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Giap BD, Srinivasan K, Mahmoud O, Mian SI, Tannen BL, Nallasamy N. Adaptive Tensor-Based Feature Extraction for Pupil Segmentation in Cataract Surgery. IEEE J Biomed Health Inform 2024; 28:1599-1610. [PMID: 38127596 PMCID: PMC11018356 DOI: 10.1109/jbhi.2023.3345837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Cataract surgery remains the only definitive treatment for visually significant cataracts, which are a major cause of preventable blindness worldwide. Successful performance of cataract surgery relies on stable dilation of the pupil. Automated pupil segmentation from surgical videos can assist surgeons in detecting risk factors for pupillary instability prior to the development of surgical complications. However, surgical illumination variations, surgical instrument obstruction, and lens material hydration during cataract surgery can limit pupil segmentation accuracy. To address these problems, we propose a novel method named adaptive wavelet tensor feature extraction (AWTFE). AWTFE is designed to enhance the accuracy of deep learning-powered pupil recognition systems. First, we represent the correlations among spatial information, color channels, and wavelet subbands by constructing a third-order tensor. We then utilize higher-order singular value decomposition to eliminate redundant information adaptively and estimate pupil feature information. We evaluated the proposed method by conducting experiments with state-of-the-art deep learning segmentation models on our BigCat dataset consisting of 5,700 annotated intraoperative images from 190 cataract surgeries and a public CaDIS dataset. The experimental results reveal that the AWTFE method effectively identifies features relevant to the pupil region and improved the overall performance of segmentation models by up to 2.26% (BigCat) and 3.31% (CaDIS). Incorporation of the AWTFE method led to statistically significant improvements in segmentation performance (P < 1.29 × 10-10 for each model) and yielded the highest-performing model overall (Dice coefficients of 94.74% and 96.71% for the BigCat and CaDIS datasets, respectively). In performance comparisons, the AWTFE consistently outperformed other feature extraction methods in enhancing model performance. In addition, the proposed AWTFE method significantly improved pupil recognition performance by up to 2.87% in particularly challenging phases of cataract surgery.
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Sun S, Sun M, Tang J, Yang F, Liu Z, Zhao S, Huang Y. A comparative study of pupil offset measurement using Pentacam and Keratron Scout in myopic young adults. Clin Exp Optom 2024; 107:40-46. [PMID: 37156100 DOI: 10.1080/08164622.2023.2203316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/11/2023] [Indexed: 05/10/2023] Open
Abstract
CLINICAL RELEVANCE Assessing the consistency of pupil offset measurements between the Pentacam and Keratron Scout is essential for the refractive surgery design of young myopic patients. BACKGROUND Accurate preoperative measurement of pupil offset is critical to achieving a better quality of vision after refractive surgery. The Pentacam and Keratron Scout are commonly used in hospitals, and evaluating their consistency is essential for accurate measurement of pupil offset. METHODS Six hundred eyes (600 subjects) were included in this study. Pupil offset and its X, Y-component were measured by Pentacam and Keratron Scout, respectively. Agreement and repeatability between the two devices were identified by intraclass correlation coefficient and Bland-Altman plots with 95% limits of agreement. Paired t-tests and Pearson analysis were used to compare the differences and correlations between the two devices. RESULTS The mean age of all subjects was 23 ± 5 years. The mean pupil offset magnitude obtained from Pentacam and Keratron Scout was 0.16 ± 0.08 mm and 0.15 ± 0.07 mm. The 95% limits of agreement (-0.11-0.13, -0.09-0.11, and -0.11-0.12) and intraclass correlation coefficient (0.82, 0.84, and 0.81) demonstrated good agreement and repeatability of the two devices in measuring pupil offset and its X, Y-component. A significant correlation between the two devices was found (r = 0.71, 0.73, and 0.70). The direction of pupil offset measured by the devices was both predominately towards the superonasal quadrant. CONCLUSION Pentacam and Keratron Scout showed good agreement in measuring pupil offset and its X, Y-component, which can be used interchangeably in clinical practice.
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Affiliation(s)
| | | | | | | | | | - Shaozhen Zhao
- Tianjin Medical University Eye Hospital, College of Optometry, Institute of Ophthalmology, National Clinical Medical Research Center for Eye, Ear, Nose and Throat Diseases, Tianjin Branch, Tianjin Key Laboratory of Retinal Function and Diseases, Tianjin 300384, China
| | - Yue Huang
- Tianjin Medical University Eye Hospital, College of Optometry, Institute of Ophthalmology, National Clinical Medical Research Center for Eye, Ear, Nose and Throat Diseases, Tianjin Branch, Tianjin Key Laboratory of Retinal Function and Diseases, Tianjin 300384, China
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Fernández J, Burguera N, Rocha-de-Lossada C, Rodríguez-Calvo-de-Mora M, Rodríguez-Vallejo M. Agreement between Two Devices for Measuring Pupil Diameter in Patients Implanted with Multifocal Intraocular Lenses. Vision (Basel) 2023; 7:vision7020040. [PMID: 37218958 DOI: 10.3390/vision7020040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/12/2023] [Accepted: 05/03/2023] [Indexed: 05/24/2023] Open
Abstract
The purpose of this study was to evaluate the agreement between three methods for measuring pupil size in patients implanted with multifocal intraocular lenses (MIOLs): Keratograph 5M (K5M), Pentacam AXL Wave (PW), and a simple hand ruler. Sixty-nine subjects implanted with MIOLs and measured at the three-month follow-up visit were included in this retrospective analysis. K5M and PW were used to measure the photopic (PP) and mesopic (MP) pupil sizes, and a hand ruler was used to measure the pupil under environmental light conditions (135 lux). The Bland-Altman method with its limits (LoAs) was used to assess the agreement. The median PP was 2.8, 2.95, and 3 mm for K5M, PW, and the ruler, respectively (p < 0.05). Differences in PP were statistically significant for all paired comparisons (p < 0.0005) except between PW and the ruler (p = 0.44). The LoAs for the difference in PP between K5M and PW was 0.63 mm. The mean difference for MP between K5M and PW was 0.04 mm (p = 0.34) with LoAs of 0.72 mm. MP measured with K5M and PW could be considered interchangeable, although a correction of -0.3 mm (IC95%: -0.23 to -0.39) should be applied to PP measured with PW to attain the K5M mean.
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Affiliation(s)
- Joaquín Fernández
- Department of Ophthalmology (Qvision), VITHAS Almería Hospital, 04120 Almería, Spain
| | - Noemí Burguera
- Department of Ophthalmology (Qvision), VITHAS Almería Hospital, 04120 Almería, Spain
| | - Carlos Rocha-de-Lossada
- Department of Ophthalmology (Qvision), VITHAS Almería Hospital, 04120 Almería, Spain
- Department of Ophthalmology, VITHAS Málaga, 29016 Málaga, Spain
- Department of Ophthalmology, Hospital Regional Universitario de Málaga, Plaza del Hospital Civil, S/N, 29009 Málaga, Spain
- Departamento de Cirugía, Universidad de Sevilla, Área de Oftalmología, Doctor Fedriani, S/N, 41009 Sevilla, Spain
| | - Marina Rodríguez-Calvo-de-Mora
- Department of Ophthalmology (Qvision), VITHAS Almería Hospital, 04120 Almería, Spain
- Department of Ophthalmology, VITHAS Málaga, 29016 Málaga, Spain
- Department of Ophthalmology, Hospital Regional Universitario de Málaga, Plaza del Hospital Civil, S/N, 29009 Málaga, Spain
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Mito T, Ukai Y, Nakatsugawa Y, Shibata T, Shibata S, Kubo E, Sasaki H. Orientation of the intermediate-vision zone of rotationally asymmetric multifocal intraocular lenses and photic phenomena. Jpn J Ophthalmol 2023; 67:318-325. [PMID: 37029853 DOI: 10.1007/s10384-023-00988-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 02/16/2023] [Indexed: 04/09/2023]
Abstract
PURPOSE To evaluate the association between the orientation of the intermediate-vision zone and postoperative photic phenomena in eyes implanted with rotationally asymmetric multifocal intraocular lenses with + 1.5 diopters near addition. STUDY DESIGN Retrospective comparative case series. METHODS We performed the photic phenomena test (PPT) to quantitatively evaluate photic phenomena at 1-3 months after cataract surgery with Lentis Comfort LS-313 MF15 or Lentis Comfort Toric LS-313 MF15T insertion (Oculentis; Santen Pharmaceutical). In cases of bilateral surgeries, only the right eye was included in the analysis. We also conducted a questionnaire survey about the photic phenomena. RESULTS The study included 96 eyes from 96 patients. The intermediate-vision zones of 44, 19, 19, and 14 eyes were fixed in the inferior, superior, nasal, and temporal directions, respectively. The measured PPT values for halo, glare, and starburst were equivalent in all the fixed directions. Eighty-four eyes (87.5%) perceived a triangle-shaped halo, and the direction of fixation for the intermediate-vision zone and the extension direction of this photic phenomenon were consistent in 94.0% of the eyes. Less than 10% of the patients responded "moderate" or "severe" for the triangle-shaped halo, glare, and starburst in fixed directions with low frequency in the questionnaire. CONCLUSION No qualitative or quantitative difference was found in photic phenomena in eyes implanted with the LS-313 MF15 or the MF15T regardless of the fixation direction. Our study revealed that many patients were aware of a triangle-shaped halo extending in the direction of the intermediate-vision zone.
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Affiliation(s)
- Tsuyoshi Mito
- Department of Ophthalmology, Kanazawa Medical University, Kahoku-Gun, Uchinada, Ishikawa, 920-0293, Japan.
| | - Yuki Ukai
- Department of Ophthalmology, Kanazawa Medical University, Kahoku-Gun, Uchinada, Ishikawa, 920-0293, Japan
| | - Yui Nakatsugawa
- Department of Ophthalmology, Kanazawa Medical University, Kahoku-Gun, Uchinada, Ishikawa, 920-0293, Japan
| | - Teppei Shibata
- Department of Ophthalmology, Kanazawa Medical University, Kahoku-Gun, Uchinada, Ishikawa, 920-0293, Japan
| | - Shinsuke Shibata
- Department of Ophthalmology, Kanazawa Medical University, Kahoku-Gun, Uchinada, Ishikawa, 920-0293, Japan
| | - Eri Kubo
- Department of Ophthalmology, Kanazawa Medical University, Kahoku-Gun, Uchinada, Ishikawa, 920-0293, Japan
| | - Hiroshi Sasaki
- Department of Ophthalmology, Kanazawa Medical University, Kahoku-Gun, Uchinada, Ishikawa, 920-0293, Japan
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Distribution of Pupil Size and Associated Factors: Results from the Population-Based Gutenberg Health Study. J Ophthalmol 2022; 2022:9520512. [PMID: 36119137 PMCID: PMC9481399 DOI: 10.1155/2022/9520512] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 07/28/2022] [Indexed: 11/21/2022] Open
Abstract
Results 18,335 eyes of 9,559 participants aged 40 to 80 years were included in the analysis. Median pupil diameter was 4.19 mm in right eyes and 4.12 mm in left eyes. A smaller pupil was associated with older age, hyperopic refractive error, previous cataract surgery, diabetes, obesity, and ACE inhibitor intake, whereas wider pupil was associated with female gender, arterial hypertension, intake of tricyclic antidepressants, and intake of SNRI and tetracyclic antidepressants. Socioeconomic status and smoking were not associated with pupil size. Conclusion Individuals of older age, after cataract surgery, under therapy with ACE inhibitors and with diabetes have a smaller pupil. This should be taken into account when planning nonmydriatic fundus photography-based screening programs, for instance, for diabetic retinopathy.
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Ordiñaga-Monreal E, Castanera-Gratacós D, Castanera F, Fambuena-Muedra I, Vega F, Millán MS. Pupil size differences between female and male patients after cataract surgery. JOURNAL OF OPTOMETRY 2022; 15:179-185. [PMID: 33549502 PMCID: PMC9068520 DOI: 10.1016/j.optom.2020.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 09/09/2020] [Accepted: 09/18/2020] [Indexed: 05/31/2023]
Abstract
PURPOSE To evaluate the changes in pupil diameter in women and men after cataract surgery. The correlation of pupillary changes with the variables age and anterior chamber depth will be analyzed. METHODS The values of 109 randomized eyes who underwent cataract surgery were obtained and divided into two groups, 71 women and 38 men. Pupil diameter was measured preoperatively and 3-months postoperatively using the pupillometer software of the Topolyzer Vario (Wavelight Laser Technologie AG). Anterior chamber depth was obtained with Pentacam® (Oculus). Differences in pupillary diameters were investigated and correlations with age and anterior chamber depth were analyzed. RESULTS For mesopic pupils, the male group had greater reduction in their postoperative pupillary diameter, -0.56 mm (-12.4%), than the female group, -0.38 mm (-8.2%), P = 0.025. Photopic postoperative pupils reduced to a lesser extent, yet more in men than in women (-0.11mm [-4.5%] vs. -0.04 [-1.6%], P = 0.048). Weak significant negative correlation was found between photopic pupillary changes in women with age (r = -0.24, P = 0.041), and positive correlation for mesopic pupillary changes in men with age (r = +0.34, P = 0.039). CONCLUSIONS Patients experience pupil reduction after cataract surgery in general, but more in men than in women and for both photopic and mesopic lighting conditions. The differences are statistically significant and have moderate clinical relevance. Concerning pupillary changes, weak but opposite sign correlations were found between male/female gender and age. Trial registration number at ClinicalTrials.gov Identifier: NCT04286646.
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Affiliation(s)
- Enrique Ordiñaga-Monreal
- Clínica Oftalmológica TACIR, Centro Médico TEKNON, Barcelona, Spain; Departament d'Òptica i Optometria, Universitat Politècnica de Catalunya - BARCELONATECH, Terrasa, Spain.
| | | | | | | | - Fidel Vega
- Departament d'Òptica i Optometria, Universitat Politècnica de Catalunya - BARCELONATECH, Terrasa, Spain
| | - María S Millán
- Departament d'Òptica i Optometria, Universitat Politècnica de Catalunya - BARCELONATECH, Terrasa, Spain
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Sun Y, Hammer M, Yildirim TM, Khoramnia R, Auffarth GU. Pupil dynamics after in-the-bag versus anterior and retropupillary iris-fixated intraocular lens implantation. Sci Rep 2021; 11:21436. [PMID: 34728749 PMCID: PMC8564516 DOI: 10.1038/s41598-021-01051-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 10/12/2021] [Indexed: 11/09/2022] Open
Abstract
An Intraocular Lens (IOL) fixated on the iris either anteriorly, as a phakic IOL, or posteriorly, as an aphakic IOL, can influence pupil motility. In this interventional case series study, we evaluated pupil size under different levels of illumination (scotopic = 0.04 lx, low-mesopic = 0.4 lx and high-mesopic = 4 lx) for anterior iris-claw IOL fixation for correcting myopia or hyperopia (IFPH), retropupillary iris-claw IOL fixation to correct aphakia or as treatment for late in-the-bag IOL dislocation/subluxation (IFRP), and capsular-fixation IOL in-the-bag implantation (IB). Pupil size was measured preoperatively for the IFPH- and IB-group as well as 6 months after surgery for all groups. We analyzed a total of 70 eyes: 22 eyes of 11 patients with phakic IOLs, 22 eyes of 20 patients in the IFRP group and 26 eyes of 13 patients in the IB group. Both IFPH and IB showed a smaller postoperative scotopic pupil size, compared with the preoperative values. When compared to postoperative values of IB and IFPH, IFRP showed a significantly smaller postoperative scotopic pupil size (IFPH: 5.89 ± 0.83 mm, IFRP: 4.37 ± 0.83 mm, IB: 5.34 ± 0.98 mm, p < 0.001) while no differences were seen at high-mesopic lighting. Neither of the surgical techniques seems to impair the constriction of the pupil.
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Affiliation(s)
- Yanxiu Sun
- Department of Ophthalmology, Peking University Third Hospital, Northgarden Road 49, Haidian District, Beijing, 100191, China.,International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, Ruprecht-Karls University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Maximilian Hammer
- International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, Ruprecht-Karls University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Timur M Yildirim
- International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, Ruprecht-Karls University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Ramin Khoramnia
- International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, Ruprecht-Karls University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Gerd U Auffarth
- International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, Ruprecht-Karls University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
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Teshigawara T, Meguro A, Mizuki N. The Effect of Age, Postoperative Refraction, and Pre- and Postoperative Pupil Size on Halo Size and Intensity in Eyes Implanted with a Trifocal or Extended Depth-of-Focus Lens. Clin Ophthalmol 2021; 15:4141-4152. [PMID: 34703200 PMCID: PMC8524255 DOI: 10.2147/opth.s327660] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 10/04/2021] [Indexed: 12/28/2022] Open
Abstract
Purpose Halos are a chief source of patient dissatisfaction after multifocal intraocular lens (IOL) implantation. The primary purpose of this study was to investigate the influence of age, postoperative refraction, and pre- and postoperative pupil size on postoperative halo size with a trifocal diffractive IOL (AcrySof IQ PanOptix) and extended depth-of-focus (EDOF) IOL (TECNIS Symfony) to determine whether these factors could predict postoperative halo size. Patients and Methods This single-center, open-label study conducted between October 2018 and April 2020 in Yokosuka, Japan included 160 patients: 80 with PanOptix and 80 with Symfony IOLs. Size and intensity of the halos were examined binocularly using a computer-based simulator (Eyeland Design Network GmbH) and scored from 0 (minimum) to 10 (maximum) at 1, 3, and 6 months postoperatively, along with the change in each variable for both IOLs. The respective correlations of halo size with age, postoperative refraction, pre- and postoperative pupil size, and discomfort level due to the halo were also investigated 6 months postoperatively. Results Halo size and intensity were significantly mitigated between 1, 3, and 6 months postoperatively. Throughout the observation period, halo size was significantly larger with PanOptix than with Symphony (P < 0.05), and halo intensity was significantly higher with Symphony than with PanOptix (P < 0.05). The pre- and postoperative pupil size correlated positively with halo size, while age and postoperative refraction were negatively correlated, for both IOLs. Conclusion Understanding the features and predictive preoperative factors of halos in different types of multifocal IOLs may be useful in improving patient satisfaction.
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Affiliation(s)
- Takeshi Teshigawara
- Department of Ophthalmology, Yokosuka Chuoh Eye Clinic, Yokosuka, Kanagawa, 238-0008, Japan.,Tsurumi Chuoh Eye Clinic, Yokohama, Kanagawa, 230-0051, Japan.,Department of Ophthalmology, Yokohama City University School of Medicine, Yokohama, Kanagawa, 236-0004, Japan
| | - Akira Meguro
- Department of Ophthalmology, Yokohama City University School of Medicine, Yokohama, Kanagawa, 236-0004, Japan
| | - Nobuhisa Mizuki
- Department of Ophthalmology, Yokohama City University School of Medicine, Yokohama, Kanagawa, 236-0004, Japan
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Shorstein NH, Liu L, Carolan JA, Herrinton L. Endophthalmitis Prophylaxis Failures in Patients Injected With Intracameral Antibiotic During Cataract Surgery. Am J Ophthalmol 2021; 227:166-172. [PMID: 33571472 DOI: 10.1016/j.ajo.2021.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 02/06/2021] [Accepted: 02/06/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE To estimate the association of cefuroxime and moxifloxacin in relation to the occurrence of endophthalmitis following phacoemulsification cataract surgery. DESIGN Retrospective clinical cohort study. METHODS We studied patients with noncomplex phacoemulsification cataract surgery in Kaiser Permanente Northern California during 2014-2019. Data were obtained for acute, postoperative endophthalmitis within 90 days of phacoemulsification, including culture and antibiogram results, intracameral and topical antibiotic agent, and dose. In a post hoc analysis, we also examined preoperative anterior chamber depth (ACD) and postoperative anterior chamber volume (ACV). RESULTS Of 216,141 surgeries, endophthalmitis occurred in 0.020% of moxifloxacin-injected eyes and 0.013% of cefuroxime eyes (relative risk 1.62 with 95% CI 0.82-3.20, P = .16). Of the 34 (0.016%) cases of endophthalmitis, cefuroxime 1 mg was injected into 13 eyes and moxifloxacin 0.1% into 21 eyes. Organisms with antibiograms were identified in 12 (35%) cases. Of these, bacteria recovered from cefuroxime-injected eyes were resistant to cefuroxime in all cases (4/4), with Enterococcus comprising half of these. In eyes injected with moxifloxacin 0.1%, 6 out of 7 organisms were sensitive to moxifloxacin injected with 0.1 mL and in 1 eye injected with 1 mL. Streptococcus was the most common organism recovered (6/9) in moxifloxacin-injected eyes. Preoperative ACD and postoperative calculated ACV were higher in eyes injected with moxifloxacin. CONCLUSIONS Endophthalmitis cases with positive cultures were generally related to organism resistance in cefuroxime eyes but to sensitive organisms in moxifloxacin eyes. Moxifloxacin doses may have been insufficient in eyes with larger ACV.
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Fernández J, Rodríguez-Vallejo M, Martínez J, Burguera N, Piñero DP. Pupil Diameter in Patients With Multifocal Intraocular Lenses. J Refract Surg 2020; 36:750-756. [PMID: 33170282 DOI: 10.3928/1081597x-20200813-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 08/05/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE To evaluate the distribution of pupil size in patients implanted with multifocal intraocular lenses (IOLs) and to assess the variations according to age. METHODS A total of 168 eyes that had implantation of several multifocal IOLs and were measured at the 3-month follow-up visit were included in the analysis. The Keratograph 5M (Oculus Optikgeräte) was used to measure the photopic and mesopic pupil size, as well as the average between both (average pupil size). Eyes were stratified in four groups by age: 50 years or younger, 51 to 60 years, 61 to 70 years, and older than 70 years. RESULTS Considering the total sample, 84.5% and 95.8% of eyes had a photopic pupil size of 3 and 3.5 mm or less, respectively. The mesopic pupil size was greater than 4.5 mm in 39.3% and greater than 5 mm in 16.7% of eyes. The average pupil size was 3.5 and 4 mm or less in 54.2% and 85.1% of eyes, respectively. Mesopic pupil size resulted in a steeper decrease with age than photopic pupil size: 0.028 versus 0.015 mm/year, respectively. Statistically significant differences were found among the four age groups (P < .0005). No significant mean differences were found between multifocal IOL models for photopic pupil size, mesopic pupil size, or average pupil size (P > .05). CONCLUSIONS Eyes implanted with multifocal IOLs had a photopic pupil size of 3.5 mm or less and mesopic pupil size of 5 mm or less. Mesopic and photopic pupil size decreased 0.28 and 0.15 mm per decade, respectively. This information can help surgeons to understand the general functioning of multifocal IOLs whose performance varies with pupil size. [J Refract Surg. 2020;36(11):750-756.].
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Kanellopoulos AJ. Scheimpflug vs Scanning-Slit Corneal Tomography: Comparison of Corneal and Anterior Chamber Tomography Indices for Repeatability and Agreement in Healthy Eyes. Clin Ophthalmol 2020; 14:2583-2592. [PMID: 32943840 PMCID: PMC7481306 DOI: 10.2147/opth.s251998] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 08/14/2020] [Indexed: 12/11/2022] Open
Abstract
Purpose To evaluate and compare the repeatability and agreement of Scheimpflug vs scanning-slit tomography of the cornea and the anterior chamber in terms of keratometric and tomographic indices in healthy eyes. Methods The 20 eyes of 10 healthy participants underwent 3 consecutive measurements using both Scheimpflug-tomography and scanning-slit tomography, diagnostic devices. Multiple corneal and anterior chamber tomographic parameters were recorded and evaluated to include corneal keratometry and its axis; corneal best-fit sphere (BFS), pachymetry mapping, angle kappa, anterior chamber depth (ACD), pupil diameter, and location. Repeatability for each device was assessed using the within each subject standard deviation of sequential exams, the coefficient variation (CV) and the intraclass correlation coefficient (ICC). Agreement between the two devices was assessed using Bland-Altman plots with 95% limits of agreement (LoA) and correlation coefficient (r). Results Both devices were found to have high repeatability (ICC>0.9) both in keratometric and other tomographic measurements. Scheimpflug tomography's repeatability though appeared superior in the average keratometry values, anterior and posterior BFS, thinnest corneal pachymetry value and location (p<0.05). Agreement: Statistically significant inter-device differences were noted in the mean values of K1, K2, BFS, ACD and thinnest corneal pachymetry (p<0.05). Despite the agreement differences noted, the two devices were well correlated (r>0.8) in respective measurements with Scheimpflug delivering consistently lower values than the scanning-slit tomography device. Conclusion Scheimpflug-tomography repeatability was found to be superior to that of scanning-slit tomography in this specific study, in most parameters evaluated. Inter-device agreement evaluation suggests that reading from the two devices may not be used interchangeably in absolute values, yet they are well correlated with Scheimpflug delivering consistently lower values in most.
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Affiliation(s)
- Anastasios John Kanellopoulos
- Department of Ophthalmology, The LaserVision Clinical and Research Eye Institute, Athens, Attiki, Greece.,Department of Ophthalmology, New York University Medical School, New York City, NY, USA
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Ahmadi H, Lund‐Andersen H, Kolko M, Bach‐Holm D, Alberti M, Ba‐Ali S. Melanopsin-mediated pupillary light reflex and sleep quality in patients with normal tension glaucoma. Acta Ophthalmol 2020; 98:65-73. [PMID: 31062491 DOI: 10.1111/aos.14133] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 04/10/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE The intrinsically photosensitive retinal ganglion cells (ipRGCs) and sleep quality are impaired in patients with primary open-angle glaucoma (POAG). In this study, we investigated whether ipRGCs and sleep quality were also impaired in patients with normal tension glaucoma (NTG). METHODS We performed pupillometry and sleep quality assessment in 15 patients with NTG and 17 healthy age-matched controls. Pupillometry protocol consisted of monocular stimulation with high illuminance (100 lux) red (633 nm, 300 cd/m2 or 15.23 log quanta/cm2 /s) and blue light (463 nm, 332 cd/m2 or 15.27 log quanta/cm2 /s) and binocular pupil measurements. Prior to light stimulation, patients were dark-adapted for 5 min. The late postillumination pupillary response (PIPRL ate ) to blue light was used as marker of ipRGC activity. Sleep quality was assessed by Pittsburgh Sleep Quality Index (PSQI) questionnaire. RESULTS The PIPRL ate to blue light was significantly reduced in patients with NTG compared to healthy subjects (p < 0.001), indicating impairment of the melanopsin-mediated pupillary pathway. There was no significant difference in the response elicited by red light (p = 0.6). Baseline pupil diameter and pupillary constriction amplitude to both red and blue light were reduced in patients with NTG (p < 0.05). The global score in PSQI was not significantly different between healthy controls and patients with NTG, indicating normal sleep quality (p = 0.6). Furthermore, we found no correlation between sleep parameters and pupillary light reflex parameters. CONCLUSION Patients with NTG exhibited reduced ipRGC activity compared to healthy subjects, while no differences were observed in sleep quality.
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Affiliation(s)
- Hamid Ahmadi
- Department of Ophthalmology Rigshospitalet Glostrup Denmark
- Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - Henrik Lund‐Andersen
- Department of Ophthalmology Rigshospitalet Glostrup Denmark
- Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - Miriam Kolko
- Department of Ophthalmology Rigshospitalet Glostrup Denmark
- Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - Daniella Bach‐Holm
- Department of Ophthalmology Rigshospitalet Glostrup Denmark
- Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - Mark Alberti
- Department of Ophthalmology Rigshospitalet Glostrup Denmark
- Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - Shakoor Ba‐Ali
- Department of Ophthalmology Rigshospitalet Glostrup Denmark
- Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
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Abstract
PURPOSE OF REVIEW Cataract surgery is the most common surgical procedure performed worldwide. Small pupils have been an eternal challenge for cataract surgeons; insufficient pupil dilation is associated with increased complication rates, including capsule rupture, vitreous loss, iris trauma or postoperative inflammation. The aim of the current review is to present the methods for pupil dilation and the risk factors for a small pupil in a cataract patient. RECENT FINDINGS Risk factors for intraoperative small pupil include diabetes, intraoperative floppy iris syndrome, pseudoexfoliation syndrome, receiving glaucoma medications, having undergone previous ocular surgery and iris sphincter sclerosis from aging. There is a wide range of options to manage the small pupil, including pharmacological treatment, mechanical stretching, dilation with iris hooks or pupil expanders. We recommend a stepwise approach for intraoperative pupil dilation, from pharmacological mydriasis to pupil expanders. SUMMARY The current article discusses risk factors for a small pupil and the methods for pupil dilation in a cataract patient. Every cataract surgeon needs to be ready to cope with a small pupil, both manifesting preoperatively and intraoperatively.
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Reply:. J Cataract Refract Surg 2020; 46:163-164. [DOI: 10.1097/j.jcrs.0000000000000005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Shorstein NH, Gardner S. Injection volume and intracameral moxifloxacin dose. J Cataract Refract Surg 2019; 45:1498-1502. [PMID: 31444079 DOI: 10.1016/j.jcrs.2019.04.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 03/15/2019] [Accepted: 03/26/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE To test the effect of injection volume and concentration on dosing and residence time of moxifloxacin in the anterior chamber (AC). SETTING Kaiser Permanente, Walnut Creek, California, USA. DESIGN Experimental study. METHODS Moxifloxacin 0.5%/0.05 mL, moxifloxacin 0.5%/0.10 mL, and moxifloxacin 0.15%/0.50 mL were drawn into 5 1.0 mL syringes each, injected into tared vials, and weighed. The doses delivered were calculated. The AC concentrations and elimination rates of the drug for two AC volumes were modeled for each dosing method. RESULTS The 0.05 mL injection volume resulted in the greatest range (35 μg) of delivered dose compared with larger injection volumes (≤25 μg). The mathematical model predicted that variation in dosing in each group would result in differences of 12 minutes or less for the presence of the drug in the AC. Injection of 0.5%/0.1 mL produced AC concentrations above 500 μg/mL for 1.9 to 3.0 hours and above 64 μg/mL for 5.5 to 6.5 hours, depending on the AC volume; however, flushing with a 0.15% concentration sustained AC levels for 1.9 hours and 5.5 hours, respectively, for the two AC volumes. CONCLUSIONS Smaller injection volumes of a higher concentration moxifloxacin resulted in less accuracy and less precision in the delivered dose (0.05 mL, P = .005; 0.10 mL, P = .03); however, the clinical significance of this might vary. Injection of 0.5%/0.1 mL and flushing with 0.15%/0.5 mL of moxifloxacin would provide similar drug AC residence times according to the model. Flushing provided more consistent AC concentrations with differing AC volumes.
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Lee H, Zukaite I, Juniat V, Dimitry ME, Lewis A, Nanavaty MA. Changes in symmetry of anterior chamber following routine cataract surgery in non-glaucomatous eyes. EYE AND VISION 2019; 6:19. [PMID: 31309126 PMCID: PMC6607582 DOI: 10.1186/s40662-019-0144-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 06/12/2019] [Indexed: 11/26/2022]
Abstract
Background To assess minimum and maximum changes in anterior chamber dimensions following routine cataract surgery in non-glaucomatous eyes. Methods Forty-two eyes (42 participants) underwent routine cataract surgery with same surgeon and were assessed preoperatively, 1, 3, 6 and 12 months postoperatively. Primary outcome measure: Angle-to-angle diameter (AAD) (at 0-180o, 45-225o, 90-270o, 135-315o), Anterior-chamber-angle (ACA) (at 0o, 45o, 90o, 135o, 180o, 225o, 270o and 315o) and central anterior chamber depth (ACD) at all visits. Secondary outcome measures: relationship to axial length (AL). Results The mean AAD and ACA increased post-operatively in all meridians at all visits postoperatively. At 12 months, there was a maximum change in AAD in horizontal meridian (506.55 ± 468.71 μm) and least in vertical meridian (256.31 ± 1082.3 μm). The mean percentage increase in ACA postoperatively was least at 90o (5% increase compared to 29–35% elsewhere). Central ACD deepened at all postoperative visits and this did not change over 12 months. There was no correlation between AAD, ACA and ACD with AL at any visit. Conclusion The AAD, ACA and ACD increases following cataract surgery in non-glaucomatous eyes, but at 12 months increase in AAD is least in vertical compared to horizontal meridian. Also, ACA was narrower (only 5% increase) superiorly compared to elsewhere (29–35% increase in ACA). This may have implications with regards to surgeries performed in the anterior chamber and corneal endothelial cell loss.
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Affiliation(s)
- Hanbin Lee
- Sussex Eye Hospital, Brighton & Sussex University Hospitals NHS Trust, Eastern Road, Brighton, BN2 5BF UK
| | - Ieva Zukaite
- Sussex Eye Hospital, Brighton & Sussex University Hospitals NHS Trust, Eastern Road, Brighton, BN2 5BF UK
| | - Valerie Juniat
- Sussex Eye Hospital, Brighton & Sussex University Hospitals NHS Trust, Eastern Road, Brighton, BN2 5BF UK
| | - Maria E Dimitry
- Sussex Eye Hospital, Brighton & Sussex University Hospitals NHS Trust, Eastern Road, Brighton, BN2 5BF UK
| | - Amanda Lewis
- Sussex Eye Hospital, Brighton & Sussex University Hospitals NHS Trust, Eastern Road, Brighton, BN2 5BF UK
| | - Mayank A Nanavaty
- Sussex Eye Hospital, Brighton & Sussex University Hospitals NHS Trust, Eastern Road, Brighton, BN2 5BF UK
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Zhu Y, He T, Zhu H, Chen J, Zhou J. Static and dynamic pupillary characteristics in high myopic eyes with two implantable collamer lenses. J Cataract Refract Surg 2019; 45:946-951. [DOI: 10.1016/j.jcrs.2019.01.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 01/23/2019] [Accepted: 01/23/2019] [Indexed: 11/27/2022]
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Qureshi A, Chen H, Saeedi O, Kaleem MA, Stoleru G, Margo J, Kalarn S, Alexander JL. Anterior segment ultrasound biomicroscopy image analysis using ImageJ software: Intra-observer repeatability and inter-observer agreement. Int Ophthalmol 2018. [PMID: 29516316 DOI: 10.1007/s10792-018-0882-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE In this novel study, we demonstrate a standardized imaging and measurement protocol of anterior segment (AS) structures with reliability analysis using ultrasound biomicroscopy (UBM) and ImageJ software. METHODS Ten pediatric and young adult patients undergoing examination under anesthesia for AS pathology were imaged using UBM. Four trained observers analyzed 20 images using ImageJ. Forty-five structural parameters were measured. Those that relied on the trabecular-iris angle (TIA) as a reference landmark were labeled TIA-dependent (TD) and all others were labeled non-TIA dependent (NTD). Intra-observer repeatability (IOR) and inter-observer agreement (IOA) of measurements were determined using coefficient of variation (CV) and intra-class correlation (ICC) followed by assessment of Bland-Altman plots (BAP) for each pair of observers, respectively. RESULTS For NTD parameters, non-ciliary body (CB) related measurements showed CV range 0.60-16.22% and ICC range 0.84-0.89, whereas CB-related parameters showed CV range 2.86-23.40% and ICC range 0.29-0.92. For TD parameters, parameters < 2 degrees removed from reference showed CV range 0.02-5.40% and ICC range 0.89-1.00, whereas parameters > 1 degree removed showed CV range 0.63-27.44% and ICC range 0.22-1.00. No systematic proportional bias was detected by BAPs. CONCLUSIONS Preplaced landmarks yielded good IOR and IOA in quantitative assessment of AS structures that were NTD and non-CB-related or less removed from the reference. CB-related NTD measurements varied greatly in IOR and IOA, indicating protocol modifications or CB qualitative assessments needed to improve accuracy. Variability in TD measurements increased the further removed from the reference, which supports implementation of a reliable reference landmark to minimize variation.
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Affiliation(s)
- Azam Qureshi
- University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Haoxing Chen
- University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Osamah Saeedi
- University of Maryland Eye Associates, Baltimore, MD, USA.,Department of Ophthalmology, University of Maryland, Baltimore, MD, USA
| | - Mona A Kaleem
- University of Maryland Eye Associates, Baltimore, MD, USA.,Department of Ophthalmology, University of Maryland, Baltimore, MD, USA
| | - Gianna Stoleru
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jordan Margo
- University of Maryland Eye Associates, Baltimore, MD, USA.,Department of Ophthalmology, University of Maryland, Baltimore, MD, USA
| | - Sachin Kalarn
- Department of Ophthalmology, University of Maryland, Baltimore, MD, USA
| | - Janet L Alexander
- University of Maryland Eye Associates, Baltimore, MD, USA.,Department of Ophthalmology, University of Maryland, Baltimore, MD, USA
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Ba-Ali S, Lund-Andersen H, Brøndsted AE. Cataract surgery affects the pupil size and pupil constrictions, but not the late post-illumination pupil response. Acta Ophthalmol 2017; 95:e252-e253. [PMID: 27778446 DOI: 10.1111/aos.13291] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Shakoor Ba-Ali
- Department of Ophthalmology; Rigshospitalet; Glostrup Denmark
- Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
| | - Henrik Lund-Andersen
- Department of Ophthalmology; Rigshospitalet; Glostrup Denmark
- Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
| | - Adam Elias Brøndsted
- Department of Ophthalmology; Rigshospitalet; Glostrup Denmark
- Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
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Measurement of and Factors Associated with the Anterior Chamber Volume in Healthy Chinese Adults. J Ophthalmol 2017; 2017:6762047. [PMID: 28168046 PMCID: PMC5259661 DOI: 10.1155/2017/6762047] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 11/29/2016] [Accepted: 12/14/2016] [Indexed: 12/03/2022] Open
Abstract
Purpose. To measure the anterior chamber volume (ACV) and determine factors associated with the ACV in healthy Chinese adults. Methods. In this cross-sectional study, we used swept-source optical coherence tomography (SS-OCT) to measure ACV and other anterior segment parameters. Factors associated with ACV were also determined. Results. A total of 313 healthy Chinese adults were enrolled. The anterior segment parameters, including ACV, could be measured by SS-OCT with excellent repeatability and reproducibility. There was a significant difference between the horizontal and vertical anterior chamber widths (ACW) (P < 0.05), with a mean difference of 390 μm. The ACV (mean 153.83 ± 32.42 mm3) was correlated with most of the anterior segment parameters, especially anterior chamber depth (ACD), which accounted for about 85% of the variation of ACV. Most of the anterior segment parameters were significantly correlated with age, and the relative changes in ACV and ACD were greatest in subjects aged 41–50 years. Conclusion. ACV was correlated with most of the anterior segment parameters measured in this study, particularly ACD. The relatively large difference between horizontal and vertical ACW suggests that the ACV could and should be measured using multiple OCT scans.
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McKee HD, Jhanji V. Theoretical Effect of Lens Position and Corneal Curvature on the Near Focal Point of Multifocal Intraocular Lenses. J Refract Surg 2016; 32:64-6. [PMID: 26812717 DOI: 10.3928/1081597x-20151207-04] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 10/21/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE To determine the effect of lens position and corneal curvature on the near focal point of different multifocal intraocular lenses. METHODS Near focal points for various multifocal intraocular lenses were calculated using a refractive vergence formula. Median, high, and low values for lens position and corneal curvature were used. RESULTS Lens position and corneal curvature both affected the theoretical near point of multifocal intraocular lenses. The effect was more pronounced for lower power adds. There was overlap of near focal points for the different near adds of the Tecnis multifocal lenses (AMO, Abbott Park, IL) across the range of lens positions and corneal curvatures seen in a normal population. CONCLUSIONS Clinicians need to be aware of the effect of lens position and corneal curvature on the near focal point of intraocular lenses.
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Hwang HB, Yim HB, Chung SK. Effect of diabetic retinopathy and diabetes on the intraocular straylight in pseudophakic eyes. BMC Ophthalmol 2015; 15:130. [PMID: 26464020 PMCID: PMC4604714 DOI: 10.1186/s12886-015-0120-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 09/29/2015] [Indexed: 11/27/2022] Open
Abstract
Background The aim of this study was to prove the relationship between the intraocular straylight level and diabetic retinopathy (DR) according to disease severity. Also, we aimed to evaluate whether diabetes mellitus (DM) per se could be a risk factor of increased intraocular straylight although we did not rely on a definite sign of DR in this study. Methods In this prospective comparative study, ninety three eyes were enrolled and divided into four groups as follows: Group 1 (26 eyes), without DR or DM; Group 2 (25 eyes), with DM but without DR; Group 3 (21 eyes), mild to moderate non-proliferative DR; and Group 4 (21 eyes), severe non-proliferative DR. To measure the intraocular straylight in an objective manner, the C-quant straylight meter was used to preoperatively and 2 months postoperatively in all patients who underwent phacoemulsification surgery. All the patients also underwent a macular optical coherence tomography and hemoglobin A1c (HbA1c) analysis. A comparison of straylight levels adjusted by age among four groups was performed postoperatively. Results The postoperative level of intraocular straylight was statistically significantly different among four groups (P <0.05). When adjusted for ages, Group 4 showed the highest straylight level when compared with Group 3 and the other two groups (P <0.05). Group 1 showed the lowest straylight level in comparison with Group 2 and the other two groups (P <0.05). There was no significant correlation between HbA1c level, duration of diabetes and postoperative straylight level. Conclusions The level of intraocular straylight at 2 months postoperatively had a tendency to increase as the severity of DR increased. Additionally, the straylight level was higher in DM patients without DR than in patients without DM. Therefore, the severity of DR seemed to influence the intraocular straylight level. Although there is no definite sign of DR, DM per se can be a risk factor for increasing intraocular straylight. In conclusion, the level of intraocular straylight seems to be a sensitive test for detecting early retinal damage secondary to DM.
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Affiliation(s)
- Hyung Bin Hwang
- Department of Ophthalmology and Visual Science, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, South Korea.
| | - Hye Bin Yim
- Department of Ophthalmology and Visual Science, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, South Korea.
| | - Sung Kun Chung
- Postal address: Department of Ophthalmology and Visual Science, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, Republic of Korea.
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Brøndsted AE, Sander B, Haargaard B, Lund-Andersen H, Jennum P, Gammeltoft S, Kessel L. The Effect of Cataract Surgery on Circadian Photoentrainment: A Randomized Trial of Blue-Blocking versus Neutral Intraocular Lenses. Ophthalmology 2015; 122:2115-24. [PMID: 26233628 DOI: 10.1016/j.ophtha.2015.06.033] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Revised: 06/18/2015] [Accepted: 06/18/2015] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Cataract decreases blue light transmission. Because of the selective blue light sensitivity of the retinal ganglion cells governing circadian photoentrainment, cataract may interfere with normal sleep-wake regulation and cause sleep disturbances. The purpose was to investigate the effect of cataract surgery on circadian photoentrainment and to determine any difference between blue-blocking and neutral intraocular lenses (IOLs). DESIGN The study was a single-center, investigator-driven, double-masked, block-randomized clinical trial. PARTICIPANTS One eye in 76 patients with bilateral age-related cataract eligible for cataract surgery was included. METHODS Intervention was cataract surgery by phacoemulsification. Patients were randomized to receive a blue-blocking or neutral IOL. MAIN OUTCOME MEASURES Primary outcome was activation of intrinsic photosensitive ganglion cells using post-illumination pupil response (PIPR) to blue light from 10 to 30 seconds after light exposure as a surrogate measure. Secondary outcomes were circadian rhythm analysis using actigraphy and 24-hour salivary melatonin measurements. Finally, objective and subjective sleep quality were determined by actigraphy and the Pittsburgh Sleep Quality Index. RESULTS The blue light PIPR increased 2 days (17%) and 3 weeks (24%) after surgery (P < 0.001). The majority of circadian and sleep-specific actigraphy parameters did not change after surgery. A forward shift of the circadian rhythm by 22 minutes (P = 0.004) for actigraphy and a tendency toward an earlier melatonin onset (P = 0.095) were found. Peak salivary melatonin concentration increased after surgery (P = 0.037). No difference was detected between blue-blocking and neutral IOLs, whereas low preoperative blue light transmission was inversely associated with an increase in PIPR (P = 0.021) and sleep efficiency (P = 0.048). CONCLUSIONS Cataract surgery increases photoreception by the photosensitive retinal ganglion cells. Because of inconsistency between the significant findings and the many parameters that were unchanged, we can conclude that cataract surgery does not adversely affect the circadian rhythm or sleep. Longer follow-up time and fellow eye surgery may reveal the significance of the subtle changes observed. We found no difference between blue-blocking and neutral IOLs, and, because of the minor effect of surgery in itself, an effect of IOL type seems highly unlikely.
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Affiliation(s)
- Adam Elias Brøndsted
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark; Faculty of Health Sciences, University of Copenhagen, Denmark.
| | - Birgit Sander
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
| | - Birgitte Haargaard
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark; Faculty of Health Sciences, University of Copenhagen, Denmark
| | - Henrik Lund-Andersen
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark; Faculty of Health Sciences, University of Copenhagen, Denmark
| | - Poul Jennum
- Faculty of Health Sciences, University of Copenhagen, Denmark; Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet, Glostrup, Denmark
| | - Steen Gammeltoft
- Clinical Biochemistry Section, Department of Diagnostics, Rigshospitalet, Glostrup, Denmark
| | - Line Kessel
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark; Faculty of Health Sciences, University of Copenhagen, Denmark
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Ro JW, Yi KY, Kim HK, Hyon JY, Wee WR, Shin YJ. Internal Lens Signal Measured by Dual Scheimpflug Anterior Segment Analyzer. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2015. [DOI: 10.3341/jkos.2015.56.5.702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jin Woo Ro
- Department of Ophthalmology, Hallym University College of Medicine, Chuncheon, Korea
| | - Ka Young Yi
- Department of Ophthalmology, Hallym University College of Medicine, Chuncheon, Korea
| | - Ha Kyung Kim
- Department of Ophthalmology, Hallym University College of Medicine, Chuncheon, Korea
| | - Joon Young Hyon
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
| | - Won Ryang Wee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
| | - Young Joo Shin
- Department of Ophthalmology, Hallym University College of Medicine, Chuncheon, Korea
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