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We investigated how long-term visual experience with habitual spherical aberration (SA) influences subjective depth of focus (DoF). Nine healthy cycloplegic eyes with habitual SAs of different signs and magnitudes were enrolled. An adaptive optics (AO) visual simulator was used to measure through-focus high-contrast visual acuity after correcting all monochromatic aberrations and imposing + 0.5 μm and − 0.5 μm SAs for a 6-mm pupil. The positive (n = 6) and negative (n = 3) habitual SA groups ranged from 0.17 to 0.8 μm and from − 1.2 to – 0.12 μm for a 6-mm pupil, respectively. Although all optical conditions were identical, and the subjective DoFs were expected to be the same for all participants, the DoFs of individuals differed between the positive and negative habitual SA groups. For the positive habitual SA group, the mean DoF with positive AO-induced SA (2.14 D) was larger than that with negative AO-induced SA (1.88 D); for the negative habitual SA group, a smaller DoF was measured with positive AO-induced SA (1.94 D) than that with negative AO-induced SA (2.14 D). Subjective DoF tended to be larger when the induced SA in terms of sign and magnitude was closer to the participant's habitual SA. Our findings suggest that neural adaptation to habitual SA compensated for optical blur at multiple object distances, perceptually expanding DoF. As a result, the outcomes of optical treatments for presbyopia may differ due to the neural compensation mechanism influenced by an individual's visual experience with their habitual optics. [ABSTRACT FROM AUTHOR]

Presbyopia is a common age-related visual impairment. With the aging of the population, the incidence of presbyopia is increasing globally, becoming a worldwide public health concern. Treatment options for presbyopia include optical lens correction, surgical intervention, and pharmacological therapy. Pharmacological treatments for presbyopia are non-invasive, reversible, and have emerged over the past decade. Following the US Food and Drug Administration's approval of 1.25% pilocarpine for presbyopia, the use of pilocarpine and its compound formulations has gained increased attention, with some drugs entering clinical phase II/III trials (www.clinicaltrials.gov). Therefore, this article primarily describes and analyzes the progress of research on the use of pilocarpine and its compound formulations for presbyopia, as well as the challenges that remain to be addressed. The optimal dosage form, the optimal concentration, the long-term safety, and patient compliance should be further explored, and there is a lack of multi-center evidence-based medicine research to support it. The aim of this article is to provide a reference for researchers to conduct further in-depth investigations in this area. [ABSTRACT FROM AUTHOR]

Purpose: Investigations into the correction of presbyopia have considered lens design, clinical implications and the development of objective metrics such as the visual Strehl ratio. This study investigated the Jacobi–Fourier phase mask as an ophthalmic element in the correction of presbyopia. The goal was to develop a contact or intraocular lens whose performance was largely insensitive to changes in pupil diameter. Methods: Numerical simulations based on Fourier optics were performed to evaluate three different Jacobi–Fourier polynomials, with the aim of providing a range of clear vision (1 Dioptre (D)). Performance was evaluated for three pupil sizes (6, 4 and 2 mm), while polychromatic images were simulated using three different wavelengths (656.3, 587.6 and 486.1 nm). The Neural Transfer function was included in the simulation. To validate the method and results, we used the Visual Strehl combined objective metric (VSCombined) currently used in visual optics. This metric gives more weight to the phase transfer function and is more suitable for non‐symmetrical phase functions. Results: Numerical validation showed the suitability of the Jacobi–Fourier phase masks for extending the range of clear vision of presbyopic eyes, providing a visual acuity of at least 0.10 logMAR (6/7.5 Snellen) at all distances between 1 and 6 m. The results show a range of clear vision of 1D was not affected by changes in pupil size, an increase in retinal image contrast accompanied by image artefact reduction by increasing the radial order of the Jacobi–Fourier phase mask and a reduction of wavelength dependence of the retinal images. These results are supported by simulated images and the objective criterion VSCombined. Conclusions: The use of Jacobi–Fourier phase masks as ophthalmic elements for presbyopic correction show promising results, with a good range of clear vision and reduced dependence on pupil size and chromatic aberration. [ABSTRACT FROM AUTHOR]

Purpose: To assess visual outcomes and stability of lens alignment more than 3 years after implanting either the AT Lisa Tri Toric (Carl Zeiss Meditec) or the Acrysof IQ Restor Toric (Alcon Laboratories, Inc) intraocular lens (IOL). Methods: Patients who had received either the AT Lisa Tri Toric or the Acrysof IQ Restor Toric IOL were included in the study. The average follow-up period was 5.4 years for the AT Lisa Tri Toric group and 7.9 years for the Acrysof IQ Restor group. The examinations covered included: subjective refraction, monocular and binocular corrected and uncorrected visual acuity at far (4 m), intermediate (75 cm), and near (40 cm) distances, binocular best-corrected defocus curve analysis (4 m), contrast sensitivity evaluation, assessment of IOL axial position, and presence of positive dysphotopsia. Results: A total of 42 eyes were evaluated. Both groups exhibited good long-term lens axial stability. The AT Lisa Tri Toric group had a mean misalignment of 4.8 ± 3.2° from the preoperatively determined axis, whereas the Acrysof IQ Restor Toric group had an average misalignment of 5.4 ± 4.5° (no statistically significant difference, P =.578). Mean achieved spherical equivalent was −0.19 ± 0.36 diopters (D) for the AT Lisa Tri Toric group and 0.15 ± 0.39 D for the Acrysof IQ Restor Toric group. In the AT Lisa Tri Toric group, 18 eyes (72%) achieved an uncorrected distance visual acuity of 0.10 logarithm of the minimum angle of resolution (20/25 Snellen) or better, compared to 15 eyes (88%) in the Acrysof IQ Restor Toric group. Overall, 21 eyes (84%) in the AT Lisa Tri Toric group and 14 eyes (83%) in the Acrysof IQ Restor Toric group achieved a postoperative spherical equivalent refraction between −0.50 and +0.50 D. Conclusions: Both the AT Lisa Tri Toric and the Acrysof IQ Restor Toric IOLs showed good long-term stability and functional outcomes. They proved to be effective options for restoring vision at far, intermediate, and near distances, providing a viable solution for presbyopia correction even several years after implantation. [J Refract Surg. 2024;40(11):e845–e853.] [ABSTRACT FROM AUTHOR]

Purpose: To evaluate range of visual acuity, visual quality, and safety of the IC-8 small-aperture (SA) intraocular lens (IOL) (Apthera; Bausch & Lomb, Inc) in patients with cataract. Methods: This was a prospective, multicenter, open-label, parallel-group, non-randomized, examiner-masked, 12-month clinical study conducted at 21 sites in the United States. Included patients (N = 453) received either the SA IOL (targeted to −0.75 diopters) in one eye and a monofocal or monofocal toric IOL (targeted to plano) in the fellow eye (SA IOL group, n = 343) or bilateral monofocal/monofocal toric IOLs (control group, n = 110). Results: At 6 months, the SA IOL group achieved superior binocular uncorrected intermediate and near visual acuity (P <.0001) and equivalent binocular uncorrected distance visual acuity versus the control group. In SA IOL eyes, 99.1% achieved monocular corrected distance visual acuity of 0.3 logarithm of the minimum angle of resolution or better. The SA IOL and control groups had comparable binocular photopic and mesopic contrast sensitivities at 6 months both with and without glare. The SA IOL group reported few visual symptoms overall, although at higher rates than in the control group. Conclusions: The SA IOL group exhibited improved intermediate and near vision, comparable distance vision and binocular contrast sensitivities, and few visual symptoms or adverse events versus the bilateral monofocal/monofocal toric IOL group, suggesting that the SA IOL is an effective option for presbyopia correction at the time of cataract surgery. [J Refract Surg. 2024;40(11):e824–e835.] [ABSTRACT FROM AUTHOR]

The article discusses a study conducted in the Garhwal region to evaluate the impact of digital strain on ocular health and the economic burden on the Indian population. The study included patients aged 15-60 with prolonged computer exposure and used objective tests like Schirmer's and tear break-up time. Results showed a high prevalence of digital strain, with males having a higher tendency for moderate to severe symptoms. A severity-based treatment protocol was proposed, and the study highlighted the financial burden associated with digital strain. Further research with a larger sample size is recommended to validate the findings and treatment protocol. [Extracted from the article]

Purpose: Glaucoma medication may accelerate the progression of presbyopia. The aim of this study was to compare presbyopia between controls and patients with glaucoma in their 40s. Methods: This was a cross-sectional study of bilateral phakic participants aged between 40 and 49, which included controls (n = 114, mean age 46.1 ± 2.7 y) and patients with primary open-angle glaucoma (n = 105, 46.4 ± 2.7 y) who had been using FP receptor agonists, beta blockers, and carbonic anhydrase inhibitors for at least six months. We compared the near add power between the two groups. Results: The mean near add power and the prevalence of symptomatic presbyopia (near add power ≥ 1.50 D) were 1.16 ± 0.74 D and 42.1% for controls and 1.77 ± 0.71 D (p < 0.01) and 79.0% (p < 0.01) for glaucoma patients, respectively. The odds ratio (OR) and confidence interval for symptomatic presbyopia were associated with age (1.36, 1.21–1.52), ganglion cell complex thickness (0.96, 0.94–0.99), presence of glaucoma (6.19, 3.13–12.23), and number of glaucoma medications (4.26, 2.42–7.43). Among medications, only FP receptor agonists (5.79, 2.68–12.32) produced significant results. Survival analysis showed that glaucoma patients reached the threshold of a near add power of +1.50 D significantly sooner than controls (p < 0.05; log-rank test). Conclusions: Glaucoma patients, especially those using FP receptor agonists, had higher near add power than controls. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to assess the optical quality of myopic and presbyopic IPCLs with different additional powers, and to investigate the effects of pupil size on the optical quality of these IPCLs using an in-vitro modulation transfer function (MTF) measurement system. Methods: Linear scatter functions (LSFs) were recorded using the OPAL Vector system and an eye phantom consisting of wet cells filled with a balanced salt solution. A myopic IPCL or a presbyopic IPCL was placed in the posterior chamber of this model. The MTF was calculated from the LSF using the fast Fourier transform techniques. The effective apertures were set at 2.0 to 5.0 mm in 1.0 mm steps. Results: The in-focus MTF values of the myopic IPCL and presbyopic IPCL with additional powers of + 2.0 and + 4.0 diopters at 100 cycles/mm for an effective aperture of 3.0 mm were 43%, 27%, and 24%, respectively. The in-focus MTF value of both myopic and presbyopic IPCLs was the highest when the effective aperture was set at 3.0 mm, and it gradually worsened when the effective aperture became larger than 3.0 mm at 20, 60, and 100 cycles/mm. Conclusions: Both myopic and presbyopic IPCLs provided excellent MTF values, but the additional power profile can deteriorate optical performance in presbyopic IPCL-implanted eyes, even with a low additional power. Pupil size can influence visual quality in IPCL-implanted eyes for both myopia and presbyopia. Key Messages: What is known: • Implantable phakic contact lens (IPCL) has been reported to be effective for the treatment of both myopia and presbyopia, with a noticeable advantage in reducing the patients' cost burden. • The optical properties of IPCL have not yet been thoroughly investigated, neither for myopic IPCLs nor for presbyopic IPCLs. What is new: • The MTF of presbyopic IPCL was slightly lower than that of myopic IPCL even with a low additional power. • The MTF values of both myopic and presbyopic IPCLs were the highest for a 3.0 mm-pupil size, with gradually worsened for a larger pupil size. [ABSTRACT FROM AUTHOR]

Introduction: Pinhole intraocular lenses (IOLs) were developed to improve reading by compensating for loss of accommodative function. The IC-8® Apthera™ is a small-aperture presbyopia-correcting IOL that combines the proven principle of small-aperture optics with an aspheric monofocal lens to deliver a continuous range of vision for patients with cataracts from distance to near vision. Posterior capsule opacification is the most common sequela after cataract surgery. It is effectively treated by laser capsulotomy. However, if the laser beam is incorrectly focused, the IOL can be permanently damaged (pits/shots). Methods: In this experimental study, yttrium–aluminum-garnet (YAG) pits were purposefully created. Defects were analyzed and compared between the periphery of the ring in the clear area of the hydrophobic acrylic lens and at the carbon black (CB)-polyvinylidene fluoride (PVDF) filtering component (FilterRing™) of the pinhole lens. All defects were made using identical settings/energy levels (2.6 mJ). The damage induced to the IC-8® Apthera™ IOL was examined by low-magnification images, light microscopy, scanning electron microscopy, and micro-computed tomography (micro-CT). Results: YAG defects in the carbon black filter ring were much more severe than those in the clear zone due to the high absorption of the carbon black. Massive defects and destruction of the lens with tearing out of fragments and particles were observed. The missing volume calculated from the micro-CT reconstruction was 0.266 mm3, which is 1.6% of the entire IOL volume, or more than 1000 times the volume damaged in the largest shot in the periphery. Conclusion: Based on the results, we highly recommend using the lowest possible energy levels, posterior offset setting, and circular pattern for maximum safety when performing laser capsulotomy with pinhole implants. Care should be taken to avoid creating irreversible iatrogenic defects that may affect overall quality. The safest area for performing capsulotomy seems to be the periphery of the ring segment. Video available for this article. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to assess and compare the effectiveness and side effects of various concentrations of pilocarpine eye drops (1.5%, 1.25%, and 1%), with and without 0.1% brimonidine, in treating presbyopia, specifically in a Thai population. Materials and Methods: A prospective, randomized, double-blinded, and crossover trial was conducted at Siriraj Hospital from August 2022 to April 2023. The study included emmetropic individuals aged 40 to 60 with presbyopia (near visual acuity not exceeding J1+) and refractive errors within +/- 0.5D. Ten subjects were randomly assigned to six groups for the different concentrations and type of eye drops using a computer-generated systematic randomization to receive 1.5%, 1.25%, and 1% pilocarpine with and without 0.1% brimonidine. And visual outcomes including visual acuity at distance and near were measured at 2, 4, and 6 hours post-application, with adverse effects monitored. Primary outcome was visual acuity at near after applied topical eye drops. Results: Among the 10 participants (30% male, median age 46.5 years old), 1.25% pilocarpine and combined 1.25% pilocarpine + 0.1% brimonidine significantly improved near visual acuity at all time points (statistically significant with Bonferroni correction). Adverse effects, such as dry eye and irritation, were more common with 1.5% pilocarpine + 0.1% brimonidine. Conclusion: In this preliminary study, 1.25% pilocarpine and 1.25% pilocarpine + 0.1% brimonidine showed promise in effectively treating presbyopia in the Thai study population, with acceptable side effect rates. Further research with larger sample sizes is needed to confirm these findings and provide more robust insights into presbyopia management in the Asian demographic. [ABSTRACT FROM AUTHOR]

We report a surgically challenging case, in the context of a diagnosis of juvenile glaucoma refractory to drug therapy, multi-operated, known patient with congenital ichthyosis, part of Dorfman–Chanarin Syndrome (DCS), with a single functional eye. She is a young patient (54) and housewife in an urban environment known to have DCS and BE (both eyes), strong myopia, and congenital nystagmus. She initially underwent cataract surgery in 2015 and again in 2017. As of 2015, she was known to have juvenile glaucoma under maximal therapy. The important increases in pressure started in 2020 when the dermatological condition worsened (exacerbation of skin changes in the context of ichthyosis), the patient is in menopause, and presbyopia has set in. The glaucoma could no longer be controlled with medication and required serial surgery in both eyes (initially in the right eye in 2020 and in the left eye in 2023). The right eye showed a favorable evolution until 2024, when a second trabeculectomy became necessary, with a favorable evolution. Conclusions: To our knowledge, such a case has not been documented in the medical literature. Frequent monitoring of intraocular pressures and prompt treatment are required. It is a rare association, a very complicated case of managing a patient with refractory glaucoma and multiple associated ophthalmic and systemic pathologies. We are also dealing with a single functional eye, difficult to manage due to a thin sclera that has caused intraoperative difficulties, and the association of congenital nystagmus and strabismus. [ABSTRACT FROM AUTHOR]

Background: To evaluate clinical outcomes and visual quality 3 months after mini-monovision (spherical equivalent [SE] between − 0.25 D and − 0.50 D) femtosecond laser-assisted in situ keratomileusis (FS-LASIK) for correction of high myopia in patients with presbyopia. Methods: Patients who had mini-monovision FS-LASIK for high myopia (SE < -6.0 D) and aged between 40 and 50 years were included. At the 3-month postoperative visit, we evaluated full range of visual acuity; defocus curve; optical quality; accommodation function, contrast sensitivity and stereopsis. Binocular tests were done twice, once in mini-monovision condition and once with the residual myopia in the non-dominant eye corrected. Subjective visual quality was evaluated with questionnaire postoperatively with mini-monovision correction. Results: Clinical data of 31 cases were analyzed. The average patient age was 42.58 ± 3.06 years. At the 3-month follow-up, the mean uncorrected binocular visual acuity at distance, intermediate, and near was − 0.11 ± 0.07, -0.06 ± 0.10, and 0.04 ± 0.11 logMAR separately. In comparison, patients with binocular full distance correction achieved better uncorrected distance visual acuity (UDVA), and they achieved superior uncorrected near visual acuity (UNVA, P = 0.04) with mini-monovision correction. FS-LASIK induced significant increases in higher-order aberrations (HOAs) (P < 0.001). For accommodative function, only the negative relative accommodation (NRA) improved significantly after surgery (P < 0.001). A slight decrease in contrast sensitivity was observed at low spatial frequency with mini-monovision correction (P < 0.05). Questionnaire demonstrated high satisfaction with near vision and visual quality. Conclusion: FS-LASIK with mini-monovision (SE between − 0.25 D and − 0.50 D) appeared to be safe and effective in treating high myopia combined with presbyopia to get satisfying visual quality at distant and at near. [ABSTRACT FROM AUTHOR]

Introduction: We previously reported a case of a patient with bilateral congenital cataract identified in the Ogasawara village, Bonin Islands, Japan, on a visit by an ophthalmologist and describe its course over 17 years from initial surgery. Here, we report on a secondary intraocular lens (IOL) implantation that was subsequently performed at 22 years and 5 months of age. Methods: After cataract surgery at 7 months, the aphakic patient began amblyopia treatment using extended-wear soft contact lenses (SCLs). After 10 years of age, SCLs were chosen to achieve crossed monovision considering the cosmetic appearance when facing other people. At 22 years of age, a secondary IOL implantation was performed. Secondary implant in the patient considered appearance and postoperative vision without glasses, we selected the crossed monovision method using a monofocal IOL. The postoperative targeted refraction for the right (non-dominant eye) and left eyes (dominant eye) planed − 0.33D and − 2.25D, respectively. Results: At 3 months after surgery, the corrected distance visual acuity (CDVA) with IOLs for the right and left eyes was 20/16 and 20/60, respectively, and the binocular visual acuity was 20/16 for distant vision and 20/25 for near vision. The CDVA for the right eye was: 20/13 × IOL = sph−0.25D and that for the left eye was: 20/13 × IOL = sph −1.75D D/cyl −0.50D/Ax170°. Although the exotropia was complicated by dissociated horizontal deviation and dissociated vertical deviation, there were no significant changes in ocular position before and after surgery. The patient was satisfied with achieving independence from spectacles and SCLs. Conclusion: The use of the crossed monovision method with monofocal IOLs in this patient and defective binocular function created a visual environment with no inconvenience in everyday life after secondary IOL implantation. In terms of secondary implant after amblyopia treatment, the IOL type or postoperative targeted refraction must be chosen to maintain or improve the visual environment obtained with the amblyopia treatment. [ABSTRACT FROM AUTHOR]

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Marjan Farid,1 Sheri L Rowen,2 Majid Moshirfar,3 Derek Cunningham,4 Ian B Gaddie,5 Gerard Smits,6 Teresa Ignacio,6 Preeya K Gupta7 1UCI Health, Irvine, CA, USA; 2NVISION Eye Centers, Newport Beach, CA, USA; 3Hoopes Vision Research Center, Hoopes Vision, Draper, UT, USA; 4Dell Laser Consultants, Austin, TX, USA; 5Gaddie Eye Centers, Louisville, KY, USA; 6Orasis Pharmaceuticals, Ponte Vedra, FL, USA; 7Triangle Eye Consultants, Raleigh, NC, USACorrespondence: Marjan Farid, UCI Health, 850 Health Sciences Road, Irvine, CA, 92617, USA, Tel +1-949-824-2020, Fax +1-855-376-5057, Email mfarid@hs.uci.eduPurpose: To evaluate the efficacy of 0.2% and 0.4% pilocarpine HCl (CSF-1) for the treatment of presbyopia and to determine the contributions of pilocarpine HCl and diclofenac sodium on the efficacy of fixed-dose combination (FDC) formulations.Patients and Methods: This was a Phase 2b, multicenter, randomized, double-masked, parallel-group clinical trial. Adults (45– 64 years) with presbyopia were randomized 1:1:1 to 3 arms (Pilo arm: pilocarpine HCl; Pilo-Diclo FDC arm: pilocarpine HCl with 0.006% diclofenac sodium; Control arm: 0.006% diclofenac sodium). Participants in Pilo and Pilo-Diclo FDC arms received 0.2% pilocarpine HCl (0.2% Pilo or 0.2% Pilo FDC, respectively) from days 1– 8, and 0.4% pilocarpine HCl (CSF-1 or CSF-1-FDC, respectively) from days 8– 15. Primary efficacy endpoint was achievement of ≥ 3-line (15-letter) gain in mesopic, monocular distance-corrected near visual acuity (DCNVA) at 40 cm, 1 hour post-treatment of the study eye on days 8 and 15 in the per protocol (PP) population. Safety endpoints were assessed.Results: One hundred and sixty-six participants were randomized (intent-to-treat, N = 166; PP, n = 160). There were no statistical differences between 0.2% Pilo or 0.2% Pilo FDC versus Control at 1 hour post-treatment on day 8. On day 15, 43.1% and 46.9% of participants receiving CSF-1-FDC (0.4% Pilo FDC) or CSF-1 (0.4% Pilo), respectively, achieved ≥ 3-line gain at 1 hour post-treatment in mesopic DCNVA compared with 16.1% of Control group in the PP population, meeting the primary endpoint (P = 0.0015 and P = 0.0002, respectively). All formulations were well tolerated.Conclusion: CSF-1 demonstrated significant improvements in mesopic DCNVA and favorable safety. Pilocarpine HCl as a single active ingredient, at the concentration of 0.4% (CSF-1), provided a transient, therapeutic effect for presbyopia.Keywords: pilocarpine hydrochloride, presbyopia, minimum effective concentration

Background: Presbyopia, a common age-related condition affecting near vision, impacts over a billion people worldwide. The aim of this paper is to review the main reports and results of clinical trials, comparing the newest pharmacological treatment options for presbyopia, their mechanisms of action, and possible side effects. Main text: Pharmacological approaches, involving eye drops that target the underlying mechanisms of presbyopia, have gained growing interest. Two key pharmacological agents in this field are miotics and lens softeners. Miotics enhance near vision temporarily by creating a pinhole effect, though they may cause side effects and are under further investigation for long-term use with ongoing research also exploring the potential benefits of combining them with other drugs to improve outcomes and reduce adverse reactions. Lens softeners, on the other hand, aim to restore the flexibility of the lens, addressing one of the primary causes of presbyopia. Despite early trials, further development of lens softeners has been suspended. A notable advancement in this field is the recent FDA approval of 1.25% and 0.4% pilocarpine, a miotic agent, for presbyopia treatment. This milestone highlights the growing interest in pharmacological solutions for presbyopia, with several new drugs and their combinations currently being investigated for potential FDA approval. Conclusions: pharmacological treatments, particularly miotics like pilocarpine, represent a promising alternative to conventional methods for managing presbyopia. Continued research into these treatments, especially combinations of drugs, may offer more effective and convenient options for presbyopia patients in the future.

With the intensification of global aging,presbyopia has gradually become a global problem, and presbyopia correction surgery has emerged in recent years. The application of laser technology has brought great convenience to refractive surgery, and it also plays an increasingly important role in the correction of presbyopia. The emergence of excimer laser and femtosecond laser technology has opened a new world of surgical treatment for presbyopia, and brought new hope for surgical correction of presbyopia. In this paper, the application and new progress of excimer laser and femtosecond laser in presbyopia surgery are described.

With the popularization of small incision lenticule extraction(SMILE), a large number of one-piece corneal stromal lenticules are removed during surgery. As an additional product of surgery, the experimental research and clinical reuse of extracted corneal stromal lenticules from SMILE have become a research hotspot in recent years. Corneal stromal lenticules are thin and transparent, rich in sources, low in cost, and have the advantages of low immunogenicity and good tissue compatibility, so they can be used as important source of cells and corneal stroma research, and also can be used as good biomaterials for corneal reinforcement, patch graft, refractive correction, and lacrimal duct embolization in clinical study. This article reviews the clinical application of SMILE-derived lenticule in the treatment of corneal-related diseases, correction of hyperopia and presbyopia, coverage of glaucoma drainage valve to prevent their exposure, and its use in lacrimal duct plug, aiming to fully recognize the reuse of lenticules in clinical practice, expand its surgical indication, and providing new directions for the treatment of other eye diseases and its application in tissues and organs.

Cataract is one of the leading causes of blindness worldwide; its prevalence increases with age, ranging from 3.9 % among 55–64 years old to 92.6 % among those aged 80 years or more. Intraocular lenses (IOLs) are used in cataract surgery to replace the natural human lens and/or correct refractive errors. In recent years, a wide range of IOLs have been developed for the correction of presbyopia, which have surpassed traditional monofocal intraocular lenses. With an increased life duration and lifestyle changes, an increasing number of patients are not content with excellent distant vision alone but wish to have adequate near- and intermediate-distance vision. The review presents modern approaches to the correction of presbyopia by IOLs produced with the help of various technologies. The mechanisms of presbyopia correction, the general principles of multifocal IOL use, extended depth of focus (EDOF) technology, the advantages and drawbacks of individual IOL categories such as multifocal IOLs, improved monofocal IOLs, and deep focus IOLs are discussed. Special attention is given to terminology. Specifically, the concepts of EDOF and multifocal IOLs are distinguished, which however are not mutually exclusive as bifocal IOL, aspherical monofocal IOL, diffraction or refraction trifocal IOL can have EDOF characteristics (with partial range limitation at near distance in order to minimize dysphotoptic complaints). Taking into account the active marketing strategies of IOL manufacturers, the presented data can be useful in clinical practice, facilitating and structuring the relevant information for the ophthalmologist. Innovative solutions in the development of materials, optical platforms and the design of intraocular lenses for intraocular presbyopia correction provide a differentiated approach to achieving high functional results depending on the individual needs of patients.

Introduction. This review presents the current knowledge about the methods of lens surgery for the correction of refractive errors in patients with presbyopia and other refractive errors. And also about possible methods of minimization of ultrasound load during the surgery.Purpose. To present current relevant literature scientific knowledge on refractive lens surgery, possible ways of minimization of ultrasound load and new IOL models.Material and methods. To perform the review the literature references were searched through the abstract databases PubMed and Scopus for the period up to and including 2023 using the keywords “zero phaco”, “refractive lens exchange”, “presbyopia”, “femtosecond laser”, “U/S phaco”, “premium IOL”, “refractive error surgery”, “endothelial dystrophy”. A total of 76 articles related to the review topic were selected.Results. Multiple studies confirmed efficacy, safety and fast visual rehabilitation after lens surgery with maximal ultrasound load reduction, in particular in patients with metabolic disorders and predisposition to corneal dystrophies.Conclusion. The literature review suggests that with increasing patient expectations and the use of premium IOLs in the era of refractive lens surgery, predictability and accuracy have become essential. Thus, the technology of safe lens femtosurgery has greatly improved surgical techniques and has revolutionized ophthalmic surgery in recent decades.

Introduction. Presbyopia is a global problem affecting more than 1.5 billion people worldwide. Projections indicate an increase in the average age of the population to 40 years by 2050, which is associated with an increase in the presbyopia incidence and corresponding economic losses. Despite the widespread prevalence of presbyopia, there are currently no effective methods for early prevention and restoration of dynamic accommodation and a standardized approach to assessing age-related changes in the lens that underlie presbyopia. The purpose: to study the effect of age-related changes in the lens on accommodation and to consider modern pharmacological approaches to the prevention and treatment of presbyopia.Methods. A multicenter prospective study was conducted, including analysis of visual acuity, the nearest point of clear vision and the volume of accommodation in individuals aged 40 to 55 years. Study participants were prescribed pyrenoxine (Catalin) as eye drops three times daily for 4 months. The study included 382 questionnaires collected from 29 ophthalmologists.Results. As a result of the study, the average distance to the nearest point of clear vision decreased slightly, but the reserve of accommodation remained at the same level. This indicates the absence of significant progression of age-related decrease in the reserve of accommodation as one of the manifestations of presbyopia and the possible effectiveness of pyrenoxine in preserving the elastic properties of the lens.Conclusion. The study confirmed the effectiveness of pyrenoxine in the prevention of presbyopia and the preservation of accommodative abilities in middle-aged people. The concept of Dysfunctional Lens Syndrome may be useful for clinical practice by providing opportunities for early diagnosis and treatment of presbyopia. Incorporating this concept into clinical guidelines may improve approaches to the treatment and prevention of age-related lens changes.

Abstract Background To evaluate clinical outcomes and visual quality 3 months after mini-monovision (spherical equivalent [SE] between − 0.25 D and − 0.50 D) femtosecond laser-assisted in situ keratomileusis (FS-LASIK) for correction of high myopia in patients with presbyopia. Methods Patients who had mini-monovision FS-LASIK for high myopia (SE < -6.0 D) and aged between 40 and 50 years were included. At the 3-month postoperative visit, we evaluated full range of visual acuity; defocus curve; optical quality; accommodation function, contrast sensitivity and stereopsis. Binocular tests were done twice, once in mini-monovision condition and once with the residual myopia in the non-dominant eye corrected. Subjective visual quality was evaluated with questionnaire postoperatively with mini-monovision correction. Results Clinical data of 31 cases were analyzed. The average patient age was 42.58 ± 3.06 years. At the 3-month follow-up, the mean uncorrected binocular visual acuity at distance, intermediate, and near was − 0.11 ± 0.07, -0.06 ± 0.10, and 0.04 ± 0.11 logMAR separately. In comparison, patients with binocular full distance correction achieved better uncorrected distance visual acuity (UDVA), and they achieved superior uncorrected near visual acuity (UNVA, P = 0.04) with mini-monovision correction. FS-LASIK induced significant increases in higher-order aberrations (HOAs) (P

Masahiko Ayaki, Akiko Hanyuda, Kazuno Negishi Department of Ophthalmology, Keio University School of Medicine, Tokyo, JapanCorrespondence: Masahiko Ayaki; Kazuno Negishi, Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan, Email mayaki@olive.ocn.ne.jp; kazunonegishi@keio.jpPurpose: Risk factors for presbyopia have not been fully determined although previous studies suggested presbyopia was associate with age, dry eye, and retinal ganglion cell complex thickness (GCC). We accessed these signs and common ocular symptoms in the middle-aged population focusing on sex differences when women have drastic hormonal change.Methods: This cohort study consecutively enrolled 2743 patients aged 36– 45 years (n=1000), 46– 55 years (n=1000), and 56– 65 years (n=743). All underwent ocular surface tests and had near add power and GCC measured. Common ocular symptoms were asked using questionnaire.Results: Among female participants, visual symptoms (eye strain and photophobia) were more prevalent in the age group 46– 55, whereas non-visual symptoms (dryness, irritation, and pain) were not. We identified symptomatic presbyopia (near add power ≥ 1.5D) in 14.4%, 73.8%, and 97.8%, positive corneal staining in 29.1%, 23.8%, and 23.9%, and a mean GCC of 98.2 μm, 105.3 μm, and 89.6 μm in the age groups 36– 45, 46– 55, and 56– 65, respectively. Mean tear break-up time were 3.3, 3.5, and 3.3 seconds, respectively. Results indicated a large progression of presbyopia (P< 0.01) from the period of 36– 45 years onward and significantly increased GCC (P< 0.01) in women of age group 46– 55. No notable tendency was observed in symptoms and GCC for male participants.Conclusion: Visual symptoms in women were worse between 46 and 55 years than before or after these ages. The increase of symptomatic presbyopia and GCC may be contributing to visual symptoms in addition to menopausal transition symptoms in this age group.Keywords: presbyopia, sex difference, near add power, menopause, eye strain

The prevalence of presbyopia and nuclear cataracts (NUC) is reported to be higher in tropical areas than that in other regions, suggesting a potential influence of high temperatures on lens health. Transient receptor potential vanilloid (TRPV) channels play a crucial role in detecting ambient temperatures across various species, with TRPV1 and TRPV4 expressed in lens epithelial cells. In this study, we investigated whether ambient temperatures affect TRPV1 and TRPV4 activity in the lens, potentially contributing to the development of presbyopia and NUC. We conducted experiments using cultured human lens epithelial cell lines under different temperature conditions. Our results revealed that the mitogen-activated protein kinase (MEK)/extracellular signal-regulated kinase (ERK) and p38 pathways, downstream molecules of TRPV1, were activated, while Src family kinase, a downstream molecule of TRPV4, was inhibited at 37.5 °C culture compared to 35.0 °C. Confocal microscope images demonstrated higher expression of TRPV1 in 3D-structured cells under high-temperature culture conditions. Additionally, in organ culture lenses, higher elasticity was observed at elevated temperatures compared to that at lower temperatures. These results suggest that high ambient temperatures may induce lens sclerosis via TRPV1 activation, potentially contributing to the development of presbyopia and NUC. [ABSTRACT FROM AUTHOR]

Abstract Background The visual performance and the optical quality of a segmental refractive extended depth-of-focus (EDoF) intraocular lens (IOL) were evaluated in a prospective, single-arm, single-center study. Methods A total of 20 patients (40 eyes) after bilateral implantation of the refractive segmental EDoF Acunex Vario AN6V were included. Assessment procedure: refraction outcome, monocular and binocular uncorrected (UCVA) and distance-corrected visual acuity (DCVA), defocus curve, contrast sensitivity (CS), higher-order aberrations (HOAs) and patient satisfaction were evaluated 1 and 3 months after surgery. Results At 3-month follow-up, mean spherical equivalent was − 0.23 ± 0.32 D. Binocular uncorrected distance visual acuity (VA) at distance, intermediate and near was − 0.08 ± 0.06 logMAR at 4 m, -0.03 ± 0.06 logMAR at 66 cm and 0.16 ± 0.06 logMAR at 40 cm, respectively. The binocular defocus curve showed a VA better than 0.20 logMAR over a range from + 1.50 to − 2.45 D. Contrast sensitivity aligned with monofocal lenses, highlighting the lens’s clinical value. Aberrometry showed minimal changes in corneal aberrations. NEI-RQL-42-Questionnaire showed a high patient satisfaction for daily activities and revealed reduced dependence on glasses, particularly for near and intermediate vision. The Acunex Vario AN6V demonstrated minimal dysphotopsias, making it a promising option for those seeking spectacle independence. Conclusion This segmental refractive EDoF IOL provides a high degree of spectacle independence for far and intermediate distances with functional near VA. Although inducing residual coma aberrations, it showed subjectively good results with little dysphotopsias. Trial registration This study protocol was reviewed and approved by ethics committee of Charité University, Berlin, Germany, with approval number EA4/126/20.

The article presents a clinical example of intraocular presbyopia correction in a patient who previously underwent laser vision correction by LASIK for mild myopia. Before the surgery, the distance VA mono- and binocular was 1.0, ADD for reading distance 40 cm +2.0 D, objective refraction sph +0.5 D cyl -0.25 D ax 980, left eye sph +0.75 D cyl -0.25 D ax 660. The patient was given a simultaneous bilateral refractive lens exchange with an implantation of a trifocal aspheric intraocular lens in the right eye and a trifocal toric aspheric intraocular lens in the left eye. We used the following IOL calculation formulas: ASCRS mean IOL power, Shammas formula, Barrett true K formula, Masket formula, Modified Masket formula, Haigis-L formula. 1 week postop: UDVA OU = 1.0, UNVA 40 cm = 1.0, UVA 70 cm = 0.7. The objective refraction OD was sph +0.0, D cyl -0.75 D ax 163, OS sph +0.25 D, cyl -0.0 D. The compliance with the modified algorithms of pre-and intraoperative behavior of the operating team, thorough preparation of the patient, careful calculation of the IOL allowed us to obtain the predictive refractive result with a high level of visual satisfaction and absence of undesirable postoperative phenomena. The patient underwent the examination with Salzburg reading desk before and after the surgery, to confirm the excellent functional results of the treatment. Despite the fact that simultaneous same day IOL implantation in both eyes, especially in eyes with previously operated corneas, is still disputable, the above case confirms that with modern equipment, precise multi formula calculation, and ample experience help achieve excellent functional and refractive results.

Mera F Haddad,1 Nour Abdo,2 May M Bakkar1 1Department of Allied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan; 2Department of Public Health, Jordan University of Science and Technology, Irbid, JordanCorrespondence: Mera F Haddad, Department of Allied Medical Sciences, Jordan University of Science and Technology, POBox 3030, Irbid, 22110, Jordan, Tel +962797151304, Email mfhaddad@just.edu.joPurpose: To assess public awareness and knowledge about presbyopia and their compliance to ocular examination in Jordan.Patients and Methods: A cross-sectional survey was designed to interview people in different provinces of Jordan. Socio-demographic data such as age, gender and level of education and region was reported. The first part of the questionnaire assessed awareness of presbyopia in terms of the need for spectacles with age, age of onset, possible causes of presbyopia and methods of presbyopia management. The second part of the questionnaire evaluated compliance of the participants with ocular examination in terms of frequency and motive to do general eye check, intraocular pressure (IOP), fundus exam and visual acuity.Results: A total of 802 participants (232 males, 570 females) with an average age of 28 (± 11.6) completed the questionnaire. Most participants (84.2%) knew that glasses are needed for near vision as age increases, and 62.8% estimated the age at which spectacles are required (40 years or older). Over half understood that presbyopia is correctable and progressive. Age significantly influenced knowledge about the need for near vision spectacles, and whether presbyopia is preventable and progressive (both p < 0.05). Females were more knowledgeable about these aspects. The frequency of eye examinations, particularly fundus exams and IOP tests, was significantly influenced by age but not by education. Gender only significantly affected the frequency of vision checks (p = 0.01), with females being more likely to adhere to them.Conclusion: This study demonstrated a good level of awareness and knowledge about presbyopia among Jordanians, especially those over 40 and females. Regular eye check-ups were more common among young participants and females. Addressing misconceptions about presbyopia’s preventability and promoting regular eye exams are crucial for early diagnosis and management of presbyopia and other serious eye conditions.Keywords: awareness, presbyopia, eye examination, Jordan

Abstract Background Addressing presbyopia in the aging population, particularly in non-cataractous patients, remains a challenge. This study evaluates the outcomes of refractive lens exchange (RLE) with AT LISA tri 839MP trifocal intraocular lens (IOL) implantation in a Chinese presbyopic population without cataracts. Methods The study included 164 eyes from 82 patients undergoing bilateral RLE at Peking Union Medical College Hospital. Comprehensive evaluations encompassed visual acuities, refraction, ocular aberrometry, and subjective outcomes via the VF-14 questionnaire. The focus was on postoperative visual performance, refractive outcomes, safety, objective optical quality, and patient satisfaction. Results 100%, 90.2%, and 89.0% of patients achieved binocular UDVA, UNVA, and UIVA of logMAR 0.1 or better at 6 months postoperatively. 97.6% of eyes were within ± 1.00 D of emmetropia postoperatively. Optical quality assessments showed increases in modulation transfer function and Strehl ratios (p

Abstract Background This study investigated patients’ awareness of presbyopia and its management approaches and their preferred methods for near vision correction. Methods In Saudi Arabia, 785 participants (aged between 35 and 60 years) completed a structured survey online, consisting of hard copies and direct interviews. The survey consisted of twenty-eight items divided into three parts. It was designed to record participants’ awareness of and preferences for presbyopia and its refractive corrections. Nonparametric tests and descriptive analyses were conducted to analyse participants’ responses. Result Approximately half of the participants had difficulty with near vision activities, such as reading newspapers or using mobile phones. Among all the participants, 76% were not aware of presbyopia. The prevalence of uncorrected presbyopia was 48% of the 785. The majority (82%) felt that spectacles were acceptable for correction of presbyopia. Most reported that they did not experience social stigma when using reading spectacles (87% of participants). When asked if they were aware of management approaches other than spectacles, 72% responded with not at all. Most participants had no earlier knowledge of the use of multifocal contact lenses or eye drops for presbyopia correction (67% and 82%, respectively). In the present study, some tendencies to use corrective approaches to presbyopia other than spectacles were noted. Finally, participants’ age, sex, region, education, and income had a statistically significant impact on essential parts of their responses (p

K Ashley Tuan,1 Douglas P Benoit,1 Brett O’Connor2 1Visioneering Technologies, Incorporated, Medical Affairs, Alpharetta, GA, USA; 2MyEyeDr-Mandarin, Jacksonville, FL, USACorrespondence: Douglas P Benoit, Visioneering Technologies, Incorporated, Medical Affairs, Alpharetta, GA, USA, Email dbenoit@vtivision.comPurpose: Employing “relative plus” (Add) power to extend the functional vision range is a primary method to correct presbyopia with contact lenses. Simultaneous vision contact lenses are typically associated with visual disturbances at higher Add powers, often resulting in compromised vision and necessitating specialized fitting methods. Among mature individuals suffering from presbyopia, we evaluated the visual performance of a catenary curve-based extended depth of focus (EDOF) optical profile contact lens with a simplified fitting process.Methods: Mature individuals suffering from presbyopia with Add requirements of +2.00 D or more were recruited. Monocular and binocular visual acuities were obtained across optical vergences ranging from − 4.00 D to +2.00 D to generate defocus curves for best spectacle-corrected distance vision (baseline) and center-distance, catenary curve-based contact lenses (catenary). A subjective questionnaire evaluating the lenses was employed.Results: Twenty-four mature individuals suffering from presbyopia, average age 59.2 (range: 51– 68 years) and average Add requirement of +2.24 D (range +2.00 D to +2.50 D) were enrolled. Under high-contrast conditions, the catenary lens provided functional binocular vision (0.30 logMAR or better) at all optical vergences from distance to − 3.50 D (equivalent to 28 cm). Participants demonstrated a significant improvement (p < 0.05) in binocular visual acuity while wearing the catenary lens with an imposed defocus of − 1.50 D to − 4.00 D (equivalent to object distances from 66 cm to 25 cm). Subjective ratings with the catenary lens were equivalent to those documented at baseline.Conclusion: The catenary curve-based lenses provided a full range of functional vision while maintaining clear distance vision for individuals suffering from advanced presbyopia. Comparison with previous results involving this lens indicates that these findings are also generalizable to wearers with lower Add requirements. This EDOF design provides a universal Add which is sufficient for advanced presbyopia.Trial Registration: ClinicalTrials.gov. Identifier: NCT05495971.Keywords: presbyopia, multifocal contact lens designs, catenary optics, defocus curves, extended depth of focus

Sarah E Guthrie,1 Doerte Luensmann,1 Jill Woods,1 Jose Vega,2 Gary Orsborn2 1Centre for Ocular Research & Education (CORE), School of Optometry and Vision Science, University of Waterloo, Waterloo, Ontario, Canada; 2CooperVision Incorporated, San Ramon, CA, USACorrespondence: Sarah E Guthrie, Email sarah.guthrie@uwaterloo.caPurpose: To explore links between subjective comfort and vision in habitual multifocal soft contact lens (MFCL) wearers when refit with daily disposable MFCLs, to determine which factors are relevant for success with MFCLs and evaluate consistency between MFCLs of different designs.Patients and Methods: This work examined subjective measures in a randomised, participant masked, bilateral wear crossover study at five optometry practices. Fifty-eight habitual MFCL wearers wore stenfilcon A multifocal (stenA-MF; CooperVision Inc) and delefilcon A multifocal (delA-MF; Alcon) for two-weeks. Subjective ratings included satisfaction with comfort and vision and agreement questions.Results: Agreement with “I would like to wear this MFCL in the future” was taken to indicate success with each MFCL; agreement was significantly higher with stenA-MF. There was strong correlation between agreement responses for “I would like to wear this MFCL in the future” and “MFCL met my needs for vision” with both lenses (p< 0.01). However, it was only with stenA-MF, which had higher agreement responses to both statements (p< 0.05), that responses to these two statements correlated with satisfaction with end-of-day (EOD) comfort (p< 0.01). These differences in correlations between the two lenses are seemingly driven by greater satisfaction with stenA-MF for near and intermediate vision (p< 0.05).Conclusion: Subjective vision and comfort were only correlated when vision met the needs of most participants. Meeting participants’ needs for vision correlated strongly with wanting to wear a MFCL. Results indicate that meeting vision needs is more important than meeting comfort needs when influencing whether presbyopic patients continue wearing MFCLs.Keywords: comfort, vision, presbyopia, soft contact lens, correlation

Purpose: Analysis of results of combined implantation of non­diffractive IOL with extended depth of focus and multifocal IOL.Materials and methods. The study included 40 patients (80 eyes) after cataract phacoemulsification or clear lens removal with a mean follow­up of 15.4 ± 1.2 (12–22) months. Women accounted for 60 % (n = 24) and men for 40 % (n = 16). 20 patients (40 eyes) with bilateral AcrySof IQ Vivity implantation formed the minimonovision group (group I), and 20 patients (40 eyes) with AcrySof IQ Vivity implantation in the dominant eye (n = 20) and Acrysof IQ Panoptix implantation in the non­dominant eye (n = 20) formed the group of mix­-and­-match implantation (group II).Results. At the maximum follow­up period of 3 months, UCNVA in group I was 0.61 ± 0.14, in group II — 0.82 ± 0.09 (p = 0.048), BCNVA — 0.66 ± 0.17 and 0.92 ± 0.14, respectively (p = 0.039). No significant differences were found between groups comparing UCIVA, BCIVA, UCDVA and BCDVA (p > 0.1), but slightly higher values were determined in patients after bilateral implantation of Acrysof IQ Vivity IOLs. In group I, 2 patients (10 %) had glare and 2 (10 %) had halo. Patients did not complain about difficulties in driving in the darkness. In 9 cases out of 20 (45 %) patients required spectacle correction for reading. In group II, adverse optical phenomena were identified in 7 patients (35 %), of which 4 patients (20 %) had glare and 3 (15 %) had halo. None of the patients required spectacle correction for reading. In both groups, 95 % of cases (19 patients) rated the surgical outcome as “excellent” and 5 % (1 patient) as “good”. Conclusion. For the first time in Russia, the results of combined (mix­-and­match) implantation of EDOF and trifocal IOLs in comparison with bilateral IOL implantation in presbyopic patients were analyzed. The advantage of combined implantation for achieving better near visual acuity and comparable incidence of adverse optical phenomena was shown.

Abstract Background To evaluate the optical performance and safety of a new multifocal lens with a novel optical design featuring two additional foci (or intensifiers) in patients with cataract and presbyopia. Methods In this single-center, non-randomized prospective observational study, 31 patients underwent implantation of the new multifocal IOL between March 2020 and November 2021 at a tertiary clinical center in Buenos Aires and Ramos Mejia, Argentina. Postoperative examinations with emphasis on uncorrected and corrected visual acuity at distance and near and at two different intermediate distances (80 cm and 60 cm) were performed during the 3 postoperative months. Results Of the 31 patients who underwent implantation of the new IOL, 30 underwent bilateral surgery (61 eyes in total). At 3 months, all 61 eyes had an uncorrected distance visual acuity (UCDVA) of at least 0.15 logMAR; 57 eyes (93%) had an uncorrected distance visual acuity (UCDVA) of 0.1 logMAR and 27 eyes (44%) had an UCDVA of 0.0 logMAR. At 80 cm, 60 eyes (98%) had an uncorrected intermediate visual acuity (UCIVA) of at least 0.1 log MAR and 48 eyes (79%) had an UCIVA of 0.0 logMAR. Conclusion The new multifocal IOL with a novel optical concept (5 foci) showed a wide range of visual acuity especially at intermediate and near distances in patients undergoing cataract surgery. Uncorrected visual acuity was excellent at all tested distances, monocularly and binocularly, spectacle independence and patient satisfaction were high.

Nuno Campos1,2 1Hospital Garcia de Orta, Almada, Portugal; 2Hospital CUF TEJO, Lisboa, PortugalCorrespondence: Nuno Campos, Ophthalmology Department, Hospital Garcia de Orta, Almada, Portugal, Email nunocampos.dr@gmail.comPurpose: To assess the clinical outcomes, the rate of spectacle independence, and patient satisfaction of an enhanced depth of focus (EDOF) LuxSmart™ IOL targeted for mini-monovision in patients who had undergone bilateral cataract surgery.Methods: Twenty patients underwent bilateral LuxSmart IOL implantation with the non-dominant eye targeted for − 0.50 diopters. Best-corrected distance (CDVA) and uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA) at 66 cm, uncorrected near visual acuity (UNVA) at 40 cm, and defocus curve were assessed. Patient-reported visual function was inquired by Catquest-9SF, and the rate of spectacle independence in all daily-life activities was calculated. The presence of photic phenomena was evaluated. A p-value lower than 0.05 was considered statistically significant.Results: The mean IOL power was +21.50 ± 4D (16.5– 26D), and all were non-toric. Thirty-seven (92.5%) eyes were within ± 0.5D of predicted target. The postoperative MRSE was 0.06 ± 0.42D and − 0.45 ± 0.22D in dominant and non-dominant eyes. Every patient achieved distance binocular vision better than 0.1 logMAR. The non-dominant eyes showed lower CDVA (p< 0.001). The UIVA was higher in non-dominant eyes (p< 0.001). Binocular uncorrected near visual acuity was 0.12 ± 0.1, and uncorrected near visual acuity was higher in non-dominant eyes (p< 0.001). LuxSmart IOL provided a sustained visual acuity of 0.3 logMAR or better between +1.00D and − 2.50D. A total of 25% of patients reported frequent halos and glare. Despite achieving higher degrees of satisfaction, seven patients (35%) denied total spectacle independence in their daily-life activities, particularly for activities requiring continuous near vision.Conclusion: This study shows that LuxSmart EDOF IOL in mini-monovision strategy performs well for distance and intermediate vision. Although visual acuity for near also achieved very good results, the considerable rate of spectacle dependence, in particular for near, and the rate of photic phenomena do not support this IOL to be safely implanted in patients desiring spectacle independence at time of cataract surgery.Keywords: cataract, presbyopia, IOL, EDOF, LuxSmart, mini-monovision

Objective: Unknown etiology Background: This case report illustrates the incidental detection of atypical hyporeflective bleb-like structures in an otherwise asymptomatic human cornea, highlighting the effectiveness of non-invasive biophotonic imaging techniques such as optical coherence tomography (OCT) and large-area confocal laser scanning microscopy (CLSM). Case Report: A 57-year-old man underwent a comprehensive ophthalmological examination, including slit-lamp biomicroscopy, corneal topography, and densitometry, as part of a clinical study. The patient presented with a clear cornea, a deep and optically empty anterior chamber, and a clear crystalline lens in both eyes. Best-corrected distance visual acuity was -0.1 logMAR. He denied ocular pain, tearing, or photophobia. There was no history of ocular trauma, infectious or genetic diseases, or ocular surgery. Further, OCT and large-area CLSM were employed for a more in-depth analysis of the corneal structure. Standard ophthalmological assessments indicated normal ocular health with no apparent corneal abnormalities. High-resolution OCT and large-area CLSM imaging revealed atypical hyporeflective bleb-like structures within the corneal epithelium and sub-basal nerve plexus but not in the stroma. Conclusions: The authors hypothesize that the observed findings may indicate an early stage of epithelial basement membrane dystrophy, potentially preceding the manifestation of clinical symptoms, detectable solely through advanced biophotonic imaging methods. It is important to emphasize that these observations do not represent a definitive diagnosis. Nevertheless, the discovery of these atypical structures via advanced imaging underscores the importance of incorporating non-invasive biophotonic techniques into preoperative eye examinations in certain situations. This approach could significantly improve the early detection and management of corneal diseases, leading to improved patient outcomes. [ABSTRACT FROM AUTHOR]

This article explores the challenges of classifying intraocular lenses (IOLs) based on their structure, optical outcomes, and functional outcomes. The authors stress the need for clear differentiation between these categories to avoid confusion. They propose a functional classification system for IOLs based on the range of field and shape of the best distance corrected monocular visual acuity defocus curves. The article highlights the importance of considering functional outcomes, such as dysphotopsia, in addition to visual acuity when choosing an IOL. The authors also identify the limitations of current classification systems and call for further research in this area. [Extracted from the article]

This article provides an evidence-based appraisal of enhanced monofocal intraocular lenses (IOLs) in cataract surgery. It reviews 66 articles and 3 reviews to analyze the scientific evidence on the superiority of enhanced monofocal IOLs over conventional monofocal IOLs. The majority of the studies suggest that enhanced monofocal IOLs offer improved intermediate visual function without compromising distance vision, contrast sensitivity, or visual quality. However, further cost-effectiveness studies and consensus statements from eyecare professional organizations are needed to support the widespread use of enhanced monofocal IOLs. The document also provides a list of studies on the topic, with varying funding sources and mentions the potential cost-effectiveness and clinical benefits of enhanced monofocal IOLs. [Extracted from the article]

Objectives: It was aimed to compare the clinical results of the mini-monovision technique (MMV) with enhanced monofocal intraocular lens (IOL) and trifocal IOL applications and to evaluate the intereye differences in the MMV group. Materials and Methods: This retrospective observational study evaluated the results of cataract surgeries performed on 48 eyes of 24 patients. Surgeries in Group I were performed for MMV using the RayOne EMV IOL targeting emmetropia in dominant eyes (Group IA) and -0.70 diopter (D) myopia in non-dominant eyes (Group IB), while those in Group II were performed with the AcrySof® IQ PanOptixTM TNFT00 IOL targeting emmetropia. After the surgeries, uncorrected and corrected distance, intermediate, and near distance visual acuities, contrast sensitivity measurements, and defocus curves were determined. Subjective evaluation was made with the National Eye Institute Visual Function Questionnaire (NEI VFQ-25). The groups were compared statistically. Results: Postoperative refraction mean spherical equivalent was -0.25±0.22 D, -0.67±0.33 D, and -0.16±0.31 D in the three groups, respectively. A statistical difference was identified in favor of Group IA for uncorrected distance vision and in favor of Group IB for near vision (p<0.05). There was no difference in bilateral uncorrected visions in Groups I and II (p>0.05). While contrast sensitivity was better in Group I at all spatial frequencies (p<0.05), better vision was achieved in the defocus curve at distance in Group IA and at near in Group IB. In the binocular evaluation, it was seen that Groups I and II had similar results. In the subjective evaluation, NEI-VFQ-25 scores were 94.1±4.2/100 in Group I and 91.5±3.0/100 in Group II at 6 months (p>0.05). Photic complaints were significantly more common in Group II. Conclusion: With the MMV technique, it was observed that enhanced monofocal lenses provided better visual acuity at all distances and less dysphotopsia than trifocal lenses, whereas trifocal lenses were better at providing independence from glasses. [ABSTRACT FROM AUTHOR]

Patients prescribed pilocarpine ophthalmic solution are advised to be cautious when driving at night, but studies evaluating the effects of pilocarpine hydrochloride ophthalmic solution 1.25% (pilo), approved to treat presbyopia, on driving at night are lacking. This double-masked, crossover, phase 3b study evaluated night-driving performance with pilo or the placebo once daily. Forty-three adults (40–55 years) with presbyopia impacting daily activities and mesopic, high-contrast, binocular distance-corrected near vision 6/12–6/30 were randomised to bilateral treatment with pilo followed by placebo or placebo followed by pilo (with a ≥7-day washout between interventions). Night-driving performance was evaluated at twilight at a closed-circuit course. Primary efficacy endpoint: overall composite night-driving performance Z score at the end of the 7–14-day intervention period, 1 hour post-instillation. Pilo was considered non-inferior if the lower limit of the 95% confidence interval (CI) for the least squares mean difference (LSMD, pilo minus placebo) was >–0.25. Other efficacy endpoints: individual components of the night-driving performance test (hazard avoidance rate; road sign recognition rate and distance; pedestrians recognition distance; overall driving and lane-keeping times) and night-driving experience questionnaire. Safety included treatment-emergent adverse events (TEAEs). The mean overall composite Z scores were −0.121 (pilo) and 0.118 (placebo). The LSMD (pilo minus placebo) was −0.224 (95% CI, −0.346, −0.103), with 3 of the 7 individual tasks being significantly better with the placebo. The questionnaire did not reveal significant differences between pilo and the placebo. There were no serious or severe TEAEs and no TEAE-related discontinuations. The most common ocular TEAEs were headache and visual impairment with pilo (both 27.9%), and dry eye (7.0%) with the placebo. The overall performance of night driving was inferior with pilo, compared with placebo. The study findings are consistent with the current class labelling and provide evidence to inform regulators and assist clinicians considering prescribing pilo to adults who seek treatment of presbyopia symptoms and drive at night. ClinicalTrials.gov identifier: NCT04837482. [ABSTRACT FROM AUTHOR]

Uncorrected presbyopia has been shown to reduce Zanzibari women's quality of life. In this mixed-methods study, we examined the subjective wellbeing and self-reported work performance among older women entrepreneurs with functional presbyopia before and shortly after correction, and how poor vision at close distance affected their daily lives. Women entrepreneurs underwent eye examination to identify those with uncorrected functional presbyopia. Their subjective wellbeing and work performance were both measured in Cantril's ladder. Ready-made glasses were then provided and 30 minutes to an hour later, their subjective wellbeing and work performance was remeasured. Twenty women entrepreneurs were interviewed to understand their lived experience with uncorrected presbyopia. Two-hundred-seventeen women entrepreneurs were included in the survey (mean age 51.6 years, SD 8.64). Women entrepreneurs had a mean subjective wellbeing score of 3.32 (SD 1.10) pre-correction and 5.99 (SD 1.13) post-correction (p <.001), and a mean self-rated current work performance score of 4.62 (SD 1.36) before correction and 5.47 (SD 1.35) post-correction (p <.001). One-hundred-and-ninety (87.6%) and 121 women entrepreneurs (55.8%) rated their current subjective wellbeing and work performance scores < 5, respectively. Around 1/4 of women entrepreneurs reported having severe difficulties with near tasks. Poor vision at a close distance caused by uncorrected functional presbyopia negatively affected economic, physical and psychosocial aspects of women entrepreneurs' lives. Subjective wellbeing and self-reported work productivity scores improved significantly shortly after presbyopia was corrected. More research with longer follow-up is needed to understand the full benefits of correcting presbyopia. [ABSTRACT FROM AUTHOR]

Purpose: To explore the impact of refractive status on presbyopia progression among patients with presbyopia. Methods: This retrospective observational study included patients with presbyopia who visited the Seventh Affiliated Hospital of Sun Yat-sen University and Shenzhen Polytechnic Medical College between May 2018 and August 2022. The amplitude of accommodation (AMP) and near addition power (ADD) at 6 months and 1 year were collected. Results: A total of 103 patients with presbyopia were included in this study: 42 patients with myopia, 23 patients with emmetropia, and 38 patients with hyperopia. There were significant differences in ΔAMP(6-month) and ΔADD(6-month) among patients with different refractive statuses, and the values of emmetropic patients and hyperopic patients were higher than in myopic patients (all P < 0.001). The ΔAMP(1-year) and ΔADD(1-year) of hyperopic patients were significantly higher than in emmetropic patients and myopic patients (all P < 0.001). The ΔADD(1-year) of emmetropic patients was greater than in myopic patients (P = 0.045), but there were no significant differences in ΔAMP(1-year) between patients with emmetropia and myopia (P = 0.090). Conclusions: The progression of presbyopia in hyperopic patients was relatively more significant than for emmetropia, followed by myopia. The prescription of presbyopia glasses might need to be replaced more frequently in patients with hyperopia. [ABSTRACT FROM AUTHOR]

This document is a response to a letter to the editor regarding a study on calculating individual vitreous volume for tailored patient dosing in intravitreal therapy. The authors of the study appreciate the positive response from the letter's authors and acknowledge the importance of considering the lens status (phakic or pseudophakic) in the calculation of vitreous volume. They discuss the limitations of their study and present a clinical case that shows the minor relevance of lens status in the calculation. The authors recommend their formula for predicting vitreous volume and suggest further studies to analyze the advantages and disadvantages of a customized approach in intravitreal therapy. [Extracted from the article]

Background: The visual performance and the optical quality of a segmental refractive extended depth-of-focus (EDoF) intraocular lens (IOL) were evaluated in a prospective, single-arm, single-center study. Methods: A total of 20 patients (40 eyes) after bilateral implantation of the refractive segmental EDoF Acunex Vario AN6V were included. Assessment procedure: refraction outcome, monocular and binocular uncorrected (UCVA) and distance-corrected visual acuity (DCVA), defocus curve, contrast sensitivity (CS), higher-order aberrations (HOAs) and patient satisfaction were evaluated 1 and 3 months after surgery. Results: At 3-month follow-up, mean spherical equivalent was − 0.23 ± 0.32 D. Binocular uncorrected distance visual acuity (VA) at distance, intermediate and near was − 0.08 ± 0.06 logMAR at 4 m, -0.03 ± 0.06 logMAR at 66 cm and 0.16 ± 0.06 logMAR at 40 cm, respectively. The binocular defocus curve showed a VA better than 0.20 logMAR over a range from + 1.50 to − 2.45 D. Contrast sensitivity aligned with monofocal lenses, highlighting the lens's clinical value. Aberrometry showed minimal changes in corneal aberrations. NEI-RQL-42-Questionnaire showed a high patient satisfaction for daily activities and revealed reduced dependence on glasses, particularly for near and intermediate vision. The Acunex Vario AN6V demonstrated minimal dysphotopsias, making it a promising option for those seeking spectacle independence. Conclusion: This segmental refractive EDoF IOL provides a high degree of spectacle independence for far and intermediate distances with functional near VA. Although inducing residual coma aberrations, it showed subjectively good results with little dysphotopsias. Trial registration: This study protocol was reviewed and approved by ethics committee of Charité University, Berlin, Germany, with approval number EA4/126/20. [ABSTRACT FROM AUTHOR]

Background: Addressing presbyopia in the aging population, particularly in non-cataractous patients, remains a challenge. This study evaluates the outcomes of refractive lens exchange (RLE) with AT LISA tri 839MP trifocal intraocular lens (IOL) implantation in a Chinese presbyopic population without cataracts. Methods: The study included 164 eyes from 82 patients undergoing bilateral RLE at Peking Union Medical College Hospital. Comprehensive evaluations encompassed visual acuities, refraction, ocular aberrometry, and subjective outcomes via the VF-14 questionnaire. The focus was on postoperative visual performance, refractive outcomes, safety, objective optical quality, and patient satisfaction. Results: 100%, 90.2%, and 89.0% of patients achieved binocular UDVA, UNVA, and UIVA of logMAR 0.1 or better at 6 months postoperatively. 97.6% of eyes were within ± 1.00 D of emmetropia postoperatively. Optical quality assessments showed increases in modulation transfer function and Strehl ratios (p < 0.05). High-order aberrations decreased significantly (p < 0.05). Despite the high incidence of posterior capsule opacification (83.2%), managed with early Nd: YAG capsulotomy, no other severe complications were reported. Patient-reported outcomes indicated high satisfaction, with an average VF-14 score of 94.3 ± 10.2 and 93.5% achieving complete spectacle independence. Halo (66.2%) was the most commonly reported optical phenomena, followed by glare (18.2%), and starburst (7.8%) after surgery. Conclusions: Bilateral RLE with trifocal IOLs in presbyopic patients without cataracts significantly improves visual acuity and reduces ocular aberrations in presbyopic patients. The procedure offers high patient satisfaction and spectacle independence, though it requires careful patient selection and management of expectations regarding potential photic phenomena. [ABSTRACT FROM AUTHOR]

Background: This study investigated patients' awareness of presbyopia and its management approaches and their preferred methods for near vision correction. Methods: In Saudi Arabia, 785 participants (aged between 35 and 60 years) completed a structured survey online, consisting of hard copies and direct interviews. The survey consisted of twenty-eight items divided into three parts. It was designed to record participants' awareness of and preferences for presbyopia and its refractive corrections. Nonparametric tests and descriptive analyses were conducted to analyse participants' responses. Result: Approximately half of the participants had difficulty with near vision activities, such as reading newspapers or using mobile phones. Among all the participants, 76% were not aware of presbyopia. The prevalence of uncorrected presbyopia was 48% of the 785. The majority (82%) felt that spectacles were acceptable for correction of presbyopia. Most reported that they did not experience social stigma when using reading spectacles (87% of participants). When asked if they were aware of management approaches other than spectacles, 72% responded with not at all. Most participants had no earlier knowledge of the use of multifocal contact lenses or eye drops for presbyopia correction (67% and 82%, respectively). In the present study, some tendencies to use corrective approaches to presbyopia other than spectacles were noted. Finally, participants' age, sex, region, education, and income had a statistically significant impact on essential parts of their responses (p < 0.05). Conclusion: Presbyopia is a highly prevalent age-related ocular disorder, and a significant percentage of cases are uncorrected due to a lack of awareness or reluctance to wear spectacles. More efficient health education about presbyopia and its corrective alternatives is urgently needed. [ABSTRACT FROM AUTHOR]

AbstractPurposeMaterials and methodsResultsConclusions\nIMPLICATIONS FOR REHABILITATIONThis study aims to explore the meaningful contributions of rehabilitation for participants living with persistent pain.A phenomenological methodology was used. Thirteen purposefully selected participants, who self-identified as substantially improved from persistent pain due to rehabilitation, were interviewed in-depth. Data were analyzed using reflexive thematic analyses.Participants included three men and ten women, age ranging from 22–69 years, pain duration was 2–30 years. Seven interconnected themes were developed: 1) indication of negative pain and health care experiences, 2) supporting working alliance with healthcare professionals, 3) Pain Dialogue, 4) improved self-awareness and self-regulation, 5) different view on pain, 6) autonomy and personal growth and 7) hope and new perspective. Integration of these themes provided a framework for understanding meaningful contributions of rehabilitation from the participants’ perspective.The study identified seven interconnected themes enhancing meaningful contributions of rehabilitation for participants who have substantially improved from persistent pain. These findings provide a novel conceptual understanding of how rehabilitation can foster recovery. The themes strongly support person-centred care, an understanding of Pain Dialogue and personal growth through the lens of the lived experience. The quality of the therapeutic relationship is considered a central vehicle for improved health outcomes.A rehabilitation participant perspective can contribute to better outcomes in pain rehabilitation.A shift from a pain-centred to a person-centred approach should be considered to enhance meaningful contributions of rehabilitation.Pain Education should be reconceptualized into Pain Dialogue.The quality of the therapeutic relationship can be regarded as a key driver for the effectiveness of person-centred care and Pain Dialogue.A rehabilitation participant perspective can contribute to better outcomes in pain rehabilitation.A shift from a pain-centred to a person-centred approach should be considered to enhance meaningful contributions of rehabilitation.Pain Education should be reconceptualized into Pain Dialogue.The quality of the therapeutic relationship can be regarded as a key driver for the effectiveness of person-centred care and Pain Dialogue. [ABSTRACT FROM AUTHOR]

This article discusses a case study of a Spanish-speaking male who experienced traumatic superior oblique palsy (SOP) and dry eye after being hit in the eye. The patient's symptoms improved with the use of prism lenses and lubricating eye drops. The article emphasizes the importance of differentiating between acquired and congenital cases of SOP and ruling out other potential causes. It also provides information on the diagnosis and management of SOP, including the use of the prism-measured alternate cover test and treatment options such as temporary prism correction and surgery. [Extracted from the article]

Purpose: To assess visual and refractive outcomes and visual function after bilateral RayOne Trifocal toric and nontoric intraocular lens (IOL) (Rayner) implantation in patients with presbyopia. Methods: Charts of patients with presbyopia who underwent refractive lens exchange with bilateral implantation of the RayOne Trifocal IOL (toric and non-toric) were retrospectively reviewed. Visual and refractive outcomes were evaluated at 3 months. Patient satisfaction, spectacle independence, and visual disturbance profile were assessed by questionnaires. Results: A total of 5,226 patients were assigned to one of two groups: 1,010 patients had toric IOL implantation (toric group) and 4,216 patients received the non-toric model (non-toric group). Mean ± standard deviation visual acuity at 3 months for the toric group was binocular uncorrected distance visual acuity (UDVA) of 0.07 ± 0.11 logMAR, monocular corrected distance visual acuity (CDVA) of 0.05 ± 0.07 logMAR, binocular uncorrected near visual acuity (UNVA) at 40 cm of 0.10 ± 0.09 logMAR, binocular uncorrected intermediate visual acuity (UIVA) at 40 cm of 0.13 ± 0.12 logMAR, postoperative spherical equivalent (SE) of −0.21 ± 0.47 diopters (D), and cylinder of −0.34 ± 0.40 D. The non-toric group had binocular UDVA of 0.04 ± 0.08 logMAR, monocular CDVA of 0.05 ± 0.07 logMAR, binocular UNVA of 0.10 ± 0.08 logMAR, binocular UIVA of 0.13 ± 0.11 logMAR, SE of −0.08 ± 0.38 D, and cylinder of −0.28 ± 0.34 D. No statistically significant differences were found in achieving spectacle independence and there were high levels of satisfaction in both groups. Conclusions: In this retrospective analysis with more than 5,000 patients, both the toric and non-toric RayOne Trifocal IOL models provided good visual performance at all distances, resulting in excellent levels of spectacle independence and patient satisfaction. [J Refract Surg. 2024;40(7):e468–e479.] [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effectiveness, safety, and stability of a modified PRESBYOND Laser Blended Vision protocol (Carl Zeiss Meditec AG) for correcting hyperopic astigmatism and presbyopia, using Custom Refractive Software Master (CRSM) targeting over a 6-month period. Methods: A total of 636 eyes of 318 patients with a mean age of 51.05 ± 4.71 years (range: 40 to 60 years) met the inclusion and exclusion criteria. All patients completed a 6-month follow-up. CRSM software was used to generate ablation profiles for the MEL90 excimer laser (Carl Zeiss Meditec AG). The target refraction was emmetropic for the dominant eyes and between −0.75 and −1.12 diopters (D) for the near eyes. Results: Visual and refractive results were studied separately by the dominant and non-dominant eyes. The mean attempt to correct for spherical equivalent refraction was +2.17 ± 1.16 D (range: −1.00 to +5.37 D). The mean attempted cylinder was −0.60 ± 0.75 D (range: −4.00 to 0.00 D). All eyes monocularly achieved uncorrected distance visual acuity (UDVA) of 20/25 or better after refractive treatment and 88% achieved 20/20. Binocularly all eyes achieved UDVA of 20/25 or better and 96.54% achieved 20/20. Ninety-eight percent of the patients maintained their corrected distance visual acuity before surgery and UDVA 6 months after surgery. Conclusions: This hyperopic micro-anisometropia protocol with PRESBYOND Laser Blended Vision was an effective, safe, and well-tolerated refractive treatment. It was an effective procedure with excellent results for UDVA and uncorrected near visual acuity and demonstrates that binocular summation exists. [ J Refract Surg. 2024;40(7):e480–e489.] [ABSTRACT FROM AUTHOR]

Background: To evaluate the optical performance and safety of a new multifocal lens with a novel optical design featuring two additional foci (or intensifiers) in patients with cataract and presbyopia. Methods: In this single-center, non-randomized prospective observational study, 31 patients underwent implantation of the new multifocal IOL between March 2020 and November 2021 at a tertiary clinical center in Buenos Aires and Ramos Mejia, Argentina. Postoperative examinations with emphasis on uncorrected and corrected visual acuity at distance and near and at two different intermediate distances (80 cm and 60 cm) were performed during the 3 postoperative months. Results: Of the 31 patients who underwent implantation of the new IOL, 30 underwent bilateral surgery (61 eyes in total). At 3 months, all 61 eyes had an uncorrected distance visual acuity (UCDVA) of at least 0.15 logMAR; 57 eyes (93%) had an uncorrected distance visual acuity (UCDVA) of 0.1 logMAR and 27 eyes (44%) had an UCDVA of 0.0 logMAR. At 80 cm, 60 eyes (98%) had an uncorrected intermediate visual acuity (UCIVA) of at least 0.1 log MAR and 48 eyes (79%) had an UCIVA of 0.0 logMAR. Conclusion: The new multifocal IOL with a novel optical concept (5 foci) showed a wide range of visual acuity especially at intermediate and near distances in patients undergoing cataract surgery. Uncorrected visual acuity was excellent at all tested distances, monocularly and binocularly, spectacle independence and patient satisfaction were high. [ABSTRACT FROM AUTHOR]