Lens Color and Macular Pigment Density after Cataract Surgery: A Randomized Clinical Trial.

Femtosecond Laser-Assisted Cataract Surgery: Precision, Practice, and the Path to Personalization.

To evaluate the postocclusion surge characteristics of venturi and peristaltic-generated vacuum levels. University setting, Salt Lake City, Utah. Experimental study. The Johnson & Johnson Veritas machine and Ellips FX handpiece with standard pack tips, with variable peristaltic and venturi settings, were used. A standard quadrant removal preset had the settings: vacuum 450 mm Hg, aspiration 60 mm Hg, and bottle heights 41 cm and 81 cm. To monitor pressure changes, a rubber disk was fixed within a sealed chamber fitted with an electric sensor. The phacoemulsification tip was inserted through a small opening; the foot pedal was set to position 3. The tip was in contact with the disk to replicate tip occlusion and then pulled from the disk to simulate occlusion break. 10 trials were performed for each intraocular pressure and vacuum type. A significant difference ( P < .01) was observed in postocclusion surge magnitude between venturi and peristaltic pumps at 41 cm and 81 cm bottle heights. No significant difference was observed in surge duration at either bottle height. Average duration of surge for venturi and peristaltic at 41 cm was 1.56 ± 0.75 seconds and 2.25 ± 0.40 seconds, respectively; at 81 cm 2.27 ± 1.41 seconds and 2.90 ± 1.10 seconds, respectively. Data suggest that at bottle heights of 41 cm and 81 cm, with indicated settings, venturi settings on the Veritas platform have a lower postocclusion surge magnitude compared with peristaltic settings. This indicates that there may be a platform-specific lower risk for posterior capsular tear when using venturi settings in the Veritas system during cataract surgery.

Pseudophakic mini-monovision.

To evaluate the effectiveness and usability of a safety-first, clinician-validated conversational artificial intelligence (AI) chatbot for cataract surgery education compared with standard brochures. University Hospital (UZ Brussel), Brussels, Belgium. Prospective, single-center, randomized controlled trial. Adults scheduled for cataract operation were randomized to receive either standard information brochures alone (control group) or brochures plus access to a hospital-specific chatbot ("Mina"). Primary outcomes were knowledge gain, change in preinformation to postinformation anxiety, and satisfaction. Those outcomes were measured with questionnaires. Secondary outcomes included chatbot usability (measured with the System Usability Scale [SUS]) and engagement with the chatbot. 64 patients were randomized (chatbot group 33, control group 31). Postoperative questionnaires were completed by 35 patients (14/33 chatbot, 21/31 control). No significant differences were detected in knowledge gain, anxiety change, or satisfaction ( P > .05). Knowledge increased in both groups after receiving information ( P < .001). In the chatbot group, 17 of 33 (52%) did not engage with the chatbot. Participants engaging with the chatbot tended to be younger (mean age: 64.1 ± 10.9 years) than those who did not (mean age: 74.1 ± 10.5 years). Among users, 63% of submitted questions matched validated answers. The SUS mean score indicated high usability (83.1 ± 12.1). A custom-built chatbot with only clinician-validated responses showed high usability but did not improve knowledge, reduce anxiety, or increase satisfaction compared with brochures. Chatbot engagement barriers, particularly among older adults, and limits of validated-only content indicate the need for a hybrid approach of those models, to balance safety and flexibility in digital patient education.

Antimicrobial resistance is increasingly recognized in veterinary ophthalmology, yet its development remains largely unnoticed in daily clinical practice. Although resistant ocular pathogens are reported worldwide, antimicrobial prescribing decisions are frequently made without feedback on local resistance patterns. This Viewpoint discusses aggregated antibiograms as a practical tool to improve situational awareness and support antimicrobial stewardship in veterinary ophthalmology. While antibiograms do not quantify reductions in antimicrobial resistance, their systematic use can provide contextual information that may help inform empirical treatment decisions and encourage reflection on routine prescribing. Using perioperative antibiotic use in cataract surgery as an example, we highlight how routine ophthalmic practices may benefit from re-evaluation based on accumulated data. Making resistance patterns visible through aggregated antibiograms is a feasible, immediately actionable step toward more responsible antimicrobial use, with relevance to clinical and One Health considerations.

How I Became a Spitfire Pilot during My Cataract Operation

Global Patterns of Myopia, Age, Sex, and Vision Loss: A Comparative Analysis of US and South Korean National Surveys.

Develop and compare predictive accuracy of two mathematical models: the logarithmic model and generalized estimating equation (GEE) model for estimating postoperative axial length (AL) in children following bilateral cataract surgery with primary intraocular lens (IOL) implantation, aiming to enhance IOL power selection. Comparison of mathematical prediction models. Eyes of children who underwent bilateral cataract surgery between January 2011 and December 2021 were included in the analysis. Data were only included if AL measurements were available preoperatively and at least 6 months postoperatively. The logarithmic and GEE models were developed and evaluated based on baseline AL (AL₀) and age at operation (age₀). Model performance was assessed using R² values, Lin's concordance correlation coefficients (CCC), and Bland-Altman analysis. One hundred one eyes (45 female, 56 male) with 401 postoperative AL measurements (median: 4/eye) were included. The derived logarithmic model was: AL = AL₀ + 2.87 × log₁₀ (age/age₀), yielding an R² of 0.8611 and a Lin's coefficient of 0.9149. The GEE model was: AL = -1.89 + 1.09 × AL₀ + 2.65 × log₁₀ (age) - 3.17 × log₁₀ (age₀) + 0.52 × (log₁₀ age₀ × log₁₀ age), showing an R² of 0.8682 and a Lin's coefficient of 0.9275. Predictions falling outside the 95% confidence interval were 7.5% for the logarithmic model and 7.7% for the GEE model. Both the logarithmic and GEE models demonstrated high reliability in predicting future AL based on baseline AL and age at surgery enhancing the accuracy of pediatric IOL power calculations.

Author reply to comment on: Management of positive and negative dysphotopsia post cataract surgery

Intravitreal (IVT) injections are now among the most frequently performed intraocular procedures globally. Evidence regarding post-IVT-injection infectious endophthalmitis is primarily derived from a limited number of randomized controlled trials and retrospective case series. This study assesses visual acuity outcomes after IVT biologic therapy utilizing data from a large-scale ophthalmic registry, with the objective of elucidating the real-world effects of post-IVT-injection infectious endophthalmitis on patient visual function. Data were obtained from the Intelligent Research in Sight® (IRIS®) Registry, focusing on subjects who received commercially available IVT anti-VEGF and anti-complement biologic drugs. As of 31 December 2024, 1,998,399 individuals received at least one IVT injection in one or both eyes, and 13,074 subjects (affecting 13,317 eyes) were diagnosed with infectious endophthalmitis. Incidence of infectious endophthalmitis per IVT injection was 0.052%. The cumulative rate of infectious endophthalmitis per subject rose from 0.31% after 10 IVT injections to 0.58% after 60 injections. The proportion of subjects who were legally blind (defined as ≤ 35 letters or ≤ 20/200) increased from 19.4% before the infectious endophthalmitis event to 46.1% afterward. In total, 94 eyes affected by infectious endophthalmitis underwent evisceration or enucleation. Subjects with retinal vein occlusion and myopic choroidal neovascularization had the highest incidence rates of infectious endophthalmitis compared with those with neovascular (wet) age-related macular degeneration and diabetic macular edema/diabetic retinopathy. In the real world, the cumulative incidence of infectious endophthalmitis per subject is positively correlated with the total number of IVT injections administered. While the incidence of post-IVT-injection infectious endophthalmitis was comparable to literature values reported after cataract surgery, visual acuity outcomes were worse in the post-IVT injection group. Implementing strategies aimed at reducing IVT injection frequency may have the potential to lower the incidence of infectious endophthalmitis and the consequent risk of significant vision loss.

The nonlinear optical properties of transparent ocular media have been shown to alter the focused intensity distribution of femtosecond laser pulses, potentially affecting the precision of laser ophthalmic surgery. In this study, the nonlinear refractive index [Formula: see text] of porcine aqueous humor, crystalline lens and vitreous humor was measured using two complementary techniques: the standard Z-scan-derived D4σ method and the phase-object imaging method. Both were performed with a tunable femtosecond laser source across the visible to near-infrared range (650-900nm). All measured [Formula: see text] values were found to be close to [Formula: see text] within experimental uncertainties, with no measurable nonlinear absorption detected. Notably, the phase-object technique proved particularly well-suited for slightly scattering or heterogeneous media, such as the freshly extracted crystalline lens, when calibrated against a reference medium (here, water). These experimental results allow for a quantitative numerical assessment of pulse and beam degradation due to nonlinear refraction during procedures like cataract surgery, as well as an evaluation of its potential impact on photodisruption geometry.

Large-scale, real-world collection of refractive outcomes after cataract surgery through patient-mediated mobile photography.

Although regional disparities in access to surgical care have been reported across medical specialties, nationwide evaluations of variation in ophthalmic surgical services remain limited. This study examined prefecture-level differences in major ophthalmic surgeries in Japan using publicly available claims data. We analyzed the ninth release of the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB Open Data) for fiscal year 2022 (April 2022-March 2023). Prefecture-level procedure counts were extracted for cataract surgery (K282), vitrectomy (K279-K281 and related codes), glaucoma surgery (relevant K-codes), and corneal transplantation. To reduce potential underestimation in non-Diagnosis Procedure Combination settings, ophthalmology-related procedures reimbursed under the Short-Stay Surgery Basic Fee 3 (A400) were identified and incorporated according to predefined mapping rules. Surgical rates per 100,000 population and per board-certified ophthalmologist were calculated. Regional inequality was quantified using population-weighted Gini coefficients. Associations between ophthalmologist density and surgical volume were assessed using Pearson's correlation coefficients. Nationwide totals were 1,777,502 cataract surgeries, 154,336 vitrectomies, 80,753 glaucoma surgeries, and 2,895 corneal transplantations. Prefecture-level surgical rates per 100,000 population varied 1.8-fold for cataract surgery, 3.3-fold for vitrectomy, and 7.8-fold for glaucoma surgery. Several prefectures reported no corneal transplantation cases. Population-weighted Gini coefficients were 0.064 for cataract surgery, 0.125 for vitrectomy, 0.190 for glaucoma surgery, and 0.351 for corneal transplantation. Similar patterns were observed after adjusting for age structure, indicating that regional disparities were not solely explained by demographic differences. Ophthalmologist density varied 2.5-fold across prefectures and was positively correlated with surgical volume for cataract surgery and vitrectomy, but not for glaucoma surgery. Using nationwide claims data, we identified substantial regional variation in major ophthalmic surgical procedures in Japan, with greater inequality observed for more specialized surgeries. These findings provide a population-level description of ophthalmic surgical distribution and may inform future evaluations of healthcare resource allocation.

Amaç: Fakoemülsifikasyon cerrahisi sonrası kornea şeffaflığı ve ön segment parametrelerindeki değişimleri değerlendirmek. Gereç ve Yöntem: Çalışmaya, görme bulanıklığı şikayeti bulunan, katarakt tanısı konmuş ve fakoemülsifikasyon cerrahisi yapılmış 36 hastanın 50 gözü dahil edildi. Ön segment optik koherens tomografi (ÖS-OKT) ve kornea tomografisi ile ölçülen ön kamara açısı (ÖKA), ön kamara hacmi (ÖKH), açı açılma mesafesi (AAM), trabeküler iris boşluk alanı (TİBA) ve ön kamara parametreleri değerlendirildi. Ameliyat öncesi, ameliyat sonrası birinci hafta ve birinci aydaki kornea dansitometri değerleri karşılaştırıldı. Bulgular: Hastaların 19'u (%52,8) kadındı. Ortalama yaş 62,8±11,3 yıldı. Hastaların ortalama en iyi düzeltilmiş görme keskinliği (EİDGK) cerrahi sonrası anlamlı şekilde artarken, göz içi basıncı (GİB) anlamlı şekilde azaldı (p=0,001 tümü için). ÖS-OKT ile ölçülen ÖKA, AAM ve TİBA değerlerinde ameliyat sonrası dönemde anlamlı artış izlendi (p=0,001 tümü için). Pentacam HR cihazı ile elde edilen ÖKA ve ÖKH değerlerinde ameliyat sonrası anlamlı bir artış gözlendi (p=0,001 tümü için). Korneal dansitometri değerlerinde; ön, merkezi ve total tabakalardaki çeşitli dairesel alan ölçümlerinde anlamlı artış saptanırken (p&lt;0,05 tümü için), arka tabakada anlamlı bir fark gözlenmedi (p&gt;0,05). Sonuç: Katarakt cerrahisini takiben ön kamara derinleşmekte; ÖKA, AAM ve TİBA değerlerinde artış görülmektedir. Özellikle ön ve merkezi tabakalarda kornea dansitometrisinde gözlenen artışın; ameliyat sonrası kornea ödemi, cerrahi kaynaklı kuru göz başlangıcı ve topikal ilaç kullanımına ikincil gelişen epitelyal değişikliklere bağlı olabileceği öne sürülmüştür.

To investigate whether cataract surgery is a risk factor for developing new-onset thyroid eye disease in patients with preexisting thyroid disorders using a large, population-level database. The study utilized a large database of deidentified electronic health records. Patients who underwent cataract extraction were divided into 2 cohorts and were balanced using propensity score matching for demographic factors and comorbidities, including age, sex, race, diabetes mellitus, hyperlipidemia, and nicotine dependence. The incidence of thyroid eye disease-related outcomes was assessed at 3-time intervals following the surgery date: up to 3 months, 3-6 months, and 6-12 months. The need for orbital decompression surgery was also assessed. A secondary sensitivity analysis was conducted for patients with hyperthyroidism. After propensity score matching, 87,179 pairs were analyzed. Patients with thyroid disease had a significantly higher risk for the composite thyroid eye disease outcome at all time intervals: 0-3 months (risk ratio [RR]: 1.30, 95% confidence interval [CI]: 1.12-1.51), 3-6 months (RR: 1.30, 95% CI: 1.12-1.51), and 6-12 months (RR: 1.51, 95% CI: 1.33-1.71). The risk was even more pronounced in the hyperthyroid subgroup (n = 8,381), reaching a 103% increased risk at 6-12 months (RR: 2.03, 95% CI: 1.39-2.95). While no significant difference was observed for orbital decompression surgery in the immediate postoperative period, a significantly increased risk emerged at the 6-12-month interval (RR: 1.59, 95% CI: 1.13-2.24). Cataract surgery is associated with a significantly increased risk of developing thyroid eye disease-related outcomes in patients with underlying thyroid disease. While the overall incidence may be low, the potential consequences can be serious, highlighting the importance of clinical awareness, patient counseling, and close postoperative monitoring for this at-risk population.

To investigate the prevalence and clinical characteristics of Charles Bonnet Syndrome (CBS) in patients referred for bilateral cataract surgery. This prospective, cross-sectional clinical trial included 391 patients attending cataract assessment at a single-center tertiary cataract clinic. After clinical examination, participants were screened for presence of visual hallucinations (VHs). Participants experiencing complex VHs were further questioned regarding characteristics of their hallucinatory experiences to properly determine if they were attributable to CBS. CBS was defined as complex visual hallucinations with retained insight, no medical history or medication known to cause hallucinations and not limited to hypnagogic or hypnopompic states (hallucinations happening shortly before falling asleep and/or shortly after waking up). Nineteen (4.9%) patients experienced complex VHs. Of these, 11 (2.8%) were diagnosed with CBS while 8 (2.1%) had complex hypnagogic and/or hypnopompic VHs. Multivariable logistic regression analysis identified lower best-corrected visual acuity (BCVA) in the better seeing eye asa significant predictor of CBS. When excluding participants with a BCVA>0.3, prevalence of complex VHs rose to 10.0%. Three of the patients with CBS (27.3%) had ocular comorbidities: two had exudative age-related macular degeneration (AMD), and one had drusenoid AMD. In the overall cohort, twenty-four patients (6.1%) reported prior knowledge of CBS. CONCLUSION: CBS was observed in a clinically relevant minority of cataract patients requiring bilateral surgical intervention. Given the high prevalence of cataract among the elderly, this study highlights the importance of healthcare personnel being aware of CBS and other complex VHs and their potential consequences for cataract patients.

Purpose: To critically examine the evidence base underlying smart intraocular lens (IOL) marketing claims, quantify the magnitude of underreported adverse effects, evaluate the role of commercial incentives in shaping clinical adoption, and argue that the designation “smart” constitutes a marketing construct rather than a meaningful clinical distinction. Methods: A critical narrative review was conducted synthesizing evidence from independent (non-manufacturer-sponsored) clinical outcome studies, systematic reviews, explantation registries, patient-reported outcome data, medicolegal case analyses, regulatory documentation, and financial disclosures in the smart IOL literature. Satisfaction and adverse event data were disaggregated by sponsorship sources to evaluate reporting bias. Results: Manufacturer-sponsored trials report satisfaction rates exceeding 90–98%, while independent tertiary referral studies document dissatisfaction in up to 94.7% of referred patients, with persistent photic phenomena (halos, glare, starbursts, diplopia) affecting 43–95% of recipients depending on assessment methodology. The Cochrane systematic review confirms significantly elevated risks of glare (RR 1.41) and halos (RR 3.58) relative to monofocal IOLs. Explantation rates among dissatisfied patients range from 0.85% to 7%, with neuroadaptation failure; an inherent consequence of simultaneous vision optics, identified as a leading cause. Financial analysis reveals that smart IOLs generate per-procedure revenue increases of 200–500% over standard monofocal implantation, creating structural incentives that compromise objective patient counseling. Critically, the evidence base upon which smart IOLs were approved systematically excludes the patients most likely to experience complications, inflating apparent efficacy while masking real-world failure rates. Conclusions: The smart IOL industry operates on a business model that conflates technological sophistication with clinical superiority. The evidence does not support the claim that smart IOLs represent a categorically better option for the majority of cataract patients. A substantial and inadequately disclosed minority of recipients experience degraded visual quality, persistent dysphotopsia, and neuroadaptation failure; outcomes that would not have occurred with monofocal implantation. The “smart” designation functions primarily as a pricing and marketing mechanism rather than a reliable indicator of superior patient outcomes.

To evaluate the impact of cataract surgery on disease activity in neovascular age-related macular degeneration (nAMD) and determine whether choroidal biomarkers and macular neovascularization (MNV) subtypes predict increased postoperative treatment requirements. This retrospective study included 84 eyes from 84 patients with nAMD who underwent phacoemulsification while receiving intravitreal anti-VEGF therapy. Increased treatment need was defined as a shortened injection interval or occurrence of submacular hemorrhage. Pre-and postoperative choroidal vascularity index (CVI), subfoveal choroidal thickness (SFCT), and central subfield thickness (CST) were analyzed using EDI-OCT within 1 month before and after surgery. MNV subtypes were classified as type 1, type 2, retinal angiomatous proliferation (RAP), and polypoidal choroidal vasculopathy (PCV). Best-corrected visual acuity remained stable after cataract surgery (from 0.39 ± 0.27 [20/50] to 0.38 ± 0.28 logMAR [20/50]; p = 0.907), with no significant differences among MNV subtypes. Increased treatment need occurred in 45.2% of eyes. Both CVI and SFCT increased significantly postoperatively (p < 0.001). Eyes with increased treatment need showed significantly higher preoperative and postoperative CVI (p = 0.003 and p = 0.032, respectively). The PCV subtype demonstrated the highest rates of increased treatment need and the shortest injection intervals. Higher preoperative CVI independently predicted increased postoperative treatment need (OR = 1.13; p = 0.019). Cataract surgery may affect disease activity in a subset of patients with nAMD, particularly those with PCV and increased CVI. Preoperative choroidal characteristics such as CVI and SFCT may provide valuable insights for risk stratification and postoperative management.

Optimizing use of an ocular risk score for anesthesiologist intervention in cataract surgery