Evaluating tear clearance rate with optical coherence tomography.

PURPOSE: To assess the early-phase of tear clearance rate (TCR) with anterior segment optical coherence tomography (OCT) and to determine the association between TCR and other clinical measures of the tear film in a group of young subjects with different levels of tear film quality. METHODS: TCR was classified as the percentage decrease of subject's inferior tear meniscus height 30s after instillation of 5µl 0.9% saline solution. Fifty subjects (32F and 18M) aged (mean±standard deviation) 25.5±4.3 years volunteered for the study. It consisted of a review of medical history, Ocular Surface Disease Index (OSDI) questionnaire, tear film osmolarity measurements, slit lamp examination and TCR estimation based on dynamic measurements of the lower tear meniscus with OCT. Estimates of TCR were contrasted against subject age and tear film measures commonly used for dry eye diagnosis, which includes OSDI score, fluorescein tear film break-up time (FBUT), tear meniscus height (TMH), blinking frequency, tear film osmolarity and corneal staining. RESULTS: The group mean TCR was 29±13% and 36±19% respectively after 30 and 60s margin after saline solution instillation. Statistically significant correlations were found between TCR and FBUT (r2=0.319, p<0.001), blinking frequency (r2=0.138, p<0.01), tear film osmolarity (r2=0.133, p<0.01) and subject's age (r2=0.095, p<0.05). CONCLUSIONS: Anterior segment optical coherence tomography allows following changes of tear meniscus morphology post saline solution instillation and evaluating the TCR. OCT based TCR might be used as additional measure of the lacrimal functional unit.

Objective assessment of the effect of pupil size upon the power distribution of multifocal contact lenses.

AIM: To analytically assess the effect of pupil size upon the refractive power distributions of different designs of multifocal contact lenses. METHODS: Two multifocal contact lenses of center-near design and one multifocal contact lens of center-distance design were used in this study. Their power profiles were measured using the NIMO TR1504 device (LAMBDA-X, Belgium). Based on their power profiles, the power distribution was assessed as a function of pupil size. For the high addition lenses, the resulting refractive power as a function of viewing distance (far, intermediate, and near) and pupil size was also analyzed. RESULTS: The power distribution of the lenses was affected by pupil size differently. One of the lenses showed a significant spread in refractive power distribution, from about -3 D to 0 D. Generally, the power distribution of the lenses expanded as the pupil diameter became greater. The surface of the lens dedicated for each distance varied substantially with the design of the lens. CONCLUSION: In an experimental basis, our results show how the lenses power distribution is affected by the pupil size and underlined the necessity of careful evaluation of the patient's visual needs and the optical properties of a multifocal contact lens for achieving the optimal visual outcome.

Simulated prototype of posterior chamber phakic intraocular lens for presbyopia correction.

PURPOSE: To evaluate the visual impact of adding different spherical aberration values to an Implantable Collamer Lens phakic intraocular lens (pIOL) to increase the depth of focus using an adaptive optics visual simulator. SETTING: University of Valencia, Valencia, Spain. DESIGN: Experimental study. METHODS: Wavefront aberrations in -3.00 D and -6.00 diopter (D) pIOLs were measured in vitro. Afterward, different simulated pIOL experimental prototypes were created along with variances in the spherical aberration. An adaptive optics visual simulator was used to simulate vision after the implantation of the different pIOL prototypes from their wavefront aberrations. The corrected distance visual acuity (CDVA) and depth of focus were measured in 3.0 and 4.5 mm pupils. RESULTS: In a 3.0 mm pupil, the CDVA achieved with -3.00 and -6.00 D pIOLs and all pIOL prototypes evaluated was above 20/20 except for a -6.00 D pIOL + spherical aberration 4 at 50% CDVA contrast, which decreased to 20/25. However, in a 4.5 mm pupil, the CDVA obtained with the pIOL prototypes decreased significantly and was more pronounced when the spherical aberration induced was negative. The depth of focus increment was larger with the highest spherical aberration added and with a small pupil. Nevertheless, it was independent of the sign of the added spherical aberration. CONCLUSIONS: The outcomes show that residual negative spherical aberration after pIOL implantation will disrupt the CDVA. However, some residual positive spherical aberration after pIOL implantation increased the depth of focus with excellent CDVA, providing a possible pIOL design for young presbyopic patients. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Fixed mydriatic pupil associated with an intraocular pressure rise as a complication of the implant of a Phakic Refractive Lens (PRL).

We describe a case report of a patient that was implanted with a posterior chamber phakic intraocular lens (Phakic Refractive Lens, PRL) for the correction of moderate myopia and who developed postoperatively a fixed mydriasis compatible with an Urrets-Zavalia Syndrome (UZS). Specifically, a sudden acute increase of IOP in the left eye was observed in the immediate postoperative period. After IOP stabilization, the refractive result was good, but a fixed and mydriatic pupil appeared. This condition led the patient to experience visual discomfort, halos, and glare associated with high levels of higher-order aberrations in spite of the good visual result. A tinted-contact lens was fitted in order to minimize those symptoms. The UZS should be considered as a possible complication after implantation of posterior chamber phakic intraocular lenses.

Long-term comparison of corneal aberration changes after laser in situ keratomileusis: mechanical microkeratome versus femtosecond laser flap creation.

PURPOSE: To compute and compare visual acuity, refractive outcomes, and anterior corneal aberration changes after myopic laser in situ keratomileusis (LASIK) with flap creation by a mechanical microkeratome and by a femtosecond laser. SETTING: Private practice refractive surgery center, Valencia, Spain. DESIGN: Comparative case series. METHODS: Patients were assigned to have LASIK flap creation with a mechanical microkeratome (Carriazo-Barraquer) or a femtosecond laser (IntraLase). The Visx S2 excimer laser was used for myopic ablation in all cases. Main outcome measures included uncorrected and corrected distance visual acuities and the defocus equivalent. Higher-order aberrations (HOAs) were computed from the anterior corneal surface measured with topography for 4.0 mm and 6.0 mm pupil diameters before and 48 months after surgery. RESULTS: The study evaluated 50 patients (98 eyes). The root mean square of HOAs increased postoperatively by a factor of approximately 1.9 in both groups and with both pupil diameters. There were no statistically significant differences between the 2 groups in the increase in anterior corneal aberrations, mean postoperative visual acuity, or residual refraction. All visual and optical performance metrics remained stable throughout the 4-year follow-up. There were no complications with flap creation and no postoperative complications. CONCLUSIONS: The increase in anterior corneal aberrations after myopic LASIK was similar after mechanical microkeratome and femtosecond laser flap creation. Visual acuity, refraction, and the optical quality of the cornea after LASIK remained stable through 4 years postoperatively in both groups.

Clinical evaluation of the new TGDc-01 "PRA" palpebral tonometer: comparison with contact and non-contact tonometry.

PURPOSE: The TGDc-01 "PRA" (Ryazan State Instrument, Ryazan, Russia) tonometer is a new portable small-sized tonometer that measures intraocular pressure (IOP) through the eyelid. The purpose of this study is to assess the repeatability of the TGDc-01 IOP measurements by comparing them against those obtained with Goldmann tonometer and with those from Perkins applanation tonometer, Xpert (Reichert, Depew, NY) noncontact tonometer, and Tono-Pen XL (Medtronic Solan, Jacksonville, FL) digital tonometer. METHODS: Fifty-eight right eyes of 58 young subjects were measured with each of the tonometers. Noncontact tonometry was performed first, followed by Goldmann and Perkins applanation tonometer (in random order), digital Tono-Pen XL, and finally TGDc-01 tonometer (sitting and supine position). Correlation analysis was used to evaluate the relationship between the Goldmann tonometer and the remaining tonometers used in this study. Plotting the difference between the methods against mean was also done to compare the tonometers. The hypothesis of zero bias was examined by a paired t-test. The 95% limits of agreement (LoA) were also calculated. RESULTS: TGDc-01 showed no statistical difference between the IOP measurements obtained in sitting and supine positions. A poor relationship between the TGDc-01 and Goldmann tonometer was found (r = 0.173; p = 0.001). Although the mean differences between Goldmann and Tonopen XL, Xpert, and TGDc-01 IOP measurements were statistically significant, the wider 95% LoA was observed when comparing the Goldmann and TGDc-01 tonometers. Computation of the 95% LoA resulted in a wide bias range when comparing the TGDc-01 with all the tonometers used in this study. CONCLUSIONS: The TGDc-01 "PRA" tonometer was not comparable with the other techniques used in the study. The wide dispersion range of the values obtained shows low repeatability of the TGDc-01 for screening purposes. These results could be because of the technique of measurement and/or interindividual variables.