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Purpose: To describe the accuracy of monofocal intraocular lens power calculation in patients with keratoconus using total keratometry (TK) and standard keratometry (K) with conventional and keratoconus-modified formulas., Setting: Asociación Para Evitar la Ceguera en México, Mexico City, Mexico., Design: Observational, retrospective, non-randomized, comparative study., Methods: Biometric data from IOL Master 700 and postoperative refraction were collected from patients with keratoconus who had undergone cataract surgery. Predicted refraction of each patient was calculated using K and TK with the following formulas: SRK/T, Barrett Universal II, Panacea, Kane, Kane keratoconus, and Barrett True-K keratoconus (predicted and measured posterior corneal astigmatism [PCA]). Refractive prediction error, mean absolute error, trimmed mean, median absolute error, standard deviation, and percentage of eyes within ± 0.50 D, ± 1.00 D, ± 1.50 D, ± 2.00, and > 2.00 D were determined., Results: 55 keratoconic eyes of 40 patients were included. RPE in patients with keratoconus was < 1.00 D with all formulas. Barrett True-K keratoconus with predicted PCA registered the lowest MAE and MedAE. All formulas showed a discrete increase in myopic error percentage when calculations were performed using TK as opposed to K., Conclusions: Barrett True-K for keratoconus showed the highest accuracy, closely followed by Kane KC. BTK KC pPCA or mPCA with standard keratometries could serve as the primary choice in eyes with keratoconus and steepness < 60 D. In the absence of keratoconus-modified formulas, TK input in conventional formulas improves the prediction outcome., Competing Interests: Declarations Conflict of interest Roberto Gonzalez-Salinas, MD, MSc, PhD reports personal fees from LayerBio Inc., and Alcon Laboratories, outside the submitted work. None of the previous disclosures conflict with the present work. The other authors have no relevant financial or non-financial interests to disclose. Ethics approval This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics (License No. CONBIOETICA09-CEI-006–20170306) and Research Committee (License No. COFEPRIS 17-CI-09–003-142) of Asociación Para Evitar la Ceguera en México I.A.P on July 26th, 2022 (SA-22–09). Consent to publish Not applicable. Informed consent Informed consent was obtained from all participants for personal and biometrics data gathering., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

Background: To investigate corneal higher-order aberrations (HOAs) and choroidal characteristics in myopic individuals and explore the association between HOAs and choroidal parameters., Methods: Myopic participants were categorized into three groups based on axial lengths (ALs). We compared corneal HOAs, including spherical (Z 4 0 ), comatic (Z 3   - 1 and Z 3 1 ), and trefoil (Z 3   - 3 and Z 3 3 ) aberrations, as well as choroidal vascularity index (CVI) and choroidal thickness (CT). Linear regression analysis was used to assess the relationships among corneal HOAs, CVI, CT, spherical equivalent, and AL., Results: Groups 1, 2, and 3 included 105, 98, and 118 eyes, respectively. Group 3 exhibited lower spherical HOA root mean square and Z 4 0 values than group 1(p < 0.05). Group 1 showed lower Z 3 1 levels than other groups (p < 0.001). Groups 1 and 2 had higher mean, central, and I2 vertical CVIs than group 3 (p < 0.05). Group 1 had a larger vertical S1 CVI than group 3 (p < 0.05). Group 3 had smaller horizontal CVI values in all regions except N2 (p < 0.05). Both the mean and CT in all regions decreased as AL increased (p < 0.001). The comatic (Z 3 1 ) and trefoil (Z 3 3 ) components were predictors of mean horizontal CVI, and the comatic (Z 3 1 ) component was correlated with both mean vertical and horizontal CT., Conclusion: Longer AL myopic patients exhibited lower absolute values of spherical aberration and horizontal coma. Alterations in choroid in myopic patients correlated with corneal HOAs. Our results suggest a potential connection between the optical quality and ocular perfusion in myopia., Competing Interests: Declarations Ethics approval and consent to participate The study protocol adhered to the tenets of the Declaration of Helsinki and was approved by the Ethics Committee of Wenzhou Medical University. All patients have been informed of the purpose of the experiment and signed informed consent. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

In this single-center study, 62 eyes of 41 patients with regular astigmatism, who received cataract surgery with TECNIS Eyhance Toric II intraocular lens (IOL) insertion between January 1, 2022, and June 30, 2023, were retrospectively investigated. At 3 months postoperatively, there were significant improvements in the mean logMAR uncorrected distance visual acuity (VA) (from 0.64 ± 0.42 to 0.11 ± 0.13, p < 0.001) and logMAR corrected distance VA (from 0.28 ± 0.30 to 0.03 ± 0.06, p < 0.001). An 81.9% reduction in astigmatism (from 1.66 ± 0.49 D corneal cylinder preoperatively to - 0.30 ± 0.39 D refractive cylinder at 3 months postoperatively, p < 0.001) was observed. In the vector analysis, the average of difference vector was 0.27 ± 0.35 D, and the average correction index was 1.09 ± 0.22, revealing a minimal overcorrection. Mean IOL misalignment at 3 months postoperatively was 0.68 ± 4.17°, and average absolute misalignment was 3.41 ± 2.44°. Defocus curves showed < 0.2 logMAR range between - 0.85 and 1.27 diopters, and distance-corrected near and intermediate VA were 0.38 ± 0.14 and 0.17 ± 0.13, respectively. These results indicate that the new enhanced monofocal toric IOL is a safe and effective treatment for astigmatic eyes with cataract., Competing Interests: Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: This study aims to explore the effects of the iris-ciliary angle (ICA) on the accurate prediction of the vault after implantable collamer lens (ICL) using the manufacturer's online calculation and ordering system (OCOS)., Methods: The participants were categorized into three groups according to the size of ICA as follows: narrow ICA group (< 40°); normal ICA group (40°-60°); wide ICA group (> 60°). We compared the preoperative ocular characteristics and postoperative vault at 3 months among the three groups. Bivariate correlation was used to analyze the correlation between vault and ICA, and multiple linear regression was used to further analyze the correlation between vault and preoperative parameters. Ordered multicategorical logistic regression analyses were used to further illustrate the effect of different ICA groups on postoperative vault distribution., Results: This study included 278 eyes of 157 individuals. There were no statistically significant differences in preoperative ocular parameters among the three ICA groups, while the postoperative vault was minimal in the wide ICA group, followed by the normal and then the narrow ICA group (p < 0.001). The correlation between ICA and vault at 3 months postoperatively was significant in both bivariate correlation and multiple linear regression analysis (both P < 0.001). Ordered multicategorical logistic regression analyses showed that the odds of having a higher vault were 2.586 (P = 0.002) and 5.534 (P < 0.001) times in the normal and narrow ICA groups, respectively, compared to the wide ICA group., Conclusions: The size of the ICA has a significant impact on vault created by the recommended ICL size for OCOS. Therefore, ICA should be considered when selecting ICL size using the OCOS recommended sizes preoperatively., Competing Interests: Declarations Ethics approval and consent to participate The study protocol was approved and the requirement to obtain informed written consent was waived by the Ethics Committee of the Second Affiliated Hospital of Zhejiang University School of Medicine. (NO: IR2023454). This study was performed in accordance with the tenets of the Declaration of Helsinki. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Compare Zcalc with other formulas on spherical equivalent prediction errors (PE) and explore the relationship between PE and ocular parameters. Optimize 709 IOL power calculation. 114 eyes with age-related cataract and preoperative regular corneal astigmatism of more than 1.5D were included. They underwent cataract surgery followed by implantation of a toric intraocular lens (Zeiss Torbi 709 M) calculated by Zcalc formula. The prediction errors of spherical equivalent (SE) were analysed 3 months post-surgery. The refractive prediction errors of Zcalc, Barrett Universal II, Kane, and K6 formulas were 0.07 ± 0.63D, - 0.36 ± 0.65D, - 0.41 ± 0.67D, and - 0.31 ± 0.66D, respectively. Statistically significant difference were observed between Zcalc and other formulas. The Zcalc was prone to positive deviation, Barrett Universal II, Kane and K6 were prone to negative deviation. When the axial length is greater than 29.0 mm, the prediction errors of Kane is higher, and prone to negative deviation. Prediction errors of Zcalc are small in all eyes and prone to positive deviation. For more accurate prediction, we recommend Barrett Universal II formula for 709 IOL power calculation., Competing Interests: Declarations Competing interests The authors declare no competing interests. Institutional review Board Statement The study was conducted in accordance with the Declaration of Helsinki, and approved by the Medical Ethics Committee of Tongji Medical College, Huazhong University of Science and Technology (protocol code UHCT-IEC-SOP-016-03-01 and date of approval: Jan 31th, 2024). Informed consent Written informed consent was obtained from all subjects involved in the study., (© 2024. The Author(s).)

Background: This study aimed to investigate the safety and efficacy of the Yamane technique (flanged intrascleral haptic fixation with double-needle technique /FIHFT) for three-piece intraocular lens (IOL) implantation in Egyptian patients diagnosed with Marfan syndrome (MFS) presented with subluxated lenses (ectopia lentis, EL)., Methods: This was a retrospective evaluation of thirty-three patients who were diagnosed with MFS and had subluxated lenses in a total of forty eyes. Seven of these patients had bilateral subluxation. Lensectomy or phacoemulsification was performed with limited anterior vitrectomy, followed by IOL implantation using the FIHFT method. Data was collected from medical records, including preoperative and postoperative corrected distant visual acuity (CDVA) using logarithm of the minimal angle of resolution (log MAR), preoperative and postoperative refractions, intraoperative and postoperative complications, and follow-up periods., Results: The mean age of patients in the study was 30.79 years, with a mean follow-up of 23.9 months. Post-surgery, the refractive sphere decreased significantly from -9.1 ± 1.4 diopter (D) to -1.4 ± 0.7 D, and cylinder measurements dropped from -4.5 ± 0.8 D to -1.4 ± 0.6 D. The spherical equivalent (SEQ) also declined from -11.4 ± 1.5 D to -2.1 ± 0.8 D. The CDVA improved from 0.80 ± 0.32 to 0.18 ± 0.10 log MAR (P < 0.001). No intraoperative complications were identified. Postoperative complications included IOL decentration (12.5%), vitreous hemorrhage (7.5%), IOL slippage (5%), IOL tilt (5%), and retinal detachment (RD) (5%). Further surgical procedures were necessary for only four cases (10%), all of which had positive outcomes. IOL tilting and slippage occurring at average ages of 18 and 19 years, respectively. No other complications, such as hypotony, elevated intraocular pressure (IOP), corneal edema, iritis, IOL dislocation, cystoid macular edema (CME) or endophthalmitis, were reported., Conclusions: The Yamane technique has proven effective and safe for treating subluxated lenses in Egyptian patients with Marfan Syndrome, resulting in improved visual acuity with minimal complications, mostly minor and manageable. Comprehensive fundus examinations before and after surgery are essential for promptly identifying retinal breaks and reducing the risk of retinal detachment. IOL tilting and slippage are more common in younger patients., (© 2024. The Author(s).)

Background: Myopia is a growing healthcare concern worldwide. Increasing evidence suggests that sleep and circadian rhythms may be associated with myopia. Furthermore, the risk factors of myopia have not been studied in the Estonian population to date. This study aimed to evaluate chronotype, lifestyle factors, and parental myopia in relation to myopia in Estonian secondary school students., Methods: Grade 10 students from three secondary schools in Tallinn, each with distinct focuses: one science-oriented, one arts-oriented, and one sports-oriented, were invited to participate. They underwent a comprehensive ocular examination, including cycloplegic autorefraction and ocular biometry. Chronotype was evaluated with the Morningness - Eveningness Questionnaire. Participants reported parental myopia and replied to a set of questions, separately for schooldays and free days, to indicate the amount of time they spent outdoors, doing near work and intermediate distance activities. Myopia was defined as cycloplegic SER ≤ - 0.50 D. Logistic regression analysis was performed to assess the association of the studied factors with myopia., Results: A total of 123 students (57% female) participated in the study, with a mean age of 16.71 years (standard deviation 0.41). In a multivariable regression model, having two myopic parents was associated with higher odds of myopia (OR 3.78, 95% CI 1.15 - 12.42). We found no association between myopia and chronotype. Notably, time spent outdoors and doing near work or intermediate distance work did not affect the likelihood of having myopia. We observed that students attending the sports-oriented school had lower odds of myopia than those attending the science-oriented school (OR 0.12, 95% CI 0.03-0.51)., Conclusion: Chronotype was not associated with myopia in our study sample. Consistent with previous reports, we identified parental myopia as a myopia risk factor. Interestingly, there was no association between myopia and time spent outdoors or near work. However, the odds of myopia varied depending on the school attended by the participants, which may reflect the educational load or lifestyle of participants in earlier childhood., (© 2024. The Author(s).)

We studied which retinal area controls short-term axial eye shortening when human subjects were exposed to + 3.0D monocular defocus. A custom-built infrared eye tracker recorded the point of fixation while subjects watched a movie at a 2 m distance. The eye tracker software accessed each individual movie frame in real-time and covered the points of fixation in the movie with a uniform grey patch. Four patches were programmed: (1) foveal patch (0-3 degrees), (2) annular patch (3-9 deg), (3) foveal patch (0-3 deg) combined with an annular patch (6-9 deg), and (4) full-field patch where only 6-10 deg were exposed to the defocus. Axial eye shortening was elicited similarly with full-field positive defocus and with the foveal patch, indicating that the fovea made only a minor contribution (-11 ± 12 μm vs. -14 ± 17 μm, respectively, n.s.). In contrast, patching a 3-9 degrees annular area or fovea together with an annular area of 6-9 degrees, completely suppressed the effect when compared with full-field defocus (+ 3 ± 1 μm or -2 ± 13 μm vs. -11 ± 12 μm, respectively, p < 0.001). Finally, we found that the near-peripheral retina (6-10 degrees) is a "sweet spot" for positive defocus detection and alone can regulate eye growth control mechanism, and perhaps long-term refractive development (-9 ± 8 μm vs. full-field: -11 ± 12 μm, n.s.)., (© 2024. The Author(s).)

Purpose: To develop a quantitative tool for assessing the posterior ocular shape using widefield, volumetric optical coherence tomography (OCT) in eyes with myopia., Methods: This observational, cross-sectional study included 178 eyes from 113 participants. Participants underwent a standardized eye examination, including ocular biometry and a custom ultrawide OCT. True ocular shape was reconstructed by tracing the beam propagation from the system to the posterior eye. Gaussian curvature quantified the localized ocular shape, which was further categorized into five distinct categories. An ocular shape irregularity (OSI) was calculated using principal component analysis. Linear regression with breakpoints analyzed the relationship between ocular shape parameters and axial length (AL)., Results: Increased curvature mean and variance were associated with more severe myopia (P < 0.001). Curvature categories (convex, normal, concave, and highly concave) differed significantly between the groups (all P < 0.001). Their correlations with AL revealed significant breakpoints between 27.1 and 27.2 mm. OSI, as a single metric for quantifying ocular shape distortion, was associated with more severe myopia (P < 0.001), and its correlation with AL revealed a breakpoint at 27.2 mm with a fourfold increase in slope steepness beyond this pivot. Determination of OSI was highly reproducible and could also be obtained with fewer scans., Conclusions: Eyes exceeding 27.2 mm in length exhibit pronounced shape changes. Our framework can be seamlessly integrated into commercial OCTs for ocular shape deformation detection, which could aid in identifying eyes with pathologic myopia.

Evidence from human studies of ocular accommodation and studies of animals reared in monochromatic conditions suggest that chromatic signals can guide ocular growth. We hypothesized that ocular biometric response in humans can be manipulated by simulating the chromatic contrast differences associated with imposition of optical defocus. The red, green, and blue (RGB) channels of an RGB movie of the natural world were individually incorporated with computational defocus to create two different movie stimuli. The magnitude of defocus incorporated in the red and blue layers was chosen such that, in one case, it simulated +3 D defocus, referred to as color-signed myopic (CSM) defocus, and in another case it simulated -3 D defocus, referred to as color-signed hyperopic (CSH) defocus. Seventeen subjects viewed the reference stimulus (unaltered movie) and at least one of the two color-signed defocus stimuli for ∼1 hour. Axial length (AL) and choroidal thickness (ChT) were measured immediately before and after each session. AL and subfoveal ChT showed no significant change under any of the three conditions. A significant increase in vitreous chamber depth (VCD) was observed following viewing of the CSH stimulus compared with the reference stimulus (0.034 ± 0.03 mm and 0 ± 0.02 mm, respectively; p = 0.018). A significant thinning of the crystalline lens was observed following viewing of the CSH stimulus relative to the CSM stimulus (-0.033 ± 0.03 mm and 0.001 ± 0.03 mm, respectively; p = 0.015). Differences in the effects of CSM and CSH conditions on VCD and lens thickness suggest a directional, modulatory influence of chromatic defocus. On the other hand, ChT responses showed large variability, rendering it an unreliable biomarker for chromatic defocus-driven responses, at least for the conditions of this study.

Background: The purpose of this study was to evaluate the repeatability and agreement of multispectral refraction topography (MRT) in measuring retinal refraction before and after cycloplegia in children. The results of this study will provide valuable insights into the accuracy and reliability of MRT as a tool for assessing retinal refraction in pediatric patients., Methods: Children aged 7 to 18 years old were recruited for this prospective research. The central and peripheral retinal refraction was measured three times using multispectral refraction topography (MRT) before and after cycloplegia. The retinal deviation value (RDV) was used to describe the average peripheral refractive error of the retina. In addition, objective refraction (OR) and subjective refraction (SR) measurements were also performed., Results: A total of 60 children with a mean age of 10.50 ± 1.81 years were enrolled. Before cycloplegia, all the central and peripheral retinal refraction parameters showed good repeatability with the lowest intraclass correlation coefficient (ICC) being 0.78 in the retinal deviation value from 45° eccentricity to 53° of the retina (RDV 45-53). After cycloplegia, the repeatability of MRT was significantly enhanced (lowest ICC = 0.91 in RDV-I). The 95% limits of agreement (LoA) of the central refraction and OR ranged from - 2.1 to 1.8 D before cycloplegia, and from - 1.69 to 0.27 D after cycloplegia. The 95% LoA of the central refraction and SR ranged from - 1.57 to 0.36 D after cycloplegia. All the 95% LoA demonstrated high agreement., Conclusions: The MRT shows high agreement with autorefractometry and experienced optometrist in measuring central refraction. Additionally, the MRT provides good repeatable measurements of retinal peripheral refraction before and after cycloplegia in schoolchildren., (© 2024. The Author(s).)

This study compares the optical quality of zonal refractive multifocal and diffractive bifocal intraocular lenses (IOLs) and visual outcomes after implantation in 93 patients(93 eyes) with cataracts and high myopia. A retrospective analysis was conducted to measure visual acuity at far, intermediate, and near distances, defocus curves, wavefront aberrations, modulation transfer function (MTF), a Quality of Vision questionnaire (QoV) and visual quality self-evaluation were examined at 3 months. The results demonstrated the ZMB group showed better uncorrected near visual acuity (P < 0.01), and the MF15 group showed better uncorrected intermediate visual acuity (P < 0.001). The ZMB group provided better MTF than the MF15 group (P < 0.01) but demonstrated a worse QoV score, especially for the severity of glare, halo, and starburst (P < 0.05). The satisfaction score and spectacle independence rate in the ZMB group were higher than in the MF15 group (P < 0.01). LS-313MF15 and TecnisZMB00 offered excellent visual restoration, stable distance visual acuity, and good subjective visual function., (© 2024. The Author(s).)

This retrospective study compared postoperative prediction errors of recent formulas using standard- or total keratometry (K or TK) for intraocular lens (IOL) power calculation in post-myopic LASIK patients. It included 56 eyes of 56 patients who underwent uncomplicated cataract surgery, with at least 1-month follow-up at Keio University Hospital in Tokyo or Hayashi Eye Hospital in Yokohama, Japan. Prediction errors, absolute errors, and percentage of eyes with prediction errors within ± 0.25 D, ± 0.50 D, and ± 1.00 D were calculated using nine formulas: Barrett True-K, Barrett True-K TK, Haigis-L, Haigis TK, Pearl-DGS, Hoffer QST, Hoffer QST PK, EVO K, and EVO PK. Statistical comparisons utilized Friedman test, Conover's all-pairs post-hoc, Cochran's Q, and McNemar post-hoc testing. Root-Mean-Square Error (RMSE) was compared with heteroscedastic testing. Barrett True-K TK had the lowest median predicted refractive error (-0.01). EVO PK had the smallest median absolute error (0.20). EVO PK had the highest percentage of eyes within ± 0.25 D of the predicted value (58.9%), significantly better than Haigis-L (p = 0.047). EVO PK had the lowest mean RMSE value (0.499). The EVO PK formula yielded the most accurate IOL power calculation in post-myopic LASIK eyes, with TK/PK values enhancing accuracy., (© 2024. The Author(s).)

Objective: To compare the cycloplegic refraction in children with different iris colour categories and age groups., Methods: The cross -sectional study was conducted from December 2 022 to June 2023 at the Eye Clinic of Sehat Medical Complex, Hanjarwal, Lahore, and Khizar Eye Centre, Lahore, Pakistan, and comprised hyperopic children aged 5-12 years of either gender. Data regarding age, gender, iris colour, auto -refraction and retinoscopy before and after cycloplegic refraction was collected using a structured proforma. Data was analysed using SPSS 21., Results: Of the 139 subjects, 73(52.5%) were males and 60(47.5%) were females. There were 79(56.8%) subjects aged 5-8 ye ars and 60(43.2%) aged 9 -12 years. The iris colour dis tribution was 23(16.5%) light, 80(57.6%) med ium and 36(25 . 9%) da r k, w ith a mean visual acuity of 0.7 ±0.6. There wa s a signi ficant differe nce in non - cyclopleg ic and cycloplegic refraction for different iris colours and age groups (p<0.05)., Conclusions: Children with light iris colour accommodated more and needed a low concentration of cyclopentolate compared to those with m edi u m and dark ir is col ours. More accomm odation was noted among child ren ag ed 9-12 years.

Purpose: To describe Light Adjustable Lens (RxSight, Inc) (LAL) visual and refractive outcomes in a Japanese patient population with and without prior refractive surgery., Methods: In this retrospective chart review of patients with cataract in a private eye clinic, 34 eyes from 21 patients underwent cataract surgery with LAL implantation. Eyes underwent light treatment to adjust the patients' refraction after implantation to meet individual visual goals. Standard visual and refractive outcomes were collected. Contrast sensitivity (to assess quality of vision), clinical defocus and vergence curves (to assess range of vision), and patient satisfaction were also collected., Results: The mean prediction error of the light adjustment was -0.04 ± -0.48. Thirty-one eyes (91%) and 33 eyes (97%) were within ±0.25 and ±0.50 diopters (D) of manifest spherical equivalent target, respectively. Thirty-two eyes (94%) had residual refractive cylinder of 0.50 D or less. The full depth of focus was 3.68 D. Monocular contrast sensitivity shows frequencies equivalent to a normal population aged 50 to 60 years. The mean satisfaction score was 8.8 (scale: 1 to 10). There were no adverse events and no eyes lost corrected distance visual acuity from the light treatment., Conclusions: LALs in cataract refractive surgery hold great promise, including for the Japanese population, which have unique ocular biometrics. By providing a safe procedure and the ability for postoperative adjustments, the LAL provided a tailored approach to vision correction, ultimately improving patient outcomes and satisfaction. [ J Refract Surg . 2024;40(11):e854-e862.] ., Competing Interests: Disclosure: The authors have disclosed no potential conflicts of interest, financial or otherwise.

Purpose: To investigate the reasons for the removal and/or exchange of posterior chamber phakic intraocular lenses (PCPIOLs) and the outcomes of these procedures., Methods: In this retrospective study, PCPIOL implantations performed between January 2015 and June 2023 in a single center were reviewed. The study group consisted of the files of eyes with removed and/or exchanged PCPIOL. Visual acuities, refraction errors, endothelial cell counts, and measurements of the vault before and after exchanges were recorded. Reasons for removal and/or exchange were evaluated. The tuck-and-pull technique was used in all explantations., Results: Twenty-three of 1,490 eyes with PCPIOL implantation required removal and/or exchange. Of the explanted eyes, 17 were implanted with PCPIOLs for myopia (1.21% of all myopic corrections) and 6 were implanted with PCPIOLs for hyperopia (6.59% of all hyperopic corrections). The most common reason for removal and/or exchanges after implantation was inappropriate vault (10 of the 23 total removals and/or exchanges), followed by cataract development (7 of the 23 total removals and/or exchanges). A comparison of the biometric characteristics of eyes with PCPIOL removal and/or exchange due to inappropriate vault with other PCPIOL implantations showed that anterior chamber depth, PCPIOL length, and white-to-white distance were significantly higher in the group of explanted eyes ( P < .05). All eyes with high vault in myopic patients had a 13.2- or 13.7-mm length PCPIOL., Conclusions: The main reason for PCPIOL removal and/or exchange is vault values outside the ideal limits and cataract development. Before ordering 13.2- and 13.7-mm long PCPIOLs, biometric data of both eyes and recommended PCPIOL sizes should be carefully reviewed. [ J Refract Surg . 2024;40(11):e797-e803.] ., Competing Interests: Disclosure: The authors have disclosed no potential conflicts of interest, financial or otherwise.

Purpose: To assess the incidence and causes for re-treatment following monovision laser refractive surgery in a large data study spanning a decade., Methods: The setting for this retrospective comparative study was Care Vision Laser Center, Tel Aviv, Israel. This study included patients aged 36 to 60 years who underwent monovision laser vision correction at the Care Vision Laser Centers, Israel, from January 2012 to December 2022. Demographic, preoperative, and postoperative data were retrieved for analysis., Results: Overall, 3,674 eyes of 1,847 patients were included. Re-treatment was performed in 1.28% (n = 47) of eyes, 0.84% (n = 31) distance-targeted and 0.44% (n = 16) near-targeted. Monovision reversal in near-targeted eyes occurred due to overcorrection (37.5%, n = 6 of 16), despite being on target (25%, n = 4 of 16), insufficient myopia (18.8%, n = 3 of 16), and de novo astigmatism (12.5%, n = 2 of 16). One eye was targeted for near vision due to de novo astigmatism. Re-treatment in distance-targeted eyes was due to myopic undercorrection (45.2%, n = 14 of 31), myopic regression (19.4%, n = 6 of 31), myopic overcorrection (12.9%, n = 4 of 31), hyperopic regression (6.5%, n = 2 of 31), astigmatism undercorrection (6.5%, n = 2 of 31), de novo astigmatism (6.5%, n = 2 of 31), and astigmatism regression (3.2%, n = 1 of 31). Re-treatment was more likely in distance targeted eyes of patients with monovision compared to near-targeted eyes ( P = .025) and patients without monovision ( P < .001)., Conclusions: In monovision laser vision correction, retreatment in the near-targeted eye is rare when the ideal near target (-1.50 to -1.25 diopters) is achieved. However, the distance-targeted eye is more likely to require re-treatment. Surgeons can plan monovision surgery and advise patients accordingly. [ J Refract Surg . 2024;40(11):e892-e897.] ., Competing Interests: Disclosure: The authors have disclosed no potential conflicts of interest, financial or otherwise.

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.] ., Competing Interests: Disclosure: JV is a consultant for AcuFocus, Inc and Bausch & Lomb, Inc; BLF is a consultant for Alcon Laboratories, Inc, Bausch & Lomb, Inc, and Imprimis Pharmaceuticals and has participated in a safety monitoring board or advisory board for Stroma Medical and Ziemer. KS has received grants or contracts from AcuFocus, Inc (payment to institution) and Bausch Health (payment to institution), is a consultant for Bausch & Lomb, Inc, receives honoraria from Bausch & Lomb, Inc, and has received equipment, materials, drugs, medical writing, gifts, or other services from AcuFocus, Inc (delivered to institution) and Bausch & Lomb, Inc (delivered to institution). LL is a current employee of and MM is a former employee of AcuFocus, Inc. SM has disclosed no potential conflicts of interest, financial or otherwise.

Purpose: To compare the effect of superior and temporal clear corneal incisions, regardless of the steep axis, on postoperative changes in corneal higher order aberrations (HOAs) in patients with healthy corneas and mild preoperative corneal astigmatism., Methods: In this prospective cohort study, the right eyes of study participants were randomly assigned to one of two groups prior to cataract surgery: temporal incision (TI) and superior incision (SI). Preoperatively and 6 weeks after surgery, measurements were taken of corneal HOAs over a 6-mm optical zone., Results: The study included 102 eyes (50 eyes in the TI group and 52 eyes in the SI group) that underwent routine phacoemulsification using a 2.4-mm clear corneal incision. Significant changes in vertical coma ( P = .019), horizontal coma ( P = .042), and vertical trefoil ( P = .001) were observed in the SI group. In the subgroup analysis of the SI group, significant changes in vertical coma ( P = .025) and vertical trefoil ( P = .047) were observed in the eyes with preoperative with-the-rule corneal astigmatism, and significant changes in horizontal coma ( P = .038) were observed in eyes with preoperative against-the-rule corneal astigmatism. The TI group showed no significant difference between the preoperative and postoperative periods., Conclusions: The SI induced vertical and horizontal coma in accordance with the preoperative axis of the steep meridian. These alterations in corneal HOAs may affect the quality of vision after surgery. TI may potentially provide an advantage over SI in terms of corneal HOAs. [ J Refract Surg . 2024;40(11):e792-e796.] ., Competing Interests: Disclosure: The authors have disclosed no potential conflicts of interest, financial or otherwise.

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.] ., Competing Interests: Disclosure: GUA and RK report research grants, travel expenses, lecture fees, and consulting for Alcon Laboratories, Inc, and research grants, travel expenses, and lecture fees for Carl Zeiss Meditec. The remaining authors have disclosed no potential conflicts of interest, financial or otherwise.

Purpose: To compare variance of manifest refraction (MR) measurement and variance of refractive outcomes after keratorefractive lenticule extraction (KLEx) in the same cohort., Methods: This was a retrospective study of consecutive patients attending at least three preoperative refractions before undergoing KLEx. All manifest refractions were performed according to a standard protocol. Additionally, automated refraction, spectacles prescription, wavefront refraction, and tomography/topography were also considered when determining the treatment refraction. Variance of postoperative outcomes was compared to variance of MR measurement., Results: The difference in MR of 153 eyes between the first and last preoperative visit showed a mean pairwise absolute difference of 0.22 ± 0.22 diopters (D) (range: 0.00 to 1.25 D) in spherical equivalent (SE). The 95% limit of agreement (LoA) was within 0.73 D for sphere, 0.60 D for cylinder, and 0.61 D for SE. Standard deviation (SD) for corrected distance visual acuity (CDVA) was 0.06 logarithm of the minimum angle of resolution (logMAR) and the 95% LoA was within 1.3 Snellen lines. The differences between reproducibility of the two last preoperative MR and the variance of postoperative outcomes after KLEx (ie, the isolated repeatability of corneal lenticule extraction) was SD of 0.13 D for sphere, cylinder, and SE, and 11 degrees in axis, respectively., Conclusions: Predictability of KLEx was equal to variance of refraction measurement. Isolated repeatability of the laser treatment was better than the reproducibility of MR. Thus, the authors have shown for the first time that precision of KLEx has reached such a level today that further improvement is limited by MR measurements. [ J Refract Surg . 2024;40(11):e814-e823.] ., Competing Interests: Disclosure: ST is a consultant to Carl Zeiss Meditec. The remaining authors have disclosed no potential conflicts of interest, financial or otherwise.

Purpose: To compare the safety and efficacy of individualized ray-tracing-guided femtosecond laser-assisted in situ keratomileusis (FS-LASIK) for correction of myopia and myopic astigmatism., Methods: This prospective, randomized, double-blind, contralateral eye study included 68 eyes of 34 patients with myopia or myopic astigmatism requiring FS-LASIK treatment. For each patient, one eye was randomly assigned to receive the ray-tracing-guided treatment, whereas the contralateral eye underwent Q-value-adjusted ablation. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction spherical equivalent (MRSE), sphere, cylinder, effective optical zone (EOZ), and 6-mm corneal aberrations were measured and analyzed before operation and after a 3-month postoperative follow-up., Results: At 3 months postoperatively, the UDVA of 20/16 or better was measured in 94% of eyes in the ray-tracing group and 85% of eyes in the Custom-Q group ( P = .064). Forty-seven percent in the ray-tracing group and 32% in the Custom-Q group gained one or more Snellen lines of CDVA ( P = .043). The MRSE, refractive astigmatism, surgically induced astigmatism, and difference vector were better in the Custom-Q group ( P < .05). The postoperative corneal HOAs and optical path difference were significantly better in the ray-tracing group ( P = .008). The EOZs of the ray-tracing and Custom-Q groups were 5.77 and 5.43 mm ( P < .001), and the average ablation depths of the ray-tracing and Custom-Q groups were 100.97 and 85.24 µm ( P < .001), respectively., Conclusions: Despite the overcorrection and excessive ablation of corneal tissue, ray-tracing-guided FS-LASIK in clinical practice was found to be safe and effective for myopic correction both with and without astigmatism, particularly in achieving UDVA and inducing fewer corneal HOAs and less OPD. [ J Refract Surg . 2024;40(11):e804-e813.] ., Competing Interests: Disclosure: The authors have disclosed no potential conflicts of interest, financial or otherwise.

Purpose: To assess objective reading performance at intermediate and near distances using the Salzberg Reading Desk (SRD) (SRD Vision) in patients with cataract who underwent the implantation of a diffractive extended depth of focus intraocular lens (EDOF IOL) in the dominant eye and a hybrid multifocal EDOF IOL in the non-dominant eye., Methods: This prospective, non-comparative, interventional study included 46 eyes of 23 patients with cataract who underwent bilateral cataract surgery with implantation of the DFR00V Tecnis Synergy IOL (Johnson & Johnson Surgical Vision) in the non-dominant eye and the DXR00V Tecnis Symfony OptiBlue IOL (Johnson & Johnson Surgical Vision) in the dominant eye. At postoperative 6 months, the Salzburg Reading Desk was used to assess distance-corrected reading performance at near and intermediate distances., Results: Although the monocular reading acuity at the preferred intermediate distance was statistically significantly better in the eyes implanted with the DXR00V IOL, it was better with the DFR00V IOL at preferred near distances. The mean binocular distance-corrected preferred intermediate and near reading acuity was 0.07 ± 0.09 (20/23) and 0.13 ± 0.09 (20/27) logarithm of the minimum angle of resolution, respectively. Other parameters of reading performance, such as reading speed, reading distance, reading time, and smallest scale log print size, were similar between the two IOL groups when assessed monocularly., Conclusions: Implanting a DFR00V IOL in the non-dominant eye and a diffractive DXR00V IOL in the dominant eye resulted in excellent binocular reading acuity and speed at intermediate and near distances. [ J Refract Surg . 2024;40(11):e778-e782.] ., Competing Interests: Disclosure: KMR is a consultant to Johnson & Johnson Vision. GOW is a consultant to and has received lecture fees from Johnson & Johnson Vision. The remaining authors have disclosed no potential conflicts of interest, financial or otherwise.

Purpose: To present the outcomes and detail the surgical procedure employed in the initial 102 eyes treated with keratorefractive lenticule extraction (KLEx) using the FEMTO LDV Z8 platform (Ziemer Ophthalmic Systems)., Methods: This was a retrospective analysis of 102 eyes of 53 patients treated with KLEx at the American University of Beirut Medical Center. Visual, refractive, topographic, and aberrometric parameters were evaluated 1 week and 1, 3, 6, and 12 months postoperatively., Results: Mean preoperative spherical equivalent refraction (SEQ) was -4.11 ± 1.82 diopters (D) (range: -10.00 to -1.625 D) and mean preoperative cylinder was -0.75 ± 0.65 D (range: -3.00 to 0.00 D). Postoperatively, the mean SEQ was 0.06 ± 0.54 D (range: -2.88 to +1.00 D) at 1 week and -0.04 ± 0.26 D at 12 months and was within ±0.50 D in 95.6% and ±1.00 D in 100% of eyes. A total of 96.7% of eyes had an uncorrected distance visual acuity (UDVA) of 20/20 at 12 months postoperatively. Fifty percent gained one or more lines of corrected distance visual acuity (CDVA), 5 eyes (5.4%) lost one line, and none lost two or more lines. No suction losses were encountered and all extracted lenticules were intact without tears., Conclusions: The application of KLEx using the FEMTO LDV Z8 platform yields safe and effective outcomes, aligning comparably with established modes of lenticule extraction and femtosecond laser-assisted laser in situ keratomileusis procedures previously employed and accepted within the field of refractive surgery. [ J Refract Surg . 2024;40(11):e898-e905.] ., Competing Interests: Disclosure: STA is a consultant for Ziemer Ophthalmic Systems AG. The remaining authors have no disclosed no potential conflicts of interest, financial or otherwise.

Purpose: To compare the subjective refraction and Innov-Eyes (Alcon Laboratories, Inc) wavefront-measured refraction in patients with myopia and astigmatism before refractive surgery., Methods: Consecutive myopic patients planning to receive refractive surgery with ages between 18 and 50 years old were retrospectively enrolled. The subjective and wavefront-measured refraction (InnovEyes platform) were compared, and the influential factors for the measurement difference were analyzed., Results: Of the 500 eyes enrolled, the mean age was 29.3 ± 6.8 years. Mean wavefront-measured refraction was 0.58 ± 0.62 diopters (D) more myopic and 0.10 ± 0.27 D more astigmatic than subjective refraction ( P < .001). Wavefront-measured refraction exhibited excellent consistency and significant correlation with subjective refraction. Linear regression demonstrated that age ( P = .008) and wavefront-measured sphere standard deviation ( P < .001) were positively correlated with spherical measurement difference, and total quality score ( P < .001) and accommodative response (binocular cross-cylinder) ( P = .011) demonstrated a negative correlation with spherical and cylindrical measurement difference. The patients with low wavefront measurement quality had significantly greater spherical differences than those with high-quality measurement ( P < .001). The patients with accommodative lead had greater spherical equivalent differences than other participants ( P = .047)., Conclusions: Wavefront-measured refraction had excellent consistency with subjective refraction, although it measured more myopia and astigmatism than subjective refraction. The spherical measurement difference was greater in older patients and those with accommodative lead. More stable and higher quality repeated measurements will yield closer results between wavefront-measured and subjective refraction. [ J Refract Surg . 2024;40(11):e836-e844.] ., Competing Interests: Disclosure: The authors have disclosed no potential conflicts of interest, financial or otherwise.

Purpose: To compare and assess the visual, refractive, and tomographic results of patients with corneal ectasia treated with either corneal allogenic intrastromal ring segments (CAIRS) or synthetic intrastromal corneal ring segments (ICRS) without concomitant corneal cross-linking., Methods: In this retrospective cohort study, 34 eyes with CAIRS were matched to 34 eyes with ICRS using the propensity score matching technique. Each group was matched on a oneto-one basis using multiple parameters such as central corneal thickness, vertical and horizontal coma, maximum anterior keratometry, steepest keratometry, and age. Visual, refractive, topographic, and aberrometric data were measured at baseline, 1 week, 1 month, 3 months, and 1 year postoperatively., Results: Initial preoperative parameters were similar between the two groups. Both groups showed significant improvement at last follow-up time in corrected distance visual acuity (CDVA) (0.52 ± 0.23 to 0.16 ± 0.18 logarithm of the minimum angle of resolution [logMAR], P < .001; 0.44 ± 0.27 to 0.17 ± 0.21 logMAR, P < .001), topographic astigmatism (4.45 ± 2.75 to 3.14 ± 1.93 diopters [D], P = .001; 3.66 ± 2.22 to 2.36 ± 1.46 D, P = .007), maximum anterior keratometry (55.85 ± 7.53 to 50.69 ± 6.38 D, P < .001; 54.59 ± 6.95 to 50.71 ± 4.51 D, P = .003), and vertical coma (1.49 ± 1.02 to 0.38 ± 0.65 D, P < .001; 1.22 ± 0.75 to 0.52 ± 0.57 D, P < .001) for CAIRS and ICRS, respectively. The improvements observed in both groups at the last follow-up visit were comparable; however, the CAIRS group demonstrated a higher percentage of eyes gaining two or more Snellen lines of CDVA (60% vs 31.58%, P = .04), and a greater magnitude of reduction in vertical coma compared to the ICRS group, although this difference did not reach statistical significance. No major complications were observed with both groups, and one eye lost one CDVA line in the ICRS group. The mean thickness of the CAIRS segments at the last follow-up visit was 401.06 ± 100.12 µm, compared to 435.29 ± 26.19 µm for ICRS. Both CAIRS and ICRS demonstrated significant compression of stromal thickness above the segment (36.19% and 32.00%, respectively)., Conclusions: When adequately matched for preoperative disease type and severity, eyes with CAIRS had a similar and notable clinical improvement compared to ICRS, with possibly better improvement in vertical coma and CDVA. [ J Refract Surg . 2024;40(11):e863-e876.] ., Competing Interests: Disclosure: SJ has a patent pending for special trephines, devices, and processes used to create these segments, as well as for the corneal allogenic intrastromal ring segments and various types of shaped corneal segments. The remaining authors have reported no potential conflicts of interest, financial or otherwise.

Purpose: To compare the refractive outcomes and the complications of implantation surgery by the Carlevale IOL to the Artisan iris-claw IOL., Methods: Retrospective comparative study of consecutive surgical cases between 2019 and 2021 in our tertiary centre in Paris, France., Results: We included 142 eyes in the Artisan group and 63 in the Carlevale group. Post-operative astigmatism at one month was 2.3 ± 1.6 D in the Carlevale group, 3.3 ± 2.5 D in the Artisan group with corneal incisions, and 1.8 ± 1.4 D in the Artisan group with scleral incisions ( p  = 0.015). Surgery duration was higher ( p  = 0.007) with the Carlevale IOL (70.8 ± 31.3 min) than with the Artisan IOL (58.3 ± 23.2 min). The complication rates were similar at one month between the two groups (25.4% in Artisan, 27% in Carlevale). The mean follow-up was longer in the Artisan group (234.5 days vs. 77 days, p  < 0.001)., Conclusion: Artisan iris-claw IOL seems to induce higher astigmatism than Carlevale sutureless scleral-fixated IOL at one month when injected through a corneal incision, but not when injected through a scleral incision. Therefore cataract surgeons should avoid wide corneal incisions in implantation surgery whenever possible., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Purpose: To study the effect of corneal white-to-white diameter on Pentacam Scheimpflug cornea tomography and Corvis ST corneal visualization Scheimpflug technology parameters in myopic eyes., Methods: In this retrospective cross-sectional study, 190 eyes of 190 Chinese myopic patients (spherical equivalent range: -1.25 D to -11.00 D) assessed for refractive surgery using Pentacam and Corvis ST devices were included. Patients were divided into groups based on corneal diameter: group A <12 mm, and group B ≥12 mm. Age, gender, spherical equivalent, Pentacam variables, and Corvis ST variables were collected. Statistical analysis was performed using IBM SPSS Statistics (Version 28.0)., Results: There were 110 patients in group A and 80 patients in group B, with no statistically significant difference in age, gender, or spherical equivalence. For Pentacam data, group A had significantly higher Belin/Ambrosio Enhanced Ectasia Display (BAD-D) scores than group B (0.88 vs. 0.44) and pachymetric progression index (minimum, average, and maximum), and steeper front keratometric values, whereas group B had larger anterior chamber depth and maximum Ambrosio-relational thickness (ARTmax) (462.54 vs. 503.93). BAD-D indices, pachymetric progression indices, and front keratometric values had negative correlations with corneal diameter, whereas ARTmax and back keratometric values had positive correlations. For Corvis ST data, group A had a significantly higher corneal biomechanical index (CBI) (negatively correlated) while group B had a higher Ambrosio relational thickness to the horizontal profile (ARTh) (473.60 vs. 570.78) (positively correlated)., Conclusion: Corneal diameter influences both Pentacam and Corvis ST parameters, with smaller corneal diameters having a higher BAD-D and a lower ARTmax and ARTh. In addition, this is the first study to report a correlation between posterior surface corneal power and corneal diameter. As refractive surgery evaluation relies on these parameters, taking corneal diameter into account would improve both sensitivity and specificity in pre-refractive surgery screening for ectasia/keratoconus., (Copyright © 2024 Copyright: © 2024 Indian Journal of Ophthalmology.)

Purpose: To evaluate incision-related astigmatism (IRA) on the anterior and total cornea after implantable collamer lens (ICL) implantation through superior and temporal corneal incisions., Methods: The retrospective study included 141 eyes of 80 consecutive patients who underwent ICL implantation. An ocular examination was performed preoperatively and at 1 and 6 months postoperatively. The magnitude and axis of corneal astigmatism were assessed with keratometry (AstigK) and total corneal refractive power (TCRP, AstigTCRP) using a Scheimpflug camera, while the IRA obtained from keratometry (IRAK) and TCRP (IRATCRP) were evaluated using vector analysis., Results: At 6 months, AstigK significantly decreased from 1.45 ± 0.72 D to 1.15 ± 0.75 D in the superior incision group, whereas it increased from 1.70 ± 0.74 D to 1.88 ± 0.79 D in the temporal incision group (both P < 0.001). AstigTCRP significantly decreased from 1.32 ± 0.74 D to 1.09 ± 0.80 D in the superior incision group, while it increased from 1.61 ± 0.78 D to 1.83 ± 0.86 D in the temporal incision group (both P < 0.001). IRAK was 0.55 ± 0.30 D and 0.35 ± 0.25 D in the superior and temporal incision groups, respectively, while IRATCRP was 0.50 ± 0.28 D and 0.40 ± 0.26 D in the superior and temporal incision groups, respectively. IRAK was larger in the superior incision group than in the temporal incision group for both low- (P = 0.009) and high-astigmatism (P = 0.017)., Conclusions: Incisions in ICL surgery cause corneal flattening in the meridian of the incision. The superior incision had a greater IRAK compared to the temporal incision., (Copyright © 2024 Copyright: © 2024 Indian Journal of Ophthalmology.)

IOL calculation can now be considered a solved problem. However, the problem of sharing the knowledge of the underlying physical and mathematical basics is still unsolved. Also, the necessary hard- and software tools for an IOL calculation approximating the accuracy of prescribed glasses are not yet generally available. The aim of this survey is a clarification of the basics and of some historical pitfalls that still lead to persisting misunderstandings., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Purpose: To evaluate the 1-year effects of orthokeratology (OK) lenses and spectacle lenses with highly aspherical lenslets (HALs) on axial length (AL) elongation in children with unilateral myopic anisometropia., Methods: This ambispective cohort study recruited 81 children aged 8-14 years with unilateral myopic anisometropia. Of these, 42 participants (mean age 11.07 ± 1.54 years; 23 males) were treated with monocular OK lenses (OK group), and 39 (mean age 10.64 ± 1.72 years; 22 males) with binocular HALs (HAL group). Changes in AL and spherical equivalent refraction (SER) from baseline at 3, 6 and 12 months were compared between eyes and groups. Kaplan-Meier estimation and Cox proportional hazard regression were performed to analyse the risk of myopia onset in the initially non-myopic eyes., Results: Mean axial elongation in the myopic and non-myopic eyes at the 12-month follow-up visit were 0.17 ± 0.20 and 0.41 ± 0.26 mm in the OK group (p < 0.001) and 0.10 ± 0.15 and 0.12 ± 0.12 mm in the HAL group (p = 0.32), respectively. Compared with the OK group, the non-myopic eyes in the HAL group had less axial elongation, lower cumulative myopia incidence and percentage of participants with rapid myopic shift at the 6- and 12 month follow-up (all p < 0.05). Cox regression analysis showed that a higher initial SER decreased the risk of myopia onset significantly in the initially non-myopic eyes (B = -2.06; 95% CI, 0.03-0.49; p = 0.003)., Conclusions: Monocular OK lenses suppressed axial elongation in the myopic eye and minimised anisometropia; however, the non-treated contralateral eye may experience faster myopia onset and myopic shift. Binocular HALs can effectively reduce axial elongation in both eyes of children with unilateral myopic anisometropia., (© 2024 College of Optometrists.)

Introduction: This work aimed to establish the largest UK and Ireland consensus on myopia management in children and young people (CYP)., Methods: A modified Delphi consensus was conducted with a panel of 34 optometrists and ophthalmologists with expertise in myopia management., Results: Two rounds of voting took place and 131 statements were agreed, including that interventions should be discussed with parents/carers of all CYP who develop myopia before the age of 13 years, a recommendation for interventions to be publicly funded for those at risk of fast progression and high myopia, that intervention selection should take into account the CYP's hobbies and lifestyle and that additional training for eye care professionals should be available from non-commercial sources. Topics for which published evidence is limited or lacking were areas of weaker or no consensus. Modern myopia management contact and spectacles are suitable first-line treatments. The role and provision of low-concentration atropine needs to be reviewed once marketing authorisations and funding decisions are in place. There is some evidence that a combination of low-concentration atropine with an optical intervention can have an additive effect; further research is needed. Once an intervention is started, best practice is to monitor non-cycloplegic axial length 6 monthly., Conclusion: Research is needed to identify those at risk of progression, the long-term effectiveness of individual and combined interventions, and when to discontinue treatment when myopia has stabilised. As further evidence continues to emerge, this consensus work will be repeated to ensure it remains relevant., (© 2024 The Author(s). Ophthalmic and Physiological Optics published by John Wiley & Sons Ltd on behalf of College of Optometrists.)

Purpose: To estimate the astigmatic power of the crystalline lens and the whole eye without phakometry using a set of linear equations and to provide estimates for the astigmatic powers of the crystalline lens surfaces., Methods: Linear optics expresses astigmatic powers in the form of matrices and uses paraxial optics and a 4 × 4 ray transfer matrix to generalise Bennett's method comprehensively to include astigmatic elements. Once this is established, the method is expanded to estimate the contributions of the front and back lens surfaces. The method is illustrated using two examples. The first example is of an astigmatic model eye and compares the calculated results to the original powers. In the second example, the method is applied to the biometry of a real eye with large lenticular astigmatism., Results: When the calculated powers for the astigmatic model eye were compared to the actual powers, the difference in the power of the eye was 0.03 0.13 0.04 T D (where T represents the matrix transpose) and for the crystalline lens, the difference was 0.08 0.29 0.08 T D (power vector format). A second example applies the method to a real eye, obtaining lenticular astigmatism of -5.84 × 175., Conclusions: The method provides an easy-to-code way of estimating the astigmatic powers of the crystalline lens and the eye., (© 2024 The Author(s). Ophthalmic and Physiological Optics published by John Wiley & Sons Ltd on behalf of College of Optometrists.)

Objectives: The aim of this study was to evaluate the impact of wearing center-near (CN) and center-distance (CD) multifocal contact lenses (MFCLs) on spherical aberrations and visual acuity in patients with early presbyopia., Methods: Fifty participants with early presbyopia wore CN-MFCLs and CD-MFCLs for 1 week. The average corrected refractive power was -2.65±1.67 D. Spherical aberration was measured using an auto-refractor after 1 week of lens use., Results: No significant difference in overall visual acuity was observed when using either lens. Participants favored CD-MFCLs for distance vision and CN-MFCLs for near vision. This study highlighted variations in aberration and satisfaction based on age, refractive errors, and individual responses. Patients with positive spherical aberrations tended to benefit from CN-MFCLs, which improved both distance and near vision, although additional correction was required for clear distance vision. Patients with early presbyopia generally preferred CN-MFCLs when positive aberration was prevalent, whereas those with negative aberration reported greater satisfaction with distance vision when wearing CD-MFCLs., Conclusions: This study confirmed that wearing MFCLs leads to changes in spherical aberration and visual acuity in patients with early presbyopia, particularly when positive aberration prevails. Future research should investigate these effects across different stages of presbyopia., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2024 Contact Lens Association of Ophthalmologists.)

Purpose: It is common to hear talk of 'responders' and 'non-responders' with respect to myopia control interventions. We consider the reality of distinguishing these sub-groups using data from the first year of the Low-concentration Atropine for Myopia Progression (LAMP) study., Methods: The first year of the LAMP study was a robustly designed, placebo-controlled trial of three different low concentrations of atropine using a large sample size (N > 100 randomised to each group). The authors subsequently published mean axial elongation and myopia progression rates by age group. We used these data to calculate efficacy in terms of both absolute reduction in myopic progression and absolute reduction in axial elongation for each of the different atropine concentrations at each age group. We then compared these efficacy data to the overall progression for each of the two progression metrics., Results: Plotting efficacy as a function of overall myopia progression and axial elongation for each of the different atropine concentrations demonstrates the invariant nature of efficacy, in terms of clinically meaningful reduction in progression, despite a substantial range of underlying overall progression. That is, faster progressors-the so-called non-responders-achieved similar reduction in axial elongation and myopia progression as the slower progressors-the so-called responders-within the various atropine treatment groups., Conclusion: The use of the terms, responders and non-responders, during myopia progression interventions is not supported by evidence. Those designated as such may simply be slower or faster progressors, who, on average achieve the same benefit from treatment., (© 2024 College of Optometrists.)

Purpose: To assess the visual impact of Diffusion Optics Technology™ 0.2 DOT lenses (SightGlass Vision Inc.) designed for myopia control on primary gaze. DOT spectacle lenses contain light scattering elements that scatter light as it passes through the lens which, in turn, reduces retinal image contrast., Methods: Fifty-one children (12.2 ± 1.3, range 10-14 years; 51% females) were randomly assigned to wear DOT spectacle (n = 27) or single vision lenses (n = 24) across six investigational sites in North America. Binocular high- and low-contrast distant visual acuities, near visual acuity, reading speed, contrast sensitivity, stereoacuity and glare were assessed in primary gaze after at least 3 years of wear, with the study 95% powered in all metrics to detect significant differences between the groups., Results: Mean binocular distance high-contrast (-0.09 ± 0.02 vs. -0.08 ± 0.02 logMAR, p = 0.81), low-contrast (0.05 ± 0.02 vs. 0.07 ± 0.02 logMAR, p = 0.52) and near visual acuity with glare sources (-0.06 ± 0.03 vs. -0.09 ± 0.03 logMAR, p = 0.32) were similar for DOT and single vision lens wearers, respectively. Contrast sensitivity was similar between children wearing DOT or single vision lenses across 11 of the 16 spatial frequencies (p > 0.05). Mean stereopsis was similar (p = 0.30) with the DOT lenses (33.2 ± 12.5″) and single vision lenses (38.1 ± 14.2″). Functional reading speed metrics were similar in both study groups, as was the objectively measured head tilt during reading (p > 0.05). The mean halo radius was 0.56° ± 0.17° with the DOT lenses compared with 0.50° ± 0.12° with single vision lenses (p = 0.02), but the statistically significant difference was smaller than the non-inferiority bound of 0.4°., Conclusion: Diffusion optics technology lenses provide a clinically equivalent visual experience to a standard single vision lens., (© 2024 SightGlass Vision. Ophthalmic and Physiological Optics published by John Wiley & Sons Ltd on behalf of College of Optometrists.)

Purpose: To evaluate the rotational stability and capsular bag performance of a blue light-absorbing hydrophobic acrylic open-loop single-piece intraocular lens (IOL) with a blast-finished anchor wing haptic design during the first 6 postoperative months., Methods: In this prospective clinical study, patients with age-related cataract and potential postoperative corrected distance visual acuity (CDVA) of 0.2 logMAR or better were included. The patients received a non-toric hydrophobic acrylic single-piece IOL with an axis mark (YST0.00; Nidek Co. Ltd, Japan). Surgeries were video-taped. Retroillumination images were acquired 1 h, 1 week and 6 months postoperatively. Rotational stability was assessed by precise image overlay. At 6 months, Purkinje meter measurements were performed to evaluate tilt and decentration., Results: In total, 100 eyes of 77 patients were included in the analysis. Mean absolute rotation was 2.1 ± 1.7° (median 1.7, range: 0-7.9) at 6 months (1 h - 6 months postoperatively). IOL rotation was ≤3° and ≤6° in 74 (74%) and 98 (98%) eyes, respectively. Mean absolute IOL rotation from the end of surgery to 6 months was 2.5 ± 2.2° (median 2.3, range: 0-15.6; n = 78). Mean tilt (pupillary axis) and decentration were 4.1 ± 1.9° (median 4.0, range: 0.5-8.2) and 0.35 ± 0.17 mm (median 0.32, range: 0.06-0.91) respectively (n = 84). Postoperatively, 98 (98%) eyes achieved a CDVA of 0.2 logMAR or better, 95 (95%) of ≤0.1 and 81 (81%) of ≤0.0., Conclusions: This hydrophobic acrylic single-piece IOL showed an excellent rotational stability and capsular bag position with low tilt and decentration values., Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: The authors have no proprietary or financial interest in any of the materials or equipment mentioned in this study. Oliver Findl is a scientific adviser to Alcon, Croma, Carl Zeiss Meditec AG, Johnson & Johnson and Merck. Nino Hirnschall is a scientific adviser to Carl Zeiss Meditec AG and Hoya Surgical.

Purpose: To assess the effect of preoperative Belin-Ambrósio deviation (BAD-D) index on 2-year visual, refractive, and tomographic outcomes, as well as the efficacy and safety of photorefractive keratectomy (PRK) surgery., Setting: Eye clinic, Mashhad, Iran., Design: Prospective cohort study., Methods: This study included 66 patients (66 eyes) who underwent PRK surgery, with a minimum follow-up period of 2 years. Participants were divided into 2 groups: preoperative BAD-D ≥1.60 (high BAD-D) and preoperative BAD-D <1.60 (low BAD-D). Preoperative and postoperative visual, refractive, and tomographic parameters were evaluated, and the efficacy and safety of the procedure were compared between groups., Results: 66 patients with a mean age of 35.50 ± 8.21 years (range 22 to 55 years) were included. Postoperatively, the mean spherical equivalent (SE) of refractive error was +0.32 ± 0.65 diopters (D) in the high BAD-D group and +0.18 ± 0.66 D in the low BAD-D group ( P = .40). In addition, at 2 years of follow-up, the mean uncorrected distance visual acuity was 0.98 ± 0.07 in the high BAD-D group and 0.97 ± 0.08 in the low BAD-D group ( P = .905). Among the postoperative tomographic parameters, front elevation thickness, maximum Ambrósio relational thickness, astigmatism, and central corneal thickness were significantly different between the 2 groups (all, P < .05). At the 2-year follow-up, the mean Safety Index was 1.02 ± 0.04, and 1.01 ± 0.04 in high and low BAD-D groups, respectively ( P = .37), and the mean Efficacy Index was 0.99 ± 0.07 and 0.98 ± 0.06 in high and low BAD-D groups, respectively ( P = .40)., Conclusions: The preoperative BAD-D index does not predict postoperative visual, refractive, and tomographic outcomes in patients with low-to-moderate myopia. However, in patients with normal preoperative BAD-D values, higher agreement was expected between the attempted and achieved SE., (Copyright © 2024 Published by Wolters Kluwer on behalf of ASCRS and ESCRS.)

Purpose: To assess corneal sensitivity and the ocular surface in patients undergoing primary femtosecond laser in situ keratomileusis (FS-LASIK) and those undergoing FS-LASIK retreatment under the same flap due to residual refractive error., Setting: Ekol Eye Hospital, Izmir, Turkey., Design: Prospective case series., Methods: 19 patients with previous FS-LASIK who had myopic and astigmatic refractive error were included in the study group, and 19 age-matched and sex-matched patients undergoing FS-LASIK for the first time as the control group. Corneal sensitivity, Schirmer test, tear film break-up time (TBUT), Oxford grading scheme for ocular surface staining, and Ocular Surface Disease Index (OSDI) were measured preoperatively and at postoperative 1 week and 1, 3, and 6 months., Results: The mean refractive correction in the study and control groups, respectively, was 2.18 ± 0.78 diopters (D) (range: 1.00 to 3.50) and 2.76 ± 1.20 D (range: 1.00 to 4.50; P = .07). Corneal esthesiometry results in the study and control groups, respectively, were 6.10 ± 12.55 vs 9.90 ± 11.50 mm at 1 week ( P = .001), 41.95 ± 6.98 vs 45.09 ± 5.88 mm at 1 month ( P = .004), 56.09 ± 3.37 vs 56.19 ± 2.52 mm at 3 months ( P = .8), and 58.60 ± 2.01 vs 58.80 ± 1.39 mm at 6 months ( P = .5). Significant difference between the 2 groups in Schirmer test score that disappeared at postoperative 3 months and in TBUT and ocular surface staining that disappeared at 6 months, whereas the statistically significant difference in OSDI score persisted at 6 months ( P = .03) was detected., Conclusions: Corneal surface sensitivity and ocular surface health are more impaired in patients undergoing FS-LASIK retreatment due to residual refractive error., (Copyright © 2024 Published by Wolters Kluwer on behalf of ASCRS and ESCRS.)

Purpose: To investigate the progression patterns and risk factors of axial elongation in young adults with nonpathologic high myopia., Design: Prospective, clinical observational cohort study with 2- to 4-year follow-up., Methods: A total of 1043 eyes of 563 participants (3515 medical records) aged 18 to 50 years with nonpathologic high myopia (axial length [AL] ≥ 26 mm; myopic maculopathy < diffuse chorioretinal atrophy; without posterior staphyloma) were included from 1546 participants (6318 medical records). Annual axial elongation was calculated via linear mixed-effect models. The associated risk factors of axial elongation were determined by ordinal logistic regression analysis, with generalized estimate equations for eliminating an interocular correlation bias., Results: Based on 5359 times of AL measurements, the annual axial elongation of participants (mean [SD] age 31.39 [9.22] years) was 0.03 mm/year (95% confidence interval [CI], 0.03-0.04; P < .001) during a 30.23 (6.06) months' follow-up. Severe (>0.1 mm/year), moderate (0.05-0.09 mm/year), mild (0-0.049 mm/year), and nil (≤0 mm/year) elongation was observed in 122 (11.7%), 211 (20.2%), 417 (40.0%), and 293 (28.1%) eyes. The following risk factors were significantly associated with axial elongation: baseline AL ≥ 28 mm (odds ratio [OR], 4.23; 95% CI, 2.95-6.06; P < .001); age < 40 years (OR, 1.64; 95% CI, 1.18-2.28; P = .003); axial asymmetry (OR, 2.04; 95% CI, 1.26-3.29; P = .003), and women (OR, 1.52; 95% CI, 1.13-2.2.05; P = .006). Using antiglaucoma medications was a protective factor (OR, 0.46; 95% CI, 0.27-0.79; P = .005), which slowed 75% of axial elongation from 0.04 (0.06) to 0.01 (0.06) mm/y (P < .001)., Conclusions: Axial elongation continued in young adults with nonpathologic myopia. Risk factors included longer baseline AL and axial asymmetry, younger age, and woman. Topical use of antiglaucoma medications may be useful to reduce ongoing axial elongation., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Purpose: To explore the features of the dominant and nondominant eyes in patients with cataracts and predict ocular dominance shift (ODS) based on preoperative indicators., Setting: Changsha Aier Eye Hospital, Changsha, Hunan, China., Design: Prospective, observational study., Methods: Patients with age-related cataracts who underwent unilateral cataract surgery were enrolled in this study. Before the procedure, uncorrected distance visual acuity (UDVA) was assessed and noncycloplegic subjective refraction evaluations were conducted to determine corrected distance visual acuity. Total astigmatism, corneal astigmatism, and intraocular astigmatism were measured using OPD-Scan III. Cataract type was assessed using slitlamp biomicroscopy based on the Lens Opacities Classification System III. Ocular dominance (OD) was determined under corrected conditions using the hole-in-card test. Follow-up visits occurred at 1 day, 1 week, and 1 month postoperatively. After 1 month, OD was re-evaluated, and participants completed the 9-item Short-Form Cataract Questionnaire., Results: 94 patients (188 eyes) were enrolled in the study. The analysis showed that the ODS rate of unilateral cataract surgery was 40.4%. In addition, age, UDVA of the nondominant eye, posterior subcapsular cataract, and total astigmatism were risk factors for ODS. No difference in vision-related quality of life was detected between patients who had ODS and those who did not., Conclusions: Several preoperative parameters as potential risk factors of ODS after cataract surgery were identified. These findings provide guidance for predicting changes in the dominant eye and may improve the precise selection of intraocular lenses and implementation of monovision strategies., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of ASCRS and ESCRS.)

Purpose: To compare 2 different datasets, using Eyetemis, an online analytical tool designed for assessing the spherical equivalent prediction errors (SEQ-PEs) of intraocular lens (IOL) power calculation formulas after cataract surgery., Setting: Institutional., Design: Retrospective case series., Methods: The study comprised 2 distinct datasets of patients who had undergone successful cataract surgery. Dataset 1 includes standard eyes, whereas Dataset 2 includes eyes with keratoconus. An online tool was used for SEQ-PE analysis across the 2 datasets, adhering to ISO standards for evaluating accuracy based on trueness and precision. The tool incorporates robust t tests for comparing the trimmed mean of the data, adjusting for heteroscedasticity. IOL constants in Dataset 1 were optimized for the comparison of Hoffer Q, Holladay 1, SRK/T, Haigis, and Barrett Universal II (BUII) formulas. In Dataset 2, IOL constants from the IOLCon website were used for the comparison of the BUII and its designated KCN version: Barrett TrueK Keratoconus (TrueK [KCN])., Results: For Dataset 1, the trimmed mean SEQ-PE values of all formulas were not significantly different from zero. BUII had superior precision and accuracy compared with all other formulas, except from Haigis ( P ≤ .04). For Dataset 2, BUII's trimmed-mean SEQ-PE was significantly different from zero (0.59 diopters [D], P < .01), unlike the TrueK (KCN) (0.12 D, P = .10). In addition, TrueK (KCN) exhibited enhanced precision and accuracy relative to BUII ( P < .01)., Conclusions: The online analysis tool provides a streamlined approach for assessing the prediction accuracy of SEQ refraction after cataract surgery, effectively evaluating trueness, precision, and overall accuracy through the use of advanced statistical methods., (Copyright © 2024 Published by Wolters Kluwer on behalf of ASCRS and ESCRS.)

Purpose: To describe a novel technique for preparing multiple corneal allogeneic ring segments (CAIRS) from a single corneal graft using femtosecond laser technology., Methods: This is a case series of 10 eyes from 10 patients with keratoconus who underwent FS-assisted CAIRS implantation using corneas from 4 donors at the Hospital Foundation Adolphe de Rothschild-Noémie de Rothschild institute. A preoperative and postoperative examination was performed at 1 day, 1 week, and 1 month. Anterior segment OCT and corneal tomography with aberrometric and pachymetric analyses were performed at each visit. Visual, refractive, and topographic parameters were extracted. The thickness and width of implanted CAIRS were analyzed., Results: Patients were classified according to keratoconus severity: group A (maximal keratometry Kmax <75D) and group B (Kmax >75D). At 1 month postoperatively, both groups A and B showed a significant decrease in mean keratometry by 4.78 ± 1.57D and 12.87 ± 4.62D, respectively. Total and higher order aberrations decreased by 5.66 ± 4.55 and 0.65 ± 1.54 in group A and by 9.45 ± 9.15 and 0.49 ± 1.39 in group B, respectively. The corrected distance visual acuity improved by 4.8 ± 1.7 lines in group A. Visual improvement was not significant in group B. One eye in group B exhibited acute rejection and required explantation., Conclusions: FS-assisted multiple CAIRS implantation using a single corneal graft maximizes the utilization of viable corneal tissue. CAIRS implantation is an effective and biocompatible therapeutic alternative, particularly in cases of moderate to advanced keratoconus with Kmax <75D., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: We evaluated the timing at and extent to which midterm to long-term keratometric changes can occur in year 1 to 7 after corneal collagen cross-linking (CXL) in patients with keratoconus., Methods: We conducted a subgroup analysis of a retrospective cohort study of all consecutive patients who underwent CXL at our cornea center between 2007 and 2011. The inclusion criteria comprised CXL according to the Dresden protocol and a full set of keratometry parameters collected by Scheimpflug tomography preoperatively and at year 1, 3, 5, and 7 after CXL. In addition, best-corrected visual acuity was evaluated., Results: Sixty-three eyes of 47 patients were enrolled. Mean age was 25.46 years ±7.39 years (80.9% male patients). All relevant keratometric parameters showed significant improvement at year 1 after CXL (except for posterior astigmatism). According to mixed-effects model analysis, they all showed further significant change at different points in time between year 1, 3, 5, and 7 (except for K1). In addition, best-corrected visual acuity improved statistically significant between year 1, 3, 5, and 7. Suspected disease progression was noted in 22.2% of patients, mostly between year 1 and 3 after CXL., Conclusions: After initial improvement 1 year after CXL, keratometric and functional parameters were stable until year 5 after CXL in most cases; further improvement can take place even after up to 7 years post-CXL. By contrast, in case of disease progression, changes seem to occur already between year 1 and 3 after CXL., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: To investigate whether standard keratometry (K) or total corneal power (TCP) leads to more accurate refractive outcomes for intraocular lens (IOL) power calculation., Setting: Public hospital., Design: Retrospective evaluation of a diagnostic test instrument., Methods: Preoperatively, all patients underwent optical biometry with Anterion, a swept-source optical coherence tomography device providing both K and TCP. The same IOL model was implanted in all cases. The whole sample was divided into a training dataset, used to optimize the formula constants, and a testing dataset, used to investigate the spherical equivalent prediction error (SEQ-PE) of 8 IOL power formulas. Trueness, precision, and accuracy were evaluated by means of the robust 2-sample t test. Cochran Q test was performed to assess whether the percentage of eyes with an SEQ-PE within each threshold was significantly different; in such an event, the McNemar test was then applied., Results: Both the training and testing datasets included 317 eyes. No significant differences were detected for trueness because of constant optimization. Precision and accuracy were better when K was entered, although a statistically significant difference was observed only with the EVO (precision: P = .02 and accuracy: P = .03) and Haigis ( P < .01 for both precision and accuracy) formulas. No significant differences were observed for the percentage of eyes with an absolute SEQ-PE within any threshold., Conclusions: With most formulas, IOL power calculation is not more accurate when TCP is used instead of K., (Copyright © 2024 Published by Wolters Kluwer on behalf of ASCRS and ESCRS.)

Purpose: To compare the long-term refractive outcomes and visual quality after keratorefractive lenticule extraction (KLEx) and EVO-implantable collamer lens (ICL) implantation for high myopia., Setting: Eye & ENT Hospital of Fudan University, Shanghai, China., Design: Retrospective study., Methods: This study included 31 KLEx-treated patients (31 eyes, spherical equivalent: -7.62 ± 1.22 diopters [D]) and 32 ICL-treated patients (32 eyes, spherical equivalent: -8.22 ± 1.18 D). Refractive outcomes and objective visual quality were examined. Subjective visual quality was evaluated by a customized questionnaire. Patients' satisfaction was graded., Results: 5 years postoperatively, the efficacy (KLEx: 0.96 ± 0.20; ICL: 1.03 ± 0.20; P = .164) and safety indices (KLEx: 1.12 ± 0.20; ICL: 1.21 ± 0.19; P = .067) were comparable. Statistically higher proportions of ICL-treated eyes achieved a postoperative uncorrected distance visual acuity of 20/20 or better ( P = .035). Refractive predictability was similar between the 2 groups ( P = .947), whereas more KLEx-treated eyes had myopic refractive errors ( P < .001). Total coma was significantly higher after KLEx ( P = .020), and greater total trefoil was observed after ICL implantation ( P = .006). Haloes were the primary visual disturbance in both groups (KLEx: 64.5%; ICL: 93.8%). The incidences of haloes ( P < .001), glare ( P = .004), and starbursts ( P = .043) were notably higher after ICL implantation. The patient's satisfaction scores were similar (KLEx: 9.10 ± 1.27; ICL: 9.10 ± 1.27; P = .894)., Conclusions: For high myopia, EVO-ICL yielded better long-term refractive outcomes than KLEx. Haloes were the chief concern in both groups, with a significantly higher incidence after ICL implantation., (Copyright © 2024 Published by Wolters Kluwer on behalf of ASCRS and ESCRS.)

Introduction: Demands for myopia management are rising. A web-based tool that allows home-performed self-assessments of visual acuity (VA) and refractive error may enable hybrid care pathways and aid in identifying those with deteriorating visual performance. The tool has been validated in adult populations, but has yet to be evaluated in children. This study compared home-performed VA and refraction self-assessments to conventional measurements obtained at the clinic in a population of myopic children., Methods: Myopic children aged ≥6 years old were invited to perform web-based eye tests at home, assisted by a parent. At two myopia control clinics, they also underwent measurements of VA using a Snellen chart and refractive error using cycloplegic autorefraction. Agreement between the tests, repeatability of the web-based test and associations between clinical characteristics and web-based test accuracy were evaluated., Results: A total of 147 children were enrolled, of whom 116 (51% male; mean age 13 ± 3 years; mean spherical equivalent refraction (SEQ) -5.58 ± 3.05) performed the web-based tests at home. Overall, the home-performed VA self-assessment and the Snellen chart assessment at the clinic agreed well (mean difference 0.03 ± 0.11 logMAR). A significant proportional bias was identified (β 0.65, p < 0.001), indicating underestimated web-based VA scores when the child's vision declined. The sensitivity to detect VA poorer than 0.10 logMAR was 94%; the specificity was 71%. The web-based refractive error algorithm measured more myopia progression compared to clinic observations (mean difference SEQ 0.40 ± 0.51 dioptres). Age, sex or use of atropine drops were not significantly associated with test accuracy., Conclusions: The web-based test for self-assessing vision, performed at home by children with assistance from their parents, yielded VA scores with a precision similar to Snellen chart testing conducted in a clinical setting. However, the web-based refractive error algorithm overestimated myopia progression and requires recalibration for this specific age group., (© 2024 The Author(s). Ophthalmic and Physiological Optics published by John Wiley & Sons Ltd on behalf of College of Optometrists.)

Background: A high-frequency point-of-care (POC) ultrasound instrument was used to evaluate the microstructural and biomechanical properties of the anterior sclera in vivo using parameters computed from quantitative ultrasound (QUS) methods., Methods: In this cross-sectional study, both eyes of 85 enrolled patients were scanned with the POC instrument and ultrasound data were processed to obtain QUS parameters. Pearson correlation and multi-linear regression were used to identify relationships between QUS parameters and refractive error (RE) or axial length. After categorising eyes based on RE, binary support vector machine (SVM) classifiers were trained using the QUS or ophthalmic parameters (anterior chamber depth, central corneal thickness, corneal power, and intraocular pressure) to classify each eye. Classifier performance was evaluated by computing the area under the receiver-operating characteristic curve (AUC)., Results: Individual QUS parameters correlated with RE and axial length (p < 0.05). Multi-linear regression revealed significant correlation between the set of QUS parameters and both RE (R = 0.49, p < 0.001) and axial length (R = 0.46, p = 0.001). Classifiers trained with QUS parameters achieved higher AUC (𝑝 = 0.06) for identifying myopic eyes (AUC = 0.71) compared to classifiers trained with ophthalmic parameters (AUC = 0.63). QUS-based classifiers attained the highest AUC when identifying highly myopic eyes (AUC = 0.77)., Conclusions: QUS parameters correlate with progressing myopia and may be indicative of myopia-induced microstructural and biomechanical changes in the anterior sclera. These methods may provide critical clinical information complementary to standard ophthalmic measurements for predicting myopia progression and risk assessment for posterior staphyloma formation., (© 2024 Royal Australian and New Zealand College of Ophthalmologists.)

Purpose: Scleral fixation of intraocular lenses constitutes a surgical option in cases where there is inadequate capsular support or zonular insufficiency. Knotless techniques, such as the z-suture technique, avoid suture-related complications, such as conjunctival erosion or exposure. The purpose of this study was to evaluate the visual outcomes and postoperative complications of patients who underwent scleral z-suture fixation of the Akreos AO® intraocular lenses., Methods: A retrospective, observational study was conducted, including 22 eyes of 20 patients who underwent Akreos AO® intraocular lenses using the z- suture scleral fixation technique., Results: The mean age of the patients was 55,64 ± 28,47 years old, and the mean follow-up time was 25,64 months. The most common indication for surgery was previous complicated cataract surgey. The mean postoperative spherical equivalent was +0,058D ± 0,79D, with values ranging from - 1,50D to +1,00D. Mean best-corrected visual acuity was 0,178 ± 0,15 logMAR. Intraocular pressure was 15,07 ± 2,56 mmHg on the day after surgery, and 16 ± 2,15 mmHg 1 month after. No suture-related complications were observed in any patient postoperatively. One patient had a slight inferonasal lens dislocation and another patient had a severe case of herpetic keratitis posoperatively., Discussion: The knotless z-suture technique appears to be a reliable and safe way to fix an intraocular lens in the sclera, regardless of the patient's age. Our results show good visual results and predictable refractive outcomes. Decades of follow-up may be necessary to assess the long-term risk of lens dislocation., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: To explore the association of sleep timings, duration, consistency, and chronotype with premyopia and myopia among Indian children., Methods: This hospital-based cross-sectional study included 453 children, aged 6-12 years. Two myopia participants were selected for each individual with the corresponding premyopia or emmetropia. All children underwent cycloplegic autorefraction and ocular biometric tests. The Children's Sleep Habits Questionnaire (CSHQ) and parental information on behavioral habits were used to assess the association of sleep parameters with myopia and premyopia using logistic regression models., Results: Both myopia and premyopia exhibited significant late bedtime, short sleep duration, early wakeup time on only weekdays, and longer weekend catch-up sleep than emmetropia children (p < 0.05). In multivariate analysis, late bedtime (more than 24:00 a.m.) on weekdays (Odds ratio, OR = 3.63, 95% CI [0.74, 8.68]) as well as on free days (OR = 1.04, 95% CI [0.02, 8.08]); and early wake-up time only on weekdays (5:00-6:00 a.m., OR = 2.16, 95% CI [0.24, 6.76] and 06:00-07:00 a.m., OR = 2.42, 95% CI [0.51, 8.44]) were associated with increased risk of myopia (all p < 0.05) but not premyopia. After adjusting the confounding factors, when each of the eight CSHQ subscale components was analyzed, only bedtime resistance, night waking, and daytime sleepiness scores were significantly associated with a higher risk for premyopia and myopia (p < 0.05)., Conclusions: The sleep quality components, including bedtime resistance, night waking, and daytime sleepiness, equally involve a higher risk for myopia as well as premyopia., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.