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Erdinest N, London N, Landau D, Barbara R, Barbara A, Naroo SA. Higher order aberrations in keratoconus. Int Ophthalmol 2024; 44:172. [PMID: 38594548 DOI: 10.1007/s10792-024-03118-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 03/24/2024] [Indexed: 04/11/2024]
Abstract
INTRODUCTION Keratoconus is a progressive disorder of the cornea that causes thinning (Sedaghat et al. in Sci Rep 11(1):11971, 2021), ectasia, and irregular astigmatism, resulting in poor visual acuity that cannot be corrected with standard sphero-cylindrical spectacle lenses. One feature distinguishing keratoconic corneas is ocular aberrations, manifesting up to five or six times the amount of higher-order aberrations than a normal, healthy eye. These aberrations can cause visual disturbances even at the very early stages of the disease. METHODS In the past, a diagnosis was derived from clinical symptoms, but technological advances have revealed multiple pre-clinical features, allowing for the differentiation between keratoconic and normal eyes at a much earlier stage. These include anterior and posterior corneal surface elevations, the corneal pachymetry profile, corneal epithelial patterns, wavefront aberration metrics, and corneal biomechanics (Sedaghat et al. in Sci Rep 11(1):11971, 2021).This review discusses the aberrations associated with keratoconus, how to measure them, and treatment methods to minimize their negative influence. CONCLUSIONS Early diagnosis can lead to early treatment and may allow for arresting progression, thereby improving the long-term prognosis. With the acceleration of refractive surgery, it is important to identify patients with keratoconus, as they are usually contraindicated for refractive surgery.
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Affiliation(s)
- Nir Erdinest
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | - David Landau
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ramez Barbara
- Ophthalmology Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Adel Barbara
- IVISION Cornea and Refractive Surgery Center, Haifa, Israel
| | - Shehzad A Naroo
- College of Health and Life Sciences, Aston University, Birmingham, UK
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Bartol-Puyal FDA, Giménez G, Méndez-Martínez S, Larrosa JM, Polo V, Pablo L. Efficacy of estimations of Hartmann-Shack sensors in small pupil sizes. Saudi J Ophthalmol 2024; 38:168-172. [PMID: 38988783 PMCID: PMC11232754 DOI: 10.4103/sjopt.sjopt_123_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 06/12/2023] [Accepted: 06/15/2023] [Indexed: 07/12/2024] Open
Abstract
PURPOSE The purpose of this study was to evaluate the in vivo efficacy of the estimations of wavefront analyzers using Hartmann-Shack technology to measure optical aberrations when the pupil size is smaller than the evaluated pupil area. METHODS Patients implanted with the monofocal ZCB00 intraocular lens (Johnson and Johnson) were examined with the KR-1W Wavefront Analyzer (Topcon) without pharmacological mydriasis and with it afterward. Optical aberrations were analyzed considering a 4-mm pupil and a 6-mm pupil for both examinations. RESULTS Sixty-six eyes of 33 patients with a mean axial length of 23.35 ± 0.91 mm were assessed. The mean pupil diameter at the baseline examination was 5.05 ± 0.88 mm and under pharmacological mydriasis, it was 6.29 ± 0.84 mm. Outcomes were similar with and without dilation in the 4-mm comparison. However, there was a great disparity in the 6-mm comparison. Most of the values obtained under mydriasis were statistically lower than at baseline (P < 0.05). CONCLUSION The iris interferes with measurements of wavefront aberrations, and therefore, real pupil size should always be checked before evaluating optical aberrations with Hartman-Shack sensors. When pupil size is smaller than the analyzed diameter, ocular, and internal, and sometimes, corneal aberrations are estimated far more positive than real values.
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Affiliation(s)
- Francisco de Asís Bartol-Puyal
- Department of Ophthalmology, Miguel Servet University Hospital, Zaragoza, Spain
- Aragon Institute for Health Research (IIS Aragón), Miguel Servet Ophthalmology Research and Innovative Group (GIMSO), Zaragoza, Spain
- Department of Surgery, University of Zaragoza, Zaragoza, Spain
| | - Galadriel Giménez
- Department of Ophthalmology, Miguel Servet University Hospital, Zaragoza, Spain
- Aragon Institute for Health Research (IIS Aragón), Miguel Servet Ophthalmology Research and Innovative Group (GIMSO), Zaragoza, Spain
| | - Silvia Méndez-Martínez
- Aragon Institute for Health Research (IIS Aragón), Miguel Servet Ophthalmology Research and Innovative Group (GIMSO), Zaragoza, Spain
| | - José M. Larrosa
- Department of Ophthalmology, Miguel Servet University Hospital, Zaragoza, Spain
- Aragon Institute for Health Research (IIS Aragón), Miguel Servet Ophthalmology Research and Innovative Group (GIMSO), Zaragoza, Spain
- Department of Surgery, University of Zaragoza, Zaragoza, Spain
- Biotech Vision SLP, University of Zaragoza, Zaragoza, Spain
| | - Vicente Polo
- Department of Ophthalmology, Miguel Servet University Hospital, Zaragoza, Spain
- Aragon Institute for Health Research (IIS Aragón), Miguel Servet Ophthalmology Research and Innovative Group (GIMSO), Zaragoza, Spain
- Department of Surgery, University of Zaragoza, Zaragoza, Spain
- Biotech Vision SLP, University of Zaragoza, Zaragoza, Spain
| | - Luis Pablo
- Department of Ophthalmology, Miguel Servet University Hospital, Zaragoza, Spain
- Aragon Institute for Health Research (IIS Aragón), Miguel Servet Ophthalmology Research and Innovative Group (GIMSO), Zaragoza, Spain
- Department of Surgery, University of Zaragoza, Zaragoza, Spain
- Biotech Vision SLP, University of Zaragoza, Zaragoza, Spain
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Saad A, Frings A. Influence of perfluorohexyloctane (Evotears®) on higher order aberrations. Int Ophthalmol 2023; 43:5025-5030. [PMID: 37864619 PMCID: PMC10724091 DOI: 10.1007/s10792-023-02905-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 09/27/2023] [Indexed: 10/23/2023]
Abstract
PURPOSE To prospectively assess the effect of regular application of perfluorohexyloctane (F6H8; Evotears®) on the tear film lipid layer, higher order aberrations (HOA) and the repeatability of measurements in healthy eyes. METHODS This prospective clinical study included 104 eyes treated with F6H8 four times daily for four weeks (group A) and 101 eyes that served as controls (group B). Measurements were performed with the WASCA aberrometer (Carl Zeiss Meditec GmbH, Jena, Germany). Main outcome measurement in addition to subjective refraction were the root mean square values of HOA measured before and after the intervention. RESULTS Regular use of F6H8 over a period of four weeks significantly increases HOA in healthy eyes (p < 0.05). In addition, the repeatability of measurement increases after the application of F6H8. CONCLUSION F6H8 may be a suitable treatment option to improve the accuracy of refractive assessment, although it increases HOA. Further studies are needed to confirm the effect on HOA and the repeatability of measurement.
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Affiliation(s)
- Amr Saad
- Department of Ophthalmology, University Hospital Duesseldorf, Heinrich-Heine University, Moorenstraße 5, 40225, Duesseldorf, Germany.
| | - Andreas Frings
- Department of Ophthalmology, University Hospital Duesseldorf, Heinrich-Heine University, Moorenstraße 5, 40225, Duesseldorf, Germany
- Augenheilkunde und Augenlaserzentrum PD Dr. med. Frings Nuremberg, Jena, Germany
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Koh S, Maeda N, Terao M, Maeda H, Kosaki R, Kozaki J, Nishida K. Optical Quality and Visual Performance With Different Toric Contact Lens Designs. Eye Contact Lens 2023; 49:483-488. [PMID: 37713280 DOI: 10.1097/icl.0000000000001037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2023] [Indexed: 09/17/2023]
Abstract
OBJECTIVES To evaluate the optical quality of different toric contact lens (CL) designs and compare their on-eye visual correction performance. METHODS Twenty soft CL wearers aged 20 to 39 years were enrolled. Two daily disposable silicone-hydrogel toric CLs were tested: the "Eyelid Stabilized Design" (ESD-CL) and prism-ballast design (PB-CL); a spherical daily disposable silicone hydrogel CL (spherical CL) was used as a control. On-eye performance was compared for corrected distance visual acuity (CDVA), astigmatism, and ocular higher-order aberrations (HOAs); astigmatism and ocular HOAs were measured with a wavefront sensor. The subjective quality of vision, rated for "blurred vision" and "double vision," lens rotation, and fitting were also compared. RESULTS The ESD-CLs, PB-CL, and no-CL provided better CDVA than spherical CL ( P <0.05). Compared with spherical CL and no CL, PB-CL and ESD-CLs caused significantly lesser astigmatism ( P <0.05). Coma was significantly lesser with ESD-CLs than that with PB-CL ( P <0.05); total HOAs did not differ among the four conditions. The subjective ratings for blurred and double vision were significantly lower with ESD-CLs than those with spherical CL ( P <0.05). CONCLUSIONS Toric CLs provide a better CDVA than spherical CLs. However, differences in coma and subjective symptoms may occur because of the design of toric CLs.
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Affiliation(s)
- Shizuka Koh
- Department of Innovative Visual Science (S.K.), Osaka University Graduate School of Medicine, Osaka, Japan; Department of Ophthalmology (S.K., N.M., K.N.), Osaka University Graduate School of Medicine, Osaka, Japan; and Kozaki Eye Clinic (N.M., M.T., H.M., R.K., J.K.), Osaka, Japan
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Koh S, Inoue R, Iwamoto Y, Mihashi T, Soma T, Maeda N, Nishida K. Comparison of Ocular Wavefront Aberration Measurements Obtained Using Two Hartmann-Shack Wavefront Aberrometers. Eye Contact Lens 2023; 49:98-103. [PMID: 36729105 DOI: 10.1097/icl.0000000000000965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 11/03/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To assess agreement between measurements of ocular wavefront aberrations obtained using the Pentacam AXL Wave (Oculus Optikgeräte GmbH) (Aberrometer A) and KR-1W (Topcon Corp) (Aberrometer B), both of which are based on the Hartmann-Shack principle. METHODS In this prospective case-control study, ocular wavefront aberrations measurements were obtained using both aberrometers in patients with keratoconus (KC) and control participants. Ocular wavefront aberrations were measured through the natural pupil without dilation using both devices in a dark room. For both aberrometers, accommodation was inhibited by automatically adding fogging. The individual Zernike coefficients from the second to fourth order were compared between the two aberrometers for a 4-mm pupil diameter. RESULTS Twenty-six KC and 29 control eyes were assessed. Statistically significant correlations ( P <0.05) were observed for all Zernike coefficients, except for Z 4-2 in the control group. Bland-Altman analysis indicated good agreement between aberrometers and no statistically significant differences in the control group. However, in the KC group, patterns of proportional error were observed in vertical coma Z 3-1 (r=0.338, P =0.008), trefoil Z 4-4 (r=0.701, P =0.003), secondary astigmatism Z 4-2 (r=0.348, P =0.025), and spherical aberrations Z 40 (r=0.407, P =0.012). CONCLUSIONS The Zernike coefficient values measured by the two aberrometers were well correlated in the control and KC groups. However, in eyes with KC, Aberrometer B tended to present greater values in several Zernike coefficients than Aberrometer A, suggesting that wavefront measurements obtained using the two aberrometers are not interchangeable in patients with KC.
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Affiliation(s)
- Shizuka Koh
- Department of Innovative Visual Science (S.K., R.I.), Osaka University Graduate School of Medicine, Osaka, Japan; Department of Ophthalmology (S.K., Y.I., T.S., K.N.), Osaka University Graduate School of Medicine, Osaka, Japan; SEED CO. (R.I.), LTD., Tokyo, Japan; and Department of Orthoptics (T.M.), Faculty of Medical Technology, Teikyo University, Tokyo, Japan
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Lou W, Du W, Jin H, Hu Y. Comparison of anterior corneal aberrations measured by Scheimpflug and Placido Disc System for myopes. BMC Ophthalmol 2022; 22:512. [PMID: 36578031 PMCID: PMC9798706 DOI: 10.1186/s12886-022-02753-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 12/21/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND To ascertain the agreement of corneal aberrations obtained from the Pentacam and the KR-1W in myopic populations and to investigate the influence of the level of myopia as well as the laterality on the agreement. METHODS In this observational study, a rotating Scheimpflug camera (Pentacam AXL) and a Hartmann-Shack wavefront analyzer with Placido-disc topographer (KR-1W) were used to measure the aberrations of myopes in the anterior corneal surface by one experienced operator. All examinations were computed across a 6 mm diameter. Six subgroups were generated according to the degree of myopia (mild, moderate, and severe myopia) and the laterality of eyes (right and left eyes). RESULTS The study included 245 eyes of 170 participants. For certain anterior corneal aberrations, statistically significant differences existed between the Pentacam and the KR-1W (all P < .05). The values of Zernike (Z)(2,0), Z(2,2), Z(3,1), and Z(4,0) varied in all levels of myopia regardless of the laterality, with the values of the Pentacam constantly larger than the KR-1W in the measurement of Z(2,0), Z(2,2), and Z(4,0). For 2nd to 6th aberrations, both instruments correlated poorly to moderately. The width of limits of agreement between the two instruments was clinically too wide (> 0.1 μm) for aberrations closely correlated with visual quality, including Z(3, ± 3), Z(3, ± 1), and Z(4,0), and almost all aberrations, indicating poor agreement. CONCLUSIONS In clinical practice, the Pentacam based on Scheimpflug technology and the KR-1W based on Placido Disc System are not interchangeable in measuring anterior corneal aberration for myopes regardless of myopia degree and the laterality, suggesting that a consistent instrument should be selected for surgical design as well as follow-up.
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Affiliation(s)
- Wei Lou
- grid.452753.20000 0004 1799 2798Department of Ophthalmology, Shanghai East Hospital, Tongji University School of Medicine, No.150 Jimo Road, Shanghai, 200120 China
| | - Wei Du
- grid.16821.3c0000 0004 0368 8293Department of Ophthalmology, Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University, No.600 Yishan Road, Shanghai, 200030 China
| | - Haiying Jin
- grid.452753.20000 0004 1799 2798Department of Ophthalmology, Shanghai East Hospital, Tongji University School of Medicine, No.150 Jimo Road, Shanghai, 200120 China
| | - Ying Hu
- grid.16821.3c0000 0004 0368 8293Department of Ophthalmology, Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University, No.600 Yishan Road, Shanghai, 200030 China
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Koh S, Inoue R, Maeno S, Mihashi T, Maeda N, Jhanji V, Nishida K. Characteristics of Higher-Order Aberrations in Different Stages of Keratoconus. Eye Contact Lens 2022; 48:256-260. [PMID: 35333804 DOI: 10.1097/icl.0000000000000897] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To characterize higher-order aberrations (HOAs) in clinical and subclinical keratoconus (KC). METHODS The study included 33, 36, and 26 patients with clinical, topographic (no clinical signs), and pretopographic (normal topography and no clinical signs) KC and 30 controls. Ocular and corneal HOAs for the 4-mm pupils were measured using a wavefront sensor and expanded up to the sixth order of Zernike polynomials. The magnitudes of trefoil, coma, tetrafoil, secondary astigmatism, and spherical aberration were calculated via Zernike vector analysis and used as HOA parameters along with total HOAs. Area under the receiver operating characteristic curve (AUROC) values for each wavefront parameter for pretopographic KC were compared. RESULTS Control eyes and eyes with pretopographic KC had significantly lower ocular or corneal total HOAs and Zernike vector terms than those with clinical KC and topographic KC, except for ocular tetrafoil between topographic KC and pretopographic KC and spherical aberration among all groups. The AUROCs for corneal total HOAs and corneal coma for pretopographic KC and control eyes were 0.781 (100% sensitivity and 47% specificity) and 0.735 (73% sensitivity and 73% specificity), respectively. CONCLUSION Corneal total HOAs and corneal coma exhibited a potential ability to discriminate pretopographic KC from normal control eyes.
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Affiliation(s)
- Shizuka Koh
- Departments of Innovative Visual Science (S.K., R.I.), and Ophthalmology (S.K., S.M., N.M., K.N.), Osaka University Graduate School of Medicine, Osaka, Japan; SEED Co, Ltd (RI), Tokyo, Japan; Department of Orthoptics (T.M.), Faculty of Medical Technology, Teikyo University, Tokyo, Japan; and Department of Ophthalmology (V.J.), University of Pittsburgh School of Medicine, Pittsburgh, PA
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Kundu G, Shetty R, Ranade R, Trivedi D, Lalgudi VG, Nuijts RMMA, Annavajjhala S, Khamar P. Repeatability and Agreement of a New Scheimpflug Device and a Hartmann-Shack Aberrometer With a Ray-Tracing Aberrometer in Normal, Keratoconus, and CXL Groups. J Refract Surg 2022; 38:201-208. [PMID: 35275005 DOI: 10.3928/1081597x-20220110-01] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE To assess repeatability and agreement of a Scheimpflug topographer and a Hartmann-Shack aberrometer with a ray-tracing aberrometer in normal, keratoconus, and corneal cross-linking (CXL) groups. METHODS In this cross-sectional, observational study, normal, keratoconus, and CXL groups with 125 eyes in each of the three groups were included. All eyes underwent three sets of measurements, at a single visit, using the Pentacam AXL Wave (Oculus Optikgeräte GmbH) and iTrace (Tracey Technologies). Keratometry, pachymetry, objective refraction, and total ocular aberrations including root mean square (RMS) lower order aberrations (LOAs), RMS higher order aberrations (HOAs), RMS coma, and spherical aberrations (SA) were analyzed. Objective assessment of haze after CXL was done using the Pentacam AXL Wave. Repeatability was assessed using within-subject standard deviation (Sw), test-retest variability, within-subject coefficient of variation (COV), and intraclass correlation coefficient (ICC). Bland-Altman analysis assessed 95% limits of agreement and correlation coefficient (r) determined the strength of the relationship between measurements. RESULTS The Pentacam AXL Wave had Sw for keratometry of 0.12 in the normal group and 0.15 in the keratoconus group and lower (poorer) Sw of 0.17 in the CXL group. For pachymetry, Sw was 9.18, 9.53, and 10.11 in the normal, keratoconus, and CXL groups, respectively. Total aberrations had ICCs ranging from 0.88 for RMS HOAs to 0.95 for SA in the normal group, 0.86 for RMS HOAs to 0.92 for SA in the keratoconus group, and 0.72 for RMS HOAs to 0.82 for SA (poorer) in the CXL group. In the normal group, mean differences between the two devices were nonsignificant for all parameters except SA (0.011 ± 0.038 μm, P < .01; limits of agreement = -0.09 to 0.07; r = 0.87). In the keratoconus group, mean differences were significant in all aberrations except RMS LOAs (-0.27 ± 0.85 μm, P = .10; limits of agreement = -3.3 to 3.8; r = 0.92). In the CXL group, all parameters varied significantly (P < .006). CONCLUSIONS The Pentacam AXL Wave showed comparable repeatability in the normal and keratoconus groups, but was poorer in the CXL group, more so with increasing corneal haze. Both devices can be used interchangeably in normal eyes, except for SA, but not in eyes with keratoconus or CXL for aberration measurements. [J Refract Surg. 2022;38(3):201-208.].
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Repeatability and Agreement of Wavefront aberrations of Pentacam AXL Wave- a new hybrid topographer and aberrometer with ITrace in healthy eyes. J Cataract Refract Surg 2021; 48:408-416. [PMID: 34393184 DOI: 10.1097/j.jcrs.0000000000000775] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 08/06/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess repeatability and agreement of Pentacam AXL Wave, with iTrace aberrometer. SETTING Narayana Nethralaya, Bangalore, India. DESIGN Prospective ,cross-sectional study. METHODS One hundred eyes of 100 patients underwent three sets of measurements, at a single visit, using Pentacam AXL Wave (Oculus, Germany) and iTrace (Tracey Technologies, USA).Lower-order aberration (LOA), higher-order aberration (HOA), Coma and Spherical Aberrations (SA) were analyzed. Repeatability was assessed using within-subject standard deviation (Sw), test-retest variability (TRT), within-subject coefficient of variation (COV) and Intraclass Correlation Coefficient (ICC). The Bland-Altman analysis was used to assess 95% limits of agreement (LoA) and the correlation coefficient (r) to determine strength of relationship between measurements. RESULTS All measurements with Pentacam AXL Wave had repeatability with an ICC for total ocular aberrations ranging from 0.84 for HOAto 0.92 for LOA and corneal from 0.76 for HOA to 0.86 for LOA The Sw, TRT, COV of all aberrations were significantly lower (better) than those of iTrace (p < 0.001). The mean differences between 2 devices were insignificant for the comparison of all parameters, except for spherical aberration (0.011(0.002571 to 0.02008; P= 0.01). Both devices showed excellent corelations for ocular aberrations (tHOA (P=0.12,LoA= -0.52 to 0.025; r= 0.89); LOA (P=0.14, LoA = -2.71 to 2.61 ; r= 0.96) coma (P=0.27, LoA = -0.11 to 0.12; r= 0.89) and in SA (P=0.01, LoA = -0.09 to 0.07;r=0.97)). CONCLUSIONS The repeatability estimates for wavefront aberrations using Pentacam AXL Wave were significantly better than that using iTrace. Both devices showed excellent corelations for total ocular aberrations.
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de Asís Bartol-Puyal F, Giménez G, Méndez-Martínez S, Altemir I, Larrosa JM, Polo V, Pablo L. Bias of near-infrared light in evaluation of patients implanted with multifocal intraocular lenses. Int Ophthalmol 2021; 41:3171-3181. [PMID: 34032978 DOI: 10.1007/s10792-021-01882-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 05/12/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To compare visual quality between subjective tests and optical devices using near-infrared (NIR) light in patients implanted with monofocal, multifocal and enlarged depth-of-focus (EDoF) intraocular lenses (IOLs). METHODS Cross-sectional study enrolling patients aged between 55 and 75 (axial length between 22 and 25 mm) bilaterally implanted with Tecnis IOLs (Johnson & Johnson) four months previously: 40 patients (80 eyes) with monofocal ZCB00, 41 patients (82 eyes) with bifocal diffractive ZMB00 and 48 patients (96 eyes) with EDoF Symfony. They were examined using subjective and objective tests. The subjective tests comprised visual acuity (VA) with ETDRS charts, contrast sensitivity (CS) with Pelli-Robson and CSV-1000E tests, and clear vision range (CVR). The objective tests using NIR light were performed with the KR-1 W wavefront analyzer and the OQAS. RESULTS In the subjective tests, the monofocal group achieved the best outcomes in some of the VA and CS sections, while the bifocal group obtained the worst outcomes in some of the CS sections. In the objective tests, the bifocal group achieved the best results for VA and CS. Discrepancies between pseudoaccommodation range and CVR were found in the bifocal and EDoF groups. CONCLUSIONS Assessment of visual quality using NIR light implies greater bias for diffractive lenses than for EDoF lenses. This bias may be even greater with devices using longer light wavelengths or Hartmann-Shack technology. The difference in wavelength between NIR and visible light leads to dimming of near-vision focus and magnification of distance focus.
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Affiliation(s)
- Francisco de Asís Bartol-Puyal
- Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain. .,Miguel Servet Ophthalmology Research Group (GIMSO), Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain. .,University of Zaragoza, Zaragoza, Spain.
| | - Galadriel Giménez
- Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain.,Miguel Servet Ophthalmology Research Group (GIMSO), Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain.,University of Zaragoza, Zaragoza, Spain
| | - Silvia Méndez-Martínez
- Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain.,Miguel Servet Ophthalmology Research Group (GIMSO), Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain.,University of Zaragoza, Zaragoza, Spain
| | - Irene Altemir
- Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain.,Miguel Servet Ophthalmology Research Group (GIMSO), Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain.,University of Zaragoza, Zaragoza, Spain
| | - José Manuel Larrosa
- Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain.,Miguel Servet Ophthalmology Research Group (GIMSO), Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain.,University of Zaragoza, Zaragoza, Spain
| | - Vicente Polo
- Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain.,Miguel Servet Ophthalmology Research Group (GIMSO), Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain.,University of Zaragoza, Zaragoza, Spain
| | - Luis Pablo
- Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain.,Miguel Servet Ophthalmology Research Group (GIMSO), Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain.,University of Zaragoza, Zaragoza, Spain.,Biotech Vision SLP, University of Zaragoza, Zaragoza, Spain
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Delgado-Tirado S, López-Miguel A, Báez-Peralta Y, González-Buendía L, Fernández I, Alió JL, Maldonado MJ, Coco-Martín RM. Monochromatic higher order aberrations in highly myopic eyes with Staphyloma. BMC Ophthalmol 2021; 21:223. [PMID: 34006229 PMCID: PMC8130529 DOI: 10.1186/s12886-021-01965-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 04/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prevalence of high myopia is continuously increasing, thus, patients affected with staphyloma are abundant worldwide. Assessment of the quality of vision in these patients is mandatory for a proper clinical counselling, specially when undergoing surgical procedures that require intraocular lenses implantation. Thus, the purpose of the study was to assess monochromatic higher order aberrations (HOAs) in highly myopic eyes with staphyloma with or without a dome-shaped macula. METHODS Participants underwent spectral-domain optical coherence tomography, ocular axial biometry, dual Scheimpflug photography and integrated Placido disk topography, and Hartmann-Shack wavefront analysis. Five groups were evaluated: a low-moderate myopia control group (< 6.00 diopters, n = 31) and four high myopia (≥6.00 diopters) groups: eyes without staphyloma (n = 18), eyes with inferior staphyloma (n = 14), eyes with posterior staphyloma without dome-shaped macula (n = 15) and eyes with posterior staphyloma with dome-shaped macula (n = 17). Subsequently, two new groups (including all participants) were created to assess differences between myopia with and without staphyloma. One-way analysis of covariance was performed using age and lens densitometry as covariates. RESULTS Statistically significant (p ≤ 0.05) differences in anterior corneal fourth-order HOAs were observed between the low-moderate myopia and no-dome-shaped macula (Mean: 0.16 μm) and dome-shaped macula posterior staphyloma groups (Mean: 0.12 μm) in younger patients (≤45 years old). The same groups also showed (p ≤ 0.05) significant differences for anterior corneal primary spherical aberration (Mean: 0.19 and 0.13 μm, respectively). In addition, anterior corneal tetrafoil was significantly higher (p = 0.04) in dome-shaped macula compared to no-dome-shaped macula (Mean: 0.18 vs 0.06 μm, respectively). When all participants were grouped together, significantly lower mean anterior corneal primary spherical aberration (0.15 μm vs. 0.27 μm, p = 0.004) and higher internal primary spherical aberration (0.04 μm vs. -0.06 μm, p = 0.04) was observed in staphyloma compared to no-staphyloma myopic patients. CONCLUSIONS Eyes with high myopia and staphyloma have less positive anterior corneal primary spherical aberration and less negative internal primary spherical aberration, suggesting that the anterior corneal surface tends to mimic in a specular fashion the posterior pole profile. This corneal behaviour appears to change in patients older than 45 years.
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Affiliation(s)
| | - Alberto López-Miguel
- Instituto de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Valladolid, Spain.,Networks for Cooperative Research in Health (Oftared), Instituto de Salud Carlos III, Madrid, Spain
| | - Yazmin Báez-Peralta
- Instituto de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Valladolid, Spain
| | - Lucía González-Buendía
- Instituto de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Valladolid, Spain
| | - Itziar Fernández
- Instituto de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Valladolid, Spain
| | - Jorge L Alió
- Networks for Cooperative Research in Health (Oftared), Instituto de Salud Carlos III, Madrid, Spain.,Division of Ophthalmology, School of Medicine, Universidad Miguel Hernández, Alicante, Spain
| | - Miguel J Maldonado
- Instituto de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Valladolid, Spain. .,Networks for Cooperative Research in Health (Oftared), Instituto de Salud Carlos III, Madrid, Spain.
| | - Rosa M Coco-Martín
- Instituto de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Valladolid, Spain.,Networks for Cooperative Research in Health (Oftared), Instituto de Salud Carlos III, Madrid, Spain
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A. Bartol-Puyal F, Giménez G, Altemir I, Larrosa J, Polo V, Pablo L. Optical aberrations in three different intraocular lens designs of a same platform. Saudi J Ophthalmol 2021; 35:126-130. [PMID: 35391809 PMCID: PMC8982946 DOI: 10.4103/1319-4534.337865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 06/02/2020] [Accepted: 11/21/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE: To compare internal optical aberrations between three different intraocular lenses (IOL) of the same Tecnis platform: monofocal ZCB00, multifocal ZMB00, and enlarged depth-of-focus (EDoF) Symfony ZXR00. METHODS: We included in this study 236 eyes of 118 patients who had been bilaterally implanted either with the monofocal, the multifocal, or the EDoF IOL. They were examined with the K1-RW wavefront analyzer (Topcon Medical Systems) 2 months after surgery. Patients with any ocular pathology were excluded from the study. Only high-order aberrations (HOA) of the third and fourth orders of the Zernike polynomials were considered. RESULTS: Forty-three patients (86 eyes) were implanted with the monofocal IOL, 45 patients (90 eyes) with the ZMB00 IOL, and 30 patients (60 eyes) with the EDoF Symfony IOL. Mean age was 62.42 ± 7.38, 63.60 ± 6.01, and 64.74 ± 5.84 years, respectively. Mean axial length was 23.37 ± 1.00, 23.49 ± 1.00, and 23.54 ± 0.73 mm, respectively. For a 6-mm pupil, internal total HOA in the monofocal group was 1.01 ± 1.75 μm; in the bifocal group was 1.35 ± 2.12 μm; and in the Symfony group was 0.72 ± 0.63 μm. No optical aberration differences were found among the three groups (P > 0.05). CONCLUSION: There are no differences regarding internal optical aberrations between these three IOLs when analyzing them with optical aberrometry. Patients’ pupil size should be considered for the selection of the most appropriate IOL to be implanted, because despite a same optical platform, every IOL implies a different increase of HOA with larger pupil sizes.
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Suliman A, Rubin A. A review of higher order aberrations of the human eye. AFRICAN VISION AND EYE HEALTH 2019. [DOI: 10.4102/aveh.v78i1.501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Asano H, Hiraoka T, Seki Y, Shibata T, Osada H, Saruta T, Hatsusaka N, Fujikake F, Tabata Y, Mhina C, Sanyiwa A, Oshika T, Sasaki H. Distribution of corneal spherical aberration in a Tanzanian population. PLoS One 2019; 14:e0222297. [PMID: 31513608 PMCID: PMC6742233 DOI: 10.1371/journal.pone.0222297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 08/26/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose To investigate the distribution of corneal spherical aberration (SA) in Tanzanian people of African descent, and to examine the correlation between corneal SA and ocular parameters. Design Cross-sectional population-based study. Methods Residents aged 40 years and older in three villages in the Mkuranga district in Tanzania were enlisted as study participants. Corneal higher-order aberrations (HOAs) for the right eye were measured with a wavefront analyzer (KR-1W, Topcon) and calculated for the central 6.0-mm zone. Corneal curvature radius (CR), corneal astigmatism, and axial length (AL) were also measured and their correlation with corneal SA was assessed. Results The right eyes of 657 participants (336 male, 321 female) were analyzed. The mean age of the subjects was 57.2 ± 10.3 years (mean ± SD). The mean corneal SA (Zernike spherical aberration coefficient C40) was 0.188 ± 0.095 μm (-0.242 to 0.613). The SAs in about three-quarters of all subjects were between 0.10 and 0.30 μm. The root mean squares of total corneal HOAs and the third- and fourth-order aberrations were 0.629 ± 0.250 μm, 0.539 ± 0.236 μm, and 0.269 ± 0.110 μm, respectively. Corneal SA showed weak significant correlations with CR (Spearman’s rank correlation coefficient, r = -0.177, p < 0.001), corneal astigmatism (r = -0.142, p < 0.001), AL (r = -0.168, p < 0.001), and age (r = -0.085, p < 0.05). Conclusions This finding may be beneficial for selecting aspheric intraocular lens in this population.
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Affiliation(s)
- Hiroki Asano
- Department of Ophthalmology, Tsuchiura Kyodo Hospital Namegata District Medical Center, Ibaraki, Japan
- * E-mail:
| | - Takahiro Hiraoka
- Department of Ophthalmology, Institute of Clinical Medicine, University of Tsukuba, Ibaraki, Japan
| | - Yusuke Seki
- Department of Ophthalmology, Kanazawa Medical University, Ishikawa, Japan
| | - Teppei Shibata
- Department of Ophthalmology, Kanazawa Medical University, Ishikawa, Japan
| | - Hiromi Osada
- Department of Ophthalmology, Kanazawa Medical University, Ishikawa, Japan
- Department of Ophthalmology, Nagano Matsushiro General Hospital, Nagano, Japan
| | - Takanori Saruta
- Department of Ophthalmology, Tsuchiura Kyodo Hospital Namegata District Medical Center, Ibaraki, Japan
| | - Natsuko Hatsusaka
- Department of Ophthalmology, Kanazawa Medical University, Ishikawa, Japan
| | - Fukumi Fujikake
- Visual Science Course, Department of Rehabilitation, Faculty of Medical Science and Welfare, Tohoku Bunka Gakuen University, Miyagi, Japan
| | | | - Cellina Mhina
- Department of Ophthalmology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Anna Sanyiwa
- Department of Ophthalmology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Tetsuro Oshika
- Department of Ophthalmology, Institute of Clinical Medicine, University of Tsukuba, Ibaraki, Japan
| | - Hiroshi Sasaki
- Department of Ophthalmology, Kanazawa Medical University, Ishikawa, Japan
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Analysis of Intrasession Repeatability of Ocular Aberrometric Measurements and Validation of Keratometry Provided by a New Integrated System in Mild to Moderate Keratoconus. Cornea 2019; 38:1097-1104. [DOI: 10.1097/ico.0000000000002034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Leisser C, Hirnschall N, Ullrich M, Findl O. Repeatability of wavefront measurements in pseudophakic eyes. SPEKTRUM DER AUGENHEILKUNDE 2019. [DOI: 10.1007/s00717-018-0419-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Intrasession Repeatability and Intersession Reproducibility Measurements Using VX120 Multidiagnostic Unit. Eye Contact Lens 2018; 44 Suppl 2:S266-S272. [PMID: 29461300 DOI: 10.1097/icl.0000000000000486] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The VX120 multidiagnostic unit is a multidiagnostic instrument that combines several functions: autorefraction, keratometry, corneal topography, aberrometry, pachymetry, and noncontact tonometry. The purpose of this study was to determine the intrasession repeatability and the intersession reproducibility of all parameters measured by the VX120 multidiagnostic unit in a sample of normal healthy eyes. METHODS Three repeated measurements in the right eye of the volunteers were taken with VX120. Repeatability of the sphere, cylinder, axis, anterior corneal powers (K flat and K steep, 3-mm pupil), high- and low-order aberration root mean square (HOA-RMS and LOA-RMS, 3-mm pupil), eccentricity, white-to-white (WTW), anterior chamber depth (ACD), and central corneal thickness (CCT) (2-mm central) was analyzed. Within-subject SD (Sw), precision, repeatability, coefficient of variation (CV), and the intraclass correlation coefficient (ICC) were calculated. RESULTS The CV was low for K flat and K steep, WTW, ACD, and CCT with a range from 0.34% to 1.16%. The CV was higher for sphere, cylinder, HOA-RMS, and LOA-RMS and eccentricity with a range among 6.92% to 54.24%. The ICC showed high values in all parameters except in HOA-RMS (0.720-0.776) and eccentricity (0.889) in first session with moderate agreement. Comparing the intrasession repeatability of first and second session, statistically significant differences (P<0.01) were found between both sessions just to the CV for all parameters (except cylinder values) measured with VX120. However, nonstatistically significant differences (P>0.13) were found for Sw, precision, and repeatability values. CONCLUSIONS The VX120 multidiagnostic unit provides repeatable measurements in anterior corneal power (K flat and K steep), WTW, ACD, and CCT. However sphere, cylinder, HOA-RMS, LOA-RMS, and eccentricity showed worse repeatability. Intersession reproducibility showed good results with little differences between sessions in healthy subjects.
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Hayashi K, Sato T, Yoshida M, Yoshimura K. Corneal shape changes of the total and posterior cornea after temporal versus nasal clear corneal incision cataract surgery. Br J Ophthalmol 2018; 103:181-185. [PMID: 29777048 PMCID: PMC6362889 DOI: 10.1136/bjophthalmol-2017-311710] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 04/03/2018] [Indexed: 11/07/2022]
Abstract
Aim To compare changes in the shape and astigmatism of the total and posterior cornea between eyes with a nasal clear corneal incision (CCI) and eyes with a temporal CCI in cataract surgery. Methods The left eyes of 100 patients undergoing phacoemulsification were randomly assigned to undergo a 2.4 mm nasal (nasal CCI group) or temporal CCI (temporal CCI group). Corneal astigmatic changes were compared between groups using power vector analysis, and corneal shape changes were compared using videokeratography maps at 2 days, and at 2, 4 and 8 weeks postoperatively. Results The mean J0 and J45 values of the total cornea were significantly greater in the nasal CCI group than in the temporal CCI group at 2 and 4 weeks postoperatively (p≤0.0392), but did not differ significantly between groups at 2 days and 8 weeks. The videokeratography maps revealed a wedge-shaped flattening in the total cornea and a steepening in the posterior cornea around the CCIs in both groups at 2 days postoperatively; those were more prominent in the nasal CCI group than in the temporal CCI group. The wound-related changes diminished by 8 weeks postoperatively in the total and posterior cornea, and were not markedly different between groups at 8 weeks postoperatively. Conclusion Corneal shape and astigmatic changes were comparable between groups at 8 weeks postoperatively, although the changes were greater after nasal CCI than after temporal CCI in the early postoperative periods, indicating that nasal or temporal CCI can be selected based on the surgeon’s preference.
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Shetty R, Kochar S, Grover T, Khamar P, Kusumgar P, Sainani K, Sinha Roy A. Repeatability of a Commercially Available Adaptive Optics Visual Simulator and Aberrometer in Normal and Keratoconic Eyes. J Refract Surg 2018; 33:769-772. [PMID: 29117417 DOI: 10.3928/1081597x-20170718-02] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 07/14/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the repeatability of aberration measurement obtained by a Hartmann-Shack aberrometer combined with a visual adaptive optics simulator in normal and keratoconic eyes. METHODS One hundred fifteen normal eyes and 92 eyes with grade I and II keratoconus, as per the Amsler-Krumeich classification, were included in the study. To evaluate the repeatability, three consecutive measurements of ocular aberrations were obtained by a single operator. Zernike analyses up to the 5th order for a pupil size of 4.5 mm were performed. Statistical analyses included the intraclass correlation coefficient (ICC) and within-subject standard deviation (SD). RESULTS For intrasession repeatability, the ICC value for sphere and cylinder was 0.94 and 0.93 in normal eyes and 0.98 and 0.97 in keratoconic eyes, respectively. The ICC for root mean square of higher order aberrations (HOARMS) was 0.82 in normal and 0.98 in keratoconic eyes. For 3rd order aberrations (trefoil and coma), the ICC values were greater than 0.87 for normal eyes and greater than 0.92 for keratoconic eyes. The ICC for spherical aberration was 0.92 and 0.90 in normal and keratoconic eyes, respectively. CONCLUSIONS Visual adaptive optics provided repeatable aberrometry data in both normal and keratoconic eyes. For most of the parameters, the repeatability in eyes with early keratoconus was somewhat better than that for normal eyes. The repeatability of the Zernike terms was acceptable for 3rd order (trefoil and coma) and spherical aberrations. Therefore, visual adaptive optics was a suitable tool to perform repeatable aberrometric measurements. [J Refract Surg. 2017;33(11):769-772.].
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Xu Z, Hua Y, Qiu W, Li G, Wu Q. Precision and agreement of higher order aberrations measured with ray tracing and Hartmann-Shack aberrometers. BMC Ophthalmol 2018; 18:18. [PMID: 29374460 PMCID: PMC5787271 DOI: 10.1186/s12886-018-0683-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Accepted: 01/16/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To assess the precision and agreement of measurements of higher order aberrations (HOAs) obtained with a ray tracing aberrometer (iTrace) and a Hartmann-Shack aberrometer (Topcon KR-1 W). METHODS Prospective evaluation of the diagnostic test. Data from the right eyes of 92 normal subjects obtained using the two devices were included in this study. Two observers performed 3 consecutive scans to determine the intraobserver repeatability and interobserver reproducibility. About one week later, one observer performed an additional 3 consecutive scans to obtain the intersession reproducibility. The within-subject standard deviation (Sw), test-retest repeatability (TRT) and intraclass correlation coefficient (ICC) were used to assess the precision, while Bland-Altman plots were performed to assess the agreement. RESULTS For intraobserver repeatability of the ocular, corneal and internal HOAs, Topcon KR-1 W showed a 2.77Sw of 0.079 μm or less and ICCs of 0.761 or more; and iTrace showed a 2.77Sw of 0.105 μm or less and ICCs of 0.805 or more. The ICCs of the internal HOAs of interobserver reproducibility were less than 0.75 except for spherical aberration (SA) (0.862), and interobserver reproducibility of the counterpart showed similar but lower results. For the ocular, corneal and internal HOA measurements, statistically significant differences existed between the Topcon KR-1 W and iTrace (all P < 0.05). No significant differences were observed in the ocular SA and internal coma. CONCLUSIONS The ray tracing and Hartmann-Shack method aberrometers provided excellent repeatability but less reliable reproducibility in the measurement of HOAs (except for SA). The two aberrometers should not be interchangeable in clinical application because of the significant differences in HOA measurements between them.
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Affiliation(s)
- Zequan Xu
- Department of Ophthalmology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, NO. 600, Yishan Road, Xuhui District, Shanghai, 200233, China
| | - Yanjun Hua
- Department of Ophthalmology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, NO. 600, Yishan Road, Xuhui District, Shanghai, 200233, China
| | - Wei Qiu
- Department of Ophthalmology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, NO. 600, Yishan Road, Xuhui District, Shanghai, 200233, China
| | - Guoqiang Li
- Visual and Biomedical Optics Lab, Department of Ophthalmology and Visual Science, The Ohio State University, 1330 Kinnear Road, Columbus, OH, USA
| | - Qiang Wu
- Department of Ophthalmology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, NO. 600, Yishan Road, Xuhui District, Shanghai, 200233, China.
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Piñero DP, Cabezos I, López-Navarro A, de Fez D, Caballero MT, Camps VJ. Intrasession repeatability of ocular anatomical measurements obtained with a multidiagnostic device in healthy eyes. BMC Ophthalmol 2017; 17:193. [PMID: 29047369 PMCID: PMC5648429 DOI: 10.1186/s12886-017-0589-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 10/16/2017] [Indexed: 11/10/2022] Open
Abstract
Background To evaluate the intrasession repeatability of anterior chamber depth (ACD), central (CCT) and peripheral corneal thickness (PCT), white-to-white diameter (WTW), and irido-corneal angle (IA) measurements obtained with a multidiagnostic device in healthy eyes. Methods A total of 107 eyes of 107 patients ranging in age from 23 to 65 years were examined with the VX120 system (Visionix-Luneau Technologies). Three consecutive measurements were obtained with this device to assess the intrasession repeatability of ACD, CCT, PCT at different nasal and temporal locations, WTW, and nasal and temporal IA. Data analysis included the calculation of within-subject standard deviation (Sw), intrasubject precision (1.96xSw), coefficient of variation (CV) and intraclass correlation coefficient (ICC). Results The Sw and CV for ACD was 0.03 mm and 1.16%, respectively, with an ICC of 0.992. The Sw values for central and peripheral pachymetric measurements were below 9 μm, with CV of less than 1.6% and ICC of 0.976 or higher. For IA measurements, Sw values of 0.84 or lower were found, with a CV between 1 and 2%, and an ICC of more than 0.970. The Sw for WTW was 0.24 mm and the CV was 1.95%. No statistically significant correlations were found between any anatomical parameter evaluated and their Sw and CV values associated (−0.220 ≤ r ≤ 0.204, p ≥ 0.125). Conclusions The VX120 system is able to provide repeatable measurements of anatomical parameters in healthy eyes. Inter-observer repeatability should be evaluated in future studies.
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Affiliation(s)
- David P Piñero
- Group of Optics and Visual Perception, Department of Optics, Pharmacology and Anatomy, University of Alicante, Crta San Vicente del Raspeig s/n 03016, San Vicente del Raspeig, Alicante, Spain.
| | - Inmaculada Cabezos
- Group of Optics and Visual Perception, Department of Optics, Pharmacology and Anatomy, University of Alicante, Crta San Vicente del Raspeig s/n 03016, San Vicente del Raspeig, Alicante, Spain
| | | | - Dolores de Fez
- Group of Optics and Visual Perception, Department of Optics, Pharmacology and Anatomy, University of Alicante, Crta San Vicente del Raspeig s/n 03016, San Vicente del Raspeig, Alicante, Spain
| | - María T Caballero
- Group of Optics and Visual Perception, Department of Optics, Pharmacology and Anatomy, University of Alicante, Crta San Vicente del Raspeig s/n 03016, San Vicente del Raspeig, Alicante, Spain
| | - Vicente J Camps
- Group of Optics and Visual Perception, Department of Optics, Pharmacology and Anatomy, University of Alicante, Crta San Vicente del Raspeig s/n 03016, San Vicente del Raspeig, Alicante, Spain
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Fukuoka S, Arita R, Shirakawa R, Morishige N. Changes in meibomian gland morphology and ocular higher-order aberrations in eyes with chalazion. Clin Ophthalmol 2017; 11:1031-1038. [PMID: 28615923 PMCID: PMC5460643 DOI: 10.2147/opth.s133060] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To examine the changes in meibomian gland morphology and ocular higher-order aberrations (HOAs) in eyes with chalazion and its excision. METHODS Seven male patients with previous history of chalazion excision and seven control male subjects were enrolled. Changes in meibomian gland morphology (meiboscores, gland dropout, and shortening) were evaluated by using meibography equipped in a wavefront analyzer KR-1W and in a slit-lamp device BG-4M. Ocular HOAs were measured sequentially with KR-1W. The tear film breakup time (BUT) was measured. RESULTS Both KR-1W and BG-4M visualized meibomian gland as clear similar images. The tear film BUT (mean ± SD, 5.6±3.0 vs 9.4±2.3 seconds, P=0.025), the total meiboscore (median [interquartile range], 2 (2-3) vs 0 (0-1), P=0.007) as well as the meibomian gland dropout rate (86% vs 14%, P=0.008) and shortening rate (100% vs 29%, P=0.031) differed significantly between the patient and control groups. The first total ocular HOAs (0.142±0.063 vs 0.130±0.015, P=0.80) were similar in both groups, whereas the stability index of the total HOAs over time (0.0041±0.0048 vs -0.0012±0.0020, P=0.030) differed significantly between the patient and control groups. CONCLUSIONS Chalazion and its excision were associated with dropout and shortening rate of meibomian glands. The morphological changes of meibomian glands in chalazion may be associated to instability of the tear film, which was suggested by the tear film BUT and the stability of ocular HOAs.
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Affiliation(s)
- Shima Fukuoka
- Department of Ophthalmology, Omiya Hamada Eye Clinic.,Lid and Meibomian Gland Working Group (LIME), Saitama-shi, Saitama.,Department of Ophthalmology, University of Tokyo School of Medicine, Bunkyo-ku, Tokyo
| | - Reiko Arita
- Lid and Meibomian Gland Working Group (LIME), Saitama-shi, Saitama.,Department of Ophthalmology, University of Tokyo School of Medicine, Bunkyo-ku, Tokyo.,Department of Ophthalmology, Itoh Clinic, Saitama-shi, Saitama
| | - Rika Shirakawa
- Lid and Meibomian Gland Working Group (LIME), Saitama-shi, Saitama.,Department of Ophthalmology, University of Tokyo School of Medicine, Bunkyo-ku, Tokyo
| | - Naoyuki Morishige
- Lid and Meibomian Gland Working Group (LIME), Saitama-shi, Saitama.,Department of Ophthalmology, Oshima Eye Hospital, Fukuoka-shi, Fukuoka, Japan
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Ortiz-Toquero S, Rodriguez G, de Juan V, Martin R. Repeatability of Wavefront Aberration Measurements With a Placido-Based Topographer in Normal and Keratoconic Eyes. J Refract Surg 2017; 32:338-44. [PMID: 27163620 DOI: 10.3928/1081597x-20160121-04] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 12/03/2015] [Indexed: 12/26/2022]
Abstract
PURPOSE To determine and compare the repeatability of anterior corneal higher order aberrations (HOAs) using a Placido-based topographer (Allegro Topolyzer; WaveLight Technologie AG, Alcon Laboratories, Erlangen, Germany) in a sample of normal and keratoconic eyes. METHODS Three repeated measurements of each cornea of normal and keratoconic eyes were taken with the Allegro Topolyzer. Repeatability of the HOAs (3rd- and 4th-order individual values and normalized polar Zernike coefficients, coma-like, root mean square (RMS) up to 8th-order values, HOA RMS, and total RMS for 6-mm pupil diameter) and central corneal power (3-mm pupil) were analyzed. Within-subject standard deviation (Sw), precision, repeatability, coefficient of variation (CV), and the intraclass correlation coefficient (ICC) were calculated. RESULTS Zernike coefficients were significantly different between the normal (36 eyes of 36 patients) and keratoconus (36 eyes of 36 patients) groups (P ≤ .03) except in Z(+1) 3, Z(+3) 3, Z(-4) 4, and Z(+4) 4. In the normal group, Sw was 0.031 µm or less, CV ranged from 6.49% (spherical aberration) to 37.18% (secondary astigmatism), and ICC values ranged from 0.227 to 0.982. In the keratoconus group, Sw was 0.059 µm or less, CV ranged from 2.06% (total RMS) to 25.82% (tetrafoil), and ICC values ranged from 0.839 to 0.996. In analyzing the keratoconus stages (Amsler-Krumeich classification), the repeatability of the Zernike coefficients tended to improve with increasing keratoconus stage. CONCLUSIONS The repeatability of corneal wavefront aberration provided by the Allegro Topolyzer was better in keratoconic eyes (good and moderate repeatability) than in normal eyes (moderate and poor repeatability). These results are important to eye care practitioners and refractive surgeons during refractive surgery planning or keratoconus detection, classification, and management. [J Refract Surg. 2016;32(5):338-344.].
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Otero C, Vilaseca M, Arjona M, Martínez-Roda JA, Pujol J. Comparison of the Adaptive Optics Vision Analyzer and the KR-1 W for measuring ocular wave aberrations. Clin Exp Optom 2016; 100:26-32. [PMID: 27432594 DOI: 10.1111/cxo.12413] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 01/05/2016] [Accepted: 01/07/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The aim was to assess the agreement in the measurement of ocular aberrations between a new Adaptive Optics Vision Analyzer (AOVA, Voptica, Murcia, Spain) and a commercial aberrometer (KR-1 W, Topcon, Tokyo, Japan), both based on the Hartmann-Shack technique. METHODS One experienced examiner measured 29 healthy right eyes nine consecutive times with the two instruments. The individual Zernike coefficients and the root mean square (RMS) of each order from the second to the fifth order, the higher-order RMS (RMSHOA ), the total RMS (RMSTOT ) and the values of the spherical equivalent (M) and Jackson cross-cylinder (J0 and J45 ) were compared. All aberrations were computed for a 4.0 mm pupil diameter. RESULTS Bland and Altman analysis showed good agreement between instruments and most of the parameters showed no statistically significant differences. Although the largest mean differences were obtained for the defocus coefficient C(2,0) and the spherical equivalent (M) with a mean difference (and standard deviation) of 0.190 ± 0.099 µm and -0.150 ± 0.188 D, respectively, they were clinically acceptable and significant correlations were found between the AOVA and KR-1 W for the major refractive components such as spherical equivalent (r = 0.995, p < 0.001), J0 (r = 0.964, p < 0.001), J45 (r = 0.901, p < 0.001) and C(4,0) (r = 0.575, p = 0.001). CONCLUSION The results suggest good agreement between instruments. Accommodation and misalignment of the measurements may play a role in some of the statistically significant differences that were obtained, specifically for defocus C(2,0), vertical coma C(3,-1) and spherical aberration C(4,0) coefficients; however, these differences were clinically irrelevant.
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Affiliation(s)
- Carles Otero
- Davalor Research Center (DRC), Universitat Politècnica de Catalunya, Terrassa, Spain
| | - Meritxell Vilaseca
- Davalor Research Center (DRC), Universitat Politècnica de Catalunya, Terrassa, Spain
| | - Montserrat Arjona
- Davalor Research Center (DRC), Universitat Politècnica de Catalunya, Terrassa, Spain
| | - Joan A Martínez-Roda
- Centre for Sensors, Instruments and Systems Development (CD6), Universitat Politècnica de Catalunya, Terrassa, Spain
| | - Jaume Pujol
- Centre for Sensors, Instruments and Systems Development (CD6), Universitat Politècnica de Catalunya, Terrassa, Spain
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Prakash G, Jhanji V, Srivastava D, Suhail M, Rong SS, Bacero R, Philip R. Single Session, Intra-observer Repeatability of an Advanced New Generation Hartmann-Shack Aberrometer in Refractive Surgery Candidates. J Ophthalmic Vis Res 2016; 10:498-501. [PMID: 27051500 PMCID: PMC4795405 DOI: 10.4103/2008-322x.176893] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Gaurav Prakash
- Department of Cornea and Refractive Surgery, NMC Eye Care, New Medical Center Specialty Hospital, Abu Dhabi, United Arab Emirates
| | - Vishal Jhanji
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Dhruv Srivastava
- Department of Cornea and Refractive Surgery, NMC Eye Care, New Medical Center Specialty Hospital, Abu Dhabi, United Arab Emirates
| | - Muhammad Suhail
- Department of Cornea and Refractive Surgery, NMC Eye Care, New Medical Center Specialty Hospital, Abu Dhabi, United Arab Emirates
| | - Shi-Song Rong
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Ruthchel Bacero
- Department of Cornea and Refractive Surgery, NMC Eye Care, New Medical Center Specialty Hospital, Abu Dhabi, United Arab Emirates
| | - Reena Philip
- Department of Cornea and Refractive Surgery, NMC Eye Care, New Medical Center Specialty Hospital, Abu Dhabi, United Arab Emirates
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Hao J, Li L, Tian F, Zhang H. Comparison of two types of visual quality analyzer for the measurement of high order aberrations. Int J Ophthalmol 2016; 9:292-7. [PMID: 26949654 DOI: 10.18240/ijo.2016.02.22] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 03/04/2015] [Indexed: 11/23/2022] Open
Abstract
AIM To compare the difference and agreement of KR-1W and iTrace for measurement of high order aberrations. METHODS KR-1W and iTrace were respectively used in a group of healthy people (40 volunteers, 32 eyes) to measure the high order aberration (HOA) of corneal, internal and total ocular. The clinical difference and agreement of two instruments were respectively evaluated by paired-samples t-test and Bland-Altman analysis. RESULTS The paired-samples t-test showed that the corneal HOA measured by the two instruments had no statistical differences (P>0.05); but the internal and total ocular HOA had significant statistical differences (P<0.05), and the mean results measured by iTrace were higher than that of KR-1W. However, Bland-Altman analysis revealed that the HOA of corneal and internal were all in 95% limits of agreement; and just one point of total ocular HOA was beyond the 95% limits of agreement. CONCLUSION KR-1W and iTrace were consistent well in the measurement of corneal, internal and total ocular HOA, especially for the cornea.
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Affiliation(s)
- Jing Hao
- Department of Cataract, Tianjin Medical University Eye Hospital, Tianjin 300384, China; North China University of Science and Technology, Tangshan 063000, Hebei Province, China
| | - Lin Li
- Tangshan Gongren Hospital, Tangshan 063000, HeBei, China
| | - Fang Tian
- Department of Cataract, Tianjin Medical University Eye Hospital, Tianjin 300384, China
| | - Hong Zhang
- Department of Cataract, Tianjin Medical University Eye Hospital, Tianjin 300384, China
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Precision (Repeatability and Reproducibility) and Agreement of Corneal Power Measurements Obtained by Topcon KR-1W and iTrace. PLoS One 2016; 11:e0147086. [PMID: 26752059 PMCID: PMC4709181 DOI: 10.1371/journal.pone.0147086] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 12/26/2015] [Indexed: 11/19/2022] Open
Abstract
Purpose To evaluate the repeatability and reproducibility of corneal power measurements obtained by Topcon KR-1W and iTrace, and assess the agreement with measurements obtained by Allegro Topolyzer and IOLMaster. Methods The right eyes of 100 normal subjects were prospectively scanned 3 times using all the 4 devices. Another observer performed additional 3 consecutive scans using the Topcon KR-1W and iTrace in the same session. About one week later, the first observer repeated the measurements using the Topcon KR-1W and iTrace. The steep keratometry (Ks), flat keratometry (Kf), mean keratometry (Km), J0 and J45 were analyzed. Repeatability and reproducibility of measurements were evaluated by the within-subject standard deviation (Sw), coefficient of variation (CoV), test-retest repeatability (2.77Sw), and intraclass correlation coefficient (ICC). Agreements between devices were assessed using Bland-Altman analysis and 95% limits of agreement (LoA). Results Intraobserver repeatability and interobserver and intersession reproducibility of the Ks, Kf and Km showed a CoV of no more than 0.5%, a 2.77Sw of 0.70 D or less, and an ICC of no less than 0.99. However, J0 and J45 showed poor intraobserver repeatability and interobserver and intersession reproducibility (all ICCs not greater than 0.446). Statistically significant differences existed between Topcon KR-1W and IOLMaster, Topcon KR-1W and iTrace, Topcon KR-1W and Topolyzer, iTrace and Topolyzer, iTrace and IOLMaster for Ks, Kf and Km measurements (all P < 0.05). The mean differences between Topcon KR-1W, iTrace, and the other 2 devices were small. The 95% LoA were approximately 1.0 D to 1.5 D for all measurements. Conclusions The Ks, Kf and Km obtained by Topcon KR-1W and iTrace showed excellent intraobserver repeatability and interobserver and intersession reproducibility in normal eyes. The agreement between Topcon KR-1W and Topolyzer, Topcon KR-1W and IOLMaster, iTrace and Topolyzer, iTrace and IOLMaster, Topcon KR-1W and iTrace were not so good, they should not be interchangeable in clinical application. Given that the intraobserver repeatability and interobserver and intersession reproducibility of corneal astigmatism measurements obtained by Topcon KR-1W and iTrace were poor, it should be cautious that Topcon KR-1W and iTrace were applied for the preparation of toric lens implantation.
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Otero C, Vilaseca M, Arjona M, Martínez-Roda JA, Pujol J. Repeatability of aberrometric measurements with a new instrument for vision analysis based on adaptive optics. J Refract Surg 2015; 31:188-94. [PMID: 25751836 DOI: 10.3928/1081597x-20150224-03] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 01/19/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate intersession and intrasession repeatability of aberration data obtained with a new visual simulator based on adaptive optics, which includes a Hartmann-Shack aberrometer (Adaptive Optics Vision Analyzer; Voptica S.L., Murcia, Spain). METHODS Thirty-one healthy right eyes were included in the study. To evaluate intrasession repeatability, three consecutive measurements without repositioning the patient or realigning the eye were obtained. Intersession repeatability was evaluated in three sessions. Aberrometric data computed from the second to the fifth order for a 4-mm pupil were used. Statistical analysis included the repeated measures analysis of variance (or the Wilcoxon signed rank test), the coefficient of repeatability, the Bland-Altman method, and the intraclass correlation coefficient. RESULTS No significant differences in the intrasession and intersession repeatability analysis for any of the parameters (P > .05) were found, suggesting a consistent variability of the instrument over time. Similar coefficient of repeatability values were obtained in the three sessions. The Bland-Altman analysis confirmed differences close to zero and the variations were independent of the mean within and between sessions. The intersession intraclass correlation coefficient values were generally above 0.75, suggesting moderate to high repeatability. However, some exceptions were found in the intrasession analysis. CONCLUSIONS The findings suggest that the new instrument provides consistent and repeatable aberrometric data. It is therefore a suitable tool to perform consistent and repeatable visual simulations.
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Kanellopoulos AJ, Asimellis G, Georgiadou S. Digital pupillometry and centroid shift changes after cataract surgery. J Cataract Refract Surg 2015; 41:408-14. [DOI: 10.1016/j.jcrs.2014.05.049] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Revised: 05/21/2014] [Accepted: 05/26/2014] [Indexed: 10/24/2022]
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Zhu X, Ye H, Yang J, Lu Y. Effect of pupil size on higher-order aberrations in high-myopic pseudophakic eyes with posterior staphyloma. Eye (Lond) 2014; 29:98-105. [PMID: 25323850 DOI: 10.1038/eye.2014.242] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 09/10/2014] [Indexed: 01/19/2023] Open
Abstract
PURPOSE To evaluate the effect of pupil size on higher-order aberrations (HOAs) in high-myopic pseudophakic eyes with posterior staphyloma using KR-1W aberrometer. METHODS Forty eyes of 40 high-myopic cataract patients with posterior staphyloma and 20 eyes of 20 age-related cataract patients with normal axial length were recruited. At 1 month after phacoemulsification and intraocular lens implantation, ocular and internal HOAs as well as the visual quality data in the two groups were evaluated with KR-1W analyzer before and after mydriasis. RESULTS Compared with normal axial length eyes, high-myopic pseudophakic eyes with posterior staphyloma had significantly lower values of internal coma both under 4-mm and 6-mm pupil sizes (P<0.001 and 0.020), as well as internal total HOAs (P<0.001) and third-order aberrations at 6-mm pupil size (P=0.018). Statistically significant differences were also found in the variation from 4- to 6-mm pupil sizes for internal coma (P=0.001), internal third-order aberrations (P=0.009), internal total HOAs (P=0.007), and ocular coma aberrations (P=0.006) between two groups. After mydriasis, Strehl ratio increased significantly in high-myopic eyes, whereas decreased slightly in normal axial length eyes (P=0.032 when compared with the variation between the two groups). Statistically significant differences were also found for the variation of modulation transfer functions (MTFs) at frequencies of 15, 30, 45, and 60 cycles/degree between the two groups (P=0.002, 0.002, 0.004, and 0.010, respectively). CONCLUSIONS High-myopic pseudophakic eyes with posterior staphyloma had significantly lower internal coma and less coma variations during mydriasis.
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Affiliation(s)
- X Zhu
- Department of Ophthalmology, Eye and Ear, Nose, and Throat Hospital of Fudan University, Shanghai, People's Republic of China
| | - H Ye
- Department of Ophthalmology, Eye and Ear, Nose, and Throat Hospital of Fudan University, Shanghai, People's Republic of China
| | - J Yang
- Department of Ophthalmology, Eye and Ear, Nose, and Throat Hospital of Fudan University, Shanghai, People's Republic of China
| | - Y Lu
- Department of Ophthalmology, Eye and Ear, Nose, and Throat Hospital of Fudan University, Shanghai, People's Republic of China
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Park JH, Ahn DS, Moon SJ, Lee DJ, Han SY, Lee KH. Clinical Results and Optical Quality of Diffractive Multifocal IOL Implantation after Myopic Refractive Surgery. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2014. [DOI: 10.3341/jkos.2014.55.12.1779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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