Correlations between Quality of Vision, Higher Order Aberrations and Non-Invasive Keratographic Tear Film Break-Up Time in Pseudophakic Eyes after Uncomplicated Phacoemulsification

Aims: In this study, we aimed to investigate the intercorrelations between tear film break up time, measured non-invasively using non-invasive keratographic break-up time (NIKBUT), higher order aberrations (HOA) and quality of vision (QoV) in pseudophakic patients.Study Design: Cross-sectional.Methods: Thirty-five pseudophakic aged patients aged 50 years or older, and 35 control phakic patients aged 17 to 23 years with corrected visual acuity of 20/20 were included in this study. All subjects underwent similar examination including QoV questionnaire, aberrometry to measure HOA, and NIKBUT. HOA was measured with the OPD-Scan/ ARK 10000 corneal analyzer (Nidek CO. Ltd), expressed as Root Mean Square (RMS) HOA and NIKBUT was assessed using non-invasive TF-Scan module Keratograph 5M (K5M), equipped with modified tear film scanning function (Oculus, Wetzlar, Germany). Statistical analysis was performed to find the correlation between NIKBUT, HOA and QoV.Results: Patients in the pseudophakic group were significantly older (median age 66 vs. 20 years; P<0.01), had shorter NIKBUT (10.5 vs. 17.2; P<0.01), lower QoV score (1.63 vs. 0.68; P=0.04), and higher RMS HOA (0.5 vs. 0.26; P<0.01) compared to control group. NIKBUT was inversely correlated with RMS HOA (r = -0.19; p = 0.03) and RMS HOA was significantly correlated with QoV, even after adjustment for age and gender (r = -0.21; P0.04). NIKBUT <9.93s was correlated with lower QoV. The area under the curve was 0.81 (95% CI = 0.67 � 0.95, p = 0.012), and had 100% sensitivity and 61% specificity.Conclusion: Shorter NIKBUT was correlated with greater HOA and greater HOA was correlated with lower QoV. NIKBUT value of shorter than 9.93s could potentially predict pseudophakic patients who will likely experience visual symptoms leading to decreased QoV; thus, the use of artificial tears might be beneficial.

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.

Quality of vision in patients implanted with aspherical and spherical intraocular lens: Intraindividual comparison.

Aims: To compare the quality of vision in pseudophakic patients implanted with aspherical and spherical intraocular lenses (IOLs). Materials and Methods: Randomized prospective longitudinal intrapatient comparison between aspherical and spherical IOLs performed on 22 patients who underwent bilateral cataract surgery. Best corrected visual acuity, subjective contrast sensitivity, Strehl ratio and spherical aberrations (SA), and higher order wavefront aberrations for a 3.5 mm and a 6.0 mm pupil were measured after 3 months of cataract surgery. Results: SA (Z4,0) decreased significantly in eyes with aspherical IOL implant (P = 0.004). Modulation transfer function (MTF) and point spread function (PSF) resulted no significant difference between the two groups (P = 0.87; P = 0.32). Conclusion: Although the SA is significantly lower in eyes implanted with aspherical IOL, the quality of vision determined with MTF and PSF does not significantly differ for subjective and objective parameters that were analyzed.

Evaluation of visual quality after overnight orthokeratology in pre-adolescent myopes / 中华实验眼科杂志

Background Orthokeratology has been proved to temporarily alter the equivalent sphere,but its effects on visual quality deserve attention.Objective The present study was to investigate the visual quality after overnight orthokeratology in pre-adolescent myopes.Methods Written informed consent was obtained form each subject prior to entering into this series.A descriptive study design was used.One hundred and fifty eyes of 76 teenagers aged (14.90± 1.24)years with low and moderate myopia (-2.79 ± 0.82)D were included in the study.Fitted with Ortho-K contact lens,the lens was wore every night for over 8 hours.Subjective refraction,uncorrected visual acuity (UCVA),contrast sensitivity function,corneal-topography,and aberrometry were examined before,1 week and 3 months after the initiation of orthokeratology.Visual quality was generally evaluated by comparing before wearing,1 week and 3 months after wearing using the National Eye Institute refractive error quality of life instrument (NEI-RQL-42TM).All the procedures were performed by the same clinician.Results Spherical equivalent refractions were (-0.33± 1.02) D and (-0.26 ± 0.60) D 1 week and 3 months after orthokeratology,showing significant decline in comparison with (-2.79±0.82) D of before orthokeratology (P =0.001,0.001).However,no considerable difference was seen between 1 week and 3 months after orthokeratology (P=0.161).Contrast sensitivity function was significantly different in all spatial frequencies before wearing,1 week and 3 months after wearing,and those of 1 week and 3 months after wearing were significantly lower than those of before wearing (1 week:3 cpd P =0.001,6 cpd P=0.001,12 cpd P＜0.05,18 epd P＜0.05 ;3 months:3 cpd P=0.001,6 cpd P=0.001,12 cpd P＜0.05,18 cpd P＜0.05).There was no significant change in contrast sensitivity function between 1 week and 3 months of orthokeratology (P＞0.05).Flat K,steep K and corneal eccentricity (e) were significantly reduced (P =0.000),and surface asymmetry index (SAI) and surface regularity index (SRI) were significantly improved after orthokeratology in comparison with before orthokeratology (both P =0.001).Root mean square (RMS) of total higher-order,third-order and fourth-order aberrations were significantly increased (P＜0.05),but RMS of whole aberration and second-order aberrations significantly decreased after orthokeratology (P＜ 0.05).There were no significant changes in the fifth-order,sixth-order and seventh-order aberration among pre-wear,1 week and 3 months after orthokeratology.Scales of dark to bright,nocturnal driving,glare,visual fluctuate and halo were lower than those before orthokeratology (P＜0.05).The scales of visual fluctuate between 1 month and 3 months after orthokeratology had significant differences (P＜0.01),while the rest of the scales had no significant differences (P＞0.05).Conclusions Orthokeratology can reduce myopic diopter 1 week after orthokeratology.The overnight wearing of fitted orthokeratology can decrease contrast sensitivity and increase corneal surface irregularity and RMS of third-order and fourth-order.Compared with spectacles,orthokeratology reduces subjective visual quality,especially nocturnal quality.

Straylight in Normal and Cataractous Eyes of Koreans

PURPOSE: To compare intraocular straylight in normal and cataractous eyes as the morphology and to compare straylight as the result of subjective symptoms in early cataract cases using the C-quant straylight meter, the only tool to measure light scattering in media. METHODS: Straylight values were measured in 217 normal eyes and 138 cataractous eyes. Cataractous eyes were classified into posterior subcapsular opacity, anterior subcapsular opacity and nucleosclerosis. Straylight values of each group were measured. The 56 early cataractous eyes were categorized into two groups, depending on the presence of subjective symptoms, and each straylight value was measured. The preoperative and postoperative straylight values of early cataracts were also compared. RESULTS: The mean straylight values of normal and cataractous eyes were 1.34 and 2.46, respectively. The value of posterior subcapsular opacity (2.81) was significantly higher than that of anterior subcapsular opacity (2.33) and nucleosclerosis (1.99). The straylight values of early cataracts were significantly higher in the group with subjective symptoms (2.02) than in the group without subjective symptoms (1.56). The postoperative straylight value decreased to 1.42. CONCLUSIONS: The posterior subcapsular cataract showed significantly high intraocular straylight, indicating that light scattering occurred to a greater extent in this group. Light scattering occurred more in early cataractous eyes with subjective symptoms than in eyes without symptoms, and light scattering was reduced after surgery. The C-quant straylight meter, which measures the light scattering in media, can be a useful tool to determine the time of cataract surgery and to evaluate the quality of vision.

Outcomes after Implantable Contact Lens for Moderate to High Myopia

PURPOSE: To evaluate the efficacy, safety, predictability and subjective symptoms of the implantable contact lens to treat moderate to high myopia. METHODS: A Staar Collamer posterior chamber phakic IOL was implanted in 83 eyes of 44 patients with spherical equivalent -10.10D (-3.87~-19.37D). Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), refraction, adverse events, subjective quality of vision and satisfaction were evaluated. Mean follow-up was 4.9 months (3~9 months). RESULTS: All patients had a UCVA of 0.7 or better, and 61.4% had UCVA of 1.0 or better. Gains of 2 or more lines of BCVA occurred in 15 eyes (18.1%). Mean spherical equivalent refraction at postoperative 3 months was -0.37D (+0.25~-1.75D) and remained stable. There was no change in cylinder diopters. 81.9% of eyes were within +/-0.5D, and 97.6% were within +/-1.0D of predicted refraction. Glare and halo was observed in 5 eyes (6%) after laser iridotomy, lens flipping in 1 eye (1.2%), corneal edema in 2eyes (2.4%), drug induced ocular hypertension in 4eyes (4.8%). There was no case of cataract, glaucoma, retinal detachment, and lens dislocation. There was significant decrease of pupil diameter at postoperative 1 month and decreased pupil diameter was maintained until the last examination. Generally patient satisfaction was very good. But, some patients reported poor in the category of glare and halo. CONCLUSIONS: ICL implantation had good visual, refractive results, and stability. Long term follow-up is required to confirm the significant complications that do not occur in most patients over time.

The Surgical Outcome of Clear Lens Extraction in High Myopia

PURPOSE: The authors evaluated the clinical results, the degree of satisfaction regarding daily activities and the quality of life after clear lens extraction in high myopes. METHODS: Thirty nine eyes of 23 high myopes over minus 10 diopters underwent clear lens extraction and had minimum follow up of 3 months. The preoperative and postoperative refractive status and subjective satisfaction about surgical result were evaluated. The average follow up period was 10.4 months. (range, 3~24 months) RESULTS: Preoperative mean spherical equivalent and mean target refractive error were -17.40+/-4.00D (range, -11.25~-28.25D) and -1.40+/-0.46D (range, -0.3~-2.2D), respectively. Three months postoperatively, mean spherical equivalent was -1.64+/-0.96D (range, +0.5~-3.62 D). Three months postoperatively uncorrected visual acuity was compared with preoperative best spectacle corrected visual acuity. Visual acuity was decreased two lines or more in 4 eyes (10.3%) and in 23 eyes (59.9%) 20/20 was noted or visual acuity increased 2 lines or more. Posterior capsular opacification (PCO) was noted in 12 eyes (30.8 %) and was the most common postoperative complication within 3 months. Three months postoperatively, every patient was asked about their satisfaction of surgery. All except one patient were satisfied with their daily activities after surgery. and all patients except two complained of difficulty in near vision. CONCLUSIONS: The clear lens extraction can improve quality of life in extremely high myopes, but posterior capsular opacity and decreased near visual acuity should be considered in deciding surgery.

Comparison of the Clinical Results of Lensectomy and LASIK for High Myopia

We retrospectively evaluated clinial results of 13 eyes of 8 patients who underwent lensectomy and 11 eyes of 7 patients who underwent LASIK(laser assisted in sity keratomileusis) for correction of high myopia. Clinical outcomes of uncorrected and corrected visual acuity, postoperative refraction, and contrast sensitivity were evaluated. Subjective tests concerning glare, night halos, or decrement of night vision were also performed in each group. Postoperative uncorrected and corrected visual acuities were not significantly different between two groups. Predicatability was significantly higher in lensectomy group than that of LASIK group. Mean contrast sensitivity value of highest frequency(20 cpd) in LASIK group was significantly lower than that in lensectomy group. Subjective glare or night hlaos occurred more in LASIK group. During follow-up, visual loss with 2 lines or more was noted in 2 eyes due to postoperative complications in lensectomy group. No complication occurred in LASIK group. LASIK has been considered reasonably predictable and safe method for correction of high myopia. But our data suggest that lensectomy may give better quality of vision postoperatively compared to LASIK for high myopia. If prophylactic treatments which are aimed to prevention of postoperative complications are carried out prior to lensectomy, lensectomy is a reasonable refractive surgical potion especially for middle-aged patients with high myopia.

Life quality of vision after corneal refractive surgery / 眼科

Life vision is the visual ability during daily life and work. Far and near visual acuities are needed for good life vision, but visual balances including binocular balance, day and night balance, and far and near balance, are more important. The golden standard of evaluating corneal refractive surgery is not only the anticipated corrected visual acuity, but also the good life quality of vision. Higher quality corneal refractive surgery includes three major parts: excellent excimer laser device; favorable surgical environment and consummate surgical technique; customized analysis and surgical design. These three interrelate with each other and are equally important. (Ophthalmol CHN, 2006, 15:161-163 )