calculations.

Purpose: Compare the agreement between the finally fitted back optic zone radius (BOZR) of a spherical gas permeable (GP) contact lense (CL) with those proposed by different guidelines currently available to fit GP CLs in keratoconus. Methods: The BOZR fitted in 81 keratoconus eyes (46 patients) were recorded and compared with the BOZR calculated with ten different guidelines (identified after a literature review) proposed to calculate the first diagnostic lens BOZR to be fitted in keratoconus. Arithmetic and absolute mean difference between both BOZR were calculated (paired t-test). The success rate of each guideline (difference between both BOZR ≤0.05 mm) was calculated for different keratoconus stages (Amsler-Krumeich classification). Agreement between BOZR was evaluated using Bland-Altman analysis. Results: The BOZR proposed by all guidelines correlated with the final BOZR that was fitted (R2 > 0.71; P < 0.01). A statistically significant difference was found between the BOZR suggested by all guidelines and the BOZR that was prescribed (P < 0.05), except for three Guidelines (P ≥ 0.11). CALCULENS.com presented the best agreement (mean difference of 0.00 ± 0.12 mm), and 50.6% of cases showed ≤0.05 mm of difference with the BOZR that was fitted. However, the worst guideline showed an agreement of -0.38 ± 0.22 mm, and just 3.8% of cases had ≤0.05 mm of difference with the final fitted BOZR. Conclusion: BOZR calculated with most of the analyzed guidelines shows statistical differences with final fitted BOZR, suggesting a lack of clinical validation of these guidelines. The selection of the BOZR with CALCULENS.com could provide a better starting point for spherical GP CL fitting in keratoconus eyes.

A comparison of two optical coherence tomography-angiography devices in pseudoexfoliation glaucoma versus primary open-angle glaucoma and healthy subjects.

PURPOSE: To compare peripapillary vascular parameters derived from two optical coherence tomography angiography devices in pseudoexfoliation glaucoma, primary open-angle glaucoma, and healthy controls and to evaluate their diagnostic accuracy. METHODS: Observational, cross-sectional study. In total, 20 eyes with pseudoexfoliation glaucoma, 20 primary open-angle glaucoma eyes matched by peripapillary retinal nerve fiber layer thickness, and 20 control eyes were recruited. Participants underwent standard automated perimetry and peripapillary retinal nerve fiber layer analysis by Optovue and Cirrus optical coherence tomography. Vascular parameters provided by Angiovue and Angioplex optical coherence tomography angiography were compared. Their diagnostic accuracy and correlation with structural and functional parameters were assessed. RESULTS: All peripapillary optical coherence tomography angiography vascular parameters were significantly different among groups (all p < 0.05). The whole image capillary density and peripapillary capillary density by Angiovue were significantly lower in pseudoexfoliation glaucoma compared with primary open-angle glaucoma (p = 0.009 and p = 0.001, respectively). Conversely, vascular parameters by Angioplex were not statistically different between primary open-angle glaucoma and pseudoexfoliation glaucoma. A good correlation was found using Angiovue between whole image capillary density and visual field mean deviation (0.758, p < 0.001), peripapillary capillary density and visual field mean deviation (0.729, p = 0.001), and peripapillary capillary density and peripapillary retinal nerve fiber layer thickness in eyes with pseudoexfoliation glaucoma (0.716, p = 0.001). Angiovue parameters showed higher area under the receiver operating characteristic curves than Angioplex to discriminate among groups. CONCLUSION: Only Angiovue detected a significantly lower capillary density in pseudoexfoliation glaucoma compared to primary open-angle glaucoma at similar glaucoma damage. Both, Angiovue and Angioplex demonstrated a decreased capillary density in glaucoma eyes compared to healthy eyes. Furthermore, Angiovue-derived vascular parameters showed better correlation with functional and structural parameters and a higher diagnostic capacity to discriminate among groups compared to Angioplex.

Lamina cribrosa position and Bruch's membrane opening differences between anterior ischemic optic neuropathy and open-angle glaucoma.

PURPOSE:: To compare the optic nerve head morphology among primary open-angle glaucoma, non-arteritic anterior ischemic optic neuropathy eyes, their fellow healthy eyes and control eyes, using spectral-domain optical coherence tomography with enhanced depth imaging. METHODS:: Observational cross-sectional study including 88 eyes of 68 patients. In this study, 23 non-arteritic anterior ischemic optic neuropathy eyes, 17 fellow unaffected eyes, 25 primary open-angle glaucoma eyes, and 23 age-matched control eyes were included. Peripapillary retinal nerve fiber layer thickness and optic disk area were evaluated. Bruch's membrane opening diameter, optic cup depth, anterior lamina cribrosa depth, and prelaminar tissue thickness were assessed. RESULTS:: Non-arteritic anterior ischemic optic neuropathy and primary open-angle glaucoma eyes had similar visual field mean deviation and peripapillary retinal nerve fiber layer thickness (P = 0.6 and P = 0.56, respectively). Bruch's membrane opening diameter was significantly larger in primary open-angle glaucoma eyes than in control eyes (P = 0.02). Lamina cribrosa and disk cup were deeper in eyes with primary open-angle glaucoma than both control and non-arteritic anterior ischemic optic neuropathy eyes (P < 0.001). Prelaminar tissue thickness was significantly thinner in primary open-angle glaucoma eyes than in non-arteritic anterior ischemic optic neuropathy eyes (P < 0.001). Lamina cribrosa was shallower in both non-arteritic anterior ischemic optic neuropathy and unaffected fellow eyes compared to healthy eyes (P < 0.001 and P = 0.04, respectively). No differences were found in the optic disk area. CONCLUSION:: A forward lamina cribrosa placement and not a smaller disk could be involved in the pathogenesis of non-arteritic anterior ischemic optic neuropathy. A significantly larger Bruch's membrane opening diameter was found in primary open-angle glaucoma eyes compared with control eyes. This issue has clinical implications because Bruch's membrane opening has been considered a stable reference for disk-related measures.

Reduction of Peripapillary Vessel Density by Optical Coherence Tomography Angiography from the Acute to the Atrophic Stage in Non-Arteritic Anterior Ischaemic Optic Neuropathy.

PURPOSE: To analyse superficial peripapillary vascularization in non-arteritic anterior ischaemic optic neuropathy (NAION) at acute and atrophic (3 months) stage. PROCEDURES: Prospective case-control study including 6 patients with NAION and 10 age-matched healthy controls evaluated with optical coherence tomography angiography (OCT-A; Angioplex-Cirrus) at acute and atrophic stage. Apart from the -commercially provided measurements for vessel density (VD) and perfusion density (PD), a custom image analysis was used to quantify the peripapillary capillary density (PCD). RESULTS: NAION-group demonstrated a significant decrease in the PCD, VD and PD compared with fellow unaffected and control groups at acute and atrophic stage. At 3 months, the average and the temporal sector in PCD correlated with logMAR VA (-0.943, p = 0.005 and -0.829, p = 0.042 for average and temporal sectors respectively) and with MD (0.943, p = 0.005; and 0.899; p = 0.015, respectively). Over 3 months, there was a significant PCD reduction at the temporal sector and at the inner circle in VD and PD, which correlated with ganglion cell-inner plexiform layer (GCIPL) thinning over the 3 months period after the acute NAION (0.749, p = 0.020; 0.885, p = 0.002; 0.767, p = 0.016 respectively). CONCLUSION: Both strategies demonstrated a significant peripapillary microvascular dropout in NAION, but the customized analysis detected them -earlier. A progressive vessel reduction occurs within the first 3 months, which correlates with GCIPL thinning.

Simultaneous evaluation of the lamina cribosa position and choroidal thickness changes following deep sclerectomy.

PURPOSE:: To assess the changes in peripapillary and macular choroidal thickness, and in the lamina cribrosa position following deep sclerectomy. METHODS:: Prospective study, including 39 eyes with open-angle glaucoma following deep sclerectomy. Choroidal thickness was automatically measured using swept-source optical coherence tomography at four peripapillary locations (superior, temporal, inferior, and nasal) and at the macular area in nine fields plotted with Early Treatment Diabetic Retinopathy Study grid. Optic nerve head was evaluated by Spectralis optical coherence tomography with enhanced depth imaging technology. All measurements were performed preoperatively and at 1 week and 2 months after surgery. RESULTS:: The mean intraocular pressure significantly decreased 1 week and 2 months after surgery ( p < 0.001). A significant peripapillary choroidal thickening was observed at all locations 1 week postoperatively ( p ≤ 0.002) and in the temporal quadrant 2 months after surgery ( p = 0.027). There was a significant thickening in all macular choroidal thickness measurements at 1 week ( p < 0.001) and 2 months ( p < 0.05), except at subfoveal and inner nasal locations. The mean peripapillary and macular choroid thickness was 22.8% and 19.7% at 1 week and 6.2% and 7.8% at 2 months, respectively. A significant forward lamina cribrosa displacement occurred at every postoperative stage ( p < 0.001). Multivariate analysis showed a significant correlation between the magnitude of intraocular pressure reduction and the anterior lamina cribrosa movement (0.623, p = 0.000) and a negative correlation between the intraocular pressure change and the mean peripapillary and macular choroidal thickening (-0.527, p = 0.002; -0.568, p = 0.002, respectively). CONCLUSION:: There was a significant reversal lamina cribrosa displacement measured from Bruch's membrane opening reference despite a significant peripapillary choroidal thickening following deep sclerectomy. Both findings were significantly correlated with the change in intraocular pressure.

Automated Evaluation of Choroidal Thickness and Minimum Rim Width Thickness in Nonarteritic Anterior Ischemic Optic Neuropathy.

BACKGROUND: The aim of this study was to evaluate and compare peripapillary choroidal thickness (pCT) and macular choroidal thickness (CT), Bruch membrane opening-minimum rim width (BMO-MRW), retinal nerve fiber layer (RNFL) thickness, and optic disc area among nonarteritic anterior ischemic optic neuropathy (NAION) eyes, the contralateral unaffected eyes, and healthy control eyes. METHODS: Twenty-six patients diagnosed with NAION (29 affected and 21 unaffected eyes) and 29 healthy matched control individuals (29 eyes) were analyzed by swept-source optical coherence tomography. All participants underwent scanning by Spectralis optical coherence tomography to analyze BMO-MRW, RNFL thickness, and optic disc area. RESULTS: Mean pCT in the NAION eyes, unaffected fellow eyes, and the control group was 130.5 ± 72.1 µm, 149.6 ± 75.7 µm, and 103.7 ± 36.7 µm, respectively (analysis of variance [ANOVA], P = 0.04). Mean macular CT in the NAION eyes, unaffected fellow eyes, and the control group was 226.1 ± 79.8 µm, 244.6 ± 81.4 µm, and 189.9 ± 56.4 µm, respectively (ANOVA, P = 0.03). Mean and all sectorial RNFL and BMO-MRW thickness values were significantly thinner in the NAION eyes vs the unaffected fellow and control eyes (P ≤ 0.00). The unaffected fellow eyes in NAION patients showed a significantly thicker average and sectorial BMO-MRW values than control eyes (P ≤ 0.02) except for the nasal sector (P = 0.09). Mean optic disc area derived from BMO analysis was not significantly different among groups (ANOVA, P = 0.86). CONCLUSIONS: The fellow unaffected eyes in patients with NAION showed significantly thicker mean peripapillary and macular choroidal and BMO-MRW thicknesses than disease-free control eyes. No differences in the mean optic disc area were found. Both a thick peripapillary choroid and a thick neuroretinal rim might contribute to the development of NAION or possibly be a secondary phenomenon.

Optical Coherence Tomography to Differentiate Papilledema from Pseudopapilledema.

PURPOSE OF REVIEW: Mild papilledema may be difficult to distinguish by clinical observation from pseudopapilledema. An accurate diagnosis is critical to avoid invasive workup and unwarranted treatment. In this review, we focus on the development and subsequent role of optical coherence tomography (OCT) in detecting and differentiating optic nerve head drusen (ONHD) from papilledema and other causes of acquired swelling of the optic disc. RECENT FINDINGS: Newer OCT technologies which permit deeper penetration to improve detection of ONHD were also reviewed. Enhanced depth imaging (EDI) spectral-domain OCT and swept-source (SS) OCT are currently recognized as the most reliable and sensitive tools to diagnose ONHD. OCT devices currently available provide a means to quantify drusen dimensions, to evaluate the integrity of neighboring structures and to monitor axonal and neuronal damage, yielding additional information to better understand the relationship between the morphological features of drusen, and their effects on the structure and function of the optic nerve.

Relationship between corneal biomechanical properties and optic nerve head changes after deep sclerectomy.

PURPOSE: To evaluate corneal biomechanical properties and optic nerve head (ONH) changes following deep sclerectomy (DS) and the relation to each other. METHODS: Forty-nine eyes with primary open-angle glaucoma that underwent DS were studied. Corneal biomechanical properties were assessed using the Ocular Response Analyzer and the ONH was evaluated by Spectralis optical coherence tomography with enhanced depth imaging technology before surgery and 3 months postoperatively. Changes in corneal hysteresis (CH), corneal resistance factor (CRF), optic nerve cupping, prelaminar tissue thickness, and lamina cribrosa depth and thickness were registered. A correlation matrix and multiple linear regression models were used to determine predictors of ONH changes. RESULTS: At 3 months after surgery, mean corneal compensated intraocular pressure (IOPcc) significantly decreased by 27.9% (p<00.001) and mean Goldmann-correlated IOP (IOPg) decreased by 30.52% (p<00.001). Mean CH increased and CRF decreased by 18.4% and 10.1%, respectively (p<00.001). There was a significant reversal of ONH cupping mainly due to a prelaminar tissue thickening (p<00.001). Significant associations were found between ONH cupping reversal and prelaminar tissue thickening with preoperative IOPcc (p = 0.046), IOPg (p = 0.02), and CRF (p = 0.002) and with changes in IOP, CH, and CRF (p<00.001, p = 0.004, p = 0.018, respectively) after surgery. CONCLUSIONS: Corneal hysteresis increased and CRF decreased significantly 3 months after DS. Corneal resistance factor was the single largest preoperative factor influencing cupping reversal changes. Despite the influence of preoperative variables, postoperative IOP reduction was the only independent factor influencing changes observed in the ONH after surgery.

Relationship between lamina cribrosa displacement and trans-laminar pressure difference in papilledema.

PURPOSE: The purpose of this study was to describe morphological changes in lamina cribrosa (LC), prelaminar tissue thickness (PTT) and Bruch's membrane opening (BMO) in eyes affected by papilledema and correlate them with trans-LC-pressure difference (TLCD). METHODS: This was a prospective study, including twelve eyes newly diagnosed of papilledema. Eyes underwent scanning with Spectralis-OCT with enhanced depth imaging to compare BMO, anterior LC surface position (LC depth-LCD-) and PTT before and after oedema resolution. Correlation analysis between these parameters and TLCD was performed. RESULTS: TLCD inversely correlated with LCD at baseline and directly with LC reversal movement after lowering cerebrospinal fluid pressure (CSFP) (ρSpearman: -0.739, p = 0.006; ρSpearman: 0.844, p = 0.001 respectively). At onset, RNFL thickening and BMO were significantly larger in eyes with TLCD > -9.2 mmHg (group 2) compared with TLCD < -9.2 mmHg (group 1) [p = 0.007, p = 0.041 respectively]. A significant RNFL and BMO shrinking were observed, but they were significantly larger in group 2. The magnitude of LC displacement following oedema resolution was significantly larger and in the opposite direction in group 2 vs group 1 (-68.7 µm vs 19.5 µm, p = 0.016). TLCD correlated with RNFL thickening at baseline (ρSpearman: 0.667, p = 0.018) and with RNFL thinning at last visit (ρSpearman: 0.673, p = 0.017). TLCD correlated with mean deviation (MD) (ρSpearman: 0.712, p = 0.014) and visual field index (VFI) (ρSpearman: -0.657, p = 0.028) at onset. MD and VFI were worse in group 2. CONCLUSIONS: LC position was significantly related to TLCD in papilledema. Eyes with higher TCLD showed significantly larger backward LC movement, BMO shrinking and RNFL thinning after lowering CSFP compared with eyes with lower TLCD, where LC movement occurred in the opposite direction.

New web-based algorithm to improve rigid gas permeable contact lens fitting in keratoconus.

PURPOSE: To calculate and validate a new web-based algorithm for selecting the back optic zone radius (BOZR) of spherical gas permeable (GP) lens in keratoconus eyes. METHODS: A retrospective calculation (n=35; multiple regression analysis) and a posterior prospective validation (new sample of 50 keratoconus eyes) of a new algorithm to select the BOZR of spherical KAKC design GP lenses (Conoptica) in keratoconus were conducted. BOZR calculated with the new algorithm, manufacturer guidelines and APEX software were compared with the BOZR that was finally prescribed. Number of diagnostic lenses, ordered lenses and visits to achieve optimal fitting were recorded and compared those obtained for a control group [50 healthy eyes fitted with spherical GP (BIAS design; Conoptica)]. RESULTS: The new algorithm highly correlated with the final BOZR fitted (r2=0.825, p<0.001). BOZR of the first diagnostic lens using the new algorithm demonstrated lower difference with the final BOZR prescribed (-0.01±0.12mm, p=0.65; 58% difference≤0.05mm) than with the manufacturer guidelines (+0.12±0.22mm, p<0.001; 26% difference≤0.05mm) and APEX software (-0.14±0.16mm, p=0.001; 34% difference≤0.05mm). Close numbers of diagnostic lens (1.6±0.8, 1.3±0.5; p=0.02), ordered lens (1.4±0.6, 1.1±0.3; P<0.001), and visits (3.4±0.7, 3.2±0.4; p=0.08) were required to fit keratoconus and healthy eyes, respectively. CONCLUSION: This new algorithm (free access at www.calculens.com) improves spherical KAKC GP fitting in keratoconus and can reduce the practitioner and patient chair time to achieve a final acceptable fit in keratoconus. This algorithm reduces differences between keratoconus GP fitting (KAKC design) and standard GP (BIAS design) lenses fitting in healthy eyes.

Analysis of cataract surgery induced astigmatism: Two polar methods comparison.

PURPOSE: Surgically induced astigmatism (SIA) caused by the incision after cataract surgery may be calculated to improve IOL toric power calculation and achieve better visual outcome. SIA could be determined as the difference between preoperative and postoperative keratometry expressed in polar values using different equations. The objective of this study is to compare the SIA calculated with two different polar value analysis methods [Method #1: KP (90)/KP (135) developed to be used with incisions placed at 90° and Method #2: AKP/AKP (+45) developed to be used independently of the incision location]. METHODS: Preoperative and one month postoperative data of 210 cataractous eyes (131 patients) undergoing uncomplicated cataract surgery were assessed. All incisions were performed at 11 o'clock (120°). No sutures were used in any patient. IOLMaster (Carl Zeiss Meditec, Dublin, Ireland) keratometry was used to polar calculation. RESULTS: The average age was 66.25±12.33 years (range 22-89). SIA polar value data calculated with Method #1 were KP (90) -0.06±0.52D and KP (135) +0.05±0.91D and calculated with Method #2 were AKP -0.10±0.87D and AKP (+45) +0.02±0.02D. However, SIA value represented in traditional notation (diopters@axis in degrees) was the same value independently of the method used to calculate; +0.65@110.70°. CONCLUSION: SIA value is independent of the polar method used to its calculation and slight variations in the incision position could be accepted without clinical relevant impact in SIA magnitude. Both methods [Method #1: KP (90)/KP (135) and Method #2: AKP/AKP (+45)] are useful to calculate SIA with superior incisions at 120°.

Success of Rigid Gas Permeable Contact Lens Fitting.

OBJECTIVES: To assess the percentage of successful rigid gas permeable (GP) contact lenses (CLs) fit for both refractive and therapeutic reasons. METHODS: New CLs (soft or GP) fittings were retrospectively analyzed and divided into refractive and therapeutic prescriptions. A standardized fitting protocol that included complete CLs information after a first eye examination, a diagnostic fitting visit, a dispensing visit, and a prescribing visit was used in all fittings. A GP fitting was defined as successful if full-time wear and optimal ocular surface physiology were both achieved at the review assessment 2 to 3 weeks after lens dispensing. RESULTS: Of 232 new CLs fittings analyzed, 166 were refractive fittings (71.6%) and 66 were therapeutic (28.4%). Of the refractive fittings, 88 subjects (53%) were initially fitted with GP CLs and 61 (69.3%) of these met the criteria for successful GP fitting. Within this group, a different percentage of successful fits were found for neophyte (72%), previous soft lens wearers (62%), and previous GP wearers (92.3%). Of the therapeutic fittings, 61 subjects (92.4%) were initially fitted with GP CLs and 59 (96.7%) of these met the criteria for successful GP fitting. CONCLUSIONS: Following a standardized CLs fitting protocol, a relatively high percentage of successful GP fits was achieved for refractive (7/10 subjects) and therapeutic (9/10 subjects) prescriptions. These results will improve the information available to patients and aid in their CL choices by providing them with a realistic attitude. It will also help eye care practitioners in their clinical activities by providing evidence-based information.

Optic Nerve Head Biomechanic and IOP Changes Before and After the Injection of Aflibercept for Neovascular Age-Related Macular Degeneration.

PURPOSE: We investigated the early effects of intravitreal aflibercept injection (IAI) on optic nerve head (ONH) morphology. METHODS: All of the participants underwent applanation tonometry and enhanced depth imaging by spectral-domain optical coherence tomography immediately before injection, and within 5 and 30 minutes after IAI. Changes in the anterior lamina cribrosa surface depth, prelaminar tissue thickness (PTT), optic cup width, optic cup depth, and Bruch's membrane opening (BMO) were assessed. RESULTS: The study included 30 eyes of 30 subjects with a mean age of 77.4 ± 6.8 years (range, 65-89 years) following IAI (2 mg in 0.05 ml). Within 5 minutes after injection, the mean cup depth, mean cup width, and BMO were significantly increased (P = 0.013, P = 0.000, and P = 0.004, respectively), whereas the mean PTT was thinned (P = 0.009). These morphologic changes returned to near baseline values 30 minutes after injection. Cup widening and BMO expansion (P = 0.000; r, 0.668), as well as cup deepening and prelaminar thinning (P = 0.000; r, -0.838), were significantly correlated. The magnitude of cup deepening and prelaminar tissue thinning correlated with the IOP change in the opposite direction than expected (P = 0.039; r, -0.379 and P = 0.377; r, 0.040). CONCLUSIONS: A significant widening and deepening of the optic cup, BMO expansion, and prelaminar tissue thinning occurred following IAI for neovascular AMD. Eyes having greater optic disc cup deepening and prelaminar tissue condensation after IAI, associated with a lower IOP increase after injection, suggesting that ONH compliance might buffer the effect of additional intravitreal fluid injection on IOP values.

Advantages, limitations, and diagnostic accuracy of photoscreeners in early detection of amblyopia: a review.

Amblyopia detection is important to ensure proper visual development and avoid permanent decrease of visual acuity. This condition does not produce symptoms, so it is difficult to diagnose if a vision problem actually exists. However, because amblyopia treatment is limited by age, early diagnosis is of paramount relevance. Traditional vision screening (conducted in <3 years) is related with difficulty in getting cooperation from a subject to conduct the eye exam, so accurate objective methods to improve amblyopia detection are necessary. Handheld devices used for photoscreening or autorefraction could offer advantages to improve amblyopia screening because they reduce exploration time to just few seconds, no subject collaboration is needed, and they provide objective information. The purpose of this review is to summarize the main functions and clinical applicability of commercially available devices for early detection of amblyopia and to describe their differences, advantages, and limitations. Although the studies reviewed are heterogeneous (due to wide differences in referral criteria, use of different risk factors, different types of samples studied, etc), these devices provide objective measures in a quick and objective way with a simple outcome report: retest, pass, or refer. However, due to major limitations, these devices are not recommended, and their use in clinical practice is limited.

Agreement of corneal measurements between dual rotating Scheimpflug-Placido system and Placido-based topography device in normal and keratoconus eyes.

PURPOSE: To compare the anterior corneal measurements between Placido-based topography and dual-Scheimpflug topography in healthy and keratoconus eyes. SETTING: Optometry Research Group, Instituto Universitario de Oftalmobiología Aplicada, University of Valladolid, Valladolid, Spain. DESIGN: Comparative case series. METHODS: The mean simulated keratometry (K), flat K, steep K, astigmatism power, corneal astigmatism axis, J0, J45, maximum corneal power point, and white-to-white (WTW) distance were collected and compared between healthy eyes and keratoconus eyes. RESULTS: The study evaluated in 56 healthy eyes and 56 keratoconus eyes. Placido-based topography underestimated all topographic values except J45 and WTW in healthy eyes and J0, maximum corneal power point, and WTW in keratoconus eyes, with statistically significant differences in astigmatism (healthy), flat K (keratoconus), axis (keratoconus), J0, J45, and WTW (P < .05). Healthy eyes showed better agreement (95% limits of agreement: simulated K -0.13 to 0.40; steep K -0.30 to 0.59; flat K -0.29 to 0.51; astigmatism -0.60 to 0.64; J0 -1.15 to 1.13; J45 -1.10 to 1.20; maximum corneal power point -0.70 to 1.17; WTW -0.96 to 0.76 mm) than keratoconic eyes (simulated K -2.84 to 4.55; steep K -2.80 to 5.21; flat K -3.68 to 4.70; astigmatism -1.90 to 2.95; J0 -2.85 to 3.20; J45 -3.21 to 3.05; maximum corneal power point -7.00 to 4.51 D; WTW -1.00 to 0.88). CONCLUSIONS: Healthy eyes showed better agreement than keratoconus eyes between Placido-based and dual-Scheimpflug topography. Both instruments could be used interchangeably with caution in healthy eyes, but not in keratoconus management. FINANCIAL DISCLOSURE: None of the authors has a financial or proprietary interest in any material or method mentioned.