Visual acuity and defocus curves with six multifocal intraocular lenses.

PURPOSE: The purpose of this prospective, randomized, double-masked, study was to compare the visual performance of patients after bilateral implantation of six different IOLs. METHODS: The following IOLs were used in the study: SV25T0 (n = 19), ATLISA 809M (n = 18), ATLISA Tri 839MP (n = 19), ZKB00 (n = 20), ZLB00 (n = 20) and Symfony ZXR00 (n = 20). Visual performance was assessed by the monocular distance-corrected visual acuity at 4 m (CDVA), distance-corrected intermediate visual acuity (DCIVA) at 60 cm and distance-corrected near visual acuity (DCNVA) at 40 cm. Binocular defocus curves were obtained for a range of defocus from + 1.50 D to - 4.50 D, in 0.50 D steps. Quality of life was assessed with the VF-14 questionnaire. RESULTS: CDVA was better with the Symfony ZXR00 than with the SV25T0 (p = 0.032), ATLISA Tri 839MP (p = 0.032) and ATLISA 809M (p = 0.018). The Symfony ZXR00 offered the best DCIVA, followed by the ZKB00. The best and worst DCNVA results corresponded to the ZLB00, and the SV25T0 and Symfony ZXR00, respectively. Defocus curves at distance were good in all groups, although the Symfony had a wider range of clear vision (- 1.50 D to + 0.50 D), with no decay. For intermediate vision, only the Symfony obtained sharp visual acuity. The ATLISA 809M, ATLISA Tri 839MP and ZLB00 were superior at near distance. CONCLUSIONS: The extended depth of focus of the Symfony ZXR00 offers a superior range of clear vision at far and intermediate distances than other multifocal designs, with worse results at near distance. Visual outcomes reflect the particular optical, geometrical and power distribution characteristics of each IOL.

Far and Near Contrast Sensitivity and Quality of Vision with Six Presbyopia Correcting Intraocular Lenses.

The objective of this prospective, randomized, double-masked study was to compare the contrast sensitivity and quality of vision of patients bilaterally implanted with the following six different presbyopia correcting intraocular lenses (IOLs): SV25T0 (n = 19), ATLISA 809M (n = 18), ATLISA TRI 839MP (n = 19), ZKB00 (n = 20), ZLB00 (n = 20) and Symfony ZXR00 (n = 20). For comparison purposes, 36 patients were implanted with a monofocal lens (ZA9003). Contrast sensitivity was assessed binocularly at distance under photopic, mesopic and mesopic plus glare conditions, and at near under photopic conditions. Quality of vision was explored in terms of photic phenomena and spectacle independence. Overall, the monofocal lens offered better contrast sensitivity, under all illumination conditions, and less occurrence and intensity of photic phenomena. Amongst the multifocal IOL (MIOL) designs, the extended depth of focus Symfony ZXR00 provided better contrast sensitivity than the other MIOLs, particularly at intermediate and high spatial frequencies. Up to 40% and 50% of patients implanted with MIOLs reported glare and halos, respectively. The SV25T0 resulted in less occurrence and intensity of halos. The evaluation of photic phenomena and contrast sensitivity under different illumination conditions may reflect real-life, visually challenging situations, and thus provide insightful information to assist ophthalmic surgeons when selecting the best intraocular lens for their patients.

Optical Performance of a Monofocal Intraocular Lens Designed to Extend Depth of Focus.

PURPOSE: To test the performance of a new monofocal intraocular lens, intended to extend depth of focus (Tecnis Eyhance, ICB00; Johnson & Johnson Vision, Inc) (ICB-IOL), in comparison to a standard monofocal IOL (Tecnis 1-piece, ZCB00; Johnson & Johnson Vision, Inc) (ZCB-IOL) of the same platform and material. METHODS: Assessment of the optical performance of the two IOLs was made in vitro using an optical test bench with a model eye. The spherical aberration, modulation transfer function (MTF), and area under the MTF (MTFa) were obtained for pupil sizes ranging from 2 to 5 mm. Through-focus MTFa curves between -3.00 and +1.00 diopters (D) were obtained with three pupil sizes (2, 3, and 4.5 mm). Halo formation was also assessed for both lenses. RESULTS: The ICB-IOL had slightly worse optical quality at its best focus (ie, lower MTF scores at distance vision) and more negative spherical aberration than the ZCB-IOL for pupils ranging from 2 to 3 mm. The maximum of the through-focus MTFa curve of the ICB-IOL with a 2-mm pupil shifted to a myopic defocus of -0.50 D. For larger pupils (≥ 3.5 mm), there were no differences in spherical aberration, MTF scores, and halo energy between the two lenses. CONCLUSIONS: The new ICB-IOL is a modified monofocal lens with 0.50 D of additional power in its central 2-mm zone and more negative spherical aberration values, which induce a myopic shift of the maximum of optical quality and could improve intermediate vision. For pupils larger than 3.5 mm, there were no differences between IOLs. The new ICB-IOL design would produce photic phenomena comparable to a standard IOL. [J Refract Surg. 2020;36(9):625-632.].

Visual acuity and image quality in 5 diffractive intraocular lenses.

PURPOSE: To compare objective image quality at distant, intermediate, and near foci with the corresponding visual acuity (VA) in patients symmetrically implanted with 5 different diffractive multifocal intraocular lenses (IOLs) (ReSTOR SV25T0, Tecnis ZKB00, Tecnis ZLB00, AT LISA 809, and AT LISA Tri 839MP) and a monofocal lens (Tecnis ZA9003) 3 months after cataract intervention. METHODS: Objective image quality, measured as the area under the modulation transfer function curve (AMTF), was tested in vitro in an eye model. In addition, corrected distance visual acuity and distance-corrected intermediate and near visual acuities (DCIVA and DCNVA) were assessed in a group of 79 patients, randomly implanted with one of the lenses. RESULTS: Image quality and VA at the distant focus was good for all lens designs, but was similarly compromised at the intermediate focus, where the best DCIVA corresponded to the low add ZKB00. At the near focus, the monofocal lens and the distance dominant SV25T0 had the worst AMTF values, with the ZLB00 presenting the best DCNVA. The relationship between AMTF and VA was found not to be linear, with VA being similarly good for AMTF values over a certain threshold. CONCLUSIONS: Visual acuity of pseudophakic patients reflected the optical quality of the specific IOL design within a certain range of measurements, beyond which maximum VA is limited by other ocular, optical, and neuropsychophysical factors.

Halo and Through-Focus Performance of Four Diffractive Multifocal Intraocular Lenses.

PURPOSE: To compare, as a function of pupil size, the through-focus performance and halo features of four diffractive intraocular lenses (IOLs). METHODS: Three diffractive bifocal IOLs (ReSTOR +2.5 D SV25T0, Tecnis +2.75 D ZKB00, and AT LISA +3.75 D 809M) and a diffractive trifocal IOL (AT LISA tri +3.33 D, +1.66 D 839MP) were tested in vitro in a modified International Organization for Standardization eye model. The modulation transfer function (MTF) at the IOLs' foci was obtained with pupils ranging from 2.0 to 5.0 mm. Through-focus MTF curves (at 50 cycles/mm) were compared among all the IOLs. The halo formation and characteristics were obtained from image analysis. RESULTS: The multifocal IOLs studied in this work showed, at their foci, secondary out-of-focus images, which originate halos and whose characteristics depend on the lens design and pupil size. The smallest halo occurred for the distance focus of the SV25T0. The distance and near foci of the SV25T0 yielded, respectively, the best and lowest optical quality among the studied IOLs. The distance focus of the ZKB00, AT LISA, and AT LISA tri were of similar quality, but the near focus of the ZKB00 outperformed the near foci of the rest of the IOLs. The IOLs' optical performance gradually deteriorates as pupil increases. CONCLUSIONS: Differences in the design of the diffractive IOLs translate into differences in optical quality at their foci, through-focus performance, and halo features, which can offer further information to surgeons when selecting which IOL to implant.

Efficacy comparison of glutaraldehyde-phenate vs other glutaraldehydes in fomites disinfection, by different methods.

OBJECTIVE: To compare the efficacy of glutaraldehyde-phenate against four other glutaraldehydes. DESIGN: We use two methods: (1) Bacteriostatic method- With 97 microrganisms of 8 different species. (2) Bactericide method- With a low contamination (10(4)cfu) plus organic soil (simulating the work conditions of glutaraldehyde when we wash fomites before disinfection), we used six microorganisms (the most sensitive and the most resistant, according to the first method, of three species: P. aeruginosa, R. pneumoniae and S. aureus) in different times and concentrations. RESULTS: Glutaraldehyde-phenate is the most active against Gram-positives, but less with Gram-negatives. However when we study the total effect of the five glutaraldehydes, there are no significant differences among the mean of the minimum inhibitory concentrations (MICm). With the bactericide method the total bactericide effect (0% survival) is easily achieved with the five glutaraldehydes at 2% dilution, but when we reduced the concentration (1/16) we needed 60 minutes for glutaraldehyde-phenate and 15-30 minutes with the rest. CONCLUSIONS: The five products have got a similar efficacy in higher concentration, but at 1/16 dilution glutaraldehyde-phenate need increase the contact-time on the fomite.

[The evaluation of the mutagenic activity of public drinking water by the Ames test]. / Evaluación de la actividad mutagénica de aguas de consumo público por medio del test de Ames.

BACKGROUND: The sources of potential mutagens in our environment are many, but the most important of these is water for public consumption. This is a result of the chlorinating process which is the main reason for the appearance of these mutagens. With this in mind, the aim of our study was to check a possible mutagenic activity, using the Ames test, in organic concentrates taken from water for public consumption in Madrid. METHODS: Several bacterial strains were used, namely Salmonella histidine dependent TA1535, TA1538, TA98 and TA100, taken originally from Salmonella typhimurium LT2. Each test was performed twice, with or without the introduction of the mammalian-microsome activation (S9 mix), as per the indications in Ames. The plate incorporation assay was used to test the mutagenicity. All samples of the water in question were processed and treated so as to create concentrates of organic chlorinated compounds. RESULTS: The highest levels of mutagenicity appeared in the TA1535 strain and in the tests where the microsome fraction was not used (IM = 1.94). CONCLUSIONS: With regard to mutagenic evaluation in organic concentrates taken from water for public consumption, no positive activity was found in any of the tester strains.

Comparison of far and near contrast sensitivity in patients symmetrically implanted with multifocal and monofocal IOLs.

PURPOSE: A prospective, randomized, double-masked, clinical trial was designed to evaluate distance and near contrast sensitivity (CS) in patients symmetrically, and randomly, implanted with 4 different multifocal intraocular lens (MIOL) designs (ReSTOR SN6AD1, ReSTOR SN60D3, ReZoom NXG, and Tecnis ZMA00) and a monofocal control group (Tecnis ZA9003), 6 months after cataract intervention. METHODS: Photopic, mesopic, and mesopic with glare distance CS, as well as photopic near CS, was evaluated with the CSV-1000 CS test and the Vistech VCTS 6000 system, respectively, in a group of 180 patients attending the ophthalmology department of Sant Pau Hospital, Barcelona, for cataract intervention and lens implantation. RESULTS: Statistically and clinically significant differences were found between the monofocal and multifocal lens groups at all spatial frequencies and illumination conditions, both during distance and near CS evaluation (all p<0.05), with the monofocal lens offering the best performance in all cases. Contrast sensitivity was similarly compromised in all MIOL models at distance, although MIOLs with diffractive optics and aspheric profiles showed a non-statistically significant trend to perform better in mesopic conditions. Near CS was lower for refractive, distance dominant lens designs, particularly at medium to high spatial frequencies. CONCLUSIONS: The present results, which reflect intraocular lens (IOL) characteristics in optics, profile, and add power, may contribute to help surgeons decide on the type of IOL most suitable for each patient by taking into consideration the individual needs for critical distance and near vision, both in terms of visual acuity and contrast sensitivity.

Stereo-acuity in patients implanted with multifocal intraocular lenses: is the choice of stereotest relevant?

PURPOSE: A randomized and double-blinded study design was implemented to assess the stereo-acuity in patients symmetrically implanted with four types of multifocal intraocular lenses (MIOLs), compared to a monofocal lens (control group). In addition, the influence of the type of test employed for the evaluation of stereo-acuity was explored. MATERIALS AND METHODS: Six months after cataract intervention, stereo-acuity was measured with the Titmus and TNO stereotests in 143 patients implanted with one of the following MIOL lens types: hybrid spherical SN60D3, hybrid aspheric SN6AD1, diffractive aspheric ZMA00 and refractive spherical NXG1. A control group implanted with the monofocal aspheric ZA9003 (in which stereo-acuity was measured with a near addition) was also included in the study. RESULTS: Statistically significant better stereo-acuity was found in the monofocal group with both stereotests (except for the SN60D3 group with the Titmus test) (all p < 0.001). No significant differences in stereo-acuity between MIOLs were found using the Titmus test. However, with the TNO, patients implanted with hybrid diffractive MIOLs exhibited statistically significant worse stereo-acuity than those with the refractive design (SN60D3, p < 0.001; SN6AD1, p = 0.006). CONCLUSIONS: Patients implanted with MIOLs have worse stereo-acuity than those implanted with monofocal IOLs due to the decrease in retinal image contrast originating in the simultaneous presence of two images. A wavelength-based stereotest such as the TNO induces large differences in image contrast between fellow eyes implanted with diffractive-based MIOLs, which may result in an underestimation of the real stereo-acuity of the patient.

Visual acuity, contrast sensitivity, subjective quality of vision, and quality of life with 4 different multifocal IOLs.

PURPOSE: This prospective, randomized, double-masked, clinical trial was designed to evaluate visual acuity, contrast sensitivity, subjective quality of vision, and quality of life in 47 patients symmetrically, and randomly, implanted with 4 different IOL designs (SN6AD1, SN60D3, ReZoom NXG1, and Tecnis ZMA00), 3 months after cataract intervention. METHODS: Binocular corrected and uncorrected distance visual acuity, binocular distance corrected (BCNVA) and uncorrected (UCNVA) near visual acuity, binocular distance corrected (BCIVA) and uncorrected (UCIVA) intermediate visual acuity, photopic, mesopic, and mesopic with glare contrast sensitivity, quality of vision, and quality of life were evaluated. RESULTS: Statistically and clinically significant differences were found in BCNVA and UCNVA at 33 cm between high and low add power IOLs, while diffractive SN6AD1 lenses achieved better UCNVA at 40 cm than refractive ReZoom IOLs. Asphericity and low add power were found to improve BCIVA. Contrast sensitivity was similarly compromised in all IOL models, although diffractive optics and aspheric profiles performed better in mesopic conditions. All IOL types received similar overall satisfaction and quality of life scores. Whereas ReZoom patients depended on their spectacles for near tasks, intermediate vision was spectacle independent. Photic phenomena were present in all IOLs, albeit more frequent in ReZoom IOLs. CONCLUSIONS: The present results, which reflect IOL characteristics in optics, profile, and add power, may contribute to help surgeons decide on the type of IOL most suitable for each patient, especially those with high visual demands at near and intermediate distances.

[The seroepidemiology of the hepatitis A virus in children and adolescents]. / Seroepidemiología del virus de la hepatitis A en niños y adolescentes.

OBJECTIVE: To know the prevalence of antibodies against hepatitis A virus (anti-HAV) in a population of children and teenagers pertaining to three municipalities of the Autonomous Community of Madrid (CAM). DESIGN: Cross-study. SITE. The study was conducted in three public schools centers of the municipalities located in the Southeast of the (CAM). PATIENTS AND OTHER PARTICIPANTS: Students between the ages of 6 and 17 whose parents authorized them to be tested. MEASUREMENTS AND MAIN RESULTS: The presence of anti-HAV antibodies in the serum of 729 students was investigated. Thirty eight of them presented a positive mark, which indicates a prevalence of 5.34%. In the males, the prevalence was 5.7% and in the females it was 5%. CONCLUSIONS: The prevalence of anti-HAV antibodies is low in our population, agreeing with the delay in the age that the infection is acquired according to various publications.

[Research activity on pediatric vaccines in Spain: descriptive analysis of prospective studies published between 1990 and 1998]. / Actividad investigadora en vacunas pediátricas en España: análisis descriptivo de los estudios prospectivos publicados entre 1990 y 1998.

OBJECTIVE: To describe the overall characteristics of prospective studies on vaccines in children, performed by Spanish investigators and published between 1990 and 1998. METHODS: Through a bibliographic research on MEDLINE and EMBASE, 24 prospective studies, performed in Spain, published as original papers, and with objectives directly related to the administration of vaccines to children have been identified. These studies were grouped as: clinical trials (group A), studies performed on established vaccination programmes (group B), and those that could not be included in the above mentioned groups (group C). RESULTS: 5, 9 and 10 studies belonged to groups A, B and C, respectively. More than 12,800 subjects participated in these studies, belonging to both normal population or specific risk groups. In 11 studies, the study population comprised newborns and infants. The vaccines under investigation were: hepatitis B (10 studies), DTPe/Pa (6), MMR (3), flu (2), Hib (1), hepatitis A (1), and meningococcus A and C (1) to address different objectives (in most of them, immunogenicity and/or reactogenicity). Nine had external financial support; 21 were performed by hospital and/or primary care investigators, and 18 in the Vasque Coutry, Madrid or Valencia. 13 publications reported obtaining informed consent, and 8 on the approval of the study protocol by an independent committee. Ten studies were published by international journals. CONCLUSIONS: This study shows that most of the studies are conducted by clinicians, with vaccines targetted to newborns and infants, with no external financial support, in a small number of autonomous communities, and usually published in Spanish Journals. The submission of this type of studies to a research ethics committee is desirable, something done to a lesser extent than obtaining informed consent.

[Prevalence of hepatitis C virus infection in school children in an urban and suburban area of Madrid]. / Prevalencia de infección por el virus de la hepatitis C en escolares de un área urbana y periurbana de Madrid.

OBJECTIVE: To find the prevalence of hepatitis C virus infection. DESIGN: Cross sectional study. SETTING: School children of the Autonomous Community of Madrid. PATIENTS AND OTHER PARTICIPANTS: 560 school children of 4 and 17 years-old. MEASUREMENTS AND MAIN RESULTS: ELISA II the anti-HCV appeared in 0,36% of population. CONCLUSIONS: Our prevalence is the same a other studies and we think that it haven't different factors in our community different of others with a similar prevalence in adults population.

[Thoracic radiography in occupational health examination of hospital personnel. Making decisions]. / La radiografía de tórax en los exámenes de salud laboral de trabajadores hospitalarios. Toma de decisiones.

BACKGROUND: The routine chest radiography has been legally suppressed because of its low diagnostic profitability in non selected populations. Health surveillance of occupational populations at respiratory risk is entering a transitional period, where new guidelines are needed. Therefore, we determined to study the percentage of pathological findings in the chest radiographies of health examinations for hospital workers and whether it was possible to obtain explicative models allowing to calculate the probability of radiographies alteration. METHODS: A representative stratified sample of workers belonging to the Hospital La Paz in Madrid is studied, elaborating a transversal study based on the first health examination of their clinical history and two chest radiographies of further examinations. We carried out a multivariant analysis to calculate the probability of their alteration. RESULTS: We obtain alterations percentages of 19% for the first chest radiography; 23.5%, 22% and 21% for the two further ones and for the total, respectively. The explicative models obtained are based on age, family and personal antecedents of the respiratory disease, number of cigarettes smoked, cholesterol levels, the Mantoux test and the previous radiographies alteration. CONCLUSIONS: These equations may be an additional instrument together with labour environment considerations and within a clinical context, to help to the health specific occasional surveillance of the respiratory risk of hospital personnel.

[Epidemiological study of fertility in adolescents in the Autonomous Community of Madrid]. / Estudio epidemiológico de la fecundidad en adolescentes en la Comunidad Autónoma de Madrid.

OBJECTIVE: The purpose of this study was to research the frequency and distribution of fertility in adolescence and, in looking at different environments within the Autonomous Community of Madrid (ACM), to evaluate the relationship of fertility rates to determined variables of a socio-economic, educational and demographic nature. DESIGN: An observational crossover study was carried out. SETTING: Autonomous Community of Madrid. PATIENTS AND OTHERS PARTICIPANTS: In this study, the specific rate of fertility in adolescents (SRFA) was calculated and the correlation between the SRFA and variables of a socioeconomic, educational and demographic nature were analysed by means of the multiple linear regression method. MEASUREMENTS AND MAIN RESULTS: We found important differences in the distribution of fertility within the ACM. There was also a positive correlation (p < 0.05) between the SRFA and those variables which expressed the percentages of illiteracy, industrial workers and with the synthetic youth index. A negative correlation (p < 0.05) was found for the percentages of graduates, professionals and technicians, managers and directors and with the synthetic ageing index. We found no correlation with the unemployment index. On applying the multivariant model, the variable that weighed most on fertility was the level of education, which was in our case measured by the percentage of illiteracy. CONCLUSIONS: We found an uneven spread of adolescents' fertility rates in the Autonomous Community of Madrid. The fertility rates were higher in those boroughs where there was more illiteracy.