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Schnider C, Yuen L, Rampat R, Zhu D, Dhallu S, Trinh T, Gurnani B, Abdelmaksoud A, Bhogal-Bhamra G, Wolffsohn JS, Naroo SA. BCLA CLEAR presbyopia: Management with intraocular lenses. Cont Lens Anterior Eye 2024; 47:102253. [PMID: 39068141 DOI: 10.1016/j.clae.2024.102253] [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: 07/30/2024]
Abstract
Cataract surgery including intraocular lens (IOL) insertion, has been refined extensively since the first such procedure by Sir Harold Ridley in 1949. The intentional creation of monovision with IOLs using monofocal IOL designs has been reported since 1984. The first reported implantation of multifocal IOLs was published in 1987. Since then, various refractive and or diffractive multifocal IOLs have been commercialised. Most are concentric, but segmented IOLs are also available. The most popular are trifocal designs (overlaying two diffractive patterns to achieve additional focal planes at intermediate and near distances) and extended depth of focus designs which leave the patient largely spectacle independent with the reduced risk of bothersome contrast reduction and glare. As well as mini-monovision, surgical strategies to minimise the impact of presbyopia with IOLs includes mixing and matching lenses between the eyes and using IOLs whose power can be adjusted post-implantation. Various IOL designs to mimic the accommodative process have been tried including hinge optics, dual optics, lateral shifts lenses with cubic-type surfaces, lens refilling and curvature changing approaches, but issues in maintaining the active mechanism with post-surgical fibrosis, without causing ocular inflammation, remain a challenge. With careful patient selection, satisfaction rates with IOLs to manage presbyopia are high and anatomical or physiological complications rates are no higher than with monofocal IOLs.
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Affiliation(s)
| | - Leonard Yuen
- ONE Medical Doctors Group & Day Surgical Centre, Quarry Bay, Hong Kong
| | | | - Dagny Zhu
- NVISION Eye Centers Rowland Heights, CA, USA
| | - Sandeep Dhallu
- Department of Clinical, Pharmaceutical and Biological Science, University of Hertfordshire, Hatfield, UK
| | - Tanya Trinh
- Mosman Eye Clinic, Sydney, New South Wales, Australia; Sydney Hospital and Sydney Eye Hospital, New South Wales, Australia
| | - Bharat Gurnani
- Gomabai Netralaya and Research Centre, Neemuch, Madhya Pradesh, India
| | | | | | - James S Wolffsohn
- College of Health & Life Sciences, Aston University, Birmingham, United Kingdom
| | - Shehzad A Naroo
- College of Health & Life Sciences, Aston University, Birmingham, United Kingdom.
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Schallhorn SC, Hettinger KA, Hannan SJ, Venter JA, Teenan D, Schallhorn JM. Effect of residual sphere on uncorrected visual acuity and satisfaction in patients with monofocal and multifocal intraocular lenses. J Cataract Refract Surg 2024; 50:591-598. [PMID: 38350162 PMCID: PMC11146176 DOI: 10.1097/j.jcrs.0000000000001418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 01/31/2024] [Accepted: 02/01/2024] [Indexed: 02/15/2024]
Abstract
PURPOSE To assess the effect of residual sphere on vision and satisfaction in pseudophakic patients. SETTING Private clinics, United Kingdom. DESIGN Retrospective case series. METHODS A multivariate model evaluated the effect of 1-month residual sphere on outcomes of pseudophakic patients. Odds ratios (ORs) were calculated to assess the relative risk of not achieving ≥20/20 monocular uncorrected distance visual acuity (UDVA), ≥20/50 uncorrected near visual acuity (UNVA), and not being satisfied with vision. ORs were assessed for residual sphere -1.00 to +1.00 diopter (D) in quarter-diopter steps, using 0.00 D as a reference. RESULTS The analysis included 38 828 multifocal and 11 571 monofocal intraocular lenses (IOLs). The residual myopic sphere ≤-0.25 D and hyperopic sphere ≥+0.50 D had a clinically meaningful effect on UDVA. Although monofocal IOLs had an improvement in UNVA with every additional 0.25 D of myopia, the change in ORs with increasing myopia was not significant for multifocal IOLs. The mean improvement in UNVA comparing eyes with 0.00 D and -1.00 D sphere was 0.26 logMAR for monofocal and 0.03 logMAR for multifocal IOLs. Low near-addition IOLs had a slightly higher gain in UNVA with increasing myopia, but the gain was not as substantial as with monofocal IOLs. The effect of ametropia on satisfaction was more pronounced for multifocal IOLs. For every 0.25 D of residual myopia, there was >25% increase in dissatisfied patients. CONCLUSIONS Although myopia improved UNVA in eyes with monofocal IOL, multifocal IOLs did not benefit from residual myopia. Multifocal IOL patients desiring distance vision should be targeted closest to emmetropia, even if it means targeting slight hyperopia.
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Affiliation(s)
- Steven C. Schallhorn
- From the Department of Ophthalmology, University of California, San Francisco, San Francisco, California (S.C. Schallhorn, J.M. Schallhorn); Optical Express, Glasgow, United Kingdom (S.C. Schallhorn, Hettinger, Hannan, Venter, Teenan); Carl Zeiss Meditec, Inc., Dublin, California (S.C. Schallhorn); F.I. Proctor Foundation, University of California, San Francisco, San Francisco, California (J.M. Schallhorn)
| | - Keith A. Hettinger
- From the Department of Ophthalmology, University of California, San Francisco, San Francisco, California (S.C. Schallhorn, J.M. Schallhorn); Optical Express, Glasgow, United Kingdom (S.C. Schallhorn, Hettinger, Hannan, Venter, Teenan); Carl Zeiss Meditec, Inc., Dublin, California (S.C. Schallhorn); F.I. Proctor Foundation, University of California, San Francisco, San Francisco, California (J.M. Schallhorn)
| | - Stephen J. Hannan
- From the Department of Ophthalmology, University of California, San Francisco, San Francisco, California (S.C. Schallhorn, J.M. Schallhorn); Optical Express, Glasgow, United Kingdom (S.C. Schallhorn, Hettinger, Hannan, Venter, Teenan); Carl Zeiss Meditec, Inc., Dublin, California (S.C. Schallhorn); F.I. Proctor Foundation, University of California, San Francisco, San Francisco, California (J.M. Schallhorn)
| | - Jan A. Venter
- From the Department of Ophthalmology, University of California, San Francisco, San Francisco, California (S.C. Schallhorn, J.M. Schallhorn); Optical Express, Glasgow, United Kingdom (S.C. Schallhorn, Hettinger, Hannan, Venter, Teenan); Carl Zeiss Meditec, Inc., Dublin, California (S.C. Schallhorn); F.I. Proctor Foundation, University of California, San Francisco, San Francisco, California (J.M. Schallhorn)
| | - David Teenan
- From the Department of Ophthalmology, University of California, San Francisco, San Francisco, California (S.C. Schallhorn, J.M. Schallhorn); Optical Express, Glasgow, United Kingdom (S.C. Schallhorn, Hettinger, Hannan, Venter, Teenan); Carl Zeiss Meditec, Inc., Dublin, California (S.C. Schallhorn); F.I. Proctor Foundation, University of California, San Francisco, San Francisco, California (J.M. Schallhorn)
| | - Julie M. Schallhorn
- From the Department of Ophthalmology, University of California, San Francisco, San Francisco, California (S.C. Schallhorn, J.M. Schallhorn); Optical Express, Glasgow, United Kingdom (S.C. Schallhorn, Hettinger, Hannan, Venter, Teenan); Carl Zeiss Meditec, Inc., Dublin, California (S.C. Schallhorn); F.I. Proctor Foundation, University of California, San Francisco, San Francisco, California (J.M. Schallhorn)
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Vought V, Vought R, Lee AS, Zhou I, Garneni M, Greenstein SA. Application of sentiment and word frequency analysis of physician review sites to evaluate refractive surgery care. ADVANCES IN OPHTHALMOLOGY PRACTICE AND RESEARCH 2024; 4:78-83. [PMID: 38590556 PMCID: PMC10999482 DOI: 10.1016/j.aopr.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 03/03/2024] [Accepted: 03/06/2024] [Indexed: 04/10/2024]
Abstract
Background Online physician reviews increase transparency in health care, helping patients make informed decisions about their provider. Language processing techniques can quantify this data and allow providers to better understand patients' experiences, perspectives, and priorities. The objective of this study was to assess patient satisfaction and understand the aspects of care that are valued by patients seeking refractive care using sentiment and word frequency analysis. Methods Written reviews and Star ratings for members of the Refractive Surgery Alliance Society practicing in the United States were collected from Healthgrades, a popular physician rating website. Surgeons with at least one written review were included in the study. Reviews were scored from -1 (most negative) to +1 (most positive) using Valence Aware Dictionary sEntiment Reasoner (VADER). Reviews were stratified by demographic characteristics, namely gender, region, and years in practice. Word frequency analysis was applied to find the most common words and phrases. Results A total of 254 specialists and 3104 reviews were analyzed, with an average of 4.4/5 stars and mean 48 ratings each. Most physicians had positive reviews (96%, average VADER = 0.69). Younger physicians (<20 years since residency) had significantly higher Stars rating than senior peers (>20 years) (P < 0.001). A similar trend was observed in VADER score (0.71 vs 0.69), although not statistically significant (P = 0.06). No statistical differences were observed between Stars rating and VADER score by gender (P = 0.66, P = 0.83) or by geographical region (P = 0.74, P = 0.07). "Staff" (n = 1269), "professional" (n = 631), "office" (n = 523), "questions" (n = 424), and "friendly" (n = 386) were frequently used in reviews, along with phrases such as "the staff" (n = 273) and "my questions" (n = 174). "Surgery" (n = 719), "staff" (n = 576), "procedure" (n = 251), "experience" (n = 243), and "professional" (n = 240) were the most common words in positive reviews, while "surgery" (n = 147), "office" (n = 86), "staff" (n = 54), "time" (n = 47), and "insurance" (n = 28) were the most commonly used in negative reviews. Conclusions Both the average Stars and VADER sentiment score suggest a high satisfaction among refractive patients. Word frequency analysis revealed that patients value non-clinical aspects of care, including interactions with staff, insurance coverage, and wait-times, suggesting that improving non-clinical factors could enhance patient satisfaction with refractive surgery.
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Affiliation(s)
- Victoria Vought
- Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Rita Vought
- Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Andrew S. Lee
- Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Irene Zhou
- Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Mansi Garneni
- Washington University School of Medicine, St. Louis, MO, USA
| | - Steven A. Greenstein
- Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, NJ, USA
- Cornea and Laser Eye Institute, Teaneck, NJ, USA
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Alarcon A, Del Aguila Carrasco A, Gounou F, Weeber H, Cánovas C, Piers P. Optical and clinical simulated performance of a new refractive extended depth of focus intraocular lens. Eye (Lond) 2024; 38:4-8. [PMID: 38580743 PMCID: PMC11080621 DOI: 10.1038/s41433-024-03041-0] [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] [Received: 01/22/2024] [Revised: 03/14/2024] [Accepted: 03/15/2024] [Indexed: 04/07/2024] Open
Abstract
OBJECTIVES The purpose of this study is to evaluate the optical and expected clinical performance of a new refractive Extended Depth of Focus (EDF) intraocular lens (IOL) designed to maintain a monofocal-like dysphotopsia profile. METHODS Simulated visual acuity (sVA) with varying defocus was calculated using the area under the Modulation Transfer Function measured in an average eye model and from computer simulations in eye models with corneal higher-order aberrations. Tolerance to defocus was evaluated using computer simulations of the uncorrected distance sVA under defocus. To evaluate the dysphotopsia profile, halo pictures obtained using an IOL-telescope, as well as simulated images in a realistic eye model under defocus were assessed. The results of the refractive EDF were compared to those of a diffractive EDF of the same platform. RESULTS The refractive EDF IOL provides similar range of vision to the diffractive EDF IOL with the same distance, and similar intermediate and near sVA. The refractive EDF IOL provides the same tolerance to hyperopia as the diffractive EDF but more tolerance to myopia. Halo pictures and simulations showed that the refractive EDF provides comparable dysphotopsia profile to the monofocal IOL and better than the diffractive EDF. CONCLUSIONS The results of this preclinical study in clinically relevant conditions show that the new refractive EDF IOL is expected to provide similar range of vision to the diffractive IOL of the same platform and higher tolerance to refractive errors. The refractive EDF provides a dysphotopsia profile that is better than the diffractive EDF and comparable to that of the monofocal IOL, also in the presence of residual refractive errors.
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Affiliation(s)
- Aixa Alarcon
- Johnson and Johnson Vision Van Swietenlaan 5, Groningen, 9728 NX, The Netherlands.
| | | | - Franck Gounou
- Johnson and Johnson Vision Van Swietenlaan 5, Groningen, 9728 NX, The Netherlands
| | - Henk Weeber
- Johnson and Johnson Vision Van Swietenlaan 5, Groningen, 9728 NX, The Netherlands
| | - Carmen Cánovas
- Johnson and Johnson Vision Van Swietenlaan 5, Groningen, 9728 NX, The Netherlands
| | - Patricia Piers
- Johnson and Johnson Vision Van Swietenlaan 5, Groningen, 9728 NX, The Netherlands
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Liu X, Hannan SJ, Schallhorn SC, Schallhorn JM. Angle Kappa is Not Correlated with Patient-Reported Outcomes After Multifocal Lens Implantation. Clin Ophthalmol 2024; 18:605-612. [PMID: 38435374 PMCID: PMC10906724 DOI: 10.2147/opth.s452147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/16/2024] [Indexed: 03/05/2024] Open
Abstract
Purpose To examine the effect of preoperative angle kappa on patient-reported outcomes after multifocal lens placement during cataract surgery and determine if it is an effective measure for preoperative patients screening for multifocal lens placement. Setting Private refractive surgery clinics. Design Retrospective cohort study. Methods All patients undergoing bilateral cataract or refractive lens exchange surgery with a target of emmetropia between 2013 and 2017 at Optical Express (Glasgow, UK) with multifocal lens placement for whom preoperative angle kappa measurement and a postoperative month 1 patient-reported outcomes measures were available were included. Results A total of 1368 patients were identified. Median preoperative angle kappa was 0.41mm with an interquartile range of 0.30mm to 0.53mm. Preoperative angle kappa did not have a significant association with patient-reported satisfaction with vision (correlation coefficient 0.15, 95% confidence interval -0.081 to 0.39, P = 0.20) nor with patient-reported photic phenomena (P > 0.09 for all comparisons). A receiver-operator characteristic analysis did not yield a viable cutoff predictive of patient-reported satisfaction. Conclusion Angle kappa was not predictive of patient-reported satisfaction in this study. This study did not find evidence that it should be used as a screening test for patients considering multifocal intraocular lens placement.
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Affiliation(s)
- Xi Liu
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Military Medical University), Chongqing, People’s Republic of China
- Key Laboratory of Visual Damage and Regeneration & Restoration in Chongqing, Chongqing, People’s Republic of China
| | | | - Steven C Schallhorn
- Carl Zeiss Meditec, Dublin, CA, USA
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA
| | - Julie M Schallhorn
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA
- Francis I. Proctor Foundation, University of California United States, San Francisco, CA, USA
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Fernández J, Burguera N, Rocha-de-Lossada C, Rachwani-Anil R, Rodríguez-Vallejo M. Objective cataract grading methods and expected contrast sensitivity reestablishment with multifocal intraocular lenses. Int Ophthalmol 2023; 43:2825-2832. [PMID: 36871115 DOI: 10.1007/s10792-023-02680-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 02/25/2023] [Indexed: 03/06/2023]
Abstract
PURPOSE To determine the cut-off points for age and metrics provided by cataract grading objective systems for which a reestablishment in contrast sensitivity (CS) is expected after multifocal intraocular lens (MIOL) implantation. METHODS One hundred seven subjects were included in this retrospective analysis carried out during the screening for presbyopia and cataract surgery. Monocular distance corrected contrast sensitivity defocus curve (CSDC) and visual acuity were measured, and crystalline lens sclerosis was graded with three objective metrics: Ocular Scatter Index (OSI), Dysfunctional Lens Index (DLI) and Pentacam Nucleus Staging (PNS). A CS value of 0.8 logCS at far distance, following published literature on this matter, was selected to compute the cut-off that maximized the detection of eyes exceeding this value at the preoperative screening, either for age or objective metrics. RESULTS The CDCS showed a stronger correlation than CDVA with objective grading methods, whereas all objective metrics were significantly correlated between them (p < 0.05). The cut-offs for age, OSI, DLI and PNS were ≤ 62, ≤ 1.25, ≥ 7.67 and ≤ 1, respectively. The OSI provided the highest area under the receiver operating characteristic curve (0.85) followed by the age (0.84), DLI (0.74) and PNS (0.63). CONCLUSIONS Surgeons conducting clear lens exchange should communicate the possible distance CS loss after surgery with MIOL implantation according to the previous described cut-offs points. Age in combination with any cataract grading objective system is recommended to detect possible inconsistencies.
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Affiliation(s)
- Joaquín Fernández
- Qvision, Department of Ophthalmology, VITHAS Almería Hospital, 04120, Almería, Spain
| | - Noemí Burguera
- Qvision, Department of Ophthalmology, VITHAS Almería Hospital, 04120, Almería, Spain
| | - Carlos Rocha-de-Lossada
- Qvision, Department of Ophthalmology, VITHAS Almería Hospital, 04120, Almería, Spain
- 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
| | - Rahul Rachwani-Anil
- Hospital Norte de Málaga, Avenida Poeta Muñoz Rojas, s/n, Málaga, 29200, Antequera, Spain
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Gomes JAP, Azar DT, Baudouin C, Bitton E, Chen W, Hafezi F, Hamrah P, Hogg RE, Horwath-Winter J, Kontadakis GA, Mehta JS, Messmer EM, Perez VL, Zadok D, Willcox MDP. TFOS Lifestyle: Impact of elective medications and procedures on the ocular surface. Ocul Surf 2023; 29:331-385. [PMID: 37087043 DOI: 10.1016/j.jtos.2023.04.011] [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: 04/07/2023] [Accepted: 04/10/2023] [Indexed: 04/24/2023]
Abstract
The word "elective" refers to medications and procedures undertaken by choice or with a lower grade of prioritization. Patients usually use elective medications or undergo elective procedures to treat pathologic conditions or for cosmetic enhancement, impacting their lifestyle positively and, thus, improving their quality of life. However, those interventions can affect the homeostasis of the tear film and ocular surface. Consequently, they generate signs and symptoms that could impair the patient's quality of life. This report describes the impact of elective topical and systemic medications and procedures on the ocular surface and the underlying mechanisms. Moreover, elective procedures performed for ocular diseases, cosmetic enhancement, and non-ophthalmic interventions, such as radiotherapy and bariatric surgery, are discussed. The report also evaluates significant anatomical and biological consequences of non-urgent interventions to the ocular surface, such as neuropathic and neurotrophic keratopathies. Besides that, it provides an overview of the prophylaxis and management of pathological conditions resulting from the studied interventions and suggests areas for future research. The report also contains a systematic review investigating the quality of life among people who have undergone small incision lenticule extraction (SMILE). Overall, SMILE refractive surgery seems to cause more vision disturbances than LASIK in the first month post-surgery, but less dry eye symptoms in long-term follow up.
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Affiliation(s)
- José Alvaro P Gomes
- Dept. of Ophthalmology and Visual Sciences, Federal University of Sao Paulo/Paulista School of Medicine (UNIFESP/EPM), Sao Paulo, SP, Brazil.
| | - Dimitri T Azar
- University of Illinois College of Medicine, Chicago, IL, USA
| | - Christophe Baudouin
- Quinze-Vingts National Eye Hospital & Vision Institute, IHU FOReSIGHT, Paris, France
| | - Etty Bitton
- Ecole d'optométrie, Université de Montréal, Montréal, Canada
| | - Wei Chen
- Eye Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | | | - Pedram Hamrah
- Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Ruth E Hogg
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Belfast, UK
| | | | | | | | | | - Victor L Perez
- Foster Center for Ocular Immunology, Duke University Eye Center, Durham, NC, USA
| | - David Zadok
- Shaare Zedek Medical Center, Affiliated to the Hebrew University, School of Medicine, Jerusalem, Israel
| | - Mark D P Willcox
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
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Pahljina C, Sarny S, Hoeflechner L, Falb T, Schliessleder G, Lindner M, Ivastinovic D, Mansouri K, Lindner E. Glaucoma Medication and Quality of Life after Phacoemulsification Combined with a Xen Gel Stent. J Clin Med 2022; 11:jcm11123450. [PMID: 35743517 PMCID: PMC9225126 DOI: 10.3390/jcm11123450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/30/2022] [Accepted: 06/12/2022] [Indexed: 02/06/2023] Open
Abstract
Glaucoma has a significant impact on quality of life. Here, we aimed to evaluate the influence of a reduction in glaucoma medications on quality of life and patient satisfaction after phacoemulsification combined with the Xen gel stent. We carried out a cross-sectional survey of patients who underwent phacoemulsification with the Xen gel stent at the Medical University of Graz, Austria. Quality of life was assessed using the German version of the Glaucoma Symptoms Scale (GSS)—questionnaire. Patients were also asked whether the operation reduced glaucoma medications and to indicate their overall satisfaction from 1 (totally discontented) up to 10 (totally contented). Questionnaires of 80 patients were evaluated. A total of 36 patients (45.0%) reported a reduction in glaucoma medications. Three items of the GSS were significantly better in patients who needed fewer glaucoma medications after the operation (“hard to see in daylight”, 75.0 ± 31.1 vs. 57.7 ± 39.1, p = 0.035; “hard to see in dark places”, 81.1 ± 28.7 vs. 54.9 ± 41.2, p = 0.002; and “halos around lights”, 88.3 ± 25.9 vs. 68.8 ± 38.6, p = 0.002). Patient satisfaction was significantly higher when the procedure led to a reduction in glaucoma medication (8.3 ± 2.0 vs. 6.8 ± 3.1; p = 0.034). The reported quality of life and patient satisfaction were significantly better when phacoemulsification with the Xen gel stent reduced the number of glaucoma medications needed.
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Affiliation(s)
- Christian Pahljina
- Department of Ophthalmology, Medical University Graz, 8036 Graz, Austria; (C.P.); (S.S.); (L.H.); (T.F.); (G.S.); (D.I.)
| | - Stephanie Sarny
- Department of Ophthalmology, Medical University Graz, 8036 Graz, Austria; (C.P.); (S.S.); (L.H.); (T.F.); (G.S.); (D.I.)
| | - Lukas Hoeflechner
- Department of Ophthalmology, Medical University Graz, 8036 Graz, Austria; (C.P.); (S.S.); (L.H.); (T.F.); (G.S.); (D.I.)
| | - Thomas Falb
- Department of Ophthalmology, Medical University Graz, 8036 Graz, Austria; (C.P.); (S.S.); (L.H.); (T.F.); (G.S.); (D.I.)
| | - Gernot Schliessleder
- Department of Ophthalmology, Medical University Graz, 8036 Graz, Austria; (C.P.); (S.S.); (L.H.); (T.F.); (G.S.); (D.I.)
| | - Marlene Lindner
- Department of Dentistry, Medical University Graz, 8036 Graz, Austria;
| | - Domagoj Ivastinovic
- Department of Ophthalmology, Medical University Graz, 8036 Graz, Austria; (C.P.); (S.S.); (L.H.); (T.F.); (G.S.); (D.I.)
| | - Kaweh Mansouri
- Glaucoma Research Center, Montchoisi Clinic, Swiss Visio, 1006 Lausanne, Switzerland;
| | - Ewald Lindner
- Department of Ophthalmology, Medical University Graz, 8036 Graz, Austria; (C.P.); (S.S.); (L.H.); (T.F.); (G.S.); (D.I.)
- Correspondence:
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Reply: Effect of residual astigmatism on uncorrected visual acuity and patient satisfaction in pseudophakic patients. J Cataract Refract Surg 2021; 47:1493-1494. [PMID: 34675162 DOI: 10.1097/j.jcrs.0000000000000806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Ganesh S, Brar S, Rp N, Rathod D. Clinical Outcomes, Contrast Sensitivity, Reading Performance and Patient Satisfaction Following Bilateral Implantation of AT LARA 829MP EDoF IOLs. Clin Ophthalmol 2021; 15:4247-4257. [PMID: 34707344 PMCID: PMC8544275 DOI: 10.2147/opth.s331860] [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] [Received: 07/30/2021] [Accepted: 09/28/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the visual outcomes, contrast sensitivity, reading performance and patient satisfaction after bilateral implantation of AT LARA extended depth of focus (EDoF) intraocular lenses (IOLs). Methods Patients undergoing phacoemulsification for age-related cataract and satisfying the eligibility criteria underwent bilateral implantation with AT LARA EDoF IOLs (Carl Zeiss Meditec, Jena, Germany). At follow-up visits of 1, 3, 6 and 12 months, binocular uncorrected and corrected distance, intermediate and near visual acuity, reading performance, defocus curve, contrast sensitivity and patient satisfaction for dysphotopsia and spectacle independence were evaluated. Results A total of 60 eyes from 30 patients with a mean age of 65.40±7.71 years were included in the study. At 12 months, 83% of patients (n=25) had binocular cumulative uncorrected distance visual acuity (UDVA) of 20/20 or better. Postoperative spherical equivalent refraction accuracy was within ±0.50 D for 95% of eyes (n=57) and refractive cylinder accuracy was within ≤0.50 D in 95% of eyes (n=57). The mean binocular uncorrected near visual acuity (UNVA) was 0.16±0.09 logMAR, and the mean uncorrected intermediate visual acuity (UIVA) at 60 and 80 cm was 0.01±0.09 and 0.03±0.08 logMAR, respectively, at 12 months. Reading speeds at 40, 60 and 80 cm showed improvement over time. No patient had complaints of severe dysphotopsia and none of the patients required glasses for any activity. No eye underwent YAG-laser capsulotomy for significant posterior capsule opacification at the end of mean follow-up. Conclusion In our limited experience of 30 patients at 12 months, AT LARA EDoF IOLs resulted in excellent visual outcomes for uncorrected distance, intermediate and near visual acuity. The incidence of dysphotopsia and spectacle dependence was low, resulting in good patient satisfaction. Trial Registry CTRI/2020/08/027105 (www.ctri.nic.in).
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Affiliation(s)
- Sri Ganesh
- Department of Phaco-Refractive Surgery, Nethradhama Super Speciality Eye Hospital, Bangalore, Karnataka, India
| | - Sheetal Brar
- Department of Phaco-Refractive Surgery, Nethradhama Super Speciality Eye Hospital, Bangalore, Karnataka, India
| | - Nikhil Rp
- Department of Phaco-Refractive Surgery, Nethradhama Super Speciality Eye Hospital, Bangalore, Karnataka, India
| | - Dishitha Rathod
- Department of Phaco-Refractive Surgery, Nethradhama Super Speciality Eye Hospital, Bangalore, Karnataka, India
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McNeely RN, Moutari S, Stewart S, Moore JE. Visual outcomes and patient satisfaction 1 and 12 months after combined implantation of extended depth of focus and trifocal intraocular lenses. Int Ophthalmol 2021; 41:3985-3998. [PMID: 34546493 PMCID: PMC8572828 DOI: 10.1007/s10792-021-01970-3] [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: 04/15/2021] [Accepted: 07/16/2021] [Indexed: 12/27/2022]
Abstract
Purpose To assess the 1-month and 12-month postoperative visual performance and subjective outcomes following combined implantation of an extended depth of focus (EDOF) intraocular lens (IOL) and a trifocal IOL. Methods The study enrolled consecutive patients undergoing refractive lens extraction or cataract surgery with combined implantation of an EDOF IOL (dominant eye) and trifocal IOL. Uncorrected (UDVA) and best-corrected (CDVA) distance visual acuities, uncorrected intermediate (UIVA) and near (UNVA) visual acuities, and subjective questionnaires were evaluated 1 month and 12 months postoperatively. Results The study enrolled 58 consecutive patients. Binocular UDVA, UIVA and UNVA were − 0.08 ± 0.07 logMAR, 0.15 ± 0.14 logMAR and 0.17 ± 0.11 logMAR at 1 month, compared to − 0.09 ± 0.06 logMAR (P = .323), 0.11 ± 0.10 logMAR (P = .030) and 0.13 ± 0.10 logMAR (P = 0.008) at 12 months. Satisfaction was high with 93.1% of patients fulfilled or more than fulfilled postoperatively, and 84.5% and 86.3% reported spectacle independence for near at the respective postoperative assessments. The mean daytime and nighttime quality of vision (QoV) scores were 9.12 ± 0.94 and 7.88 ± 1.74 at 1 month, compared to 9.24 ± 0.78 (P = .183) and 8.26 ± 1.38 (P = .043) at 12 months. Conclusions This IOL combination provides good unaided visual acuity at 1 and 12 months postoperatively, with high functional vision and postoperative satisfaction reported at 1 and 12 months. However, a significant improvement in overall nighttime QoV at the 12 months assessment was found.
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Affiliation(s)
- Richard N McNeely
- Cathedral Eye Clinic, 89-91 Academy Street, Belfast, BT1 2 LS, Northern Ireland, UK
| | - Salissou Moutari
- School of Mathematics and Physics, Queens University Belfast, Belfast, Northern Ireland, UK
| | - Stephen Stewart
- Cathedral Eye Clinic, 89-91 Academy Street, Belfast, BT1 2 LS, Northern Ireland, UK
| | - Jonathan E Moore
- Cathedral Eye Clinic, 89-91 Academy Street, Belfast, BT1 2 LS, Northern Ireland, UK. .,Biomedical Sciences Research Institute, University of Ulster, Coleraine, Northern Ireland, UK. .,Tianjin Medical University, Tianjin, China. .,Aston University, Birmingham, UK.
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12
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Abstract
The extended depth-of-focus intraocular lenses (EDOF IOLs) represent one of the most exciting advancements in the field of lens surgery. EDOF IOLs promise an excellent visual experience, minimizing visual disturbances (ie, halos and glare) commonly associated with multifocal IOLs. The pros and cons of EDOF IOLs should be evaluated in comparison with other more traditional multifocal or monofocal IOLs. The aim of this review is to provide the most current information regarding EDOF IOLs for power calculating formulas, refractive outcomes, incidence of photic phenomena, and patient satisfaction.
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13
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Effect of residual astigmatism on uncorrected visual acuity and patient satisfaction in pseudophakic patients. J Cataract Refract Surg 2021; 47:991-998. [PMID: 34290195 DOI: 10.1097/j.jcrs.0000000000000560] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 12/14/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the effect of residual astigmatism on postoperative visual acuity and satisfaction after intraocular lens (IOL) surgery. SETTING Private practice, United Kingdom. DESIGN Retrospective case series. METHODS Postoperative data of patients who had previously undergone refractive lens exchange or cataract surgery were used in a multivariate regression model to assess the effect of residual astigmatism on 3 months postoperative monocular uncorrected distance visual acuity (UDVA) and patient satisfaction. The analysis was based on residual refraction in the dominant eye of each patient. Odds ratios were calculated to demonstrate the effect of increasing residual astigmatism on UDVA and satisfaction with separate calculations for monofocal and multifocal IOLs. RESULTS Three months postoperative outcomes of 17 152 dominant eyes were used in multivariate regression analysis. Compared with eyes with 0.00 diopter (D) residual astigmatism, the odds of not achieving 20/20 vision in eyes with 0.25 to 0.50 D residual astigmatism increased by a factor of 1.7 and 1.9 (P < .0001) in monofocal and multifocal IOLs, respectively. For the residual astigmatism 0.75 to 1.00 D, the odds ratio for not achieving 20/20 vision compared with eyes with no astigmatism was 6.1 for monofocal and 6.5 for multifocal IOLs (P < .0001). The effect of residual astigmatism on satisfaction was more evident at the 0.75 to 1.00 D level, where the odds of not being satisfied with vision increased by a factor of 2.0 and 1.5 in patients with monofocal and multifocal IOLs, respectively (P < .0001). The orientation of astigmatism was not a significant predictor in multivariate analysis. CONCLUSIONS Multivariate analysis in a large population of patients demonstrated that low levels of residual astigmatism can degrade visual acuity. Corneal astigmatism of 0.50 D or greater should be included in surgical planning.
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Schallhorn SC, Schallhorn CS, Teenan D, Venter JA, Hannan SJ, Schallhorn JM. One-Year Outcomes in a Large Series of Patients Following Implantation of an Extended Depth of Focus Intraocular Lens. J Refract Surg 2021; 37:380-388. [PMID: 34170773 DOI: 10.3928/1081597x-20210315-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate clinical outcomes 1 year after implantation of an extended depth of focus intraocular lens (IOL) in a large series of patients. METHODS Outcomes of patients who underwent refractive lens exchange or cataract surgery with the implantation of the AT LARA 829MP IOL (Carl Zeiss Meditec AG) were retrospectively reviewed. The near (40 cm), intermediate (66 cm), and distance visual acuity, refractive outcomes, and cumulative rate of adverse events and secondary procedures were evaluated at 12 months postoperatively. RESULTS A total of 1,894 eyes of 977 patients were implanted with the AT LARA 829MP IOL, with 62.1% of eyes available for the 12-month visit. The overall secondary procedure rate for the whole cohort was: Nd:YAG = 7.8%, laser vision correction = 7.5%, and IOL explantation = 0.63%. The reasons for IOL exchange were intraoperative complications (3 eyes/0.16%) and quality of vision issues (9 eyes/0.48%). Of all eyes available for the 12-month visit that did not undergo laser vision correction or an IOL exchange, 72.0% had monocular uncorrected distance visual acuity of 20/20 or better and the percentage of eyes with monocular uncorrected intermediate and near visual acuity of 20/50 or better was 96.2% and 81.0%, respectively. At 12 months postoperatively, 87.6% of eyes were within ±0.50 diopters of emmetropia. No change in refraction occurred between the 6- and 12-month postoperative visits. CONCLUSIONS The AT LARA 829MP extended depth of focus IOL is able to provide functional distance, intermediate, and near visual acuity. Complications related to the platform of the IOL were uncommon. [J Refract Surg. 2021;37(6):380-388.].
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Bilbao-Calabuig R, Gónzalez-López F, Llovet-Rausell A, Ortega-Usobiaga J, Tejerina Fernández V, Llovet-Osuna F. Lens-based surgical correction of presbyopia. Where are we in 2020? ACTA ACUST UNITED AC 2020; 96:74-88. [PMID: 32868085 DOI: 10.1016/j.oftal.2020.07.012] [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: 04/28/2020] [Revised: 07/19/2020] [Accepted: 07/20/2020] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Presbyopia is the progressive and irreversible loss of accommodation due to aging. It is one of the main causes of loss of quality of life in people from 45 years of age, due to the, often novel, dependence on spectacles. The eagerness to correct it by ophthalmologists impulsed by the desire of millions of people who suffer from it, has become one of the main drivers for the development of intraocular lens (IOL) technology over the last twenty years. MATERIAL AND METHODS This review briefly presents the different alternatives that have allowed us to improve the crystalline lens surgical approach of presbyopia; from monofocal lenses and monovision technique, accommodative, refractive, and diffractive multifocal lenses, and finally the most recent extended depth of focus/field lenses known as EDOFs. RESULTS Each IOL has its advantages, limitations and disadvantages. Furthermore, there is no single lens that suits the needs of all patients. CONCLUSIONS It is necessary to know the variety of lenses available, and to have an in-depth understanding of their optical properties, as well as the impact that these will have later on their clinical performance and on the visual quality of the patients. This should help us to select the best alternative for each of them.
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Affiliation(s)
- R Bilbao-Calabuig
- Unidad de Cirugía Refractiva y Cataratas, Clínica Baviera-Aier Hospital Eye Group, Madrid, España.
| | - F Gónzalez-López
- Unidad de Cirugía Refractiva y Cataratas, Clínica Baviera-Aier Hospital Eye Group, Madrid, España
| | - A Llovet-Rausell
- Unidad de Cirugía Refractiva y Cataratas, Clínica Baviera-Aier Hospital Eye Group, Valencia, España; Servicio Oftalmología, Hospital Universitario La Fe, Valencia, España
| | - J Ortega-Usobiaga
- Unidad de Cirugía Refractiva y Cataratas, Clínica Baviera-Aier Hospital Eye Group, Bilbao, España
| | - V Tejerina Fernández
- Unidad de Cirugía Refractiva y Cataratas, Clínica Baviera-Aier Hospital Eye Group, Madrid, España
| | - F Llovet-Osuna
- Unidad de Cirugía Refractiva y Cataratas, Clínica Baviera-Aier Hospital Eye Group, Madrid, España; Unidad de Cirugía Refractiva y Cataratas, Clínica Baviera-Aier Hospital Eye Group, Valencia, España
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