Improvement In Distance Visual Acuity Research Articles

At-Home Trial of Four Different Head-Mounted Displays in Visual Rehabilitation of People with Stargardt Disease.

To examine the potential of different head-mounted displays in the rehabilitation of individuals with visual impairment. This prospective explorative study conducted between September 2019 and August 2020 included participants with Stargardt disease with moderate to severe visual impairment and a relatively preserved peripheral visual field. AceSight, eSight 3, IrisVision Live, and Jordy were tested. After instruction and training, participants chose two head-mounted displays for home use for two weeks per device. The Canadian Occupational Performance Measure was used for evaluation. Twelve participants (aged 16-53 years) tested all head-mounted displays in the clinic. Distance visual acuity and reading distance improved with all head-mounted displays and eSight and Irisvision improved near visual acuity. Six participants decided not to test the head-mounted display at home due to lack of time or energy, dizziness and discomfort, double vision and peripheral visual field limitation, or aesthetics. After home use, the participants reported improved visual function at a distance with IrisVision, AceSight, and e-Sight, whereas only AceSight improved vision during near tasks. IrisVision and eSight improved reading ability, and none of the devices improved vision during tasks involving computers. Five participants used the devices sparingly, and five avoided public use owing to aesthetics. We found an improvement in distance visual acuity and increased reading distance for all tested head-mounted displays. Additionally, IrisVision and eSight improved visual function at near and eSight also improved contrast vision at distance. Despite the possibility of improving vision, social stigma and device aesthetics kept the participants from using head-mounted displays in public and limited their use at home.

A Prospective Trial to Assess the Efficacy of Eye-Tracking-Based Binocular Treatment versus Patching for Children’s Amblyopia: A Pilot Study

ABSTRACT Purpose To assess visual acuity (VA) and stereoacuity (SA) improvements in children with amblyopia treated with either binocular dichoptic treatment or patching treatment. Methods In this pilot prospective coherent study, 34 participants between 4 and 9 years of age with unilateral anisometropic amblyopia and without history of prior amblyopia treatment were enrolled into three groups. Full treatment group (FTG; n = 12): participants were prescribed the binocular dichoptic treatment to watch for 90 minutes per day, 5 days a week. Part-time treatment group (PTTG; n = 8): participants were prescribed the same binocular treatment as FTG, 90 minutes per day, 3 days per week. Patching treatment group (PTG; n = 14): participants wore an adhesive patch over the dominant eye for 2 hours per day, 7 days per week. Amblyopic-eye distance visual acuity (DVA), near visual acuity (NVA) and SA were evaluated at baseline, 4, 8, and 12 weeks. Results At 12 weeks, mean amblyopic-eye DVA improved 1.8 lines (95% CI, 1.1–2.5) in FTG, 1.5 lines (95% CI, 0.4–2.7) in PTTG and 3.0 lines (95% CI, 2.0–4.0) in PTG. The amblyopic-eye NVA improved 2.9 lines (95% CI, 2.4–3.5) in FTG, 1.7 lines (95% CI, 0.5–3.0) in PTTG and 2.8 lines (95% CI, 1.8–3.9) in PTG. The SA improved 0.38 log-arcseconds (95% CI, 0.24–0.53) in FTG, 0.59 log-arcseconds (95% CI, 0.36–0.82) in PTTG and 0.40 log-arcseconds (95% CI, 0.13–0.67) in PTG. No significant differences were found in DVA, NVA or SA improvement between FTG and PTG at 12 weeks. Conclusions VA and SA after binocular dichoptic treatment produced a similar therapeutic outcome to patching, suggesting a potential value for binocular therapy when treating anisometropic moderate degree of Children’s amblyopia.

Myopia: A Behavioral Approach for Prescribing and Vision Therapy

Myopia has reached serious epidemic proportions in many developed countries throughout the world, and is a public health issue with which the optometric profession is deeply concerned. Different clinical approaches are available to the optometrist for treatment of myopia. For the majority of patients, prescribing minus lenses to achieve 20/20 visual acuity at distance does little to prevent a patient from becoming more myopic or to improve vision function in the broadest sense, though it provides immediate improvement in distance visual acuity. A behavioral optometric clinical approach is presented in this paper to give the doctor a clear-cut strategy offering more alternatives to the patient with myopia. Employing this approach has the potential to prevent patients from developing myopia to levels higher than -2.00 diopters, reversing minus lens powers in patients that come to the optometrist already wearing a minus lens prescription, and reducing dependency on using minus lens prescriptions. Vision therapy is addressed as a procedure to improve a patient’s vision function in addition to visual acuity. Book retinoscopy is employed as a valuable technique to arrive at a training eyeglass prescription. At the completion of treatment, a patient typically improves in distance visual acuity, reduces minus lens powers, develops increased confidence in vision capabilities (with and without minus lens wear), develops an awareness and appreciation for additional aspects of vision such as space, forms, colors, patterns, periphery, and feels empowered that they have learned how to improve distance vision through self-initiated control.

Clinical Outcomes of Use of Low Vision Aids for Enhancement of Residual Vision in Diabetic Retinopathy

Purpose: To investigate clinical outcomes of use of low vision aids for enhancement of residual vision in people with Diabetic Retinopathy (DR).
 Study Design: Cross-sectional study.
 Place and Duration of Study: Hayatabad Medical Complex Peshawar, from January 2018 to December 2019.
 Methods: Eighty-one consecutive patients with DR were assessed in a low vision clinic for vision rehabilitation. Data regarding distance and near visual acuity (VA), refractive error, types of low vision aids (LVAs), VA with best correction and with LVAs were collected and analyzed.
 Results: A total of 81 people with DR, 63% were male. Mean age was 58.48 ± 13.54 years. With mean duration of 12.6 years of diabetes, 29.6% had Insulin dependent while 70.4% had non-Insulin dependent diabetes. At presentation, 63% had moderate vision impairment (0.5 > VA > 1.0), 14.8% had severe vision impairment (1.0 > VA > 1.3) and 22.2% had blindness (VA < 1.3).With LVAs, 97.5% achieved distance VA of Log MAR 0.4 or better. Mean improvement in distance VA with LVAs was Log MAR 0.95 ± 0.19 (P = 0.000; 95% CI). Near VA improved significantly with LVAs and the number of participants who could see 1M or better with their own glasses increased from 7.4% to 97.5% (p < 0.001). Binocular telescopes 2.1X were the most preferred low vision device for distance vision and prismatic magnifying spectacles for near vision.
 Conclusion: Visual rehabilitation through the use of LVAs was helpful in patients with low vision caused by diabetic retinopathy. Hence, improving the quality of life.
 Key Words: Diabetic retinopathy, blindness, visual rehabilitation, low vision aids, Pakistan.

Long-Term Stability With the Athens Protocol (Topography-Guided Partial PRK Combined With Cross-Linking) in Pediatric Patients With Keratoconus.

To evaluate the safety, efficacy, and stability of topography-guided partial PRK combined with corneal cross-linking (CXL) (the Athens Protocol [AP]) in pediatric patients with keratoconus over a 4-year follow-up period. This prospective study included 39 keratoconic eyes of 21 patients younger than 18 years with clinical and imaging evidence of keratoconus progression. Partial topography-guided excimer laser ablation in conjunction with high-fluence CXL was performed in all patients according to the AP. Uncorrected distance visual acuity, corrected distance visual acuity, refraction, keratometry, endothelial cell density, topography, and tomography using both Scheimpflug and optical coherence tomography (OCT) were evaluated for 4 years postoperatively. At 4 years postoperative, there was significant improvement in mean uncorrected distance visual acuity from 0.51 ± 0.31 (decimal) to 0.65 ± 0.26 (decimal; P < 0.05). Mean corrected distance visual acuity improved from 0.71 ± 0.22 (decimal) preoperatively to 0.81 ± 0.19 (decimal; P < 0.05), respectively. Mean flat keratometry (K1) and mean steep keratometry (K2) readings reduced from 44.95 ± 3.71 D and 49.32 ± 5.05 D, respectively, preoperatively to 43.14 ± 2.95 D and 46.28 ± 4.87 D, respectively, (P < 0.05) at 4 years. The mean anterior maximum keratometry (Kmax) reading reduced from 56.81 ± 2.94 D preoperatively to 48.11 ± 3.17 D at 48 months. The mean index of height decentration was 0.105 ± 0.054 μm preoperatively and 0.049 ± 0.024 (P < 0.05) at 4 years postoperative. Mean preoperative corneal thickness at the thinnest point was 436.7 ± 42.6 μm preoperatively, 392.50 ± 45.68 μm at 12 months postoperative, and 418.42 ± 17.01 μm at 4-year follow-up. Late-onset deep corneal haze, a potential intrinsic complication of this technique in pediatric patients, was encountered in 2 cases at least 1 year after the procedure. Long-term results of the AP seem to be safe and effective in pediatric patients, with marked improvement in visual function and keratometric symmetry indices.

Microbial keratitis following intracorneal ring implantation

BackgroundThe aim of this study is to identify predisposing factors, the clinical course and visual outcomes in patients with keratitis after intracorneal ring implantation.MethodsIn a retrospective study, 11 patients with documented keratitis after intracorneal ring implantation and 71 matched controls with uncomplicated surgery were enrolled. Patients were examined for slitlamp findings and corrected distance visual acuity at time of the initial presentation, one month later and six months later. Smears and cultures were provided in all cases. Relevant data in controls were extracted from their medical records, and statistical analysis was done.ResultsKeratitis onset time ranged from three to 56 days. The incidence was 2.7 per cent over two years. All pathogens were Gram‐positive cocci, and the most frequent was Staphylococcus spp. No relationship was found between keratitis occurrence and the ring type or the femtosecond procedure, but the rate of keratitis was higher in patients with the horizontal position of intracorneal ring segments (p = 0.001; Fisher's exact test). All cases were treated with implant explantation and tunnel irrigation with antibiotics. In three cases, amniotic membrane transplantation was performed, and two cases finally underwent penetrating keratoplasty. The final six month corrected distance visual acuity was 0.68 ± 0.35. Poor corrected distance visual acuity improvement was associated with the ulcer size at the first day of the diagnosis (p = 0.011; Spearman's rho).ConclusionThe only predisposing factor was the horizontal position of the ring. A careful evaluation in the early post‐operative period for any sign of the infiltration would be helpful. Early diagnosis with proper management including fortified antibiotic therapy specifically against Gram‐positive cocci and removal of the intracorneal ring seems to result in acceptable visual outcomes in later follow‐up. However, a corneal transplant may be the only choice in advanced infectious complications.

Effects of bifocals on visual acuity in children with Down syndrome: a randomized controlled trial.

PurposeChildren with Down syndrome (DS) typically have reduced visual acuity (VA) and accommodation lag, but it is unclear whether prescribed glasses should correct both distance VA (DVA) and near VA (NVA) due to the lack of RCTs. We therefore conducted a multicentre RCT to compare the effects of bifocals designed to correct both DVA and NVA with distance‐correcting unifocal glasses in children with DS.MethodsA total of 119 children with DS, aged 2–16, were randomly allocated for bifocal or unifocal glasses (with full correction of refraction error in cycloplegia) in 14 Dutch hospitals and followed during 1 year. VA data were analysed in relation to baseline VA with ancova.ResultsTreatment groups showed no differences at baseline. Shortly after receiving new corrections (~6 weeks), uncrowded NVA (bifocals 0.18 ± 0.33 LogMar; unifocals 0.09 ± 0.19 LogMar) and crowded NVA with bifocals (bifocals 0.13 ± 0.36 LogMar; unifocals 0.08 ± 0.33 LogMar) were significantly better than at baseline, but these short‐term improvements in NVA were not significantly different between the two treatments (p > 0.151). The 1‐year treatment differences were as follows: significantly larger improvement for bifocals compared to unifocals in both uncrowded NVA (bifocals 0.23 ± 0.29 LogMar, unifocals 0.12 ± 0.30 LogMar, p = 0.045) and crowded NVA (bifocals 0.31 ± 0.28 LogMar; unifocals 0.16 ± 0.30 LogMar, p = 0.017). Improvements in DVA were comparable (bifocals 0.07 ± 0.21 LogMar, unifocals 0.08 ± 0.22 LogMar, p = 0.565). Children with poor baseline VA improved more. Accommodation lag stayed unchanged.ConclusionAfter one year, bifocals with full correction of ametropia led to significantly larger improvement of both uncrowded NVA and crowded NVA in children with DS with accommodation lag compared to unifocals.

The key informant strategy to determine the prevalence and causes of functional low vision among children in South India

ABSTRACTPurpose: To report the prevalence and causes of functional low vision (FLV) in school-age children in Coimbatore District, Tamil Nadu, India and to report our experience using the key informant (KI) method in this setting.Methods: Children suspected of having low vision were identified by KIs or Aravind Eye Hospital personnel in Coimbatore District. All identified children underwent a cycloplegic refraction and full eye exam. A primary cause of decreased vision was determined for each child. The prevalence of FLV was calculated for children 6–14 years old. Spectacles and low vision devices were provided free of charge.Results: 345 children aged 6–14 years were referred and 231 had FLV. The positive-predictive value of KI referrals was 64.5%. The prevalence of FLV was 0.071% (7.1 per 10,000; 95% CI 0.062–0.080%) and ranged from 0.026% to 0.141% across the district’s blocks. Older children (age 11–14 years; OR 1.41; 95% CI 1.09–1.82) and males (OR 1.52; 95% CI 1.16–1.98) had greater odds of being diagnosed with FLV. The most common causes of FLV were retinal disorders (30.0%) and amblyopia (25.5%). Low vision devices were provided to 169 children who had a mean near and distance visual acuity improvement of 0.31 and 0.63 logMAR, respectively (p < 0.001).Conclusions: This study reports a moderate prevalence of FLV and demonstrates the ability of KIs to identify school-age children with FLV in South India. The provision of basic low vision services can improve visual outcomes in this population.

Surgery for cataracts in people with age-related macular degeneration.

Cataract and age-related macular degeneration (AMD) are common causes of decreased vision that often occur simultaneously in people over age 50. Although cataract surgery is an effective treatment for cataract-induced visual loss, some clinicians suspect that such an intervention may increase the risk of worsening of underlying AMD and thus have deleterious effects on vision. The objective of this review was to evaluate the effectiveness and safety of cataract surgery compared with no surgery in eyes with AMD. We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) (2016, Issue 11), Ovid MEDLINE, Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE Daily (January 1946 to December 2016), Embase (January 1980 to December 2016), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to December 2016), the ISRCTN registry (www.isrctn.com/editAdvancedSearch), ClinicalTrials.gov (www.clinicaltrials.gov), and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 2 December 2016. We included randomized controlled trials (RCTs) and quasi-randomized trials that enrolled participants whose eyes were affected by both cataract and AMD in which cataract surgery was compared with no surgery. Two review authors independently evaluated the search results against the inclusion and exclusion criteria. Two review authors independently extracted data, assessed risk of bias for included studies, and graded the certainty of evidence. We followed methods as recommended by Cochrane. We included two RCTs with a total of 114 participants (114 study eyes) with visually significant cataract and AMD. We identified no ongoing trials. Participants in each RCT were randomized to immediate cataract surgery (within two weeks of enrollment) or delayed cataract surgery (six months after enrollment). The risk of bias was unclear for most domains in each study; one study was registered prospectively.In one study conducted in Australia outcomes were reported only at six months (before participants in the delayed-surgery group had cataract surgery). At six months, the immediate-surgery group showed mean improvement in best-corrected visual acuity (BCVA) compared with the delayed-surgery group (mean difference (MD) -0.15 LogMAR, 95% confidence interval (CI) -0.28 to -0.02; 56 participants; moderate-certainty evidence). In the other study, conducted in Austria, outcomes were reported only at 12 months (12 months after participants in the immediate-surgery group and six months after participants in the delayed-surgery group had cataract surgery). There was uncertainty as to which treatment group had better improvement in distance visual acuity at 12 months (unit of measure not reported; very low-certainty evidence).At 12 months, the mean change from baseline between groups in cumulated drusen or geographic atrophy area size was small and there was uncertainty which, if either, of the groups was favored (MD 0.76, 95% CI -8.49 to 10.00; 49 participants; low-certainty evidence). No participant in one study had exudative AMD develop in the study eye during 12 months of follow-up; in the other study, choroidal neovascularization developed in the study eye of 1 of 27 participants in the immediate-surgery group versus 0 of 29 participants in the delayed-surgery group at six months (risk ratio 3.21, 95% CI 0.14 to 75.68; 56 participants; very low-certainty evidence). Quality of life was measured using two different questionnaires. Scores on the Impact of Vision Impairment (IVI) questionnaire suggested that the immediate-surgery group fared better regarding vision-related quality of life than the delayed-surgery group at six months (MD in IVI logit scores 1.60, 95% CI 0.61 to 2.59; low-certainty evidence). However, we could not analyze scores from the Visual Function-14 (VF-14) questionnaire from the other study due to insufficient data. No postoperative complication was reported from either study. At this time, it is not possible to draw reliable conclusions from the available data as to whether cataract surgery is beneficial or harmful in people with AMD after 12 months.Although cataract surgery provides short-term (six months) improvement in BCVA in eyes with AMD compared with no surgery, it is unclear whether the timing of surgery has an effect on long-term outcomes. Physicians must make recommendations to their AMD patients regarding cataract surgery based on experience and clinical judgment until large controlled trials are conducted and their findings published.There is a need for prospective RCTs in which cataract surgery is compared with no surgery in people with AMD to better evaluate whether cataract surgery is beneficial or harmful in all or a subset of AMD patients. However, ethical considerations preclude withholding surgery, or delaying it for several years, if it may be a potentially beneficial treatment. Designers of future trials are encouraged to utilize existing standardized systems for grading cataract and AMD and for measuring key outcomes: visual acuity, change in visual acuity, worsening of AMD, quality of life measures, and adverse events.

Epithelium-on corneal collagen crosslinking for management of advanced keratoconus

To report the 1-year visual and keratometric results of epithelium-on corneal collagen crosslinking (CXL) for advanced keratoconus (median maximum keratometry [K]≥58.0 diopters [D]). School of Ophthalmology and Optometry and Eye Hospital of Wenzhou Medical College, Wenzhou, China. Prospective case series. Patients with bilateral progressive keratoconus had tetracaine-enhanced epithelium-on CXL. The worse eye had CXL, and the fellow eye was not treated. Results were reported 1, 3, 6, and 12months postoperatively. The outcomes were compared with those in the fellow untreated eyes. Twenty-one eyes of 21 patients with a median age of 20.4years (interquartile range [IQR], 9.5years) were treated. A significant improvement in postoperative uncorrected distance visual acuity was observed at 12months (P=.002). Postoperative corrected distance visual acuity improved at 6months and 12months (P≤.009) compared with baseline values. The maximum K decreased by 1.63 D from the median preoperative maximum K of 62.7 D (IQR, 12.9 D) at 12months (P<.001). The reduction in maximum K was higher after CXL than in untreated eyes at the end of 12months (P=.001). Correlation analysis between the preoperative maximum K values and the change over 6 to 12months between different studies showed a significant correlation (r=-0.764, P<.001; Spearman correlation). Epithelium-on CXL was an effective treatment for patients with advanced keratoconus. A higher preoperative maximum K value correlated with greater corneal flattening after CXL. None of the authors has a financial or proprietary interest in any material or method mentioned.

Descemet's stripping automated endothelial keratoplasty (DEAEK). Systematic review of clinical-effectiveness and safety

ObjectiveTo conduct a systematic review of the efficacy/effectiveness, safety and cost of Descemet's stripping automated endothelial keratoplasty (DSAEK) technique in patients with corneal endothelial failure. MethodsComprehensive literature search was conducted in the main biomedical databases from January to May 2012. ResultsFollowing a critical perusal of the total of 485 abstracts retrieved, 16 case series and one economic evaluation study were included. Corrected distance visual acuity and uncorrected distance visual acuity improved after treatment with DSAEK, attaining values of 0.6–0.8 and 0.5 respectively. The degree of post-DSAEK astigmatism was not significant with respect to baseline values. The main complications were graft dislocation-detachment (1.5–23%), primary failure (0–12%) and endothelial rejection (0.8–8.5%). ConclusionsIn Fuchs’ dystrophy and bullous keratopathy, data on the effectiveness of DSAEK indicate post-intervention improvement in uncorrected and corrected distance visual acuity. Astigmatism arising after DSAEK was not significant. The most significant post-DSAEK complications are linked to the viability of the graft, with the most frequent complications being dislocation-detachment and, to a lesser extent, endothelial rejection. The studies that assess DSAEK are case series, and for the most part retrospective. The quality of this type of studies is both low and limited.

Matched Comparison Study of Total and Partial Epithelium Removal in Corneal Cross-linking

To compare the 1-year results of total versus partial epithelium removal in corneal cross-linking in the treatment of progressive keratoconus. This retrospective study compared the results of total (the total group) versus partial (the partial group) approaches of epithelium removal in corneal cross-linking. Eighty eyes of 65 patients (40 eyes in each group) were enrolled. The mean age of the participants was 25.48 ± 4.80 years and 62.5% were male. One-year changes in vision parameters, refraction, and Pentacam (Oculus Optikgeräte GmbH, Wetzlar, Germany) indices were compared between the two groups using repeated measures analysis of variance. One year after corneal cross-linking, uncorrected distance visual acuity in the total and partial group improved by 0.13 ± 0.42 and 0.12 ± 0.36 logMAR (P = .447), respectively, and corrected distance visual acuity improved by 0.00 ± 0.19 and 0.13 ± 0.20 logMAR (P = .001), respectively. Spherical equivalent decreased by 0.44 ± 1.25 diopters (D) in the total group and 0.56 ± 1.47 D in the partial group (P = .710). The decrease in maximum keratometry was 0.39 ± 0.93 and 0.01 ± 0.95 D in the total and partial group, respectively (P = .037), and the decrease in mean keratometry was 0.42 ± 0.93 and 0.00 ± 0.65 D (P = .015), respectively. Central corneal thickness decreased by 18.39 ± 20.66 μm in the total group and 0.11 ± 13.29 μm in the partial group (P < .001). One year after corneal cross-linking, both approaches showed similar results in terms of uncorrected distance visual acuity. With the partial approach, there was slightly better corrected distance visual acuity improvement and central corneal thickness maintenance, but slightly better corneal flattening was achieved with the total removal. Long-term studies are needed to compare these two approaches in terms of stability of results and stopping the progression of keratoconus.

Monthly microperimetry (MP1) measurement of macular sensitivity after dexamethasone implantation (Ozurdex) in retinal vein occlusions.

To evaluate changes in macular sensitivity as measured via microperimetry (MP) in patients with macular edema (ME) secondary to retinal vein occlusion (RVO) after dexamethasone implantation (DEX implantation, Ozurdex), in comparison to distance visual acuity, reading ability, and spectral domain optical coherence tomography (SD-OCT). Twenty-three patients with ME secondary to RVO were treated with a DEX implantation in this prospective, observational case study. Patients were controlled at baseline and then monthly with microperimetry and assessment of distance visual acuity, reading ability, and SD- OCT. Side effects of the DEX implant were monitored by measuring the intraocular pressure (IOP) and lens grading with Lens Opacities Classification System (LOCS) charts. The 23 patients with RVO included 16 patients with branch retinal vein occlusion (BRVO) and 7 patients with central retinal vein occlusion (CRVO). Improvement in distance visual acuity, reading ability, and in central 8-points microperimetry showed statistical significance from month 1 to 3, whereas the 40-points microperimetry improved with statistical significance from month 1 to 2. The reduction of central retinal thickness measured with SD-OCT remained statistically significant until month 4. Subgroup analysis of patients with BRVO and CRVO confirmed the best test results observed at month two after DEX implantation. The highest macular sensitivity was measured two months after DEX implantation. This corresponds to the best test results for distance visual acuity, reading ability, and SD-OCT observed two months after treatment.

Queratoplastia endotelial automatizada con pelado de membrana de Descemet (DSAEK). Revisión sistemática sobre efectividad y seguridad

ObjectiveTo conduct a systematic review of the efficacy/effectiveness, safety and cost of Descemet's stripping automated endothelial keratoplasty (DSAEK) technique in patients with corneal endothelial failure. MethodsComprehensive literature search conducted in the main biomedical databases from January-May 2012. ResultsFollowing a critical perusal of the total of 485 abstracts retrieved, 16 case series and one economic evaluation study were included. Corrected distance visual acuity and uncorrected distance visual acuity improved after treatment with DSAEK, attaining values of 0.6 to 0.8 and 0.5 respectively. The degree of post-DSAEK astigmatism was not significant with respect to baseline values. The main complications were graft dislocation-detachment (1.5-23%), primary failure (0-12%) and endothelial rejection (0.8-8.5%). ConclusionsIn Fuchs’ dystrophy and bullous keratopathy, data on the effectiveness of DSAEK indicate post-intervention improvement in uncorrected and corrected distance visual acuity. Astigmatism arising after DSAEK was not significant. The most significant post-DSAEK complications are linked to the viability of the graft, with the most frequent complications being dislocation-detachment and, to a lesser extent, endothelial rejection. The studies that assess DSAEK are case series, and for the most part retrospective. The quality of this type of studies is both low and limited.

Refractive errors in Cameroonians diagnosed with complete oculocutaneous albinism

BackgroundAlbinism causes significant eye morbidity and amblyopia in children. The aim of this study was to determine the refractive state in patients with complete oculocutaneous albinism who were treated at the Gynaeco-Obstetric and Paediatric Hospital, Yaoundé, Cameroon and evaluate its effect on vision.MethodsWe carried out this retrospective study at the ophthalmology unit of our hospital. All oculocutaneous albino patients who were treated between March 1, 2003 and December 31, 2011 were included.ResultsThirty-five patients (70 eyes) diagnosed with complete oculocutaneous albinism were enrolled. Myopic astigmatism was the most common refractive error (40%). Compared with myopic patients, those with myopic astigmatism and hypermetropic astigmatism were four and ten times less likely, respectively, to demonstrate significant improvement in distance visual acuity following optical correction.ConclusionManaging refractive errors is an important way to reduce eye morbidity-associated low vision in oculocutaneous albino patients.

Femtosecond-Assisted Keratopigmentation Double Tunnel Technique in the Management of a Case of Urrets-Zavalia Syndrome

To describe the successful use of a double intrastromal tunnel femtosecond-assisted keratopigmentation technique to manage a case of unilateral Urrets-Zavalia syndrome. A 33-year-old man was referred with a history of trauma in his right eye due to a labor-related accident. Because of myopic anisometropia, he had been previously implanted with an angle-supported phakic intraocular lens. The patient presented iris atrophy and a fixed dilated pupil. He complained of severe and incapacitating photophobia, glare, and decreased vision. To obtain a complete iris replica, the surgery involved creation of double keratopigmented intrastromal tunnels using femtosecond laser and micronized mineral pigments. The deepest layer was stained black first and then the superficial layer was stained with a contoured greenish blue-gray color, which matched the contralateral eye. In the immediate postoperative period, the patient reported a complete elimination of photophobia associated with the corrected distance visual acuity improvement. A very adequate cosmetic outcome was also achieved. Stability was observed during the 12-month follow-up. A femtosecond-assisted keratopigmentation technique using 2 pigmented intrastromal tunnels to achieve an intracorneal pigmented replica of the iris was effective in improving the patient's severe visual function disability and cosmetic appearance. To the best of our knowledge, this is the first report of severe visual function disability caused by atrophic iris and a fixed dilated pupil treated with double intrastromal layers of keratopigmentation by means of femtosecond-created tunnels.

Clinical and quality of life data correlation with a single-optic accommodating intraocular lens

PurposeTo examine a single-optic accommodating intraocular lens (IOL) visual performance by correlating IOL implanted eyes’ defocus curve with the intraocular aberrometric profile and the impact on the quality of life (QOL). MethodsProspective consecutive case series study including a total of 25 eyes of 14 patients with ages ranging between 52 and 79 years old. All cases underwent cataract surgery with implantation of the single-optic accommodating IOL Crystalens HD (Bausch & Lomb). Distance and near visual acuity outcomes, intraocular aberrations, the defocus curve and QOL (NEI VFQ-25) were evaluated 3 months after surgery. ResultsA significant improvement in distance visual acuity was found postoperatively (p=0.02). Mean postoperative LogMAR uncorrected near visual acuity was 0.44±0.23 (20/30). 60% of eyes had a postoperative addition between 0 and 1.5diopters (D). The defocus curve showed an area of maximum visual acuity for the levels of defocus corresponding to distance and intermediate vision (−1 to +0.5D). Postoperative intermediate visual acuity correlated significantly some QOL indices (r≥0.51, p≤0.03; difficulty in going down steps or seeing how people react to things that patient says) as well as with J0 component of manifest cylinder. Postoperative distance-corrected near visual acuity correlated significantly with age (r=0.65, p<0.01). ConclusionsThis accommodating IOL seems to be able to restore the distance visual function as well as to provide an improvement in intermediate and near vision with a significant impact on patient's QOL, although limited by age and astigmatism. Future studies with larger sample sizes should confirm all these trends.

Simultaneous corneal inlay implantation and laser in situ keratomileusis for presbyopia in patients with hyperopia, myopia, or emmetropia: Six-month results

To evaluate the safety and efficacy of simultaneous Kamra corneal inlay implantation and laser in situ keratomileusis (LASIK) for the treatment of presbyopia in emmetropic, hyperopic, or myopic patients. Private center, Tokyo, Japan. Cohort study. Patients had bilateral LASIK with simultaneous implantation of a corneal inlay in the nondominant eye to treat presbyopia and ametropia between September 2009 and April 2010. The efficacy and safety were determined by the spherical equivalent (SE) in the eye with the inlay. The study enrolled 360 eyes of 180 patients with a mean age of 52.4 years ± 5.1 (SD) (range 41 to 65 years). Sixty-four patients were available for the 6-month postoperative examination. The mean logMAR uncorrected near visual acuity in the eye with the inlay improved 7 lines in hyperopic eyes, 6 lines in emmetropic eyes, and 2 lines in myopic eyes. The mean logMAR uncorrected distance visual acuity improved by 3 lines, 1 line, and 10 lines, respectively. Simultaneous intracorneal inlay implantation and LASIK to treat presbyopia with emmetropia, hyperopia, or myopia was clinically safe and effective, yielding improvement in distance and near visual acuity. Patients were satisfied with decreased dependence on reading glasses regardless of the preoperative SE range. However, postoperative symptoms, such as dry eyes, halo, glare, or night-vision disturbances, occurred occasionally. Dr. Waring has a financial interest in and is world surgical monitor for Acufocus. No other author has a financial or proprietary interest in any material or method mentioned.

Topography-guided hyperopic and hyperopic astigmatism femtosecond laser-assisted LASIK: long-term experience with the 400 Hz eye-Q excimer platform

The purpose of this study was to evaluate the safety and efficacy of topography-guided ablation using the WaveLight 400 Hz excimer laser in laser-assisted in situ keratomileusis (LASIK) for hyperopia and/or hyperopic astigmatism. We prospectively evaluated 208 consecutive LASIK cases for hyperopia with or without astigmatism using the topography-guided platform of the 400 Hz Eye-Q excimer system. The mean preoperative sphere value was +3.04 ± 1.75 (range 0.75-7.25) diopters (D) and the mean cylinder value was -1.24 ± 1.41 (-4.75-0) D. Flaps were created either with Intralase FS60 (AMO, Irvine, CA) or FS200 (Alcon, Fort Worth, TX) femtosecond lasers. Parameters evaluated included age, preoperative and postoperative refractive error, uncorrected distance visual acuity, corrected distance visual acuity, flap diameter and thickness, topographic changes, higher order aberration changes, and low contrast sensitivity. These measurements were repeated postoperatively at regular intervals for at least 24 months. Two hundred and two eyes were available for follow-up at 24 months. Uncorrected distance visual acuity improved from 5.5/10 to 9.2/10. At 24 (8-37) months, 75.5% of the eyes were in the ±0.50 D range and 94.4% were in the ±1.00 D range of the refractive goal. Postoperatively, the mean sphere value was -0.39 ± 0.3 and the cylinder value was -0.35 ± 0.25. Topographic evidence showed that ablation was made in the visual axis and not in the center of the cornea, thus correlating with the angle kappa. No significant complications were encountered in this small group of patients. Hyperopic LASIK utilizing the topography-guided platform of the 400 Hz Eye-Q Allegretto excimer and a femtosecond laser flap appears to be safe and effective for correction of hyperopia and/or hyperopic astigmatism. The results are impressive for refractive error correction and stability and for improvement of both uncorrected and corrected distance visual acuity.

Correlation of Visual Performance With Quality of Life and Intraocular Aberrometric Profile in Patients Implanted With Rotationally Asymmetric Multifocal IOLs

To examine the visual performance of a rotationally asymmetric multifocal intraocular lens (IOL) by correlating the defocus curve of the IOL-implanted eye with the intraocular aberrometric profile and impact on the quality of life. A prospective, consecutive, case series study including 26 eyes from 13 patients aged between 50 and 83 years (mean: 65.54±7.59 years) was conducted. All patients underwent bilateral cataract surgery with implantation of a rotationally asymmetric multifocal IOL (Lentis Mplus LS-312 MF30, Oculentis GmbH). Distance and near visual acuity outcomes, intraocular aberrations, defocus curve, and quality of life (assessed using the National Eye Institute Visual Functioning Questionnaire-25) were evaluated postoperatively (mean follow-up: 6.42±2.24 months). A significant improvement in distance visual acuity was found postoperatively (P<.01). Mean postoperative logMAR distance-corrected near visual acuity was 0.19±0.12 (∼20/30). Corrected distance visual acuity and near visual acuity of 20/20 or better were achieved by 30.8% and 7.7% of eyes, respectively. Of all eyes, 96.2% had a postoperative addition between 0 and 1.00 diopter (D). The defocus curve showed two peaks of maximum visual acuity (0 and 3.00 D of defocus), with an acceptable range of intermediate vision. LogMAR visual acuity corresponding to near defocus was directly correlated with some higher order intraocular aberrations (r⩾0.44, P⩽.04). Some difficulties evaluated with the quality of life test correlated directly with near and intermediate visual acuity (r⩾0.50, P⩽.01). The Lentis Mplus multifocal IOL provides good distance, intermediate, and near visual outcomes; however, the induced intraocular aberrometric profile may limit the potential visual benefit.