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Purpose To review the published literature assessing the efficacy and safety of presbyopia-correcting intraocular lenses (IOLs) for the treatment of presbyopia after cataract removal. Methods Literature searches were undertaken in January 2018 and September 2020 in the PubMed, Medline, and Cochrane Library databases. This yielded 761 articles, of which 34 met the criteria for inclusion in this assessment and were assigned a level of evidence rating by the panel methodologist. Thirteen studies were rated level I and 21 studies were rated level II. Results Presbyopia-correcting lenses were effective at improving distance and near visual acuity after cataract surgery. Near acuity at different focal lengths was related directly to the effective add power of multifocal and extended depth-of-focus (EDOF) IOLs. Most multifocal and EDOF lenses that were compared with a control monofocal lens demonstrated that patient-reported spectacle independence was superior to the monofocal lens. All patients who had multifocal and EDOF lenses implanted showed decreased contrast sensitivity and reported more visual phenomena as compared with control participants who received monofocal lenses. Conclusions Presbyopia-correcting lenses improve uncorrected near and distance visual acuity and decrease spectacle dependence after cataract surgery. Mesopic contrast sensitivity is decreased compared with monofocal lenses, and patient-reported visual phenomena are more likely in patients receiving multifocal or EDOF lenses.

PURPOSE: Recent innovations in mobile technology for the measurement of vision present a valuable opportunity to measure visual function in non-clinical settings, such as in the home and in field-based surveys. This study evaluated agreement between a tablet-based measurement of distance and near acuity, and contrast sensitivity as compared to gold-standard clinical tests. METHODS: Participants aged ≥55 years recruited from a tertiary eye clinic underwent testing with three tablet-based and corresponding gold-standard clinical measures (ETDRS distance acuity, Pelli-Robson contrast sensitivity, and MNRead near acuity). Correlation and agreement between tablet-based and clinical tests were assessed. RESULTS: A total of 82 participants with a mean age of 69.1 (SD=7.6) years, and majority female (67.1%) and white (64.6%), were enrolled in this study. The mean (SD) difference between the tests (gold-standard – tablet) was −0.04 (0.08) logMAR for distance acuity, −0.11 (0.13) log units for contrast sensitivity, and −0.09 (0.12) logMAR for near acuity. 95% limits of agreement for distance acuity (−0.21, 0.12 logMAR), near acuity (−0.34, 0.14 logMAR), and contrast sensitivity (−0.36, 0.14 logCS) were also determined. The correlation between tablet-based and gold-standard tests was strongest for distance acuity (r=0.78), followed by contrast sensitivity (r=0.75), and near acuity (r=0.67). The agreement between the standard and tablet-based methods did not appear to be dependent on the level of vision. CONCLUSIONS: This study demonstrates the agreement of tablet-based and gold-standard tests of visual function in older adults. These findings have important implications for future population vision health surveillance and research.

Background: A near vision game has been developed for the autostereoscopic screen of the Nintendo 3DS console. Ease of use and time for testing by non–English-speaking patients was not known. Methods: Adult and pediatric patients in a remote Burma clinic were compared with US military staff with each performing conventional near acuity, Stereo Fly, and Ishihara color in addition to PDI Check game, so results could be correlated and timed. Results: Seventeen Burma adults (aged 19–58), 20 Burma children (aged 7–15), and 14 US military staff (aged 21–36) completed the testing. Conventional testing correlated with PDI Check for stereo (P

Background/AimsOngoing and recent clinical trials for geographic atrophy (GA) have used different outcomes. The goal of this study was to identify a core outcome set (COS) important for patients, clinicians and researchers, and to propose the use of COS in the design of future GA trials.MethodsFive-component project including: Delphi method with patients and experts, focus groups and interviews with patients, relatives and workers supporting patients. Three hundred and one patients (301) with age-related macular degeneration participated in round 1 of a Delphi exercise. Most subjects had GA; 183 patients (61%) were females and the median (range) age was 77 (50–99) years. In round 2, of the 301 of the first round, 100 participants were randomly selected of whom 76 agreed to take part. In a parallel Delphi exercise, panellists comprised a mix of non-clinical scientists and clinicians (43 in the initial and 21 in the final round). In addition, interviews and focus groups consisting of patients (n=20), family members (n=4) and support workers (n=5) were undertaken.ResultsCore outcomes identified as important for age-related macular degeneration trials were the health of the outer retina, multimodal estimation of lesion size, reading speed, best corrected distance and near acuity, low luminance visual acuity, patient reported visual performance and safety.ConclusionThis study identified a set of core outcomes that should be used in GA trials. The COS include patient-reported outcome measures, near visual acuity, reading speed and assessment of the outer retina.

To report the reproducibility, sensitivity, specificity, and predictive value of home monitoring for disease activity in neovascular age-related macular degeneration (ARMD). Participants were trained to complete three separate home monitoring tasks, designed to identify subtle changes in visual function that may indicate increasing neovascular ARMD disease activity. These included measurement of near acuity and assessments of environmental distortion and overall visual function. The need for repeat intra-vitreal injection, as predicted by home monitoring, was compared to standard clinical assessment involving ETDRS distance acuity, slit lamp examination, and spectral domain ocular coherence tomography. Although all participants were able to complete the home monitoring tasks, the reproducibility of each of the three tasks was modest. Cohen’s kappa was 0.118 (p = 0.54) for the comparison of the outcome of the home monitoring exercise with the gold standard of hospital assessment to determine disease activity. The sensitivity of the home monitoring exercise was 33.3 % (95 % CI 15.2–51.4) and the specificity was 77.8 % (95 % CI 61.8–93.8). This study suggests that current tests of visual function, which are readily completed at home, cannot replace traditional clinic-based assessments for neovascular ARMD disease activity. Instead, such tests are likely to remain complementary to standard assessment in clinic.

Objectives. To investigate the relationship between vision and disability in the elderly. Methods. We used a baseline visual indicator (combining near acuity with Snellen equivalent Results. In multiadjusted analyses, near visual impairment, alone or associated with distance visual function loss, was associated with greater risk of developing ADL limitations (P = .027), IADL limitations (P = .002), and participation restriction (P Conclusions. Both near and distance visual loss was associated with greater functional decline over time, and the combination of the two could be even worse. Public Health Implications. In the context of rapid aging of the population, maintaining good vision in the elderly represents a promising prevention track, visual impairment being common in the elderly, largely undermanaged, and mostly reversible. Further research, especially trials, is necessary to estimate the public health impact of such interventions.

PURPOSE To determine the combined impact of uncorrected astigmatism, pupil diameter, and wavefront aberrations on the distance and near visual performance of pseudophakic eyes with monofocal intraocular lens (IOL) implants using objective image quality (IQ) metrics. METHODS Monocular distance (4 m) and near (40 cm) logMAR acuities of 15 emmetropic pseudophakic eyes were obtained without astigmatism and with 2.5 diopters myopic to 2.5 diopters hyperopic astigmatism induced along a 90-degree axis. The IQ metrics were calculated from the participant's wavefront aberrations and habitual pupil diameter for all values of astigmatism and correlated with logMAR acuity. The analysis was repeated without higher-order aberrations (HOAs) and with the entire wavefront data for 6-, 3-, and 1.5-mm pupil diameters. RESULTS Distance acuity deteriorated with uncorrected astigmatism (p < 0.01), whereas near acuity improved with uncorrected myopic astigmatism and deteriorated with uncorrected hyperopic astigmatism (both p < 0.01). The logEW IQ metric showed the best correlation with logMAR acuity (r = 0.86). Distance logEW values deteriorated whereas near logEW values improved in the presence of HOAs for all values of uncorrected astigmatism (p < 0.01). Distance logEW values for 6- and 3-mm pupil diameters were worse than that of the 1.5-mm pupil diameter for all values of uncorrected astigmatism and for both viewing distances (p < 0.01). CONCLUSIONS Image quality metrics analysis can be used successfully to determine the impact of uncorrected astigmatism, pupil diameter, and HOAs on the distance and near logMAR acuities of pseudophakic eyes with monofocal IOL implants. The improvement in near IQ with uncorrected myopic astigmatism and HOAs suggests that these two factors supplement each other to improve near visual performance of pseudophakic eyes. Such an improvement in near vision is however associated with a loss of distance vision in these eyes.

Purpose Reliable estimation of visual acuity requires that observers maintain a constant distance from the target, but use of chin rests is not always feasible. Our aim was to quantify children's movement during community testing and its impact on near (40 cm) and intermediate (150 cm) acuity measures. Methods Thirty-three 7-year-old children performed several acuity tests run on a tablet computer, administered in the child's home by a trained lay screener. The tablet webcam was used to derive a continuous estimate of the child's position during testing. We estimated acuity using both the recommended viewing distance and using trial-by-trial estimates of the child's physical distance from the screen. Results Although initial positioning in the 40-cm viewing distance condition was accurate, on 18% of trials children moved sufficiently to support a 0.1 logMAR improvement in acuity, leading 16% of staircases to overestimate acuity by more than one line. Initial positioning for the 150-cm condition was less accurate, but the longer viewing distance minimized the impact of children's movement on the visual angle of the target. Overall, at 150 cm 8% of staircases were overestimated by more than 0.1 logMAR. Conclusions Children move substantially during intermediate and near acuity tests despite assessors encouraging maintenance of the correct viewing distance. Translational Relevance Real-time estimates of the child's physical distance from the target are possible when assessments are conducted on camera-enabled devices. Correction for movement will likely lead to more accurate measures of near and intermediate visual acuity.

To ascertain whether conventional treatment can improve visual function in adults with amblyopia. Sixteen patients aged 21–67 years old were instructed to wear glasses for refractive correction and to patch the non-amblyopic eye for at least 1 h per day. Visual acuity, measured with crowded optotypes for distance and near acuity, was checked every 3 months, and followed for a mean (SD) of 14.1 (4.2) months. Prognostic factors related to the subsequent results, an improvement of 3 or more lines logMAR in distance visual acuity, were evaluated. Of 16 patients, 5 (31 %) improved 3 or more lines of distance and 5 (31 %) in near acuity. The mean improvement in distance was 2.4 lines logMAR (95 % CI 1.4–3.5) and 2.4 lines logMAR for near acuity (95 % CI 1.5–3.3). Patients aged under 45 years (p = 0.0357) and with severe amblyopia (p = 0.0337), defined as a corrected distance visual acuity of worse than −0.699 logMAR, were associated with a good response. Conventional treatment may improve the visual acuity of amblyopic eyes even in adult patients.

To compare visual acuity outcomes and ocular and intraocular optical quality in patients with a monofocal intraocular lens (IOL) or a multifocal IOL with rotational asymmetry.Vissum Corporation, Alicante, Spain.Comparative case series.Consecutive eyes of cataract patients were divided into 2 groups. One group received a Lentis Mplus LS-312 multifocal IOL and the other, an Acri.Smart 48S monofocal IOL. Distance and near visual acuities, contrast sensitivity, intraocular aberrations (global minus corneal aberrations), and defocus curves were evaluated preoperatively and postoperatively during a 3-month follow-up.The study evaluated 52 eyes of 29 patients (age range 36 to 87 years); 24 eyes were in multifocal IOL group and 28 eyes, in the monofocal IOL group. Both groups had a significant improvement in uncorrected and corrected distance visual acuities and in distance-corrected near visual acuity (DCNVA) postoperatively (P ≤ .04). The multifocal IOL group had significantly better uncorrected near acuity and DCNVA (Jaeger [J] 5 versus J2) (both P.01). The defocus curves showed significantly better visual acuities in the multifocal group at several levels of defocus. The multifocal group had significantly higher amounts of postoperative intraocular primary coma (P.01), especially in eyes with significant IOL tilt, although there were no significant differences in contrast sensitivity between the 2 IOL groups (P ≥ .25).The new-generation multifocal IOL restored distance, intermediate, and near visual function after cataract surgery. The optical quality with this type of IOL was particularly affected by IOL tilt and decentration.

Purpose To assess the visual outcomes after cataract surgery with implantation of a refractive multifocal intraocular lens (IOL) with a +3.00 D addition (add). Setting Centro Internacional de Microcirugia Ocular, Seville, Spain. Methods This prospective study evaluated visual outcomes after cataract surgery with implantation of a Rayner M-flex 630F +3 IOL over a 12-month follow-up. Monocular and binocular uncorrected and corrected distance, intermediate, and near visual acuities were recorded. Distance contrast sensitivity under photopic and mesopic conditions, subjective dysphotopic phenomena, and subjective spectacle dependence were assessed. Results The study enrolled 32 eyes of 22 patients. Twelve months postoperatively, the mean monocular corrected distance acuity was 0.03 ± 0.05 logMAR and the mean corrected near acuity was 0.04 ± 0.05 logMAR. The binocular uncorrected and corrected near acuity was 0.25 ± 0.08 logMAR and 0.03 ± 0.02 logMAR, respectively, at 6 months, with no changes thereafter. No patients reported dysphotopic phenomena at the 12-month visit. Of patients having binocular IOL implantation, 90% were spectacle independent for distance vision and 70% for near vision at 6 months. Conclusion The refractive multifocal IOL with a +3.00 D add provided satisfactory visual outcomes through a full range of vision. Financial Disclosure Neither author has a financial or proprietary interest in any material or method mentioned.

Macular degeneration has a severe impact on a person's ability to perform activities of daily living. This study investigated the impact of in-home training in eccentric viewing on near acuity and performance of activities of daily living. The results suggest that eccentric viewing can ameliorate the impact of the loss of vision that is due to macular degeneration.

Purpose: The aim of this work was to evaluate the role of low vision aids in improving visual performance and response in children with low vision. Study Design: Prospective clinical case series. Materials and Methods: This study was conducted on 50 patients that met the international criteria for a diagnosis of low vision. Their ages ranged from 5 to 15 years. Assessment of low vision included distance and near visual acuity assessment, color vision and contrast sensitivity function. Low vision aids were prescribed based on initial evaluation and the patient's visual needs. Patients were followed up for 1 year using the tests done at the initial examination and a visual function assessment questionnaire. Results: The duration of visual impairment ranged from 1 to 10 years, with mean duration ± SD being 4.6± 2.3299. The near visual acuities ranged from A10 to A20, with mean near acuity ± SD being A13.632 ± 3.17171. Far visual acuities ranged from 6/60 (0.06) to 6/24 (0.25), with mean far visual acuity ± SD being 0.122 ± 0.1191. All patients had impaired contrast sensitivity function as tested using the vision contrast testing system (VCTS) chart for all spatial frequencies. Distance and near vision aids were prescribed according to the visual acuity and the visual needs of every patient. All patients in the age group 5-7 years could be integrated in mainstream schools. The remaining patients that were already integrated in schools demonstrated greater independency regarding reading books and copying from blackboards. Conclusion: Our study confirmed that low vision aids could play an effective role in minimizing the impact of low vision and improving the visual performance of children with low vision, leading to maximizing their social and educational integration.

To assess the visual results after bilateral implantation of the bifocal Acri.LISA 366D intraocular lens (IOL) (Acri.Tec AG).Fernández-Vega Ophthalmological Institute, Oviedo, Spain.Eighty-one patients had bilateral implantation of the distance-dominant bifocal Acri.LISA 366D IOL in a prospective study. Monocular and binocular best corrected distance visual acuity and best distance-corrected near visual acuity, binocular best distance-corrected intermediate visual acuity, and distance contrast sensitivity under photopic (85 cd/m(2)) and mesopic (5 cd/m(2)) conditions were determined.At the 3-month postoperative visit, the mean binocular best corrected distance acuity was 0.048 +/- 0.111 logMAR and the mean binocular best distance-corrected near acuity, 0.012 +/- 0.0084 logMAR (both approximately 20/20). The mean binocular best distance-corrected intermediate acuity changed significantly as a function of the distance of the test, from 0.012 +/- 0.084 logMAR (approximately 20/20) at 33 cm to 0.265 +/- 0.099 logMAR (approximately 20/40) at 70 cm (P.01). Contrast sensitivity was within normal limits under photopic and mesopic conditions. Binocular contrast sensitivity was statistically significantly better than monocular contrast sensitivity at all spatial frequencies under both illumination levels (P.01).The Acri.LISA 366D IOL provided a satisfactory full range of vision; a high level of uncorrected and corrected distance, intermediate, and near acuity; and improved contrast sensitivity under photopic and mesopic conditions.

Purpose To present the clinical results that demonstrate the efficacy of the Tetraflex accommodative intraocular lens (IOL) in providing both enhanced distance and near acuity. Design Single-center prospective data collection performed in Manchester, United Kingdom. Participants A series of 95 eyes of 59 patients implanted with the Tetraflex lens was performed by a single surgeon. Thirty-six of these cases were implanted bilaterally. Intervention Implantation of the Tetraflex accommodative IOL. Main Outcome Measures Prospective data collection included both uncorrected distance visual acuity (UCDVA) and uncorrected near visual acuity (UCNVA) testing, manifest refraction, best-corrected distance visual acuity (BCDVA), distance corrected near visual acuity (DCNVA), and the amplitude of accommodation. Intraoperative and postoperative complications also were reported. Results At 6 months after surgery, 63% of all cases achieved a DCNVA of 20/40 or better. Virtually all of the patients had at least 1 diopter (D) of accommodative amplitude (98% at 1 month; 100% at 3 and 6 months); 75.7% had at least 2 D at 6 months after surgery. At 6 months or later, 92.2% had 20/40 or better UCDVA. The proportion of cases achieving a UCNVA of 20/40 or better remained relatively constant at 45% to 47%. At 6 months and later, 98.7% had a BCDVA of 20/40 or better. In the bilaterally implanted series, at 1 month after surgery, all patients had at least 1 D of accommodative ability; 96% had at least 2 D at 6 months. One hundred percent achieved a BCDVA, 89.3% achieved a DCNVA, and 74.1% achieved a UCNVA of 20/40 or better at 6 months after surgery. Conclusions The Tetraflex accommodating IOL provides enhanced near vision with good distance vision 6 months after surgery.

PURPOSE. To evaluate near and distance visual performance after implantation of a diffractive multifocal intraocular lens (MIOL) (AcrySof ReSTOR ® ) or a refractive MIOL (Array ® 2) in bilateral cataract surgery. METHODS. In this prospective, comparative trial, 18 patients with bilateral cataract were selected to have lens surgery with asymmetric MIOL implantation. Eighteen eyes received ReSTOR MIOL and the 18 fellow eyes were implanted with Array 2. Five months after second lens implantation, main postoperative outcomes were uncorrected and distance corrected near visual acuities (VA). Secondary outcomes were distance VA and near acuity with power add, contrast sensitivity with and without glare (Pelly-Robson Contrast Sensitivity Chart, CSV1000 HGT). Quality of vision was measured by comparing the severity of visual symptoms as referred to a masked interviewer. RESULTS. Patients reported similar postoperative distance visual acuities for both eyes. ReSTOR-implanted eyes showed better uncorrected and distance corrected near acuity than eyes with Array 2 (p=0.002 and p=0.003, respectively). Intermediate VA with distance correction was slightly higher with the Array 2 MIOL (p=0.058). No important difference was observed in contrast sensitivity, glare disability, and subjective rating of light sensations. Severe photic phenomena were reported only for one Array 2-implanted eye. CONCLUSIONS. The diffractive MIOL showed better uncorrected and distance corrected near VA. The refractive Array 2 MIOL had a tendency to better value for intermediate distance. Disturbing photic phenomena were observed only in one case with the Array 2 MIOL.

Purpose To test an automated, tablet-based self-testing method for the determination of low contrast near visual acuity in ophthalmic patients. Methods The Mobile Assessment of Vision by intERactIve Computer (MAVERIC) system consists of a calibrated tablet computer (Samsung Galaxy Tab S 8.4) running purpose-built software housed in a bespoke physical booth. Near low contrast (25%) visual acuity was measured in one eye using the MAVERIC system and a near ETDRS chart at a distance of 40 cm on a population of ophthalmic patients with various retinal conditions. Patients independently completed testing using the MAVERIC system once an explanation of its use had been given. Repeat measures of near acuity were also conducted using the MAVERIC system. Results The MAVERIC system displayed excellent repeatability. Bland Altman analysis of data showed reasonable agreement between measurements obtained using MAVERIC and the near ETDRS chart. The degree of difference between data sets was consistent. Conclusions This study demonstrates the potential viability of the MAVERIC self-testing system as a means to test low contrast near visual acuity in ophthalmic patients with a high degree of reliability and thus a potential method of both initial assessment and monitoring of near visual acuity in such patients.

Purpose To assess the correlation between continuous curvilinear capsulorhexis (CCC) size and visual outcomes in patients with an accommodating intraocular lens (IOL). Setting Heidelberg IOL and Refractive Surgery Research Group, Department of Ophthalmology, Ruprecht-Karls-University of Heidelberg, Heidelberg, Germany. Methods Nineteen eyes had phacoemulsification and implantation of a 1CU accommodating IOL (HumanOptics AG). Three months after surgery, the uncorrected and best corrected distance and near visual acuities and the distance corrected near visual acuity were measured. Retroillumination photographs were taken to assess CCC size and centration and the amount of overlap between the CCC and IOL optic. The photographs were analyzed using Evaluation of Posterior Capsule Opacification system software. Results The mean age of the patients was 53.5 years (range 30 to 73 years). The mean uncorrected distance acuity improved from 0.05 preoperatively to 0.70 at 3 months and the best corrected near acuity, from 0.30 to 0.94. The mean postoperative distance corrected near acuity was 0.5 (range 0.1 to 1.0), which improved to 0.9 with near correction. The mean CCC size (4.3 mm) and amount of CCC decentration (0.35 mm) did not correlate with visual outcomes. However, there was a correlation between the amount of CCC–optic overlap (mean 35%; range 16% to 55%) and distance corrected near acuity (r = 0.641, P = .003). Distance corrected near acuity was better with less overlapping; that is, with a larger CCC. Conclusions A larger capsulorhexis with less CCC–optic overlapping gave better near visual outcomes. Results indicate that an overlap between 25% and 35%, which correlates with a CCC between 4.5 mm and 5.0 mm, provides the best capsule strength without compromising accommodation with the single-piece 1CU IOL.

To compare the near functional capacities of patients with an accommodating intraocular lens (IOL) with those of patients with a conventional monofocal IOL.Department of Ophthalmology, University of Chieti, Chieti, Italy.This prospective double-blind case-control study comprised 42 eyes that had phacoemulsification and implantation of 1 of 2 types of IOLs: HumanOptics accommodating 1CU(R) (study group) and Eurocrystal IFP 3G 6.00 (control group). The main outcome measures were subjective refraction, uncorrected distance acuity, best corrected distance acuity, distance corrected near acuity at 40 cm, best corrected near acuity at 40 cm, and subjective amplitude of accommodation. Patients were examined 7, 30, 90, and 180 days after surgery.Postoperatively, both groups had excellent uncorrected distance acuity, best corrected distance acuity, and best corrected near acuity. In the study group, the mean distance corrected near acuity (Jaeger) was 5.43 +/- 0.98 (SD) (range 4 to 7) at 7 days, 2.33 +/- 0.48 (range 2 to 3) at 1 and 3 months, and 3.66 +/- 2.12 (range 2 to 7) at 6 months. In the control group, the mean distance corrected near acuity was 7.43 +/- 0.50 (range 7 to 8) during the entire follow-up. The differences between the groups was statistically significant (P.001). The mean amplitude of accommodation was 0.00 diopter (D) in the control group and 1.14 +/- 0.44 D (range 0.75 to 2.00 D) in the study group at 7 days, 2.36 +/- 0.28 D (range 2.00 to 2.75 D) at 30 and 90 days, and 1.90 +/- 0.77 D (range 0.75 to 2.75 D) at 6 months.The 1CU accommodating IOL provided better useful spectacle-free near visual acuity than the conventional monofocal IOL. However, the accommodating mechanism can play a role in capsule fibrosis.

BACKGROUND: Enhancement of visual acuity has been demonstrated when retesting takes place within 24 hours and appears to be due to chart memory. Significant chart letter subset memory has been found after a single acuity measurement and can still be present 10 days after an examination involving several acuity measurements. Control of chart memory may increase the precision of acuity measurement. METHOD: A single acuity measurement was used to establish chart letter subset memory. Retroactive interference methods for the inhibition of chart letter memory have been compared using a letter recognition memory test. The experimental methods used to promote forgetting included a spelling backward exercise and near acuity assessment using a contra-chart. The contra-chart is constructed from the 16 letters not involved in the distance chart that was used to establish chart memory. RESULTS: Assessment of near vision using a contra-chart was found to inhibit chart letter memory. CONCLUSIONS: The contra-chart appears to have research and clinical applications that require control of measurement imprecision due to chart memory. Contra-charts obviate the need to use equivalent charts, which have the disadvantages of being difficult to use and control only for memory of letter sequences. The contra-chart can be included easily in an examination protocol for research or in a clinical examination sequence for which it will have the additional purpose of providing a guide to near vision performance.

OBJECTIVE: To improve on present reading chart designs, providing a quick and accurate method to measure the near acuity threshold, of particular importance with low vision patients. DESIGN: The Practical Near Acuity Chart (PNAC) uses a single paragraph with 3 simple related words on each line (12 lower case letters). The line print size decreases in a logMAR progression (N80-N5). METHODS: The time taken to measure near acuity of 53 subjects aged 9-91 years with the PNAC and Bailey-Lovie near chart was recorded and compared to their distance acuity (Bailey-Lovie chart), contrast sensitivity (Melbourne Edge Test) and ability to read extracts of newsprint. RESULTS: There was no difference in near acuity threshold using related or un-related words. There was a high correlation (r = 0.97) between near acuity measured with the PNAC and Bailey-Lovie charts. However, the time taken to measure near acuity was significantly faster with the PNAC (32 +/- 2 s vs 76 +/- 4 s, p < 0.001). Near acuity measured with either chart was highly correlated (p < 0.001) to distance acuity (r = 0.74), contrast sensitivity (r = 0.62) and ability to read newsprint (r = 0.87). The PNAC was shown to have high test-reliable (r = 0.99). CONCLUSIONS: The PNAC offers a quick but accurate way to measure near acuity and shows a high degree of correlation with distance acuity, contrast sensitivity and the ability to read newsprint.

The clinical performance of Focus Progressives multifocal contact lenses and Acuvue Bifocal contact lenses was evaluated in a group of 42 presbyopes, with equal numbers of individuals having low, medium, and high spectacle add requirements. Following visual performance assessment with an optimal sphero-cylinder spectacle refractive correction, each individual wore each of the two types of contact lenses in successive random order. Each type of lens was used in a daily-wear mode for a period of 7 to 12 days, with follow-up and/or refitting visits occurring after 2 to 5 days, and again after 4 to 7 days of attempted wear. Testing for all three forms of refractive correction encompassed Snellen acuities at distance and near, Bailey-Lovie acuities under high and/or low ambient illumination conditions at near, intermediate, and far viewing distances, stereoacuity, a timed visuomotor task (needle threading), apparent glare/flare, and the nearwork range of subjectively clear binocular vision. The contact lenses also were evaluated for handling, comfort, distance and near ghosting, subjective visual quality, acceptability for common tasks (e.g., using a phone directory), and personal preferences.As might be expected, distance and near acuity, stereoacuity, and visuomotor task performance were somewhat better with sphero-cylinder spectacle correction than with either of the two types of contact lenses. However, several performance differences between the multifocal and bifocal lenses were noted. The Focus Progressives lenses provided significantly better distance acuity under both high and low illumination conditions, and received significantly higher ratings for visual quality (overall and at distance), comfort, and handling. The Focus Progressives lenses were preferred 5:1 over the Acuvue Bifocal lenses. No differences existed between the lenses with respect to near visual acuities, the perceived quality of the near vision, the nearpoint binocular range, stereoacuity, or the acceptability of vision for common nearwork tasks. The results suggest that although both types of lenses afford presbyopes a viable alternative to spectacles, the Focus Progressives lens is superior in many ways to the Acuvue Bifocal lens.

BACKGROUND The implantation of a diffractive multifocal lens (dMIOL) as alternative to a monofocal lens is justified if after surgery there is practically no need to wear glasses. PATIENTS AND METHODS 31 patients had an implantation of a total of 35 dMIOLs (3M 815 LE). We evaluated the visual acuity, the refractive data and the patients' attitude to wearing glasses. The average age was 67.0 +/- 11.8 years. Follow up took place after 18.7 +/- 5.4 months. RESULTS The mean value of the uncorrected distance acuity was 0.59 +/- 0.17 and the corrected distance acuity 0.96 +/- 0.13. The uncorrected near acuity amounted to Jg 2.40 +/- 0.94, best distance correction was Jg 1.49 +/- 0.55. The patients still accepted an average of 0.68 +/- 0.37 dpt for the best near correction (near vision over the diffractive near focus) and thus achieved Jg 1.46 +/- 0.55. At the best distance correction plus 3.5 dpt, the near visual acuity was improved to 1.03 +/- 0.17. 54.8% of the patients indicated that they did not use glasses at all. 32.3% stated that they only used glasses for reading. 9.7% wore bifocals all the time, and 3.2% always used glasses for the distance. CONCLUSIONS Regarding distance vision, the dMIOL is equivalent to monofocal lenses. Without any correction the results of the dMIOLs for the near vision are superior to monofocal lenses. Glasses can be dispensed with if the uncorrected visual acuity of the operated eye is at least 0.6 Jg 2-3 after surgery and the other eye too, does not need any correction. In case the postoperative visual acuity is worse, good visual acuity of the other eye may render glasses unnecessary. Part of the patients put up with a correctable loss of visual acuity in order not to become dependent on glasses. The need to wear glasses may be decreased considerably by implanting a dMIOL in both eyes and by avoiding postoperative refraction errors.

A healthy 42 year old white woman was referred by her optician with subjective loss of visual field, particularly in her right eye. She had previously been functioning normally, but the notable deterioration in her visual field meant that she had recently lost the confidence to drive. Her central vision was unaffected. She had no family history of eye problems. Best corrected distance visual acuity (Snellen) was 6/6 bilaterally and near acuity was N5 bilaterally. She had a mild relative afferent pupillary defect in the right eye. Examination of the anterior segment of each eye was normal and Goldmann applanation tonometry showed pressures of 12 mm Hg in each eye. Dilated fundal examination showed bilaterally unremarkable maculas and retinas. Both optic discs had an irregular margin and confluent pale bumpy surface over the entire optic nerve head (fig 1⇓). Goldmann visual field tests showed gross constriction bilaterally (fig 2⇓). B-scan ultrasonography of both eyes showed highly echogenic bodies in both optic nerve heads. Fig 1 Colour photographs of the right (A) and left (B) optic disc showing irregular disc margins and multiple excrescences over the entire optic nerve head. Autofluorescent emissions from the right (C) and left (D) optic discs Fig 2 Goldmann visual field plots showing bilateral advanced constriction, which was worse on the right (A) than on the left (B) ### 1 What is the diagnosis? #### Short answer Bilateral advanced optic disc …

Purpose To assess which aspects of postoperative visual function (visual acuity, contrast acuity, or color confusion) are correlated with visual function-related quality of life measurements after successful surgery for macula-off rhegmatogenous retinal detachment (RRD). Methods In patients with a primary macula-off RRD, best correct visual acuity (BCVA), color confusion indices (CCI sature and desature), and contrast acuity were measured at 12 months postoperatively in both the RRD eye and the fellow control eye, and the 25-item National Eye Institute Visual Function Questionnaire (VFQ-25) was filled out. Results Forty-five patients with a primary unilateral macula-off RRD were included. There was a significant difference between operated and fellow control eyes with regard to LogMAR BCVA (P < 0.0001), Log contrast acuity (P < 0.0001), sature CCI (P = 0.018), and desature CCI (P = 0.018). Correlations were observed between the composite VFQ-25 score and postoperative LogMAR BCVA (R = -0.53, P < 0.0005) and Log contrast acuity (R = 0.47, P = 0.001). In addition, correlations were found between postoperative LogMAR BCVA and Log contrast acuity and the following subscales: driving, near acuity, role difficulties, and general vision. Also, a correlation between the subscale mental health and LogMAR BCVA was found. No correlations were found between any VFQ-25 scales and the CCIs. Conclusion Postoperative BCVA, contrast acuity and color confusion in operated macula-off RRD eyes were significantly worse compared to their fellow control eyes. Several vision-related quality of life parameters were highly correlated with postoperative BCVA and contrast acuity.

Item does not contain fulltext To compare outcomes between a new design apodized diffractive hydrophilic multifocal intraocular lens (IOL) (Seelens MF; study group), and a well-known apodized diffractive hydrophobic multifocal IOL (SN6AD1; control group). A comparative case series comparing refractive and visual outcomes at distance and near. Patient satisfaction with a validated questionnaire, dysphotopsia and straylight measurement scores were recorded at 3 months post-operatively. The study group comprised 48 eyes and the control group 37 eyes. At 3 months post-operatively the mean uncorrected distance visual acuity (UDVA) was not statistically significant different between the study group and the control group (0.02 +/- 0.07 logMAR [SD] vs 0.04 +/- 0.09 logMAR). Corrected distance visual acuity (CDVA) was statistically significantly better with the study lens (-0.04 +/- 0.05 logMAR vs -0.01 +/- 0.04 logMAR (p < 0.019). There was no clinical or statistical significant difference at the 40 cm distance (0.09 +/- 0.12 logMAR vs 0.08 +/- 0.09 logMAR). The study group had statistically significant better uncorrected near acuity at 50 and 60 cm distances (p < 0.03 and p < 0.007, respectively). In terms of satisfaction the lenses performed equally. Halos were seen less often with the study lens. Straylight, as a parameter for visual quality, was significantly less with the study lens. Conclusion: The Seelens MF performs equally as well as the well-known SN6AD1 for UCDA and CDVA. The Seelens MF performs better at intermediate distance, and seems to allow for better depth of focus, and increased visual quality. More study is needed to corroborate the last finding. 01 oktober 2013

Background: Presbyopia is an age-related loss of lens accommodation resulting in difficulty in performing near task with attendant effect on the quality of life. Objective: The objective of the study was to determine the prevalence of presbyopia and presbyopic spectacle correction coverage among public school teachers in Ifo township, with a view to providing a baseline information that could be useful for advocacy and planning appropriate intervention. Study Design: The study was a descriptive, cross-sectional study. Materials and Methods: Six hundred public school teachers aged 30 years and above were examined in 25 clusters using a multistage random sampling technique with probability proportional to size. Questionnaire was used to obtain information on demographic data, sources of spectacle and barriers to spectacle use. All participants underwent a standardised protocol including visual acuity assessment (distance and near acuity), anterior and posterior segment examinations and refraction. Results: Six hundred teachers were examined with an age range of 30–61 years. The mean age was 44.7 ± 7.5 years and the male to female ratio was 1:2.2. The prevalence of presbyopia was 81.3% and 38.5% of the presbyopic teachers did not have presbyopic correction. However, the average age of onset of presbyopia was earlier in females 33 years compared to 36 years observed in males, although not statistically significant ( P = 0.88). The presbyopic correction coverage was 61.5%. One hundred and eighty-six (62%) presbyopic teachers obtained their spectacle from opticians, and the main barriers to the use of near vision spectacle were lack of awareness (23.7%) and cost (13.7%). Conclusion: This study demonstrated a high prevalence of presbyopia among public school teachers in Ifo town, South-West Nigeria, but less presbyopic spectacle correction coverage.

Purpose Amblyopia is a disorder of visual processing. There is evidence that the parvocellular pathway, which prefers chromatic stimuli, is selectively damaged in amblyopia. Consistent with this hypothesis, previous studies have demonstrated that patients with amblyopia show poorer performance on colour vision tests. Methods Ten adult amblyopic subjects (3 strabismic, 5 anisometropic and 3 mixed) were tested using the Farnsworth Munsell 100 Hue (FM100Hue)colour vision test. In separate testing sessions, positive spherical lenses were used to induce blur in the fellow eye (FFE)to match the near acuity of the amblyopic eye (AME). The test (all boxes)was performed under five conditions(randomised): AME,FFE,binocularly (BIN),FFE with blur and BIN with the FFE blurred. Age matched controls were included to assess the effect of defocus in normal subjects, with blur placed in front of the non-dominant eye to induce mild, moderate or severe blur. Results Amblyopic participants performed well in the FM100Hue test, with scores falling within normal age means in 9/11 subjects (in the AME). Strabismic amblyopes had a more pronounced deficit in error scores. Across all amblyopic subjects, performance was significantly beter under BIN conditions (p=0.023). Induced blur in controls only affected error scores under the severe blur condition, and had litle effect in amblyopic participants. Conclusion This study has shown that amblyopes perform well in this commonly performed colour vision test, and demonstrated improved test performance under binocular conditions. The low spatial frequency of the stimuli may allow for extensive pooling of chromatic information therefore allowing performance of this test to be robust to a parvocellular dysfunction.

Background Common refractive bifocal IOLs feature 2 or 3 spherical zones with different refraction; the design of the Array multifocal IOL consists of 5 concentric zones, each of them providing a progressive near addition with multiple foci by means of an aspherical surface. Methods As a part of a prospective study, distance and near visual acuity, contrast sensitivity, glare and depth of field were examined in 15 patients with the Array lens and a monofocal control group 12 months after implantation. Subjective assessment of the optical quality was performed by detailed asking for optical symptoms. Results were retrospectively compared with the one year follow-up of 15 patients with diffractive bifocal IOLs. Results No difference was found for best corrected far and near visual acuity and sensitivity for high contrasts. Glare and sensitivity for low contrasts of the monofocal IOL was significantly superior to both multifocal models. Array IOL and diffractive IOL achieved a near acuity of Nieden 2-1 with only distance correction; defocus curves revealed an increase in the depth of field, but with a superiority of the Array lens in intermediate imaging. Optical symptoms as halos were much more frequent in patients with the diffractive IOL than in the Array group. Conclusions Functional results of the Array multifocal IOL seem to be comparable to those of the diffractive bifocal IOL, but with the advantage of an improved intermediate imaging and a reduction of optical side effects.

Objective: To determine the pattern of presentation of presbyopia in Yenagoa. Method: All consecutive new patients presenting to the eye clinic of the Department of Ophthalmology of the Niger Delta University complaining of blurred vision or asthenopia while doing near work, whose near acuity improved to at least N8 (Jaeger) with the addition of a convex lens were studied. Distance and near acuity were done using the Snellen and the Jaeger charts respectively, followed by a full ocular examination including objective and subjective refraction. Statistical analysis was done using the statistical package for social scientists (SPSS, 11.0). Results: A total of 1168 new patients were reviewed, out of which 149 were diagnosed as presbyopic. There were 73 males and 76 females (M: F =1:1.04), with an age range of 34-83 years (mean 45.6 years: SD±4.172). Most of the patients (72.5%) were emmetropes. Hypermetropia was the commonest refractive error (16.8%) followed by astigmatism (8.7%). Myopia was found to be rare (2.0%). The earliest age at presentation was 34 years with a mean of 45.6 years (SD±4.172) for both sexes. The mean add requirement for the male patients was +2.061 (SD±0.470) while that for the female patients was +1.715 (SD±0.345). The difference in add requirement was found to be statistically significant (p=0.00001). Conclusion: Presbyopia occurred early among the population studied. The add requirement was also high. The mean add requirement for male patients was found to be higher than that for the female patients. Keywords: presbyopia, add, onset, Yenagoa, hypermetropia, near vision

Purpose To evaluate any effect of cataractous vision on handwriting performance. Methods Nine patients were enrolled for Phase I with an average age of 75 yrs (range: 69 to 84 yrs). Visual acuity (VA) was evaluated using the European-wide logMAR charts for far, intermediate and near vision. Measurements were performed pre-operatively and three- months post-operatively, with habitual correction, under both monocular and binocular viewing conditions. Patients were asked to give signature and handwriting samples at each visit. The signatures were compared, focusing on the general characteristics of line quality, general design, size, arrangement, spacing, slant and their sub-elements. Results Average monocular and binocular VA was found to improve at all measured distances post-operatively. E.g., average binocular intermediate acuity increased from 0.52 (±0.29) to 0.20 (±0.24) logMAR, while near acuity increased from 0.70 (±0.33) to 0.52 (±0.17) logMAR. The forensic analysis showed that cataractous vision tends to influence some general characteristics, eg decreasing the line quality of the allographs and creating significant dissimilarity on the size sub-elements. On average, the general characteristics of general design, intra-allograph ratio and slant were not influenced by the compromised vision. A number of "non liquet" results were manifested, caused by the complete differentiation of the structure of certain allographs before and after the cataract surgery. Conclusion Cataractous vision compromises some handwriting characteristics. Future research will focus on quantifying and exporting the results to the general population.

By means of a new optical device developed by Reiner, an "optical implantation" of 6 different bi- and multifocal intraocular lenses (MIOLs) was performed in 20 young healthy subjects, and results were compared with those of a monofocal reference IOL. The following parameters were investigated: distance and near visual acuity, depth of focus and contrast sensitivity. The median of distance visual acuity was 1.0 in all IOLs with the exception of a 7-zone refractive MIOL (0.75). Near acuity without near addition was 1.0 in all MIOL models; through focus curves of all MIOLs showed an increase in depth of focus with a typical two peak course. Contrast sensitivity at high contrasts was reduced for the 7-zone-model, but contrast sensitivity at low contrasts was significantly reduced for all MIOLs, except the 2- and 3-zone refractive models.

OBJECTIVE: To determine the quality of vision with the ‘True Vista’ bifocal IOL. STUDY DESIGN: Prospective multicentre study of postoperative results at 4–6 and 7–11 months after surgery. SETTING: Twenty ophthalmic centres in Europe participating. PATIENTS: 367 monocular implants performed to date; 164 adults (best cases) at 4–6 months and 73 at 7–11 months; contrast acuity tested in 67 patients (best cases). MAIN OUTCOME MEASURES: Uncorrected and best corrected distance and near acuity and contrast acuity (Regan Low Contrast Acuity Charts, 96%, 50%, 25%, 11%); near acuity measured by a Snellen chart (Lighthouse Chart) at 7–11 months and by reading charts at 4–6 months. RESULTS: At 4–6 (7–11) months best corrected distance acuity was 20/40 or better in 97% (99%), best corrected near acuity 20/30 or better in 91% (83%) and uncorrected near acuity 20/30 or better in 64% (59%). Near acuity (Lighthouse Chart) was slightly lower than reading acuity (reading charts) (P = 0.12). Distance contrast acuity was slightly reduced at low contrast (11%) only, while contrast acuity at near focus was significantly lower than at far focus (96%: P = 0.0001; 50%: P = 0.0001; 25%: P = 0.001; 11%: P = 0.02). CONCLUSIONS: The design of the ‘True Vista’ bifocal IOL emphasizes the far focus, thereby providing good distance vision as distance vision is more important than near vision. The reduced resolution at near focus, despite of normal reading acuity, may be compensated by a near add when necessary.

After a mean follow up of 19 months, the visual characteristics of eyes with bifocal diffractive intraocular lenses (IOLs) ("bifocals") in one eye were compared with those of fellow eyes with monofocal IOLs ("monofocals") in 29 bilateral Pseudophakic patients. All of the eyes had a distance-corrected acuity of 0.6 or more, but 24.1% of the bifocals and 48.3% of the monofocals had an acuity of 1.00. Near acuity with distance correction was J2 or more in 93.1% of the bifocals and in 17.4% of the monofocals (without correction: 79.3% and 41.4%, respectively). In 55.2% of the bifocals and 20.7% of the monofocals, the combined uncorrected acuity was 0.5 or more for distance and J2 or more for near. Fogging revealed a similar depth of focus in the monofocals and a similar distance focus in the bifocals. The bifocals had two peaks of acuity but no "plateau" between them. The eye with the monofocal IOL was preferred by 37.9% and the eye with the bifocal IOL by 10.3%. Vision in no eye was rated "poor." Visual disturbances were more frequent in the bifocals. No glasses were prescribed for 20.7% of all of these patients; 65.5% required bifocal glasses; 44.8% managed most of daytime without glasses.

Purpose To compare visual acuity after bilateral implantation of 2 models of multifocal aspheric intraocular lenses (IOLs). Setting Fernandez-Vega Ophthalmological Institute, Oviedo, and University of Valencia, Valencia, Spain. Methods Prospective study of patients who had bilateral implantation of an AcrySof ReSTOR SN6AD3 IOL (Group 1) or an Acri.LISA 366D IOL (Group 2). Six months postoperatively, binocular uncorrected and best corrected distance visual acuity, uncorrected-distance and best distance-corrected near visual acuity, best corrected intermediate visual acuity, and the defocus curve were measured in both IOL groups. Results Group 1 comprised 36 eyes (18 patients) and Group 2, 40 eyes (20 patients). The mean binocular values in Group 1 and Group 2, respectively, were as follows: best corrected distance acuity, −0.05 ± 0.09 logMAR and −0.08 ± 0.08 logMAR (both approximately 20/20); best distance-corrected near acuity, −0.01 ± 0.16 logMAR and −0.05 ± 0.07 logMAR; best corrected intermediate acuity at 80 cm, 0.20 ± 0.18 logMAR (approximately 20/32) and 0.16 ± 0.13 logMAR (approximately 20/25) and at 60 cm, 0.16 ± 0.16 logMAR (approximately 20/25) and 0.18 ± 0.13 logMAR (approximately 20/25). There were no statistically significant between-group differences in visual acuity at any distance (P>.3). Defocus curves were similar between groups (2.00 to −5.00 diopters) (P>.26). Conclusions The 2 multifocal aspheric IOL models gave similar and good high-contrast visual acuity at distance and near. Intermediate visual acuity, also comparable between IOL models, was better than published results of a spherical IOL model.

PURPOSE: To assess the near and distance visual acuity achieved with implantation of the ReSTOR SA60D3 and SN60D3 (Alcon Laboratories Inc) and Tecnis ZM900 (Abbott Medical Optics [AMO]) multifocal intraocular lens (IOL) after cataract surgery. METHODS: This is a retrospective study of 108 eyes of 54 patients who underwent uneventful bilateral phacoemulsification of cataract and IOL implantation at an ophthalmic center in Singapore by a single surgeon. Inclusion criteria were visually significant cataracts, corneal astigmatism RESULTS: No difference in mean postoperative uncorrected and best spectacle-corrected visual acuity for distance among the groups was noted. The ZM900 lens was significantly better than both ReSTOR lenses for uncorrected near vision with 96.7% achieving N5 compared to 75% of SA60D3 patients and 83.3% of SN60D3 patients ( P =.003). For distance corrected near vision, 100% of ZM900 patients achieved N5 compared to 83.3% for each the SA60D3 and SN60D3 IOLs ( P =.005). No significant difference between both ReSTOR lenses for near vision was noted. CONCLUSIONS: All three IOLs provide similar uncorrected and best corrected distance visual acuity. However, the ZM900 IOL provides better binocular distance corrected and uncorrected near acuity than the SA60D3 or SN60D3. The ZM900 IOL group was more myopic preoperatively compared to the other two groups, which may be a contributing factor. [ J Refract Surg. 2010;26:177–182.]

Objective: A cross-sectional survey of 560 computer users in Enugu urban, Enugu State was conducted between August and December 2002.The prevalence of asthenopic symptoms and risk factors to the occurrence of asthenopia were determined. Method: Interview was done using structured, pre-tested, interviewer- administered questionnaire. Subjects were examined with Snellen's chart to measure distance visual acuity, jaegers reading chart for near acuity, pen torch for anterior segment examination, direct ophthalmoscope for fundoscopy, streak retinoscope for refraction and metre tape for distance between the screen and the subject Result: Out of 560 subjects interviewed and examined 401 (71.6%) had asthenopic symptoms. Headache was the most common symptom occurring in 35% of the subjects. Tearing was seen in 27.1%, ocular discomfort or pains accounted for 26.6%. Some subjects had more than one symptom. Presence of ametropia was found to be significantly related to the occurrence of asthenopia (P=0.0), as also the female gender compared to the males, P=0.0000007. Distance of operators to their monitors, age of operators and the use of screen filters did not seem to significantly influence occurrence of asthenopia (P= 0.71, P=0.55 and P=0.39 respectively). Majority of the subjects (96%) had good vision (VA of 6/6- 6/18). Conclusion: Presence of ametropia is related to occurrence of asthenopia. Correction of existing ametropia would contribute to visual comfort of computer (vdt) users. Pre- employment and regular ocular examination should be made accessible to those who make regular and long use of computers. Keywords : Asthenopia, Computer users, Nigeria. Orient Journal of Medicine Vol. 19 (1-4) 2007: pp. 43-48

Multifocal intraocular lenses (IOLs) are being developed to improve the depth of focus of pseudophakic patients. However, the authors noted good uncorrected distance and near acuity in 32 pseudophakic patients with postoperative refraction of myopic astigmatism and round reactive pupils where a plano convex monofocal posterior chamber IOL was used. They suggest that for appropriate clinical assessment of the effectiveness and safety of multifocal IOLs, a randomized, controlled, double-masked clinical trial be undertaken to compare monofocal with multifocal IOLs. In such a trial, they suggest aiming for myopic astigmatism in the monofocal IOL group.

Forty-three patients were examined three months after implantation of a multifocal or bifocal intraocular lens following cataract extraction. With far vision correction, simultaneous bifocal function with far acuity better than 0.5 and near acuity better than Nieden 3 was achieved in 95.4% of these cases. Glare sensitivity was tested with the BAT and mesopic visual acuity was examined with the Ocutrast. No statistical differences were found between these patients and a control group with monofocal IOLs.

To report the change of contrast sensitivity (CS) after photodynamic therapy (PDT) vs full macular translocation (FMT) for neovascular age-related macular degeneration (AMD), and to relate this to other measures of visual function (distance and near acuity).Fifty patients (50 eyes) with predominantly classic subfoveal choroidal neovascularisation (CNV) secondary to AMD were randomized to PDT or FMT. CS was measured with Pelli-Robson charts. Acuity scores of near visual function (NVS) were calculated after testing with visual acuity cards of the Swiss National Association of and for the Blind (SNAB). Best corrected distance visual acuity (DVA) was determined according to a standardized protocol with EDTRS charts. Primary end point was the change of CS at 12-month examination from baseline. The interaction of the CS with NVS and DVA was analysed.Mean CS showed a decrease in both treatment groups (FMT: -2 letters, PDT: -3 letters, p=0.969) at 12-month examination from baseline. While mean NVS improved by seven letters in the FMT group, a decrease of more than ten letters was seen in the PDT group (p0.05). We found no agreement between CS and high-contrast acuity (NVS, DVA). In FMT patients, the parameters at baseline (CS, NVS, DVA) correlated poorly with the corresponding 12-month results, therefore providing no informative basis to predict the later functional development. In contrast, PDT patients showed strong baseline-to-outcome coherence with baseline measures also associated with better final values.Although FMT can initiate recovery of near and distance acuity over the period of 1 year in selected patients with classic CNV, CS did not differ between FMT and PDT. We found no close connection of CS with DVA or NVS, especially after FMT. Knowledge about the unequal variation of visual parameters can provide more comprehensive information when advising patients on different therapeutic options. That also applies in particular to vascular endothelial growth factor inhibitors, which seem to promise an even higher extent of gain in CS and to reach the peak of recovery at an earlier time.

BACKGROUND The Array-MIOL offers the advantage of an increased depth of focus; the aim of our study was to compare other functional results with those of a monofocal IOL. METHODS Uncorrected and corrected distance and near visual acuity were measured in the early postoperative period and after 3 months. Results of contrast acuity (Regan charts) and contrast sensitivity (BVAT II-SG video acuity tester) of the Array-MIOL and a monofocal IOL were compared at the 3-months follow-up. RESULTS Distance visual acuity of the multifocal group did not differ from the monofocal results; uncorrected and distance corrected near acuity were significantly superior in Array patients. The monofocal IOL showed a superior contrast acuity only at the 11% level and a superior contrast sensitivity only at one spatial frequency (20 cpd). Bilateral implantation of the Array-MIOL seems to further improve functional results. CONCLUSION Implantation of the Array silicone multifocal IOL offers the advantage of pseudoaccommodation without relevant impairment of other visual functions.

Purpose To investigate the effect of periocular warming on accommodation amplitude and near vision after prolonged near work in visual display terminal (VDT) workers in an office setting. Design Prospective interventional observational case series. Participants Ten healthy Japanese male volunteers (mean age, 39.3±2 years [range, 36–43]) with a best distance corrected visual acuity (VA) of >20/20 who performed near work for 7 hours were included in the study. Main Outcome Measures The differences of subjective and objective accommodations, near acuity, and pupil diameters were compared and studied in 2 experimental settings with and without periocular warming. Methods Two experiments were performed on each subject on 2 different days. In one experiment, the subjects wore an eye mask and closed their eyelids for 10 minutes after 7 hours of VDT work (lid closure [LC] group). In the other experiment, the subjects applied warming sheets (WSs) to their eyelids and the periocular region and wore masks for 10 minutes again after 7 hours of VDT work (WS group). Visual display terminal work was performed under the same settings on both days. Subjective and objective accommodations, near vision, and pupil diameters were measured immediately before and immediately after the resting or warming procedure and again 90 minutes after the resting or warming procedures. Results Fifty percent of eyes had an increase in the accommodation amplitude of at least 0.5 diopters immediately after application of the WSs. Forty percent of eyes still maintained the accommodation amplitude level at 90 minutes. The mean near logarithm of the minimum angle of resolution VA immediately after application of WSs and at 90 minutes significantly improved relative to the near acuity values after simple eyelid closure. Conclusion Periocular warming was found to be associated with increases in subjective and objective accommodations, with a concomitant improvement in near VA. Periocular warming with disposable WSs is a simple and effective method of increasing near work-related ergonomy.

Purpose To evaluate near visual performance after implantation of a pseudoaccommodating intraocular lens (IOL) (Crystalens® AT-45, eyeonics) or a multifocal IOL (refractive model, AMO Array®; diffractive model, AcriTec TwinSet) after lens surgery. Settings Instituto Oftalmologico de Alicante, Miguel Hernandez University, Alicante, Spain. Methods Forty patients were included in this prospective clinical comparative study. The patients were divided into 3 groups according to the type of IOL implanted. Group 1 included 24 eyes (12 patients) implanted with the Crystalens IOL; Group 2, 32 eyes (16 patients) with the Array IOL, and Group 3, 24 eyes (12 patients) with the TwinSet IOL. Bilateral phacoemulsification and IOL implantation were performed in all patients, and the follow-up was 1 year. The postoperative main visual outcome evaluations were uncorrected and best corrected distance and near visual acuities, mean add for near, and best distance-corrected near acuity. Results In Group 1, the mean uncorrected near acuity was 20/40 preoperatively and 20/25 after 1 year. The mean preoperative best distance-corrected near acuity was 20/32 and 20/25 after 1 year. In Group 2, the mean uncorrected near acuity was 20/40 and 20/25, respectively. The mean preoperative best distance-corrected near acuity was 20/32 and 20/25 after 1 year. In Group 3, the mean uncorrected near acuity was 20/63 preoperatively; after 1 year, it was approximately 20/25. The mean best distance-corrected near acuity was 20/50 and 20/25, respectively. A neodymium:YAG laser capsulotomy was performed for posterior capsule opacification when required, with no change in the refractive outcome. Conclusions Implantation of multifocal and pseudoaccommodating IOLs provides adequate near vision restoration. The TwinSet IOL provided faster recovery of near vision than the other 2 IOLs. The Crystalens IOL provided less postoperative visual phenomena with favorable near vision. The Array IOL achieved the most comfortable distance and near vision.

To prospectively assess the clinical and visual outcomes of phacoemulsification and implantation of a rollable intraocular lens (IOL) with a thin optic and compare the results with those of implantation of a foldable acrylic IOL.Department of Ophthalmology, Tokyo Dental College, Ichikawa General Hospital, Ichikawa, Chiba, Japan.Sixteen consecutive eyes of 8 patients (4 women, 4 men) with corticonuclear cataract had small-incision clear corneal phacoemulsification with implantation of a rollable ThinOptX IOL (ThinOptX Inc.) in the capsular bag. Twenty eyes of 10 age- and sex-matched patients (5 women, 5 men) with the same diagnosis had phacoemulsification and intracapsular implantation of an AcrySof foldable acrylic IOL (MA60BM, Alcon). The patients' refractive status and uncorrected and best corrected distance visual acuities were assessed preoperatively and 1 week and 1, 3, and 6 months after surgery. The uncorrected and best corrected near acuities were measured before and 6 months after surgery. Contrast visual acuity was measured with variable contrast charts 1, 3, and 6 months after surgery, and the results in the 2 IOL groups were compared. Anterior segment photography, intraocular pressure (IOP) measurement, specular microscopy, and fundoscopy were done before surgery and at 1, 3, and 6 months.The final best corrected distance acuity was better than 20/25 in all eyes with a ThinOptX IOL and 18 eyes (90%) with an AcrySof IOL. The best corrected near acuity was better than 20/40 in 12 eyes (75%) and 14 eyes (70%), respectively. The mean contrast acuity with charts 2 and 3 was significantly higher in the ThinOptX group than in the AcrySof group at all examinations (P.05). The final mean postoperative induced astigmatism was 0.06 diopter (D) +/- 0.50 (SD) and 0.25 +/- 0.68 D, respectively (P.05). There were no differences in IOP or corneal endothelial cell density between the 2 groups at any examination. No intraoperative or postoperative complications occurred.ThinOptX IOL implantation provided best corrected near and distance visual acuities comparable to those provided by the AcrySof IOLs. The significantly higher contrast acuities attained after implantation of the ThinOptX lens may be attributable to its ultrathin properties.

Purpose: To evaluate the efficacy and safety of bilateral multifocal intraocular lens (IOL) implantation after cataract surgery. Setting: Oftalmologico de Valencia-CEOVAL, Valencia, Venezuela. Methods: This retrospective study evaluated patient charts for the patient selection method, preoperative evaluation, surgical technique, postoperative visual and refractive outcomes, and complications. It included 70 eyes of 35 patients who had lens extraction with bilateral implantation of an Array multifocal IOL. Fourteen eyes of 7 patients had hyperopia with presbyopia, and 56 eyes of 28 patients had cataract. Results: All eyes achieved an uncorrected distance acuity of 20/40 or better and an uncorrected near acuity of J5 or better. Six patients (18%) reported moderate halos, and 22 patients (63%) occasionally wore glasses. Conclusion: Bilateral multifocal IOL implantation was effective and safe in cataract and hyperopic patients with presbyopia, providing good uncorrected distance and near acuities.

To determine whether with-the-rule (WTR) or against-the-rule (ATR) astigmatism gives a better visual outcome after cataract and intraocular lens (IOL) implantation surgery by comparing the uncorrected distance and near visual acuities in eyes with low, simple, myopic residual astigmatism.S. Geraldo Eye Hospital, Federal University of Minas Gerais, Belo Horizonte, Brazil.Two groups of 10 eyes each, one with WTR and the other with ATR simple, myopic astigmatism, were studied after uneventful cataract and IOL implantation surgery. All patients had an uncorrected distance visual acuity of 20/40 or better. The negative cylinder ranged from 1.00 to 1.50 diopters (D). The uncorrected distance and near visual acuities of the two groups were compared.There was no statistically significant between-group difference in uncorrected distance visual acuity. However, for uncorrected near, the difference between groups was highly statistically significant (P.001). Patients with ATR astigmatism had much better uncorrected near acuity than those with WTR astigmatism.In pseudophakia, low, simple, ATR myopic astigmatism is better than WTR astigmatism because it provides superior uncorrected near visual acuity.

Purpose: To assess near visual acuity and patient satisfaction with the 3M diffractive multifocal intraocular lens (IOL). Setting: Asan Medical Center, Ulsan University, Seoul, Korea. Methods: Near acuity of 50 eyes implanted with the diffractive multifocal IOL was evaluated postoperatively. Near visual acuity was measured with best distance correction at 33 cm and then at each patient's preferred distance with an extra add of −0.25, +0.25, +0.50, or +0.75 D to the best distance correction. Mean follow-up was 11 months. Results: All eyes obtained a near vision of J3 or better with the best distance correction and 34 (68.0%) obtained J1 or better. Extra add power increased near vision and was preferred in 44 eyes (88.0%) even though the reading distance was shortened. Conclusion: We recommend adding more than +3.5 D to the 3M multifocal IOL.