Short-term visual performance of soft multifocal contact lenses for presbyopia / Desempenho visual de curto prazo de présbitas usando diferentes lentes de contato multifocais hidrofílicas

ABSTRACT Purpose: To compare visual acuity (VA), contrast sensitivity, stereopsis, and subjective visual performance of Acuvue® Oasys® for Presbyopia (AOP), Air Optix® Aqua Multifocal (AOMF), and Air Optix® Aqua Single Vision (AOSV) lenses in patients with presbyopia. Methods: A single-blinded crossover trial was conducted. Twenty patients with mild presbyopia (add ≤+1.25 D) and 22 with moderate/severe presbyopia (add ≥+1.50 D) who wore lenses bilaterally for 1 h, with a minimum overnight washout period between the use of each lens. Measurements included high- and low-contrast visual acuity (HCVA and LCVA, respectively) at a distance, contrast sensitivity (CS) at a distance, HCVA at intermediate (70 cm) and near (50 cm & 40 cm) distances, stereopsis, and subjective questionnaires regarding vision clarity, ghosting, overall vision satisfaction, and comfort. The test variables were compared among the lens types using repeated-measures ANOVA. Results: Distance variables (HCVA, LCVA, and CS) were significantly worse with multifocal lens than with AOSV lens (p≤0.008), except for AOMF lens in the mild presbyopia group in which no significant difference was observed (p>0.05). Multifocal lenses had significantly greater HCVA at 40 cm than AOSV lens (p≤0.026). AOMF lens had greater intermediate HCVA than AOP lens (p<0.03). AOP lens demonstrated greater improvements in stereopsis than AOMF and AOSV lens in the moderate/severe presbyopia group (p≤0.03). Few significant differences in subjective variables were observed, with no significant difference in the overall vision satisfaction observed between lens types (p>0.05). The proportions of patients willing to buy AOSV, AOMF, and AOP lenses were 20%, 40%, and 50%, respectively, in the mild presbyopia group and 14%, 32%, and 23%, respectively, in the moderate/severe presbyopia group; however, these differences were not statistically significant (p≥0.159). Conclusions: Further development of multifocal lenses is required before significant advantages of multifocal lenses over single vision lens are observed in patients with presbyopia.

RESUMO Objetivo: Comparar a acuidade visual, sensibilidade ao contraste, estereopsia e desempenho visual subjetivo de présbitas usando lentes de contato Acuvue Oasys para presbiopia (AOP), Air Optix Aqua Multifocal (AOMF) e Air Optix Aqua Single Vision (AOSV). Método: Foi realizado estudo mascarado simples, cruzado. Vinte pacientes com presbiopia baixa (adição ≤+1,25 D) e 22 com presbiopia média/alta (adição ≥+1,50 D) usaram cada lente bilateralmente durante 1 hora, com descanso mínimo de uma noite entre as diferentes lentes. As medições incluíram acuidade visual para distância em alto e baixo contraste (HCVA, LCVA), sensibilidade ao contraste para distância (CS), HCVA para distância intermediária (70 cm) e para perto (50 cm e 40 cm), estereopsia e questionários subjetivos sobre nitidez visual, fantasmas, satisfação visão geral e conforto. As variáveis foram comparadas entre os tipos de lentes, utilizando medidas repetidas ANOVA. Resultados: As variáveis para distância (HCVA, LCVA, CS) foram significativamente piores com as multifocais em relação a AOSV (p≤0,008), exceto para AOMF no grupo de baixa adição, que não foi significativamente diferente (p>0,05). As multifocais foram significativamente melhores do que a AOSV para HCVA em 40 cm (p≤0,026). AOMF superou AOP para HCVA intermediária (p<0,03). AOP superou AOMF e AOSV em relação à estereopsia no grupo de presbiopia médio/alto (p≤0,03). Houve poucas diferenças significativas nas variáveis subjetivas, mas a satisfação visual global não foi significativamente diferente entre as lentes (p>0,05). A disposição para comprar lentes AOSV, AOMF e AOP foi: 20%, 40%, 50%, respectivamente, no grupo de presbiopia baixa; 14%, 32%, 23% no grupo de presbiopia média/alto, mas essas diferenças não foram estatisticamente significativas (p≥0,159). Conclusões: Melhorias futuras parecem ser necessárias para produção de uma lente multifocal que forneça aos présbitas uma vantagem significativa sobre a lente de visão única.

Evaluating the Importance of Long-term Follow up in a Dietitian Led Weight Management Service in the Community.

Background: According to current reports, 26% of adults in the United Kingdom are obese, Royal College of Physicians [1]. This highlights a need for practical, affordable and scalable intervention strategies that induce and effectively maintain clinically significant levels of weight loss. The Drop in to Stay on Track (DIST) service offers patients post weight loss intervention (WLI) support for weight maintenance and lifestyle changes. The purpose of the investigation was to evaluate a current community based dietitian led weight maintenance service to determine whether long term support and monitoring assist with weight maintenance/ weight loss post intervention. Methods: Over a period of a year, patients (n=44) attended an initial dietitian developed and led WLI. Upon competition patients were invited to attend the DIST service for long term support. Weights were collected pre and post WLI as well as at each time the patient utilized the DIST service. Weight changes were analysed using SPSS 20 statistical software and compared with DIST attendance frequency. Results: The majority (84%) of participants had either maintained (10%) or lost (74%) weight at their last recorded DIST session. Table 1 highlights the various statistically significant weight decreases from WLI referral. Discussion: It is clear from the findings of numerous studies that preventing weight regain is extremely challenging Perri et al. [2]. Recent reviews suggest that weight maintenance efforts should be long in duration with a focus on relapse prevention and problem solving to combat regain Brantley et al. [3]. Our findings from our evaluation suggest long term support and monitoring is beneficial for weight maintenance/weight loss post weight management intervention and further research is required to analyse greater numbers. Conclusion: Extended care is a necessary and effective method to optimise both continuous weight loss and long term weight maintenance.