Overall Quality Of Vision Research Articles

Wear Experience of a Water Surface Daily Disposable Contact Lens in Existing Silicone Hydrogel Planned Replacement Lens Wearers.

PurposeThe health benefits of silicone hydrogel lens materials and a daily replacement modality have been demonstrated in previous studies; however, existing planned replacement lens wearers may resist changing to a new lens replacement schedule. The purpose of this study is to evaluate the wear experience of satisfied planned replacement silicone hydrogel wearers when refit into a silicone hydrogel daily disposable lens.Patients and MethodsIn this open-label, non-comparison study, satisfied wearers of two week planned replacement contact lenses were evaluated for inclusion criteria and refit with optimized prescriptions in their habitual lenses. At a follow-up visit one week later, participants were refit with the study daily disposable lenses and completed visual analog scale (VAS) surveys of initial quality of vision, comfort, and satisfaction. Participants returned for a final visit after two weeks of wearing the study daily disposable lenses. At the final visit, VAS surveys for both overall and end of day (EOD) vision, comfort, and dryness were completed. Overall median and interquartile range (IQR) were assessed for all surveys in the study.ResultsThirty individuals completed the study (29.1 ± 7.8 years old; 19 female). Median (IQR) results for the initial impression VAS surveys were 92.50(11.75) for quality of vision, 92.50(18.00) for comfort, and 93.00(18.00) for satisfaction. Final VAS survey results revealed median scores of 87.50(25.00) for EOD quality of vision and 82.50(51.25) for EOD comfort. The median overall quality of vision was 91.00(17.00) and overall comfort was 93.00(28.50). Median (IQR) overall dryness was 28.50(49.00) and median EOD dryness was 30.50(64.25).ConclusionThe findings of this study suggest that providers can successfully refit satisfied wearers of early generation silicone hydrogel planned replacement lenses into a new generation silicone hydrogel daily disposable lens while maintaining satisfaction.

Clinical Comparison of a Silicone Hydrogel and a Conventional Hydrogel Daily Disposable Contact Lens.

PurposeTo compare the subjective performances of verofilcon A daily disposable silicone hydrogel contact lenses (CLs) and etafilcon A hydrogel CLs.MethodsSuccessful wearers of spherical soft CLs for distance correction were prospectively randomized to wear verofilcon A or etafilcon A lenses for 1 week and crossed over to the alternative lenses. The primary study objective was a comparison of distance visual acuity (VA). Exploratory endpoints included subjective overall lens preference (5-point scale) and subjective ratings (10-point scales) of end-of-day (EOD) vision, overall handling, insertion comfort, EOD comfort, overall quality of vision, overall comfort, vision throughout the day, lens handling at insertion, and lens handling at removal.ResultsOf 92 subjects (184 eyes), 46 each were randomized to verofilcon A or etafilcon A lenses and subsequently crossed over to the other lenses. Evaluation of distance VA showed that verofilcon A lenses were noninferior to etafilcon A lenses. Comparison of lens preference showed that 68 (73.9%) subjects somewhat or strongly preferred verofilcon A lenses, whereas 21 (22.9%) somewhat or strongly preferred etafilcon A lenses (p<0.0001). Mean ± SD ratings of EOD vision (8.6±1.5 vs 7.7±1.9), overall handling (8.7±1.5 vs 6.9±2.3), insertion comfort (9.2±1.0 vs 7.7±1.9), and EOD comfort (8.0±1.9 vs 7.0±2.2) were all significantly (p≤0.0001 each) higher for verofilcon A than for etafilcon A lenses. Mean ± SD ratings of overall quality of vision (8.9±1.2 vs 8.2±1.8), overall comfort (8.6±1.5 vs 7.4±1.8), vision throughout the day (8.9±1.3 vs 8.1±1.8), lens handling at insertion (9.0±1.4 vs 6.9±2.5), and lens handling at removal (8.3±2.1 vs 7.7±2.2) were also significantly higher for verofilcon A lenses. No subject experienced any ocular adverse events.ConclusionAfter 1 week of wear, the study population reported that ratings for subjective endpoints were significantly higher for verofilcon A lenses than for etafilcon A lenses.

Comparison of the visual performance and quality of vision with combined symmetrical inferonasal near addition versus inferonasal and superotemporal placement of rotationally asymmetric refractive multifocal intraocular lenses

To compare the postoperative quality of vision between different bilateral placements of near segments of rotationally asymmetric refractive multifocal intraocular lenses (IOLs) and to determine how this affects visual performance. Cathedral Eye Clinic, Belfast, Northern Ireland, United Kingdom. Retrospective comparative case series. The study enrolled consecutive patients having refractive lens exchange and implantation of rotationally asymmetric multifocal IOLs. Group 1 received bilateral SBL-3 IOLs and Group 2 received bilateral Lentis Mplus LS-312 MF30 IOLs, with the near segments placed inferonasally in each group. Group 3 received a Lentis Mplus LS-312 MF20 IOL in the dominant eye with the near segment positioned superotemporal and a Lenstec SBL-3 IOL positioned inferonasally in the fellow eye. Binocular uncorrected (UDVA) and corrected distance visual acuities, binocular uncorrected near (UNVA) and intermediate (UIVA) visual acuities, binocular distance-corrected near and intermediate visual acuities, and quality of vision were evaluated over 3months postoperatively. The study enrolled 180 patients (360 eyes). There was no significant difference between the groups in binocular UDVA, UIVA, and UNVA; however, there was a significant difference between the groups in quality of vision (P≤.001). Group 3 had significantly better overall quality of vision. When implanting rotationally asymmetric multifocal IOLs, a combination of superotemporal placement of the near segment (+2.00 diopter [D] addition [add]) in the dominant eye with inferonasal placement of the near segment (+3.00 D add) in the fellow eye yielded consistent, high overall quality of vision and uncorrected visual acuity. None of the authors has a financial or proprietary interest in any material or method mentioned.

Quality of vision with traditional monovision versus modified monovision

AbstractPurpose To compare binocular subjective quality of vision with modified monovision (MMV) (ie different combinations of spherical (SA4) and secondary spherical (SA6) aberration on each eye) versus traditional monovision (TMV) with different level of anisometropiaMethods A numerical eye model was used to generate images (ie three 0.4 logMAR high contrast letters) viewed through a 4.7mm pupil, degraded by various condition of SA and for proximities from ‐5D to 5D (Naked eye, SA4‐0.4μm, SA4+0.4μm, SA4‐0.4 and SA6+0.2μm, SA4+0.4 and SA6‐0.2μm). Binocular vision was simulated using a 3D‐NVIDIA video device projecting different image on each eye. Binocular through‐focus (TF) quality of vision was evaluated using a grading scale (ITU‐R 500 recommendation) by four subjects with TMV for different level of anisometropia (ie 0.5 to 3D at 0.5D step) and with various combination of MMVResults Area under TF curve (ie a way to evaluate quality of vision) measured for a fair or higher image quality was increased with TMV and MMV compared to naked eye because of the summation of the two best monocular curves. With TMV, a 2.5D anisometropia was the more effective to increase area under TF curve with however a lack of intermediate vision. With MMV the greatest increase of quality of vision was obtained with reverse profile of SA4 and SA6 on each eye (ie SA4‐0.4 and SA6+0.2μm on one eye and SA4+0.4 and SA6‐0.2μm on the other eye). Compared to TMV, reverse profiles of MMV showed a significant benefit in improving area under TF curve thanks to a better quality of intermediate visionConclusion MMV especially with reverse profiles of SA improved overall quality of vision without the lack of intermediate quality of vision intermediate quality of vision induced by TMV

Therapeutic use of mini-scleral lenses in a patient with Graves’ ophthalmopathy

Patients with Graves’ ophthalmopathy can be very challenging to manage secondary to the complex nature of their disease presentation. Patients may present with a variety of ocular findings including: lid retraction, periorbital and lid swelling, chemosis, conjunctival hyperemia, proptosis, optic neuropathy, restrictive myopathy, exposure keratopathy and/or keratoconjunctivitis sicca. Mini-scleral and scleral lens designs have been important in the management of irregular and regular corneas, and in the therapy of ocular surface diseases.We present here the case of a 48-year-old Caucasian male who had been diagnosed with Graves’ ophthalmopathy 13 years earlier. With significant ocular surface staining and over ten diopters of astigmatism, the patient had never been able to wear contact lenses comfortably. After being fit with the Mini-Scleral Design™ lenses, his vision improved to 20/25 OU, his ocular surface improved, and overall quality of vision increased.

Evaluation of the higher order wavefront aberrations and the quality of vision after correction of aphakia by a retropupillary implantation of the Verisyze® iris‐claw intraocular lens

Abstract Purpose To investigate the influence of the secondary implantation site of the Verisyse® iris‐claw intraocular lens (IOL) on high order aberrations (HOAs) using wavefront analysis in aphakic patients. Methods Twenty five aphakic patients (25 eyes) who had been left aphakic after complicated phacoemulsification, leaving no capsular support, but good iris support and clear unwounded cornea implantated with the aphakic Verisyse®(AMO) IOL either implanted retropupilarely or over the iris. Wavefront aberrations and contrast sensitivity were measured using the Imagine Eyes IRX3 SH aberrometer. Results Twelve patients were implanted in the anterior chamber versus thirteen, who had the IOL clipped behind the iris. Surgery was uneventful in all patients. No postoperative complication was observed in the two groups. Best corrected visual acuity was significantly higher and HOAs were significantly lower in the retropupilarely implanted group. Simulated contrast sensitivity results calculated from Point Spread Function measurements were significantly better in the retropupilarly implanted group. There was no significant difference regarding HOAs and vision quality between the retropupillary implanted group and the panel of control âtients implanted with standard monofocal IOL in the capsular bag. Conclusion In addition to being atraumatic, the Verisyse® IOL implanted behind the iris may restore vision in the absence of capsular support in a more physiological way than when fixated over the iris. The overall quality of vision is better when the Verisyse® is implanted behind the iris and comparable to values obtained with standard monofocal IOLs.

Functional outcomes after bilateral implantation of apodized diffractive aspheric acrylic intraocular lenses with a +3.0 or +4.0 diopter addition power: Randomized multicenter clinical study

To evaluate functional outcomes after bilateral implantation of apodized diffractive aspheric acrylic intraocular lenses (IOLs) with a +3.0 or +4.0 diopter (D) addition (add) power. Twelve study centers in the United States. This randomized patient-masked parallel-group 6-month follow-up study comprised patients having bilateral cataract extraction with implantation of an AcrySof IQ ReSTOR SN6AD3 IOL with a +4.0 D add power (+4.0 D group) or an AcrySof IQ ReSTOR SN6AD1 IOL with a +3.0 D add power (+3.0 D group) (both IOLs, Alcon, Inc.). Visual acuity, defocus testing, patient-reported outcomes, and safety measures were assessed. Of the 279 patients, 141 were in the +3.0 D group and 138 were in the +4.0 D group. Binocular distance-corrected intermediate visual acuity was statistically significantly better in the +3.0 D group than in the +4.0 D group (P<.0001); there was no difference in binocular near or distance visual acuity. There were no statistically significant differences in visual disturbances between the 2 groups. Patients in both groups reported excellent overall spectacle independence, near visual function, and satisfaction with the IOLs. Intermediate vision at a mean reading distance of approximately 40 cm was better with the aspheric IOL with a +3.0 D add than with the aspheric IOL with a +4.0 D add, as shown by the near peak in the mean binocular defocus curve; near and distance acuity were similar between the 2 IOLs. Patients reported excellent overall quality of vision, spectacle independence, and satisfaction.

Correlation of Aberrometry, Contrast Sensitivity, and Subjective Symptoms With Quality of Vision After LASIK

To compare which parameter category (wavefront data, psychophysical data, or subjective symptoms) predicts best subjective quality of vision after LASIK. Twenty-eight eyes (15 patients) were included. Twenty-three eyes (12 patients) underwent uneventful LASIK; 5 eyes (3 patients) were symptomatic eyes treated with myopic LASIK elsewhere. Mean preoperative spherical equivalent refraction was -4.79+/-1.92 diopters (D) (range: -1.63 to -7.13 D); mean patient age was 36.6+/-7.4 years (range: 18 to 48 years). All examinations were performed 1 month postoperatively. The wavefront error was described with Zernike polynomials (6-mm pupil). Psychophysical tests included high-contrast visual acuity and contrast sensitivity with and without glare at 167 cd/m(-2), 1.67 cd/m(-2), and 0.167 cd/m(-2) with best spectacle correction. Correspondingly, overall subjective quality of vision and frequency of visual symptoms (glare, halos, starbursts, ghosting, blur) were assessed for three lighting conditions (photopic, high-mesopic, and low-mesopic) using a questionnaire with a visual analog scale. For each parameter category and each lighting condition, a multiple stepwise backwards regression model with the overall quality of vision item value as dependent was applied. Under all lighting conditions, subjective symptom scores predicted subjective quality of vision best (adjusted R2=0.83-0.92) with blur as the main predictor throughout all conditions. Psychophysical tests did not significantly predict postoperative subjective quality of vision. The adjusted R2 for the Zernike coefficients was highest for low-mesopic (0.56) and lowest for photopic conditions (0.31). Different parameter categories for the description of optical quality did not predict subjective quality of vision after LASIK equally. Subjective symptom scores had the highest predictability, whereas psychophysical tests with spectacle correction had no predictability. The latter probably do not reflect all dimensions of subjective quality of vision.

Visual Function in Patients With Choroidal Neovascularization Resulting From Age-Related Macular Degeneration: The Importance of Looking Beyond Visual Acuity

A detailed understanding of overall quality of vision may help primary care physicians, optometrists, and general ophthalmologists to improve the care of patients with choroidal neovascularization (CNV) resulting from age-related macular degeneration (AMD). Published literature was reviewed using Medline searches and the authors' knowledge of the field. Both visual acuity and contrast sensitivity are strongly associated with the ability to perform vision-related activities of daily living. CNV resulting from AMD often leads to scotoma, which is also strongly associated with the ability to perform everyday activities such as reading and driving. Contrast sensitivity and visual field extent may be better predictors of many abilities than visual acuity. Laser photocoagulation, verteporfin therapy, and pegaptanib sodium have been proven to reduce the risk of visual acuity loss in patients with CNV resulting from AMD. Laser photocoagulation frequently causes scotoma, but data on its effects on other aspects of overall quality of vision are scarce. Verteporfin therapy has been shown to also reduce the risk of contrast sensitivity loss and has been associated with stabilization or reduction of scotoma size. Treatment effects beyond visual acuity have not been investigated for pegaptanib. Detailed assessment of overall quality of vision also aids the design of vision rehabilitation programs tailored to the needs of individual patients. Understanding the impact of vision loss on patients with CNV resulting from AMD and assessing treatment benefits requires assessment of overall quality of vision. Primary care physicians and optometrists have an important role in ensuring that patients receive the best possible care, which can be aided by prompt referral to an ophthalmologist or retina specialist and collaboration with low-vision specialists and optometrists who together can make detailed assessments of overall quality of vision, implement appropriate treatment, and design effective rehabilitation strategies.

Custom-contoured ablation pattern method for the treatment of decentered laser ablations

Purpose: To evaluate the custom-contoured ablation pattern (C-CAP) method as a tool for providing customized laser ablations for decentered ablations based on corneal topography data. Setting: Department of Ophthalmology, Stanford University, Stanford, California, USA. Methods: In a prospective noncomparative interventional case series, 8 eyes from 7 post-laser in situ keratomileusis (LASIK) patients and 1 post-photorefractive keratectomy (PRK) patient with symptomatic laser decentration were treated with the C-CAP method. The Zeiss Humphrey topography system was used to identify and analyze decentered ablations. The computer software allowed the surgeon to preoperatively model the effect of various ablation schemes on the preoperative topography until a scheme that alleviated the decentration was identified. The planned ablation parameters, which included size, depth, and location of the ablation, were programmed into the Visx S4 excimer laser before treatment. Results: The mean follow-up after C-CAP ablation was 4.2 months (range 1.8 to 6.3 months). At the last postoperative examination, no eye lost a line of best spectacle-corrected visual acuity (BSCVA). The uncorrected visual acuity (UCVA) improved by 3 lines in 1 eye (12.5%), by 2 lines in 1 eye (12.5%), and by 1 line in 3 eyes (37.5%); it remained unchanged in 2 eyes (25.0%) and decreased by 1 line in 1 eye (12.5%). The BSCVA improved by 3 lines in 1 eye (12.5%), by 2 lines in 2 eyes (25.0%), and by 1 line in 3 eyes (37.5%); it remained unchanged in 2 eyes (25.0%). In all eyes, including those without improvement in UCVA or BSCVA, a significant improvement in centration and subjective complaints was achieved. The pre-C-CAP and post-C-CAP root-mean-square (RMS) wavefront data were available in 5 of 8 eyes. The total and higher-order RMS aberrations decreased by 41.7% ( P = .0027) and 45.5% ( P = .039), respectively, after C-CAP treatment. Conclusions: Early U.S. results show the topography-driven C-CAP method is an effective tool to address untreatable postsurgical decentration. This method is presented as a technique to enhance the overall quality of vision, reduce patient-perceived visual aberrations, regularize the corneal surface, and maximize BSCVA.

The effect of add power on distance vision with the Acuvue Bifocal contact lens

This study was designed to determine if subjective evaluation of quality of distance vision with the Acuvue Bifocal contact lens could be correlated with high- and low-contrast acuity scores. LogMAR visual acuities of 20 non-presbyopic subjects were measured using high and low-contrast Bailey-Lovie charts. Each subject wore an Acuvue Bifocal contact lens with add powers +1.00, +1.50, +2.00, and +2.50, each optimized for best distance acuity. Subjects showed significantly decreased acuities with increasing add; a low-contrast target heightened this effect. Subjects reported a reduction in quality of distance vision, increasing fluctuation, ghosting/shadows, and halos around lights that correlated with increasing add power. Our findings suggest that the Acuvue Bifocal contact lens may be expected to perform best for presbyopes with low-to-moderate bifocal add requirement, and that clinicians should anticipate decreased low-contrast acuity and reduced overall quality of vision as add powers are increased.

Visual function index (VF-14) in exudative age-related macular degeneration of long duration

Purpose To evaluate the Visual Function Index (VF-14) questionnaire for its effectiveness in assessing visual function in patients with longstanding exudative age-related macular degeneration (AMD). Design Observational case series. Methods The records of 167 consecutive patients with recent neovascularization related to AMD between June 1990 and December 1994 at the Helsinki University Eye Clinic were analyzed in 1999. Of 121 patients still living, 74 (61%) attended the reexamination. After exclusions, data from 62 patients were analyzed. The VF-14 score, plus global assessment scores of satisfaction with vision and quality of vision, in which patients graded the subjective level of difficulty with their vision, best-corrected visual acuity (BCVA), contrast sensitivity, the area of the AMD lesion, and the shortest distance and direction from the center of the fovea to the edge of the subfoveal lesion, were analyzed. Results The VF-14 score correlated significantly with BCVA ( P < .01), contrast sensitivity ( P < .01), and global assessment scores ( P < .01), showing stronger correlations with global assessment scores than did BCVA. In multivariate regression analysis, the global assessment scale of overall quality of vision and BCVA in the better eye were significant predictors ( P < .001) of the variability in the VF-14 score. Conclusion The VF-14 reflects visual function of patients with late AMD more effectively than BCVA measurement alone. The VF-14 can thus be used to compare the visual handicap of late AMD patients with that of patients with other eye diseases.

Assessment of vision-related function in patients with age-related macular degeneration

ObjectiveTo investigate the validity of the visual function index (VF-14) in assessing visual function in patients with age-related macular degeneration (AMD). DesignProspective noncomparative observational case series. ParticipantsOne hundred fifty-nine consecutive patients attending a sole practitioner’s academic retina-only clinic from May 1998 through August 1998 and from May 1999 through August 1999. Main outcome measuresCorrelations were calculated between the VF-14 scores and the medical outcomes study 36-item short form (SF-36), weighted comorbidity scale, visual acuity and clinical AMD severity (stage), and vision self-assessment scales. Documentation of the severity of macular degeneration was performed by a sole examiner. ResultsThere was a moderately strong correlation between visual acuity and trouble with vision (r = 0.51), satisfaction with vision (r = −0.50), and overall quality of vision (r = −0.56). A strong correlation was noted between VF-14 score and patients’ self-rating of amount of trouble with vision (r = −0.67), satisfaction with vision (r = 0.62), and overall quality of vision (r = 0.67). In comparison, correlations between SF-36 score and patients’ self-rating of amount of trouble with vision, satisfaction with vision, and overall quality of vision ranged from r = 0.37 to r = −0.40. Linear regression analysis for the overall study population indicated that AMD severity was not an independently significant predictor of VF-14 score after adjusting for visual acuity. However, among patients with 20/20 vision in the better eye, AMD severity was an independently significant predictor of VF-14 score after adjusting for visual acuity in the worse eye. ConclusionsThe VF-14 exhibits a considerable degree of validity as a measure of functional impairment in patients with AMD. Age-related macular degeneration severity was an independently significant predictor of VF-14 score in the group of patients with 20/20 vision in the better eye, but this did not hold true for the overall study population. Age-related macular degeneration is associated with substantial impairment in reported visual function.

Laser in situ keratomileusis with a scanning excimer laser for the correction of low to moderate myopia with and without astigmatism

Purpose: To evaluate the safety and effectiveness of and patient satisfaction with laser in situ keratomileusis (LASIK) performed with a scanning excimer laser by experienced surgeons to correct low and moderate levels of myopia and astigmatism. Setting: Clinique Laservue, Montreal, Quebec, Canada. Methods: A consecutive series of 125 patients (236 eyes) with myopia of −0.5 to −7.0 diopters (D) and cylinder less than 2.5 D were enrolled in this single-center prospective clinical trial. The patients were treated with LASIK and followed for 6 months. The System-ALK Automated Corneal Shaper® microkeratome (Bausch & Lomb Surgical) with a 180 μm thickness plate and the Technolas® 217 excimer laser (Bausch & Lomb Surgical) with PlanoScan software for the stromal ablation were used in all procedures. Since this version of PlanoScan tended to undercorrect, a mean of 14.7% was added to the standard nomogram. Patient satisfaction was assessed by questionnaires administered preoperatively and 1 and 6 months postoperatively. Retreatments for enhancement were not performed during the 6-month follow-up. Results: Six months after LASIK (86.4% follow-up), the mean postoperative manifest spherical equivalent was +0.02 D ± 0.64 (SD) compared with a preoperative mean of −4.01 ± 1.59 D. The uncorrected visual acuity was 20/40 or better in 94.6% of eyes and 20/20 or better in 81.9%. A total of 91.2% were within ±1.0 D of emmetropia and 73.0% were within ±0.5 D. Only 2 eyes were overcorrected by >1.0 D. Of the eyes with astigmatic myopia, 86.8% were within ±1.0 D of the intended cylinder correction (by vector analysis) and 73.0% were within ±0.5 D. The refractions were generally stable after 1 month, and the change in refraction between postoperative examinations was within ±0.5 D in 88.0% of eyes. A 1-line decrease in best spectacle-corrected visual acuity was seen in 11.3% of eyes, and no eye lost more than 1 line. An increase of 1 or 2 lines was seen in 45.1%. No intraoperative problems occurred, and the interface was clear in all eyes. At 6 months, most symptoms present significantly more frequently than preoperatively were “mild”; none were “marked” or “severe.” A total of 90.5% of eyes were reported with marked to extreme improvement in the overall quality of vision, and 99.0% of patients said they would choose LASIK surgery again. Conclusions: Mild to moderate myopia, with and without astigmatism, was corrected safely, effectively, and predictably with a high degree of patient satisfaction using LASIK with a scanning excimer laser and the System-ALK Automated Corneal Shaper.

Validity of the Visual Function Index (VF-14) in Patients With Retinal Disease

To test the validity of the Visual Function Index (VF-14) in patients with retinal disease. A self-administered questionnaire package in association with clinical examination findings. Consecutive patients attending the Vancouver General Hospital Eye Care Centre, Vancouver, British Columbia, retina clinic between May 1 and August 15, 1998. Responses to the questionnaire package as they relate to global self-assessment scales and visual acuity. In addition, correlations were calculated between the VF-14, the 36-Item Short-Form Health Survey, a Weighted Comorbidity Scale, and visual acuity scores. Five hundred forty-seven patients were given the questionnaire package to complete. The VF-14 demonstrated a moderately strong positive association with patient self-rating of amount of trouble, satisfaction, and overall quality of vision. Correlations between the 36-Item Short-Form Health Survey, visual acuity, and the global scales were mild to moderate. The VF-14 was moderately correlated with visual acuity in the better and the worse eyes. This study provides support for the validity of the VF-14 as a measure of functional impairment in patients with retinal disease. Once responsiveness has been measured and an analysis of disease subtypes has been carried out, the VF-14 will be ready for inclusion in clinical trials to evaluate patients' functional ability. Further implementation and development of this outcome measure will better our understanding of the utility of the functional assessment format for patients with retinal disease.

Visual, refractive, and subjective outcomes after photorefractive keratectomy for myopia of 6 to 10 diopters using the Nidek laser

Purpose To analyze the results of photorefractive keratectomy (PRK) for myopia of 6.0 to 10.0 diopters (D) using the Nidek laser and compare them with those in other series, including LASIK, and to analyze the subjective aspects of vision. Setting Remuera Eye Clinic, Auckland, New Zealand. Method One hundred ninety-two eyes of 162 consecutive PRK patients with a 6 month follow-up were studied. All had myopia in the range of 6.0 to 10.0 D by spherical equivalent. Astigmatism of up to 3.5 D was treated by laser simultaneously. At 6 months, uncorrected visual acuity, best spectacle-corrected visual acuity, residual refractive error, and corneal haze were recorded. After the 6 month examination, a questionnaire was sent to all patients. Results Uncorrected visual acuity of 20/20 was achieved in 59% of eyes and of 20/40 or better in 94%. The accuracy of correction was ±0.5 D of emmetropia in 77% and ±1.0 D in 94%. In 2 eyes (1.0%), corneal haze was assessed as 2+ and 2 Snellen lines of best corrected visual acuity were lost. The questionnaire revealed that 45% of patients had difficulties with night vision. This was better than before surgery in 35% but worse in 31%. Halos were seen around lights by 52%, but these were less than before surgery in 21% and worse in 26%. There was undue sensitivity to glare in 29%, but this was better than before surgery in 19% and worse in 28%. The overall quality of vision was better than before surgery in 60% and worse in 17%. Seventy-seven percent did not need spectacles. Ninety-eight percent said they would have the surgery again. Conclusions As long as the patients are informed of the limitations of PRK for myopia, the results are acceptable.

Evaluation of “high-cylinder” toric soft contact lenses

The purpose of this study was to evaluate lens performance, vision, and initial clinical success achievable with custom toric soft contact lenses fitted to patients with high amounts of astigmatism. Eleven subjects were fitted with high-water-content custom toric soft lenses for daily wear. Assessment/measurements of the lens-mark position on the eye, lens movement, visual acuity, wearing time, eye response to lens wear, and subjective evaluation of visual quality and stability were performed during the initial wearing/adaptation period. Nine subjects having an average of 3.16 D of astigmatism successfully wore the lenses on a full-time basis for 2 weeks of daily wear. The data indicated good visual acuity, but with great variability in subjective ratings of stability and quality of vision. Alignment of lenses on the eye was very good, ocular response was unremarkable, and seven of nine (78%) of the subjects elected to continue with lens wear after the initial 2 weeks of wear. The results suggest that high-cylinder toric hydrogels can provide reasonable vision and patient acceptance even while stability and overall quality of vision may be a challenge. Toric soft lenses in higher cylinder amounts, such as those utilized in this study, may be considered a reasonable vision correction option and one that can be provided in a straightforward and predictably successful manner in most cases.