Exploring the effect of hypertension on retinal microvasculature using deep learning on East Asian population.

Hypertension is the leading risk factor of cardiovascular disease and has profound effects on both the structure and function of the microvasculature. Abnormalities of the retinal vasculature may reflect the degree of microvascular damage due to hypertension, and these changes can be detected with fundus photographs. This study aimed to use deep learning technique that can detect subclinical features appearing below the threshold of a human observer to explore the effect of hypertension on morphological features of retinal microvasculature. We collected 2012 retinal photographs which included 1007 from patients with a diagnosis of hypertension and 1005 from normotensive control. By method of vessel segmentation, we removed interference information other than retinal vasculature and contained only morphological information about blood vessels. Using these segmented images, we trained a small convolutional neural networks (CNN) classification model and used a deep learning technique called Gradient-weighted Class Activation Mapping (Grad-CAM) to generate heat maps for the class "hypertension". Our model achieved an accuracy of 60.94%, a specificity of 51.54%, a precision of 59.27%, and a recall of 70.48%. The AUC was 0.6506. In the heat maps for the class "hypertension", red patchy areas were mainly distributed on or around arterial/venous bifurcations. This indicated that the model has identified these regions as being the most important for predicting hypertension. Our study suggested that the effect of hypertension on retinal microvascular morphology mainly occurred at branching of vessels. The change of the branching pattern of retinal vessels was probably the most significant in response to elevated blood pressure.

Unilateral ectasia after small-incision lenticule extraction.

A 23-year-old man developed unilateral corneal ectasia after bilateral small-incision lenticule extraction (SMILE). The preoperative corneal topography was normal, with a minimum corneal thickness of 582 µm and 586 µm in the right eye and left eye, respectively. The refractive correction was -3.00 diopters (D) sphere in the right eye and -3.50 D sphere in the left eye. At the 12-month postoperative visit, corneal topography showed early signs of ectasia in the right eye; the ectasia had deteriorated by the 15-month examination. Corneal crosslinking was performed to arrest further progression. At the last examination, the uncorrected distance visual acuity in the right eye was 0.1 logarithm of the minimum angle of resolution (logMAR) and the corrected distance visual acuity, -0.1 logMAR.

Investigating the impact of preoperative corneal astigmatism orientation on the postoperative spherical equivalent refraction following intraocular lens implantation.

BACKGROUND: To investigate the impact of the orientation of preoperative corneal astigmatism on achieving the postoperative target refraction following monofocal intraocular lens (IOL) implantation. METHODS: This study enrolled 339 eyes who had uneventful cataract surgery or refractive lens exchange (RLE) with subsequent monofocal IOL implantation. Eyes were initially categorized dependent upon axial length and then on the orientation of preoperative anterior corneal astigmatism. Group 1 had against-the-rule (ATR) anterior corneal astigmatism, group 2 had with-the-rule (WTR) anterior corneal astigmatism, and group 3 had oblique (OB) anterior corneal astigmatism. The preoperative corneal astigmatism was determined by the IOLMaster (Carl Zeiss Meditec AG). Postoperative refraction was completed for all eyes, and the results were calculated and compared for the separate groups. RESULTS: In eyes with axial lengths greater than 22.0 mm and less than 25.0 mm there was a significant difference between the magnitude of preoperative corneal astigmatism between groups 2 and 3 with 0.827 ± 0.376 D in group 2, and 0.677 ± 0.387 D in group 3. The mean postoperative spherical equivalent (SE) prediction error was - 0.132 ± 0.475 D in group 1, 0.026 ± 0.497 D in group 2, and - 0.130 ± 0.477 D in group 3. There was a significant difference between groups 1 and 2. There was no significant difference in the magnitude of preoperative corneal astigmatism and postoperative SE prediction error between the anterior corneal astigmatism orientation groups in eyes with axial lengths of less than or equal to 22.0 mm and greater than or equal to 25.0 mm. CONCLUSIONS: The orientation of preoperative anterior corneal astigmatism significantly affected the postoperative biometry prediction error in eyes with astigmatism of 1.75 D or less in eyes with the axial length between 22.0 mm and 25.0 mm. However, the results were not clinically significant.

Pupil influence on the quality of vision in rotationally asymmetric multifocal IOLs with surface-embedded near segment.

PURPOSE: To evaluate the influences of preoperative pupil parameters on the visual outcomes of the SBL-3, a rotationally asymmetric multifocal intraocular lens (IOL) with a surface-embedded near segment. SETTING: Cathedral Eye Clinic, Belfast, Northern Ireland, United Kingdom. DESIGN: Retrospective comparative case series. METHODS: Postoperatively, patients divided into 4 groups according to their pupil size as follows: Group A: 2.50 to 2.99 mm, Group B: 3.00 to 3.50 mm, Group C: 3.51 to 4.00 mm, and Group D: 4.01 to 4.50 mm. The uncorrected distance (UDVA), intermediate (UIVA), and near (UNVA) visual acuities, IOL centration and tilt, and quality of vision (QoV) questionnaires were compared between the 4 groups for 18 months postoperatively. RESULTS: The study comprised 90 patients (180 eyes). The mean preoperative pupil (photopic and mesopic) diameter was 4.3 mm ± 0.3 (SD) and 5.6 ± 1.4 mm, respectively, which decreased to 3.8 ± 0.7 mm and 4.9 ± 1.2 mm, respectively, at 18 months. Eighteen months postoperatively, both photopic and mesopic pupil groups had a statistically significant reduction in size from preoperative levels. No significant differences in UDVA, UIVA, and UNVA were found between the groups (P > .001). Significant differences in the QoV questionnaire day scores and night scores were found between the 4 groups (P < .001). CONCLUSIONS: The rotationally asymmetric multifocal IOL provided excellent optical performance during 18-months follow-up. The preoperative photopic pupil is an important parameter for consideration of this type of IOL because smaller pupils have a significant negative subjective impact on QoV.

Visual quality and performance comparison between 2 refractive rotationally asymmetric multifocal intraocular lenses.

PURPOSE: To compare the 12-month postoperative quality of vision and visual performance of 2 different refractive rotationally asymmetric multifocal intraocular lenses (IOLs). SETTING: Cathedral Eye Clinic, Belfast, Northern Ireland, United Kingdom. DESIGN: Retrospective case series. METHODS: Refractive lens exchange (RLE) patients were divided into 2 groups. Group A comprised eyes receiving a Lentis Mplus LS-312 MF30 IOL and Group B, eyes receiving a Lenstec SBL-3 IOL. Refraction, uncorrected (UDVA) and corrected distance visual acuities, uncorrected intermediate (UIVA) and near (UNVA) visual acuities, distance-corrected intermediate and near (DCNVA) visual acuities, and quality of vision were evaluated preoperatively and up to 12 months postoperatively. RESULTS: Each group comprised 90 eyes. Both groups had a high level of quality of vision 12 months postoperatively with no significant difference between the 2 groups (P = .919). There was no significant between-group difference in mean monocular and binocular UDVA, monocular UIVA, or monocular UNVA. Group B had statistically significantly better mean monocular DCNVA (P = .049), binocular UNVA (P = .011), and binocular DCNVA (P = .035). Group B had a higher percentage of complete spectacle independence. CONCLUSIONS: Both refractive rotationally asymmetric multifocal IOLs provided an excellent level of quality of vision 12 months postoperatively. Both IOL models restored distance, intermediate, and near visual function; however the IOLs in Group B provided better near visual performance.

Visual outcomes and patient satisfaction 3 and 12 months after implantation of a refractive rotationally asymmetric multifocal intraocular lens.

PURPOSE: To assess the 3-month and 12-month postoperative visual performance and subjective patient satisfaction after refractive lens exchange (RLE) with implantation of a rotationally asymmetric multifocal intraocular lens (IOL). SETTING: Cathedral Eye Clinic, Belfast, United Kingdom. DESIGN: Prospective case series. METHODS: The refraction, uncorrected (UDVA) and corrected distance visual acuities, uncorrected intermediate (UIVA) and near (UNVA) visual acuities, distance-corrected intermediate and near visual acuities, and a quality of vision (QoV) questionnaire were evaluated 3 months and 12 months after implantation of an SBL-3 IOL. RESULTS: The study enrolled 100 eyes of 50 patients. The mean monocular UDVA was -0.02 logarithm of minimum angle of resolution (logMAR) ± 0.12 (SD) 3 months postoperatively and -0.01 ± 0.10 logMAR at 12 months (P = .393). The mean monocular UIVA was 0.39 ± 0.11 logMAR and 0.41 ± 0.12 logMAR, respectively (P = .06). The mean monocular UNVA was 0.12 ± 0.13 logMAR and 0.14 ± 0.12 logMAR, respectively (P = .077). The mean QoV score was 8.26 ± 1.16 at 3 months with a significant improvement at 12 months, at which time the mean QoV score was 8.84 ± 1.08 (P ≤ .001). CONCLUSIONS: This asymmetric multifocal IOL provided excellent unaided vision with no significant difference in near, intermediate, and distance vision 3 months and 12 months postoperatively. However, there was a significant improvement in subjective outcomes at the second postoperative assessment, during which patients reported a significantly better QoV score and less blurred vision.

Rotationally asymmetric multifocal intraocular lenses: preoperative considerations and postoperative outcomes.

PURPOSE OF REVIEW: The manuscript presents a review of recently published studies reporting objective and subjective outcomes and preoperative considerations of asymmetrical multifocal intraocular lenses (IOLs). RECENT FINDINGS: Current publications suggest that asymmetrical multifocal IOLs provide good, distance, intermediate and near vision for cataract and clear lens extraction patients. The contrast sensitivity achieved is similar to monofocal IOLs. Photopic phenomenon such as glare and halos has been reduced through the use of these IOLs leading to better patient satisfaction. Centration plays a critical role and the lack of a gold standard assessment tool has led to a minority of patients experiencing lower quality of vision and side-effects such as glare and hazy vision. The frequency of dissatisfied patients can be minimized by appropriate patient selection. This is achieved by assessing pupil parameters which guides the surgeon to align the IOL accordingly. SUMMARY: Asymmetric multifocal IOLs provide the surgeon with an IOL that achieves excellent visual and refractive outcomes enabling patients to see clearly at a range of distances. Subjectively patients report low levels of photopic phenomena and high levels of spectacle independence resulting in high overall patient satisfaction.

Comparison of the visual performance and quality of vision with combined symmetrical inferonasal near addition versus inferonasal and superotemporal placement of rotationally asymmetric refractive multifocal intraocular lenses.

PURPOSE: To compare the postoperative quality of vision between different bilateral placements of near segments of rotationally asymmetric refractive multifocal intraocular lenses (IOLs) and to determine how this affects visual performance. SETTING: Cathedral Eye Clinic, Belfast, Northern Ireland, United Kingdom. DESIGN: Retrospective comparative case series. METHODS: The study enrolled consecutive patients having refractive lens exchange and implantation of rotationally asymmetric multifocal IOLs. Group 1 received bilateral SBL-3 IOLs and Group 2 received bilateral Lentis Mplus LS-312 MF30 IOLs, with the near segments placed inferonasally in each group. Group 3 received a Lentis Mplus LS-312 MF20 IOL in the dominant eye with the near segment positioned superotemporal and a Lenstec SBL-3 IOL positioned inferonasally in the fellow eye. Binocular uncorrected (UDVA) and corrected distance visual acuities, binocular uncorrected near (UNVA) and intermediate (UIVA) visual acuities, binocular distance-corrected near and intermediate visual acuities, and quality of vision were evaluated over 3 months postoperatively. RESULTS: The study enrolled 180 patients (360 eyes). There was no significant difference between the groups in binocular UDVA, UIVA, and UNVA; however, there was a significant difference between the groups in quality of vision (P ≤ .001). Group 3 had significantly better overall quality of vision. CONCLUSION: When implanting rotationally asymmetric multifocal IOLs, a combination of superotemporal placement of the near segment (+2.00 diopter [D] addition [add]) in the dominant eye with inferonasal placement of the near segment (+3.00 D add) in the fellow eye yielded consistent, high overall quality of vision and uncorrected visual acuity. FINANCIAL DISCLOSURE: None of the authors has a financial or proprietary interest in any material or method mentioned.

Threshold limit of postoperative astigmatism for patient satisfaction after refractive lens exchange and multifocal intraocular lens implantation.

PURPOSE: To determine the degree of tolerance toward different magnitudes of residual refractive astigmatism and corneal astigmatism and the angles of corneal astigmatism after implantation of an asymmetric multifocal intraocular lens (IOL). SETTING: Cathedral Eye Clinic, Belfast, United Kingdom. DESIGN: Retrospective comparative case series. METHODS: The study enrolled patients having refractive lens exchange and implantation of a Lentis Mplus LS-312 MF30 IOL. Uncorrected (UDVA) and corrected distance visual acuities, uncorrected near and intermediate visual acuities, and quality-of-vision questionnaires were evaluated. Groups were categorized based on the magnitude of refractive astigmatism and corneal residual astigmatism. Refractive astigmatism of less than 0.50 diopter (D) and more than 0.50 D and corneal astigmatism of 0.50 D or less, 0.51 to 0.75 D, 0.76 to 1.00 D, and more than 1.00 D were categorized. RESULTS: The study comprised 117 patients (234 eyes). There was a significant difference in UDVA (P = .003), refractive sphere (P = .001), and defocus equivalent (P ≤ .001) between the residual refractive astigmatism groups; however, there was no difference in quality of vision (P = .28). The same was found for corneal astigmatism with UDVA (P ≤ .001) and quality of vision (P = .16). The angle of corneal astigmatism in relation to IOL placement did not statistically affect postoperative outcomes. CONCLUSIONS: The IOL appeared to subjectively tolerate residual astigmatism well despite a statistically significant difference in UDVA with higher magnitudes of residual astigmatism. The angle of residual corneal astigmatism in relation to IOL placement did not have a significant effect on postoperative outcomes. FINANCIAL DISCLOSURE: None of the authors has a financial or proprietary interest in any material or method mentioned.

Optimized Visual Outcome After Asymmetrical Multifocal IOL Rotation.

PURPOSE: To report improved visual outcome after rotation of an asymmetrical multifocal intraocular lens (IOL). METHODS: Case report. RESULTS: A 58-year-old patient underwent bilateral phacoemulsification with asymmetrical multifocal IOL implantation. Postoperative uncorrected distance visual acuity (UDVA) was 0.0 logMAR (20/20 Snellen) and uncorrected near visual acuity was 0.0 logMAR (20/20 Snellen) in both eyes. Quality of vision questionnaire scores for day and night were 5 and 7, respectively. The center of the multifocal IOL in the dominant eye was initially found to be 0.2 mm superotemporally displaced, increasing the percentage area of 'near-add' compared to 'distance-add' within the physiological pupil. Rotation of this IOL 120° clockwise greatly improved the IOL centration within the pupil center and resulted in an immediate improvement in UDVA to -0.1 logMAR (20/16 Snellen) and quality of vision questionnaire scores to 8 and 9, respectively. CONCLUSIONS: Assessment of the centration of an asymmetrical multifocal IOL is important, particularly if there are dysphotoptic or other visual complaints. [J Refract Surg. 2016;32(7):494-496.].