Democratizing Health Care in the Metaverse: How Video Games can Monitor Eye Conditions Using the Vision Performance Index: A Pilot Study.

Objective: In a world where digital media is deeply engrained into our everyday lives, there lies an opportunity to leverage interactions with technology for health and wellness. The Vision Performance Index (VPI) leverages natural human-technology interaction to evaluate visual function using visual, cognitive, and motor psychometric data over 5 domains: field of view, accuracy, multitracking, endurance, and detection. The purpose of this study was to describe a novel method of evaluating holistic visual function through video game-derived VPI score data in patients with specific ocular pathology. Design: Prospective comparative analysis. Participants: Patients with dry eye, glaucoma, cataract, diabetic retinopathy (DR), age-related macular degeneration, and healthy individuals. Methods: The Vizzario Inc software development kit was integrated into 2 video game applications, Balloon Pop and Picture Perfect, which allowed for generation of VPI scores. Study participants were instructed to play rounds of each video game, from which a VPI score was compiled. Main Outcome Measures: The primary outcome was VPI overall score in each comparison group. Vision Performance Index component, subcomponent scores, and psychophysical inputs were also compared. Results: Vision Performance Index scores were generated from 93 patients with macular degeneration (n = 10), cataract (n = 10), DR (n = 15), dry eye (n = 15), glaucoma (n = 16), and no ocular disease (n = 27). The VPI overall score was not significantly different across comparison groups. The VPI subcomponent "reaction accuracy" score was significantly greater in DR patients (106 ± 13.2) versus controls (96.9 ± 11.5), P = 0.0220. The VPI subcomponent "color detection" score was significantly lower in patients with DR (96.8 ± 2.5; p=0.0217) and glaucoma (98.5 ± 6.3; P = 0.0093) compared with controls (101 ± 11). Psychophysical measures were statistically significantly different from controls: proportion correct (lower in DR, age-related macular degeneration), contrast errors (higher in cataract, DR), and saturation errors (higher in dry eye). Conclusions: Vision Performance Index scores can be generated from interactions of an ocular disease population with video games. The VPI may offer utility in monitoring select ocular diseases through evaluation of subcomponent and psychophysical input scores; however, future larger-scale studies must evaluate the validity of this tool. Financial Disclosures: Proprietary or commercial disclosure may be found after the references.

Stacked implantation of two prosthetic iris devices for patients with iris defects: A modified surgical technique.

Purpose: Iris pigment deficiency in patients with oculocutaneous albinism (OCA) often causes debilitating photophobia, which is routinely managed by sequential intracapsular insertion of two aniridia rings. A common concern of this technique is the risk of segment interdigitation, which can lead to intraoperative complications. Observations: In this report, we describe a modified technique through which both rings were stacked together and inserted simultaneously in a 62-year-old male patient with oculocutaneous albinism and a mild cataract. The patient underwent bilateral phacoemulsification followed by implantation of two Morcher 50E aniridia rings simultaneously, prior to IOL implantation behind the implants within the capsular bag. Post-operatively, the patient's photophobia improved dramatically, and there were no post-operative complications. Conclusions and Importance: Simultaneous insertion of two stacked aniridia rings prior to IOL implantation was a safe and successful alternative surgical method for the management of photophobia in patients with oculocutaneous albinism and cataracts.

Urgent Virtual Eye Assessments During the COVID-19 Pandemic.

Purpose: We aimed to evaluate the effectiveness and safety of a virtual eye assessment triage system implemented in response to COVID-19. Patients and Methods: We conducted a retrospective cross-sectional study using a consecutive sample of all virtual assessments conducted from March 24 to June 7, 2020 at a single ophthalmology center in Toronto, ON, Canada. Visual acuity and smartphone photographs were uploaded to an electronic assessment website. All patients were virtually triaged to an email or phone consult. Patient outcomes and satisfaction were assessed with a quality assurance survey. Primary outcome measures were the incidence of unplanned additional in-person visits and changes in treatment. Results: We performed 1535 virtual assessments. Of the triage pathways, 15% received an email consult only and 85% received a phone consult. Subsequently, 15% required an in-person assessment, 3% were referred elsewhere, and 0.1% were sent to the emergency. Presentations were most commonly cornea (52%) and retina (25%). They were non-urgent in 68% of cases and no pharmacologic treatment was required for 49%. Of 397 patients that responded out of 653 patients surveyed, 4% had an unplanned additional visit to the emergency, after which two patients underwent urgent retinal surgery and one patient underwent urgent glaucoma surgery. Two patients (0.5%) had a minor change in treatment. Conclusion: As routine regular in-person visits were not possible during the COVID-19 lockdown, virtual eye assessments provided an opportunity to triage patients. Virtual assessments have the potential to reduce in-person visits, but caution must be exercised to not miss vision-threatening conditions.

Effectiveness of a 3D-printed mask fitter in an Ophthalmology setting during COVID-19.

OBJECTIVE: To assess the effectiveness of a 3D-printed custom mask fitter in lieu of N95 respirators among ophthalmologists and other eye care professionals who may not be prioritized to receive N95 respirators amidst the coronavirus disease 2019 pandemic. METHODS: This was a proof-of-concept study from a tertiary eye care center in Oakville, Canada. All participants underwent the N95 Qualitative Fit Test with a custom mask fitter secured over an American Society for Testing and Materials Level 3 face mask. Participants answered a 10-point Likert scale questionnaire on comfort, ease of use, and feasibility of the custom mask fitter, as well as comfort of a regular face mask. RESULTS: Twenty participants were recruited. Of the 20 recruited, 18 (90%) successfully passed the fit test. The median scores for comfort, ease of use, and everyday feasibility for the custom mask fitter were 3.5, 4.5, and 3, respectively, whereas the median score for comfort of a regular face mask was 8.5. CONCLUSION: A reusable, low-cost, 3D-printed custom mask fitter is a potential effective alternative to an N95 respirator among eye care professionals but may require improvement in its design and comfort. This is especially relevant in the context of a limited supply of N95 respirators amidst a global pandemic.

Multicountry clinical outcomes of a new nondiffractive presbyopia-correcting IOL.

PURPOSE: To evaluate the effectiveness and safety of a new presbyopia-correcting intraocular lens (IOL) with a nondiffractive design, DFT015, compared with an aspheric monofocal IOL, SN60WF. SETTING: 19 investigational sites in 4 countries: Australia, Canada, Spain, and the United Kingdom. DESIGN: Prospective, randomized, parallel-group, controlled, assessor- and patient-masked clinical study. METHODS: Participants aged ≥22 years with bilateral cataracts were randomized to DFT015 or SN60WF in a 5:4 ratio and masked until final postoperative follow-up at month 6. The primary effectiveness objective was superiority of DFT015 over SN60WF in mean monocular photopic distance-corrected intermediate visual acuity (DCIVA) at month 3. Secondary effectiveness objectives included noninferiority of DFT015 to SN60WF in mean monocular photopic corrected distance visual acuity (CDVA) and superiority in the mean monocular photopic distance-corrected near visual acuity (DCNVA) at month 3. Visual disturbances were assessed at month 6. RESULTS: 282 patients were randomized to DFT015 (n = 159) or SN60WF (n = 123). All effectiveness objectives were achieved at month 3 in first eyes. For monocular photopic results in first eyes, DFT015 demonstrated superior mean DCIVA (least squares means of -0.139 logMAR in favor of DFT015, P < .001), noninferior mean CDVA (97.5% upper confidence limit [UCL] of the difference was <0.1 logMAR) and superior mean DCNVA (95% UCL of the difference was <0.0 logMAR) compared with SN60WF at month 6. DFT015 exhibited a similar visual disturbance profile to that of SN60WF. CONCLUSIONS: DFT015 provided superior intermediate and near vision and a similar visual disturbance profile compared with an aspheric monofocal IOL.

Three-dimensional morphologic nasal surface characteristics that predict the extremes of esthetics in patients with repaired cleft lip and palate.

OBJECTIVE: The purposes of this study were (1) to develop imaging methods and objective numeric parameters to describe nose morphology, and (2) to correlate those parameters with nasal esthetics for patients with clefts. METHODS: A total of 28 patients with repaired complete unilateral cleft lip and palate (CUCLP) and 20 age- and gender-matched individuals without clefts were identified. A panel of orthodontists rated and ranked nasal esthetics from nose casts for the cleft group. Best and worst esthetic cleft groups were established from the cast assessments. Three-dimensional surface coordinates of the casts were digitally mapped with an electromagnetic tracking device. Digitized nasal images were oriented, voxelated, sliced, and mathematically curve-fitted. Maximum difference, percent area difference, and maximum and minimum derivative differences between cleft and noncleft and between right and left nose sides were calculated. Differences in parameters between groups were assessed with the use of analysis of variance (ANOVA) and t tests, and correlations with esthetics were assessed with the Spearman rank correlation test. RESULTS: Differences were seen between cleft and noncleft and best and worst esthetic groups for all four parameters (p < .05). The best esthetic cleft group had (1) lower percent area difference (p < .0001), (2) lower maximum difference (p < .001), and (3) smaller differences in slope of the nose in the coronal plane (p < .0001) than the worst esthetic cleft group. CONCLUSIONS: Maximum difference and maximum derivative difference and, to a lesser degree, percent area difference can be used to identify differences between cleft and noncleft nasal morphology and to assess levels of nasal esthetics for patients with CUCLP.

Driving digital transformation of comprehensive primary health services at scale in India: an enterprise architecture framework.

In its commitment towards Sustainable Development Goals, India envisages comprehensive primary health services as a key pillar in achieving universal health coverage. Embedded in siloed vertical programmes, their lack of interoperability and standardisation limits sustainability and hence their benefits have not been realised yet. We propose an enterprise architecture framework that overcomes these challenges and outline a robust futuristic digital health infrastructure for delivery of efficient and effective comprehensive primary healthcare. Core principles of an enterprise platform architecture covering four platform levers to facilitate seamless service delivery, monitor programmatic performance and facilitate research in the context of primary healthcare are listed. A federated architecture supports the custom needs of states and health programmes through standardisation and decentralisation techniques. Interoperability design principles enable integration between disparate information technology systems to ensure continuum of care across referral pathways. A responsive data architecture meets high volume and quality requirements of data accessibility in compliance with regulatory requirements. Security and privacy by design underscore the importance of building trust through role-based access, strong user authentication mechanisms, robust data management practices and consent. The proposed framework will empower programme managers with a ready reference toolkit for designing, implementing and evaluating primary care platforms for large-scale deployment. In the context of health and wellness centres, building a responsive, resilient and reliable enterprise architecture would be a fundamental path towards strengthening health systems leveraging digital health interventions. An enterprise architecture for primary care is the foundational building block for an efficient national digital health ecosystem. As citizens take ownership of their health, futuristic digital infrastructure at the primary care level will determine the health-seeking behaviour and utilisation trajectory of the nation.

Cataract surgery in pseudoexfoliation syndrome.

PURPOSE OF REVIEW: To discuss the preoperative, intraoperative and postoperative considerations and techniques for cataract surgery in pseudoexfoliation syndrome. RECENT FINDINGS: Pseudoexfoliation syndrome is a common disorder worldwide that has been linked to the lysyl oxidase-like-one (LOXL1) gene. Its identification in patients undergoing cataract surgery has become important in preventing complications through proper preoperative planning. The management of the small pupil found in pseudoexfoliation can be achieved using various pharmacological and mechanical techniques. There are now several devices available to support the weak zonules that commonly accompany pseudoexfoliation. Postoperatively, pseudoexfoliation patients need to be followed closely to monitor for complications such as intraocular pressure spikes, inflammation and intraocular lens dislocation. SUMMARY: With proper preoperative preparation, intraoperative use of appropriate adjunctive devices, and close postoperative follow-up, favorable outcomes can be achieved in cataract surgery in pseudoexfoliation syndrome.

Retrospective analysis on the visual outcomes and photic phenomena following bilateral extended depth of focus intraocular lens implants.

OBJECTIVE: To evaluate binocular visual outcomes and presence of photic phenomena in patients with bilateral extended depth of focus (EDF) intraocular lens (IOL) implants. DESIGN: Retrospective consecutive case series. PARTICIPANTS: Patients above the age of 18 years without prior ocular pathology or surgery with bilateral EDF IOL implants (ZXR00; Johnson & Johnson Vision) between January 2015 and December 2017 in Canadian ophthalmology centres. METHODS: Patient charts were retrospectively evaluated for binocular uncorrected distance visual acuity (UCDVA), binocular corrected distance visual acuity (CDVA), binocular uncorrected near visual acuity (UCNVA), photic phenomena (glare, halos, or dysphotopsia), complications, or reoperations. Subgroup analysis investigated the effect of monovision on the above outcomes. RESULTS: In total, 87 individuals with bilateral EDF IOL implants were included in the analysis. Median logMAR pre-operative CDVA was 0.18 (0.1-0.3). The median logMAR postoperative bilateral UCDVA was 0.14 (0.00-0.18), median CDVA was 0.00 (0.00-0.10), and median UCNVA was 0.10 (0.10-0.20). Overall, 16 (18.4%) cases self-reported the presence of photic phenomena, the most common of which were halos (13.8%). Subgroup analysis determined that there was no significant difference in visual outcomes or presence of photic phenomena when stratifying patients based on the degree of postoperative monovision (p = 0.31-0.57). CONCLUSIONS: Overall, the Tecnis Symfony EDF IOL provided a reasonable range of binocular distance and near vision. Approximately 12.6% of patients self-reported any postoperative photic phenomena; however, all cases were subjectively considered mild and tolerable. Monovision had no effect on visual outcomes or the presence of photic phenomena.

Development and Reliability of an Appropriateness and Prioritization Instrument for Eye Care Practice: A Modified Delphi Process.

Purpose: To modify the Western Canada Waiting List Project (WCWLP) cataract prioritization criteria into measurement instruments for assessing appropriateness and prioritization emphasizing health-related quality of life (HRQoL) and examining reliability.Methods: A modified Delphi process was conducted using two rounds of online surveys and a face-to-face meeting. A panel of eye care experts rated the relevancy of criteria on a 5-point scale. Patient narratives highlighted the patient experience. A G-theory framework was used to assess inter- and intra-rater agreement using the criteria.Results: Nine Ophthalmologists, three Optometrists, and one General Practitioner participated in the modified Delphi process. Consensus to include/exclude was reached on all criteria. Seventeen criteria were included and 16 were excluded. The most significant changes were related to the categorization of comorbidities and expansion of HRQoL questions. The overall reliability was good (ϕ = 0.852).Conclusion: The WCWLP was modified to include appropriateness and to better reflect HRQoL. Having achieved consensus and demonstrated reliability of the criteria, the next step is to estimate weights for criteria and to validate against patient health outcomes data.

Seasonal Variation in the Incidence of Malignant Glaucoma after Cataract Surgery.

PURPOSE: To investigate a potential link between the incidence of malignant glaucoma after cataract surgery and seasonal variations in daylight. METHODS: In total, 18,374 uncomplicated cataract surgeries were performed between June 2008 and June 2013 at an ambulatory surgery center in Toronto. Toronto's average monthly daylight over that time period-in hours per day for each month-was determined. The number of malignant glaucoma cases that developed after cataract surgery performed in months with above average daylight was compared to the number of cases that developed after cataract surgery performed in months with below average daylight. Fisher's exact test was used to analyze the relationship between the development of malignant glaucoma and variation in daylight during the month of cataract surgery. RESULTS: Malignant glaucoma developed in 16 eyes. Thirteen cases of malignant glaucoma developed in months with above average daylight and three cases developed in months with below average daylight (P = 0.01). Eyes that developed malignant glaucoma in months with more daylight were slightly longer (21.95 ± 1.23 mm) than those that developed malignant glaucoma in months with less daylight (21.55 ± 0.88 mm). CONCLUSION: Light-induced choroidal expansion may play a major role in the development of malignant glaucoma following cataract surgery.

Generalized posterior keratoconus: clinical pathologic correlations.

CASE REPORT: A 73-year-old woman presented with bilateral generalized posterior keratoconus. The corneal thickness measured 0.320 mm paracentrally and 0.440 mm toward the periphery. The corneal specimen revealed absence of Bowman's layer and focal homogeneous oval stromal deposits that stained for amyloid. COMMENTS: Our case of generalized posterior keratoconus shows absence of Bowman's layer. The amyloid deposits, which also were noted clinically in the cornea of the fellow right eye, were most consistent with a diagnosis of polymorphous amyloid degeneration. To our knowledge, this is the first histopathological report of generalized posterior keratoconus.

Visual function, digital behavior and the vision performance index.

Historically, visual acuity has been the benchmark for visual function. It is used to measure therapeutic outcomes for vision-related services, products and interventions. Quantitative measurement of suboptimal visual acuity can potentially be corrected optically with proper refraction in some cases, but in many cases of reduced vision there is something else more serious that can potentially impact other aspects of visual function such as contrast sensitivity, color discrimination, peripheral field of view and higher-order visual processing. The measurement of visual acuity typically requires stimuli subject to some degree of standardization or calibration and has thus often been limited to clinical settings. However, we are spending increasing amounts of time interacting with devices that present high-resolution, full color images and video (hereafter, digital media) and can record our responses. Most of these devices can be used to measure visual acuity and other aspects of visual function, not just with targeted testing experiences but from typical device interactions. There is growing evidence that prolonged exposure to digital media can lead to various vision-related issues (eg, computer vision syndrome, dry eye, etc.). Our regular, daily interactions (digital behavior) can also be used to assess our visual function, passively and continuously. This allows us to expand vision health assessment beyond the clinic, to collect vision-related data in the whole range of settings for typical digital behavior from practically any population(s) of interest and to further explore just how our increasingly virtual interactions are affecting our vision. We present a tool that can be easily integrated into digital media to provide insights into our digital behavior.

Refractive predictability of a 3-piece intraocular lens platform versus its 1-piece counterpart.

OBJECTIVE: To compare the refractive outcomes of a 3-piece acrylic intraocular lens (IOL) with its 1-piece counterpart after phacoemulsification with in-the-bag implantation. DESIGN: Retrospective chart review. PARTICIPANTS: One-hundred twenty-six eyes of 95 patients were analyzed in the study, including 60 eyes of 43 patients receiving a 3-piece IOL and 66 eyes of 52 patients receiving a 1-piece IOL. METHODS: Randomized chart review of all patients who underwent uncomplicated phacoemulsification with in-the-bag IOL implantation with either a 3-piece hydrophobic acrylic IOL (Tecnis ZA9003) or a 1-piece hydrophobic acrylic IOL (Tecnis ZCB00) between 2006 and 2014 in a tertiary ophthalmology care centre in Mississauga, Ontario. Preoperative visual acuity and refraction, anterior chamber depth, axial length, IOL design and power, predicted refraction, postoperative visual acuity, and refraction were recorded. RESULTS: Mean absolute error was 0.40 ± 0.27 in the ZA9003 group and 0.39 ± 0.35 in the ZCB00 group, with no statistically significant difference between the 2 IOLs (p = 0.86). Mean arithmetic error was 0.11 ± 0.47 D in the ZA9003 group and 0.01 ± 0.47 D in the ZCB00 group (p = 0.019). In the ZA9003 group, 23 (38%), 42 (70%), and 52 (87%) of 60 eyes were within 0.25, 0.50, and 0.75 D, respectively, of predicted postoperative refraction. In the ZCB00 group, 32 (48%), 46 (70%), and 56 (85%) of 66 eyes were within 0.25, 0.50, and 0.75 D, respectively, of predicted postoperative refraction (p = 0.2836, p = 1.00, p = 0.8044). CONCLUSIONS: The ZA9003 and the ZCB00 have similar mean absolute error and thus appear to have similar refractive predictability.

Proportion of undetected narrow angles or angle closure in cataract surgery referrals.

OBJECTIVE: To determine the proportion of patients referred for cataract surgery consultation who had undetected narrow angles (primary angle closure suspect [PACS], primary angle closure [PAC], or primary angle closure glaucoma [PACG]). DESIGN: Retrospective chart review. PARTICIPANTS: Phakic patients referred by eye care providers (optometrists and ophthalmologists) to a tertiary centre for cataract management between July 1, 2010 and June 30, 2012 were identified and reviewed. METHODS: Demographic, referral, and specialist assessment information, as well as biometric data, including anterior segment optical coherence tomography, were collected. Patients with undetected narrow angles were identified. Univariate tests and multivariable analyses were performed to determine risk factors for narrow angles or angle closure. RESULTS: A total of 1229 patients were included. The mean patient age was 67.8 ± 13.0 years, 53.9% of patients were female, and 26.8% were Asian or South Asian. Of the sample population, 139 (11.3%) patients had PACS, 7 (0.6%) had PAC, and 12 (1.0%) had PACG. Overall, 158 (12.9%) patients had narrow angles or angle closure. Multivariable logistic regression using generalized estimating equations confirmed 3 independent predictors of PACS/angle closure: Asian race (odds ratio 2.82, p < 0.001), shorter axial length (AL) (odds ratio 1.25, p = 0.03), and smaller anterior chamber depth (ACD; odds ratio 33.3, p < 0.001). A patient of Asian race referred for cataract surgery with ACD <2.8 mm and AL <23 mm had a 52% probability of having PACS/angle closure (range 42%-62%) versus 3% if these 3 factors were not present. CONCLUSIONS: Of patients referred for cataract surgery, 1.5% were found to have undetected narrow angles or angle closure, implying that gonioscopy may not be adequately performed in this patient population.

Undetected angle closure in patients with a diagnosis of open-angle glaucoma.

OBJECTIVE: The aim of this study was to identify the proportion of patients referred to a tertiary glaucoma centre with a diagnosis of open-angle glaucoma (OAG) who were found to have angle closure glaucoma. DESIGN: Retrospective chart review. METHODS: Consecutive new patients referred for glaucoma management to a tertiary centre between July 2010 and December 2011 were reviewed. Patients whose referrals for glaucoma assessment specified angle status as "open" were included. The data collected included glaucoma specialist's angle assessment, diagnosis, and glaucoma severity. The status of those with 180 degrees or more Shaffer angle grading of 0 was classified as "closed." RESULTS: From 1234 glaucoma referrals, 179 cases were specified to have a diagnosis of OAG or when angles were known to be open. Of these, 16 (8.9%) were found on examination by the glaucoma specialist to have angle closure. Pseudoexfoliation was present in 4 of 16 patients (25%) in the missed angle-closure glaucoma (ACG) group and 22 of 108 patients (13.5%) in the remaining OAG group. There was no difference found in demographic or ocular biometric parameters between those with confirmed OAG versus those with missed ACG. CONCLUSIONS: Almost 1 in 11 patients referred by ophthalmologists to a tertiary glaucoma centre with a diagnosis of OAG were in fact found to have angle closure. Given the different treatment approaches for ACG versus OAG, this study suggests a need to strengthen angle evaluations.

Glaucomatous visual field progression with frequency-doubling technology and standard automated perimetry in a longitudinal prospective study.

PURPOSE: To compare frequency-doubling technology (FDT) perimetry with standard automated perimetry (SAP) for detecting glaucomatous visual field progression in a longitudinal prospective study. METHODS: One eye of patients with open-angle glaucoma was tested every 6 months with both FDT and SAP. A minimum of 6 examinations with each perimetric technique was required for inclusion. Visual field progression was determined by two methods: glaucoma change probability (GCP) analysis and linear regression analysis (LRA). For GCP, several criteria for progression were used. The number of locations required to classify progression with FDT compared with SAP, respectively, was 1:2 (least conservative), 1:3, 2:3, 2:4, 2:6, 2:7, 3:6, 3:7, and 3:10 (most conservative). The number of consecutive examinations required to confirm progression was 2-of-3, 2-of-2, and 3-of-3. For LRA, the progression criterion was any significant decline in mean threshold sensitivity over time in each of the following three visual field subdivisions: (1) all test locations, (2) locations in the central 10 degrees and the superior and inferior hemifields, and (3) locations in each quadrant. Using these criteria, the proportion of patients classified as showing progression with each perimetric technique was calculated and, in the case of progression with both, the differences in time to progression were determined. RESULTS: Sixty-five patients were followed for a median of 3.5 years (median number of examinations, 9). For the least conservative GCP criterion, 32 (49%) patients were found to have progressing visual fields with FDT and 32 (49%) patients with SAP. Only 16 (25%) patients showed progression with both methods, and in most of those patients, FDT identified progression before SAP (median, 12 months earlier). The majority of GCP progression criteria (15/27), classified more patients as showing progression with FDT than with SAP. Contrary to this, more patients showed progression with SAP than FDT, when analysed with LRA; e.g., using quadrant LRA 20 (31%) patients showed progression with FDT, 23 (35%) with SAP, and only 10 (15%) with both. CONCLUSIONS: FDT perimetry detected glaucomatous visual field progression. However, the proportion of patients who showed progression with both FDT and SAP was small, possibly indicating that the two techniques identify different subgroups of patients. Using GCP, more patients showed progression with FDT than with SAP, yet the opposite occurred using LRA. As there is no independent qualifier of progression, FDT and SAP progression rates vary depending on the method of analysis and the criterion used.

Dysphotopsia after temporal versus superior laser peripheral iridotomy: a prospective randomized paired eye trial.

PURPOSE: To determine if the location of neodymium:yttrium-aluminum-garnet laser peripheral iridotomy (LPI) is related to the occurrence of postoperative visual dysphotopsia. DESIGN: Randomized, prospective, single-masked, paired-eye comparative clinical trial. METHODS: setting: Private subspecialty clinic in Mississauga, Canada. study population: Patients with primary angle closure or primary angle-closure suspects were recruited and randomized to receive LPI temporally in one eye and superiorly in the other. Patients were masked to the location of treatment in each eye. intervention: Temporal or superior LPI. main outcome measures: Occurrence of new-onset linear dysphotopsia. Other visual disturbances also were assessed using a questionnaire before and 1 month after intervention. Secondary outcome measures included eyelid position, laser parameters, and any intraoperative complications. RESULTS: A total of 208 patients were recruited to the study, of which 169 (84%) completed it. New-onset linear dysphotopsia was reported in 18 (10.7%) eyes with superior LPI versus 4 (2.4%) eyes with temporal LPI (P = .002). Eleven eyes (6.5%) with superior LPI reported linear dysphotopsia despite complete eyelid coverage of the iridotomy. No significant differences were found with other visual disturbances between them. There was more pain experienced by the temporal LPI (2.8 ± 2.2 vs 2.1 ± 2.0; P = .001), despite no difference in laser energy or number of shots. Intraoperative rates of hemorrhage were similar (8.9% vs 10.1%; P = .71). CONCLUSIONS: Temporal placement of LPI is safe and was found to be less likely to result in linear dysphotopsia as compared with superior placement. Temporal iris therefore may be considered a preferred location for LPI.