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Schnider C, Yuen L, Rampat R, Zhu D, Dhallu S, Trinh T, Gurnani B, Abdelmaksoud A, Bhogal-Bhamra G, Wolffsohn JS, Naroo SA. BCLA CLEAR presbyopia: Management with intraocular lenses. Cont Lens Anterior Eye 2024; 47:102253. [PMID: 39068141 DOI: 10.1016/j.clae.2024.102253] [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] [Indexed: 07/30/2024]
Abstract
Cataract surgery including intraocular lens (IOL) insertion, has been refined extensively since the first such procedure by Sir Harold Ridley in 1949. The intentional creation of monovision with IOLs using monofocal IOL designs has been reported since 1984. The first reported implantation of multifocal IOLs was published in 1987. Since then, various refractive and or diffractive multifocal IOLs have been commercialised. Most are concentric, but segmented IOLs are also available. The most popular are trifocal designs (overlaying two diffractive patterns to achieve additional focal planes at intermediate and near distances) and extended depth of focus designs which leave the patient largely spectacle independent with the reduced risk of bothersome contrast reduction and glare. As well as mini-monovision, surgical strategies to minimise the impact of presbyopia with IOLs includes mixing and matching lenses between the eyes and using IOLs whose power can be adjusted post-implantation. Various IOL designs to mimic the accommodative process have been tried including hinge optics, dual optics, lateral shifts lenses with cubic-type surfaces, lens refilling and curvature changing approaches, but issues in maintaining the active mechanism with post-surgical fibrosis, without causing ocular inflammation, remain a challenge. With careful patient selection, satisfaction rates with IOLs to manage presbyopia are high and anatomical or physiological complications rates are no higher than with monofocal IOLs.
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Affiliation(s)
| | - Leonard Yuen
- ONE Medical Doctors Group & Day Surgical Centre, Quarry Bay, Hong Kong
| | | | - Dagny Zhu
- NVISION Eye Centers Rowland Heights, CA, USA
| | - Sandeep Dhallu
- Department of Clinical, Pharmaceutical and Biological Science, University of Hertfordshire, Hatfield, UK
| | - Tanya Trinh
- Mosman Eye Clinic, Sydney, New South Wales, Australia; Sydney Hospital and Sydney Eye Hospital, New South Wales, Australia
| | - Bharat Gurnani
- Gomabai Netralaya and Research Centre, Neemuch, Madhya Pradesh, India
| | | | | | - James S Wolffsohn
- College of Health & Life Sciences, Aston University, Birmingham, United Kingdom
| | - Shehzad A Naroo
- College of Health & Life Sciences, Aston University, Birmingham, United Kingdom.
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Petelczyc K, Bolek J, Kakarenko K, Krix-Jachym K, Kołodziejczyk A, Rękas M. Use of the perceptual point-spread function to assess dysphotopsias. PLoS One 2024; 19:e0306331. [PMID: 39028737 PMCID: PMC11259305 DOI: 10.1371/journal.pone.0306331] [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] [Received: 12/07/2023] [Accepted: 06/14/2024] [Indexed: 07/21/2024] Open
Abstract
Nowadays many patients are choosing EDOF or multifocal lenses for replacement of natural lens in cataract surgery. This can result in issues such as presence of dysphotopsias, namely halo and glare. In this work, we propose a new perimetry method to describe dysphotopsias in far-field region in a presence of bright, point-like light source. We constructed a custom device and designed measurement procedure for quantitative measurement of dysphotopias in the center of visual field and used it to examine patients with mild cataracts or implanted IOLs. Our approach may help in establishing an objective method to study and compare dysphotopsias.
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Affiliation(s)
| | - Jan Bolek
- Faculty of Physics, Warsaw University of Technology, Warsaw, Poland
| | - Karol Kakarenko
- Faculty of Physics, Warsaw University of Technology, Warsaw, Poland
| | | | | | - Marek Rękas
- Ophthalmology Department, Military Institute of Medicine, Warsaw, Poland
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3
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Balas M, Mathew DJ. Dysphotopsia and location of laser iridotomy: a systematic review. Eye (Lond) 2024; 38:1240-1245. [PMID: 38195925 PMCID: PMC11076597 DOI: 10.1038/s41433-023-02913-1] [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: 07/19/2023] [Revised: 10/30/2023] [Accepted: 12/20/2023] [Indexed: 01/11/2024] Open
Abstract
This systematic review aimed to clarify the relationship between the location of laser peripheral iridotomy (LPI), a common procedure to prevent or treat angle-closure glaucoma, and the incidence of post-procedure visual disturbances known as dysphotopsias. Understanding this relationship is crucial due to the high frequency of LPIs performed and the significant impact dysphotopsia can have on vision and quality of life. Articles investigating the relationship between LPI location and dysphotopsia in at least five patients were identified via a literature search of OVID MEDLINE (1946-November 19, 2022) and EMBASE (1946-November 19, 2022). Non-comparative and non-English studies were excluded. Studies did not require a control group to be included. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system and Cochrane Risk of Bias 2 (RoB2) tool were used to appraise included studies. Our review included three studies encompassing 1756 eyes from 878 patients. The location of LPI was grouped into superior (604 patients, 889 eyes), inferior (150 patients, 150 eyes), and nasal/temporal (443 patients, 717 eyes). The analysis showed no significant difference in the incidence of any new dysphotopsia types among the location groups post-LPI. Overall, the incidence of lines, ghost images, and blurring significantly increased after LPI, while halos and glare significantly decreased. In conclusion, the current literature suggests that the location of LPI has no significant relationship to the types and rates of dysphotopsia experienced thereafter. While there is a 2-3% risk of linear dysphotopsia after LPI regardless of location, LPI may also resolve pre-existing halos and glare.
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Affiliation(s)
- Michael Balas
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - David J Mathew
- Donald K. Johnson Eye Institute, Krembil Research Institute, University Health Network, Toronto, ON, Canada.
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada.
- Department of Lab Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.
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Bhogal-Bhamra GK, Aujla M, Kolli S, Sheppard AL, Wolffsohn JS. Glare prediction and mechanism of adaptation following implantation of hydrophilic and hydrophobic intraocular lenses. FRONTIERS IN OPHTHALMOLOGY 2024; 4:1310468. [PMID: 38984113 PMCID: PMC11182291 DOI: 10.3389/fopht.2024.1310468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 04/01/2024] [Indexed: 07/11/2024]
Abstract
Purpose Glare is a known side effect of intraocular lens (IOL) implantation, affected principally by IOL material and optics, although it is reported subjectively to decrease in impact with time. However, little objective data have been published on changes over time, how these relate to subjective reports, and whether those who will report greater glare symptoms can be predicted prior to IOL implantation. Methods A total of 32 patients (aged 72.4 ± 8.0 years) with healthy eyes were implanted bilaterally with hydrophilic 600s (Rayner, Worthing, UK) or hydrophobic Acrysof (Alcon, Texas, USA) acrylic IOLs (n = 16 each, randomly assigned). Each patient reported their dysphotopsia symptoms subjectively using the validated forced choice photographic questionnaire for photic phenomena, and halo size resulting from a bright light in a dark environment was quantified objectively in eight orientations using the Aston Halometer. Assessment was performed binocularly pre-operatively and at 1, 2, 3, and 4 weeks after IOL implantation. Setting The study was carried out at the National Health Service Ophthalmology Department, Queen Elizabeth Hospital, Birmingham, UK. Results Visual acuity (average 0.37 ± 0.26 logMAR) did not correlate with subjective glare (r = 0.184, p = 0.494) or objective glare (r = 0.294, p = 0.270) pre-surgery. Objective halo size (F = 112.781, p < 0.001) decreased with cataract removal and IOL implantation and continued to decreased over the month after surgery. Subjective dysphotopsia complaints (p < 0.001) were also greater pre-surgery, but did not change thereafter (p = 0.228). In neither case was there a difference with IOL material (p > 0.05). It was not possible to predict post-surgery dysphotopsia from symptoms or a ratio of symptoms to halo size pre-surgery (p > 0.05). Conclusions Subjective dysphotopsia and objective halos caused by cataracts are greatly reduced by implantation of IOL after cataract removal causing few perceivable symptoms. However, objective measures are able to quantify a further reduction in light scatter over the first month post-IOL implantation, suggesting that any subjective effects over this period are due to the healing process and not due to neuroadaptation.
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Affiliation(s)
- Gurpreet K Bhogal-Bhamra
- Ophthalmic Research Group, Aston University, Birmingham, United Kingdom
- University Hospitals Trust, Ophthalmology, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Maana Aujla
- Ophthalmic Research Group, Aston University, Birmingham, United Kingdom
| | - Sai Kolli
- University Hospitals Trust, Ophthalmology, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Amy L Sheppard
- Ophthalmic Research Group, Aston University, Birmingham, United Kingdom
| | - James S Wolffsohn
- Ophthalmic Research Group, Aston University, Birmingham, United Kingdom
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Xing MJ, Moulin TA, Suresh T, Gira JP, Sheybani A, Van Stavern GP. Migraine is a risk factor for pseudophakic positive dysphotopsia following monofocal lens implantation. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024:S0008-4182(24)00059-0. [PMID: 38503405 DOI: 10.1016/j.jcjo.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 11/13/2023] [Accepted: 02/25/2024] [Indexed: 03/21/2024]
Abstract
OBJECTIVE To identify neuroadaptation-related risk factors for persistent positive dysphotopsia (>6 months) following monofocal lens implantation. DESIGN Retrospective cohort study. PARTICIPANTS Patients of an academic institution and a private practice in Saint Louis, Missouri. Inclusion criteria were adults with cataract extraction between January 2010 and April 2021 with monofocal intraocular lens implantation. Exclusion criteria included dementia, <20/40 acuity, visual pathway damage, visual field loss, and significant pathology causing photopsia. METHODS Participants were surveyed via telephone. RESULTS There were 385 participants (385 eyes), of whom 66 had persistent dysphotopsia (58 positive), 298 had none, and 21 had nonpersistent dysphotopsia. Among the 58 who had positive persistent dysphotopsia, mean Pseudophakic Dysphotopsia Questionnaire 6 (PDQ-6) score was 14.11 (SD, 8.46). There were no significant differences in sex or race. Migraine prevalence was greater among those with dysphotopsia (21.2%) than among those without (11.4%; p = 0.054). History of migraine was associated with an increase in PDQ-6 score of 2.76 points (p = 0.006). Six people in each group had Visual Aura Rating Scale (VARS) scores greater than zero. Mean VARS score was 0.48 for those with dysphotopsia and 0.14 for those without (p = 0.03). History of migraine or increased VARS score, younger age, and female sex were associated with lower satisfaction. CONCLUSION History of migraine was associated with increased dysphotopsia severity and decreased patient satisfaction. Although further study with a larger sample size is warranted, these preliminary results highlight the potential of simple questions to individualize lens choice, reduce the risk of dysphotopsia, and improve patient satisfaction.
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Affiliation(s)
- Maggie J Xing
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO
| | - Thiago A Moulin
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO
| | - Tara Suresh
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO
| | | | - Arsham Sheybani
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO
| | - Gregory P Van Stavern
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO.
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Martino F, Castro-Torres JJ, Casares-López M, Ortiz-Peregrina S, Granados-Delgado P, Anera RG. Effects of alcohol consumption on driving performance in the presence of interocular differences simulated by filters. Sci Rep 2023; 13:17694. [PMID: 37848610 PMCID: PMC10582114 DOI: 10.1038/s41598-023-45057-8] [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: 06/13/2023] [Accepted: 10/15/2023] [Indexed: 10/19/2023] Open
Abstract
The role of interocular differences simulated by filters (fog filter and Bangerter foil) on visual and driving performance in alcohol users was assessed. We found that the binocular visual function deteriorates significantly in terms of contrast sensitivity (from 6 to 18 cpd). Additionally, driving performance is significantly impaired under these conditions as evidenced by increased mean speed, standard deviation of the lateral position, distance traveled outside the lane, reaction time and number of collisions. Furthermore, we found that interocular differences due to intraocular scattering and straylight are directly related to an overall reduction in visual and driving performance. This provided a comprehensive perspective from which to understand the relationship between binocular visual function, interocular differences, and driving performance. In practice, our findings contribute to the understanding of the importance of limiting interocular differences, which can be common among presbyopes corrected using the monovision technique, as well as in cases of cataract or other ocular pathology affecting only one eye, or even in cases of cataract surgery of the first eye. These interocular differences can have an adverse impact on road safety, especially when combined with moderate alcohol consumption.
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Affiliation(s)
- Francesco Martino
- Laboratory of Vision Sciences and Applications (LabVisGra), Department of Optics, University of Granada, Granada, Spain
| | - José J Castro-Torres
- Laboratory of Vision Sciences and Applications (LabVisGra), Department of Optics, University of Granada, Granada, Spain.
| | - Miriam Casares-López
- Laboratory of Vision Sciences and Applications (LabVisGra), Department of Optics, University of Granada, Granada, Spain
| | - Sonia Ortiz-Peregrina
- Laboratory of Vision Sciences and Applications (LabVisGra), Department of Optics, University of Granada, Granada, Spain
| | - Pilar Granados-Delgado
- Laboratory of Vision Sciences and Applications (LabVisGra), Department of Optics, University of Granada, Granada, Spain
| | - Rosario G Anera
- Laboratory of Vision Sciences and Applications (LabVisGra), Department of Optics, University of Granada, Granada, Spain
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Saad A, Steinberg J, Frings A. Repeatability of pupil diameter measurements using three different topography devices. PLoS One 2023; 18:e0290417. [PMID: 37594948 PMCID: PMC10437858 DOI: 10.1371/journal.pone.0290417] [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: 04/16/2023] [Accepted: 08/07/2023] [Indexed: 08/20/2023] Open
Abstract
PURPOSE To evaluate the intra- and inter-device repeatability of pupil diameter measurements using three different devices in patients prior to corneal refractive surgery. METHODS We examined preoperative measurements from a total of 204 eyes (102 patients) scheduled for corneal refractive surgery at two private centers between July and December 2021. Three consecutive scans were performed with three different devices (Sirius anterior segment analyzer, Pentacam HR, IOLMaster 500) in the same session by the same examiner under standardized conditions. To assess the intra- and inter-device repeatability, we calculated the Intraclass Correlation Coefficient (ICC) and demonstrated results using Bland-Altman plots. RESULTS The measurement accuracy (intra-device repeatability) of Sirius and IOLMaster was comparable (ICC = 0.64 and 0.61, respectively), with almost no statistically significant differences. Sirius showed the highest measurement accuracy among the three devices. Pentacam measurements resulted in lower precision, with an ICC of 0.09. The agreement between the pairs of devices (inter-device repeatability) was low (wide LoA ranges, Table 5). CONCLUSION In this study, the intra-device repeatability of Sirius and IOLMaster was higher than that of the Pentacam, although it did not achieve an optimal level across all three devices. The three devices examined cannot be used interchangeably.
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Affiliation(s)
- Amr Saad
- Department of Ophthalmology, University Hospital of Duesseldorf, Duesseldorf, Germany
| | - Johannes Steinberg
- Department of Ophthalmology, University Medical Center, Hamburg, Germany
- Zentrum Sehstärke, Hamburg, Germany
| | - Andreas Frings
- Department of Ophthalmology, University Hospital of Duesseldorf, Duesseldorf, Germany
- Augenheilkunde & Augenlaser Zentrum PD Dr. med. A. Frings, Nuremberg, Germany
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Pusnik A, Petrovski G, Lumi X. Dysphotopsias or Unwanted Visual Phenomena after Cataract Surgery. LIFE (BASEL, SWITZERLAND) 2022; 13:life13010053. [PMID: 36676002 PMCID: PMC9866410 DOI: 10.3390/life13010053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 12/17/2022] [Accepted: 12/20/2022] [Indexed: 12/28/2022]
Abstract
Dysphotopsias are unwanted visual phenomena that occur after cataract surgery. They represent some of the most common reasons for patient dissatisfaction after uncomplicated surgery for cataract phacoemulsification with in-the-bag intraocular lens (IOL) implantation. Depending on the form of the optical phenomenon and the effect it poses on vision, dysphotopsias are divided into positive and negative type. Positive dysphotopsias are usually described by patients as glare, light streaks, starbursts, light arcs, rings, haloes, or flashes of light. Negative dysphotopsias are manifested as an arc-shaped shadow or line usually located in the temporal part of the visual field, similar to a temporal scotoma. In addition to their different clinical manifestations, positive and negative dysphotopsia also have different risk factors. Even though up to 67% of patients may experience positive dysphotopsia immediately after surgery, only 2.2% of the cases have persistent symptoms up to a year postoperatively. Surgical intervention may be indicated in 0.07% of cases. The incidence of negative dysphotopsias is up to 26% of all patients; however, by one year postoperatively, the symptoms usually persist in 0.13 to 3% of patients. For both types of dysphotopsia, preoperative patients' education, accurate preoperative diagnostics, and use of an appropriate IOL design and material is mandatory. Despite all these measures, dysphotopsias may occur, and when noninvasive measures fail to improve symptoms, a surgical approach may be considered.
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Affiliation(s)
- Ambroz Pusnik
- Eye Hospital, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | - Goran Petrovski
- Center for Eye Research and Innovative Diagnostics, Department of Ophthalmology, Oslo University Hospital, 0450 Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway
- Department of Ophthalmology, University of Split School of Medicine and University Hospital Centre, 21000 Split, Croatia
| | - Xhevat Lumi
- Eye Hospital, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Center for Eye Research and Innovative Diagnostics, Department of Ophthalmology, Oslo University Hospital, 0450 Oslo, Norway
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
- Correspondence:
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Omidi P, Cayless A, Langenbucher A. Intensity simulation of photic effects after cataract surgery for off-axis light sources. PLoS One 2022; 17:e0272705. [PMID: 35930598 PMCID: PMC9355184 DOI: 10.1371/journal.pone.0272705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 07/25/2022] [Indexed: 11/18/2022] Open
Abstract
Photopsia is a photic phenomenon that can be associated with intraocular lenses after cataract surgery. To calculate the relative light intensity of photic effects observed after cataract surgery at the foveal region as the most sensitive region of the retina, photopsia was simulated using the ZEMAX optical design software. The simulations are based on the Liou-Brennan eye model with a pupil diameter of 4.5 mm and incorporating implanted IOLs. The hydrophilic IOLs implanted in the eye model have a power of 21 diopter (D) with an optic diameter of 6 mm and 7 mm. Four different intensity detectors are located in specific regions of the eye in this simulation. The ray-tracing analysis was carried out for variations of incident ray angle of 0° to 90° (temporally) in steps of 1°. Depending on the range of incident ray angle, the light intensity was detected at detectors located on the fovea, nasal side of the retina, or the edge surface of the IOLs. Some portion of the input light was detected at specific incident angles in the foveal region. By altering the IOLs edge design to a fully reflective or anti-reflective surface, the range over which the light intensity is detected on the fovea can be shifted. Additionally, with the absorbing edge design, no intensity was detected at the foveal region for incident ray angles larger than 5°. Therefore an absorbing edge design can make photic effects less disturbing for patients.
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Affiliation(s)
- Pooria Omidi
- Department of Experimental Ophthalmology, Saarland University, Homburg, Saar, Germany
- * E-mail:
| | - Alan Cayless
- School of Physical Sciences, The Open University, Milton Keynes, United Kingdom
| | - Achim Langenbucher
- Department of Experimental Ophthalmology, Saarland University, Homburg, Saar, Germany
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Das KK, Kalapala AR. Assessment of spectral properties of positive dysphotopsia or glare caused by LED sources for different types of intraocular lenses. OPTICS EXPRESS 2022; 30:27140-27148. [PMID: 36236891 DOI: 10.1364/oe.465822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/01/2022] [Indexed: 06/16/2023]
Abstract
Light emitting diodes (LEDs) have become a major source of lighting conditions. The increased prevalence of LED light sources introduces new concerns for the spectral effects of positive dysphotopsia (PD) or glare type photic phenomena for pseudo-phakic patients with intraocular lenses (IOLs). A significant amount of work has been published in the area of spectral discomfort and sensitivity of LEDs as well as automotive lighting. The wavelength dependence or spectral properties of PD due to LEDs for IOLs has not been reported. This study, to our knowledge, is the first one to assess the glare characteristics of four commercially available IOL models with different material types and design features using an optical bench and non-sequential ray trace simulations with LEDs of different wavelengths. A novel approach of representing the reflected and transmitted IOL glare utilizing Fresnel coefficients is found to be in close agreement with the measurements.
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Küchlin S, Hartmann ES, Reich M, Bleul T, Böhringer D, Reinhard T, Lagrèze WA. Pediatric cataract surgery: Rate of secondary visual axis opacification depending on intraocular lens type. Ophthalmology 2022; 129:997-1003. [PMID: 35595073 DOI: 10.1016/j.ophtha.2022.05.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/06/2022] [Accepted: 05/10/2022] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To assess the time course of secondary visual axis opacification (VAO) that led to additional surgery after primary intraocular lens (IOL) implantation in children and to describe further surgical outcomes. Comparison of different lens types. DESIGN Single center, retrospective analysis of children aged 1-14 years who underwent cataract surgery with primary IOL implantation. The surgical technique was either in-bag IOL placement with primary posterior capsulotomy and anterior vitrectomy or bag-in-lens IOL placement. We excluded eyes with visually significant ocular comorbidities. SUBJECTS Total of 135 eyes of 95 children. Of these, 64 had received an acrylic three-piece IOL, 51 an acrylic single-piece IOL, and 20 an acrylic single-piece bag-in-lens IOL. The median ages at surgery were 53 months (IQR 35-75), 52 months (27-65), and 60 months (40-84) in the 3-piece, 1-piece, and bag-in-lens group, respectively. METHODS Analysis of medical records. We used the Kaplan-Meier method and a cox proportional hazards model with pre-defined adjustments for age at surgery, year of surgery, and socioeconomic deprivation (GISD score by postal code) to analyze VAO-free survival by lens type. Patients were invited to attend a clinical visit to achieve longer follow-ups. MAIN OUTCOME MEASURES The rate of survival without VAO that required clearing of the visual axis after cataract surgery with primary IOL implantation. Any other surgical complications. RESULTS The overall median follow-up was 19 months (IQR 3-58). There were 13 cases of VAO, occurring at a median of 10 months (IQR 10-12) after surgery. Of these, 1 eye had a 3-piece in-bag IOL, 10 eyes had 1-piece in-bag IOLs, and 2 eyes had bag-in-lens IOLs. The adjusted hazard ratio was 32.8 (95% CI: 3.3-327, p=0.003) for 1-piece acrylic IOLs and 19.6 (1.22-316, p=0.036) for bag-in-lens IOLs, compared to 3-piece acrylic in-bag IOLs. Two eyes with bag-in-lens surgery (10%) had an iris capture. There was one case of endophthalmitis. We found no cases of postoperative retinal detachment or new glaucoma. CONCLUSIONS Children with secondary visual axis opacification that required a procedure to clear the visual axis generally presented within fifteen months. Opacification rates were lowest when a 3-piece acrylic IOL was used.
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Affiliation(s)
- Sebastian Küchlin
- Eye Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Emma Sophia Hartmann
- Eye Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Pediatric Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michael Reich
- Eye Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Tim Bleul
- Eye Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Daniel Böhringer
- Eye Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Thomas Reinhard
- Eye Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Wolf A Lagrèze
- Eye Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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12
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Ahn H, Jun I, Seo KY, Kim EK, Kim TI. Femtosecond laser-assisted cataract surgery after corneal refractive surgery. Sci Rep 2022; 12:4263. [PMID: 35277568 PMCID: PMC8917192 DOI: 10.1038/s41598-022-08297-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 03/04/2022] [Indexed: 11/24/2022] Open
Abstract
Cataract is the leading cause of blindness worldwide, and advanced cataract techniques such as femtosecond laser-assisted cataract surgery (FLACS) have been commercially available. Corneal refractive surgery (CRS) is one of the most popular surgeries for the correction of refractive errors. CRS changes the cornea not only anatomically but also pathophysiologically. However, there has been no clinical research analyzing the refractive and safety outcomes of FLACS after CRS. The aim of this retrospective chart review and comparative study is to evaluate the effect and safety of FLACS after CRS comparing with conventional PCS. Participants with a previous CRS history who underwent FLACS or conventional PCS were included in this study. The visual outcomes and the refractive outcomes including refractive, corneal, and ocular residual astigmatism were compared. The safety outcomes were then studied intraoperatively and postoperatively. A total of 102 patients with age-related cataract were enrolled. At 3 months postoperatively, UCVA, BCVA, and predictive error were not significantly different between the FLACS and conventional PCS groups. Reduction of refractive astigmatism was higher in FLACS. Postoperative ORA was significant lower in FLACS. Reduction of ORA was higher in FLACS. The intraoperative and postoperative complications were also not significantly different between the two groups. FLACS could effectively change refractive astigmatism and ORA; without more complications than conventional PCS. FLACS’ competitive edge in postoperative ORA may provide better visual quality than conventional PCS in patients with a previous history of CRS.
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Affiliation(s)
- Hyunmin Ahn
- Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Ikhyun Jun
- Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea.,Department of Ophthalmology, Corneal Dystrophy Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemungu, Seoul, 03722, Korea
| | - Kyoung Yul Seo
- Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Eung Kweon Kim
- Department of Ophthalmology, Corneal Dystrophy Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemungu, Seoul, 03722, Korea.,Saevit Eye Hospital, Goyang, Gyunggi-do, Korea
| | - Tae-Im Kim
- Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea. .,Department of Ophthalmology, Corneal Dystrophy Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemungu, Seoul, 03722, Korea.
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13
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Randomized contralateral comparison of visual outcomes following implantation of two monofocal aspherical intraocular lenses after cataract surgery. Int Ophthalmol 2022; 42:1563-1571. [DOI: 10.1007/s10792-021-02150-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 12/17/2021] [Indexed: 10/19/2022]
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14
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Omidi P, Cayless A, Langenbucher A. Simulation of photic effects after cataract surgery for off-axis light sources. PLoS One 2022; 17:e0262457. [PMID: 35051191 PMCID: PMC8775293 DOI: 10.1371/journal.pone.0262457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 12/23/2021] [Indexed: 11/18/2022] Open
Abstract
Photopsia is a phenomenon that sometimes disturbs patients after cataract surgery. To evaluate the impact of the edge design of intraocular lenses (IOL) on the location, shape and relative intensity of photic effects at the retina caused by photopsia in pseudophakic eyes, photopsia was simulated using ZEMAX software. The structural parameters of the pseudophakic eye model are based on the Liou-Brennan eye model parameters with a pupil diameter of 4.5 mm. The IOLs implanted in the eye model have a power of 21 diopter (D) with optical diameter of 6 mm and 7 mm. From the ray-tracing analysis, covering variations of incident ray angle of 50° to 90° from temporally, a photic image is detected at the fovea at specific ray angles of 77.5° (6 mm IOL) and 78.2° (7 mm IOL). This photic image disappears when a thin IOL with an edge thickness of 0 mm or a thick IOL with absorbing edges is replaced in the eye model. With an anti-reflective edge, this photic image remains, but with a fully reflecting edge it disappears at the critical angles and appears with different shapes at other angles. The intensity of this photic image can be reduced by changing the edge design to a frosted surface. Most of the photic patterns in IOLs are not observed with absorbing and thin edge designs. IOLs with anti-reflecting and fully reflecting edges generate disturbing photic effects at different angles on the fovea. IOLs with frosted edges reduce the contrast of the photic effects and make them less disturbing for patients.
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Affiliation(s)
- Pooria Omidi
- Department of Experimental Ophthalmology, Saarland University, Homburg, Saarland, Germany
- * E-mail:
| | - Alan Cayless
- School of Physical Sciences, The Open University, Milton Keynes, United Kingdom
| | - Achim Langenbucher
- Department of Experimental Ophthalmology, Saarland University, Homburg, Saarland, Germany
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15
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Dysphotopsia, a lingering issue after cataract surgery: effect of IOL optic size. J Cataract Refract Surg 2022; 48:1-2. [PMID: 34929711 DOI: 10.1097/j.jcrs.0000000000000864] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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16
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Adre E, Tonk R. Positive and Negative Dysphotopsias: Causes, Prevention, and Best Strategies for Treatment. CURRENT OPHTHALMOLOGY REPORTS 2021. [DOI: 10.1007/s40135-021-00278-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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17
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Abstract
PURPOSE To evaluate clinical outcomes of intraocular lens (IOL) exchange for intolerable positive dysphotopsia (PD). SETTING Private practice, Advanced Vision Care, Los Angeles, California, USA. DESIGN Retrospective review, case series. METHODS Fifty-six eyes of 46 pseudophakic patients requiring surgical management of PD between 2013 and 2019 were reviewed. Thirty-seven eyes had PD alone and 19 had combined negative dysphotopsia and PD. INCLUSION CRITERIA corrected distance visual acuity of 20/30 or better without significant corneal, retinal, or optic nerve pathology. EXCLUSION CRITERIA corneal, macular, or optic nerve disease and multifocal dysphotopsia alone (defined patterns of concentric multiple halos or spider web patterns when looking at a point source of light). Primary outcome measure was improvement or resolution of self-reported PD symptoms by 3 months postoperatively. Secondary outcome measures included analysis of intraocular lenses (IOLs) that induced PD for IOL material, index of refraction, and edge design. RESULTS IOL materials successful in the alleviation of PD symptoms were as follows: 20 (87.8%) of 33 silicone, 15 (76.2%) of 21 copolymer, and 2 poly(methyl methacrylate) (100%). However, when considering IOL exchange for an acrylic to silicone optic or acrylic to collamer optic, the percentages of improvement are indistinguishable at 87% and 88%, respectively. CONCLUSIONS PD symptoms might be improved by changing the IOL material and, therefore, index of refraction. Although edge design plays an important role in etiology, changing the IOL material to a lower index of refraction may prove to be an effective surgical strategy to improve intolerable PD.
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18
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Dysphotopsiae and functional quality of vision after implantation of an intraocular lens with a 7.0 mm optic and plate haptic design. J Cataract Refract Surg 2021; 48:75-82. [PMID: 34224478 DOI: 10.1097/j.jcrs.0000000000000735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/18/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine the impact of IOL with 7.0 mm optic and plate haptic design on incidence of dysphotopsiae and visual functions after cataract surgery. SETTING Day-care clinic. DESIGN A prospective monocentric randomized patient-blinded comparative clinical study. METHODS Following preoperative measurements, patients underwent cataract surgery with implantation of two IOL designs - with 7.0 mm optic and plate haptics (group 1) or with 6.0 mm optic and C-loop haptics (group 2). In month 1, 3 and 12 follow-ups patients were examined, answered a questionnaire regarding satisfaction, spectacle dependence, frequency and extent of positive and negative dysphotopsiae, and underwent contrast sensitivity, mesopic vision and glare sensitivity testing. The data were analyzed as nominal, ordinal and metric with Chi-Square, Mann-Whitney-U, Wilcoxon and t-tests. RESULTS Group 1 comprised 57 eyes (43 patients) and group 2 comprised 63 eyes (43 patients). Corrected distance visual acuity was the same between groups throughout the study. Group 1 showed significantly lower incidence of positive and negative dysphotopsiae in month 1 follow-up (p=0.021 and 0.015, respectively) and a higher satisfaction rate in month 3 follow-up (p=0.006). Mean contrast sensitivity and mesopic vision with and without glare were the same in both groups. Positive dysphotopsiae cases in month 12 follow-up revealed lower photopic contrast sensitivity (p=0.005, 0.036 and 0.047, respectively), longer AL and greater preoperative pupil dynamics (p=0.04 and 0.06). CONCLUSIONS The IOL design with 7.0 mm optic diameter and plate haptics reduces dysphotopsiae, provides good visual acuity, contrast sensitivity, mesopic vision with and without glare and high patient satisfaction.
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19
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Fernández J, Rodríguez-Vallejo M, Martínez J, Burguera N, Piñero DP. What we have learnt from 30 years living with positive dysphotopsia after intraocular lens implantation?: a review. EXPERT REVIEW OF OPHTHALMOLOGY 2021. [DOI: 10.1080/17469899.2021.1917997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Joaquín Fernández
- Department of Ophthalmology (Qvision, VITHAS Hospital, Almería, Spain
| | | | - Javier Martínez
- Department of Ophthalmology (Qvision, VITHAS Hospital, Almería, Spain
| | - Noemi Burguera
- Department of Ophthalmology (Qvision, VITHAS Hospital, Almería, Spain
| | - David P Piñero
- Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante, Spain
- Department of Ophthalmology (Imqo-oftalmar), Vithas Medimar International Hospital, Alicante, Spain
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20
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Rampat R, Gatinel D. Multifocal and Extended Depth-of-Focus Intraocular Lenses in 2020. Ophthalmology 2020; 128:e164-e185. [PMID: 32980397 DOI: 10.1016/j.ophtha.2020.09.026] [Citation(s) in RCA: 107] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 09/14/2020] [Accepted: 09/21/2020] [Indexed: 10/23/2022] Open
Abstract
Ophthalmic surgeons have been overwhelmed by the influx of multifocal intraocular lens (IOL) options in recent years, with close to 100 IOLs on the market in 2020. This practical and technical update on a representative group of established as well as newly launched multifocal IOLs on the market focuses on multifocal IOLs, including extended depth-of-focus lenses. We also describe the optical basis of lens platforms used and thorough preoperative planning to aid decision making. This allows the surgeon the knowledge base to deliver the required relative customized spectacle independence with the least photic phenomenon and loss of contrast possible while achieving high individual patient satisfaction. Data of reviewed IOLs displayed in tabular format include mean monocular uncorrected distance, intermediate, and near visual acuities (logarithm of the minimum angle of resolution), with standard deviations and ranges where available. The range of vision targeted, pupil dependence, toric availability, as well as type of optical platform, are provided as a practical guide to demystify existing terminology on the market that may create interest around a seemingly new design that is actually not novel at all. Halos and glare experienced, levels of patient satisfaction, and spectacle independence achieved also are summarized. A wide range of multifocal IOLs options are available on the market to surgeons. Comprehensive patient selection and examination, combined with knowledge of the most recent options and adequate patient counseling, including neuroadaptation, can avoid dissatisfaction. Many recently available IOLs are awaiting formal results, but the methods by which we label and compare these types of IOLs must also be standardized.
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Affiliation(s)
- Radhika Rampat
- Anterior Segment and Refractive Surgery Department, Rothschild Foundation Hospital, Paris, France
| | - Damien Gatinel
- Anterior Segment and Refractive Surgery Department, Rothschild Foundation Hospital, Paris, France.
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21
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Masket S. Same Day Bilateral Cataract Surgery-Who Benefits? Ophthalmology 2020; 128:11-12. [PMID: 32951873 PMCID: PMC7498406 DOI: 10.1016/j.ophtha.2020.08.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 08/20/2020] [Indexed: 11/27/2022] Open
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22
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Ashena Z, Maqsood S, Ahmed SN, Nanavaty MA. Effect of Intraocular Lens Tilt and Decentration on Visual Acuity, Dysphotopsia and Wavefront Aberrations. Vision (Basel) 2020; 4:vision4030041. [PMID: 32937750 PMCID: PMC7559075 DOI: 10.3390/vision4030041] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/17/2020] [Accepted: 09/11/2020] [Indexed: 02/07/2023] Open
Abstract
Tilt and decentration of intraocular lenses (IOL) may occur secondary to a complicated cataract surgery or following an uneventful phacoemulsification. Although up to 2–3° tilt and a 0.2–0.3 mm decentration are common and clinically unnoticed for any design of IOL, larger extent of tilt and decentration has a negative impact on the optical performance and subsequently, the patients’ satisfaction. This negative impact does not affect various types of IOLs equally. In this paper we review the methods of measuring IOL tilt and decentration and focus on the effect of IOL tilt and decentration on visual function, in particular visual acuity, dysphotopsia, and wavefront aberrations. Our review found that the methods to measure the IOL displacement have significantly evolved and the available studies have employed different methods in their measurement, while comparability of these methods is questionable. There has been no universal reference point and axis to measure the IOL displacement between different studies. A remarkably high variety and brands of IOLs are used in various studies and occasionally, opposite results are noticed when two different brands of a same design were compared against another IOL design in two studies. We conclude that <5° of inferotemporal tilt is common in both crystalline lenses and IOLs with a correlation between pre- and postoperative lens tilt. IOL tilt has been noticed more frequently with scleral fixated compared with in-the-bag IOLs. IOL decentration has a greater impact than tilt on reduction of visual acuity. There was no correlation between IOL tilt and decentration and dysphotopsia. The advantages of aspheric IOLs are lost when decentration is >0.5 mm. The effect of IOL displacement on visual function is more pronounced in aberration correcting IOLs compared to spherical and standard non-aberration correcting aspherical IOLs and in multifocal versus monofocal IOLs. Internal coma has been frequently associated with IOL tilt and decentration, and this increases with pupil size. There is no correlation between spherical aberration and IOL tilt or decentration. Although IOL tilt produces significant impact on visual outcome in toric IOLs, these lenses are more sensitive to rotation compared to tilt.
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Affiliation(s)
- Zahra Ashena
- Sussex Eye Hospital, Brighton & Sussex University Hospitals NHS Trust, Eastern Road, Brighton BN2 5BF, UK;
| | - Sundas Maqsood
- Eastbourne District General Hospital, Kings Drive, Eastbourne BN21 2UD, UK;
| | - Syed Naqib Ahmed
- Northampton General Hospital, Cliftonville, Northampton NN1 5BD, UK;
| | - Mayank A. Nanavaty
- Sussex Eye Hospital, Brighton & Sussex University Hospitals NHS Trust, Eastern Road, Brighton BN2 5BF, UK;
- Brighton & Sussex Medical School, University of Sussex, Falmer, Brighton BN1 9PX, UK
- Correspondence: ; Tel.: +44-01273-606126
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23
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Masket S, Fram NR. Pseudophakic Dysphotopsia: Review of Incidence, Cause, and Treatment of Positive and Negative Dysphotopsia. Ophthalmology 2020; 128:e195-e205. [PMID: 32800744 DOI: 10.1016/j.ophtha.2020.08.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 08/08/2020] [Accepted: 08/10/2020] [Indexed: 11/16/2022] Open
Abstract
We reviewed the literature concerning positive dysphotopsia (PD) and negative dysphotopsia (ND) regarding cause, incidence, and clinical and surgical management. In addition, we summarized our surgical experience in managing dysphotopsia. A PubMed review, limited to English language articles, yielded 149 citations; multifocal (diffractive optic) and phakic intraocular lens (IOL) dysphotopsia were excluded. Overall, 39 articles were determined to be relevant for the objectives of this investigation. Regarding PD, 7 articles corroborated that the cause of PD is related primarily to internal reflection of oblique light rays that strike the square (truncated) edge of the IOL and are reflected onto the retinal surface. No round-edged foldable IOLs are available in the United States at this time, although IOLs modified with a round anterior edge and square posterior edge show a trend toward decreased incidence of PD. High index of refraction (I/R), surface reflectivity, and IOL optic design are additional causative factors for PD. Regarding the authors' surgical experience, changing the optic material to have a lower I/R improved PD symptoms in the large majority of patients. The cause of ND seems to be multifactorial and less well understood, with some disparity between clinical and laboratory findings. Four articles that explore using ray-tracing optical modeling suggest an "illumination gap," in which some temporally incident light rays to the nasal retina pass anterior to the IOL and some are refracted posteriorly by the IOL, resulting in a gap and resultant temporal shadow. However clinically, ND is associated invariably with well-centered in-the-bag IOLs. Other implicating factors include nasal anterior capsule override, haptic orientation, large-angle κ value, and high hyperopia. Persistent ND has been treated successfully or reduced with reverse (anterior) optic capture, sulcus IOL placement, piggyback IOLs, and neodymium:yttrium-aluminum-garnet nasal capsulectomy. Two articles reference a new optic edge designed to capture the anterior capsulotomy, mimicking reverse optic capture. Persistent dysphotopsia after cataract surgery is a significant cause for patient dissatisfaction. The cause and management of both ND and PD are of significance, and new IOL designs and alternative surgical strategies may help to mitigate these unintended side effects of IOL implantation.
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Affiliation(s)
- Samuel Masket
- Advanced Vision Care, Los Angeles, California, and Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Nicole R Fram
- Advanced Vision Care, Los Angeles, California, and Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.
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24
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Affiliation(s)
- Samuel Masket
- Advanced Vision Care, Stein Eye Institute, Geffen School of Medicine, UCLA, Los Angeles, CA, USA
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25
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In vitro and schematic model eye assessment of glare or positive dysphotopsia-type photic phenomena: Comparison of a new material IOL to other monofocal IOLs. J Cataract Refract Surg 2018; 45:219-227. [PMID: 30471850 DOI: 10.1016/j.jcrs.2018.09.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 08/16/2018] [Accepted: 09/05/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE To compare the glare-type photic phenomena for a new intraocular lens (IOL) to other monofocal IOLs, and to investigate how IOL design features might affect these phenomena. SETTING Alcon Laboratories, Inc., Fort Worth, Texas; John A Moran Eye Center, University of Utah, Salt Lake City, USA. DESIGN Schematic model eye evaluation and in vitro study. METHODS Five monofocal IOL models (Clareon CNA0T0, Tecnis ZCB00, enVista MX60, Eternity W-60, and Vivinex XY1) were used to evaluate glare or positive dysphotopsia-type phenomena. Optical simulations of incoming light were generated using nonsequential ray-tracing software based on a collimated light source for various off-axis angles of illumination. The simulation analyses were verified using a laboratory in vitro bench-top glare measurement system. RESULTS The Clareon and Vivinex IOLs produced focused off-axis images with negligible peripheral glare characteristics. The Tecnis and enVista IOLs produced dispersed images with additional glare characteristics at 45 degrees of off-axis illumination and higher. The Eternity IOL showed the highest edge-reflected glare characteristic, likely because of its straight optic edge geometry. The laboratory bench images and glare intensity profiles were consistent with the simulation data. CONCLUSIONS In vitro and nonsequential ray-tracing evaluations showed that straight optic edges and peripheral nonimaging optic geometry might contribute to positive dysphotopsia. The IOL designs with optic edge curvature and full functional optics demonstrated the lowest level of glare-type photic phenomena. Only clinical studies can confirm whether the differences observed between the IOLs in vitro are clinically significant.
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26
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Pál S, Fișuș AD, Vultur F, Horvath K. The Efficacy of Questionnaire-based Evaluation in Determining the Incidence of Recent Pseudophakic Dysphotopsia. JOURNAL OF INTERDISCIPLINARY MEDICINE 2018. [DOI: 10.1515/jim-2018-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background: Dysphotopsias are optical side effects experienced by patients who underwent cataract surgery. This unwanted photic phenomenon has gained ground and is a major postoperative concern. Visual acuity is not sufficient in evaluating the postoperative visual function.
The aim of this study was to determine the efficacy of using a preexistent questionnaire in determining the presence of dysphotopsia.
Material and method: We conducted a prospective study, using the modified Visual Function Index (VF-14) and the Ocular Surface Disease Index (OSDI) surveys, completed on patients that underwent uncomplicated phacoemulsification with intraocular lens implantation between November 2016 and November 2017. Patients included in the study had no known ocular comorbidities and had no other possible postoperative explanation for these visual phenomena. Three weeks after the surgery, the questionnaire was filled up by one individual examiner.
Results: Of the 50 patients considered, 37 patients met all the inclusion criteria and were successfully enrolled in the study, with a mean age of 75.88 years. Dysphotopsia phenomena were present in 13.51% of cases; 60% of these patients described the presence of positive dysphotopsia, and 40% complained of temporal shadows. The best corrected visual acuity was over 0.8 in 75.67% of the cases.
Conclusion: Although there is no objective test to diagnose this early postoperative complication, pseudophakic dysphotopsia should not be overlooked and additional chair time is needed.
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Affiliation(s)
- Szilvia Pál
- University of Medicine and Pharmacy , Tîrgu Mureș , Romania
| | - Andreea Dana Fișuș
- University of Medicine and Pharmacy , Tîrgu Mureș , Romania
- Ophtalmology Clinic, Mureș County Hospital , Tîrgu Mureș , Romania
| | - Florina Vultur
- University of Medicine and Pharmacy , Tîrgu Mureș , Romania
- Ophtalmology Clinic, Mureș County Hospital , Tîrgu Mureș , Romania
| | - Karin Horvath
- University of Medicine and Pharmacy , Tîrgu Mureș , Romania
- Ophtalmology Clinic, Mureș County Hospital , Tîrgu Mureș , Romania
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27
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Fişuş AD, Madaras Z, Horváth KU. Research Article. The Prevalence of Dysphotopsia in Patients with Recent Cataract Surgery. ACTA MEDICA MARISIENSIS 2017. [DOI: 10.1515/amma-2017-0002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Pseudophakic dysphotopsia are becoming increasingly important as unwanted side effect after cataract surgery. Objective: The purpose of this study is to compare the photic symptoms experienced by patients after cataract surgery. Material and method: This is a prospective study that included 105 eyes from 99 patients, which underwent uncomplicated phacoemulsification and IOL implantation, between June 2015 and June 2016, performed at Ophthalmology Clinic Tg Mureș. Patients without visually consequential ocular co-morbidity completed a questionnaire, designed to assess subjectively perceived visual functioning and identify symptoms of dysphotopsia. Results: From the total number of patient, hydrophobic lenses were implanted in 95 patients and 10 patients received hydrophilic lenses. Photic effects were reported in 18% of treated eyes. Although the percentage of dysphotopsia is higher in the hydrophobic lenses category, there was no significant statistical difference between the two categories. Conclusion: The incidence and significance should not be overlooked, thus visual acuity is not enough for evaluating postoperative visual function.
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Affiliation(s)
| | - Zoltán Madaras
- Tîrgu Mureş County Hospital, Ophthalmology Clinic, Romania
| | - Karin Ursula Horváth
- Tîrgu Mureş County Hospital, Ophthalmology Clinic Romania
- University of Medicine and Pharmacy Tîrgu Mureş, Romania
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28
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Palkovits S, Findl O. Pseudophake Dysphotopsien. SPEKTRUM DER AUGENHEILKUNDE 2016. [DOI: 10.1007/s00717-016-0313-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Eppig T, Spira C, Tsintarakis T, El-Husseiny M, Cayless A, Müller M, Seitz B, Langenbucher A. Ghost-image analysis in phakic intraocular lenses with central hole as a potential cause of dysphotopsia. J Cataract Refract Surg 2016; 41:2552-9. [PMID: 26703506 DOI: 10.1016/j.jcrs.2015.05.034] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 05/18/2015] [Accepted: 05/19/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE To analyse the optical effect of an artificial hole in the optic centre of posterior chamber phakic intraocular lenses. SETTING Institute of Experimental Ophthalmology, Saarland University, Homburg/Saar, Germany. DESIGN Experimental simulation study. METHODS Four eye models with an ametropia of -4 D, -8 D, +4 D, and +8 D were created in the ray tracing software ASAP. Refractive correction of these models was implemented with a model of an Implantable Collamer Lens (ICL). Each eye was set up twice with 1 eye receiving a conventional ICL without a central hole and the second an ICL with a central hole. Ray bundles were traced for lateral visual field angles from 0 to 60 degrees in steps of 1 degree. Ray propagation and retinal illumination were then compared between the 2 ICL models. RESULTS All eye models showed ghost images originating from the anterior surface of the ICL. Eye models with the ICL with central hole showed additional light spots in the peripheral areas of the retina originating from reflections at the cylindrical wall of the central hole in the ICL. The average intensity of ghost images in the temporal retinal hemisphere was between 30 and 40 dB less than the maximum intensity of the primary image. CONCLUSION A central hole within a posterior chamber phakic intraocular lens may cause stray light and ghost images (positive dysphotopsia) although the on-axis visual quality of the eye with the ICL is mostly unaffected. FINANCIAL DISCLOSURE The authors have no financial interest in any of the material presented in this paper.
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Affiliation(s)
- Timo Eppig
- From the Institute of Experimental Ophthalmology (Eppig, Langenbucher), Saarland University, Homburg/Saar, Germany; Department of Ophthalmology (Spira, Tsintarakis, El-Husseiny, Müller, Seitz), Saarland University Medical Center, Homburg/Saar, Germany; Department of Physical Sciences (Cayless), Open University, Milton Keynes, Buckinghamshire, United Kingdom.
| | - Corinna Spira
- From the Institute of Experimental Ophthalmology (Eppig, Langenbucher), Saarland University, Homburg/Saar, Germany; Department of Ophthalmology (Spira, Tsintarakis, El-Husseiny, Müller, Seitz), Saarland University Medical Center, Homburg/Saar, Germany; Department of Physical Sciences (Cayless), Open University, Milton Keynes, Buckinghamshire, United Kingdom
| | - Themistoklis Tsintarakis
- From the Institute of Experimental Ophthalmology (Eppig, Langenbucher), Saarland University, Homburg/Saar, Germany; Department of Ophthalmology (Spira, Tsintarakis, El-Husseiny, Müller, Seitz), Saarland University Medical Center, Homburg/Saar, Germany; Department of Physical Sciences (Cayless), Open University, Milton Keynes, Buckinghamshire, United Kingdom
| | - Moatasem El-Husseiny
- From the Institute of Experimental Ophthalmology (Eppig, Langenbucher), Saarland University, Homburg/Saar, Germany; Department of Ophthalmology (Spira, Tsintarakis, El-Husseiny, Müller, Seitz), Saarland University Medical Center, Homburg/Saar, Germany; Department of Physical Sciences (Cayless), Open University, Milton Keynes, Buckinghamshire, United Kingdom
| | - Alan Cayless
- From the Institute of Experimental Ophthalmology (Eppig, Langenbucher), Saarland University, Homburg/Saar, Germany; Department of Ophthalmology (Spira, Tsintarakis, El-Husseiny, Müller, Seitz), Saarland University Medical Center, Homburg/Saar, Germany; Department of Physical Sciences (Cayless), Open University, Milton Keynes, Buckinghamshire, United Kingdom
| | - Marc Müller
- From the Institute of Experimental Ophthalmology (Eppig, Langenbucher), Saarland University, Homburg/Saar, Germany; Department of Ophthalmology (Spira, Tsintarakis, El-Husseiny, Müller, Seitz), Saarland University Medical Center, Homburg/Saar, Germany; Department of Physical Sciences (Cayless), Open University, Milton Keynes, Buckinghamshire, United Kingdom
| | - Berthold Seitz
- From the Institute of Experimental Ophthalmology (Eppig, Langenbucher), Saarland University, Homburg/Saar, Germany; Department of Ophthalmology (Spira, Tsintarakis, El-Husseiny, Müller, Seitz), Saarland University Medical Center, Homburg/Saar, Germany; Department of Physical Sciences (Cayless), Open University, Milton Keynes, Buckinghamshire, United Kingdom
| | - Achim Langenbucher
- From the Institute of Experimental Ophthalmology (Eppig, Langenbucher), Saarland University, Homburg/Saar, Germany; Department of Ophthalmology (Spira, Tsintarakis, El-Husseiny, Müller, Seitz), Saarland University Medical Center, Homburg/Saar, Germany; Department of Physical Sciences (Cayless), Open University, Milton Keynes, Buckinghamshire, United Kingdom
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Singh H, Wang JCC, Desjardins DC, Baig K, Gagné S, Ahmed IIK. Refractive outcomes in nanophthalmic eyes after phacoemulsification and implantation of a high-refractive-power foldable intraocular lens. J Cataract Refract Surg 2016; 41:2394-402. [PMID: 26703488 DOI: 10.1016/j.jcrs.2015.05.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Revised: 05/25/2015] [Accepted: 05/26/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate the refractive and postoperative outcomes of a high-power foldable intraocular lens (IOL) in nanophthalmic eyes. SETTING Six ophthalmic surgical centers in Canada. DESIGN Retrospective case series. METHODS Consecutive charts of nanophthalmic patients having cataract extraction and insertion of the CT Xtreme D IOL were reviewed. Demographic and clinical data were collected, including age, sex, axial length (AL), minimum keratometry (K) value and maximum K value, corneal white-to-white (WTW), anterior chamber depth, lens thickness (LT), and complications. The following preoperative and operative data were collected: uncorrected distant visual acuity (UDVA), corrected distant visual acuity (CDVA), sphere, cylinder, and spherical equivalence (SE). The primary outcome measure was change in SE. The secondary outcome measures were changes in UDVA and CDVA. RESULTS A total of 21 eyes from 13 patients with a mean follow-up time of 9.6 ± 8.5 months were studied. Mean preoperative data were: age (51.4 ± 15.2 years), AL (16.63 ± 0.68 mm), minimum K value (46.20 ± 2.26 D), maximum K value (47.55 ± 2.34 D), anterior chamber depth (2.60 ± 0.49 mm), WTW (11.08 ± 1.38 mm), LT (4.70 ± 0.97 mm), and IOL power implanted (+49.9 ± 3.3 diopters [D]). SE improved from +16.11 ± 3.26 D preoperatively to +2.00 ± 2.37 D postoperatively (P < .0001). UDVA improved from 1.47 ± 0.30 logMAR preoperatively to 0.74 ± 0.43 logMAR postoperatively (P = .016). CDVA did not change significantly. Five eyes (23.8%) had serious postoperative complications. Of these eyes, 2 had malignant glaucoma, 2 had vitreous hemorrhages, and 1 eye had a vitreous hemorrhage with retinal detachment resulting in visual acuity of no light perception. CONCLUSION Implanting foldable high-power IOLs in a series of nanophthalmic eyes yielded significant improvement in UDVA and SE. Cataract surgery in these eyes carries increased risk. FINANCIAL DISCLOSURE Iqbal Ike K. Ahmed is a consultant to Carl Zeiss Meditec AG. No other author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Harmanjit Singh
- From the Department of Ophthalmology and Vision Sciences (Singh, Ahmed), University of Toronto, Toronto, Ontario, Canada; Faculty of Medicine (Wang), University of British Columbia, Vancouver, British Columbia, Canada; Département d'Ophtalmologie (Gagné), Université de Montréal, Montréal, Québec, Canada; Department of Ophthalmology (Baig), The Eye Institute, University of Ottawa, Ottawa, Ontario, Canada; Trillium Health Partners (Ahmed), Mississauga, Ontario, Canada; Credit Valley EyeCare (Ahmed), Mississauga, Ontario, Canada
| | - Jay Ching-Chieh Wang
- From the Department of Ophthalmology and Vision Sciences (Singh, Ahmed), University of Toronto, Toronto, Ontario, Canada; Faculty of Medicine (Wang), University of British Columbia, Vancouver, British Columbia, Canada; Département d'Ophtalmologie (Gagné), Université de Montréal, Montréal, Québec, Canada; Department of Ophthalmology (Baig), The Eye Institute, University of Ottawa, Ottawa, Ontario, Canada; Trillium Health Partners (Ahmed), Mississauga, Ontario, Canada; Credit Valley EyeCare (Ahmed), Mississauga, Ontario, Canada
| | - Daniel Christian Desjardins
- From the Department of Ophthalmology and Vision Sciences (Singh, Ahmed), University of Toronto, Toronto, Ontario, Canada; Faculty of Medicine (Wang), University of British Columbia, Vancouver, British Columbia, Canada; Département d'Ophtalmologie (Gagné), Université de Montréal, Montréal, Québec, Canada; Department of Ophthalmology (Baig), The Eye Institute, University of Ottawa, Ottawa, Ontario, Canada; Trillium Health Partners (Ahmed), Mississauga, Ontario, Canada; Credit Valley EyeCare (Ahmed), Mississauga, Ontario, Canada
| | - Kashif Baig
- From the Department of Ophthalmology and Vision Sciences (Singh, Ahmed), University of Toronto, Toronto, Ontario, Canada; Faculty of Medicine (Wang), University of British Columbia, Vancouver, British Columbia, Canada; Département d'Ophtalmologie (Gagné), Université de Montréal, Montréal, Québec, Canada; Department of Ophthalmology (Baig), The Eye Institute, University of Ottawa, Ottawa, Ontario, Canada; Trillium Health Partners (Ahmed), Mississauga, Ontario, Canada; Credit Valley EyeCare (Ahmed), Mississauga, Ontario, Canada
| | - Sébastien Gagné
- From the Department of Ophthalmology and Vision Sciences (Singh, Ahmed), University of Toronto, Toronto, Ontario, Canada; Faculty of Medicine (Wang), University of British Columbia, Vancouver, British Columbia, Canada; Département d'Ophtalmologie (Gagné), Université de Montréal, Montréal, Québec, Canada; Department of Ophthalmology (Baig), The Eye Institute, University of Ottawa, Ottawa, Ontario, Canada; Trillium Health Partners (Ahmed), Mississauga, Ontario, Canada; Credit Valley EyeCare (Ahmed), Mississauga, Ontario, Canada
| | - Iqbal Ike K Ahmed
- From the Department of Ophthalmology and Vision Sciences (Singh, Ahmed), University of Toronto, Toronto, Ontario, Canada; Faculty of Medicine (Wang), University of British Columbia, Vancouver, British Columbia, Canada; Département d'Ophtalmologie (Gagné), Université de Montréal, Montréal, Québec, Canada; Department of Ophthalmology (Baig), The Eye Institute, University of Ottawa, Ottawa, Ontario, Canada; Trillium Health Partners (Ahmed), Mississauga, Ontario, Canada; Credit Valley EyeCare (Ahmed), Mississauga, Ontario, Canada.
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Current Theories and Methods for Managing Negative Dysphotopsia. Int Ophthalmol Clin 2016; 56:107-16. [PMID: 27257726 DOI: 10.1097/iio.0000000000000123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gharaee H, Zabihifard M, Eslampour A, Hassanzadeh S, Shafiee M. A comparative study on visual and optical performance of Akreos AO and Kontur AB IOLs after phacoemulsification cataract surgery. J Curr Ophthalmol 2016; 28:12-6. [PMID: 27239596 PMCID: PMC4881222 DOI: 10.1016/j.joco.2016.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 02/03/2016] [Accepted: 02/03/2016] [Indexed: 10/28/2022] Open
Abstract
PURPOSE Akreos AO and Kontur AB are two commonly used intraocular lenses (IOLs) in Iran. This study was designed to evaluate the visual performance of these lenses. METHODS In a comparative interventional study, 35 patients (70 eyes) were recruited, and each IOL was implanted in one eye of the patients, randomly. Best corrected visual acuity (BCVA), contrast sensitivity, aberrometric analysis, and depth of focus were evaluated 1 month and 3 months postoperatively. A visual quality questionnaire was also filled for each eye, and the results were compared. RESULTS Mean age of the patients was 60.97 ± 7.00 years. BCVA was not significantly different between the two eyes, before, 1 month, and 3 months postoperatively (p > 0.05 for all). Photopic and mesopic contrast sensitivity was not different between the two lenses instead of photopic 18 cycles per degree, 3 months postoperatively and in mesopic 6 cycles per degree 1 month postoperatively (p = 0.034 and p = 0.002, respectively). Aberrometric factors including HoRMS, Total RMS, and Higher order without Z(4,0) were not significantly different between the two lenses (p > 0.05 for all), but they were slightly lower for Akreos AO. Post-operative distance-corrected visual acuity for intermediate and near vision were not different between the two groups (p > 0.05, respectively). CONCLUSION Visual performance of Akreos AO and Kontur AB is similar. However, contrast sensitivity and aberrometric parameters are slightly better for Akreos AO IOL.
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Affiliation(s)
- Hamid Gharaee
- Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Masoud Zabihifard
- Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Alireza Eslampour
- Eye Research Center, Department of Ophthalmology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Samira Hassanzadeh
- Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Masoud Shafiee
- Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Domínguez-Vicent A, Ferrer-Blasco T, Pérez-Vives C, Esteve-Taboada JJ, Montés-Micó R. Optical quality comparison between 2 collagen copolymer posterior chamber phakic intraocular lens designs. J Cataract Refract Surg 2016; 41:1268-78. [PMID: 26189382 DOI: 10.1016/j.jcrs.2014.09.050] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 08/30/2014] [Accepted: 09/29/2014] [Indexed: 11/18/2022]
Abstract
PURPOSE To compare the optical quality in vitro of 2 designs of the Visian Implantable Collamer Lens phakic intraocular lens (pIOL) for different powers and optical apertures. SETTING University of Valencia, Valencia, Spain. DESIGN Experimental study. METHODS The Nimo TR1504 deflectometry device was used to measure the V4c pIOL, which has a smaller optic diameter, and the V5 pIOL, which has a larger optic diameter. The pIOLs were measured for -3.00 diopters (D), -6.00 D, -9.50 D, and -10.50 D at different optical apertures from 3.00 to 6.00 mm depending on the IOL power and model. The root mean square of higher-order aberrations (RMS HOAs) was analyzed. The Strehl ratio, point-spread functions (PSFs), and simulated images were calculated from wavefront aberrations. RESULTS There were no statistically significant differences in any Zernike RMS or RMS HOAs between the 2 pIOL models with the same power and optical aperture (P > .05). Both pIOLs had negative spherical aberration that increased with the pIOL power. Strehl ratio values showed no statistically significant differences between the pIOLs with the same power and pupil aperture. Minimal differences were seen in the PSFs and simulated images between the pIOLs. CONCLUSIONS Both pIOLs showed good and comparable in vitro optical quality similar that of a perfect lens in that they should not affect visual performance after implantation. Patients with larger pupil diameters could benefit from the pIOL with the larger optic diameter because it showed better in vitro optical quality than the previous design with a smaller optic diameter. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Alberto Domínguez-Vicent
- From the Optometry Research Group (GIO), Department of Optics, University of Valencia, Valencia, Spain
| | - Teresa Ferrer-Blasco
- From the Optometry Research Group (GIO), Department of Optics, University of Valencia, Valencia, Spain
| | - Cari Pérez-Vives
- From the Optometry Research Group (GIO), Department of Optics, University of Valencia, Valencia, Spain
| | - Jose J Esteve-Taboada
- From the Optometry Research Group (GIO), Department of Optics, University of Valencia, Valencia, Spain
| | - Robert Montés-Micó
- From the Optometry Research Group (GIO), Department of Optics, University of Valencia, Valencia, Spain.
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Radmall BR, Floyd A, Oakey Z, Olson RJ. Refractive index and its impact on pseudophakic dysphotopsia. Clin Ophthalmol 2015; 9:1353-8. [PMID: 26229427 PMCID: PMC4516203 DOI: 10.2147/opth.s86980] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose It has been shown that the biggest dissatisfier for uncomplicated cataract surgery patients is pseudophakic dysphotopsia (PD). While edge design of an intraocular lens (IOL) impacts this problem, refractive index is still controversial as to its impact. This retrospective cohort study was designed to determine the role of increasing refractive index in PD. Patients and methods This study was conducted at the John A. Moran Eye Center, University of Utah, USA. A retrospective chart review identified patients who received one of two hydrophobic acrylic single piece IOLs (AcrySof WF SP [SN60WF] or Tecnis SP [ZCB00]), which differed mainly by refractive index (1.55 versus 1.47). Eighty-seven patients who had received implantation of a one-piece hydrophobic acrylic IOL were enrolled. Patients were included if the surgery had been uncomplicated and took place at least a year before study participation. All eligible patients had 20/20 best corrected vision, without any disease known to impact visual quality. In addition to conducting a record review, the enrolled patients were surveyed for PD, using a modified National Eye Institute Visual Function questionnaire, as well as for overall satisfaction with visual quality. Results Statistical analysis demonstrated no difference between the two cohorts regarding PD, general visual function, and overall visual satisfaction. Conclusion The study suggests that with the two IOLs assessed, increasing the refractive index does not increase incidence of PD or decrease overall visual satisfaction.
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Affiliation(s)
- Bryce R Radmall
- Department of Ophthalmology, Casey Eye Institute, Oregon Health and Science University, Portland, OR, USA
| | - Anne Floyd
- Department of Ophthalmology, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Zack Oakey
- Department of Ophthalmology, Gavin Herbert Eye Institute, University of California, Irvine, CA, USA
| | - Randall J Olson
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
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Lum F, Tarver ME, Kahook MY, Oetting TA, Rorer E, Hilmantel G, Calogero D, Kiang T, Berdahl JP, Coleman AL, Eydelman MB. Special Commentary: Food and Drug Administration and American Academy of Ophthalmology Sponsored. Ophthalmology 2015; 122:1522-31. [DOI: 10.1016/j.ophtha.2015.02.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Revised: 02/18/2015] [Accepted: 02/27/2015] [Indexed: 10/23/2022] Open
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Determinants of patient satisfaction and function related to vision following cataract surgery in eyes with no visually consequential ocular co-morbidity. Graefes Arch Clin Exp Ophthalmol 2015; 253:1735-44. [PMID: 25968132 DOI: 10.1007/s00417-015-3038-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 04/23/2015] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To investigate subjectively reported outcomes following cataract surgery and the relationships between such outcomes in the context of falling thresholds for cataract surgery. SETTING Large, private, non-refractive cataract practice, Institute of Eye Surgery, Whitfield Clinic, Waterford, Ireland METHODS Pre-operative, intra-operative and post-operative data of 2552 eyes undergoing phacoemulsification and implantation of the Tecnis(R) ZCB00 1-piece intraocular lens (IOL) by a single surgeon between July 2009 and October 2013 was analysed. Patients without visually consequential ocular co-morbidity completed two validated questionnaires, designed to assess subjectively perceived visual functioning and identify symptoms of dysphotopsia following cataract surgery. RESULTS 54.8 % of questionnaire respondents were entirely satisfied (satisfaction 10/10) post-operatively, with 83.7 % reporting satisfaction of ≥7/10. Satisfaction was positively associated with patient age and negatively associated with spectacle dependence, dysphotopsia, and function related to vision (NEI VF-11) score. The mean (±standard deviation[SD]) dysphotopsia score was 1.36 (±1.9; scale 0-10), with 40 % of respondents reporting no dysphotopsia symptoms and 9.8 % reporting clinically meaningful dysphotopsia. The mean (±SD) National Eye Institute visual function-11 (NEI VF-11) score was 0.33 (±0.53; scale 0-4) and reduced function related to vision was associated with increasing severity of dysphotopsia symptoms. When linear regression was applied, 17.5 % of the variation in functionality was attributable to symptoms of dysphotopsia. CONCLUSION Dysphotopsia is an important determinant of a patient having difficulty with vision-related tasks following cataract surgery, and patient satisfaction is positively associated with patient age and negatively associated with spectacle in dependence, dysphotopsia and function related to the vision (NEI VF-11) score.
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Makhotkina NY, Berendschot TTJM, Beckers HJM, Nuijts RMMA. Treatment of negative dysphotopsia with supplementary implantation of a sulcus-fixated intraocular lens. Graefes Arch Clin Exp Ophthalmol 2015; 253:973-7. [PMID: 25947640 PMCID: PMC4445254 DOI: 10.1007/s00417-015-3029-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 04/09/2015] [Accepted: 04/20/2015] [Indexed: 11/06/2022] Open
Abstract
Purpose Our aim was to evaluate the resolution of negative dysphotopsia after supplementary implantation of a sulcus-fixated intraocular lens (IOL). Methods This was a retrospective case series. Patients with severe negative dysphotopsia were treated with supplementary implantation of the Rayner Sulcoflex Aspheric (653 L) IOL. Primary outcome measurements were subjectively reported complaints of dysphotopsia, best corrected distance visual acuity (CDVA), iris-IOL distance, anterior chamber depth (ACD) and volume (ACV), angle opening distance and trabecular-iris space area at 500 and 750 μm. Results A Rayner Sulcoflex IOL was implanted in seven patients (nine eyes) with negative dysphotopsias. Symptoms resolved completely in six eyes, partially in one eye and remained unchanged in two eyes. We did not find any significant changes in CDVA. Angle opening distance, ACD, ACV and iris-IOL distance reduced significantly after Sulcoflex IOL implantation. Conclusions Supplementary implantation of a Sulcoflex IOL can successfully treat negative dysphotopsia. The decrease in anterior segment dimensions in combination with the displacement of light rays by the rounded edges of a Sulcoflex IOL may contribute to the resolution of symptoms.
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Affiliation(s)
- Natalia Y Makhotkina
- University Eye Clinic, Maastricht University Medical Centre, P. Debyelaan 25, 6202 AZ, Maastricht, The Netherlands,
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Primary reverse optic capture with implantation of capsular tension ring to prevent pseudophakic negative dysphotopsia. J Cataract Refract Surg 2015; 41:891-2. [PMID: 25840311 DOI: 10.1016/j.jcrs.2014.11.041] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Accepted: 11/25/2014] [Indexed: 11/24/2022]
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Quality of Vision after Bilateral Multifocal Intraocular Lens Implantation. Ophthalmology 2015; 122:700-10. [DOI: 10.1016/j.ophtha.2014.10.002] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 09/07/2014] [Accepted: 10/03/2014] [Indexed: 11/21/2022] Open
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Kim JA, Ha AN, Kwon JW, Wee WR, Han YK. Clinical Characteristics and Patient's Satisfaction in Pseudophakic Negative Dysphotopsia. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2014. [DOI: 10.3341/jkos.2014.55.5.669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jeong Ah Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Laboratory of Corneal Regenerative Medicine and Ocular Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Ah Nul Ha
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Laboratory of Corneal Regenerative Medicine and Ocular Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Ji Won Kwon
- Department of Ophthalmology, Myongji Hospital, Kwandong University College of Medicine, Goyang, Korea
| | - Won Ryang Wee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Laboratory of Corneal Regenerative Medicine and Ocular Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Young Keun Han
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Department of Ophthalmology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
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Wilkins MR, Allan BD, Rubin GS, Findl O, Hollick EJ, Bunce C, Xing W. Randomized trial of multifocal intraocular lenses versus monovision after bilateral cataract surgery. Ophthalmology 2013; 120:2449-2455.e1. [PMID: 24070808 DOI: 10.1016/j.ophtha.2013.07.048] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2013] [Revised: 07/30/2013] [Accepted: 07/30/2013] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE To compare spectacle independence in patients randomized to receive bilateral multifocal intraocular lenses (IOLs) or monofocal IOLs with the powers adjusted to produce monovision. DESIGN Randomized, multicenter clinical trial. PARTICIPANTS A total of 212 patients with bilateral, visually significant cataract. METHODS Before bilateral sequential cataract surgery, patients were randomized (allocation ratio 1:1) to receive bilateral Tecnis ZM900 diffractive multifocal lenses (Abbott Medical Optics, Santa Ana, CA) or Akreos AO monofocal lenses (Bausch & Lomb, Rochester, NY) with the powers adjusted to target -1.25 diopters (D) monovision. Outcomes were assessed 4 months after the second eye underwent operation. MAIN OUTCOME MEASURES The primary outcome was spectacle independence. Secondary outcomes included questionnaires (VF-11R, dysphotopsia symptoms, and satisfaction) and visual function measures (near, intermediate, and distance logarithm of minimum angle of resolution [logMAR] visual acuity, stereoacuity, contrast sensitivity, and forward light scatter). RESULTS A total of 212 patients were randomized, and 187 patients (88%) returned for assessment 4 months after surgery. Uniocular distance refractions in the monovision arm showed a mean spherical equivalent of +0.075 D in the distance eye and -0.923 in the near eye. In the multifocal arm, the mean distance spherical equivalents were -0.279 D and -0.174 D in the right and left eyes, respectively. A total of 24 of 93 patients (25.8%) in the monovision arm and 67 of 94 patients (71.3%) in the multifocal arm reported never wearing glasses (P<0.001, Fisher exact test). The adjusted odds ratio of being spectacle free was 7.51 (95% confidence interval, 3.89-14.47). Binocular uncorrected acuities did not differ significantly for distance (0.058 logMAR for monovision vs. 0.076 for multifocal, P = 0.3774) but were significantly worse in the multifocal arm for intermediate acuity (0.149 vs. 0.221, P = 0.0001) and in the monovision arm for near acuity (0.013 vs. -0.025, P = 0.037). In the first postoperative year, 6 patients (5.7%) in the multifocal arm underwent IOL exchange (4 had a bilateral and 2 had a unilateral exchange). No patients in the monovision arm underwent IOL exchange. CONCLUSIONS Patients randomized to bilateral implantation with the diffractive multifocal Tecnis ZM900 were more likely to report being spectacle independent but also more likely to undergo IOL exchange than those randomized to receive monofocal implants (Akreos AO) with the powers adjusted to give low monovision.
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Affiliation(s)
- Mark R Wilkins
- Moorfields Eye Hospital, London, United Kingdom; University College London, Institute of Ophthalmology, London, United Kingdom.
| | - Bruce D Allan
- Moorfields Eye Hospital, London, United Kingdom; University College London, Institute of Ophthalmology, London, United Kingdom
| | - Gary S Rubin
- University College London, Institute of Ophthalmology, London, United Kingdom; NIHR Moorfields Biomedical Research Centre, London, United Kingdom
| | | | | | - Catey Bunce
- Moorfields Eye Hospital, London, United Kingdom
| | - Wen Xing
- Moorfields Eye Hospital, London, United Kingdom
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Kinard K, Jarstad A, Olson RJ. Correlation of visual quality with satisfaction and function in a normal cohort of pseudophakic patients. J Cataract Refract Surg 2013; 39:590-7. [PMID: 23395326 DOI: 10.1016/j.jcrs.2012.11.023] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2012] [Revised: 10/31/2012] [Accepted: 11/07/2012] [Indexed: 11/18/2022]
Abstract
PURPOSE To select a normal post-cataract-surgery cohort, determine visual quality parameters, and compare these parameters with self-reported satisfaction and visual function. SETTING John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. DESIGN Retrospective cohort study. METHODS A cohort of pseudophakic patients was selected based on uneventful surgery, good corrected visual acuity (no worse than logMAR 0.02), and lack of ocular complaints or pathology including dry-eye syndrome or posterior capsule opacification. A single-piece high-refractive-index acrylic intraocular lens, age 50 or older, and at least 1 year out from surgery were other inclusion criteria. Testing included logMAR corrected distance visual acuity (CDVA), mesopic 10% contrast logMAR CDVA with and without glare, straylight determination, Rasch-modified National Eye Institute Visual Function questionnaire 11R (NEI VF-11R), custom pseudophakic dysphotopsia survey, and overall satisfaction question. Correlations were determined between these parameters. RESULTS Of the 2953 patients considered, 70 patients met all criteria, provided consent, and enrolled. Only pseudophakic dysphotopsia (r = -0.60; P<.0001) and the NEI VF-11R (r = -0.44; P<.0001) correlated with overall satisfaction. In addition, pseudophakic dysphotopsia correlated with the NEI VF-11R (r = 0.58; P<.0001). CONCLUSIONS When evaluating a highly controlled population with expected high satisfaction after cataract surgery, pseudophakic dysphotopsia was clearly the only significant dissatisfier. Furthermore, dysphotopsia highly correlated with the NEI VF-11R questionnaire; thus, symptoms of dysphotopsia are also seen to have functional significance. A shortened NEI VFQ survey and satisfaction correlated strongly with the full survey.
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Affiliation(s)
- Krista Kinard
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah 84132, USA
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Holladay JT, Zhao H, Reisin CR. Negative dysphotopsia: the enigmatic penumbra. J Cataract Refract Surg 2012; 38:1251-65. [PMID: 22727295 DOI: 10.1016/j.jcrs.2012.01.032] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Revised: 01/27/2012] [Accepted: 01/29/2012] [Indexed: 11/15/2022]
Abstract
PURPOSE To determine the cause of negative dysphotopsia and the location, appearance, and relative intensity of such images in pseudophakic eyes. SETTING Baylor College of Medicine, Houston, Texas, USA. DESIGN Reporting available data addressing a specific clinical question. METHODS Negative dysphotopsia was simulated using the Zemax optical design program. The nominal values for the pseudophakic eye model were as follows: IOL power, 20.0 diopters (D); corneal power, 43.5 D; Q value, -0.26; axial IOL depth behind pupil, 0.5 mm; external anterior chamber depth (corneal vertex to iris plane), 4.0 mm; optic diameter, 6.0 mm; pupil diameter, 2.5 mm. RESULTS From the first ray-tracing simulation, analysis of the image for the nominal parameters showed 2 annuli (ring-shaped) shadows. The inner annulus shadow was located from a retinal visual field angle of 86.0 to 100.0 degrees (width 14.0 degrees), and the outer annular shadow was located from 105.9 to 123.3 degrees (width 17.4 degrees). Superimposing the inner annulus on the human visual field showed that the shadow would be apparent only temporally, where it is within the limits of the visual field and functional retina. The patient would perceive this as a temporal dark crescent-shaped partial shadow (penumbra). CONCLUSIONS Primary optical factors required for negative dysphotopsia are a small pupil, a distance behind the pupil of 0.06 mm or more and 1.23 mm or less for acrylic, a sharp-edged design, and functional nasal retina that extends anterior to the shadow. Secondary factors include a high index of refraction optic material, angle α, and the nasal location of the pupil relative to the eye's optical axis. FINANCIAL DISCLOSURE Drs. Zhao and Reisin are employees of and Dr. Holladay is a consultant to Abbott Medical Optics, Inc. No author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Jack T Holladay
- Department of Ophthalmology, Baylor College of Medicine, Houston, Texas 77402-0717, USA.
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Schrecker J, Zoric K, Meßner A, Eppig T. Effect of interface reflection in pseudophakic eyes with an additional refractive intraocular lens. J Cataract Refract Surg 2012; 38:1650-6. [DOI: 10.1016/j.jcrs.2012.03.039] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Revised: 03/15/2012] [Accepted: 03/17/2012] [Indexed: 10/28/2022]
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Abstract
PURPOSE To demonstrate a new optic edge design that preserves advantages of the square-edged optic and substantially reduces intensity of the light pattern formed at the retina by internal reflection off the optic edge. METHODS Non-sequential ray tracing (Zemax optical design software) was used to model light intensity and distribution of the light pattern at the retina formed by internal light reflection off different optic edges in intraocular lens of otherwise equivalent configurations. RESULTS A maximum intensity of the light pattern formed by internal reflection off the optic edge occurs within 35 to 42.5° of the field angle. An undulated square-edged optic reduces the maximum light intensity of the light pattern formed at the retina by a factor of 5, when compared with a conventional double square-edged optic. CONCLUSIONS Edge undulation of the square-edged optic is an effective addition to intraocular lens designs that reduces the potential for dysphotopsia caused by the optic edge internal reflection of light.
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Hong X, Liu Y, Karakelle M, Masket S, Fram NR. Ray-tracing optical modeling of negative dysphotopsia. JOURNAL OF BIOMEDICAL OPTICS 2011; 16:125001. [PMID: 22191914 DOI: 10.1117/1.3656745] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Negative dysphotopsia is a relatively common photic phenomenon that may occur after implantation of an intraocular lens. The etiology of negative dysphotopsia is not fully understood. In this investigation, optical modeling was developed using nonsequential-component Zemax ray-tracing technology to simulate photic phenomena experienced by the human eye. The simulation investigated the effects of pupil size, capsulorrhexis size, and bag diffusiveness. Results demonstrated the optical basis of negative dysphotopsia. We found that photic structures were mainly influenced by critical factors such as the capsulorrhexis size and the optical diffusiveness of the capsular bag. The simulations suggested the hypothesis that the anterior capsulorrhexis interacting with intraocular lens could induce negative dysphotopsia.
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Affiliation(s)
- Xin Hong
- Alcon Laboratories, 6201 South Freeway, Fort Worth, Texas 76134, USA.
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Thiagarajan M, McClenaghan R, Anderson DF. Comparison of visual performance with an aspheric intraocular lens and a spherical intraocular lens. J Cataract Refract Surg 2011; 37:1993-2000. [DOI: 10.1016/j.jcrs.2011.05.046] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2010] [Revised: 04/26/2011] [Accepted: 05/12/2011] [Indexed: 10/16/2022]
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Pseudophakic negative dysphotopsia: Surgical management and new theory of etiology. J Cataract Refract Surg 2011; 37:1199-207. [DOI: 10.1016/j.jcrs.2011.02.022] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Revised: 01/26/2011] [Accepted: 02/03/2011] [Indexed: 11/20/2022]
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Welch NR, Gregori N, Zabriskie N, Olson RJ. Satisfaction and dysphotopsia in the pseudophakic patient. Can J Ophthalmol 2010; 45:140-3. [PMID: 20379298 DOI: 10.3129/i09-266] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE To examine factors that influence satisfaction after uncomplicated cataract surgery. DESIGN Retrospective case review and examination of patients. PARTICIPANTS Sixty-one consecutive patients, seen at the John A. Moran Eye Center, University of Utah School of Medicine, who had uncomplicated cataract surgery from 1 practice and 40 consecutive control patients who met the inclusion criteria and were willing to participate. METHODS Inclusion criteria were best-corrected visual acuity (BCVA) of at least 20/20, without any ocular disease that might affect vision. Patients were given a complete ophthalmic examination, had photos of the intraocular lens (IOL) and capsule taken, and were asked questions about dysphotopsia and satisfaction. A group of patients >65 years old with 20/20 BCVA and without other ophthalmic diagnoses were recruited, asked the same questions, and compared. RESULTS The only significant correlation with dissatisfaction was dysphotopsia (r = 0.602, CI 0.42-0.74, p < 0.0001). BCVA, uncorrected visual acuity, posterior capsular opacification, and anterior capsule overlap of the optic were not significantly correlated. The IOL patients were significantly worse for reported glare (p < 0.0001), photophobia (p < 0.0001), and flashes of light (p = 0.0002), but not for halos. CONCLUSIONS While satisfaction with cataract removal and IOL placement is high, dysphotopsia is the most important contributor to dissatisfaction and is relatively common. Furthermore, these symptoms are much worse than in age-matched controls. Research seeking to ameliorate dysphotopsia is clinically important.
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Affiliation(s)
- Nathan R Welch
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City, Utah 84132, USA
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