Lines Of Best-corrected Visual Acuity Research Articles

Posterior chamber phakic intraocular lens (ICL) for hyperopia: Ten-year follow-up

To evaluate the long-term safety, efficacy, predictability, and stability of implantation of a Collamer implantable contact lens (ICL) (Staar) to correct hyperopic refractive errors. Ophthalmology Department, Santa Rita Hospital, Vercelli, Italy. Fifty-nine eyes of 34 patients with hyperopia had implantation of an ICL. Patients were examined preoperatively (baseline) and 1 day, 1 week, 1, 3, and 6 months, and 1, 2, 4, 6, 8, and 10 years postoperatively. Main outcome measures were subjective and objective refractions, uncorrected visual acuity, best corrected visual acuity (BCVA), variation in intraocular pressure (IOP), anterior chamber depth (ACD), variation in endothelial cells, adverse events, and patient satisfaction. Nine patients had ICL implantation in 1 eye and 25 patients, in both eyes. Preoperatively, the spherical equivalent (SE) was between +2.75 diopters (D) and +11.75 D and astigmatism was between +0.50 D and +1.00 D. The mean SE of the manifest refraction was +0.07 +/- 0.54 D; refraction stabilized quickly and remained stable throughout the follow-up period. At 10 years, the safety index was 111 and the efficacy index, 96.8. Of the eyes, 86.5% had a change in SE refraction within +/-0.50 D; 1.6% lost 1 Snellen line of BCVA. The mean endothelial cell loss was 4.7%, which remained almost unchanged throughout the follow-up period. The mean variation in ACD was -14.9% and in IOP, +5.3%. The results confirmed the long-term safety, efficacy, accuracy, and predictability of ICL implantation for hyperopia. The Collamer material was well tolerated in all eyes.

Characteristics of and risk factors for contact lens-related microbial keratitis in a tertiary referral hospital

A retrospective case-control study was conducted at a tertiary referral hospital to determine the characteristics of and risk factors for contact lens (CL) related presumed microbial keratitis. Two hundred and ninety-one cases of presumed microbial keratitis were retrospectively identified over a 2-year period. Records were reviewed for a history of CL wear and, where identified, CL, demographic, and clinical data were collected. Lens wearing controls (n=186) were identified by a community telephone survey. Multiple logistic regression estimated risk factors for infection and vision loss. Ninety-nine (34%) new cases of presumed microbial keratitis were associated with CL wear. Overnight soft CL use was associated with an increased risk of infection compared to daily disposable CL wear (odds ratio (OR): 8.03, 95% confidence interval (CI): 1.82-35.46). Compared with older CL wearers, 15-24 year olds had a 3.5 times greater risk of infection (OR, 95% CI: 1.7-7.4). Of the 84 cases with available data, 24 (29%) lost two or more lines of best-corrected visual acuity. Delaying treatment by 49-72 h had a 4.5 times (OR, 95% CI: 1.4-14.9) greater risk of visual loss compared to seeking treatment early. Of the 99 cases of infection, 88 were scraped and 78% (69/88) of these returned a positive culture. Gram-positive bacteria were the predominant causative organisms. Overnight use of CL and youth carry a greater risk of infection. Practitioners should reinforce the importance of proper CL care at all times, and early presentation following the onset of symptoms.

Primary piggyback implantation using the ReSTOR intraocular lens: Case series

To assess the postoperative outcomes of piggyback implantation using the AcrySof ReSTOR intraocular lens (IOL) (model SA60D3, Alcon Surgical Laboratories). Hospital Oftalmológico de Brasília, Brasília, Brazil. Thirteen eyes of 7 patients who had phacoemulsification with piggyback IOL implantation were analyzed prospectively. In all cases, a ReSTOR IOL was implanted in the capsular bag and a second silicone IOL was implanted in the ciliary sulcus. Information collected included uncorrected visual acuity (UCVA) at near and distance, best corrected visual acuity (BCVA), and spherical equivalent (SE) before and after surgery. The patients were followed for 12 months. The mean distance UCVA was 0.25 (20/80) preoperatively and 0.88 (20/23) at the last follow-up (1 year), which was significantly better than before surgery (P<.05). The mean SE was +4.25 diopters (D) +/- 1.5 (SD) preoperatively and +0.15 +/- 0.44 D (range -0.50 to +0.75 D) at 1 year, which was significantly better than preoperatively (P<.05). No patient lost lines of BCVA after surgery. At the last follow-up, all eyes had a near UCVA of J1 and none required spectacles for near or distance vision. Piggyback implantation using the ReSTOR IOL appeared to be a safe and efficient procedure providing high-quality visual acuity for near and distance vision in selected patients.

Primary Intravitreal Bevacizumab (Avastin) for Diabetic Macular Edema: Results from the Pan-American Collaborative Retina Study Group at 6-Month Follow-up

To report the 6-month anatomic and best-corrected visual acuity (BCVA) response after primary intravitreal bevacizumab (Avastin) in patients with diabetic macular edema (DME). Interventional retrospective multicenter study at 6 centers from 6 countries of patients with DME. We reviewed the clinical records of 88 consecutive patients (110 eyes) with DME. Seventy-eight eyes of 64 consecutive patients with a minimum follow-up of 6 months and mean age of 59.7+/-9.3 years were included in this analysis. Patients were treated with at least one intravitreal injection of 1.25 mg or 2.5 mg of bevacizumab and underwent Early Treatment Diabetic Retinopathy Study (ETDRS) BCVA testing, ophthalmoscopic examination, optical coherence tomography (OCT), and fluorescein angiography (FA) at baseline and follow-up visits. Repeated-measures analysis of variance was used to compare mean values. Changes in BCVA, OCT, and FA. Mean follow-up was 6.31+/-0.81 months (range, 6-9). Sixteen (20.5%) eyes needed a second injection at a mean of 13.8 weeks (range, 4-28), and 6 eyes needed a third injection (7.7%) at a mean of 11.5 weeks (range, 5-20). The mean baseline BCVA was 0.87 (logarithm of the minimum angle of resolution), and the final mean BCVA was 0.6, a difference that was statistically significant (P<0.0001). Final BCVA analysis by subgroups demonstrated that 32 (41.1%) eyes remained stable, 43 (55.1%) improved > or =2 ETDRS lines of BCVA, and 3 (3.8%) decreased > or =2 ETDRS lines of BCVA. Mean central macular thickness at baseline by OCT was 387.0+/-182.8 mum and decreased to a mean of 275.7+/-108.3 at end of follow-up (P<0.0001). No ocular or systemic adverse events were observed. Primary intravitreal bevacizumab at doses of 1.25 to 2.5 mg seem to provide stability or improvement in VA, OCT, and FA in DME at 6 months. Follow-up is still short to make any specific treatment recommendations; however, the results appear promising. Evaluation in a multicenter randomized controlled clinical trial with longer follow-up is needed.

Long-term Study of Artisan Phakic Intraocular Lens Implantation for the Correction of Moderate to High Myopia: Ten-Year Follow-up Results

Purpose To determine the long-term performance of the Artisan phakic intraocular lens (PIOL) for the correction of myopia. Design Long-term (10 years) retrospective follow-up study. Participants Eighty-nine eyes of 49 patients who underwent Artisan PIOL implantation for the correction of myopia. Methods Comparisons were made between preoperative clinical data and the clinical data at 1, 6, and 10 years after surgery. Main Outcome Measures Refractive stability, refractive predictability, safety, efficacy, best-corrected visual acuity (BCVA), uncorrected visual acuity (UCVA), intraocular pressure, intraoperative problems, corneal endothelial cell density, corneal endothelial cell loss, and glare levels were evaluated. Results The mean spherical equivalent (SE) after 10 years was −0.70±1.00 diopters (D; range, −4.00 to 2.00 D), with no significant change in mean SE between 1, 6, and 10 years. At 10 years, 68.8% of all eyes were within 1.0 D of the intended correction. At 10 years, 31.2% (n = 24) gained 1 or more Snellen lines of BCVA and 2.6% (n = 2) lost more than 2 Snellen lines of BCVA; 93.3% reached a BCVA of 20/40 or better, and 82.0% reached a UCVA of 20/40 or better. The mean intraocular pressure remained stable and was 15.5±3.5 mmHg (range, 7–25 mmHg) at 10 years. The mean endothelial cell loss was −8.86±16.01% (range, −51.69% to 34.43%) at 10 years. Conclusions Long-term results demonstrate that the implantation of an Artisan PIOL for the correction of moderate to high myopia is a stable, predictable, and safe method when strict inclusion criteria for surgery are applied. There was no significant loss of corneal endothelial cells and no reports of long-term glare. To determine the long-term performance of the Artisan phakic intraocular lens (PIOL) for the correction of myopia. Long-term (10 years) retrospective follow-up study. Eighty-nine eyes of 49 patients who underwent Artisan PIOL implantation for the correction of myopia. Comparisons were made between preoperative clinical data and the clinical data at 1, 6, and 10 years after surgery. Refractive stability, refractive predictability, safety, efficacy, best-corrected visual acuity (BCVA), uncorrected visual acuity (UCVA), intraocular pressure, intraoperative problems, corneal endothelial cell density, corneal endothelial cell loss, and glare levels were evaluated. The mean spherical equivalent (SE) after 10 years was −0.70±1.00 diopters (D; range, −4.00 to 2.00 D), with no significant change in mean SE between 1, 6, and 10 years. At 10 years, 68.8% of all eyes were within 1.0 D of the intended correction. At 10 years, 31.2% (n = 24) gained 1 or more Snellen lines of BCVA and 2.6% (n = 2) lost more than 2 Snellen lines of BCVA; 93.3% reached a BCVA of 20/40 or better, and 82.0% reached a UCVA of 20/40 or better. The mean intraocular pressure remained stable and was 15.5±3.5 mmHg (range, 7–25 mmHg) at 10 years. The mean endothelial cell loss was −8.86±16.01% (range, −51.69% to 34.43%) at 10 years. Long-term results demonstrate that the implantation of an Artisan PIOL for the correction of moderate to high myopia is a stable, predictable, and safe method when strict inclusion criteria for surgery are applied. There was no significant loss of corneal endothelial cells and no reports of long-term glare.

The Influence of Incision-Induced Astigmatism and Axial Lens Position on the Correction of Myopic Astigmatism with the Artisan Toric Phakic Intraocular Lens

To evaluate postoperative astigmatism with regard to incision-induced astigmatism and deviation in axial alignment with the use of preoperative limbal marking with the Javal keratometer (Haag Streit, Bern, Switzerland) in eyes implanted with the Artisan toric phakic intraocular lens (IOL) (Ophtec, Groningen, The Netherlands). Prospective nonrandomized trial. Fifty-four eyes of 33 patients with myopia (mean, -9.67 diopters [D]) and astigmatism (mean, -3.44 D). The enclavation site was marked on the limbus using the Javal keratometer. The Artisan toric phakic IOL was implanted according to the axis marked on the limbus. Follow-up was a minimum of 6 months. Safety index, efficacy index, predictability, safety, and vector analysis of total refractive correction were determined. The effects of axis misalignment and incision-induced astigmatism on the final refractive error were evaluated. At 6 months after surgery, the safety index was 1.29+/-0.29 and the efficacy index was 1.04+/-0.35. Mean spherical equivalent subjective refraction reduced from -11.39+/-4.86 D before surgery to -0.38+/-0.57 D at 6 months. Sixty-seven percent of eyes were within 0.50 D of attempted refraction and 89% were within 1.00 D. Mean preoperative cylinder was 2.92+/-1.60 D at 91.4 degrees . At 6 months, the mean cylinder was 0.28+/-0.54 D at 174.3 degrees . No eyes lost 2 or more lines of best-corrected visual acuity at 6 months. Eighty-three percent of eyes achieved uncorrected visual acuity of 20/40 and 28% achieved 20/20. Vector analysis of total surgically induced astigmatism revealed a mean cylindrical change of 3.21+/-1.71 D. Average axis misalignment was 0.37+/-5.34 degrees . The mean incision-induced astigmatism was 0.74+/-0.61 D at 0.2 degrees . Implantation of the myopic toric IOL leads to safe, efficacious, and predictable results. The level of unpredictability caused by minor axis IOL misalignment has minimal effects on the residual refractive error. The procedure of axis alignment with the Javal keratometer seems to be an accurate method of marking the eye for toric IOL implantation. Incision-induced astigmatism can result in an overcorrection of the cylinder. A systematic undercorrection of -0.50 D for attempted cylindrical outcome could result in an achieved correction closer to emmetropia.

Posterior Corneal Curvature Changes after Undersurface Ablation of the Flap and In-the-Bed LASIK Retreatment

To analyze LASIK retreatment-induced changes in the posterior corneal curvature (PCC) with undersurface ablation of the flap (UAF) and in-the-bed techniques. Nonrandomized, comparative, interventional study. Forty-six eyes with a residual spherical equivalent refraction between -0.37 and -2.75 diopters (D) and astigmatism between 0.0 and -1.25 D were included prospectively. In 23 eyes, the calculated postenhancement flap thickness exceeded 150 microm using micropachymetric optical coherence tomography, whereas with further ablation of the bed, the residual bed thickness (RBT) would have been <250 microm, or <55% of the pre-LASIK central pachymetry. In another 23 eyes, RBT allowed the planned ablation for a calculated post-retreatment RBT exceeding 250 microm, >55% of the pre-LASIK central pachymetry. Eyes with insufficient RBT for further ablation underwent UAF retreatment, whereas those with adequate RBT received conventional in-the-bed LASIK retreatment. Examinations were performed before retreatment and 3 and 6 months postoperatively. No eye was lost to follow-up. Micropachymetry, Orbscan II scanning-slit PCC data, and visual acuity (VA). The groups did not differ in age, intraocular pressure, or retreatment ablation depth, but the UAF eyes had a lower mean pre-retreatment RBT (270.7+/-25.4 microm) than conventional enhancement eyes (353.0+/-41.5 microm) (P = 0.001). Eyes undergoing UAF had no significant change in PCC, whereas eyes undergoing conventional retreatment had an increase in the posterior corneal power within the central 3-mm zone (P = 0.008) 3 months after retreatment. No significant changes occurred thereafter. The amount of change in posterior corneal power within the 3-mm central zone from before to after retreatment differed significantly between the groups (mean difference, 0.135 D; 95% confidence interval, 0.022-0.248 D; P = 0.02). No keratectasia developed clinically, and no retreated eye lost or gained > or =2 lines of best-corrected VA. Six months after retreatment, the efficacy and safety indices for the UAF procedure were 0.96 and 1.01, respectively, and 1 and 1.06 for conventional LASIK enhancement. Undersurface ablation of the flap retreatment appears to have less potential for changing the posterior corneal surface than conventional LASIK enhancement and can help reduce the likelihood of retreatment-induced keratectasia.

Transpupillary thermotherapy for the treatment of occult CNV in age‐related macular degeneration: a prospective randomized controlled pilot study

To evaluate whether transpupillary thermotherapy (TTT) reduces the risk of moderate visual loss in patients with occult choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD). A group of 25 patients were recruited and randomized into TTT or placebo groups. Patients were included if they had a subfoveal purely or predominantly (> 50%) occult CNV secondary to AMD with best corrected visual acuity (BCVA) of 6/60 or better and the lesion was not larger than 4.5 mm. Treatment was carried out using an 810-nm Oculight diode laser with a fixed spot size covering the whole lesion according to the standard protocol. The same procedure was used for the control group, except that the power was set at zero. The patients were followed up at 6 weeks, 3 months and then every 6 months for up to 2 years. A maximum of three treatments were administered in both groups if there was evidence of persistent leakage from CNV. At the 12-month follow-up, there was no significant difference in the mean values for BCVA distance and near or contrast sensitivity between the treatment and control groups. The Mann-Whitney test was used to assess the differences in BCVA and contrast sensitivity between the groups, both at baseline and at the 12-month follow-up. No statistically significant difference was found; both groups lost on average two lines of BCVA. Transpupillary thermotherapy appeared to have been of no benefit in preventing further visual loss in patients with occult CNV in this pilot study.

Influence of photodynamic therapy for age related macular degeneration upon subjective vision related quality of life

Photodynamic therapy (PDT) has been used in the treatment of choroidal neovascularisation secondary to age-related macular degeneration (AMD). This study prospectively investigated patients' subjective change in visual function following PDT as treatment for AMD. Eighty-two consecutive patients receiving PDT in Tasmania, Australia, between May and November 2003 were recruited. In conjunction with a comprehensive clinical examination, the Visual Function-14 (VF-14) questionnaire was administered. Final follow-up occurred between February and March 2005. The VF-14 was scored by traditional summary scoring and by Rasch analysis. Five of the 82 (6.1%) subjects recruited were excluded from analysis. PDT was performed on average 5.7+/-2.6 times per patient. Raw VF-14 scores tended towards being significantly lower at follow-up than at baseline (67.6+/-27.2 against 64.5+/-27.7; P=0.052), and did significantly deteriorate using a collapsed Rasch analysis (P=0.0102). Following treatment, 38 (47.5%) eyes had lost three or more Snellen lines of best-corrected visual acuity. Patients undergoing PDT typically report reasonable visual function. In parallel with visual acuity, self-reported visual function may deteriorate slightly after PDT for AMD, but not as much as reported in untreated AMD.

Wavefront-Guided versus Standard LASIK Enhancement for Residual Refractive Errors

To assess efficacy, safety, predictability, stability, and changes in higher-order aberrations (HOAs) and contrast sensitivity (CS) after wavefront-guided and standard LASIK enhancement for the correction of residual refractive errors. Prospective, randomized, comparative clinical study. Twenty eyes of 20 consecutive patients (spherical equivalent [SE], -2.01+/-1.36 diopters [D]) treated with wavefront-guided Zyoptix Ablation Refinement software (ZAR) LASIK and 20 eyes of 20 consecutive patients (SE, -1.81+/-1.21 D) treated with standard Planoscan LASIK, both for residual refractive error enhancement. Efficacy, safety, predictability, stability, HOAs, and CS were evaluated before and after enhancement at 6 months' follow-up. Uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), manifest refraction, CS by means of the Functional Acuity Contrast Test, and HOAs by means of Zywave aberrometry were evaluated preoperatively and 6 months after retreatment. At 6 months postoperatively, UCVA was 20/25 or better in 100% of the eyes. Efficacy indexes were 1.09 for ZAR patients and 0.95 for Planoscan patients. No eyes lost > or =1 line of BCVA; in the ZAR group, 2 eyes gained 1 line and 6 eyes gained > or =2 lines; in the Planoscan group, 3 eyes gained 1 line. The ZAR group showed a percentage of eyes (94.4%) within the 0.5-D range in SE higher than that shown by the Planoscan group (88.8%). After 6 months, the HOA root mean square (RMS) increased on average by a factor of 1.44 for the Planoscan group (P = 0.003). No change or reduction in HOA RMS was found in the ZAR group (factor of 0.96; P>0.01). Contrast sensitivity was reduced in the Planoscan group only at the highest spatial frequency (18 cycles per degree; P<0.01). There was a significant reduction of CS as a function of HOA increase for the Planoscan group (P<0.0001). No changes were observed for the ZAR group at any spatial frequency (1.5-18 cycles per degree; P>0.01). Wavefront-guided LASIK using the ZAR algorithm is an effective and safe procedure for treatment of residual refractive errors. Wavefront-guided LASIK does not increase HOAs and does not modify CS compared with preoperative values. Wavefront-guided LASIK seems to be better than standard LASIK for retreatments.

The Effect of Hyperopic Laser in Situ Keratomileusis on Refractive Accommodative Esotropia

To evaluate the efficacy of laser in situ keratomileusis (LASIK) for discarding spectacles and simultaneously correcting ocular alignment in patients with refractive accommodative esotropia. LASIK was performed on 20 eyes of 10 patients (mean age, 24.3 years; range, 11 to 43 years) using a Technolas 217C excimer laser. The target refraction was emmetropia. Visual acuity (uncorrected and best-corrected), refractive error, and ocular alignment were recorded before and after LASIK. Minimum follow-up was 12 months. The mean preoperative uncorrected and corrected angle of deviation was 37.1 prism diopters (PD) (range, 17 to 80; standard deviation (SD), 19.8)) and 14.74 PD (range, 0 to 50; SD, 12.9) of esotropia, respectively, which changed to 7.2 PD (range, 0 to 50; SD, 15.78) without correction postoperatively (p=0.005). Of 20 eyes, 15% lost one line of best-corrected visual acuity, 10% gained two lines, and 75% showed no change. LASIK could be considered an alternative treatment for patients with refractive accommodative esotropia with intolerance to glasses and contact lenses.

CustomCornea wavefront retreatment after conventional laser in situ keratomileusis

To evaluate the safety and efficacy of performing laser in situ keratomileusis (LASIK) retreatment using the Alcon CustomCornea system in patients who had prior myopic LASIK using conventional (nonwavefront) software. Private practice ophthalmology clinic, St. Paul, Minnesota, USA. In this prospective interventional trial, consecutive patients having CustomCornea retreatment following conventional LASIK were evaluated. Main outcome measures were uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), refractive error, and higher-order aberrations (HOAs). Fourteen eyes of 10 patients were evaluated, with a mean follow-up of 5.3 months (range 6.2 to 15.4 months). Mean UCVA improved from 20/50 (logMAR) to 20/26 (P<.001). Mean spherical equivalent changed from -1.45 diopters (D) to +0.52 (P<.00001). Total aberrations, HOAs, defocus, and spherical aberration improved significantly. No eye lost a line of BCVA; 4 eyes (28.6%) gained 1 line, and 1 eye (7.1%) gained 2 lines. Ten eyes (71.4%) were within 0.5 D of emmetropia. Four eyes were overcorrected by 1.00 to 2.00 D. Risk factors for overcorrection included increased HOAs, higher spherical aberration, and not using the surgeon's offset at the time of surgery. Wavefront retreatment following conventional LASIK is safe and effective. Care must be taken when treating patients with higher amounts of total aberration, especially spherical aberration. Refractive results are closer to emmetropia when the surgeon's offset is used.

Flap suturing with proparacaine for recurrent epithelial ingrowth following laser in situ keratomileusis surgery

To evaluate the safety and efficacy of flap suturing with proparacaine application for the management of recurrent epithelial ingrowth following laser in situ keratomileusis (LASIK). Private consultation practice and Department of Ophthalmology, Rush University, Chicago, Illinois, USA. Six eyes of 5 patients with recurrent epithelial ingrowth had flap lifting followed by debridement of interface epithelial cells, interface application of proparacaine, and the placement of interrupted 10-0 nylon sutures. Four eyes achieved a best corrected visual acuity (BCVA) of 20/40 or better. Two eyes required repeat debridement with suturing and were stable with at least a 1-year follow-up. No eye lost more than 1 line of BCVA. Three eyes regained excellent uncorrected visual acuity due to a reduction in induced astigmatism. Recurrent epithelial ingrowth following LASIK surgery can be a visually debilitating condition. Flap suturing with interface proparacaine application may be effective in preventing further recurrences of epithelial ingrowth after initial debridement.

Results of resident-performed laser in situ keratomileusis

To analyze the results of resident-performed laser in situ keratomileusis (LASIK). Rush University Medical Center, Department of Ophthalmology, Chicago, Illinois, USA. This retrospective study comprised 44 consecutive eyes of 22 patients who had LASIK performed from August 2000 through February 2002. Based on preoperative spherical equivalent, the eyes were divided into a low myopia group (A) (-1.0 to -6.0 diopter [D]) and a higher myopia group (B) (> -6.01 D). Preoperative and postoperative spherical equivalent (SE), best corrected visual acuity (BCVA), and uncorrected visual acuity (UCVA) were measured and analyzed within each group. Patients had at least 2 follow-up visits, with the second visit occurring between 1 and 9 months postoperatively. Preoperatively, the mean SE in Group A was -3.93 D +/- 1.53 (SD) and in Group B, -8.49 +/- 1.70 D. At the final visit, the SE in Group A decreased to -0.29 +/- 0.55 D and in Group B, -1.09 +/- 0.87 D. The UCVA in Group A at the final visit was 20/20 or better in 43% of eyes and 20/40 or better in 100% of eyes. In Group B, the UCVA was 20/20 or better in 31% of eyes and 20/40 or better in 75% of eyes. In all eyes, the BCVA improved by 1 line in 16% or remained the same in 84%. No eyes lost any lines of BCVA. The SE taken at the last visit was within +/-0.5 D in 69% of all eyes and within +/-1.0 D in 82% of all eyes. The incidence of patients needing retreatment in resident-performed LASIK surgery was 3 of 44 (6.8%). Laser in situ keratomileusis performed by residents is a safe and effective procedure for correction of refractive error. Postoperative UCVA, refractive error, retreatment rate, and loss of BCVA were consistent with published results from nonresident surgeons. These results also exceeded the U.S. Food and Drug Administration requirements for LASIK surgery.

Comparison of the potential acuity meter and pinhole tests in predicting postoperative visual acuity after cataract surgery

To compare the accuracy of potential acuity meter (PAM) and pinhole (PH) tests in predicting visual acuity after cataract surgery. Department of Ophthalmology and Visual Sciences, University of the Philippines, Philippine General Hospital, Manila, and Asian Eye Institute, Makati, Philippines. This prospective study comprised 64 eyes with mild to moderate cataract that had uneventful phacoemulsification. The PAM and PH tests were performed to predict postoperative visual acuity. Best corrected visual acuity (BCVA) 4 weeks after surgery was compared with the predicted visual acuity. The number of lines of inaccuracy was calculated by subtracting the BCVA from the predicted visual acuity. The variables analyzed were type of predictive test and preoperative BCVA. The eyes were divided according to preoperative BCVA as follows: Group 1, 20/20 to 20/50; Group 2, 20/60 to 20/100; Group 3, 20/200 or worse. The PH predicted visual acuity was correct in 5% of eyes and the PAM predicted acuity, in 17%. The PH predicted acuity was accurate within 1, 2, and 3 lines of BCVA in 23%, 40%, and 54% of eyes, respectively, and the PAM predicted acuity, in 64%, 81%, and 92% of eyes, respectively. The mean number of lines of inaccuracy was significantly less with the PH than with the PAM (3.47 lines +/- 2.42 [SD] and 1.60 +/- 1.55 lines, respectively) (P=.0005). The mean lines of inaccuracy in Group 1 were 2.49 +/- 1.52 for the PH and 1.14 +/- 0.99 for the PAM (P=.027); in Group 2, 3.17 +/- 1.99 PH and 1.65 +/- 1.80 PAM (P=.642); and in Group 3, 6.58 +/- 3.03 PH and 2.67 +/- 2.10 PAM (P=.240). The PAM was more accurate than the PH in predicting visual acuity after cataract surgery. The accuracy of both tests decreased in patients with poorer preoperative visual acuity.

Traumatic cataract and other adverse events with the implantable contact lens

To evaluate the surgical outcome and adverse events associated with implantation of the implantable contact lens (ICL) for the correction of high myopia or high hyperopia. Helsinki University Eye Hospital, Helsinki, Finland. In this nonrandomized prospective clinical trial, the ICL V4 was implanted in 26 eyes of 13 patients with normal enrollment criteria (younger than 45 years, a clinically clear crystalline lens) (Group 1) and the V2, V3, or V4 were implanted in 38 eyes of 22 patients with heterogeneous criteria (older than 45 years or opacities in the crystalline lens) (Group 2). The main outcome measures were lens opacity classification system (LOCS II) assessment and transparency analysis of the lens. In Group 1, microdensitometric assessment showed no decrease in crystalline lens transparency and no statistically significant increase in crystalline lens density at any follow-up examination (P>.05). The incidence of anterior subcapsular (AS) opacities was 7.7%, and no eye developed clinically significant cataract during the mean follow-up of 13.2 months +/- 12.3 (SD). No myopic eye lost a line of best corrected visual acuity (BCVA); 50.0% of hyperopic eyes lost 1 line of BCVA. Sixty-eight percent of myopic eyes and 75.0% of hyperopic eyes were within +/-1.0 diopter of the predicted refraction. In Group 2, the incidence of AS opacities was 47.4% and 10 eyes (26.3%) developed clinically significant cataract during the mean follow-up of 30.9 +/- 18.0 months. The visual and refractive results were similar to those in Group 1 at 1 month, but due to progressive AS opacities in the crystalline lens, 23.4% of eyes lost BCVA lines during the follow-up. Intraoperative complications were few and insignificant. Implantation of the ICL for correction of high myopia or high hyperopia appears to be a safe procedure with good visual and refractive results immediately. There was no decrease in the transparency or increase in the density of the crystalline lens with the latest generation of the ICL device in the normal group, indicating enhanced safety. Progressive lens opacification in the heterogeneous group shows there are risk factors for cataract formation; ie, type V3 ICL, preexisting lens opacities, and older patient age. Anterior subcapsular opacities are most likely the result of trauma.

Artisan iris-claw phakic intraocular lens followed by laser in situ keratomileusis for high hyperopia

To evaluate safety, efficacy, predictability, stability, complications, and patient satisfaction after Artisan phakic intraocular lens (IOL) implantation followed by laser in situ keratomileusis (LASIK) for the correction of high hyperopia. Instituto Oftalmólogico de Alicante, Alicante, Spain. This prospective trial included 39 eyes with a mean preoperative spherical equivalent (SE) of 7.39 diopters (D) +/- 1.30 (SD) and a cylinder between 0 and -4.25 D. The Artisan iris-fixated phakic IOL (Ophtec) for hyperopia was implanted, and LASIK was performed 6 to 8 months later. The best corrected visual acuity (BCVA), uncorrected visual acuity (UCVA), refraction, endothelial cell loss (ECL), endothelium morphologic analysis, and patient satisfaction were recorded. The minimum follow-up was 12 months. At 1 year, 37 eyes (94.9%) were within +/-1.00 D of emmetropia and 31 eyes (79.5%) were within +/-0.50 D. Thirty-five eyes (89.7%) achieved a UCVA of 0.5 or better. There was a statistically significant decrease in BCVA after phakic IOL implantation, but this effect was corrected after LASIK. Nine eyes (23.1%) lost 1 line of BCVA; 7 eyes (17.9%) gained at least 1 line. One eye (2.6%) showed a change in SE greater than 1.0 D over the follow-up period. The mean ECL was 10.9%, but morphologic analysis suggested no additional damage caused by LASIK over that produced by phakic IOL surgery. Overall patient satisfaction was high. The combination of Artisan phakic IOL implantation and LASIK safely, predictably, and effectively reduced high hyperopia. A loss of 1 line of BCVA should be expected in about one third of eyes implanted with this IOL. Halos and glare at night remain a potential problem.

Changes in contrast sensitivity after Artisan lens implantation for high myopia

To determine the effects of Artisan lens implantation on contrast sensitivity. Prospective consecutive interventional case series. Forty-nine eyes of 30 patients with myopia and myopia with astigmatism, who underwent implantation of the Artisan iris-fixated phakic intraocular lens. Preoperative testing served as the control. Implantation of the Artisan phakic intraocular lens to correct myopia. Refractive predictability and Snellen visual acuity were evaluated preoperatively and at least 4 months postoperatively. Additionally, photopic and mesopic contrast sensitivities were measured at 1.5, 3, 6, 12, and 18 cycles per degree, with and without glare testing. The mean preoperative spherical equivalent (SE) was -12.16 diopters (D) (range, -6.88 to -18.00). The mean postoperative SE was -0.46+/-0.58 D (range, +0.50 to -1.75). Ninety percent of eyes were within 1.00 D of the predicted result, and 39% gained > or =1 lines of best-corrected visual acuity (BCVA). When compared with preoperative measurements, postoperative contrast sensitivity was increased under photopic conditions and slightly decreased under mesopic conditions. Adverse events were one wound leak requiring resuturing in the immediate postoperative period and one subluxed lens after significant blunt trauma. No eyes lost > or =2 lines of BCVA. Artisan implantation for the correction of high myopia seems to be a predictable procedure. Increases in photopic contrast sensitivity values after implantation of this phakic intraocular lens stand in distinction to the decreases in photopic contrast sensitivity previously reported after LASIK correction of this degree of myopia.

A new visual evoked potential system for vision screening in infants and young children

With a prevalence of 3-5%, amblyopia represents a major public health problem. Effective treatment depends on early detection, and a broad consensus of professional opinion supports vision screening of infants and young children. No single method of screening has been demonstrated to be superior in detecting amblyopia and all methods have significant limitations. We assessed a new, "child-friendly" visual evoked potential (VEP) system (ENFANTtrade mark II, Diopsys Corp., Metuchen, NJ) for use in screening. We studied 122 children, aged 6 months to 5 years, comparing test results in a masked fashion to results of standard ophthalmologic examinations. A statistical program analyzed VEP differences between fellow eyes to determine a "pass" or "fail" for each child. For verbal patients, clinical amblyopia was defined as an interocular difference of two or more lines in best-corrected visual acuity. For preverbal patients, clinical amblyopia was defined by the clinician's decision to treat with occlusion or atropine penalization. Preverbal children with significant refractive errors or structural eye pathology were also considered clinically abnormal. The test was completed by 94% of the study group, each child requiring an average of 10 minutes to complete testing of both eyes. The sensitivity was 0.973, the specificity 0.808, the positive predictive value 0.706, and the negative predictive value 0.984. With its easy electrode placement and rapid, attractive stimulus, the new system overcomes technical difficulties which were associated with older VEP techniques. The test shows promise as a screening tool for detecting amblyopia and other visual deficits in young children.

Phakic intraocular lens implantation versus clear lens extraction in highly myopic eyes of 30- to 50-year-old patients

Purpose: To compare the outcome of treatment for myopia by phakic intraocular lens (IOL) implantation or by clear lens extraction (CLE). Setting: Service d'Ophtalmologie, Hôpital Purpan, Toulouse, France. Methods: Thirty-nine patients from 32 to 49 years of age were studied. Forty-one eyes of 21 patients received a phakic IOL, and 36 eyes of 18 patients had phacoemulsification of the crystalline lens. The mean preoperative spherical equivalent (SE) was −13.6 diopters (D) ± 3.0 (SD) in the phakic IOL group and −16.7 ± 3.8 D in the CLE group. Results: Postoperatively, the mean SE was −1.06 ± 0.78 D in the IOL group and −1.88 ± 0.83 D in the CLE group. At 12 months, the best corrected visual acuity (BCVA) had improved in 78.0% of eyes in the IOL group and 83.3% in the CLE group; no eye lost 1 line of BCVA. In 3 eyes (7.31%) in the IOL group, opacification of the crystalline lens developed 34, 36, and 44 months after implantation. Visual recovery after phacoemulsification was excellent. No eye in this group lost 1 or more lines of BCVA between 1 and 4 years of the initial surgery. In the CLE group, a retinal detachment occurred in 2 eyes at 39 and 43 months. The final BCVA in these eyes was counting fingers and 20/200. Conclusion: Implantation of a phakic IOL in a highly myopic eye of a patient between 30 and 50 years of age can be considered an adequate technique with a lower risk for loss of BCVA than CLE.