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Purpose: To investigate the epidemiologic, demographic, and basic clinical characteristics of individuals with keratoconus managed by optometrists in New Zealand (NZ)/Aotearoa., Methods: A prospective, longitudinal, nationwide, survey protocol was completed for every patient with keratoconus who underwent a consultation with participating optometrists in a 2-year period. Data for each patient included date of birth, sex, self-reported ethnicity, new or previous diagnosis, uncorrected (UCVA) and best-corrected visual acuity (BCVA), type of refractive correction required to obtain BCVA and keratometric readings obtained using keratometry or computerized topography., Results: One thousand eight hundred sixty-nine cases were identified, with a mean age of 41.0 ± 15.7 years, 56.4% being men, and 87.3% with previous diagnosis. The distribution of cases was skewed toward Auckland (41.6%), Waikato (21.3%), Wellington (16.8%), and Bay of Plenty (13.3%). Self-reported ethnicities were predominantly NZ European (54.4%), Māori (24.7%), and Pacific Peoples (15.5%), disproportionate to the general population profile (74.0%, 14.9%, and 7.4% respectively). Most eyes (64.3%) were managed with rigid contact lenses (corneal lens in 34.2%). The mean K-mean was 49.0 ± 5.7 D. The mean UCVA was 6/42 and BCVA was 6/9. Māori and Pacific Peoples had both the highest K-mean and proportions of eyes graded stage IV on the Amsler-Krumeich scale., Conclusions: The results indicate that keratoconus is relatively common in NZ with at least 1869 patients managed by optometrists in 2 years. Most eyes had mild to moderate disease; however, Māori and Pacific Peoples seem to have greater disease severity. An ethnic predilection is apparent, with Māori and Pacific Peoples overrepresented relative to their population proportions, reinforcing a long-held clinical suspicion., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: To evaluate the agreement of selected higher order aberration measurements between aberrometers based on three different wavefront technologies., Methods: Twenty-three eyes of 23 participants were compared between Zywave, OPD-Scan III, and iDesign aberrometers, for total ocular aberrations. Participants were between 19 and 69 years of age, and exclusion criteria were previous ocular surgery or trauma, contact lens wear within the preceding 2 weeks, and ocular or systemic disease. Corneal aberrations were compared between the OPD-Scan III and GALILEI™ G2 aberrometers. Zernike coefficients of vertical and oblique trefoil, vertical and horizontal coma, and spherical aberration were analyzed in R software., Results: In all, 276 scans were captured in total, with a male-to-female ratio of 11:12. Total ocular vertical coma [mean difference (MD) = 0.026 μm, P < 0.005], vertical trefoil (MD = 0.033 μm, P < 0.05), and spherical aberration (MD = 0.022 μm, P < 0.05) differed significantly between the iDesign and OPD-Scan III. Differences in total vertical (MD = 0.072 μm, P < 0.05) and oblique trefoil (MD = 0.058 μm, P < 0.05) were demonstrated between the Zywave and OPD-Scan III, and spherical aberration (MD = 0.030 μm, P < 0.005) between iDesign and Zywave. iDesign corneal horizontal coma (MD = 0.025 μm, P < 0.05) and spherical aberration (MD = 0.043 μm, P < 0.005) measurements were significantly different between the GALILEI™ G2 and the OPD-Scan III., Conclusion: Zywave, iDesign, and OPD-Scan III, and GALILEI TM G2 and OPD-Scan III may be used interchangeably for their total ocular and corneal wavefront functions, respectively; however, care must be taken if using these devices for guiding ablation or monitoring corneal disease., Competing Interests: None

Purpose: To assess the effects of two weeks of regular phospholipid liposomal spray application on lipid layer grade, tear film stability, subjective comfort, visual acuity, and lipid deposition in silicone hydrogel contact lens wearers., Methods: Thirty-one existing contact lens wearers were enrolled and fitted with two week planned replacement silicone hydrogel contact lenses (Acuvue ® Oasys ® ) in a prospective, randomized, paired-eye, investigator-masked trial. A phospholipid liposomal spray (Tears Again ® ) was applied to one eye (randomized) four times daily for two weeks. LogMAR high contrast visual acuity (VA), low contrast glare acuity (LCGA), non-invasive tear film break-up time (NIBUT), and lipid layer grade (LLG) were measured at baseline and day 14, in both treated and control eyes. Subjective comfort relative to baseline, and spectrofluorophotometric assessment of contact lens surface lipid deposition were also assessed on day 14., Results: All measurements did not differ at baseline between treated and control eyes. Lipid layer thickness and tear film stability were increased on day 14 in treated eyes (all p<0.05), but not in control eyes (all p>0.05). A greater proportion of participants reported improved comfort in the treated eye relative to the control eye (p=0.002). There were no significant differences in visual acuity or in contact lens surface lipid deposition, between treated and control eyes, on day 14 (all p>0.05)., Conclusion: The phospholipid liposomal spray increased tear film stability, lipid layer thickness and subjective comfort in silicone hydrogel contact lens wearers, without adversely affecting visual acuity or contact lens surface lipid deposition., (Copyright © 2016 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Pregnancy influences ocular changes which may exacerbate existing or develop new pathology. This review summarises the existing evidence on the association between pregnancy and progressive keratoconus or iatrogenic keratectasia. Ten online databases were searched systematically. Eligible studies were published in English and reported objective ophthalmic outcomes for women with evidence of (i) a new diagnosis of keratoconus, (ii) keratoconus progression or (iii) iatrogenic keratectasia following refractive surgery; during or within one year of pregnancy. Strength of evidence was assessed using the Oxford Centre for Evidence-Based Medicine levels of evidence. Seventeen articles have reported 33 peripartum women with new-onset or progressive ectasia, evident by signs of corneal hydrops or protrusion (n = 8); steepening on topography imaging (n = 20); a mean decline in best corrected visual acuity by +0.20 logMAR (95% CI −0.01 to +0.40, n = 23); a mean increase in maximum keratometry by 2.18 D (95% CI 1.44 to 2.91, n = 42); a mean decline in spherical equivalent refraction by −1.33 D (95% CI −1.73 to −0.93, n = 41); and a mean increase in astigmatism by −1.61 D (95% CI −2.46 to −0.75, n = 19). Pregnancy is associated with progressive ectasia in some women including those with previously stable keratoconus, or a history of laser-assisted in situ keratomileusis surgery or no history of corneal ectasia. This review highlights the heterogeneity in limited existing evidence, the need for a standardised definition of ectasia progression and further prospective studies for clinical guidelines. Closely monitoring women at risk may assist in early intervention with collagen cross-linking and prevent peripartum vision loss. [ABSTRACT FROM AUTHOR]

Purpose To characterize the effect of incision size on corneal incision repair and remodeling over 3 months after cataract surgery. Setting Department of Ophthalmology, Auckland District Health Board, Auckland, New Zealand. Design Prospective case series. Methods Eyes having routine cataract surgery were randomized to receive 2.20 mm or 2.85 mm uniplanar clear corneal incisions. Anterior segment optical coherence tomography of incision thickness, length, width, gaping, and angle and specular microscopy of endothelial cell density (ECD), polymegathism, and pleomorphism were completed at baseline and 1, 7, 30, and 90 days postoperatively. Results Each incision group comprised 50 eyes (50 patients). Ninety-nine patients (99%) attended all assessments. The Descemet membrane detachment rate was greater than 50% with 2.20 mm incisions (P =.01). Patients with Descemet membrane detachments had increased endothelial wound gaping, slower visual recovery, and increased corneal thickness at the incision site at all visits (φ = 0.54, P <.01). The 2.20 mm group had greater polymegathism despite no difference in the mean phacoemulsification energy between groups (2.20 mm: 32.3% ± 6.2% [SD]; 2.85 mm: 30.8% ± 6.5%) (P =.02). Ninety days postoperatively, the 2.20 mm group had a lower mean ECD (2195 ± 360 cells/mm2) than the 2.85 mm group (2397 ± 335 cells/mm2) (P =.01). Final visual acuity, gaping, and angles were not significantly different between the groups. Conclusions The 2.20 mm wide corneal incisions were more prone to trauma than 2.85 mm incisions during routine cataract surgery. Corneal incisions with signs of trauma were associated with prolonged visual recovery and slower healing postoperatively. [ABSTRACT FROM AUTHOR]

Purpose To quantify pseudophakic refractive error prediction with the Hill-RBF, Barrett Universal II, and SRK/T formulas and to evaluate the temporal effects of anterior chamber depth (ACD) and keratometric changes on postoperative refraction. Setting Department of Ophthalmology, University of Auckland and Auckland District Health Board, Auckland, New Zealand. Design Prospective case series. Methods Patients listed for cataract surgery were prospectively recruited. Optimum intraocular lens (IOL) power and predicted refractive outcomes were calculated, and the predicted refraction was compared with objective refractive outcomes at 1-week and 1-month and 3-month follow-ups. Results The study comprised 100 patients (100 eyes). The mean axial length was 23.4 mm ± 1.1 (SD). The mean keratometry was 43.9 ± 1.3 diopters (D). The mean absolute prediction errors at 3-months were: Universal II: 0.50 ± 0.46 D, RBF: 0.49 ± 0.43 D, and SRK/T: 0.52 ± 0.49 D. The Universal II formula was better than all other methods at 1 week ( P = .02); no method was superior at 1 month ( P = .46) or 3 months ( P = .37). The RBF method predicted the highest proportion of eyes within ±0.25 D at 3 months. Keratometric changes primarily occurred 1 to 4 weeks postoperatively ( P = .03) and trended toward corneal steepening (+0.11 D, P < .01). A significant mean hyperopic shift occurred 4 to 12 weeks postoperatively (+0.18 D, P < .01), accompanied by a trend toward increasing ACD (+0.04 mm, P = .03). Conclusions The Universal II and RBF methods were better than SRK/T in medium length eyes (22 to 24.5 mm). It might be prudent to expect a progressive hyperopic shift in the 3 months after surgery because of posterior IOL migration. [ABSTRACT FROM AUTHOR]