National Eye Institute Refractive Error Research Articles

Patient’s Quality of Life After 3-and 6-Months Cataract Surgery

Cataract surgery is the most common elective procedure and has been shown to increase patients' visual acuity. However, visual acuity alone cannot adequately represent their quality of life. Quality of life can be measured with a standardized questionnaire, such as the National Eye Institute Refractive Error Quality of Life Instrument. Patients with better quality of life pre-operatively will benefit less from cataract surgery. This study aimed to describe patients' quality of life after long-term cataract surgery in the National Eye Center Cicendo Eye Hospital. This cross-sectional descriptive study used primary data collected using a questionnaire from March to May 2022. The subjects were 33 people with cataracts who underwent uncomplicated cataract surgery at Cicendo National Eye Hospital over the past three and six months of the study. Patients who met the inclusion criteria were given the NEI-RQL 42 questionnaire. In visual clarity, patient expectations, near vision, far vision, daily fluctuations, activity limitations, suboptimal correction, and satisfaction with correction variables, an increase in value at three months was observed, yet slightly decreased at 6 months. There was decreased glare complaints, symptoms, and dependence on correction at preoperative, 3 months, and 6 months. An increase in the level of concern and appearance from preoperative, 3 months, and 6 months post-operative was observed. Thus, an improvement in the patient's quality of life is observed three months after surgery, yet decreases slightly in six months after surgery.

Visual Performance of School-age Children Wearing Dual-Focus Soft Contact Lenses: A Randomized Controlled Trial

To investigate the effect of wearing dual-focus soft contact lenses (DFSCL) on the visual performance of school-age children. In this randomized controlled clinical trial, 64 children aged 8 to 12 years with spherical equivalent refraction between -0.75 D and -4.00 D were recruited in our hospital in October 2022. Using the envelope method, the subjects were evenly and randomly assigned to the control group wearing single vision spectacles (SVS) or the intervention group wearing MiSight dual-focus soft contact lenses (DFSCL) from CooperVision. Follow-up examinations were conducted once every 3 months. The corrected visual acuity, contrast sensitivity function (CSF), and the scores for National Eye Institute Refractive Error Quality of Life Instrument-42 (NEI-RQL-42) were compared between the control and intervention groups. By December 2023, a total of 58 subjects completed follow-up (30 in the SVS group and 28 in the DFSCL group). No significant difference in corrected visual acuity was observed between subjects wearing DFSCL and those wearing SVS. The CSF of the DFSCL group was comparable to that of the SVS group across the spatial frequencies of 3, 6, 12, and 18 cpd (P>0.05). According to the results of the NEI-RQL-42 survey at the 6-month follow-up, the score for ocular discomfort symptoms was 89±14 in the SVS group and 79±16 in the DFSCL group (P=0.008), reflecting that the DFSCL group had a 12.66% higher level of discomfort. For appearance, the score was 70±32 in the SVS group and 92±22 in the DFSCL group (P=0.002), showing a 31.43% improvement in the DFSCL group. In addition to providing the normal visual acuity and CSF, wearing MiSight DFSCL also leads to better satisfaction with the appearance.

Quality of life following LASIK surgery at a tertiary center in North India.

Laser-assisted in situ keratomileuses (LASIK) refractive surgery is a cutting-edge and developing area of ophthalmology. Reshaping the cornea during refractive surgery helps patients become less dependent on glasses or contact lenses. The aim of the present study was to evaluate the visual outcome, quality of life, and patient satisfaction following LASIK surgery at a tertiary care center in North India using the National Eye Institute Refractive Error Quality of Life (NEIRQL-42) questionnaire. NEI-RQL, a 42-item measure with 13 subscales. The questionnaire was administered to a sample size of 71 patients who underwent LASIK Surgery at a tertiary center in North India. Data were collected pre- and post-surgery (1,3,6 month post-LASIK) for myopic or hyperopic refractive error. Statistical analysis was done using the Friedman test and Wilcoxon signed-rank test. In myopic patients, the mean preoperative spherical equivalent (SE) was -4.19 ± 2.28D in the right eye and -4.26 ± 2.28D in the left eye and post-op SE -0.06±0.29 (p=0.00). The largest improvements (>25 points) on the 0 to 100 possible score range, were seen in activity limitations, dependence on correction, appearance, and satisfaction with correction subscales. The subscale glare showed a statistically significant difference (worsening) whereas a non-significant change (P> 0.05) was recorded only in the sub-optimal correction sub-scale. The NEIRQL-42 is a responsive tool to evaluate vision-related changes in quality of life after LASIK surgery in the Indian population. The best surgical expectancy and QoL can be expected at 6 months following surgery.

Quality of vision and outcomes after bilateral implantation of pseudo-non diffracting beam IOL.

To analyze the objective and subjective visual performances of a new hybrid refractive/aspheric extended depth of focus (EDOF) intraocular lens (IOL). In this monocentric prospective study patients with bilateral cataracts underwent cataract surgery and were implanted with a Lucidis IOL (SAV-IOL SA, Neuchâtel, Switzerland) in both eyes, 1 week apart from each other. At 3 months from implantation postoperative evaluations included monocular and binocular uncorrected and distance-corrected distant (4 m), intermediate (80 cm, 67 cm) and near (40 cm) visual acuities (UDVA/DCVA, UI80-67VA/DCI80-67VA, UNVA/DCNVA), binocular defocus curves, halometry, contrast sensitivity and objective quality-of-vision measurements. Also, patients were also asked to complete the national eye institute refractive error quality of life (NEI-RQL-42) questionnaire. Twenty-five patients (50 eyes) were included. The mean postoperative binocular UDVA, UI80VA, UI67VA and UNVA were-0.02 ± 0.13, 0.05 ± 0.09, 0.05 ± 0.08 and 0.03 ± 0.1 LogMar, and did not significantly differ from their corrected counterparts. On binocular defocus curves a VA ≥0.05LogMar was found between +0.50 and - 2.50 D of vergence, whereas the mean distance from the central stimulus on halometry was 1.23 ± 0.01. Mean ocular and corneal radical mean square at 4 mm were 0.31 ± 0.28 and 0.19 ± 0.07, respectively; whereas the mean Strehl ratio was 0.2 ± 0.09. Lucidis IOLs demonstrated excellent visual performances, especially at close distances while maintain good quality of vision, contrast sensitivity, and overall patient-satisfaction.

Wavefront-guided PRK treatment of myopia using a refractive aberrometer.

To evaluate the safety, effectiveness, and patient-reported outcomes of wavefront-guided photorefractive keratectomy (PRK) for the correction of myopic refractive errors with and without astigmatism. U.S. multicenter study. Prospective, nonrandomized clinical investigation. 334 eyes (167 patients) underwent wavefront-guided PRK with the STAR S4 IR Excimer Laser System. Patients had preoperative myopic refractive errors with sphere up to -8.00 diopters (D) and cylinder up to -4.00 D with a maximum spherical equivalent (SE) of -10.00 D. All eyes were targeted for emmetropia, and treatment plans were derived from the iDESIGN system wavefront measurements. At 6 months, the point of refractive stability, 99.4% of eyes achieved 20/20 or better uncorrected distance visual acuity (UDVA), 92% of eyes achieved 20/16 or better UDVA, 85.5% of eyes achieved manifest refraction SE (MRSE) within 0.50 D of target, mean SE was -0.06, and less than 1% of eyes lost more than 2 lines of corrected distance visual acuity. Glare and halos occurred with similar or lower frequencies at 6 months vs preoperative. Results from the National Eye Institute Refractive Error Quality of life questionnaire showed statistically significant improvements at 6 months vs preoperative across most measures of vision-related functioning and well-being. Approximately 98% of patients reported high satisfaction with their overall vision at 6 months. Wavefront-guided PRK with the iDESIGN aberrometer was safe, effective, and predictable for the correction of low to moderate myopia with and without astigmatism and led to high patient satisfaction.

Astigmatism Tolerance and Visual Outcomes After Bilateral Implantation of a Hybrid Continuous Transitional Focus IOL.

To evaluate the astigmatism tolerance and the visual outcomes after implantation of a premium intraocular lens (IOL) with a continuous transitional focus (Precizon Presbyopic; Ophtec BV) in pseudophakic presbyopia correction. This prospective study enrolled 20 patients (40 eyes) after bilateral phacoemulsification and IOL implantation. Corrected and uncorrected visual acuities at 4 m and 80, 67, and 40 cm (CDVA, UDVA, DCI80VA, UI80VA, DCI67VA, UI67VA, DCNVA, and UNVA), astigmatic and spheric defocus curve, mean reading speed (MRS), critical print size (CPS), contrast sensitivity, optical aberrations (modulation transfer function [MTF] cut-off, Strehl ratio, and higher order aberration root mean square [HOA RMS]), objective halometry, and National Eye Institute Refractive Error Quality of Life Instrument 42 [NEI RQL-42] questionnaire were evaluated 3 months after surgery. Astigmatic defocus curves revealed a tolerance up to -1.00 and +0.75 diopters (D) for with-the-rule astigmatism, and up to -1.00 and +1.00 D for against-the-rule astigmatism. Binocular spheric defocus curve showed that the mean visual acuity was greater than 0.15 logMAR from 1.00 to -1.00 D. MRS, CPS, MTF cut-off, Strehl ratio, and HOA RMS were 116.97 ± 21.94 words/min, 0.45 ± 0.06 logRDA, 20.03 ± 4.86 cycles/degree, 0.11 ± 0.07, and 0.28 ± 0.09, respectively. Contrast sensitivity was within the normal range for all tested light conditions. The NEI RQL-42 evidenced high subjective satisfaction for all subscales, especially for far vision, activity limitations, dependence on correction, suboptimal correction, appearance, and satisfaction with correction. The Precizon Presbyopic IOL allows good astigmatism tolerance and both objective and subjective high quality of vision. [J Refract Surg. 2023;39(1):33-39.].

Vision Quality Questionnaire Assessment in Patients After Topography-Guided Photorefractive Keratectomy for Irregular Astigmatism Secondary to Radial Keratotomy.

AimTo evaluate the vision-related quality of life with the National Eye Institute Refractive Error Quality of Life (NEI-RQL) questionnaire in patients with astigmatism secondary to radial keratotomy surgery who underwent topography-guided photorefractive keratectomy.MethodsProspective non-randomized clinical trial. This study included 15 patients (30 eyes) aged > 21 years, mean age 55.1 (SD, 3.5) years, 53.3% female, with astigmatism ≤ - 6.00 D resulting from radial keratotomy, which could have been associated with hyperopia ≤ + 6.00 D. Photorefractive keratectomy with topography-guided custom ablation treatment was used in all cases. The patients answered the NEI-RQL questionnaire preoperatively and at 4 and 48 months after topography-guided photorefractive keratectomy. The following data were collected: age, sex and education level, pre-operative refraction data, visual acuity with or without correction, pachymetry, and keratometry.ResultsThere was a significant difference between pre-and postoperative NEI-RQL scores for the domains clarity of vision, near vision, far vision, diurnal fluctuation, activity limitations, glare, symptoms, correction dependence, appearance, and satisfaction with correction (p < 0.001).ConclusionTopography-guided photorefractive keratectomy improved vision-related quality of life in patients with a history of irregular astigmatism secondary to radial keratotomy.

Extended Depth of Focus Versus Monofocal IOLs in Patients With High Myopia: Objective and Subjective Visual Outcomes.

To compare the objective and subjective outcomes between the extended depth of focus (EDOF) Mini Well intraocular lens (IOL) and the aspheric monofocal Mini-4-Ready IOL (both SIFI S.p.A.) in patients with high myopia. In this prospective comparative study, 40 patients with high myopia (axial length ≥ 26 mm) were enrolled: 20 patients were bilaterally implanted with the EDOF Mini Well IOL (EDOF group) and 20 patients were bilaterally implanted with the Mini-4-Ready IOL (monofocal group). Three-month follow-up data included corrected and uncorrected distance visual acuity at 4 m and 80, 67, and 40 cm, defocus curves, subjective and objective contrast sensitivity, objective optical quality (calculated with Optical Quality Analysis System; Visiometrics SL), halometry, and reading performance. Subjective visual quality was evaluated with National Eye Institute Refractive Error Quality of Life Instrument 42 scores. All visual acuities were significantly better in the EDOF group (P ⩽ .04) except monocular and binocular uncorrected and corrected distance visual acuities for distance (P ≥ .50). Defocus curves for myopic and hyperopic values were better in the EDOF group (P ⩽ .05), apart from +0.50 to -0.50 D (P ≥ .16). Contrast sensitivity curves was worse in the EDOF group in the mesopic-with-glare condition (P ⩽ .04). No differences were found in halometric values (P ≥ .15) and OQAS outcomes (P ≥ .47). National Eye Institute Refractive Error Quality of Life Instrument 42 subscale scores were better for expectation, near vision, activity limitations, and dependence on correction in the EDOF group (P ⩽ .04). Intermediate and near visual acuities were better in the EDOF group than in the monofocal group, with a comparable visual quality index between groups. [J Refract Surg. 2022;38(3):158-166.].

Comparison of Improvement of Quality of Life After Using Ready- Made Spectacles and Custom-Made Spectacles in Junior High School Students in Bandung District

Introduction: Uncorrected refractive error remains a leading cause of blindness and visual impairment among different population groups worldwide. In school children, it has a considerable impact on quality of life including social development, school performance and academic achievement that can affect their future. Management of refractive errors in developing countries is not adequate related to the cost, availability and distance of health and optical services. Hence, early detection and intervention with ready-made spectacles at the time of school children vision screening programs is expected to help solving these problems. Objective: To evaluate outcome measure of wearing ready-made spectacles (RMS) and custom-made spectacles (CS) on children’s quality of life.Method: A non-inferiority trial with a margin of 25%, cluster-randomized trial. Children aged 11-15 years in Bandung Regency, that meet the inclusion criteria were randomized to receive RMS and CS. Main study outcome was global score on the National Eye Institute Refractive Error Quality of Life- 42 after one month of wearing study glasses, comparing both group. Result: A total of 220 eligible subject were allocated to RMS (n = 110) and CS groups (n = 110) respectively. Baseline and end line score data were available for 220 (100%) of subjects. Improvement of quality of life in RMS group was 19.48±9.33 and CS was 24.14±9.68 with D = -18.11(CI 95% - 19.36 to -16.64). Conclusion: Improvement of quality of life in RMS group is non-inferior compare with CS group

Psychiatric morbidity of patients with keratoconus: A cross-sectional study

BackgroundThis study aimed to determine the prevalence of psychiatric disorders in patients with keratoconus and the effect of clinical parameters and psychiatric morbidity on quality of life in this patient group. Materials and methodsThis cross-sectional study enrolled 94 patients with keratoconus. All patients underwent a complete ophthalmic and psychiatric examination and completed the The National Eye Institute Refractive Error Quality of Life Instrument-42 (NEI-RQL-42), Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) questionnaires. The current diagnosis of psychiatric disorders was determined using the Structured Clinical Interview for DSM-IV (SCID). The impact of disease severity (binocular BCVA ≥0.4 logMAR, steep K reading ≥52, and Amsler-Krumeich grades) on vision-related quality of life was also analyzed. ResultsThe patients' mean age was 23.9 ± 4.8 (range, 18–40) years. Of the 94 participants 35 (37.2%) had a psychiatric diagnosis, 13 (13.8%) had moderate-severe depression and 20 (21.2%) had moderate-severe anxiety according to the BDI and BAI, respectively. The probability of having a psychiatric disorder was higher if the keratoconus was more severe. Patients with a psychiatric diagnosis scored lower on physical functioning, role limitations due to emotional problems, energy/fatigue; emotional well-being, social functioning and pain subscales of the Short Form-36 (SF-36). Having a SCID-1 psychiatric diagnosis and the presence of a psychiatric disorder did not significantly affect NEI-RQL-42 questionnaire scores. ConclusionsThere was high psychiatric morbidity among patients with keratoconus. Having a psychiatric disorder was associated with lower QoL as measured using the SF-36.

Clinical Effectiveness of Laser-Induced Increased Depth of Field for the Simultaneous Correction of Hyperopia and Presbyopia.

To evaluate the visual outcomes of patients with presbyopic hyperopia, comparing the current standard of monovision treatment with a novel bilateral presbyopic LASIK (Custom-Q mode) technique. This prospective comparative study of consecutive eligible patients with presbyopic hyperopia undergoing a bilateral presbyopic laser in situ keratomileusis technique was conducted between January 2018 and February 2019. After contact lens-simulated monovision measurements were obtained, the non-dominant eyes had a negative aspheric ablation profile planned using the Custom-Q nomogram (Alcon Laboratories, Inc). The dominant eye was operated on with a positive aspheric ablation profile. Visual acuity testing, refraction, corneal asphericity (▵Q), higher order aberrations, and a satisfaction questionnaire (National Eye Institute Refractive Error Quality of Life) were evaluated after the monovision trial and postoperatively. Twenty-eight patients, with a mean age of 56.03 ± 4.31 years, were included in the study. At 6 months, 100% of patients achieved 20/20 or better binocular uncorrected distance visual acuity (UDVA) versus 57% in the monovision group, 100% of patients achieved 20/25 or better binocular uncorrected intermediate visual acuity versus 32% in the monovision group, and 92.86% of patients achieved 20/25 or better binocular uncorrected near visual acuity (UNVA) in both groups. In contact lens monovision simulation, no patient reached a UDVA of 20/50 or better, with only 3.6% having a UNVA of 20/40 or better. The questionnaire demonstrated high patient satisfaction. The outcomes confirm the superiority of increased depth of focus using negative spherical aberration modulation in the non-dominant eye compared with contact lens monovision. They also demonstrate the effectiveness of positive spherical aberration induction to improve intermediate and near vision in the dominant eye. [J Refract Surg. 2021;37(1):16-24.].

Comparative analysis of objective and subjective outcomes of two different intraocular lenses: trifocal and extended range of vision

ObjectiveTo evaluate objective and subjective outcomes after bilateral implantation of two different multifocal intraocular lenses, which correct pseudophakic presbyopia in an adequate and homogeneous population court.Methods and analysisFifty patients were...

Premium intraocular lens implantation in eyes with vitrectomy done.

Phacoemulsification with premium intraocular lens (IOL) implantation has been increasingly popular in the recent years. However, it is not commonly implanted in eyes who had underwent previous vitrectomy surgery as the contrast sensitivity is thought to be reduced and surgeons are worried about poor visualization of the posterior segment after implantation. Since cataract and vitreoretinal diseases often coexist, premium IOLs should be a considerable option for implantation in carefully selected cases. This study aims at reporting the postoperative near and distance visual acuity and subjective quality of vision in eyes with premium IOLs implantation and vitrectomy done. Twenty eyes with posterior vitrectomy and premium IOL implantation from 2006 to 2018 were included. Fourteen eyes were included in Group 1 with patients who underwent a combined phacovitrectomy surgery in the same setting, and six eyes were included in Group 2 with patients who received premium IOL implantation after previous posterior vitrectomy. Both the postoperative corrected distance and near visual acuity at 1month, 3month and 1year are improved in both groups. The subjective quality of vision as graded by the National Eye Institute Refractive Error Quality of Life Instrument-42 questionnaire also showed high patient satisfaction in both groups. We conclude that the presence of a multifocal IOL does not impede visualization of the posterior segment during vitrectomy surgery and surgical complications were not raised. With careful patient selection and preoperative assessment, premium IOLs can be a considerable option in patients requiring posterior vitrectomy. Retrospectively registered with the HKSH Medical Group Research Committee (Ref No. RC-2019-31, Date of registration: December 13, 2019).

Extended Depth of Focus Versus Monofocal IOLs: Objective and Subjective Visual Outcomes.

To evaluate and compare the objective and subjective outcomes between bilateral implantation of the extended depth of focus (EDOF) Mini Well intraocular lens (IOL) and the aspheric monofocal Mini-4-Ready IOL (both SIFI S.p.A., Catania, Italy). This prospective comparative study included 25 patients (50 eyes) bilaterally implanted with an EDOF Mini Well IOL (EDOF group) and 25 patients (50 eyes) bilaterally implanted with a Mini-4-Ready IOL (monofocal group). Three-month follow-up data included corrected and uncorrected distance visual acuity at 4 m and 80, 67, and 40 cm. Defocus curves, subjective and objective contrast sensitivity, and objective optical quality (modulation transfer function cutoff and Strehl ratio calculated with Optical Quality Analysis System [OQAS]; Visiometrics SL, Terrassa, Spain), halometry, and reading performance were measured. Subjective visual quality was evaluated based on National Eye Institute Refractive Error Quality of Life Instrument 42 (NEI RQL-42) scores. Postoperative uncorrected and corrected monocular and binocular intermediate and near visual acuity was significantly better in the EDOF group (P < .001). No differences were observed for distance visual acuity (P ⩾ .312). Defocus curve outcomes for myopic values were better in the EDOF group (P < .001). No significant differences were found in hyperopic (obtained in steps of +0.50 diopters [D] from emmetropia to 1.50 D) values (P ⩾ .095), contrast sensitivity curves (P ⩾ .087), or OQAS outcomes (P ⩾ .138). Halometric values were significantly better in the monofocal group (P < .05). There was a correlation between mean keratometry values and intermediate/near visual acuity. Significantly better NEI RQL-42 subscale scores for near vision, far vision, activity limitations, glare, dependence on correction, and suboptimal correction were noted in the EDOF group (P < .05). Intermediate and near visual acuity was better after EDOF IOL than after aspheric monofocal IOL implantation while maintaining similar levels of visual quality, except for halo perception. [J Refract Surg. 2020;36(4):214-222.].

Evaluation of visual quality after EVO-ICL implantation for hypermyopia: An observational study.

The purpose of this retrospective study was to evaluate the visual quality, objective scattering index, aberration, etc after Implantable Collamer Lens with center hole (EVO-ICL) implantation to treat patients with hypermyopia (diopter > −10 D).A total of 30 eyes underwent EVO-ICL implantation. The uncorrected distance visual acuity (UDVA), best-corrected visual acuity (BCVA), equivalent spherical degree, aberration, visual quality parameters, and corneal endothelial cell density were compared preoperative and postoperative. Fill in the National Eye Institute Refractive Error Quality of Life Instrument-42 before and after surgery.The modulation transfer function (MTF), Optical Quality Analysis System (OQAS) II values (OV 100%, 20%, 9%), and Stahl ratio 1 and 3 months after surgery were higher than the respective preoperative values. The objective scatter index value increased 1 week after surgery, but decreased 1 and 3 months after surgery compared with the preoperative values. Total aberration (TA), total low-order aberration (tLOAs), and defocus decreased at 1 week and 3 months after EVO-ICL implantation. Total high-order aberration (tHOAs) and spherical aberration were significantly increased 1 week after surgery and decreased 3 months after surgery, and the difference was statistically significant. Astigmatism, coma, and clover were not significantly different in each time period. TA, tLOAs, tHOAs, defocus, and spherical aberration were higher at 1 week than 3 months after surgery. At 3 months after surgery, the scores of the patients’ NEI-RQL-42 scale were all improved except that the glare was lower than that before surgery. There was no significant difference in the density of corneal endothelial cells before and 3 months after surgery.For patients with hypermyopia, the postoperative subjective and objective visual quality of EVO-ICL implantation was better than preoperative.

Vision-Specific Quality of Life: Laser-Assisted in situ Keratomileusis Versus Overnight Contact Lens Wear.

To compare the visual-related quality of life in myopic subjects with different refractive treatments such as continuous wear of silicone-hydrogel contact lenses (CL), corneal refractive therapy (CRT), and laser-assisted in situ keratomileusis (LASIK). The National Eye Institute Refractive Error Quality of Life Instrument (NEI RQL-42) questionnaire was administered to 96 subjects with a mean age of 30.0±7.9 years. There were 72 myopic subjects with a mean spherical equivalent of -2.74±0.98 D (-5.50 to -1.25 D). Subjects were corrected with LASIK (n=24), Paragon CRT orthokeratology lenses (n=24), and lotrafilcon A silicone-hydrogel CL under continuous wear (n=24). The NEI RQL-42 survey was used to compare differences between groups as well as with an emmetropic group (n=24). After 1 year of treatment, significant differences were found among all groups in the subscales glare (P=0.017), symptoms (P=0.016), dependence on correction (P<0.001), and worry (P<0.001). The mean difference compared with emmetropes were -5.5% (P=0.063) for LASIK patients, -2.0% (P=0.212) for orthokeratology subjects, and +1.6% (P=0.934) for the silicone-hydrogel CL group. Myopic subjects analyzed in this study reported better vision-related quality of life when they were corrected with continuous wear silicone-hydrogel lenses. The average score reached by CRT was similar to emmetropes, which showed the main disadvantage in worry subscale. The patients who underwent LASIK had the lowest valuation, highlighting the decreases in scores of diurnal fluctuations, glare, and especially in expectations and worry subscales, due to the first and second subscales, but especially to the false expectations created about treatment.

Efficacy of Toric Contact Lenses in Fitting and Patient-Reported Outcomes in Contact Lens Wearers.

To assess whether patient-reported measures are improved with soft toric contact lenses (TCLs) compared with soft spherical contact lenses (SCLs) and whether clinical time needed to fit TCL is greater than SCL. Habitual contact lens wearers with vertexed spherical refraction +4.00 to +0.25 D or -0.50 to -9.00 D and cylinder -0.75 to -1.75 DC were randomly assigned to be binocularly fitted into a TCL or SCL, and masked to treatment assignment. Time to successful fit was recorded. After 5 days, the National Eye Institute Refractive Error Quality of Life Instrument (NEI-RQL-42) and modified Convergence Insufficiency Symptom Survey (CISS) were completed. After washout, subjects were fit into the alternative lens design (TCL or SCL). Outcomes were evaluated using linear mixed models for the time to fit and CISS score, generalized linear model for the successful fit, and Wilcoxon tests for the NEI-RQL-42. Sixty subjects (71.7% women, mean age [±SD] = 27.5±5.0 years) completed the study. The mean time to fit the TCL was 10.2±4.3 and 9.0±6.5 min for the SCL (least square [LS] mean difference (TCL-SCL)=1.2, P=0.22). Toric contact lens scored better than SCL in global NEI-RQL-42 score (P=0.006) and the clarity of vision (P=0.006) and satisfaction with correction subscales (P=0.006). CISS showed a 15% reduction in symptoms (LS mean difference [TCL-SCL]=-2.20, P=0.02). TCLs are a good option when trying to improve the vision of patients with low-to-moderate astigmatism given the subjective improvements in outcomes.

Vision-Related Quality of Life and Perception of Military Readiness and Capabilities Following Refractive Surgery Among Active Duty U.S. Military Service Members.

To assess vision-related quality of life and military readiness and capabilities among active duty U.S. military service members undergoing refractive surgery. In this prospective, single-center, observational study, active duty U.S. military service members electing to undergo refractive surgery were asked to complete a military performance questionnaire and the National Eye Institute Refractive Error Quality of Life Instrument (NEI RQL-42) preoperatively and at 6 months postoperatively. On the military performance questionnaire, participants rated (1 = very bad to 5 = very good) how they felt their vision affected their military readiness and capabilities after refractive surgery. Among 360 participants at 6 months postoperatively, the overall mean military performance score increased from 3.6 ± 0.8 to 4.8 ± 0.3, a change of 1.2, with 91.7% of the participants indicating an overall improvement in readiness and capability (P < .001). Scores measuring overall individual readiness, contribution to unit's mission, use of night vision goggles, function at night, weapons sighting ability, employment of personal masks, weather extreme environmental conditions, and optical support were significantly higher postoperatively (P < .001). For the NEI RQL-42, scores were significantly higher postoperatively for the subscales clarity of vision, expectations, near vision, far vision, diurnal fluctuations, activity limit, glare, dependence on correction, worry, appearance, and satisfaction with correction (all P < .001), but not for symptoms after refractive surgery (P = .403). Refractive surgery significantly improves military readiness and capabilities and vision-related quality of life of active duty U.S. military service members with refractive error. [J Refract Surg. 2018;34(9):597-603.].

Vision screening for correctable visual acuity deficits in school-age children and adolescents.

Vision screening for correctable visual acuity deficits in school-age children and adolescents.

Comparison of implantation of multifocal intraocular lens with different additional diopter

Objective To compare the visual quality after implantation of multifocal intraocular lenses(IOLs)with different additional diopter or their combination in both eyes. Methods One hundred and eighty eyes of 90 patients with cataract that underwent phacoemulsification and implantation of a multifocal IOL were divided into 3 groups, each group had 60 eyes of 30 cases. The + 2.5 D group received IOL implantation of + 2.5 D addition; the+ 3.0 D group received IOL implantation of + 3.0 D addition; the combined group of binocular received IOL implantation both + 2.5 D addition in one eye and + 3.0D addition in other eye. The visual acuities of 30 cm, 50 cm and 5m were observed 6 months after surgery. Quality of vision, patient satisfaction and spectacle independence were evaluated with the National Eye Institute Refractive Error Quality of Life Instrument-42 questionnaire. Results The difference in uncorrected distant vision was not significant among 3 groups 6 months after surgery.The uncorrected near vision in+ 3.0 D group and the combined group were better than that in + 2.5 D group(P=0.003, 0.016). In + 2.5 D group and the combined group uncorrected intermediate vision were better than that in+ 3.0 D group(P=0.000, 0.002). The uncorrected vision at 30 cm, 60 cm and 5 m distances in the combined group were good after surgery.In the combined group, the expectation(P=0.017, 0.002) and activity limitation(P=0.006, 0.019)were obviously better than those in other two groups.The + 2.5D group of incidence of glare was less than that of other two groups(P=0.004, 0.009). The differences in other survey items of the three groups were not statistically significant. Conclusion The bilateral implantation of the same multifocal IOL can improve the vision of near and intermediate distances, the combination of these IOLs in both eyes can increase the range of spectacle independence without compromising the contrast sensitivity and quality of vision. Key words: Lens, intraocular, multifocal; Cataract; Visual acuity, distance, intermediate, near