Hyperopic Patients Research Articles

Refractive Lens Exchange: A Review.

In recent decades, technical advancements in lens surgery have considerably improved safety and refractive outcomes. This has led to a much broader range of indications for refractive lens exchange (RLE). Effective restoration of uncorrected distance and near visual acuity is possible with modern presbyopia correcting intraocular lenses (IOLs). Hyperopic patients who are fully presbyopic were identified as ideal candidates for RLE. For myopic patients, an increased risk of retinal detachment has been reported, which leads to a higher threshold to perform RLE in this patient group. The most frequent postoperative complications include posterior capsular opacification, deviation from the target refraction and cystoid macular edema. Thus, adequate planning of surgery, careful patient selection, as well as comprehensive counseling are crucial for successful RLE.

The effects of refractive status on the outcomes of strabismus surgery in patients with esotropia

BackgroundThe success of the strabismus surgery can hinge on several factors. One of these factors is refractive condition like hyperopia or myopia. Our study seeks to evaluate the surgical outcomes in patients with esotropia and myopia.MethodsThis case-control study encompassed all surgical cases of esotropia at Torfe and Negah Hospital between 2016 and 2021, which satisfied our specified inclusion criteria. The initial variables from electronic medical records were collected, including demographic, clinical, and surgery-related factors. At the final follow-up appointment, the level of eye deviation, both at distance and near, was recorded. We considered the operation a “success” for patients with a post-surgery distance eye deviation of 10(Pd) or less. Patients with greater deviation were classified as surgery failure. Statistical analyses were executed using SPSS software (version 16.0), and a P-value less than 0.05 was considered significant.ResultsOf the 194 patients evaluated, 112 were incorporated into the study. Surgical failure was observed in 14.29% of myopic patients, 29.79% of hyperopic patients, and 31.82% of emmetropic patients. The myopia group displayed a 0.19 odd ratio for surgical failure compared to the combined hyperopia and emmetropia groups, not statistically significant (OR: 0.19, CI 95%: 0.03–1.02). Additionally, patients diagnosed with Lateral Rectus Under-action were found to be 6.85 times more likely to experience surgery failure(OR: 6.85, CI 95%: 1.52–30.94). An elevated risk of surgical failure was also identified in patients who underwent Inferior Oblique Weakening procedure, indicated by a 3.77-fold increase in the odds ratio for failure(OR: 3.77, CI 95%: 1.08–13.17).ConclusionIn our study, despite numerical disparities, there was no statistical difference among the success rates of all esotropia patients with different refractive errors. The patients with LRUA or IOOA showed lower success rates. Myopic patients had higher post-op overcorrection with lower reoperation rates compared to hyperopic or emmetropic patients.

Impact of Refractive Status on Presbyopia Progression among Patients with Presbyopia.

To explore the impact of refractive status on presbyopia progression among patients with presbyopia. This retrospective observational study included patients with presbyopia who visited the Seventh Affiliated Hospital of Sun Yat-sen University and Shenzhen Polytechnic Medical College between May 2018 and August 2022. The amplitude of accommodation (AMP) and near addition power (ADD) at 6 months and 1 year were collected. A total of 103 patients with presbyopia were included in this study: 42 patients with myopia, 23 patients with emmetropia, and 38 patients with hyperopia. There were significant differences in ΔAMP(6-month) and ΔADD(6-month) among patients with different refractive statuses, and the values of emmetropic patients and hyperopic patients were higher than in myopic patients (all P < 0.001). The ΔAMP(1-year) and ΔADD(1-year) of hyperopic patients were significantly higher than in emmetropic patients and myopic patients (all P < 0.001). The ΔADD(1-year) of emmetropic patients was greater than in myopic patients (P = 0.045), but there were no significant differences in ΔAMP(1-year) between patients with emmetropia and myopia (P = 0.090). The progression of presbyopia in hyperopic patients was relatively more significant than for emmetropia, followed by myopia. The prescription of presbyopia glasses might need to be replaced more frequently in patients with hyperopia.

Pre-Cycloplegic Exam Benefit of Photoscreening and Accommodation-Relaxing Skiascopy.

Seeking a quick way to estimate refractions for challenging pediatric patients, we studied two non-contact methods with particular attention to accuracy and level of stress in uncovering cycloplegic hyperopia. Newly referred and follow-up pediatric eye patients had timed school bus accommodation-relaxing skiascopy (SBARS) and Plusoptix A12 (Px) photoscreener testing before cyclopentolate 1% confirmatory examinations. The ABCD ellipsoid univariate method based on relative blur and vector components was used to compare dry sphero-cylinder refraction estimates with cycloplegic. Receiver operating characteristic (ROC) curves were used to determine screening value. Three compared refractions were attempted in 191 racially diverse children of whom 100 were age 0.2-3.9 years and 91 were 4 to 14 years. Plusoptix failed to yield a result in 21 and an additional 21 were interpreted as an excess sphere. Median spherical equivalent did not differ between Px and SBARS for 149 with Px readings but in hyperopic patients, Plusoptix uncovered 27% less hyperopia. The ellipsoid for SBARS of 0.8 was better than 2.4 for Plusoptix (Mann-Whitney p<0.001). Plusoptix was fastest (3-15 seconds) followed by SBARS (15-30 seconds) compared to 30-45 minutes for cycloplegic exam. Non-contact quick refractive methods enhanced confirmatory cycloplegic pediatric exam in high-risk pediatric patients.

Hyperopic LASIK and postoperative corneal steepness: revisiting the 49-diopter limit.

To compare corrected distance visual acuity (CDVA) outcomes of hyperopic laser in situ keratomileusis (LASIK) with a postoperative corneal steepness above vs below 49 diopters (D). Care-Vision Laser Centers, Tel-Aviv, Israel. Retrospective study. This study included consecutive patients who underwent hyperopic LASIK between January 2013 and December 2019. Hyperopic patients were divided into 2 groups based on postoperative corneal steepness with steep corneas defined >49.0 D and the control group ≤49.0 D. Adjustments were performed to account for differences in baseline and intraoperative parameters. Overall, 1703 eyes of 1703 patients were included. Mean age was 48.3 ± 10.0 years, and 45.3% were male. Preoperatively, the steep group (2.4%, n = 41/1703) had steeper mean (44.6 D vs 43.1 D, P < .001) and steep (45.1 D vs 43.5 D, P < .001) keratometry, worse logMAR CDVA (0.07 vs 0.04, P = .02), and higher sphere (4.9 D vs 2.9 D, P < .001). Intraoperatively, they had a higher spherical treatment (4.6 D vs 2.8 D, P < .001). After hyperopic LASIK, the steep group had worse logMAR CDVA (0.10 vs 0.06, P = .01). However, after accounting for differences in baseline and spherical treatment, no significant differences were found in postoperative logMAR CDVA (0.06 vs 0.06, P = .99). The factors that remained associated with worse postoperative CDVA were higher spherical treatment (0.01 logMAR per 1 D, P < .001) and preoperative CDVA (0.60 logMAR per 1.00 logMAR, P < .001). Postoperative corneal steepness greater than 49 D is not associated with worse visual outcomes after hyperopic LASIK. However, lower preoperative visual potential and higher spherical treatment applied are associated with worse outcomes. The 49 D cutoff should be revisited.

ASSOCIATION BETWEEN ABO BLOOD GROUPS AND REFRACTIVE ERRORS

Objective: Study Design: To nd out association between ABO blood groups and refractive errors. Descriptive cross sectional study. This study was conducted in SMS Medical college , De Method: pt of Ophthalmology from 1st July 2022 till 1st August 2022 . A total of 100 patients having age group 15-40 years of both genders were enrolled in the study. The patients having other eye diseases and blood dyscrasias were excluded from the study. The data was analyzed. Out of 100 patients, 60 patients (60%) of myopia Results: were presented between 15 to 35 years of age. No hyperopic patient was present between 40 to 50 years of age. 32(32%) out of 50 patients were having blood group O and myopia while only 24(24%) out of 100 patients were associated with blood group A and B. Only 6(6%) hyperopic patients were having blood group A and O while 8(8%) were associated with blood group B. Conclusion: Blood group O shows slight predominance to myopia while other blood groups showed no specic association with other refractive errors.

Evaluación del músculo ciliar y del grosor escleral anterior en miopes altos mediante tomografía de coherencia óptica

PurposeTo assess ciliary muscle (CM) and anterior scleral thickness (AST) dimensions in vivo in high myopia using swept-source optical coherence tomography (SS-OCT) and to compare with emmetropic and hyperopic subjects. MethodsCross-sectional study that included 34 high myopic patients (≥−6 diopters [D]), 90 emmetropes (−1 to +1D) and 38 hyperopic patients (≥+3.5D). CM thickness (CMT) and AST were measured in the temporal and nasal quadrants at 1, 2, and 3mm from the scleral spur using SS-OCT. In addition, the length of the CM (CML) was evaluated. ResultsThe dimensions of the CML and the CMT at any of their measurement points were greater in high myopes and emmetropes than in hyperopes, both in the nasal and temporal quadrants (P<.001). However, there were no differences between high myopes and emmetropes for any of the parameters (P≥.076) except for the CMT at 3mm in the temporal quadrant (P<.001). There were no differences in the AST between high myopes, emmetropes and hyperopes, in any of the measurement points or quadrants studied (P>.05). ConclusionsThe SS-OCT allows to measure the CM in vivo, not observing differences in its dimensions between high myopes and emmetropes, but they were smaller in hyperopes. In the measurement of the anterior sclera, no differences were observed between the three groups analyzed according to refraction.

Assessment of the ciliary muscle and scleral anterior thickness in high myopia by optical coherence tomography

PurposeTo assess ciliary muscle (CM) and anterior scleral thickness (AST) dimensions in vivo in high myopia using swept-source optical coherence tomography (SS-OCT) and to compare with emmetropic and hyperopic subjects. MethodsCross-sectional study that included 34 high myopic patients (≥ −6 diopters [D]), 90 emmetropes (−1 to +1 D) and 38 hyperopic patients (≥ +3.5 D). CM thickness (CMT) and AST were measured in the temporal and nasal quadrants at 1, 2, and 3 mm from the scleral spur using SS-OCT. In addition, the length of the CM (CML) was evaluated. ResultsThe dimensions of the CML and the CMT at any of their measurement points were greater in high myopes and emmetropes than in hyperopes, both in the nasal and temporal quadrants (P < .001). However, there were no differences between high myopes and emmetropes for any of the parameters (P ≥ .076) except for the CMT at 3 mm in the temporal quadrant (P < .001). There were no differences in the AST between high myopes, emmetropes and hyperopes, in any of the measurement points or quadrants studied (P > .05). ConclusionsThe SS-OCT allows to measure the CM in vivo, not observing differences in its dimensions between high myopes and emmetropes, but they were smaller in hyperopes. In the measurement of the anterior sclera, no differences were observed between the three groups analyzed according to refraction.

Factors Predicting Loss of Best-Corrected Visual Acuity After Hyperopic Laser-Assisted In Situ Keratomileusis.

The aim of this study was to identify risk factors for the loss of corrected distance visual acuity (CDVA) after uncomplicated hyperopic laser-assisted in situ keratomileusis (LASIK). A retrospective study including hyperopic patients who underwent microkeratome-assisted LASIK between January 2000 and December 2019 at Care-Vision Laser Centers, Tel-Aviv, Israel. Loss of CDVA was defined as ≥ 2 lines (0.20 logarithm of the minimum angle of resolution [logMAR] increase). Excluded were patients who had loss of CDVA because of intraoperative or postoperative complications or developed cataract at their final visit. Overall, 1998 eyes of 1998 patients were included in the study, of which 35 eyes (1.75%) had CDVA loss at final follow-up (mean 387 days). The vision-loss group had a significantly greater spherical treatment (3.4 vs. 2.8 D, P = 0.02), ablation depth (69.4 vs. 53.8 μm, P = 0.01), a higher proportion of treatments with a smaller optic zone (6.0 mm) (31.4% vs. 13.4%, P = 0.002), treatment with the EX200 (Alcon) excimer rather than the EX500 (Alcon) (74.3% vs. 39.0%, P < 0.001), and treatment with the Moria M2-90 microkeratome rather than the Moria Sub-Bowman's keratomileusis (SBK) microkeratome (65.7% vs. 29.6%, P < 0.001). In multivariate binary logistic regression, factors that remained significant predictors of CDVA loss were a greater spherical treatment (per 1 D treatment, odds ratio = 1.42, 95% CI, 1.11-1.81, P = 0.004) and the use of the Moria M2-90 microkeratome (odds ratio = 4.66, 95% CI, 2.30-9.45, P < 0.001). In patients undergoing uncomplicated hyperopic LASIK, a greater spherical hyperopic treatment is associated with a higher risk for vision loss. Transition to a newer microkeratome model significantly reduced vision loss rate.

Prescribing patterns for paediatric hyperopia among paediatric eye care providers.

To survey paediatric eye care providers to identify current patterns of prescribing for hyperopia. Paediatric eye care providers were invited, via email, to participate in a survey to evaluate current age-based refractive error prescribing practices. Questions were designed to determine which factors may influence the survey participant's prescribing pattern (e.g., patient's age, magnitude of hyperopia, patient's symptoms, heterophoria and stereopsis) and if the providers were to prescribe, how much hyperopic correction would they prescribe (e.g., full or partial prescription). The response distributions by profession (optometry and ophthalmology) were compared using the Kolmogorov-Smirnov cumulative distribution function test. Responses were submitted by 738 participants regarding how they prescribe for their hyperopic patients. Most providers within each profession considered similar clinical factors when prescribing. The percentages of optometrists and ophthalmologists who reported considering the factor often differed significantly. Factors considered similarly by both optometrists and ophthalmologists were the presence of symptoms (98.0%, p = 0.14), presence of astigmatism and/or anisometropia (97.5%, p = 0.06) and the possibility of teasing (8.3%, p = 0.49). A wide range of prescribing was observed within each profession, with some providers reporting that they would prescribe for low levels of hyperopia while others reported that they would never prescribe. When prescribing for bilateral hyperopia in children with age-normal visual acuity and no manifest deviation or symptoms, the threshold for prescribing decreased with age for both professions, with ophthalmologists typically prescribing 1.5-2 D less than optometrists. The threshold for prescribing also decreased for both optometrists and ophthalmologists when children had associated clinical factors (e.g., esophoria or reduced near visual function). Optometrists and ophthalmologists most commonly prescribed based on cycloplegic refraction, although optometrists most commonly prescribed based on both the manifest and cycloplegic refraction for children ≥7 years. Prescribing patterns for paediatric hyperopia vary significantly among eye care providers.

Association of Different Type of Refractive Errors with Parental Cousin Marriages

Refractive errors are the major reason of visual impairment and its prevalence has increased over time. Refractive errors affect ocular structures as corneal shape, eye’s axial length, vitreous changes and retinal dystrophies. Uncorrected and high degree of refractive errors are the leading cause of blindness worldwide. Due to several mechanism, there is an increased risk of refractive errors with parental cousin marriages. Objective: To find association of different types of refractive errors in patients with positive history of parental consanguinity, and to evaluate that which type of refractive error is more compromised. Methods: A cross-sectional study accompanied 175 patients having positive history of consanguinity age between 14-35 years was performed at the University of Lahore, Teaching Hospital Pakistan during September 2020 to January 2021. Using non probability convenient sampling technique 175 individuals were evaluated for refractive error type with positive parental consanguinity. To measure distance visual acuity of patients, Standard Snellen chart at (6m) was used. Data were recorded by asking the patients to fill a self-made Performa. Results: Myopic refractive error is most common type of error with consanguinity patients as compare to hyperopic patients. Second most common error occurs myopic astigmatism. Hypermetropia was seen very less with consanguinity history. Refractive errors in total families found 68% with myopia and myopic astigmatism 40%. Conclusions: Refractive errors found more with consanguinity history as compare to patients with absence of consanguinity history.

Refractive lens exchange - who is getting it, what are they getting, how are they doing?

The purpose of this article is to provide a review of the literature on refractive lens exchange and present a retrospective analysis of 55 patients who underwent refractive lens exchange at a single practice. Our study substantiates refractive lens exchange as an important option for presbyopic patients, hyperopic patients or patients with extremely high refractive error who desire spectacle independence. Our study reveals that the refractive lens exchange population is younger than the average cataract population and their primary motivations are to resolve hyperopic or myopic refractive errors, gain spectacle independence, and address near vision loss. A variety of presbyopia-addressing intraocular lens options are available and we present our experience with multifocal, extended depth-of-focus, light-adjustable, and monofocal lenses.

Evaluation of retinal microcirculation alterations using OCTA in hyperopic ametropic amblyopia patients before and after treatment

PurposeWe aimed to compare retinal microcirculation in hyperopic ametropic amblyopia patients before and after treatment and in healthy children using optical coherence tomography angiography (OCTA), and to explore the pathogenesis of hyperopic ametropic amblyopia.MethodsEighteen patients with hyperopic ametropic amblyopia aged 4–8 years were selected as the patient group, and 18 age-matched healthy children were randomly selected as controls. The foveal avascular zone (FAZ) area, perimeter and circularity, vessel density (VD) and perfusion density (PD) of macular superficial retinal capillary plexus, macular thickness, peripapillary retinal nerve fiber layer thickness, and ganglion cell-inner plexiform layer thickness were compared between both groups. After 6 months of amblyopia treatment, the same parameters were measured again.ResultsThe VD and PD in the central, inner, inner nasal, and inner inferior regions in hyperopic ametropic amblyopia were lower than in the control group after adjustment for axial length. After 6 months of treatment, the VD increased significantly, except in the outer nasal and outer inferior regions. The PD in the central (p < 0.001), inner superior (p = 0.001), inner inferior (p = 0.011) and inner temporal (p = 0.026) regions increased. The FAZ perimeter and circularity significantly differed between the groups. After 6 months of treatment, the FAZ area and perimeter decreased, but circularity increased.ConclusionHyperopic ametropic amblyopia eyes showed a significant decrease in vessel and perfusion densities. After amblyopia treatment, the vessel and perfusion densities of patients with hyperopic ametropic amblyopia increased, suggesting that abnormalities in the microvascular system are a pathogenic factor of amblyopia.

Eyeglass correction: influence on the morphometric parameters of the anterior chamber and the eye hydrodynamics in presbyopes with hyperopia

The work of accommodative apparatus has a regulatory effect on the hydrodynamics of eye and it is involved in ensuring the normal outflow of intraocular fluid (IOF). Age-related weakening of accommodation leads to a deterioration in the state of hydrodynamics, and especially significant shifts are expected in patients with axial hyperopia in the anatomical boundaries of “short” eye.Purpose. To evaluate the effect of correction with progressive lenses and monofocal ones on hydrodynamic indicators and certain morphometric parameters of the anterior chamber in presbyopic patients with hyperopia under conditions of long-term habitual professional eye strain.Material and methods. 25 subjects (50 eyes) of 44–55 y. o. (mean age 47 ± 1,6 years) were examined in January-July 2022. There were 8 males and 17 females with presbyopia and hyperopia. All patients were examined at the end of their working day: the first examination was performed in the initial state without correction, the second one − under using correction with monofocal lenses (control group) or progressive ones (main group). The examination methods included visometry, autorefractometry, pneumotonometry, ultrasound biometry, computerized tonography, determination of accommodation amplitude using the push-up test, optical coherence tomography of the eye anterior segment.Results. The critic tension of hydrodynamics, the decreasing of anterior chamber depth and iridocorneal angle width were revealed in presbyopic hyperopic patients under the conditions of eye strain at a near distance without correction with eyeglasses. Using of correction with progressive lenses led to significant increasing of the accommodation amplitude (p &lt; 0,001), decreasing of IOP (p &lt; 0,001), increasing of aqueous humor outflow (p &lt; 0,001), deepening of the anterior chamber (p &lt; 0,001) and increasing of the iridocorneal angle width (p &lt; 0,001) compared to the initial state. No significant changes in these parameters were revealed in the users of monofocal lenses compared to the initial state.Conclusion. Using of progressive lenses as a permanent correction has a positive effect on ocular hydrodynamics and morphometric parameters of the anterior chamber in presbyopic hyperopes. Lack of correction in hyperopic patients of presbyopic age not only causes of eye fatigue but also can lead to disruption of hydrodynamic balance and development of glaucoma.

Supracor Multifocal Corneal Laser-Assisted In Situ Keratomileusis Procedure for the Correction of Presbyopia in Hyperopic Eyes.

To investigate the outcomes of unilateral Supracor treatment to enhance near vision while maintaining good distance vision in hyperopic eyes. This prospective interventional study includes consecutive hyperopic patients with presbyopia. All eyes underwent femtosecond laser-assisted in situ keratomileusis treatment for hyperopia with an additional Supracor multifocal treatment algorithm in nondominant eyes. Monocular and binocular uncorrected and spectacle-corrected distance visual acuity (UCDVA and SCDVA), monocular and binocular uncorrected near visual acuity (UNVA), and distance-corrected near visual acuity at 40 cm and high-order aberration changes and complications were evaluated for 6 months. Sixty-four patients with a mean age of 51.91 ± 3.64 were enrolled. After 6-month follow-up, the mean binocular UCDVA and UNVA were 0.03 ± 0.05 and 0.04 ± 0.06 logMAR, respectively. UCDVA (logMAR) of nondominant and dominant eyes was 0.30 ± 0.18 and 0.03 ± 0.05, respectively. Preoperative and postoperative mean ± standard deviation manifest refraction spherical equivalent was +1.84 ± 0.75 and -0.48 ± 0.57, respectively, in nondominant eyes and +1.77 ± 0.69 and +0.12 ± 0.33, respectively, in dominant eyes. No complications were observed. Supracor procedure in nondominant eyes may improve functional near, intermediate, and distance vision without significant photic phenomena in presbyopic patients with low and moderate hyperopia.

Comment on: Influence of ocular biometric parameters such as effective lens position, keratometry, and axial length on near add power of multifocal intraocular lens.

We read with interest the manuscript by Wu et al.1 The authors conduced a review about the variability of multifocal intraocular lens (mIOL) addition depending on biometric eye parameters, compiling the theoretical background provided in the scientific literature. The main clinical implication is that this variability should be considered in surgical planning, as the authors remark in the conclusion. Beyond the theoretical background, which was already described by Savini et al.,2 the review missed some important clinical evidence for translation to real practice in mIOL selection. We would like to give our point of view about some important messages for clinical practice and comment on the possible corrections needed. “In clinic, myopic patients with steep cornea often have longer effective lens position (ELP), which reduces near focal point of mIOLs, whereas hyperopic patients with flat cornea have the opposite situation.” This situation is not commonly observed in clinical practice. Patients with a longer axial length (AXL) have a longer ELP, and corneal power is inversely correlated with AXL, which means that eyes with a longer AXL usually have flatter corneas, contrary to the authors' sentence. Thus, the formula considering all the parameters should be used for a correct estimation of the addition (EA) because the higher EA due to lower corneal power is usually dominated by a lower EA due to a longer ELP in longer eyes.3 Wu et al. state: “A larger ELP should be more suitable for a higher near add power of mIOLs and a lower ELP should be more suitable for a higher near add power of mIOLs.”1 We assume the authors based this recommendation on the study by Savini et al., but there is a mistake in the second half of the sentence, which we believe should read: “…lower ELP should be more suitable for a lower near add power of mIOLs.”2 Wu et al. state: “They also found that variations in ELP had a greater effect on the position of the near focal point than K.”1 This is true, the ELP dominates the EA in comparison with keratometry (K), but other factors should be considered beyond the EA calculation. According to clinical evidence, near vision goes beyond the EA. Keratometry has demonstrated frequent relationships with near vision performance, whereas relationships between EA and near visual performance could depend on mIOL design.4 Wu et al. state: “Considering that the defocusing curve can roughly reflect the real near addition of mIOLs,….”1 Clinical evidence supports that EA could underestimate the effective addition calculated from defocus curves.5 In conclusion, beyond the EA calculation for mIOL selection, near vision could be influenced by other eye biometric parameters and mIOL optical characteristics (such as light distribution). Some clinical evidence has demonstrated that eyes with higher corneal power (steeper corneas related to short eyes) have lower areas under the visual acuity defocus curve in the near range.4 Therefore, although the theoretical basis of EA recommends low-addition mIOLs for short eyes, our clinical studies suggest that caution should be exercised when selecting low-addition mIOLs in short eyes in patients with higher expectations of spectacle independence. The theory of EA for mIOL selection is more valid if the same optical design is used for different additions; however, different additions come from different manufacturers and optical designs. Surgeons should consider that EA theory might not always be accomplished. In addition, it should not be forgotten that selecting a higher EA for improving near vision might also lead to poorer intermediate vision, and nowadays, decisions should be made considering patient needs throughout the entire range of vision.

Analysis of accuracy of twelve intraocular lens power calculation formulas for eyes with axial hyperopia.

The purpose was to compare twelve intraocular lens power calculation formulas for eyes smaller than 22.0 mm in terms of absolute error (AE), the percentage of postoperative emmetropia, and agreement interval in Bland-Altman analysis. The data of hyperopic patients who underwent uneventful phacoemulsification between January 2016 and July 2021 were reviewed. Intraocular lens power was calculated using Holladay 1, SRK/T, Hoffer Q, Holladay 2, Haigis, Barrett Universal II, Hill-RBF, Ladas, Kane, Emmetropia Verifying Optical (EVO), Pearl-DGS, and K6 formulas. Three months after phacoemulsification, refraction was measured, and the mean AE was calculated. The percentage of patients with full visual acuity (VA) without any correction, with ± 0.25D, ±0.5D, ±0.75D, and limits of agreement for each formula was established. Seventy-two patients, whose ocular axial length (AL) ranged between 20.02 mm and 21.98 mm, were included. The Kane formula achieved the lowest mean AE of 0.09 ± 0.09 just before EVO (0.12 ± 0.09), Hill-RBF (0.17 ± 0.12), and Hoffer Q formulas (0.19 ± 0.16). In addition, with the Kane formula, the percentage of patients with full VA without any correction (80.6%) was the highest ahead of EVO and Hoffer Q formulas (51.5% and 50.0%, respectively). Finally, Kane, EVO, and Hill-RBF obtained the lowest agreement interval (0.4923, 0.5815, and 0.7740, respectively). The Kane formula is recommended for intraocular lens power calculation for eyeballs with the AL smaller than 22.0 mm. The EVO formula gives very promising results in regarding the accuracy of intraocular lens power for hyperopic eyes.

High prevalence of refractive errors in an elderly population; a public health issue

PurposeTo determine the prevalence of myopia and hyperopia and their associated demographic and ocular factors in people 60 years of age and above.MethodsThe sampling was performed using a multi-stage stratified random cluster sampling method. The complete demographic and case history information were collected through an interview. Then, all participants underwent optometric examinations including measurement of uncorrected and best-corrected visual acuity, objective, and subjective refraction. Myopia and hyperopia were defined as a spherical equivalent (SE) refraction worse than -0.50 diopters (D) and + 0.50 D, respectively.ResultsThree thousand three hundred ten of 3791 invitees participated, and the data of 3263 individuals were analyzed for this report. The mean age of participants was 68.25 ± 6.53 (60 to 97) years, and 1895 (58.1%) of them were female (number of male/female participants = 1368/1895). The prevalence of myopia and hyperopia was 31.65% (95% CI: 29.68 -33.61) and 45.36% (95% CI: 43.36 -47.37), respectively. The prevalence of severe myopia and hyperopia was 1.14% (95% CI: 0.73 -1.55) and 2.27% (95% CI: 1.57 -2.97), respectively. Based on the results of multiple logistic regression, the prevalence of myopia had a statistically significant direct relationship with age (OR: 1.04; p < 0.001), history of glaucoma surgery (OR:2.75; p < 0.001), pseudophakia (OR: 2.27; p < 0.001), axial length (OR:3.05; p < 0.001), and mean keratometry (OR:1.61; p < 0.001). The education level was significantly inversely related to the myopia prevalence. Moreover, a history of glaucoma surgery (OR:0.44; p < 0.001), pseudophakia (OR = 0.15; p < 0.001), axial length (OR:35; p < 0.001) and mean keratometry (OR:0.62; p < 0.001) were significantly inversely related to the prevalence of hyperopia. 19% and 40.02% of myopic and hyperopic patients had complete visual acuity after correction of refractive error, respectively.ConclusionThe prevalence of refractive errors was high in the Iranian elderly population. A large percentage of the elderly still did not have complete visual acuity after the correction of refractive errors indicating the necessity for attention to other ocular diseases in this age group. The history of cataract and glaucoma surgery could be associated with a myopic shift of refractive error.

A study on efficacy of various formulas for intraocular lens power calculation in hyperopic patients at a tertiary care center

ABSTRACT Purpose: Our study was conducted to evaluate and compare the predictive capacity of five intraocular lens (IOL) power calculation formulas (SRK/T, HOFFERQ, HOLLADAY1, HAIGIS, BARRETT UNIVERSAL II) in eyes with axial length (AL) &lt;22 mm. Subjects and Methods: In our study, 100 patients with a preoperative AL of &lt;22 mm were included. All patients underwent uneventful cataract surgery with IOL implantation and postoperative target of refraction were analyzed after 40 days. The mean estimation error and mean absolute error (MAE) were calculated for each formula, and ANOVA test was applied to compare the differences in the MAEs of the formulas. A statistically significant difference was defined as P &lt; 0.05. Results: A statistically significant difference was seen between Barrett Universal II formula in comparison to SRK/T formula. There was no statistically significant difference seen among the absolute error of all the five IOL power calculation formula groups. Conclusions: Among the formulas compared, Barrett Universal II formula is the most accurate in predicting postoperative refractive error in hyperopic patients. Hoffer Q, Haigis, and Holladay 1 formula give better results than the commonly used SRK/T formula.

Trans-Epithelial Photorefractive Keratectomy in the Treatment of Myopia, Hyperopia and Astigmatism: Five-Year Results

We aimed to report the five-year results of Trans-epithelial Photorefractive Keratectomy (TPRK) in treating all kinds of refractive errors. In this retrospective cohort study, we quantitatively compared the clinical findings and assessment of optical and refractive parameters, including slit-lamp, corneal topography, Best Corrected Visual Acuity (BCVA), and Uncorrected Distance Visual Acuity (UDVA) in 172 eyes of myopic, hyperopic, and astigmatic patients before and five years after trans-PRK. The average time for post-surgery epithelial healing was 2.97 0.83 days in male and 2.94 0.87 days in female patients; the pain score in a week following the operation was 1.88 0.68 in males and 2.25 0.73 in females. Corneal haze was observed in five patients. No long-term adverse effect was reported. The pre-operative UDVA was 0.84 0.32 in male and 0.87 0.34 in female patients; while the postoperative UDVA was -0.02 0.04 in male and -0.01 0.02 in female patients. There was a highly significant correlation (P&lt;0.001) in all indices except UDVA, which was almost near to being significant (P=0.07). In this survey, the mean safety and index were nearly 1.00. TPRK is a safe and efficient therapeutic procedure to treat all types of refractive errors, including myopia, hyperopia, and astigmatism, with no significant adverse effect. Being touchless and having a short recovery time are two main characteristics of this refractive surgery.