Significant Differences In Uncorrected Distance Visual Acuity Research Articles

Short-term clinical outcomes after implantation of monofocal intraocular lens with enhanced intermediate function in eyes with epiretinal membrane

Our study evaluated the clinical outcomes after implantation of a monofocal intraocular lens (IOL) with enhanced intermediate function in eyes with epiretinal membrane (ERM). Patients with preexisting ERM who underwent cataract surgery with implantation of monofocal IOL with enhanced intermediate function were included retrospectively. According to the ERM grade and central subfield thickness (CST) obtained from preoperative optical coherence tomography, patients were divided into non-fovea-involving and fovea-involving ERM groups. At 1 month after surgery, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), contrast sensitivity, defocus curve, and satisfaction questionnaire were evaluated. Postoperative clinical findings were compared with age-matched controls without ERM. A total of 50 patients’ eyes (28 and 22 in the non-fovea-involving and fovea-involving ERM groups, respectively) were compared with 42 control eyes. One month post-surgery, significant differences in UDVA, CDVA, and CST (corrected P was < 0.001, = 0.001, and < 0.001, respectively) were observed between the fovea-involving ERM and control group; however, no significant differences in UIVA and UNVA were observed between the two groups. Contrast sensitivity showed inferior results in the fovea-involving group without significance. Photic phenomena were reported less in the fovea-involving group than in the non-fovea-involving group. More than 70% of patients in both ERM groups were satisfied. Implantation of monofocal IOL with enhanced intermediate function could be a good option for patients with ERM that need intermediate vision.

Effect of femtosecond laser-assisted arcuate keratotomy versus toric intraocular lens implantation on correction of astigmatism in cataract surgery: a systematic review and meta-analysis.

To compare the efficacy of femtosecond laser-assisted arcuate keratotomy (FSAK) combined with non-toric intraocular lens (IOL) implantation versus Toric IOL (TIOL) implantation in correcting corneal astigmatism in cataract patients. Relevant literature was searched in databases including PubMed, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and SinoMed. Data from the included studies were extracted. A meta-analysis was conducted to compare the correction performance of FSAK combined with non-toric IOL implantation and TIOL implantation using postoperative refractive astigmatism, correction index, and uncorrected distance visual acuity (UDVA) outcomes. Publication bias assessment and sensitivity analysis were also performed. Five comparative studies were ultimately included in the meta-analysis. The TIOL group had smaller postoperative refractive astigmatism and a greater correction index compared to the FSAK group. The mean differences in postoperative refractive astigmatism and correction index between the two groups were - 0.19D (95% CI = 0.12 to 0.26, P < 0.01, I2 = 7%) and - 0.09 (95% CI = - 0.18 to 0.00, P = 0.04, I2 = 0%), respectively. We found no statistically significant difference in UDVA between the two groups (95% CI = - 0.01 to 0.11, P = 0.09, I2 = 70%). FSAK combined with non-toric IOL implantation was found to be less effective than TIOL implantation in correcting preoperative corneal astigmatism in cataract patients. The difference in the effectiveness of astigmatism correction between the two surgical methods seems to diminish, as the degree of preoperative corneal astigmatism decreases.

Influence of decentration of plate-haptic toric intraocular lens on postoperative visual quality

BackgroundTo evaluate the influence of decentration of plate-haptic toric intraocular lens (IOLs) on visual quality.MethodsThis study enrolled 78 eyes of 78 patients. Patients in group A were implanted with toric IOLs, and patients in group B were implanted with monofocal IOLs. All patients were divided into group A1 and B1 (decentration below 0.3 mm) and group A2 and B2 (decentration above 0.3 mm). The uncorrected distance visual acuity (UDVA), best corrected visual acuity (BCVA), modulation transfer function cutoff (MTF cutoff), objective scatter index (OSI), strehl ratio (SR), optical interference and patients’ satisfaction were measured in different pupils at three months postoperatively. The associations between decentration and visual quality were analyzed by Spearman correlation.ResultsThere were no significant differences in UDVA, BCVA, MTF cutoff, OSI, SR, optical interference and patients’ satisfaction among subgroups. The differences in decentration between groups A and B were not statistically significant. In group A2, the total higher order aberrations (tHOAs) at pupil sizes of 3 mm (P = 0.046), 5 mm (P = 0.014), spherical aberrations at pupil sizes of 3 mm (P = 0.011), 4 mm (P = 0.014), 5 mm (P = 0.000), secondary astigmatism at pupil sizes of 3 mm (P = 0.002), 4 mm (P = 0.005) were higher than in group B2. Compared to group A1, group A2 had higher spherical aberrations at pupil sizes of 4 mm (P = 0.042), 5 mm (P = 0.001), 6 mm (P = 0.038), secondary astigmatism at pupil sizes of 3 mm (P = 0.013), 4 mm (P = 0.005), 6 mm (P = 0.013). Group B2 has higher coma and secondary astigmatism than group B1 at 6-mm pupil (P = 0.014, P = 0.045). Significant positive correlations were found between spherical aberrations and the decentration of group A1 and A2 at 6-mm pupils.ConclusionThe decentration above 0.3 mm negatively affected visual quality due to increased tHOAs, spherical aberrations, coma and secondary astigmatism aberrations, the influence become larger with increasing pupil diameter. And toric IOLs are more affected by decentration than monofocal IOLs.

Comparison of visual outcomes after two types of mix-and-match implanted trifocal extended-depth-of-focus and trifocal intraocular lenses

To compare visual outcomes between two types of mix-and-match implanted trifocal extended-depth-of-focus (EDoF) and trifocal intraocular lenses (IOLs). A total of 212 eyes of 106 subjects with mix-and-match implanted FineVision Triumf and FineVision HP IOLs (Triumf-HP group) and 212 eyes of 106 subjects with mix-and-match implanted Zeiss AT LARA and AT LISA IOLs (AT LARA-LISA group) were enrolled in this retrospective case-control study. Uncorrected distance visual acuity (UDVA), uncorrected near visual acuity (UNVA), and binocular distance-corrected defocus curves were measured between 6 and 10weeks after cataract surgery. There was no significant difference in UDVA among the four IOLs. UNVA was the best in eyes with the FineVision HP IOL (0.04 ± 0.06 logMAR), followed by eyes with the AT LISA IOL (0.07 ± 0.07 logMAR), the FineVision Triumf IOL (0.09 ± 0.09 logMAR), and the AT LARA IOL (0.11 ± 0.08 logMAR), respectively. The AT LARA-LISA group had better visual acuity than the Triumf-HP group between - 1.00 D and - 1.50 D of defocus, and the Triumf-HP group had better visual acuity than the AT LARA-LISA group between - 3.00 D and - 4.00 D of defocus. Mix-and-match implantation of trifocal EDoF and trifocal IOLs provided good visual outcomes in far, intermediate, and near distances. The mix-and-match implantation of Triumf-HP IOLs led to better visual outcomes in near vision, while that of the AT LARA-LISA IOLs led to better visual outcomes in intermediate vision.

Visual Performance Following Bilateral Implantation of Refractive Rotationally Asymmetric Bifocal Intraocular Lens (LS-313 MF30) or Apodized Diffractive Bifocal Intraocular Lens (ReSTOR SN6AD1).

PurposeThis study compared the clinical outcomes after cataract surgery with implantation of refractive rotationally asymmetric bifocal intraocular lens (IOL) (LS-313 MF30) and apodized diffractive bifocal IOL (ReSTOR SN6AD1).MethodsThis was a prospective, non-randomized, controlled study, where patients diagnosed with age-related cataracts were selected for phacoemulsification combined with bilateral IOL implantation. Based on the type of IOL voluntarily implanted, the patients were divided into two groups, ie, refractive and diffractive groups. In total, 30 cases (60 eyes) were in a refractive group, while 30 cases (60 eyes) were in diffractive group. Three months after surgery, we examined the uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), defocus curve, objective visual quality, and subjective questionnaire.ResultsThree months after surgery, the UIVA of the refractive group (0.18 ± 0.08) logMAR was better than that of the diffractive group (0.29 ± 0.16) logMAR (P < 0.05). No significant difference in UDVA and UNVA was noted between the two groups. For a 4mm pupil diameter, the intraocular and total eye aberration, higher-order aberration (HOA), coma, spherical aberration, and trefoil in the refractive group were significantly higher than those in diffractive group (P < 0.05). The intraocular modulation transfer function (MTF), intraocular strehl ratio (SR), total eye MTF, and total eye SR in the refractive group were lower than those in diffractive group (P < 0.05). No significant difference in glare incidence, spectacle independence rate, and patient satisfaction was observed between the two groups (P > 0.05). The halos incidence in the refractive group was lower than the diffractive group (P < 0.05).ConclusionBoth bifocal IOLs obtained satisfactory UDVA and UNVA, with higher patient satisfaction. Unlike the apodized diffractive bifocal IOL, the refractive rotationally asymmetric bifocal IOL yielded slightly better UIVA, lower halos incidence, whereas the apodized diffractive bifocal IOL showed a better objective visual quality.

Visual outcomes after three different surgical procedures for correction of refractive error in patients with thin corneas.

To investigate and compare the visual and refractive outcomes of small incision lenticule extraction (SMILE), laser assisted sub-epithelial keratomileusis (LASEK), and LASEK combined with corneal collagen cross-linking (LASEK-CXL) surgery in patients with less than 500 µm of central corneal thickness (CCT). The retrospective medical records review was conducted on the patients with CCT less than 500 µm treated with SMILE, LASEK, and LASEK-CXL. There was a total of 172 eyes, 76 eyes were in the SMILE group, 53 eyes in the LASEK group, and 43 eyes in the LASEK-CXL group. Uncorrected distance visual acuity (UDVA), spherical equivalent refraction (SE), and corneal haze were followed up in the three groups for 12mo. At 12mo postoperatively, there were no statistically significant differences in UDVA and in the absolute value of SE between the three groups. The predictability within ±0.50 D in the SMILE group (85.5%) was significantly higher than in both the LASEK group (64.2%, P<0.01) and the LASEK-CXL group (69.8%, P=0.04). The efficacy index and safety index were not significantly different among the three groups. Corneal haze at 12mo postoperatively was higher in the LASEK-CXL group (27.9%) than in the SMILE group (2.6%, P<0.01) and in the LASEK group (7.5%, P<0.01). In patients with CCT less than 500 µm, SMILE, LASEK, and LASEK-CXL appear to be effective for myopic correction. Among them, SMILE surgery shows the highest predictability.

Refractive characteristics of keratoconus eyes with corneal Vogt's striae: A contralateral eye study

PurposeThe aim of this study was to assess and compare clinical characteristics of bilateral keratoconus patients with unilateral Vogt's striae. MethodsIn this contralateral eye study, refractive status were evaluated in patients with bilateral keratoconus whose corneas had definite slit-lamp biomicroscopic evidence of unilateral Vogt's striae. All cases underwent a comprehensive ophthalmic examination. Some refractive errors components provided by autorefraction were converted to vectorial notation for power vector analysis. Finally, the outcomes were compared between keratoconus eyes with and without Vogt's striae. ResultsFifty patients aged 20 to 38 years (27.43±5.5) were recruited in this study. The results showed a significant difference in uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), non-cycloplegic and cycloplegic autorefraction including sphere, cylinder, spherical equivalent, and J0, between keratoconus eyes with and without Vogt's striae (all P<0.05), except for J45 (P=0.518 in non-cycloplegic autorefraction and P=0.574 in cycloplegic autorefraction). Comparison of cycloplegic and non-cycloplegic autorefraction in both study groups showed significant differences in the sphere and spherical equivalent (all P<0.001), but no significant difference was found in cylinder, J0, and J45 between the study groups (all P>0.05). ConclusionsComparison of the cycloplegic and non-cycloplegic autorefraction in keratoconus eyes with and without Vogt's striae showed significant differences in UDVA, CDVA, and some refractive errors components provided by autorefraction between the two groups, with a worse condition in KCN eyes with Vogt's striae.

Influence of Cap Thickness on Corneal Curvature and Corneal Biomechanics After SMILE: A Prospective, Contralateral Eye Study.

To evaluate the impact of cap thickness for small incision lenticule extraction (SMILE) on changes in corneal curvature and biomechanics. One hundred eyes (50 patients) were enrolled in this prospective contralateral eye study. The difference in manifest refraction spherical equivalent (MRSE) in the same patient was less than 0.50 diopters. SMILE was performed with a randomized cap thickness of 110 µm in one eye and 140 µm in the other eye. MRSE, uncorrected distance visual acuity (UDVA), and corneal curvature and biomechanics were evaluated. The anterior and posterior surfaces of the corneal curvature (mean keratometry [Km] values 2, 4, and 6 mm from the pupil center) were measured by Pentacam HR (Oculus Optikgeräte, Wetzlar, Germany) and changes in corneal biomechanics at 6 months postoperatively by Scheimpflug technology. There was no significant between-group difference in UDVA or MRSE postoperatively. Postoperative changes in Km at the anterior surface (ΔKm-ant) in the 4-mm zone were significantly higher in the 110-µm group than in the 140-µm group at 1 day and 1, 3, and 6 months postoperatively (P = .043, .045, .003, and .049, respectively); at 3 months, the ΔKm-ant in the 6-mm zone was higher in the 110-µm group (P = .035). The changes in second appla-nation time, deformation amplitude, and integrated radius were significantly less in the 110-µm group (P = .031, .049, and < .001, respectively). A thicker corneal cap caused less change in anterior surface curvature after SMILE for moderate or low myopia, with no significant difference in UDVA and MRSE. [J Refract Surg. 2020;36(2):82-88.].

Prospective 2-year study of accelerated pulsed transepithelial corneal crosslinking outcomes for Keratoconus.

To report 2-year outcomes of transepithelial, accelerated, pulsed, corneal crosslinking (t-ACXL) for patients with progressive keratoconus. Prospective, interventional case series at a university hospital tertiary referral centre. Forty eyes with progressive keratoconus undergoing t-ACXL were included. Treatment was performed with pulsed illumination (1 s on/1 s off) using 45 mW/cm2 for 5 min and 20 s, for a surface dose of 7.2 J cm2. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction spherical equivalent (MRSE), corneal tomography, anterior segment optical coherence tomography (OCT) and confocalmicroscopy were evaluated preoperatively and at 12 and 24 months postoperatively. The mean patient age was 23.32 ± 5.18 years (SD) (range 14-42 years). The mean CDVA significantly improved from 0.38 ± 0.32 logMAR at baseline to 0.30 ± 0.21 logMAR at 24 months (P < 0.01). There was no significant difference in UDVA, MRSE, asymmetry indices, tomographic parameters and endothelial density. The improvement in visual acuity was inversely correlated with preoperative CDVA and preoperative KMax. No complications were encountered. In this prospective study, t-ACXL appeared safe and effective in halting progression of keratoconus within a follow-up period of 24 months.

Comparison of clinical and functional results of conventional and femtosecond laser-assisted cataract phacoemulsification

To perform a comparative analysis of ultrasound and hydrodynamic parameters, and the outcomes of femtosecond laser-assisted cataract surgery (FLACS) and conventional phacoemulsification cataract surgery (CPCS). This prospective cohort study included 246 eyes. The first group consisted of 138 patients who underwent FLACS, second group - 108 patients after CPCS. Total ultrasound time was 95.36±47.93 and 113.3±97.71 seconds (p=0.04) in the 1st and the 2nd groups, respectively. The duration of torsional ultrasound was 84.72±50.03 seconds in 1st group (p=0.04) and 113.3±97.71 seconds in the 2nd group (p=0.04). Aspiration time was 208.3±95.86 seconds in the 1st group (p=0.04) and 258.43±158.81 seconds in the 2nd group (p=0.04). On the 3-4th day after the surgery, uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA) were significantly better in the 1st group - 0.62±0.21 (LogMAR 0.20±0.19) and 0.53±0.15 (LogMAR 0.30±0.21) (p=0.01), respectively, compared to the 2nd group with UDVA of 0.75±0.18 (LogMAR 0.10±0.16) and CDVA of 0.69±0.19 (LogMAR 0.20±0.15) (p=0.04). Central corneal thickness (CCT) was 573.41±33.12 and 632.43±58.30 μm in the 1st and 2nd groups, respectively (p=0.020). At 1 month post-op there were no statistically significant differences in UDVA (p=0.17), CDVA (p=0.40) or CCT (p=0.50) between the groups. Compared with CPCS, total ultrasound time (p=0.04), torsional ultrasound time (p=0.04) and aspiration time (p=0.04) were significantly lower in the FLACS group. CCT was significantly lower (p=0.02), while UDVA (p=0.04) and CDVA (p=0.01) were significantly higher in the FLACS group in the early post-operative period (3-4 days after surgery). There were no statistically significant differences in the parameters between the groups 1 month after the surgery.

Therapeutic Effects of Lamellar Keratoplasty on Terrien Marginal Degeneration.

To evaluate the therapeutic effects of lamellar keratoplasty (LK) on Terrien marginal degeneration (TMD). Retrospective interventional case series. Medical records of 63 patients (71 eyes) who received LK for TMD at Qingdao Eye Hospital, Shandong Eye Institute from December 1995 to March 2014 were reviewed. A total of 56 eyes were treated with partial LK and 15 eyes with total LK. Complications, visual acuity recovery, and graft status were evaluated. Mean age of the patients was 50.4 ± 16.8 years. The follow-up period was 2.5 ± 0.9 years. The uncorrected distance visual acuity (UDVA) increased from preoperative 0.90 ± 0.44 logarithm of the minimum angle of resolution (logMAR) to 0.53 ± 0.27 logMAR at 1 year after surgery (t = 16.256, P < 0.001). The corrected distance visual acuity (CDVA) was 0.69 ± 0.30 logMAR preoperatively, and increased to postoperative 0.38 ± 0.22 logMAR (t = -19.982, P < 0.001). After surgery, mean astigmatism was 5.33 ± 2.44 diopters (D) compared with preoperative 10.19 ± 4.32 D (t = 7.351, P < 0.001), and the spherical equivalent decreased from preoperative -2.23 ± 2.34 D to -0.75 ± 2.04 D (t = -2.677, P = 0.012). There was a significant difference in UDVA, ΔUDVA, CDVA, ΔCDVA, and refractive astigmatism between the partial LK and total LK groups. The most common intraoperative complication was corneal perforation. The postoperative complications included double anterior chamber, persistent graft epithelium defects, corneal vascularization, immune rejection, graft ulcers, cataract, and recurrence of marginal degeneration. LK can effectively reduce refractive errors, improve visual acuity, and reduce the risk of corneal perforation for patients with TMD. The visual acuity after partial LK is superior to that after total LK.

Comparison of ocular higher-order aberrations after SMILE and Wavefront-guided Femtosecond LASIK for myopia

BackgroundTo compare changes in higher-order aberrations (HOAs) following small incision lenticule extraction (SMILE) and wavefront-guided femtosecond laser-assisted in situ keratomileusis (WFG FS-LASIK), and to investigate correlations between preoperative spherical equivalence (SE) and components of HOAs affecting visual quality.MethodsSixty-five myopic eyes from 38 patients were enrolled in the study retrospectively, either having undergone SMILE or WFG FS-LASIK. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refractive error, and individual Zernike coefficients of 3rd- to 6th-order HOAs were measured before and 3 months after the surgeries and were compared using the Mann-Whitney test or Student’s t-test. Additional generalized estimating equation analyses (GEE) were used to control for within-subject biases in individual Zernike coefficients between the right and left eyes of the same patients.ResultsThere was no significant difference in UDVA or CDVA after WFG FS-LASIK (Mean ± SD: −0.02 ± 0.07 and −0.04 ± 0.22 respectively, in logMAR) and after SMILE (−0.01 ± 0.06 and −0.04 ± 0.04 respectively). However, greater vertical coma aberration was found after SMILE (p = 0.036). Preoperative SE was correlated to induced horizontal coma (r = −0.608, p = 0.001) in WFG FS-LASIK, and correlated to induced vertical coma (r = −0.459, p = 0.003) in SMILE.ConclusionsBoth SMILE and WFG FS-LASIK can achieve planned visual outcomes in correcting myopia and myopic astigmatism. However, higher vertical coma was shown in SMILE than WFG FS-LASIK which might be a potentially impact factor for patients’ vision under certain lighting conditions and needs further investigation.

A Meta-Analysis Comparing Postoperative Complications and Outcomes of Femtosecond Laser-Assisted Cataract Surgery versus Conventional Phacoemulsification for Cataract.

Objective. This meta-analysis aimed to compare the outcomes and postoperative complications between femtosecond laser-assisted cataract surgery (FLACS) and conventional phacoemulsification cataract surgery (CPCS). Methods. Bibliographic databases, including PubMed, Embase, and Cochrane library, were systematically searched for references on or before September 2015 regarding the outcomes and complications by FLACS or CPCS. Data on corneal endothelial cell loss, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refractive outcomes, and postoperative complications were retrieved. Results. A total of 9 trials were included in this analysis. Refractive outcomes (MD = −0.21, 95% CI: −0.39~0.03, P = 0.02) were significantly improved after FLACS. Although corneal endothelial cell loss was not significantly reduced after FLACS, there was a trend towards lower corneal endothelial cell loss (mean difference (MD) = 197.82, 95% confidence interval (CI): 2.66~392.97, P = 0.05) after FLACS. There was no significant difference in UDVA (MD = −0.01, 95% CI: −0.13~0.10, P = 0.80) or CDVA (MD = −0.03, 95% CI: 0.07~0.00, P = 0.09) between the two surgeries. Elevated intraocular pressure and macular edema were most commonly developed complications after cataract surgery, and the incidence of these complications associated with the two surgeries was similar. Conclusion. Compared with CPCS, FLACS might achieve higher refractive stability and corneal endothelial cell count. Nevertheless, further study is needed to validate our findings.

Comparison of visual quality after the implantation of different types of intraocular lens

Objective To compare the efficacy of different types of intraocular lens (IOL) implantation for age-related cataract. Methods A retrospective case series. Clinical data of 148 eyes of 162 cases of age-related cataract, were collected from April to December in 2014 at our hospital and all subjects were divided into three groups: simple cataract surgery combined with the traditional spherical IOL implantation in 44 eyes, zero spherical aberration AO IOL implantation in 56 eyes and negative spherical aberration ZCB IOL implantation in 48 eyes. The differences in patients age, preoperative uncorrected distance visual acuity and axial length among three groups were not statistically significant (P>0.05). The corneal astigmatism of all patients were less than 0.75 D. Uncorrected distance visual acuity (UCVA), best corrected distance visual acuity (BCVA), uncorrected near visual acuity (UNVA) and best corrected near vision (BCNA) were assessed preoperatively, 1 week, 1 month and 3 months after the surgery. And the ocular spherical aberration of the patients in 3 groups were assessed 3 months after the surgery. The total ocular spherical aberration of all subjects were measured by using the Ray tracing methed with pupil diameters of 4.0 mm. Results After three months, there were not statistically significant differences in UCVA, BCVA, UNVA and BCNA among three groups. After three months there was statistically significant difference among groups in total ocular spherical aberration. According to the data of corneal spherical aberration, the total ocular spherical aberration of patients in each group was divided into 3 grades. It is founded that the total ocular spherical aberration had no statistically significant defferences among groups when the corneal spherical aberration grade was less than 0.15 μm or greater than 0.45 μm. However, there was statistically significant difference when corneal spherical aberration grade was from 0.15 m to 0.45 μm. Conclusion Our earlier observation shows that negative spherical aberration IOL implantation is superior to traditional spherical IOL and aspheric IOL. Key words: Lens, intraocular, various types; Spherical aberration; Visual quality; Comparation

Visual outcomes after femtosecond laser in situ keratomileusis flap complications

To compare visual outcomes in normal and complicated laser in situ keratomileusis (LASIK) flaps constructed with a femtosecond laser. Wilford Hall Ambulatory Surgical Center, San Antonio, Texas. Retrospective chart review. The main outcome measures were uncorrected distance visual acuity (UDVA) and best-corrected distance visual acuity (CDVA) at 1 month post-surgery, which were compared in patients with and without complications during flap creation. This retrospective chart review identified 586 eyes of 293 consecutive patients who had bilateral simultaneous femtosecond LASIK for myopia. A normal flap was attained in 539 (91.8%) of patients. At 1 month postoperatively, the mean UDVA was 20/19.1, and the CDVA was 20/16.8. 3 (0.51%) of patients experienced an incomplete side cut or intraoperative flap tear (the mean 1-month uncorrected distance visual acuity [UDVA] was 20/17.5 and the corrected distance visual acuity [CDVA] was 20/16.9 in both groups). Microstriae were seen in 28 (4.8%) of patients (mean 1-month UDVA, 20/21.7; CDVA, 20/17.4). Diffuse lamellar keratitis appeared in 4 (0.68%) of patients (mean 1-month UDVA, 20/21.7; CDVA, 20/15.6). Epithelial ingrowth developed in 9 (1.5%) of patients (mean 1-month UDVA, 20/18.7; CDVA, 20/16.9). There was no statistically significant difference in UDVA or CDVA at 1 month postoperatively between complicated and uncomplicated flaps (P > .05), and complicated flaps did not lose a statistically significant amount of CDVA or low-contrast acuity (CDVA 5%) compared to preoperative values. Intraoperative and postoperative complications of LASIK flaps created with the femtosecond laser were rare, and their visual outcomes were equivalent to those of normal flaps. Charles D. Reilly is a consultant to Alcon Labs and Abbott Medical Optics at present, but was not at the time of the study. For the remaining authors none are declared.

Retrospective evaluation of the influence of pupil size on visual acuity after KAMRA inlay implantation.

To investigate the influence of pupil size on visual acuity after KAMRA inlay (AcuFocus, Inc., Irvine, CA) implantation. Five hundred eighty-four presbyopic eyes of 584 patients who underwent LASIK were evaluated. Uncorrected near visual acuity (UNVA), uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and corrected near visual acuity (CNVA) were measured. Two groups were classified: small pupil (pupil diameter < 6 mm) and large pupil (pupil diameter ≥ 6 mm) for both mesopic (pupil diameter < 4 mm) and photopic (pupil diameter ≥ 4 mm) pupil size parameters. The follow-up period was 6 months. There were no significant differences in UNVA (P = .98) and CNVA (P = .16) between the mesopic pupil size groups; however, there were significant differences in UDVA (P = .023) and CDVA (P = .039). There was a weak correlation between pupil size and UDVA of the large mesopic pupil size group (rs = 0.129, P = .04). There were no significant differences in UNVA (P = .78), CNVA (P = .92), UDVA (P = .19), and CDVA (P = .60) for the photopic pupil size groups. Pupil size does not have an influence on the resultant visual acuity after KAMRA inlay implantation. No correlation was found between preoperative and postoperative pupil size and visual acuity for the mesopic pupil groups.

Visual quality assessment in patients with orange-tinted blue light–filtering and clear ultraviolet light–filtering intraocular lenses

To evaluate potential differences in the quality of vision after implantation of a blue light-filtering intraocular lens (IOL) and an ultraviolet (UV) light-filtering IOL. Department of Ophthalmology, Ruhr-University, Bochum, Germany. Prospective randomized cohort study. Patients with age-related cataract had bilateral standardized small-incision Kelman phacoemulsification-based cataract surgery with implantation of a blue light-filtering IOL (Oculaid PC 440Y Orange Series) in 1 eye and a UV light-filtering IOL (Oculaid PC 430 Elite Series) in the other eye. Outcome measures included scotopic and photopic corrected distance visual acuity (CDVA) and photopic uncorrected distance visual acuity (UDVA), color discrimination, and contrast sensitivity with and without glare. A questionnaire was used to assess patient satisfaction. Postoperative follow-up visits were scheduled at 1, 3, and 6 months. Twenty-two patients (44 eyes) completed the study. There were no statistically significant differences in UDVA, CDVA, or contrast sensitivity with or without glare between the 2IOL groups. Color discrimination was significantly decreased in eyes with blue light-filtering IOLs compared with UV light-filtering IOLs, except along the red-green axis (P=.118). No subjective differences in color or light perception were found. Both IOL types provided similar postoperative visual function except color perception, which was slightly better in eyes with a clear IOL. Although differences were not clinically significant, information about potential disturbances in color vision might be provided before implanting an orange blue light-filtering IOL. No author has a financial or proprietary interest in any material or method mentioned.

Transepithelial photorefractive keratectomy: Clinical results

To assess the effectiveness, safety, and comfort of transepithelial photorefractive keratectomy (PRK) using the Amaris laser platform. Ophthalmic Consultants of Beirut, Jal-El-Dib, Metn, Lebanon. Comparative case series. Myopic eyes with or without astigmatism were treated by transepithelial PRK (study group) and compared with variable-adjusted eyes treated by conventional PRK (control group) during which the epithelium was removed with alcohol. Postoperative pain, epithelial healing time, uncorrected distance visual acuity (UDVA), manifest refraction, and haze were analyzed. The mean subjective postoperative pain score (out of 10, indicating worst pain) at 48 hours was 2.0 in the study group (50 eyes) and 4.5 in the control group (50 eyes) (P=.02). The mean time to complete epithelial healing was 2.5 days ± 0.6 (SD) and 3.7 ± 0.8 days, respectively (P=.01). At 1 week, the UDVA was statistically significantly better in the control group; however, at 3 months, there was no statistically significant difference in UDVA, corrected distance visual acuity, or manifest refraction between the groups. Haze was significantly less in the study group (P<.01). Transepithelial PRK for mild to moderate myopia with or without astigmatism was safe and easier to perform than conventional PRK, and patients had less pain, less postoperative haze, and a faster healing time. The visual outcomes with the 2 techniques were comparable. No author has a financial or proprietary interest in any material or method mentioned.

Long-term follow-up of photorefractive keratectomy for myopia: Comparative study of excimer lasers

To compare the long-term results of photorefractive keratectomy (PRK) for low to moderate myopia performed using a broad-beam laser system or a scanning-slit laser system. Department of Ophthalmology, University of Helsinki, Helsinki, Finland. Case-control study. This follow-up study comprised eyes with myopia (-1.25 to -7.00 diopters [D]) or myopic astigmatism (astigmatism lower than -2.50 D) corrected by PRK using a broad-beam (Visx) or scanning-slit (Nidek) laser. Follow-up included a visit at 3 months and at more than 8years. The uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and manifest refraction were recorded. The broad-beam group comprised 27 eyes and the scanning-slit group, 34 eyes. At the last postoperative follow-up, the UDVA was 0.0 or better in 55% of eyes in the broad-beam group and 65% of eyes in the scanning-slit group. The CDVA was 0.0 or better in all eyes in the broad-beam group and 96% of eyes in the scanning-slit group. Regarding predictability, 48% and 73% of the eyes, respectively, were within ±0.50 D of the intended spherical equivalent refraction. There were no statistically significant differences between the 2 laser groups in any preoperative or postoperative parameter. There were no significant differences in UDVA, CDVA, or SE after PRK for low to moderate myopia between the broad-beam laser system and the scanning-slit laser system. No author has a financial or proprietary interest in any material or method mentioned.

Apodized diffractive intraocular lens implantation after laser in situ keratomileusis with or without subsequent excimer laser enhancement

To evaluate the long-term refractive and visual outcomes of apodized diffractive multifocal intraocular lens (IOL) implantation after myopic laser in situ keratomileusis (LASIK) with or without subsequent excimer laser enhancement. University of Texas Southwestern Medical Center at Dallas, Texas, USA. Comparative case series. This study comprised consecutive patients who had implantation of an AcrySof ReSTOR multifocal IOL after previous LASIK. Included were eyes that had refractive surgery enhancement with a Visx Star S4 excimer laser for residual refractive error correction and eyes that had neodymium:YAG (Nd:YAG) capsulotomy. Of the 49 eyes (38 patients), 21 (42.9%) had laser enhancement and 25 (51.0%) had an Nd:YAG capsulotomy. The mean follow-up was 14.2 months ± 7.23 (SD) (range 9 to 29 months). Although the uncorrected distance visual acuity (UDVA) was significantly worse in eyes with enhancement than in those with no enhancement at 1 month and 6 months (P<.05), there was no significant difference in UDVA between the 2 groups at the last follow-up (P>.05). At the last follow-up, 36 (73.5%) of the 49 eyes had a UDVA of 20/25 or better and an uncorrected near visual acuity of Jaeger 1 or better concurrently; 46 eyes (93.9%) were within ±1.00 diopter (D) of emmetropia, and 41 (83.7%) were within ±0.50 D. Apodized diffractive multifocal IOL implantation and excimer laser enhancement in eyes with previous myopic LASIK provided good results.