Measurement of accommodative amplitude using wavefront aberrometer

@#<p style="font-size: 12.16px; text-align: justify;"><strong>OBJECTIVE:</strong> To measure and compare the accommodative amplitude of Filipino patients with different accommodative conditions using a wavefront aberrometer.</p> <p style="font-size: 12.16px; text-align: justify;"><strong>METHODS:</strong> A total of 120 eyes of 67 patients seen in a private eye center were included and divided into two groups (phakic and pseudophakic). After undergoing routine ophthalmologic examination that included manifest refraction and visual acuity testing, accomodative amplitude was measured using the iTraceTM wavefront aberrometer. Comparison of the measurements was made between the accommodative amplitude of phakic pre-presbyopes and presbyopes, and between eyes implanted with monofocal and accommodating intraocular lenses (IOLs).</p> <p style="font-size: 12.16px; text-align: justify;"><strong>RESULTS</strong>: The mean age of the pre-presbyopes was 27 years, presbyopes 50 years, monofocal IOL 69 years and accommodating IOL 67 years. The mean accommodative amplitude of the pre-presbyopes was 1.64 ± 1.06D, presbyopes 0.99 ± 0.42D, monofocal IOL 0.36 ± 1.16D, and accommodating IOL 0.94 ± 0.89D. The pre-presbyopes had a higher accommodative amplitude than the presbyopes (p=0.008), while the accommodating IOL subgroup had a higher amplitude than the monofocal IOL subgroup (p=0.02). Increasing age was correlated with decreasing amplitude in the phakic group (r2=0.926). There was no correlation between refractive error and amplitude of accommodation in the phakic and pseudophakic groups (r2=0.02 for both groups).</p> <p style="font-size: 12.16px; text-align: justify;"><strong>CONCLUSION:</strong> The wavefront aberrometer is a reliable tool in objectively measuring accommodative amplitude. Pre-presbyopes and accommodating IOLs were shown to have higher amplitudes of accommodation than presbyopes and monofocal IOLs.</p>

The quality of life in patients with non-surgical and surgical presbyopic corrections

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To compare the quality of life using the National Eye Institute Refractive Error Quality of Life (NEI-RQL) instrument in 40-60 year-old patients with reading glasses and presbyopic LASIK correction and in 60-80 year-old patients with monofocal and multifocal intraocular lenses (IOLs).</p> <p style="text-align: justify;"><strong>METHODS:</strong> Patients aged 40-80 years old with reading glasses (group 1a) or presbyopic LASIK treatment (group 1b) and bilateral pseudophakia with monofocal (group 2a) or multifocal IOLs (group 2b) were recruited. All patients answered the NEI-RQL questionnaire. The responses in the self-administered questionnaires were collated, analyzed, and compared between the subgroups.</p> <p style="text-align: justify;"><strong>RESULTS</strong>: One hundred fifty patients (median age 60 years, range 41-80 years) completed the NEI-RQL questionnaire. Subjects (age 41-59 years) who underwent presbyopic LASIK correction had a higher mean NEI-RQL (p=0.19) and higher subscale score for satisfaction (p=0.42) than those wearing reading glasses. However, the differences were not satistically significant.</p> <p style="text-align: justify;"><strong>CONCLUSION:</strong> Presbyopic LASIK improved uncorrected near visual acuity and provided spectacle independence in presbyopes; however, patient satisfaction was similar to those who with reading glasses. Multifocal IOLs significantly improved uncorrected near visual acuity and spectacle independence in pseudophakic patients with high patient satisfaction.</p>

A five-year review of refractive procedures, outcomes and complications

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To evaluate the visual and refractive outcomes of LASIK, PRK, phakic IOL, and Supracor as treatment for errors of refraction, including presbyopia, performed at a private eye center.<br /><br /><strong>METHODS:</strong> This is a retrospective, single-center, single-surgeon study that reviewed the surgical outcomes of patients who underwent LASIK, PRK, phakic IOL, and Supracor from January 2010 to December 2014. Main outcome measures were postoperative uncorrected and corrected distance, intermediate, and near visual acuity (for Supracor), and mean manifest-refraction spherical equivalent (MRSE) of patients who had at least 1 month follow up. Complications and enhancements were analyzed independently.<br /><br /><strong>RESULTS:</strong> Data were analyzed from 1,366 eyes of 771 patients. LASIK was the most commonly performed procedure (68%), followed by PRK (18.3%), Supracor (10.2%), and phakic IOL (3.7%). The postoperative mean MRSE at 1 month for LASIK, PRK, and phakic IOL were -0.08 ± 0.36, +0.06 ± 0.52 and -0.11 ± 0.44, respectively. The mean postoperative logMAR uncorrected distance visual acuity (UDVA) at 1 month for LASIK, PRK, and phakic IOL were 0.02 ± 0.10, 0.07 ± 0.12, 0.001 ± 0.09, respectively. In the Supracor group, the mean preoperative and postoperative spherical equivalent were +1.12 ± 0.8 and -0.76 ± 0.62, respectively. The mean postoperative logMAR UDVA and uncorrected near visual acuity (UNVA) for Supracor were 0.24 ± 0.19 and 0.02 ± 0.08, respectively. The most common postoperative complication was symptomatic dry eye (13%). Regression and off-target outcomes occurred in 24 (1.8%) and 13 eyes (1%), respectively. Overall enhancement rate was 2%.<br /><br /><strong>CONCLUSION:</strong> LASIK remained to be the most common refractive procedure, with femtosecond laser-created flap becoming the norm. Refractive and visual outcomes showed good efficacy with all the refractive procedures. Complication and enhancement rates were low.</p>

Demographic and clinical profile of patients who underwent refractive surgery screening

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To describe the demographic and clinical profile of patients who underwent refractive surgery screening.<br /><br /><strong>METHODS:</strong> Medical records of patients who sought consult for refractive surgery from January 2010 to December 2014 at a refractive center were reviewed and analyzed. The preoperative clinical conditions, optical characteristics of myopes and hyperopes, refractive screening tests, and causes for disqualification were determined.<br /><br /><strong>RESULTS:</strong> A total of 1215 patients who sought consult for refractive surgery had a mean age of 36.45 ± 11.60 years. Seven hundred ten (58.44%) were females and 860 (70.78%) were Filipinos. Nine hundred eighty eight (81%) were myopes. The mean manifest refractive spherical equivalent (MRSE) for myopic patients was -4.41D±2.98 with mean uncorrected distance vision (UCDVA) of 20/400 (logMAR 1.26) and mean best-corrected distance vision (BCDVA) of 20/20 (logMAR 0.02). For hyperopic patients, the mean MRSE was +1.33D±3.76 with mean UCDVA of 20/40 (logMAR 0.33) and mean BCDVA of 20/20 (logMAR 0.001). Reasons for disqualification from undergoing a refractive procedure included thin cornea (5.27%), irregular corneal topography (2.39%), steep cornea (0.78%), high refractive errors (0.41%), optic nerve (0.41%), and retina (0.25%) pathologies.<br /><br /><strong>CONCLUSION:</strong> Patients who underwent screening for refractive surgery were young, mostly female, with myopic refractive errors. LASIK remained the most popular refractive surgery procedure. </p>

Comparison of the rotational stability of different toric intraocular lens implants

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To compare the rotational stability and cylinder reduction of different toric intraocular lenses (IOLs).<br /><strong>METHOD:</strong> This was a prospective, cross-sectional study of 68 eyes that had at least 0.75 diopters (D) of corneal astigmatism prior to cataract surgery and were at least 3 months post-toric IOL implantation (Envista, AcrySof, FineVision). Patients recruited underwent visual acuity testing, manifest refraction, pupil dilation, and toric IOL axis determination. Actual axis position was obtained and compared to the intended axis calculated from the tonic IOL calculator. Any difference between the two was considered an axis deviation. Main outcome measures were postoperative deviation of the IOL axis from the intended axis, uncorrected distance visual acuity (LIDVA), best corrected distance visual acuity (BCDVA), manifest refraction, and cylinder reduction.<br /><strong>RESULTS:</strong> There was no significant difference in the rotational stability of the three different types of toric IOLs (p=0.95). Mean axis deviation for .AcrySof, Envista, and FineVision were 2.43, 2.66, and 2.75 degrees, respectively. There was a significant decrease in the cylinder from preoperative to postoperative levels for all groups (p=0.00 for Envista, p=0.03 for AcrySof, and p=0.00 for Fine-Vision). There were significant improvements in the mean UCVA and BCDVA after cataract surgery and implantation of toric IOLs for all three groups.<br /><strong>CONCLUSION:</strong> The three IOL platforms (AcrySof, Envista, and FineVision) showed good rotational stability and significant cylinder reduction:Visual and refractive outcomes improved after surgery.<br /><br /></p>