Orientation of the intermediate-vision zone of rotationally asymmetric multifocal intraocular lenses and photic phenomena.

PURPOSE: To evaluate the association between the orientation of the intermediate-vision zone and postoperative photic phenomena in eyes implanted with rotationally asymmetric multifocal intraocular lenses with + 1.5 diopters near addition. STUDY DESIGN: Retrospective comparative case series. METHODS: We performed the photic phenomena test (PPT) to quantitatively evaluate photic phenomena at 1-3 months after cataract surgery with Lentis Comfort LS-313 MF15 or Lentis Comfort Toric LS-313 MF15T insertion (Oculentis; Santen Pharmaceutical). In cases of bilateral surgeries, only the right eye was included in the analysis. We also conducted a questionnaire survey about the photic phenomena. RESULTS: The study included 96 eyes from 96 patients. The intermediate-vision zones of 44, 19, 19, and 14 eyes were fixed in the inferior, superior, nasal, and temporal directions, respectively. The measured PPT values for halo, glare, and starburst were equivalent in all the fixed directions. Eighty-four eyes (87.5%) perceived a triangle-shaped halo, and the direction of fixation for the intermediate-vision zone and the extension direction of this photic phenomenon were consistent in 94.0% of the eyes. Less than 10% of the patients responded "moderate" or "severe" for the triangle-shaped halo, glare, and starburst in fixed directions with low frequency in the questionnaire. CONCLUSION: No qualitative or quantitative difference was found in photic phenomena in eyes implanted with the LS-313 MF15 or the MF15T regardless of the fixation direction. Our study revealed that many patients were aware of a triangle-shaped halo extending in the direction of the intermediate-vision zone.

Vision With Retrodots and Factors for Declining Visual Function.

Purpose: We investigated decline in the visual function of eyes with retrodots (RDs)-a subtype of cataract. Method: This study included 57 eyes with RD opacity only (mean age 72.3 ± 5.2 years) and 34 eyes with transparent lenses (mean age 71.4 ± 3.7 years). A physician diagnosed lens opacity. Using the Kanazawa Medical University Classification and Grading System, the eyes were classified into the RD-1 (37 eyes, RDs <25% of the 3-mm pupil area) and RD-2 (20 eyes, RDs ≥25% of the 3-mm pupil area) groups. Corrected distance visual acuity, contrast visual acuity, ocular refractive power, lens power, straylight, and backward light-scattering intensity and their relationship with visual function decline and optical characteristics of the eyeball were evaluated. Results: Corrected distance visual acuity was significantly lower in the RD eyes than in controls. Contrast visual acuity decreased significantly in the RD-2 eyes in all environments and in the RD-1 eyes in the evening (EVE) and EVE + glare. Straylight was significantly higher in the RD-2 eyes than in the controls and RD-1 eyes but not different between the RD-1 eyes and controls. The RD-2 eyes were significantly more myopic than the controls and RD-1 eyes. Conclusion: When the opacity of RD eyes is ≥25%, the visual acuity and contrast visual acuity decrease and straylight increases. Furthermore, myopia occurs as the refractive power of the lens increases. Moreover, visual function decline may be due to an increase in the straylight value, which is necessary for determining surgical indications.

Positive dysphotopsia after intrascleral intraocular lens fixation: a case report.

BACKGROUND: Positive dysphotopsia is a symptom caused by the reflection of incident light through the pupil at the inner surface of the intraocular lens (IOL) edge after cataract surgery and is perceived as an abnormal arcuate or radiating photopic image at night or indoors with a light source. Although positive dysphotopsia is one of the most important symptoms that affect patients after cataract surgery, it is still not well known even among ophthalmologists. Positive dysphotopsia as the cause of patient complaint following intraocular surgery other than cataract surgery has not been identified. CASE PRESENTATION: A 52-year-old man underwent IOL extraction and intrascleral IOL fixation for bilateral IOL subluxation at another hospital. The right eye had good subjective visibility, but the patient noticed symptoms of light sources appearing divided into multiple lights indoors after surgery in the left eye. Because the cause of the symptoms could not be identified, the patient visited our department. At the time of his first visit, the corrected visual acuity in both eyes was good, and ocular findings in eye position, motility, intraocular pressure, and fundus were within normal limits. The elongated holes of peripheral iridectomy (PI) created during previous intrascleral IOL fixation were observed to be approximately 2 mm in length on the nasal side in both eyes. The PI hole in the right eye was covered by the optics of the IOL, whereas the edge of the IOL overlapped the center of the PI hole in the left eye. Accordingly, we concluded that the abnormal photopic image in the left eye was caused by positive dysphotopsia, in which light passing through the PI hole was reflected by the edge of the IOL. We attempted surgical closure of the PI hole, resulting in the complete disappearance of positive dysphotopsia. CONCLUSIONS: A PI hole created during intrascleral IOL fixation may cause postoperative positive dysphotopsia depending on the position of the IOL edge. Thus, surgeons should be aware of the importance of the size and location of the PI hole when creating it during surgery.

Quantitative assessment of photic phenomena in the presbyopia-correcting intraocular lens.

This was a prospective study to evaluate the feasibility of the photic phenomena test (PPT) for quantifying glare, halo, and starburst. We compared two presbyopia-correcting intraocular lenses (IOLs), the Symfony IOL and the PanOptix IOL, as well as the monofocal Clareon IOL in 111 IOL-implanted eyes of 111 patients who underwent the PPT 1 month postoperatively. The reproducibility of photic phenomena with the PPT was assessed in 39 multifocal IOL-implanted eyes of 20 patients and among the examiners. Patients with ocular diseases, except for refractive errors, were excluded. The mean values of the groups were evaluated. Bland-Altman plots were used to analyze statistical data (Easy R version 1.37; R Foundation for Statistical Computing, Vienna, Austria). The PPT reproducibility assessment revealed no fixed bias or regressive significance. Reproducibility was confirmed. The glare size did not differ significantly between the Symfony, PanOptix, and Clareon groups. The halo size was significantly larger in the Symfony group (p < 0.01) than in the PanOptix group. The halo intensity was significantly brighter in the PanOptix group (p < 0.01) than in the Symfony group. In contrast, no halos were perceived in the Clareon group. The starburst size or intensity did not differ significantly between the Symfony, PanOptix, and Clareon groups. We identified the photic phenomenon related to various IOLs.

Association among pterygium, cataracts, and cumulative ocular ultraviolet exposure: A cross-sectional study in Han people in China and Taiwan.

PURPOSE: Pterygium is an ocular surface disorder mainly caused by ultraviolet (UV) light exposure. This study explored the relationships between six cataract types with pterygium and UV exposure. METHODS: We have previously studied cataracts in residents of three regions in China and Taiwan with different UV intensities. From that study, we identified 1,547 subjects with information on the presence or absence of pterygium. Pterygium severity was graded by corneal progress rate. Cataracts were graded by classification systems as three main types (cortical, nuclear, posterior subcapsular) and three subtypes (retrodots, waterclefts, fiber folds) with high prevalence in middle-aged and elderly people. We calculated the cumulative ocular UV exposure (COUV) based on subject data and National Aeronautics and Space Administration data on UV intensities and used logistic regression to calculate odds ratios for the associations of COUV, cataract, and pterygium. RESULTS: We found an overall pterygium prevalence of 23.3%, with significant variation among the three regions. Four cataract types (cortical, nuclear, posterior subcapsular, and retrodots) were significantly associated with the presence of pterygium. CONCLUSIONS: There was a significant association between COUV and pterygium, indicating that COUV is associated with the risk of pterygium development and that pterygium is useful as an index of UV exposure. Furthermore, the type of cataract in eyes with pterygium may indicate the level of UV exposure.

UV Index Does Not Predict Ocular Ultraviolet Exposure.

Purpose: The ultraviolet index (UVI), available online, is an international linear scale of levels from 0 to 13+ that warns about the risk of sunburn; however, it does not address the risk to eyes. Our purpose was to develop a useful instrument to warn the public against ocular ultraviolet (OUV) exposure and to serve as a tool for researching UV-induced ocular diseases. Methods: A rotating model head that included ultraviolet B (UVB) sensors documented UV irradiance at the crown and at the eyes spanning eight azimuths from sunrise to sunset under different climatic conditions in each season. The dose intensities obtained were compared with their respective UVI levels. Doses to the eyes were mathematically transformed to develop an OUV index with linear levels from 0 to 13+, similar to the UVI. Then, readings from both instruments were compared. Results: UV exposure at the crown increases with solar culmination, whereas that to the eye is greater under low rather than maximum solar altitude. The OUV index levels were higher than recorded UVI levels in the summer under low solar altitude in the early morning and mid- to late afternoon and were markedly higher all day in winter when solar altitude remains low. Conclusions: The UVI does not provide sufficient warning about the risks of ocular UV damage. The proposed OUV index is a useful instrument to warn the public against OUV exposure and to serve as a tool for researching UV-induced ocular diseases. Translational Relevance: The OUV index is useful to prevent ocular UV-related diseases.

Correction: Association between ultraviolet radiation exposure dose and cataract in Han people living in China and Taiwan: A cross-sectional study.

[This corrects the article DOI: 10.1371/journal.pone.0215338.].

Association between ultraviolet radiation exposure dose and cataract in Han people living in China and Taiwan: A cross-sectional study.

PURPOSE: We investigated associations between ocular ultraviolet (UV) radiation exposure dose and cataract opacities among Han people living in China and Taiwan, to assess the effects of UV exposure intensity. METHODS: This cross-sectional study included Han people aged ≥40 years (1,801 individuals, 450 in Sanya, 636 in Taiyuan, and 715 in Taichung) as subjects who completed a questionnaire including items about diabetes, smoking, steroid use, work history, and time spent outdoors, and underwent an ophthalmic examination. Right eye axial length was measured using A-mode ultrasonography or IOLMaster. Slit-lamp imaging under maximum mydriasis was used to classify cataracts into three major types [cortical (COR), nuclear (NUC), and posterior subcapsular cataracts (PSC)] and two subtypes [retrodots (RD) and waterclefts (WC)] by one ophthalmologist. COR was divided into opacity presence (CEN+) or absence (CEN-) in the central 3-mm diameter area of the pupil. COR was also subdivided into three groups according to opacity shape: axle-shaped opacity concomitant with WC, wedge-shaped opacity around the pupil to the eye center, and ring-shaped opacity in the lens equator along the pupillary margin. The cumulative ocular UV exposure (COUV) was calculated. A logistic regression analysis was used for multivariate analysis. RESULTS: Cataract odds ratios in high COUV eyes were 5.35 for NUC, 1.87 for PSC, and 1.35 for RD. In eyes with WC, risk of COR ring-shaped opacity significantly increased but that of wedge-shaped opacity (CEN+) significantly decreased. In eyes without WC, risk of COR axle-shaped opacity (CEN-) and ring-shaped opacity significantly increased but that of wedge-shaped opacity (CEN+) significantly decreased. CONCLUSIONS: Increased COUV level among Han people may be a risk factor for the development of nuclear cataracts, PSC, retrodots and ring-shaped cortical cataract. Risk of ocular UV exposure for cortical cataract may differ by opacity shape.