Diurnal Variation in Straylight in Patients With Fuchs Endothelial Corneal Dystrophy and Controls.

PURPOSE: The goal of this study was to investigate diurnal changes in intraocular straylight in relation to other corneal parameters and subjective complaints in patients with Fuchs endothelial dystrophy and healthy controls. METHODS: This is a prospective study conducted in 2 tertiary care hospitals in Germany and the Netherlands. Patients with Fuchs endothelial dystrophy (n = 71) and healthy controls (n = 34) were included. Patients with Fuchs dystrophy were grouped by the presence of subjective complaints and measured over multiple time points during the day. Measurements included intraocular straylight using the C-Quant and corneal thickness and backscatter using a Scheimpflug camera. A separate group of healthy controls was measured intensively with repeated straylight measurements directly after waking. An exponential decay model was used to model the diurnal change. RESULTS: Healthy controls showed an average straylight baseline of 1.17 log(s) with an increase in straylight after waking of 0.22 log(s). In the repeated measurements subgroup, the increase in morning straylight lasted for 22 minutes. Patients with Fuchs dystrophy showed a morning increase in straylight of 0.21 log(s) present up to 4 hours after waking before reaching an average baseline of 1.30 log(s). Straylight was positively correlated with anterior corneal backscatter, r = 0.21, P = 0.022, and corneal thickness, r = 0.46, P < 0.01. CONCLUSIONS: Healthy eyes experience a diurnal straylight increase similar to patients with Fuchs dystrophy in intensity. However, in Fuchs dystrophy, the resolution of increased straylight is prolonged over multiple hours compared with minutes in healthy eyes. This suggests pathological exacerbation of a physiological diurnal change. This mechanism can play a role in subjective complaints experienced by patients with Fuchs dystrophy.

ASCRS calculator formula accuracy in multifocal intraocular lens implantation in hyperopic corneal refractive laser surgery eyes.

PURPOSE: To evaluate the accuracy of different intraocular lens (IOL) power calculation formulas available on the American Society of Cataract and Refractive Surgery calculator in calculating multifocal IOL power in eyes with previous hyperopic corneal refractive laser surgery. DESIGN: Retrospective case series. SETTING: Amsterdam University Medical Center, University of Amsterdam, and Retina Total Eye Care, Driebergen, the Netherlands. METHODS: This study compared the accuracy of 3 formulas using historical refractive data (ie, Masket, modified Masket, and Barrett True-K) and 3 formulas using no previous refractive data (ie, Shammas, Haigis-L, and Barrett True-K no-history). RESULTS: Sixty-four eyes were included. The variance of the prediction error of the various formulas was similar and ranged from 0.27 D2 to 0.33 D2 (P = .99). The modified Masket formula had a significantly higher median absolute prediction error than the Masket formula, Barrett True-K formula, and mean value of all formulas (P < .001). CONCLUSION: All formulas showed comparable accuracy in predicting IOL power in eyes after hyperopic corneal refractive laser surgery except for the modified Masket formula, which performed less accurately than the Masket formula, Barrett True-K formula, and mean value of all formulas.

Evaluation of Different IOL Calculation Formulas of the ASCRS Calculator in Eyes After Corneal Refractive Laser Surgery for Myopia With Multifocal IOL Implantation.

PURPOSE: To compare the accuracy of different intraocular lens (IOL) calculation formulas available on the American Society of Cataract and Refractive Surgery (ASCRS) post-refractive surgery IOL power calculator for the prediction of multifocal IOL power after previous corneal refractive laser surgery for myopia. METHODS: An analysis and comparison were performed of the accuracy of three methods using surgically induced change in refraction (ie, Masket, Modified Masket, and Barrett True-K formulas) and three methods using no previous data (ie, Shammas, Haigis-L, and Barrett True-K No History formulas). The average of all formulas was also analyzed and compared. RESULTS: Thirty-six eyes of 36 patients were included. All formulas, except for the Masket, Modified Masket, and Barrett True-K formulas, had myopic mean numerical errors that were significantly different from zero (P ⩽ .01). The median absolute error of the Shammas formula (0.52 diopters [D]) was significantly higher compared to all of the other formulas (P < .05), except for the Haigis-L formula (P = .09). Comparing the formulas using no previous data, the Barrett True-K No History formula had the lowest median absolute error (0.33 D, P < .001). CONCLUSIONS: The Shammas formula showed the least accuracy in predicting IOL power in eyes with multifocal IOL implantation after previous corneal refractive laser surgery for myopia. In eyes with all available data, all formulas performed equally except for the Shammas formula, whereas in eyes lacking historical data, the Barrett True-K No History formula performed best. [J Refract Surg. 2019;35(1):54-59.].

Multifocal intraocular lens implantation after previous hyperopic corneal refractive laser surgery.

PURPOSE: To describe the outcomes in terms of the refraction and visual acuity of multifocal intraocular lens (IOL) implantation in patients with previous hyperopic corneal refractive laser surgery. SETTING: Academic Medical Center, University of Amsterdam, Amsterdam, and Retina Total Eye Care, Driebergen, the Netherlands. DESIGN: Retrospective case series. METHODS: Results were analyzed 3 months after implantation of a multifocal IOL (Acrysof Restor SN6AD1) in patients after previous corneal refractive laser surgery for hyperopia. The primary outcome measures were uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and refraction. The secondary outcome measures were the number of laser enhancements and posterior capsule opacification (PCO) rates. RESULTS: Forty eyes of 40 patients were included. Sixteen eyes (40.0%) had lens extraction because of cataract, and 24 eyes (60.0%) had refractive lens exchange. The mean postoperative UDVA was 0.16 logarithm of the minimum angle of resolution (logMAR) ± 0.18 (SD), and the mean postoperative CDVA was 0.01 ± 0.08 logMAR. The mean postoperative spherical equivalent was 0.04 ± 0.92 diopter (D). Twenty-five eyes (62.5%) were within ±0.50 D of emmetropia, and 35 eyes (87.5%) were within ±1.0 D of emmetropia. Nine eyes (22.5%) had a laser enhancement because of a residual refraction error. Eleven eyes (27.5%) had a neodymium:YAG laser capsulotomy because of PCO. CONCLUSIONS: In general, multifocal IOL implantation after corneal refractive laser surgery for hyperopia resulted in good visual acuity and refraction. The magnitude of previous hyperopia did not influence the refractive predictability.

Effects of Corneal Scars and Their Treatment With Rigid Contact Lenses on Quality of Vision.

OBJECTIVES: To study the effects of corneal scars and the treatment of these scars with rigid gas-permeable (RGP) contact lenses on quality of vision including straylight. Visual effects were related to scar characteristics such as size and grade. METHODS: Straylight and best-corrected visual acuity were measured in 23 patients with corneal scars during and after RGP contact lens wear. Contralateral eyes were used as controls, and age-normal values in case of bilateral scars. Straylight measurements were performed using the compensation comparison method of the Oculus C-Quant instrument. RESULTS: Scarred eye straylight values were 1.53 log(s) without contact lens and 1.60 log(s) with contact lens (P=0.043). Healthy eyes without contact lens had a mean straylight value of 1.13 log(s), corresponding to age-normal values. Contact lens wear increased straylight in healthy eyes to 1.26 log(s) (P<0.001). Visual acuity improved from 0.66 logarithm of minimal angle of resolution (logMAR) to 0.19 logMAR with contact lens wear in eyes with a corneal scar (P<0.001). CONCLUSIONS: Corneal scars can have a strong effect on quality of vision by diminishing visual acuity and increasing straylight. The increase in straylight from corneal scars on its own can lead to a serious visual handicap. Contact lens treatment did not improve straylight, but showed a slight worsening. As the recovery of visual acuity with contact lens wear far exceeded straylight increase, contact lenses remain a clinically useful treatment option in most patients with corneal scars.

Vernal shield ulcers treated with frequently installed topical cyclosporine 0.05% eyedrops.

PURPOSE: To report on the beneficial results of an intense regimen of 0.05% cyclosporine eye drops, eight times a day in patients with therapy resistant vernal shield ulcers. METHODS: Case cohort of four eyes of three male children with vernal keratoconjunctivitis complicated by shield ulcers, who were treated with frequent cyclosporine 0.05% eye drops and observed for up to 5 years. RESULTS: Quick resolution of the shield ulcers and complete re-epithelialization within 14-25 days was observed after adding intensive treatment with cyclosporine 0.05% to regular anti-inflammatory, histamine blocking, and surgical therapy. In one patient, additional scraping of the bottom of the ulcer was needed. CONCLUSIONS: In patients with vernal shield ulcers, frequent installation of low-concentration cyclosporine eye drops seems to have a promising therapeutical value.

Topical bevacizumab treatment in aniridia.

PURPOSE: To report the results of long-term topical treatment with bevacizumab (Avastin) 5 mg/mL eyedrops in a case of aniridia-related neovacularization of the cornea. METHODS: Interventional case report. A female patient with aniridia had a decrease in the best corrected visual acuity from 0.32 to 0.02 in the OS over the course of 4 years, secondary to central corneal neovascularization and epithelial breakdown. Vision in the OD was 0.2. In 2008, at age 28, a shared decision was made to start off-label treatment with bevacizumab eyedrops 0.5% in both eyes. After 9 years, the visual acuity in the OD remained stable, with stability of the macropannus and maintenance of central corneal clarity. In the OS, the central corneal neovascularization regressed, the epithelium regained its clarity, and after cataract surgery visual acuity was regained to 0.32. RESULTS: After 9 years of treatment with topical bevacizumab, vision acuity is comparable to the situation of 12 years previously: Visual acuity remained stable in the ODS. CONCLUSION: In a young patient with progressive corneal neovascularization secondary to aniridia, stability of central corneal neovascularization was obtained and corneal clarity was preserved by adding a daily drop of bevacizumab 5 mg/mL. No adverse events occurred. Vessel growth was inhibited, and as such, the progression of the natural history of the patient's disease was halted. More clinical study with longer follow-up is needed to investigate the applicability of treatment with topical VEGF inhibitors in aniridia.

Multifocal intraocular lens implantation after previous corneal refractive laser surgery for myopia.

PURPOSE: To describe the refraction and visual acuity outcomes of multifocal intraocular lens (IOL) implantation in patients with previous corneal refractive laser surgery for myopia. SETTING: Academic Medical Center, University of Amsterdam, Amsterdam, and Retina Total Eye Care, Driebergen, the Netherlands. DESIGN: Retrospective cohort study. METHODS: The 3-month results after implantation of a multifocal IOL (Acrysof Restor) in patients who had corneal refractive laser surgery for myopia were analyzed. The primary outcome measures were corrected distance visual acuity, uncorrected distance visual acuity (UDVA), and refraction. The secondary outcome measures were number of laser enhancements, corneal irregularity, pre-laser magnitude of myopia, and posterior capsule opacification (PCO) rate. RESULTS: Seventy-seven eyes of 43 patients were included. Twenty-nine eyes had lens extraction because of cataract, and 48 eyes had a refractive lens exchange. The mean postoperative UDVA was 0.14 logarithm of minimum angle of resolution ± 0.22 (SD). The mean postoperative spherical equivalent was -0.38 ± 0.78 diopter (D). Fifty-seven percent of eyes were within ±0.50 D of emmetropia, and 86% were within ±1.0 D. Sixteen eyes (20.8%) had laser enhancement because of residual refraction. Fourteen eyes (18.2%) had a neodymium:YAG laser capsulotomy because of PCO. Eyes with pre-laser myopia greater than 6.0 D had a less predictable outcome than eyes with pre-laser myopia less than 6.0 D (P = .026). CONCLUSIONS: Multifocal IOL implantation after corneal refractive laser surgery for myopia resulted in good visual acuity and refraction. Results were less predictable with myopia greater than 6.0 D.

Increased Straylight in Patients With Keratoconjunctivitis Sicca.

PURPOSE: (1) To qualify complaints of quality of vision in patients with (severe) keratoconjunctivitis sicca by examining straylight values and (2) to check for an effect of scleral lens wear on straylight. METHODS: Straylight was measured in 16 patients with severe keratoconjunctivitis sicca using the Oculus C-Quant. In 9 of these patients, scleral lenses were used, and straylight was measured with and without scleral lenses. Other tests included the Schirmer test, visual acuity, the van Bijsterveld score, and a straylight questionnaire. RESULTS: Patients with keratoconjunctivitis sicca had a mean straylight OD of log(s) = 1.36 ± 0.19 SD and OS of log(s) = 1.45 ± 0.17 SD. Mean age was 56 ± 9.3 SD. This was significantly higher than the mean age-matched normal value of log(s) = 1.10 (P < 0.001). Such a straylight increase is functionally significant. The difference in straylight with and without scleral lenses was 0.06 log units ± 0.02 SD, but this was not statistically significant for OD (P = 0.134) and OS (P = 0.293). No correlation was found between straylight and the van Bijsterveld score on the corneal section for OD (P = 0.326) and OS (P = 0.433). CONCLUSIONS: Keratoconjunctivitis sicca leads to increased straylight. However, this increase was not correlated to the amount of surface damage graded with the van Bijsterveld score. Further study on the cornea is necessary to determine the source of the increased straylight. Scleral lenses do not have a noteworthy influence on straylight in these patients.

Opacification of the Intraocular Lens After Descemet Stripping Endothelial Keratoplasty.

PURPOSE: To report the incidence of opacification of the intraocular lens (IOL) after Descemet stripping endothelial keratoplasty (DSEK) in an academic ophthalmology clinic. METHODS: In this retrospective case series, all patients who underwent DSEK between 2003 and 2013 were included. In 2008, the first patient presented with reduced vision as a result of opacification of the IOL in our clinic. The period between DSEK surgery and diagnosis of IOL opacification, Snellen corrected distance visual acuity before and after the appearance of IOL opacification, IOL specifications, and incidence of IOL exchange were assessed. RESULTS: A total of 160 eyes were operated on. Opacification was seen in 8 eyes (5%) and was diagnosed between 4 and 24 months after DSEK (mean, 9.6; SD, 6.3; range, 4-24 months). The mean Snellen corrected distance visual acuity was 0.6 (SD, 0.2; range, 0.2-0.8) before opacification and 0.3 (SD, 0.2; range, 0.02-0.6) after opacification of the IOL occurred. The IOL material was hydrophilic acrylic in all patients. In 4 eyes, IOL exchange was performed. CONCLUSIONS: Opacification of the IOL can be a vision-threatening late complication after DSEK and was seen in 8 of 160 eyes.

LASIK flap breakthrough in Nd:YAG laser treatment of epithelial ingrowth.

PURPOSE: To present two cases with complications after Nd:YAG laser treatment of epithelial ingrowth. METHODS: Case reports. RESULTS: Dense central recurrent epithelial ingrowth was treated with a Nd:YAG laser directed at the epithelial nests in the LASIK flap interface in one case. Misalignment of the aiming beam after movement resulted in perforation of the LASIK flap, followed by renewed epithelial ingrowth through the new defect. The epithelial ingrowth receded and became more translucent as a result of the treatment, but the area of the perforation remained irregular. In another case, use of the Nd:YAG laser to treat recurrent epithelial ingrowth adjacent to the flap edge created a cavitation bubble that broke through the flap edge, creating a new epithelial channel through which ingrowth recurred. CONCLUSIONS: Surface breakthrough and renewed epithelial ingrowth is a possible complication of Nd:YAG laser treatment of epithelial ingrowth.

Straylight before and after phacoemulsification in eyes with preoperative corrected distance visual acuity better than 0.1 logMAR.

PURPOSE: To report the outcomes of changes in straylight before and after phacoemulsification in eyes with preoperative corrected distance visual acuity (CDVA) better than 0.1 logMAR. SETTING: Private refractive surgery clinic, Driebergen, the Netherlands. DESIGN: Cohort study. METHODS: Standard phacoemulsification with implantation of a monofocal or multifocal intraocular lens (IOL) was performed. Preoperative and 3-month postoperative straylight values, CDVA, and refractive error were compared. RESULTS: The study enrolled 160 eyes (89 patients). The mean CDVA was 0.02 ± 0.05 logMAR (range -0.1 to 0.1 logMAR) preoperatively and 0.00 ± 0.04 logMAR (range -0.1 to 0.2 logMAR) postoperatively. The mean preoperative straylight was 1.21 ± 0.20 log(s) (range 0.80 to 1.74 log[s]) and 1.11 ± 1.16 log(s) (range 0.76 to 1.63 log[s]), respectively; the improvement was statistically significant. There was a correlation between high preoperative straylight values and postoperative improvement in straylight values. CONCLUSIONS: In eyes with relatively good CDVA of 0.1 logMAR or better (decimal 0.8 or better; Snellen 20/25 or better), straylight improved by 0.10 log(s) after cataract surgery. A subgroup of 44 eyes had an improvement of more than 0.20 log(s), which is comparable to a 2-line improvement on the vision chart.

Indications for and outcomes of tertiary referrals in refractive surgery.

PURPOSE: To review the spectrum of disease, symptomatology, and management offered to patients referred for a second opinion after refractive surgery. METHODS: A prospective cohort study was done on all patients referred from October 1, 2006, to September 30, 2011, to a tertiary eye clinic after refractive surgery of any kind (ie, corneal laser surgery, conductive keratoplasty, radial keratotomy, phakic implants, refractive lens exchanges, or any combination thereof). Data analysis was performed on all demographic and clinical aspects of this cohort, including the initial complaint, type of referral, number of complaints, procedure previously performed, diagnosis at our center, type of advice given, and rate and type of surgical intervention. RESULTS: One hundred thirty-one eyes (69 patients) were included. Corneal refractive surgery was performed in 82% (108 eyes), and 11% (14 eyes) were seen after phakic intraocular lens (PIOL) implantation and 7% (9 eyes) after refractive lens exchange. The most common diagnoses were tear film dysfunction (30 eyes, 23%), residual refractive error (25 eyes, 19%), and cataract (20 eyes, 15%). Most patients (42 patients, 61%) were treated conservatively. In 27 patients (39%), 36 eyes (28%) were managed surgically. Severe visual loss was seen in 1 eye. CONCLUSIONS: No major problems were found in most second opinions after refractive surgery referral. Dry eyes, small residual refractive error, or higher-order aberrations were the most common complaints. Surgical intervention was needed in 36 eyes (28%), almost half of which were cataract extractions. Severe visual loss was seen in 1 eye with a PIOL. There was no incidence of severe visual loss in keratorefractive and refractive lens exchange procedures.

Calcification of a hydrophilic acrylic intraocular lens after Descemet-stripping endothelial keratoplasty: case report and laboratory analyses.

We describe the case of an 83-year-old woman who had uneventful phacoemulsification with implantation of a tripod hydrophilic acrylic intraocular lens (IOL). Because of postoperative corneal decompensation, 2 Descemet-stripping endothelial keratoplasty (DSEK) procedures were performed within 2 years. After the second procedure, the graft was not well attached, requiring an intracameral injection of air on day 3. Approximately 9 months later, opacification was observed on the anterior surface of the IOL, with a significant decrease in visual acuity. The IOL was explanted within the capsular bag. Laboratory analyses revealed granular deposits densely distributed in a round pattern within the margins of the capsulorhexis. Granules were located at the anterior surface/subsurface of the IOL and stained positive for calcium (alizarin red and von Kossa method). Scheimpflug photography revealed high levels of light scattering from the opacified area. Surgeons should be aware of possible localized calcification following DSEK procedures in pseudophakic patients with hydrophilic acrylic IOLs.

Intraocular pressure after descemet stripping endothelial keratoplasty (DSEK).

To assess the incidence of elevated intraocular pressure (IOP) after descemet stripping endothelial keratoplasty (DSEK). Retrospective case series. From the start of the technique in our hospital in 2003 until the middle of 2010, 73 eyes underwent DSEK, of which 66 (90.5 %) had a clear graft 1 year after surgery. IOP data pre- and postoperatively were analyzed. Follow-up was 1-5 years (mean 3.8, SD 1.3). Mean age was 71 years (SD 11, range 43-89). Three eyes (4.5 %) had a history of glaucoma before DSEK. Mean pre-operative IOP was 12.4 mmHg (SD ± 4.3). Mean IOP 1 day post-operatively was 16.4 mmHg (±9.2). Mean IOP after 1 and 6 months, and 1, 3, and 5 years were, respectively, 13.9 (±5.3), 14.7 (±5.6), 14.2 (±5.4), 13.8 (±3.7), and 12.6 (±3.5). Seventeen percent (11 eyes) had a postoperative rise in IOP which needed medical or surgical intervention: 8 % (5 eyes) had a rise in IOP 1 day after DSEK, of which 1 underwent a trabeculectomy 7 months after DSEK surgery; 6 % (4 eyes) had a rise in IOP later in the postoperative period, which could all be managed medically; and 3 % (2 eyes) had increased IOP 1 day after DSEK and later in the postoperative period, both eyes underwent a trabeculectomy 5 and 24 months, respectively, after DSEK surgery. An increase in IOP was encountered in 17 % of DSEK patients. Checking the IOP in the short and long postoperative period is necessary.

The relationship between the optical density of cataract and its influence on retinal nerve fibre layer thickness measured with spectral domain optical coherence tomography.

PURPOSE: The purpose of this study was to model the influence of cataract on Spectral Domain Optical Coherence Tomography (SDOCT) image quality and Retinal Nerve Fibre Layer (RNFL) thickness measurements. METHODS: SDOCT images, made with two different devices (3DOCT-1000, Topcon and Cirrus HD-OCT), before and after cataract surgery were compared and judged against measurements from normal subjects using artificial filters simulating the effects of cataract. Optical density of the images was calculated based on a mathematical model described previously. RESULTS: In total, forty-eight eyes were included for pre- and postoperative cataract extraction measurements. OCT image quality significantly (p < 0.001) improved postoperative and postoperative RNFL thickness was significantly (p < 0.001) thicker in both groups of patients. The measurements using artificial filters showed a rather precise linear relation between change in filter induced optical density and change in RNFL thickness (R = 0.941, p < 0.001 for 3DOCT-1000 and R = 0.785, p < 0.001 for Cirrus HD-OCT). For the patient groups, the relation was less marked, 3DOCT-1000 Rs = 0.697, p < 0.03 and Cirrus HD-OCT Rs = 0.444, p < 0.03. The predictive potential based on the found linear relationship between OCT-effective optical density of cataract and the cataract-induced underestimation was however limited, and mean difference ± SD between predicted and measured RNFL thickness were 1.68 ± 7.55 (3DOCT-1000) and 3.71 ± 2.97 (Cirrus HD-OCT) micron. CONCLUSIONS: A linear relationship exists between OCT-effective optical density of cataract and underestimation of RNFL thickness measured with OCT. This finding holds promise to correct for cataract-induced changes in RNFL measurements, but will differ for each type of OCT device.

Effect of Nd:YAG laser capsulotomy on refraction in multifocal apodized diffractive pseudophakia.

PURPOSE: To evaluate the effect on refraction of neodymium:YAG (Nd:YAG) laser posterior capsulotomy for posterior capsule opacification (PCO), and to evaluate the correlation between automated and subjective refraction in multifocal apodized diffractive pseudophakia. METHODS: A retrospective study of 75 pseudophakic eyes (50 patients) with multifocal apodized diffractive pseudophakia, treated for PCO with Nd:YAG laser posterior capsulotomy, was performed. Pre- and postintervention values of refractive and visual parameters were compared. The outcomes of autorefraction and subjective refraction were also compared. RESULTS: Uncorrected and corrected distance visual acuity improved significantly after Nd:YAG capsulotomy (P<.001). No significant changes were noted in defocus equivalent, astigmatic power vectors J(0) and J(45), and overall blurring strength in subjective refraction and autorefraction. Spherical equivalent changed significantly in autorefraction (P=.008), but not in subjective refraction. Autorefraction and subjective refraction were highly correlated in spherical equivalent, defocus equivalent, and blurring strength (r(2)>0.59). In approximately 7% of eyes, a change of more than 0.50 diopters in spherical equivalent in subjective refraction occurred. CONCLUSIONS: In most cases, Nd:YAG laser capsulotomy in patients with multifocal pseudophakia did not result in a change in refraction. However, 7% of eyes experienced a significant change in subjective refraction. Autorefraction correlated well with subjective refraction in apodized diffractive multifocal IOLs.

Straylight measurements as an indication for cataract surgery.

PURPOSE: To assess adding straylight measurements to the indication for cataract surgery. SETTING: Onze Lieve Vrouwe Hospital, Amsterdam, and Zonnestraal Eye Clinic, Hilversum, The Netherlands. DESIGN: Prospective interventional cohort study. METHODS: Before and after cataract extraction, corrected distance visual acuity (CDVA) and straylight were recorded in all patients. Subjective complaints were documented by the 39-item National Eye Institute Visual Function Questionnaire (NEI VFQ-39) and a straylight questionnaire. RESULTS: The population comprised 217 patients with a mean age of 72 years ± 9.12 (SD) (range 29 to 90 years). Preoperatively, the mean straylight was 1.55 ± 0.29 log(s) and the mean CDVA, 0.28 ± 0.21 logMAR. Visual acuity and straylight showed little correlation (R(2) = 0.08). The mean postoperative improvement in CDVA was 0.26 ± 0.20 logMAR (range -0.12 to 1.12 logMAR) and in straylight, 0.31 ± 0.32 log(s) (range -0.50 to 1.27 log[s]). The preoperative breakeven point (50% chance of postoperative improvement) was 0.06 logMAR for CDVA and 1.29 log(s) for straylight. Preoperative and postoperative questionnaires showed straylight had almost the same influence as visual acuity on quality of vision. CONCLUSIONS: Straylight and visual acuity measure different aspects of quality of vision and influenced subjective visual quality almost equally. When straylight was added to preoperative considerations of cataract extraction, postoperative results were more predictable. FINANCIAL DISCLOSURE: The Netherlands Academy of Arts and Sciences has a proprietary interest in the C-Quant Straylight meter. No author has a financial or proprietary interest in any material or method mentioned.

Correlation of straylight and visual acuity in long-term follow-up of manual descemet stripping endothelial keratoplasty.

PURPOSE: Long-term quality of vision after Descemet stripping endothelial keratoplasty (DSEK) was evaluated and correlated with corneal characteristics and subjective complaints. METHODS: Thirty-four eyes were examined; patients had a single visit 6 to 64 months after DSEK for Fuchs dystrophy. Best-corrected distance acuity (BCDA) and straylight were analyzed. To better evaluate long-term postoperative BCDA changes, longitudinal data were used from earlier visits. Corneal thickness was measured with the Visante anterior segment optical coherence tomography. Interface, stromal, and endothelial haze were semiquantitatively graded using the slit lamp. Vision-related quality of life was evaluated with the 39-item National Eye Institute Visual Function Questionnaire and a straylight questionnaire. Correlation analysis comparing corneal characteristics with visual quality was performed. RESULTS: Mean postoperative time was 1027 ± 453 days. Mean BCDA at this time was 0.33 ± 0.19 logarithm of the minimal angle of resolution. BCDA remained stable with long-term postoperative follow-up. Straylight averaged 1.47 ± 0.19, on average 0.12 log units higher than normal for age-related pseudophakic eyes (P < 0.001). BCDA correlated with corneal haze (r = 0.50), whereas straylight showed a nonsignificant association (P = 0.12). Neither BCDA nor straylight correlated with corneal thickness. Mean Visual Function Questionnaire 39 score was 77/100, and mean score of the straylight questionnaire was 46/100. CONCLUSION: Quality of vision after DSEK does not return to normal levels of age-matched pseudophakic eyes, with decreased BCDA and increased straylight. Questionnaire scores indicate mild (Visual Function Questionnaire 39) to moderate (straylight) subjective visual impairment. Corneal thickness and haze do not offer an adequate explanation for the decreased visual quality.