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Yang Y, Ning R, Xu S, Xiahou J, Li J, Savini G, Schiano-Lomoriello D, Zhou X, Huang J. Evaluation of the Agreement Between a New Pyramid Wavefront Sensor Aberrometer and Scheiner-Smirnov Aberrometers. J Refract Surg 2024; 40:e218-e228. [PMID: 38593257 DOI: 10.3928/1081597x-20240311-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
PURPOSE To assess agreement between a new aberrometer (Osiris-T; CSO) employing pyramid wavefront sensor technique and Scheiner-Smirnov aberrometer (OPD-Scan III; Nidek) on measuring ocular, corneal, and internal aberrations in healthy participants. METHODS The measurements were conducted three times consecutively by an experienced examiner. The total root mean square (RMS) aberrations, higher order aberration RMS, coma Z3±1, trefoil Z3±3, spherical aberration Z40, and astigmatism II Z4±2 up to 7th order were exported in both 4-and 6-mm pupil zones. The parameters between the two devices were statistically compared using the paired t-test, and the differences assessed with Bland-Altman plots and 95% limits of agreement. RESULTS This prospective study included 70 right eyes of 70 healthy participants with an average age of 25.94 ± 6.59 years (range: 18 to 47 years). The mean difference in the two devices ranged from 0.01 µm for astigmatism II Z4±2 to 0.63 µm for total RMS in 4 mm and from 0.01 to 1.41 µm in 6-mm pupil size. The Bland-Altman analysis of ocular, corneal, and internal aberrations indicated high agreement between the two devices and the maximum absolute values for 95% limits of agreement ranged from 0.03 to 1.06 µm for 4-mm pupil diameters and 0.12 to 1.13 µm for 6-mm pupil diameters. CONCLUSIONS The newly developed pyramid wavefront sensor technique aberrometer demonstrated a high agreement with a Scheiner-Smirnov aberrometer when measuring ocular, corneal, and internal aberrations in healthy participants. Thus, the two aberrometers may be considered interchangeable for clinical applications. [J Refract Surg. 2024;40(4):e218-e228.].
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Meer E, Gutkind N, Hua P, Ying GS, Sulewski M, Bhatt N. Outcomes of resident physician-performed cataract surgery in a diverse veterans affairs health system population. Indian J Ophthalmol 2023; 71:3344-3351. [PMID: 37787233 PMCID: PMC10683690 DOI: 10.4103/ijo.ijo_285_23] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 10/04/2023] Open
Abstract
Purpose To evaluate visual acuity (VA) outcomes and complications from resident physician-performed cataract surgery in a diverse Veterans Affairs Hospital population. Methods A retrospective chart review was conducted for patients who underwent cataract surgery performed by resident physicians from 01/01/2013 to 12/31/2015 at the Veterans Affairs Medical Center. Intraoperative and postoperative clinical information, best-corrected VA (BCVA) (1 day, months 1, 2-3, and 6), and surgery complications were extracted. Univariable and multivariable linear regression models were performed for risk factors of BCVA change. Results This study included 1183 patients, with mean (SD) age of 70.8 (9.3) years. 1154 (97.5%) were males, 493 (41.7%) African-American, and 681 (57.6%) Caucasian. The mean (SD) VA in logMAR was 0.69 (0.74) at baseline, improved to 0.19 (0.36) at 1 month, 0.16 (0.34) at 2-3 months, and 0.14 (0.36) at 6 months. 1080 (91.3%) patients experienced VA improvement from baseline and 1023 (86.5%) patients achieved at least 20/40 BCVA at 1 month. There were 86 (7.3%) complications, most commonly including 47 (4.0%) posterior capsular tears and 64 (5.4%) vitreous loss. In multivariable analysis, younger age (P < 0.0001), worse baseline VA (P < 0.0001), and absence of iris prolapse (P < 0.001) were significantly associated with greater improvement in VA at 1 month. Conclusion In a diverse VAMC, resident-performed cataract surgeries achieved significant improvement in VA with a cumulative complication rate lower than previously reported. Resident physician education may benefit from specific focus on prevention of iris prolapse and better incision construction during surgery as these intraoperative events often led to delayed stabilization of visual outcome beyond 1 month.
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Affiliation(s)
- Elana Meer
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
- Department of Ophthalmology, University of California, San Francisco, United States
| | - Naomi Gutkind
- Department of Ophthalmology, University of California, San Francisco, United States
- Department of Ophthalmology, University of Miami Bascom Palmer Eye Institute, Miami, FL, United States
| | - Peiying Hua
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Gui-Shuang Ying
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Michael Sulewski
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
- Department of Ophthalmology, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, United States
| | - Nirali Bhatt
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
- Department of Ophthalmology, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, United States
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Li Y, Jin L, Wu M, Huang Y. Evaluation value of subjective visual quality examination on surgical indications of the early cataracts based on objective scatter index values. Front Med (Lausanne) 2022; 9:1075693. [PMID: 36582278 PMCID: PMC9792837 DOI: 10.3389/fmed.2022.1075693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 11/14/2022] [Indexed: 12/14/2022] Open
Abstract
Aim To evaluate the subjective visual functions of early cataracts patients and assess their surgical indications. Methods Eyes were separated into a control group (Group A without cataract) and two early cataracts groups (Group B with 2.0 ≤ OSI < 3.0 and Group C with 3.0 ≤ OSI < 4.0). The objective scatter index (OSI), modulation transfer function cut-off frequency (MTF cut-off), and Strehl ratio (SR) values were applied to measure objective visual functions. The contrast sensitivity (CS) and scores of the questionnaires (QOL and VF-14) characterized subjective visual functions. Above visual functions were compared among three groups. Postoperative visual functions in Group B and C were analyzed to assess the outcome of surgery. Results Ninety two subjects (126 eyes) were included in the study. All objective visual function in Group B were significantly better than Group C (all P < 0.01), but worse than Group A (all P < 0.01). Except for 1.5 c/d CS, subjective visual function in Group A were significantly better than Group B and C (all P < 0.05), but there was no significant differences between Group B and C. As for eyes that underwent surgery in Group B and C, all visual functions significantly improved after surgery (P < 0.05), except for 1.5 c/d CS in Group C. There were no significant differences among the three groups after surgery. Conclusion The subjective visual function can be impaired in early cataracts patients with OSI < 3.0, whose objective visual functions were statistically better than patients with OSI ≥ 3.0. These patients can benefit equally from surgery as patients with OSI ≥ 3.0. Subjective visual functions can be used as surgical indications for these patients.
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Duan L, Dang G, Ge J, Gao Y, Wang L. Visual function assessment of Chinese cataract patients after individual aspheric intraocular lens implantation according to preoperative cornea spherical aberration. Technol Health Care 2022; 31:831-839. [PMID: 36442220 DOI: 10.3233/thc-220154] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND: Aspheric intraocular lens (IOLs) implantation has been widely applied in cataract surgery. However, there is no consensus on the optimal guidance for the operations in IOLs implantation. OBJECTIVE: This study evaluated the visual function of Chinese cataract patients six months after cataract surgery with two different guiding ideologies. METHODS: We evaluated 50 patients (61 eyes) with implantation of different aspheric IOLs (SN60WF IOLs, ZCB00 IOLs, PY-60AD IOLs, AO IOLs) 6 months after cataract surgery. Twenty-four patients (30 eyes) under individual implantation were ascribed to group 1 and 26 patients (31 eyes) with randomized implantation were ascribed to the control group (group 2). Postoperatively parameters included monocular best-corrected visual acuity (BCVA), contrast sensitivity (CS), total spherical aberration Z (4, 0) at 5 mm pupil size, and patient satisfaction. The quality of life after operation was assessed through the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25). RESULTS: Six months after cataract operation, the contrast sensitivity with glare of group 1 at 2.5∘ was 0.697 ± 0.027, and 0.532 ± 0.049 in group 2. Besides, there was no significant difference at any other special frequency. The mean spherical aberration Z (4, 0) at 5 mm pupil size in group 1 was 0.015 ± 0.028 um, and in group 2 was 0.043 ± 0.109 um, with a significant difference (p< 0.01). The mean scores obtained from NEI VFQ-25 were not significantly different. CONCLUSION: It is effective to implant aspheric IOLs individually according to preoperative corneal spherical aberration. Patients obtained better contrast sensitivity with glare at 2.5∘, but there was no significant difference in BCVA, contrast sensitivity at other special frequency, and subjective visual function.
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Affiliation(s)
- Lian Duan
- Department of Ophthalmology, Qianfoshan Hospital Affiliated to Shandong University, Jinan, Shandong, China
- Department of Ophthalmology, Qianfoshan Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - Guangfu Dang
- Department of Ophthalmology, Qianfoshan Hospital Affiliated to Shandong University, Jinan, Shandong, China
- Department of Ophthalmology, Qianfoshan Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - Jinling Ge
- Mingshui Eye Hospital, Jinan, Shandong, China
- Department of Ophthalmology, Qianfoshan Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - Yang Gao
- Department of Ophthalmology, Qianfoshan Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - Lihua Wang
- Department of Ophthalmology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China
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Shah N, Dakin SC, Mulholland PJ, Racheva K, Matlach J, Anderson RS. The Effect of Induced Intraocular Stray Light on Recognition Thresholds for Pseudo-High-Pass Filtered Letters. Transl Vis Sci Technol 2022; 11:4. [PMID: 35511149 PMCID: PMC9078078 DOI: 10.1167/tvst.11.5.4] [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] [Indexed: 11/24/2022] Open
Abstract
Purpose The Moorfields Acuity Chart (MAC)—comprising pseudo-high-pass filtered “vanishing optotype” (VO) letters—is more sensitive to functional visual loss in age-related macular degeneration (AMD) compared to conventional letter charts. It is currently unknown the degree to which MAC acuity is affected by optical factors such as cataract. This is important to know when determining whether an individual's vision loss owes more to neural or optical factors. Here we estimate recognition acuity for VOs and conventional letters with simulated lens aging, achieved using different levels of induced intraocular light scatter. Methods Recognition thresholds were determined for two experienced and one naive participant with conventional and VO letters. Stimuli were presented either foveally or at 10 degrees in the horizontal temporal retina, under varying degrees of intraocular light scatter induced by white resin opacity-containing filters (WOFs grades 1 to 5). Results Foveal acuity only became significantly different from baseline (no filter) for WOF grade 5 with conventional letters and WOF grades 4 and 5 with VOs. In the periphery, no statistical difference was found for any stray-light level for both conventional and VOs. Conclusions Recognition acuity measured with conventional and VOs is robust to the effects of simulated lens opacification, and thus its higher sensitivity to neural damage should not simultaneously be confounded by such optical factors. Translational Relevance The MAC may be better able to differentiate between neural and optical deficits of visual performance, making it more suitable for the assessment of patients with AMD, who may display both types of functional visual loss.
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Affiliation(s)
- Nilpa Shah
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Steven C Dakin
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.,School of Optometry & Vision Science, University of Auckland, Auckland, New Zealand
| | - Pádraig J Mulholland
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.,Centre for Optometry and Vision Science, School of Biomedical Sciences, University of Ulster at Coleraine, N Ireland, UK
| | - Kalina Racheva
- Institute of Neurobiology, Bulgarian Academy of Sciences, Sofia, Bulgaria
| | - Juliane Matlach
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.,Department of Ophthalmology, University Medical Centre, Johannes Gutenberg University Mainz, Germany
| | - Roger S Anderson
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.,Centre for Optometry and Vision Science, School of Biomedical Sciences, University of Ulster at Coleraine, N Ireland, UK
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Cataract Surgery in One-Eyed Patients: A Cohort Study of 100 Patients. J Ophthalmol 2021; 2021:5581512. [PMID: 34594578 PMCID: PMC8478556 DOI: 10.1155/2021/5581512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 06/08/2021] [Accepted: 09/08/2021] [Indexed: 11/20/2022] Open
Abstract
Purpose To determine the course and outcomes of cataract surgery in one-eyed patients. Methods This retrospective cohort study was conducted at the University Hospital of Nice, France. All one-eyed patients who underwent cataract surgery in their functional eye between January 2014 and December 2018 were included. A one-eyed patient was defined as having a visual acuity (VA) ≤20/200 in the other eye. Data were collected from the medical records and included the sociodemographic factors, the past medical history, data from the preoperative and postoperative clinical examinations, the surgical course, and the visual outcomes. Results One hundred one-eyed patients with a mean age of 74.01 years were included (48 men/52 women). The mean preoperative VA was 20/100 (+0.74 logMAR). The VA ranged between 20/200 and 20/40 in 75 (75%) patients, was >20/40 in 8 (8%), and was <20/200 in 17 (17%) patients. Fifty-eight (58%) patients were operated on an outpatient basis. General or locoregional anesthesia was used in 29 (29%) and 9 (9%) patients, respectively. All cataract surgery procedures were performed by phacoemulsification. Five (5%) patients experienced intraoperative complications. Seventy-three (73%) one-eyed patients achieved a final VA ≥20/40. The mean final VA was 20/50 (+0.37 logMAR) (p < 0.001). Conclusion A low rate of intraoperative complications was observed in one-eyed patients during cataract surgery. In most cases, a good visual recovery was achieved after cataract surgery, even in patients who experienced a surgical complication.
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Wei L, He W, Wang J, Zhang K, Du Y, Qi J, Meng J, Qiu X, Cai L, Fan Q, Zhao Z, Tang Y, Ni S, Guo H, Song Y, He X, Ding D, Lu Y, Zhu X. An Optical Coherence Tomography-Based Deep Learning Algorithm for Visual Acuity Prediction of Highly Myopic Eyes After Cataract Surgery. Front Cell Dev Biol 2021; 9:652848. [PMID: 34124042 PMCID: PMC8187805 DOI: 10.3389/fcell.2021.652848] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/19/2021] [Indexed: 12/23/2022] Open
Abstract
Background Due to complicated and variable fundus status of highly myopic eyes, their visual benefit from cataract surgery remains hard to be determined preoperatively. We therefore aimed to develop an optical coherence tomography (OCT)-based deep learning algorithms to predict the postoperative visual acuity of highly myopic eyes after cataract surgery. Materials and Methods The internal dataset consisted of 1,415 highly myopic eyes having cataract surgeries in our hospital. Another external dataset consisted of 161 highly myopic eyes from Heping Eye Hospital. Preoperative macular OCT images were set as the only feature. The best corrected visual acuity (BCVA) at 4 weeks after surgery was set as the ground truth. Five different deep learning algorithms, namely ResNet-18, ResNet-34, ResNet-50, ResNet-101, and Inception-v3, were used to develop the model aiming at predicting the postoperative BCVA, and an ensemble learning was further developed. The model was further evaluated in the internal and external test datasets. Results The ensemble learning showed the lowest mean absolute error (MAE) of 0.1566 logMAR and the lowest root mean square error (RMSE) of 0.2433 logMAR in the validation dataset. Promising outcomes in the internal and external test datasets were revealed with MAEs of 0.1524 and 0.1602 logMAR and RMSEs of 0.2612 and 0.2020 logMAR, respectively. Considerable sensitivity and precision were achieved in the BCVA < 0.30 logMAR group, with 90.32 and 75.34% in the internal test dataset and 81.75 and 89.60% in the external test dataset, respectively. The percentages of the prediction errors within ± 0.30 logMAR were 89.01% in the internal and 88.82% in the external test dataset. Conclusion Promising prediction outcomes of postoperative BCVA were achieved by the novel OCT-trained deep learning model, which will be helpful for the surgical planning of highly myopic cataract patients.
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Affiliation(s)
- Ling Wei
- Department of Ophthalmology, Eye and ENT Hospital, Eye Institute, Fudan University, Shanghai, China.,Key Laboratory of Myopia, NHC Key Laboratory of Myopia, Fudan University, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Wenwen He
- Department of Ophthalmology, Eye and ENT Hospital, Eye Institute, Fudan University, Shanghai, China.,Key Laboratory of Myopia, NHC Key Laboratory of Myopia, Fudan University, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | | | - Keke Zhang
- Department of Ophthalmology, Eye and ENT Hospital, Eye Institute, Fudan University, Shanghai, China.,Key Laboratory of Myopia, NHC Key Laboratory of Myopia, Fudan University, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Yu Du
- Department of Ophthalmology, Eye and ENT Hospital, Eye Institute, Fudan University, Shanghai, China.,Key Laboratory of Myopia, NHC Key Laboratory of Myopia, Fudan University, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Jiao Qi
- Department of Ophthalmology, Eye and ENT Hospital, Eye Institute, Fudan University, Shanghai, China.,Key Laboratory of Myopia, NHC Key Laboratory of Myopia, Fudan University, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Jiaqi Meng
- Department of Ophthalmology, Eye and ENT Hospital, Eye Institute, Fudan University, Shanghai, China.,Key Laboratory of Myopia, NHC Key Laboratory of Myopia, Fudan University, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Xiaodi Qiu
- Department of Ophthalmology, Eye and ENT Hospital, Eye Institute, Fudan University, Shanghai, China.,Key Laboratory of Myopia, NHC Key Laboratory of Myopia, Fudan University, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Lei Cai
- Department of Ophthalmology, Eye and ENT Hospital, Eye Institute, Fudan University, Shanghai, China.,Key Laboratory of Myopia, NHC Key Laboratory of Myopia, Fudan University, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Qi Fan
- Department of Ophthalmology, Eye and ENT Hospital, Eye Institute, Fudan University, Shanghai, China.,Key Laboratory of Myopia, NHC Key Laboratory of Myopia, Fudan University, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Zhennan Zhao
- Department of Ophthalmology, Eye and ENT Hospital, Eye Institute, Fudan University, Shanghai, China.,Key Laboratory of Myopia, NHC Key Laboratory of Myopia, Fudan University, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Yating Tang
- Department of Ophthalmology, Eye and ENT Hospital, Eye Institute, Fudan University, Shanghai, China.,Key Laboratory of Myopia, NHC Key Laboratory of Myopia, Fudan University, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Shuang Ni
- Department of Ophthalmology, Heping Eye Hospital, Shanghai, China
| | - Haike Guo
- Department of Ophthalmology, Heping Eye Hospital, Shanghai, China
| | - Yunxiao Song
- Illinois Computer Science, University of Illinois, Champaign, IL, United States
| | - Xixi He
- Visionary Intelligence Ltd, Beijing, China
| | | | - Yi Lu
- Department of Ophthalmology, Eye and ENT Hospital, Eye Institute, Fudan University, Shanghai, China.,Key Laboratory of Myopia, NHC Key Laboratory of Myopia, Fudan University, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Xiangjia Zhu
- Department of Ophthalmology, Eye and ENT Hospital, Eye Institute, Fudan University, Shanghai, China.,Key Laboratory of Myopia, NHC Key Laboratory of Myopia, Fudan University, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
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Dervenis N, Praidou A, Dervenis P, Chiras D, Little B. Visual Acuity Outcomes after Phacoemulsification in Eyes with Good Visual Acuity before Cataract Surgery. Med Princ Pract 2021; 30:285-291. [PMID: 33494090 PMCID: PMC8280449 DOI: 10.1159/000514662] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 01/21/2021] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE to analyse cataract surgery outcomes and related factors in eyes presenting with good visual acuity. SUBJECT AND METHODS A retrospective longitudinal study of patients undergoing phacoemulsification between 2014 and 2018 in Moorfields Eye Hospital was conducted. Pre- and post-operative visual acuities were analysed. Inclusion criteria were age ≥40 years and pinhole visual acuity ≥6/9 pre-operatively. Exclusion criteria were no post-operative visual acuity data. The visual acuity change variable was also defined according to post-operative visual acuity being above or below the Snellen 6/9 threshold. RESULTS 2,720 eyes were included. The unaided logMAR visual acuity improved from 0.54 to 0.20 (p < 0.001), the logMAR visual acuity with glasses improved from 0.35 to 0.05 (p < 0.001), and the logMAR pinhole visual acuity improved from 0.17 to 0.13 (p < 0.001); 8.1% of patients had Snellen visual acuity <6/9 post-operatively. Mean follow-up period was 23.6 ± 9.9 days. In multivariate analysis, factors associated with visual acuity <6/9 post-operatively were age (OR = 0.96, 95% confidence interval [CI] [0.95, 0.98], p < 0.001), vitreous loss (OR = 0.21, 95% CI [0.08, 0.56], p = 0.002), and iris trauma (OR = 0.28, 95% CI [0.10, 0.82] p = 0.02). CONCLUSIONS Visual acuity improved significantly, although at least 8.1% of them did not reach their pinhole preoperative visual acuity. Worse visual acuity outcomes were associated with increasing age, vitreous loss, and iris trauma. The 6/9 vision threshold may not be able to accurately differentiate those who may benefit from cataract surgery and those who may not.
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Affiliation(s)
- Nikolaos Dervenis
- Moorfields Eye Hospital, London, United Kingdom
- *Correspondence to: Nikolaos Dervenis,
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Zhang J, Jin G, Jin L, Ruan X, Gu X, Wang W, Chen X, Wang L, Dai Y, Liu Z, Luo L, Liu Y. Profiles of intraocular higher-order aberrations in healthy phakic eyes: prospective cross-sectional study. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:850. [PMID: 32793694 DOI: 10.21037/atm-20-1023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Ocular wavefront aberration is a crucial optical factor affecting retinal imaging. Internal aberrations contributed to compensation mechanism of ocular aberration. However, previous studies mainly focused on total and corneal higher order aberrations, and little is known about the profile of internal HOA (IHOA) in healthy subjects. Methods Participants with healthy crystalline lenses were prospective enrolled. The root mean square (RMS) of IHOAs for a pupil diameter of 4 mm were measured with an iTrace aberrometer. Lenticular parameters were measured with a swept source anterior segment optical coherence tomography (AS-OCT). Regression analyses were used to determine factors associated with logarithmic IHOAs. Results Sixty-six Chinese participants (132 eyes) ranging from 5 to 59 years were analyzed. Logarithmic IHOA was positively associated with axial length (AL) (coefficient =0.101, P=0.016), and negatively associated with ocular refraction (coefficient =-0.032, P=0.023). Logarithmic internal coma increased by 0.161/mm (P=0.016) as AL became longer and decreased by 0.081/diopter (P<0.001) as ocular refraction became hyperopic. Lens tilt (coefficient =-0.121, P=0.037), decentration (coefficient= 3.027, P=0.003), and radius of anterior lens surface curvature (RAL) (coefficient= 0.096, P=0.026) were associated with logarithmic internal trefoil. lens tilt was also associated with logarithmic internal spherical aberration (coefficient =-0.195, P=0.018) and second astigmatism (coefficient =-0.132, P=0.030). Binocularly, the extent of coma, trefoil was different, while that of spherical aberration, secondary astigmatism was consistent. The vectors of the same type of IHOAs were nearly paralleled. Conclusions IHOAs are mainly affected by ocular refraction, RAL, lens tilt and decentration. Intraocular differences and directions of higher-order aberrations follow certain rules, and their effects on visual function warrant further study.
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Affiliation(s)
- Jiaqing Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Guangming Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Ling Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xiaoting Ruan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xiaoxun Gu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Wei Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xiaoyun Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Lanhua Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Ye Dai
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Zhenzhen Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Lixia Luo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yizhi Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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Abstract
PURPOSE OF REVIEW To provide a consolidated update regarding preoperative evaluation for cataract surgery. RECENT FINDINGS Visual acuity alone is a poor gauge of cataract disability. Modalities such as wave front aberrometry, lens densitometry, and light-scatter assessments can quantify optical aspects of cataract and may prove clinically useful in surgical evaluation. Advances in biometry are driving improvements in refractive outcomes, which in turn have increased patient expectations. Future advances in biometry technology may include three-dimensional imaging of the cornea and lens. Screening for ocular comorbidities has become increasingly important, particularly to guide lens selection. Risk stratification systems can help guide surgical decisions and may decrease intraoperative complication rate. A comprehensive medical history and physical is currently mandated for all Medicare patients undergoing cataract surgery but may be of limited utility for low-risk patients. SUMMARY Rising patient expectations and a growing number of surgical choices have expanded the cataract preoperative evaluation. A systematic and comprehensive examination which includes identifying any ocular comorbidity is essential for surgical planning and counseling on visual prognosis. New technologies will continue to inform, but not replace, sound clinical judgment.
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From Presbyopia to Cataracts: A Critical Review on Dysfunctional Lens Syndrome. J Ophthalmol 2018; 2018:4318405. [PMID: 30050689 PMCID: PMC6040261 DOI: 10.1155/2018/4318405] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 06/05/2018] [Indexed: 01/19/2023] Open
Abstract
Dysfunctional lens syndrome (DLS) is a term coined to describe the natural aging changes in the crystalline lens. Different alterations in the refractive properties and transparency of the lens are produced during the development of presbyopia and cataract, such as changes in internal high order aberrations or an increase in ocular forward scattering, with a potentially significant impact on clinical measures, including visual acuity and contrast sensitivity. Objective technologies have emerged to solve the limits of current methods for the grading of the lens aging, which have been linked to the DLS term. However, there is still not a gold standard or evidence-based clinical guidelines around these new technologies despite multiple research studies have correlated their results with conventional methods such as visual acuity or the lens opacification system (LOCS), with more scientific background around the ocular scattering index (OSI) and Scheimpflug densitometry. In either case, DLS is not a new evidence-based concept that leads to new knowledge about crystalline lens aging but it is a nomenclature change of two existing terms, presbyopia and cataracts. Therefore, this term should be used with caution in the scientific peer-reviewed literature.
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