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1.
J Refract Surg ; 37(9): 609-615, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34506237

RESUMO

PURPOSE: To evaluate whether intraoperative aberrometry improves the accuracy of refractive outcomes after cataract surgery in highly myopic, highly hyperopic, and post-refractive eyes. METHODS: This single-center, retrospective review compared the spherical equivalent of postoperative refraction to that predicted by the Barrett Universal II formula versus Optiwave Refractive Analysis (ORA) (Alcon Laboratories, Inc) for highly myopic and hyperopic eyes and to the Barrett True K formula versus ORA for post-refractive eyes. The number and magnitude of lens changes were analyzed and used to determine in how many cases refractive surprises were affected by ORA, with additional subanalysis of outcomes based on average keratometry values. RESULTS: ORA led to a change in the lens power implanted in 48% (96 of 198) of eyes, and prevented hyperopic surprise in 27% (15 of 55) and excess myopia in 46% (19 of 41). Steeper keratometry values correlated with more frequent changes on ORA-recommended implanted intraocular lens (P = .0031). ORA led to a similar percentage of eyes falling within ±0.50, ±0.75, and ±1.00 diopters compared to the Barrett Universal II and Barrett True K formulas. In post-refractive eyes, ORA led to a similar mean absolute error when compared to the Barrett True K formula (P = .62). For highly myopic eyes with an axial length of greater than 27 mm, ORA demonstrated a trend toward lower mean absolute error when compared to the Barrett Universal II formula (P = .076). CONCLUSIONS: ORA demonstrated similar refractive results to the Barrett True K formula in post-refractive eyes and to the Barrett Universal II formula in highly myopic and hyper-opic eyes and may provide additional benefit for eyes with steeper corneas or an axial length of greater than 27 mm. [J Refract Surg. 2021;37(9):609-615.].


Assuntos
Lentes Intraoculares , Miopia , Facoemulsificação , Aberrometria , Biometria , Humanos , Miopia/cirurgia , Óptica e Fotônica , Refração Ocular , Estudos Retrospectivos
2.
J Cataract Refract Surg ; 47(8): 1056-1063, 2021 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-34292891

RESUMO

PURPOSE: To evaluate the comparability and variability of subjective refraction (SR), autorefraction (AR), and wavefront aberrometry (WA) in pseudophakic patients. SETTING: Hanusch Hospital, Vienna, Austria. DESIGN: Prospective study. METHODS: Subjective refraction was performed by 2 independent examiners at 2 study visits. Furthermore, 5 measurements of AR and WA were performed in each patient at both visits. Agreement between the 3 refraction methods for spherical equivalent (M) and cylindrical vectors (J0, J45) was analyzed using Friedman multiple comparison and Bland-Altman plots. Predictability of spherical equivalent determined by SR from AR and WA measurements was tested with partial least squares regression and random forest regression. RESULTS: Ninety eyes of 90 pseudophakic patients were measured. The mean absolute error and arithmetic mean difference of SR measurements of M, J0, and J45 were comparable between both examiners. A small mean difference was found for SR between both visits. Spherical equivalent was more negative when measured by AR [-0.87 diopters (D)] and WA (-0.90 D) compared with SR (-0.60 D), whereas astigmatic vectors agreed well. Good test-retest reliability was found between all 3 refraction methods for M, J0, and J45. Partial least squares regression and random forest regression showed moderate predictive power for M measured by objective refraction and SR. CONCLUSIONS: Reproducibility and reliability of SR measurements in pseudophakic patients showed good agreement. AR and WA measured the spherical equivalent more myopic than SR, whereas astigmatic vectors were comparable between the 3 methods after uneventful cataract surgery.


Assuntos
Extração de Catarata , Testes Visuais , Aberrometria , Humanos , Estudos Prospectivos , Refração Ocular , Reprodutibilidade dos Testes
3.
Optom Vis Sci ; 98(3): 289-294, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33633020

RESUMO

SIGNIFICANCE: The SVOne may prove useful to quickly and easily assess refractive correction needs in community screenings and low-resource settings, but not all subjects were testable with the device. PURPOSE: This study aimed to compare the SVOne handheld, smartphone-based wavefront aberrometer with a tabletop autorefractor in identifying refractive errors in elderly subjects. METHODS: Participants 50 years or older at community eye screenings with visual acuity worse than 20/40 in either eye underwent autorefraction followed by two SVOne trials. Power vectors of right eye data were analyzed. RESULTS: Of 84 subjects who underwent autorefraction, 67 (79.8%) were successfully autorefracted with the SVOne, of whom 82.1% (55/67) had a successful repeat reading. Mean M (spherical equivalent) values from tabletop and handheld autorefraction were -0.21 D (95% confidence interval [CI], -0.71 to +0.29 D) and -0.29 D (95% CI, -0.79 to +0.21 D), respectively (P > .05). Mean astigmatism values from tabletop and handheld devices were +1.06 D (95% CI, 0.87 to 1.26 D) and +1.21 D (95% CI, 0.99 to 1.43 D), respectively (P > .05). Intraclass correlation coefficients between devices were 0.95 (95% CI, 0.93 to 0.97) for M, 0.78 (95% CI, 0.66 to 0.86) for J0, and 0.45 (95% CI, 0.24 to 0.63) for J45 (P < .05 for all). Excellent test-retest correlation between SVOne measurements was noted for M (Pearson correlation [r] = 0.96; P < .05), but a weaker correlation was noted for J0 and J45 (r = 0.67 and r = 0.63 [P < .05 for both], respectively). CONCLUSIONS: The SVOne provided strong agreement for M, with the majority of readings within ±1.00 D of each other, when compared with the tabletop autorefractor. A weaker but still good correlation was noted for astigmatism. Similar findings were noted when assessing repeatability.


Assuntos
Aberrometria/instrumentação , Aberrações de Frente de Onda da Córnea/diagnóstico , Refração Ocular/fisiologia , Erros de Refração/diagnóstico , Seleção Visual/métodos , Idoso , Idoso de 80 Anos ou mais , Serviços de Saúde Comunitária/métodos , Aberrações de Frente de Onda da Córnea/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Erros de Refração/fisiopatologia , Reprodutibilidade dos Testes , Acuidade Visual/fisiologia
4.
J Refract Surg ; 37(1): 60-68, 2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-33432996

RESUMO

PURPOSE: To assess the accuracy of intraoperative aberrometry, the Barrett True-K No History (Barrett TKNH), Barrett TKNH with posterior corneal measurements (Barrett TKNH with PC), Shammas-PL, and Haigis-L formulas in patients with cataract who had prior myopic refractive surgery. METHODS: This was a retrospective consecutive case series of patients with prior myopic refractive surgery undergoing cataract extraction. Mean absolute error (MAE) and median absolute error (MedAE) of refraction prediction were compared for each formula. Interactions of each biometry measurement were modeled for each formula to evaluate those with the most significant impact on refraction prediction. RESULTS: One hundred sixteen eyes of 79 patients were analyzed. MAE was 0.40 ± 0.33 diopters (D) for intraoperative aberrometry and 0.42 ± 0.31 D for the Barrett TKNH, 0.38 ± 0.30 D for the Barrett TKNH with PC, 0.47 ± 0.38 D for the Shammas-PL, and 0.56 ± 0.39 D for the Haigis-L formulas. Comparisons between formulas were significant for Barrett TKNH versus Barrett TKNH with PC formulas (P = .046), Barrett TKNH with PC versus Shammas-PL formulas (P = .023), and for all comparisons with the Haigis-L formula (P < .001), and not significant for all other comparisons (P > .05). Eyes were within ±0.50 D of prediction 73%, 72%, 69%, 62%, and 52% of the time for intraoperative aberrometry, the Barrett TKNH with PC, Barrett TKNH, Shammas-PL, and Haigis-L formulas, respectively. Corneal asphericity (Q value) was significantly associated with prediction error for all five methods. Changes in anterior chamber depth had a significant impact on Shammas-PL prediction errors. CONCLUSIONS: Newer technology using information from the posterior cornea modestly improved outcomes when compared to established methods for intraocular lens selection in eyes that had previous laser refractive surgery for myopia. [J Refract Surg. 2021;37(1):60-68.].


Assuntos
Lentes Intraoculares , Miopia , Facoemulsificação , Procedimentos Cirúrgicos Refrativos , Aberrometria , Biometria , Córnea , Humanos , Implante de Lente Intraocular , Miopia/cirurgia , Óptica e Fotônica , Refração Ocular , Estudos Retrospectivos
5.
Am J Ophthalmol ; 225: 69-75, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33385369

RESUMO

PURPOSE: This study sought to evaluate the demographic profile, clinical features, topographic features, and biomechanical and aberrometric characteristics in pediatric keratoconus (KC). DESIGN: Cross-sectional study. METHODS: Pediatric KC cases <18 years of age were evaluated at a tertiary hospital. Main outcome measurements were demographic profile, clinical features, visual acuity, corneal topography, aberrometry, and biomechanical and confocal microscopy findings. RESULTS: A total of 116 eyes of 62 consecutive patients were recruited with a mean ± age of 14.7 ± 2.77 years (range: 8-18 years); 46 of 62 (88%) were males; 57 of 62 cases (92%) had bilateral disease; 53 of 116 eyes (46%) had progressive KC; and 9 of 116 eyes (8%) had acute hydrops. Systemic associations were found in 6 of 62 patients (9.7%) and ocular associations in 77 of 116 eyes (66.3%); 68 of 116 eyes (58.6%) had associated vernal keratoconjunctivitis (VKC). Among eyes with VKC, 29 of 68 eyes (46%) were in stage IV KC, versus 25% of eyes with no VKC (P = .004). The mean ± SD refractive spherical equivalent was -4.72 ± 3.32 diopters (D), and refractive astigmatism was 3.69 ± 3.09 D. The mean values of maximum keratometry, thinnest pachymetry, and corneal higher-order aberrations were 60.89 ± 10.9 D, 396.05 ± 95.03 µm, and 1.18 ± 1.2 µm, respectively. Values of corneal hysteresis and corneal resistance factor correlated with the stage of KC (r = -0.26; P = .007). CONCLUSIONS: Pediatric KC was commonly associated with VKC in this cohort. Eyes with VKC had more severe KC than those without VKC. Nearly half of the patients presented with progressive disease. Corneal biomechanical changes correlated well with stage of KC in this pediatric age group.


Assuntos
Fenômenos Biomecânicos/fisiologia , Córnea/fisiopatologia , Topografia da Córnea , Aberrações de Frente de Onda da Córnea/fisiopatologia , Ceratocone/diagnóstico , Ceratocone/fisiopatologia , Aberrometria , Adolescente , Criança , Conjuntivite Alérgica/fisiopatologia , Paquimetria Corneana , Estudos Transversais , Feminino , Humanos , Masculino , Estudos Prospectivos , Refração Ocular/fisiologia , Acuidade Visual/fisiologia
6.
Br J Ophthalmol ; 105(1): 22-26, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32217537

RESUMO

PURPOSE: To assess the repeatability and reliability of the most important tomographic parameters for characterising keratoconus measured with a Pentacam HR (high resolution). METHODS: Overall, 230 eyes in 158 patients with keratoconus were analysed. We performed five consecutive corneal tomography examinations for each eye with a Pentacam HR in patients with keratoconus. Study eyes were classified into three groups depending on the maximum posterior elevation (max_BFS_post): grade 1 for cases of keratoconus with a max_BFS_post of 40 µm; grade 2 for those with a max_BFS_post of between 41 and 75 µm and grade 3 for those with a max_BFS_post of over 75 µm. We calculated the intraclass correlation coefficients (ICCs) and repeatability limits of parameters from tomography and aberrometry. RESULTS: All the parameters were found to have excellent ICCs (0.9). The repeatability limits for the key parameters were higher than 0.5D for the power parameters, 20° for the axis of corneal astigmatism and 10 µm for the thinnest corneal thickness. Further, we obtained repeatability limits of above 0.1 µm for the aberrometry values and overall greater than 15° for the coma axis. All the values increase with the severity of keratoconus, except for that of the coma axis which falls with keratoconus grade. CONCLUSIONS: The reliability indicated by ICCs supports the view that the Pentacam HR is useful for the diagnosis of keratoconus. The repeatability limits suggest that new criteria should be established for monitoring progression taking into account the real measurements that can be made using this system.


Assuntos
Diagnóstico por Imagem/métodos , Ceratocone/diagnóstico por imagem , Aberrometria , Adulto , Paquimetria Corneana , Topografia da Córnea , Feminino , Humanos , Masculino , Estudos Prospectivos , Reprodutibilidade dos Testes , Tomografia/instrumentação , Acuidade Visual , Adulto Jovem
7.
J Cataract Refract Surg ; 47(4): 542-546, 2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-32694306

RESUMO

Accommodative intraocular lenses (IOLs) are suitable options for patients desiring less dependence on spectacles after cataract surgery. Accommodative IOLs do not require diffractive optics and, therefore, might be used in a wider range of patients who have mild comorbidities or wish to avoid photopsia associated with diffractive IOLs. However, a small percentage of patients have experienced vault, or capsular contraction syndrome (CCS), due to fibroblastic metaplasia of lens epithelial cells. Early detection of CCS might be managed with Nd:YAG capsulotomy; however, accommodative IOLs with significant CCS have required viscodissection of the fibrosis and placement of a capsular tension ring. A challenge with this maneuver is using the operating microscope to determine whether the accommodative IOL has returned to planar position. This article describes a new technique using serial intraoperative wavefront aberrometry measurements of lenticular astigmatism during accommodative IOL repositioning to determine a planar endpoint in the reduction of vault.


Assuntos
Reposicionamento de Medicamentos , Lentes Intraoculares , Aberrometria , Acomodação Ocular , Humanos , Implante de Lente Intraocular , Desenho de Prótese
8.
Cutan Ocul Toxicol ; 40(1): 14-20, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33342322

RESUMO

AIM: To evaluate the short-term effect of 0.15% sodium hyaluronate (SH), 0.20% SH, and Trehalose + 0.15% SH on anterior corneal aberrations in dry eye patients. METHODS: 76 eyes of 76 dry eye patients were divided into three groups. Non-preserved 1.5 mg/mL SH was administered in group 1, non-preserved 2.0 mg/mL SH was administered in group 2, and non-preserved trehalose 30 mg/mL and 1.5 mg/mL SH was administered in group 3. Aberrometry measurements were performed before and 10 min after application of the artificial tear drop. Using the Pentacam Scheimpflug imaging system, total root mean square (RMS), lower-order aberration (LOA), higher-order aberrations (HOAs), spherical aberration (SA), trefoil, and coma aberrations were investigated. RESULTS: In each group; the RMS of total, LOA, HOAs, and spherical aberration were significantly decreased after the artificial drop instillation, compared with those of them at baseline; and in groups 1 and 2, vertical trefoil term was also significantly increased, compared with those of them at baseline. According to intergroup analyzes, there was no significant outcome. CONCLUSIONS: It was observed that three artificial tears reduced the anterior corneal aberrations, in a 10-min period. The short-term effect of three artificial tears on the anterior corneal aberration was similar.


Assuntos
Síndromes do Olho Seco/tratamento farmacológico , Ácido Hialurônico/administração & dosagem , Lubrificantes Oftálmicos/administração & dosagem , Trealose/administração & dosagem , Aberrometria , Adulto , Idoso , Córnea/diagnóstico por imagem , Córnea/efeitos dos fármacos , Síndromes do Olho Seco/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento , Adulto Jovem
9.
Cutan Ocul Toxicol ; 40(1): 21-25, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33353410

RESUMO

PURPOSE: The aim of this study was to examine the effects of long-term use of hydroxychloroquine (HQ) on the pachymetric, aberrometric, and densitometric values of the cornea and corneal endothelium in lupus patients. METHOD: Twenty-two eyes (study group) of 22 patients using HQ for treatment of lupus and 25 eyes (control group) of 25 healthy individuals were included in this prospective study. A specular microscopy was used to measure corneal endothelial cell density (ECD), percentage of hexagonal cells (HEX%), coefficient of variation of the cell size (CV). Then, a Pentacam® HR corneal tomography system was used to measure central corneal thickness (CCT), corneal aberrometry values in 6-mm pupil diameters and corneal densitometry values in 6-mm corneal zones (0-2 mm and 2-6 mm). RESULTS: While ECD was significantly lower in the study group than in the control group (p = 0.034), CCT was significantly higher in the study group (p = 0.032). The higher-order aberrations values and the anterior corneal densitometry values in the 0-2 mm and 2-6 mm corneal zones in the study group were found to be significantly higher than the control group (p = 0.021, p = 0.007 and p = 0.013). CONCLUSION: Prolonged use of HQ may cause some changes in the cornea. In the follow-up of these cases, detailed examination of the cornea as well as the macula may be important for the protection of corneal health.


Assuntos
Córnea/efeitos dos fármacos , Doenças da Córnea/prevenção & controle , Endotélio Corneano/efeitos dos fármacos , Hidroxicloroquina/efeitos adversos , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Aberrometria , Adolescente , Adulto , Córnea/diagnóstico por imagem , Doenças da Córnea/induzido quimicamente , Paquimetria Corneana , Estudos Transversais , Densitometria , Endotélio Corneano/diagnóstico por imagem , Feminino , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Tomografia de Coerência Óptica , Adulto Jovem
10.
J Cataract Refract Surg ; 47(7): 902-906, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-33315741

RESUMO

PURPOSE: To evaluate the repeatability of aphakic intraoperative wavefront aberrometry and compare it with preoperative and postoperative aberrometry. SETTING: Department of Ophthalmology, Hanusch Hospital, Vienna, Austria. DESIGN: Prospective case series. METHODS: Patients scheduled for cataract surgery were each measured 3 consecutive times using Hartmann-Shack wavefront sensing (HS-WFS) preoperatively, intraoperatively in aphakia, and 2 months postoperatively after intraocular lens implantation by a single examiner. Intraclass correlation coefficients (ICCs) of spherical equivalent (SE) values were evaluated for each timepoint. Intrasubject standard deviation (Sw) as repeatability (Sr) with corresponding repeatability limit () and mean SE differences with corresponding limits of agreement (LoA) were calculated for comparison. RESULTS: A high consistency of repeated measurements was found with ICCs above 0.9 for each of the 3 timepoints. Intraobserver repeatability (Sr) and repeatability limit (r) of intraoperative aberrometry SE measurements (30 eyes of 30 patients) were 0.34 diopters (D) and 0.95 D, respectively. The LoA for intraoperative aphakic SE across 3 consecutive measurements were -0.71 to +0.85 D. For comparison, Sr and r for phakic preoperative measurements in the cataractous state (30 eyes of 30 patients) and postoperative measurements in the pseudophakic state (24 eyes of 24 patients) were 0.33 D and 0.93 D and 0.23 D and 0.64 D, respectively. Similarly, the LoA for preoperative and postoperative SE measurements were -0.66 to +0.60 D and -0.27 to +0.45 D, respectively. CONCLUSIONS: HS-WFS test-retest reliability was high for all 3 timepoints, but the intraoperative setting resulted in a lower repeatability and broadened the agreement range.


Assuntos
Catarata , Refração Ocular , Aberrometria , Humanos , Estudos Prospectivos , Reprodutibilidade dos Testes
11.
BMC Ophthalmol ; 20(1): 450, 2020 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-33198718

RESUMO

BACKGROUND: Currently, there is no standard technique for determining corneal astigmatism. The iTrace wavefront aberrometry of cornea calculated steep power and axis based on the best Zernike mathematical fit from all topo data within 4 mm circle. It was supposed to be more accurate than iTrace simulated keratometry which was calculated based on only 4 points on the circle of 3 mm. This aim of this study was to evaluate visual outcomes and rotational stability after toric intraocular lens (IOL) implantation using the wavefront aberrometry of the cornea with iTrace. SETTING: Single site in China, Shanxi Eye Hospital, Shanxi, China. DESIGN: Prospective case series. METHODS: The study included 85 eyes of 63 patients undergoing phacoemulsification and toric IOL implantation. The IOL power and cylinders were chosen with the help of the iTrace toric planning program using wavefront keratometric astigmatism. Astigmatic changes were assessed using Alpins vector method over a 3-month follow-up period. RESULTS: Preoperative mean corneal topographic astigmatism was 1.91 diopters (D) ± 0.69 (standard deviation). Postoperative mean refractive astigmatism decreased significantly to 0.48 D ± 0.34. Surgical induced astigmatism was 1.73 D ± 0.77 and the mean correction index was 0.89 ± 0.22, showing a slight undercorrection. The proportion of astigmatism ≤0.50 D increased from 0 to 71.8% postoperatively. CONCLUSIONS: This is the first study on evaluation of clinical outcomes of toric IOL implantation in corneal astigmatism patients using iTrace wavefront keratometric readings. The findings show that use of iTrace built-in toric calculator is safe and effective for planning toric IOL surgery for wavefront keratometric astigmatism. TRIAL REGISTRATION: Current Controlled Trials ISRCTN94956424 , Retrospectively registered (Date of registration: 05 February 2020).


Assuntos
Astigmatismo , Lentes Intraoculares , Facoemulsificação , Aberrometria , Astigmatismo/diagnóstico , Astigmatismo/cirurgia , China , Córnea/cirurgia , Humanos , Implante de Lente Intraocular , Estudos Prospectivos , Refração Ocular , Acuidade Visual
12.
Optom Vis Sci ; 97(9): 775-789, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32941333

RESUMO

SIGNIFICANCE: This study shows the optical and visual quality behavior of modern scleral lenses (SLs) in the medium and long term in patients with irregular cornea (IC) and regular cornea (RC). PURPOSE: The purpose of this study was to evaluate the 12-month optical quality outcomes with SL in patients with IC and RC. METHODS: Sixty-nine patients completed the 12 months of follow-up (99 eyes with IC and 27 with RC). LogMAR high- and low-contrast visual acuity, whole eye aberrometry, and the size (Light Disturbance Index, %) and shape (BFCIrregSD, mm) of night vision disturbances were measured at baseline with habitual correction (HC), best spectacle correction (BSC), and SL at all the follow-up visits (1, 3, 6, and 12 months). Subjective visual quality was measured with the Quality of Vision (QoV) questionnaire. RESULTS: After SL fitting, high-contrast visual acuity improved significantly compared with HC and BSC in the IC group (average improvement of +0.35 ± 0.32 and +0.29 ± 0.26 to +0.08 ± 0.14, P < .001) and RC group (+0.17 ± 0.23 and +0.12 ± 0.23 to +0.10 ± 0.23, P < .05). Light Disturbance Index decreased significantly with SL compared with HC and BSC from 13.85 ± 13.99% and 15.89 ± 13.38% to 5.75 ± 4.51% in the IC group (P < .001) and 6.16 ± 5.38 and 5.98 ± 5.39 to 3.99 ± 3.05 in the RC group (P < .05). BFCIrregSD also decreased significantly, namely, in the IC group (-51%). All subscales of the QoV questionnaire had a statistically significant decrease (improvement) with SL (P < .05). CONCLUSIONS: Scleral lenses promote a better subjective and objective visual quality, mainly in patients with IC. Additional measurements such as night vision disturbances, aberrometry, and subjective perceptions should be considered to characterize the visual enhancement promoted by SL in RC and IC patients.


Assuntos
Lentes de Contato , Aberrações de Frente de Onda da Córnea/terapia , Ceratocone/terapia , Óptica e Fotônica , Esclera , Acuidade Visual/fisiologia , Aberrometria , Adulto , Aberrações de Frente de Onda da Córnea/fisiopatologia , Feminino , Seguimentos , Humanos , Ceratocone/fisiopatologia , Masculino , Pessoa de Meia-Idade , Ajuste de Prótese , Inquéritos e Questionários
13.
Optom Vis Sci ; 97(9): 732-740, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32976324

RESUMO

SIGNIFICANCE: To achieve maximum visual benefit, wavefront-guided scleral lens corrections (WGCs) are aligned with the underlying wavefront error of each individual eye. This requirement adds complexity to the fitting process. With a view toward simplification in lens fitting, this study quantified the consequences of placing WGCs at two pre-defined locations. PURPOSE: This study aimed to quantify performance reduction accompanying the placement of the WGC at two locations: (1) the average decentered location (ADL; average decentration observed across individuals wearing scleral lenses) and (2) the geometric center (GC) of the lens. METHODS: Deidentified residual aberration and lens translation data from 36 conventional scleral lens-wearing eyes with corneal ectasia were used to simulate WGC correction in silico. The WGCs were decentered from the eye-specific pupil position to both the ADL and GC locations. The impact of these misalignments was assessed in terms of change (from the aligned, eye-specific pupil position) in higher-order root mean square (HORMS) wavefront error, change in log of the visual Strehl ratio (logVSX), and predicted change in logMAR visual acuity (VA). RESULTS: As expected, HORMS increased, logVSX decreased, and predicted VA was poorer at both ADL and GC compared with the aligned condition (P < .001). Thirty-four of 36 eyes had greater residual HORMS, and 33 of 36 eyes had worse logVSX values at the GC than at the ADL. In clinical terms, 19 of 36 eyes at the ADL and 35 of 36 eyes at the GC had a predicted loss in VA of three letters or greater. CONCLUSIONS: The placement of the WGC at either ADL or GC is predicted to lead to a noticeable reduction in VA for more than half of the eyes studied, suggesting the simplification of the fitting process is not worth the cost in performance.


Assuntos
Lentes de Contato , Aberrações de Frente de Onda da Córnea/terapia , Ceratocone/terapia , Esclera , Aberrometria , Adulto , Aberrações de Frente de Onda da Córnea/fisiopatologia , Feminino , Humanos , Ceratocone/fisiopatologia , Masculino , Ajuste de Prótese , Pupila/fisiologia , Refração Ocular/fisiologia , Acuidade Visual/fisiologia
14.
Int Ophthalmol ; 40(12): 3251-3257, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32770491

RESUMO

PURPOSE: To determine if there was a clinically significant difference in clinical outcomes after toric IOL implantation based on intraoperative aberrometry (IA), where eyes were measured either in the aphakic state only or both the aphakic and pseudophakic states. METHODS: A prospective, randomized, contralateral eye study was performed at one site in Poughkeepsie, NY, USA. Subjects included patients presenting for uncomplicated bilateral cataract surgery eligible for toric lens implantation with regular corneal astigmatism in both eyes whose toric IOL implantation was based on IA. One eye was measured when aphakic and the other when both aphakic and pseudophakic. The primary outcome measure was the magnitude of residual refractive astigmatism. Secondary measures included the percentage of eyes with 0.50D or less of residual refractive astigmatism, the spherical equivalent refraction and the time for IA measurement. RESULTS: Mean residual refractive astigmatism was not statistically significantly different between groups (0.32D ± 0.46D IA_1 vs. 0.23D ± 0.35D IA_2, p = 0.25), nor was the percentage of eyes with a residual refractive cylinder of 0.50D or less (94% in both groups, p = 1.0). The average time to measure the pseudophakic eye was 3 min, 46 s. Aphakic IA measurements appeared to produce better spherical equivalent refractive results relative to preoperative calculations. CONCLUSION: Pseudophakic IA measurements took nearly 4 min per case. Residual refractive astigmatism was not appreciably lower when pseudophakic IA measurements were made after aphakic IA measurements, which suggests aphakic IA measurements alone provide good clinical results with toric IOLs.


Assuntos
Astigmatismo , Catarata , Lentes Intraoculares , Facoemulsificação , Aberrometria , Astigmatismo/diagnóstico , Astigmatismo/cirurgia , Humanos , Implante de Lente Intraocular , Estudos Prospectivos , Refração Ocular , Acuidade Visual
15.
Ophthalmic Physiol Opt ; 40(5): 549-556, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32808381

RESUMO

PURPOSE: High sampling density optical metrology combined with pupil- and image-plane numerical analyses were applied to evaluate a novel spectacle lens containing multiple small zones designed to slow myopia progression. METHODS: High-resolution aberrometry (ClearWave, www.lumetrics.com) was used to sample wavefront slopes of a novel spectacle lens, Defocus Incorporated Multiple Segments (DIMS) (www.hoya.com), incorporating many small, positive-powered lenslets in its periphery. Using wavefront slope and error maps, custom MATLAB software ('Indiana Wavefront Analyzer') was used to compute image-plane point-spread functions (PSF), modulation transfer functions (MTF), simulated images and power distributions created by the dual-focus optic for different pupil sizes and target vergences. RESULTS: Outside of a central 10 mm zone containing single distance optical power, a hexagonal array of small 1 mm lenslets with nearest-neighbour separations of 0.5 mm were distributed over the lens periphery. Sagittal and curvature-based measures of optical power imperfectly captured the consistent +3.50 D add produced by the lenslets. Image plane simulations revealed multiple PSFs and poor image quality at the lenslet focal plane. Blur at the distance optic focal plane was consistent with a combination of diffraction blur from the distance optic and the approximately +3.50 D of defocus from the 1 mm diameter near optic zones. CONCLUSION: Converging the defocused beams generated by the multiple small (1 mm diameter) lenslets to a blurred image at the distance focal plane produced a blur magnitude determined by the small lenslet diameter and not the overall pupil diameter. The distance optic located in between the near-add lenslets determines the limits of the optical quality achievable by the lens. When compared to the optics of a traditional concentric-zone dual-focus contact lens, the optics of the DIMS lens generates higher-contrast images at low spatial frequencies (<7 cycles per degree), but lower-contrast at high spatial frequencies.


Assuntos
Lentes de Contato , Óculos , Miopia/terapia , Óptica e Fotônica , Refração Ocular/fisiologia , Acuidade Visual , Aberrometria , Desenho de Equipamento , Humanos , Miopia/fisiopatologia
16.
Medicine (Baltimore) ; 99(34): e21937, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846863

RESUMO

RATIONALE: Microspherophakia is characterized by a small, spherical crystalline lens with increased sagittal diameter. Because of the uncertainty about the outcome, as well as the complexity of the operation and development of complications, the management and timing of surgical intervention for microspherophakia are still debated. Lens extraction is effective for avoiding the risk of pupillary blockage, but the outcome after operation is controversial. The iTrace (Tracey, USA) report shows the influence of low-order aberrations (LOA) and high-order aberrations (HOA), which may be valuable in predicting postoperative outcome. Our report concerns a child with microspherophakia who underwent lens extraction via the analysis of visual quality by iTrace. PATIENT CONCERNS: Our report is on the case of a 7-year-old girl whose parents observed she had to bring her papers and books extremely close to her face to read. On examination, the girl was bilaterally diagnosed microspherophakia with a small tremble lens. The objective refraction was -15.0 diopter of spherical power (DS)/-1.00 diopter of cylindrical power (DC) × 180 right eye (OD) and -12.5 DS/-1.50 DC × 20 left eye (OS). The HOA of OD and OS were high up to 0.926 and 0.659, respectively by iTrace. The visual quality remained terrible after correcting LOA (high myopia and astigmatism). According to iTrace report, the patient would get a good visual quality by extracting the clear lens with HOA from cornea after correcting LOA. The girl's parent opted for surgery on the left eye. DIAGNOSIS: Due to the patient's symptoms, examination results, she was diagnosed with microspherophakia. INTERVENTIONS: The patient underwent clear lens extraction by ultrasonic phacoemulsification and intraocular lens implantation. OUTCOMES: The first day after operation, total HOA was decreased to 0.077. Total LOA was 0.713. Corrected distance visual acuity (CDVA) is 20/20. One week after surgery, HOA was 0.110 and LOA was 0.328. CDVA was 20/25. CDVA was still 20/25 one month after surgery. The total HOA was 0.110 and the LOA was 0.334 by iTrace. LESSONS: ITrace not only plays an important role in analyzing potential reasons of undesirable preoperative visual quality but also can predict postoperative outcomes. All these functions are helpful for determining surgical intervention of microspherophakia cases.


Assuntos
Aberrometria/instrumentação , Doenças da Córnea/cirurgia , Ectopia do Cristalino/cirurgia , Glaucoma/cirurgia , Iris/anormalidades , Implante de Lente Intraocular/métodos , Facoemulsificação/instrumentação , Ultrassom/métodos , Astigmatismo/cirurgia , Criança , Doenças da Córnea/diagnóstico , Topografia da Córnea/instrumentação , Ectopia do Cristalino/diagnóstico , Feminino , Glaucoma/diagnóstico , Humanos , Iris/cirurgia , Miopia/cirurgia , Resultado do Tratamento , Acuidade Visual
17.
J Refract Surg ; 36(7): 442-448, 2020 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-32644166

RESUMO

PURPOSE: To evaluate measurement repeatability and clinical results for pyramidal aberrometry in routine myopic wavefront-guided laser in situ keratomileusis (LASIK). METHODS: Results from 265 consecutive eyes treated with myopic wavefront-guided LASIK using the Amaris 1050RS Excimer Laser and Peramis pyramidal aberrometer (SCHWIND eye-tech-solutions GmbH) were reviewed. Limits of repeatability were calculated for the aberrometric refraction spherical equivalent and higher order aberrations for the Peramis aberrometer using results from three consecutive scans acquired preoperatively and postoperatively for the first 100 eyes treated. RESULTS: The 95% limits of repeatability for pyramidal aberrometric measurement were: 0.3 diopters (D) for sphere, 0.2 D for cylinder, and 0.1 D (dioptric equivalent) for 3rd and 4th order aberration indices. A total of 95% of eyes were within ±0.50 D of the manifest refraction spherical equivalent target postoperatively. Uncorrected distance visual acuity was 20/20 or better in 96% of 232 eyes with a plano refraction target outcome. A total of 97% of eyes had a refraction cylinder of 0.50 D or less. No eyes lost one or more line of corrected distance visual acuity. CONCLUSIONS: These data demonstrate good measurement repeatability, safety, and efficacy for pyramidal aberrometry in routine myopic LASIK. [J Refract Surg. 2020;36(7):442-448.].


Assuntos
Aberrometria/métodos , Córnea/diagnóstico por imagem , Ceratomileuse Assistida por Excimer Laser In Situ/métodos , Miopia/cirurgia , Refração Ocular/fisiologia , Cirurgia Assistida por Computador/métodos , Acuidade Visual , Adulto , Feminino , Humanos , Lasers de Excimer/uso terapêutico , Masculino , Miopia/diagnóstico , Miopia/fisiopatologia , Estudos Retrospectivos , Resultado do Tratamento
18.
J Refract Surg ; 36(7): 481-490, 2020 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-32644171

RESUMO

PURPOSE: To systematically compare and rank the predictability of no-history intraocular lens (IOL) power calculation methods after myopic laser refractive surgery. METHODS: PubMed, Embase, the Cochrane Library, and the U.S. trial registry (www.ClinicalTrial.gov) were used to systematically search trials published up to August 2019. Included were case series studies reporting the following outcomes in patients with cataract undergoing phacoemulsification after laser refractive surgery: percentage of eyes with a refractive prediction error (PE) within ±0.50 and ±1.00 diopters (D), mean absolute error (MAE), and median absolute error (MedAE). A network meta-analysis was conducted using the STATA software version 13.1 (STATACorp LLC). RESULTS: Nineteen studies involving 1,098 eyes and 19 formulas were identified. A network meta-analysis for the percentage of eyes with a PE within ±0.50 D found that ray-tracing (Okulix), intraoperative aberrometry (Optiwave Refractive Analysis [ORA]), BESSt, and Seitz/Speicher/Savini (Triple-S) (D-K SRK/T), and Fourier-Domain OCT-Based formulas were more predictive than the Wang/Koch/Maloney, Shammas-PL, modified Rosa, Ferrara, and Equivalent K reading at 4.5 mm using the Double-K Holladay 1 formulas. With regard to ranking, the top four formulas as per the surface under the cumulative ranking curve (SUCRA) values for the percentage of eyes with a PE within ±0.50 D were the Okulix, ORA, BESSt, and Triple-S (D-K SRK/T). With regard to MAE, the ORA showed lower errors when compared to the Shammas-PL formula. In this regard, the top four formulas based on the SUCRA values were the Triple-S, BESSt, ORA, and Fourier-Domain OCT-Based formulas. The SToP (SRK/T), ORA, Fourier-Domain OCT-Based, and BESSt formulas had the lowest MedAE. CONCLUSIONS: Considering all three outcome measures of highest percentages of eyes with a PE within ±0.50 and ±1.00 D, lowest MAE, and lowest MedAE, the top three no-history formulas for IOL power calculation in eyes with previous myopic corneal laser refractive surgery were: ORA, BESSt, and Triple-S (D-K SRK/T). [J Refract Surg. 2020;36(7):481-490.].


Assuntos
Aberrometria/métodos , Biometria/métodos , Extração de Catarata , Cirurgia da Córnea a Laser/métodos , Miopia/cirurgia , Óptica e Fotônica , Refração Ocular/fisiologia , Humanos , Miopia/diagnóstico , Miopia/fisiopatologia , Metanálise em Rede , Acuidade Visual
19.
Cornea ; 39(10): 1227-1234, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32639312

RESUMO

PURPOSE: To investigate the long-term corneal changes in patients with Fuchs endothelial corneal dystrophy contributing to superior postoperative visual outcomes after Descemet membrane endothelial keratoplasty (DMEK) compared with Descemet stripping automated endothelial keratoplasty (DSAEK). METHODS: Using retrospective analysis, we evaluated 9 patients with Fuchs endothelial corneal dystrophy who underwent DSAEK in 1 eye and DMEK in the fellow eye. Patients were genotyped for the triplet repeat expansion in the TCF4 gene and imaged using optical coherence tomography, Scheimpflug imaging, and in vivo confocal microscopy through focusing. RESULTS: Eight of 9 subjects were genotyped, and all were found to harbor the triplet repeat expansion. The average time between endothelial keratoplasty and imaging was 76 ± 22 and 37 ± 9 months after DSAEK and DMEK, respectively. The mean best spectacle-corrected visual acuity (logMAR) was 0.04 ± 0.05 and 0.11 ± 0.03 in the DMEK eyes versus DSAEK eyes (P = 0.02), respectively. Posterior corneal higher order aberrations were less in the DMEK eyes compared with fellow DSAEK eyes (0.25 ± 0.06 and 0.66 ± 0.25, respectively, P ≤ 0.01). Using confocal microscopy through focusing, we found that the persistent anterior stromal haze was correlated between the right and left eyes (R = 0.73, P ≤ 0.05), but total stromal backscattering was higher for the DSAEK eyes (P ≤ 0.05). CONCLUSIONS: DSAEK inherently results in higher total stromal backscattering (haze) compared with DMEK because of the addition of stromal tissue. Lower higher order aberrations of the posterior cornea and lower total stromal backscattering (haze) may both contribute to superior visual outcomes after DMEK compared with DSAEK.


Assuntos
Opacidade da Córnea/fisiopatologia , Substância Própria/fisiopatologia , Aberrações de Frente de Onda da Córnea/fisiopatologia , Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior/métodos , Distrofia Endotelial de Fuchs/cirurgia , Aberrometria , Idoso , Idoso de 80 Anos ou mais , Feminino , Distrofia Endotelial de Fuchs/genética , Distrofia Endotelial de Fuchs/fisiopatologia , Técnicas de Genotipagem , Humanos , Masculino , Microscopia Confocal , Estudos Retrospectivos , Tomografia de Coerência Óptica , Fator de Transcrição 4/genética , Expansão das Repetições de Trinucleotídeos/genética , Acuidade Visual/fisiologia
20.
Korean J Ophthalmol ; 34(3): 227-234, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32495531

RESUMO

PURPOSE: To compare refractive error measured by hand-held wavefront aberrometers with postcycloplegic autorefraction (AR) and cycloplegic refraction (CR). METHODS: The medical records of patients who received refractive measurements using the wavefront aberrometer, postcycloplegic AR, and CR between January 2014 and January 2016 were retrospectively analyzed. The mean differences, 95% confidence intervals, and limits of agreement (LOA) were calculated for the refractive vector components (M, J0, and J45 ). RESULTS: Fifty-one patients (9.0 ± 5.5 years, male 41.2%) were enrolled in this study, and only the right eye of each was included. Refractive errors ranged from -9.25 to +7.25 diopters (D) for spherical equivalent (median, 0.75 D). The M component was not significantly different among the three methods (p = 0.080). However, the J0 vector component was significantly different (p < 0.001). After post hoc analysis, the wavefront aberrometer obtained more positive values for J0 compared to the other methods. The J45 component was not significantly different among the three methods (p = 0.143). The mean difference between the wavefront aberrometer and postcycloplegic AR was -0.115 D (LOA, -1.578 to 1.348 D) for M, 0.239 D (LOA, -0.371 to 0.850 D) for J0, and -0.015 D (LOA, -0.768 to 0.738 D) for J45 . The mean difference between the wavefront aberrometer and CR was -0.220 D (LOA, -1.790 to 1.350 D) for M, 0.300 D (LOA, -0.526 to 1.127 D) for J0, and -0.079 D (-0.662 to 0.504 D) for J45 . CONCLUSIONS: The wavefront aberrometer showed good agreement with postcycloplegic AR and CR in spherical equivalents, but tended to produce slightly myopic results. The wavefront aberrometer also overestimated with-the-rule astigmatism. Therefore, we recommend that the device be used for estimations of refractive error, which may be useful for patients who have postural difficulties, live in undeveloped countries, or are bedridden.


Assuntos
Aberrometria/instrumentação , Refração Ocular/fisiologia , Erros de Refração/diagnóstico , Criança , Desenho de Equipamento , Feminino , Humanos , Masculino , Erros de Refração/fisiopatologia , Reprodutibilidade dos Testes , Estudos Retrospectivos
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