Multifocal versus modified monovision corrections: A non-dispensing comparison of visual assessment in presbyopic neophytes

Purpose: To compare the visual performance of two simultaneous?vision soft multifocal contact lenses and to compare multifocal contact lens and its modified monovision counterpart in presbyopic neophytes. Methods: A double?masked, prospective, comparative study was conducted on 19 participants fitted with soft PureVision2 multifocal (PVMF) and clariti multifocal (CMF) lenses in random order. High? and low?contrast distance visual acuity, near visual acuity, stereopsis, contrast sensitivity, and glare acuity were measured. The measurements were conducted using multifocal and modified monovision design with one brand and then repeated with another brand of lens. Results: High?contrast distance visual acuity showed a significant difference between CMF (0.00 [?0.10–0.04]) and PureVision2 modified monovision (PVMMV; ?0.10 [?0.14–0.00]) correction (P = 0.003) and also between CMF and clariti modified monovision (CMMV; ?0.10 [?0.20–0.00]) correction (P = 0.002). Both modified monovision lenses outperformed CMF. The current study did not show any statistically significant difference between contact lens corrections for low?contrast visual acuity, near visual acuity, and contrast sensitivity (P > 0.01). Stereopsis at near distance was significantly lower with both modified monovision (PVMMV: 70 [50–85]; P = 0.007, CMMV: 70 [70–100]; P = 0.006) and with CMF (50 [40–70]; P = 0.005) when compared to spectacles (50 [30–70]). Glare acuity was significantly lower with multifocal (PVMF: 0.46 [0.40–0.50]; P = 0.001, CMF: 0.40 [0.40–0.46]; P = 0.007) compared with spectacles (0.40 [0.30–0.40]), but no significant difference was noted between the multifocal contact lenses (P = 0.033). Conclusion: Modified monovision provided superior high?contrast vision compared to multifocal correction. Multifocal corrections performed better for stereopsis when compared to modified monovision. In parameters like low?contrast visual acuity, near acuity, and contrast sensitivity, both the corrections performed similarly. Both multifocal designs showed comparable visual performances.

Calidad de vida en pacientes con visión monocular posterior a la cirugía de catarata / Quality of life in patients with monocular vision after cataract surgery

Objetivo: Evaluar la calidad de vida relacionada con la visión, en pacientes con catarata tratados con monovisión inducida con lente intraocular monofocal. Métodos: Se realizó un estudio experimental antes y después con un solo grupo. Para esto fueron reclutados 50 pacientes tributarios de cirugía de catarata, que presentaban presbiopía. Se evaluó la visión funcional (agudeza visual de cerca y de lejos), sin corrección, mejor corregida y la calidad de vida relacionada con la visión (cuestionario VF-14) antes y después de la cirugía. Resultados: El promedio de edad fue de 59,6 años y predominó el sexo femenino (60,0 por ciento). La mediana de la agudeza visual sin corrección en el ojo dominante poscirugía fue de 0,80 y la del equivalente esférico de -0,16 dioptrías, mientras que en el no dominante fue de 0,50 y de -1,68 dioptrías, respectivamente. La mediana de la agudeza visual sin corrección de cerca fue de 0,80. El 86,0 por ciento de los pacientes no requirió espejuelos después de la cirugía. La puntuación promedio del VF-14 precirugía ubicaba el 50 por ciento de los pacientes con una incapacidad parcial para desarrollar una actividad por causa visual. Después de la cirugía la totalidad de los pacientes no presentaba esta limitación visual. Conclusiones: La cirugía de catarata mejora la calidad de vida relacionada con la visión(AU)

Objective: Evaluate vision-related quality of life in cataract patients treated with induced monovision with monofocal intraocular lens. Methods: An experimental before-after one-group study was conducted. A selection was made of 50 presbyopic patients scheduled for cataract surgery. The variables evaluated were uncorrected and best corrected functional vision (near and far visual acuity) and vision-related quality of life (VF-14 questionnaire) before and after surgery. Results: Mean age was 59.6 years. Female sex prevailed (60.0 percent). Mean uncorrected postoperative visual acuity was 0.80 in the dominant eye and 0.50 in the non-dominant eye, whereas mean spherical equivalent was -0.16 diopters in the dominant eye and -1.68 diopters in the non-dominant eye. Mean uncorrected near visual acuity was 0.80. Of the patients studied, 86.0 percent did not require eyeglasses after surgery. Average preoperative VF-14 score showed that 50 percent of the patients had a partial disability to carry out an activity due to visual causes. After surgery no patient had such a visual limitation. Conclusions: Cataract surgery improves vision-related quality of life(AU)

Influences of different reserved diopters during cataract extraction combined with TECNIS Symfony intraocular lens implantation on visual quality of presbyopia correction / 中华实验眼科杂志

Objective@#To compare the efficacy and visual quality of biocular cataract surgery combined with TECNIS Symfony intraocular lens(IOL) implantation in the correction of presbyopia with three different methods of reserved diopters.@*Methods@#A prospective cohort design was adopted.From October in 2016 to December in 2018, 120 patients 240 eyes with binocular cataract surgery implanted TECNIS Symfony IOL were divided into regular group, micro-near-vision group and micro-monovision group according to different reserved diopters, 40 patients 80 eyes in each group.The binocular IOL reserved diopter is + 0.10--0.20 D in regular group.The binocular IOL reserved diopter is -0.20--0.50 D in micro-near-vision group, meanwhile, the dominant eye reserved diopter is + 0.10--0.20 D, and the non-dominant eye reserved the myopia of -0.50--0.75 D in micro-monovision group.Defocus curves of single eye and binocular were measured and full distance visual acuity were analyzed 3 months after surgery.MTF values were detected by iTrace and compared between different groups.Visual function questionnaire of multifocal intraocular lenes (MIOLs)were analyzed and spectacle independence rate of presbyopia correction and disturbing photic phenomena were compared 3 months after surgery.This study protocol was approved by the ethics committee of Chongqing Aier Mega Eye Hospital, and this study followed the Declaration of Helsinki.@*Results@#Compared with regular group, the whole defocus curve of micro-near-vision group actually shifted to the right by 0.35 D, with almost no change in shape.The shape of the binocular defocus curve of micro-monovision group changed significantly compared with that of regular group, that is the wave peak became significantly wider, and the downward trend was more gentle.Spectacle independence rate of the three groups were all 100.00%, spectacle independence rate of intermediate distance in Micro-monovision group was 100.00%, which was higher than that of regular group(80.00%) and micro-near-vision group(90.00%), and the differences were statistically significant (χ2=37.04; P<0.01). The MTF value of the dominant eye was higher than that of the non-dominant eye in the Micro-monovision group, and the difference was statistically significant(t=3.74, P=0.001). There was no statistically significant difference in the occurrence rate of disturbing photic phenomena among the three groups(P>0.05).@*Conclusions@#Different reserved diopter design during cataract extraction combined with TECNIS Symfony IOL implantation suits different patients.Among the three different reserved diopters methods, the effect of micro-monovision method can obtain the highest spectacle independence rate, and provide satisfactory binocular far to near full-distance visual acuity.

Influences of different reserved diopters during cataract extraction combined with TECNIS Symfony intraocular lens implantation on visual quality of presbyopia correction / 中华实验眼科杂志

Objective To compare the efficacy and visual quality of biocular cataract surgery combined with TECNIS Symfony intraocular lens( IOL) implantation in the correction of presbyopia with three different methods of reserved diopters. Methods A prospective cohort design was adopted. From October in 2016 to December in 2018,120 patients 240 eyes with binocular cataract surgery implanted TECNIS Symfony IOL were divided into regular group,micro-near-vision group and micro-monovision group according to different reserved diopters,40 patients 80 eyes in each group. The binocular IOL reserved diopter is +0. 10--0. 20 D in regular group. The binocular IOL reserved diopter is -0. 20--0. 50 D in micro-near-vision group, meanwhile, the dominant eye reserved diopter is +0. 10--0. 20 D, and the non-dominant eye reserved the myopia of -0. 50--0. 75 D in micro-monovision group. Defocus curves of single eye and binocular were measured and full distance visual acuity were analyzed 3 months after surgery. MTF values were detected by iTrace and compared between different groups. Visual function questionnaire of multifocal intraocular lenes ( MIOLs ) were analyzed and spectacle independence rate of presbyopia correction and disturbing photic phenomena were compared 3 months after surgery. This study protocol was approved by the ethics committee of Chongqing Aier Mega Eye Hospital, and this study followed the Declaration of Helsinki. Results Compared with regular group, the whole defocus curve of micro-near-vision group actually shifted to the right by 0. 35 D,with almost no change in shape. The shape of the binocular defocus curve of micro-monovision group changed significantly compared with that of regular group,that is the wave peak became significantly wider,and the downward trend was more gentle. Spectacle independence rate of the three groups were all 100. 00％, spectacle independence rate of intermediate distance in Micro-monovision group was 100. 00％, which was higher than that of regular group (80. 00％) and micro-near-vision group(90. 00％),and the differences were statistically significant (χ2=37. 04;P<0. 01). The MTF value of the dominant eye was higher than that of the non-dominant eye in the Micro-monovision group,and the difference was statistically significant(t=3. 74,P=0. 001). There was no statistically significant difference in the occurrence rate of disturbing photic phenomena among the three groups(P>0. 05). Conclusions Different reserved diopter design during cataract extraction combined with TECNIS Symfony IOL implantation suits different patients. Among the three different reserved diopters methods, the effect of micro-monovision method can obtain the highest spectacle independence rate, and provide satisfactory binocular far to near full-distance visual acuity.

Clinical Study of Changes in Eye Dominance after Pseudophakic Conventional Monovision

PURPOSE: The purpose of this study was to evaluate whether eye dominance changes after conventional pseudophakic monovision, and to identify factors that affect changes in eye dominance. METHODS: This retrospective study included 70 patients who underwent bilateral conventional monovision cataract surgery. Patients were divided into two groups based on whether they experienced a change in the dominant eye. We compared patients' uncorrected distance visual acuity (UCDVA), uncorrected near visual acuity (UCNVA), best-corrected visual acuity (BCVA), spherical equivalent, stereopsis, and time interval between cataract surgeries. RESULTS: The mean age was 71.26 ± 10.84 (range, 25–90) years, mean interval between surgery in each eye was 118.46 ± 183.50 (range, 17–1,018) days, and mean postoperative diopter difference was 1.16 ± 0.53 (range, 0.00–2.75) diopters. After bilateral cataract surgery, 22 patients (31.43%) experienced a change in eye dominance, whereas 48 patients (68.57%) experienced no change. There were no differences in the time interval between cataract surgeries, preoperative UCDVA and UCNVA, pre- and postoperative BCVA, or stereopsis in either group. Patients who experienced a change in eye dominance showed smaller differences between preoperative and postoperative spherical equivalent, compared with patients who experienced no change in eye dominance (t-test, p < 0.05). CONCLUSIONS: Twenty-two (31.43%) patients whose nondominant eyes were targeted for near vision showed altered eye dominance after conventional monovision cataract surgery. Eye dominance shows greater plasticity in patients with smaller differences between preoperative and postoperative spherical equivalent.

Stereopsis function of presbyopia effected by correcting of monovision contact lens / 中华实验眼科杂志

Objective This study was to study the effect of monovision contact lens (MV-CL) on distant and near vision,distant and near stereopsis,and to identify the effect of degree of monovision on vision function.Methods A prospective case observational study was designed.The clinical data of sixty-eight eyes of 47 cases were collected from November 2010 to August 2014 in Henan Provincial Corps Hospital,Chinese People's Armed Police Forces.Sixty-eight eyes of 47 cases wore contact lenses to improve near vision,in which the other eye of 21 cases with hyperopia wearing contact lenses to improve distant vision.Besides,far and near stereopsis were measured before and two weeks after wearing lenses respectively;and scotopia were measrued with lenses and in naked eyes respectively.Compared the changes of vision and stereopsis in patients before and after the MV-CL,and conducted the patient satisfaction survey.Results There were 89％ (42/47 cases) and 6％ (3/47 cases) of the patients whose naked far and near vision was 0.8/0.33 (J4) at 2 weeks after MV-CL and before MV-CL,respectively.There were no statistical significance about change of near stereopsis with Titmus stereopicture and the Yan's near random-dot stereogram (x2=1.30,0.56;both at P＞0.05).There were no statistical significance about change with apparent machine random dot stereogram iterative crossed parallax and uncrossed disparity (x2 =0.16,0.11;both at P＞0.05).The far distance fusion range and far stereopsis were not significantly different between before and after MV-CL (x2 =0.22,0.16;both at P＞0.05).Titmus stereopicture tests showed that there was a decrease in the number of people who had foveal stereopsis,while an increase was found in people who had macular stereopsis after MV-CL,but the difference had no statistical significance (x2 =2.28,P ＞ 0.05).Conclusions Near vision can be obviously increased and presbytism can be relieved by MV-CL.Stereopsis of some patients are decreased after MV-CL,but this can be accepted by the patients and there is no obvious decrease in far range of fusion.

Influence of monovision design of cataract surgery on the prognosis visual quality in cataract patients / 国际眼科杂志(Guoji Yanke Zazhi)

· AIM:To investigate the influence of monovision design of cataract surgery on the prognosis visual quality in cataract patients.· METHODS:Totally 84 cases cataract patients (168 eyes) who receiving cataract surgery were enrolled from February 2016 to February 2017 in our hospital to conduct a prospective study.According to the different near addition in the monovision design,patients were divided into low near addition group (1.25D-1.75D) and high near addition group (2.25D-2.75D),each group was 42 cases.At postoperative 6mo,the binocular uncorrected near visual acuity,uncorrected intermediate visual acuity,uncorrected distance visual acuity and stereoscopic vision were compared between two groups.The visual function survival quality score before and after treatment were compared.· RESULTS:The binocular uncorrected intermediate and distance visual acuity in the low near addition group respectively was 0.27 ± 0.20,0.09 ± 0.08,and that in the high near addition group respectively was 0.29 ± 0.25,0.10±0.07,which had no statistically significant difference between two groups (P＞0.05).The binocular uncorrected near visual acuity in the high near addition group was 0.03±0.06,which was significantly better than the low near addition group 0.07 ± 0.04,the difference was statistically significant (P＜ 0.05).Before the treatment,the visual function-14(VF-14) score in each two group respectively was 27.93± 4.52,28.24 ± 4.91;after the treatment,VF-14 score in each two group respectively was 82.04±14.31,81.22±13.70,which had no statistically significant difference between two groups (P＞0.05).After treatment,the VF-14 score both significantly increased in the two groups (P＜0.05).The proportion of patients with the normal stereoscopic vision,peripheral stereovision and macular stereovision in the low near addition group respectively was 47.6％,31.0％,21.4％;and that in the high near addition group respectively was 42.9％,23.8％,33.3％,which had no statistically significant difference between two groups (P＞0.05).· CONCLUSION:Two kinds of near addition have similar advantages to cataract patients after cataract surgery on uncorrected visual acuity,the quality of visual function and stereopsis.

Comparison of Clinical Outcomes between Laser Blended Vision and Monovision Laser Refractive Surgery for Presbyopia

PURPOSE: To compare the efficacy and safety of Laser Blended Vision (LBV) and monovision laser refractive surgery (monovision) for presbyopia correction in patients with myopia. METHODS: This retrospective comparative study included 42 eyes of 21 patients with LBV and 50 eyes of 25 patients with monovision. Monocular and binocular distance, intermediate and near visual acuity, and refractive changes were evaluated preoperatively and 3 months after the surgery and compared. The patients in the LBV group underwent further evaluation of spherical aberration 3 months after the surgery and treatment satisfaction 3-6 months after the surgery. RESULTS: The mean age of the patients was 47.9 years in the LBV group and 41.7 years in the monovision group. Three months after surgery, the spherical equivalents were +0.11 ± 0.17 D in the dominant eye and -1.52 ± 0.36 D in the non-dominant eye in the LBV group. In contrast, the spherical equivalents were +0.23 ± 0.26 D in the dominant eye and -0.82 ± 0.28 D in the non-dominant eye in the monovision group. All patients achieved a binocular uncorrected distance visual acuity of 0.10 (log MAR) or better, and 86% of the LBV group and 100% of the monovision group achieved a binocular uncorrected intermediate visual acuity of better than 0.10. Moreover, 95% of the LBV group and 100% of the monovision group achieved a binocular uncorrected near visual acuity of better than 0.18. In the LBV group, mean spherical aberration increased after surgery than before, but it was not statistically significant. Complications such as corneal opacity that could decrease visual acuity were absent in both groups. Overall patient satisfaction after surgery was 80% in the LBV group. CONCLUSIONS: Despite the relatively higher mean age of the LBV group, both groups showed similar results regarding presbyopia correction in patients with myopia.

Clinical Results of Pseudophakic Monovision 1 Year after Cataract Surgery

PURPOSE: In this study, the visual performance and patient satisfaction one year after monovision cataract surgery and the results after 2 months. METHODS: Thirty patients who had bilateral cataract surgery between February 2010 and January 2014 treated with monovision therapy and received postoperative examinations for at least one year after surgery were enrolled in the present study. The eye with the more severe cataract had the surgery first and was corrected for distance vision targeted at emmetropia. The fellow eye was operated for near vision targeted to -1.50~-2.50 diopter (D) range considering the patient's need for near task and preoperative refractive errors 2-4 weeks after the first operation. Binocular uncorrected distance visual acuity (UCDVA), uncorrected near visual acuity (UCNVA), spherical equivalent, anisometropia, stereopsis, patient satisfaction for far and near distance, and spectacle dependence were evaluated preoperatively and two months and one year postoperatively. RESULTS: The mean age of patients was 71.9 years. Two months and one year after the surgery, the binocular UCDVA (log MAR) were 0.03 ± 0.10 and 0.08 ± 0.14, UCNVA were 0.21 ± 0.15 and 0.25 ± 0.14, anisometropia were 1.28 ± 0.68 and 1.29 ± 0.76 D, and stereopsis were 301.67 ± 251.28 and 251.67 ± 269.28 arcsec, respectively. One year after the surgery, the number of patients answering ‘Better’ or ‘Much better’ for distant vision was 27 (90%) and for near vision 22 (73.3%); 11 patients (36.7%) answered ‘Not dependent on spectacles at all’. CONCLUSIONS: Monovision is an effective method to correct presbyopia after bilateral cataract surgery. Visual performances and patient satisfaction at one year after cataract surgery were not different compared with those at two months.

Surgical treatment of presbyopia

Presbyopia is the progressive reduction in the ability to focus on near objects, and as an age-related condition, the prevalence of presbyopia is expected to increase with the aging of society. A number of corneal surgical procedures are available for the treatment of presbyopia, including monovision laser in situ keratomileusis (LASIK)/laser-assisted subepithelial keratomileusis (LASEK), conductive keratoplasty, presbyopic LASIK, and corneal inlay. Implantation of presbyopia-correcting intraocular lenses (IOLs), such as refractive/diffractive IOLs or accommodating IOLs, is also an option. Despite the variety of treatment options available, a perfect solution has yet to be developed and patients may present with visual or optical complications such as halos, glare, or decreased contrast sensitivity. As such, careful selection and customization of treatment is essential, based on patients' individual needs and requirements for vision.

Influence of age-related cataract and cataract-surgery on dominance eye / 中华实验眼科杂志

Background The alteration of dominance eye is associated with visual quality in patients with age-related cataract or after cataract-surgery.However,the study on the relationship of dominance eye shift with vision following cataract-surgery is lack.Objective This study was to observe the influence of age-related cataract and cataract surgery on ocular dominance in the elderly.Methods A serial cases-observational study was designed.Eighty-seven patients with age-related cataract were collected from December 2011 to April 2012 in Affiliated Eye Hospital of Wenzhou Medical University,and phacoemulsification combined with intraocular lens (IOL) implantation was performed in all the patients.The patients were grouped into binocular vision difference (best corrected distance vision) ≥2 lines group (42 patients) and ≤ 1 line group (45 patients) on the standard logarithmic visual acuity chart.The frequency and shift of dominant eye were determined by card-hole method or thumb method before operation and 1 day,1 week,1 month and 3 months after operation.The difference in the frequencies of dominant eye between before and after operation was analyzed with MecNmar test.Results The median of best corrected distance vision (LogMAR) was 0.40 (0.00-1.40) in preoperation and 0.00 (-0.08-0.30) in postoperation,with significant difference between them (Z=-9.481,P =0.000).In the binocular vision difference ≥ 2 lines group,the dominant eyes were 24 in the right eyes and 18 in the left eyes.The milder cataractous eyes were identified as dominant eyes in 33 (78.57％) patients and heavier cataractous eyes were determined as dominant eyes in 9 (21.43％) patients before operation.However,the right eye was evidenced as dominant eye in 31 patients and the left eye was in 11 patients after operation.In the 42 patients,dominant eye shifted from the left eyes to the right eyes in 10 patients and from the right eyes to the left eyes in 3 patients,and 4 patients presented an unstable change binocularly.In 45 patients of the binocular vision difference ≤ 1 line group,the dominant eyes were the right eyes in 27 patients and the left eyes in 18 eyes in preoperation ; while after operation,dominant eye altered form the left eyes to the right eyes in 3 patients and form the right eyes to the left eyes in 1 patient,and unstable change occurred in 5 patients.There were no significant differences in the frequency of dominant eyes between before and after operation both the two groups (group A:P =0.092 ; group B:P =0.727).Conclusions Age-related cataract impact on eye dominance.Dominance eye may occur alteration binocularly following cataract surgery,which is one of causes of visual discomfort.

Long-Term Results of LASIK for Presbyopia Correction in Myopic Patients Using Aspheric Micro-Monovision

PURPOSE: To evaluate the efficacy, safety, and satisfaction of patients who underwent LASIK for presbyopia correction in myopic patients using aspheric micro-monovision. METHODS: LASIK for presbyopic correction using aspheric micro-monovision was performed in 18 patients between December 2010 and December 2011. Distance, intermediate, and near visual acuity, refractive change, and patient's satisfaction were evaluated for at least 12 months after the surgery. RESULTS: Among dominant eyes, 100% achieved uncorrected distance and intermediate visual acuity of 0.8 or better and 100% of the eyes achieved 0.8 or better binocularly. In the non-dominant eyes, 83% achieved uncorrected near visual acuity of J3 or better, and 94% of the eyes achieved J3 or better binocularly. Postoperatively, the mean manifest refraction spherical equivalent (MRSE) of the dominant eyes were -0.09 +/- 0.35D, -0.17 +/- 0.42D, and -0.17 +/- 0.47D at 1, 6 and 12 months, respectively. The MRSE of the non-dominant eyes were -0.94 +/- 0.53D, -1.03 +/- 0.56D, and -1.02 +/- 0.50D at postoperative 1, 6, and 12 months, respectively, without significant regression. After surgery, the patient's overall satisfaction score was good (4.2 out of 5). CONCLUSIONS: The aspheric micro-monovision protocol showed good distance, intermediate, and near visual outcomes, and was a well-tolerated, stable, and effective procedure for treating patients with myopic presbyopia.

Advance in mechanism and clinical application of ocular dominance / 中华实验眼科杂志

The researches on ocular dominance have been continuing deeply last decade years since the concept was first described by means by Porta in 1593.Based on the neurophysiology and molecular biology,it is confirmed that the procedure of ocular dominance involves sublayer 4C of the visual cortex,N-Methyl-D-aspartate (NMDA)-receptor,a-calmodulin kinase Ⅱ (aCaMK Ⅱ),synapses and about candidate gens.Meanwhile,ocular dominance theory plays an important guiding role in optometry,laser-assisted in situ keratomileusis and cataract operation.In this review,the mechanism and clinical application of ocular dominance were summarized.

LASIK for Myopia with Presbyopia Using the Aspheric Micro-Monovision Technique

PURPOSE: To evaluate the efficacy, safety, and satisfaction of patients who underwent the aspheric micro-monovision protocol for the correction of myopia with presbyopia. METHODS: A retrospective, noncomparative study included 40 eyes of 20 consecutive patients with myopia and presbyopia who were treated with LASIK-induced micro-monovision. Monocular and binocular visual outcomes of uncorrected and best-corrected distance, intermediate, and near visual acuity were measured. Depth of focus, spherical aberration, stereopsis and satisfaction were evaluated before surgery and 3 months after surgery. RESULTS: Mean patient age was 48.7 years. Monocular uncorrected distance visual acuity was 0.8 in 94% of dominant eyes, and monocular uncorrected near visual acuity was J3 in 94% in non-dominant eyes. Binocular uncorrected near visual acuity was J2 in 94% and J5 in 100% of dominant and non-dominant patient eyes, respectively. Binocular uncorrected distance visual acuity was 1.0 in 100% of patients, and binocular uncorrected near visual acuity was J2 in 94% of patients. Our results showed a significant improvement in depth of focus and a positive shift in spherical aberration in dominant eyes; however, there were no significant changes in the non-dominant eyes. There was no change in stereopsis or contrast sensitivity at any of the tested spatial frequencies. Satisfactory scores were achieved in all eyes. CONCLUSIONS: The aspheric myopic micro-monovision protocol was well-tolerated, stable, and effective for treating patients with presbyopia in myopic astigmatism.

Clinical Outcomes of Monovision Induced by Presbyopic Correcting Conductive Keratoplasty

PURPOSE: To evaluate the efficacy, safety, and satisfaction of patients who underwent conductive keratoplasty (CK). METHODS: CK was performed in 20 patients between April and December 2009. Surgeries were performed on the dominant eye with emmetropia as the postoperative goal and on the non-dominant eye with mild myopia as the postoperative goal. Patients' satisfaction, refractive change, and visual acuity were evaluated for at least 3 months after the surgery. RESULTS: Preoperatively, the mean manifest refraction spherical equivalent (MRSE) of the non-dominant and dominant patient eyes was 0.56 +/- 0.48 D and 0.88 +/- 0.25 D, respectively. Postoperatively, the mean MRSE of the non-dominant and dominant patient eyes was -1.65 +/- 0.56 D and -0.06 +/- 0.36D at 1 month, -1.33 +/- 0.40 D and 0.17 +/- 0.37 D at 3 months, and -1.10 +/- 0.44 D and 0.31 +/- 0.33 D at 6 months, respectively, indicating significant effect regression. Eleven out of 20 patients (55%) were disappointed with the results of CK. CONCLUSIONS: Conductive keratoplasty led to significant regression of refractive effects during follow-up. Monovision with CK is suggested to be a temporary refractive procedure in patients with presbyopia.

Visual Function and Patient Satisfaction in Pseudophakic Monovision

PURPOSE: To evaluate visual performance as well as patient satisfaction and to explore factors associated with clinical outcomes in pseudophakic monovision acquired after bilateral phacoemulsification and sequential monofocal intraocular lens (IOL) implantation. METHODS: The present retrospective study examined patients with pseudophakic monovision. Preoperative and postoperative binocular uncorrected distant visual acuity (UCDVA), uncorrected near visual acuity (UCNVA), refractive errors and postoperative near stereopsis were measured. Postoperative measurements were obtained at least 6 months after the fellow eye surgery. Patient satisfaction and independence from glasses were evaluated using a questionnaire. RESULTS: Preoperative and postoperative binocular UCDVA, UCNVA, and differences in spherical equivalent refractive error were statistically significant. Postoperative near stereopsis was 107.1 arcsec. Questionnaire responses showed that 71.4% of patients were less dependent on glasses and 85.7% were satisfied with the postoperative visual performance. Various designs of monovision, such as crossed monovision or customized minimonovision with moderate myopic defocus showed the same level of patient satisfaction. Patients who were older than 60 years or had poorer preoperative binocular UCDVA showed higher satisfaction. CONCLUSIONS: Pseudophakic monovision is an effective approach for managing loss of accommodation after cataract surgery, especially in patients older than 60 years.

Pseudophakic monovision is an important surgical approach to being spectacle-free.

There are few studies on pseudophakic monovision even though it is widely applied. We reviewed the published literature on pseudophakic monovision. Surgeons select patients who not only have a strong desire to be free of glasses after surgery, but also fully understand monovision design and its drawbacks. However, other criteria adopted for pseudophakic monovision are very different. Both traditional monovision and cross monovision are used in pseudophakic monovision, and the target binocular anisometropia ranges from –1.0 D to –2.75 D. Postoperative results were acceptable in every study and most patients were satisfied, with vision being improved and presbyopia corrected. Complications were decreased stereopsis, contrast sensitivity, and visual fields, similar to other types of monovision. The term “pseudophakic monovision” should include more than just monocular intraocular lens implantation in two eyes, and further studies are required.

Extracción de cristalino transparente en pacientes hipermétropes / Extraction of transparent crystalline lens in hypermetrope patients

OBJETIVOS: Describir los resultados obtenidos en la extracción de cristalino transparente de pacientes hipermétropes. MÉTODOS: Se efectuó un estudio descriptivo, prospectivo y longitudinal, en el período de septiembre de 2009 a febrero de 2010. Fueron estudiados 60 ojos de 30 pacientes con hipermetropía, quienes acudieron al Instituto Cubano de Oftalmología Ramón Pando Ferrer y no cumplieron los criterios establecidos para cirugía refractiva corneal. Se aplicó la fórmula Hoffer Q por IOL máster para el cálculo del lente intraocular, técnica quirúrgica estándar, facoemulsificación (facoaspiración), poder ultrasónico: 10 por ciento (pulsado), vacío: 350 mmHg, flujo: 25 cc/min; túnel corneal, capsulorrexis amplia e implante de lente intraocular monofocal en saco capsular. Se realizó el análisis estadístico por promedio asociado a prueba T para datos pareados. RESULTADOS: La edad promedio fue de 39 ± 2,6 años. La longitud axil promedio fue de 21 ± 2 mm. La mejor agudeza visual sin correcci¾n ascendi¾ de 0,08 en el preoperatorio a 0,72 en el posoperatorio. La mejor agudeza visual con corrección varió de 0,92 a 0,98. El valor de la esfera se redujo de 5,25 a - 0,50 y el cilindro de 0,75 a - 0,25 dioptrías; en consecuencia, el equivalente esférico disminuyó de 4,75 en el preoperatorio a -1,00 dioptrías en el período posoperatorio, específicamente en el ojo dominante a 0,46 y en el no dominante a -0,97 dioptrías. CONCLUSIONES: La monovisión resulta efectiva en los pacientes. La extracción de cristalino transparente en pacientes hipermétropes es una opción útil cuando estos no son candidatos a cirugía refractiva corneal

OBJECTIVES: To describe the results obtained in the extraction of the transparent crystalline lens in hypermetrope patients. METHODS: A longitudinal, prospective and descriptive study was conducted from September, 2009 to February, 2010. Sixty eyes was studied from 30 patients presenting with hypermetropy who came to Ramón Pando Ferrer Cuban Institute of Ophthalmology due to they not fulfilled the criteria established for corneal refractory surgery. Hoffer W by IOL master formula was applied for estimation of intraocular lens, standard surgical technique, phacoemulsification (phacoaspiration), ultrasonic power: 10 percent (pulsed), empty: 350 mm Hg, flow: 25 cc/min; corneal tunnel, wide capsulorrhesis and implant of monofocal intraocular lens in capsular sac. For paired data a statistical analysis by t-test associated average was carried out. RESULTS: Mean age was of 39 ± 2,6 years. The mean axial length was of 21 ± 2 mm. The better visual acuity without correction rise of 0,08 in the preoperative period to 0.72 in the postoperative one. The better visual acuity with correction varied from 0.92 to 0.98. The value of sphere decreased from 5.25 to 0.50 and the cylinder from 0.75 to 0.25 dioptres; consequently, the spherical equivalent decreased from 4.75 in preoperative period to 1,00 dioptres in the postoperative one, specifically in the dominant eye to 0.46 and in the non-dominant one to -0.97 dioptres. CONCLUSIONS: Monovision is effective in the patients. The extraction of transparent crystalline lens in patients with hypermetropy is a useful option when they are not candidates to corneal refractive surgery

Monovisión con láser de excímeros en pacientes présbitas / Monovision with Excimer laser surgery in presbyopic patients

OBJETIVO: Describir los resultados refractivos obtenidos mediante la cirugía con láser de excímeros en pacientes présbitas hipermétropes y miopes con monovisión. MÉTODOS: Se realizó un estudio descriptivo, longitudinal prospectivo, con 60 pacientes, 18 miopes y 42 hipermétropes sometidos a cirugía con láser de excímeros para corregir la presbicia con el método de la monovisión en el Servicio de Córnea y Cirugía Refractiva del Instituto Cubano de Oftalmología Ramón Pando Ferrer en el período comprendido entre febrero del 2009 y febrero del 2010. Las variables utilizadas fueron: agudeza visual con corrección preoperatoria y posoperatoria y sin ellas (lejos y cerca), y equivalentes esféricos. Para presentar la información se utilizó la media y desviación estándar de ambas. RESULTADOS: En el preoperatorio se observó que la agudeza visual promedio mejoraba de un valor de 0,1 y 0,3 sin corrección para miopes e hipermétropes, respectivamente a 0,94 y 0,97 de agudeza visual binocular sin corrección para estos mismos grupos en el posoperatorio, lo cual corrige de esta manera equivalentes esféricos promedios de -4,63 dioptrías y +2,21 dioptrías en cada grupo. La agudeza visual cercana promedio para ambos grupos fue de Jeager 1 - 2 y los equivalentes esféricos promedios alcanzados para visión lejana fueron de -0,02 ± 0,27 dioptrías para miopes y +0,09 ± 0,34 dioptrías para hipermétropes; en visión cercana, o sea, en el ojo no dominante fue de -1,7 ± 0,22 dioptrías para el primer grupo y de -1,4 ± 0,38 dioptrías para el segundo grupo. CONCLUSIONES: Se halló mejoría de la agudeza visual sin corrección tanto para la visión lejana como para la cercana después de la cirugía. Los equivalentes esféricos fueron ampliamente modificados para ambos grupos tanto en los ojos dominantes como en los no dominantes para facilitar el resultado visual en ambas distancias con la precisión en los resultados visuales antes previstos que caracterizan a la cirugía con láser de excímeros

OBJECTIVES: To describe the refractive results achieved with Excimer laser surgery in presbyopic patients, both hyperopic and myopic, with monovision. METHODS: A prospective, longitudinal and descriptive study was performed on 60 presbyopic patients, 18 myopic and 42 hyperopic, who underwent Excimer laser surgery to correct presbyopia based on the monovision method at the Corneal and Refractive Surgery Service of Ramón Pando Ferrer Cuban Institute of Ophthalmology from February 2009 to February 2010. The variables used were pre- and post-operative visual acuity with correction, visual acuity without binocular correction, both near and distant, and spheral equivalents. For presenting this information, the mean and standard deviation were used for all variables. RESULTS: In the preoperative phase, it was observed that average visual acuity improved from 0,1 and 0,3 for myopic and hyperopic patients without correction, to 0,94 and 0,97 binocular visual acuity without correction for the same groups in the postoperative phase, thus correcting their average spherical equivalent of 4,63 D and +2,21 D respectively. Average near visual acuity for both groups was Jeager (J) 1 - 2 and average spheral equivalents reached for distant vision were 0,02 ± 0, 27 D for myopic and +0.09 ± 0,34 D for hyperopic patients. For near vision, i.e. in the non- dominant eye, the spheral equivalent values were 1.7 ± 0,22 D for myopic and 1.4 ± 0,38 D for hyperopic patients. CONCLUSIONS: After surgery both myopic and hyperopic patients experienced improvement in their visual acuity without correction for distant as well as for near vision. Spheral equivalents were widely modified in both groups for the dominant and non-dominant eyes, in order to facilitate the final visual result in both distances with the foreseen precision in the visual results that characterizes the Excimer laser surgery

Monovisión con lente intraocular monofocal en pacientes présbitas / Monovision with monofocal intraocular lens in prebyopic patients

OBJETIVO: Describir los resultados refractivos obtenidos mediante la cirugía del cristalino en pacientes présbitas hipermétropes y miopes con monovisión. MÉTODOS: Se realizó un estudio descriptivo, prospectivo, longitudinal con 21 pacientes, 13 miopes y 8 hipermétropes sometidos a cirugía del cristalino para corregir la presbicia con el método de la monovisión en el Servicio de Microcirugía del Instituto Cubano de Oftalmología Ramón Pando Ferrer entre febrero del 2009 y febrero del 2010. Las variables utilizadas fueron: agudeza visual con corrección preoperatoria y posoperatoria y sin ella, lejos y cerca, y equivalentes esféricos. Se utilizó la media y desviación estándar para presentar la información. RESULTADOS: En el preoperatorio la agudeza visual promedio mejoraba de un valor de 0,7 y 0,9 corregida para miopes e hipermétropes respectivamente a 0,88 y 0,94 de agudeza visual binocular sin corrección para estos mismos grupos en el posoperatorio, corrigiendo de esta manera equivalentes esféricos promedios de -8,27 D y +6,26 D en cada grupo. La agudeza visual cercana promedio para ambos grupos fue de Jeager 2 y los equivalentes esféricos promedios alcanzados para visi¾n lejana fueron de -0,32 D para miopes y +0,26 D para hipermétropes; en visión cercana, o sea, en el ojo no dominante es de -1,6 D para el primer grupo y -1,3 D para el segundo grupo. CONCLUSIONES: Se halló mejoría indudable de la agudeza visual sin corrección tanto para la visión lejana como para la cercana después de la cirugía. Los equivalentes esféricos fueron ampliamente modificados para ambos grupos tanto en los ojos dominantes como en los no dominantes para facilitar el resultado visual en ambas distancias. Los resultados obtenidos corroboran que la monovisión produce un mayor beneficio en la visión cercana que el perjuicio que provoca en la visión lejana lo que la hace muy exitosa para cierto grupo de pacientes

OBJECTIVES: To describe the refractive results achieved in presbyopic patients, both hyperopic and myopic, with monovision METHODS: A prospective, longitudinal and descriptive study was carried out in 21 patients, 13 myopic and 8 hyperopic, who underwent lens surgery to correct presbyopia based on the monovision procedure at the Microsurgery Service of the Ramón Pando Ferrer Cuban Institute of Ophthalmology from February 2009 to February 2010. The variables were pre and postoperative visual acuity with/without correction, both near and distant, and spheral equivalents. Mean and standard deviation values were used to present all variables. RESULTS: It was found that average visual acuity with correction improved from 0,7 and 0,9 in myopic and hyperopic patients respectively to 0,88 and 0,94 of binocular visual acuity without correction in the postoperative phase, thus correcting their average spheral equivalents of 8,27 diopters (D) and +6,26 D in each group. The average visual acuity for near vision for both groups was Jeager (J) 2 and the average spheral equivalents reached for distant vision were -0,32 D for myopic and +0,26 D for hyperopic patients. For near vision, i.e. in the non- dominant eye, the spheral equivalent values were 1,6 D for the first group and 1,3 D for the second group. CONCLUSIONS: After surgery there was an undoubted improvement in visual acuity without correction, in near as well as in distant vision. Spherical equivalents were widely modified for both groups in both the dominant and the non-dominant eye, improving vision at both distances. The achieved results corroborate that the benefits brought about by monovision in near vision are more important than the damages it causes in distant vision, making it very successful for certain groups of patients