Transient Light Sensitivity Syndrome (TLSS) Incidence Following Femtosecond LASIK for Myopic and Hyperopic Eyes and Femtosecond SMILE for Myopic Eyes.

PURPOSE: To evaluate and compare the incidence of transient light sensitivity syndrome (TLSS) after myopic laser in situ keratomileusis (LASIK), hyperopic LASIK, and myopic small incision lenticule extraction (SMILE). METHODS: A retrospective analysis was performed of consecutive LASIK and myopic SMILE cases, performed with the VisuMax femtosecond laser and MEL 80 or MEL 90 excimer laser (both Carl Zeiss Meditec AG) between January 2010 and February 2021 at London Vision Clinic, London, United Kingdom. A chart review was performed to find cases of clinically significant TLSS, identified as patients prescribed anti-inflammatory medications between 2 weeks and 6 months after surgery to manage photophobia. The incidence of TLSS was calculated for three groups: myopic SMILE, myopic LASIK, and hyperopic LASIK. The incidence of TLSS was then calculated for three subgroups within each treatment type based on spherical equivalent refraction treated. For myopic SMILE and myopic LASIK, it was 0.00 to -4.00 diopters (D) (low), -4.01 to -8.00 D (moderate), and -8.01 to -14.00 D (high). For hyperopic LASIK, it was 0.00 to +2.00 D (low), +2.01 to +4.00 D (moderate), and +4.01 to +6.50 D (high). RESULTS: The range of treatment for myopia was similar between the LASIK and SMILE groups. The incidence of TLSS was 1.2% for the myopic SMILE group, 5.3% for the myopic LASIK group, and 9.0% for the hyperopic LASIK group. The difference was statistically significant between all groups (P < .001). For myopic SMILE, the incidence of TLSS was independent of spherical equivalent refraction for low (1.4%), moderate (1.0%), and high (1.1%) myopia (P > .05). Similarly, for hyperopic LASIK, the incidence was similar for low (9.4%), moderate (8.7%), and high (8.7%) hyperopia (P > .05). In contrast, for myopic LASIK, the incidence of TLSS was "dose-dependent" on refractive error treated, with an incidence of 4.7% for low, 5.8% for moderate, and 8.1% for high myopia (P < .001). CONCLUSIONS: The incidence of TLSS was higher after myopic LASIK than after myopic SMILE, higher after hyperopic than myopic LASIK, and "dose-dependent" for myopic LASIK but did not vary by correction in myopic SMILE. This is the first report describing the phenomenon of late TLSS occurring between 8 weeks and 6 months after surgery, [J Refract Surg. 2023:39(6):366-373.].

Large Population Outcomes of Small Incision Lenticule Extraction in Young Myopic Patients.

PURPOSE: To evaluate the outcomes of small incision lenticule extraction (SMILE) for myopia in a large population of young adults. METHODS: In this retrospective case series, the patient population consisted of the first 4,138 consecutive SMILE treatments using the VisuMax femtosecond laser (Carl Zeiss Meditec) between 2012 and 2018 at the London Vision Clinic. Inclusion criteria were myopic spherical equivalent up to -9.00 diopters (D), cylinder up to 6.00 D, corrected distance visual acuity of 20/20 or better, age younger than 40 years, and follow-up of 12 months. Outcomes analysis was performed using the Standard Graphs for Reporting Refractive Surgery. RESULTS: Data were available at 12 months in 3,722 eyes (90%), and 416 eyes (10%) were lost to follow-up. Mean attempted spherical equivalent refraction (SEQ) was -4.61 ± 1.84 D (range: -1.12 to -9.00 D). Mean cylinder was -0.78 ± 0.66 D (range: 0.00 to -6.00 D). Postoperatively, the mean SEQ relative to target was -0.13 ± 0.30 D (range: -1.35 to +1.25 D) and was within ±0.50 D in 88.1% and ±1.00 D in 99.6% of eyes. Uncorrected distance visual acuity was 20/20 or better in 95.4% of eyes and 20/25 or better in 98.7% of eyes. One line of CDVA was lost in 3.0% of eyes, and 0.08% (n = 3) lost two or more lines of CDVA, for which CDVA was restored following phototherapeutic keratectomy treatment. There was a statistically significant improvement of 0.05, 0.06, 0.07, and 0.07 log units for contrast sensitivity at 3, 6, 12, and 18 cycles per degree, respectively (P < .001). CONCLUSIONS: SMILE achieved excellent outcomes for myopia up to -9.00 D with cylinder up to -5.50 D for a large population in patients without presbyopia. [J Refract Surg. 2022;38(8):488-496.].

Randomised controlled trial of an accommodative support lens designed for computer users.

PURPOSE: Accommodative support (AS) lenses are a low add progressive addition spectacle lens designed to ease symptoms in computer vision syndrome (CVS). The study aims to investigate if (1) AS lenses improve CVS symptoms; (2) binocular/accommodative functions predict a benefit from AS lenses and (3) wearing AS lenses for six months impacts on binocular/accommodative functions. METHODS: Pre-presbyopic adults with symptoms of CVS (Computer Vision Syndrome Questionnaire, CVS-Q© , score ≥ 6) were randomly allocated to wear AS lenses or control single vision (SV) lenses. The CVS-Q© and a battery of optometric tests were applied at baseline and after three and six months. Participants and researchers were masked to participant group. After six months, the SV group were unmasked and changed to AS lenses and one week later asked to choose which they preferred. RESULTS: The change in CVS-Q© scores from baseline to six months did not differ significantly in the two groups. At the end of the one week period, when the control group wore the AS lenses, control group participants were significantly more likely to prefer AS lenses to SV lenses. No optometric functions correlated with the benefit from AS lenses. AS lenses did not have any adverse effects on binocular or accommodative function. CONCLUSIONS: In pre-presbyopic adults, there was no greater improvement in CVS-Q© scores in the group wearing AS lenses than in the control group. No adverse effects on optometric function (including accommodation) are associated with wearing AS lenses.

Referrals from community optometrists to the hospital eye service in Scotland and England.

OBJECTIVES: This audit assesses communication between community optometrists (COs) and hospital eye service (HES) in Scotland and England. METHODS: Optometric referrals and replies were extracted from six practices in Scotland and England. If no reply was found, replies/records were copied from HES records. De-identified referrals, replies and records were audited against established standards, evaluating whether referrals were necessary, accurate and directed to the appropriate professional. The referral rate (RR) and referral reply rate (RRR) were calculated. RESULTS: From 905 de-identified referrals, RR ranged from 2.6 to 8.7%. From COs' perspective, the proportion of referrals for which they received replies ranged from 37 to 84% (Scotland) and 26 to 49% (England). A total of 88-96% of referrals (Scotland) and 63-76% (England) were seen in the HES. Adjusting for cases when it is reasonable to expect replies, RRR becomes 45-92% (Scotland) and 38-62% (England) with RRR significantly greater in Scotland (P = 0.015). Replies were copied to patients in 0-21% of cases. Referrals were to the appropriate service and judged necessary in ≥90% of cases in both jurisdictions. Accuracy of referral ranged from 89 to 97% (Scotland) and 81 to 98% (England). The reply addressed the reason for referral in 94-100% of cases (Scotland) and 93-97% (England) and was meaningful in 95-100% (Scotland) and 94-99% (England). CONCLUSIONS: Despite the interdisciplinary joint statement on sharing patient information, this audit highlights variable standard of referrals and deficits in replies to the referring COs, with one exception in Scotland. Replies from HES to COs are important for patient care, benefitting patients and clinicians and minimising unnecessary HES appointments.

Is reading rate in digital eyestrain influenced by binocular and accommodative anomalies?

Introduction: Symptoms experienced when using digital devices are known as digital eyestrain (DES) or computer vision syndrome. They can be categorised as either external (associated with dry eye) or internal (related to refractive, accommodative or binocular vision anomalies). In a large cohort of adults with DES, we investigate the prevalence of binocular and accommodative anomalies, contrasting different diagnostic approaches, to evaluate potential mechanisms for the benefit from +0.75D addition lens that has been previously reported. Methods: Participants (20−40y) were selected using the Computer Vision Syndrome Questionnaire (CVS-Q) tool as suffering with DES. A comprehensive eye examination was given to each participant, and this paper concentrates on “internal factors”, detected with a refraction and comprehensive testing of binocular and accommodative functions. The effects of low-powered addition lenses (+0.50D, +0.75D, +1.25D; and plano controls) were assessed by double-masked testing with the Wilkins Rate of Reading Test (WRRT) and by subjective preference. Results: As previously reported, most participants showed a subjective preference for one of the three convex lenses we used, with +0.75D chosen most frequently. Performance at the WRRT was significantly improved with +0.50D and +0.75D, but not +1.25D. Using a variety of diagnostic criteria, there were no strong associations between WRRT results or CVS-Q scores and any binocular or accommodation functions. The one finding of significance is that a disproportionate number of participants who benefited from adds had an eso-fixation disparity on the near Mallett unit, although this only affected 5% of the population. Conclusions: DES is a collection of diverse symptoms that have a multifactorial aetiology. In the sample described here, binocular and accommodative anomalies do not seem to be a major cause of DES. (AU)

Is reading rate in digital eyestrain influenced by binocular and accommodative anomalies?

INTRODUCTION: Symptoms experienced when using digital devices are known as digital eyestrain (DES) or computer vision syndrome. They can be categorised as either external (associated with dry eye) or internal (related to refractive, accommodative or binocular vision anomalies). In a large cohort of adults with DES, we investigate the prevalence of binocular and accommodative anomalies, contrasting different diagnostic approaches, to evaluate potential mechanisms for the benefit from +0.75D addition lens that has been previously reported. METHODS: Participants (20-40y) were selected using the Computer Vision Syndrome Questionnaire (CVS-Q) tool as suffering with DES. A comprehensive eye examination was given to each participant, and this paper concentrates on "internal factors", detected with a refraction and comprehensive testing of binocular and accommodative functions. The effects of low-powered addition lenses (+0.50D, +0.75D, +1.25D; and plano controls) were assessed by double-masked testing with the Wilkins Rate of Reading Test (WRRT) and by subjective preference. RESULTS: As previously reported, most participants showed a subjective preference for one of the three convex lenses we used, with +0.75D chosen most frequently. Performance at the WRRT was significantly improved with +0.50D and +0.75D, but not +1.25D. Using a variety of diagnostic criteria, there were no strong associations between WRRT results or CVS-Q scores and any binocular or accommodation functions. The one finding of significance is that a disproportionate number of participants who benefited from adds had an eso-fixation disparity on the near Mallett unit, although this only affected 5% of the population. CONCLUSIONS: DES is a collection of diverse symptoms that have a multifactorial aetiology. In the sample described here, binocular and accommodative anomalies do not seem to be a major cause of DES. Nevertheless, in view of the multifactorial aetiology it is recommended that patients with the symptoms of DES are assessed with a comprehensive eye examination. Patients with an esophoric fixation disparity on the near Mallett unit are particularly likely to benefit from near additions.

Referrals from community optometrists to the hospital eye service in England.

PURPOSE: In the UK, most referrals to the hospital eye service (HES) originate from community optometrists (CO). This audit investigates the quality of referrals, replies, and communication between CO and the HES. METHODS: Optometric referrals and replies were extracted from three practices in England. If no reply letter was found, the records were searched at each local HES unit, and additional replies or records copied. De-identified referrals, replies and records were audited by a panel against established standards to evaluate whether the referrals were necessary, accurate and directed to the appropriate professional. The referral rate (RR) and referral reply rate (RRR) were calculated. RESULTS: A total of 459 de-identified referrals were extracted. The RR ranged from 3.6%-8.7%. The proportion of referred patients who were seen in the HES unit was 63%-76%. From the CO perspective, the proportion of referrals for which they received replies ranged from 26%-49%. Adjusting the number of referrals for cases when it would be reasonable to expect an HES reply, RRR becomes 38%-62%. Patients received a copy of the reply in 3%-21% of cases. Referrals were made to the appropriate service in over 95% of cases, were judged necessary in 93%-97% and were accurate in 81%-98% of cases. The referral reply addressed the reason for the referral in 93%-97% and was meaningful in 94%-99% of cases. The most common conditions referred were glaucoma, cataract, anterior segment lesions, and neurological/ocular motor anomalies. The CO/HES dyad (pairing) in the area with the lowest average household income had the highest RR. CONCLUSIONS: In contrast with the Royal College of Ophthalmologists/College of Optometrists joint statement on sharing patient information, CO referrals often do not elicit a reply to the referring CO. Replies from the HES to COs are important for patient care, benefitting patients and clinicians, and minimising unnecessary HES appointments.

An investigation of low power convex lenses (adds) for eyestrain in the digital age (CLEDA) / Investigación sobre las lentes convexas de baja potencia (adiciones) para la fatiga en la era digital (CLEDA)

INTRODUCTION: Digital eye strain (DES; computer vision syndrome) is a common cause of symptoms when viewing digital devices. Low-powered convex lenses (adds) have been recommended for the condition and "accommodative support" designs developed on this premise. The present research reports the extent to which dry eye is present in this population and the effect of convex lenses on symptoms and visual performance. METHODS: The CVS-Q instrument was used to select pre-presbyopic adults with the symptoms of DES. Participants received a full eye examination including an assessment of dry eye with a modified SANDE questionnaire and using DEWS I criteria. The immediate effect of low-powered convex lenses (low adds: +0.50D, +0.75D, +1.25D) was investigated using subjective preference and a double-masked comparison with plano lenses with the Wilkins Rate of Reading Test (WRRT). Throughout this testing, participants wore their full distance refractive correction, based on non-cycloplegic retinoscopy and subjective refraction. RESULTS: The signs and symptoms of dry eye were frequently present. Most participants reported a subjective preference for low adds, with +0.75D the most commonly preferred lens. Low adds (+0.50D and +0.75D; but not +1.25D) were associated with significantly improved performance at the WRRT. One quarter of participants read more than 10% faster with these additional convex lenses. CONCLUSIONS: The study population was aged 20-40y and mostly worked on desktop computers. It is possible that +1.25D add may be more advantageous for people who are older or work more at closer viewing distances. Many symptomatic users of digital devices report a preference for low adds and use of these lenses is often associated with an improvement in reading performance

INTRODUCCIÓN: La fatiga digital (DES; síndrome visual informático) es una causa común de síntomas, a causa de la visualización de dispositivos digitales. Se han recomendado lentes convexas de baja potencia para esta situación, así como diseños de "apoyo acomodativo" desarrollados sobre la base de este principio. Los informes de investigación actuales reportan el alcance de la presencia de ojo seco en esta población, así como el efecto de las lentes convexas en los síntomas y el desempeño visual. MÉTODOS: Se utilizó el instrumento CVS-Q para seleccionar adultos pre-presbiópicos con síntomas de DES. Se realizó un examen visual completo a los participantes, incluyendo valoración de ojo seco con un cuestionario SANDE modificado, y utilizando los criterios DEWS I. Se investigó el efecto inmediato de las lentes convexas de baja potencia (adiciones bajas: +0,50D, +0,75D, +1,25D) utilizando la preferencia subjetiva y una comparación doble ciego con lentes planas mediante la prueba Wilkins Rate of Reading Test (WRRT). A lo largo de esta prueba, los participantes utilizaban su corrección refractiva de distancia completa, basada en retinoscopia no ciclopéjica y refracción subjetiva. RESULTADOS: Los signos y síntomas del ojo seco estuvieron frecuentemente presentes. Muchos participantes reportaron una preferencia subjetiva de bajas adiciones, siendo las lentes de +0,75D las más comúnmente preferidas. Las bajas adiciones (+0,50D y +0,75D, pero no +1,25D) se asociaron a un desempeño significativamente mejorado en la prueba WRRT. Un 25% de los participantes leyeron un 10% más rápido con estas lentes convexas adicionales. CONCLUSIONES: La edad de la población de estudio fue de 20 a 40 años, trabajando la mayoría de dichos sujetos en ordenadores de mesa. Es posible que la adición de +1,25D sea más ventajosa para personas de mayor edad, o que trabajen más con distancias de visualización más próxima. Muchos usuarios de dispositivos digitales sintomáticos reportan una preferencia por bajas adiciones, asociándose a menudo el uso de estas lentes a una mejora del desempeño lector

An investigation of low power convex lenses (adds) for eyestrain in the digital age (CLEDA).

INTRODUCTION: Digital eye strain (DES; computer vision syndrome) is a common cause of symptoms when viewing digital devices. Low-powered convex lenses (adds) have been recommended for the condition and "accommodative support" designs developed on this premise. The present research reports the extent to which dry eye is present in this population and the effect of convex lenses on symptoms and visual performance. METHODS: The CVS-Q instrument was used to select pre-presbyopic adults with the symptoms of DES. Participants received a full eye examination including an assessment of dry eye with a modified SANDE questionnaire and using DEWS I criteria. The immediate effect of low-powered convex lenses (low adds: +0.50D, +0.75D, +1.25D) was investigated using subjective preference and a double-masked comparison with plano lenses with the Wilkins Rate of Reading Test (WRRT). Throughout this testing, participants wore their full distance refractive correction, based on non-cycloplegic retinoscopy and subjective refraction. RESULTS: The signs and symptoms of dry eye were frequently present. Most participants reported a subjective preference for low adds, with +0.75D the most commonly preferred lens. Low adds (+0.50D and +0.75D; but not +1.25D) were associated with significantly improved performance at the WRRT. One quarter of participants read more than 10% faster with these additional convex lenses. CONCLUSIONS: The study population was aged 20-40y and mostly worked on desktop computers. It is possible that +1.25D add may be more advantageous for people who are older or work more at closer viewing distances. Many symptomatic users of digital devices report a preference for low adds and use of these lenses is often associated with an improvement in reading performance.

A latitudinal cline in the efficacy of endogenous signals: evidence derived from retinal cone contraction in fish.

Like many physiological systems synchronised to the light:dark cycle, retinomotor movements in 'lower' vertebrates are controlled by both the ambient illumination and input from endogenous circadian oscillators. In the present study, we examine the relative influence of these two signals in various species of teleost fish with different latitudes of origin. We find equatorial species show very strong endogenous control. The cones of the glowlight tetra, for example, continue to go through undiminished cycles of contraction and relaxation that mirror the previous light:dark cycle for at least two weeks in continual darkness. To quantify the relative effectiveness of the ambient light compared with endogenous signals in causing cone contraction, the degree to which seven teleost species responded to light during the dark phase of their light:dark cycle was examined. In this situation the retina receives conflicting instructions; while the light is acting directly to cause light adaptation, any endogenous signal tends to keep the retinal elements dark adapted. The further from the equator a species originated, the more its cones contracted in response to such illumination, suggesting animals from higher latitudes make little use of endogenous oscillators and rely more on ambient illumination to control behaviours. Equatorial species, however, rely on internal pacemakers to a much greater degree and are relatively insensitive to exogenous light signals. Because these data are consistent with published observations in systems as diverse as melatonin synthesis in Arctic reindeer and the behaviour of regional populations of Drosophila, latitudinal clines in the efficacy of circadian oscillators may be a common feature among animals.