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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; 47:102156. [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] [MESH Headings] [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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Skrzypecki J, Izdebska J, Ordon AJ, Przybek-Skrzypecka J, Szaflik JP. Spherical aberrations and their role in modern ophthalmology. Clin Exp Optom 2023; 106:703-710. [PMID: 36822601 DOI: 10.1080/08164622.2022.2160235] [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: 07/20/2022] [Revised: 10/31/2022] [Accepted: 11/03/2022] [Indexed: 02/25/2023] Open
Abstract
Spherical aberration is an imperfection of the optical system of the human eye. The role of spherical aberration of the human eye in the quality of vision and pseudoaccommodation is reviewed. Spherical aberration is an imperfection of the optical system of the human eye. In most cases, due to well-developed neuroadaptation, it is insignificant for the perception of the image. Nevertheless, its role in modern ophthalmology is far from straightforward. On the one hand, there are clinical scenarios in which an excess of spherical aberration degrades the retinal image and leads to a high dissatisfaction rate among patients.©Recently, there is a growing interest in the modulation of spherical aberration in the clinical setting. Modern intraocular lenses as well as laser refractive procedures are aimed at interfering with spherical aberrations of the optical system in order to increase range of pseudoaccommodation. Here, we review the role of spherical aberration of the human eye in the quality of vision and pseudoaccommodation.
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Affiliation(s)
- Janusz Skrzypecki
- Departament of Ophthalmology, Independent Public University Eye Hospital, Warsaw, Poland
- Department of Experimental Physiology and Pathophysiology, Medical University of Warsaw, Warsaw, Poland
| | - Justyna Izdebska
- Departament of Ophthalmology, Independent Public University Eye Hospital, Warsaw, Poland
- Department of Ophthalmology, Medical University of Warsaw, Warsaw, Poland
| | - Agata Joanna Ordon
- Departament of Ophthalmology, Independent Public University Eye Hospital, Warsaw, Poland
- Department of Binocular Vision Pathophysiology and Strabismus, Medical University of Lodz, Lodz, Poland
| | - Joana Przybek-Skrzypecka
- Departament of Ophthalmology, Independent Public University Eye Hospital, Warsaw, Poland
- Department of Ophthalmology, Medical University of Warsaw, Warsaw, Poland
| | - Jacek Pawel Szaflik
- Departament of Ophthalmology, Independent Public University Eye Hospital, Warsaw, Poland
- Department of Ophthalmology, Medical University of Warsaw, Warsaw, Poland
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Naik MN, Khader MA, Murthy SI. Periorbital aesthetic concerns in patients seeking corneal refractive surgery. Indian J Ophthalmol 2021; 69:2771-2775. [PMID: 34571632 PMCID: PMC8597454 DOI: 10.4103/ijo.ijo_471_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Purpose: To report the frequency of periorbital aesthetic abnormalities in patients undergoing refractive surgery and to report the ability of the patient and the refractive surgeon in picking up these findings compared to the oculoplastic surgeon. Methods: Single-center, prospective observational case series. All patients underwent standard pre-operative work-up for refractive surgery, answered a study questionnaire, and underwent face photographs (with and without glasses). The patient, the refractive, and the oculoplastic surgeons evaluated the photographs to categorize the concerns as none, presence of ptosis, tear trough deformity, scleral show, and others. The findings of the oculoplastic surgeon were taken as the standard of reference. Results: The photographs of 121 patients were analyzed. The mean age was 25.76 ± 3.75 years and 72% were males. The main indication for surgery was to eliminate dependency on glasses in a majority (76%) followed by cosmesis in 23%. The oculoplastic surgeon noted tear trough deformity in 14 (11.5%) cases, scleral show in 51 (42.1%), ptosis in 35 (28.9%), and other findings in 45 (37.1%). When the symmetrical scleral show was excluded, the patient picked up aesthetic concerns in only 8.26%, the refractive surgeon in 14% as compared to 39% by the oculoplastic surgeon (P < 0.01). Conclusion: Periorbital aesthetic significant findings were noted in 39% of the patients undergoing corneal refractive surgery when assessed by an oculoplastic surgeon. The refractive surgeon was able to pick up less than 50% of these. We recommend a basic aesthetic initial evaluation prior to refractive surgery and photographic documentation, especially in cosmetically aware patients.
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Affiliation(s)
- Milind N Naik
- Ophthalmic Plastic Surgery Service, L. V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, India
| | - Mohammed A Khader
- Ophthalmic Plastic Surgery Service, L. V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, India
| | - Somasheila I Murthy
- Cornea Service, The Cornea Institute, L. V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, India
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Rampat R, Gatinel D. Multifocal and Extended Depth-of-Focus Intraocular Lenses in 2020. Ophthalmology 2020; 128:e164-e185. [PMID: 32980397 DOI: 10.1016/j.ophtha.2020.09.026] [Citation(s) in RCA: 107] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 09/14/2020] [Accepted: 09/21/2020] [Indexed: 10/23/2022] Open
Abstract
Ophthalmic surgeons have been overwhelmed by the influx of multifocal intraocular lens (IOL) options in recent years, with close to 100 IOLs on the market in 2020. This practical and technical update on a representative group of established as well as newly launched multifocal IOLs on the market focuses on multifocal IOLs, including extended depth-of-focus lenses. We also describe the optical basis of lens platforms used and thorough preoperative planning to aid decision making. This allows the surgeon the knowledge base to deliver the required relative customized spectacle independence with the least photic phenomenon and loss of contrast possible while achieving high individual patient satisfaction. Data of reviewed IOLs displayed in tabular format include mean monocular uncorrected distance, intermediate, and near visual acuities (logarithm of the minimum angle of resolution), with standard deviations and ranges where available. The range of vision targeted, pupil dependence, toric availability, as well as type of optical platform, are provided as a practical guide to demystify existing terminology on the market that may create interest around a seemingly new design that is actually not novel at all. Halos and glare experienced, levels of patient satisfaction, and spectacle independence achieved also are summarized. A wide range of multifocal IOLs options are available on the market to surgeons. Comprehensive patient selection and examination, combined with knowledge of the most recent options and adequate patient counseling, including neuroadaptation, can avoid dissatisfaction. Many recently available IOLs are awaiting formal results, but the methods by which we label and compare these types of IOLs must also be standardized.
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Affiliation(s)
- Radhika Rampat
- Anterior Segment and Refractive Surgery Department, Rothschild Foundation Hospital, Paris, France
| | - Damien Gatinel
- Anterior Segment and Refractive Surgery Department, Rothschild Foundation Hospital, Paris, France.
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Sharma G, Chiva-Razavi S, Viriato D, Naujoks C, Patalano F, Bentley S, Findley A, Johnson C, Arbuckle R, Wolffsohn J. Patient-reported outcome measures in presbyopia: a literature review. BMJ Open Ophthalmol 2020; 5:e000453. [PMID: 32685693 PMCID: PMC7359053 DOI: 10.1136/bmjophth-2020-000453] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 05/18/2020] [Accepted: 06/12/2020] [Indexed: 12/02/2022] Open
Abstract
Presbyopia is the age-related loss of near-distance focusing ability. The aim of this study was to identify patient-reported outcome measures (PROMs) used in clinical trials and quality-of-life studies conducted in individuals with presbyopia and to assess their suitability for use in individuals with phakic presbyopia. Literature searches were performed in Medline and Embase up until October 2017. Specific search terms were used to identify presbyopia studies that included a PROM. All clinical trials with PROM-supported endpoints in presbyopia were identified on ClinicalTrials.gov. Further searches were conducted to retrieve articles documenting the development and psychometric evaluation of the PROMs identified. A total of 703 records were identified; 120 were selected for full-text review. Twenty-one clinical trials employed PROMs to support a primary or secondary endpoint. In total, 13 PROMs were identified; a further 23 publications pertaining to the development and validation of these measures were retrieved. Most PROMs were developed prior to release of the Food and Drug Administration (FDA) 2009 patient-reported outcome guidance and did not satisfy regulatory standards. The Near Activity Visual Questionnaire (NAVQ) was identified as the most appropriate for assessing near-vision functioning in presbyopia. While the NAVQ was developed in line with the FDA guidance, the items do not reflect changes in technology that have occurred since the questionnaire was developed in 2008 (eg, the increase in smartphone use), and the measure was not validated in a purely phakic presbyopia sample. Further research is ongoing to refine the NAVQ to support trial endpoints related to changes in near-vision functioning associated with phakic presbyopia.
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Affiliation(s)
| | | | | | | | | | - Sarah Bentley
- Adelphi Values Patient-Centered Outcomes, Bollington, UK
| | - Amy Findley
- Adelphi Values Patient-Centered Outcomes, Bollington, UK
| | - Chloe Johnson
- Adelphi Values Patient-Centered Outcomes, Bollington, UK
| | - Rob Arbuckle
- Adelphi Values Patient-Centered Outcomes, Bollington, UK
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Abstract
SIGNIFICANCE Existing patient-reported outcome instruments in refractive error are paper-based questionnaires. They are not comprehensive and psychometrically robust. This study has identified the content of the refractive error-specific item banks that aim to provide comprehensive and scientific measurement of refractive error-specific quality of life. PURPOSE The purpose of this study was to identify minimally representative, optimally informative, and efficient sets of items for measuring quality of life in people with refractive error. METHODS First, items were identified from existing patient-reported outcome instruments. Second, items were developed from qualitative studies with people with refractive error (48 and 101 in-depth interviews in Australia and Nepal, respectively). Third, classification and selection of items were done based on a set of systematic criteria using an iterative process of binning and winnowing. The resulting items underwent cognitive testing with people with refractive error in Australia and in Nepal. Each step was guided by an expert panel consensus. RESULTS We retrieved 792 items from the existing patient-reported outcome instruments. From the interviews conducted in Australia, a total of 2367 comments were coded into 807 initial items. Similarly, from the interviews conducted in Nepal, 3477 comments were coded into 914 initial items. After binning and winnowing, followed by cognitive testing, a final set of items comprising 337 items for the Item-pool (Australia) and 308 items for the Item-pool (Nepal), both spanning 12 domains, was obtained. Forty-seven percent of items were common across the two item pools. In the Item-pool (Nepal), 65% items were common for corrected and uncorrected refractive error. CONCLUSIONS We identified the content of two different sets of item banks to comprehensively measure the impact of refractive error on quality of life for people in Australia and Nepal, which may be applicable to high-income country settings and low- and middle-income country settings, respectively. Future work aims to develop computer-adaptive testing system to administer the item banks, resulting in useful measurement tools for researchers, clinicians, and policy planners.
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Grzybowski A, Kanclerz P, Muzyka-Woźniak M. Methods for evaluating quality of life and vision in patients undergoing lens refractive surgery. Graefes Arch Clin Exp Ophthalmol 2019; 257:1091-1099. [PMID: 30824995 DOI: 10.1007/s00417-019-04270-w] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 01/16/2019] [Accepted: 02/11/2019] [Indexed: 10/27/2022] Open
Abstract
PURPOSE Cataract surgery has evolved into a procedure that generally yields the best postoperative refractive result attainable. Patients with multifocal intraocular lenses (IOLs) present higher rates of spectacle independence, although reduced intermediate vision, dysphotopsias, and a loss of image quality might also be experienced. The aim of the study was to review the methods for assessing quality of life and vision in patients undergoing lens refractive surgery in randomized controlled trials. METHODS We reviewed the PubMed web platform to identify relevant studies using the following keywords: quality of life, quality of vision, lens surgery, lens exchange, refractive lens exchange, cataract, cataract surgery, intraocular lens, IOL, multifocal, and monovision. RESULTS An increasing number of studies have focused on patient-reported outcomes (PROs). Only a few of the available visual function questionnaires can be regarded as useful in lens refractive surgery with multifocal IOL implantation. Many self-developed questionnaires have emerged that have not been adequately validated or found to feature properly evaluated repeatability, hampering the possibility of comparing outcomes. CONCLUSIONS This review describes the existing PROs instruments and informs the choice of an appropriate measure in lens refractive surgery. Rasch-developed tools should be utilized for measuring quality of life and vision in patients undergoing lens refractive surgery and there is a number of highly robust tools available.
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Affiliation(s)
- Andrzej Grzybowski
- Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland. .,Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, Gorczyczewskiego 2/3, 60-554, Poznan, Poland.
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Patient-reported Outcomes for Assessment of Quality of Life in Refractive Error: A Systematic Review. Optom Vis Sci 2017; 94:1102-1119. [PMID: 29095758 DOI: 10.1097/opx.0000000000001143] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
SIGNIFICANCE This review has identified the best existing patient-reported outcome (PRO) instruments in refractive error. The article highlights the limitations of the existing instruments and discusses the way forward. PURPOSE A systematic review was conducted to identify the types of PROs used in refractive error, to determine the quality of the existing PRO instruments in terms of their psychometric properties, and to determine the limitations in the content of the existing PRO instruments. METHODS Articles describing a PRO instrument measuring 1 or more domains of quality of life in people with refractive error were identified by electronic searches on the MEDLINE, PubMed, Scopus, Web of Science, and Cochrane databases. The information on content development, psychometric properties, validity, reliability, and responsiveness of those PRO instruments was extracted from the selected articles. The analysis was done based on a comprehensive set of assessment criteria. RESULTS One hundred forty-eight articles describing 47 PRO instruments in refractive error were included in the review. Most of the articles (99 [66.9%]) used refractive error-specific PRO instruments. The PRO instruments comprised 19 refractive, 12 vision but nonrefractive, and 16 generic PRO instruments. Only 17 PRO instruments were validated in refractive error populations; six of them were developed using Rasch analysis. None of the PRO instruments has items across all domains of quality of life. The Quality of Life Impact of Refractive Correction, the Quality of Vision, and the Contact Lens Impact on Quality of Life have comparatively better quality with some limitations, compared with the other PRO instruments. CONCLUSIONS This review describes the PRO instruments and informs the choice of an appropriate measure in refractive error. We identified need of a comprehensive and scientifically robust refractive error-specific PRO instrument. Item banking and computer-adaptive testing system can be the way to provide such an instrument.
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Kandel H, Khadka J, Lundström M, Goggin M, Pesudovs K. Questionnaires for Measuring Refractive Surgery Outcomes. J Refract Surg 2017; 33:416-424. [DOI: 10.3928/1081597x-20170310-01] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 01/18/2017] [Indexed: 11/20/2022]
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Meidani A, Tzavara C, Dimitrakaki C, Pesudovs K, Tountas Y. Femtosecond Laser–assisted LASIK Improves Quality of Life. J Refract Surg 2012; 28:319-26. [DOI: 10.3928/1081597x-20120403-01] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Accepted: 03/27/2012] [Indexed: 11/20/2022]
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Berdeaux G, Meunier J, Arnould B, Viala-Danten M. Measuring benefits and patients' satisfaction when glasses are not needed after cataract and presbyopia surgery: scoring and psychometric validation of the Freedom from Glasses Value Scale (FGVS). BMC Ophthalmol 2010; 10:15. [PMID: 20497555 PMCID: PMC2881904 DOI: 10.1186/1471-2415-10-15] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2009] [Accepted: 05/24/2010] [Indexed: 11/30/2022] Open
Abstract
Background The purpose of this study was to reduce the number of items, create a scoring method and assess the psychometric properties of the Freedom from Glasses Value Scale (FGVS), which measures benefits of freedom from glasses perceived by cataract and presbyopic patients after multifocal intraocular lens (IOL) surgery. Methods The 21-item FGVS, developed simultaneously in French and Spanish, was administered by phone during an observational study to 152 French and 152 Spanish patients who had undergone cataract or presbyopia surgery at least 1 year before the study. Reduction of items and creation of the scoring method employed statistical methods (principal component analysis, multitrait analysis) and content analysis. Psychometric properties (validation of the structure, internal consistency reliability, and known-group validity) of the resulting version were assessed in the pooled population and per country. Results One item was deleted and 3 were kept but not aggregated in a dimension. The other 17 items were grouped into 2 dimensions ('global evaluation', 9 items; 'advantages', 8 items) and divided into 5 sub-dimensions, with higher scores indicating higher benefit of surgery. The structure was validated (good item convergent and discriminant validity). Internal consistency reliability was good for all dimensions and sub-dimensions (Cronbach's alphas above 0.70). The FGVS was able to discriminate between patients wearing glasses or not after surgery (higher scores for patients not wearing glasses). FGVS scores were significantly higher in Spain than France; however, the measure had similar psychometric performances in both countries. Conclusions The FGVS is a valid and reliable instrument measuring benefits of freedom from glasses perceived by cataract and presbyopic patients after multifocal IOL surgery.
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Affiliation(s)
- Gilles Berdeaux
- Health Economics Eurmea, Alcon Laboratories, 4, rue Henri Sainte-Claire Deville, 92563 Rueil-Malmaison Cedex, France
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