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Purpose@#To evaluate the reliability and validity of the Cataract-related Visual Function Questionnaire (CVFQ). @*Methods@#A prospective cross-sectional study of 141 cataract patients was conducted from March 2022 to June 2022. The questionnaire was created based on a literature review and advice from an expert panel. This study determined its construct validity, criterion validity, internal consistency, and test-retest reliability. @*Results@#The CVFQ consists of 15 items distributed among five categories: overall visual quality, overall visual function, distance vision, near vision, and glare. In the exploratory factor analysis of validity, the first three principal components explained 77.8% of the variance. The p-values in the Spearman correlation test comparing the pre- and postoperative total CVFQ score and best-corrected visual acuity (BCVA) were 0.006 and 0.004, respectively. In the reliability analysis, Cronbach’s alpha was > 0.9 for internal consistency and the p-values of each subcategory were all significant in the analysis of test-retest reliability. @*Conclusions@#Our results indicate that the CVFQ is useful for measuring the visual quality and visual function of cataract patients in Korea.
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Purpose@#We report a case of aqueous misdirection syndrome triggered by pilocarpine use after laser iridotomy, which was treated by pars plana vitrectomy and phacoemulsification.Case summary: A 48-year-old female patient presented with sudden-onset right eye pain and decreased vision. The patient had presented to another institute with similar symptoms 20 days prior; she had been diagnosed with acute angle closure. Laser iridotomy was performed, followed by administration of pilocarpine twice daily. In the right eye, visual acuity was hand motion, and intraocular pressure was 31 mmHg. The laser iridotomy site was located at the 11 o’clock position; microcysts, anterior chamber cells, corneal endothelium precipitates, and glaukomflecken were observed. The anterior chamber was shallow due to forward movement of the lens and iris. Despite the application of atropine and pressure-lowering eyedrops, anterior chamber shallowing continued along with a progressive myopic shift of -4.5 diopters. Therefore, the patient was diagnosed with aqueous misdirection syndrome. Pars plana vitrectomy was performed, followed by phacoemulsification, intraocular lens insertion, and posterior capsulotomy. During surgery, vitreous inflammation, a peripheral snowball, and an anterior hyaloid inflammatory membrane were observed, indicating the presence of intermediate uveitis. @*Conclusions@#The administration of miotics after laser iridotomy, intraocular inflammation, and uveitis can lead to aqueous misdirection syndrome. Effective treatment of aqueous misdirection syndrome involves controlling inflammation and performing surgery.
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Purpose@#To identify clinical factors associated with the early reduction of corneal sensitivity (CS) in patients with herpes zoster ophthalmicus (HZO). @*Methods@#Total 30 subjects were divided into two groups according to the occurrence of an early reduction of CS (group 1, normal CS; group 2, decreased CS). The demographics, ocular manifestations of HZO, and the ocular surface parameters were compared between two groups. Then, the relative risks of variables were analyzed to expect the early decrease of CS by HZO using logistic regression analysis. @*Results@#Among total 30 subjects, the CS decreased in 10 subjects (3.2 ± 1.4 cm, group 2) and the other 20 subjects revealed normal CS (6.0 ± 0.0 cm, group 1). The age was higher in the group 2 (67.0 ± 16.6 years) than in group 1 (48.0 ± 17.6 years, p = 0.013), but sex and the comorbidity of diabetes mellitus was not difference between groups. The presence of corneal punctate epithelial erosions was a single factor among the ocular manifestations of HZO, which discriminated group 1 (5%) and group 2 (60%, p = 0.002). The ocular surface staining scores (i.e., National Eye Institute scores and Sjögren’s International Collaborative Clinical Alliance ocular surface score) were higher in group 2 (p = 0.001 and p = 0.021, respectively) than in group 1. The existence of corneal punctate epithelial erosions revealed as a sole risk factor for the early reduction of CS (odds ratio = 33.085; p = 0.016). @*Conclusions@#It is necessary to pay attention to the possible occurrence of neurotrophic keratopathy especially in older patients with HZO showing an initial presence of corneal punctate epithelial erosions.
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Purpose@#We report a case of adult-onset atypical Stevens-Johnson syndrome (SJS) in which only the oral and ocular mucosae were involved, without skin lesions. Case summary: A 33-year-old man was referred to our institute with recent severe oral mucositis and bilateral conjunctival hyperemia and pseudomembrane formation, which occurred 5 days after taking cold medicine, including a non-steroidal anti-inflammatory drug, acetaminophen and cefaclor, for pharyngitis with fever. At the initial visit, the patient had an epithelial defect of the bulbar and tarsal conjunctiva in both eyes. Conservative treatment using topical eye drops was started, with suspicion of atypical SJS. In addition, HLA-A alleles were typed to assess possible genetic susceptibility to the relevant drugs, and HLA-A*11:01 and HLA-A*31:01 alleles were confirmed. Immunoglobulin (Ig) G against Mycoplasma pneumoniae was positive and IgM was negative at 10 months after the initial onset of disease. One year after the disease onset, autologous serum eye drops, oral and topical steroids, 0.1% cyclosporine eye drops, and antibiotic eye drops were maintained and the corneal and conjunctival erosions were much improved. @*Conclusions@#Although atypical SJS is very rare, it is important to suspect it early by taking a history of any preceding medication or possible concurrent mycoplasma pneumonia, because atypical SJS may affect the oral and ocular mucosae without skin lesions.
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Purpose@#To report a case with bilateral circumscribed posterior keratoconus with different results of refractive error between eyes after cataract surgery. Case summary: A 57-year-old man was referred for decreased vision and suspected keratoconus in both eyes. The corrected visual acuity was 0.04 in the right eye and 0.2 in the left eye. On slit-lamp microscopy and anterior-segment optical coherence tomography (AS-OCT) examination, the excavation of the posterior corneal surface was observed in the central area of the right eye and in the mid-to-inferior area of the left eye. Considering the posterior corneal refractive power measured within the 8-mm zone on AS-OCT, we expected the postoperative hyperopic shift in the refractive error of 2.61 diopters (D) in the right eye and 2.17 D in the left eye. Accordingly, the adjusted predicted refractive error was determined as -0.68 D in the right eye and -1.06 D in the left eye, based on the Barrett Universal II formula. The postoperative values of the spherical equivalent by manifest refraction was -1.0 D in the right eye and -3.0 D in the left eye at 1 month, which was close to the predicted target in the right eye, but myopic by approximately 2.0 D in the left eye, compared to the predicted values. @*Conclusions@#In patients with bilateral circumscribed posterior keratoconus, the location, depth, and area of the excavation of the posterior corneal surface should be considered independently in both eyes to calculate the intraocular lens power more accurately.
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Purpose@#We investigated the contributing factors affecting the ocular discomfort on instillation and compliance of 0.1% cyclosporin A (CsA) cationic nanoemulsion eye drops. @*Methods@#We enrolled patients who were prescribed 0.1% CsA eye drops (Ikervis®) and who filled out an eye drop satisfaction questionnaire to assess ocular discomfort on instillation (questions Q1-Q4) and compliance of eye drops (Q5-Q7). First, to identify the contributing factors affecting the early ocular discomfort of 0.1% CsA instillation and compliance, Q1-Q7 scores were correlated with respect to age, sex, instillation period duration, meibomian gland dysfunction, tear secretion, corneal sensitivity, corneal erosions, Sjögren's International Collaborative Clinical Alliance ocular staining score (OSS), tear matrix metalloproteinase 9 (MMP-9), and ocular surface disease index in patients who completed the first questionnaire within the first 3 months of instillation of 0.1% CsA (referred to as Cohort 1). Second, to evaluate the change in ocular discomfort on instillation and compliance, along with the prolonged instillation of 0.1% CsA, the changes in individual scores for questions Q1-Q7 were analyzed in patients who completed at least two or more serial questionnaires (corresponding to Cohort 2). @*Results@#In Cohort 1 (74 eyes in 39 patients), the scores for ocular discomfort on instillation (Q1-Q4) were higher in females and correlated negatively with the instillation period duration and age and positively with tear secretion, corneal erosions, OSS, and tear MMP-9 grades. The higher the grade of tear MMP-9, the lower the compliance score of Q5. In Cohort 2 (34 patients), the scores for ocular discomfort on instillation tended to decrease as the cumulative instillation period lengthened. @*Conclusions@#The results of this study may aid clinicians in explaining to patients the ocular discomfort on instillation of 0.1% CsA, so as to improve treatment compliance.
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Purpose@#We explored changes in the various clinical parameters of dry eye disease (DED), including the tear matrix metalloproteinase 9 (MMP-9) level, soon after cataract surgery. We sought correlations between such changes and ocular surface discomfort. @*Methods@#In 106 patients (106 eyes) who underwent cataract surgery, we evaluated meibomian gland dysfunction, tear secretion, corneal sensitivity, tear break-up time, corneal erosion status, the Sjögren’s International Collaborative Clinical Alliance (SICCA) ocular staining score, tear osmolarity, the tear MMP-9 level, and the ocular surface disease index (OSDI) before, and 1 week and 1 month after surgery. All eyes were instilled with topical moxifloxacin, a steroid, and a non-steroidal anti-inflammatory drug daily for 1 month postoperatively. The 1-month delta OSDI scores correlated with the 1-month delta DED parameters. We compared the latter parameters between patients in whom the MMP-9 level decreased (MMP-9-decreased group) at 1 month with those in whom it did not (MMP-9-not decreased group). @*Results@#Overall, 89.5% of total patients exhibited preoperative DED. The tear MMP-9 level fell at 1 month postoperatively, tear secretion (evaluated using the Schirmer I test) decreased at 1 week, and the OSDI scores fell at both 1 week and 1 month. We found no significant correlation between the 1-month delta OSDI scores and the 1-month delta DED parameters. The 1-month OSDI score fell to a significantly greater extent in the MMP-9-decreased group. @*Conclusions@#Routine, local anti-inflammatory treatment after cataract surgery may briefly reduce the tear MMP-9 level and ocular surface discomfort.
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Purpose@#We report a case of conjunctival pyogenic granuloma that developed after sub-Tenon’s block at the inferotemporal conjunctival quadrant during cataract surgery.Case summary: A 74-year-old male patient with senile cataract, diabetic retinopathy and open-angle glaucoma, who was using a combination of timolol/tafluprost and brimonidine eyedrops, underwent uneventful cataract surgery after sub-Tenon’s block at the inferotemporal conjunctival quadrant of his right eye. Moxifloxacin, 1% prednisolone acetate and 0.1% bromfenac sodium hydrate were administered daily for 1 month post-surgery, by which time a pink-colored, oval-shaped granulomatous mass had developed on the inferotemporal conjunctiva, at the site of the sub-Tenon’s block. Dexamethasone and antibiotic combination eye drops were administered without resection of the mass, which had markedly regressed after 2 weeks and disappeared completely 6 weeks after treatment. @*Conclusions@#Patients should be informed of the possibility of conjunctival pyogenic granuloma prior to cataract surgery using sub-Tenon’s block, and it is important to carefully check the block site and compliance with eyedrops at follow-up visits. Conjunctival pyogenic granuloma can be successfully treated with topical steroids.
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Purpose@#We report a case of adult-onset atypical Stevens-Johnson syndrome (SJS) in which only the oral and ocular mucosae were involved, without skin lesions. Case summary: A 33-year-old man was referred to our institute with recent severe oral mucositis and bilateral conjunctival hyperemia and pseudomembrane formation, which occurred 5 days after taking cold medicine, including a non-steroidal anti-inflammatory drug, acetaminophen and cefaclor, for pharyngitis with fever. At the initial visit, the patient had an epithelial defect of the bulbar and tarsal conjunctiva in both eyes. Conservative treatment using topical eye drops was started, with suspicion of atypical SJS. In addition, HLA-A alleles were typed to assess possible genetic susceptibility to the relevant drugs, and HLA-A*11:01 and HLA-A*31:01 alleles were confirmed. Immunoglobulin (Ig) G against Mycoplasma pneumoniae was positive and IgM was negative at 10 months after the initial onset of disease. One year after the disease onset, autologous serum eye drops, oral and topical steroids, 0.1% cyclosporine eye drops, and antibiotic eye drops were maintained and the corneal and conjunctival erosions were much improved. @*Conclusions@#Although atypical SJS is very rare, it is important to suspect it early by taking a history of any preceding medication or possible concurrent mycoplasma pneumonia, because atypical SJS may affect the oral and ocular mucosae without skin lesions.
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Purpose@#To report a case with bilateral circumscribed posterior keratoconus with different results of refractive error between eyes after cataract surgery. Case summary: A 57-year-old man was referred for decreased vision and suspected keratoconus in both eyes. The corrected visual acuity was 0.04 in the right eye and 0.2 in the left eye. On slit-lamp microscopy and anterior-segment optical coherence tomography (AS-OCT) examination, the excavation of the posterior corneal surface was observed in the central area of the right eye and in the mid-to-inferior area of the left eye. Considering the posterior corneal refractive power measured within the 8-mm zone on AS-OCT, we expected the postoperative hyperopic shift in the refractive error of 2.61 diopters (D) in the right eye and 2.17 D in the left eye. Accordingly, the adjusted predicted refractive error was determined as -0.68 D in the right eye and -1.06 D in the left eye, based on the Barrett Universal II formula. The postoperative values of the spherical equivalent by manifest refraction was -1.0 D in the right eye and -3.0 D in the left eye at 1 month, which was close to the predicted target in the right eye, but myopic by approximately 2.0 D in the left eye, compared to the predicted values. @*Conclusions@#In patients with bilateral circumscribed posterior keratoconus, the location, depth, and area of the excavation of the posterior corneal surface should be considered independently in both eyes to calculate the intraocular lens power more accurately.
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Purpose@#We investigated the contributing factors affecting the ocular discomfort on instillation and compliance of 0.1% cyclosporin A (CsA) cationic nanoemulsion eye drops. @*Methods@#We enrolled patients who were prescribed 0.1% CsA eye drops (Ikervis®) and who filled out an eye drop satisfaction questionnaire to assess ocular discomfort on instillation (questions Q1-Q4) and compliance of eye drops (Q5-Q7). First, to identify the contributing factors affecting the early ocular discomfort of 0.1% CsA instillation and compliance, Q1-Q7 scores were correlated with respect to age, sex, instillation period duration, meibomian gland dysfunction, tear secretion, corneal sensitivity, corneal erosions, Sjögren's International Collaborative Clinical Alliance ocular staining score (OSS), tear matrix metalloproteinase 9 (MMP-9), and ocular surface disease index in patients who completed the first questionnaire within the first 3 months of instillation of 0.1% CsA (referred to as Cohort 1). Second, to evaluate the change in ocular discomfort on instillation and compliance, along with the prolonged instillation of 0.1% CsA, the changes in individual scores for questions Q1-Q7 were analyzed in patients who completed at least two or more serial questionnaires (corresponding to Cohort 2). @*Results@#In Cohort 1 (74 eyes in 39 patients), the scores for ocular discomfort on instillation (Q1-Q4) were higher in females and correlated negatively with the instillation period duration and age and positively with tear secretion, corneal erosions, OSS, and tear MMP-9 grades. The higher the grade of tear MMP-9, the lower the compliance score of Q5. In Cohort 2 (34 patients), the scores for ocular discomfort on instillation tended to decrease as the cumulative instillation period lengthened. @*Conclusions@#The results of this study may aid clinicians in explaining to patients the ocular discomfort on instillation of 0.1% CsA, so as to improve treatment compliance.
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Purpose@#We explored changes in the various clinical parameters of dry eye disease (DED), including the tear matrix metalloproteinase 9 (MMP-9) level, soon after cataract surgery. We sought correlations between such changes and ocular surface discomfort. @*Methods@#In 106 patients (106 eyes) who underwent cataract surgery, we evaluated meibomian gland dysfunction, tear secretion, corneal sensitivity, tear break-up time, corneal erosion status, the Sjögren’s International Collaborative Clinical Alliance (SICCA) ocular staining score, tear osmolarity, the tear MMP-9 level, and the ocular surface disease index (OSDI) before, and 1 week and 1 month after surgery. All eyes were instilled with topical moxifloxacin, a steroid, and a non-steroidal anti-inflammatory drug daily for 1 month postoperatively. The 1-month delta OSDI scores correlated with the 1-month delta DED parameters. We compared the latter parameters between patients in whom the MMP-9 level decreased (MMP-9-decreased group) at 1 month with those in whom it did not (MMP-9-not decreased group). @*Results@#Overall, 89.5% of total patients exhibited preoperative DED. The tear MMP-9 level fell at 1 month postoperatively, tear secretion (evaluated using the Schirmer I test) decreased at 1 week, and the OSDI scores fell at both 1 week and 1 month. We found no significant correlation between the 1-month delta OSDI scores and the 1-month delta DED parameters. The 1-month OSDI score fell to a significantly greater extent in the MMP-9-decreased group. @*Conclusions@#Routine, local anti-inflammatory treatment after cataract surgery may briefly reduce the tear MMP-9 level and ocular surface discomfort.
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Purpose@#We report a case of conjunctival pyogenic granuloma that developed after sub-Tenon’s block at the inferotemporal conjunctival quadrant during cataract surgery.Case summary: A 74-year-old male patient with senile cataract, diabetic retinopathy and open-angle glaucoma, who was using a combination of timolol/tafluprost and brimonidine eyedrops, underwent uneventful cataract surgery after sub-Tenon’s block at the inferotemporal conjunctival quadrant of his right eye. Moxifloxacin, 1% prednisolone acetate and 0.1% bromfenac sodium hydrate were administered daily for 1 month post-surgery, by which time a pink-colored, oval-shaped granulomatous mass had developed on the inferotemporal conjunctiva, at the site of the sub-Tenon’s block. Dexamethasone and antibiotic combination eye drops were administered without resection of the mass, which had markedly regressed after 2 weeks and disappeared completely 6 weeks after treatment. @*Conclusions@#Patients should be informed of the possibility of conjunctival pyogenic granuloma prior to cataract surgery using sub-Tenon’s block, and it is important to carefully check the block site and compliance with eyedrops at follow-up visits. Conjunctival pyogenic granuloma can be successfully treated with topical steroids.
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Purpose@#We describe the clinical aspects of allergy to a brinzolamide 1.0%/brimonidine 0.2% fixed combination (BBFC) in Korean patients with glaucoma. @*Methods@#The medical records of 117 glaucoma patients treated with BBFC were retrospectively analyzed in terms of sex, age, glaucoma type, follow-up period after prescription of eyedrops, number of eyedrop preparations used, allergy onset, and clinical characteristics. @*Results@#The incidence of ocular allergy during BBFC use was 12.8%. Allergy developed after an average of 8.58 months (range, 0.93-25.80 months); half of all allergies were evident within the first 5 months. The most common type of allergy was follicular conjunctivitis (53.4%), followed by papillary conjunctivitis and blepharoconjunctivitis. Systemic side-effects and eye discomfort (0.09%) were largely confined to non-allergic patients. @*Conclusions@#An understanding of the clinical pattern of BBFC allergy in Korean glaucoma patients could facilitate treatment compliance and patients’ education.
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Purpose@#To report a case of chronic granulomatous anterior uveitis which occurred after 2-year use of eye drops containing brimonidine.Case summary: A 82-year-old patient with intermittent angle-closure glaucoma had been using 1% brinzolamide/0.2% brimonidine fixed combination eye drops for two years. Bilateral eyelid edema, conjunctival injection, glare, and mucous discharge occurred one month prior, but did not improve, regardless of artificial tears and anti-allergy drug treatment. Mutton fat keratic precipitates, conjunctival injection, and diffuse conjunctiva hypertrophy at the palpebral and bulbar conjunctiva, multiple follicles, and papillary hypertrophy were observed in the slit lamp examination. Based on the diagnosis of chronic granulomatous anterior uveitis with allergic conjunctivitis caused by brimonidine, only an artificial tear preparation was used after the drug was stopped. Anterior uveitis and conjunctivitis improved rapidly and disappeared completely within one month. @*Conclusions@#Brimonidine-induced chronic granulomatous anterior uveitis is a very rare disease, but it can be easily and quickly treated just by withdrawal of the drug. In the case of long-term use of brimonidine, it is essential to diagnose the possible side effects of the drug and to avoid unnecessary investigations and interventions.
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Purpose@#To report two cases of atypical conjunctival lesions that differ from the well-known typical papillary or follicular conjunctivitis after the use of brimonidine.Case summary: In the first case, a 46-year-old female patient diagnosed with binocular normal tension glaucoma visited our hospital. After topical application of 1% brinzolamide/0.2% brimonidine fixed-combination eye drops for 7 months, a number of yellow follicles confined to the left upper bulbar conjunctiva with mild conjunctival injection and conjunctival edema were observed under slit lamp microscopy examination. After stopping brimonidine for 2 weeks, conjunctival injection and follicles decreased and, 1 month later, bulbar conjunctival follicles had disappeared completely. Since changing the eye drops to a brinzolamide/timolol fixed combination, there was no recurrence of the condition. In the second case, a 70-year-old female patient who had been diagnosed with binocular normal tension glaucoma a year ago had been using 0.15% brimonidine. On slit lamp examination, bilateral eyelid edema and overall diffuse conjunctival tissue hypertrophy and multiple follicles appeared on the upper and lower palpebral conjunctiva, the bulbar conjunctiva, the conjunctival fornix, and the lacrimal caruncle. Bilateral conjunctival biopsy was performed to differentiate conjunctival lymphoma, and granulomatous inflammation was confirmed by biopsy. After stopping 0.15% brimonidine treatment and changing to latanoprost, conjunctival lesions improved and there was no recurrence. @*Conclusions@#If atypical conjunctival lesions are observed in patients using topical brimonidine, side effects related to brimonidine should be considered. Our results indicated marked improvement within 2 weeks of stopping brimonidine treatment.
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Purpose@#We analyzed changes in mini-scleral lens parameters after repetitive ethylene oxide (EO) sterilization. @*Methods@#We measured the base curve radius (BCR), the optical power, the central lens thickness (CLT), and the overall lens diameter (OLD) of 67 basic, oblate-type mini-scleral lenses (Onefit A; BIUMTEC, Seoul, Korea) before and after three repeats of EO sterilization at 2-week intervals. The sterilization process (15 hours in duration) included a core step featuring exposure to gaseous EO for 180 minutes at 1.5 bar and 56°C. @*Results@#The BCR changes in the basic type of mini-scleral lens after EO sterilization were -0.011 ± 0.004 mm, -0.024 ± 0.005 mm, and -0.021 ± 0.005 mm for the first, second, and third sterilizations, respectively; all changes were significant. None of optical power, CLT, or OLD were affected by EO sterilization. We found no significant correlation between any baseline value and the change thereof after sterilization. @*Conclusions@#Repeated EO sterilization of mini-scleral lenses did not change the optical power, CLT, or OLD, but significantly reduced the BCR. EO should not be used to sterilize mini-scleral lenses.
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Purpose@#To report two cases of atypical conjunctival lesions that differ from the well-known typical papillary or follicular conjunctivitis after the use of brimonidine.Case summary: In the first case, a 46-year-old female patient diagnosed with binocular normal tension glaucoma visited our hospital. After topical application of 1% brinzolamide/0.2% brimonidine fixed-combination eye drops for 7 months, a number of yellow follicles confined to the left upper bulbar conjunctiva with mild conjunctival injection and conjunctival edema were observed under slit lamp microscopy examination. After stopping brimonidine for 2 weeks, conjunctival injection and follicles decreased and, 1 month later, bulbar conjunctival follicles had disappeared completely. Since changing the eye drops to a brinzolamide/timolol fixed combination, there was no recurrence of the condition. In the second case, a 70-year-old female patient who had been diagnosed with binocular normal tension glaucoma a year ago had been using 0.15% brimonidine. On slit lamp examination, bilateral eyelid edema and overall diffuse conjunctival tissue hypertrophy and multiple follicles appeared on the upper and lower palpebral conjunctiva, the bulbar conjunctiva, the conjunctival fornix, and the lacrimal caruncle. Bilateral conjunctival biopsy was performed to differentiate conjunctival lymphoma, and granulomatous inflammation was confirmed by biopsy. After stopping 0.15% brimonidine treatment and changing to latanoprost, conjunctival lesions improved and there was no recurrence. @*Conclusions@#If atypical conjunctival lesions are observed in patients using topical brimonidine, side effects related to brimonidine should be considered. Our results indicated marked improvement within 2 weeks of stopping brimonidine treatment.
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Purpose@#We analyzed changes in mini-scleral lens parameters after repetitive ethylene oxide (EO) sterilization. @*Methods@#We measured the base curve radius (BCR), the optical power, the central lens thickness (CLT), and the overall lens diameter (OLD) of 67 basic, oblate-type mini-scleral lenses (Onefit A; BIUMTEC, Seoul, Korea) before and after three repeats of EO sterilization at 2-week intervals. The sterilization process (15 hours in duration) included a core step featuring exposure to gaseous EO for 180 minutes at 1.5 bar and 56°C. @*Results@#The BCR changes in the basic type of mini-scleral lens after EO sterilization were -0.011 ± 0.004 mm, -0.024 ± 0.005 mm, and -0.021 ± 0.005 mm for the first, second, and third sterilizations, respectively; all changes were significant. None of optical power, CLT, or OLD were affected by EO sterilization. We found no significant correlation between any baseline value and the change thereof after sterilization. @*Conclusions@#Repeated EO sterilization of mini-scleral lenses did not change the optical power, CLT, or OLD, but significantly reduced the BCR. EO should not be used to sterilize mini-scleral lenses.
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BACKGROUND: To objectively investigate accommodative response to various refractive stimuli in subjects with normal accommodation. METHODS: This prospective, non-randomized clinical trial included 64 eyes of 32 subjects with a mean spherical equivalent −1.4 diopters (D). We evaluated changes in accommodative power, pupil diameter, astigmatic value, and axis when visual stimuli were applied to binocular, monocular (dominant eye, non-dominant eye, ipsilateral, and contralateral), and pinhole conditions. Visual stimuli were given at 0.25 D (4 m), 2 D (50 cm), 3 D (33 cm), and 4 D (25 cm) and accommodative response was evaluated using open view binocular autorefractor/keratometer. RESULTS: The accommodative response to binocular stimulus was 90.9% of the actual refractive stimulus, while that of the monocular stimulus was 84.6%. The binocular stimulus induced a smaller pupil diameter than did the monocular stimulus. There was no difference in accommodative response between the dominant eye and non-dominant eye or between ipsilateral and contralateral stimuli. As the refractive stimuli became stronger, the absolute astigmatic value increased and the direction of the astigmatism axis became more horizontal. Pinhole glasses required 10%–15% less accommodative power compared with the monocular condition. CONCLUSION: Binocular stimuli enable more precise and effective accommodation than do monocular stimuli. Accommodative response is composed of 90% true accommodation and 10% pseudo-accommodation, and the refractive stimulus in one eye affects the contralateral eye to the same extent. This should be taken into account when developing guidelines for wearing smart glasses while driving, as visual stimulation is applied to only one eye, but far distance attention is constantly needed. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03557346