Belin/Ambrósio Enhanced Ectasia Display in cataract surgery and relation to final visual acuity / Belin/Ambrósio Enhanced Ectasia Display na cirurgia de catarata e sua relação com a acuidade visual final

ABSTRACT Objective To analyze and describe the coefficients found on maximum Ambrósio Relational Thickness-Maximum (ART-Max) and Belin/Ambrósio Enhanced Ectasia Display total deviation (BAD-D) in eyes with normal corneal topography subjected to cataract surgery with premium intraocular lens implantation and correlated these data with final visual acuity. Methods ART-Max and BAD-D data from 103 eyes of patients subjected to implantation of diffractive bifocal intraocular lens, with normal corneal topography who achieved visual acuity of 20/20 or 20/25 without correction after cataract surgery were analyzed. The groups with normal and abnormal values were compared using the chi-square test. Results Thirty-two (31.1%) and 71 (68.9%) eyes presented normal and abnormal ART-Max values, respectively. The difference between these groups was significant (p=0.0002). Fifty-five (53.4%) and 48 (46.6%) eyes had normal and abnormal BAD-D, respectively, and intergroup difference was not significant (p=0.9576). Conclusion Among patients with normal corneal topography who underwent premium intraocular and had good final visual acuity of 20/20 or 20/25, suspicious or abnormal indices of ART-Max and BAD-D were frequent, providing evidence that it possibly should not be a contraindication.

RESUMO Objetivo Analisar e descrever os coeficientes numéricos encontrados nos exames Ambrósio Relational Thickness-Maximum (ART-Max) e desvio total do Belin/Ambrósio Enhanced Ectasia Display (BAD-D) em olhos com topografia normal submetidos ao implante de lente intraocular premium na cirurgia de catarata, correlacionando-os com a acuidade visual final pós-operatória. Métodos Foram analisados os resultados de ART-Max e BAD-D de 103 olhos de pacientes submetidos ao implante de lentes bifocais difrativas, que apresentavam exame topográficos normal e alcançaram acuidade visual 20/20 ou 20/25 sem correção visual no pós-operatório final. Para a análise estatística entre os grupos normais e anormais ou suspeitos, utilizou-se o teste do qui-quadrado. Resultados Foram encontrados 32 (31,1%) olhos com ART-Max normal e 71 (68,9%) com ART-Max suspeito/anormal. A diferença entre os grupos foi significativa (p=0,0002). Quanto ao BAD-D, foram encontrados 55 (53,4%) olhos com resultados normais e 48 (46,6%) com resultados suspeitos/anormais. A diferença entre os grupos não foi significativa (p=0,9576). Conclusão Entre os pacientes com topografia normal submetidos ao implante de lentes premium e que alcançaram acuidade visual 20/20 ou 20/25, os índices suspeitos ou anormais de ART-Max e BAD-D eram frequentes, não se configurando em contraindicação para a realização do implante.

Comparing prediction accuracy between total keratometry and conventional keratometry in cataract surgery with refractive multifocal intraocular lens implantation.

We aimed to compare refractive outcomes between total keratometry using a swept-source optical biometer and conventional keratometry in cataract surgery with refractive multifocal intraocular lens (IOL) implantation. We included patients who underwent cataract surgery with refractive multifocal IOL implantation. The IOL power was calculated using conventional formulas (Haigis, SRK/T, Holladay 2, and Barrett Universal II) as well as a new formula (Barrett TK Universal II). The refractive mean error, mean absolute error, and median absolute error were compared, as were the proportions of eyes within ± 0.25 diopters (D), ± 0.50 D, and ± 1.00 D of prediction error. In total 543 eyes of 543 patients, the absolute prediction error of total keratometry was significantly higher than that of conventional keratometry using the SRK/T (P = 0.034) and Barrett Universal II (P = 0.003). The proportion of eyes within ± 0.50 D of the prediction error using the SRK/T and Barrett Universal II was also significantly higher when using conventional keratometry than total keratometry (P = 0.010 for SRK/T and P = 0.005 for Barrett Universal II). Prediction accuracy of conventional keratometry was higher than that of total keratometry in cataract surgery with refractive multifocal IOL implantation.

Evaluation of postoperative refractive error correction after cataract surgery.

Suboptimal cataract surgery outcomes remain a challenge in most developing countries. In Ghana, about 2 million people have been reported to be blind due to cataract with about 20% new cases being recorded yearly. The aim of this study was to evaluate postoperative correction of refractive errors after cataract surgery in a selected eye hospital in Ashanti Region, Ghana. This was a retrospective study where medical records of patients (aged 40-100) who reported to an eye hospital in Ghana from 2013-2018 were reviewed. Included in the study were patients aged ≥40 years and patients with complete records. Data on patient demographics, type of surgery, intra-ocular lens (PCIOL) power, availability of biometry, postoperative refraction outcomes, pre- and postoperative visual acuity were analyzed. Data of two hundred and thirteen eyes of 190 patients who met the inclusion criteria were analyzed. Descriptive analysis and Chi-square test were carried out to determine the mean, median, standard deviation and relevant associations. The mean ± SD age was 67.21±12.2 years (51.2% were females). Small Incision Cataract Surgery (99.5%) with 100% IOL implants was the main cataract surgery procedure in this study. Pre-operative biometry was performed for 38.9% of all patients on their first eye surgery and 41.5% for second eye surgeries. About 71% eyes in this study were blind (presenting VA<3/60) before surgery; 40.4% had post-operative VA <3/60. Pre-existing ocular comorbidities discovered post- surgery, attributed to suboptimal visual outcomes. More than half (55.3%) of patients did not undergo postoperative refraction due to loss to follow-up. Year of surgery (p = .017), follow up visits< 2months (p < .0001) and discovered comorbidity post-surgery (p = .035) were the factors significantly associated with postoperative refraction. Myopia and compound myopic astigmatism were the dominant refractive error outcomes. The timing of post-operative refraction had a significant effect on postoperative refraction done. These findings indicate a clinically meaningful significance between completion of postoperative care and postoperative refraction done. Consequently, with settings in most developing countries, where less biometry is done, it is appropriate that post-operative refractive services are encouraged and done earlier to enhance the patients' expectations while increasing cataract surgery patronage.

Application of big-data for epidemiological studies of refractive error.

PURPOSE: To examine whether data sourced from electronic medical records (EMR) and a large industrial spectacle lens manufacturing database can estimate refractive error distribution within large populations as an alternative to typical population surveys of refractive error. SUBJECTS: A total of 555,528 patient visits from 28 Irish primary care optometry practices between the years 1980 and 2019 and 141,547,436 spectacle lens sales records from an international European lens manufacturer between the years 1998 and 2016. METHODS: Anonymized EMR data included demographic, refractive and visual acuity values. Anonymized spectacle lens data included refractive data. Spectacle lens data was separated into lenses containing an addition (ADD) and those without an addition (SV). The proportions of refractive errors from the EMR data and ADD lenses were compared to published results from the European Eye Epidemiology (E3) Consortium and the Gutenberg Health Study (GHS). RESULTS: Age and gender matched proportions of refractive error were comparable in the E3 data and the EMR data, with no significant difference in the overall refractive error distribution (χ2 = 527, p = 0.29, DoF = 510). EMR data provided a closer match to the E3 refractive error distribution by age than the ADD lens data. The ADD lens data, however, provided a closer approximation to the E3 data for total myopia prevalence than the GHS data, up to age 64. CONCLUSIONS: The prevalence of refractive error within a population can be estimated using EMR data in the absence of population surveys. Industry derived sales data can also provide insights on the epidemiology of refractive errors in a population over certain age ranges. EMR and industrial data may therefore provide a fast and cost-effective surrogate measure of refractive error distribution that can be used for future health service planning purposes.

Topical Review: Causes of Refractive Error After Silicone-oil Removal Combined with Cataract Surgery.

SIGNIFICANCE: This review summarizes the main factors of refractive error after silicone oil removal combined with cataract surgery.The post-operative refractive results of silicone oil removal combined with cataract surgery are closely related to the patient's future vision quality. This report summarizes the factors that influence the difference between the actual post-operative refractive power and the pre-operatively predicted refractive power after silicone oil removal combined with cataract surgery, including axial length, anterior chamber depth, silicone oil, commonly used tools for measuring intraocular lens power, and intraocular lens power calculation formulas, among others. The aim of the report is to assist clinical and scientific research on the elimination of refractive error after silicone oil removal combined with cataract surgery.

Development of refractive error in children treated for retinopathy of prematurity with anti-vascular endothelial growth factor (anti-VEGF) agents: A meta-analysis and systematic review.

OBJECTIVE: To investigate refractive error development in preterm children with severe retinopathy of prematurity (ROP) treated with anti-vascular endothelial growth factor (anti-VEGF) agents and laser photocoagulation. METHODS: Selection criteria were comparative studies that compared the refractive errors in children, birthweights ≤1500 grams and gestational ages ≤30 weeks, and treatments for Type I ROP with intravitreal bevacizumab (IVB) versus laser photocoagulation. Studies were identified using PubMed, Google Scholar, and published reviews. Meta-analyses were performed on the post-treatment outcomes of spherical equivalent (SEQ), cylindrical power, and prevalence of high myopia. Longitudinal development of refractive error in IVB, or in laser-treated children, or in normal full-term children was visually summarized. RESULTS: Two randomized controlled trials and 5 non-randomized studies, including a total of 272 eyes treated by IVB and 247 eyes treated by laser, were included in this study. Compared with laser-treated children, IVB-treated children have less myopic refractive error (P<0.001), lower prevalence of high myopia (P<0.05), and less astigmatism (P = 0.02). CONCLUSIONS: Treatment with IVB is associated with less myopia and astigmatism than laser treatment for infants with severe ROP. Given the complexity of ROP and the variability of dosing, our review supports close monitoring of refractive error outcomes in children treated with IVB.

Approximating sum-of-segments axial length from a traditional optical low-coherence reflectometry measurement.

PURPOSE: To present the Cooke-modified axial length (CMALInitial) method, which closely approximates sum-of-segments AL. Notably, sum-of-segments AL has been shown to improve predictions of many intraocular lens (IOL) power formulas; however, calculating this AL requires information that is not readily available. DESIGN: Comparative case series. PATIENTS: Distinct datasets of 215 eyes and 1442 eyes, which were measured before cataract surgery with a commercially available optical biometer (Lenstar LS 900), were identified. The AL measured by this machine was labeled "traditional AL." MAIN OUTCOME MEASURE: Prediction Error. METHODS: The CMALInitial, sum-of-segments AL, and traditional AL methods with Bland-Altman plots and r2 values were compared, along with graphs of prediction errors. RESULTS: The CMALInitial was developed from 215 eyes and evaluated in the 1422-eye validation dataset. The r2 for CMALInitial versus the sum-of-segments AL was 0.99983. The predictions based on CMALInitial were compared with those based on traditional AL using the Hoffer Q, Holladay 1, SRK/T, and Holladay 2 IOL formulas. The CMALInitial produced more accurate predictions in all four formulas (P < .001). Eyes in all datasets were then combined to create the final recommendation: CMALFinal = 1.23853 + 0.95855 × traditional AL - 0.05467 × lens thickness (all measurements in millimeters). CONCLUSIONS: A modified AL method (CMAL) was easy to calculate. Using CMAL improved predictions for at least four IOL power prediction formulas, especially at extreme ALs. Caution is advised if using CMAL with other formulas.

Refractive outcomes of phacoemulsification after pars plana vitrectomy using traditional and new intraocular lens calculation formulas.

PURPOSE: To evaluate refractive outcomes of cataract surgery in previously vitrectomized eyes and compare the accuracy of intraocular lens (IOL) calculation formulas in this population. SETTING: Stony Brook University Hospital, Stony Brook, New York, USA. DESIGN: Retrospective case series. METHODS: All electronic medical records of patients who had phacoemulsification from 2013 to 2017 were reviewed. Patients who had previously had pars plana vitrectomy in the same eye were selected. Patients with a history of refractive surgery, silicone oil in the eye, or other factors preventing accurate IOL power calculation were excluded. RESULTS: The mean postoperative spherical equivalent was -0.16 diopter (D) ± 0.81 (SD) (n = 61). The mean prediction errors were 0.30 ± 0.82 D, -0.09 ± 0.76 D, 0.23 ± 0.76 D, 0.25 ± 0.81 D, 0.04 ± 0.85 D, 0.30 ± 0.82 D, 0.33 ± 0.79 D, and 0.45 ± 0.80 D with the Holladay 1, Wang/Koch (WKA) adjusted Holladay 1 (n = 14), Holladay 2 (n = 48), SRK/T, WKA SRK/T (n = 14), Hill-Radial Basis Function (n = 50), and Ladas formulas, respectively. The formula with the highest percentage of predictions within ±0.50 D of the postoperative outcome was the Holladay 2 (60.42%). Statistically significant differences between the predicted and actual refractive outcomes were found with all formulas (P < .05) except the WKA Holladay and WKA SRK/T. Intraclass correlation showed low repeatability (<0.50) for all formulas. CONCLUSIONS: Refractive outcomes after cataract extraction in vitrectomized patients can be variable and more hyperopic than the predicted outcomes using traditional and newer IOL calculation methods. Thus, predicting refractive outcomes in this population is challenging, and patients should be counseled accordingly.

Estimation of intraocular lens position from full crystalline lens geometry: towards a new generation of intraocular lens power calculation formulas.

In a cataract surgery, the opacified crystalline lens is replaced by an artificial intraocular lens (IOL). To optimize the visual quality after surgery, the intraocular lens to be implanted must be selected preoperatively for every individual patient. Different generations of formulas have been proposed for selecting the intraocular lens dioptric power as a function of its estimated postoperative position. However, very few formulas include crystalline lens information, in most cases only one-dimensional. The present study proposes a new formula to preoperatively estimate the postoperative IOL position (ELP) based on information of the 3-dimensional full shape of the crystalline lens, obtained from quantitative eye anterior segment optical coherence tomography imaging. Real patients were measured before and after cataract surgery (IOL implantation). The IOL position and the postoperative refraction estimation errors were calculated by subtracting the preoperative estimations from the actual values measured after surgery. The proposed ELP formula produced lower estimation errors for both parameters -ELP and refraction- than the predictions obtained with standard state-of-the-art methods, and opens new avenues to the development of new generation IOL power calculation formulas that improve refractive and visual outcomes.

Comparative Efficacy of the New Optical Biometer on Intraocular Lens Power Calculation (AL-Scan versus IOLMaster).

PURPOSE: To evaluate the agreement in axial length (AL), keratometry, and anterior chamber depth measurements between AL-Scan and IOLMaster biometers and to compare the efficacy of the AL-Scan on intraocular lens (IOL) power calculations and refractive outcomes with those obtained by the IOLMaster. METHODS: Medical records of 48 eyes from 48 patients who underwent uneventful phacoemulsification and IOL insertion were retrospectively reviewed. One of the two types of monofocal aspheric IOLs were implanted (Tecnis ZCB00 [n = 34] or CT Asphina 509M [n = 14]). Two different partial coherence interferometers measured and compared AL, keratometry (2.4 mm), anterior chamber depth, and IOL power calculations with SRK/T, Hoffer Q, Holladay2, and Haigis formulas. The difference between expected and actual final refractive error was compared as refractive mean error (ME), refractive mean absolute error (MAE), and median absolute error (MedAE). RESULTS: AL measured by the AL-Scan was shorter than that measured by the IOLMaster (p = 0.029). The IOL power of Tecnis did not differ between the four formulas; however, the Asphina measurement calculated using Hoffer Q for the AL-Scan was lower (0.28 diopters, p = 0.015) than that calculated by the IOLMaster. There were no statistically significant differences between the calculations by MAE and MedAE for the four formulas in either IOL. In SRK/T, ME in Tecnis-inserted eyes measured by AL-Scan showed a tendency toward myopia (p = 0.032). CONCLUSIONS: Measurement by AL-Scan provides reliable biometry data and power calculations compared to the IOLMaster; however, refractive outcomes of Tecnis-inserted eyes by AL-Scan calculated using SRK/T can show a slight myopic tendency.

Müller glia-derived PRSS56 is required to sustain ocular axial growth and prevent refractive error.

A mismatch between optical power and ocular axial length results in refractive errors. Uncorrected refractive errors constitute the most common cause of vision loss and second leading cause of blindness worldwide. Although the retina is known to play a critical role in regulating ocular growth and refractive development, the precise factors and mechanisms involved are poorly defined. We have previously identified a role for the secreted serine protease PRSS56 in ocular size determination and PRSS56 variants have been implicated in the etiology of both hyperopia and myopia, highlighting its importance in refractive development. Here, we use a combination of genetic mouse models to demonstrate that Prss56 mutations leading to reduced ocular size and hyperopia act via a loss of function mechanism. Using a conditional gene targeting strategy, we show that PRSS56 derived from Müller glia contributes to ocular growth, implicating a new retinal cell type in ocular size determination. Importantly, we demonstrate that persistent activity of PRSS56 is required during distinct developmental stages spanning the pre- and post-eye opening periods to ensure optimal ocular growth. Thus, our mouse data provide evidence for the existence of a molecule contributing to both the prenatal and postnatal stages of human ocular growth. Finally, we demonstrate that genetic inactivation of Prss56 rescues axial elongation in a mouse model of myopia caused by a null mutation in Egr1. Overall, our findings identify PRSS56 as a potential therapeutic target for modulating ocular growth aimed at preventing or slowing down myopia, which is reaching epidemic proportions.

Reducing defocus aberration of a compound and human hybrid eye using liquid lens.

We propose a self-adaption focal length adjustment method of a compound and human hybrid eye with a non-uniform microlens array model (NUMLA) to reduce defocus aberration by using the liquid lens. The models are deduced and verified through simulations. The method can self-adaptively adjust the focal length according to object distance and image distance. The results show that (1) the RMS spot radii of the traditional uniform microlens array at different rings are 21 µm, 187 µm, 304 µm, 526 µm, and 803 µm. However, those of the NUMLA are 21 µm, 47 µm, 98 µm, 178 µm, and 287 µm, which indicates that the NUMLA can reduce the defocus aberration. (2) When the object distance and the image distance vary, the defocus aberration can be significantly reduced through the adjustment of the focal length, which validates the effectiveness of the proposed method. (3) The volumes of the liquid lens in the cavity at the peripheral rings are larger than that at the central rings. The results are beneficial for providing a simple solution to reduce the defocus aberration of the compound and human hybrid eye.

Knowledge, attitude and associated factors among primary school teachers regarding refractive error in school children in Gondar city, Northwest Ethiopia.

INTRODUCTION: Refractive error is an important cause of correctable visual impairment in the worldwide with a global distribution of 1.75% to 20.7% among schoolchildren. Teacher's knowledge about refractive error play an important role in encouraging students to seek treatment that helps in reducing the burden of visual impairment. OBJECTIVE: To determine knowledge, attitude and associated factors among primary school teachers regarding refractive error in school children in Gondar city. METHODS: Institution based cross-sectional study was conducted on 565 primary school teachers in Gondar city using pretested and structured self-administered questionnaire. For processing and analysis, SPSS version 20 was used and variables which had a P value of <0.05 in the multivariable analysis were considered as statistically significant. RESULT: A total of 565 study subjects were participated in this study with a mean age of 42.05 ± 12.01 years. Of these study participants 55.9% (95% CI: 51.9, 59.8) had good knowledge and 57.2% (95% CI: 52.9, 61.4) had favorable attitude towards refractive error. History of spectacle use [AOR = 2.13 (95% CI: 1.32, 3.43)], history of eye examination [AOR = 1.67 (95% CI: 1.19, 2.34)], training on eye health [AOR = 1.94 (95% CI; 1.09, 3.43)] and 11-20 years of experience [AOR = 2.53 (95% CI: 1.18, 5.43)] were positively associated with knowledge. Whereas being male [AOR = 2.03 (95% CI: 1.37, 3.01)], older age [AOR = 3.05 (95% CI: 1.07, 8.72)], 31-40 years of experience [AOR = 0.23 (95% CI: 0.07, 0.72)], private school type [AOR = 1.76 (95% CI: 1.06, 2.93)] and 5th -8th teaching category [AOR = 1.54 (95% CI: 1.05, 2.24)] were associated with attitude. CONCLUSION: Knowledge and attitude of study subjects were low which needs training of teachers about the refractive error.

Comparative study of visual function and ocular aberrations of two different one-piece designed hydrophilic acrylic intraocular lens.

PURPOSE: To determine whether the aspherical IOL, Tecnis ZCB00, can improve the visual quality by measuring visual acuity, wavefront aberrations, and contrast sensitivity. METHODS: It was a retrospective case series. Patients who underwent phacoemulsification cataract surgery were divided into two groups. One group (Group TC) was implanted with one-piece aspherical acrylic IOL (Tecnis ZCB00, AMO); the other (Group SA) was implanted with one-piece spherical acrylic IOL (Sensar AAB00, AMO). Eighty-eight eyes were selected into this study, among them 43 eyes in 26 male cases and 45 eyes in 29 female cases. Thirty-six eyes in 23 cases were in Group TC, and 52 eyes in 32 cases were in Group SA. Three months postoperatively, aberrations were analyzed with i-Trace visual function analyzer (Tracy Technologies, USA). Contrast sensitivities were measured with Takaci-CGT-1000 contrast glare tester (Seiko, Japan). RESULTS: All the 88 eyes underwent phacoemulsification with intraocular lens implantation, without complications during or after surgery. Three months postoperatively, the uncorrected vision acuity in Group TC was significantly better than in Group SA (P = 0.007). At the pupil size of 5.0 mm, higher-order aberrations in Group TC were significantly higher than in Group SA (P = 0.02), especially the spherical aberration (Z 40 ) (P < 0.001); at the pupil size of 4.0 mm, Z 40 in Group SA was statistically higher than in Group TC (P < 0.001); at the pupil size of 3.0 mm, higher-order aberrations such as coma (Z 3-1,1 ) and trefoil aberration (Z 3-3,3 ) in Group SA were obviously higher than in Group TC (P = 0.01). In the low spatial frequency, the contrast sensitivity and the glare sensitivity in Group TC were significantly higher than in Group SA (P < 0.05). CONCLUSIONS: By the short-term follow-up (3 months), the aspherical acrylic IOL can reduce the higher-order aberrations (especially the spherical aberration) and increase the contrast sensitivity to improve the visual performance.

Management of Reverse Pellucid Type Topography.

PURPOSE: Evaluation of the etiopathogenesis and management of topographic reverse pellucid pattern after rigid intraocular lens (IOL) implantation with wide limbal clear corneal incision (CCI). METHODS: Fifteen eyes with a history of gradual decrease in vision after IOL surgery with at least 6.5-mm CCI were diagnosed with wound dehiscence and were managed with tight resuturation, delayed, and selective suture removal. The improvement in uncorrected and corrected distance visual acuities (UDVA and CDVA, respectively) and refractive errors were analyzed, at least 6 months postoperatively. RESULTS: Postoperatively, UDVA improved in 13/15 eyes (86.7%), whereas CDVA also improved for at least 2 Snellen lines in 11/15 eyes (73.3%) (P<0.01 for both). In all patients, against-the-rule astigmatism changed to with-the-rule astigmatism pattern and the amount of cylinder decreased as the sutures are removed progressively. Vector analysis of astigmatism showed an arithmetic mean of corrected amount of cylinder of 4.17±2.10 D using manifest refraction data and 4.90±2.83 D using keratometric data at the last follow-up. CONCLUSION: Low visual acuity together with high astigmatism after rigid IOL surgery should prompt the surgeon for considering wound dehiscence that could be managed by careful and deliberate wound revision.

Reviewing the visual benefits of femtosecond laser-assisted cataract surgery: Can we improve our outcomes?

Femtosecond laser-assisted cataract surgery (FLACS) was introduced in 2009 and has increasingly been incorporated into surgical practice. The automation of three key aspects of cataract surgery was expected to deliver a significant improvement in both refractive and safety outcomes. The published literature has not yet shown consistent refractive improvement above conventional techniques. The purpose of this paper is to review current FLACS refractive outcomes and explore factors that may have contributed to the current findings and whether future improvements are possible.

The Use of Capsular Tension Rings to Reduce Refractive Shift in Patients With Implantation of Trifocal Intraocular Lenses.

PURPOSE: To determine whether use of a capsular tension ring (CTR) can increase refractive stability in patients with implantation of two different trifocal intraocular lenses (IOLs). METHODS: A prospective, consecutive series of eyes underwent refractive lens exchange with implantation of two different trifocal IOL designs: FineVision Micro F (non-toric) and FineVision POD FT (toric) (PhysIOL, Liege, Belgium). Power calculation was determined using the Haigis formula. Refractive lens exchange surgery was performed according to the standard Memira protocol. Refractive results and stability were assessed at 2 weeks and 3 months postoperatively. RESULTS: Three hundred eighty-eight eyes were included in the analysis. Overall, 71% and 76% of MicroF eyes implanted with (n = 139) and without (n = 104) a CTR, respectively, had hyperopic shift; 9% of MicroF eyes with a CTR had a shift of greater than +0.50 to +0.75 or less diopters (D) and 4% had a shift of greater than +0.75 D. In MicroF eyes without a CTR, 12% and 3% of eyes experienced a refractive shift of greater than +0.50 to +0.75 D or less and greater than +0.75 D, respectively. In the POD FT group, 72% and 69% of eyes with (n = 81) and without (n = 64) a CTR, respectively, had hyperopic shift; 10% of POD FT eyes with a CTR had a change of greater than +0.50 to +0.75 D or less and 7% had a shift of greater than +0.75 D. In POD FT eyes without a CTR, 13% and 3% experienced a refractive shift of greater than +0.50 to +0.75 D or less and greater than +0.75 D, respectively. For the MicroF design, the best refractive stability was found in the CTR group and the poorest stability in the non-CTR group (P = .084). For the POD FT design, the best refractive stability was found in the non-CTR group and the poorest stability in the CTR group (P = .297). CONCLUSIONS: Up to 7% of eyes implanted with FineVision trifocal IOLs had a hyperopic shift of greater than +0.75 D approximately 2 weeks to 3 months postoperatively. Using a CTR in MicroF eyes had no statistically significant effect on refractive stability. Placing a CTR with POD FT IOLs appeared to reduce refractive stability, although not significantly. [J Refract Surg. 2017;33(12):802-806.].

Cluster-randomized controlled trial of the effects of free glasses on purchase of children's glasses in China: The PRICE (Potentiating Rural Investment in Children's Eyecare) study.

BACKGROUND: Offering free glasses can be important to increase children's wear. We sought to assess whether "Upgrade glasses" could avoid reduced glasses sales when offering free glasses to children in China. METHODS: In this cluster-randomized, controlled trial, children with uncorrected visual acuity (VA)< = 6/12 in either eye correctable to >6/12 in both eyes at 138 randomly-selected primary schools in 9 counties in Guangdong and Yunnan provinces, China, were randomized by school to one of four groups: glasses prescription only (Control); Free Glasses; Free Glasses + offer of $15 Upgrade Glasses; Free Glasses + offer of $30 Upgrade Glasses. Spectacle purchase (main outcome) was assessed 6 months after randomization. RESULTS: Among 10,234 children screened, 882 (8.62%, mean age 10.6 years, 45.5% boys) were eligible and randomized: 257 (29.1%) at 37 schools to Control; 253 (28.7%) at 32 schools to Free Glasses; 187 (21.2%) at 31 schools to Free Glasses + $15 Upgrade; and 185 (21.0%) at 27 schools to Free Glasses +$30 Upgrade. Baseline ownership among these children needing glasses was 11.8% (104/882), and 867 (98.3%) children completed follow-up. Glasses purchase was significantly less likely when free glasses were given: Control: 59/250 = 23.6%; Free glasses: 32/252 = 12.7%, P = 0.010. Offering Upgrade Glasses eliminated this difference: Free + $15 Upgrade: 39/183 = 21.3%, multiple regression relative risk (RR) 0.90 (0.56-1.43), P = 0.65; Free + $30 Upgrade: 38/182 = 20.9%, RR 0.91 (0.59, 1.42), P = 0.69. CONCLUSIONS: Upgrade glasses can prevent reductions in glasses purchase when free spectacles are provided, providing important program income. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02231606. Registered on 31 August 2014.