Surgical treatment of presbyopia I

Presbyopia is an age-related condition that progressively decreases the ability to focus on near objects. Minimally invasive surgical techniques have been developed to improve near vision, including laser in situ keratomileuses (LASIK) and corneal inlay. Most have similar approaches using monovision or increasing the depth of focus. Monovision laser refractive surgery is a combination of conventional LASIK, LASIK which creates a multifocal cornea (central near or peripheral near) and aspheric micro-monovision LASIK with a special ablation profile, which develops spherical aberration. Conductive keratoplasty is a method that uses radiofrequency energy to shrink the mid-peripheral corneal stromal tissue. However, it is not used because of regression. A corneal inlay is a small device that is implanted in the corneal flap or pocket made by a femtosecond laser. It is inserted into the non-dominant eye. There are various inlays such as the Flexivue Microlens (refractive), Raindrop (corneal shape-changing), and KAMRA (small-aperture) inlays. However, the safety and effectiveness of these inlays have not been proven over a long follow-up period, so care is required when performing inlay implantation. All presbyopia treatments can improve near vision but also have limitations and side effects such as reduced far vision, contrast sensitivity, or increased glare. Therefore, it is essential to select patients carefully. Mechanisms associated with presbyopia are not fully understood, and presbyopia remains challenging for ophthalmologists.

Surgical treatment of presbyopia II

This review gives an overview of the current multifocal intraocular lenses (IOLs) landscape, in terms of the technology, benefits, and limitations of different premium IOLs, as well as significant clinical outcomes. Cataract is the most common cause of visual impairment in older adults. From 1980, the number of blind and visually impaired people have decreased due to cataract surgery. As the number of surgical procedures increases every year, patient demands have also changed with many patients expecting excellent visual acuity without glasses. Multifocal IOLs can provide spectacle-independence for near, intermediate, and distant vision tasks. Multifocal IOLs can be classified into bifocal, trifocal, and extended depth of focus multifocal IOLs. The ultimate goal of multifocal lenses includes reduced incidence of photic phenomena, and improved uncorrected near, intermediate, and far visual acuities for those working with computers and smartphones, as well as no contrast sensitivity loss. Although some patients have issues with halos and glare, overall patient satisfaction and quality of life are generally high after multifocal IOL implantation. Careful patient selection should be made to satisfy different individual needs.

Probiotics as a Potential Immunomodulating Pharmabiotics in Allergic Diseases: Current Status and Future Prospects

The prevalence of allergic disorders has dramatically increased over the past decade, particularly in developed countries. Apart from gastrointestinal disorders, neoplasia, genital and dermatological diseases etc., dysregulation of gut microbiota (dysbiosis) has also been found to be associated with increased risk of allergies. Probiotics are increasingly being employed to correct dysbiosis and, in turn, to modulate allergic diseases. However, several factors like strain variations and effector metabolites or component of them in a bacterial species can affect the efficacy of those as probiotics. On the other hand, host variations like geographical locations, food habits etc. could also affect the expected results from probiotic usage. Thus, there is a glaring deficiency in our approach to establish probiotics as an irrefutable treatment avenue for suitable disorders. In this review, we explicate on the reported probiotics and their effects on certain allergic diseases like atopic dermatitis, food allergy and asthma to establish their utility. We propose possible measures like elucidation of effector molecules and functional mechanisms of probiotics towards establishing probiotics for therapeutic use. Certain probiotics studies have led to very alarming outcomes which could have been precluded, had effective guidelines been in place. Thus, we also propose ways to secure the safety of probiotics. Overall, our efforts tend to propose necessary discovery and quality assurance guidelines for developing probiotics as potential immunomodulatory ‘Pharmabiotics.’

Trifocal versus Bifocal Diffractive Intraocular Lens Implantation after Cataract Surgery or Refractive Lens Exchange: a Meta-analysis

BACKGROUND: We compared the efficacy between trifocal and bifocal diffractive intraocular lens (IOL) implantation. METHODS: Through PubMed, MEDLINE, EMBASE, and CENTRAL, we searched potentially relevant articles published from 1990 to 2018. Defocus curves, visual acuities (VAs) were measured as primary outcomes. Spectacle dependence, postoperative refraction, contrast sensitivity (CS), glare, and higher-order aberrations (HOAs) were measured as secondary outcomes. Effects were pooled using random-effects method. RESULTS: We included 11 clinical trials, with a total of 787 eyes (395 subjects). The trifocal IOL group showed better binocular distance VA corrected with defocus levels of −0.5, −1.0, −1.5, and −2.5 diopter than the bifocal IOL group (All P ≤ 0.004). The trifocal IOL group showed better monocular uncorrected distance and intermediate VAs (mean difference [MD], −0.04 logarithm of the minimum angle of resolution [logMAR]; 95% confidence interval [CI], −0.07, −0.01; P = 0.006 and MD, −0.07 logMAR; 95% CI, −0.13, −0.01; P = 0.03, respectively). Postoperative refraction, glare, CS, and HOAs were not significantly different from each other. CONCLUSION: The overall findings indicate that trifocal diffractive IOL implantation is better than the bifocal diffractive IOL in intermediate VA, and provides similar or better in distance and near VAs without any major deterioration in the visual quality.

Clinical Outcomes of Diffractive Aspheric Trifocal Intraocular Lens Implantation

PURPOSE: To evaluate the clinical outcomes of patients with diffractive aspheric trifocal intraocular lens FineVision Pod F IOL (PhysIOL, Liège, Belgium) implantation. METHODS: Thirty eight eyes received phacoemulsification and implantation of FineVision Pod F IOL. Uncorrected distant visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), refractive values, and defocus curve were evaluated at postoperative 1 month and 3 months. Optical quality was evaluated with the contrast sensitivity test, OQAS® (Optical Quality Analysis System, Visiometrics, Cerdanyola del Vallès, Spain) and questionnaire. RESULTS: At the 3-month postoperative follow-up, the mean spherical equivalent was 0.01 ± 0.31 D and the mean UDVA, UIVA and UNVA were 0.04 ± 0.07, 0.19 ± 0.12, and 0.04 ± 0.07, respectively. Mean contrast sensitivities at 0.75, 1.5, 3, 6, 12, and 18 cycles per degrees were 2.00 ± 1.54, 2.16 ± 1.60, 2.25 ± 1.76, 2.16 ± 1.83, 1.52 ± 1.47 and 1.03 ± 0.95 respectively and mean objective scatter index by OQAS® (Optical Quality Analysis System, Visiometrics) was 1.54 ± 0.74. In satisfaction analysis, general satisfaction with surgery was 89% and spectacle independence were 89% at far, 78% at intermediate and 83% at near distance. Postoperative dissatisfaction factors were dryness (36%), glare at night (32%), halo (18%). CONCLUSIONS: The FineVision Pod F IOL showed excellent distant and near visual acuities with an effective intermediate visual acuity. The eyes with FineVision Pod F IOL expected to achieve the favorable visual outcome and patient satisfaction.

Current Issues and Future Considerations in Undergraduate Medical Education from the Perspective of the Korean Medical Doctor Development System / 의학교육논단

Observation of the current Korean medical education and training system shows that certain negative traits of unchangeable solidification engraft themselves so deeply into the overarching system that they are now hampering the state of the national health welfare. Focusing only on undergraduate medical education, we can point out some glaring side-effects that should be of concern to any stakeholder. For instance, a graduate can legally begin his career as an independent practitioner immediately after passing the licensing exam and return to the old stuck school-year system of 2-year-premedical and 4-year-medical programs where outcome-based and integrated curricula are incomplete and unsatisfactory. In terms of learning opportunities, the balance between patient care and public health, as well as that between in-hospital highly specialized practice and community-based general practice, has worsened. Every stakeholder should be aware of these considerations in order to obtain the insight to forge a new direction. Moreover, our medical schools must prepare our students to take on the global roles of patient care within the Fourth Industrial Revolution, health advocacy for the imminent super-aged society, and education and research in the bio-health industry, by building and applying the concept of academic medicine. We will need to invest more resources, including educational specialists, into the current undergraduate medical education system in order to produce proper outcomes, smart curriculum, innovative methods of teaching and learning, and valid and reliable monitoring and evaluation. The improved quality of undergraduate medical education is the starting point for the success of the national system for public health and medical care as a whole, and therefore its urgency and significance should be emphasized to the public. The medical society should go beyond fixing what is broken and usher in a new era of cooperation and collaboration that invites other health professionals, governmental partners, law-makers, opinion leaders, and the general public in its steps toward the future.

Intraindividual Comparison of Visual Outcomes between Blue Light-filtering and Ultraviolet Light-filtering Intraocular Lens

PURPOSE: To compare the clinical results of short-term visual acuity and quality of vision after implantation of a yellow-tinted blue light-filtering intraocular lens (IOL) (Acrysof IQ® SN60WF) and an clear ultraviolet (UV) light filtering IOL (enVista™ MX60) in the same patient. METHODS: 44 patients with bilateral cataract received an SN60WF in one eye and an MX60 in the other eye. All eyes were evaluated for refraction power and uncorrected visual acuity (UCVA) at preoperative and 1, 3 months postoperatively. At postoperative 3 months, corrected visual acuity, quality of vision (OQAS II®), contrast sensitivity (CGT 2000®) and visual field (Humphrey Field Analyzer®), and subjective patients' response to the degree of brightness were evaluated. Furthermore, glistening degree, intraocular stability, and posterior capsular opacification were examined. RESULTS: There were no significant differences in average refractive power or UCVA at 1 and 3 months (p > 0.05) between the two groups. At 3 months after cataract surgery, the quality of vision according to OQAS II®, the contrast sensitivity according to CGT 2000® with the glare either on or off, and visual field; showed no difference between the two groups (p > 0.05). Both IOLs had no glistening and posterior capsular opacity. The patients' response to the degree of brightness shows that MX60 (48.3%) has a higher degree of satisfaction. CONCLUSIONS: Yellow-tinted blue light-filtering IOL and clear UV light-filtering IOL had no difference in short-term visual acuity and quality of vision. Subjective brightness perception, however, was better with clear UV light-filtering IOL.

Efficacy of Anterior Stromal Puncture Using 5% NaCl Eye Drops for Prolonged Time in Recurrent Corneal Erosion Syndrome

PURPOSE: The purpose of this study is to evaluate the efficacy of the combined treatment of anterior stromal puncture with the concurrent use of 5% NaCl eye drops for 6 months for recurrent corneal erosion syndrome. METHODS: A retrospective chart review was conducted for 21 patients (21 eyes) who underwent the combined treatment of anterior stromal puncture with 5% NaCl eye drops qid for 6 months to treat recurrent corneal erosion syndromes. The patients' age, gender, history of corneal trauma, history of ocular surgery, recurrence rate, need for additional treatments after recurrence and complication were analyzed. RESULTS: The mean age was 42.05 ± 13.83 years (19-68 years) with no significant difference in gender, and the mean follow up period was 8.48 ± 2.76 months (6-15 months). Among the 21 eyes 14 eyes (66.7%) had a previous history of corneal trauma, 2 eyes (9.52%) had previous refractive surgery, 1 eye (4.8%) had corneal dystrophy, 2 eyes (9.5%) had diabetic mellitus and 5 eyes (28.81%) had an unknown origin. Furthermore, 3 eyes (14.3%) developed recurrences and 2 eyes were resolved with conservative treatment while 1 eye needed additional anterior stroma puncture. There was no recurrence after retreatment with anterior stroma puncture. No significant complications such as infection or inflammation developed with the exception of corneal opacity in which one patient developed glare due to corneal opacity. CONCLUSIONS: The combined treatment of anterior stromal puncture with 5% NaCl eye drops for a prolonged time might be effective at preventing the recurrence of refractory recurrent corneal erosion syndrome with conservative treatments.

A Case of Migraine with Aura Related to the Percutaneous Closure of Atrial Septal Defect

PURPOSE: To report a case of migraine attacks with aura that occurred after percutaneous closure of an atrial septal defect (ASD) with the Amplatzer septal occluder device. CASE SUMMARY: A 58-year-old female presented with glare and scintillation that lasted 3 days. She had a history of percutaneous ASD intervention 3 weeks prior. Because ophthalmologic examination revealed nothing remarkable, the patient underwent observation. However, two months later, she revisited our department, presenting with aggravated glare, scintillation, and severe photophobia. Also, she presented with scintillation followed by a headache starting from the right temporal area extending to the occipital area. The patient was diagnosed with migraine with aura, which was newly developed after percutaneous ASD closure. After switching medication from acetylsalicylic acid to clopidogrel, the frequency and intensity of the headaches were reduced. No recurrence of ophthalmic symptoms or headache was observed during the 1-year follow-up. CONCLUSIONS: Percutaneous closure of ASD can be complicated by the appearance of migraine attacks with aura. When patients present with glare and scintillation, ophthalmologists must consider the possibility of migraine with aura and migraine induced by secondary causes. Thus, detailed history taking should be taken in order to make an early diagnosis of migraine.

Comparison of Clinical Long-Term Outcomes with Two Types of One-Piece Aspheric Intraocular Lenses after Cataract Surgery

PURPOSE: To compare the clinical outcomes of glistening-free intraocular lens (IOL) and conventional 1-piece aspheric IOL in implanted in-the-bag. METHODS: After phacoemulsification performed by a single surgeon, 2 different IOLs were implanted: enVista MX60 (glistening-free 1-piece aspheric IOL) in 38 eyes (group A) and AcrySof IQ (conventional 1-piece aspheric IOL) in 46 eyes (group B). Glare symptom score (0-5) obtained by questionnaires, best corrected visual acuity (BCVA), Functional Acuity Contrast Test (FACT), posterior capsular opacity (PCO), glistening formation and spherical equivalent error were compared and analyzed preoperatively and 6 months and 12 months postoperatively. RESULTS: A statistically significant improvement of BCVA and contrast sensitivity postoperatively was observed in all groups. There was statistically significant increase of glistening in group B compared with group A. However, there was no significant difference of FACT scores of spatial frequency in A, B, C, D and E columns and glare symptom score (0-10) obtained by questionnaires 12 months after surgery. Spherical equivalent errors were -0.38 +/- 0.27 D and -0.36 +/- 0.28 D for groups A and B, respectively. PCO occurred in 2 eyes in group A and 4 eyes in group B. CONCLUSIONS: EnVista MX60 IOL showed less glistening formation than AcrySof IQ IOL, however, there was no significant difference in terms of vision quality such as BCVA, FACT and glare symptom score at 12 months postoperatively.

Comparison of Intracorneal Inlay for Presbyopia Correction: Hydrogel and Small-Aperture Inlays with a Six- Months Follow-Up

PURPOSE: To study the safety and efficacy of corneal reshaping and small-aperture inlays and compare the clinical results. METHODS: From February 2014 to November 2014, 22 corneal reshaping inlays were inserted at Asan Medical Center and from October 2012 to March 2013, 26 small-aperture inlay surgeries were performed: 6 eyes at Asan Medical Center and 20 eyes at Samsung Medical Center. The preoperative and postoperative parameters were reviewed retrospectively and included monocular uncorrected distance visual acuity (UDVA; log MAR), uncorrected near visual acuity (UNVA; log MAR), refraction and corneal curvature based on automated refractor keratometry, reading distance and patient satisfaction. RESULTS: In the hydrogel inlay group, preoperative mean monocular UNVA was 0.83 +/- 0.05 and monocular UDVA 0.07 +/- 0.03. At 6 months, mean monocular UNVA was 0.23 +/- 0.05 and UDVA 0.05 +/- 0.02. The most preferred mean reading distance in the hydrogel inlay group was 39.38 +/- 3.18 cm. In the small-aperture inlay group, preoperative mean monocular UNVA was 0.4 +/- 0.06 and monocular uncorrected visual acuity 0.27 +/- 0.04. At 6 months, mean monocular UNVA was 0.11 +/- 0.02 and UDVA 0.09 +/- 0.05 and the most preferred mean reading distance was 44.23 +/- 5.17 cm. Although 85% of patients in the corneal reshaping inlay group were satisfied or very satisfied, only 20% of patients in the small-aperture inlay group were satisfied. CONCLUSIONS: Both inlays are considered good options for correcting presbyopia. However, postoperative satisfaction score was higher and less glare symptoms were reported in the hydrogel inlay group.

Clinical Outcomes of Diffractive Trifocal Intraocular Lens in Both Eyes: A 6-Month Follow-Up

PURPOSE: To evaluate clinical outcomes after cataract surgery with bilateral implantation of the diffractive trifocal intraocular lens (IOL). METHODS: Forty-four eyes of 22 patients were analyzed in the present study from July 2014 to December 2014. Phacoemulsification with bilateral implantation of an AT Lisa tri 839 MP IOL (Carl Zeiss Meditec, Jena, Germany) was performed. Over a 6-month follow-up, the main outcome measures were uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA) at 80 cm, uncorrected near visual acuity (UNVA) at 40 cm, and spherical equivalent refraction. Visual quality and patient satisfaction were evaluated using a Quality of Vision questionnaire. Finally, the defocus curve was measured. RESULTS: The mean monocular UNVA, UIVA, and UDVA were 0.23, 0.22, and 0.02 log MAR at 1 month, 0.21, 0.20, and 0.01 log MAR at 3 months and 0.20, 0.22, and 0.01 log MAR at 6 months postoperatively, respectively. The mean binocular UNVA, UIVA, and UDVA were 0.16, 0.12, and 0.0 log MAR at 1 month, 0.15, 0.11, and 0.0 log MAR at 3 months and 0.15, 0.13, and 0.0 log MAR at 6 months postoperatively, respectively. Twelve patients reported glare and 17 patients reported halo. Defocus curve showed best visual acuity results at 0.0 D and second peak at - 2.5 D. The intermediate-vision values were stable. CONCLUSIONS: Diffractive trifocal IOL provided excellent distance, intermediate, and near visual outcomes.

A comparison of distance visual acuity testing using a standard ETDRS chart and a tablet device

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To determine if the portable iPad 3rd generation device with an anti-glare screen protector and installed with the 2020 Duo FLEX visual acuity can be used as an alternative method of distance acuity testing and to compare it with a standard ETDRS visual acuity chart.<br /><br /><strong>METHODS:</strong> Healthy volunteers with or without spectacle correction were selected and underwent visual acuity testing with an iPad 3 device and a standard ETDRS chart. The iPad 3 was fitted with an anti-glare matte screen protector and installed with the 2020 Duo FLEX visual acuity chart. The subjects read the optotypes in the standard ETDRS chart and the iPad 3 at distances of 4 and 2 meters. Visual acuity results were computed and recorded as logMAR units. Mean differences between the 2 devices were compared using paired t-test.<br /><br /><strong>RESULTS:</strong> A total of 46 healthy subjects (92 eyes), mean age of 24 years, had mean logMAR scores at 4 meters of 0.165 and 0.093 for the ETDRS chart and iPad 3 respectively (p<0.001). The mean logMAR scores at 2 meters were -0.049 and -0.089 respectively (p=0.016).<br /><br /><strong>CONCLUSION:</strong> Distance visual acuity testing using the iPad 3 device with high resolution screen equipped with anti-glare screen protector was significantly different from the standard ETDRS chart. Before tablet devices can be used to test visual acuity clinically, they should be standardized and tested.</p>

Assessment of Posterior Capsular Opacification of Korean Using Straylight and Glare Sensitivity Meter

PURPOSE: To evaluate posterior capsular opacity (PCO) using straylight and glare sensitivity meter and to compare availability of straylight and glare sensitivity with known methods for PCO evaluation. METHODS: Thirty-six pseudophakic eyes with PCO were selected for this study. Best-corrected visual acuity (BCVA), straylight (C-quant, Oculus GmbH, Wetzlar, Germany) and glare sensitivity (Binoptometer, Oculus GmbH, Wetzlar, Germany) were measured before mydriasis. After mydriasis, PCO images were captured with a slit-lamp and analyzed using the Evaluation of Posterior Capsular Opacification (EPCO) program (EPCO software, University of Heidelberg, Heidelberg, Germany). The same measurements were taken after capsulotomy and compared with pre-capsulotomy data. RESULTS: After capsulotomy, BCVA, EPCO score and straylight were improved with statistical significance (p < 0.05). Cases of PCO with mildly decreased visual acuity showed statistically significantly improved EPCO score and straylight (p < 0.05). Glare sensitivity did not show significant improvement but was statistically significantly correlated with straylight (p = 0.023, Rho = 0.732). CONCLUSIONS: Straylight is an available measurement for evaluation of PCO. Glare sensitivity meter which correlates with straylight can be used as a supportive measurement.

Assessment of Posterior Capsular Opacification of Korean Using Straylight and Glare Sensitivity Meter

PURPOSE: To evaluate posterior capsular opacity (PCO) using straylight and glare sensitivity meter and to compare availability of straylight and glare sensitivity with known methods for PCO evaluation. METHODS: Thirty-six pseudophakic eyes with PCO were selected for this study. Best-corrected visual acuity (BCVA), straylight (C-quant, Oculus GmbH, Wetzlar, Germany) and glare sensitivity (Binoptometer, Oculus GmbH, Wetzlar, Germany) were measured before mydriasis. After mydriasis, PCO images were captured with a slit-lamp and analyzed using the Evaluation of Posterior Capsular Opacification (EPCO) program (EPCO software, University of Heidelberg, Heidelberg, Germany). The same measurements were taken after capsulotomy and compared with pre-capsulotomy data. RESULTS: After capsulotomy, BCVA, EPCO score and straylight were improved with statistical significance (p < 0.05). Cases of PCO with mildly decreased visual acuity showed statistically significantly improved EPCO score and straylight (p < 0.05). Glare sensitivity did not show significant improvement but was statistically significantly correlated with straylight (p = 0.023, Rho = 0.732). CONCLUSIONS: Straylight is an available measurement for evaluation of PCO. Glare sensitivity meter which correlates with straylight can be used as a supportive measurement.

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.

Quality of vision in refractive and cataract surgery, indirect measurers: review article / Qualidade visual em cirurgia refrativa e catarata, medidores indiretos: artigo de revisão

Visual acuity is the measurement of an individual's ability to recognize details of an object in a space. Visual function measurements in clinical ophthalmology are limited by factors such as maximum contrast and so it might not adequately reflect the real vision conditions at that moment as well as the subjective aspects of the world perception by the patient. The objective of a successful vision-restoring surgery lies not only in gaining visual acuity lines, but also in vision quality. Therefore, refractive and cataract surgeries have the responsibility of achieving quality results. It is difficult to define quality of vision by a single parameter, and the main functional-vision tests are: contrast sensitivity, disability glare, intraocular stray light and aberrometry. In the current review the different components of the visual function are explained and the several available methods to assess the vision quality are described.

Qualidade Visual é a medida da capacidade individual de reconhecer detalhes de um objeto no espaço. Medições de função visual na clínica oftalmológica são limitadas por vários fatores, tal como máximo contraste e assim podem não refletir adequadamente as condições visuais reais, bem como os aspectos subjetivos da percepção do mundo pelo paciente. O sucesso em uma cirurgia está não apenas em restaurar linhas de visão, mas sim qualidade visual. Portanto, as cirurgias refrativas e de catarata têm a responsabilidade de alcançar resultados de qualidade. É difícil definir qualidade visual por um único parâmetro, sendo os principais testes de função visual: sensibilidade ao contraste; glare; dispersão intraocular da luz e aberrometria. Nesta revisão os diferentes componentes da função visual são explicados e os diversos métodos disponíveis para se avaliar a qualidade de visão são descritos.

The Efficacy of Vaccinium Uliginosum for Early Age-Related Macula Degeneration

PURPOSE: To evaluate the effect of Bog Bilberry (Vaccinium uliginosum) extract in eyes with early age-related macular degeneration (AMD). METHODS: Forty-four eyes of forty four patients with early AMD were included in this randomized, double-blinded, and placebo-controlled study. All participants were randomly assigned to either the placebo group (n = 24), or the bog bilberry extract group (n = 20). Before drug administration, an ophthalmic examination which included slit lamp microscopy, best corrected visual acuity, and intraocular pressure was performed, and repeated 1and 3 months after treatment. Objective scatter index, glare and tear film break-up time were checked by Optical Quality Analysis System (OQAS, Visiometrics, Spain) and drusen volume, central macular thickness, and RPE and IS/OS junction thickness were investigated with spectral-domain optical coherence tomography (Spectralis, Heidelberg, Germany). RESULTS: In the bog bilberry extract group, RPE and IS/OS junction thickness was significantly increased compared to the placebo group after 3 months of drug administration. CONCLUSIONS: Bog Bilberry extract may play a favorable role in preventing the atrophic change of RPE and IS/OS junction layer and the progression of early macular degeneration.

Research on Ocular Fatigability Induced by Multimedia and Instrument Features

PURPOSE: The aim of the present study was to evaluate the different features of such instruments and how they cause ocular fatigability. METHODS: Under the same settings and circumstances, 75 participants were asked to read the novel, "You without me?" in different formats including paper book, E-book (biscuit(R), Interpark Inc., LG INNOTECK LTD, Korea) and LCD reader (iPad(R), Apple Inc., United States). For every 10 minutes of reading, 10 minutes of rest was provided. After finishing the novel, the participants were asked to complete a questionnaire, and the data obtained were statistically analyzed using univariate analysis. RESULTS: Compared to paper book readers (1.93), LCD readers (2.40) complained of insufficient lubrication in the eye (p = 0.038), and experience more letter-floating illusions (1.92) than did paper book readers (1.49) (p = 0.043). Moreover, compared to the other formats including the E-book (20%) and paper book (8%), LCD readers (72%) experienced more significant glare symptoms (n = 23) and could read at a faster rate than the other groups of readers (n = 26). CONCLUSIONS: In the present study, the I-Pad caused ocular fatigability more easily than the other formats examined. No statistical significance of ocular discomfort or fatigability was observed among the different format groups. Further investigation with a greater number of age-controlled participants should be conducted prior to designing a study to determine the best format for reading.

Quantitative Measurement of Glare Disability Using a Glaremeter

PURPOSE: To report glare disability measured by a glaremeter. METHODS: Glaremeter values were measured in 270 normal eyes and 100 pseudophakic eyes. The normal eyes were classified into 3 age groups (teenage to 60's) with 90 eyes in each group. The pseudophakic eyes were classified into the monofocal IOL (intraocular lens) and multifocal IOL implanted groups with 50 eyes in each group. Glaremeter values of each group were measured using a glaremeter under photopic (82.2 +/- 5.1 cd/m2) and mesopic (5.5 +/- 0.3 cd/m2) conditions. RESULTS: The highest mean glaremeter value in the normal eyes was 8657.34 +/- 691.04 mm2 under the photopic condition and 8837.97 +/- 805.83 mm2 under the mesopic condition in the oldest group. The glaremeter value of the multifocal IOL implanted group was 9390.87 +/- 846.7 mm2 under the photopic condition and 9799.87 +/- 823.72 mm2 under the mesopic condition, which was significantly higher than the normal eye and the monofocal IOL implanted groups (p < 0.05). CONCLUSIONS: In the normal population, the mean glaremeter values were increased according to age, and a significant increase was observed in the multifocal IOL implanted group. The present study results provide good basic data for cataract and presbyopia refractive surgery predicted to produce glare disability inevitably.