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Postoperative residual refractive error following cataract surgery is not an uncommon occurrence for a large proportion of modern-day patients. Residual refractive errors can be broadly classified into 3 main categories: myopic, hyperopic, and astigmatic. The degree to which a residual refractive error adversely affects a patient is dependent on the magnitude of the error, as well as the specific type of intraocular lens the patient possesses. There are a variety of strategies for resolving residual refractive errors that must be individualized for each specific patient scenario. In this review, the authors discuss contemporary methods for rectification of residual refractive error, along with their respective indications/contraindications, and efficacies.

Purpose: Our aim was to conduct a cost-effectiveness analysis (CEA) of monofocal and multifocal intraocular lenses (IOLs) for cataract patients in Taiwan., Methods: This prospective nonrandomized study was designed to evaluate the effectiveness of monofocal and multifocal IOLs by means of visual performance, visual quality, vision-related quality of life, and spectacle-independence rates. The direct costs were calculated using the payment points of the fee schedule for medical services multiplied by the treatment items. The concept of incremental cost effectiveness ratios was used to evaluate the costs of different types of IOLs in cataract surgery and postoperative outcomes in patients., Findings: A total of 61 patients from the monofocal IOL group (n = 21), multifocal IOL group 1 (n = 22), and multifocal IOL group 2 (n = 18) who completed the study were included in the analysis. No significant differences were observed in mean ages or patient to eye ratio. Significant differences in effectiveness after the implantations of monofocal and multifocal IOLs were observed for spectacle-free rate and monocular contrast sensitivity under glare conditions only. The incremental cost-effectiveness ratios of monofocal versus multifocal IOLs indicated that it cost an additional $57 to $58 (US dollars) to increase each 1% of the spectacle-independence rate., Implications: This study's results indicated that multifocal IOLs provided better effectiveness on vision-related indicators like the incremental cost effectiveness ratios of postoperative spectacle-independence rate and binocular best-corrected visual acuity measurements at near vision. Our findings suggest that multifocal IOLs can be highly cost effective for patients who prefer to be spectacle free, so it is important to ensure that patients have realistic expectations when making choices between monofocal and multifocal IOLs., (Copyright © 2014 Elsevier HS Journals, Inc. All rights reserved.)

Purpose: To design, fabricate, and evaluate novel materials to remove silicone oil (SiO) droplets from intraocular lenses (IOL) during vitreoretinal surgery., Methods: Three different designs were fabricated using soft lithography of polydimethylsiloxane (PDMS), three-dimensional (3D) inverse PDMS fabrication using water dissolvable particles, and atomic layer deposition (ALD) of alumina (Al 2 O 3 ) on surgical cellulose fibers. Laboratory tests included static and dynamic contact angle (CA) measurements with water and SiO, nondestructive x-ray microcomputer tomography (micro-CT), and microscopy. SiO removal was performed in vitro and ex vivo using implantable IOLs and explanted porcine eyes., Results: All designs exhibited enhanced hydrophobicity and oleophilicity. Static CA measurements with water ranged from 131° to 160° and with SiO CA approximately 0° in 120 seconds following exposure. Nondestructive x-ray analysis of the 3D PDMS showed presence of interconnected polydispersed porosity of 100 to 300 μm in diameter. SiO removal from IOLs was achieved in vitro and ex vivo using standard 20-G vitrectomy instrumentation., Conclusion: Removal of SiO from IOLs can be achieved using materials with lower surface energy than that of the IOLs. This can be achieved using appropriate surface chemistry and surface topography. Three designs, with enhanced hydrophobic properties, were fabricated and tested in vitro and ex vivo. All materials remove SiO within an aqueous environment. Preliminary ex vivo results were very promising, opening new possibilities for SiO removal in vitreoretinal surgeries., Translational Relevance: This is the first report of an instrument that can lead to successful removal of SiO from the surface of IOL. In addition to the use of this instrument/material in medicine it can also be used in the industry, for example, retrieval of oil spills from bodies of water.

Purpose: Present a case of dislocation of an Implantable Collamer Lens (ICL) that occurs after blunt trauma and review the published literature on this topic., Methods: Case report and literature review using PubMed., Results: A 44 year-old male presented to the emergency department with sudden onset of blurry vision after blunt trauma to the left eye. Three years prior, he had undergone bilateral ICL placement for high myopia. On examination, the superotemporal haptic was noted to be dislocated into the anterior chamber, but there was no endothelial touch by the dislocated lens. The patient had an associated hyphema that was medically managed, and 2 weeks after the injury, the patient underwent ICL repositioning. A review of the literature was performed and five previous cases of ICL dislocation were identified. Three of these occurred after blunt trauma. One of these cases was associated with endothelial touch and decompensation and eventually required a descement's stripping endothelial keratoplasty (DSAEK)., Conclusion: Dislocation of ICLs after blunt trauma is a rare but important potential sequela of the procedure and can lead to corneal decompensation if there is lens-endothelial touch. All patients who suffer blunt dislocation of ICL should be followed long-term after repositioning for signs of endothelial loss and dysfunction.

Purpose: To evaluate the safety and effectiveness of a single-piece hydrophobic acrylic intraocular lens (IOL) (enVista® MX60; Bausch and Lomb Incorporated, Rochester, NY, USA) following implantation to correct aphakia subsequent to extracapsular cataract extraction in adults., Subjects and Methods: This was an open-label, non-interventional, observational study conducted in 19 university and private-practice settings in Europe and the Asia-Pacific region to investigate clinical outcomes of the MX60 IOL in standard practice. Eligible subjects were at least 18 years of age and had undergone standard phacoemulsification and extracapsular cataract extraction with implantation of the MX60 IOL. The primary safety endpoint was the occurrence of adverse events, and the primary effectiveness endpoints included visual and refractive outcomes and stability, with data collected up to 2 years post-procedure., Results: In this multicenter study, pooled data of 255 eyes were collected and analyzed. Excellent visual and refractive outcomes and stability were demonstrated. At postoperative visit 4 (61-180 days postoperative), 62.2% of subjects achieved a Snellen best-corrected distance visual acuity (CDVA) of 20/20 (decimal 1.00), and 97.8% of subjects achieved a CDVA of 20/40 (decimal 0.50) or better. One eye (1.0%) underwent neodymium:yttrium aluminum garnet capsulotomy at 12 months post-procedure. No glistenings of any grade were reported for any subject at any visit. Adverse events were infrequent and were consistent with incidences generally reported with cataract surgery., Conclusion: This study, which enrolled all comers, provided evidence of the excellent safety and effectiveness of the MX60 IOL in standard practice. Favorable clinical outcomes included outstanding visual and refractive outcomes and stability. No glistenings were reported at any postoperative visit.

Purpose: After cataract surgery, the ability to accommodate is lost. For this reason, a mechatronic IOL is being developed at the moment: The Artificial Accommodation System. This device requires an easily measureable indicator of the distance of the observed object to determine the demand of accommodation. As the pupil constricts with near vision, pupil size might be such an indicator. Our research focused on whether the pupil can control an artificial lens., Methods: A study with 14 healthy subjects aged between 24 and 64 years was conducted. An artificial lens with variable refractive power was mounted in front of one eye. In this eye, natural accommodation was greatly reduced or absent due to presbyopia, pseudophakia, or iatrogenic cycloplegia. The lens' refractive power was changed in a computer-controlled manner depending on changes in the pupil diameter of the second eye, which could not see the fixation stimulus. The subject's task was to get a clear focused image of the target in different distances., Results: The lens can be controlled by the pupil intuitively (P < 1.8 × 10(-18)). Without prior knowledge, 11/14 subjects passed the first trial, and 31/41 trials were successful. Only one subject was not able to control the lens at all. Most subjects comprehended instantly how to use the unfamiliar lens control to bring a target into focus., Conclusions: This study emphasizes the plasticity of the visual control system. Positioning accuracy was acceptable, but the control must be optimized to facilitate maintaining a defined refractive power.

Study Objectives: To evaluate whether blue-light-blocking intraocular lens implantation affects the sleep quality of cataract patients., Design: Pre-test/post-test experiment., Setting: N/A., Participants: 40 patients having bilateral cataracts with level higher than N3 (LOCS II) nucleus hardness, including 26 females (65%) and 14 males (35%)., Interventions: Cataract phacoemulsification followed by blue-light-blocking intraocular lens (IOLs, SN60WF, Alcon Laboratories, USA) implantation., Measurements and Results: Patients were contacted in site before cataract surgery and followed by telephone at least 2 months later after second-eye surgery. Pittsburgh Sleep Quality Index (PSQI) questionnaires were administered to evaluate sleep quality. Median age of patients was 74 years (IQR 70 to 78). The median PSQI globe scores were 7 before surgery and 4 after surgery (Z = -2.121, p = 0.037). More specifically, there were significant differences on subjective sleep quality (Z = -2.064, p = 0.045), sleep duration (Z = -2.037, p = 0.047) and daytime dysfunction (Z = -2.142, p = 0.034) when compared between before and after surgeries. The ratio of poor sleepers (PSQI > 5) was reduced significantly after surgery (χ² = 14.532, p < 0.001)., Conclusions: Blue-light-blocking IOL had a significantly beneficial effect on the sleep quality of cataract patients.

Intraocular lens development is driven by higher patient expectations for ideal visual outcomes. The recently US Food and Drug Administration-approved Softec HD(™) lens is an aspheric, hydrophilic acrylic intraocular lens (IOL). The hydrophilic design of the lens is optimized to address dysphotopsia while maintaining biocompatibility, optical clarity, resistance to damage, and resistance to biocontamination. Aspheric lenses decrease postoperative spherical aberration. The addition of the Softec lens provides clinicians with another option for IOL placement; however, randomized comparative studies of this lens to others already on the market remain to be completed.