Secondary IOL implantation for an aphakic patient with congenital cataract living in Bonin Islands; follow-up study.

Introduction: We previously reported a case of a patient with bilateral congenital cataract identified in the Ogasawara village, Bonin Islands, Japan, on a visit by an ophthalmologist and describe its course over 17 years from initial surgery. Here, we report on a secondary intraocular lens (IOL) implantation that was subsequently performed at 22 years and 5 months of age. Methods: After cataract surgery at 7 months, the aphakic patient began amblyopia treatment using extended-wear soft contact lenses (SCLs). After 10 years of age, SCLs were chosen to achieve crossed monovision considering the cosmetic appearance when facing other people. At 22 years of age, a secondary IOL implantation was performed. Secondary implant in the patient considered appearance and postoperative vision without glasses, we selected the crossed monovision method using a monofocal IOL. The postoperative targeted refraction for the right (non-dominant eye) and left eyes (dominant eye) planed - 0.33D and - 2.25D, respectively. Results: At 3 months after surgery, the corrected distance visual acuity (CDVA) with IOLs for the right and left eyes was 20/16 and 20/60, respectively, and the binocular visual acuity was 20/16 for distant vision and 20/25 for near vision. The CDVA for the right eye was: 20/13 × IOL = sph-0.25D and that for the left eye was: 20/13 × IOL = sph -1.75D D/cyl -0.50D/Ax170°. Although the exotropia was complicated by dissociated horizontal deviation and dissociated vertical deviation, there were no significant changes in ocular position before and after surgery. The patient was satisfied with achieving independence from spectacles and SCLs. Conclusion: The use of the crossed monovision method with monofocal IOLs in this patient and defective binocular function created a visual environment with no inconvenience in everyday life after secondary IOL implantation. In terms of secondary implant after amblyopia treatment, the IOL type or postoperative targeted refraction must be chosen to maintain or improve the visual environment obtained with the amblyopia treatment.

The Global Leadership Mentoring Community: An evaluation of its impact on nursing leadership.

AIM: To evaluate a year-long mentorship program, pairing nurses from different regions across the world to support their global leadership capability, and identifying additional consequences of their participation. BACKGROUND: Investment in developing nurse leaders continues as a strategic global imperative. Building on the first cohort's recommendations, this second program illustrates continued progress. PROGRAM EVALUATION: Using the logic model of program evaluation, this non-empirical paper uses data collected from anonymized questionnaires and participants' stories to help improve the program, illustrating innovative practices to develop the confidence and competence of emerging and established nurse leaders globally. DISCUSSION: The value of mentorship was recognized, and there were gains for both mentors and mentees in the development of leadership confidence and competence. Through engagement and collaboration with the whole community, participants were encouraged to understand their own and others' cultures avoiding assumptions and stereotypes. CONCLUSION: This evaluation illustrates that in addition to helping improve future programs, mentorship has enabled the growth of individuals' skill sets and the confidence to reach out to peers across the world to understand the meaning of global health and to make a meaningful contribution to the challenges they face. IMPLICATIONS FOR NURSING PRACTICE: Nurse managers should be encouraged to develop and formalize a mentoring culture to benefit the leadership competence and well-being of their workforce. IMPLICATIONS FOR NURSING POLICY: Every nurse has a responsibility to invest in nursing leadership for themselves and others. Mentorship can assist nurse leaders to build workforce capability to lead and contribute to the policy agenda locally, nationally, and internationally. Starting early and at the individual level, global mentorship programs can develop leadership expertise to help nurses find their voice and strengthen their confidence and competence to lead and therefore build the strategic leaders of the future.

Evaluation of Eye Alignment before and after Cataract Surgery.

Purpose: To assess changes in eye alignment before and after cataract surgery.Subjects and methods: The medical records of 786 cataract patients without eye movement limitation who underwent bilateral cataract surgery under topical anesthesia with monofocal IOL placement were retrospectively reviewed at the Eye Center of Sanno Hospital in Japan.Results: Before cataract surgery, 121 of the 786 patients (15.4%) had constant strabismus, 263 (33.5%) had intermittent strabismus, and 402 (51.1%) had phoria. Among the 121 patients with constant strabismus on the preoperative exam, 64 (52.9%) had exotropia without vertical strabismus, 7 (5.8%) had esotropia without vertical strabismus, and 6 (5.0%) had vertical strabismus without a horizontal component. After surgery, 98 of the 786 patients (12.5%) had constant strabismus, 126 (16.0%) had intermittent strabismus, 562 (71.5%) had phoria. The rate of eye alignment agreement before and after surgery was 72.3% overall. We found that 17 patients (2.2%) who did not have constant strabismus preoperatively developed constant strabismus postoperatively, and all of these patients experienced binocular diplopia. Characteristics of patients at risk for constant strabismus and diplopia postoperatively included patients with vertical deviation preoperatively (intermittent or phoria).Conclusions: Uncomplicated cataract surgery under topical anesthesia did not influence eye alignment classification in 72.3% of patients; however, patients with vertical deviation preoperatively were more likely to transition to constant strabismus after surgery.

Developing competencies in genetics nursing: Education intervention for perinatal and pediatric nurses.

Nurses need to be appropriately trained in genetics to provide clinical care based on best practice for patients and families. This exploratory study describes an educational intervention using authentic stimulus material centered on a clinical case study of a family with a baby with Down syndrome. Quantitative and qualitative data were collected from a sample of 15 nurses and 27 students from three universities in Japan before and after completing an entry-level workshop on competency-based genetics nursing. Participants reported increased perceived genetics knowledge and clinical confidence. Despite more than 90% of the participants reporting that they understood the underlying genetics knowledge, their confidence and the ethical aspects of genetics nursing had not been promoted after the seminar. In contrast, the reflections, coded into three categories, showed they recognized families' needs for psychological support, family decision making, and protection and privacy and suggested that nurses had undergone a profound shift in understanding about these issues. Although indicating that a single seminar was insufficient, the study findings will be useful to develop educational materials on genetics for both students and nurses.

Biometry: a tool for the detection of amblyopia risk factor in children.

PURPOSE: To determine optical biometry data criteria for the detection of abnormal refraction in preschool children, and to evaluate the accuracy of these criteria for detecting amblyopia refractive risk factor (ARF), as defined in the 2013 guidelines of the American Association for Pediatric Ophthalmology and Strabismus (AAPOS). METHODS: The present study included 200 eyes of 100 preschool children with normal eyes for the experimental determination of criteria and 142 eyes of 71 preschool children for validation of these criteria. Statistical data from normal eyes were used to determine both "high sensitivity failure criterion" and "high specificity failure criterion" associated with corneal astigmatism, interocular difference in axial length, and the prediction interval of a regression formula for predicting corneal power from axial length. Ophthalmological examination of children for validation included testing cycloplegic refraction and optical biometry testing. Outcomes from optical biometry criteria were compared with determination via ophthalmological examination, and the accuracy of the criteria for detecting ARF was evaluated. RESULTS: Sensitivity of the "high sensitivity failure criterion" for detecting 2013 AAPOS ARF was 100%, while the specificity was 80.5%. The sensitivity of the "high specificity failure criterion" was 93.3%, while the specificity was 95.1%. CONCLUSIONS: The criteria derived from optical biometry data in this study exhibited excellent sensitivity and specificity for detecting ARF. This study may lead to a new approach to vision screening in preschool children.

The Repeatability of Values Measured Using the Spot Vision Screener in Healthy Children and Children with Refractive Errors.

Purpose: To determine the repeatability of refractive values measured using the Spot vision screener in healthy children and children with refractive errors. Methods: This cross-sectional study included 170 eyes of 85 healthy children (normal group), and 50 eyes of 25 children wearing spectacles for refractive errors (spectacles group). The spherical equivalent value, cylindrical value, and inter-ocular differences in the spherical equivalent values were analyzed. The repeatability of the refractive values measured using the Spot vision screener was determined using intra-class correlation coefficients (ICCs) and 95% limits of agreement. Results: In the normal group, ICC values for the spherical equivalent value, cylindrical value, and amount of anisometropia were 0.77, 0.80, and 0.64, respectively. In the spectacles group with spectacles they were 0.89, 0.67, and 0.78, respectively. In the spectacles group without spectacles they were 0.96, 0.78, and 0.97, respectively. The 95% limits of agreement between consecutive measurements for the spherical equivalent value, cylindrical value, and amount of anisometropia were within ±1.00 D in the normal group and the spectacles group with spectacles, and over ±1.00 D in the spectacles group without spectacles. Conclusions: The Spot vision screener can ensure better than moderate repeatability with and without spectacles.

Prediction of pupil size under binocular open-view settings using the new CASIA2 device.

PURPOSE: Pupillometry should be performed under conditions as close to natural viewing as possible. The present study aimed to determine whether pupil size in binocular open-view settings can be predicted based on pupil size measured using the CASIA2 device. METHODS: The present study included 61 participants (25 men and 36 women; mean age, 49 ± 15 years; age range, 22-69 years) with no history of ophthalmic disease other than refractive errors and cataract. We measured pupil size using the new CASIA2 device and a binocular open-view digital pupillometer (FP-10000II, TMI Co., Ltd., Saitama). Intra-class and inter-class reliabilities were evaluated by measuring pupil times three times with each device (two independent examiners) in 21 of the 61 participants. Reproducibility was analyzed using intra-class and inter-class correlation coefficients (ICCs). Regression formulae for calculating FP10000II pupil size based on CASIA2 pupil size were developed via simple linear regression analyses. RESULTS: Both devices exhibited high ICC values (> 0.80). The regression formulae for calculating the FP10000II pupil size for the distant and near views based on CASIA2 pupil size were y = 0.5702x + 0.4611 (determination coefficient, 0.67) and y = 0.502x + 0.445 (determination coefficient, 0.64), respectively. CONCLUSIONS: Pupil size under binocular open-view settings can be predicted based on simultaneous measurement of pupil size during evaluation of the anterior segment using the CASIA2 device. The calculated pupil size may represent a useful index for determining the most appropriate treatment strategy in candidates for cataract and refractive surgery.

Differences in the Stimulus Accommodative Convergence/Accommodation Ratio using Various Techniques and Accommodative Stimuli.

PURPOSE: To investigate differences in the stimulus accommodative convergence/accommodation (AC/A) ratio using various techniques and accommodative stimuli, and to describe a method for determining the stimulus AC/A ratio. METHODS: A total of 81 subjects with a mean age of 21 years (range, 20-23 years) were enrolled. The relationship between ocular deviation and accommodation was assessed using two methods. Ocular deviation was measured by varying the accommodative requirement using spherical plus/minus lenses to create an accommodative stimulus of 10.00 diopters (D) (in 1.00 D steps). Ocular deviation was assessed using the alternate prism cover test in method 1 at distance (5 m) and near (1/3 m), and the major amblyoscope in method 2. The stimulus AC/A ratios obtained using methods 1 and 2 were calculated and defined as the stimulus AC/A ratios with low and high accommodation, respectively, using the following analysis method. The former was calculated as the difference between the convergence response to an accommodative stimulus of 3 D and 0 D, divided by 3. The latter was calculated as the difference between the convergence response to a maximum (max) accommodative stimulus with distinct vision of the subject and an accommodative stimulus of max minus 3.00 D, divided by 3. RESULTS: The median stimulus AC/A ratio with low accommodation (1.0 Δ/D for method 1 at distance, 2.0 Δ/D for method 1 at near, and 2.7 Δ/D for method 2) differed significantly among the measurement methods (P < 0.01). Differences in the median stimulus AC/A ratio with high accommodation (4.0 Δ/D for method 1 at distance, 3.7 Δ/D for method 1 at near, and 4.7 Δ/D for method 2) between method 1 at distance and method 2 were statistically significant (P < 0.05), while method 1 at near was not significantly different compared with other methods. CONCLUSIONS: Differences in the stimulus AC/A ratio value were significant according to measurement technique and accommodative stimuli. However, differences caused by measurement technique may be reduced by using a high accommodative stimulus during measurements.

Evaluation of visual function in preschool-age children using a vision screening protocol.

PURPOSE: To evaluate the relationship between uncorrected visual acuity and refraction and binocular function using a vision screening protocol. METHODS: In total, 760 children (3-6 years old) who were enrolled in 4 nursery schools in Otawara, Japan, were recruited; a total of 1,520 eyes were examined. We assessed uncorrected near visual acuity, manifest refraction, stereopsis, and eye position. Subjects were divided into 4 subgroups according to the lowest uncorrected near visual acuity value compared between the 2 eyes: group 1 (visual acuity [VA] ≤0.00 [logarithm of the minimum angle of resolution]), group 2 (VA 0.15-0.05), group 3 (VA 0.52-0.22), and group 4 (VA >0.52). These parameters were compared among the groups. RESULTS: The sample number of each of the 4 sub-groups was as follows: group 1, 608; group 2, 114; group 3, 27; and group 4, 11. The median spherical equivalent values were -1.13 diopter (D) in group 1 and -1.00 in group 2, which were more myopic than group 4. Median cylindrical power in group 1 was 0.25 D, and was the lowest among all groups. In group 1, median anisometropia was 0.38 D and median corneal astigmatism value was 1.13 D; both values were lowest in group 1. With regard to binocular function, 89.6% of the subjects in group 1 had 60 arcseconds or better in near stereopsis and 98.8% had no detectable strabismus, which were significantly different from the findings in the other groups. The percentage of subjects in group 1 who had 80 arcseconds or worse in near stereopsis was 10.4%. In contrast, 90.9% of the subjects in group 4 had 80 arcseconds or worse in near stereopsis, and 18.2% had intermittent or manifest strabismus. CONCLUSION: We suggest that examination of refraction and stereopsis in preschool-age children undergoing vision screening is an important supplement to visual acuity testing.

Etiology and outcomes of secondary surgical intervention for dissatisfied patients after pseudophakic monovision.

PURPOSE: To evaluate the etiology and the clinical outcomes of secondary surgical interventions for dissatisfied patients after pseudophakic monovision. SETTING: Department of Ophthalmology, Kitasato University Hospital, Kanagawa, Japan. DESIGN: Retrospective case series. METHODS: This study comprised 12 eyes in 12 patients (age 66.2 ± 5.6 years) who underwent photorefractive keratectomy (PRK) enhancement to improve their dissatisfaction after pseudophakic monovision. We quantitatively assessed the visual and refractive outcomes and the subjective satisfaction measured using a visual analog scale, that ranged from 0 (very dissatisfied) to 10 (very satisfied), before and 3 months after PRK enhancement. RESULTS: Six (50%) of the 12 patients were dissatisfied with their various distance visions because of a large amount of anisometropia (≥2.50 D). Two (16.7%) were dissatisfied with their distance vision after conventional monovision because of residual cylindrical errors (≥0.75 D) in the dominant eye. Three (25%) was an unknown origin. The remaining one of the 12 patients was dissatisfied due to the unadaptability to crossed monovision. Eleven (91.7%) eyes were within ±0.5 D of the targeted correction after PRK enhancement. The overall satisfaction score was significantly improved, from 3.7 ± 2.4 (range 0-7) preoperatively to 6.0 ± 2.4 (range 2-9) postoperatively (p = 0.02). No vision-threatening complications were seen throughout the observation period. CONCLUSIONS: PRK enhancement was effective with predictable refractive results and thus improved patient satisfaction for dissatisfied patients after pseudophakic monovision. These findings also suggest that the accurate correction of refractive errors plays a key role in successful pseudophakic monovision.

Food allergy response capabilities of mothers and related factors.

A parent's ability to confidently manage a child's food allergy (i.e. food allergy response capability) is considered instrumental toward treating this disorder; however, little is known regarding this measure and associated factors. A questionnaire survey among 280 qualified participants identified the greatest food allergy response capability as "spousal collaboration", followed by "elimination diet capacity", "gathering information from medical professionals", "knowledge about food allergies", and "stress coping". These capabilities were associated with maternal and household health status, food items eliminated and their number, anaphylaxis experience, and type of medical facility used. This measure represented a predictor of maternal quality of life and health status, household health status, and overall life stress (not related to childrearing). Thus, to improve food allergy response capability, multidisciplinary cooperation and support are required from professionals, such as physicians, nurses, nutritionists, and clinical psychologists. Nurses in particular must take an interest in the situations these mothers face and in their emotions; elicit their power to cope with stress; provide knowledge about food allergies; provide individualized, specific information about elimination diets; and conduct interventions to enable spousal cooperation.

Association Between Ocular Dominance and Anisometropic Hyperopia.

INTRODUCTION AND PURPOSE: Anisometropia, a relative difference in the refractive state of the two eyes, is common in hyperopic patients. We investigated the association between ocular dominance (sighting dominance) and refractive asymmetry in patients with hyperopia. METHODS: This retrospective study included 223 hyperopic patients with a mean age of 10.1 ± 3.6 years (range 3 to 21 years). Refractive error was measured with cycloplegic refraction, and axial length was measured with IOLMaster® (Carl Zeiss Meditec, Dublin, CA). Ocular dominance was assessed with the hole-in-the-card test. The amount of hyperopic anisometropia was subdivided into four groups: less than 0.50 D, 0.50-0.99 D, 1.00-1.99 D, and 2.00 D or greater. RESULTS: Ocular dominance of the right and left eye was seen in 66% and 34% of the patients, respectively. The nondominant eye had higher hyperopia, astigmatism, and shorter axial length than the dominant eye (P < 0.001). In the group with spherical equivalent anisometropia of ≥0.50 D in particular, the nondominant eye was significantly more hyperopic and had shorter axial length than the dominant eye (both P < 0.001). CONCLUSIONS: The current study revealed that the nondominant eye had a greater hyperopic refractive error and shorter axial length than the dominant eye, in patients who had a high degree of anisometropia in particular.

[Epidemiological Study of Poor Visual Acuity among Schoolchildren in Bonin Islands].

PURPOSE: To investigate the change in uncorrected visual acuity (UCVA) among schoolchildren in Bonin Islands. SUBJECTS AND METHODS: UCVA of schoolchildren aged 6 to 14 years, was collected from reports of School Health Examination Surveys conducted from 1981 to 2012. The proportion of schoolchildren with poor UCVA in the Bonin Islands was compared with those in metropolitan Tokyo. The results in Bonin Islands were also divided into two groups, before- and after-1996 when terrestrial television broadcasting service has been started, and the data of those two groups were compared. RESULTS: The proportion of schoolchildren with poor UCVA in Bonin Islands was lower than that in Tokyo. Among the residents of Bonin Islands, the proportion of schoolchildren with UCVA of < 1.0 was higher in the after-1996 group than in the before- 1996 group, with a clear increase in schoolchildren with poor UCVA after 1996 (p < 0.01, Fisher's exact test), examined among the 4th grade of elementary school or above. After 1996, 26.6% of first graders at a public junior high school had poor UCVA of < 0.7, whereas before 1996 no such case could be detected. CONCLUSION: The present study revealed that the proportions of schoolchildren with poor UCVA in Bonin Islands was lower than that in Tokyo; but in the residents of Bonin Islands after 1996, the proportion of the schoolchildren with poor UCVA increased.

Experiences regarding maternal age-specific risks and prenatal testing of women of advanced maternal age in Japan.

The number of pregnant women of advanced maternal age has increased worldwide. Women in this group have an increased chance of fetal abnormality. To explore Japanese women's experiences regarding maternal age-specific risks and prenatal testing, we conducted a descriptive qualitative study. Semi-structured interviews were conducted with 16 women aged 35 years or over who had given birth within the previous three months to a healthy, term infant. Thematic analysis of transcribed interview data was performed and three major themes were identified: inadequate understanding of genetic risks; insufficiently informed choice regarding prenatal testing; and need for more information from health professionals. Some participants were not aware of maternal age-specific risks to the fetus. Many took their cues from health professionals and did not raise the topic themselves, but would have considered prenatal testing if made aware of the risks. Nurses, midwives and other health professionals need to adequately inform pregnant women about the genetic risks to the fetus and offer testing at an appropriate stage early in the pregnancy.

Evaluation of Sensory Dominance Using Binocular Rivalry as Related to Ocular Deviations.

INTRODUCTION AND PURPOSE: To investigate the relationship between sensory dominance and ocular deviations. PATIENTS AND METHODS: Sixty-three patients were evaluated with a new device for the measurement of exclusive visibility during binocular rivalry. The patients were consisted of twenty-three with exotropia (XT), twenty with intermittent exotropia [X(T)], twenty with exophoria (XP), respectively. Device is composed of two retinometers, their holders in which angle and position can be adjustable and a PC for data storage and analysis. In each of eyes, exclusive visibility of one stimulus during binocular rivalry was measured for 60 sec, and the strength of ocular dominance was evaluated by the difference of exclusive visibility between dominant and nondominant eye. RESULTS: The difference of exclusive visibility time between dominant and nondominant eye were 9.8±3.7 sec in the XT group, 6.1±4.1 sec in the X(T) group and 2.2±1.5 sec in the XP group, respectively. There were significant differences between XT and X(T) (P<0.01) as well as between XT and XP (P<0.001). CONCLUSIONS: The present result indicates that sensory dominance was obviously influenced by ocular deviations since exclusive visibility of dominant eye was prolonged with decreasing the opportunity of normal binocular vision such as XT or X(T).

Binocular function in patients with pseudophakic monovision.

PURPOSE: To evaluate the relationship between ocular deviation and stereopsis and fusion in patients who had pseudophakic monovision surgery. SETTING: Department of Ophthalmology, Kitasato University Hospital, Kanagawa, Japan. DESIGN: Retrospective comparative case series. METHODS: Patients had surgical monovision correction with monofocal intraocular lens placement followed by routine postoperative examinations. The alternate prism cover test was used to measure motor alignment. Sensory tests for binocularity included sensory fusion determinations using the Worth 4-dot test, near stereopsis test, and fusion amplitude measured with a prism bar. Patients with monovision were categorized as having small-angle exophoria (≤10.0 prism diopters [Δ]) or moderate-angle exophoria (>10.0 Δ). RESULTS: This study comprised 60 patients with a mean age of 70.2 years ± 7.7 (SD). The difference in the mean stereopsis values between patients with small-angle exophoria and patients with moderate-angle exophoria was statistically significant (P<.001). In the moderate-angle exophoria group, 10 patients (62.5%) developed intermittent exotropia after surgery; however, no serious ocular deviation problems were observed. The fusion amplitudes in patients with pseudophakic monovision were approximately similar to normal values. Patients with moderate-angle exophoria were more likely to fail the Worth 4-dot test than those with small-angle exophoria. CONCLUSIONS: In patients with pseudophakic monovision having a near exophoria angle of more than 10.0 Δ, the possibility of changes in ocular deviation and stereopsis after surgery is a concern. Moreover, the application of monovision in patients with a previous moderate-angle exophoria should be carefully considered. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Association between ocular dominance and refractive asymmetry.

PURPOSE: To investigate the association between ocular dominance (sighting dominance) and refractive asymmetry in phakic patients. METHODS: This retrospective study included 3,012 patients with a mean age of 29.0 ± 5.3 years (range: 20 to 39 years). Refractive error was determined with cycloplegic refraction and axial length was determined with IOLMaster (Carl Zeiss Meditec, Dublin, CA). Ocular dominance was assessed using the hole-in-the-card test. RESULTS: The right and left eyes were dominant in 77.7% and 22.3% of the patients, respectively. In the high anisometropia group (⩾ 2.0 diopters), the non-dominant eyes had significantly higher myopic spherical equivalents and longer axial lengths than the dominant eyes (P < .05). However, there were no significant differences in these parameters in the low anisometropia group. CONCLUSION: The current study revealed that non-dominant eyes had a greater myopic refractive error and longer axial length than the dominant eyes, especially in the patients who had high amounts of anisometropia.

Five-year follow-up of ocular deviation in bilaterally pseudophakic patients.

PURPOSE: To investigate long-term ocular deviation in patients who had undergone implantation of a monofocal intraocular lens (IOL) in both eyes. METHODS: Eighty-eight patients with exophoria (average age, 68 ± 8 years; average axial length, 23.9 ± 0.9 mm) scheduled for bilateral phacoemulsification and monofocal IOL implantation were recruited. Before surgery and at 1, 3, and 6 months and 1, 2, 3, 4, and 5 years after surgery, we assessed ocular deviation near stereopsis in patients wearing their normal spectacles. RESULTS: At 5 years after surgery, near stereopsis had a median value of 50 arcsec and the mean stereopsis was 85.8 ± 101.8 arcsec; 85 patients (85%) had good stereopsis (ie, ≥100 arcsec). Of the total patients, 12.5% shifted from exophoria to intermittent strabismus or exotropia at near vision, and near stereopsis decreased. Most of them had a preoperative near exophoria angle of more than 12 prism diopters. CONCLUSION: In bilaterally pseudophakic patients with a near exophoria angle of more than 12 prism diopters, we should be concerned about the possibility of variations in ocular deviation and stereopsis after cataract surgery.

Five-year clinical study of patients with pseudophakic monovision.

PURPOSE: To assess the long-term clinical outcomes and acceptability of pseudophakic monovision. SETTING: Department of Ophthalmology, Kitasato University Hospital, Kanagawa, Japan. DESIGN: Case series. METHODS: Patients who had surgery using the monovision method with monofocal intraocular lenses had routine postoperative examinations. Assessed were visual acuity, near stereopsis, ocular deviation, patient satisfaction, and the rate of spectacle dependence preoperatively and 1, 3, and 6 months and 1, 2, 3, 4, and 5 years postoperatively. RESULTS: The study enrolled 54 patients with a mean age of 74.7 years ± 7.9 (SD). The mean difference in the spherical equivalent refractive error between eyes of each patient was 2.13 diopters. The binocular uncorrected distance visual acuity was at least 0.10 logMAR in 98% of patients, with 76% achieving Jaeger 2 or better binocular uncorrected near visual acuity. Near stereopsis in patients who shifted from exophoria to intermittent exotropia decreased, although no serious problems were observed. The rate of spectacle dependence was 88% preoperatively, 41% at 1 year, and 22% at 5 years. Patient satisfaction improved gradually during the follow-up. CONCLUSION: Pseudophakic monovision was an effective approach for correcting presbyopia throughout the 5-year observation period; however, a longer follow-up, including further studies is necessary to allow selection of appropriate patients. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.