Comparison of Ectasia versus Pseudoectasia using the Ectasia Risk Factor Score System

Objectives@#To evaluate and compare ectasia and pseudoectasia in post-myopic LASIK patients presenting with corneal topographic changes indicative of ectasia using the Ectasia Risk Factor Score System (ERFSS).@*Methods@#Single-center retrospective comparative case series of a consecutive chart review of cases in 18 years who underwent bilateral myopic-LASIK and showed topographic changes indicative of ectasia.@*Results@#Four patients were included. Group 1: pseudoectasia eyes, consisting of two patients with bilateral pseudoectasia, and Group 2: ectasia eyes, consisting of two patients with unilateral ectasia. The clinical course of the cases was discussed and compared based on the ERFSS parameters: topography pattern, residual stromal bed thickness, age, preop thinnest cornea, and pre-operative spherical equivalent (SE) manifest refraction (MR). Group 1 scored zero to low risk for developing ectasia while Group 2-eyes with ectasia scored moderate risk. The predictive value of the ERFSS was 1 in this study.@*Conclusion@#The ERFSS is a good measure in deciding the suited treatment plan for patient undergoing refractive procedure. Knowing the clinical course of ectasia and pseudoectasia is helpful in the therapeutic approach since pseudoectasia is reversible when identified and managed early as seen in this study.

Comparison of visual performance of monofocal intraocular lenses with different asphericities

Objective@#To compare the visual performance and patient-reported outcomes of three types of monofocal intraocular lenses (IOL) with different asphericities.@*Methods@#This cross-sectional, comparative study comprised of 62 pseudophakic eyes divided into three groups corresponding to the IOL that they were previously implanted with (Tecnis ZCB00 negative aspheric IOL, EnVista MX60 neutral aspheric IOL and Akreos Adapt spheric IOL). Mean refractive spherical equivalent (MRSE), best-corrected far visual acuity (BCVA), spherical aberration (SA), contrast sensitivity (SC), halo and starburst, and responses to a qualitative questionnaire (NEI-RQL) were measured.@*Results@#There was no significant difference in MRSE (P=0.74) and BCVA (P=0.52) among the three groups. There was a statistically significant difference (P=0.00) in mean internal (lens) SA, measured through a 5mm pupil, among Tecnis (-0.150 μm), EnVista (+0.022 μm) and Akreos Adapt (+0.094 μm). Compared to the Akreos Adapt, the Tecnis and EnVista groups had significantly better CS at 6 CPD and 12 CPD under mesopic testing without glare (P= 0.01) and at 6 CPD mesopic testing with glare (P=0.04). Halo scores were insignificant among the three groups. However, starburst scores were significantly worse in the Akreos Adapt IOL than the Tecnis and EnVista (P=0.01). There was no difference in questionnaire responses among the three groups.@*Conclusion@#The negative aspheric and neutral aspheric lenses showed significantly lower SA resulting in better CS in mesopic conditions and better starburst scores. MRSE, BCVA and subjective satisfaction were statistically similar regardless of the type of monofocal intraocular lens

A comparative evaluation of visual, refractive, and patient-reported outcomes of three diffractive trifocal intraocular lenses

@#OBJECTIVE: To compare the visual, refractive, and patient-reported outcomes of eyes implanted with one of 3 trifocal intraocular lenses (IOLs). METHODS: This is a cross-sectional, comparative, non-interventional study wherein subjects implanted with FineVision Micro F, AT LISA tri 839MP or AcrySof IQ PanOptix trifocal IOL after phacoemulsification were recruited. Manifest refraction, uncorrected and corrected visual acuity (VA) at distance, intermediate and near vision, contrast sensitivity, modulated transfer function (MTF) values and questionnaire answers were compared among the 3 groups using analysis of variance (ANOVA). RESULTS: Fifty-seven (57) eyes were included in the study: 21 eyes with FineVision (group A), 21 eyes with LISA tri (group B), and 15 eyes with PanOptix IOL (group C). The post-operative mean manifest spherical equivalent was -0.01D, -0.07D, and 0.05D, respectively (p=0.083). Uncorrected distance VA and best-corrected distance VA were similar among the groups. Groups A and C had better uncorrected and corrected intermediate VA at 80 cm and at 60 cm compared to group B. Group A had significantly better uncorrected near visual acuity than groups B and C (p=0.032). Mesopic contrast sensitivity testing showed group C had higher contrast sensitivities without glare in at the spatial frequency of 6 CPD (p=0.038) and with glare at 3 CPD (p=0.039) and at 12 CPD (p=0.009). MTF average height analysis showed that the group A had significantly superior resolution in far targets compared to groups B and C (p=0.001). At near targets, groups A and C had better resolutions compared to group B (p=0.017). There was no significant difference in patient satisfaction for far, intermediate and near VA among the groups. CONCLUSION: Eyes implanted with any of the 3 trifocal IOL designs achieved excellent uncorrected and bestcorrected distance, intermediate and near vision. FineVision and PanOptix provided significantly better intermediate vision than LISA tri at both 80 cm and 60 cm testing distance. FineVision had better near visual outcomes than PanOptix and LISA tri. Patient satisfaction was high in all 3 trifocal IOLS

Efficacy of vitamin supplementation in preventing color vision abnormalities among patients undergoing DOTS for Tuberculosis

Objective@#To determine if vitamin supplementation can prevent the development of color vision abnormalities in patients taking ethambutol as part of DOTS for tuberculosis (TB).@*Methods@#A randomized, placebo-controlled, single-blind clinical trial was conducted among newly diagnosed category-1 TB patients enrolled in DOTS health centers in the third district of Manila from June 2011 to August 2012. Before starting therapy, the participants underwent a complete eye evaluation including baseline color vision tests using the Ishihara Color Vision Plates (Ishihara), Farnsworth Panel D-15 (FD 15), and Lanthony Desaturated D-15. Only subjects who passed the three color vision tests were included in the study. They were divided into 2 groups: Group A received vitamin supplementation and Group B received a placebo. Follow-up color vision testing was done monthly for 3 months.@*Results@#There were 105 patients included in the study, 77 males and 28 females, age ranging from 16 to 68 years with a mean of 37 years. Forty three (43) patients received vitamin supplementation (group A) and 62 received placebo (group B). After one month of DOTS, 5 of 43 patients (11. 6%) in group A and 10 of 62 patients (16.1%) in group B developed color vision abnormalities, detected only with the Lanthony Desaturated test. The absolute risk reduction (ARR) of color vision abnormalities by vitamin supplementation was 4.5%, with the number needed to treat (NNT) of 23. After the second month of therapy, ARR was 7.4% and NNT was 14. ARR was highest in the third month at 8.3%, with a corresponding decreased NNT of 12. Among patients who developed color vision abnormalities, reversal of the abnormalities was observed in 80% of 5 subjects in group A, and 40% of 10 patients in group B. By the third month of treatment, all in group A already had normal color vision, while 40% in group B still showed abnormal color vision. @*Conclusion@#This study showed that vitamin supplementation was effective in reducing the risk of, and in reversing cases of, color vision abnormalities among patients undergoing DOTS therapy for tuberculosis.

Incidence, indications, and outcomes of Yag Capsulotomy in eyes Implanted with an accommodating intraocular lens

Objectives@#To do report the incidence of capsular changes in Crystalens-implanted eyes and analyze the indications and outcomes of yag capsulotomy. @*Methods@#We reviewed the records of 411 eyes of 258 patients implanted with the Crystalens IOL. Capsular change indications for yag capsulotomy were posterior capsular opacification (PCO), lens tilt, and capsular striae. Eyes in each indication were further subdivided into therapeutic yag (TY) and prophylactic yag (PY) groups. Outcomes before and after yag capsulotomy were analyzed. @*Results@#Ninety of 411 crystalens-implanted eyes (22%) had undergone yag capsulotomy. Sixty-one eyes had PCO, 12 had lens tilt, and 17 had striae. Twenty-seven eyes belonged to the therapeutic (TY) and 63 eyes to the prophylactic (PY) yag subgroups. The mean interval between phacoemulsification and yag capsulotomy was 10 months. In the TY PCO subgroup, uncorrected distance visual acuity (UDVA) changed from 20/40 pre-yag to 20/25 post-yag, uncorrected near visual acuity (UNVA) from J3 to J2, manifest refraction spherical equivalent (MRSE) from -0.43D to -0.2D. In the TY tilt subgroup, UDVA changed from 20/50 to 20/30, UNVA was unchanged at J2, and MRSE from -1.21D to -0.89D. In the TY striae group, UDVA changed from 20/50 to 20/30, UNVA from J3 to J2, and MRSE from 0.62D to -0.4D. In the PY PCO subgroup, UDVA was unchanged at 20/25, UNVA unchanged at J2, and MRSE changed from -0.52D to -0.47D. In the PY tilt subgroup, UDVA changed from 20/25 to 20/20, UNVA unchanged at J2, and MRSE changed from -0.87D to -0.45D. In the PY striae subgroup, UDVA was unchanged at 20/30, UNVA changed from J3 to J2, and MRSE changed from -0.62D to -0.7D. @*Conclusion@#Capsular changes occurred after Crystalens implantation that necessitated yag capsulotomy. Once vision has deteriorated, a therapeutic yag treatment can help improve vision. If capsular changes have occurred but vision has not deteriorated, a prophylactic yag capsulotomy can stabilize visual and refractive outcomes.

Comparison of flap thickness, visual outcomes, and higher order aberrations in eyes that underwent LASIK flap creation using a femtosecond laser versus a mechanical microkeratome

Objective@#To compare the predictability of flap thickness, visual and refractive outcomes, and higher order aberrations in eyes that underwent myopic LASIK using either a Technolas femtosecond laser or a Zyoptix XP mechanical microkeratome for flap creation.@*Methods@#The study involved a total of 44 eyes of 22 patients who underwent LASIK. Flap creation was randomized to using the Technolas femtosecond laser in one eye and Zyoptix XP microkeratome in the contralateral eye. Flap thickness was measured intraoperatively using ultrasonic pachymetry and postoperatively using the Visante ASOCT. Refractive outcome, visual acuity (VA), higher order aberrations, and contrast sensitivity were compared between the two groups.@*Results@#Twenty-two patients had LASIK for myopia or myopic astigmatism. Using ultrasonic pachymetry intraoperatively, the mean flap thickness was 134 (±10) um and 124 (±23) um in the femtosecond (FS) and microkeratome (MK) groups respectively. Comparing the deviation of the actual from the intended flap thickness, the FS group had statistically lower standard deviation compared to the MK group (p=0.04). Using the AS-OCT, the mean flap thickness at 3 months postoperatively was 119 (±10.82) um and 123 (±15.77) um in the FS and MK groups respectively. The difference in standard deviation between the two groups did not reach statistical significance (p=0.19). The mean spherical equivalent at 3 months was -0.45D (±0.42) and -0.13D (±0.16) respectively. Eightynine percent (89%) of eyes had uncorrected VA of 20/20 or better in both groups. All eyes attained best corrected VA of 20/20 or better in both groups. Differences in total higher order aberrations (p=0.09) and contrast sensitivity scores (p=0.47) were not statistically different between the two groups. @*Conclusion@#Flap thickness predictability was better using the Technolas femtosecond laser compared to the XP microkeratome blade. Visual and refractive outcomes, higher order aberrations, and contrast sensitivity were comparable between the 2 groups.

Clinical comparison of visual and refractive outcomes of two models of accommodative intraocular lenses

Objective@#To evaluate the visual and refractive outcomes of eyes implanted with the Crystalens HD and the Crystalens AO intraocular lens.@*Methods@#We retrospectively reviewed the records of 159 eyes of 100 patients implanted with the Crystalens HD IOL and 108 eyes of 66 patients implanted with the Crystalens AO IOL. Visual and refractive outcomes preoperatively and postoperatively were assessed and compared between the lenses. @*Results@#At 1 year, uncorrected distance VA was 20/30 in 78% of eyes in the HD and 76% of eyes in the AO groups. Uncorrected intermediate VA was 20/30 in 90% of eyes in both groups. Uncorrected near VA was J3 in 92% in the HD and 90% in the AO groups. Comparing the two groups, the difference in uncorrected distance (p=0.60), intermediate (p=0.77), and near (p=0.64) vision was not statistically significant. Spherical equivalent was -0.42D +/-0.51D in the HD and -0.6 +/-0.48D in the AO groups (p=0.10). @*Conclusion@#Refractive outcomes were similar between the Crystalens HD and AO groups. Mild myopic refractive outcomes were targeted and achieved in both lens groups. These refractive outcomes provided good uncorrected distance, intermediate, and near vision postoperatively.

Visual outcomes and higher-order aberrations of wavefront vs. combined wavefront aspheric

Objective@#We compared the efficacy, safety, refractive and visual outcomes, and aberrometry results of wavefront-guided aspheric treatment (WTA) versus wavefront-guided treatment (WT).@*Methods@#This prospective, contralateral, comparative study included 60 eyes of 30 patients who underwent myopic LASIK. One eye of each patient was randomized to either WTA or WT. Patients were followed up for 3 months postoperatively. Two-tailed paired t-test was used to determine statistical significance.@*Results@#At 3 months, 93% of eyes in the WTA group and 83% in the WT group had high-contrast uncorrected distance visual acuity (UDVA) of 20/20, while 87% in both groups achieved low-contrast UDVA of 20/40 or better. Sixty-four percent in the WTA gained 1 or more lines of low-contrast corrected distance visual acuity (CDVA) compared to 50% in the WT group. The mean sphere was 0.17D in the WTA and 0.14D in the WT (p = 0.63). The mean spherical equivalent was –0.04D for WTA and –0.03D for WT (p = 0.88). All eyes in both groups were within ±1.00D of the target emmetropia. The mean change in total higher-order aberration (HOA) was 0.07 μm in the WTA compared to 0.15 μm in the WT group (p = 0.04). The mean change in spherical aberration was –0.01 μm in the WTA and 0.18 μm in the WT group (p < 0.001). The mean change in Q value was significantly lower in the WTA (0.31) than in the WT group (0.63) (p < 0.001).@*Conclusion@#Wavefront aspheric LASIK (WTA) is a safe and effective treatment for myopic astigmatism. Refractive and visual outcomes were similar for both groups. WTA had less induction of higher-order aberration, lower spherical aberration, and better preservation of corneal asphericity (Q value). This translated to more lines of low-contrast vision gained compared to WT. Keywords: LASIK, Wavefront-guided, Aspheric, Spherical aberration, higher-order aberration, Corneal curvature

Prevalence of color-vision deficiency among male high-school students

@#Objective This study determined the prevalence of color-vision deficiency among male high-school students in a public school. Methods Male high-school students were screened for color-vision deficiency using 6 plates of the Ishihara pseudoisochromatic plates. All students with one or more errors were reexamined at a later date with the full 15 Ishihara plates and the Farnsworth D15 (FD15) test. A detailed history was taken and an ocular examination was conducted. Students who identified less than 10 plates correctly on the FD15 were classified as color-deficient and underwent the Farnsworth Munsell 100 hue (FM 100) test. The results were statistically analyzed. Results A total of 1,258 male high-school students, aged 12 to 16 years, were included in the study, 122 of whom failed the screening test. Of these, 106 completed the 15 Ishihara plates. Sixty-five failed and were classified as color-visiondeficient, of which 64 (98%) were deutans. Deutan was also the most common deficiency determined using the FD15 (78.95%) and FM100 (44.19 %) hue tests. Conclusion The prevalence of color-vision deficiency among male students in a public high school was 5.17% (65/1,258). The most common deficiency was the deutan type.

Color-vision abnormalities among patients undergoing tuberculosis treatment

Objective@#This study determined the incidence of and risk factors for color-vision abnormalities among Filipino patients undergoing directly observed treatment short-course (DOTS) for tuberculosis.@*Methods@#A prospective single-cohort study involving newly diagnosed patients with category-1 tuberculosis, recruited from DOTS health centers in Manila, was conducted. All patients were given a fixed-dose combination of rifampicin, isoniazid, ethambutol, and pyrazinamide for 60 days, after which treatment was continued with rifampicin and isoniazid for 4 more months. The participants underwent complete eye evaluation including color-vision testing and were followed up every month up to the conclusion of treatment.@*Results@#Out of 93 patients initially enrolled, 64 completed the prescribed follow-up and constituted the study group. Baseline color vision was normal. After 1 month of therapy, color vision tested with the Ishihara plates remained normal in all patients, but one failed the Farnsworth Panel D 15 and was classified as tritan while 30 (47.88%) failed the Lanthony Desaturated test. The type of abnormality was unclassified in 20 (66.67 %)patients and tritan in 10 (33.3%). Visual acuity remained unchanged from baseline. Repeat testing after ethambutol and pyrazinamide were stopped showed that color vision was normal using the Ishihara plates and the Farnsworth test, while 5 failed the Lanthony test. Of these, 3 were unclassified and 2 were tritan. In the 3rd to 6th months follow-up, no color-vision abnormalities were noted in the 3 tests. The only risk factor identified was age (p = 0.01) with older patients having a higher risk.@*Conclusion@#The incidence of color-vision abnormalities among patients undergoing DOTS was 47.88% using the Lanthony Desaturated test after an average of 39.66 days on quadruple anti-TB therapy. Age was the only significant risk factor observed. The color-vision abnormalities returned to normal within an average of 37.85 days after discontinuing ethambutol and pyrazinamide.