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Craig JP, Barsam A, Chen C, Chukwuemeka O, Ghorbani-Mojarrad N, Kretz F, Michaud L, Moore J, Pelosini L, Turnbull AMJ, Vincent SJ, Wang MTM, Ziaei M, Wolffsohn JS. BCLA CLEAR Presbyopia: Management with corneal techniques. Cont Lens Anterior Eye 2024:102190. [PMID: 38851946 DOI: 10.1016/j.clae.2024.102190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2024]
Abstract
Corneal techniques for enhancing near and intermediate vision to correct presbyopia include surgical and contact lens treatment modalities. Broad approaches used independently or in combination include correcting one eye for distant and the other for near or intermediate vision, (termed monovision or mini-monovision depending on the degree of anisometropia) and/or extending the eye's depth of focus [1]. This report provides an overview of the evidence for the treatment profile, safety, and efficacy of the range of corneal techniques currently available for managing presbyopia. The visual needs and expectations of the patient, their ocular characteristics, and prior history of surgery are critical considerations for patient selection and preoperative evaluation. Contraindications to refractive surgery include unstable refraction, corneal abnormalities, inadequate corneal thickness for the proposed ablation depth, ocular and systemic co-morbidities, uncontrolled mental health issues and unrealistic patient expectations. Laser refractive options for monovision include surface/stromal ablation techniques and keratorefractive lenticule extraction. Alteration of spherical aberration and multifocal ablation profiles are the primary means for increasing ocular depth of focus, using surface and non-surface laser refractive techniques. Corneal inlays use either small aperture optics to increase depth of field or modify the anterior corneal curvature to induce corneal multifocality. Presbyopia correction by conductive keratoplasty involves application of radiofrequency energy to the mid-peripheral corneal stroma which leads to mid-peripheral corneal shrinkage, inducing central corneal steepening. Hyperopic orthokeratology lens fitting can induce spherical aberration and correct some level of presbyopia. Postoperative management, and consideration of potential complications, varies according to technique applied and the time to restore corneal stability, but a minimum of 3 months of follow-up is recommended after corneal refractive procedures. Ongoing follow-up is important in orthokeratology and longer-term follow-up may be required in the event of late complications following corneal inlay surgery.
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Affiliation(s)
- Jennifer P Craig
- Department of Ophthalmology, Aotearoa New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand; College of Health & Life Sciences, Aston University, Birmingham, UK.
| | | | - Connie Chen
- Department of Optometry, Chung Shan Medical University, Taichung City, Taiwan
| | - Obinwanne Chukwuemeka
- Cornea, Contact Lens and Myopia Management Unit, De-Lens Ophthalmics Family and Vision Care Centre, Abuja, Nigeria
| | - Neema Ghorbani-Mojarrad
- School of Optometry and Vision Science, University of Bradford, Bradford, UK; Wolfson Centre for Applied Health Research, Bradford Royal Infirmary, Bradford, UK
| | | | | | | | | | - Andrew M J Turnbull
- Royal Bournemouth Hospital, University Hospitals Dorset, UK; Faculty of Life and Health Sciences, Ulster University, UK
| | - Stephen J Vincent
- Optometry and Vision Science, Centre for Vision and Eye Research, Queensland University of Technology, Brisbane, Australia
| | - Michael T M Wang
- Department of Ophthalmology, Aotearoa New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
| | - Mohammed Ziaei
- Department of Ophthalmology, Aotearoa New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
| | - James S Wolffsohn
- Department of Ophthalmology, Aotearoa New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand; College of Health & Life Sciences, Aston University, Birmingham, UK
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Wolffsohn JS, Berkow D, Chan KY, Chaurasiya SK, Fadel D, Haddad M, Imane T, Jones L, Sheppard AL, Vianya-Estopa M, Walsh K, Woods J, Zeri F, Morgan PB. BCLA CLEAR Presbyopia: Evaluation and diagnosis. Cont Lens Anterior Eye 2024:102156. [PMID: 38641525 DOI: 10.1016/j.clae.2024.102156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2024]
Abstract
It is important to be able to measure the range of clear focus in clinical practice to advise on presbyopia correction techniques and to optimise the correction power. Both subjective and objective techniques are necessary: subjective techniques (such as patient reported outcome questionnaires and defocus curves) assess the impact of presbyopia on a patient and how the combination of residual objective accommodation and their natural DoF work for them; objective techniques (such as autorefraction, corneal topography and lens imaging) allow the clinician to understand how well a technique is working optically and whether it is the right choice or how adjustments can be made to optimise performance. Techniques to assess visual performance and adverse effects must be carefully conducted to gain a reliable end-point, considering the target size, contrast and illumination. Objective techniques are generally more reliable, can help to explain unexpected subjective results and imaging can be a powerful communication tool with patients. A clear diagnosis, excluding factors such as binocular vision issues or digital eye strain that can also cause similar symptoms, is critical for the patient to understand and adapt to presbyopia. Some corrective options are more permanent, such as implanted inlays / intraocular lenses or laser refractive surgery, so the optics can be trialled with contact lenses in advance (including differences between the eyes) to better communicate with the patient how the optics will work for them so they can make an informed choice.
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Affiliation(s)
- James S Wolffsohn
- School of Optometry, Health and Life Sciences, Aston University, Birmingham, United Kingdom.
| | - David Berkow
- Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel
| | - Ka Yin Chan
- Centre for Eye and Vision Research (CEVR), 17W Hong Kong Science Park, Hong Kong
| | - Suraj K Chaurasiya
- Department of Contact Lens and Anterior Segment, CL Gupta Eye Institute, Moradabad, India; Department of Optometry and Vision Science, CL Gupta Eye Institute, Moradabad, India
| | - Daddi Fadel
- Centre for Ocular Research & Education (CORE), School of Optometry & Vision Science, University of Waterloo, Waterloo, Canada
| | - Mera Haddad
- Faculty of Applied Medical Sciences, Department of Allied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Tarib Imane
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, College of Medicine, University of Illinois at Chicago, United States
| | - Lyndon Jones
- Centre for Eye and Vision Research (CEVR), 17W Hong Kong Science Park, Hong Kong; Centre for Ocular Research & Education (CORE), School of Optometry & Vision Science, University of Waterloo, Waterloo, Canada
| | - Amy L Sheppard
- School of Optometry, Health and Life Sciences, Aston University, Birmingham, United Kingdom
| | - Marta Vianya-Estopa
- Vision and Hearing Research Centre, Anglia Ruskin University, Cambridge, United Kingdom
| | - Karen Walsh
- CooperVision Inc., San Ramon, CA, United States
| | - Jill Woods
- Centre for Ocular Research & Education (CORE), School of Optometry & Vision Science, University of Waterloo, Waterloo, Canada
| | - Fabrizio Zeri
- School of Optometry, Health and Life Sciences, Aston University, Birmingham, United Kingdom; University of Milano-Bicocca, Department of Materials Science, Milan, Italy
| | - Philip B Morgan
- Eurolens Research, Division of Pharmacy and Optometry, University of Manchester, United Kingdom
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Onyszkiewicz M, Hilmers J, Rejdak R, Zrenner E, Straßer T. Effects of Miosis on the Visual Acuity Space under Varying Conditions of Contrast and Ambient Luminance in Presbyopia. J Clin Med 2024; 13:1209. [PMID: 38592033 PMCID: PMC10931829 DOI: 10.3390/jcm13051209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/15/2024] [Accepted: 02/16/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Presbyopia is an age-related ocular condition, typically affecting individuals aged over 40 years, characterized by a gradual and irreversible decline in the eye's ability to focus on nearby objects. Correction methods for presbyopia encompass the use of corrective lenses, surgical interventions (corneal or lens based), and, more recently, the FDA-approved topical administration of 1.25% pilocarpine. While prior research has demonstrated the efficacy of daily pilocarpine eye drop application in enhancing near visual acuity by increasing the depth of focus leveraging the pinhole effect, limited knowledge exists regarding its influence on visual acuity under varying conditions of contrast and ambient luminance. Methods: This study aims to investigate the impact of these variables on visual acuity, employing the VA-CAL test, among 11 emmetropic and 11 presbyopic volunteers who reported subjective difficulties with near vision. This study includes evaluations under natural conditions with a pinhole occluder (diameter of 2 mm), and subsequent administration of 1% pilocarpine (Pilomann, Bausch + Lomb, Laval, Canada). Results: The VA-CAL results demonstrate the expected, statistically significant effects of contrast and ambient luminance on visual acuity in both emmetropic and presbyopic volunteers. Furthermore, in emmetropic individuals, the application of pilocarpine resulted in a statistically significant reduction in visual acuity. In contrast, presbyopes did not exhibit statistically significant differences in the visual acuity space under either the pinhole or pilocarpine conditions when compared to natural conditions. Conclusions: The pharmacological treatment of presbyopia with pilocarpine eye drops, intended to enhance near vision, does not adversely affect visual acuity in presbyopes. This suggests that pilocarpine may offer a viable alternative for individuals averse to wearing corrective eyewear.
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Affiliation(s)
- Maksymilian Onyszkiewicz
- Institute for Ophthalmic Research, University of Tuebingen, 72076 Tuebingen, Germany; (M.O.); (E.Z.)
- Chair and Department of General and Pediatric Ophthalmology, Medical University of Lublin, 20-059 Lublin, Poland
| | - Julian Hilmers
- Institute for Ophthalmic Research, University of Tuebingen, 72076 Tuebingen, Germany; (M.O.); (E.Z.)
- STZ Eyetrial, University Eye Hospital Tuebingen, 72076 Tuebingen, Germany;
| | - Robert Rejdak
- STZ Eyetrial, University Eye Hospital Tuebingen, 72076 Tuebingen, Germany;
| | - Eberhart Zrenner
- Institute for Ophthalmic Research, University of Tuebingen, 72076 Tuebingen, Germany; (M.O.); (E.Z.)
- University Eye Hospital Tuebingen, 72076 Tuebingen, Germany
| | - Torsten Straßer
- Institute for Ophthalmic Research, University of Tuebingen, 72076 Tuebingen, Germany; (M.O.); (E.Z.)
- Chair and Department of General and Pediatric Ophthalmology, Medical University of Lublin, 20-059 Lublin, Poland
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Zhang G, Cao H, Qu C. Efficacy, Safety, Predictability, and Stability of LASIK for Presbyopia Correction: A Systematic Review and Meta-analysis. J Refract Surg 2023; 39:627-638. [PMID: 37675909 DOI: 10.3928/1081597x-20230802-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
PURPOSE To determine the efficacy, safety, predictability, and stability of laser in situ keratomileusis (LASIK) in the treatment of presbyopia. METHODS The databases of CNKI, VIP, Wan-Fang, CBM, Chinese Clinical Registry, PubMed, The Cochrane Library, Web of Science, Embase, and ClinicalTrials.gov were searched until March 2023. The authors chose the studies of LASIK in the treatment of presbyopia. Outcomes were efficacy, safety, predictability, and stability. The review was registered in the international platform of registered systematic review and meta-analysis protocols (INPLASY202350005). RESULTS A total of 28 non-randomized controlled trials (15,861 eyes) were included. The results showed that after LASIK, (1) the distance efficacy decreased (mean difference [MD]: 0.02, 95% CI: 0.0 to 0.03, P < .05) and the near efficacy increased (MD: -0.01, 95% CI: -0.19 to-0.02, P < .05); (2) the distance safety decreased (MD: 0.07, 95% CI: 0.04 to 0.10, P < .0001) and near safety increased (MD: -0.19, 95% CI: -0.39 to 0.02, P > .05); (3) the predictability within ±1.00 and ±0.50 D was 94% (relative risk [RR]: 0.94, 95% CI: 0.90 to 0.98, P < .001) and 80% (RR: 0.80, 95% CI: 0.74 to 0.86, P < .001), respectively; and (4) 6 months postoperatively, the percentage of spherical equivalent changing within ±0.50 D was 95% (RR: 0.95, 95% CI: 0.89 to 0.99, P < .001). CONCLUSIONS The near efficacy, predictability, and stability of LASIK for presbyopia correction were satisfactory; however, the distance efficacy and distance safety decreased. [J Refract Surg. 2023;39(9):627-638.].
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Near visual acuity and patient-reported outcomes in presbyopic patients after bilateral multifocal aspheric laser in situ keratomileusis excimer laser surgery. J Cataract Refract Surg 2021; 46:944-952. [PMID: 32773548 DOI: 10.1097/j.jcrs.0000000000000198] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine improvement of near visual acuity by bilateral multifocal aspheric laser in situ keratomileusis (LASIK) treatments in presbyopic patients. SETTING Goethe-University, Frankfurt, Germany. DESIGN Prospective, nonrandomized trial. METHODS Thirty presbyopic patients underwent LASIK treatment with a multifocal aspheric ablation profile using an excimer laser (PresbyMAX). The first 15 patients received a multifocal aspheric ablation profile combined with micromonovision. For the consecutive 15 patients, less depth of focus was included on the distance eye (hybrid). Outcome parameters were uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected and distance-corrected intermediate visual acuities, uncorrected near visual acuity (UNVA), and distance-corrected near visual acuity (DCNVA); manifest refraction spherical equivalent; subjective quality of vision; and spectacle independence. RESULTS The data of 29 patients were analyzed and showed that binocular CDVA changed from -0.16 ± 0.10 logarithm of the minimum angle of resolution (logMAR) preoperatively to 0.05 ± 0.20 logMAR UDVA and -0.06 ± 0.14 logMAR CDVA (P = .000, P = .001) 1 year postoperatively. Near visual acuity improved from 0.47 ± 0.13 logMAR (DCNVA) and 0.48 ± 0.26 logMAR (UNVA) to 0.19 ± 0.19 logMAR (DCNVA, P < .001) and 0.05 ± 0.15 logMAR (UNVA, P < .001). The hybrid and the μ-monovision group did not differ statistically except for a better DCNVA in the µ-monovision patients (0.21 ± 0.15 logMAR vs 0.34 ± 0.17 logMAR, P = .034). Of the hybrid and µ-monovision patients, 21 (72%) and 12 (41%) had a binocular CDVA and UDVA of 20/20 or better, 8 patients (28%) lost 1 line, 3 (10%) lost 2 lines, 4 (14%) lost 3 lines, and 2 (7%) lost 4 lines of CDVA. CONCLUSIONS The PresbyMAX laser seemed to satisfy most of the patients, although they experienced a loss of CDVA. The gain of near visual acuity and therefore reported less need of spectacles seemed to compensate for this loss.
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Liu F, Zhang T, Liu Q. One year results of presbyLASIK using hybrid bi-aspheric micro-monovision ablation profile in correction of presbyopia and myopic astigmatism. Int J Ophthalmol 2020; 13:271-277. [PMID: 32090037 DOI: 10.18240/ijo.2020.02.11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 12/09/2019] [Indexed: 11/23/2022] Open
Abstract
AIM To analyze one year clinical outcomes and subjective rating of hybrid bi-aspheric multifocal central presbyLASIK with micro-monovision for correction of presbyopia and myopic astigmatism. METHODS Seventy-four eyes of 37 patients consecutively treated with presbyLASIK were assessed. The mean age of the patients was 43.8±3.0y with a mean spherical equivalent refraction of -5.21±1.87 diopters (D) and mean astigmatism of -0.82±0.64 D. Visual acuity, manifest refraction, contrast sensitivity, aberrometry and patients' subjective rating were evaluated pre- and postoperatively. RESULTS At 1y postoperatively (68 eyes of 34 patients), the mean spherical equivalent (SE) refraction in distance eyes was 0.06±0.05 D, whereas the achieved SE in near eyes was -0.83±0.05 D. Ninety-nine percent of eyes were within ±0.50 D of target correction of SE. The binocular mean uncorrected distance visual acuity (UDVA) was 0.00±0.18 logMAR (20/20). Sixty-four percent of patients achieved 0.0 logMAR (20/20) or better of UDVA and 0.1 logRAD or better of UNVA as well. There was a binocularly loss of one line CDVA after surgery for only one patient (3%, 1/34) and no patient lost 2 lines. The changes in binocular contrast sensitivity (CS) in all test conditions were not significant at any frequency after surgery. The changes of entire eye total higher order aberrations (tHOA) and spherical aberrations (SA) significantly higher in near eyes than in distance eyes. The overall satisfaction score for surgery was 93±8. CONCLUSION The hybrid bi-aspheric multifocal central presbyLASIK with micro-monovision appears to be an efficacious option for myopic presbyopes. One year postoperative outcomes in a relatively young presbyopia population indicate improvements in both far and near vision with high satisfaction.
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Affiliation(s)
- Fang Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
| | - Ting Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
| | - Quan Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
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Taneri S, Kiessler S, Rost A, Verma S, Arba-Mosquera S, Dick HB. Varifocal Versus Monofocal LASIK in Presbyopic Hyperopic Eyes. J Refract Surg 2019; 35:459-466. [PMID: 31298726 DOI: 10.3928/1081597x-20190528-01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 05/27/2019] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare varifocal (SupraCor; Technolas Perfect Vision GmbH, Munich, Germany) to monofocal (Zyoptix TissueSaving; Bausch & Lomb, Rochester, NY) LASIK in patients with hyperopic presbyopia. METHODS In this prospective, non-randomized, comparative case series, consecutive patients with hyperopia, presbyopia, and emmetropia as target refraction were bilaterally treated with varifocal (8 patients) or monofocal (7 patients) LASIK. The study was designed for 35 patients, but was terminated early after interim analysis. Outcomes (preoperative and 1 day, 1 week, 1 month, and 3 months postoperative) were: monocular and binocular uncorrected near visual acuity (UNVA), distance-corrected near visual acuity (DCNVA), uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), low-contrast UDVA and CDVA, efficacy, and safety. RESULTS Preoperative data were similar in both groups. Monocular and binocular UNVA were not significantly different between both groups at any follow-up visit. At 3 months, mean monocular UNVA was 0.40 logMAR in both groups. Monocular DCNVA and binocular CDVA were not significantly different between groups. Monocular mean CDVA was 0.00 ± 0.06 logMAR after varifocal LASIK and -0.06 ± 0.04 logMAR after monofocal LASIK. The efficacy index was 0.9 after vari-focal LASIK and 0.88 after monofocal LASIK (not significant). The safety index was 1.08 after varifocal LASIK and 1.125 after monofocal LASIK (not significant). CONCLUSIONS With emmetropia as target refraction, varifocal ablations yielded no additional benefit compared to monofocal ablations in hyperopic presbyopic LASIK. The authors speculate that epithelial remodeling masks the impact of a varifocal ablation pattern and that a myopic postoperative refraction (modified monovision) may be necessary to further improve near and intermediate vision. These results demonstrate the value of a control group in studies evaluating presbyopia corrections. [J Refract Surg. 2019;35(7):459-466.].
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Villanueva A, Vargas V, Mas D, Torky M, Alió JL. Long-term corneal multifocal stability following a presbyLASIK technique analysed by a light propagation algorithm. Clin Exp Optom 2019; 102:496-500. [PMID: 30866063 DOI: 10.1111/cxo.12883] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 01/16/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND There is a lack of scientific evidence on long-term follow-up of the outcomes of the presbyLASIK techniques. This study aimed to objectively evaluate corneal stability three years following excimer laser central presbyLASIK. METHODS This is a longitudinal, retrospective, observation of a consecutive series of cases comprising 24 eyes which had been treated by central myopic or hyperopic Presbymax central presbyLASIK. Eyes treated with the same version of presbyLASIK software were included and followed by corneal topography at three months, one and three years after surgery. Based on the corneal topography data, customised software - based on a light propagation algorithm and developed using Matlab software - was used to analyse the simulated behaviour of light through the ocular media. The range of objective corneal depth of focus was also measured. RESULTS Results were assessed separately for myopes and hyperopes at pupillary diameters of 3.0 and 6.0 mm. The results showed corneal multifocality outcomes to remain constant (p > 0.05) throughout the three-year follow-up period. CONCLUSION The use of light propagation analysis of the multifocal anterior corneal surface following a Presbymax central presbyLASIK procedure demonstrated stable outcomes over a three-year follow-up period.
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Affiliation(s)
- Asier Villanueva
- Department of Optics and Optometry, University of Alicante, Alicante, Spain
| | | | - David Mas
- Department of Optics and Optometry, University of Alicante, Alicante, Spain
| | - Magda Torky
- Department of R&D, Vissum Corporation, Alicante, Spain
| | - Jorge L Alió
- Department of R&D, Vissum Corporation, Alicante, Spain.,Department of Ophthalmology, University Miguel Hernández, Alicante, Spain
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Verdoorn C. Comparison of a hydrogel corneal inlay and monovision laser in situ keratomileusis in presbyopic patients: focus on visual performance and optical quality. Clin Ophthalmol 2017; 11:1727-1734. [PMID: 29033538 PMCID: PMC5614777 DOI: 10.2147/opth.s142075] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To compare the visual performance and optical quality after Raindrop Near Vision Inlay implantation or monovision LASIK for the correction of presbyopia. MATERIALS AND METHODS In this retrospective case-series study, patients previously treated in the nondominant eye with monovision LASIK were compared with patients previously implanted with Raindrop Near Vision Inlay. The study enrolled 16 inlay and 15 monovision LASIK patients. Uncorrected near visual acuity, uncorrected distance visual acuity, binocular stereopsis, patient satisfaction, and patient task performance were assessed. RESULTS Postoperatively, the mean spherical equivalent was -0.66 D (0.78 SD) for the inlay group and -1.03 D (0.56 SD) for the monovision LASIK group. Monocularly, at uncorrected near distances, 60% of inlay patients and 47% of monovision LASIK patients achieved ≥20/20. Monocularly, at uncorrected far distances, 75% of inlay patients and 40% of monovision LASIK patients achieved ≥20/32 vision. Binocularly, at near distances, 79% of inlay patients and 53% of monovision LASIK patients obtained ≥20/20 vision. All patients achieved ≥20/20 binocularly for distance. On average, inlay patients obtained 98 seconds of arc and monovision LASIK patients obtained 286 seconds of arc for stereopsis. Most (79%) of the inlay patients and 66% of monovision LASIK patients were satisfied with their near vision, while 86% of inlay patients and 67% of monovision LASIK patients were satisfied with their distance vision. CONCLUSION Patients receiving corneal inlays demonstrated better near and distance visual acuities, binocular stereopsis, task performance, and satisfaction, when compared to patients treated with monovision LASIK.
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Chan TCY, Kwok PSK, Jhanji V, Woo VCP, Ng ALK. Presbyopic Correction Using Monocular Bi-aspheric Ablation Profile (PresbyMAX) in Hyperopic Eyes: 1-Year Outcomes. J Refract Surg 2017; 33:37-43. [PMID: 28068445 DOI: 10.3928/1081597x-20161006-03] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 08/29/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE To present the 1-year outcomes of combining monocular bi-aspheric ablation profile and contralateral monofocal LASIK in hyperopic patients with presbyopia. METHODS In this retrospective case series, 36 consecutive patients (72 eyes) who underwent simultaneous bi-aspheric ablation (PresbyMAX: SCHWIND Eye-Tech-Solutions GmbH and Co KG, Kleinostheim, Germany) in the non-dominant eye and monofocal regular LASIK in the dominant eye for correction of hyperopia and presbyopia were reviewed for 1 year. Binocular uncorrected distance (UDVA), near (UNVA), corrected distance (CDVA), and distance corrected near (DCNVA) visual acuity and manifest refraction were analyzed postoperatively. RESULTS At 1 year, the mean binocular UDVA improved significantly from 0.26 ± 0.25 to 0.039 ± 0.088 logMAR (P < .001). Binocular UNVA also improved from 0.73 ± 0.30 to 0.10 ± 0.22 logRAD (P < .001). Eighty-seven percent of patients achieved UDVA of 20/25 or better and 90% had UNVA of J3 or better. Simultaneous binocular distance and near vision of 20/25 and J2 or better was achieved in 70%. Only 17% of patients had a binocular DCNVA of J2 or better. No patient suffered from a loss of 2 lines of CDVA. Refractive stability was achieved for both eyes from 1 month postoperatively. The re-treatment rate was 14% for improvement of near vision within 6 months to 1 year. CONCLUSIONS Presbyopic correction using monocular PresbyMAX combined with monofocal regular LASIK in the fellow eye is safe and acceptable in hyperopic patients. [J Refract Surg. 2017;33(1):37-43.].
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Hipsley A, Ma DHK, Sun CC, Jackson MA, Goldberg D, Hall B. Visual outcomes 24 months after LaserACE. EYE AND VISION 2017; 4:15. [PMID: 28812042 PMCID: PMC5473977 DOI: 10.1186/s40662-017-0081-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 06/01/2017] [Indexed: 12/04/2022]
Abstract
Background To evaluate the effects on near and intermediate visual performance after bilateral Laser Anterior Ciliary Excision (LaserACE) procedure. Methods LaserACE surgery was performed using the VisioLite 2.94 μm erbium: yttrium–aluminum–garnet (Er:YAG) ophthalmic laser system in 4 oblique quadrants on the sclera over the ciliary muscle in 3 critical zones of physiological importance (over the ciliary muscles and posterior zonules) with the aim to improve natural dynamic accommodative forces. LaserACE was performed on 26 patients (52 eyes). Outcomes were analyzed using visual acuity testing, Randot stereopsis, and the CatQuest 9SF patient survey. Results Binocular uncorrected near visual acuity (UNVA) improved from +0.20 ± 0.16 logMAR preoperatively, to +0.12 ± 0.14 logMAR at 24 months postoperatively (p = 0.0014). There was no statistically significant loss in distance corrected near visual acuity (DCNVA). Binocular DCNVA improved from +0.21 ± 0.17 logMAR preoperatively, to +0.11 ± 0.12 logMAR at 24 months postoperatively (p = 0.00026). Stereoacuity improved from 74.8 ± 30.3 s of arc preoperatively, to 58.8 ± 22.9 s of arc at 24 months postoperatively (p = 0.012). There were no complications such as persistent hypotony, cystoid macular edema, or loss of best-corrected visual acuity (BCVA). Patients surveyed indicated reduced difficulty in areas of near vision, and were overall satisfied with the procedure. Conclusions Preliminary results of the LaserACE procedure show promising results for restoring visual performance for near and intermediate visual tasks without compromising distance vision and without touching the visual axis. The visual function and visual acuity improvements had clinical significance. Patient satisfaction was high postoperatively and sustained over 24 months. Trial registration NCT01491360 (https://clinicaltrials.gov/ct2/show/NCT01491360). Registered 22 November 2011.
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Affiliation(s)
| | - David Hui-Kang Ma
- Department of Ophthalmology, Chang Gung Memorial Hospital, Kweishan, Taoyuan Taiwan.,Department of Chinese Medicine, Chang Gung University, Kweishan, Taoyuan Taiwan.,Center for Tissue Engineering, Chang Gung Memorial Hospital, Kweishan, Taoyuan Taiwan
| | - Chi-Chin Sun
- Department of Ophthalmology, Chang Gung Memorial Hospital, Kweishan, Taoyuan Taiwan.,Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Mitchell A Jackson
- Ace Vision Group Inc, 39655 Eureka Drive, Newark, CA 94560 USA.,Jackson Eye, Lake Villa, IL USA
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13
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Kang P, McAlinden C, Wildsoet CF. Effects of multifocal soft contact lenses used to slow myopia progression on quality of vision in young adults. Acta Ophthalmol 2017; 95:e43-e53. [PMID: 27495880 DOI: 10.1111/aos.13173] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 05/25/2016] [Indexed: 12/12/2022]
Abstract
PURPOSE To assess the effects of multifocal soft contact lenses (MF SCLs) used for myopia control on visual acuity (VA) and subjective quality of vision. METHODS Twenty-four young adult myopes had baseline high and low-contrast VAs and refractions measured and quality of vision assessed by the Quality of Vision (QoV) questionnaire with single vision SCLs. Additional VA and QoV questionnaire data were collected immediately after subjects were fitted with Proclear MF SCLs and again after a 2-week adaptation period of daily lens wear. Data were collected for two MF SCL designs, incorporating +1.50 and +3.00 D peripheral near additions, with a week washout period allowed between the two lens trials. RESULTS High- and low-contrast VAs were initially reduced with both MF SCL designs, but subsequently improved to be not significantly reduced in the case of high-contrast VA by the end of the 2-week adaptation period. The quality of vision was also reduced, more so with the +3.00 D MF SCL. Quality of Vision (QoV) scores describing frequency, severity and bothersome nature of visual symptoms indicated symptoms worsening rather than resolving over the 2-week period, particularly so with the +3.00 D MF SCL. CONCLUSION Low and high add MF SCLs adversely affected vision on initial insertion, with sustained effects on low-contrast VA and QoV scores but not high-contrast VA. Thus, high-contrast VA is not a suitable surrogate for quality of vision. In prescribing MF SCLs for myopia control, clinicians should educate patients about these effects on vision.
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Affiliation(s)
- Pauline Kang
- School of Optometry; University of California; Berkeley California USA
- School of Optometry and Vision Science; The University of New South Wales; Sydney New South Wales Australia
| | - Colm McAlinden
- ABM University Health Board; Swansea UK
- Flinders University; Adelaide South Australia Australia
- Wenzhou Medical University; Wenzhou China
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14
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Affiliation(s)
- W Neil Charman
- Division of Pharmacy and Optometry; Faculty of Biology, Medicine and Health; University of Manchester; Manchester UK
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15
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Mai ELC, Lian IB, Chang DCK. Assessment of contrast sensitivity loss after intrastromal femtosecond laser and LASIK procedure. Int J Ophthalmol 2016; 9:1798-1801. [PMID: 28003982 DOI: 10.18240/ijo.2016.12.16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 06/12/2016] [Indexed: 11/23/2022] Open
Abstract
AIM To assess the loss of contrast sensitivity (CS) function for INTRACOR or intrastromal femtosecond laser presbyopia procedure to conventional LASIK procedures. METHODS Patients were recruited from a refractive surgery center for either INTRACOR or conventional LASIK. INTRACOR was performed on 8 eyes and LASIK was performed for 40 eyes in an overlapping period. Pre-operative evaluation and post-operative follow up for up to three months was done. Drops of CS in 4 spatial frequency (3 cpd, 6 cpd, 12 cpd and 18 cpd) right before and 3mo after the surgery were compared by Wilcoxon signed ranks test. RESULTS For INTRACOR, CS threshold showed significant drop at both glare and non-glare condition, the drop was seen in all 4 spatial frequency. The averaged loss over the 4 spatial frequencies 3mo after surgery was 1.18 for non-glare and 0.71 for glare. For LASIK the CS threshold drop was most significant in 12 cpd for glare. CONCLUSION INTRACOR procedure produces a gain of near vision for presbyopia patients but also introduces a high lost of contrast sensitivity plus worsen of vision quality. Pre-surgical patient selection and advise should be given with specific regards to night driving and glare conditions.
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Affiliation(s)
- Elsa L C Mai
- Far Eastern Memorial Hospital, Taipei 100, Taiwan, China
| | - Ie-Bin Lian
- National Changhua University of Education, Changhua 500, Taiwan, China
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16
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Aristeidou A, Taniguchi EV, Tsatsos M, Muller R, McAlinden C, Pineda R, Paschalis EI. The evolution of corneal and refractive surgery with the femtosecond laser. EYE AND VISION 2015; 2:12. [PMID: 26605365 PMCID: PMC4655461 DOI: 10.1186/s40662-015-0022-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 06/20/2015] [Indexed: 01/12/2023]
Abstract
The use of femtosecond lasers has created an evolution in modern corneal and refractive surgery. With accuracy, safety, and repeatability, eye surgeons can utilize the femtosecond laser in almost all anterior refractive procedures; laser in situ keratomileusis (LASIK), small incision lenticule extraction (SMILE), penetrating keratoplasty (PKP), insertion of intracorneal ring segments, anterior and posterior lamellar keratoplasty (Deep anterior lamellar keratoplasty (DALK) and Descemet's stripping endothelial keratoplasty (DSEK)), insertion of corneal inlays and cataract surgery. As the technology matures, it will push surgical limits and open new avenues for ophthalmic intervention in areas not yet explored. As we witness the transition from femto-LASIK to femto-cataract surgery it becomes obvious that this innovation is here to stay. This article presents some of the most relevant advances of femtosecond lasers to modern corneal and refractive surgery.
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Affiliation(s)
| | - Elise V Taniguchi
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA USA ; Massachusetts Eye and Ear Infirmary/Schepens Eye Research Institute, Boston Keratoprosthesis Laboratory, Harvard Medical School, Boston, 02114 MA USA
| | | | - Rodrigo Muller
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA USA
| | - Colm McAlinden
- Flinders University, Adelaide, South Australia Australia ; Wenzhou Medical University, Wenzhou, Zhejiang China
| | - Roberto Pineda
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA USA
| | - Eleftherios I Paschalis
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA USA ; Massachusetts Eye and Ear Infirmary/Schepens Eye Research Institute, Boston Keratoprosthesis Laboratory, Harvard Medical School, Boston, 02114 MA USA
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17
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Nagy ZZ, McAlinden C. Femtosecond laser cataract surgery. EYE AND VISION 2015; 2:11. [PMID: 26605364 PMCID: PMC4655462 DOI: 10.1186/s40662-015-0021-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 06/20/2015] [Indexed: 12/31/2022]
Abstract
Femtosecond laser (FSL) cataract surgery is in its infancy but is rapidly gaining popularity due to the improved consistency and predictability for corneal incisions and anterior capsulorhexis. It enables subsequently less phacoemulsification energy and time to be employed, which has gains in terms of reduced corneal oedema. In addition, the FSL allows better circularity of the anterior capsulotomy, capsule overlap, intraocular lens (IOL) placement and centration of the IOL. These advantages have resulted in improved visual and refractive outcomes in the short term. Complication rates are low which reduce with surgeon experience. This review article focuses on the Alcon LenSx system.
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Affiliation(s)
- Zoltan Z Nagy
- Department of Ophthalmology, Semmelweis University, Maria u. 39, H-1085 Budapest, Hungary
| | - Colm McAlinden
- Flinders University, Bedford Park, Adelaide, South Australia Australia ; School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang China
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