Apparent accommodation in pseudophakic eyes with refractive against-the-rule, with-the-rule and minimum astigmatism

Five-Year Clinical Outcomes of Low-Add-Power Segmented Rotationally Asymmetrical Intraocular Lens

INTRODUCTION

This study assessed 5-year results of rotationally asymmetric multifocal intraocular lens (IOL) with +1.5 diopters (D) near addition (Lentis Comfort LS-313 MF15, Teleon Surgical B.V., Spankeren, Netherlands).

METHODS

In 38 eyes of 20 patients (76.8 ± 4.6 years) who were examined at both 1 and 5 years after surgery, clinical data were retrospectively collected.

RESULTS

Corrected and uncorrected distance visual acuity (5 m) and uncorrected and distance-corrected intermediate visual acuity (70 cm) were excellent, with no significant differences between 1 and 5 years after surgery. Uncorrected and distance-corrected near visual acuity (30 cm) remained lower. Contrast sensitivity was within the normal range at both 1 and 5 years. The percentage of patients who reported "never or hardly use spectacles" for far, intermediate, and near vision was 95.0%, 85.0%, and 35.0%, respectively. Glare and halo were slightly increased from 1 to 5 years after surgery, but the severity remained none or mild. All patients reported "very high" or "high" level of overall satisfaction. There were no notable postoperative complications.

CONCLUSIONS

During 5 years after surgery, low-add-power segmented multifocal IOL maintained excellent distance and intermediate visual acuity as well as good contrast sensitivity. Glare and halo symptoms were mild, and patients' satisfaction level was high.

TRIAL REGISTRATION

University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR) identifier UMIN000048353.

Analysis of uncorrected near visual acuity after extended depth-of-focus AcrySof® Vivity™ intraocular lens implantation

A newly developed extended-depth-of-focus AcrySof® Vivity™ intraocular lens (IOL), which has a wavefront-shaped anterior surface, has shown a promising outcome in minimizing dysphotopsia, the biggest issue after diffractive type IOL implantation. On the contrary, relatively low uncorrected near visual acuity (UNVA) has been raised as a demerit of this IOL. However, there is only limited information about the UNVA after Vivity implantation. In the present study, we compared the uncorrected distant and intermediate visual acuity (UDVA and UIVA) and UNVA according to the range of refractive error (RE) from 91 eyes from 91 patients implanted with Vivity IOL. Then we assessed the biometric factors for their association with UNVA from 66 eyes with a RE within ± 0.25 D. The UDVA was worst in eyes with RE < -0.50 D (0.17 ± 0.21), which was significantly worse than in any other group (P < 0.001 for every analysis). The UIVA was worst in eyes with RE of 0.25 to 0.50 D (0.35 ± 0.07 D), which was significantly worse than in eyes with RE of -0.50 to -0.26 D (P = 0.020) and in eyes with RE of -0.25 to -0.01 D (P = 0.028). The UNVA was worst in eyes with RE of 0.25 to 0.50 D (0.40 ± 0.14 D), which was significantly worse than in eyes with RE of -0.50 to -0.26 D (P = 0.022), which suggests that the extent of monovision should be limited up to -0.50 diopter. On univariate analysis for UNVA in eyes with a RE within ± 0.25 D, the anterior chamber depth (R = 0.257; P = 0.037) and pupil size (R = 0.451; P < 0.001) had a statistically significant relation to UNVA, while multivariate analysis showed the pupil size (β = 0.451; P < 0.001) as the sole indicator, suggesting eyes with a small pupil size might receive a UNVA benefit.

Prediction of distance visual acuity in presbyopic astigmatic subjects

This study was aimed to determine the effect of the amount of astigmatism on distance visual acuity, and to provide a prediction formula of visual acuity according to astigmatism, in a presbyopic population. We comprised 318 eyes of 318 consecutive patients (158 phakic and 160 pseudophakic subjects) without any eye diseases, except for refractive errors with astigmatism of 3 diopter or less. We assessed the relationship of the spherical equivalent visual acuity (SEVA) with astigmatism, and also provided a regression formula of visual acuity according to astigmatism in such subjects. We found a significant correlation between the SEVA and the amount of astigmatism (r = 0.715, p < 0.001) in the entire study population. We obtained similar results, not only in phakic eyes (r = 0.718, p < 0.001), but also in pseudophakic eyes (r = 0.717, p < 0.001). The regression formula was expressed as follows: y = 0.017x² + 0.125x − 0.116 (R² = 0.544), where y = logMAR SEVA, and x = astigmatism. We also found no significant differences in the SEVA for matched comparison among the with-the-rule (WTR), against-the-rule (ATR), and oblique (OBL) astigmatism subgroups (p = 0.922). These regression formulas may be clinically beneficial not only for estimating the visual prognosis after astigmatic correction, but also for determining the surgical indication of astigmatic correction.

Static and Dynamic Factors Associated With Extended Depth of Focus in Monofocal Intraocular Lenses

PURPOSE

To analyze factors affecting depth of focus (DOF) and near vision functionality in eyes implanted with aspheric monofocal intraocular lenses (IOLs).

METHODS

This prospective study included 111 eyes of 74 patients that underwent phacoemulsification with monofocal IOL implantation. Ninety-one normal eyes were randomized to receive aberration-free (n = 30) or negative-spherical aberration (SA) IOLs (n = 61). Twenty post-hyperopic femto-LASIK eyes received aberration-free IOLs. Corneal higher-order aberrations (SA, coma, trefoil, and corneal asphericity) for a 6 mm pupil were measured by Scheimpflug tomography. Ray-tracing metrics (visual Strehl optical transfer function [VSOTF], effective range of focus [EROF], sphere shift [SS], EROF-SS), pupil size measurements at far and near, and ocular and corneal SA were obtained using ray-tracing aberrometry. Distance-corrected near visual acuity (DCNVA) and subjective defocus curves up to ±4.0 diopters were evaluated.

RESULTS

Multivariable logistic regression found corneal profile and IOL type to be determinants of extended DOF with monofocal IOLs. The aberration-free IOL group showed significantly better DCNVA and higher total SA than the negative-SA group. Post-hyperopic LASIK eyes showed significantly better DCNVA; higher negative SA, coma, and Q value (P < .05), and smaller pupil size (P = .05) than normal eyes implanted with aberration-free IOLs.

CONCLUSION

Corneal profile and type of IOL implanted were the most important factors influencing near vision functionality with aspheric monofocal IOLs. Higher positive SA in the aberration-free group potentially led to better DCNVA than the negative-SA group in normal eyes. Hyperprolate corneas had better DOF curves and DCNVA than normal corneas. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.

The differences of corneal astigmatism in different populations and its quantitative analysis

Objective

To analyze the differences of corneal astigmatism in different age groups.

Methods

The clinical data of the patients from the outpatient Department of Ophthalmology of the Tengzhou Central People's Hospital from April 2014 to June 2014 was screened and statistically analyzed. The corneal curvature was measured by three different instruments: Keratometer, IOL Master and Sirius corneal topography. The changes of the corneal astigmatism in different groups were evalutaed in the study.

Results

Corneal astigmatism of different groups showed no statistical difference and the average corneal astigmatism of 70˜79 age group were higher than younger groups. As the age grew, the with-the-rule astigmatism gradually reduced from 85.8% ( A Group) to 31.0% (F Group). The against-the-rule astigmatism increased from 6.7% ( A Group ) to 45.0% (F Group).

Conclusion

The proportion of the with-the-rule astigmatism gradually reduced with the growth of age. The proportion of the against-the-rule astigmatism increased significantly. The oblique astigmatism had no obvious change before the age of 40. The proportion of oblique astigmatism increased obviously at the 40˜49 group and tended to be stable. After the age of 60, the proportion of different types of astigmatism tended to be stable.

A comparison of surgical efficacy between a 1.8-mm microincision and 3.2-mm and 5.5-mm incisions for phacoemulsification

Phacoemulsification is a commonly used surgical method in cataract surgery. This paper observes and compares the surgical efficacy of three incisions of different length for phacoemulsification to identify the optimal method for cataract surgery. Ninety patients were enrolled in the present study and divided into three groups. The 1.8-mm group received Bausch & Lomb MI60 foldable intraocular lens (IOL) implantation (n=30), 3.2-mm group received Bausch & Lomb Akreos AO foldable lens implantation (n=30), and 5.5-mm group received Alcon TYPE 05 rigid IOL implantation (n=30). Visual acuity, Oculyzer-based anterior segment analysis, and corneal endothelial cell count before surgery, and 3, 7, 30, and 90d after surgery were recorded and compared. Pseudophakic accommodation three days, one week, one month, and three months after surgery was determined. Intraoperative ultrasound time and ultrasonic energy were recorded. It was finally concluded that for phacoemulsification with the same phaco tip, a 1.8-mm microincision can lead to quicker recovery of visual acuity, more stable astigmatism, and higher pseudophakic accommodation than conventional incision.