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The aim of this study was to collect the scientific literature on the correction of presbyopia with laser in situ keratomileusis (presbyLASIK) in last years and to analyse the quality of such scientific evidence using a validated methodology for conducting a systematic review. A total of 42 articles were initially identified, but after applying the selection criteria and an additional manual search a total of 23 articles were finally included: 2 non-randomized controlled clinical trials (NRCT) and 21 case series. Quality assessment of NRCTs and case series was performed with the ROBINS-I and the 20-criterion quality appraisal checklist defined by Moga et al. (IHE Publ 2012), respectively. For NRCT, the risk of bias was moderate in one study and serious in the other NRCT, being the main sources of risk, the domains related to confounding, selection of participants and measurement of outcomes. For case series studies, the main source of risk of bias was subjects not entering the study at the same point of the conditions (different levels of presbyopia). Likewise, a significant level of uncertainty was detected for the following items: consecutive recruitment of patients, blinding of outcome assessors to the intervention that the patient received, and conclusions of the study not supported by the results. Research on presbyLASIK to this date is mainly focused on case series generating a limited level of scientific evidence. The two NRCTs identified only demonstrated the potential benefit of combining the multiaspheric profile with some level of monovision in the non-dominant eye. The author DPP has been supported by the Ministry of Economy, Industry and Competitiveness of Spain within the program Ramón y Cajal, RYC-2016-20471.

Objective: Strabismic amblyopia is a motor and sensory deficit produced by unilateral constant strabismus and binocular imbalance. The aim of this study was to analyse the retinal fixation pattern using microperimetry in subjects with strabismus with and without amblyopia associated, and to compare the results with those obtained in normal subjects. Methods: Prospective comparative study conducted at the Optometric Clinic of the University of Valencia and Oftalvist Alicante (Spain) including 46 eyes with ages from 3 to 16 years. Three groups were differentiated: patients with persistent strabismic amblyopia after occlusion and active therapy (group 1, 7 patients, 30.4%), strabismic patients without amblyopia (group 2, 8 patients, 34.8%) and a control group (8 patients, 34.8%). Microperimetric analysis was performed with the Macular Integrity Assessment (MAIA) system (Centervue, Padova, Italy) and using the following parameters: P1% and P2% fixation indexes, and the ellipse areas (BCEA) for 95% and 63% of points for the first 10 seconds, 30 seconds, 60 seconds, and the total examination time. Results: Significant differences were found between groups for dominant eyes in P2 calculated at 30 (p = .04) and 60 seconds (p = .03). However, these differences between groups in non-dominant eyes were close to statistical significance (p = .07 and p = .08). Specifically, P2 was significantly lower in group 1 compared to control group (p = .01). Best corrected visual acuity was found to be significantly correlated (p ≤ .04) with total P1 (dominant eye, r = −0.51; non-dominant eye, r = −0.50), total P2 (dominant eye, r = −0.50; non-dominant eye, r = −0.50), and BCEA63 (dominant eye, r = 0.50; non-dominant eye, r = 0.40) and BCEA95 (dominant eye, r = 0.50; non-dominant eye, r = 0.40) measured at 10 seconds. Conclusions: The preliminary results of this study seem to indicate that subjects with strabismus have fixation instability regardless of the presence or absence of amblyopia. This work was supported by the Ministerio de Economía, Industria y Competitividad, Gobierno de España [RYC-2016-20471].

Background: Treatment of amblyopia in esotropic subjects with accommodative component currently consists of optical correction and subsequent occlusion, or penalisation, of the dominant eye. This treatment obtains a good outcome in visual acuity but poor outcomes in binocular vision. An intervention protocol that could improve the outcome of conventional treatment is presented. Methods: A retrospective study in subjects with amblyopia associated with both fully accommodative and partially accommodative esotropia is presented. Subjects were refracted under cycloplegia and treated with occlusion (passive therapy). Subjects who did not achieve orthotropia through optical correction (partially accommodative esotropia) performed an active therapy (full‐time prismatic correction and subsequent fusional vergence therapy or surgery in larger angles > 12 prism dioptres). After treatment, the subjects were examined by a masked optometrist in an external ophthalmology clinic. Results: Twenty‐six subjects (12 males and 14 females) aged from six to 13 years (median 8.50; interquartile range [IQR] 3) were included. Median age of detection was three years (IQR 1). All the subjects were hyperopic. In the baseline, median best‐corrected visual acuity of the amblyopic eye was 0.40 logMAR (IQR 0.30) and 0.00 logMAR (IQR 0.01) in the dominant eye. After the treatment, the median best‐corrected visual acuity in the amblyopic eye was 0.06 logMAR (IQR 0.08). These differences were statistically significant (p

Purpose To characterize the fixation and macular integrity of subjects with multiple sclerosis (MS) with and without previous optic neuritis (ON) using microperimetry (MP). Methods Fifty-five eyes of MS patients, subdivided into three groups (28 eyes without ON, 16 with previous ON, and 11 eyes with previous ON in the contralateral eye), and 43 healthy eyes were enrolled (January–November 2018). All cases were evaluated using the MAIA microperimeter (Centervue), analyzing the following parameters: average macular threshold (AT), fixation indexes (P1 and P2), bivariate contour ellipse area (BCEA) for 95% and 63% of points, and horizontal (H) and vertical (V) axes of the ellipse of fixation. Results All MS groups showed a significant reduced AT compared with the control group (p 0.05). Mean AT was correlated with the examination time in all three groups (between ρ = − 0.798 p

The use of digital devices provides a wide range of possibilities for measuring and improving visual function, including concepts such as perceptual learning and dichoptic therapy. Different technologies can be used to apply these concepts, including, in recent years, the introduction of virtual reality (VR) systems. A preliminary experience in treating anisometropic amblyopia through an immersive VR device and using prototype software is described. A total of 4 children were treated by performing 18 office-based sessions. Results showed that distance VA in amblyopic eyes remained constant in two subjects, whereas the younger subjects improved after the training. Near VA improved in three subjects. All subjects showed an increase in the stereopsis of at least one step, with three subjects showing a final stereopsis of a 60 s arc. A total of three subjects showed an increase of approximately 0.5 CS units for the spatial frequency of 3 cpd after the training. Results from this pilot study suggest that visual training based on perceptual learning through an immersive VR environment could be a viable treatment for improving CS, VA, and stereopsis in some children with anisometropic amblyopia. Future studies should support these preliminary results. This research was supported by CDTI (Centro para el Desarrollo Tecnológico Industrial, Ministry of Economy and Competitiveness of Spain) using the PID program (Proyectos de Investigación y Desarrollo) in the context of the Project NEIVATECH (Neuroplasticity through Virtual Reality for Amblyopia) with the grant number 111705. E.M-P was supported by the European Union-NextGenerationEU.

The goal of this study was to analyze the agreement between the Medmont E300 and the Visionix VX120+ systems in terms of non-invasive tear break-up time (NIBUT) and tear meniscus height (TMH) measurements. A total of 60 eyes (30 healthy subjects) were enrolled. NIBUT and TMH were evaluated with Medmont E300; first NIBUT, NIBUT50%, and TMH were evaluated with Visionix VX120+. Both evaluations were performed in a random order by the same clinician for right, left, and both eyes. The Medmont E300 provided significantly higher NIBUT than Visionix VX120+ for first NIBUT in right, left, and both eyes (p ≤ 0.003) and NIBUT50% in left and both eyes (p ≤ 0.042). The TMH measured with VX120+ was significantly higher than with Medmont E300 considering both eyes (p = 0.037). No significant correlations were found between both devices for either NIBUT (p ≥ 0.11) or TMH (p ≥ 0.09). Passing–Bablok regression analyses revealed poor agreement between devices for NIBUT and TMH outcomes. VX120+ is expected to provide substantial lower first NIBUT values than the NIBUT measured by Medmont E300. Clinicians should consider not using both instruments as interchangeable for dry eye diagnosis. The author D.P.P. has been supported by the Ministry of Economy, Industry and Competitiveness of Spain within the program Ramón y Cajal, RYC-2016-20471. This research received no external funding. E.M.P. has been supported by European Union-NextGenerationEU.

Multifocal intraocular lenses (IOLs) are currently usually implanted for the treatment of cataracts because they have been proved to be superior to monofocal IOLs with respect to spectacle independence. In turn, they are associated with a higher prevalence of dysphotopsia symptoms that is one of the most common causes of patient dissatisfaction. Neuroadaptation seems to play a major role in the optimal adaptation to multifocal IOLs. In this context, the development of strategies that facilitate the neuroadaptation process to multifocality might be an effective strategy to reduce patients’ dissatisfaction. Video games have been proved to be effective for the improvement of visual acuity and for the promotion of neuroplasticity in elderly subjects and other populations with cortical-related visual impairment. This narrative review highlights the physiological potential of video games as a perceptual strategy to improve visual acuity and promote neuroplasticity in patients using multifocal IOLs, although research is still needed to confirm these benefits in this specific population, with only one comparative study to this date providing evidence of them. Coco-Martin MB, Maldonado-López MJ, Molina-Martín A and Piñero DP are supported by CDTI (Centro para el Desarrollo Tecnológico Industrial, Ministry of Economy and Competitiveness of Spain) by means of the program PID (“Proyectos de Investigación y Desarrollo”); The author Piñero DP has been also supported by the Ministry of Economy, Industry and Competitiveness of Spain within the program Ramón y Cajal (RYC-2016-20471); Valenzuela PL is supported by a contract granted by University of Alcalá (FPI2016).

Eye movement disorders have been reported in patients with multiple sclerosis (MS) as saccadic disturbances. Several methods have been described for the assessment of saccades, including the K-D and DEM tests. The performance of these tests also involves attention, language, and other brain areas which have been reported to be altered in MS patients. The aim of the study was to determine how developmental eye movement (DEM) and King-Devick (K-D) tests are affected in MS-patients. It was also to analyze whether a resolved episode of optic neuritis (ON) has a negative influence. Subjects with MS showed worse outcomes (higher times) in DEM test (72 (26) s and a K-D test (56 (22) s compared to healthy subjects (64 (7) s and 55 (11) s, respectively). However, a previous ON episode did not worsen the MS-times of DEM (80 (33) s or of K-D (62 (33) s. Horizontal saccades with the DEM showed differences between subjects with MS (with and without ON) and healthy ones (p < 0.05), whereas no such differences were found in the vertical saccades. According to the DEM instructions, MS patients would present heterogeneous oculomotor and non-visual disturbances. Regarding the K-D test, only the third card (the most complex one) showed differences (p < 0.05) between groups. These tests can capture impairment of attention, language, and other areas that correlate with suboptimal brain function in addition to the oculomotor dysfunctions present in subjects with MS. The author David P. Piñero has been supported by the Ministry of Economy, Industry, and Competitiveness of Spain within the program Ramón y Cajal, RYC‐2016‐20471.

This retrospective study was conducted to evaluate the efficacy of the combined treatment of occlusion and active vision therapy in a total of 27 amblyopic children, including 14 strabismic and 13 anisometropic cases. For such purpose, changes in distance and near visual acuity as well as in the binocular function was evaluated during a two-year follow-up. In both amblyopia groups, significant improvements were found in distance and near visual acuity in the non-dominant eye (p < 0.001). In the strabismic amblyopia group, the percentage of patients with binocular function score (BF) > 3.3 decreased significantly from a baseline value of 64.3% to a two-year follow-up value of 7.1% (p < 0.001). In the anisometropic amblyopia group, this percentage also decreased significantly from a baseline value of 15.4% to a two-year follow-up value of 0.0% (p < 0.001). No recurrences were observed in the anisometropic amblyopia group, whereas recurrence occurred in two cases of the strabismic amblyopia group after finishing the vision rehabilitation process. In conclusion, the combined approach of the treatment evaluated is efficacious for providing an improvement in visual acuity and binocular function in both anisometropic and strabismic amblyopia, which was maintained over time. The author David P Piñero has been supported by the Ministry of Economy, Industry and Competitiveness of Spain within the program Ramón y Cajal, RYC‐2016‐20471.

The main objective of the current study was to investigate further the relationship of the overall length of the eye with a great variety of anterior segment parameters, including scleral geometry. A total of 64 eyes of 32 participants with ages from 12 to 52 years were included in this prospective non-randomized single-center study. All participants underwent a complete eye examination, including an analysis of corneo-scleral shape with a Fourier-domain profilometer. A strong negative correlation was found between axial length and temporal-nasal ocular sagittal height difference for different chord lengths. For the right eye, a consistent and stable linear model was obtained to predict the axial length from the spherical equivalent, the corneal diameter, the high-order aberrations root mean square, and the minimum sagittal height for 13- and 14-mm chord. For the left eye, a model was obtained to predict the axial length from the spherical equivalent and the mean corneal curvature, including other parameters such as corneal diameter or high-order aberrations, depending on the chord length, considered for estimating the sagittal height values. More studies with larger samples are needed to confirm these preliminary outcomes. This article is funded by the Project UAIND18-06B of the University of Alicante within the program “Ayudas destinadas a la formación predoctoral en colaboración con empresas 2018” supported by the Vicerrectorado de Investigación y Transferencia de Conocimiento. The author David P Piñero was also supported by the Ministry of Economy, Industry and Competitiveness of Spain within the program Ramón y Cajal, RYC-2016-20471.

Amparo Gil-Casas,1,2 David P Piñero-Llorens,2 Ainhoa Molina-Martin2 1Clínica Optométrica, Fundació Lluís Alcanyís, University of Valencia, Valencia, Spain; 2Optics and Visual Perception Group (GOPV), Department of Optics, Pharmacology, and Anatomy, University of Alicante, Alicante, SpainCorrespondence: Ainhoa Molina-MartinDepartment of Optics, Pharmacology, and Anatomy, University of Alicante, Carretera San Vicente del Raspeig, San Vicente del Raspeig, 03690, Alicante, SpainTel +34 965 903-400Email ainhoa.molina@ua.esPurpose: Oculomotor disorders have been reported in multiple sclerosis (MS) in up to 80% of cases. There have been studies evaluating binocular vision in several neurological diseases, but not in MS. Considering that a high percentage of eye-movement anomalies have been reported, the aim of this study was to analyze binocular vision in these subjects.Methods: A total of 59 participants with MS — 21 with monocular optic neuritis, eleven with binocular optic neuritis, and 27 without optic neuritis — and 26 age-matched controls were enrolled. Binocular vision was analyzed using near point of convergence (NPC), positive and negative fusional vergence for far and near distance, measurement of heterophoria at both distances with cover and modified Thorington tests, and random-dot stereoscopy.Results: The percentage of subjects with abnormal NPC values was highest in the MS group, followed by the MSONm (MS with optic neuritis in one eye), MSONb (MS with optic neuritis in both eyes), and control groups. MS patients showed an esophoric trend at near distance. Positive fusional vergence showed no significant differences between control and MS groups, but higher variability in recovery was found in MS groups. Negative fusional vergence at near distance showed significant differences between the control group and the two MS groups, with optic neuritis for both break-point and recovery values. A high percentage of patients with MS had alterations on stereopsis.Conclusion: Alterations in binocular vision were present in MS, with divergence at near distance and stereopsis the most affected parameters. Likewise, MS patients with optic neuritis showed worse binocular vision.Keywords: multiple sclerosis, binocular vision, near point of convergence, heterophoria, fusional vergences, stereopsis

Purpose: To evaluate different intraocular lens (IOL) designs and to determine whether extended depth of focus (EDOF) lenses provide a higher depth of field (DOF) than the rest considering both subjective and objective measurements. Methods: A total of 100 eyes undergoing cataract surgery were divided into six groups depending on the IOL implanted: bifocal designs were Tecnis ZMB and ZLB (Abbott Laboratories, Illinois, USA), trifocal designs were Finevision (PhysIOL, Liège, Belgium) and AT LISA Tri (Carl Zeiss Meditec., Jena, Germany) and EDOF designs were Symfony (Abbott Laboratories, Illinois, USA) and MiniWell (SIFI MedTech, Catania, Italy). Subjective DOF was obtained from defocus curves for the range of vergences which provide a VA over 0.1 LogMAR and 0.2 LogMAR. Aberrometry was measured and Visual Strehl Optical Transference Function (90%) was used to quantify objectively the DOF. Results: Symfony IOL group showed better subjective and objective DOF compared to the rest of IOL groups, with statistically significant differences (p

Background: The objective of this study was to compare the central corneal curvature and astigmatism measurements obtained with three different systems in healthy eyes and to assess the level of interchangeability between them. Methods: This was a comparative study examining 30 healthy eyes of 30 patients (age 15–53 years). A complete eye examination was performed in all cases including analysis of anterior corneal curvature and astigmatism with three devices: the colour‐LED topography system Cassini (i‐Optics) (CAS), the Scheimpflug‐based system Pentacam (Oculus Optikgeräte) (PTC) and the optical biometer IOL‐Master 500 (Carl Zeiss Meditec) (IOLM). Differences between devices in terms of curvature in the flattest (flat K) and steepest meridians (steep K) as well as in the magnitude (AST) and power vector components of astigmatism (J0 and J45) were evaluated. The interchangeability between devices was evaluated with the Bland–Altman method. Results: Statistically significant differences between devices were found in steep K and flat K (p

Purpose To evaluate the intrasession repeatability of anterior corneal topographic and aberrometric measurements provided by a color-LED topographer as well as their interchangeability with those provided by a Scheimpflug-based system in healthy eyes. Methods Thirty-five healthy eyes of 35 patients (age, 16–66 years) were enrolled. A complete eye examination was performed in all cases including a complete corneal analysis with the Scheimpflug-based system Pentacam (Oculus Optikgeräte) (one measurement) and the Cassini system (i-Optics) (three consecutive measurements). Intrasession repeatability of the Cassini measurements was assessed with the within-subject standard deviation (Sw) and the intraclass correlation coefficient (ICC). The Bland-Altman analysis was used to evaluate the agreement between both devices. Results Mean Sw for keratometric readings was 0.02 mm (ICC ≥ 0.992), ranging between 0.16 and 0.05 D (ICC 0.930–0.978) for anterior and total astigmatic measurements. Mean Sw for asphericity and corneal diameter were 0.06 (ICC 0.926) and 0.03 mm (IC 0.997), respectively. Aberrometric parameters showed ICCs ≥ 0.816, except for Z42 (ICC 0.741) and Z44 (ICC 0.544). When comparing devices, statistically significant differences were found for most of topographic and aberrometric data (p ≤ 0.044). Likewise, ranges of agreement between devices were clinically relevant (keratometry > 0.06 mm; total astigmatic components > 0.69 D; asphericity 0.35; second-, third-, and fourth-order Zernike terms, more than 0.20, 0.13, and 0.01 μm, respectively). Conclusions Consistent anterior corneal topographic, total corneal astigmatic, and aberrometric measurements are obtained with color-LED topography in healthy eyes, which are not interchangeable with those provided by the Scheimpflug-based topography. The author David P Piñero has been supported by the Ministry of Economy, Industry and Competitiveness of Spain within the program Ramón y Cajal, RYC-2016-20471.

Purpose To establish normative values of retinal sensitivity and parameters describing the fixation pattern using macular analyzer integrity assessment (MAIA) microperimetry (Centervue, Padova, Italy) in adults and children. Methods A sample of 237 eyes of 237 healthy subjects aged between 10 and 70 years (mean age 30.63 ± 16.23 years) was evaluated using the MAIA microperimeter. The following parameters provided by the MAIA device were evaluated: average threshold (AT), macular integrity, fixation indexes (P1% and P2%), bivariate contour ellipse area (BCEA) for 95% and 63% of points, and horizontal (H) and vertical (V) axes of the ellipse of fixation. Differences between different age-related groups were evaluated. Correlation of microperimetric parameters with age was also assessed. Results Median retinal sensitivity of the overall sample was 32.90 dB (interquartile range 1.80 dB). Median P1 and P2 values were 98.00% (6.00) and 100.00% (1.00), respectively. Median BCEA for 95% and 63% of points were 2.40°2 (4.50) and 0.30°2 (0.50), respectively. Median H and V were 0.90° (0.80) and 0.90° (0.70), respectively. Age was significantly correlated with the following parameters in subjects from 21 to 70 years of age (pConclusions Retinal sensitivity in healthy eyes tends to decrease with age as well as the stability of the pattern of fixation. A normative database in terms of retinal sensitivity threshold and fixation performance can be established in this type of eyes.

Microperimetry (MP) is a technology that allows the study of retinal sensitivity at different foveal and parafoveal areas as well as eye fixation. It is a technique of functional evaluation, providing a direct correlation between anatomical and functional outcomes. There are a great variety of studies which evaluate the repeatability or reliability of measurements obtained with this technology and also describe and explore different clinical applications. MP has been shown to be useful in the characterization of sensory and motor conditions, such as amblyopia or nystagmus. Concerning ocular pathology, several studies have confirmed the usefulness of MP for evaluating and analyzing different retinal pathological conditions, such as age-related macular degeneration or glaucoma, and for analyzing the effect of different medical or surgical treatments for these conditions. MP has also been shown to be useful for visual training or rehabilitation in some specific cases.

One of the main challenges in 3D integral imaging (InI) is to overcome the limited depth of field of displayed 3D images. Although this limitation can be due to many factors, the phenomenon that produces the strongest deterioration of out-of-focus images is the facet braiding. In fact, the facet braiding is an essential problem, since InI 3D monitors are not feasible if the braiding problem is not solved. In this paper, we propose a very simple method for overcoming the facet braiding effect which is a serious limitation for realization of 3D TV based on InI. Hybrid experiments are presented to verify the theoretical analysis.

Purpose: To evaluate the reliability and intersession agreement of measurements of retinal sensitivity as well as of the fixation pattern obtained in healthy eyes with a microperimeter integrating the mechanism of the scanning laser ophthalmoscope (SLO) with the static perimetry. Methods: This study included a sample of 44 healthy eyes of 44 subjects of a mean age of 27.0 ± 8.5 years. In all cases, microperimetric exams with the MAIA system (Centervue, Padova, Italy) were performed in three different sessions to evaluate the intersession repeatability. The consistency of measurements was analyzed by using the Friedman test and by analyzing the correlation between consecutive measurements. Agreement between the first and third sessions was assessed by using the Passing–Bablok regression analysis. The following parameters were analyzed: average threshold (AT), macular integrity (MI) index, fixation indexes P1 and P2, bivariate contour ellipse area (BCEA), major and minor axes of the ellipse and high preferred retinal locus position (PRLh). Results: Not statistically significant differences were found in the evaluated parameters between the three sessions (p ≥ 0.193). The correlation between consecutive measurements was moderate to strong for all parameters evaluated (r ≥ 0.49, p