Best Corrected Near Visual Acuity Research Articles

Effects of different types of intraocular lens implantation on patient's visual quality and function after phacoemulsification

Objective: To explore the effects of different types of intraocular lens (IOL) implantation on patient's visual quality and function after phacoemulsification. Methods: The clinical data of patients with monocular cataract who underwent phacoemulsification in the Department of Ophthalmology, People's Hospital Affiliated to Shandong First Medical University between December 2021 and May 2023 were retrospectively analyzed. According to the types of IOL, the patients were divided into monofocal group, bifocal group and depth of focus extension group. Three months later, uncorrected distance visual acuity (UCDVA), best corrected distance visual acuity (BCDVA), uncorrected intermediate visual acuity (UCIVA), best corrected intermediate visual acuity (BCIVA), uncorrected near visual acuity (UCNVA) and best corrected near visual acuity (BCNVA) were detected. Contrast sensitivity and total wavefront aberration were measured by visual function analyzer. Satisfaction with visual quality was evaluated by hospital-made satisfaction questionnaire. Results: A total of 92 patients were included, with 31 males and 61 females, and their age was (61.8±5.2) years. There were 43, 28 and 21 cases in monofocal group, bifocal group and depth of focus extension group, respectively. No statistically significant difference was found in clinical baseline data among the three groups. UCIVA, UCDVA, BCIVA and BCDVA in depth of focus extension group were 1.01±0.13, 0.92±0.18, 1.21±0.19 and 1.20±0.23, respectively, which were higher than those in monofocal group (0.62±0.12, 0.74±0.13, 1.02±0.17, 1.07±0.19, respectively) and bifocal group (0.67±0.15, 0.78±0.14, 1.01±0.16, 1.01±0.18, respectively), while absolute value of spherical equivalent [(-0.42±0.07) D] was lower than that in the other two groups [ (-0.49±0.05) D and (-0.45±0.08) D] (both P<0.05). UCNVA and BCNVA in bifocal group were 0.91±0.18 and 1.25±0.18, which were higher than those in depth of focus extension group (0.63±0.24 and 1.19±0.17) (both P<0.05). There were no significant differences in contrast sensitivity among the three groups under day vision or between monofocal group and bifocal group under night vision (all P>0.05), but the contrast sensitivity was higher in depth of focus extension group under night vision (3.0, 6.0, 12.0 c/d) than other two groups (all P<0.05). The score of ocular discomfort was the highest in bifocal group, followed by depth of focus extension group and monofocal group (both P<0.05). The score of visual interference in bifocal group was lower than that in monofocal group and depth of focus extension group (both P<0.05). The scores of subjective feeling in bifocal group and depth of focus extension group were higher than that in monofocal group (both P<0.05). The reading score was the highest in bifocal group, followed by depth of focus extension group and monofocal group (both P<0.05). There was no significant difference in total low-order aberration among the three groups (P=0.472). The total aberration and higher-order aberration [(0.74±0.35) μm and (0.41±0.12) μm] were the highest in monofocal group, followed by bifocal group [(0.61±0.21) μm and (0.22±0.09) μm] and depth of focus extension group [(0.46±0.13) μm and (0.06±0.09) μm] (all P<0.05). Conclusions: IOL implantation with depth of focus extension can enhance visual range, night vision and contrast sensitivity, and thus effectively improve postoperative visual quality and function in cataract patients. The bifocal IOL can better improve the patient's UCNVA and BCNVA, resulting in high satisfaction with visual quality.

Enhanced Monofocal Intraocular Lenses in Fuchs' Endothelial Dystrophy Patients: Results from Triple Descemet Membrane Endothelial Keratoplasty Procedure.

Descemet membrane endothelial keratoplasty (DMEK) is currently regarded as the most effective surgical procedure for addressing Fuchs Endothelial Corneal Dystrophy (FECD), frequently performed in conjunction with cataract surgery. In this retrospective study, we present a comparison of visual performance, clinical outcomes, and optical quality between two types of monofocal Intraocular Lenses (IOLs): one standard and one enhanced intermediate vision model, implanted in patients who underwent combined phacoemulsification and DMEK surgery. This single center comparative retrospective study was conducted at the Eye Clinic of the University of Florence (Italy) and included a total of 48 eyes of 48 patients affected by FECD and cataract. All patients underwent combined DMEK with phacoemulsification procedures. The patients' data were analyzed and divided into two groups: one group (standard group) consisted of 24 eyes that underwent phaco-DMEK with implantation of a monofocal IOL, and the second group (enhanced monofocal group) included 24 eyes that underwent phaco-DMEK with implantation of an enhanced monofocal IOL. In both groups, the following monocular visual outcomes were evaluated 6 months after surgery: Uncorrected Distance Visual Acuity (UDVA) and Best-Corrected Distance Visual Acuity (BCDVA) at 4 mts; Uncorrected Intermediate Visual Acuity (UIVA), Distance-Corrected Intermediate Visual Acuity (DCIVA) at 66 cm; Uncorrected Near Visual Acuity (UNVA) and Best Corrected Near Visual Acuity (BCNVA). Monocular defocus curves were also assessed. Furthermore, optical quality in terms of Contrast Sensitivity (CS) in photopic conditions, Higher-Order Aberrations (HOAs) at a pupil size of 5 mm. Modulation Transfer Function (MTF), Objective Scatter Index (OSI), and Strehl ratio, were also analyzed. A Patient-Reported Spectacle Independence Questionnaire was revised to evaluate spectacle independence outcomes. the two groups did not exhibit statistically significant differences in terms of UDVA, BCDVA, UNVA and BCNVA, photopic CS, HOAs, OSI, Strehl ratio, and MTF. However, in the phaco-DMEK enhanced monofocal IOL group, significantly better results were observed in terms of UIVA and DCIVA as well as a different defocus curve profile at 1.50 D, providing better defocus results at intermediate distance compared with the ZCB00 IOL. In our study, we found that enhanced monofocal lens performed favorable visual outcomes, even in cases of FECD, compared to standard monofocal IOLs. Comparable optical quality observed in the Eyhance group could allow surgeons to consider these lenses as a viable option for selected patients with FECD.

Outcomes of extended depth of focus intraocular lenses implantation

This article compares the outcomes of implantation of two EDOF IOLs in patients with presbyopia and/or cataract. The prospective study included 60 patients (81 eyes) after implantation of EDOF IOL Tecnis Symfony (32 patients, 45 eyes; group 1) or EDOF IOL AcrySof IQ Vivity (28 patients, 36 eyes; group 2). The mean follow-up period was 3.9±1.3 months. All groups showed a significant (p<0.05) increase in uncorrected near visual acuity (UCNVA), intermediate visual acuity (UCIVA), and distance visual acuity (UCDVA) at the maximum follow-up time compared to preoperative values. In group 1, the best corrected near visual acuity (BCNVA) increased from 0.61±0.10 to 0.82±0.16 at the maximum follow-up time, and in group 2 - from 0.58±0.08 to 0.67±0.12 (p>0.05). Both groups showed a significant increase in best corrected intermediate and distance visual acuity (BCIVA and BCDVA) at the maximum follow-up time. The increase in the indicator compared to the preoperative period was not significant in both groups (p>0.05). The frequency of side optical phenomena was low in both groups. No significant differences were found between the groups (p>0.05). This study presents a comparative analysis of the results of implantation of two different EDOF IOLs. Both lenses were comparable in most of the studied parameters, including providing good distance and intermediate vision, functional near vision, as well as a low frequency of side optical phenomena. In all cases the patients were satisfied with the results of the surgical intervention.

Intraoperative Iridectomy in Femto-Laser Assisted Smaller-Incision New Generation Implantable Miniature Telescope.

In this study, we aimed to report the short-term (6 months) effects on visual functionality and safety of femto-laser assisted smaller-incision new-generation implantable miniature telescope (SING-IMT™) implanting, particularly related to postsurgical intraocular pressure increase, in patients suffering from end-stage age-related macular degeneration (AMD) and cataract. This device, designed for monocular use, aims to minimise the impact of the central scotoma by projecting the images onto a larger area of the photoreceptors surrounding the macula. In this prospective multicentric observational case series study, 6 eyes of 6 patients who underwent SING-IMT™ implantations were enrolled. At baseline and 6 months follow-up, best corrected distance visual acuity (BCDV) and best corrected near visual acuity (BCNVA), intraocular pressure (IOP), anterior chamber depth, endothelial cells count were assessed. In addition, IOP was also measured at 7, 15, 30, 45 days, and at 3 months follow-up. Finally, the incidence of complications was evaluated. At final follow-up, in the study eyes, mean BCDVA improved by +10.0 letters (6.25; 13.8) letters and mean BCNVA improved by -0.30 logMAR (-0.55; -0.20). At postoperative month 6, we reported a mean IOP decrease of 4.50 mmHg (-5.75; -0.25). Interestingly, 83.3% of patients had an increased IOP value in at least one of the first two postoperative follow-ups (7 days and 15 days). In patients in whom intraoperative mechanical iridotomy was not performed, it was necessary to perform a postoperative YAG laser iridotomy to improve IOP management. Compared to the baseline, ECD loss at 6 months follow-up was 12.6%. The SING IMT™ device was found to be effective in the distance and near vision improvement, without serious postoperative complications. We recommend intraoperative mechanical iridectomy in order to easily manage post-operative IOP and to avoid sudden IOP rise with its possible consequences. These good results can be a hope to partially improve the quality of life of patients suffering from severe end stage macular atrophy.

Twelve-month follow-up after posterior 25G vitrectomy due to idiopathic full-thickness macular hole treated with “inverted ILM flap” technique

Background: We conducted a prospective, follow-up study to analyze a long-term recovery process after posterior vitrectomy for idiopathic full-thickness macular hole. Material and methods: Sixty eyes were evaluated in 59 patients who underwent surgery for idiopathic fullthickness macular hole using posterior 25G vitrectomy with the “inverted ILM flap” technique from the beginning of 2013 to the end of 2014. In 55 eyes, posterior 25G phaco-vitrectomy with ILM peeling was performed using the “inverted ILM flap” technique with IOL implantation. In 5 pseudophakic eyes, posterior vitrectomy was performed with the technique as above. All patients were interviewed regarding the duration of the disease and pre- and postoperatively at intervals of 1, 3, 6, and 12 months. The following tests were performed: best-corrected visual acuity (BCVA), best-corrected near visual acuity (BCNVA), intraocular pressure (IOP) measurement, physical examination of the anterior and posterior segment of the eye, and spectral domain optical coherence tomography (SD-OCT). Results: The anatomical success in the study was 95%, and we achieved the improvement in visual acuity in 91.7% of the operated eyes. The visual acuity in the time interval before surgery and 12 months afterward improved from 0.1 to 0.29 and was statistically significant (p &lt; 0.05). Shorter duration and smaller hole size were significant predictors of improved postoperative visual acuity. The U-type of the hole closure predisposed to the most significant improvement in visual acuity in patients. Conclusions: The obtained functional and anatomical results may confirm the effectiveness of posterior vitrectomy using the “inverted ILM flap” technique in treating idiopathic full-thickness macular holes. The observed sparce complications did not differ from the complication profile described by other authors.

Safety and efficacy of A1-UV aspheric intraocular lens implantation over the postoperative 5 years

Objective: To evaluate the clinical safety and efficacy of A1-UV aspheric intraocular lens (IOL) implantation over the postoperative 5 years. Methods: Prospective cohort study. The subjects came from a finished multicenter, randomized and controlled clinical trial with a follow-up period of 1 year from April to November 2012. The clinical research centers were Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Peking University Third Hospital, Tianjin Medical University Eye Hospital, and Daping Hospital of Army Medical University. Cataract patients in the experimental group were implanted with A1-UV type IOL, while cataract patients in the control group were implanted with SN60WF type IOL, and monocular patients were enrolled. From April to May 2018, patients enrolled in the previous study were recalled for follow-up and continued observation. The visual acuity, spherical equivalent, postoperative complications, non-contact intraocular pressure and subjective evaluation results were statistically analyzed preoperatively, at 1 to 2 days, 1 week, 1 month, 3 months, 6 months, 1 year and 5 years after operation. The main statistical methods included Mann Whitney U test, Wilcoxon signed rank test, independent sample t test, chi square test and Fisher exact test. Results: A total of 42 subjects (22 in the experimental group and 20 in the control group) completed 5-year continuous observation. Among the 42 subjects, 28 were female and 14 were male. The age was (70±9) years, and the time from surgery to recall was (5.77±0.19) years. The age, gender distribution, left/right eye distribution, axial length, IOL power and nucleus hardness classification data of the experimental group and the control group were balanced and comparable (all P>0.05). At different visiting time points, there was no significant difference in the best corrected distance visual acuity (BCDVA), best corrected near visual acuity (BCNVA), uncorrected distance visual acuity (UCDVA) and uncorrected near visual acuity (UCNVA) between the groups (all P>0.05). At 5 years after operation, the UCDVA, BCDVA and BCNVA of the two groups were significantly improved compared with the baseline [all P<0.01; UCDVA was improved from 0.75 (0.30 to 1.30) to 0.10 (-0.10 to 0.70) in the experimental group and from 0.75 (0.30 to 1.60) to 0.20 (-0.10 to 0.80) in the control group; BCDVA was from 0.60 (0.10 to 1.00) to 0.00 (-0.10 to 0.54) in the experimental group and from 0.60 (0.10 to 1.60) to 0.10 (-0.10 to 0.50) in the control group; BCNVA was from 0.55 (0.00 to 1.10) to 0.10 (-0.10 to 0.60) in the experimental group and from 0.55 (0.10 to 1.60) to 0.10 (-0.20 to 0.60) in the control group], but there was no significant change in the UCNVA (both P>0.05). There were no significant differences in the spherical equivalent, intraocular pressure, subjective evaluation of visual adverse symptoms, distance vision spectacle independence and comprehensive evaluation of satisfaction between the groups (all P>0.05). In the experimental group, one eye (4.5%) had an abnormal pupil, one eye (4.5%) had an abnormal IOL with a few particles on the surface of the IOL but no glistening, and 3 eyes (13.6%) had posterior capsular opacification (PCO); in the control group, one eye (5.0%) had an abnormal cornea, five eyes (25.0%) had abnormal IOLs [one eye (5.0%) had IOL calcification, and four eyes (20.0%) had IOL glistening], and one eye (5.0%) had PCO with posterior capsular folds and IOL tilt. There was no significant difference in PCO and IOL abnormality between the two groups (both P>0.05), but there was significant difference in the occurrence of IOL glistening (P=0.04). Conclusion: The long-term effect of A1-UV aspheric IOL on improving the UCDVA is stable and good, with high subjective satisfaction of patients, a low incidence of PCO, no glistening and good biocompatibility, over the postoperative 5 years. (Chin J Ophthalmol, 2021, 57: 41-47).

Long-Term Visual Quality after Microincision Cataract Surgery.

Purpose Few studies have focused on long-term postoperative visual quality. This study aimed to evaluate the long-term visual quality after microincision cataract surgery (MICS). Methods 96 patients (144 eyes) diagnosed with age-related cataracts were enrolled in this one-year study. The patients underwent MICS and received aspheric monofocal intraocular lens implants. Uncorrected distance visual acuity (UDVA) was evaluated together with best-corrected distance visual acuity (BCDVA), best-corrected near visual acuity (BCNVA), contrast sensitivity, and surgically induced astigmatism (SIA). Results Compared to preoperative measurements, UDVA, BCDVA, and BCNVA were significantly better after surgery (P < 0.001), and they remained stable throughout follow-up. Contrast sensitivity was also significantly better after surgery (P < 0.001). Mean SIA during follow-up was 0.57 ± 0.33 D at 1 week, 0.36 ± 0.25 D at 3 months, and 0.18 ± 0.16 D at 1 year. SIA decreased significantly during the postoperative period (P < 0.001). The 1-year postoperative absolute residual diopter value was 0.32 ± 0.28 D. Conclusion MICS can provide excellent visual quality as soon as on postoperative day 1, which persists during the follow-up period of 1 year. In contrast to previous studies, SIA decreases over time and may not completely stabilize for as long as 1 year postoperatively.

Effect of age and refractive error on quick contrast sensitivity function in Chinese adults: a pilot study

PurposeTo evaluate the potential effect of age and refractive error on visual acuity (VA) performance and quick contrast sensitivity function (qCSF) in normal Chinese adults.MethodNinety-two subjects with normal best corrected distance VA (BCDVA) were enrolled in this pilot study. Measurements included BCDVA, best corrected near VA (BCNVA), unaided VA (UNVA), habitual spectacle-corrected near VA (SCNVA) and qCSF. For analyses, subjects were categorized into three age groups (20~40 years, 41~60 year and >60 years) and four refractive groups (hyperopia, emmetropia, myopia and high myopia). Relationships between age, refractive error, types of VA and qCSF were tested using simple and multiple linear regressions analyses.ResultMean age and refractive error of the study participants were 44.04 ± 12.68 years and −1.86 ± 2.91D, respectively. Among the stratified age groups, a hyperopic shift of refraction (−3.24 ± 2.88D vs. −1.24 ± 2.64D vs. 0.39 ± 1.42D, respectively; P < 0.001) and a reduction in BCNVA (P = 0.014), SCNVA (P < 0.001) and cut-off spatial frequency (SF) (P = 0.032) were found with increasing age. Among the four refractive groups, the SCNVA and cut-off SF of hyperopia were worse compared to the other refractive statuses (all P < 0.05). Age was significantly associated with cut-off SF (standardized β = −0.29, P = 0.005) after adjustment for SER, gender and all types of VA.ConclusionFor normal Chinese adults with normal BCDVA, age was the main factor associated with CSF, which may be independent of refractive error.

Presbyopia and Ocular Conditions Causing Near Vision Impairment in Older Adults From the Brazilian Amazon Region

To investigate the prevalence and causes of near vision impairment (NVI) in a population of older adults from the Brazilian Amazon Region. Population-based cross-sectional study. Cluster sampling was used in randomly selecting subjects 45 years of age and older from urban and rural areas of Parintins city, Brazil. Participants underwent ophthalmic examination, including uncorrected (UCNVA), presenting (PNVA), and best-corrected near visual acuity (BCNVA) from each eye; biomicroscopy; funduscopy; and subjective refraction, including testing with additional lenses for near vision optical correction. A principal cause for NVI was assigned by the ophthalmologist and presbyopia was defined as UCNVA ≤ 20/40 changing to > 20/40 with BCNVA. Free-of-charge glasses were provided for those in need. A total of 2384 subjects were enumerated and 2025 had reliable NVA measurements from both eyes. The prevalence of NVI in the better-seeing eye was 96.5% with UCNVA, decreasing to 81.1% with PNVA and to 20.5% with BCNVA. Presbyopia was the principal cause of NVI in 71.8%, followed by cataract (16.5%) and pterygium (2.5%), and was associated with younger age and high schooling. Glasses for near vision were prescribed and provided to 1414 (69.8%) participants. A high prevalence of NVI was detected even in those wearing glasses for near. Prescription and provision of low-cost reading glasses should be considered by Brazilian health authorities to address this easily and promptly correctable form of vision impairment.

Meta-analysis of clinical randomized controlled trials comparing refractive with diffractive multifocal intraocular lenses in cataract surgery

To systematic review the effectiveness of refractive multifocal intraocular lens (MIOL) versus diffractive MIOL in the treatment of cataract. Randomized controlled trials comparing refractive MIOL with diffractive MIOL were identified by searching PubMed (1966 to May, 2013), EMbase (1980 to May, 2013), Medline (1966 to May, 2013), and The Cochrane Library (Issue 1, 2013). We also hand-searched related journals. All the searches were restricted in English or Chinese. Methodological quality of randomized controlled trials (RCT) was evaluated by simple evaluate method that recommended by the Cochrane Collaboration. Data extracted by two reviewers with designed extraction form. RevMan software (release 5.2) was used for data management and analysis. A total of 11 trials (1460 eyes) were included for systematic review. Subgroup analyses were used according to different model comparison of MIOL. The results showed a significant difference in the mean of the uncorrected distance visual acuity (UCDVA) and the uncorrected intermediate visual acuity (UCIVA) in the refractive MIOL group with WMD -0.04, 95%CI -0.06 to -0.03 (P < 0.01) and WMD -0.05, 95%CI -0.09 to -0.02 (P = 0.001). It showed a significantly difference in the mean of the uncorrected near visual acuity (UCNVA), complete spectacle independent rate, halo rate and glare rate in the diffractive MIOL group with WMD 0.11, 95%CI 0.08 to 0.15 (P < 0.01), WMD 2.98, 95%CI 2.17 to 4.09 (P < 0.01), WMD 1.52, 95%CI 1.14 to 2.04 (P = 0.004) and WMD 1.27, 95%CI 1.07 to 1.50 (P = 0.005). There was no significant difference between the two groups in the mean of the best corrected distance visual acuity (BCDVA), the best distance corrected intermediate visual acuity (BDCIVA), the best distance corrected near visual acuity (BDCNVA) and the best corrected near visual acuity (BCNVA) with WMD -0.01, 95%CI -0.03 to 0.01 (P = 0.45), WMD -0.06, 95%CI -0.15 to 0.03 (P = 0.18), WMD 0.08, 95%CI -0.01 to 0.17 (P = 0.09) and WMD -0.02, 95%CI -0.26 to 0.23 (P = 0.88). Patients implanted with refractive MIOL show better uncorrected distance and intermediate visual acuity; patients implanted with diffractive MIOL show better uncorrected near visual acuity with less likely to appear light halo, glare and other visual adverse reactions. As for spectacles correction cases, patients implanted with diffractive or refractive MIOL have considerable performances in the far, middle, near visual acuity.

Vitrectomy with Internal Limiting Membrane Peeling versus No Peeling for Idiopathic Full-Thickness Macular Hole

To determine whether internal limiting membrane (ILM) peeling improves anatomic and functional outcomes of full-thickness macular hole (FTMH) surgery when compared with the no-peeling technique. Systematic review and individual participant data (IPD) meta-analysis undertaken under the auspices of the Cochrane Eyes and Vision Group. Only randomized controlled trials (RCTs) were included. Patients with idiopathic stage 2, 3, and 4 FTMH undergoing vitrectomy with or without ILM peeling. Macular hole surgery, including vitrectomy and gas endotamponade with or without ILM peeling. Primary outcome was best-corrected distance visual acuity (BCdVA) at 6 months postoperatively. Secondary outcomes were BCdVA at 3 and 12 months; best-corrected near visual acuity (BCnVA) at 3, 6, and 12 months; primary (after a single surgery) and final (after >1 surgery) macular hole closure; need for additional surgical interventions; intraoperative and postoperative complications; patient-reported outcomes (PROs) (EuroQol-5D and Vision Function Questionnaire-25 scores at 6 months); and cost-effectiveness. Four RCTs were identified and included in the review. All RCTs were included in the meta-analysis; IPD were obtained from 3 of the 4 RCTs. No evidence of a difference in BCdVA at 6 months was detected (mean difference, -0.04; 95% confidence interval [CI], -0.12 to 0.03; P=0.27); however, there was evidence of a difference in BCdVA at 3 months favoring ILM peeling (mean difference, -0.09; 95% CI, -0.17 to-0.02; P=0.02). There was evidence of an effect favoring ILM peeling with regard to primary (odds ratio [OR], 9.27; 95% CI, 4.98-17.24; P<0.00001) and final macular hole closure (OR, 3.99; 95% CI, 1.63-9.75; P=0.02) and less requirement for additional surgery (OR, 0.11; 95% CI, 0.05-0.23; P<0.00001), with no evidence of a difference between groups with regard to intraoperative or postoperative complications or PROs. The ILM peeling was found to be highly cost-effective. Available evidence supports ILM peeling as the treatment of choice for patients with idiopathic stage 2, 3, and 4 FTMH.

Long-term results of clear lens extraction combined with piggyback intraocular lens implantation to correct high hyperopia.

To assess the refractive outcome of clear lensectomy combined with piggyback intraocular lens implantation in highly hyperopic patients. This case review included 19 eyes of 10 patients with high hyperopia and axial length less than 21mm. Intraocular lens power was calculated for emmetropia using the Holladay II formula in 17 eyes, and SRK/T formula in 2 eyes following clear lens extraction and piggyback intraocular lens implantation. Patients were examined periodically over 24 months for visual acuity and spherical equivalent (SE). The mean postoperative SE at 24 months was 0.20±1.39D (range, -3.00 to 2.50D), better than preoperative 9.81±2.62D (range, +6.00 to +14.50D) (P<0.001). Five eyes had SE within ±0.5D of emmetropia and 11 eyes within ±1.00D at postoperative 24 months. The mean postoperative uncorrected visual acuity (UCVA) at 24 months was 0.60±0.36, significantly improved compared to preoperative 1.39±0.33 (P<0.001). The mean best-corrected visual acuity (BCVA) at 24 months was 0.49±0.35, not statistically different compared to preoperative 0.38±0.30 (P=0.34). Twelve eyes maintained and 1 gained 1 or more Snellen line of BCVA, 4 eyes lost 1 line, and 2 eyes lost 2 lines at 24 postoperative months. Twelve eyes best-corrected near visual acuity (BCNVA) achieved J1 at postoperative 24 months compared to preoperative 7 eyes and the other 7 eyes better than J3. Clear lens extraction combined piggyback intraocular lens implantation appears to be an effective procedure to correct high hyperopia but mild overcorrection and intralenticular opacification may require secondary procedure.

Comparison of clinical efficacy between multifocal and monofocal intraocular lens implantation for the treatment of cataract

Background Multifocal intraocular lens (IOL) can produce two focus distance based on the principle of diffraction-refraction,and the full range of vision is better than monofocal IOL.So multifocal IOL can provide cataract patients better far,middle and near distant vision.Objective This study was to investigate and compare the clinical efficacy between multifocal IOL and monofocal IOL implantation in the patients after cataract surgery.Methods One hundred eyes of 100 patients with cataract enrolled in Gaomi People's Hospital from June 2010 to September 2012 and were divided into the monofocal IOL group and multifocal IOL group,with the matched demographic and medical baseline characteristics between the two groups.All the patients were aware of the trial and a written informed consent was obtained from each patient prior to the surgery.Multifocal IOL (Acrysof ReSTOR SA60D3) was implanted in the multifocal IOL group,and monofocal IOL was implanted in the monofocal IOL group after phacoemulsification.Uncorrected distant visual acuity (UCDVA),best corrected distant visual acuity (BCDVA),uncorrected near visual acuity (UCNVA),best corrected near visual acuity (BCNVA),uncorrected middle distance visual acuity (UCMVA) and distant-corrected near visual acuity (DCNVA) between the two groups were observed and compared,and near stereo acuity,IOL higher-order aberrations under the pupillary diameters of 3 mm and 5 mm,optimum reading distance and reading speed were compared 3 months after surgery.The satisfaction rates of patients for each visual function district were analyzed by a questionnaire survey.Results UCNVA and DCNVA in the multifocal IOL group were significantly better than those of the monofocal IOL group 3 months after surgery,and the differences were statistically significant (t=15.48,22.44,both at P＜0.05).UCMVA at the distance of 25,30,40,50,60 cm in the multifocal IOL group were better than ones of the single IOL group (t=12.60,16.75,23.18,14.04,7.60,all at P＜0.05).Uncorrected near stereo acuity in the multifocal IOL group was (49.1 ±15.2),showing a significant reduction in comparison with (85.3 ± 18.6) of the multifocal IOL group (t=10.66,P＜0.05).The total higher-order aberrations,spherical aberration and coma under the pupil diameter of 3 mm and 5 mm were not significantly different between the two groups (all at P＞0.05).The optimal reading distance in the multifocal IOL group was (33.5 ± 4.1) cm,and was significantly shorter than (46.3 ± 5.2) cm of the monofocal IOL (t=13.67,P＜0.05).The reading speed in the multifocal IOL group was (172.5 ± 52.3) words/minute,and that in the monofocal IOL group was (108.3 ± 31.4) words/minute,with the significant difference between them (t =7.44,P＜0.05).The patients who were satisfied with the functional areas of near vision and middle-distance vision were more in the multifocal IOL group than those of the monofocal IOL group (x2=56.59,40.85,both at P＜0.05),but those in the distance vision zone between the two groups was no significant different (x2=3.09,P＞0.05).Conclusions Comparison with the monofocal IOL,multifocal IOL implantation for the treatment of cataract can obtain clear imaging both at the far-distance and middle-and near-distance.Multifocal IOL implantation can improve the life quality of cataract patients after operation. Key words: Intraocular lens/multifocal, monofocal; Cataract; Life quality

Wavefront aberration and accommodation power in eyes with aspheric multifocal intraocular lens implantation

目的 评价白内障超声乳化摘出联合非球面衍射型多焦点人工晶状体(MIOL)植入术后患者的波前像差及拟调节力.方法 将进行白内障超声乳化联合人工晶状体植入术且年龄45～70岁的36例50眼患者随机分为2组,MIOL组患者17例25眼植入Acrysof ReSTOR MIOL,单焦点人工晶状体(SIOL)组患者19例25眼植入Acrysof SIOL.术后3个月检查裸眼及矫正远近视力,最佳矫正远视力下的近视力(DCNVA)、波前像差、调制传递函数(MTF)、拟调节力,并比较脱近用镜率.结果 术后3个月,2组患者术后裸眼远视力和最佳矫正远视力差异均无统计学意义(P＞0.05);MIOL组术后裸眼近视力和DCNVA明显优于SIOL组(P＜0.05);球面像差Zernike C12、4阶高阶像差及总体高阶像差比较MIOL组与SIOL组间差异均无统计学意义(P＞0.05);MTF值在各空间频率2组间差异均无统计学意义(P＞0.05).视近拟调节力:MIOL组为(0.925±0.549)D,SIOL组为(0.390±0.235),差异有统计学意义(P＜0.05).脱近用镜率:MIOL组(80%)优于SIOL组(24%)(P=0.000).结论 ReSTOR衍射型MIOL眼能提供良好的远近视力,拟调节幅度较SIOL大,能有效改善白内障患者术后的视觉质量。

One-Year Outcomes with New-Generation Multifocal Intraocular Lenses

To compare new-generation multifocal intraocular lenses (IOLs) with monofocal IOLs. Randomized prospective clinical trial. Sixty-two consecutive patients with cataract, seen between January of 2005 and January of 2006 at the Department of Ophthalmology of Palermo University Hospital in Italy, were bilaterally implanted with monofocal (AR 40, Advanced Medical Optics [AMO], Santa Ana, CA; 15 patients), multifocal refractive (Array SA40N, AMO; 16 patients), multifocal refractive (ReZoom, AMO; 15 patients), or multifocal diffractive pupil-independent (Tecnis ZM900, AMO; 16 patients) IOLs. Bimanual phacoemulsification. Primary outcomes were far, near, and intermediate visual acuity of the 4 IOL-implanted groups. Secondary outcomes were defocusing curves, contrast sensitivity, patients' quality of life (7-item visual function questionnaire [VF-7], halos and glare presence, overall satisfaction), and spectacle independence. Snellen visual acuity was measured as uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), uncorrected near visual acuity (UCNVA), best distance corrected near visual acuity (BDCNVA), best corrected near visual acuity (BCNVA), uncorrected intermediate visual acuity (UCIVA), and best distance corrected intermediate visual acuity (BDCIVA). UCNVA was 20/50 in the monofocal IOL group, compared with 20/32 or better in the multifocal IOL groups (P<0.0005). The monofocal IOL group exhibited a lower BDCNVA than the multifocal IOL groups (P<0.0005). The diffractive multifocal IOL group performed better than either refractive group (P = 0.007). UCIVA was significantly different (P = 0.001) among the groups: monofocal (AR 40) 20/32; multifocal refractive (Array SA40N) 20/30; multifocal refractive (ReZoom) 20/25; and multifocal diffractive (Tecnis ZM900) 20/30. Defocusing curves with -3.00 diopter lens exhibited a better trend in the diffractive group. The refractive multifocal IOL groups exhibited lower contrast sensitivities at 3 cycles/degree (P = 0.038). The VF-7 mean score was significantly lower in the monofocal than the multifocal IOL groups (P = 0.002). Night halos were more common in the refractive groups (P<0.01). Spectacle independence was 20% in the monofocal IOL group, 43.7% and 53.3% in the refractive multifocal IOL groups, and 87.5% in the diffractive multifocal IOL group (P<0.05). Multifocal IOLs provide a greater depth of focus and higher patient satisfaction, and make intermediate and near visual tasks easier than do monofocal lenses. New-generation, diffractive, pupil-independent multifocal IOLs provide better near vision, equivalent intermediate vision, less unwanted photic phenomena, and greater spectacle independence than either monofocal or refractive multifocal IOLs.

Implantable Miniature Telescope for the Treatment of Visual Acuity Loss Resulting from End-Stage Age-Related Macular Degeneration: 1-Year Results

To evaluate the safety and efficacy of an implantable visual prosthetic device (IMT; VisionCare Ophthalmic Technologies, Saratoga, CA) in patients with bilateral, end-stage age-related macular degeneration (AMD). Prospective, open-label, multicenter clinical trial with fellow eye controls. A total of 217 patients (mean age, 76 years) with AMD and moderate to profound bilateral central visual acuity loss (20/80-20/800) resulting from bilateral untreatable geographic atrophy, disciform scars, or both were enrolled. A visual prosthetic device (implantable telescope), designed to enlarge retinal images of the central visual field, was implanted monocularly in the capsular bag after lens extraction. Fellow eyes were not implanted to provide peripheral vision and served as controls. Study patients participated in 6 visual rehabilitation visits after surgery. Best-corrected distance visual acuity (BCDVA) and best-corrected near visual acuity (BCNVA), quality-of-life scores from the National Eye Institute 25-item Visual Function Questionnaire (NEI VFQ-25) and the Activities of Daily Life scale, endothelial cell density (ECD), and incidence of complications and adverse events. At 1 year, 67% of implanted eyes achieved a 3-line or more improvement in BCDVA versus 13% of fellow eye controls (P<0.0001). Fifty-three percent of implanted eyes achieved a 3-line or more improvement in both BCDVA and BCNVA versus 10% of fellow eyes (P<0.0001). Mean BCDVA and BCNVA improved 3.5 lines and 3.2 lines, respectively, in implanted eyes versus 0.8 lines and 1.8 lines, respectively, in fellow eyes (P<0.0001). Change in visual acuity was not related to lesion type. Mean NEI VFQ-25 scores improved by more than 7 points from baseline (P<0.01) on 7 of 8 relevant subscales. Eleven eyes did not receive the device because of an aborted procedure. Endothelial cell density was reduced by 20% at 3 months and 25% at 1 year. The decrease in ECD was correlated with postsurgical edema (P<0.0001), and there was no evidence that endothelial cell loss is accelerated by ongoing endothelial trauma after implantation. This implantable visual prosthesis can improve visual acuity and quality of life in patients with moderate to profound visual impairment caused by bilateral, end-stage AMD.

Change on long-term postoperative contrast sensitivity of multifocal intraocular lens implantation

目的 比较多焦点人工晶状体(MIOL)与单焦点工人晶状体(SIOL)术后远期视力及对比敏感度的改变,以评价MIOL的有效性和安全性.方法 MIOL组33例50眼,SIOL组28例43眼,随访时间均为术后7月以上;随访时均检查视力及矫正近视力下的对比敏感度(CS).结果 MIOL组的非矫正远视力、矫正远视力和矫正近视力与SIOL组者均无明显差异(P＞0.05).MIOL组非矫正近视力、矫正远视度数下的近视力均优于SIOL组,二者间差异均有统计学意义(P＜0.05).两组病例各空间频率段的CS值均位于正常值范围;将矫正近视力分为＜1.0与≥1.0两组比较时,MIOL组在6.0～18 CPD频率段前者的CS值较后者降低,差异有统计学意义(P＜0.05),SIOL组仅在18 CPD频率段的差异有统计学意义;将散光分为≥0.50 D及＜0.50 D两组进行比较时,MIOL组在3.0～18 CPD频率段前者均较后者下降,差异有统计学意义(P＜O.05),SIOL组仅在18CPD频率段受影响.结论 植入MIOL者术后远期CS值恢复正常,但易受激光和矫正近视力的影响。

Long-term follow-up of visual functions after pediatric cataract extraction and intraocular lens implantation

To assess the visual acuity and binocular function of children after pediatric cataract extraction and intraocular lens implantation. 47 children with 68 eyes (< 13 years old) were included in the study: 12 children with monolateral traumatic cataract, 14 children with monolateral congenital cataract and 21 children with bilateral congenital cataract. Cataract type, cataract extent, age at surgery and presence of strabismus and nystagmus and the best corrected distant visual acuity (BCDVA) before surgery were recorded and as well. In addition, the best corrected near visual acuity (BCNVA) and binocular function were followed up for an average of (41.3 +/- 12.3) months. Statistical analysis was used to define factors that correlated with achieving good visual acuity and binocular function. BCDVA and BCNVA were 0.5 or better in 34 eyes (50.0%) and a good binocular function was achieved in 18 children (38.3%). Age at surgery, extent of cataract, absence of strabismus and nystagmus were significant for good BCDVA. Age at surgery, absence of strabismus and nystagmus, good BCDVA were significant for good binocular function. Good visual acuity and binocular function can be achieved after pediatric cataract extraction and intraocular lens implantation. Multiple factors correlated with achieving good visual function such as timing of surgery, type and extent of cataract, absence of strabismus and nystagmus etal.