Uncorrected Distance Visual Acuity Research Articles

Effect of Cyclotorsion Compensation in Small Incision Lenticule Extraction Surgery for the Correction of Myopic Astigmatism: A Systematic Review and Meta-Analysis.

Small incision lenticule extraction (SMILE) has made notable advancements in addressing myopic astigmatism. Nevertheless, the potential impact of cyclotorsion on surgical outcomes cannot be overlooked. This study aims to assess the effectiveness of cyclotorsion compensation technology in SMILE surgery for the correction of myopic astigmatism, examining its influence on postoperative visual quality. A systematic review and meta-analysis were conducted. A comprehensive literature search was performed using databases, including PubMed, Web of Science, EMBASE, Cochrane Library, EBSCO, Scopus, CNKI, VIP, and Wan Fang. Studies meeting the criteria were selected and included. Data were independently extracted by three authors. Clinical outcome parameters were analyzed using Review Manager version 5.3. This meta-analysis included ten studies. The results showed that, compared with the control group (cyclotorsion compensation was not performed in SMILE), the following indicators in the cyclotorsion compensation group were: residual astigmatism (RA) [weighted mean difference (MD) = 0.73, 95% confidence interval (CI) + 0.26 to + 1.19, P = 0.002], spherical equivalent (SE) (MD = 1.99, 95% CI + 0.77 to + 3.21, P = 0.001), coma (MD = -0.06, 95% CI -0.08 to -0.04, P < 0.00001), higher-order aberrations (HOAs) (MD = -0.04, 95% CI -0.06 to -0.02, P < 0.0001), follow-up 6-month angle of error (AE) (MD = -2.67, 95% CI -3.71 to -1.63, P < 0.00001), and follow-up 6-month uncorrected distance visual acuity (UDVA) (MD = -0.05, 95% CI -0.08 to -0.01, P = 0.005), and the differences in results were statistically significant. However, the differences among correction index, index of success (IOS), targeted induced astigmatism (TIA), magnitude of error (ME), and spherical aberration (SA) were not statistically significant. Cyclotorsion compensation proves to be effective and predictable for correcting myopic astigmatism. The cyclotorsion compensation group demonstrated advantages over the control group in terms of postoperative residual astigmatism, and it induced fewer coma aberrations. Whether cyclotorsion compensation can lead to better visual quality remains to be seen, and further research on correcting myopic astigmatism through cyclotorsion compensation is warranted.

Comparison of Early Vision Quality of SBL-2 and SBL-3 Segmented Refractive Lens.

To compare objective quality of vision in patients undergoing phacoemulsification with implantation of a bilateral segmented multifocal intraocular lens (SMIOL). A retro-prospective study included 110 eyes of 55 patients who underwent cataract surgery with bilateral SMIOL implantation. Patients were divided according to the type of implanted intraocular lens into group 1 (SBL-2, 62 eyes) and group 2 (SBL-3, 48 eyes). Postoperatively, monocular and binocular uncorrected distance visual acuity (UCDVA), corrected distance visual acuity (BCDVA), uncorrected intermediate visual acuity (UCIVA, at 66 cm), uncorrected near visual acuity (UCNVA, at 40 cm), corrected near visual acuity (BCNVA) and defocus curve were measured and evaluated. The follow-up period was 6 months. Mean UCDVA in group 1 (SBL-2) was 0.010 ±0.15 LogMAR monocularly, 0.01 ±0.10 LogMAR binocularly, and in group 2 (SBL-3) was 0.02 ±0.11 LogMAR monocularly and -0.07 ±0.09 LogMAR binocularly. Binocular defocus curves showed that the SBL-3 group performed better than the SBL-2 lens at a vergence of -1.50 D corresponding to 66 cm (center distance), averaging 0.03 ±0.11 LogMAR, while the SBL-2 group averaged 0.12 ±0.14 LogMAR (p = 0.01). The -2.50 D vergence characterizing near vision (40 cm) was achieved by the SBL-2 lens in our study at 0.33 ±0.15 LogMAR and by the SBL-3 lens at 0.00 ±0.11 LogMAR (p = 0.00). Both SMIOLs provided very good vision at all tested distances 6 months postoperatively. The SBL-2 lens performed better in UCIVA, while the SBL-3 lens excelled in UCDVA and UCNVA.

Visual outcomes of combined use of implantable collamer lens implantation and laser corneal visual correction for myopia over -18.00 diopters.

To explore visual outcomes in patients with extreme myopia receiving an implantable collamer lens (ICL) at -18.00 diopters (D), with central port, followed by bioptics by laser vision correction (laser in situ keratomileusis [LASIK] or photorefractive keratectomy [PRK]) to address residual myopia or myopic astigmatism. Clínica Baviera (Aier Eye Hospital Group), Bilbao, Spain. Retrospective analysis of cases. The study assessed uncorrected distance visual acuity, corrected distance visual acuity (CDVA), predictability, safety, efficacy, and patient satisfaction after implantation of the ICL and bioptics. The model implanted was V4c and EVO, with a correction of -18.00 D. Bioptics were performed at least 3 months after implantation, and patients were followed up for at least 3 months after LASIK or PRK. The analysis included 125 eyes from 90 patients. Of these, 51.2% underwent LASIK and 48.8% PRK. Mean time from implantation to bioptics was 5.9 ± 9.4 months. Patients were followed up for a mean of 40.2 ± 37.9 months after bioptics. Median manifest refractive spherical equivalent was -2.89 D before bioptics and -0.49 D after. Median CDVA was 0.18 logMAR before bioptics and 0.17 after. The mean safety and efficacy indices were 2.22 ± 1.88 and 2.06 ± 1.85, respectively. Visual outcomes and safety indices after ICL implantation and subsequent LASIK or PRK in patients with extreme myopia are excellent.

Efficacy comparison of combining cross-linking and refractive laser ablation in progressive keratoconus: systematic review and meta-analysis

ObjectiveThis study assessed the effect of combining corneal collagen cross-linking (CXL) with refractive laser ablation techniques for the treatment of keratoconus, a progressive corneal disorder. MethodsWe performed a systematic review and meta-analysis to assess the effect of combined CXL and refractive techniques. We included all published clinical trials or observational studies published by September 1, 2023. We calculated and compared the standardized mean difference (SMD) between CXL alone and CXL plus laser ablation for uncorrected distance visual acuity, best-corrected distance visual acuity, spherical equivalent manifest refraction, sphere and cylinder, flat keratometry (K1), steep keratometry (K2), and central corneal thickness. ResultsWe identified 13 studies that fulfilled our inclusion and exclusion criteria. The average follow-up was 21.3 ± 11.8 months. The CXL plus laser ablation group showed improvement in uncorrected distance visual acuity logMAR (SMD, –0.35; 95% CI, –0.67 to –0.04; p = 0.029), best-corrected distance visual acuity logMAR (SMD, –0.17; 95% CI, –0.30 to –0.03; p = 0.014), spherical equivalent manifest refraction (SMD, –0.28; 95% CI, 0.06–0.50; p = 0.013), and change in maximal corneal curvature (Kmax; SMD, –0.41; 95% CI, –0.69 to –0.13; p = 0.004) compared with CXL alone. However, central corneal thickness decreased further among patients who underwent CXL plus laser ablation (SMD, –0.37; 95% CI, –0.66 to –0.07; p = 0.016). No effect was observed in terms of sphere (p = 0.878), cylinder (p = 0.859), K1 (p = 0.907), or K2 (p = 0.169). Ectasia was not observed as an adverse effect resulting from the additional corneal ablation performed during the CXL treatments. ConclusionsThis study showed that combining refractive laser ablation techniques with standard or accelerated CXL treatment improved visual and refractive outcomes and anterior corneal curvature values.

Comparison of toric intraocular lens alignment between femtosecond laser-assisted capsular marking and digital marking.

To compare the accuracy of toric intraocular lens (IOL) alignment between femtosecond laser-assisted capsular marking and digital marking. Ruhr University Eye Clinic, Bochum, Germany. Prospective clinical trial. In this study, 28 eyes of 23 patients, who underwent femtosecond laser-assisted cataract surgery with implantation of a toric IOL, were included. Intraoperatively, both femtosecond laser-assisted capsular marking and digital marking were applied simultaneously and compared in every case. The toric IOL was aligned to the capsular markings. Postoperatively, the axis of the capsular markings and toric IOL alignment was examined. Visual acuity and refractive outcomes were evaluated. Both alignment methods were performed without intraoperative complications in all cases. 25 eyes were included in the final analysis. Misalignment was significantly lower with femtosecond laser-assisted capsular marking than with digital marking (1.71 ± 1.25 degrees vs 2.64 ± 1.70 degrees, P = .016). Deviation from the target axis of the toric IOL was 1.62 ± 1.24 degrees 4 to 6 weeks postoperatively. Postoperative uncorrected distance visual acuity was 0.14 ± 0.13 logMAR, and residual astigmatism was 0.3 ± 0.23 diopter (D) with an astigmatism ≤0.5 D in 93% of eyes. Both methods showed excellent results for the alignment of toric IOLs. However, femtosecond laser-assisted capsular marking was significantly more precise than digital marking and showed good refractive results. In addition, capsular marking offers the possibility to avoid parallax error and evaluating postoperative IOL rotation.

Clinical Results of a Trifocal Toric Intraocular Lens Using the Holladay Total Surgically Induced Astigmatism Formula for Correcting Low Corneal Astigmatism in Japanese Patients.

To evaluate the effectiveness and safety of the AcrySof IQ PanOptix toric intraocular lens (IOL) with cylinder power of 1.0 D (TFNT20) in a Japanese population with low corneal astigmatism and compare with historical control data for nontoric IOLs. Tokyo Dental College Suidobashi Hospital, Tokyo, Japan. Prospective, single-center study. Patients ≥20 years old received TFNT20 IOL in at least 1 eye based on Alcon Toric calculator (Holladay Total surgically induced astigmatism). Effectiveness endpoints included the percentage of eyes with refractive cylinder ≤0.25 D at 30-60 days after surgery, which was compared with a historical control threshold rate of 29.2% for nontoric IOLs and refractive cylinder ≤0.50 D. Monocular uncorrected distance visual acuity (UDVA; 5 m), uncorrected intermediate visual acuity (UIVA; 60 cm), uncorrected near visual acuity (UNVA; 40 cm), and adverse events were evaluated. Of 41 eyes implanted with TFNT20 IOLs, 37 eyes (90%) achieved refractive cylinder ≤0.25 D at 30-60 days after surgery, demonstrating the superiority of TFNT20 compared with historical data (P<0.0001). Refractive cylinder of ≤0.50 D was achieved by 41 eyes (100%). At 30-60 days, mean ± SD monocular CDVA was -0.15 ± 0.07 logMAR, UDVA was -0.09 ± 0.09 logMAR, UIVA was -0.00 ± 0.07 logMAR, and UNVA was 0.03 ± 0.07 logMAR. Six eyes (15%) had elevated postoperative intraocular pressure, which returned to normal and was not device-related. TFNT20 IOLs successfully reduced postoperative refractive cylinder and provided good distance, intermediate, and near uncorrected VAs in Japanese patients with low corneal astigmatism.

A Modified Four-point Scleral Fixation of Intraocular Lens in Aphakic Eyes without Adequate Capsular Support

Background: Polypropylene is a commonly used suturing material for intraocular lens (IOL) scleral fixation, but a high breakage rate after several years of follow-up is reported. Meanwhile, Gore-Tex has been a popular artificial material in ophthalmic surgery. Aim: This pilot study investigated the safety and efficacy of a modified surgical technique for scleral fixation of a four-point, close-loop haptic IOL using Gore-Tex as the suture material for aphakic patients without adequate capsular support. Methods: A modified IOL scleral fixation technique was developed using a four-point, close-loop haptic IOL and Gore-Tex as the suture material. Patients undergoing the operation between March 2018 and May 2019 at one center were included in the study. The preoperative uncorrected distance visual acuity (UDVA) with spectacles and postoperative UDVA with an IOL were compared as the main outcome. Follow-up time was 17–43 months. Results: A total of 10 eyes of 10 patients were enrolled, including 3 with iatrogenic IOL dislocation, 3 with iatrogenic lens drop, 2 with traumatic lens dislocation, and 2 with late in-the-bag IOL dislocation. The mean age was 70.8 ± 12.11 years. The mean UDVA, evaluated by the logarithm of the minimum angle of resolution, was decreased from preoperative 1.89 ± 0.28 to postoperative 0.58 ± 0.70 (P &lt; 0.001). No complications were reported except in one case with a postoperative corneal ulcer which healed after antibiotic treatment. Conclusion: The favorable outcome suggests Gore-Tex sutures as a safe and stable material for IOL scleral fixation. Prospective studies with a larger sample size would be necessary for more details on the safety and efficacy of the Gore-Tex suture in IOL scleral fixation.

Long-term Results after Bilateral Implantation of Extended Depth of Focus Intraocular Lenses with Mini-Monovision.

To assess long-term clinical results following bilateral Tecnis Symfony ZXR00 intraocular lens implantation with mini-monovision. The medical records of cataract patients who underwent bilateral implantation of ZXR00 with intended mini-monovision (target refraction of -0.3 diopters [D] in dominant eye and -0.6D in nondominant eye) between April 2019 and March 2021 were assessed. Postoperative uncorrected distance visual acuity (UDVA), corrected distance VA (CDVA), uncorrected intermediate VA (UIVA), uncorrected near VA (UNVA), and rate of spectacle dependence for near distance were investigated at 3 months and 2 years after surgery. This study included 61 patients (122 eyes) with average age of 61.8 ± 7.7 years. At 2 years postoperatively, binocular logarithm of the minimum angle of resolution UDVA, UIVA, UNVA, and CDVA were 0.086 ± 0.094, 0.056 ± 0.041, 0.140 ± 0.045, and 0.012 ± 0.024, respectively. The monocular manifest refraction spherical equivalent was -0.31 ± 0.38 in the dominant eye and -0.53 ± 0.47 in the nondominant eye at 3 months postoperatively, and -0.38 ± 0.43 in the dominant eye and -0.61 ± 0.54 in the nondominant eye at 2 years postoperatively. Eight out of 61 patients (13.1%) needed glasses 3 months after surgery, and nine out of 61 patients (14.8%) needed glasses 2 years after surgery. The bilateral implantation of ZXR00s with mini-monovision allows for a good VA at wide range of distance from far to near, thereby resulting in high rate of spectacle independence. These results have held up well even after 2 years after surgery.

Cataract surgery with new monofocal intraocular lens enhanced for intermediate vision and standard monofocal intraocular lens for retinal disorder.

To investigate the difference in the initial surgical results between a new monofocal intraocular lens (IOL) with enhanced intermediate vision and the standard monofocal IOL in patients with retinal disease. We retrospectively reviewed the medical records of patients with retinal disease who underwent cataract surgery due to accompanying cataracts. Types of retinal diseases were investigated and best-corrected distant visual acuity, distant uncorrected visual acuity (UCVA), intermediate UCVA, near UCVA, and spherical equivalent were recorded at each visit. The surgical results were investigated at 1day, 1week, and 1month after surgery. Seventeen eyes treated with a new monofocal IOL enhanced for intermediate vision (ICB00 group) and 18 eyes treated with the standard monofocal IOL (AAB00 group) were included in this study. There were no significant differences in the baseline characteristics, including the type of underlying retinal disease, between the groups. There were no significant differences between the groups in terms of distant, intermediate, or near UCVA at day 1 and week 1 after surgery. However, at 1month after surgery, the ICB00 group showed a significantly better intermediate vision improvement than the AAB00 group (p = 0.001). Even in patients with cataract accompanied by retinal disease, the use of the ICB00 IOL showed significant improvement in intermediate vision compared to the use of the AAB00 (standard monofocal) IOL. The ICB00 IOL might be a good option for patients with cataract and retinal disease in the era of increased intermediate vision needs in daily life.

Laser vision correction after radial keratotomy: systematic review and meta-analysis.

Laser vision correction for residual refractive errors in patients with previous radial keratotomy (RK) presents a challenging task. Different techniques have been used with varying outcomes. This study aimed to systematically review published articles on refractive surgeries in post-RK patients by conducting a search on PubMed, Scopus, and Web of Science. The final analysis included 35 studies that described a total of 888 eyes. Our systematic review and meta-analysis demonstrated a significant improvement in uncorrected distance visual acuity (UDVA) for photorefractive keratectomy (PRK), topography-guided PRK, wavefront-guided PRK, and femtosecond laser-assisted in situ keratomileusis (LASIK) while mechanical microkeratome LASIK did not yield such significant improvements. Moreover, our results suggest that post-RK patients with hyperopia had a significant improvement in UDVA, whereas no such improvement was observed in patients with myopia.

Impact of removing soft contact lenses 1day versus 1month before surgery on the outcomes of microkeratome laser in situ keratomileusis.

To compare the outcomes, safety, efficacy, and predictability of microkeratome laser in situ keratomileusis (LASIK) 24h and one month or more after removing soft contact lenses. ULTRALASIK Eye Center, Dubai, United Arab Emirates. The patients were divided based on the time of discontinuation of the soft contact lenses before LASIK (Group 1 at 24h and Group 2 at one month or longer), and the two groups were well matched. Schirmer's testing, tear break-up time, corrected distance visual acuity, uncorrected distance visual acuity, manifest refraction spherical equivalent, and infection rate were evaluated preoperatively and at one week, one month, and six months after treatment. Group 1 (G1) comprised 1025 eyes, and group 2 (G2) had 1052 eyes. The groups were comparable preoperatively. The overall-mentioned outcomes were comparable between groups with uncorrected distance visual acuity of - 0.084 ± 0.12 logMAR in G1 and - 0.078 ± 0.17 logMAR in the G2 at 6months (P = 0.322). Tear break-up time as well as Schirmer's testing results was also comparable with no evidence of increased risk of dry eyes or non-inflammatory complications in any of the groups on follow-up visits at 1week (P = 0.421), 1month (P = 0.101), and 6months (P = 0.399) postoperatively. Finally, no infectious complications were recorded in either of the groups. With the absence of corneal warpage, no statistical or clinical difference in microkeratome LASIK outcomes and safety was spotted between the groups despite the difference in SCL discontinuation time before the procedure.

Evaluation of Clinical Results of Implantation of Toric Intraocular Lenses Including their Rotational Stability.

The aim of the study was to evaluate the clinical results of the implantation of the toric intraocular lens Acrysof IQ Toric SN6AT3_8(Alcon Laboratories, Inc., Fort Worth, TX, USA), including an evaluation of its rotational stability. 30 eyes of 16 patients (4 males, 12 females; mean age 68 years) with regular corneal astigmatism ranging from -1.5 to -4.0 Dcyl were included in this retrospective study. All the patients underwent uncomplicated cataract surgery with the implantation of a toric intraocular lens (TIOL) at the Department of Ophthalmology of the Faculty of Medicine and Dentistry of Palacký University in Olomouc and University Hospital Olomouc during the course of 2020. Follow-up examinations were performed 3-6 months after cataract surgery. We monitored the resulting uncorrected distance visual acuity (UDVA), postoperative refraction, rotational stability of the implanted lens and subjective patient satisfaction. mean preoperative corneal astigmatism was -2.41 ±0.67 Dcyl. UDVA improved from a mean value of 0.45 ±0.25 (expressed in decimal Snellen optotype values) to 0.91 ±0.16. The spherical equivalent value of 0.41 ±2.92 improved to -0.11 ±0.27 postoperatively. The mean deviation from the planned axis was 4.87 ±4.75. Subjective satisfaction was rated by patients on a scale of 1-5, with a mean score of 1.5. TIOL implantation is a safe and effective solution for patients with corneal astigmatism and cataract. Our results demonstrate improved UDVA, rotational stability of the TIOL and subjective patient satisfaction with the outcome of the surgery.

Long-term outcomes of LASIK for myopia

Introduction &amp; Objectives : Myopia is a major healthcare burden worldwide. Refractive surgery is used to correct refractive error for patients who wanted less reliance on glasses and contact lenses. LASIK is one of the most commonly used procedures for correction of myopia. This study aims to evaluate the long-term outcomes of LASIK procedure for myopia.&#x0D; Methods : A literature search was conducted for the years of 2017 to 2013 from PubMed with the search term "LASIK" AND "myopia" AND ("efficacy" OR "long-term outcomes"). All abstracts were reviewed and evaluated, and articles relevant to the topic was reviewed for this study.&#x0D; Results : Out of 71 articles from search results, 7 articles were selected for review. At the last follow up from 3-12 years, uncorrected distance visual acuity (UDVA) of -0.03 – 0.39 logMAR was achieved. Around 64% - 90% patients achieved UDVA of 20/20 or better. Myopic progression was found with the mean of 0.63 – 0.97 D. The efficacy index and safety index was at 0.67 - 1.01 MR and 1.02 - 1.09 respectively at the end of follow up.&#x0D; Conclusion : The data showed that LASIK had an excellent long-term safety and efficacy for treatment of myopia, although small percentage of patients experienced mild myopic progression.

OUTCOMES COMPARISON AFTER SMALL INCISION LENTICULE EXTRACTION (SMILE) AND FEMTOSECOND-LASER ASSISTED IN SITU KERATOMILEUSIS (FS-LASIK) IN LOW-MODERATE MYOPIA PATIENTS

Abstract&#x0D; Introduction &amp; Objectives : Uncorrected myopia is the leading cause of visual impairment globally. It can be corrected by refractive surgeries, such as Small Incision Lenticule Extraction (SMILE) and Femtosecond Laser- Assisted In Situ Keratomileusis (FS-LASIK). SMILE technique is less-invasive than FS-LASIK, characterized by all-in-one femtosecond laser and flapless procedure. Correction of low-moderate myopia requires a special concern because even slight decreased in visual quality may be noticed by the patients and affect their satisfaction. The purpose of this study to compare the refractive outcomes after SMILE and FS-LASIK in low-moderate myopia patients.&#x0D; Methods : This is a prospective analytical observational study that was conducted in a tertiary hospital in Indonesia. Four refractive outcome parameters (predictability, efficacy, safety, and stability) were assessed at 1 day, 1 week, and 1 month postoperatively.&#x0D; Results : SMILE was performed on 22 eyes with spherical equivalent (SE) -3.60±1.07 D and FS-LASIK on 20 eyes with SE -2.91±1.53 D. At 1 month, the predictability as the proportion of eyes within SE ±0.50 D were 95.5% in SMILE and 80% in FS-LASIK (p=0.174), the efficacy as the proportion of eyes achieving uncorrected distant visual acuity (UDVA) ≥20/20 were 63.6% in SMILE and 35% in FS- LASIK (p= 0.064), the stability as the proportion of eyes experiencing SE change &gt;0.50 D were 4.5% in SMILE and 5% in FS-LASIK (p=1.000). No eyes from both groups had corrected distant visual acuity (CDVA) loss of ≥2 lines (p=1.000).&#x0D; Conclusion : SMILE and FS-LASIK were both predictable, effective, safe, and stable for low-moderate myopia patients.

Visual And Refractive Outcomes of Myopia Astigmatism After Small Incision Lenticule Extraction (ReLEx SMILE) Procedures; Retrospective Study

Abstract&#x0D; Introduction &amp; Objectives : Small Incision Lenticule Extraction (ReLEx SMILE) is becoming more popular as a flapless and minimally invasive form of laser vision correction for the treatment of myopia and myopia astigmatism. This study aimed to assess postoperative visual and refractive outcomes of SMILE- based correction of myopia astigmatism, to evaluate the efficacy, predictability, safety, and stabilityof this procedure over a one-month postoperative period&#x0D; Methods : This retrospective study evaluated 200 eyes of 100 patients who underwent ReLEX SMILE technique, using the Zeiss VisuMax Laser between July 2020 and October 2022. Before surgery, 1 day and 1 month after surgery, the efficacy, predictability, safety, and stability of the procedure were assessed.&#x0D; Results : The preoperative Mean Uncorrected Distance Visual Acuity (UCVA) was 1.55 ± 0.53. Corrected Distance Visual Acuity (BCVA) was 20/20 or better in 74.50% and 90% of eyes in 1 day and 1 month after surgery, respectively. MRSE reduced from -5.22 ± 2.44 to -0.22 ± 0.54 at 1 day post-operative, and -0.19 ± 0.51 at 1 month. 75% of eyes had an unchanged BCVA between 1 day and 1 month after surgery. 72% of eyes achieved spherical equivalent within ±0.5 D and 94% of eyes were within ±1.0 1 month after surgery. The intraoperative complication was suction loss in two patients.&#x0D; Conclusion : SMILE can be considered an effective and safe refractive surgery for the treatment of myopia astigmatism.

Comparison of Visual Acuity and Defocus Curve after Cataract Surgery with Pure Extended Depth Focus Lens and Mini-Monovision - Interim Analysis -

Abstract&#x0D; Introduction &amp; Objectives : Presbyopia after cataract surgery is still a problem despite recent surgical techniques and intraocular lens technology development. Mini-monovision techniques and pure extended depth of focus (EDoF) lenses are alternatives to achieve good distance and intermediate visual acuity at relatively inexpensive.This study aims to compare the clinical outcome after cataract surgery with binocular mini-monovision and cataract surgery using a pure monocular EDoF lens.&#x0D; Methods : Subjects were randomized into the mini-monovision group (standard monofocal lenses with -1.25 D of anisometropia) and the pure EDoF group. The blinding was achieved by masking the clinical outcome examiners.&#x0D; Results : Interim analysis of 16 patients revealed the outcome of uncorrected and corrected distance visual acuity (UCDVA and BCDVA) were not significantly different between groups. Median of uncorrected intermediate visual acuity (UIVA) and mean of uncorrected near visual acuity (UNVA) of binocular mini-monovision were 0.10 (0-0.10) LogMar and 0.26 + 0.12 LogMar. Median UIVA &amp; mean UNVA monocular EDoF were 0.19 (0.14-0.50) LogMar and 0.54 + 0.11 LogMar, respectively. The Mann- Whitney U test of UIVA between groups revealed p=0.001, and the unpaired T-test of UNVA revealed p=0.000. Mean defocus curve of -2.50 D lens were 0.31 LogMar in binocular mini- monovision group and 0.51 LogMar monocular in EDoF group (p=0.019).&#x0D; Conclusion : UIVA, UNVA and defocus curve of -2.50 D lens in the mini-monovision group were better than the EDoF group.

Monovision versus multifocal intraocular lens implantation in cataract patients: a systematic review and meta-analysis

Abstract&#x0D; Introduction &amp; Objectives : Modern cataract surgery technique entails replacing the crystalline lens with an artificial intraocular lens (IOL). While the standard monofocal IOL implantation with monovision technique has been cost- effective and provided patients with good visual acuity, multifocal IOLs present the prospect of spectacle-free vision despite various adverse outcomes. It remained contentious whether multifocal IOLs were superior to monovision. Our review provide an up-to-date assessment of monovision vs. multifocal IOL implantation's visual acuity and spectacle independence following cataract surgery.&#x0D; Methods : A systematic search was performed in April 2023 on six databases (Medline, SCOPUS, Proquest, EBSCO, Embase, and PubMed). Studies were extracted for the following outcome of interest: monovision, multifocal intraocular lens, spectacle independence, and visual acuity. All studies published up to April 2023 were reviewed. Cochrane risk of bias tool (RoB 2) was used to screen studies for risk of bias where appropriate. A meta-analysis was done to quantify any reported quantitative data.&#x0D; Results : Ten studies were identified. Pooling analysis for uncorrected binocular distance visual acuity and binocular uncorrected near visual acuity showed no difference between monovision vs. multifocal IOL (SMD 0,31; 95% CI -0,21 to 0,82 and SMD 0,41; 95% CI -0,58 to 1,40, respectively). Spectacle independence showed monovision was inferior to multifocal IOL (OR 0,22; 95% CI 0,08 to 0,61; heterogeneity I2=75%).&#x0D; Conclusion : Current evidence showed that multifocal IOL had comparable visual acuity to monovision with slightly higher likelihood of being spectacle-free. Despite that, monovision can be an efficacious and affordable option to be implemented in countries with high cataract burden.

A comparative study of two presbyopia-correcting intraocular lenses combining bifocal and extended depth-of-focus profiles.

To compare the visual performance of two presbyopia-correcting intraocular lenses (IOLs) that combine both bifocal and extended depth-of-focus profiles, Artis® Symbiose® Plus (Symbiose Plus; Cristalens Industrie, Lannion, France) and Tecnis® Synergy® (Synergy; Johnson & Johnson Vision, Santa Ana, CA, USA). The medical records of patients with cataract bilaterally implanted with either Symbiose Plus or Synergy between January 2022 and January 2023 were assessed. The principal measures of postoperative findings included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected intermediate visual acuity (UIVA), uncorrected near (40 and 33cm) visual acuity (UNVA), objective optical quality (OOQ) parameters, distance-corrected defocus curve analysis, and surveys of subjective satisfaction. Total of 96 eyes from 48 patients were enrolled. Each group was equally composed of 24 patients, 48 eyes. There were no significant differences between the two groups on baseline characteristics. Both IOLs displayed excellent binocular UDVA, CDVA, and UNVA (40 and 33cm) with no statistical difference (p = 0.467(UDVA), p = 0.584(CDVA), p = 0.096(40-cm UNVA), and p = 0.621(33-cm UNVA)). However, with regard to UIVA, the Synergy group showed significantly superior results (p < 0.001). In contrast, the Symbiose Plus group showed significantly better results on OOQ parameters and patient-reported quality of vision survey outcomes (both p < 0.001). Both IOLs provided a decent continuous range of vision from near to far distance.

Effect of residual sphere on uncorrected visual acuity and satisfaction in patients with monofocal and multifocal intraocular lenses.

To assess the effect of residual sphere on vision and satisfaction in pseudophakic patients. Private clinics, United Kingdom. Retrospective case series. A multivariate model evaluated the effect of 1-month residual sphere on outcomes of pseudophakic patients. Odds ratios (ORs) were calculated to assess the relative risk of not achieving ≥20/20 monocular uncorrected distance visual acuity (UDVA), ≥20/50 uncorrected near visual acuity (UNVA), and not being satisfied with vision. ORs were assessed for residual sphere -1.00 to +1.00 diopter (D) in quarter-diopter steps, using 0.00 D as a reference. The analysis included 38 828 multifocal and 11 571 monofocal intraocular lenses (IOLs). The residual myopic sphere ≤-0.25 D and hyperopic sphere ≥+0.50 D had a clinically meaningful effect on UDVA. Although monofocal IOLs had an improvement in UNVA with every additional 0.25 D of myopia, the change in ORs with increasing myopia was not significant for multifocal IOLs. The mean improvement in UNVA comparing eyes with 0.00 D and -1.00 D sphere was 0.26 logMAR for monofocal and 0.03 logMAR for multifocal IOLs. Low near-addition IOLs had a slightly higher gain in UNVA with increasing myopia, but the gain was not as substantial as with monofocal IOLs. The effect of ametropia on satisfaction was more pronounced for multifocal IOLs. For every 0.25 D of residual myopia, there was >25% increase in dissatisfied patients. Although myopia improved UNVA in eyes with monofocal IOL, multifocal IOLs did not benefit from residual myopia. Multifocal IOL patients desiring distance vision should be targeted closest to emmetropia, even if it means targeting slight hyperopia.

Enhanced Monofocal Intraocular Lenses in Fuchs' Endothelial Dystrophy Patients: Results from Triple Descemet Membrane Endothelial Keratoplasty Procedure.

Descemet membrane endothelial keratoplasty (DMEK) is currently regarded as the most effective surgical procedure for addressing Fuchs Endothelial Corneal Dystrophy (FECD), frequently performed in conjunction with cataract surgery. In this retrospective study, we present a comparison of visual performance, clinical outcomes, and optical quality between two types of monofocal Intraocular Lenses (IOLs): one standard and one enhanced intermediate vision model, implanted in patients who underwent combined phacoemulsification and DMEK surgery. This single center comparative retrospective study was conducted at the Eye Clinic of the University of Florence (Italy) and included a total of 48 eyes of 48 patients affected by FECD and cataract. All patients underwent combined DMEK with phacoemulsification procedures. The patients' data were analyzed and divided into two groups: one group (standard group) consisted of 24 eyes that underwent phaco-DMEK with implantation of a monofocal IOL, and the second group (enhanced monofocal group) included 24 eyes that underwent phaco-DMEK with implantation of an enhanced monofocal IOL. In both groups, the following monocular visual outcomes were evaluated 6 months after surgery: Uncorrected Distance Visual Acuity (UDVA) and Best-Corrected Distance Visual Acuity (BCDVA) at 4 mts; Uncorrected Intermediate Visual Acuity (UIVA), Distance-Corrected Intermediate Visual Acuity (DCIVA) at 66 cm; Uncorrected Near Visual Acuity (UNVA) and Best Corrected Near Visual Acuity (BCNVA). Monocular defocus curves were also assessed. Furthermore, optical quality in terms of Contrast Sensitivity (CS) in photopic conditions, Higher-Order Aberrations (HOAs) at a pupil size of 5 mm. Modulation Transfer Function (MTF), Objective Scatter Index (OSI), and Strehl ratio, were also analyzed. A Patient-Reported Spectacle Independence Questionnaire was revised to evaluate spectacle independence outcomes. the two groups did not exhibit statistically significant differences in terms of UDVA, BCDVA, UNVA and BCNVA, photopic CS, HOAs, OSI, Strehl ratio, and MTF. However, in the phaco-DMEK enhanced monofocal IOL group, significantly better results were observed in terms of UIVA and DCIVA as well as a different defocus curve profile at 1.50 D, providing better defocus results at intermediate distance compared with the ZCB00 IOL. In our study, we found that enhanced monofocal lens performed favorable visual outcomes, even in cases of FECD, compared to standard monofocal IOLs. Comparable optical quality observed in the Eyhance group could allow surgeons to consider these lenses as a viable option for selected patients with FECD.