Ocular parameters associated with visual performance of enhanced monofocal intraocular lens.

BACKGROUND: An enhanced monofocal intraocular lenses (IOLs) (Tecnis Eyhance ICB00 and Tecnis Eyhance Toric DIU) has been developed to enhance intermediate vision while avoiding the disadvantages of multifocal IOLs. Although many studies have demonstrated the improvement of intermediate visual acuity with enhanced monofocal IOLs, it is not known specifically for which patients these IOLs should be recommended or avoided. In this study, we aim to find out which ocular parameters affect vision performance and photic phenomenon of ICB00 or DIU at different distances. METHODS: Patients who underwent cataract surgery with ICB00 or DIU, performed by a single surgeon, were included. Before surgery, the patients' age, gender, axial length, anterior chamber depth, spherical aberration Z (4,0), vertical coma, horizontal coma, angle kappa (κ), angle alpha (α), and other ocular parameters were investigated. One month after surgery, uncorrected near visual acuity (UNVA at 40 cm), uncorrected intermediate visual acuity (UIVA at 66 cm), uncorrected distance logMAR visual acuity (UDVA), IOL decentration, and quality of vision (QoV) questionnaires were conducted. RESULTS: A total of 43 patients (58 eyes) were included. The results of the univariate linear regression analyses showed a negative correlation between spherical aberration and logMAR UNVA and UIVA (p = 0.003, ß=-0.51 and p = 0.018, ß=-0.23, respectively) and a positive correlation between angle α and logMAR UIVA (p = 0.036, ß = 0.19). Deeper anterior chamber depth (ACD) was associated with poorer total QoV (p = 0.018, ß = 14.43), particularly in glare, halo, blur, and fluctuation perception. A higher degree of IOL decentration tended to decrease UNVA and UIVA (Pearson correlation coefficient, r = 0.336 and r = 0.221, respectively); however, no significant effect was observed on UDVA (Pearson correlation coefficient, r = 0.042). CONCLUSIONS: In enhanced monofocal IOLs, a higher level of spherical aberration is associated with better performance in UNVA and UIVA, whereas a larger angle α has a negative impact. A deeper ACD negatively affects the QoV.

Quality of vision after myopic refractive surgeries: SMILE, FS-LASIK, and ICL.

BACKGROUND: To characterize the quality of vision after SMILE, FS-LASIK, and ICL implantation and evaluate the related factors. METHODS: 131 eyes of 131 myopic patients (90 female, 41 male) who underwent refractive surgeries including SMILE (35 patients), FS-LASIK (73 patients), and ICL implantation (23 patients) were analyzed. The Quality of Vision questionnaires were completed 3 months after surgery, and the results were characterized and analyzed with baseline characteristics, treatment parameters, and postoperative refractive outcomes using logistic regression analysis to find out predicted factors. RESULTS: Mean age was 26.5 ± 4.6 years (range: 18 to 39 years) and mean preoperative spherical equivalent was - 4.95 ± 2.04 diopters (D) (range: -1.5 to -13.5). Safety and efficacy index was comparable between different techniques: the safety index was 1.21 ± 0.18, 1.22 ± 0.18, and 1.22 ± 0.16 and the efficacy index were 1.18 ± 0.20, 1.15 ± 0.17, 1.17 ± 0.15 for SMILE, FS-LASIK and ICL respectively. The mean overall QoV score was 13.40 ± 9.11, with mean frequency, severity, and bothersome score of 5.40 ± 3.29, 4.53 ± 3.04, and 3.48 ± 3.18 respectively, and there was no significant difference between different techniques. Overall, the symptom with the highest scores was glare, following fluctuation in vision and halos. Only the scores of halos were significantly different among different techniques (P < 0.000). Using ordinal regression analysis, mesopic pupil size was identified as a risk factor (OR = 1.63, P = 0.037), while postoperative UDVA was a protective factor (OR = 0.036, P = 0.037) for overall QoV scores. Using binary logistic regression analysis, we found that patients with larger mesopic pupil size had an increased risk to experience glare postoperatively; compared to ICL, patients who underwent SMILE or FS-LASIK tended to report fewer halos; patients with better postoperative UDVA were less likely to report blurred vision and focusing difficulty; with larger residual myopic sphere postoperatively, patients experienced focusing difficulties and difficulty judging distance or depth perception more frequently. CONCLUSIONS: SMILE, FS-LASIK, and ICL had comparable visual outcomes. Overall, glare, fluctuation in vision, and halos were the most frequently experienced visual symptoms 3 months postoperatively. Patients with ICL implanted tended to report halos more frequently compared with SMILE and FS-LASIK. Mesopic pupil size, postoperative UDVA, and postoperative residual myopic sphere were predicted factors for reported visual symptoms.

Intense pulsed-light treatment improves objective optical quality in patients with meibomian gland dysfunction.

BACKGROUND: To evaluate changes in objective optical quality following intense pulsed light (IPL) treatment combined with meibomian gland (MG) expression (MGX) in patients with MG dysfunction (MGD). METHODS: This retrospective cross-sectional study included MGD-related dry eye disease (DED) patients who received IPL treatment between March and December 2021 at Kim's Eye Hospital, Seoul, Republic of Korea. Each patient underwent four sessions of IPL treatment using Lumenis M22 (Lumenis Ltd., Yokneam, Israel) and MGX at three-week intervals. RESULTS: This study included 90 eyes from 45 patients with MGD. The mean age was 52.3 ± 16.1 years (range, 20-75 years), and 53.3% (24/45) of patients were female. Compared with the baseline, all clinical symptoms and signs significantly improved after IPL treatment combined with MGX. All optical quality parameters obtained with an optical quality analysis system (OQAS: Visiometrics, Castelldefels, Spain) have improved significantly over the baseline (p < 0.001). CONCLUSIONS: In patients with MGD, IPL treatment combined with MGX improved the objective optical quality and clinical signs and symptoms of DED.

Influence of ocular biometric factors on the defocus curve in an enlarged depth-of-focus intraocular lens.

BACKGROUND: To assess the influence of biometric measurements on the defocus curve after the implantation of enlarged depth-of-focus (EDoF) intraocular lens (IOL). METHODS: Patients who underwent cataract surgery with bilateral implantation of Tecnis Symfony IOL were enrolled. Preoperatively, axial length (AL), corneal keratometry (K), pupil size and corneal aberrations were measured. 1 month after surgery, distance, intermediate, and near visual acuities (VA) were recorded. At 3 months, monocular and binocular corrected contrast sensitivities under photopic and mesopic lighting conditions were measured with CSV-1000E test. At 6-months, the defocus curve between -5.00 to + 3.00 diopters (D) was assessed in steps of 0.50 D, and NEI-RQL-42 questionnaire was administered. RESULTS: One hundred thirty one eyes of 66 patients were included. Binocular logMAR VA better than 0.1 for intermediate vision was obtained in 90% of patients, whereas only 17.7% obtained that result in near vision. The rate of satisfaction was high (96%) and most of them (85.5%) had no or little difficulties in near vision. The mean amplitude of the defocus curve was 2.35D ± 0.73D, and smaller AL, smaller pupils, younger age, and male sex were associated with wider range of clear vision. CONCLUSIONS: Tecnis Symfony IOL enables functional vision at all distances, but demographic variables and preoperative biometric measurements like AL and pupil size influence the postoperative amplitude of the defocus curve. These parameters could be used to predict the performance of EDoF IOLs.

Benefits of using corneal topography to choose subjective refraction technique in keratoconus (RE-CON): a prospective comparative crossover clinical study.

PURPOSE: In prospective no-masking, comparative, crossover monocenter clinical trial, we aimed to evaluate whether the optimal subjective refraction technique varies with the keratoconus topography and to identify relevant topographic criteria. METHOD: This study included 72 keratoconus eyes with impaired visual acuity. Each eye tested three methods of refraction (Jackson cylinder, astigmatism dial, stenopeic slit), resulting in three eyeglass lenses. Patients were assigned to the group corresponding to the eyeglass lens offering the best visual acuity. Five topographical characteristics were collected via the Pentacam: mean keratometry (Km), maximum keratometry (Kmax), distance from corneal center to Kmax (dKmax), Belin/Ambrosio Display (BAD_D), and index of surface variance (ISV). RESULTS: Forty-six eyes were included in the dial group (64.8%), 23 eyes in the cylinder group (32.4%), and only 2 eyes in the slit group (2.8%); thus, we only compared dial and cylinder groups. The main analysis retrieved a significant probability to choose dial technic for BAD_D (p = 0.024); when BAD_D is > 9.71 (ROC threshold), the positive predictive value (PPV) = 89.5%, and for ISV, p = 0.012; when ISV is > 77, PPV = 89.1%. The sub-analysis of patients with different visual acuities between cylinder and dial confirmed these results with slightly different thresholds: the probability to choose dial technic was for BAD_D, p = 0.03; when BAD_D is > 7.55, PPV = 90%, and for ISV, p = 0.0084; when ISV is > 71, PPV = 88.5%. CONCLUSION: Refraction method is linked to topographic indices ISV and BAD_D. A BAD_D > 7.55 indicates the dial method. In addition to keratoconus screening and diagnosis, this study suggests a new application of the topographer to select a suitable refraction method for eyeglass prescription. TRIAL REGISTRATION: Study registered on the ClinicalTrials.gov database under n°: NCT04174209.

Impact of Decentration and Tilt on Spherical, Aberration Correcting, and Specific Aspherical Intraocular Lenses: An Optical Bench Analysis.

INTRODUCTION: The human eye is not optically symmetrical, and very few intraocular lens (IOLs) are perfectly centered in the eye. That is why contrast sensitivity can degrade in some conditions, especially in low light. In an optical bench analysis, we compare spherical (A), aberration correcting (B), and specific aspherical lenses (C) in terms of impact of decentration and tilt on the modulation transfer function as well as the simulated overall quality with USAF test targets. MATERIAL AND METHODS: The OptiSpheric IOL PRO2 was used to measure the optical performance of IOLs (A, B, C). In order to assess the optical quality of the IOLs, the optical quality parameters for the aperture size of 3.0 mm and 4.5 mm at the IOL plane were assessed. Through Frequency Modulation Transfer Function (MTF) and Strehl Ratio (SR) values, as well as the "US Airforce 1951 resolution test chart images" as qualitative simulation, were analyzed. All measurements (ISO) were repeated and done for centered, decentered (1 mm), and tilted (5°) IOLs. RESULTS: Centered: The MTF (mean) at 50 lp/mm (IOL A, B, C) with 3.0-mm aperture was 0.794/0.716/0.797 (ISO-1 cornea) and 0.673/0.752/0.723 (ISO-2 cornea) and with 4.5-mm aperture 0.728/0.365/0.751 (ISO 1) and 0.276/0.767/0.505 (ISO 2). The SR (mean) with 3.0-mm aperture was 0.763/0.829/0.898 and with 4.5-mm aperture 0.228/0.386/0.432. Decentered by 1 mm: The MTF (mean) at 50 lp/mm with 3.0-mm aperture was 0.779/0.459/0.726 (ISO 1) and 0.695/0.381/0.662 (ISO 2). The MTF (mean) at 50 lp/mm with 4.5-mm aperture was 0.732/0.348/0.653 (ISO 1) and 0.355/0.069/0.346 (ISO 2). The SR (mean) with 3.0-mm aperture was 0.829/0.543/0.397 and with 4.5-mm aperture was 0.259/0.145/0.192. Tilted by 5°: The MTF (mean) at 50 lp/mm with 3.0-mm aperture was 0.731/0.705/0.751 (ISO 1) and 0.623/0.727/0.732 (ISO 2). The MTF (mean) at 50 lp/mm with 4.5-mm aperture was 0.579/0.406/0.701 (ISO 1) and 0.277/0.512/0.429 (ISO 2). The SR (mean) with 3.0-mm aperture was 0.539/0.478/0.514 and with 4.5-mm aperture was 0.262/0.136/0.201. CONCLUSION: Aberration correcting IOLs perform best when perfectly centered. The optical performance of aberration correcting IOLs can be markedly downgraded by misalignment. The examined ZO optic performed well in decentration and tilt. The ZO concept seems to be a good alternative to aspheric lenses, as it achieves to combine benefits of spherical and aspheric intraocular lenses. There is no perfect IOL, but fitting and choosing the right one for the individual case seems to be crucial to take advantage of benefits and minimize disadvantages. This is why knowledge of optical properties is also mandatory for the surgeon.

Changes in higher-order aberrations after vitrectomy for vitreomacular interface diseases.

BACKGROUND AND OBJECTIVE: To evaluate ocular wavefront aberrations after vitrectomy in patients with vitreomacular interface diseases. METHODS: Thirty eyes of 30 patients with vitreomacular interface diseases were included in this prospective study. A Sirius topographer (SCHWIND eye-tech-solutions, Germany) was used to measure corneal aberrations and a Hartmann Shack aberrometer (IRX-3; Imagine Eyes, Orsay, France) to measure ocular aberrations. Data were recorded at baseline and 3 months after vitrectomy. RESULTS: Eight patients were excluded due to the formation of cataract during the post-operation follow-up period. Data of 22 eyes (13 eyes with epiretinal membrane, two eyes with epiretinal membrane with vitreomacular traction, one eye with vitreomacular traction, and six eyes with macular hole) were analyzed for the study. The corneal aberrations such as coma, trefoil, spherical aberration, and root mean square of total higher-order aberrations did not significantly change after vitrectomy. The preoperative ocular aberrations such as coma 0.33 (0.14-0.47) µm, trefoil 0.28 (0.15-0.44) µm, root mean square of higher-order aberrations 0.51 (0.45-0.68) µm, root mean square of total aberrations 1.38 (1.16-2.60) µm were significantly reduced to 0.21 (0.14-0.29) µm, 0.20 (0.14-0.30) µm, 0.36 (0.21-0.52) µm, 0.15 (1.13-1.41) µm, respectively, after vitrectomy. CONCLUSION: The ocular higher-order aberrations were significantly reduced after vitreomacular surgery for vitreomacular interface diseases.

Assessment of the correlation of the tear breakup time with quality of vision and dry eye symptoms after SMILE surgery.

PURPOSE: It is well reported that dry eye symptoms can increase after many refractive surgery procedures. This study aims to provide a clinical understanding of the correlation of fluorescein tear film breakup time (FTBUT) with quality of vision (QoV) and dry eye symptoms following small incision lenticule extraction surgery (SMILE). METHODS: Patients electing to have SMILE surgery were subdivided into 2 groups: Group 1 included short preoperative FTBUTs of 3 to 6 seconds (s); Group 2 included long FTBUTs of ≥ 8 s. Uncorrected distance visual acuity, corrected distance visual acuity, manifest refraction, FTBUT, QoV and Ocular Surface Disease Index (OSDI) questionnaires were recorded 1 and 6 months postoperatively. RESULTS: Thirty-nine subjects were included in each group. There was no significant difference in visual outcomes between the 2 groups at both the 1- and 6-month postoperative assessments. FTBUT remained significantly lower in group 1. Oxford staining was initially higher for group 1 at 1 month (P = 0.007), but there was no significant difference at 6 months (P = 0.180). There was no significant difference in QoV or OSDI scores between the 2 groups at both postoperative visits. CONCLUSIONS: Low preoperative FTBUT (3-6 s) does not appear to negatively affect postoperative visual outcomes or results in a greater likelihood of dry eye symptoms and poor ocular surface compared to eyes with a longer preoperative FTBUT. These results suggest that a low preoperative FTBUT does not necessarily increase the likelihood of poor visual acuity, dry eyes symptoms, or poor ocular surface outcomes following SMILE surgery.

[Opto-functional results in keratoconus patients after intrastromal keratoplasty]. / Optiko-funktsional'nye rezul'taty posle intrastromal'noi keratoplastiki pri keratokonuse.

Intrastromal keratoplasty with allograft implantation can stop the progression of keratoconus (KC) and improve visual acuity (VA). Although optimization of keratometric parameters and an increase in VA improve the quality of vision (QoV), there are other indicators that affect the QoV and the quality of life (QoL) of patients and require further study. PURPOSE: Analysis of quantitative and qualitative characteristics of vision in patients with stage II and III keratoconus who underwent intrastromal allokeratoplasty. MATERIAL AND METHODS: The study included 15 patients (15 eyes) with stage II-III KC (Amsler-Krumeich classification) aged 17 to 38 years old (28.8±6.2). All patients underwent intrastromal keratoplasty with implantation of an allograft in the form of a wide incomplete ring. The following parameters were assessed before and 6 months after surgery: distance VA with and without correction, near VA with and without correction, VA with glare effect, high-order aberrations (HOA), thickness of the tear film lipid layer, spatial contrast sensitivity (SCS) under photopic and mesopic conditions with light filters, reading speed. RESULTS: VA without correction increased from 0.15 to 0.7; with correction from 0.35 to 0.7. The glare effect with varying degrees of illumination did not affect VA either before or after surgery. Statistically significant changes were observed when comparing the aberrations «coma¼, «spherical¼, «trefoil¼ before and after the intervention, they became inverted. The thickness of the tear film lipid layer did not change significantly when comparing pre- and postoperative data. The use of light filters (orange, yellow) did not lead to significant changes in the VA and SCS under photopic and mesopic conditions. CONCLUSION: The use of a wide intrastromal allograft to correct deformity and stabilize the cornea in keratoconus improves the patients' quality of vision and visual performance.

Extended depth-of-focus (EDOF) AcrySof® IQ Vivity® intraocular lens implant: a real-life experience.

PURPOSE: Extended depth-of-focus (EDOF) is a promising intraocular lens (IOL) technology for cataract surgery. The aim of the study was to report the real-life experience related to the implant of EDOF AcrySof® IQ Vivity® (Alcon Inc., USA) IOL. METHODS: The study was designed as a interventional, prospective, case series with 3 months of follow-up. Patients needing cataract surgery, without any other kind of ocular diseases, were recruited and implanted with AcrySof® IQ Vivity® IOL. We evaluated the refractive success of this IOL through complete ophthalmologic assessments and the administration of the Quality of Vision test. The main outcome measures were the refractive outcome; far, intermediate, and near vision; and Quality of Vision score. RESULTS: We included 108 eyes (54 patients; age 62 ± 5 years). Intra-operative and post-operative complications were 0%. Thirty out of 100 eyes (28%) required toric IOL. Best-corrected visual acuity improved from 0.4 ± 0.3 LogMAR to 0.0 ± 0.0 LogMAR (p < 0.01). Refractive outcome was very good for far and intermediate visions, whereas a spherical addition of at least + 1.0D was required for near vision. The mean Quality of Vision score was of 15.5 ± 6.5. The most complained visual disturbances were haloes and glares, although resulting well-tolerated. Dynamic pupillometry findings well-correlated with the amount of complained post-operative visual discomforts. CONCLUSIONS: AcrySof® IQ Vivity® IOL is a well-tolerated choice to correct far and intermediate vision. Spectacles are needed to optimize near vision. Our data strongly suggest dynamic pupillometry as a useful investigation to optimize post-operative refractive success.

Correlation between improvement in visual acuity and QOL after Ranibizumab treatment for age-related macular degeneration patients: QUATRO study.

BACKGROUND: To evaluate the correlation between visual acuity improvement and vision-related QOL after ranibizumab treatment in Japanese patients with AMD. METHODS: In this one-year prospective, interventional, open-label, multicenter study involving four sites, patients with neovascular AMD were enrolled and observed for 12 months. Treatment-naïve patients received 0.5 mg ranibizumab as needed after three initial monthly doses. The best corrected visual acuity (BCVA) and central macular thickness (CMT) were measured at every visit. Evaluations with the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) and patient satisfaction questionnaire were performed at baseline and 3 and 12 months after initial treatment. The primary endpoint was change in BCVA and QOL 3 months after ranibizumab treatment. QOL outcomes were also assessed in the better and poor BVCA subgroups. RESULTS: The study enrolled 100 patients. The mean logMAR BCVA after treatment improved significantly from 0.43 to 0.30 at 3 months (p< 0.0001), and 0.28 at 12 months (p< 0.0001). The mean NEI-VFQ-25 composite scores improved from 79.48 to 84.13 at 3 months (p< 0.0001), and 86.0 at 12 months (p< 0.0001). The 3 and 12-month changes in NEI-VFQ-25 score and BCVA showed significant correlation. In the poor baseline visual acuity group (decimal BCVA ≤0.5), there was a significant correlation between the changes in the NEI-VFQ-25 score and BCVA (p=0.02) but not in the better baseline visual acuity group (decimal BCVA > 0.6, p=0.1) at 3 months. There were no significant differences in the satisfaction questionnaire score from baseline to at 3 months (p=0.54) and 12 months (p=0.23). The average CMT improved significantly from 340 to 264 µm at 3 months (p< 0.0001) and to 268 µm at 12 months (p< 0.0001). CONCLUSIONS: Intravitreal ranibizumab treatment resulted in improvement in visual acuity, anatomical change, and visual function change in Japanese AMD patients. Significant improvement was seen in patient visual function, and this was correlated with changes in VA, except immediately after loading dose treatment in patients with higher baseline VA. The patients' satisfaction with the treatment remained unchanged during the study period. TRIAL REGISTRATION: This study is registered at UMIN Clinical Trials Registry ( UMIN000012013 ). Registered October 10, 2013, as prospective study.

Visual outcomes and patient satisfaction 1 and 12 months after combined implantation of extended depth of focus and trifocal intraocular lenses.

PURPOSE: To assess the 1-month and 12-month postoperative visual performance and subjective outcomes following combined implantation of an extended depth of focus (EDOF) intraocular lens (IOL) and a trifocal IOL. METHODS: The study enrolled consecutive patients undergoing refractive lens extraction or cataract surgery with combined implantation of an EDOF IOL (dominant eye) and trifocal IOL. Uncorrected (UDVA) and best-corrected (CDVA) distance visual acuities, uncorrected intermediate (UIVA) and near (UNVA) visual acuities, and subjective questionnaires were evaluated 1 month and 12 months postoperatively. RESULTS: The study enrolled 58 consecutive patients. Binocular UDVA, UIVA and UNVA were - 0.08 ± 0.07 logMAR, 0.15 ± 0.14 logMAR and 0.17 ± 0.11 logMAR at 1 month, compared to - 0.09 ± 0.06 logMAR (P = .323), 0.11 ± 0.10 logMAR (P = .030) and 0.13 ± 0.10 logMAR (P = 0.008) at 12 months. Satisfaction was high with 93.1% of patients fulfilled or more than fulfilled postoperatively, and 84.5% and 86.3% reported spectacle independence for near at the respective postoperative assessments. The mean daytime and nighttime quality of vision (QoV) scores were 9.12 ± 0.94 and 7.88 ± 1.74 at 1 month, compared to 9.24 ± 0.78 (P = .183) and 8.26 ± 1.38 (P = .043) at 12 months. CONCLUSIONS: This IOL combination provides good unaided visual acuity at 1 and 12 months postoperatively, with high functional vision and postoperative satisfaction reported at 1 and 12 months. However, a significant improvement in overall nighttime QoV at the 12 months assessment was found.

Refractive, visual, and subjective quality of vision outcomes for very high myopia LASIK from - 10.00 to - 13.50 diopters.

BACKGROUND: To evaluate laser-assisted in situ keratomileusis (LASIK) outcomes, subjective quality of vision (QoV) and patient satisfaction in eyes with very high myopia (VHM) above - 10.00 diopters (D). METHODS: Consecutive myopic and myopic-astigmatism eyes with spherical equivalent (SEQ) ranging between - 10.00 to - 13.50 D underwent LASIK with the WaveLight® Allegretto Wave® Eye-Q 400 Hz excimer laser. Treatment accuracy, efficacy, safety, stability, cylinder vectors, and higher-order aberrations were evaluated, together with subjective QoV and night vision disturbances (NVDs). RESULTS: 114 eyes had a preoperative SEQ of - 11.02 ± 0.81 D, with a median follow-up of 24 months. A total of 72, 84, and 94% of eyes were within ± 0.50, ± 0.75 and ± 1.00 D of intended SEQ (R2 = 0.71). The efficacy index was 0.93 ± 0.20, with 51 and 81% of eyes achieving 20/20 and 20/25. The astigmatism correction index was 0.95 ± 0.33. The safety index was 1.05 ± 0.12. The average myopic regression was - 0.51 ± 0.38 D. Preoperative QoV scores improved significantly postoperatively (7.5 ± 0.8 vs. 9.1 ± 0.7; P <  0.001), with less NVDs (P <  0.001). Total, spherical and coma root mean square (RMS) postoperative ocular higher-order aberrations were 1.07 ± 0.34, 0.67 ± 0.25, and 0.70 ± 0.40 µm. CONCLUSIONS: Very high myopia LASIK between - 10.00 to - 13.50 D is safe and results in good visual outcomes, with high patient satisfaction and a significant improvement in patient-reported QoV after surgery. Appropriately selected patients within this very high myopia group can be included as LASIK candidates.

[Methods of surgical treatment of keratectasia and analysis of postsurgical quality of vision]. / Metody khirurgicheskogo lecheniya keratektazii i analiz posleoperatsionnogo kachestva zreniya.

Keratectasias are non-inflammatory dystrophic diseases of the cornea characterized by progressive bilateral thinning of the cornea that lead to deterioration in the quantitative and qualitative characteristics of vision reducing patient's quality of life. The changes can be asymmetrical and destructive. A number of surgeries have been proposed to reduce the negative effects of keratectasia including penetrating keratoplasty and its modifications, implantation of corneal ring segments, corneal cross-linking - alone and in combination with other methods, intrastromal keratoplasty. These methods can improve visual acuity to a certain degree and help slow the progression of keratectasia. This article studies various surgical methods used for treating keratectasia and analyses possible assessment of the quality of vision before and after the treatment.

Early retinal atrophy predicts long-term visual impairment after acute optic neuritis.

BACKGROUND: Visual recovery after optic neuritis (ON) used to be defined as good, although patients frequently complain of poor vision. METHODS: We carried out a prospective study on 38 consecutive patients with acute ON followed monthly for 6 months and evaluated high- and low-contrast visual acuity (HCVA and LCVA, respectively), quality of vision (National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ-25)), visual fields, and retinal thickness by spectral domain optical coherence tomography (OCT). RESULTS: We found significant impaired LCVA and color vision in ON eyes 6 months after acute ON, which impact on quality of life. LCVA and color vision were correlated with the thicknesses of the ganglion cell and inner plexiform layer (GCIPL; 2.5% LCVA r = 0.65 and p = 0.0001; color vision r = 0.75 and p < 0.0001) and that of the peripapillary retinal nerve fiber layer (pRNFL; LCVA r = 0.43 and p = 0.0098; color vision r = 0.62 and p < 0.0001). Linear regression models that included the change in the GCIPL and pRNFL thicknesses from baseline to month 1 after onset explained 47% of the change in 2.5% LCVA and 67% of the change of color vision acuity. When adjusting for the value of visual acuity at baseline, predictors of the change in vision from baseline to month 6 achieved similar performance for all three types of vision (HCVA, LCVA, and color vision). CONCLUSION: Monitoring retinal atrophy by OCT within the first month after ON onset allows individuals at a high risk of residual visual impairment to be identified.

Functional visual acuity in patients with successfully treated amblyopia: a pilot study.

PURPOSE: The aim of this study was to use conventional visual acuity measurements to quantify the functional visual acuity (FVA) in eyes with successfully treated amblyopia, and to compare the findings with those for contralateral normal eyes. METHODS: Nineteen patients (7 boys, 12 girls; age 7.5 ± 2.2 years) with successfully treated unilateral amblyopia and the same conventional decimal visual acuity in both eyes (better than 1.0) were enrolled. FVA, the visual maintenance ratio (VMR), maximum and minimum visual acuity, and the average response time were recorded for both eyes of all patients using an FVA measurement system. The differences in FVA values between eyes were analyzed. RESULTS: The mean LogMAR FVA scores, VMR (p < 0.001 for both), and the LogMAR maximum (p < 0.005) and minimum visual acuity (p < 0.001) were significantly poorer for the eyes with treated amblyopia than for the contralateral normal eyes. There was no significant difference in the average response time. CONCLUSIONS: Our results indicate that FVA and VMR were poorer for eyes with treated amblyopia than for normal eyes, even though the treatment for amblyopia was considered successful on the basis of conventional visual acuity measurements. These results suggest that visual function is impaired in eyes with amblyopia, regardless of treatment success, and that FVA measurements can provide highly valuable diagnosis and treatment information that is not readily provided by conventional visual acuity measurements.

The (lack of) relation between straylight and visual acuity. Two domains of the point-spread-function.

PURPOSE: The effect of cataract and other media opacities on functional vision is typically assessed clinically using visual acuity. In both clinical and basic research, straylight (the functional result of light scattering in the eye) is commonly measured. The purpose of the present study was to determine the link between these two measures: is visual acuity in cataract and other media opacities related to straylight? METHODS: Interdependence between acuity and straylight is addressed from three different points of view: (1) Methodological: can acuity differences affect the measurement value of straylight, and vice versa? (2) Basic optics: does the optical process of light scattering in the human eye affect both straylight and visual acuity? (3) Statistical: how strongly are acuity and straylight correlated in the practice of important clinical conditions? Experimental and theoretical aspects will be considered, with a focus on normal ageing and cataract formation. RESULTS: (1) Methodological: testing potential effects of acuity, artificially manipulated with positive trial lenses, showed no effect on measured straylight values. Since light scattering in the eye involves a low percentage of the light and has large angular spreading, contrast reduction due to straylight is limited, resulting in virtually absent acuity effects. (2) Basic optics: light scattering from the human donor eye lens is found to have virtually no effect in the centre of the point-spread-function, also for cataractous lenses, resulting in virtually absent acuity effects. (3) Statistical: literature data on straylight and visual acuity show a weak correlation for the important groups of normal ageing and cataract populations. CONCLUSIONS: The point-spread-function of the normal ageing and cataractous human eye is built upon two rather independent basic parts. Aberrations control the central peak. Light scattering controls the periphery from about 1° onwards. The way acuity and straylight are measured ensures no confounding between them. Statistically within the normal ageing and cataract populations, visual acuity and straylight vary quite independently from each other. Visual acuity losses with cataract and other media opacities are not due to straylight, but caused by aberrations and micro-aberrations. Straylight defines disability glare, and causes symptoms of glare, haloes, hazy vision etc. Overall, visual acuity and straylight are rather independent aspects of quality of vision.

Managing dissatisfaction after multifocal intraocular lens implantation through lens exchange using monofocal or alternative multifocal IOLs.

PURPOSE: To manage patient dissatisfaction following multifocal intraocular lens (MF-IOL) implantation by IOL exchange with either a monofocal or an alternative MF-IOL, and to compare outcomes in these two groups. METHODS: MF-IOL exchange was performed in 32 patients (64 eyes) with neuroadaptation failure. The MF-to-MF group involved patients who had a MF-IOL exchanged with another MF-IOL of a different optical profile and the MF-to-MO group involved patients who had a MF-IOL exchanged to a monofocal IOL. Visual outcomes and complications were analysed. The Quality of Vision (QoV) questionnaire, Visual Function Index (VF-14) and its Rasch-revised version (VF-8R) were also used to assess outcomes. RESULTS: There were no significant differences (p > 0.05) in the QoV scores between the two groups, both preoperatively and postoperatively. Preoperatively, there were no significant differences in VF-14 scores between both groups (p > 0.05). Postoperatively, there were statistically significant differences in VF-14 (total score, intermediate vision and near vision) in favour of the MF-to-MF group (p < 0.05). The postoperative VF-8R score in the MF-to-MF group was significantly better than the MF-to-MO group (p ≤ 0.001). Uncorrected and corrected near as well as corrected distance visual acuities were significantly better (p < 0.05) in the MF-to-MF group compared to the MF-to-MO group at 3 months. CONCLUSION: Patient dissatisfaction and neuroadaptation failure following MF-IOL implantation can be managed by an IOL exchange with an alternative optical design of MF-IOL or a monofocal IOL. Although, in the current study, the MF-to-MF group showed some better postoperative results, both options are feasible solutions.

Measuring quality of vision including negative dysphotopsia.

PURPOSE: To adapt the Quality of Vision Questionnaire (QoV) for measuring negative dysphotopsia and to validate the original and modified versions in the Dutch population. METHODS: The QoV was translated into Dutch according to standardized methodology. Negative dysphotopsia items were constructed based on focus group interviews, literature review and clinical data. The questionnaire was completed by 404 subjects, including contact lens wearers, patients with cataract and after cataract surgery (95.5% with a monofocal, 4.5% with a multifocal intraocular lens). Rasch analysis was applied for evaluation of reliability and validity of the original QoV and modified version, Negative Dysphotopsia QoV (ND-QoV). RESULTS: The frequency, severity and bothersome scales of the QoV and ND-QoV demonstrated good measurement precision, good fit statistics for all but one item, but significant mistargeting of more than one logit. Item estimations were stable across the study groups and scales were unidimensional with more than 50% of variance explained by the measurements. There was a positive correlation between questionnaire scores and best corrected visual acuity (r = 0.3, p < 0.01). The quality of vision measured by all three scales was significantly poorer (p < 0.01) in patients with negative dysphotopsia compared to asymptomatic pseudophakic patients. CONCLUSION: The Dutch version of the QoV questionnaire has shown good psychometric properties comparable to the native version as well as good reliability and validity. The addition of negative dysphotopsia items is a valuable modification for the reliable assessment of quality of vision in pseudophakic patients.

Beyond vision:Cataract and health status in old age, a narrative review.

Cataract is a leading cause of visual impairment in old age. Lens opacification is notoriously associated with several geriatric conditions, including frailty, fall risk, depression and cognitive impairment. The association is largely attributable to visual impairment, while other mechanisms, associated with extraocular comorbidity and lifestyle, might partly explain this correlation. Available literature suggests that cataract surgery may be effective in decreasing fall risk, improving depressive symptoms and limiting the risk of cognitive impairment and dementia incidence, although intervention studies on these outcomes are still limited. In this review we also emphasize the need to move from the concept of visual acuity to functional vision, especially in the context of the geriatric patient. Research is needed regarding the effect on the cited outcomes of different cataract treatment strategies, such as systematic bilateral versus monolateral surgery and use of different intraocular lenses.