Standard Clinical Outcomes, Light Distortion, Stereopsis, and a Quality-of-Life Assessment of a New Binocular System of Complementary IOLs.

PURPOSE: To evaluate the visual outcome, light distortion index (LDI), and quality of life (QoL) of patients implanted with two complementary intraocular lenses (IOLs) to treat cataract and presbyopia. METHODS: Twenty-seven consecutive patients with cataract were treated with the implantation of the Artis Symbiose Mid (Mid) IOL (Cristalens Industrie) in the distance-dominant eye and the Artis Symbiose Plus (Plus) IOL (Cristalens Industrie) in the contralateral eye following phacoemulsification. The primary objective was to ascertain the monocular and binocular defocus curves. Secondary endpoints included uncorrected distance visual acuity, corrected distance visual acuity, uncorrected intermediate visual acuity, and distance-corrected intermediate visual acuity at 90 and 70 cm, uncorrected near visual acuity and distance-corrected visual acuity at 40 cm, contrast sensitivity, LDI with a halometer, stereopsis, and patients' QoL with the validated Visual Function Index (VF-14) questionnaire. These measurements were collected in two visits, at 4.14 ± 3.13 and 10.30 ± 3.14 months postoperatively. RESULTS: Statistically significant differences in the monocular defocus curves were found at the defocus steps of -1.00, -1.25, -1.50, -1.75, -2.50, -2.75, -3.00, -3.50 diopters and the -4.00 diopters (P < .050). The mean binocular defocus curve was 0 logMAR or better from the +0.50 to the -2.50 D defocus steps. Contrast sensitivity was within normal values. The LDI was 12.57 (6.61)% for the Mid eyes, 14.99 ± 5.70% for the Plus eyes, and 10.36 ± 4.42% binocularly. The patients' stereopsis was 40.0 (12.5) arc-seconds. The QoL score was 95.99 (7.14) at 10 months. CONCLUSIONS: The implantation of the Artis Symbiose IOLs was a safe and effective treatment for presbyopia compensation in patients with cataract. Both IOLs are complementary and may produce a binocular depth-of-field of 3.00 diopters over 0 logMAR when used together. [J Refract Surg. 2023;39(10):654-661.].

On the protective role of the blood vessels in glaucomatous damage: A transversal study

Purpose: To corroborate whether vessels on the surface of the optic nerve head can provide protection against the loss of underlying axons in subjects with manifest glaucoma.MethodsIn this pilot study, thirty-six glaucomatous eyes with a perimetric defect in the Bjerrum area were included. The retinal nerve fiber layer (RNFL) thickness was measured in each of the sectors of the clock-hour map obtained by Cirrus HD-OCT considering the presence or absence of blood vessels. These sectors were related with their corresponding areas of the retina examined in the visual field using a mathematical model of the retina introduced by Jansonius, in order to determine the values of threshold sensitivity in those areas in the presence or absence of vessels.ResultsWe corroborated the protective role of the blood vessel for peripapillary RNFL thickness of clock-hour 12 despite obtaining a p-value (p = 0.023; w = 228.5) close to the acceptance zone (p ≥ 0.05). The mean ± standard deviation with vessel and without vessel were 70.95 ± 24.35 and 88.46 ± 23.96, respectively. No differences were found between the mean values of threshold sensitivity to the presence or absence of blood vessels in each of the sectors considered.ConclusionsOur findings do not allow us to affirm that there is an association between the presence of a vessel and protection against glaucomatous damage in subjects with an advanced manifestation of the disease. In the future, more extensive studies are needed to study this relationship in subjects with early glaucoma. (AU)

On the protective role of the blood vessels in glaucomatous damage: A transversal study.

PURPOSE: To corroborate whether vessels on the surface of the optic nerve head can provide protection against the loss of underlying axons in subjects with manifest glaucoma. METHODS: In this pilot study, thirty-six glaucomatous eyes with a perimetric defect in the Bjerrum area were included. The retinal nerve fiber layer (RNFL) thickness was measured in each of the sectors of the clock-hour map obtained by Cirrus HD-OCT considering the presence or absence of blood vessels. These sectors were related with their corresponding areas of the retina examined in the visual field using a mathematical model of the retina introduced by Jansonius, in order to determine the values of threshold sensitivity in those areas in the presence or absence of vessels. RESULTS: We corroborated the protective role of the blood vessel for peripapillary RNFL thickness of clock-hour 12 despite obtaining a p-value (p = 0.023; w = 228.5) close to the acceptance zone (p ≥ 0.05). The mean ± standard deviation with vessel and without vessel were 70.95 ± 24.35 and 88.46 ± 23.96, respectively. No differences were found between the mean values of threshold sensitivity to the presence or absence of blood vessels in each of the sectors considered. CONCLUSIONS: Our findings do not allow us to affirm that there is an association between the presence of a vessel and protection against glaucomatous damage in subjects with an advanced manifestation of the disease. In the future, more extensive studies are needed to study this relationship in subjects with early glaucoma.

Prevalencia y factores sociodemográficos asociados a la ambliopía en población preescolar / Prevalence and sociodemographic factors associated with amblyopia in preschool children

Objetivo: estimar la prevalencia de la ambliopía y su tratamiento en niños de preescolar de la provincia de Alicante (España) durante un periodo de larga duración, así como la influencia de diferentes factores sociodemográficos. Material y método: estudio observacional descriptivo transversal (2002-2015) mediante protocolo de detección de ambliopía validado (sensibilidad 89,3%; especificidad 93,1%) en niños escolarizados de 4 a 6 años. La variable principal fue la clasificación, de los 140 102 niños examinados, según el resultado de las pruebas (“normales”, “sospechosos de patología” o en “tratamiento previo”) y las variables explicativas: edad, sexo, curso escolar, tipo de gestión del colegio y su ubicación. Resultados: la prevalencia de niños con sospecha de ambliopía osciló significativamente, entre los cursos escolares, desde 8,54% hasta 23,9% (p = 0,00000). Los niños de 6 años presentaron valores de sospecha de ambliopía notablemente más altos (16,68%; p = 0,00000) y los niños matriculados en colegios privados, los más bajos (8,05%; p = 0,00000). La probabilidad de que un niño “no-normal” estuviera ya tratado aumentaba con la edad (OR 2,06; p <0,001) y con el hecho de asistir a un colegio privado (OR 1,56; p = 0,001). Conclusiones: la prevalencia de la sospecha de ambliopía fue alta en el área de estudio, siendo los niños de mayor edad y los niños pertenecientes al grupo de nivel socioeconómico más bajo los de mayor riesgo. Los programas de cribado escolar para la detección temprana de la ambliopía son recomendados para aumentar y equiparar la probabilidad de acceso al tratamiento, reduciendo así la prevalencia y la gravedad de la ambliopía en niños (AU)

Objective: to estimate the prevalence of amblyopia and its treatment in preschool children in the province of Alicante over a long time period, and assess the influence of different sociodemographic factors.Methods: cross-sectional descriptive observational study (2002-2015) using a validated amblyopia detection protocol (sensitivity, 89.3%; specificity, 93.1%) in preschool children aged 4 to 6 years. The primary outcome was the classification of the 140 102 examined children based on the test results ('normal', 'suspected amblyopia' or 'in treatment') and the explanatory variables: age, sex, school year, private/public ownership of school and school location.Results: the prevalence of children with suspected amblyopia varied significantly between school years, ranging from 8.54% to 23.9% (p=0.00000). The prevalence of suspected amblyopia was significantly higher in children aged 6 years (16.68%; p=0.00000) and lowest in those attending private schools (8.05%; p=0.00000). The probability that a child with abnormal results was already in treatment increased with age (OR 2.06; p<0.001) and with enrolment in a private school (OR 1.56; p=0.001).Conclusions: the prevalence of suspected amblyopia was high in the study area, with a higher risk in older children and children in to the lowest socioeconomic status group. School-based screening programs for early detection of amblyopia are recommended to increase and equalize access to treatment, thereby reducing the prevalence and severity of amblyopia in children. (AU)

Total Depth of Focus of Five Premium Multifocal Intraocular Lenses.

PURPOSE: To compare the in vitro optical performance of five premium multifocal intraocular lenses (IOLs), including a single-valued metric that shows the total range of distances where a multifocal IOL generates an acceptable image quality. METHODS: Through-focus modulation transfer function (MTF) and the image of a United States Air Force target were obtained for a 3-mm pupil and a wavelength of 546 nm in five multifocal IOLs (Tecnis Symfony [Johnson & Johnson], FineVision Micro F [PhysIOL], Acrysof IQ PanOptix [Novartis], and Artis Symbiose Mid and Plus [Cristalens Industrie] multifocal IOLs). Total depth of focus (TDOF) is computed by adding the vergence intervals where the through-focus MTF at 50 cycles/mm is 0.15 or greater. RESULTS: Due to their different optical designs (bifocal, trifocal, or extended depth of focus), energy is distributed differently between far, intermediate, and near focus for each multifocal IOL. The light distribution of the Symbiose Mid and Plus multifocal IOLs was similar, concentrating the energy into far focus and the intermediate into near focus, but extending the intermediate focus more (Plus) or less (Mid) toward the near focus. TDOFs were: 1.58 diopters [D] (FineVision); 1.71 D (Tecnis Symfony); 1.73 D (Artis Symbiose Plus); 1.74 D (Artis Symbiose Mid); and 1.90 D (Acrysof IQ PanOptix). CONCLUSIONS: TDOFs were similar between multifocal IOLs with a maximum difference of 0.32 D and mean value of 1.73 D. The combination of the Symbiose Mid and Plus IOLs can theoretically provide a TDOF of 2.90 D in case one is implanted in one eye and the other in the fellow eye. [J Refract Surg. 2020;36(9):578-584.].

Macular Thickness in Subjective Memory Complaints and Mild Cognitive Impairment: A Non-Invasive Biomarker.

Alzheimer's disease (AD) is the main cause of dementia worldwide, which implies an important socioeconomic problem in developed countries. Efforts to find biomarkers to diagnose AD have been intensified, especially, to detect cognitive impairment in its early stages, also known as mild cognitive impairment (MCI). Besides, there are individuals referring memory loss that is unnoticeable in the family environment and presenting normal neuropsychological tests. The former patients are included in a clinical picture that has been recently called subjective memory complaints (SMC). To achieve an early diagnosis, optical coherence tomography (OCT) has been used to measure macular thickness in patients diagnosed with MCI (supported by neuropsychological tests) and SMC (not based on neuropsychological battery). Statistically significant differences have been found in the macular thickness of the control group (274.96 ± 17.61 µm) and for both MCI (259.48 ± 22.39 µm) and SMC (261.45 ± 24.26 µm) patients. In the near future, OCT could become a reliable biomarker and a useful tool for AD screening as well as for the monitoring of the cognitive impairment associated with AD.

¿Hasta dónde llega la precocidad de la tomografía de coherencia óptica en el deterioro cognitivo? / How far reaches earliness of optical coherence tomography in cognitive impairment

Introducción. La enfermedad de Alzheimer (EA) es la primera causa de demencia mundial. Cada vez son más los esfuerzos para lograr una detección temprana del deterioro cognitivo y surgen en el panorama científico entidades diagnósticas como el deterioro cognitivo leve (DCL) y las quejas subjetivas de memoria (QSM). Debido a ello, aparecen numerosos biomarcadores estudiados para conseguir dicho objetivo, entre ellos la tomografía de coherencia óptica. Sujetos y métodos. Se ha realizado un estudio que utiliza la tomografía de coherencia óptica para medir el grosor macular y la capa de fibras nerviosas de la retina en pacientes diagnosticados de EA (n = 36), pacientes con DCL (n = 33), en individuos con QSM (n = 24) y en sujetos control (n = 45). Resultados. Se han encontrado diferencias estadísticamente significativas en cuanto al grosor macular entre todos los grupos estudiados (QSM: 261,8 ± 25,88 μm; DCL: 259,19 ± 22,582 μm; EA leve: 258,53 ± 14,804 μm; EA moderada: 249,32 ± 18,467 μm) y sujetos control (271,96 ± 15,57 μm). Respecto a la capa de fibras nerviosas de la retina, ocurre de igual manera, y la diferencia es estadísticamente significativa frente al grupo control (94,51 ± 9,203 μm) de todos los grupos (QSM: 90,44 ± 9,059 μm; DCL: 89,4 ± 10,421 μm; EA leve: 87,12 ± 10,279 μm; EA moderada: 82,25 ± 10,636 μm). Conclusión. La tomografía de coherencia óptica podría situarse como un futuro biomarcador y una herramienta de apoyo para facilitar el diagnóstico precoz del deterioro cognitivo y de la EA (AU)

Introduction. Alzheimer’s disease (AD) is the leading cause of dementia in the world today. Increasingly greater efforts are being made to be able to detect cognitive impairment in earlier stages, and diagnostic entities such as mild cognitive impairment (MCI) and subjective memory complaints (SMC) are appearing. The number of biomarkers studied with the aim of reaching this goal continues to rise, and include optical coherence tomography. Subjects and methods. The study conducted employed optical coherence tomography to measure the macular thickness and the retinal nerve fibre layer in patients diagnosed with AD (n = 36), in patients with MCI (n = 33), in individuals with SMC (n = 24) and in control subjects (n = 45). Results. Statistically significant differences have been found in terms of the macular thickness among all the groups studied (SMC: 261.8 ± 25.88 μm; MCI: 259.19 ± 22.582 μm; mild AD: 258.53 ± 14.804 μm; moderate AD: 249.32 ± 18.467 μm) and control subjects (271.96 ± 15.57 μm). The same occurs as regards the retinal nerve fibre layer and the difference is statistically significant compared with the control group (94.51 ± 9.203 μm) of all the groups (SMC: 90.44 ± 9.059 μm; MCI: 89.4 ± 10.421 μm; mild AD: 87.12 ± 10.279 μm; moderate AD: 82.25 ± 10.636 μm). Conclusion. Optical coherence tomography could be a future biomarker and support tool to facilitate the early diagnosis of cognitive impairment and AD (AU)

Utilidad de las curas locales tras dacriocistorrinostomía láser / Usefulness of local postoperative care after laser dacryocystorhinostomy

Introducción y objetivos: La epífora originada por la oclusión del drenaje nasolagrimal es la principal indicación de la dacriocistorrinostomía (DCR). Igualmente, lo son la conjuntivitis crónica y la dacriocistitis del mismo origen. La vía endoscópica nasal, y la introducción del láser (DCR láser) ha facilitado la realización de la técnica, aunque requiere un equipamiento complejo y costoso, por lo que siguen existiendo partidarios del procedimiento externo tradicional. El objetivo de este estudio es analizar la efectividad y utilidad de las curas posoperatorias de la DCR láser en el resultado final. Material y métodos: Estudiamos un grupo de 96 pacientes diagnosticados de epífora secundaria a estenosis-oclusión del conducto nasolagrimal. En 32 pacientes se realizó la intervención en ambos ojos, lo que hace un total de 128 casos. La cirugía se practicó en un ámbito privado entre enero de 1999 y diciembre de 2008. Los 128 casos se dividieron en 2 grupos: 59 casos en los que se realizaron entre 4 y 6 curas posoperatorias en los 2 meses siguientes a la cirugía. Otro grupo de 69 casos en los que se hizo una sola cura, aproximadamente a los 7 días de la intervención. La valoración definitiva del resultado de la intervención se hizo en todos los casos entre 24 y 30 meses tras la cirugía. Resultados: En 27 casos de los 128 (79% de éxitos) se produjo una reestenosis del drenaje lagrimal, sin encontrar diferencias estadísticamente significativas entre los 2 grupos. Conclusiones: En la muestra de pacientes que hemos intervenido mediante DCR láser, resulta irrelevante, en cuanto al éxito de la intervención, la realización o no de curas posoperatorias (AU)

Introduction and objectives: Epiphora caused by nasolacrimal drainage system obstruction is the main indication for dacryocystorhinostomy (DCR). So are chronic conjunctivitis and dacryocystitis from the same origin. Nasal endoscopy and the introduction of laser assisted DCR have facilitated the performance of the technique. However, it requires complex and expensive equipment, so there are still supporters of the traditional external procedure. The aim of this work was to study the effectiveness and usefulness of local postoperative care in laser DCR final result. Material and methods: We studied a group of 96 patients diagnosed with epiphora secondary to stenosis-occlusion of the nasolacrimal duct. Of these, 32 patients underwent surgery in both eyes, making a total of 128 cases. The surgery was performed in a private setting between January 1999 and December 2008. The 128 cases were divided into 2 groups: 59 cases in which between 4 and 6 postoperative cures were given in the 2 months following the surgery, and another group of 69 cases in which a single cure was given approximately 7 days after surgery. The final assessment of the outcome of the intervention was done in all cases between 24-30 months after surgery. Results: In 27 cases out of 128 (79% success), there was a restenosis of tear drainage. No statistically significant differences were found between the 2 groups. Conclusions: In the sample of patients that were intervened using laser assisted DCR, implementation of postoperative cure was irrelevant in the success of the intervention (AU)

Usefulness of local postoperative care after laser dacryocystorhinostomy.

INTRODUCTION AND OBJECTIVES: Epiphora caused by nasolacrimal drainage system obstruction is the main indication for dacryocystorhinostomy (DCR). So are chronic conjunctivitis and dacryocystitis from the same origin. Nasal endoscopy and the introduction of laser assisted DCR have facilitated the performance of the technique. However, it requires complex and expensive equipment, so there are still supporters of the traditional external procedure. The aim of this work was to study the effectiveness and usefulness of local postoperative care in laser DCR final result. MATERIAL AND METHODS: We studied a group of 96 patients diagnosed with epiphora secondary to stenosis-occlusion of the nasolacrimal duct. Of these, 32 patients underwent surgery in both eyes, making a total of 128 cases. The surgery was performed in a private setting between January 1999 and December 2008. The 128 cases were divided into 2 groups: 59 cases in which between 4 and 6 postoperative cures were given in the 2 months following the surgery, and another group of 69 cases in which a single cure was given approximately 7 days after surgery. The final assessment of the outcome of the intervention was done in all cases between 24-30 months after surgery. RESULTS: In 27 cases out of 128 (79% success), there was a restenosis of tear drainage. No statistically significant differences were found between the 2 groups. CONCLUSIONS: In the sample of patients that were intervened using laser assisted DCR, implementation of postoperative cure was irrelevant in the success of the intervention.