Comparative Analysis of the Clinical Outcomes of Two Toric Presbyopia-Correcting Intraocular Lenses.

INTRODUCTION: To evaluate and compare the clinical outcomes of two toric presbyopia-correcting intraocular lenses (IOLs). METHODS: Non-randomized prospective comparative study including 86 eyes of 51 patients (age 43-83 years) that underwent cataract surgery with implantation of one of the following two IOLs: TECNIS Toric Synergy (Johnson & Johnson Vision) (Synergy group) or AT LISA tri toric 939MP (Carl Zeiss Meditec) (ATLISA group). Visual and refractive outcomes were evaluated during a 6-month follow-up. RESULTS: At 6 months after surgery, all eyes achieved uncorrected distance visual acuity 20/25 or better in both groups, whereas 96.2% and 100% of eyes achieved uncorrected near visual acuity (UNVA) 20/25 or better in the ATLISA and Synergy groups, respectively. All eyes achieved postoperative mesopic UNVA 20/30 or better in both IOL groups; 96.2% and 100% of eyes had a manifest cylinder ≤ 0.50 D at 6 months in ATLISA and Synergy groups, respectively. Mean magnitude of error was 0.04 ± 0.20 and - 0.04 ± 0.09 D in ATLISA and Synergy groups, respectively (p = 0.05). In the defocus curve, significant differences were found between IOL groups for most of distance-corrected visual acuities, except those corresponding to defocus of 0 D (p = 0.268) and - 1 D (p = 0.361). CONCLUSIONS: The two toric presbyopia-correcting IOLs evaluated provide an efficacious astigmatic correction combined with a successful distance, intermediate and near visual rehabilitation. The visual performance seems to be better for most visual demands with the TECNIS Toric Synergy IOL, especially for distances closer than 40 cm.

Is there value in measuring near visual acuity during occlusion therapy for amblyopia?

Introduction: The purpose of this study was to investigate near and distance visual acuity (VA) prior to, during and on completion of occlusion therapy for amblyopia. Method: Fifty-four patients aged 4-7 years (mean 4.9; ±0.44) with untreated strabismic, anisometropic or mixed amblyopia were recruited to the study following refractive adaptation where applicable. All patients underwent conventional occlusion (patching). Uniocular near and distance VA was tested using age and ability appropriate Crowded LogMAR VA tests prior to, during and upon conclusion of occlusion therapy. Results: In amblyopic eyes, there was no significant difference between near and distance VA prior to occlusion therapy with LogMAR Crowded (p = .66; mean distance VA at 3 m = 0.6 LogMAR; mean near VA at 40 cm = 0.58 LogMAR), or with LogMAR Crowded Kay Picture test (p = .78, mean distance VA at 3 m = 0.44 LogMAR; mean near VA at 33 cm = 0.46 LogMAR;). No significant difference was found between near and distance VA at any visit during occlusion therapy, or on completion of occlusion therapy with LogMAR Crowded (p = .86, mean final distance VA at 3 m = 0.266 LogMAR; mean final near VA at 40 cm = 0.25 LogMAR) or LogMAR Crowded Kay Pictures (p = .74, mean final distance VA at 3 m = 0.16 LogMAR; mean final near VA at 33 cm = 0.16 LogMAR). There was no significant difference in the VA of the fellow (non-amblyopic) eyes prior to and on completion of occlusion therapy with LogMAR Crowded at distance (3 m) or near (40 cm) (p = .05, p = .40 respectively); or with LogMAR Crowded Kay Pictures at distance (3 m) or near (33 cm) (p = .89, p = .35 respectively). Discussion: Improvement in VA of amblyopic eyes did not significantly differ between near and distance testing proximites at any point during the course of occlusion therapy for amblyopia in our study. These findings may aid clinicians with appropriate test selection and help with clinical time pressures. Where patient concentration does not allow for uniocular distance vision, uniocular near vision may be used to diagnose amblyopia, and vice versa. This could prevent delay in the treatment of amblyopia.

Stereopsis after bilateral implantation of Toric intraocular lenses in high myopic cataract patients with astigmatism.

Purpose: To evaluate near, intermediate, distance visual acuity and stereopsis after bilateral implantation of Toric intraocular lenses (IOLs) in high myopic patients with astigmatism. Methods: Bilateral Toric or non-Toric IOL implantation (n â€‹= â€‹40 eyes each) was performed on high myopic cataract eyes with astigmatism. Best-corrected distance visual acuity (BCDVA), uncorrected intermediate visual acuity (UCIVA), uncorrected near visual acuity (UCNVA), residual refractive astigmatism (RRA), and near, intermediate, and distance stereoacuity were measured postoperatively at 7 days, 1 month, and 3 months. Results: The three-month postoperative BCDVA, UCIVA, and UCNVA of the Toric group were 0.08 â€‹± â€‹0.07, 0.30 â€‹± â€‹0.11, and 0.23 â€‹± â€‹0.14 LogMAR. All improved over the preoperative assessments (P â€‹< â€‹0.05). The RRA, UCIVA, and UCNVA were significantly better in the Toric group than the non-Toric group at all follow-up examinations (all P â€‹< â€‹0.05). At 3 months, the median near and intermediate stereoacuity of the Toric group were 100 (range 40 - 400) and 120 (range 50 - 400) arcsec, which were better than the non-Toric group (both P â€‹< â€‹0.05). Fine near stereopsis ≥100 arcsec was present in 65% of the Toric patients, and 50% had good intermediate stereopsis of ≥100 arcsec. However among non-Toric patients, only 15% and 5% achieved fine near and intermediate stereopsis. The postoperative BCDVA and best-corrected distance stereoacuity were similar in the two groups (P â€‹> â€‹0.05). Conclusions: In bilateral high myopic cataract patients with astigmatism, Toric IOLs not only improved UCIVA, UCNVA, and RRA, but also enhanced near and intermediate stereopsis acuity.

Cataract surgery in neovascular AMD: impact on visual acuity and disease activity.

BACKGROUND: Cataract and neovascular age-related macular degeneration (nAMD) often co-exist and both contribute to impaired vision. It has been debated whether cataract surgery can increase nAMD activity. The purpose of this retrospective study was to investigate the impact of cataract surgery on visual acuity, treatment intensity for nAMD and macular morphology in patients with on-going treatment for nAMD. METHODS: Data was obtained from the Swedish Macular Register, the Swedish National Cataract Register, optical coherence tomography (OCT) images and patient charts. All eyes were treated at the Department of Ophthalmology at the County Hospital of Västmanland, Västerås, Sweden. Follow-up was 6 months after surgery. The study was approved by the Swedish Ethical Review Authority. RESULTS: In total, 156 patients (168 eyes) were included. The mean age at cataract surgery was 82 (standard deviation, SD 6) years. Both distance and near visual acuity improved after surgery. Distance visual acuity increased from 59 (SD 12) to 66 (SD 15) letters ETDRS (P < 0.001). Proportion of eyes with normal near visual acuity increased from 12 to 41%. The anti-vascular endothelial growth factor (VEGF) treatment intensity remained unchanged: mean of 3.4 (SD 1.9) and 3.3 (SD 1.7) treatments were given 6 months pre- and postoperatively, respectively. The prevalence of intraretinal fluid (IRF) in the macula increased from 22 to 31% postoperatively, while subretinal fluid, fluid under the pigment epithelium (sub-RPE fluid) and central retinal thickness were unaltered. In eyes with new IRF, improvement in visual acuity and number of anti-VEGF treatments were similar to eyes without new IRF. CONCLUSION: Cataract surgery improved visual acuity in patients with on-going treatment for nAMD and did not affect anti-VEGF treatment intensity. Macular morphology remained unchanged. The slight increase in intraretinal fluid after surgery was not found to affect visual acuity or anti-VEGF treatment intensity. It is hypothesized that this might indicate that it represents degenerative intraretinal cystic fluid.

Non-Miotic Improvement in Binocular Near Vision with a Topical Compound Formula for Presbyopia Correction.

INTRODUCTION: The aim of this case series was to examine the association between unaided binocular visual acuity for near vision and pupil change after the instillation of a special topical formulation for presbyopia treatment. METHODS: This was a case series consisting of consecutive participants with presbyopia aged 40-70 years who were tested for visual acuity and pupil diameter before and 2 h after instillation of a formulation of pilocarpine and phenylephrine drops (FOV Tears) for presbyopia. Participants underwent subjective refraction, photopic and scotopic pupil diameter measurement and unaided monocular and binocular visual acuity testing by logMAR for distance and near vision both pre- and post-instillation of eye drops. RESULTS: The study enrolled 363 subjects (n = 176 women, 48%) with a mean (± standard deviation) age of 50.4 ± 5.8 years. Mean spherical equivalent (SE) changed significantly (- 0.17 Diopters) after instillation of the FOV Tears formulation (p < 0.001). Post-instillation of eye drops, the scotopic pupil diameter decreased by 0.97 ± 0.98 mm, and the near visual acuity by logMAR improved significantly by nearly two lines (p < 0.01). In the linear regression analyses, age (p < 0.001) and SE pre-drop instillation (p < 0.001) were associated with unaided binocular visual acuity. The changes in photopic pupil diameter and the scotopic pupil diameter were not associated with unaided binocular visual acuity. CONCLUSIONS: The use of the pilocarpine and phenylephrine formulation (FOV Tears) improved binocular visual acuity for near vision in presbyopic patients, and the effect was independent of pupil change.

The Philippine Peso Bill as an Alternative Near Visual Acuity Chart in Filipino Eyes: A Pilot Study.

Purpose: This study aimed to determine if near visual acuity measurements using a Philippine peso bill are comparable to a standard Jaeger chart. Study Design: This is a cross-sectional study comparing the near visual acuity measurements of a Philippine peso bill and a Jaeger chart among sixty subjects. Methods: LogMAR scores from the two methods were analyzed using Wilcoxon Mann-Whitney test. The relationship of the logMAR scores between these methods was determined using Spearman rank order correlation. The Bland-Altman plot was used to determine the comparability between quantitative measurements for near visual acuity using the standard Jaeger chart (reference) and the Philippine peso bill. Results: There were no significant differences in the proportion of Jaeger scores and mean logMAR equivalents between the two methods (p > 0.05). The scatter plot diagram shows a positive upward trend with a very strong and significant correlation between logMAR scores of Jaeger chart and Philippine peso bill methods (r = 0.9258, p < 0.0001). With a concordance correlation coefficient of 0.9505, there is a high agreement between these two measures. The Philippine peso bill overestimates the Jaeger chart visual acuity by 0.04 logMAR units. We suspect that the contrast between the background color and the serial numbers of the peso bill may have brought about this outcome. Conclusion: The Philippine peso bill may be used as an alternative measuring tool for near visual acuity. However, there is a tendency to overestimate the scores obtained using the Philippine peso bill. Future studies are recommended to validate the results in a tele-ophthalmology setting.

Possible limits of calibrating reading charts with the Landolt ring: a microscopic study.

PURPOSE: To evaluate microscopically whether the print quality and accuracy of sizing of Landolt ring near vision charts are adequate for the calibration of reading charts. METHODS: Near vision charts with Landolt rings from Oculus GmbH (C-Test; Wetzlar, Germany), Precision Vision (Woodstock, IL) and the RADNER Charts were examined, as well as custom-made Landolt rings optimized for print quality. Microscopic investigations and measurements were performed by using a Huvitz HSZ 600 stereomicroscope (Nikon NIS Elements software) to evaluate the height of the Landolt rings, the thickness of the lines, and the width of the openings. The deviations from the mathematically correct values, which were calculated as given in the EN/ISO 8596 and by the International Council of Ophthalmology (ICO), were analyzed (calculated for a test distance of 40 cm). RESULTS: All the near vision charts showed notable deficiencies in print quality and aberrations from the nominal values in the height, thickness of the lines, and width of the openings. The openings were too narrow, whereas the height and thickness of the lines were larger than the nominal values. Even the openings of Landolt rings optimized for print quality were not always within an acceptable 5% tolerance and need further improvement. CONCLUSION: This study reports inaccuracies in the heights, thicknesses of the lines, and widths of the openings of Landolt rings in all the near vision charts investigated. The extent of these inaccuracies excludes such near vision charts as reference tests for the calibration of reading charts. The x-height in relation to the visual angle still seems to be the most reliable method for standardizing the print sizes for reading charts.

Clinical outcomes after implantation of extended depth-of-focus AcrySof® Vivity® intraocular lens in eyes with low-grade epiretinal membrane.

PURPOSE: To evaluate the clinical outcomes of extended depth-of-focus (EDoF) AcrySof® Vivity® intraocular lens in eyes with low-grade epiretinal membrane (ERM). METHODS: Forty-five eyes with low-grade ERM and history of Vivity implantation were compared with 50 age-matched controls with Vivity implantation and no ERM. Eyes with ERM showing widening of the outer nuclear layer and loss of the foveal depression, but no ectopic inner foveal layer or outer retinal defect were eligible. Corrected and uncorrected distant visual acuity (CDVA and UDVA), uncorrected intermediate and near visual acuity (UIVA and UNVA), contrast sensitivity detected by area under the log contrast sensitivity function (AULCSF), Strehl ratio, area ratio, and occurrence of dysphotopsia were compared between groups. RESULTS: UDVA and CDVA were similar between groups (UDVA: 0.01 ± 0.05 vs 0.03 ± 0.06, P = 0.154; CDVA: 0.00 ± 0.00 vs 0.00 ± 0.02, P = 0.125). UIVA and mesopic AULCSF were significantly worse in eyes with ERM compared to those with no ERM (UIVA: 0.09 ± 0.09 vs 0.14 ± 0.10, P = 0.028; mesopic AULCSF: 1.26 ± 0.15 vs 1.17 ± 0.10, P = 0.013). The occurrence of dysphotopsia was similar in both groups (glare: P = 0.465; halo: P = 0.218; starburst: P = 0.457). DISCUSSION: Eyes with low-grade ERM showed comparable outcomes to eyes without ERM after Vivity IOL implantation. Implantation of this newly developed EDoF IOL with low addition can be of benefit to eyes with low-grade, reversible ERM that is limited to the inner retina.

A One Year Longitudinal Comparative Analysis of Visual Outcomes Between Femtosecond Laser-Assisted Cataract Surgery and Standard Phacoemulsification Cataract Surgery.

PURPOSE: To assess visual outcomes over time of femtosecond laser-assisted cataract surgery compared to standard phacoemulsification cataract surgery. DESIGN: A retrospective, single-center comparative study. METHODS: Patient data including demographics, ocular biometry, pre- and postoperative visual acuity, postoperative complications, primary (uncorrected distance visual acuity over time) and secondary visual outcomes (uncorrected near visual acuity, best distance visual acuity, patient complaints, satisfaction, and postoperative surgery) were gathered and statistically analyzed. Demographic differences between patients receiving femtosecond-laser assisted cataract surgery (FLACS) versus standard phacoemulsification cataract surgery (PCS) were corrected for outcome comparison. Safety, efficacy, predictability, and stability were analyzed for each procedure and compared. RESULTS: A total of 155 eyes in PCS and 143 eyes in FLACS were analyzed at 1 week, 3 months, and 1 year using odds ratio. The odds ratio of being 20/20 or better and 20/40 or better at the specified time periods were similar and statistically insignificant at all time periods analyzed except 20/20 or better for uncorrected distance visual acuity (UDVA) at 1 year (p=0.0001) and uncorrected near visual acuity (UNVA) at 1 week (p=0.02). In both cases, the odds of being 20/20 or better favored FLACS. Mean UDVA, UNVA, and best distance visual acuity (BDVA) were all similar and statistically insignificant between the two groups. Postoperative patient complaints, safety, efficacy, predictability, and stability between the two groups showed no statistical significance. CONCLUSION: Despite the odds ratio of being 20/20 or better favoring FLACS for UDVA at 1 year and UNVA at 1 week, the mean logMAR UDVA, BDVA, and UNVA were similar and statistically insignificant between the FLACS and PCS groups at 1 week, 3 months, and 1 year. Differences in visual acuity were likely due to differences other than surgical approaches. While both FLACS and PCS are appropriate approaches to cataract surgery, one does not appear to be superior when assessing longitudinal markers for visual acuity, safety, efficacy, predictability and stability.

Determination of the Standard Visual Criterion for Diagnosing and Treating Presbyopia According to Subjective Patient Symptoms.

Presbyopia treatments using various modalities have been developed recently; however, no standard criteria exist for the diagnosis and treatment endpoint. This study assessed the relationship between the near visual acuity (NVA) and the subjective symptoms of phakic presbyopia and determined the numerical NVA threshold to diagnose phakic presbyopia and evaluate the effectiveness of presbyopia treatment. The binocular distance, NVA with habitual correction, and monocular conventional VA were measured. Patients were asked about their awareness of presbyopia and difficulty performing near tasks. This prospective observational study included 70 patients (mean age, 56 years; range, 32-77). Most patients became aware of presbyopia in their late forties, although some had difficulty with vision-related near tasks before becoming aware of presbyopia. Eighty three percent of patients (20/24) experienced difficulty with near vision-related tasks even with excellent NVA at 40 cm with habitual correction of 0.0 logMAR (20/20 in Snellen VA). In conclusion, the current study showed that patients became aware of presbyopia in their late forties, although some had difficulty with near vision-related tasks before becoming aware of presbyopia. Further investigation should include the proposal of appropriate diagnostic criteria for presbyopia and better management for patients with presbyopia.

Clinical differences between toric intraocular lens (IOL) and monofocal intraocular lens (IOL) implantation when myopia is determined as target refraction.

BACKGROUND: The aim of this study is to analyze and compare the clinical results of toric intraocular lens (IOL) and monofocal IOL implantation when the target refraction value is -3 diopter (D) in cataract patients with corneal astigmatism > 1.5 diopters (D). METHODS: We performed a retrospective chart review for patients with corneal astigmatism > 1.5D who underwent cataract surgery and their target refraction is -3D. 100 eyes (100 patients; monofocal IOL, 60; toric IOL, 40) were enrolled in the current study. Near and distant uncorrected visual acuity (UCVA), corrected VA, spherical equivalent and refractive, corneal astigmatism were evaluated before and after surgery. RESULTS: The near UCVA of the toric IOL group (0.26 ± 0.33) after cataract surgery was significantly better than that of the monofocal IOL group (0.48 ± 0.32) (p = 0.030). The distant UCVA of the toric IOL group (0.38 ± 0.14) was also significantly better than that of the monofocal IOL group (0.55 ± 0.22) (p = 0.026). Best-corrected visual acuity (p = 0.710) and mean spherical equivalent (p = 0.465) did not show significant differences between the toric IOL group and the monofocal IOL group. In the toric IOL group, postoperative refractive astigmatism was - 0.80 ± 0.46D and postoperative corneal astigmatism was - 1.50 ± 0.62D, whereas the corresponding values in the monofocal IOL group were - 1.65 ± 0.77D and - 1.45 ± 0.64D; residual refractive astigmatism was significantly lower with toric IOL implantation compared with monofocal IOL implantation (p = 0.001). There were no postoperative complications. CONCLUSIONS: When myopic refraction such as -3D was determined as the target power in patients with corneal astigmatism, toric IOL implantation led to excellent improvement in both near and distant UCVA.

Comparison of two extended depth of focus intraocular lenses with a monofocal lens: a multi-centre randomised trial.

PURPOSE: The AT LARA 829MP is a next-generation extended depth of focus (EDOF) intraocular lens (IOL) providing continuous vision over a range of distances. The aim of this prospective multi-centre randomised trial was to compare two EDOF IOLs and one monofocal IOL. METHODS: Cataract patients between 50 and 80 years were randomised for bilateral implantation with either the AT LARA 829MP (EDOF), the TECNIS Symfony (EDOF) or the CT ASPHINA 409MP (monofocal). Follow-up was at 1 to 2 weeks, 1 month and 4 to 6 months. RESULTS: A total of 211 patients were randomised and included in the final analysis. Monocular depth of focus was significantly better for AT LARA 829MP eyes compared with that for TECNIS Symfony at all thresholds (p = 0.024, 0.001 and 0.006, for 0.1, 0.2 and 0.3 logMAR respectively) with no significant difference for binocular depth of focus. LARA eyes had significantly better monocular depth of focus at all levels compared with ASPHINA eyes (all p < 0.0001), while there was no significant difference between Symfony and ASPHINA eyes at 0.1 logMAR and 0.2 logMAR. Both EDOF IOLs were significantly better than the monofocal ASPHINA at all levels for binocular depth of focus (LARA: all p < 0.0001; Symfony: all p = 0.002). Distance visual acuity was similar for all IOLs at 6 months; intermediate and near visual acuity were significantly better for the EDOF IOLs than for the monofocal (p < 0.0001). Refraction improved in all groups relative to baseline. Contrast sensitivity was higher with the CT ASPHINA 409MP but both EDOF lenses had a better spectacle independence rate. At 6 months, all IOLs were well centred with no cases of tilt. No general safety issues were raised for any of the groups. CONCLUSION: The two EDOF intraocular lenses investigated provided good visual outcomes with comparable visual acuity at all distances. The AT LARA 829MP provided the widest monocular depth of focus at 0.1 and 0.2 logMAR, with a clear superiority compared with the monofocal IOL. TECNIS Symfony was superior to the monofocal control at 0.3 logMAR. Spectacle independence and patient satisfaction were comparable. TRIAL REGISTRATION: Trial registered on https://clinicaltrials.gov/ under the identification NCT03172351 (date of registration 1 June May 2017).

Combinations of Pilocarpine and Oxymetazoline for the Pharmacological Treatment of Presbyopia: Two Randomized Phase 2 Studies.

Purpose: To determine the safety, efficacy, and tolerability of combinations of pilocarpine (Pilo) and oxymetazoline (Oxy) ocular drops dosed once daily and identify the optimal concentration of each for the pharmacologic treatment of presbyopia. Design: Two concurrent Phase 2, multicenter, double-masked, randomized, vehicle-controlled studies, 1 short-term and 1 extended study. Participants: Emmetropic individuals affected by presbyopia and in good general health. Methods: Uncorrected near visual acuity (UNVA) was measured throughout both studies with various concentrations and combinations of Pilo (0%, 0.5% 1.0%, and 1.5%) and Oxy (0%, 0.0125%, 0.05%, and 0.125%). For safety, uncorrected distance visual acuity (UDVA) was measured, treatment-emergent adverse events (TEAEs) were recorded, and a temporal/supraorbital headache assessment was completed. Main Outcome Measures: The primary efficacy end point was mean change from baseline in UNVA. Results: In the short-term study, Pilo was shown to produce a significant dose response in the average increase of letters (P < 0.001), whereas Oxy did not have a significant impact (P = 0.4797). The addition or increase in concentration of Oxy did not reduce incidence or severity of headaches when compared with Pilo alone. Efficacy results from the extended study supported the results from the short-term study. As early as 15 minutes postadministration, a dose response could be seen, with peak effect at 1 hour. Peak improvement increased from day 1 to day 14 and was maintained up to day 28. The most common TEAE was headache. There was no clinically significant reduction in UDVA. A polynomial regression model was developed and determined that the optimal concentration range of Pilo is between 1.16% and 1.32%. Conclusions: On the basis of the results of the 2 Phase 2 studies, AGN-190584, a reading drop containing an optimized concentration of pilocarpine HCl (1.25%) delivered using a proprietary formulation, was developed and is currently under investigation in Phase 3 studies.

The Impact of Progressive Visual Field Constriction on Reading Ability in an Inherited Retinal Degeneration.

BACKGROUND: The ability to read is an important factor in the quality of life. Choroideremia is an inherited retinal degeneration presenting with gradual, progressive constriction of the central visual field, providing a useful disease model to investigate the impact of the visual field on reading ability. OBJECTIVE: The aim of this study was to provide practical guidance on the usefulness of measuring reading ability in patients. METHOD: The Radner Reading Test was administered to 33 patients (65 eyes with choroideremia). To quantify the residual retinal area, the patients underwent microperimetry and imaging. The visual angle subtended by the largest letter read by each subject was calculated using Emsley's Model Eye. RESULTS: A minimum of 1 letter must be seen to allow the eye to read, with preservation of foveal sensitivity. The relationship between reading speed and acuity varies with the visual field. The reading speed is higher in eyes with an intact fovea (p < 0.001 right eye, p = 0.06 left eye). Qualitative analysis of the direction of the intact retina did not indicate any directional impact on measurements. CONCLUSIONS: In order to read, an eye must have enough retinal width close to the fovea to see at least 1 full letter. Direction of print does not impact the ability to read, allowing results from different languages to be combined in clinical trials.

Effects of a change in the direction of view to near uncorrected visual acuity following implantation of monofocal intraocular lens.

The objective of the present study was to evaluate the effect of the direction of view of the eye on the postoperative near visual acuity of patients with monofocal intraocular lens. A total of 121 eyes in which we performed conventional cataract surgery with implantation of a monofocal lens were included in the study group. The postoperative examination of near visual acuity was performed at two different positions of the eye at a constant distance from the reading table, with the assumption of improving visual acuity when looking perpendicularly to the plane of the floor. The mutual relation of the postoperative parameters central keratometry (Kc), keratometry in the visual axis (KVA) and anterior chamber depth (ACD) for the single axial length ranges was determined using the correlation coefficients. In the case of vertical position of the eye (visual axis of the eye perpendicular to the floor), the uncorrected visual acuity following implantation of the monofocal lens was higher or equal compared to the horizontal position of the eye (visual axis of the eye parallel to the floor). The mean visual acuity at the horizontal position of the eye was 0.508 according to Jaeger's tables (P<0.001); at the vertical position, the mean value was 0.555 (P<0.001). Within the entire group, a weak association at best was observed between the postoperative parameters (Kc, KVA and ACD) and subsequent near visual acuity. Different dependence was found after categorising the group according to the axial length of the eye. In conclusion, the near visual acuity in eyes with an implanted monofocal lens for emmetropy to distance reached higher values at the vertical vs. horizontal position of the eyes. However, neither of the observed parameters (KC, KVA or ACD) can be unambiguously determined as decisive for the assumption of the described feature.

Effects of bifocals on visual acuity in children with Down syndrome: a randomized controlled trial.

PURPOSE: Children with Down syndrome (DS) typically have reduced visual acuity (VA) and accommodation lag, but it is unclear whether prescribed glasses should correct both distance VA (DVA) and near VA (NVA) due to the lack of RCTs. We therefore conducted a multicentre RCT to compare the effects of bifocals designed to correct both DVA and NVA with distance-correcting unifocal glasses in children with DS. METHODS: A total of 119 children with DS, aged 2-16, were randomly allocated for bifocal or unifocal glasses (with full correction of refraction error in cycloplegia) in 14 Dutch hospitals and followed during 1 year. VA data were analysed in relation to baseline VA with ancova. RESULTS: Treatment groups showed no differences at baseline. Shortly after receiving new corrections (~6 weeks), uncrowded NVA (bifocals 0.18 ± 0.33 LogMar; unifocals 0.09 ± 0.19 LogMar) and crowded NVA with bifocals (bifocals 0.13 ± 0.36 LogMar; unifocals 0.08 ± 0.33 LogMar) were significantly better than at baseline, but these short-term improvements in NVA were not significantly different between the two treatments (p > 0.151). The 1-year treatment differences were as follows: significantly larger improvement for bifocals compared to unifocals in both uncrowded NVA (bifocals 0.23 ± 0.29 LogMar, unifocals 0.12 ± 0.30 LogMar, p = 0.045) and crowded NVA (bifocals 0.31 ± 0.28 LogMar; unifocals 0.16 ± 0.30 LogMar, p = 0.017). Improvements in DVA were comparable (bifocals 0.07 ± 0.21 LogMar, unifocals 0.08 ± 0.22 LogMar, p = 0.565). Children with poor baseline VA improved more. Accommodation lag stayed unchanged. CONCLUSION: After one year, bifocals with full correction of ametropia led to significantly larger improvement of both uncrowded NVA and crowded NVA in children with DS with accommodation lag compared to unifocals.

An Eye on Vision: Five Questions About Vision Screening and Eye Health-Part 2.

Current evidence-based and best practice vision screening and eye health approaches, tools, and procedures are the result of revised national guidelines in the last 3 years and advances in research during the past 18 years. To help the busy school nurse, with little time to keep up with changes in children's vision practices and a growing body of literature, the National Center for Children's Vision and Eye Health at Prevent Blindness is providing answers to five questions that are often received from the field. Topical areas include (1) which numbers to record when using a 10-foot chart, (2) instrument-based screening and visual acuity, (3) screening children who wear glasses, (4) referring children who do not pass color vision deficiency screening, and (5) conducting near visual acuity screening monocularly or binocularly.

An Eye on Vision: 20 Questions About Vision Screening and Eye Health.

Current evidence-based and best practice vision screening and eye health approaches, tools, and procedures are the result of revised national guidelines in the past 3 years and advances in research during the last 16 years. To help the busy school nurse with little time to keep up with changes in children's vision practices and a growing body of literature, the National Center for Children's Vision and Eye Health at Prevent Blindness is providing answers to 20 questions received most often from the field. Question topics are: (1) arranging the screening environment, (2) occluders to cover the eyes during vision screening, (3) optotype-based screening at distance, (4) optotype-based screening at near, (5) instrument-based screening, (6) muscle imbalance screening, (7) referrals, and (8) vision screening certification.

Clinical observation of multifocal intraocular lens with aspheric astigmatism in cataract surgery / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: By comparing the aspheric and multifocal Toric intraocular lens and the aspheric intraocular lens in cataract patients,to observe the patients` visual quality,to evaluate the patients` distance visual acuity,near visual acuity,Pseudo-accommodative power,residual astigmatism,the rotational stability of AcrySof IQ Toric Restor intraocular lens (IOLs),contrast the rate of off-distance glass,the rate of off-near glass and patient satisfaction after the implantation of AcrySof IQ Toric Restor IOL in the cataract patients with preexisting corneal astigmatism.METHODS:Carried out in 46 patients (48 eyes) with age-rated cataract who receiving phacoemulsification and implantation of artificial lens in our department during February 2014 to June 2016.All the cases were randomly divided into 2 groups: experimental group: 23 cases (24 eyes),AcrySof IQ ReSTOR Toric IOL was implanted after phacoemulsification;control group: 23 cases (24 eyes),AcrySof IQ was implanted.Uncorrected distance visual acuity (UCDVA) and best corrected distance visual acuity (BCDVA),uncorrected near visual acuity (UCNVA) and best-corrected near visual acuity(BCNVA),Pseudo-accommodative power,residual astigmatism,preoperative and postoperative corneal astigmatism,the rate of off-distance glass,the rate of off-near glass and patient satisfaction were measured at 6mo postoperatively follow-up.RESULTS: BCDVA and BCNVA were not statistically different between the two groups(P<0.05).At 1wk,1,3 and 6mo postoperatively of UCDVA the experimental group were statistically better than the control group (P<0.05).UCNVA were also statistically better than the control group (P<0.05).The mean residual astigmatisms 1wk,1,3 and 6mo postoperatively were statistically differences between the control group and experimental group (P<0.05).At 6mo postoperatively,patients satisfaction of experimental group were significantly better than control group (P<0.05).Spectacles independence for near vision achieved 83% and 17% in experimental group and control group,experimental group were statistically better than control group(P<0.05).Spectacles independence for distance vision achieved 92% and 67% in experimental group and control group,experimental group were statistically better than control group(P<0.05).CONCLUSION:The results indicate that AcrySof IQ ReSTOR Toric IOLs may provide a better uncorrected distance visual acuity and uncorrected near visual acuity,which can significantly reduce preexisting corneal astigmatism in cataract surgery,improve spectacles independence for distance vision and spectacles independence for near vision,have a high patient satisfaction.

Visual acuity and patient satisfaction at varied distances and lighting conditions after implantation of an aspheric diffractive multifocal one-piece intraocular lens.

PURPOSE: The aim of the study is to evaluate the visual acuity and patient satisfaction at varied distances under photopic and mesopic lighting conditions in patients bilaterally implanted with aspheric diffractive multifocal one-piece intraocular lenses. METHODS: In this retrospective-prospective study, 16 patients with a mean age of 66.2±9.2 years (range: 50-81 years) who had undergone bilateral phacoemulsification surgery with implantation of a Tecnis multifocal one-piece intraocular lens (ZMB00) were evaluated. Monocular and binocular uncorrected and distance-corrected visual acuities were measured at distance (20 ft), intermediate (70-80 cm), and near (35-40 cm) under photopic (85 cd/m(2)) and mesopic (3 cd/m(2)) lighting conditions and were compared using the paired t-test. All patients also completed a subjective questionnaire. RESULTS: At a mean follow-up of 9.5±3.9 months, distance, near, and intermediate visual acuity improved significantly from preoperative acuity. Under photopic and mesopic conditions, 93.8% and 62.5% of patients, respectively, had binocular uncorrected intermediate visual acuity of 20/40 or better, and 62.5% and 31.3% of patients had binocular uncorrected near visual acuity of 20/20 or better. All patients were satisfied with their overall vision without using glasses and/or contact lenses when compared with before surgery. A total of 87.5% of patients reported no glare and 68.8% of patients reported no halos around lights at night. CONCLUSION: Tecnis multifocal one-piece intraocular lenses provide good distance, intermediate, and near visual acuity under photopic as well as mesopic lighting conditions. High levels of spectacle independence with low levels of photic phenomenon were achieved, resulting in excellent patient satisfaction.