Postoperative Uncorrected Distance Visual Acuity Research Articles

Astigmatic Outcomes after Wavefront-Guided and Wavefront-Optimized Refractive Surgeries for Myopia with Low to Moderate Cylinder

Purpose: To compare the efficacy and accuracy of wavefront-guided (WFG) and wavefront-optimized (WFO) PRK and LASIK for the treatment of myopia with low to moderate astigmatism.Methods: In this prospective cohort study, 215 active duty military service members (430 eyes, mean spherical equivalent -3.61 ± 1.53 D) electing either PRK or LASIK were randomized to undergo WFG or WFO treatment. Up to 12 months, postoperative visual outcomes following surgeries were compared between 4 treatment groups: WFG PRK, WFG LASIK, WFO PRK, and WFO LASIK for myopia with 0.25 to 0.50 D astigmatism (≤ 0.50 D cyl subgroup) and ≥ 0.75 D astigmatism (≥ 0.75 D cyl subgroup). High and low contrast visual acuities were assessed and vector analysis was performed.Results: At 12 months postoperatively, the surgically induced astigmatism, magnitude of error, correction and flattening indices were significantly different between treatment groups (P values ≤ 0.001) in the ≤ 0.50 D cyl subgroup. In ≥ the 0.75 D cyl subgroup, there were no significant differences in vector analysis parameters except for the magnitude of error and correction index (P values ≤ 0.010). The treatment groups were comparable in terms of postoperative uncorrected distance visual acuity, manifest spherical equivalent, and best-corrected low contrast visual acuity.Conclusions: No treatment modality showed consistent superiority in correcting low to moderate astigmatism. Overall, both PRK and LASIK using either wavefront-guided or wavefront-optimized laser platforms were similarly effective and accurate in treating myopia with a low to moderate amount of astigmatism.

Management of cataract in keratoconus: early visual outcomes of different treatment modalities.

A review of 31 eyes with keratoconus who developed cataract and underwent phacoemulsification. Visual acuities were measured 1mo postoperatively. Six eyes with a history of good corrected distance visual acuity (CDVA) and a similar refractive and topographic astigmatic axis were implanted with toric intraocular lenses (IOLs). The mean postoperative uncorrected distance visual acuity (UDVA) was 0.2 logMAR with a spherical equivalent (SE): 0.75D. Eleven eyes with a history of good CDVA and different refractive and topographic axis were implanted with monofocal IOL+/-Toric implantable collamer lenses to treat anisometropia and ametropia; mean UDVA was 0.25 logMAR with a mean SE: -0.51 D postoperatively. Six eyes with poor CDVA were first treated with intra-corneal ring segments, followed by phacoemulsification, the mean postoperative UDVA was 0.82 logMAR with an SE: 0.22 D. Eight eyes had advanced ectesia and received combined phacoemulsification and penetrating keratoplasty. Our approach is efficient in addressing ametropia after cataract surgery in keratoconic eyes.

Standard versus Accelerated Collagen Cross-Linking in Treatment of Keratoconus: Visual, Refractive, and Topographic Outcomes

Background: collagen cross-linking (CXL) is an effective, safe and rapidly progressive treatment modality for treatment of mild to moderate keratoconus not only in hindering the progression of the disease but also in improving the visual, refractive and topographic results. Objective: the study aims to compare the outcomes of standard and accelerated cross-linking in treatment of keratoconus. Patients and Methods: the present prospective study evaluated 99 eyes of 52 patients with keratoconus. They were classified into two groups; group (1) included 50 eyes (received standard CXL; 3Mw/cm2 , 30 min) (SCXL group) and group (2) 49 eyes (treated by accelerated CXL; 9Mw/cm2 , 10 min) (ACXL group). Spherical equivalent, uncorrected visual acuity, best-corrected visual acuity, and topographical analysis of the cornea were assessed at baseline and within 3 years postoperative. Simulated keratometry was measured in terms of Sim K-1, Sim K-2, K-max, cylindrical value, thickness of the cornea (at the thinnest point) and Q-value were evaluated. Results: postoperative uncorrected distance visual acuity and corrected distance visual acuity didn’t significantly changed in both groups. Postoperative spherical equivalent significantly decreased in standard CXL compared to accelerated CXL. Standard CXL had a greater effect in decreasing Simk-1, Simk-2, k-max and k-mean. K-max decreased from 52.33±5.55 to 50.35±5.14; P=0.07 and in accelerated group from 54.58±4.35 to 52.74±4.41; P=0.04. Also, postoperative corneal pachymetery (at thinnest location) was found to be more stable in standard CLX group. Conclusion: both standard and accelerated CXL are effective in early keratoconus management with better results in standard CXL procedure.

Standard versus Accelerated Collagen Cross-Linking in Treatment of Keratoconus: Visual, Refractive, and Topographic Outcomes

Background: collagen cross-linking (CXL) is an effective, safe and rapidly progressive treatment modality for treatment of mild to moderate keratoconus not only in hindering the progression of the disease but also in improving the visual, refractive and topographic results. Objective: the study aims to compare the outcomes of standard and accelerated cross-linking in treatment of keratoconus. Patients and Methods: the present prospective study evaluated 99 eyes of 52 patients with keratoconus. They were classified into two groups; group (1) included 50 eyes (received standard CXL; 3Mw/cm2 , 30 min) (SCXL group) and group (2) 49 eyes (treated by accelerated CXL; 9Mw/cm2 , 10 min) (ACXL group). Spherical equivalent, uncorrected visual acuity, best-corrected visual acuity, and topographical analysis of the cornea were assessed at baseline and within 3 years postoperative. Simulated keratometry was measured in terms of Sim K-1, Sim K-2, K-max, cylindrical value, thickness of the cornea (at the thinnest point) and Q-value were evaluated. Results: postoperative uncorrected distance visual acuity and corrected distance visual acuity didn’t significantly changed in both groups. Postoperative spherical equivalent significantly decreased in standard CXL compared to accelerated CXL. Standard CXL had a greater effect in decreasing Simk-1, Simk-2, k-max and k-mean. K-max decreased from 52.33±5.55 to 50.35±5.14; P=0.07 and in accelerated group from 54.58±4.35 to 52.74±4.41; P=0.04. Also, postoperative corneal pachymetery (at thinnest location) was found to be more stable in standard CLX group. Conclusion: both standard and accelerated CXL are effective in early keratoconus management with better results in standard CXL procedure.

Refractive and Visual Outcomes of SUPRACOR TENEO 317 LASIK for Presbyopia in Hyperopic Eyes: 24-Month Follow-up.

To analyze the efficacy, safety, predictability, and stability in hyperopic presbyopic laser in situ keratomileusis (LASIK) surgeries with the TENEO 317 algorithm (Bausch & Lomb Technolas, Munich, Germany). Eighty eyes from 40 patients who underwent hyperopic and presbyopic LASIK in this retrospective, observational, and longitudinal study were included. All patients had a 24-month follow-up. Excimer laser treatment was performed with TECNOLAS Perfect Vision GmbH TENEO 317 software version 1.25 (Bausch & Lomb) with the PROSCAN platform for the distance dominant eye and the SUPRACOR mild platform for the near dominant eye. Mean age was 53.90 ± 4.84 years (range: 42 to 66 years). Postoperative uncorrected distance visual acuity (UDVA) was 0.00 ± 0.04 (20/19.97) for the dominant eye and 0.14 ± 0.05 (20/27.65) for the non-dominant eye. Postoperative uncorrected near visual acuity was 0.51 ± 0.17 (J9) for the dominant eye and 0.09 ± 0.06 (J1.5) for the non-dominant eye, whereas 2.5% of non-dominant eyes lost two lines of corrected distance visual acuity. Half of non-dominant eyes lost one line, and 2.5% of dominant and non-dominant eyes changed 0.50 D or more between 3 and 24 months. PROSCAN surgery in the dominant eye and SUPRACOR surgery in the non-dominant eye using the TENEO 317 algorithm demonstrated that the hyperopic presbyopic excimer laser surgery technique resulted in acceptable and stable outcomes after 24 months of follow-up. [J Refract Surg. 2019;35(9):591-598.].

Prospective comparative study of tolerance to refractive errors after implantation of extended depth of focus and monofocal intraocular lenses with identical aspheric platform in Korean population

BackgroundTo evaluate the clinical outcomes of extended depth of focus (EDOF) and monofocal intraocular lenses (IOLs) that share identical aspheric platform and compare their visual acuity tolerance to postoperative refractive errors.MethodsThis non-randomized, prospective comparative study included 120 eyes undergoing cataract surgery with implantation of either Tecnis ZCB00 IOL (Abbott Medical Optics Inc., Santa Ana, CA) (monofocal group: 60 eyes of 30 patients) or Tecnis Symfony IOL (Abbott Medical Optics, Inc.) (EDOF group: 60 eyes of 30 patients). Monocular and binocular visual outcomes, changes in refraction, defocus curve, contrast sensitivity, and perception of photic phenomena (Halo & Glare Simulator; Eyeland Design Network, Vreden, Germany) were evaluated 3 months postoperatively. To compare the refractive tolerance, each group was divided into three subgroups according to the postoperative uncorrected distance visual acuity (UDVA) and postoperative spherical equivalent (SE).ResultsIn the EDOF group, the mean 3-months postoperative monocular UDVA, intermediate (UIVA), and near (UNVA) visual acuities were 0.03 ± 0.07, 0.09 ± 0.15, and 0.24 ± 0.16 logMAR, respectively. A total of 100, 96.55, and 68.97% of eyes in the EDOF group achieved binocular UDVA, UIVA, and UNVA values of 0.20 logMAR or better, respectively. In respect to refractive tolerance, the EDOF group showed higher SE values and statistically significantly better mean UDVA than the monofocal group in all subgroups, with UDVA of − 0.013 and 0.028 logMAR for EDOF and monofocal groups (p = 0.037), respectively, in the subgroup where SE was within ±0.50 D, UDVA of 0.004 and 0.048 logMAR for EDOF and monofocal groups (p = 0.046), respectively, in the subgroup where SE was within − 1.00 D, and UDVA of 0.020 and 0.083 logMAR for EDOF and monofocal groups (p = 0.026), respectively, in the subgroup where SE was more than − 1.00 D. The mean patient satisfaction scores for spectacle-free distance, intermediate, and near visual acuities were 86.0, 85.0, and 66.0, respectively.ConclusionsThe EDOF IOL provided excellent postoperative visual outcomes in far and intermediate distances, with high patient satisfaction rate. Regarding the postoperative refractive tolerance to SE, the Tecnis Symfony IOL showed better tolerance to residual postoperative refractive error than the monofocal IOL with the same material and optical platform.

Evaluation of Disk Halo Size after Implantation of a Collamer Lens with a Central Hole (ICL V4c).

Purpose To investigate disk halo size changes produced by a glare source after surgical insertion of an implantable collamer lens with a central hole (ICL V4c) for myopia correction. Methods In this prospective study, disk halo size and pupillary light response with a vision monitor were measured preoperatively and at 1 week, 1 month, and 3 months postoperatively. Pupillary light response parameters included contraction amplitude, latency, duration, and velocity; dilation latency, duration, and velocity; and initial, maximum, minimum, and average pupil diameters. Results Forty-two right eyes of 42 patients were enrolled. Postoperative uncorrected distance visual acuity was better than or equal to 20/20 in all eyes. Compared to preoperative values, disk halo size showed no significant difference at 1 week postoperatively (P > 0.05) and then decreased significantly at 1 and 3 months postoperatively (both P < 0.001). Contraction amplitude and velocity, as well as dilation velocity, decreased significantly at all postoperative time points (all P < 0.001). Disk halo size at 3 months postoperatively was significantly correlated with initial (r = 0.446, P=0.003), maximum (r = 0.483, P=0.001), minimum (r = 0.425, P=0.005), and average pupil diameters (r = 0.474, P=0.002). Conclusions After ICL V4c implantation, disk halo size was reduced in the short term. Patients with smaller pupil sizes during pupillary response to light experienced smaller halos after ICL V4c implantation.

Astigmatic correction with implantation of a light adjustable vs monofocal lens: a single site analysis of a randomized controlled trial.

To evaluate the light adjustable lens (LAL) vs a standard monofocal lens in achieving target astigmatic refraction and improving postoperative uncorrected distance visual acuity (UDVA). This randomized controlled clinical trial included 40 patients with pre-existing astigmatism and visually significant cataract. Twenty-eight patients received the LAL and 12 control patients received a monofocal intraocular lens (IOL) after cataract extraction at a single institution. The patients with the LAL underwent adjustment by ultraviolet (UV) light postoperatively plus subsequent lock-in procedures and all patients returned to clinic for follow up of study parameters at 6, 9, and 12mo. Manifest refraction, distance visual acuity, and adverse events were recorded at each visit. The mean cylinder before adjustment in eyes with the LAL was -0.89±0.58 D (-2.00 to 0.00 D) and -0.34±0.34 D (-1.25 to 0.00 D) after lock-in (P=1.68x10-8). The mean cylinder in patients with the monofocal lens was -1.00±0.32 D (-1.50 to -0.50 D) at 17-21d postoperatively, which was statistically different from the LAL cylinder post lock-in (P=1.43x10-6). UDVA in the LAL group was 20/20 or better in 79% of patients post lock-in with good stability over 12mo compared with 33% of the control patients with UDVA of 20/20 or better. These results demonstrate that the LAL is more effective in achieving target refractions and improving postoperative UDVA in patients with pre-existing corneal astigmatism than a standard monofocal lens.

Extended depth of focus lens implantation after radial keratotomy.

PurposeTo identify the visual performance of radial keratotomy (RK) patients that have undergone cataract surgery with implantation of an extended depth of focus (EDOF) intraocular lens (IOL).DesignRetrospective chart review with questionnaire.MethodsMedical charts of patients with a history of RK that had undergone phacoemulsification with implantation of the Tecnis Symfony IOL (J&J Vision) were reviewed. Data collected included preoperative demographics, number of RK incisions, pupil size, and preoperative visual acuity and manifest refraction. Primary outcome measures of the study included postoperative uncorrected distance visual acuity (UCVA) and manifest refraction spherical equivalent (SE) at each follow-up visit. Secondary outcomes included results from a telephone questionnaire assessing visual performance and satisfaction.ResultsTwenty-four eyes of 12 patients were included. UCVA improved from an average Snellen equivalent 20/73 preoperatively to 20/33 at an average final follow-up of 6 months (P=0.0011), while average manifest SE improved from +1.68 D to −0.18 D (P<0.0001). At final follow-up, 15 of 24 eyes (62.5%) were at or within 0.5 D of target refraction, while 20 of 24 eyes (83.3%) were at or within 1.0 D. In total, 79% of eyes (19 of 24) had UCVA of 20/40 or better at distance. In the survey, 78% of patients reported satisfaction with their vision after surgery and 44% of patients reported being spectacle free for all tasks.ConclusionsAn EDOF lens implant can produce good visual outcomes and satisfaction in patients with a history of RK.

Topography-guided versus wavefront-optimized laser in situ keratomileusis for myopia: Surgical outcomes

To compare the outcomes of topography-guided and wavefront-optimized surgery in patients having laser insitu keratomileusis (LASIK) for myopia. Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, and BALGEUN-EYE21 Operation Center, Gwangju, South Korea. Prospective case study. Patients had topography-guided LASIK in 1 eye and wavefront-optimized LASIK in the contralateral eye using Contoura Vision software and the WaveLight EX500 excimer laser. Refractive and visual outcomes were analyzed 3months postoperatively. The study comprised 43 patients. In both groups, the postoperative uncorrected distance visual acuity (UDVA) was 0.0 logarithm of the minimum angle of resolution or better in 90.7% of eyes and the residual spherical equivalent (SE) refractive error was ±0.75 diopter (D) in 81.4% of eyes. The UDVA, residual SE refractive error, and astigmatism did not differ significantly between the 2 groups. There was significant induction of higher-order aberrations (HOAs) in both groups, although corneal coma and trefoil did not increase and ocular trefoil decreased significantly in the topography-guided group (P=.038). However, in the wavefront-optimized group, corneal coma and trefoil increased significantly (P<.001 and P=.046, respectively) and ocular trefoil did not change significantly. In addition, topography-guided LASIK induced significantly fewer corneal total HOAs (P<.001), coma (P<.001), and trefoil (P=.020) than wavefront-optimized LASIK. Although both topography-guided LASIK and wavefront-optimized LASIK safely and effectively achieved the predicted refractive and visual outcomes, topography-guided LASIK induced fewer HOAs and significantly decreased ocular trefoil, corneal total HOAs, and coma.

Prospective, Randomized, Contralateral Eye Comparison of Wavefront-Guided and Wavefront-Optimized Laser in Situ Keratomileusis

To compare outcomes in wavefront-optimized (WFO) laser insitu keratomileusis (LASIK) to high-resolution wavefront-guided (WFG) LASIK. Randomized, fellow eye controlled, clinical trial. A total of 200 eyes of 100 patients with myopia or compound myopic astigmatism undergoing bilateral LASIK between October 2015 and February 2017 underwent wavefront-optimized (WFO) LASIK in 1 eye and wavefront-guided (WFG) LASIK in the fellow eye. Each eye was evaluated for uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), contrast sensitivity, refractive error, and wavefront aberrometry. Outcome measurement primarily UDVA at 12months. Secondary outcomes were safety, predictability, stability, refractive error, CDVA, contrast sensitivity, and higher-order aberrations at 12months. WFG LASIK had higher levels of supervision and better contrast sensitivity compared to WFO. Both types had excellent postoperative UDVA results, without a significant difference in either mean UDVA or frequency of achieving a specified UDVA, for example, 20/16 or better (all P > 0.05). The mean gain in lines of CDVA was significantly higher in the WFG than in the WFO group (0.80 ± 0.75 vs 0.62 ±0.72, respectively; P= 0.04). The WFG cohort had significantly better contrast sensitivity for mean and frequency of achieving >20/40 for <5% low-contrast sensitivity (37.1%; 95% confidence interval [CI], 27.5-46.7 vs 24.7%; 95% CI, 16.2-33.3, respectively; P=0.01) and >20/32 for <25% low-contrast sensitivity (10.3%; 95% CI, 4.3-16.4 vs 4%, respectively; 95% CI, 0.0-8.1, respectively; P= 0.04). The WFO group had a significantly higher frequency of <0.25 diopters (D) of refractive astigmatism at 12months (82.5%; 95% CI, 75.0-90.0; vs 72.1%, respectively; 95% CI, 63.2-81.2; P= 0.02) but not <0.50 D (95.6%; 95% CI, 91.9-99.8; vs 96.9, respectively; 95% CI, 93.5-100; P= 0.61). The WFG group was significantly closer to emmetropia for both sphere and spherical equivalents at all time points. Trefoil was significantly lower in the WFG group and was also significantly lower than preoperative measurements. Wavefront-optimized and high-resolution wavefront-guided LASIK achieve excellent visual outcomes. Nonetheless, treatments based on a high-resolution aberrometer appear to offer superior results in some regards.

Visual outcomes of Visian ICL implantation for high myopia in patients with shallow anterior chamber depth

BackgroundHigh myopia with shallow anterior chamber depth (ACD less than 2.8 mm) is not rare. This observational study aims to evaluate visual outcomes after implantation of the Visian Implantable Collamer Lens with a central hole (ICL V4c) in these patients.MethodsA prospective cohort of consecutive 51 eyes of 31 patients (20 to 42 years old) was followed for at least 12 months (average 15.35 ± 4.90 months, rangers from 12 to 25 months). The preoperative ACD was 2.74 ± 0.04 mm (2.65 to 2.79 mm). Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), intraocular pressure (IOP), manifest refraction, vault, and endothelial cell density (ECD) were measured during the follow-ups after surgery.ResultsAll surgeries were performed safely and no complication was observed during the follow-ups. At the last follow-up, the safety index (postoperative CDVA / preoperative CDVA) was 1.33 ± 0.60 and the efficacy index (postoperative UDVA / preoperative CDVA) was 1.14 ± 0.54. After the surgery, no eye had decreased CDVA and 59% (30 eyes) of the eyes gained at least one line. Forty-seven eyes (92%) were within ±1.0 D and 35 eyes (69%) were within ±0.5 D of the attempted refraction. The mean postoperative vault was 380.00 ± 152.84 μm (90 to 700 μm). The ECD was reduced by 8.38 ± 0.06% as compared to the preoperative value (p < 0.001). No significant change was observed in IOP (p = 0.061) at the last follow-up. Ultrasound Biomicroscopy (UBM) showed none of the eyes had trabecular-iris angle closed.ConclusionsIn this prospective observational study, ICL V4c implantation in patients with high myopia and shallow ACD achieved satisfying and stable visual outcomes. Its long-term safety and stability require further investigation.Trial registrationThis trial was retrospectively registered on 05/08/2018 under the number (ChiCTR1800017594).

Unilateral Refractive Lens Exchange with a Multifocal Intraocular Lens in Emmetropic Presbyopic Patients

ABSTRACTPurpose: To evaluate the visual outcome and patient satisfaction after a unilateral multifocal IOL implantation in the non-dominant eye of emmetropic patients with presbyopia.Methods: An interventional case series of consecutive patients who underwent unilateral phacoemulsification with femto-laser assisted cataract surgery (FLACS) and refractive lens exchange (RLE), followed by an implantation of a trifocal diffractive IOL (FineVision Micro F), was performed in the non-dominant eyes of emmetropic patients with presbyopia. After 6 months of follow-up, the main outcome measures were uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), and uncorrected near visual acuity (UNVA). Secondary outcomes included spherical equivalent (SE), refraction, contrast sensitivity, patient questionnaire and presence of visual side effects.Results: A total of 26 eyes of 26 patients, with an average age of 53.8 ± 4.1 years, were included in this study. Preoperative mean UDVA was 0.13 ± 0.04 logMAR (Snellen 20/27), UIVA was 0.46 ± 0.12 logMAR (Snellen 20/58), and UNVA was 0.66 ± 0.17 logMAR (Snellen 20/91), in comparison to postoperative mean UDVA of 0.18 ± 0.32 logMAR (Snellen 20/30) (p = 0.32), UIVA of 0.17 ± 0.21 logMAR (Snellen 20/30) (p < 0.005), and UNVA of 0.02 ± 0.10 logMAR (Snellen 20/21) (p < 0.005). Monocular UNVA of 20/25 or better in the operated eye was achieved in 23 (88%) patients. Twenty-four (96%) patients said they would recommend this procedure to family and friends. There were no intraoperative complications and no IOL exchange was required.Conclusions: A unilateral RLE of the non-dominant eye with FLACS and a trifocal diffractive IOL (FineVision Micro F) implantation in emmetropic, presbyopic patients is provides satisfactory distance, intermediate, and near visual outcomes with no complications reported in this preliminary case series.

Clinical observation of a novel technique: transscleral suture fixation of a foldable 3-looped haptics one-piece posterior chamber intraocular lens implantation through scleral pockets with intact conjunctiva

BackgroundTo present the follow-up outcomes of a modified technique of transscleral suture fixation of posterior chamber intraocular lens (PCIOL) in eyes with inadequate capsule support.MethodsA retrospective chart review of 21 patients underwent transscleral suture fixation of a foldable 3-looped haptics one-piece PCIOL implantation through scleral pockets was conducted. Preoperative data and follow-up data for at least 3 months were collected for all patients.ResultsThe mean operative duration was 36.62 ± 10.70 min. The mean pre- and post-operative LogMAR uncorrected distance visual acuity was (1.25 ± 0.50 vs. 0.41 ± 0.22, P < 0.01). The mean pre- and post-operative LogMAR best corrected visual acuity was (0.48 ± 0.25 vs. 0.33 ± 0.24, P < 0.01). The mean proportion of postoperative endothelial cell loss was 11.46 ± 4.78%. The mean postoperative anterior chamber depth was 3.05 ± 0.44 mm. The mean postoperative IOL tilt degree was 2.81 ± 1.41°, and the mean postoperative IOL decentration degree was 0.31 ± 0.13 mm. Four patients with transient corneal edema (19.0%) and three patients with transiently elevated IOP (14.3%) were observed after operation, and such complications were resolved within 1 week. No severe complications were observed.ConclusionsThe modified technique was a feasible method of PCIOL implantation.

Implantation of a diffractive–refractive trifocal intraocular lens with centralized diffractive rings: Two-year results

To compare the optical performance and quality of life after implantation of a new progressively apodized diffractive multifocal intraocular lens (IOL) and report the visual and patient-reported outcomes and contrast sensitivity. Csolnoky Ferenc Hospital, Veszprem, Hungary. Prospective case series. Patients had bilateral implantation of the trifocal IOL during cataract surgery. The preoperative corrected distance visual acuity (CDVA) and postoperative uncorrected distance visual acuity (UDVA), CDVA, uncorrected (UIVA) and corrected (CIVA) intermediate visual acuities, and uncorrected (UNVA) and corrected (CNVA) near visual acuities (all logarithm of the minimum angle of resolution) were collected. Contrast sensitivity, slitlamp photographs for evaluation of posterior capsule opacification, and a quality-of-vision questionnaire were assessed. The study comprised 100 eyes (50 patients). The mean postoperative UDVA was 0.01 at 3, 6, 12, and 24months. The mean CDVA was -0.02±0.03 (SD) at 6months, -0.04±0.05 at 1year, and 0.06±0.05 at 2years. The mean UIVA was 0.05±0.11, 0.04±0.09, and 0.06±0.11, respectively. The mean CIVA was -0.01±0.07, -0.02±0.06, and -0.01±0.07, respectively. The mean UNVA was 0.08±0.08, 0.07±0.08, and 0.10±0.09, respectively. The mean CNVA was 0.03±0.06 at 3months, 0.04±0.05 at 1year, and 0.05±0.07 at 2years. The mesopic and photopic contrast sensitivity values were within the upper normal range for age-matched values. Bilateral implantation of a new trifocal IOL with centralized diffractive rings provided good functional vision at alldistances. The levels of spectacle independence and patient satisfaction were high with minimal dysphotopsia symtoms.

Correction of Astigmatism With SMILE With Axis Alignment: 6-Month Results From 622 Eyes.

To evaluate postoperative clinical outcomes in myopic eyes with astigmatism that underwent femtosecond laser small incision lenticule extraction (SMILE) surgery with axis alignment. Overall, 622 eyes from 353 patients with myopia and astigmatism greater than -0.75 diopters (D) who had SMILE were included in this prospective study. Standard examinations were performed and visual acuity and vector astigmatism values were analyzed preoperatively and postoperatively. Preoperative manifest spherical equivalent (SE) was -6.11 ± 1.68 D (range: -0.50 to -11.25 D) and manifest refractive cylinder was -1.60 ± 0.65 D (range: -0.75 to -6.25 D). In 622 enrolled eyes with astigmatism, 29.9% did not require rotation modification during surgery, and the average rotation degree (absolute) was 2.82° ± 1.44° (range: 0° to 10°). By 6 months after SMILE, all eyes showed improved uncorrected distance visual acuity (UDVA); approximately 96.8% of eyes with astigmatism achieved the same or better UDVA postoperatively compared to the preoperative corrected distance visual acuity (CDVA). Moreover, the cylinder of all eyes was within ±1.00 D, and 97% of eyes were within ±0.50 D. Only 47 eyes exhibited a low degree of astigmatism (range: -0.75 to 0.50 D). In patients with high astigmatism (>-3.00 D), the preoperative CDVA was -0.02 ± 0.11 logMAR and the 6-month postoperative UDVA was -0.01 ± 0.16 logMAR (n = 24, P > .05), further implying the effectiveness of modified SMILE for refractive correction in patients with astigmatism. SMILE with axis alignment provides efficient, predictable, and safe refractive correction in patients with myopic astigmatism. [J Refract Surg. 2019;35(3):138-145.].

More eyes with 20/10 distance visual acuity at 12 months versus 3 months in a topography-guided excimer laser trial: Possible contributing factors

To study eyes with 20/10 uncorrected distance visual acuity (UDVA) 3months and 12months after topography-guided LASIK for myopia and myopic astigmatism, and to identify factors predictive of this excellent level of visual acuity. Nine practices in the USA. Prospective unmasked study of safety and effectiveness. The percentage of eyes with UDVA of 20/10 or better at 3months and 12months after topography-guided laser insitu keratomileusis (LASIK) with the Contoura Vision excimer laser in a U.S. Food and Drug Administration clinical trial was compared, and possible contributing factors were investigated. Preoperatively, only 1% of eyes had 20/10 corrected distance visual acuity (CDVA). Postoperatively, 7.0% of eyes had 20/10 or better UDVA at 3months, and this number increased to 16% at 12months (odds ratio, 2.48; 95% confidence interval, 1.33-4.61). The lower preoperative corneal astigmatism and postoperative refractive cylinder correlated with better postoperative UDVA and CDVA, respectively (P<.01 in all cases). The postoperative UDVA correlated with the postoperative CDVA (P<.01). The number of eyes with UDVA of 20/10 increases significantly between 3months and 12months after topography-guided LASIK and correlates with better postoperative CDVA. Eyes with lower preoperative corneal astigmatism are more likely to achieve 20/10 or better UDVA postoperatively. A significant improvement in the number of eyes with 20/10 or better from 3months to 12months after LASIK might be unique to topography-guided treatment.

Visual and keratometric outcomes in eyes undergoing small incision lenticule extraction for compound myopic astigmatism

Context The use of small incision lenticule extraction (SMILE) for compound myopic astigmatism has been subject to experimentation in the recent years. Furthermore, examination of corneal alterations has revealed conflicting conclusions, which could be attributable to demographic variation. Aims The aim of this study was to measure visual and keratometric efficacy of SMILE and correlate spherical equivalent (SE) decrements to keratometric alterations. Settings and design This was a prospective nonrandomized study. Thirty eyes of 15 patients were included in the study. Preoperative assessment included oculus Pentacam analysis. Patients were followed-up for up to 3 months, after which tomography was repeated. Statistical analysis used Descriptive statistics, t test, and linear regression analysis were carried out. Results There was a statistically significant improvement in postoperative uncorrected distance visual acuity and SE and a statistically significant change in Q value (P Conclusion SMILE is a safe and effective technique to correct cases with myopic astigmatism with an SE of up to −10 D, and a predictable positive correlation could be established between decrements in SE and decrements in anterior corneal steepening.

Visual Acuity, Rafraction, And K Reading Changes After Five Versus Six Millimeters Optical Diameter Intracorneal Ring Segments For Treatment Of Keratoconus

Purpose: To evaluate changes in visual acuity, refraction, and keratometric (K) readings after implantation of five millimeters versus six millimeters optical diameter of intracorneal ring segments (ICR) for treatment of keratoconus grade (2-4). Patients and methods: A prospective nonrandomized clinical comparative study. Thirty four eyes were included in this study. They were classified into two groups: Group I: Seventeen eyes of patients with Keratoconus grades (2-4) were subjected to 5 mm optical diameter intracorneal ring implantation. Group II: Seventeen eyes of patient with keratoconus grade (2-4)were subjected to 6 mm optical diameter intracorneal ring implantation. Results: Thirty four eyes of 22 patients (9 males and 13 females) with keratoconus grade (2-4) were enrolled in this study. The mean age + SD of the patients in group I was 26.36 ± 7.06 years and in group II was 23.09 ± 6.92 years. The mean keratometric (K) reading decreased from 50.05 ± 3.64D. to 46.96 ± 4.42D in group I and from50.48 ± 5.18D to 46.91 ± 5.44D in group II. There was a statistically significant improvement in the postoperative uncorrected distance visual acuity, corrected distance visual acuity, K readings, manifest spherical and cylindrical refractive errors, and spherical equivalent in both groups. No serious intraoperative complications were reported. Conclusion: Both 5mm and 6mm ICR improve significantly UCVA, BCVA, decreased the corneal power and corneal astigmatism but 6 mm showed significant improvement in cylindrical errors and BCVA compared to 5 mm ICR.

Anatomical and functional outcomes of toric intraocular lens implantation

Background: To minimize the residual refractive correction, toric intraocular lens (TIOL) is being increasingly used in cases undergoing cataract surgery with preexisting corneal astigmatism of ≥1.0 D. Aims: The aim of this study is to evaluate anatomical and functional outcomes of TIOL implantation in cases undergoing cataract surgery with significant corneal astigmatism using conventional manual marking of target axis and to see for any difference in outcomes based on the power of TIOL. Methodology: It is a prospective observational study. Consecutive patients with cataract and astigmatism of >1.0 D with adequate pupil dilation and no significant ocular or systemic comorbidity scheduled to undergo phacoemulsification with TIOL implantation were enrolled. Results: The mean improvement in postoperative uncorrected distance visual acuity (UDVA) over preoperative corrected distance visual acuity was 0.51 ± 0.54 logarithm of the minimum angle of resolution (95% confidence interval CI: 0.30–0.70), equivalent to 4 Snellen lines. The mean postoperative spherical equivalent is 0.38 ± 0.27; 77.4% showed within 0.50 D and the rest were within 1 D. The mean deviation of postoperative TIOL alignment from intended intraoperative TIOL alignment is 3° ± 2° (range: 0°–6°). Both the groups (low- and medium-power TIOLs) had similar postoperative UDVA, residual astigmatism, and deviation of target axis. Conclusions: There was an effective correction of preoperative corneal astigmatism and good visual outcomes with TIOL implantation. Fairly accurate TIOL alignment is achievable with manual marking of target axis. The power of TIOL did not influence postoperative UDVA, residual astigmatism, or deviation of TIOL from target axis.