Comparing microscope light-associated glare and comfort between heads-up 3D digital and conventional microscopes in cataract surgery: a randomised, multicentre, single-blind, controlled trial.

OBJECTIVE: To compare subjective levels of comfort and visual experiences related to microscope light in patients undergoing their first cataract surgery with topical anaesthesia using a digital microscope (the NGENUITY three-dimensional (3D) visualisation system) or a conventional microscope. METHODS AND ANALYSIS: A prospective, randomised, single-blinded, parallel-group, multicentre, interventional study. Patients (n=128) were randomly assigned to one of two treatment groups: the experimental group (n=63) had surgery using the digital microscope and the control group (n=65) had surgery with a conventional microscope. The primary outcome was patients' subjective experience of glare from the microscope light during surgery on a numerical scale from 0 to 10. Key secondary outcomes were patients' subjective levels of comfort and visual experiences related to the microscope light. RESULTS: The experimental group reported significantly lower levels of glare; median levels were 1.0 (0.0-4.0) for the experimental group vs 3.0 (0.0-6.0) for the control group (p=0.027). They also reported higher levels of comfort; median ratings were 8.0 (6.5-10.0) in the experimental group and 7.0 (5.0-9.0) in controls (p=0.026). There were no group differences in ratings of subjective pain or visual disturbances. Median microscope light intensity was lower in the experimental group than controls; 3425.0 (2296.0-4300.0) Lux vs 24 279.0 (16 000.0-26 500.0) Lux (p<0.0001), respectively. CONCLUSION: Compared with conventional microscopes, the NGENUITY 3D visualisation system allows surgeons to operate with lower levels of light exposure, resulting in significantly less glare and improved comfort in patients undergoing cataract surgery. TRIAL REGISTRATION NUMBER: NCT05085314.

Customized designed notch filters and applied effects on glare and contrast sensitivity in patients with dry eye syndrome.

PURPOSE: Glare visual acuity and contrast sensitivity are important indicators of visual quality. Studies have shown that the glare visual acuity and contrast sensitivity in dry eye patients tend to degenerate, further affecting their quality of life. The objective of this study was to investigate the effect of notch filters on glare VA and contrast sensitivity in patients with dry eye or with dry eye syndrome. METHOD: 36 subjects in the 20‒65 age group were diagnosed as having dry eye disease or perceived dry eye syndromes themselves who were included after the initial screening with the OSDI questionnaire, and one was subsequently excluded as they had undergone retinal detachment surgery. Finally, 35 subjects (14 male and 21 female) with a mean age of 40.66 ± 15.62 years participated in this study. All subjects wore their habitual prescriptions and four different filter lenses (namely 480, 620, dual 480 & 620 notch filter, and FL-41 tinted lens), and measured the parameters of glare visual acuity and contrast sensitivity using CSV-1000 and sine wave contrast test (SWCT), respectively. Student t-test and Repeated measurement analysis (R-ANOVA) were utilized by using SPSS 26.0 software. RESULTS: A dual-wavelength 480 & 620 nm optical notch filter had a significant anti-glare effect decreasing glare disabilities or discomfort, and leading to better visual quality, the same effect was also shown on a 480 nm notch filter lens. All participants showed a significant difference among the baseline, three notch filters (480 nm, 620 nm, dual-wavelength 480 & 620 nm), and FL-41 tinted lens were used on SWCT_A (1.5 cpd, F = 3.054, p = 0.019) and SWCT_E (18 cpd, F = 2.840, p = 0.049); but did not show statistical different on SWCT_B (3 cpd, F = 0.333, p = 0.771), SWCT_C (6 cpd, F = 1.779, p = 0.159), and SWCT_D (12 cpd, F = 1.447, p = 0.228). The baseline showed the best visual performance on CS at a low spatial frequency (SWCT_A, 1.5 cpd), any filter might reduce the contrast sensitivity at low spatial frequencies in the clinical trial, whereas 480 nm notch filter showed the best effectiveness on CS at a high spatial frequency (SWCT_E, 18 cpd), the FL-41 lens that also filters out the 480 nm band does not achieve the same effect. Moreover, patients with dry eye or those older than 40 years old preferred optical multilayer notch filters to FL-41 tinted lenses. CONCLUSION: The 480- & 620-nm dual-wavelength and 480-nm single-wavelength notch filters have the best effect on the glare visual acuity and contrast sensitivity (CS) at high spatial frequencies in dry eye patients. The 620-nm notch filter performs better in CS at low and mid-low spatial frequencies; the FL-41 tinted lens performs poorly for glare VA and CS spatial frequencies examination. Patients with glare disabilities or CS disturbance at high spatial frequencies may choose a 480-nm notch filter lens, and patients who have CS disturbance at low spatial frequencies may consider a 620-nm notch filter for the prescription.

Influencing Factors of Glare in Patients With Myopia After Small Incision Lenticule Extraction.

PURPOSE: To investigate influencing factors of glare in patients with myopia after small incision lenticule extraction (SMILE). METHODS: Thirty patients (60 eyes) aged 24.9 ± 4.5 years with spherical equivalent of -6.69 ± 1.10 diopters (D) and astigmatism of -1.25 ± 0.76 D who underwent SMILE were consecutively recruited in this prospective study. Visual acuity, subjective refraction, Pentacam corneal topography (Oculus Optikgeräte GmbH), pupillometry, and glare test (Monpack One; Metrovision) were measured preoperatively and postoperatively. All patients were followed up for 6 months. The generalized estimation equation was used to judge the determinants of glare after SMILE, and a P value less than .05 was statistically significant. RESULTS: Under mesopic conditions, the halo radii preoperatively and at 1, 3, and 6 months after SMILE were 207.72 ± 46.67, 216.17 ± 40.63, 200.67 ± 34.68, and 193.50 ± 40.75 minutes of arc (arcmin), respectively. Under photopic conditions, the glare radii were 79.10 ± 17.78, 87.00 ± 20.44, 78.00 ± 14.59, and 72.00 ± 15.27 arcmin, respectively. Compared with preoperative glare, no significant changes were detected in postoperative glare. However, glare at 6 months was statistically significantly improved compared to the values at 1 month (both P < .05). Under mesopic conditions, the main influencing factors of glare were sphere (P = .007), astigmatism (P = .032), uncorrected distance visual acuity (UDVA) (P < .001), and postoperative time (all P < .05). Under photopic conditions, the main influencing factors of glare were astigmatism, UDVA, and postoperative time (all P < .05). CONCLUSIONS: Glare improved with time during the early stages after SMILE for myopia. Less glare was found to be associated with better UDVA, and greater residual astigmatism and sphere translated to more obvious glare. [J Refract Surg. 2023;39(6):398-404.].

The dynamic changes and influencing factors of visual symptoms after small incision lenticule extraction.

BACKGROUND: To investigate the dynamic changes and influencing factors of visual symptoms after small incision lenticule extraction (SMILE). METHODS: This was a prospective observational study. Visual symptoms including glare, haloes, starbursts, hazy vision, fluctuation, blurred vision, double vision and focusing difficulties were evaluated before and 1, 3, 6 months after SMILE using a questionnaire. Generalized linear mixed models were used to assess the effects of preoperative characteristics and objective visual quality parameters on postoperative visual symptoms. RESULTS: 73 patients/146 eyes were enrolled. Preoperatively, the most common symptoms were glare (55% of eyes), haloes (48%), starbursts (44%) and blurred vision (37%). At 1 month postoperatively, the incidence and extent scores of glare, haloes, hazy vision and fluctuation rose significantly. At 3 months, the incidence and extent scores of glare, haloes and hazy vision restored to baseline. And at 6 months, the extent scores of fluctuation returned to baseline. Other symptoms (e.g., starbursts) did not change before and 1, 3, 6 months after SMILE. Preoperative visual symptoms were associated with postoperative symptoms, as patients with a symptom preoperatively had higher postoperative scores for that symptom. Age was related to postoperative extent of double vision (coefficient = 0.12, P = 0.046). There were no significant associations between postoperative visual symptoms and preoperative SE, scotopic pupil size, angle kappa (with intraoperative adjustment), postoperative HOAs or scattering indexes. CONCLUSIONS: The incidence and extent scores of hazy vision, glare, haloes and fluctuation increased at the first month after SMILE, and recovered to baseline at 3 or 6 months. Preoperative visual symptoms were associated with the postoperative symptoms and should be fully considered before SMILE.

The Effects of Blue-Light Filtering Intraocular Implants on Glare Geometry.

PURPOSE: One common complaint with natural opacified lenses is the deleterious effects of higher-order ocular aberrations and intraocular scatter, such as halos and starbursts, which are not always remedied with surgery and intraocular lens (IOL) implantation. Blue-light filtering (BLF) IOL filter scatter-prone short-wave light. Here, we determine whether BLF IOL reduce halo and starburst size. METHODS: This study was a case-control design, between- and within-subjects (contralateral implantation). Sixty-nine participants with either the BLF IOL (n = 25; AlconSN60AT), clear IOL (n = 24; AlconSA60AT or WF), or both (n = 20) IOL participated. Participants were exposed to a point source of broadband simulated sunlight, which created the appearance of halos/starbursts. Dysphotopsia was measured as the diameter of broadband light-induced halos and starbursts. RESULTS: A case-control analysis. Halo size was significantly larger (t[35.05] = 2.98, p = 0.005) in participants with the clear control lens (M = 3°55' ± 2°48'), compared to the BLF IOL (M = 1°84' ± 1°34'). Starburst size was not significantly different between groups. Contralateral analysis. Halo size was significantly smaller (t = -3.89, p = .001) in test eyes with the BLF (M = 3°16' ± 2°35') compared to the fellow control eyes (M = 5°42' ± 3°17'). Starburst size was also significantly smaller (t = -2.60, p < 0.018) in BLF test eyes (M = 9°57' ± 4°25') than the fellow eye with the clear IOL (M = 12°33' ± 5°25'). CONCLUSIONS: BLF IOL filter short-wave light and mimic retinal screening by the young, natural crystalline lens. Such filtering can reduce some deleterious effects of bright light by decreasing ocular diffusion/halos and starbursts.

A study on disability glare vision in young adult subjects.

The full assessment of the visual system must include the evaluation of the optical quality of the eye and neural visual functions. The objective evaluation of the retinal image quality is often carried out by computing the point spread function (PSF) of the eye. The central part of the PSF is associated with optical aberrations and the peripheral areas with scattering contributions. In that sense, visual acuity and contrast sensitivity function tests can be considered the perceptual neural response to those contributions characterizing the eye's PSF. However, in natural viewing conditions, visual acuity tests may provide good vision while contrast sensitivity tests can reveal visual impairment in glare vision conditions, such as exposure to bright light sources or night driving conditions. Here we present an optical instrument for the study of disability glare vision under extended Maxwellian illumination to assess the contrast sensitivity function under glare conditions. The limit of the Total Disability Glare threshold, tolerance, and glare adaptation will be investigated as a function of the angular size of the glare source (GA) and the contrast sensitivity function in young adult subjects.

Changes in Shape Discrimination Sensitivity Under Glare Conditions After Orthokeratology in Myopic Children: A Prospective Study.

Purpose: To investigate changes in shape discrimination under mesopic conditions with and without glare after orthokeratology in myopic children. Methods: This prospective study included 79 eyes of 79 myopic children (ages: 8-16 years). Shape discrimination thresholds (SDTs) were measured using radial frequency patterns, with a radial frequency of 4 cycles/360°, a peak spatial frequency of 3 cycles per degree, a contrast of 20%, and a mean radius of 1.5 degrees. SDT under mesopic conditions with and without glare was measured before orthokeratology and again at 1 week and 1 month after orthokeratology. Changes in the SDTs and their relationships to baseline ocular parameters were analyzed. Results: SDTs with glare decreased significantly at 1 week (-0.08 ± 0.15 log(arcsec), P < 0.001) and 1 month (-0.09 ± 0.15 log(arcsec), P < 0.001) after orthokeratology. SDTs without glare remained stable (P = 0.81 and P = 1.00, respectively). The difference between SDTs with and without glare also decreased significantly at 1 week (-0.10 ± 0.17 log(arcsec), P < 0.001) and at 1 month (-0.08 ± 0.18 log(arcsec), P = 0.001) after orthokeratology. Based on a multivariate analysis, the greater decrease in SDT with glare after 1 month of orthokeratology was associated with a higher baseline spherical equivalent refraction. Conclusions: Orthokeratology resulted in improved shape discrimination in myopic children under mesopic conditions but only when measured in the presence of glare.

People with high schizotypy experience more illusions in the Pattern Glare Test: Consistent with the hyperexcitability hypothesis.

Individuals diagnosed with schizophrenia spectrum disorders (SSD) exhibit a constellation of sensory and perceptual impairments, including hyporeactivity to external input. However, individuals with SSD also report subjective experiences of sensory flooding, suggesting sensory hyperexcitability. To identify the extent to which behavioural indices of hyperexcitability are related to non-psychotic symptoms of schizophrenia, we tested a non-clinical population measured for schizophrenia-like traits (schizotypy), and a behavioural measure of sensory hyperexcitability, specifically the number of illusions seen in the Pattern Glare Test. Two samples totaling 913 individuals completed an online version of the Schizotypal Personality Questionnaire - Brief Revised (SPQ-BR) and the Pattern Glare Test. Individuals with higher schizotypy traits reported more illusions in the Pattern Glare Test. Additionally, one of the three SPQ-BR factors, the disorganized factor, significantly predicted the number of illusions reported. These data illustrate the potential for research in non-clinical samples to inform clinically relevant research.

Vision With Retrodots and Factors for Declining Visual Function.

Purpose: We investigated decline in the visual function of eyes with retrodots (RDs)-a subtype of cataract. Method: This study included 57 eyes with RD opacity only (mean age 72.3 ± 5.2 years) and 34 eyes with transparent lenses (mean age 71.4 ± 3.7 years). A physician diagnosed lens opacity. Using the Kanazawa Medical University Classification and Grading System, the eyes were classified into the RD-1 (37 eyes, RDs <25% of the 3-mm pupil area) and RD-2 (20 eyes, RDs ≥25% of the 3-mm pupil area) groups. Corrected distance visual acuity, contrast visual acuity, ocular refractive power, lens power, straylight, and backward light-scattering intensity and their relationship with visual function decline and optical characteristics of the eyeball were evaluated. Results: Corrected distance visual acuity was significantly lower in the RD eyes than in controls. Contrast visual acuity decreased significantly in the RD-2 eyes in all environments and in the RD-1 eyes in the evening (EVE) and EVE + glare. Straylight was significantly higher in the RD-2 eyes than in the controls and RD-1 eyes but not different between the RD-1 eyes and controls. The RD-2 eyes were significantly more myopic than the controls and RD-1 eyes. Conclusion: When the opacity of RD eyes is ≥25%, the visual acuity and contrast visual acuity decrease and straylight increases. Furthermore, myopia occurs as the refractive power of the lens increases. Moreover, visual function decline may be due to an increase in the straylight value, which is necessary for determining surgical indications.

The Influence of HEV-Filtering Contact Lenses on Behavioral Indices of Glare.

OBJECTIVES: We assessed the effects of a HEV-filtering contact lens on positive dysphotopsia (halos and starbursts) and a behavioral index of scatter measured using two-point light thresholds. These effects were assessed by direct comparison to a clear (i.e., non-HEV filtering) contact lens tested in the fellow eye. METHODS: Sixty-one subjects were randomized and fit with study lenses and 58 subjects completed the study. A double-masked contralateral design was used. Subjects were randomized to test lens-OD, control lens-OS, or vice versa. Participants were exposed to a point source of broadband simulated sunlight (a 403-nm condition was also tested) that created the appearance of halos/starbursts. The degree of dysphotopsia was measured as the diameter of broadband and violet-induced halos, and broadband light-induced starbursts. Two-point thresholds were assessed as the minimum resolvable distance between two pinpoints of light. RESULTS: The HEV-filtering lens was statistically superior ( P <0.0001) to the clear lens in all the conditions tested. The HEV-filtering lens significantly reduced halo diameter by 30%, starburst diameter by 23%, and resolvable distance in the two-point condition by 18% (white) and 30% (violet). CONCLUSIONS: HEV-filtering contact lenses can reduce some deleterious effects of bright broadband light by decreasing light scatter, halos, and starbursts.

Assessment of spectral properties of positive dysphotopsia or glare caused by LED sources for different types of intraocular lenses.

Light emitting diodes (LEDs) have become a major source of lighting conditions. The increased prevalence of LED light sources introduces new concerns for the spectral effects of positive dysphotopsia (PD) or glare type photic phenomena for pseudo-phakic patients with intraocular lenses (IOLs). A significant amount of work has been published in the area of spectral discomfort and sensitivity of LEDs as well as automotive lighting. The wavelength dependence or spectral properties of PD due to LEDs for IOLs has not been reported. This study, to our knowledge, is the first one to assess the glare characteristics of four commercially available IOL models with different material types and design features using an optical bench and non-sequential ray trace simulations with LEDs of different wavelengths. A novel approach of representing the reflected and transmitted IOL glare utilizing Fresnel coefficients is found to be in close agreement with the measurements.

A randomized phase 2 clinical trial of phentolamine mesylate eye drops in patients with severe night vision disturbances.

PURPOSE: Dim light vision disturbances (DLD) comprise a wide range of symptoms affecting the quality of vision at low illumination including glare, halos, and starbursts. This exploratory study investigated 1.0% phentolamine mesylate ophthalmic solution (PMOS) as a treatment to improve vision and image quality for patients with DLD. METHODS: In this placebo-controlled, randomized, double-masked clinical trial, 24 adult patients with severe DLD were randomized in a 2:1 ratio to receive either one dose of PMOS or placebo. Subjects were eligible if they reported experiencing severe night vision difficulty that was not eliminated by distance spectacle correction and scored ≥0.3 log units below the normal range of contrast sensitivity assessed under mesopic conditions with glare at ≥2 spatial frequencies. Key efficacy outcomes were change from baseline in pupil diameter, contrast sensitivity, and visual acuity. Safety measures including intraocular pressure, conjunctival hyperemia, and systemic effects were also assessed. RESULTS: Eight subjects were randomized to placebo (63% female; mean age 47 years) and 16 were randomized to PMOS (75% female; mean age 42 years). Mean (SD) pupil diameter of PMOS-treated subjects decreased significantly - 1.3 mm (0 to - 2.8 mm) with p < 0.0001. Mean contrast sensitivity with glare in PMOS-treated subjects improved significantly post-treatment at spatial frequencies 3, 6, 12, and 18 cycles per degree (p ≤ 0.03). PMOS also demonstrated improvements in the numbers of letters read for mesopic and photopic, high- and low-contrast visual acuity (LCVA). Importantly, a statistically greater proportion of PMOS-treated eyes registered mesopic LCVA 5 letter (69% vs. 31%, p = 0.029) and 10 letter (34% vs. 6%, p = 0.04) improvement, with a trend at 15 letters (19% vs. 0%, p = 0.16). PMOS was well tolerated with the only reported side effect being a mild increase in conjunctival hyperemia. CONCLUSION: PMOS was well tolerated and effectively reduced pupil size with improvements in contrast sensitivity and visual acuity in adults with severe DLD. Future Phase 3 studies should be conducted to further evaluate its potential to treat DLD. TRIAL REGISTRATION: The trial registration number is NCT04004507 (02/07/2019). Retrospectively registered.

Reduction of Glare Discomfort and Photostress Recovery Time Through the Use of a High-Energy Visible-Filtering Contact Lens.

OBJECTIVES: Glare discomfort (GDC) is the slight pain (discomfort) that arises when exposed to light that exceeds one's adaptive state. Such light can also cause a temporary loss in visual function (photostress, PS). We tested the hypothesis that filtering with a high-energy visible (HEV) light-filtering contact lens can reduce GDC and speed PS recovery time. METHODS: Sixty-one subjects were randomized and fit with study lenses and 58 subjects completed as cohort (20-65 years of age). A double-masked, randomized, contralateral design was used (HEV filter on one eye; control lens on the other). Participants were given a 5-s exposure to a broadband white photostressor. Video images were analyzed, and palpebral fissure size during exposure was measured, as was PS recovery time to a 2-degree mid-wave target. RESULTS: The HEV-filtering test lens was statistically superior ( P <0.0001) to the clear comparison contact lens with respect to the magnitude of squint (44.9% squint reduction) and photostress recovery time (24.3% faster recovery). CONCLUSIONS: High-energy visible light-filtering contacts can reduce GDC and speed PS recovery. Filtering HEV light before it is incident upon the retina is a natural strategy (e.g., by the lens and macular pigment) for attenuating some of the deleterious effects of bright broadband light.

The Effects of Glare on the Perception of Visual Motion as a Function of Age.

Purpose: The purpose of this study was to determine the impact of glare, that simulated the effects of oncoming vehicle headlights, and age on different aspects of motion perception in central and peripheral vision. Methods: Twenty younger (mean age = 25 years, range = 20-32 years) and 20 older (mean age = 70 years, range = 60-79 years) visually healthy adults completed four visual motion tasks. Stimuli were presented centrally and at 15 degrees horizontal eccentricity for 2 viewing conditions: glare (continuous, off-axis) versus no glare. Motion tasks included minimum Gabor contrast required to discriminate direction of motion, translational global motion coherence, minimum duration of a Gabor to determine direction of motion (2 different size Gabors to determine spatial surround suppression), and biological motion detection in noise. Intraocular straylight was also measured (C-Quant). Results: Older adults had increased intraocular straylight compared with younger adults (P < 0.001). There was no significant effect of glare on motion thresholds in either group for motion contrast (P = 0.47), translational global motion (P = 0.13), biological motion (P = 0.18), or spatial surround suppression of motion (P = 0.29). Older adults had elevated thresholds for motion contrast (P < 0.001), biological motion (P < 0.001), and differences in surround suppression of motion (P = 0.04), relative to the younger group, for both the glare and no-glare conditions. Conclusions: Although older adults had elevated thresholds for some motion perception tasks, glare from a continuous off-axis light source did not further elevate these thresholds either in central or peripheral vision. Translational Relevance: A glare source that simulated the effect of oncoming headlights, did not impact motion perception measures relevant to driving.

Safety of DIMS Spectacle Lenses and Atropine as Combination Therapy for Myopia Progression. / Sicherheit von Brillengläsern mit DIMS-Technologie und Atropin in der Kombinationstherapie der Myopieprogression.

BACKGROUND: The aim of this study was to evaluate traffic safety of Defocus Incorporated Multiple Segments (DIMS) spectacle lenses in combination therapy with atropine. PATIENTS AND METHODS: 12 young adults (age: 24 - 45; 30,1 ± 5,7 years) were recruited to evaluate corrected distance visual acuity (CDVA), contrast sensitivity (CS; FrACT), glare sensitivity (Mesotest) under the influence of DIMS spectacle correction alone and combination therapy with 0,01% atropine. RESULTS: When looking through the central area of the DIMS lens, far vision does not decrease due to the influence of atropine; influence of glare and atropine leads to a reduction of CDVA by 0.10 logMAR. When forced to look through the DIMS area, far vision is reduced by 0.09 logMAR due to the influence of atropine in the absence of glare; in the presence of glare, no further loss of visual acuity can be observed under the influence of atropine. Contrast vision with DIMS glasses is not altered by the effects of atropine. Concerning glare sensitivity, DIMS lenses did not show any visual impairment that would be relevant to vision and road safety. Additional atropinization does not affect glare sensitivity. CONCLUSION: DIMS spectacle lenses are safe for participation in road traffic and do not relevantly impair traffic safety, neither alone nor under the acute influence of 0,01% atropine.

The pattern glare and visual memory are disrupted in patients with major depressive disorder.

BACKGROUND: Visual memory impairment is one of the most commonly complained symptoms in patients with major depressive disorder (MDD). Pattern glare is also a distorted visual phenomenon that puzzles patients with MDD. Nevertheless, how these two phenomena interact in MDD remains unknown. This study investigated the association between pattern glare and visual memory in MDD patients. METHODS: Sixty-two patients with MDD and forty-nine age-, sex- and education level-matched healthy controls (HCs) were included in this study. The Pattern Recognition Memory (PRM) test and the Brief Visual Memory Test-Revised (BVMT-R) were applied to measure visual memory. The pattern glare test including three patterns with different spatial frequencies (SFs) was used to explore pattern glare levels. RESULTS: Patients with MDD scored lower on the PRM-PCi, BVMT-R1, BVMT-R2, BVMT-R3, and BVMT-Rt and higher on the PRM-MCLd than HCs (all p < 0.05). Pattern glare scores for MDD patients were higher with mid-SF (p < 0.001), high-SF (p = 0.006) and mid-high SF differences (p = 0.01) than for HCs. A positive correlation between mid-SF and PRM-MCLd scores in all participants was observed (p = 0.01, r = 0.246). A negative correlation between mid-high difference scores and BVMT-R2 scores (p = 0.032, r = -0.317) was observed in HCs, but no significant correlation was observed in MDD patients. CONCLUSIONS: The present study showed that visual memory and pattern glare are disrupted in MDD. Visual memory may be associated with pattern glare and needs to be studied in future work.

Clinical outcomes after implantation of extended depth-of-focus AcrySof® Vivity® intraocular lens in eyes with low-grade epiretinal membrane.

PURPOSE: To evaluate the clinical outcomes of extended depth-of-focus (EDoF) AcrySof® Vivity® intraocular lens in eyes with low-grade epiretinal membrane (ERM). METHODS: Forty-five eyes with low-grade ERM and history of Vivity implantation were compared with 50 age-matched controls with Vivity implantation and no ERM. Eyes with ERM showing widening of the outer nuclear layer and loss of the foveal depression, but no ectopic inner foveal layer or outer retinal defect were eligible. Corrected and uncorrected distant visual acuity (CDVA and UDVA), uncorrected intermediate and near visual acuity (UIVA and UNVA), contrast sensitivity detected by area under the log contrast sensitivity function (AULCSF), Strehl ratio, area ratio, and occurrence of dysphotopsia were compared between groups. RESULTS: UDVA and CDVA were similar between groups (UDVA: 0.01 ± 0.05 vs 0.03 ± 0.06, P = 0.154; CDVA: 0.00 ± 0.00 vs 0.00 ± 0.02, P = 0.125). UIVA and mesopic AULCSF were significantly worse in eyes with ERM compared to those with no ERM (UIVA: 0.09 ± 0.09 vs 0.14 ± 0.10, P = 0.028; mesopic AULCSF: 1.26 ± 0.15 vs 1.17 ± 0.10, P = 0.013). The occurrence of dysphotopsia was similar in both groups (glare: P = 0.465; halo: P = 0.218; starburst: P = 0.457). DISCUSSION: Eyes with low-grade ERM showed comparable outcomes to eyes without ERM after Vivity IOL implantation. Implantation of this newly developed EDoF IOL with low addition can be of benefit to eyes with low-grade, reversible ERM that is limited to the inner retina.

Study on the Influence of Opposing Glare from Vehicle High-Beam Headlights Based on Drivers' Visual Requirements.

The anti-glare facilities in median strips are designed to block opposing headlights in order to avoid disability glare, but a large amount of headlight leakage results in uncomfortable glare, to the point that drivers can barely detect dangerous obstacles or road conditions. This paper aims to explore the glare range under high-beam headlights on drivers' visual requirements. Based on an analysis of the mechanism of headlight glare, this paper proposes a subjective headlight glare scale, and classifies glare discomfort into two categories: interference glare, and acceptability glare. Combining the scales, 24 drivers and a standard light-emitting diode automotive headlamp were used to conduct glare effect tests. The size of the laboratory that closes to scotopic vision is 12 m × 6 m. The illuminance thresholds of disability glare-interference glare (DGIG) and interference glare-acceptability glare (IGAG), along with the spatial distribution of each glare level, were collected at the longitudinal distances of 3 m, 5 m, 7 m, 10 m, and 12 m. Meanwhile, the illuminance threshold and the spatial distribution of each glare level up to a longitudinal distance of 120 m were calculated. The results indicate that disability glare is distributed in the central area, while interference glare and acceptability glare are distributed from the center to the margins. At the same longitudinal distance, the vertical illuminance of the driver's eye under the same glare level is almost equal. In the range of a longitudinal distance of 120 m, the spatial distribution of each glare level enlarges with each increase in longitudinal distance. The results can provide scientific evidence for calculating the reasonable heights of anti-glare facilities for expressways with different alignments.

The Blue Light Hazard Versus Blue Light Hype.

PURPOSE: The blue light hazard is the experimental finding that blue light is highly toxic to the retina (photic retinopathy), in brief abnormally intense exposures, including sungazing or vitreoretinal endoillumination. This term has been misused commercially to suggest, falsely, that ambient environmental light exposure causes phototoxicity to the retina, leading to age-related macular degeneration (AMD). We analyze clinical, epidemiologic, and biophysical data regarding blue-filtering optical chromophores. DESIGN: Perspective. METHODS: Analysis and integration of data regarding the blue light hazard and blue-blocking filters in ophthalmology and related disciplines. RESULTS: Large epidemiologic studies show that blue-blocking intraocular lenses (IOLs) do not decrease AMD risk or progression. Blue-filtering lenses cannot reduce disability glare because image and glare illumination are decreased in the same proportion. Blue light essential for optimal rod and retinal ganglion photoreception is decreased by progressive age-related crystalline lens yellowing, pupillary miosis, and rod and retinal ganglion photoreceptor degeneration. Healthful daily environmental blue light exposure decreases in older adults, especially women. Blue light is important in dim environments where inadequate illumination increases risk of falls and associated morbidities. CONCLUSIONS: The blue light hazard is misused as a marketing stratagem to alarm people into using spectacles and IOLs that restrict blue light. Blue light loss is permanent for pseudophakes with blue-blocking IOLs. Blue light hazard misrepresentation flourishes despite absence of proof that environmental light exposure or cataract surgery causes AMD or that IOL chromophores provide clinical protection. Blue-filtering chromophores suppress blue light critical for good mental and physical health and for optimal scotopic and mesopic vision.