Development and Validation of a Web-Based Reading Test for Normal and Low Vision Patients

Mix-and-match vs bilateral trifocal and bilateral EDOF intraocular lens implantation: the spline curve battle

PURPOSE

To compare the postoperative visual acuity curves following 3 pseudophakic presbyopic correction techniques.

SETTING

Department of Ophthalmology, University Hospital of Alexandroupolis, Alexandroupolis, Greece.

DESIGN

Prospective, randomized, comparative trial.

METHODS

For this study, patients with stage 2 Lens Opacities Classification System III cataract were divided into 3 study groups: (1) premium monovision group, including patients who received the Panoptix intraocular lens (IOL) in the recessive eye and Vivity IOL in the dominant one; (2) bilateral trifocal group, including those who received bilaterally the Panoptix IOL; and (3) bilateral xEDOF group, including patients who received bilaterally the Vivity IOL. Postoperative bilateral uncorrected distance visual acuity was measured at 25.5, 28, 33, 40, 50, 66, 100, 200, and 300 cm distances. Spline curve fitting was attempted, and areas of the curves (AOCs) and curvature k were calculated. All patients responded to the National Eye Institute Visual Functioning Questionnaire-25 (NEI-VFQ-25).

RESULTS

90 patients were equally divided into the 3 groups. Premium monovision and bilateral trifocal implantations delivered similar visual acuity (all AOC P > .05); however, the trifocal patients suffered from drops in vision acuity in certain distance ranges as expressed by negative curvature values. Bilateral xEDOF patients demonstrated worse near vision acuity ( P < .05). Premium monovision patients reported better scores in NEI-VFQ 25 ( P = .03) and in the near activities ( P = .02) and distant activities ( P = .04) subscales.

CONCLUSIONS

All surgical options provided impressive outcomes. Premium monovision appeared to deliver the best results.

Validation of a web-based distance visual acuity test

PURPOSE

To validate the Democritus Digital Acuity and Reading Test (DDART) as a distance VA (dVA) test against a series of prevalent conventional distance vision charts.

SETTING

Ophthalmology Department, University Hospital of Alexandroupolis, Alexandroupolis, Greece; Ophthalmology Department, AHEPA University Hospital, Thessaloniki, Greece; and Ophthalmica Institute of Ophthalmology & Microsurgery, Thessaloniki, Greece.

DESIGN

Prospective multicenter validation study.

METHODS

The distance best spectacle-corrected visual acuity (dBSCVA) was compared in normal (NVG) and low (LVG) vision participants against 4 prevalent conventional distance vision charts (ETDRS, Snellen, Landolt C, and Tumbling E) by a predefined 2.5-symbol noninferiority margin and intraclass correlation coefficients (ICCs). DDART's test-retest (TRT) reliability was assessed with ICCs.

RESULTS

534 participants (471 and 63 with normal and low vision, respectively) were included in the study. The mean difference between dBSCVA measured with DDART and conventional charts ranged between -0.84 and +0.85 symbols, without exceeding the 2.5-symbol noninferiority margin. ICCs indicated an excellent level of agreement for all patient groups (from 0.848 to 0.985). TRT reliability indicated differences below 1 symbol both for the NVG and LVG, with ICCs ranging between 0.912 and 0.964 for the 4 DDARTs.

CONCLUSIONS

DDART was a valid web-based dVA test that provided reliable measurements in clinical and telemedical settings, both for normal and low vision patients.

Impact of Light Conditions on Visual Performance following Premium Pseudophakic Presbyopia Corrections

The primary objective of this study was to objectively compare the visual performance of patients following premium pseudophakic presbyopia corrections in different light combinations for near- and intermediate-vision activities of daily living (ADLs). This is a prospective, comparative study. A total of 75 patients populated three study groups: G1-patients with bilateral trifocal implantation, G2-patients with bilateral bifocal implantation, and G3-patients with bilateral monofocal implantation. All participants addressed 10 ADLs in nine combinations of light temperature (3000 K, 4000 K, and 6000 K) and light intensity (25 fc, 50 fc, and 75 fc) and declared their subjectively optimal light combination while reading. G2 and G3 had the best total ADL scores in 6000 K/75 fc, while G1 had the best total ADL score in 4000 K/75 fc. Total ADL, easy ADL, and moderate difficulty ADL scores were significantly better in G2, while difficult ADL score was significantly better in G1. The majority of all groups selected 6000 K/75 fc as the most comfortable light combination, and no group selected 3000 K and 25 fc. In conclusion, trifocal patients benefit from intense daylight, while bifocal and monofocal patients benefit from intense, cold lighting. Trifocal patients present superior near-vision capacity in difficult near-vision daily tasks, while bifocal patients present superiority in easy and moderate-difficulty ADLs.

Impact of personality on the decision process and on satisfaction rates in pseudophakic presbyopic correction

PURPOSE

To explore the impact of personality on the decision process and satisfaction rates in pseudophakic presbyopic correction.

SETTING

Department of Ophthalmology, University Hospital of Alexandroupolis, Greece.

DESIGN

Prospective, comparative study.

METHODS

A consistent consultation was conducted in patients with cataract that explained the benefits and the drawbacks of bilateral trifocal correction, which was offered at no extra cost. In all participants, personality was evaluated by The Traits Personality Questionnaire 5. Data modeling with decision trees and multiple regression analysis identified the contributions of personality traits to the decision process and postoperative satisfaction.

RESULTS

Of 120 participants (60 men and 60 women), 81 (67.5%, 24 men, 57 women) selected premium correction. In men, low neuroticism and high extraversion were the primary personality contributors for selecting premium surgery. In women, all personality traits contributed to the selection process. Women were more demanding in the expected postoperative distant acuity than men (0.1 vs 0.2 logMAR) to present high satisfaction. For both men and women, openness to experience, conscientiousness, and extraversion are primary contributors for optimal satisfaction rates.

CONCLUSIONS

Men and women demonstrate differences in the selection process for premium pseudophakic surgery and differences in the expected postoperative visual acuity. It seems that the personality of the patient plays a significant role in the perceived outcome after premium surgery.

Development and Validation of the First Smart TV-Based Visual Acuity Test: A Prospective Study

(1) Background: While smartphones are among the primary devices used in telemedical applications, smart TV healthcare apps are not prevalent despite smart TVs’ penetrance in home settings. The present study’s objective was to develop and validate the first smart TV-based visual acuity (VA) test (Democritus Digital Visual Acuity Test (DDiVAT)) that allows a reliable VA self-assessment. (2) Methods: This is a prospective validation study. DDiVAT introduces several advanced features for reliable VA self-testing; among them: automatic calibration, voice recognition, voice guidance, automatic calculation of VA indexes, and a smart TV-based messaging system. Normal and low vision participants were included in the validation. DDiVAT VA results (VA_DDiVAT) were compared against the ones from: (a) the gold-standard conventional ETDRS (VA_ETDRS), and, (b) an independent ophthalmologist who monitored the self-examination testing (VA_RES). Comparisons were performed by noninferiority test (set at 2.5-letters) and intraclass correlation coefficients (ICCs). DDiVAT’s test-retest reliability was assessed within a 15-day time-window. (3) Results: A total of 300 participants (185 and 115 with normal and low vision, respectively) responded to ETDRS and DDiVAT. Mean difference in letters was −0.05 for VA_ETDRS–VA_RES, 0.62 for VA_RES–VA_DDiVAT, and 0.67 for VA_ETDRS–VA_DDiVAT, significantly lower than the 2.5 letter noninferiority margin. ICCs indicated an excellent level of agreement, collectively and for each group (0.922-0.996). All displayed letters in DDiVAT presented a similar difficulty. The overall accuracy of the voice recognition service was 96.01%. ICC for VA_DDiVAT test-retest was 0.957. (4) Conclusions: The proposed DDiVAT presented non-significant VA differences with the ETDRS, suggesting that it can be used for accurate VA self-assessment in telemedical settings, both for normal and low-vision patients.

Development and Validation of a Lighting Facility for the Objective Assessment of the Visual Performance of Presbyopic Patients in a Series of Activities of Daily Living

Introduction The primary objective of this study is to develop and validate an experimental lighting facility that allows the evaluation of near and intermediate vision in different user-defined illuminance levels. Methods This is a prospective, randomized, controlled study. Normophakic patients populated three validation groups (VGs) according to their binocular uncorrected near visual acuity (UNVA): a) VG1, 0.0-0.1 logMAR; b) VG2, 0.4 logMAR; and c) VG3, 0.7 logMAR. All participants addressed 10 near and intermediate activities of daily life (ADLs) in the three following lighting settings: 1) 25 foot candles (fc)/3000 kelvins (K), 2) 50 fc/4000 K, and 3) 75 fc/6000 K. Results Thirty patients in each group performed all ADLs in the three lighting settings. VG1 demonstrated the best ADL scores in all ADLs and lighting settings, followed by the VG2. VG3 presented the worst scores. ADLs using printed material showed significant differences among the three lighting settings for all study groups, while ADLs using screens or needing manual dexterity demonstrated no significant differences except for the Screwdriver Test (ST) in VG1. All ADL scores demonstrated a high correlation with UNVA in all lighting settings (p < 0.001). Conclusion This is the first study that validates a lighting facility for comparative studies in patients with different near vision capacities performing a series of ADLs.