Diagnostic Performance of the PalmScan VF2000 Virtual Reality Visual Field Analyzer for Identification and Classification of Glaucoma.

PURPOSE: To evaluate the diagnostic test properties of the Palm Scan VF2000Ⓡ Virtual Reality Visual Field Analyzer for diagnosis and classification of the severity of glaucoma. METHODS: This study was a prospective cross-sectional analysis of 166 eyes from 97 participants. All of them were examined by the HumphreyⓇ Field Analyzer (used as the gold standard) and the Palm Scan VF 2000Ⓡ Virtual Reality Visual Field Analyzer on the same day by the same examiner. We estimated the kappa statistic (including 95% confidence interval [CI]) as a measure of agreement between these two methods. The diagnostic test properties were assessed using sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). RESULTS: The sensitivity, specificity, PPV, and NPV for the Virtual Reality Visual Field Analyzer for the classification of individuals as glaucoma/non-glaucoma was 100%. The general agreement for the classification of glaucoma between these two instruments was 0.63 (95% CI: 0.56-0.78). The agreement for mild glaucoma was 0.76 (95% CI: 0.61-0.92), for moderate glaucoma was 0.37 (0.14-0.60), and for severe glaucoma was 0.70 (95% CI: 0.55-0.85). About 28% of moderate glaucoma cases were misclassified as mild and 17% were misclassified as severe by the virtual reality visual field analyzer. Furthermore, 20% of severe cases were misclassified as moderate by this instrument. CONCLUSION: The instrument is 100% sensitive and specific in detection of glaucoma. However, among patients with glaucoma, there is a relatively high proportion of misclassification of severity of glaucoma. Thus, although useful for screening of glaucoma, it cannot replace the HumphreyⓇ Field Analyzer for the clinical management in its current form.

Individual and Combined Effects of Diabetes and Glaucoma on Total Macular Thickness and Ganglion Cell Complex Thickness: A Cross-sectional Analysis.

Purpose: Presence of diabetes in glaucoma patients may influence findings while documenting the progression of glaucoma. We conducted the study to compare individual and combined effects of diabetes and glaucoma on macular thickness and ganglion cell complex thickness. Methods: The present study is a cross-sectional analysis of 172 eyes of 114 individuals. The groups were categorized according to the following conditions: glaucoma, diabetes mellitus, both glaucoma and diabetes (`both' group), and none of these conditions (`none' group). Patients with diabetes did not have diabetic retinopathy (DR). We compared retinal nerve fiber layer (RNFL) thickness, ganglion cell complex (GCC) thickness, foveal loss of volume (FLV), and global loss of volume (GLV) among the groups. We used random effects multivariate analysis to adjust for potential confounders. Results: The mean (SD) age of these individuals was 60.7 (10.1) years. The total average RNFL and GCC were significantly lower in the glaucoma group (RNFL: -36.27, 95% confidence intervals [CI]: -42.79 to -29.74; P < 0.05, and GCC: -26.24, 95% CI: -31.49 to -20.98; P < 0.05) and the `both' group (RNFL: -24.74, 95% CI: -32.84 to -16.63; P < 0.05, and GCC: -17.92, 95% CI: -24.58 to -11.26; P < 0.05) as compared with the `none' group. There were no significant differences in the average RNFL values and total average GCC between the diabetes group and the `none' group. The values of FLV and GLV were significantly higher in the `glaucoma' group and the `both' group as compared with the `none' group. The foveal values were not significantly different across these four groups. Among the glaucoma cases, 25% were mild, 30% were moderate, and 45% were severe; there was no significant difference in the proportion of severity of glaucoma between the `glaucoma only' and `both' groups (p=0.32). After adjusting for severity and type of glaucoma, there were no statistically significant differences in the values of average RNFL (6.6, 95% CI: -1.9 to 15.2; P=0.13), total average GCC (3.6, -95% CI: -2.4 to 9.6; P=0.24), and GLV (-3.9, 95% CI: -9.5 to 1.6; P=0.16) in the `both group' as compared with the glaucoma only group. Conclusion: We found that diabetes with no DR did not significantly affect the retinal parameters in patients with glaucoma. Thus, it is less likely that thickness of these parameters will be overestimated in patients with glaucoma who have concurrent diabetes without retinopathy.

Comparison of three newer generation freely available intraocular lens power calculation formulae across all axial lengths.

Purpose: The aim of this study is to evaluate the accuracy of three newer generation formulae (Barrett Universal II, EVO, Hill-RBF 2.0) for calculation of power of two standard IOLs-the Acrysof IQ and Tecnis ZCB00 across all axial lengths. Methods: In this retrospective series, 206 eyes of 206 patients, operated for cataract surgery with above two IOLs over the last 6 months, were included in the study. Preoperative biometry measurements were obtained from LenstarLS900. By using recommended lens constants, the mean error for each formula was calculated and compared. Then, the optimized IOL constants were calculated to reduce the mean error to zero. Mean and median absolute errors were calculated for all eyes and separately for short (AL<22.5 mm), medium (22.5-24.5 mm), and long eyes (>24.5 mm). Absolute errors and percentages of eyes within prediction errors of ±0.25 D, ±0.50 D, ±0.75 D, and ±1.00 D were compared. Results: Prediction error with using recommended lens constants was significantly lower in the Barrett Universal II formula as compared to the other two formulae. However, after optimizing lens constants, there were no significant differences in the absolute errors between the three formulae. The formulae ranked by mean absolute error were as follows: Barrett Universal II (0.304 D), EVO (0.317 D), and Hill-RBF (0.322) D. There were no significant differences between absolute errors in the three formulae in each of the short-, medium-, and long-eye subgroups. Conclusion: With proper lens constant optimization, the Barrett Universal II, EVO, and Hill-RBF 2.0 formulae were equally accurate in predicting IOL power across the entire range of axial lengths.

Comparison of Post-Cataract Surgery Visual Outcomes and Quality of Life in Patients Bilaterally Implanted with Multifocal Intraocular Lenses.

INTRODUCTION: The present study compared visual outcomes in eyes with bilateral implantation of two multifocal intraocular lenses (MFIOLs)-the Eyecryl™ ACTV diffractive multifocal IOL (group 1) and AcrySof® IQ ReSTOR® multifocal IOL (group 2). METHODS: This was a prospective, two-group observational longitudinal study of 118 eyes from 59 patients conducted at Laxmi Eye Institute, Panvel, India. We evaluated the patients at 1, 3, and 6 months. We assessed visual acuity, contrast sensitivity, higher-order aberrations, reading speed, defocus curve, stereopsis, quality of life (QOL), and adverse events in these participants. RESULTS: The median (interquartile range) best-corrected distance visual acuity was 0.18 (0, 0.18) in group 1 and 0.18 (0, 0.18) in group 2 at 1, 3, and 6 months; the difference was not statistically significant (p = 0.48). The binocular defocus curve in both groups showed two peaks at 0.0 to -0.5 D and at -2.5 D. The mean (95% confidence interval) critical print size was significantly different between groups 1 and 2 at low illumination (0.918 [0.905, 0.931] vs 1.154 [1.128, 1.180]; p = 0.004). Contrast sensitivity was significantly better in group 1 under mesopic conditions but not under scotopic conditions. Though total QOL did not differ significantly between groups, the psychosocial quality of life was significantly better in group 1. About 23% of patients in group 2 reported unwanted images, compared with 0% in group 1 (p = 0.01). CONCLUSION: We found that the Eyecryl and AcrySof groups were comparable for best-corrected visual acuity, photopic contrast sensitivity, defocus curve, reading parameters, stereopsis, and quality of vision. However, the Eyecryl group had better mesopic contrast and a lower proportion of unwanted images. Psychosocial quality of life was significantly better in the Eyecryl group; however, satisfaction was similar between groups. The cost of one of the lenses is less than the other. Thus, individuals with limited resources may opt for the Eyecryl™ ACTV, with similar visual outcomes.

Incision size changes after cataract surgery with intraocular lens implantation: comparison of 2 preloaded IOL implantation injectors.

PURPOSE: To compare incision size enlargement at different times of cataract surgery and visual outcomes after surgery in 2 different intraocular lens (IOL) delivery systems (Vivinex iSert and UltraSert Preloaded IOL Delivery System). SETTING: Tertiary care eye institution. DESIGN: Prospective nonrandomized comparison study. METHODS: All eyes had uneventful temporal clear corneal phacoemulsification cataract surgery. The surgery was done by standard direct horizontal chop with a bimanual irrigation aspiration of the cortex. The primary incision size was measured after clear corneal incision, after the completion of phacoemulsification, and after IOL implantation. RESULTS: The study comprised 276 eyes of 220 patients. The mean initial corneal incision was similar in both groups (2.2 mm). There was no significant difference in the mean incision size after phacoemulsification between the 2 groups (2.250 mm ± 0.068 mm [SD] vs 2.251 ± 0.066 mm [SD], P > .99). There was no significant difference in the mean (SD) incision size after IOL insertion between the 2 groups (2.367 ± 0.066 mm vs 2.369 ± 0.062 mm [SD], P = .815. The corrected distance visual acuity was 6/6 at 1 month in 80% of the participants in the UltraSert group and 86% in the Vivinex group. After adjusting for age, sex, grade of cataract, and IOL power, no significant difference was found in the magnitude of surgically induced astigmatism (SIA) in the Vivinex group compared with the UltraSert group (0.06, 95% CI, -0.11 to 0.24; P = .47). CONCLUSIONS: No significant difference was found in the change in the incision size, visual acuity, and SIA between UltraSert and Vivinex IOL delivery systems. This suggests that both IOL delivery systems are comparable in terms of post-IOL delivery incision enlargement for incisions of 2.2 mm.

Verion digital marking versus smartphone-assisted manual marking and isolated manual marking in toric intraocular lens implantation.

Purpose: To compare the accuracy of isolated manual marking and smartphone-assisted manual marking with the Verion image-guided system for toric intraocular lens (IOL) implantation. Methods: In this prospective observational study, 42 eyes of 36 patients planned for phacoemulsification with toric IOL implantation with corneal astigmatism >1D as measured on Lenstar LS 900 optical biometer were included. Patients were preoperatively registered and photographed on the Verion image-guided system. In the operating room, the patient's eye was manually marked at the 6 o' clock limbus (Manual axis-90°) on slit-lamp in sitting position. Next, using the smartphone android app-iToric Patwardhan, the exact mark axis was confirmed (Smartphone axis). Following this, the patient was taken on the operation table where the mark axis was confirmed with Verion digital overlay on an external screen (Verion axis). The absolute angular deviation of manual axis from Verion was compared with the absolute angular deviation of the smartphone axis from Verion as the primary outcome measure. Results: The mean absolute angular deviation between the smartphone axis and the Verion axis was 2.62°, which was significantly lower (P < 0.05) than that between the manual axis and Verion axis (4.60°). Moreover, the intraclass correlation coefficient between the smartphone axis and Verion axis was 0.88 indicating a strong agreement between the two. Conclusion: Smartphone-assisted manual marking significantly improves the accuracy of manual marking alone when comparing with the Verion Digital Marker system for toric IOL implantation.

A comparison of visual outcomes in three different types of monofocal intraocular lenses.

AIM: To compare the visual outcomes (distance and near) in patients opting for three different types of monofocal intraocular lens (IOL) (Matrix Aurium, AcrySof single piece, and AcrySof IQ lens). METHODS: The present study is a cross-sectional analysis of secondary clinical data collected from 153 eyes (52 eyes in Matrix Aurium, 48 in AcrySof single piece, and 53 in AcrySof IQ group) undergoing cataract surgery (2011-2012). We compared near vision, distance vision, distance corrected near vision in these three types of lenses on day 15 (±3) post-surgery. RESULTS: About 69% of the eyes in the Matrix Aurium group had good uncorrected distance vision post-surgery; the proportion was 48% and 57% in the AcrySof single piece and AcrySof IQ group (P=0.09). The proportion of eyes with good distance corrected near vision were 38%, 33%, and 15% in the Matrix Aurium, AcrySof single piece, and AcrySof IQ groups respectively (P=0.02). Similarly, The proportion with good "both near and distance vision" were 38%, 33%, and 15% in the Matrix Aurium, AcrySof single piece, and AcrySof IQ groups respectively (P=0.02). It was only the Matrix Aurium group which had significantly better both "distance and near vision" compared with the AcrySof IQ group (odds ratio: 5.87, 95% confidence intervals: 1.68 to 20.56). CONCLUSION: Matrix Aurium monofocal lenses may be a good option for those patients who desire to have a good near as well as distance vision post-surgery.