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Background: We aim to assess if refractive error or age may influence the repeatability of measurements using a swept-source biometer., Methods: A total of 61 subjects were evaluated with IOLMaster 700 acquiring measurements of axial length (AL), central corneal thickness (CCT), white-to-white distance (WTW), anterior aqueous depth (AQD), lens thickness (LT), and keratometry (K) readings. Repeatability was evaluated classifying the sample according to the refractive state and age by the calculation of the within-subject standard deviation (S w ), coefficient of repeatability, and intraclass correlation coefficient., Results: Very similar S w was acquired among groups for AL, CCT, and WTW. Differences found for AQD, LT, keratometry and astigmatism among refractive and age groups were not clinically significant. Refractive groups obtained a S w for AQD between 0.016 and 0.026, while for LT was between 0.023 and 0.029 mm. Besides, S w showed values from 0.014 to 0.029 mm for keratometry. Age groups obtained a S w of 0.025 and 0.016 mm for AQD, and 0.029 and 0.018 mm for LT, respectively. S w was 0.019 vs 0.018 mm for K1, 0.014 vs 0.031 mm for K2., Conclusions: IOLMaster 700 showed good repeatability for biometric and keratometric parameters in eyes classified according to their refractive error or age.

Purpose: To assess the visual outcomes, predictability, and safety of the Implantable Collamer Lens (ICL) (STAAR Surgical, Inc., Monrovia, CA) for the management of residual pseudophakic refractive error., Methods: Forty-nine pseudophakic eyes of 40 patients in which myopic, hyperopic, or toric ICLs were implanted were retrospectively analyzed. Twenty-nine eyes had been implanted with a monofocal intraocular lens (IOL) and 20 eyes had a multifocal IOL. All IOLs were implanted in the capsular bag. Of the 49 eyes included, 6 had residual refractive error after phacoemulsification without corneal pathology or surgical alteration (virgin cornea group), 12 had LASIK or photorefractive keratectomy (PRK) (excimer laser group), 8 had radial keratotomy, 5 had intrastromal corneal ring segments (ICRS) implantation, 11 had penetrating keratoplasty, and 7 had deep anterior lamellar keratoplasty (DALK). Uncorrected and corrected (CDVA) distance visual acuity and manifest refraction were evaluated., Results: The efficacy/safety indices were 0.92/1.10, 0.98/1.13, 1.04/1.11, 0.90/1.13, 0.79/1.17, and 0.71/1.23 for the virgin cornea, excimer laser, radial keratotomy, ICRS, penetrating keratoplasty, and DALK groups, respectively. No eye lost one or more lines of CDVA. The virgin cornea, excimer laser, and radial keratotomy groups showed better predictability and accuracy, with 96.2% spherical equivalent within ±1.00 diopters (D). The ICRS, penetrating keratoplasty, and DALK groups demonstrated approximately 50% spherical equivalent within ±1.00 D. There were no intraoperative or postoperative complications., Conclusions: Good refractive outcomes and a strong safety record support the use of the ICL for the correction of residual refractive error in pseudophakic eyes with previous corneal surgery. [J Refract Surg. 2018;34(10):654-663.]., (Copyright 2018, SLACK Incorporated.)

A simplified version of the human eye is known as a schematic eye model. Since the first attempts in the middle of the 19th century, numerous approaches describing new schematic eye models have been introduced. Some are able to describe the accommodation ability of the human eye. Accommodated schematic eyes could be of great interest because they explain the functionality of the human eye and they are easy to use for research purposes. Purposes include the design and testing of multifocal ophthalmic intraocular lenses, the evaluation of the effect of optical aberrations on retinal image quality, and the study of the optical performance of the eye at different distances after some refractive surgical procedures. This paper reviews and summarizes the most important features and details of accommodated schematic eye models that have been proposed in the past years., (Copyright © 2018 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

The aim of this study was to determine whether dynamic accommodation responds to isolated blur cues without feedback, and without changes in the distance of the object. Nine healthy subjects aged 21-40years were recruited. Four different aberration patterns were used as stimuli to induce blur with (1) the eye's natural, uncorrected, optical aberrations, (2) all aberrations corrected, (3) spherical aberration only, or (4) astigmatism only. The stimulus was a video animation based on computer-generated images of a monochromatic Maltese cross. Each individual video was generated for each subject off-line, after measuring individual aberrations at different accommodation levels. The video simulated sinusoidal changes in defocus at 0.2Hz. Dynamic images were observed through a 0.8mm pinhole placed at a plane conjugated with the eye's pupil, thus effectively removing potential feedback stemming from accommodation changes. Accommodation responses were measured with a Hartmann-Shack aberrometer for the four different aberration patterns. The results showed that seven out of nine subjects did not respond to any stimuli, whereas the response of the other two subjects was erratic and they seemed to be searching rather than following the stimulus. A significant reduction in average accommodative gain (from 0.52 to 0.11) was obtained when the dioptric demand cue was removed. No statistically significant differences were found among the experimental conditions used. We conclude that aberration related blur does not drive the accommodation response in the absence of feedback from accommodation., (Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Purpose: To evaluate the repeatability of an optical device (NIMO TR1504, Lambda-X, Belgium) for measuring multifocal contact lens power profiles., Methods: The NIMO TR1504 was used to measure power profiles 30 times for each of 10 different contact lenses from 4 major companies. All contact lenses were labelled as -3D for distance vision; half were for high addition and half for low addition. The optical zone in all measurements was set to 3-mm radius. For each lens, the median power profile and the residuals of the 30 measurements were calculated. The 95% confidence bands and two indices that summarize measurement errors were calculated: the repeatability limit and an index of repeatability heterogeneity, quantifying heterogeneity of measurement errors over the optical zone., Results: The repeatability limit was good (from 0.04D to 0.12D), for all multifocal contact lenses. Variability of measurement errors of power profiles was quite homogeneous along the optical zone for all lenses, although for some lenses variability was slightly higher in the centre than peripherally., Conclusions: The repeatability of measured power profiles obtained by the NIMO TR1504 is lower than 0.12D for the multifocal contact lenses., (Copyright © 2015 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Purpose: The aim was to study the interchangeability of various devices that measure anterior chamber depth (ACD) and white-to-white (WTW) distance., Methods: Eighty right eyes of eighty patients aged 20 to 40 years were included. Their spherical equivalent ranged from -4.25 to +1.00 dioptres. Each eye's ACD and the WTW distance were measured using the following devices: a Castroviejo surgical calliper, CA-200F Corneal Analyser, Orbscan II, Pentacam HR and IOLMaster 500., Results: The Pentacam HR measured significantly greater ACD (p < 0.01) than the other two devices, whereas IOLMaster 500 and Orbscan II yielded comparable (p > 0.01) distances. Nonetheless, in every device comparison, the mean difference was within clinically acceptable limits. The device comparison showed that for WTW distance measurements IOLMaster 500 yields the greatest value (p < 0.01), whereas CA-200F Corneal Analyser yields the smallest one (p < 0.01)., Conclusion: Pentacam HR, Orbscan II and IOLMaster 500 can be used interchangeably to measure ACD, whereas Orbscan II, IOLMaster 500, Castroviejo surgical calliper and CA-200F Corneal Analyser cannot be considered interchangeable, when it comes to measuring WTW distance., (© 2015 The Authors. Clinical and Experimental Optometry © 2015 Optometry Australia.)

Purpose: To evaluate the visual performance of the Proclear multifocal toric contact lens (CL; CooperVision, US) for both presbyopia and astigmatism correction., Methods: In this crossover study design, 20 presbyopic subjects with astigmatism were fitted in a random order with either Proclear multifocal toric CL or Proclear toric single vision distance CL (DCL) combined with reading spectacles. After 1 month, high-contrast distance visual acuity, near high-contrast visual acuity, distance contrast sensitivity (CS) under photopic and mesopic conditions without and with glare, near CS, defocus curve, and stereopsis were measured. Subjects were then refitted with the alternative correction, and the procedure was repeated., Results: Repeated measures analysis of variance revealed differences in visual acuity and CS (p < 0.001) between groups. Mean binocular distance visual acuity and near visual acuity obtained with multifocal toric CL were -0.01 ± 0.03 logMAR and -0.04 ± 0.06 logMAR, respectively. The mean distance CS with the multifocal toric CL was within normal limits under photopic and mesopic conditions. Under photopic conditions, distant CS was better with distance CL than with multifocal toric CL only at 18 cycles/degree. Under mesopic conditions without and with glare, there were differences between both CLs in distant CS for all spatial frequencies. There were differences between the two CLs in near CS for all spatial frequencies. Mean values of stereopsis obtained with multifocal toric CLs and with the DCL combined with reading glasses were 62 ± 12 sec of arc and 59 ± 12 sec of arc, respectively (p = 0.06). Near range of clear vision with the multifocal toric CLs was 1.55 ± 0.33D., Conclusions: The results of this study suggest that the multifocal toric CL studied is a good option to compensate both presbyopia and astigmatism, providing an optimal distance and near visual quality without compromising the stereopsis.

Purpose: To evaluate the depth of focus with monofocal intraocular lenses (IOLs) in patients with different corneal profiles using adaptive optics (AO) visual simulation., Methods: An AO visual simulator (crx1, Imagine Eyes) was used to simulate the aberration pattern of three monofocal IOLs (Acrysof IQ SN60WF [Alcon Laboratories Inc]; Akreos Adapt AO [Bausch & Lomb]; and Triplato [AJL Ophthalmic]) of different optic designs. Five groups were considered: patients without any corneal refractive surgery (normal cornea group) and with prior low and high myopic and hyperopic ablations (low myopic ablation, high myopic ablation, low hyperopic ablation, and high hyperopic ablation groups). Defocus curves for all situations were measured, with the target being moved from -5.00 to +2.50 diopters (D) in 0.25-D steps, and visual acuity was measured at all vergences., Results: Ten eyes from 10 patients were evaluated. The higher residual spherical aberration (SA) for all IOLs was obtained for the high myopic ablation group and the most negative residual SA was obtained for the high hyperopic ablation group. The best compromise between distance visual and depth of focus for the normal cornea, low myopic ablation, and high myopic ablation groups was obtained with the aspheric designs, whereas the best results for the low hyperopic and high hyperopic ablation groups were obtained with the spherical IOL., Conclusions: The results of this study suggest that the better compromise between distance visual acuity and depth of focus with the three IOLs and the different corneal profiles relies on a certain amount of positive SA. Above a certain limit of residual SA (positive or negative), visual acuity decreases at all vergences, worsening the depth of focus., (Copyright 2012, SLACK Incorporated.)

Purpose: To apply a commercially available high-resolution spectral domain optical coherence tomographer (SOCT) to assess the change in tear volume after application of a new artificial tears formulation specifically developed for contact lens (CL) users., Methods: Twenty OD from young healthy CL wearers (mean age, 24.7 ± 3.5 years) with refractive errors ranging from -0.75 to -2.50 D (mean, -1.56 ± 0.69 D) were examined. All subjects were fitted with Focus Dailies CL (Ciba Vision), and two drops of Blink Contacts (AMO), lubricating formulation specifically developed for CL wearers, were instilled after baseline measures. Tear meniscus volume (TMV) was measured immediately after and 1 min, 10, 30, and 60 min after instillation using the Copernicus HR SOCT (Optopol Tech., SA, Poland). TMV was calculated from the local area from tomograms assuming a regular distribution of the tear meniscus across the eyelid. Three scans were taken at each of the time points., Results: Mean meniscus volume without CL was 1.35 ± 1.18 μL, volume with CL was higher, 1.71 ± 1.56 μL but not significantly different (mean difference, 0.36 ± 1.31 μL). After instillation of Blink Contacts eye drops, meniscus volume increased to an average of 4.10 ± 2.91 μL. Repeated measures analysis of variance showed that values after 10 min were significantly higher than before instillation of eye drops (p < 0.01; mean difference, 0.77 ± 0.65 μL). After 30 and 60 minutes, values of TMV decreased to almost baseline (average mean difference from baseline 0.19 ± 0.18 μL at t30, p < 0.001, and 0.06 ± 0.08 μL at t60, p = 0.004)., Conclusions: High-resolution imaging of the lower tear film meniscus with SOCT systems provides useful measures of tear volume. An artificial tear formulation provides a change in tear volume that is maintained beyond 10 min, although further study, using control groups, would be desirable to determine the consistency of those higher-than-baseline values observed over time.

Purpose: To evaluate induced changes in pupil and accommodative response for different accommodative stimuli with three different multifocal contact lenses (CLs)., Methods: Accommodative and pupil responses with three aspheric multifocal CLs of simultaneous focus center near (PureVision Low Add, PureVision High Add and Focus Progressives) for two accommodative stimuli of -2.5 and -4.00 D were recorded in 10 young subjects. Accommodative response, peak velocity, and time constant of accommodation and pupil constriction were assessed. The measurements were evaluated in all the participants with distance-single vision CLs and with the three multifocal CLs. The monocular measurements were performed in a random sequence for each participant. All parameters were measured with a Hartmann-Shack aberrometer (IRX-3; Imagine Eyes, Orsay, France)., Results: Differences were not found in accommodation response for both accommodative stimuli studied between the single vision lens and the three different multifocal CLs (p > 0.05 for both stimuli). For the 2.5 D stimulus, significant differences were not found in peak velocity and time constant between the single vision lens and the three different multifocal CLs (p > 0.05 for all situations); in amplitude of pupil constriction, differences were only found for the situation with PureVision High Add, where the value was lower than the single vision lens (p = 0.015). For the 4.00 D stimulus, differences with single vision lens in peak of velocity and time constant were only found with PureVision Low Add, where the peak velocity value was higher and the time constant was lower (p = 0.024 and p = 0.032 for peak of velocity and time constant, respectively); for amplitude of pupil constriction differences were not found (p > 0.05)., Conclusions: Data obtained in this pilot study suggest that in young observers, the multifocal CLs studied do not induce large changes in accommodative system compared with the single vision lens.

Purpose: To compare the measurement of wavefront aberrations in non-cyclopleged human eyes with Hartmann-Shack and dynamic skiascopy wavefront analyzers., Methods: Eighty eyes of 40 healthy young adults (19 men, 21 women; mean age 20.8 +/- 2.5 years) with refractive errors ranging from +1.50 to -9.75 diopters (D) sphere and up to 1.75 D cylinder (mean spherical equivalent refraction -2.12 +/- 2.69 D) were examined with the Zeiss/Meditec WASCA and NIDEK OPD-Scan wavefront analyzers and with the Nippon SRW5000 binocular, open-field autorefractor without the instillation of antimuscarinic agents. Three measurements were taken with each system, in randomized sequence. To avoid differences due to instrument myopia, eyes were excluded if mean spherical equivalent refraction with any of the analyzers exceeded those obtained with the SRW5000 by more than 1.00 D; 13 eyes were excluded. Coefficient of repeatability was determined for the WASCA as the confidence interval (CI) for the differences between the repeated measures. Paired t tests with Bonferroni adjustment for multiple comparisons, correlation analysis, and Bland-Altman plots of difference versus mean were performed., Results: The coefficient of repeatability for the WASCA ranged from 0.008 to 0.022 microm. Data distribution was normal for all Zernike coefficients measured with WASCA, but only for Z(3)(-1), Z(3)(1), and Z(4)(0) measured with the OPD-Scan. Mean differences between instruments in coefficients Z(3)(-3), Z(3)(1), Z(3)(3), Z(4)(0), and Z(4)(2) and higher order root-mean-square (RMS) reached statistical significance (mean difference +/- CI: -0.054 +/- 0.021, -0.056 +/- 0.022, and 0.030 +/- 0.016 microm, respectively, P < .05 in all cases). Correlation coefficients were significant only for higher order RMS (Spearman's rho = 0.777; P > .001)., Conclusions: Although agreement is shown for higher order RMS, aberration values obtained with dynamic skiascopy and Hartmann-Shack systems on non-cyclopleged human eyes are not well correlated with each other, and are therefore not interchangeable.

Purpose: To investigate the effect of 3rd-order aberrations on human vision., Setting: Grupo de Ciencias de la Visión, University of Murcia, Murcia, Spain., Methods: The 3rd-order aberrations coma and trefoil were induced with purpose-designed soft contact lenses, 3 inducing coma (low [0.05 microm], medium [0.13 microm], high [1.03 microm]) and 3 inducing trefoil (low [0.07 microm], medium [0.17 microm], high [0.96 microm]). Monocular high-contrast (HCVA) and low-contrast (LCVA) visual acuities and contrast sensitivity were measured in 11 subjects wearing contact lenses with a 5.0 mm artificial pupil., Results: The reduction in HCVA and LCVA was statistically significant only for the highest coma and trefoil values (P<.0001). For coma, the mean change in HCVA was 0.193 logMAR +/- 0.100 (SD) and in LCVA, 0.386 +/- 0.136 logMAR. For trefoil, it was 0.204 +/- 0.128 logMAR and 0.395 +/- 0.141 logMAR, respectively. No differences were found for the lower degrees (P>.2). Contrast sensitivity was significantly reduced with the highest coma and trefoil values (P<.0001) (mean change 0.390 +/- 0.157 and 0.404 +/- 0.135, respectively). Lower degrees did not cause significant changes in contrast sensitivity (P>.1). The effect of induced coma and trefoil on HCVA, LCVA, and contrast sensitivity was similar at each level of induced aberration (P>.01)., Conclusions: Large values of coma and trefoil (approximately 1 mum) significantly reduced visual performance. Only patients with high 3rd-order aberrations, such as those that occur in refractive surgery or in cases of distorted optics, would benefit from this correction.

Purpose: To investigate the relationship between accommodation and the optical aberrations of the whole human eye, as a function of age., Methods: Sixty healthy subjects with spherical ametropia in the range +/-3 D, astigmatism less than 1 D, corrected visual acuity of 20/18 or better, and normal findings in an ophthalmic examination were enrolled. Subjects were divided into four groups, with age ranges of 19 to 29, 30 to 39, 40 to 49, and 50 to 60 years. Monochromatic optical aberrations and pupil size were measured with a Hartmann-Shack wavefront sensor under monocular viewing conditions, without pharmacological dilation or cycloplegia. Stimulus vergences were in the range of 0 to 5 D, with an increment of 0.5 D. The change in aberration during accommodation for different groups and different pupil conditions (natural and fixed 4-mm pupil) was compared., Results: Fourth-order spherical aberration (SA) became more negative with accommodation, and the rate of this change was greater in older individuals. For natural pupil conditions, there were no significant differences between age groups in the changes of the higher-order aberrations, coma, and trefoil with accommodation. However, for a 4-mm pupil, the youngest and oldest group showed significant differences in higher order RMS (root mean square) and spherical aberration compared with the other groups. High-order RMS showed a lower increase during accommodation when the pupil accommodative miosis was taken into account (natural pupil condition) than when a fixed 4-mm pupil was used., Conclusions: Aberrations change with accommodation and with age. SA changes more with accommodation do than other higher-order aberrations. SA becomes more negative with accommodation, and this change is larger in older individuals. Accommodative miosis is useful for ameliorating the increase in higher-order aberrations with accommodation.

Purpose: To retrospectively report the trends of change in several parameters of the human visual system over a wide age range in patients attending an eye clinic., Setting: University of Valencia, Valencia, Spain., Methods: The clinical records of 2654 patients were retrospectively reviewed, and the age, sex, spherocylindrical refraction, visual acuity, keratometry, and intraocular pressure were obtained. Descriptive values for each parameter and the correlations with age and between different parameters were calculated. Vectorial components of refraction, including blur, were also derived from clinical refractive data and then analyzed., Results: Several parameters changed significantly with age, particularly in patients in their sixties and older. An increase in the blur component was mainly associated with astigmatic progression and a trend toward against-the-rule orientation and had the highest correlation with total astigmatism (r= -0.319; P<.001) and visual acuity (r= -0.442; P<.001). Refractive conditions had the most homogeneous distribution in the first decade of life and the most heterogeneous distribution in the group between 61 years and 70 years., Conclusions: Best corrected visual acuity began to decrease after the 50s, while changes in the blur component were not patent until the 60s to 70s. This could be explained by the poorer optical quality of the human eye in adulthood and elderly persons. Clinically, these changes could be attributed to changes in ocular astigmatism and have an impact on the best visual acuity achievable with optical compensation.

Purpose: To determine the origin of the wavefront aberration as measured in eyes fitted with diffractive intraocular lenses (IOLs)., Methods: Wavefront aberration was measured by Shack-Hartmann aberrometry in 2 eyes fitted with diffractive bifocal contact lenses and 10 eyes implanted with Acrysof ReSTOR multifocal IOLs., Results: Problems were encountered as a result of the multiple wavefronts generated by the diffractive lenses and their dependence on wavelength. These led to ambiguities in the positions of the Shack-Hartmann spot images and in the form of the derived wavefronts., Conclusions: Aberrometry may not provide reliable information on the wavefront aberration associated with either the distance or near power of diffractive IOLs.

Purpose: To assess visual acuity tolerance to defocus caused by residual refractive errors after clear lens extraction (CLE) with apodized diffractive intraocular lens (IOL) implantation., Setting: Fernández-Vega Ophthalmological Institute, Oviedo, Spain., Methods: In this prospective study, 150 eyes of 75 consecutive patients who had bilateral CLE with implantation of an AcrySof ReSTOR Natural IOL (Alcon) were evaluated. The eyes were divided into 2 groups: myopia and hyperopia. Residual refractive errors were analyzed using vector analysis. Monocular and binocular uncorrected distance visual acuity, best corrected distance visual acuity, uncorrected distance near visual acuity, and best distance-corrected near visual acuity 6 months after surgery were recorded., Results: When the distance residual refractive error was corrected, there was a statistically significant improvement in uncorrected distance acuity in the myopia group and hyperopia group (P<.001). No differences were found between uncorrected-distance near acuity and best distance-corrected near acuity (P>.2). A significant trend toward worse visual acuity as a function of spherical equivalent (SE) value was significant only for uncorrected distance acuity (P<.001). No significant correlations were found for best corrected distance acuity, uncorrected-distance near acuity, and best distance-corrected near acuity as a function of SE (P>.2)., Conclusions: Correction of distance residual refractive error improved distance visual acuity in patients with apodized diffractive IOLs. However, near visual acuity was maintained whether the residual refractive error was corrected or not.

Purpose: To compare the effects on contrast sensitivity of the IntraLase femtosecond laser for flap creation (IntraLASIK) and standard LASIK for myopia., Methods: Two hundred eyes of 100 consecutive patients underwent LASIK treatment using the VISX S2 laser system. The femtosecond laser (15 kHz IntraLase) was used for flap creation in 100 eyes (50 patients) and a mechanical microkeratome (Carriazo-Barraquer) was used in 100 eyes (50 patients). Best spectacle-corrected contrast sensitivity was measured before and 6 months postoperatively in the IntraLASIK and mechanical LASIK groups. The IntraLASIK and mechanical LASIK-induced changes in contrast sensitivity were compared under photopic (85 cd/m2) and mesopic (5, 2.5, and 0.1 cd/m2) conditions., Results: Contrast sensitivity for eyes after IntraLASIK did not differ from preoperative values at the photopic level (85 cd/m2). However, under mesopic conditions, a statistically significant reduction (P < .01) in contrast sensitivity was found at high spatial frequencies (12 and 18 cpd), although no significant contrast sensitivity differences were observed at low and middle spatial frequencies (P > .01 for 1.5, 3, and 6 cpd). No statistically significant differences were found between IntraLASIK and mechanical LASIK for 1.5, 3, and 6 cpd at any luminance level (P > .01). IntraLASIK showed better contrast sensitivity than mechanical LASIK under mesopic conditions at 12 cpd and photopic and mesopic conditions at 18 cpd (P < .01)., Conclusions: IntraLASIK surgery demonstrated better contrast sensitivity at high spatial frequencies under photopic and mesopic conditions than mechanical LASIK.

Purpose: To study the effect of artificial tear instillation on ocular aberrations in dry-eye patients., Setting: Research, Development and Innovation Department, Instituto Oftalmológico de Alicante, Alicante, Spain., Methods: Ocular aberrations (total, spherical-like, and coma-like) were measured with a Hartmann-Shack aberrometer before and after artificial tear instillation (immediately and 10 minutes later) in 15 eyes of 15 dry-eye patients., Results: Optical aberrations showed a statistically significant reduction after artificial tear instillation (P<.01). Total aberrations decreased on average by a factor of 2 to 3 times immediately after instillation; the reduction was maintained after 10 minutes (P>.01)., Conclusions: After artificial tear instillation, the reduction in optical aberrations associated with an increasingly irregular tear film may cause an improvement in the optical quality of dry eyes. Wavefront analysis facilitates the evaluation of improvement in optical quality after artificial tear instillation in patients with dry eye.

Objective: The purpose of this study was to determine objectively the changes in optical aberrations induced by the progressive tear film irregularity after a blink and their effects on retinal image quality., Design: Prospective, consecutive, nonrandomized comparative trial (self-controlled)., Participants: Twenty healthy subjects., Main Outcome Measures: Corneal and total ocular aberrations were determined in 20 subjects at various time intervals (approximately 0, 10, and 20 seconds) after a blink. Corneal and total aberrations were measured with an Orbscan II topographer (Orbtek Inc, Salt Lake City, UT) and a Zywave aberrometer (Bausch & Lomb, Irvine, CA), respectively. All data were decomposed using Zernike polynomials to yield the root mean square wavefront deviations, in micrometers (microm), for different pupil diameters (3.5, 4.5, 5.5, and 6.5 mm). A merit function (Mf), defined as the volume under the 2-dimensional modulation transfer function as computed from the total wavefront error, was taken as the image quality metric., Results: Both corneal and total aberrations (third order and higher) showed a statistically significant increase with time after the blink for all pupil diameters except 3.5 mm. The magnitude of the increase was greater at larger pupil diameters. For a 6.5-mm pupil, the aberrations increased on average by a factor of 2.5 (total) and 2.5 (corneal). Increases in total aberration were related closely to increases in corneal aberration (P<0.0001). For a 6.5-mm pupil, after 20 seconds, the reduction in optical quality (Mf) among the subjects studied was 21+/-8%., Conclusions: After a blink, the gradual increase in optical aberration associated with the increasingly irregular tear film may cause a progressive reduction in the optical quality of the eye. These changes in aberration with time may partly limit the improvements in visual performance that are achievable by customized corneal ablation.

To compute the polychromatic through-focus image quality in eyes implanted with a new extended depth of focus (EDOF) intraocular lens (IOL). Eight eyes of four patients who underwent implantation with the AcrySof IQ Vivity EDOF IOL were analyzed. Wavefront aberrations were measured. The optical metric for the polychromatic through-focus image quality used was the Visual Strehl ratio computed in the spatial domain (VSX). Eight eyes implanted with a monofocal IOL were also examined. The normalized VSX values change with vergence for both group of IOLs. However, the depth-of-focus (DoF) for the Vivity IOL was about 0.75, 1.00, and 1.25 D larger than the monofocal IOL, for 0.1, 0.2, and 0.3 logMAR visual acuities. The DoF computed from the polychromatic through-focus image quality for the Vivity IOL was about 2.50D, being this value 1.25D wider than the monofocal one. The DoF obtained from the defocus curve was about 2.25 D for eyes implanted with the Vivity IOL. Polychromatic through-focus image quality analysis agrees with the clinical outcomes indicating that this methodology may be useful to estimate the DoF and the expected quality of vision in patients implanted with lenses from wavefront aberration measurement. This approach shows the increased DoF of the EDOF lens compared to a monofocal. [ABSTRACT FROM AUTHOR]

Purpose: To assess visual and refractive results after bilateral implantation of a trifocal intraocular lens (IOL) in patients with hyperopia. Methods: In a retrospective nonrandomized study, 196 eyes of 98 patients had bilateral implantation of a trifocal IOL. The Barrett Universal II formula was used for IOL power calculation. Eyes were divided into two groups for their analysis: low-moderate, with IOL power ranging from 22 to 26 D, and high, with IOL power ranging from 25 to 34 D. Refractive error was used to assess predictability, and corrected distance visual acuity (CDVA) and uncorrected distance visual acuity values were used to assess efficacy and safety of the surgery. Results: Six months postoperatively, our results revealed a Snellen decimal CDVA of 0.97±0.05 and 0.94±0.09, for the low-moderate and high groups, respectively. The low-moderate hyperopia group showed a 75.23% of eyes with 20/20 of CDVA and 100% of eyes with 20/25 of CDVA, and the high hyperopia group showed 60.95% and 94.29% for these values of visual acuity, respectively. The mean postoperative spherical equivalent was −0.25±0.36D and −0.24±0.42D for low-moderate and high hyperopia groups, respectively. In the case of low-moderate hyperopia group, 81% of eyes were within ±0.50D and 99% within ±1.00D. These values were 78% and 95%, respectively, for the high hyperopic eyes. Conclusion: Bilateral implantation of a trifocal IOL in hyperopic eyes provided good visual and refractive outcomes. The Barrett Universal II formula was accurate in predicting the IOL power in hyperopic eyes. [ABSTRACT FROM AUTHOR]

Purpose To determine if human accommodation uses the eye's own monochromatic aberrations to track dynamic accommodative stimuli. Methods Wavefront aberrations were measured while subjects monocularly viewed a monochromatic Maltese cross moving sinusoidally around 2D of accommodative demand with 1D amplitude at 0.2 Hz. The amplitude and phase (delay) of the accommodation response were compared to the actual vergence of the stimulus to obtain gain and temporal phase, calculated from wavefront aberrations recorded over time during experimental trials. The tested conditions were as follows: Correction of all the subject's aberrations except defocus (C); Correction of all the subject's aberrations except defocus and habitual second-order astigmatism (AS); Correction of all the subject's aberrations except defocus and odd higher-order aberrations ( HOAs); Correction of all the subject's aberrations except defocus and even HOAs (E); Natural aberrations of the subject's eye, i.e., the adaptive-optics system only corrected the optical system's aberrations (N); Correction of all the subject's aberrations except defocus and fourth-order spherical aberration (SA). The correction was performed at 20 Hz and each condition was repeated six times in randomised order. Results Average gain (±2 standard errors of the mean) varied little across conditions; between 0.55 ± 0.06 (SA), and 0.62 ± 0.06 (AS). Average phase (±2 standard errors of the mean) also varied little; between 0.41 ± 0.02 s (E), and 0.47 ± 0.02 s (O). After Bonferroni correction, no statistically significant differences in gain or phase were found in the presence of specific monochromatic aberrations or in their absence. Conclusions These results show that the eye's monochromatic aberrations are not necessary for accommodation to track dynamic accommodative stimuli. [ABSTRACT FROM AUTHOR]

Purpose To compare the optical and visual quality of a simulated Toric Implantable Collamer Lens ( TICL) and a bioptics technique to treat high myopic astigmatism. Methods An adaptive optics visual simulator was used to simulate the vision after TICL implantation and a bioptics procedure from the wavefront aberration pattern for moderate and high-myopic astigmatism. Visual acuity ( VA) at different contrasts and contrast sensitivity ( CS) at 10, 20 and 25 cycles degree−1 were measured for 3 and 5-mm pupils. Modulation Transfer Function ( MTF) and Point Spread Function ( PSF) were calculated for a 5-mm pupil. Results At a 3-mm pupil we only found statistically significant differences in VA between the two simulated surgeries at low-contrast for moderate- and high-myopic astigmatism ( p < 0.05). Statistically significant differences were found in CS at 3-mm pupil between both procedures at the highest spatial frequency for moderate-myopic astigmatism and at all frequencies for high-myopic astigmatism ( p < 0.05). At a 5-mm pupil we found statistically significant differences in VA and CS between both simulated surgeries at all contrasts and frequencies evaluated for both groups ( p < 0.05). In all cases VA and CS were better with the TICL than with the bioptics technique. MTFs for the bioptics technique were worse than those computed for the TICL. The TICL showed less spread out of the PSF than the bioptics procedure. Conclusions Simulated TICL and bioptics procedures provided good optical and visual quality, although TICL implantation provided slightly better outcomes than the bioptics procedure, especially when the pupil diameter was increased. [ABSTRACT FROM AUTHOR]

Purpose To evaluate and compare the visual performance of two simultaneous vision multifocal contact lenses ( CLs). Methods In this cross-over study design 20 presbyopic subjects were fitted with two different simultaneous vision multifocal CLs (the Pure Vision Multifocal Low Add and Acuvue Oasys for Presbyopia) in random order. After 1 month, binocular distance visual acuity ( BDVA) under photopic (85 cd/m2) and mesopic (3 cd/m2) conditions, binocular near visual acuity ( BNVA), binocular distance contrast sensitivity function ( CSF) under photopic and mesopic conditions, binocular near CSF and defocus curve were measured. Subjects were then refitted with the alternative correction and the procedure was repeated. Results Mean BDVA under photopic conditions was similar for the Acuvue Oasys for Presbyopia and Pure Vision Multifocal Low Add: 0.01 ± 0.08 and 0.00 ± 0.08 log MAR, respectively ( P = 0.45). Under mesopic conditions the values of BDVA were 0.20 ± 0.58 and 0.11 ± 0.09 log MAR, respectively ( P = 0.005). Mean BNVA was 0.20 ± 0.05 and 0.15 ± 0.08 log MAR for the Acuvue Oasys and Pure Vision Low Add, respectively ( P = 0.06). Binocular distance CSF testing revealed no statistically significant differences between lenses under photopic, mesopic or near conditions. Both lenses provided a comparable intermediate visual acuity. Conclusions Both simultaneous vision multifocal CLs provided adequate distance visual quality under photopic and mesopic conditions, and better visual acuity was provided under mesopic conditions for the Purevision lens. Both lenses provided adequate visual performance at intermediate distance, but the near visual acuity appears to be insufficient for early presbyopes who require a moderately demanding near visual quality. [ABSTRACT FROM AUTHOR]

During the past years, the wish to become independent of spectacles has been growing among cataract and presbyopic patients due to many factors, such as the increase in near visual demands, the aesthetic need for a spectacle-free image and ageing of refractive surgery patients, among others. This review assesses recently published studies that analyse visual and optical performance through different metrics of eyes implanted with multifocal intraocular lenses (IOLs), particularly hybrid IOL designs. The published evidence suggests that hybrid multifocal IOLs provide very good outcomes in a number of visual and optical performance parameters. Patients implanted with this type of IOL obtain a satisfactory full range of visual functions, including patients of particular characteristics such as highly ametropic or post-LASIK. [ABSTRACT FROM AUTHOR]

Purpose: To assess efficacy, safety and predictability after refractive lens exchange (RLE) in patients who had bilateral implantation of a distance-dominant diffractive bifocal intraocular lens (IOL). Methods: Seventeen patients (34 eyes) were examined after RLE with bilateral implantation of a diffractive bifocal 447D IOL. Eyes were divided into myopic and hyperopic groups. Monocular uncorrected distance visual acuity, best-corrected distance visual acuity (BCVA), uncorrected distance near visual acuity, and best distance-corrected near visual acuity (BCNVA) were recorded preoperatively and 6 months after surgery. Results: Efficacy indexes were 1.10 for myopic and 0.98 for hyperopic eyes, at 6 months postoperatively. No eye lost ≥ 1 line of BCVA. For the myopic group, four eyes gained 1 line, and six eyes gained ≥ 2 lines; for the hyperopic group, three eyes gained 1 line, and five eyes gained ≥ 2 lines. Safety indexes were 1.21 and 1.08 for myopic and hyperopic eyes respectively. No eye lost ≥ 1 line of BCNVA. Safety indexes at near were 1.02 for myopic and 1.01 for hyperopic eyes. Efficacy indexes at near were 1.02 for myopic and 1.00 for hyperopic eyes. Conclusions: Six-month results of bilateral implantation of a distance-dominant diffractive bifocal IOL for RLE demonstrated efficacy, safety, and predictability in correcting ametropia and presbyopia. [ABSTRACT FROM AUTHOR]

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Purpose: To analyze the prevalence and presentation patterns of corneal astigmatism in cataract surgery candidates. Setting: University of Valencia, Valencia, Spain. Methods: Refractive and keratometric values were measured before surgery in patients having cataract extraction. Descriptive statistics of refractive and keratometric cylinder data were analyzed and correlated by age ranges. Results: Refractive and keratometric data from 4540 eyes of 2415 patients (mean age 60.59 years ± 9.87 [SD]; range 32 to 87 years) differed significantly when the patients were divided into 10-year subsets. There was a trend toward less negative corneal astigmatism values, except the steepest corneal radius and the J45 vector component, in older groups (Kruskal-Wallis, P<.01). In 13.2% of eyes, no corneal astigmatism was present; in 64.4%, corneal astigmatism was between 0.25 and 1.25 diopters (D) and in 22.2%, it was 1.50 D or higher. Conclusions: Corneal astigmatism less than 1.25 D was present in most cataract surgery candidates; it was higher in about 22%, with slight differences between the various age ranges. This information is useful for intraocular lens (IOL) manufacturers to evaluate which age ranges concentrate the parameters most frequently needed in sphere and cylinder powers and for surgeons to evaluate which IOLs provide the most effective power range. [Copyright &y& Elsevier]

PURPOSE: To compute and compare anterior corneal aberration changes following hyperopic LASIK using two different excimer lasers: the VISX Star S2 and the Asclepion-Meditec MEL 70 G Scan. METHODS: The right eyes of 43 patients with preoperative refraction ranging from +0.75 to +5.50 diopters (D) and astigmatism ranging from 0.00 to 1.00 D were randomly divided into two groups. The first group was operated with the Star S2, a broad-beam excimer laser (n=22), and the second group with the MEL 70, a flying-spot excimer laser (n=21). Total higher order aberrations (Zni, n≥3), coma (Z±1/3, Z±1/5), and spherical aberration (Z40) values were computed from videokeratography using CTView software preoperatively and 6 months postoperatively, for 3.0- and 6.5-mm aperture diameters. RESULTS: Higher order aberrations, coma, and spherical aberration increased after hyperopic LASIK and were greater for larger pupil diameters in both groups. No statistically significant differences were found between the Star S2 and MEL 70 excimer lasers in terms of aberrometric increase, mean postoperative visual acuity, and residual refraction. CONCLUSIONS: Anterior corneal aberrations increase after hyperopic LASIK. The type of laser (Star S2 versus MEL 70) seems to have no impact on the amount of anterior corneal aberrations induced after hyperopic LASIK. [ABSTRACT FROM AUTHOR]

We describe a case of bilateral keratectasia after laser in situ keratomileusis (LASIK) in a patient with previous radial keratotomy and astigmatic keratotomy. The best spectacle-corrected visual acuity (BSCVA) was 20/25 in both eyes. After uneventful LASIK was performed in both eyes for low myopic astigmatism, the patient presented with progressive myopia and astigmatism and a BSCVA of 20/50 in both eyes. Videokeratography showed progressive deformation of the cornea, increasing K-values over 50.0 diopters, and irregular astigmatism. The best corrected visual acuity in both eyes improved to 20/25 with rigid poly(methyl methacrylate) contact lenses. [Copyright &y& Elsevier]

Purpose: To evaluate the optical aberrations in the cornea before and after astigmatic keratotomy (AK) combined with laser in situ keratomileusis (LASIK) in a group of patients with high myopic astigmatism.Setting: Refractive Surgery Unit, NISA Hospital Virgen del Consuelo, Valencia, Spain.Methods: Twelve patients (24 eyes) with high myopic astigmatism (from 3.50 to 6.00 diopters) participated in the study. Astigmatic keratotomy was performed as the first step to reduce astigmatism; after 2 months, the residual refractive error was corrected with LASIK. Videokeratography measurements were conducted before and after each procedure. Topography maps were used to calculate the wavefront corneal aberrations for a 6.0 mm pupil diameter.Results: Total, coma-like, and spherical-like aberrations increased significantly from preoperatively to post LASIK (×6.34, ×2.52, and ×10.50, respectively; P<.01). Astigmatic keratotomy significantly increased coma-like (×4.04; P<.01) and spherical-like (×5.66; P<.01) aberrations. After LASIK, the coma-like aberration was significantly reduced (×0.62; P = .008) and the spherical-like aberration was significantly increased (×1.86; P<.01).Conclusion: Astigmatic keratotomy increased higher-order corneal aberrations, both coma-like and spherical-like, whereas LASIK performed after AK increased the spherical-like aberration and reduced the coma-like aberration. [Copyright &y& Elsevier]

The aim of this study was to determine whether intraocular pressure (IOP), as measured by Goldmann applanation or non-contact tonometry, shows systematic changes in patients who have undergone photorefractive keratectomy (PRK) or laser in situ keratomileusis (LASIK). IOP was measured by central Goldmann and non-contact tonometry in 54 patients pre and post-PRK, and in 43 patients pre- and post-LASIK. An interval of 12 months was allowed after surgery. Patients were selected to have one of four specific initial values of refractive error (-2.5, -5.0, -7.5 and -10.0 D). Fellow unoperated eyes were used as controls. A paired Student's t-test and a one-way ANOVA test were used for statistical analysis. After PRK and LASIK, a statistically significant decrease (p < 0.01) was observed in the IOP of the treated eyes (but not for control eyes; p > 0.01). Although the magnitude of the change increased with the attempted refractive correction, this trend was not statistically significant (p > 0.01). No statistically significant differences were found between the results obtained following the two types of surgery, although the recorded fall in IOP was smaller following LASIK ( p > 0.01 ). The IOP measured after PRK and LASIK for myopia may be reduced because of reduced corneal thickness and curvature and, possibly, tissue softening after natural healing. The presence or absence of Bowman's membrane does not appear to be important in this context. The reduction in measured IOP following refractive surgery, by about 0.5 mmHg/D of myopic correction, needs to be remembered when possible abnormality of IOP in such patients is being considered. [ABSTRACT FROM AUTHOR]

Purpose: To assess visual and refractive outcomes of femtosecond laser for residual refractive error correction after refractive lens exchange (RLE) with multifocal intraocular lens (IOL) implantation. Design: Prospective, nonrandomized, masked observational case series (self-controlled). Methods: Fifty-three eyes of 31 consecutive patients were submitted to femtosecond laser surgery after RLE with multifocal IOL implantation. Patients showed an average manifest refractive error (D) of M, 0.200 ± 0.490; J 0 , −0.051 ± 0.532; and J 45 , −0.007 ± 0.371. Visual acuity (VA) was measured at distance and near vision before and six months after the surgery. Results: At six months after surgery, mean uncorrected VA was 0.83 ± 0.20 and improved in 100% of the eyes. No eye lost two or more lines of best-corrected distance VA; five eyes lost one line, 31 eyes did not change after the surgery, 13 eyes gained one line, and four eyes gained two lines. All eyes were within ± 1.00 diopters (D) and 96.2% were within ± 0.50 D of the desired refraction. The average manifest refractive error (D) after surgery was M, 0.014 ± 0.170; J 0 , 0.029 ± 0.118; and J 45 , 0.007 ± 0.061. No eye lost two or more line of best distance-corrected near VA; two eyes lost one line, 40 eyes did not change, and 11 eyes gained one line. Mean uncorrected distance near VA was 0.88 ± 0.12 at six months. Best distance-corrected near VA changed from 0.89 ± 0.14 before surgery to 0.90 ± 0.13 at six months. Conclusions: Femtosecond laser after RLE with multifocal IOL implantation is an effective procedure for correcting residual ametropia and resulted in better distance visual outcomes. [Copyright &y& Elsevier]

Purpose: To evaluate safety, efficacy, predictability, stability, complications, and patient satisfaction after Artisan phakic intraocular lens (IOL) implantation followed by laser in situ keratomileusis (LASIK) for the correction of high hyperopia. Setting: Instituto Oftalmológico de Alicante, Alicante, Spain. Methods: This prospective trial included 39 eyes with a mean preoperative spherical equivalent (SE) of 7.39 diopters (D) ± 1.30 (SD) and a cylinder between 0 and -4.25 D. The Artisan iris-fixated phakic IOL (Ophtec) for hyperopia was implanted, and LASIK was performed 6 to 8 months later. The best corrected visual acuity (BCVA), uncorrected visual acuity (UCVA), refraction, endothelial cell loss (ECL), endothelium morphologic analysis, and patient satisfaction were recorded. The minimum follow-up was 12 months. Results: At 1 year, 37 eyes (94.9%) were within ±1.00 D of emmetropia and 31 eyes (79.5%) were within ±0.50 D. Thirty-five eyes (89.7%) achieved a UCVA of 0.5 or better. There was a statistically significant decrease in BCVA after phakic IOL implantation, but this effect was corrected after LASIK. Nine eyes (23.1%) lost 1 line of BCVA; 7 eyes (17.9%) gained at least 1 line. One eye (2.6%) showed a change in SE greater than 1.0 D over the follow-up period. The mean ECL was 10.9%, but morphologic analysis suggested no additional damage caused by LASIK over that produced by phakic IOL surgery. Overall patient satisfaction was high. Conclusions: The combination of Artisan phakic IOL implantation and LASIK safely, predictably, and effectively reduced high hyperopia. A loss of 1 line of BCVA should be expected in about one third of eyes implanted with this IOL. Halos and glare at night remain a potential problem. [Copyright &y& Elsevier]

Purpose: To evaluate the efficacy, predictability, and safety of bitoric laser in situ keratomileusis (LASIK) for the correction of mixed astigmatism.Setting: Instituto Oftalmológico de Alicante, Alicante, Spain.Methods: This prospective study included 28 eyes of 21 patients with mixed astigmatism who had bitoric LASIK using the Hansatome® microkeratome (Bausch & Lomb Surgical) and the Chiron Technolas® 217 excimer laser (Bausch & Lomb Surgical). The main outcome measures were uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), defocus equivalent, blur strength, and refraction.Results: Six months after bitoric LASIK, the mean UCVA was 0.70 ± 0.23 (SD). The percentage of eyes with a UCVA of 20/40 or better was 78.6% and of 20/20, 21.4%. There was a statistically significant increase in the mean BCVA from 0.71 ± 0.19 before surgery to 0.83 ± 0.15 at 6 months (P = .0004). Three eyes (10.7%) lost 1 line of BCVA; 19 eyes (67.9%) gained 1 or more lines. The mean preoperative astigmatism of -4.04 ± 1.13 diopters (D) was reduced to -0.67 ± 0.79 D after surgery. The defocus equivalent was less than 1.00 D in 75.0% of eyes and less than 0.50 D in 64.3%. Vector analysis showed that the mean achieved correction was 97.4% of the intended correction.Conclusions: Bitoric LASIK was a safe, effective, and predictable procedure in the treatment of mixed astigmatism. It is a means to improving BCVA in a significant percentage of patients. [Copyright &y& Elsevier]

The aim of this review is to summarize the results of using posterior chamber phakic intraocular lenses (pIOLs) to restore quality of vision in keratoconus patients. These pIOLs can correct the refractive errors associated with keratoconus and can also be combined with other surgical techniques to improve the results. [ABSTRACT FROM AUTHOR]

PURPOSE: To evaluate the visual and wavefront outcomes after cataract surgery with implantation of a diffractive multifocal toric intraocular lens (I0L). SETTING: Two clinical centers, Lisbon, Portugal. DESIGN: Case series. METHODS: This study comprised patients with cataract and corneal astigmatism between 0.75 di-opter (D) and 2.50 D who had phacoemulsification with Implantation of an Acrysof IQ Restor toric I0L. Over a 3-month follow-up, the main outcome measures were uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA) at 80 cm, uncorrected near visual acuity (UIWA) at 40 cm, spherical equivalent (SE) refraction, residual astigmatism, rotational stability of the I0L, higher-order aberrations, and the presence of dysphotopic phenomena. RESULTS: The study included 38 eyes (19 patients). The mean UDVA was 0.07 logMAR ± 0.10 (SD), the mean UIVA was 0.16 ± 0.10 logMAR, and the mean UNVA was 0.02 ± 0.09 logMAR. Predictability of refractive results was very good, with an SE refraction within ±0.50 D of the attempted spherical correction in 33 eyes (87%). The mean toric I0L axis rotation was 2.97 ± 2.33 degrees. One eye required a second surgery to align the I0L axis. Ocular aberrometry and dys-photopic phenomena results were similar to those published forthe nontoric version of the toric IOL. CONCLUSION: Implantation of the diffractive multifocal toric IOL in patients with cataract and corneal astigmatism provided excellent distance, intermediate, and near visual outcomes; predict-ability of the refractive results; rotational stability; and good optical performance, allowing all patients to achieve complete spectacle independence. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the efficacy, predictability, safety, and stability of a new-model posterior chamber Implantable Collamer Lens phakic intraocular lens (pIOL) (V4c Visian) to correct myopia. Setting: Private practice, Oviedo, Spain. Design: Case series. Methods: This study enrolled patients who had implantation of a new pIOL design with a central hole for more natural aqueous flow, eliminating the need for neodymium:YAG iridotomy or peripheral iridectomy. The uncorrected (UDVA) and corrected (CDVA) distance visual acuities, refractive error, intraocular pressure (IOP), endothelial cell count, central vault, and adverse events were evaluated 6 months postoperatively. Results: The study enrolled 138 eyes (70 patients). The mean spherical equivalent decreased from −8.73 diopters (D) ± 2.54 (SD) preoperatively to −0.03 ± 0.19 D 6 months postoperatively; 98.5% of eyes were within ±0.50 D and 100% of eyes were within ±1.00 D. The mean UDVA and CDVA were 20/20 or better in 92.1% and 95.0% of eyes, respectively, at 6 months. The safety and efficacy indices were 1.01 and 1.00, respectively. Postoperatively, the IOP remained stable over time. No significant rises in IOP (including pupillary block) and no secondary cataract were found. After 6 months, the mean vault was 482.7 ± 210.5 μm (range 90 to 970 μm) and the mean endothelial cell loss was 8.5%. Conclusions: Implantation of the pIOL was effective, predictable, safe, and stable for the correction of moderate to high myopic errors. This design, which avoids iridotomy or iridectomy, provided good IOP outcomes. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned. [ABSTRACT FROM AUTHOR]

Purpose: To examine differences in efficacy, accuracy, safety, and changes in aberrations between femtosecond and mechanical microkeratome laser in situ keratomileusis (LASIK) for myopia. Setting: Department of Ophthalmology, Shanghai First People''s Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China. Design: Evidence-based manuscript. Methods: Data sources, including PubMed, Medline, EMBASE, and Cochrane Controlled Trials Register, were searched to identify potentially relevant prospective randomized controlled trials. Primary outcome measures were efficacy (uncorrected distance visual acuity ≥20/20), accuracy (±0.50 diopter mean spherical equivalent), and safety (loss of ≥2 lines of corrected distance visual acuity). Aberrations and postoperative complications were secondary outcomes. Results: Seven prospective randomized controlled trials describing a total of 577 eyes with myopia were included in this metaanalysis. At 6 months or more follow-up, no significant differences were found in the efficacy (odds ratio [OR], 1.17; 95% confidence interval [CI], 0.40 to 3.42; P=.78), accuracy (OR, 1.69; 95% CI, 0.68 to 4.20; P=.26), or safety (OR, 7.37; 95% CI, 0.37 to 147.61; P=.19). In eyes that had femtosecond LASIK, the postoperative total aberrations (mean difference −0.03 μm; 95% CI, −0.05 to −0.01; P=.002) and spherical aberrations (mean difference −0.02 μm; 95% CI, −0.03 to −0.01; P<.00001) were significantly lower. Conclusions: According to the metaanalysis, femtosecond LASIK did not have an advantage in efficacy, accuracy, and safety measures over mechanical microkeratome LASIK in the early and midterm follow-up, although it might induce fewer aberrations. Financial Disclosure: Drs. Zhang, Jin, Suo, Patel, and Montés-Micó have no financial or proprietary interest in any material or method mentioned. Additional disclosures are found in the footnotes. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the optical and visual performance after implantation of refractive or apodized diffractive multifocal intraocular lenses (IOLs). Setting: Military Health Service Institute, Warsaw, Poland. Methods: Uncorrected distance visual acuity, best distance-corrected visual acuity, best distance-corrected near visual acuity, distance contrast sensitivity under photopic conditions (CSV-1000), residual refractive error, and wavefront aberrations (LADARWave Hartmann-Shack wavefront analyzer) were measured in 23 patients who had bilateral implantation of the AcrySof ReSTOR SN60D3 IOL and 23 patients who had bilateral implantation of the ReZoom IOL…. Results: At the 6-month postoperative visit, the mean photopic uncorrected distance acuity was 0.03 ± 0.05 (SD) in the ReSTOR group and 0.02 ± 0.06 logMAR in the ReZoom group (both approximately 20/20) (P = .569). In all patients, the mean photopic best distance-corrected acuity was 0.00 logMAR (approximately 20/20) and the mean photopic best distance-corrected near acuity at 35 cm was 0.10 logMAR. The photopic contrast sensitivity was within the standard normal range in both IOL groups. The difference in photopic contrast sensitivity between groups was statistically significant (P<.001). Higher-order aberrations, in particular coma and spherical aberrations, were significantly higher in the ReZoom group (all P<.001). Conclusions: AcrySof ReSTOR SN60D3 and ReZoom IOLs provided good visual performance at distance and near under photopic conditions. Optical quality measures were significantly worse in patients with ReZoom IOLs. [Copyright &y& Elsevier]

Purpose: To assess the visual quality after bilateral implantation of the Acri.LISA 366D intraocular lens (IOL; Carl Zeiss Meditec, Jena, Germany) in patients with hyperopia. Design: Prospective, nonrandomized study. Methods: One hundred and seventy eyes of 85 patients had bilateral implantation of the Acri.LISA 366D IOL. The patients were divided into 2 groups: low to moderate hyperopia (IOL power, 21 to 24.5 diopters [D]) and high hyperopia (IOL power, 25 to 36 D). Monocular and binocular best spectacle-corrected visual acuity (BSCVA), best distance-corrected near visual acuity (BCNVA), binocular best distance-corrected intermediate visual acuity (VA), and distance contrast sensitivity (CSF) under photopic (85 cd/m2) and mesopic (5 cd/m2) conditions were determined. Results: At the 6-month postoperative visit, there were no statistically significant differences in monocular and binocular BSCVA (P = .06 and P = .09, respectively). Monocular and binocular BCNVA were comparable between both groups (P = .24 and P = .42, respectively). The mean binocular best distance-corrected intermediate VA changed significantly as a function of the distance of the test (P < .01) in both groups, and there were no statistically significant differences between groups at any distance. Differences were not found between groups in binocular CSF under mesopic and photopic conditions. Conclusions: Bilateral implantation of the Acri.LISA 366D in patients with high hyperopia provided a satisfactory full-range of vision comparable with that obtained in patients with low to moderate hyperopia. [Copyright &y& Elsevier]

Purpose: To assess visual and refractive outcomes, and rotational stability after refractive lens exchange (RLE) with toric intraocular lens (IOL) implantation to correct ametropia and preexisting astigmatism. Design: Prospective, nonrandomized, observational case series (self-controlled). Methods: This prospective, nonrandomized, and self-controlled study included 32 eyes of 19 consecutive patients with more than 1.00 diopter (D) of preexisting corneal astigmatism having RLE with AcrySof Toric IOL implantation (Alcon Laboratories Inc, Fort Worth, Texas, USA). Uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), refractive sphere, and keratometric and refractive cylinder were recorded preoperatively and 6 months after surgery. Toric IOL axis shift was also measured. A patient satisfaction, visual phenomena, and spectacle dependency questionnaire was also carried out. Results: At 6 months postoperatively, UCVA was 20/32 or better in 100% of the eyes, with 84.3% achieving 20/25 or better. One hundred percent of eyes achieved 20/25 or better BCVA. No eye lost ≥2 lines, 1 eye lost 1 line, 16 eyes did not change, 4 eyes gained 1 line, and 11 eyes gained ≥2 lines of BCVA after the surgery. Mean refractive cylinder was reduced significantly after surgery from −2.46 ± 0.99 D to −0.53 ± 0.30 D (P < .001). Vector analysis to compare attempted vs achieved correction showed that 100% of eyes were within ± 1.00 D for the spherical equivalent, and 100% of eyes were within ±0.50 D for the astigmatic components (J0 and J45). Mean toric IOL axis rotation was 0.90 ± 1.76 degrees, being ≤ 5 degrees in 96.8% of eyes evaluated. Patients were satisfied with their vision without reporting severe visual phenomena (from none to moderate). Conclusions: RLE with toric IOL implantation showed good visual and refractive outcomes for correcting spherical and cylindrical refractive errors. [Copyright &y& Elsevier]