Binocular vision alterations after refractive and cataract surgery: a review.

To review binocular and accommodative disorders documented after corneal or intraocular refractive surgery, in normal healthy prepresbyopic patients. A bibliographic revision was performed; it included works published before 1st July 2017 where accommodation and/or binocularity was assessed following any type of refractive surgical procedure. The search in Pubmed yielded 1273 papers, 95 of which fulfilled the inclusion criteria. Few publications reporting binocular vision and/or accommodative changes after refractive surgery in normal subjects were found. The reduction in fusional vergence is the most frequently reported alteration. Anisometropia is an important risk factor for postoperative binocular vision-related complaints. Most diplopia-related visual complaints, irrespective of the surgical procedure, were in fact misdiagnosed preoperative disorders. The preoperative evaluation of patients seeking spectacle/contact lens independence should include a complete binocular and accommodation assessment where parameters such as the phoric posture, accommodative amplitude and facility, near point of convergence, fusional reserves and accommodative convergence/accommodation coefficient are measured. This would allow the identification of risk factors that could compromise the success of the refractive surgery and cause clinical symptoms.

Spherical subjective refraction with a novel 3D virtual reality based system / Refracción subjetiva esférica utilizando un nuevo sistema 3D basado en realidad virtual

Purpose: To conduct a clinical validation of a virtual reality-based experimental system that is able to assess the spherical subjective refraction simplifying the methodology of ocular refraction. Methods: For the agreement assessment, spherical refraction measurements were obtained from 104 eyes of 52 subjects using three different methods: subjectively with the experimental prototype (Subj.E) and the classical subjective refraction (Subj.C); and objectively with the WAM-5500 autorefractor (WAM). To evaluate precision (intra- and inter-observer variability) of each refractive tool independently, 26 eyes were measured in four occasions. Results: With regard to agreement, the mean difference (±SD) for the spherical equivalent (M) between the new experimental subjective method (Subj.E) and the classical subjective refraction (Subj.C) was −0.034 D (±0.454 D). The corresponding 95% Limits of Agreement (LoA) were (−0.856 D, 0.924 D). In relation to precision, intra-observer mean difference for the M component was 0.034 ± 0.195 D for the Subj.C, 0.015 ± 0.177 D for the WAM and 0.072 ± 0.197 D for the Subj.E. Inter-observer variability showed worse precision values, although still clinically valid (below 0.25 D) in all instruments. Conclusions: The spherical equivalent obtained with the new experimental system was precise and in good agreement with the classical subjective routine. The algorithm implemented in this new system and its optical configuration has been shown to be a first valid step for spherical error correction in a semiautomated way (AU)

Objetivo: Realizar una validación clínica de un sistema experimental basado en realidad virtual, capaz de evaluar la refracción subjetiva esférica simplificando la metodología de la refracción ocular. Métodos: Para evaluar la concordancia, se obtuvieron mediciones de la refracción esférica de 104 ojos pertenecientes a 52 sujetos, utilizando tres métodos diferentes: subjetivamente con el prototipo experimental (Subj.E) y la refracción subjetiva clásica (Subj.C); y objetivamente con el autorrefractómetro WAM-5500 (WAM). Para evaluar la precisión (variabilidad intra e inter-observador) de cada herramienta refractiva, de forma independiente, se midieron 26 ojos en cuatro ocasiones. Resultados: Con respecto a la concordancia, la diferencia media (±DE) para el equivalente esférico (M) entre el nuevo método subjetivo experimental (Subj.E) y la refracción subjetiva clásica (Subj.C) fue de −0,034 D (±0,454 D). El 95% correspondiente a los Límites de la Concordancia (LoA) fue de (−0,856 D, 0,924 D). En relación a la precisión, la diferencia media intra observador para el componente M fue de 0,034 ± 0,195 D para Subj.C, 0,015 ± 0,177 D para WAM y 0,072 ± 0,197 D para Subj.E. La variabilidad inter observador reflejó peores valores de precisión, aunque fueron clínicamente válidos (inferiores a 0,25 D) en todos los instrumentos. Conclusiones: El equivalente esférico obtenido con el nuevo sistema experimental fue preciso y guardó consonancia con la rutina subjetiva clásica. El algoritmo introducido en este nuevo sistema, y su configuración óptica, han demostrado ser un avance válido para la corrección del error esférico de modo semi-automático (AU)

Spherical subjective refraction with a novel 3D virtual reality based system.

PURPOSE: To conduct a clinical validation of a virtual reality-based experimental system that is able to assess the spherical subjective refraction simplifying the methodology of ocular refraction. METHODS: For the agreement assessment, spherical refraction measurements were obtained from 104 eyes of 52 subjects using three different methods: subjectively with the experimental prototype (Subj.E) and the classical subjective refraction (Subj.C); and objectively with the WAM-5500 autorefractor (WAM). To evaluate precision (intra- and inter-observer variability) of each refractive tool independently, 26 eyes were measured in four occasions. RESULTS: With regard to agreement, the mean difference (±SD) for the spherical equivalent (M) between the new experimental subjective method (Subj.E) and the classical subjective refraction (Subj.C) was -0.034D (±0.454D). The corresponding 95% Limits of Agreement (LoA) were (-0.856D, 0.924D). In relation to precision, intra-observer mean difference for the M component was 0.034±0.195D for the Subj.C, 0.015±0.177D for the WAM and 0.072±0.197D for the Subj.E. Inter-observer variability showed worse precision values, although still clinically valid (below 0.25D) in all instruments. CONCLUSIONS: The spherical equivalent obtained with the new experimental system was precise and in good agreement with the classical subjective routine. The algorithm implemented in this new system and its optical configuration has been shown to be a first valid step for spherical error correction in a semiautomated way.

Oftalmopatía en la diabetes mellitus: detección desde la Atención Primaria de salud / Ophthalmic disease in diabetes mellitus: Management from primary health care

ObjetivoConocer la viabilidad de la realización de la exploración oftalmológica básica de la patología ocular del paciente diabético desde el ámbito de la Atención Primaria de Salud (APS).DiseñoEstudio transversal observacional prospectivo y multicéntrico.Participantes y métodoMuestra de 712 diabéticos tipo II. Intervenciones: realización, por parte de un optometrista, de una exploración de la agudeza visual, medición de la presión intraocular y fotografía de fondo de ojo con cámara de retina no midriática. Interpretación de los resultados e indicación de derivación realizada, a doble ciego, por oftalmólogos y médicos APS.ResultadosAlteración agudeza visual: médico APS 43,7%, oftalmólogo 36,1%, concordancia 70%; sospecha glaucoma: médico APS 8,8%, oftalmólogo 7,6%, concordancia 94%; retinopatía diabética: médico APS 28,2%, oftalmólogo 13,4%, concordancia 78%. Derivación Servicios Oftalmología: médico APS 56,8%, oftalmólogo 41,3% (p=0,001).ConclusionesEl nivel de concordancia en los diagnósticos entre médico APS y oftalmólogo hace fiable la exploración oftalmológica del paciente diabético desde el ámbito de la APS. A pesar del supradiagnóstico y del 16% de derivación no justificada realizada por parte del médico APS, se evita la derivación a las consultas de oftalmología, de cerca de la mitad de los pacientes diabéticos(AU)

ObjectiveTo study the feasibility of a basic ophthalmological examination for the eye disease in diabetic patients by Primary Health Care (PHC).InterventionsVisual acuity examination, intraocular pressure measurement and the eye fundus photograph with a non-mydriatic camera taken by an optometrist. The interpretation and subsequent referral to an ophthalmology department by ophthalmologists and general practitioners (GP).ResultsVisual acuity deficiency: GP, 43.7%; ophthalmologist, 36.1%; concordance, 70%; glaucoma suspicion: GP, 8.8%; ophthalmologist, 7.6%; concordance, 94%; diabetic retinopathy: GP, 28.2%; ophthalmologist, 13.4%; concordance, 78%. Ophthalmology Department referral: GP, 56.8%; ophthalmologist, 41.3% (P=0.001).ConclusionsAgreement between GP and ophthalmologist leads to a reliable ophthalmological examination of the diabetic patient in PHC. Despite an over-diagnosis and 16% of non-justified referrals by the GP, Ophthalmology Department referral is avoided in almost half of the diabetic patients(AU)

[Ophthalmic disease in diabetes mellitus: management from primary health care]. / Oftalmopatía en la diabetes mellitus: detección desde la Atención Primaria de salud.

OBJECTIVE: To study the feasibility of a basic ophthalmological examination for the eye disease in diabetic patients by Primary Health Care (PHC). PATIENTS AND METHODS: A multi-centre prospective study. A sample of 712 type 2 diabetics. INTERVENTIONS: Visual acuity examination, intraocular pressure measurement and the eye fundus photograph with a non-mydriatic camera taken by an optometrist. The interpretation and subsequent referral to an ophthalmology department by ophthalmologists and general practitioners (GP). RESULTS: Visual acuity deficiency: GP, 43.7%; ophthalmologist, 36.1%; concordance, 70%; glaucoma suspicion: GP, 8.8%; ophthalmologist, 7.6%; concordance, 94%; diabetic retinopathy: GP, 28.2%; ophthalmologist, 13.4%; concordance, 78%. Ophthalmology Department referral: GP, 56.8%; ophthalmologist, 41.3% (P=0.001). CONCLUSIONS: Agreement between GP and ophthalmologist leads to a reliable ophthalmological examination of the diabetic patient in PHC. Despite an over-diagnosis and 16% of non-justified referrals by the GP, Ophthalmology Department referral is avoided in almost half of the diabetic patients.