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Clinical Ophthalmology (Auckland, N.Z.) 2023To compare the clinical results achieved with the enhanced monofocal intraocular lenses (IOLs) with those of the monofocal IOL and investigate factors affecting the...
PURPOSE
To compare the clinical results achieved with the enhanced monofocal intraocular lenses (IOLs) with those of the monofocal IOL and investigate factors affecting the distance, intermediate, and near vision.
PATIENTS AND METHODS
Patients were included who underwent bilateral consecutive cataract surgeries using the same IOLs with follow-up to 1 month postoperatively. Refractions, monocular UDVA and CDVA, and binocular distance-corrected functional visual acuity at 5 meters (BDCFVA), at 66 centimeters (BDCIFVA) and at 40 centimeters (DCNVA) were assessed. Multiple regression analysis was used to assess the factors affecting binocular BDCFVA, BDCIFVA, and BDCNFVA. Subjective symptoms were assessed using the Near Activity Visual Questionnaire (NAVQ) and visual analogue scale (VAS).
RESULTS
Sixty patients (120 eyes) implanted with the Tecnis Eyhance IOL (30 patients, 60 eyes) or the Tecnis monofocal IOL (30 patients, 60 eyes) were included. The Tecnis Eyhance IOL provided significantly better binocular BDCIFVA than the Tecnis monofocal IOL in patients under 70 years of age. Multiple regression analysis showed that age was the only factor affecting distance and intermediate visual function in eyes with the Tecnis Eyhance IOL; gender, pupillary diameter, axial length, and average keratometry were not significant. There were no significant differences in subjective symptoms.
CONCLUSION
The comprehensive cohort analysis did not confirm the advantage on the intermediate vision of the Tecnis Eyhance IOL. Younger age may be an important factor to benefit from the unique optical characteristics of this IOL.
PubMed: 38146453
DOI: 10.2147/OPTH.S438599 -
Clinical Ophthalmology (Auckland, N.Z.) 2023The optical function of a novel refractive-diffractive trifocal intraocular lens (IOL) was tested in vitro to provide preclinical metrics that predict postoperative...
PURPOSE
The optical function of a novel refractive-diffractive trifocal intraocular lens (IOL) was tested in vitro to provide preclinical metrics that predict postoperative performance and may guide patient selection.
METHODS
Fundamental optical characteristics of a trifocal hydrophobic-acrylic IOL with a C-loop haptic configuration (AT ELANA 841P, Carl Zeiss Meditec) were assessed using a fully automated optical test device under both monochromatic and polychromatic conditions combined with increased or compensated spherical aberration (SA). The area under the modulation transfer function (MTFa) was calculated across a defocus range from +1D to -3.5D and used to simulate visual acuity (VA). A polychromatic point spread function (PSF) was employed to assess the light distribution and identify photic phenomena.
RESULTS
The highest MTFa values were obtained under monochromatic conditions using an SA-neutral corneal model. Nevertheless, after introducing SA and polychromatic light, the IOL performance remained good. Simulated VA values were 0.00 logMAR for distance, 0.1 logMAR at 100 cm, and progressively improving to 0.05 logMAR at 40 cm from the intermediate point. The light-spread analysis confirmed halos around the PSF center, which is a characteristic of trifocal technology.
CONCLUSION
AT ELANA 841P demonstrated good optical performance across various distances, independently of spectral and SA conditions, resulting in good simulated VA. Although light spread resembles standard trifocal IOLs, clinical studies are essential to confirm these laboratory results.
PubMed: 38143560
DOI: 10.2147/OPTH.S445461 -
Scientific Reports Dec 2023Presbyopia is an age-related physiological phenomenon in which eye gradually losses its ability to accommodate. It is one of the leading causes of visual impairment...
Presbyopia is an age-related physiological phenomenon in which eye gradually losses its ability to accommodate. It is one of the leading causes of visual impairment worldwide, especially in adults above the age of 40. If uncorrected, it can significantly impair a patient's quality of life. This study aims to evaluate the factors which affects patient's need and willingness to accept presbyopic correction. This cross-sectional analytical study was carried out in a semi urban tertiary care hospital from Jan 2021 to June 2022 among patients aged 40 and above who presented to Outpatient department (OPD). Demographic details, medical history, presenting ocular complaints pertaining to presbyopia, spectacle use and decision regarding using near vision correction were noted. Ocular examination included refraction and ocular biometry. Factors that may have influenced complaints of presbyopia or willingness to accept presbyopic correction were analysed. Three hundred and forty two patients with a mean age of 48.55 ± 6.68 years were included. Of these, 262 (76.61%) patients presented with chief complaints related to presbyopia. Those with higher educational qualification (p = 0.031), hypermetropia (p = 0.021), shallower AC depth (p = 0.028) and on medications for systemic ailments (p = 0.01), were more likely to present with chief complaints attributable to presbyopia. Among them, those with higher educational qualifications (p = 0.02) and skilled workers were more likely to accept near vision glasses (p = 0.02), while those with lower Hb (p = 0.01) and myopia (p = 0.01) were less likely to accept correction for presbyopia. Among the 80 patients without chief complaints related to presbyopia, 35 (43.75%) were not willing to accept near vision glasses. Those with higher BMI (p = 0.04) and hypermetropes (p = 0.05) were more willing to accept presbyopic correction. Presbyopia constitutes a significant reason for patients above the age of 40 visiting eye care facility. Multiple socio-economic, systemic and ocular factors influenced both the chief complaints related to presbyopia and willingness to accept presbyopic correction.
Topics: Adult; Humans; Middle Aged; Presbyopia; Cross-Sectional Studies; Quality of Life; Vision, Ocular; Myopia; Hyperopia; India
PubMed: 38129652
DOI: 10.1038/s41598-023-50288-w -
Translational Vision Science &... Dec 2023This optical bench study was designed to evaluate and compare the halos generated by presbyopia-correcting intraocular lenses (PCIOLs) and monofocal intraocular lenses...
PURPOSE
This optical bench study was designed to evaluate and compare the halos generated by presbyopia-correcting intraocular lenses (PCIOLs) and monofocal intraocular lenses (IOLs), with or without lens decentration, using an optical bench to simulate the headlight of a distant vehicle in mesopic conditions.
METHODS
Halos generated by six nondiffractive and 10 diffractive IOLs with different dioptric add powers were evaluated using a high dynamic range bench system. Halo intensities were compared by assessing the area under the measured intensity profile curve to compute the relative halo magnitude (RHM).
RESULTS
Nondiffractive PCIOLs produced smaller and less intense bench halo images than diffractive ones. RHM measurements ranged from 964 to 1896. Monofocal IOLs produced lower RHM values, whereas diffractive PCIOLs generated higher ones. When decentered by 0.5 mm with respect to the system aperture, more obviously asymmetric halo image profiles were observed in diffractive compared with nondiffractive PCIOLs.
CONCLUSIONS
Simulated bench halos of nondiffractive PCIOLs are smaller and less intense than those of diffractive PCIOLs. Additional clinical studies assessing standardized patient-reported outcomes measures are required to correlate these bench results with patient satisfaction.
TRANSLATIONAL RELEVANCE
This study contrasts the design-related simulated bench halos of nondiffractive and diffractive PCIOLs, aiming to elucidate their impact on halo perception.
Topics: Humans; Presbyopia; Lenses, Intraocular
PubMed: 38127324
DOI: 10.1167/tvst.12.12.19 -
Frontiers in Medicine 2023To investigate the effects of postoperative astigmatism on the visual outcomes following presbyopia-correcting surgery with multifocal intraocular lens implantation.
PURPOSE
To investigate the effects of postoperative astigmatism on the visual outcomes following presbyopia-correcting surgery with multifocal intraocular lens implantation.
METHODS
A comprehensive literature search was conducted using PubMed, Embase, and Web of Science for articles published until January 2023. Additionally, we included retrospective case series and prospective comparative studies. The combined mean difference (MD) with 95% confidence intervals (CI) and odds ratio (OR) with 95% CI were used to express continuous and categorical outcomes, respectively. All statistical analyses were performed using Review Manager (version 5.4.1).
RESULTS
We included nine eligible studies that analyzed 3,088 eyes. The proportion of eyes with useful postoperative visual acuity (logMAR ≤ 0.20) and residual astigmatism significantly differed with respect to the magnitude of astigmatism and presence/absence of blurred vision ( < 0.001 for both). Additionally, the mean uncorrected distance visual acuity (MD, 0.14; 95% CI, 0.06 to 0.21; = 0.0003) and uncorrected intermediate visual acuity (MD, 0.07; 95% CI, 0.00 to 0.13; = 0.04), but not the uncorrected near visual acuity (MD, 0.02; 95%CI-0.01 to 0.05; = 0.17), significantly differed according to the magnitude of astigmatism.
CONCLUSION
Astigmatism, even at low levels (≥ 0.5D), has a significant effect on visual outcomes, especially on UDVA and UIVA, following multifocal intraocular lens implantation. Accurate preoperative and postoperative evaluation of astigmatism is important.
PubMed: 38089878
DOI: 10.3389/fmed.2023.1214714 -
Taiwan Journal of Ophthalmology 2023Femtosecond laser (FSL) applications in corneal surgery have increased since its inception. Corneal surgery has undergone a tremendous transformation thanks to the... (Review)
Review
Femtosecond laser (FSL) applications in corneal surgery have increased since its inception. Corneal surgery has undergone a tremendous transformation thanks to the introduction of FSL technology. This laser makes precise, three-dimensional incisions while causing minimal damage to surrounding tissue. This review updates and summarizes current and upcoming FSL applications in corneal surgery, current commercially available FSL, and its respective applications. Refractive surgery applications include laser keratomileusis flaps, refractive corneal lenticule extraction such as small incision lenticule extraction, astigmatic keratotomy, intracorneal ring segments tunnels for keratoconus including corneal allogenic intrastromal ring segments, and presbyopia treatments with intrastromal pockets for corneal inlays and intrastromal incisions (INTRACOR). Keratoplasty applications include penetrating keratoplasty trephination; superficial and deep anterior lamellar keratoplasty trephination, lamellar dissection, and tunnel creation; posterior lamellar keratoplasty donor and recipient preparation; Bowman layer transplantation donor, and recipient preparation; and stromal keratophakia. Other applications include conjunctival graft preparation in pterygium surgery, and keratopigmentation (corneal tattooing). FSL is a surgical instrument widely used in corneal surgery because it improves reproducibility and safety in many procedures.
PubMed: 38089509
DOI: 10.4103/tjo.TJO-D-23-00083 -
Ophthalmology Science 2024To investigate whether a redistribution of water within the crystalline lens is associated with the shape deformation that occurs during accommodation.
OBJECTIVE
To investigate whether a redistribution of water within the crystalline lens is associated with the shape deformation that occurs during accommodation.
DESIGN
Observational, cross sectional study.
SUBJECTS
Eleven young adults without presbyopia (aged 18-39 years) and 9 middle-aged adults with presbyopia (aged 40-55 years).
METHODS
Magnetic resonance imaging (MRI) scans of the lens were acquired on a 3 Tesla clinical MRI scanner, without and with the presentation of a 3 Diopter accommodative stimulus. The MRIs were postprocessed using established methods to extract the geometric dimensions and spatial maps of water distribution of the lens.
MAIN OUTCOME MEASURES
Accommodative changes in the full 3-dimensional description of lens shape, the lens total-water distribution profile, and the lens free-water distribution profile.
RESULTS
Viewing of an accommodative stimulus by young subjects elicited an elastic shape deformation of the lens consistent with accommodation that was associated with an elevated, smoother free-water distribution, primarily in the anterior region of the lens. In contrast, viewing of an accommodative stimulus by presbyopic subjects produced an atypical shape deformation of the lens that was instead associated with a lowered free-water distribution, primarily in the anterior region of the lens. No discernible changes to the lens total-water distribution were observed in response to the accommodative stimulus in either subject cohort.
CONCLUSIONS
The present study suggests that protein-mediated alterations in the free-water distribution of the anterior region of the lens influence the shape deformation in accommodation, presenting pharmacological modulation of free-water distribution as an attractive novel approach for treating presbyopia.
FINANCIAL DISCLOSURES
The authors have no proprietary or commercial interest in any materials discussed in this article.
PubMed: 38027421
DOI: 10.1016/j.xops.2023.100404 -
Clinical Ophthalmology (Auckland, N.Z.) 2023To investigate the visual acuity and satisfaction of patients after Zhang & Zheng's corneal laser-enhanced accommodation refraction Q (ZZ-CLEAR-Q) surgery utilizing... (Clinical Trial)
Clinical Trial
PURPOSE
To investigate the visual acuity and satisfaction of patients after Zhang & Zheng's corneal laser-enhanced accommodation refraction Q (ZZ-CLEAR-Q) surgery utilizing differential modulation of binocular longitudinal spherical aberration and determine its clinical significance.
PATIENTS AND METHODS
This prospective observational study enrolled a consecutive cohort of patients with presbyopia who underwent ZZ-CLEAR-Q surgery between December 2020 and January 2023. The study assessed visual acuity, distance-corrected defocus curve, satisfaction, Q factor, manifest spherical equivalent, and primary spherical aberration, among others, at 3 months postoperatively. Additionally, the study conducted a binocular comparison to analyze the clinical significance of setting the different longitudinal spherical aberrations.
RESULTS
A total of 232 eyes of 116 patients were included. The binocular uncorrected distance visual acuity was 20/20 for all patients. At 3 months postoperatively, the binocular uncorrected near visual acuity was Jaeger 1 for 96% of the patients and Jaeger 2 for 100% of the patients. Furthermore, 93.1% of the patients expressed satisfaction. The monocular distance-corrected defocus curve revealed that the dominant eyes had significantly better visual acuity at 0 D (P<0.001), while the non-dominant eyes had significantly better visual acuity across various defocus levels except 0 and -0.50 D (All P<0.05). At 3 months, there were no significant differences between the expected and achieved manifest spherical equivalents, corneal Q factor values, and ocular primary spherical aberration values of both groups.
CONCLUSION
Patients with presbyopia who underwent ZZ-CLEAR-Q surgery were likely to achieve normal uncorrected visual acuity and be satisfied. The increased depth of field has clinical significance for assisting near vision.
PubMed: 38026604
DOI: 10.2147/OPTH.S437324 -
BMC Ophthalmology Nov 2023By comparing the results of the new self-contained darkroom refractive screener (YD-SX-A) versus table-top autorefractor and cycloplegic retinoscopy, to evaluate the... (Comparative Study)
Comparative Study
PURPOSE
By comparing the results of the new self-contained darkroom refractive screener (YD-SX-A) versus table-top autorefractor and cycloplegic retinoscopy, to evaluate the performance of the YD-SX-A in detecting refractive error in children and adolescents and then judge whether it can be used in refractive screening.
METHODS
Cross-sectional study. 1000 participants between the ages of 6 and 18 who visited the Optometry Center of the People's Hospital of Guangxi Zhuang Autonomous Region from June to December 2022 were selected. First, participants were instructed to measure their diopter with a table-top autorefractor (Topcon KR8800) and YD-SX-A in a noncycloplegic setting. After cycloplegia, they were retinoscopy by a professional optometrist. The results measured by three methods were collected respectively. To avoid deviation, only the right eye (1000 eyes) data were used in the statistical analysis. The Bland-Altman plots were used to evaluate the agreement of diopters measured by the three methods. The receiver operating characteristic (ROC) curves was used to analysis effectiveness of detecting refractive error of YD-SX-A.
RESULTS
The average age of participants was 10.77 ± 3.00 years, including 504 boys (50.4%) and 496 girls (49.6%). When YD-SX-A and cycloplegia retinoscopy (CR) were compared in the myopia group, there was no statistical difference in spherical equivalent (SE) (P > 0.05), but there was a statistical difference in diopter spherical (DS) and diopter cylinder (DC) (P < 0.05). Comparing the diopter results of Topcon KR8800 and CR, the difference between each test value in the myopia group was statistically significant (P < 0.05). In the hyperopia group, the comparison between YD-SX-A and CR showed no statistically significant differences in the DC (P > 0.05), but there were significant differences in the SE and DS (P < 0.05). In the astigmatism group, the SE, DS, and DC were statistically different, and the DC of YD-SX-A was lower than that of CR and Topcon KR8800. Bland-Altman plots indicated that YD-SX-A has a moderate agreement with CR and Topcon KR8800. The sensitivity and specificity of YD-SX-A for detecting myopia, hyperopia and astigmatism were 90.17% and 90.32%, 97.78% and 87.88%, 84.08% and 74.26%, respectively.
CONCLUSION
This study has identified that YD-SX-A has shown good performance in both agreement and effectiveness in detecting refractive error when compared with Topcon KR8800 and CR. YD-SX-A could be a useful tool for large-scale population refractive screening.
Topics: Adolescent; Child; Female; Humans; Male; Astigmatism; China; Cross-Sectional Studies; Hyperopia; Myopia; Optometry; Presbyopia; Pupil Disorders; Refraction, Ocular; Refractive Errors; Retinoscopy; Vision Screening
PubMed: 38012552
DOI: 10.1186/s12886-023-03231-6 -
BMC Ophthalmology Nov 2023Fuchs endothelial corneal dystrophy (FECD) is the leading indication for EK and may coexist with cataract and presbyopia. Notably, the outcomes of phacoemulsification in... (Review)
Review
Fuchs endothelial corneal dystrophy (FECD) is the leading indication for EK and may coexist with cataract and presbyopia. Notably, the outcomes of phacoemulsification in FECD patients are not as favorable as those in eyes without this condition. Historically, only monofocal intraocular lenses (IOLs) were recommended for these patients. However, recent reports have described the implantation of Premium-IOLs (such as Multifocal IOLs, Enhanced Depth of Focus IOLs, and Toric IOLs) in FECD eyes undergoing cataract surgery and Descemet membrane endothelial keratoplasty (DMEK). While the results are encouraging, they are not as optimal as those from unoperated eyes, especially when comparing simultaneous procedures to sequential ones. It's advised to perform the DMEK first to improve the accuracy of IOL calculations. Still, even successfully operated eyes may experience secondary graft failure or graft rejection after DMEK. The success rate of a secondary DMEK is typically lower than that of the initial procedure. Furthermore, if the postoperative thickness after DMEK is less than anticipated, laser enhancements might not be an option. There's a pressing need for more controlled and randomized clinical trials to ascertain the safety and effectiveness of Premium-IOLs for FECD eyes. This narrative review aims to collate evidence on the use of Premium IOL technologies in eyes receiving EK and to underscore key points for surgeons performing EK combined with cataract surgery.
Topics: Humans; Lens Implantation, Intraocular; Descemet Membrane; Presbyopia; Visual Acuity; Lenses, Intraocular; Corneal Transplantation; Fuchs' Endothelial Dystrophy; Cataract; Descemet Stripping Endothelial Keratoplasty; Retrospective Studies
PubMed: 38007433
DOI: 10.1186/s12886-023-03240-5