Two-Year Myopia Management Efficacy of Extended Depth of Focus Soft Contact Lenses (MYLO) in Caucasian Children.

PURPOSE: To evaluate the progression of myopia as assessed by change in axial length (AL) and spherical equivalent (SE) from baseline in Caucasian children wearing extended depth of focus soft contact lenses (CLs) compared to distance single-vision spectacles. DESIGN: Prospective non-randomized comparative clinical trial. METHODS: A total of 90 children (6-13 years of age) with SE ranging from -0.75 to -10.00 diopters (D) were recruited. Of these children, 45 were fitted with CLs (MYLO, mark´ennovy), whereas 45 children wore spectacles. Cycloplegic refraction was measured with an auto-refractometer (Topcon-TRK-2P) and AL with an IOLMaster-700 (Zeiss) at 6-month intervals. Subjective responses after 1 month of CL wear related to vision and comfort were determined using a questionnaire with a scale from 1 (very poor) to 10 (excellent). High-contrast visual acuity (HCVA) and contrast sensitivity (CS) were evaluated at baseline, 12, and 24 months. RESULTS: After 2 years, mean change in SE/AL in the CL group was -0.62 ± 0.30 D/0.37 ± 0.04 mm and -1.13 ± 0.20 D/0.66 ± 0.03 mm in the spectacles group (P < .001). Cumulative absolute reduction in axial elongation (CARE) was 0.29 ± 0.06 mm. Difference in SE change was -0.50 ± 0.34 D. Although 100% of CL group had an AL increase ≤0.50 mm, all participants increased ≥0.50 mm in the spectacles group. In all, 53% of the CL group and 1% in the spectacles group showed a progression in SE ≤ -0.50D. All questionnaire items showed a mean value ≥9. There was a reduction logMAR HCVA in the CL compared to the spectacles group but it was less than 1 line (P < .001). CONCLUSIONS: Use of MYLO CLs reduced axial elongation and myopia progression compared to use of distance single-vision spectacles.

Is soft toric contact lenses fitting a feasible option to improve optical quality and visual performance in corneal ectasia?

OBJECTIVES: To assess the feasibility of fitting soft toric contact lenses (STCL) in corneal ectasias and their impact on optical quality and visual performance. METHODS: A total of 22 eyes were fitted with a molded STCL: 11 eyes/9 subjects with corneal ectasia and 11 healthy eyes/11 subjects. Wavefront aberrations were analyzed using a Hartmann-Shack aberrometer. Visual performance was measured under photopic (85 cd/m 2) and mesopic (≤3 cd/m 2) conditions. High-(96 %) and low- (10 %) contrast VA (HCVA and LCVA respectively) were assessed using the ETDRS charts and contrast sensitivity (CS) using the Pelli-Robson chart. RESULTS: After STCL fitting in the ectatic corneas, oblique astigmatism increased 0.15±0.17 µm and 0.34 ± 0.36 µm for 3 mm- and mesopic pupil diameters, respectively. Mean defocus decreased 1.41 ± 0.36 µm and 2.17 ± 0.85 µm for the same pupil diameters. More positive values of vertical coma were found with a change of 0.05 ± 0.06 µm and 0.12 ± 0.10 µm for 3 mm and mesopic pupil diameters, respectively. Comparing changes between both groups, with a 3 mm pupil aperture, statistically significant differences (p < 0.05) were detected in oblique astigmatism, defocus, vertical secondary trefoil and horizontal secondary coma. In the group with corneal ectasia, photopic HCVA and LCVA improved 0.09 ± 0.11 logMAR and 0.12 ± 0.15 logMAR respectively. In mesopic conditions, HCVA, LCVA and CS improved 0.11 ± 0.12 logMAR, 0.18 ± 0.15 logMAR and 0.11 ± 0.07 log. units, respectively. CONCLUSIONS: The analyzed molded soft toric contact lens is a feasible option for good vision in corneal ectasia with moderate irregularity and negative vertical coma.

Relationship Between Flicker Modulation Sensitivity and Retinal Ganglion Cell Related Layer Thicknesses.

Purpose: Early detection of structural changes in retinal ganglion cells (RGCs) and corresponding changes in visual function is important in early degenerative diseases of the retina, but the sensitivity of both measurements is limited by the inherent variability in healthy subjects. This study investigates the relationships between RGC-related layer thicknesses and foveal and parafoveal flicker modulation sensitivity (FMS) across photopic and mesopic light levels in healthy subjects. Methods: Photopic and mesopic FMS was measured in 56 young adults, at the point of fixation and at an eccentricity of 5 degrees, in each of the four quadrants. Spectral-domain optical coherence tomography (SD-OCT) was used to measure retinal thicknesses. Relationships between foveal and parafoveal FMS and the retinal thickness in the corresponding region were examined after adjusting for confounding variables. Results: Total macular and inner retinal layer (IRL) thicknesses in the parafoveal ring were significant predictors of photopic (P = 0.034) and mesopic (P = 0.034) parafoveal FMS, respectively. The superior peripapillary retinal nerve fiber layer (pRNFL) thickness was a contributing factor to the inferior parafoveal FMS (photopic: P = 0.006 and mesopic: P = 0.021) and the inferior pRNFL thickness was also a contributing factor to the superior parafoveal FMS (photopic: P < 0.001 and mesopic: P = 0.015). Conclusions: The pRNFL thicknesses predict parafoveal FMS for both mesopic and photopic conditions in healthy eyes. Translational Relevance: The measurement of rapid flicker sensitivity in the parafoveal retina together with the pRNFL thickness profiles measured before the onset of disease, may provide a more sensitive biomarker for detecting loss of sensitivity caused by the earliest neurodegenerative changes in the eyes.

Correction of Ocular Aberrations with Prismatic Rigid Gas-permeable Contact Lenses in Keratoconic Eyes.

SIGNIFICANCE: A base-down prism was incorporated on the anterior surface of rigid gas-permeable (RGP) contact lenses to explore potential effects on the residual ocular aberrations after contact lens fitting in keratoconic eyes. PURPOSE: This study aimed to evaluate the correction of ocular aberrations with corneal prismatic RGP contact lenses in keratoconic eyes and their impact on visual function. METHODS: A cross-sectional and randomized study was performed. Seventeen eyes of 17 keratoconus patients (34.6 ± 11.1 years) were evaluated. Two designs (standard and prismatic) of a corneal RGP contact lens (KAKC; Conoptica, Barcelona, Spain) were fitted to the same eye of each patient in a random order: a standard RGP contact lens as control and a prismatic RGP contact lens with a base-down prism of 1.6 prism diopters. Ocular aberrations were measured for a pupil diameter of 3 mm with and without both contact lenses, whereas high-contrast distance visual acuity, low-contrast distance visual acuity, and contrast sensitivity were measured under photopic and mesopic conditions. RESULTS: Both contact lenses improved oblique primary astigmatism, defocus, vertical coma, coma-like, and root-mean-square higher-order aberrations compared with the unaided eyes (P < .05). Furthermore, the prismatic RGP contact lenses offered lower values of vertical coma and root-mean-square higher-order aberrations than the standard RGP contact lenses (P < .05). Both designs (standard and prismatic) produced a positive vertical coma of lower magnitude than the negative vertical coma of the unaided eyes. On the other hand, the improvement achieved in all visual function variables was the same for both contact lens designs (P ≥ .05). CONCLUSIONS: The prismatic RGP contact lenses corrected higher levels of higher-order aberrations compared with the standard RGP contact lenses. However, both contact lens designs with the same refractive power were equally efficient at improving visual function.

Changes in retinal nerve fiber layer thickness measurements in response to a trifocal intraocular lens implantation.

AIMS: To determine the changes produced on the peripapillary retinal nerve fiber layer (RNFL) thickness, measured by an spectral-domain optical coherence tomography (OCT), after the implantation of a trifocal diffractive intraocular lens (IOL) and compare them with the variations produced by a monofocal IOL implantation. METHODS: A prospective, double masked study in which 50 eyes belonging to 50 patients with bilateral cataract were enrolled. Sequentially, the first 25 patients were bilaterally implanted with the trifocal diffractive IOL AT LISA® Tri 839 MP and the following 25 patients with the monofocal IOL CT ASPHINA® 409 M/MP. RNFL thickness measurements were performed by Cirrus HD®-OCT before and six months after the second eye surgery. RESULTS: Mean patient age was 69.5 ± 6.1 years. In response to surgery, the average RNFL thickness increased 7.29 ± 10.51 µm at the AT LISA® Tri group and 1.96 ± 2.90 µm at the monofocal IOL group from the baseline (p = 0.017). Statistically significant differences in thickness variations were also detected in the superior sector (7.86 ± 7.70 µm at the AT LISA® Tri group vs 1.73 ± 5.74 µm at the monofocal group). Statistically significant differences between the pre and the postsurgery measurements were found in all sectors except the inferior one with the trifocal IOL and in two of the studied sectors (average and temporal) with the monofocal IOL. CONCLUSIONS: The IOL implantation produce changes in the RNFL thickness, which are larger in case of a trifocal diffractive IOL.

Variation of Coma Aberration With Prismatic Soft Contact Lenses.

PURPOSE: To analyze the variation in vertical coma and the rest of ocular aberrations before and after fitting prismatic soft contact lenses (PSCL). METHODS: Thirty-seven eyes of 20 healthy subjects (24.30±2.03 years) were evaluated to analyze the variation in ocular wavefront aberrations before and after fitting PSCL of different base-down prism values (1.0, 1.5, and 2.0 prism diopters [PD]), designed to study its influence in the compensation of vertical coma aberration. A Hartmann-Shack sensor with a wavelength of 780 nm was used, considering a pupil size of 3 mm. In addition, the influence of PSCL in visual function under photopic conditions in terms of high-contrast visual acuity and contrast sensitivity was evaluated. RESULTS: There was statistically significant differences (P<0.05) in ocular aberrations from first to seventh order after fitting PSCL, but only the differences in vertical tilt, horizontal tilt, defocus, vertical astigmatism, and vertical coma were clinically relevant (Strehl ratio <0.8). The mean of vertical coma (µm) was 0.022±0.030 for control, 0.045±0.064 for 1.0 PD (P=0.645), 0.048±0.053 for 1.5 PD (P=0.037), and 0.074±0.047 for 2.0 PD (P<0.001). The changes in visual function under photopic conditions were not clinically relevant. CONCLUSIONS: PSCL induce a magnitude of vertical coma aberration directly proportional to prism value without affecting the rest of ocular high-order aberrations.

Visual outcomes after progressive apodized diffractive intraocular lens implantation.

PURPOSE: To assess photopic and mesopic vision in patients implanted with the Bi-Flex® M 677 MY bifocal intraocular lens (IOL). METHODS: In this prospective clinical study, 25 patients with cataract in both eyes were subjected to cataract surgery and bilateral implantation of the Bi-Flex® M 677MY (Medicontur, Hungary) IOL. Three months after surgery, high-contrast photopic uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA) were determined. Intermediate at 65 cm (DCIVA) and near at 40 cm (DCNVA) visual acuity were also measured, both with best distance correction. The CSV-1000 test chart was used to assess contrast sensitivity (CS). Defocus curves were constructed under photopic and mesopic conditions, determining binocular best-corrected visual acuity over the range +1.50 D to -4.00 D in 0.50-D steps. A KR-1W Wavefront Analyzer was used to measure pupil size and aberrometric outcomes. Presence and type of dysphotopsia were evaluated with the Likert scale. RESULTS: Mesopic mean pupil diameter was 4.58 ± 0.73 mm. The mean values at 3 months were UDVA 0.03 ± 0.09, CDVA -0.05 ± 0.06, DCIVA 0.20 ± 0.07, and DCNVA 0.11 ± 0.08. Mean CS for the 4 frequencies examined were 1.66 ± 0.16, 1.75 ± 0.14, 1.39 ± 0.22, and 0.96 ± 0.19. Significant differences were observed in defocus curves for photopic and mesopic conditions. A significant correlation between pupil diameter and the dysphotopic photopic was found (r = 0.62; p = 0.02). CONCLUSIONS: The evaluated progressive apodized diffractive design IOL provides effective restoration of visual function in far and near vision distance with an adequate intermediate visual quality between -1.00 and -1.50 focus.

Photopic and Mesopic Performance of 2 Different Trifocal Diffractive Intraocular Lenses.

Purpose To assess photopic and mesopic vision in patients implanted with 2 different trifocal intraocular lenses (IOLs). Methods Fifty patients with cataract in both eyes had surgery with bilateral implantation of a trifocal FineVision (FV, n = 25) or AT LISA tri 839MP (LisaTri, n = 25) IOL. Three months after surgery, high-contrast photopic uncorrected distance visual acuity and corrected distance visual acuity (CDVA) were determined using the Early Treatment Diabetic Retinopathy Study test. Intermediate (65 cm) and near (40 cm) visual acuity were also measured, both with best distance correction (DCIVA and DCNVA, respectively). The CSV1000 test chart was used for binocular and monocular contrast sensitivity. Defocus curves were constructed under photopic and mesopic conditions. Results Mean patient age was 68.4 ± 5.5 years (FV) and 67.3 ± 5.6 years (LisaTri) (p = 0.540). No differences were found in terms of visual acuity between the groups. The CDVA, DCIVA, and DCNVA were 0.05 ± 0.06, 0.25 ± 0.10, and 0.13 ± 0.10 logMAR for FV and -0.04 ± 0.11, 0.32 ± 0.09, and 0.12 ± 0.11 logMAR for LisaTri, respectively (p = 0.09, p = 0.08, and p = 0.12). Photopic and mesopic defocus curves were comparable between the 2 IOL groups (p>0.05). Mesopic values were significantly worse than photopic in both groups for all the measured values (p<0.001). No differences in contrast sensitivity were observed between the 2 IOL groups (p>0.05). Conclusions Both trifocal diffractive IOLs provided good visual quality with a statistically significant decrease in mesopic conditions.

Ocular Surface Temperature During Scleral Lens Wearing in Patients With Keratoconus.

OBJECTIVE: To evaluate the ocular surface temperature using an infrared thermography camera before and after wearing scleral lens in patients with keratoconus and correlate these results with the tear production and stability. METHODS: A pilot, experimental, short-term study has been performed. Twenty-six patients with keratoconus (36.95±8.95 years) participated voluntarily in the study. The sample was divided into two groups: patients with intrastromal corneal ring (KC-ICRS group) and patients without ICRS (KC group). Schirmer test, tear breakup time (TBUT), and ocular surface temperature in the conjunctiva, limbus, and cornea were evaluated before and after wearing a scleral lens. RESULTS: The patients wore the scleral lenses from 6 to 9 hours with average of 7.59±0.73 hours. No significant changes in Schirmer test and TBUT were found for both groups. No temperature differences were found between the KC-ICRS and the KC groups for all zones evaluated. There was a slight, but statistically significant, increase in the inferior cornea, temporal limbus, and nasal conjunctival temperature for KC-ICRS group and temporal limbus temperature decreasing for the KC group after wearing scleral lens (P<0.05). The conjunctiva and limbus temperature was statistically higher than the central cornea for both groups before and after scleral lenses wearing (P<0.05), but no difference in the peripheral cornea was found. No statistically significant differences in the central corneal temperature were found between the groups after scleral lens wearing (P>0.05). CONCLUSION: Scleral contact lens seems not to modify the ocular surface temperature despite the presence of the tear film stagnation under the lens.

Forward light scatter and visual acuity before and after intrastromal corneal ring segment implantation at different stages of keratoconus.

PURPOSE: To assess forward light scatter (stray light) before and after intrastromal corneal ring segment (ICRS) implantation at different stages of keratoconus and to examine correlation between postoperative stray light and visual acuity (VA). METHODS: In 27 eyes of 27 subjects with keratoconus, stray light was determined using the compensation comparison technique before and 6 months after ICRS implantation. Monocular corrected distance VA (CDVA) was measured using a high-contrast logMAR letter chart. Corneal higher-order aberrations (HOAs), contrast sensitivity (CS) and minimum corneal thickness (CT) were also measured. RESULTS: Mean CDVA was 0.42 ± 0.28 preoperatively and 0.24 ± 0.15 logMAR postoperatively (p < 0.01). Mean corneal coma-like aberration decreased postoperatively (RMS 0.55 ± 1.18 µm, p < 0.01). Minimum CT increased 25.31 ± 18.59 µm (p < 0.01). Mean preoperative and postoperative stray light were 1.36 ± 0.31 and 1.48 ± 0.32 log units, respectively (p < 0.01). Mean changes produced in stray light (worsening) were 0.03 ± 0.21 (p > 0.05) for stage I, 0.13 ± 0.14 (p = 0.013) for stage II and 0.18 ± 0.21 (p = 0.023) for stage III. Significant positive correlation (r = 0.47, p = 0.01) was detected between postoperative stray light and postoperative CDVA such that as stray light increased, CDVA worsened (higher logMAR values). Postoperative stray light was neither associated with HOAs, CS nor minimum CT. CONCLUSIONS: Stray light values in these patients with keratoconus were higher than normal preoperatively. In eyes with stage II and III keratoconus, stray light increased 6 months after ICRS placement. Higher postoperative stray light was correlated with a worse visual acuity outcome.

Visual outcomes after bilateral trifocal diffractive intraocular lens implantation.

BACKGROUND: In recent years new models of intraocular lenses are appearing on the market to reduce requirements for additional optical correction. The purpose of this study is to assess visual outcomes following bilateral cataract surgery and the implant of a FineVision® trifocal intraocular lens (IOL). METHODS: Prospective, nonrandomized, observational study. Vision was assessed in 44 eyes of 22 patients (mean age 68.4 ± 5.5 years) before and 3 months after surgery. Aberrations were determined using the Topcon KR-1 W wave-front analyzer. LogMAR visual acuity was measured at distance (corrected distance visual acuity, CDVA 4 m), intermediate (distance corrected intermediate visual acuity, DCIVA 60 cm) and near (distance corrected near visual acuity, DCNVA 40 cm). The Pelli-Robson letter chart and the CSV-1000 test were used to estimate contrast sensitivity (CS). Defocus curve testing was performed in photopic and mesopic conditions. Adverse photic phenomena were assessed using the Halo v1.0 program. RESULTS: Mean aberration values for a mesopic pupil diameter were: total HOA RMS: 0.41 ± 0.30 µm, coma: 0.32 ± 0.22 µm and spherical aberration: 0.21 ± 0.20 µm. Binocular logMAR measurements were: CDVA -0.05 ± 0.05, DCIVA 0.15 ± 0.10, and DCNVA 0.06 ± 0.10. Mean Pelli-Robson CS was 1.40 ± 0.14 log units. Mean CSV100 CS for the 4 frequencies examined (A: 3 cycles/degree (cpd), B: 6 cpd, C: 12 cpd, D: 18 cpd) were 1.64 ± 0.14, 1.77 ± 0.18, 1.44 ± 0.24 and 0.98 ± 0.24 log units, respectively. Significant differences were observed in defocus curves for photopic and mesopic conditions (p < 0.0001). A mean disturbance index of 0.28 ± 0.22 was obtained. CONCLUSIONS: Bilateral FineVision IOL implant achieved a full range of adequate vision, satisfactory contrast sensitivity, and a lack of significant adverse photic phenomena. TRIAL REGISTRATION: Eudract Clinical Trials Registry Number: 2014-003266-2.