Good Visual Acuity Research Articles

Higher Visual Function Deficits in Children With Cerebral Visual Impairment and Good Visual Acuity.

In clinical practice Cerebral Visual Impairment (CVI) is typically diagnosed by observation of abnormal visually guided behaviors which indicate higher visual function deficits (HVFDs) suggesting abnormal brain development or brain damage in a child with a suitable clinical history. HVFDs can occur even in the presence of good visual acuity and may remain undiagnosed because the good visual acuity does not prompt further investigation. This leads to a lack of understanding of the child’s visual perceptual difficulties. In a prospective study, we determined the spectrum of HVFDs in a group of children with history suggestive of brain damage or disruption of brain development and an independent diagnosis of CVI in comparison with typically developing children with a structured 51 question inventory, the Higher Visual Function Question Inventory (HVFQI-51) adapted from the Cerebral Vision Impairment Inventory, CVI-I. Here, we show that the HVFQI-51 can detect a range of HVFDs in children with CVI with good visual acuity and clearly distinguishes these children from typically developing children. HVFDs in our study group could mostly be attributed to dorsal stream visual processing dysfunction though the spectrum varied between children. We report on the inclusion of the “not applicable” response option in analysis providing a picture of HVFDs more in tune with the overall disability of each child. We also propose a subset of 11 questions (Top-11) which discriminate between children with CVI vs. behaviors seen in typical children: this provides both a potential screening tool for initial assessment of HVFDs and a measure of CVI-related impairment, and needs further validation in a secondary independent sample.

Motion Processing Deficits in Children With Cerebral Visual Impairment and Good Visual Acuity.

PurposeWe sought to characterize neural motion processing deficits in children with cerebral visual impairment (CVI) who have good visual acuity using an objective, quantifiable method (steady-state visual evoked potentials [SSVEPs]).MethodsWe recorded SSVEPs in response to three types of visual motion – absolute motion and more complex relative and rotary motion, comparing them to form-related vernier and contour responses. We studied a group of 31 children with CVI diagnosed via detailed clinical examinations and 28 age-matched healthy controls.ResultsUsing measurements made at the appropriate response harmonics of the stimulation frequency, we found significant deficits in cerebral processing of relative and rotary motion but not of absolute motion in children with CVI compared with healthy controls. Vernier acuity, in keeping with good recognition acuity in both groups, was not different, nor were contour-related form responses.ConclusionsDeficits for complex motion but relative sparing of elementary motion and form-related signals suggests preferential damage to extra-striate visual motion areas in children with CVI. The fact that these preferential losses occur in the absence of significant acuity loss indicates that they are not secondary to reduced visual acuity, but rather are an independent vulnerability in CVI. These results corroborate parental and caregivers’ reports of difficulties with tasks that involve motion perception in children with CVI.

Classification of good visual acuity over time in patients with branch retinal vein occlusion with macular edema using support vector machine.

To identify the eyes with macular edema (ME) due to a branch retinal vein occlusion (BRVO) that have good visual acuity during the continuous anti-vascular endothelial growth factor (anti-VEGF) treatment based on the patients' clinical information and optical coherence tomography (OCT) images by using machine learning. Sixty-six eyes of 66 patients received 1 anti-VEGF injection followed by repeated injections in the pro re nata (PRN) regimen for 12months. The patients were divided into two groups: those with and those without good vision during the 1-year experimental period. Handcraft features were defined from the OCT images at the time of the first resolution of the ME. Variables with a significant difference between the groups were used as explanatory variables. A classifier was created with handcrafted features based on a support vector machine (SVM) that adjusted parameters for increasing maximal precision. The age, best-corrected visual acuity (BCVA) at the baseline, BCVA at the first resolution of the ME, integrity and reflectivity of the external limiting membrane (ELM), the ellipsoid zone (EZ), and area of the outer segments of the photoreceptors were selected as explanatory variables. The classification performance was 0.806 for accuracy, 0.768 for precision, 0.772 for recall, and 0.752 for the F-measure. The use of the SVM of the patient's clinical information and OCT images can be helpful for determining the prognosis of the BCVA during continued pro re nata anti-VEGF treatment in eyes with ME associated with BRVO.

Visual acuity, defocus curve and patient satisfaction of a new hybrid EDOF-multifocal diffractive intraocular lens.

Purpose: To evaluate the visual acuity, defocus curve and visual quality of life following bilateral implantation of a new hybrid extended depth of focus (EDOF)-multifocal diffractive intraocular lens (IOL). Methods: Patients who underwent cataract surgery with bilateral implantation of Tecnis Synergy IOL were enrolled in this study. The main outcomes were defined as uncorrected distant, intermediate and near visual acuities (UDVA, UIVA and UNVA, respectively), defocus curve and VF-14 questionnaire aimed for visual performance. Results: The mean ± SD values for binocular UDVA, UIVA and UNVA were -0.01 ± 0.04, 0.05 ± 0.03 and 0.03 ± 0.05 logMAR, respectively. Defocus curve showed a continuous vision above 0.16 logMAR between +0.50 D and -2.50 D. Patients had good visual performance with mean VF-14 scores above 3 points. Driving at night (3.47 ± 0.64) was found to be the most difficult task to perform. Spectacle independence was 100% for both distant and near vision. Conclusion: Bilateral implantation of Tecnis Synergy IOL in cataract patients shows good visual acuity and performance, covering a good visual range without any need of spectacles.

Acanthamoeba and staphylococcal keratitis with epithelial ingrowth after laser in situ keratomileusis

Introduction: A rare case of Acanthamoeba and staphylococcal keratitis after femtosecond laser–assisted laser in situ keratomileusis (LASIK), managed medically and surgically (with flap lift, scraping, and povidone–iodine 5% application) is reported. Patient and clinical findings: A 25-year-old woman presented 30 months after myopic LASIK with a painless loss of vision in the right eye. Visual acuity was 20/32, and a focal stromal opacity was observed. Diagnosis, intervention, and outcomes: The patient underwent flap lift, scraping, and application of povidone–iodine 5% to the flap interface. Samples were sent to the microbiology department for microscopic, culture, and sensitivity, and the patient was commenced with topical fluconazole, levofloxacin, and fusidic acid. Giemsa staining demonstrated 2 Acanthamoeba cysts. Microscopic examination revealed gram-positive cocci and pyogenic cells. Culture on a nonnutrient agar with a lawn of Escherichia coli identified the gram-positive organism Staphylococcus aureus. The clinical situation improved, and topical steroids were added. Mild epithelial ingrowth was noted at 4 months after flap lift; however, the growth remained stable and was under observation. The final visual outcome was good (visual acuity 20/25). Conclusions: This case emphasized the importance of precise microbiological diagnosis and consideration of early flap lift in post-LASIK infectious keratitis.

Contact Lens Fitting in Patients with Keratoconus - A Retrospective Assessment of 200 Patients.

Nowadays, keratoconus (KC) is very well treatable in a stage-oriented manner. A wide range of designs and materials of contact lenses (CL) are available for the treatment of KC. The aim of this study was to evaluate the possibilities, the possible challenges and the visual outcome of lens fitting in KC eyes. This retrospective study includes data from 200 patients who received a lens fitting trial in our contact lens service between 2006 and 2016. We documented ophthalmological parameters, the type of prescribed CL, the number of required trial lenses and possible causes of the failure of the lens fitting. The mean age at initial lens fitting was 33.9 ± 12.5 years. In 98.8% of the cases, the fitting was performed with rigid gas permeable lenses, in 90.1% with four-curve lenses. Of the total number of aspheric lenses prescribed, 87.5% were fitted in keratoconus stages "1" to "2" (topographic keratoconus classification; Oculus Keratograph). Back surface toric lenses or bitoric lenses were fitted to 61.7% in keratoconus stages "2 - 3" to "4". Before patients received their final CL, a median of 2 trial lenses were required (max. 16). Mean visual acuity with lens correction was 0.8 ± 0.2 at the initial fitting, mean visual acuity with glasses correction was 0.5 ± 0.3. In 7.7% of the eyes, the KC lens fitting was discontinued due to the advanced stage of keratoconus, requiring a corneal transplant. Reasons for discontinuing contact lens fitting included lens intolerance (2.3%), application problems (0.3%) or acute corneal hydrops (0.3%). Discontinuation of lens wearing due to incompatibilities or application problems occurred in only four cases (1.1%) in the further course after lens fitting. The use of contact lenses is an integral part of the stage-appropriate therapy of keratoconus. Good visual acuity can be achieved in all stages of keratoconus with a low drop-out rate. In most cases, the adjustment is carried out with rigid gas permeable lenses with a four-curve geometry. In initial stages, aspherical lenses may be sufficient. Toric lenses can be fitted in advanced stages when rotationally symmetrical lenses cannot achieve a satisfactory fit. If contact lenses have been successfully fitted, there are only a few cases in which patients abandon their contact lenses because of intolerance.

Anterior chamber depth variability between 2 hydrophobic acrylic 1-piece intraocular lenses: randomized trial.

To analyze the difference in anterior chamber depth (ACD) after uneventful cataract surgery between 2 hydrophobic acrylic 1-piece intraocular lenses (IOLs) with different material properties. Hanusch Hospital, Vienna, Austria. Single-center, bilateral randomized paired-eye controlled study. Patients scheduled for bilateral cataract surgery were randomized to receive the Clareon IOL in 1 eye and the AcrySof IQ IOL (both Alcon Laboratories, Inc.) in the contralateral eye. Preoperatively, a slitlamp examination, optical biometry (IOLMaster 700, Carl Zeiss Meditec AG), refraction, and visual acuity measurements were performed. ACD was assessed 1 hour and 1 week postoperatively and with additional measurement of uncorrected (UDVA) and corrected distance visual acuity (CDVA) 6 months postoperatively. 80 eyes of 40 patients were analyzed in this study. ACD at the 6-month follow-up was 3.94 ± 0.30 mm for the Clareon IOL and 3.91 ± 0.32 mm for the AcrySof IQ IOL (P = .08). Statistically significant differences in the ACD shift between both IOLs were detected between 1 week and 6 months (P = .04) and 1 hour and 6 months (P = .04). There were no statistically significant differences between both IOLs in UDVA (P = .78), CDVA (P = .59), and spherical equivalent (SE, P = .39) at the 6-month visit. The mean absolute error between the measured and the aimed SE was not significant (P = .97). There was no clinically relevant difference in ACD between the Clareon IOL and the AcrySof IQ IOL in patients after uneventful cataract surgery. Both IOLs yielded good refraction and visual acuity outcomes.

The Association between Patient Health Status and Surrogate Decision Maker Post-Traumatic Stress Disorder Symptoms in Chronic Critical Illness.

Rationale: Surrogate decision-makers of patients with chronic critical illness (CCI) are at high risk for symptoms of post-traumatic stress disorder (PTSD). Whether patient health status after hospital discharge is a risk factor for surrogate PTSD symptoms is not known. Objectives: To determine the association between patient health status 90 days after the onset of CCI and surrogate symptoms of PTSD. Methods: We performed a secondary analysis of the data from a multicenter randomized trial of a communication intervention for adult patients with CCI and their surrogate decision-makers. Results: Surrogate PTSD symptoms were measured at 90 days using the Impact of Events Scale-Revised. For patients who were alive at 90 days, location was used as a marker of health status and included the following categories: 1) home (relatively good health and low acuity), 2) acute rehabilitation (moderate care needs and impairments, generally expected to improve), 3) skilled nursing facility (moderate care needs and impairments, generally not expected to improve significantly or quickly), 4) long-term acute care facility (persistently high acute care needs and functional impairment), and 5) readmission to an acute care hospital (suggesting the highest acuity of illness and care needs of the cohort). Patients who died before 90 days were categorized as deceased. In the analyses, 365 surrogates and 256 patients were included. Among patients, 49% were female, and the mean age was 59 years. Among surrogates, 71% were female, and the mean age was 51 years. A directed acyclic graph was constructed to identify covariates to be included in the model. Compared with symptoms seen among surrogates of patients living at home, heightened PTSD symptoms were seen among surrogates of patients who were readmitted to an acute care hospital (β coefficient, 15.9; 95% confidence interval [CI], 4.5 to 27.3) or had died (β coefficient, 14.8; 95% CI, 8.8 to 20.9) at 90 days. Conclusions: Surrogates of patients with CCI who have died or have been readmitted to an acute care hospital at 90 days experience increased PTSD symptoms as compared with surrogates of patients who are living at home. These patients and surrogates represent a readily identifiable group who may benefit from enhanced emotional support.

Cases of replacing diffractive bifocal intraocular lens with extended depth of focus intraocular lens due to waxy vision.

PurposeTo investigate the postoperative course of patients who explanted a diffractive bifocal intraocular lens (IOL) due to waxy vision and implanted with an extended depth of focus IOL.MethodsThis study evaluated 29 eyes of 25 patients who underwent diffractive bifocal IOL explantation followed by TECNIS Symfony® implantation because of dissatisfaction due to waxy vision at the Takabatake West Eye Clinic between January 2018 and November 2019. The indication criteria for this surgery were patients with uncorrected distance visual acuity of 0.05 logMAR or better, without eye diseases that may affect visual function, and no dissatisfactions about photic phenomena. We investigated patient demographics, uncorrected and corrected visual acuity, manifest refraction, contrast sensitivity, subjective symptoms, time to IOL explantation, explanted IOL type, and spectacle independence.ResultsThe time to the IOL exchange after the initial IOL implantation was 55.3 ± 50.4 days (range: 14–196 days). The logMAR corrected distance visual acuity before and after IOL exchange were −0.13 ± 0.06 and −0.14 ± 0.06, respectively (p = 0.273). After IOL exchange surgery, the area under log contrast sensitivity function increased significantly from 1.07 ± 0.12 to 1.21 ± 0.12 (p < 0.001), and the waxy vision symptoms improved. The spectacle independence rate at the last visit was 88.0%.ConclusionFor patients who complain of waxy vision despite good visual acuity after diffractive bifocal IOL implantation, exchange to extended depth of focus IOL was considered one of the useful surgical options.

P37 Significance of a swollen eye in a child with Down syndrome

Case report - IntroductionDue to dysregulation of their immune system, children with Down syndrome are at increased risk of a number of conditions, including malignancy, infection and autoimmune disorders. This case highlights the importance of the MDT team working in order to fully explore possible diagnoses and reach the correct conclusion. We present a case of a relatively rare eye disorder, initially treated as peri-orbital cellulitis, that required a collaborative team approach to reach the final diagnosis.Case report - Case descriptionA 6-year-old-girl with Down syndrome was referred to the oncology and tertiary ophthalmology teams by her local paediatric team with a history of recurrent right-eye peri-orbital swelling. The impression had been of recurrent peri-orbital cellulitis which was treated with and responsive to antibiotics. However, the most recent presentation was unresponsive to antibiotics and had associated orbital symptoms of proptosis and restricted eye movement. An MRI-head showed a protruding right eye with an enhancing mass centred in the right-superior temporal-extraconal-orbit. The mass was infiltrating the extra-ocular muscles and there was low bone-marrow signal compared to the left-side. The MRI findings were discussed in the oncology MDT-meeting. Appearances were felt to be more in keeping with malignancy, rather than infection. An ophthalmology review confirmed no evidence of optic-nerve compression, so she was discharged on antibiotics with a plan made to admit for biopsy and bone marrow aspirate under general anaesthetic. Histology of the lesion was reported to show a mixed inflammatory-mass, angiocentric with no elements of neoplasia. Oncology-specific stains were negative. BMA was normal. The differential at this point was orbital-pseudo-tumour; if infection and systemic-auto-immune conditions could be excluded. Histochemical-staining of the biopsy excluded fungi, bacteria or mycobacteria. The granulomatous-nature of the infiltrate and the conspicuous presence of eosinophils were consistent with an autoimmune-condition. The little girl was discharged from the oncology team into the care of the ophthalmology and paediatric rheumatology teams for further work-up and management. She was commenced on prednisolone.On rheumatology-review, focussed-history and examination were unremarkable in terms of an underlying systemic-inflammatory condition. A full-blood-work-up was requested. Her pANCA and MPO were mildly raised, as were her inflammatory markers. In view of these results, a CT chest/abdomen angiogram was arranged which was normal. A diagnosis of orbital-pseudotumour was made. There was clinical improvement on prednisolone, so a tapering plan was provided.Case report - DiscussionFirst described by Birch-Hirschfield in 1905, orbital pseudo-tumour, also known as idiopathic orbital inflammatory syndrome (IOIS) is a benign, non-infective, inflammatory condition of the orbit without identifiable local or systemic causes. Post-treatment recurrence occurs in 37% of cases.In this case, as steroids were weaned, there was recurrence of eye symptoms with proptosis and redness of the eye. Repeat bloods were performed, and an MRI-head requested. The repeat ANCA-MPO was negative. Whilst awaiting her MRI, a further clinical review was carried out jointly by paediatric rheumatology and ophthalmology. At this appointment, there was notable proptosis which appeared to be getting worse. The impression was that there was recurrence of the inflammatory swelling, and that the sensible option would be to restart treatment with oral prednisolone. At this point, addition of a steroid-sparing DMARD was discussed. Methotrexate was chosen and commenced. The little girl continued to attend for joint rheumatology and ophthalmology reviews. She continued to have proptosis in the right eye but had excellent ocular motility and good visual-acuity. She was noted to develop a worsening in the lid swelling and possible proptosis with an intercurrent illness, perhaps suggesting that the underlying inflammatory process was still active. The plan was to continue methotrexate for 2 years and perform another orbital MRI before potentially reducing methotrexate. However, in this time the methotrexate dose was reduced due to deranged LFTs. She continued to have “flare ups” with increasing proptosis despite treatment with methotrexate. A repeat MRI after 2 years of treatment showed reduction in the size of the right supra-lateral orbital mass compared to the first scan. However, there was uniform enhancement following gadolinium injection with mild proptosis of the right-globe. The appearances were in keeping with an active granulomatous lesion. The current plan is to try and re-optimise the dose of methotrexate. If not tolerated, an alternative DMARD will need to be considered.Case report - Key learning pointsThe diagnosis of orbital pseudo-tumour is one of exclusion with evaluation directed to exclude neoplasms, infections, and systemic inflammatory disorders. It can manifest as a bilateral condition in 13% and with constitutional symptoms in 40%.Points for discussionDifferential of orbital pseudo-tumours in the paediatric populationPrognosis of pseudo-tumoursSuggested treatment pathway -- Is control to allow normal eye movement enough or should we be treating more aggressively?

New epiretinal implant with integrated sensor chips for optical capturing shows a good biocompatibility profile in vitro and in vivo

BackgroundRetinal degenerative diseases, e.g., retinitis pigmentosa, cause a severe decline of the visual function up to blindness. Treatment still remains difficult; however, implantation of retinal prostheses can help restoring vision. In this study, the biocompatibility and surgical feasibility of a newly developed epiretinal stimulator (OPTO-EPIRET) was investigated. The previously developed implant was extended by an integrated circuit-based optical capturing, which will enable the immediate conversion of the visual field into stimulation patterns to stimulate retinal ganglion cells.ResultsThe biocompatibility of the OPTO-EPIRET was investigated in vitro using the two different cell lines L-929 and R28. Direct and indirect contact were analyzed in terms of cell proliferation, cell viability, and gene expression. The surgical feasibility was initially tested by implanting the OPTO-EPIRET in cadaveric rabbit eyes. Afterwards, inactive devices were implanted in six rabbits for feasibility and biocompatibility testings in vivo. In follow-up controls (1–12 weeks post-surgery), the eyes were examined using fundoscopy and optical coherence tomography. After finalization, histological examination was performed to analyze the retinal structure. Regarding the in vitro biocompatibility, no significant influence on cell viability was detected (L929: < 1.3% dead cells; R-28: < 0.8% dead cells). The surgery, which comprised phacoemulsification, vitrectomy, and implantation of the OPTO-EPIRET through a 9–10 mm corneal incision, was successfully established. The implant was fixated with a retinal tack. Vitreal hemorrhage or retinal tearing occurred as main adverse effects. Transitional corneal edema caused difficulties in post-surgical imaging.ConclusionsThe OPTO-EPIRET stimulator showed a good biocompatibility profile in vitro. Furthermore, the implantation surgery was shown to be feasible. However, further design optimization steps are necessary to avoid intra- and postoperative complications. Overall, the OPTO-EPIRET will allow for a wide visual field and good visual acuity due to a high density of electrodes in the central retina.

A Randomized Trial of Photobiomodulation Therapy for Center-Involved Diabetic Macular Edema with Good Visual Acuity (Protocol AE)

To determine if treatment with a photobiomodulation (PBM) device results in greater improvement in central subfield thickness (CST) than placebo in eyes with center-involved diabetic macular edema (CI-DME) and good vision. Phase 2 randomized clinical trial. Participants had CI-DME and visual acuity (VA) 20/25 or better in the study eye and were recruited from 23 clinical sites in the United States. One eye of each participant was randomly assigned 1:1 to a 670-nm light-emitting PBM eye patch or an identical device emitting broad-spectrum white light at low power. Treatment was applied for 90 seconds twice daily for 4 months. Change in CST on spectral-domain OCT at 4 months. From April 2019 to February 2020, 135 adults were randomly assigned to either PBM (n= 69) or placebo (n= 66); median age was 62 years, 37% were women, and 82% were White. The median device compliance was 92% with PBM and 95% with placebo. OCT CST increased from baseline to 4 months by a mean (SD) of 13 (53) μm in PBM eyes and 15 (57) μm in placebo eyes, with the mean difference (95% confidence interval [CI]) being-2 (-20 to 16) μm (P= 0.84). CI-DME, based on DRCR Retina Network sex- and machine-based thresholds, was present in 61 (90%) PBM eyes and 57 (86%) placebo eyes at 4 months (adjusted odds ratio [95% CI]= 1.30 (0.44-3.83); P= 0.63). VA decreased by a mean (SD) of-0.2 (5.5) letters and-0.6 (4.6) letters in the PBM and placebo groups, respectively (difference [95% CI]= 0.4 (-1.3 to 2.0) letters; P= 0.64). There were 8 adverse events possibly related to the PBM device and 2 adverse events possibly related to the placebo device. None were serious. PBM as given in this study, although safe and well-tolerated, was not found to be effective for the treatment of CI-DME in eyes with good vision.

Optic Pit Maculopathy: Clinical Features and Management Options.

In this article, we review the pathogenesis, clinical features, imaging modalities and latest management options for optic pit maculopathy (OPM). The pathogenesis of OPM remains to be unclear, but imaging tools such as optical coherence tomography (OCT) and OCT angiography are enhancing our knowledge. Observation continues to be the best management strategy for patients with good visual acuity, and many cases have demonstrated spontaneous resolution. For more advanced, progressive vision loss, treatment options involving vitrectomy can be considered and discussed with the patient. Supplementary techniques to vitrectomy have been reported in small studies with relative success such as glial tissue peeling, inverted internal limiting membrane flap, optic pit plugging, and retinal fenestration. While there are multiple treatment options available for OPM, there is no consensus on the technique and surgical timing. Individual patient factors and the risks-benefits of treatment must be taken into account in guiding management. Larger clinical trials will further assist in decision making for treating OPM.

The use of OCT in good visual acuity MOGAD and AQP4-NMOSD patients; with and without optic neuritis.

Myelin oligodendrocyte-antibody-associated disease (MOGAD) often presents with severe optic neuritis (ON) but tends to recover better than in aquaporin-4 antibody neuromyelitis optica spectrum disorder (AQP4-NMOSD). We measured OCT and VEP in MOGAD and AQP4-NMOSD eyes with good visual function, with or without previous ON episodes. Surprisingly, OCT and/or VEPs were abnormal in 84% MOGAD-ON versus 38% AQP4-NMOSD-ON eyes (p = 0.009) with good vision, compared with 18% and 17% respectively of eyes with no previous ON. A sub-group with macular OCT performed as part of a research study confirmed both retinal and macular defects in visually-recovered MOGAD eyes. These findings have implications for investigation and management of MOGAD patients.

Morphological characteristics of eyes with neovascular age-related macular degeneration and good long-term visual outcomes after anti-VEGF therapy

PurposeTo analyse the morphological characteristics of eyes with neovascular age-related macular degeneration (AMD) with good long-term visual acuity after anti-VEGF (vascular endothelial growth factor) therapy.MethodsRetrospective, observational study of 175 patients...

Visual outcomes and patient satisfaction 1 and 12\xa0months after combined implantation of extended depth of focus and trifocal intraocular lenses

PurposeTo assess the 1-month and 12-month postoperative visual performance and subjective outcomes following combined implantation of an extended depth of focus (EDOF) intraocular lens (IOL) and a trifocal IOL.MethodsThe study enrolled consecutive patients undergoing refractive lens extraction or cataract surgery with combined implantation of an EDOF IOL (dominant eye) and trifocal IOL. Uncorrected (UDVA) and best-corrected (CDVA) distance visual acuities, uncorrected intermediate (UIVA) and near (UNVA) visual acuities, and subjective questionnaires were evaluated 1 month and 12 months postoperatively.ResultsThe study enrolled 58 consecutive patients. Binocular UDVA, UIVA and UNVA were − 0.08 ± 0.07 logMAR, 0.15 ± 0.14 logMAR and 0.17 ± 0.11 logMAR at 1 month, compared to − 0.09 ± 0.06 logMAR (P = .323), 0.11 ± 0.10 logMAR (P = .030) and 0.13 ± 0.10 logMAR (P = 0.008) at 12 months. Satisfaction was high with 93.1% of patients fulfilled or more than fulfilled postoperatively, and 84.5% and 86.3% reported spectacle independence for near at the respective postoperative assessments. The mean daytime and nighttime quality of vision (QoV) scores were 9.12 ± 0.94 and 7.88 ± 1.74 at 1 month, compared to 9.24 ± 0.78 (P = .183) and 8.26 ± 1.38 (P = .043) at 12 months.ConclusionsThis IOL combination provides good unaided visual acuity at 1 and 12 months postoperatively, with high functional vision and postoperative satisfaction reported at 1 and 12 months. However, a significant improvement in overall nighttime QoV at the 12 months assessment was found.

Predictive value of retinal function by the Purkinje test in patients scheduled for cataract surgery in Kinshasa, DR Congo.

To assess the retinal function in patients with dense cataracts in resource poor settings in Kinshasa, DR Congo. In a tertiary eye care center, the Purkinje entoptic test was performed as part of the ophthalmological examination in 98 eyes in patients with cataract, using a penlight. Totally 92 cataract patients including 86 patients suffered from unilateral and 6 from bilateral cataracts were included in the study. The investigator asked the patients about their perception of the vascular pattern most commonly described as a leafless or dead tree. Visual acuity≥6/60 was considered an indication of good visual function and visual acuity<6/60 of poor function. Following small incision cataract surgery, best corrected visual acuity (BCVA) was determined and compared with the preoperative findings. Out of 98 eyes, there were 80 (81.6%) where the Purkinje entoptic phenomenon was reported by the patients. After cataract surgery, out of the 80 eyes, there were 75 (93.8%) with a BCVA of better than 6/60, whereas in 5 eyes (6.2%), BCVA was 6/60 or less. Out of the 18 eyes (18.4%) where no Purkinje tree was recognized, there were 14 (77.8%) with BCVA of better than 6/60, whereas in 4 (22.2%) BCVA was 6/60 or less. The Purkinje entoptic test is successfully used for preoperative assessment of retinal function in patients with dense cataract. However, further investigation and refinement of the test is necessary to validate the method for use in sub-Saharan conditions.

Comparison of the accuracy of six intraocular lens power calculation formulas for eyes of axial length exceeding 25.0 mm

To compare intraocular lens power calculation formulas for eyes longer than 25.0mm in terms of absolute error and the percentages of postoperative emmetropia and hyperopia. The data for myopic patients who underwent uneventful phacoemulsification between October 2015 and June 2019 were reviewed. Intraocular lens power was calculated using Holladay 1, SRK/T, Hoffer Q, Holladay 2, Haigis, and Barrett Universal II formulas. The power of the lens implanted was based on Holladay 2. Three months after phacoemulsification, the refraction was measured, and the mean absolute error was calculated. The percentage of patients with good uncorrected visual acuity and percentage of hyperopic patients for each formula was established. ROC curves with a cut-off point of axial length were drawn for each formula and the area under the curve was evaluated. Seventy patients (81 eyes) whose ocular axial length ranged between 25.01mm and 28.57mm were included. The Barrett Universal II formula achieved the lowest mean absolute error of 0.08±0.08D. Additionally, with the Barrett Universal II, the percentage of patients with good uncorrected visual acuity (81.5%) was the highest, and the percentage of hyperopic patients (4.9%) was the lowest. The Barrett Universal II and Holladay 1 formulas had the largest area under curve (0.764 and 0.718, respectively). 1.The Barrett Universal II formula is recommended for intraocular lens power calculation for eyes with axial length greater than 25.0mm. 2.Considering the ROC curve method, the Barrett Universal II and Holladay 1 formulas appear to be the most appropriate.

Visual Function of Drivers and its Relation to the Occurrence of Road Traffic Accidents in Saudi Arabia

BACKGROUND: The mortality rate due to road traffic accidents (RTA) is significantly high in Saudi Arabia (SA) compared to other countries. The visual function which includes good visual acuity (VA) and binocular vision are very important factors that can contribute to the incidence of RTA. AIM: The aim of this study is to investigate the association between refractive errors (REs) and the RTA in SA. METHODS: A total of 354 participants (mean age 22.67 ± 3.22 years) were recruited randomly to participate in this study from the population of Qassim district. Data collected using the questionnaire included participants’ age, sex, and education level, ocular and medical history, driving history as well as history of RTA. Ocular health examination including VA, RE measurements, and binocular vision function vision was measured and analyzed. RESULTS: The results of this study show that 48.3% of drivers had some form of REs with 3.4% being visually impaired. 217 (61.3%) of participants have had an RTA, and 119 (54.9%) of them have had more than two accidents in the past two years. The findings show no significant association between the occurrence of RTA and uncorrected REs or binocular vision dysfunction. CONCLUSION: Our data showed significantly higher rate of RTA among Saudi drivers which is much higher than any country in the world. The current Saudi regulations for obtaining driving license need to be modified, with implementing a comprehensive eye examination prior to acquiring or renewing drivers’ licenses.

Enhanced Monofocal Extended Depth of Focus IOL With a Diffractive Surface Design.

To evaluate the refractive and visual outcomes following cataract surgery and implantation of a new enhanced monofocal extended depth of focus (EDOF) intraocular lens (IOL). Fifty eyes of 25 consecutive patients who underwent implantation of the xact Mono-EDoF IOL (Santen Pharmaceutical Co, Ltd) were enrolled in this study. Main outcome measures were refractive error and monocular corrected (CDVA) and uncorrected (UDVA) distance visual acuity values. Monocular visual acuity at different vergences (defocus curve) was obtained. Patients were evaluated at 12 months postoperatively. At 1 year of follow-up, all eyes showed a postoperative spherical equivalent within ±1.00 diopters (D) and 95% of eyes within ±0.50 D. The mean postoperative spherical equivalent was -0.15 ± 0.28 D. A total of 88% and 100% of eyes showed UDVA and CDVA of 20/25 or better, respectively. The mean values of UDVA and CDVA (Snellen decimal) were 0.94 ± 0.09 (range: 0.70 to 1.00) and 0.99 ± 0.03 (range: 0.79 to 1.00), respectively. Defocus curve showed good visual acuity at distance and intermediate distances with a depth of focus value of 1.25 D. No visual disturbances were reported in the whole sample during the entire follow-up. The current study shows that this EDOF IOL provides good visual performance at far and intermediate distances. The lens may be considered for patients interested in reducing spectacle independence at intermediate distances. [J Refract Surg. 2021;37(9):595-600.].