Higher Order Aberrations in Femtosecond Laser-Assisted Versus Manual Cataract Surgery: A Retrospective Cohort Study.

PURPOSE: To evaluate differences in higher order aberrations (HOAs) between femtosecond laser-assisted cataract surgery (FLACS) and manual cataract surgery. METHODS: In this retrospective cohort study, consecutive patients undergoing FLACS or manual cataract surgery with implantation of an intraocular lens from January 2017 to February 2018 were recruited. Patients underwent aberrometry testing at least 2 months postoperatively. The primary endpoint was internal coma < 0.32 µm, and secondary outcomes included patient-reported vision quality. Generalized estimating equations accounting for within-patient correlation were used for analysis. RESULTS: A total of 57 eyes underwent FLACS (mesopic pupil size: 4.74 ± 1.37 mm) and 50 eyes underwent manual cataract surgery (pupil size: 4.99 ± 1.24 mm). The proportion of eyes reaching internal coma < 0.32 µm was significantly greater following FLACS (54 of 57 eyes, 94.7%) relative to manual cataract surgery (39 of 50 eyes, 78.0%) (odds ratio [OR] = 5.08, 95% confidence interval [CI] = 1.24 to 20.85, P = .024). The median internal coma was 0.10 µm for FLACS and 0.12 µm for manual cataract surgery (P = .005). There were no significant differences in vision quality between treatments (P = .40). All eyes (n = 15) with satisfaction scores of 0 to 10 had internal coma < 0.20 µm, compared to those with scores of 11 to 20 (27 of 29 eyes, 93.1%), 21 to 30 (19 of 30 eyes, 63.3%), and > 30 (8 of 15 eyes, 53.3%) (P < .001). The average internal coma increased by a greater amount for manual cataract surgery than for FLACS for every increase in mesopic pupil size > 5.75 mm. CONCLUSIONS: More eyes achieved internal coma < 0.32 µm following FLACS compared to manual cataract surgery. However, this does not account for improved patient-reported vision quality. There was a correlation between internal coma and patient-reported satisfaction, and eyes with excellent patient satisfaction all had internal coma < 0.20 µm. [J Refract Surg. 2019;35(2):102-108.].

Implantation of multifocal intraocular lenses using a magnification strategy in cataractous eyes with age-related macular degeneration.

PURPOSE: To examine visual function after targeting -2.0 diopter (D) spherical equivalent (SE) when implanting a multifocal intraocular lens (IOL) in eyes with cataract and age-related macular degeneration (AMD). SETTING: Three private practices. DESIGN: Case series. METHODS: Lenses of cataractous eyes with AMD were replaced with the Acrysof Restor SN60D3 multifocal IOL, targeting an SE of -2.0 D, which yielded +5.2 D near addition. Near and distance visual acuities were examined. Patients completed a visual function questionnaire preoperatively and 6 months postoperatively. RESULTS: At 6 months, 13 patients with 20 eligible eyes were examined. The uncorrected near visual acuity improved in 18 eyes (90%) and was unchanged in 2 eyes. The corrected distance visual acuity improved in 14 eyes (70%), was unchanged in 4 eyes (20%), and decreased (≤ 3 lines) in 2 eyes (10%). All vision-related questionnaire items improved. CONCLUSION: For cataractous eyes with AMD, replacing the crystalline lens with this myopia-targeted multifocal IOL improved or maintained near vision without severely compromising distance vision. FINANCIAL DISCLOSURE: Drs. Mackool and Ernest are consultants to Alcon. Dr. Mackool is an inventor in the patent of the IOLs related to this strategy. No other author has a financial or proprietary interest in any material or method mentioned.

A new system, the LipiFlow, for the treatment of meibomian gland dysfunction.

PURPOSE: To evaluate the safety and effectiveness of the LipiFlow System compared to the iHeat Warm Compress (WC) for adults with meibomian gland dysfunction (MGD). METHODS: This was a non-significant risk, prospective, open-label, randomized, crossover multicenter clinical trial. One hundred thirty-nine subjects were randomized between LipiFlow (n=69) and WC control (n=70). Subjects in the LipiFlow group received a 12-minute LipiFlow treatment and were reexamined at 1 day, 2 weeks and 4 weeks. Control subjects received a 5-minute iHeat treatment with instructions to perform the same treatment daily for 2 weeks. At 2 weeks, they crossed over (LipiFlow Crossover) and received the LipiFlow treatment. Effectiveness parameters: meibomian gland (MG) assessment, tear break-up time (TBUT) and dry eye symptoms. Safety parameters: adverse events, ocular health exam, ocular surface staining, intraocular pressure, visual acuity and discomfort. RESULTS: LipiFlow resulted in significant improvement (P < 0.05) in MG secretion at 2 and 4 weeks (mean ± standard deviation at baseline = 6.3 ± 3.5; 2 weeks = 14.3 ± 8.7; 4 weeks = 16.7 ± 8.7); and TBUT at 2 and 4 weeks: (at baseline = 5.5 ± 2.9; 2 weeks = 6.9 ± 5.0; 4 weeks = 7.4 ± 5.5). There was no significant change in MG secretion or TBUT in the control group. LipiFlow resulted in a greater significant reduction in dry eye symptoms than the iHeat WC. The crossover group demonstrated similar significant improvement 2 weeks post-treatment with the LipiFlow. There was no significant difference between groups in the incidence of non-serious, device-related adverse events. CONCLUSION: The LipiFlow System was significantly more effective than iHeat WC. These results support its safety and effectiveness in the treatment of MGD and dry eye symptoms.

Severe photic phenomenon.

A 69-year-old man who had uneventful bilateral cataract surgery with visual acuity of 20/15 without correction presented with severe dysphotopsia. Treatment with brimonidine (Alphagan) or pilocarpine did not resolve the symptoms. A multipiece silicone intraocular lens was piggybacked into the sulcus, and the patient no longer reported dysphotopsia.

Light-transmission-spectrum comparison of foldable intraocular lenses.

PURPOSE: To compare the light transmittance of 4 currently marketed intraocular lenses (IOLs) with that of the new AcrySof Natural IOL (Alcon Laboratories, Inc.), which is designed to mimic the light-attenuating characteristics of the human crystalline lens. SETTING: Research laboratory, Alcon Research, Ltd., Fort Worth, Texas, USA. METHODS: Light-transmission spectra of 4 commonly implanted IOLs were compared with the spectrum of the AcrySof Natural IOL (model SN60AT). RESULTS: While the 4 other foldable IOLs transmitted nearly 100% (near 0% absorption) of the light in the 400 to 500 nm (blue-light) region, the AcrySof Natural IOL absorbed a significant portion of blue light. Comparison of the spectrum of the AcrySof Natural IOL with the spectrum of human crystalline lenses of various ages showed that the AcrySof Natural lens closely mimics the light-attenuating characteristics of the human crystalline lens. CONCLUSIONS: The AcrySof Natural IOL provides a transmission spectrum more like that of a human crystalline lens than do other commonly implanted foldable IOLs. The Natural IOL reduces ultraviolet and blue-light exposure to the retina, mimicking the filtering normally provided by the human crystalline lens.

Posterior capsule opacification and neodymium: YAG capsulotomy rates with AcrySof acrylic and PhacoFlex II silicone intraocular lenses.

PURPOSE: To compare the incidence and severity of posterior capsule opacification (PCO) and neodymium:YAG (Nd:YAG) capsulotomy rates between AcrySof(R) MA30BA acrylic (Alcon) and PhacoFlex(R) II SI-40NB silicone (AMO) intraocular lenses (IOLs). SETTING: Outpatient Cataract Surgery Center, TLC Eyecare and Laser Center, Jackson, Michigan, USA. METHODS: AcrySof and PhacoFlex II IOLs were implanted in fellow eyes of 156 patients requiring bilateral cataract extraction. The patients were followed for a mean of approximately 3 years for the incidence and severity of PCO and the Nd:YAG capsulotomy rates. RESULTS: Of the 63 eyes that were free of PCO throughout the study, 42 had the AcrySof IOL and 21 had the PhacoFlex II IOL. Of eyes that developed PCO, the mean severity in the AcrySof group was 16% less than that in the PhacoFlex II group. Of the 50 eyes that had an Nd:YAG capsulotomy, 17 were in the AcrySof group and 33 were in the PhacoFlex II group. All differences between groups were statistically significant (P<.05). CONCLUSION: The AcrySof MA30BA IOL was associated with less PCO proliferation and thus fewer Nd:YAG laser posterior capsulotomies than the PhacoFlex II SI-40NB IOL.

Cataract surgery after holmium:YAG laser thermal keratoplasty.

A 64-year old man had noncontact holmium:YAG (Ho:YAG) laser thermal keratoplasty (LTK) performed in the left eye on March 10, 1998, and in the right eye on January 11, 1999. The patient achieved 1.3 diopters (D) and 1.4 D of corneal steepening in the right and left eye, respectively, which was the desired amount as his refractive error before Ho:YAG LTK was low. At the 3-month postoperative examination of the left eye, cortical cataracts were observed in both eyes. Approximately 1 year later, bilateral cataract extraction was recommended because of patient-reported decreased vision at distance and near and difficulty with vision in the presence of glare. Cataract surgery and intraocular lens (IOL) implantation was performed in both eyes in August 1999 using the keratotomy readings taken after noncontact Ho:YAG LTK to calculate IOL power. Although slight flattening of the cornea occurred after cataract extraction, the refractive outcomes achieved by noncontact Ho:YAG LTK were generally preserved.