[Assessment of mesopic and contrast vision for driving licences: which cut-off values, which methods are appropriate?]

Visual outcomes and subjective experience with three intraocular lenses based presbyopia correcting strategies in cataract patients

To compare the visual outcomes and subjective experience of three intraocular lenses (IOL) implant strategies. Retrospective comparative study. This study comprised patients who underwent phacoemulsification and bilateral implantation of extended depth of focus (EDOF) IOL (ZXR00; EDOF group), blended implantation of EDOF and bifocal IOL (ZXR00/ZLB00; blended group), and bilateral implantation of trifocal IOL (AT LISA tri 839MP; trifocal group). The outcomes included visual acuity (VA), visual defocus curve, contrast sensitivity, visual quality, quality of life, spectacle independence, and patient satisfaction. Follow-up was performed 3 months after the surgery. This study included 114 eyes of 57 patients (20 in EDOF group; 16 in blended group; 21 in trifocal group). Patients in the three groups had high quality of life, patient satisfaction, and good contrast sensitivity. The EDOF group had the worst near VA, but the visual quality was the best. The blended group had good VA and slight photic disturbance. The trifocal group obtained the best whole range of VA, but the photic disturbance was significantly severe than the EDOF group. Both the blended and trifocal groups achieved high spectacle independence, but some patients in the EDOF group need spectacle when dealing with close-range tasks.

Mesopic conditions optimise the detection of visual function loss in drivers with simulated media opacity

Drivers have different visual demands across varying contrast and luminance conditions. However, vision assessments for driving are typically conducted under photopic conditions. This study investigated the sensitivity of photopic and mesopic conditions to detect contrast sensitivity (CS) loss in drivers with simulated media opacities. CS was measured in forty-seven healthy drivers aged 18–50 years (mean ± SD: 25.5 ± 6.5) under photopic and mesopic-adapted luminance levels with the Pelli-Robson chart and the Mesotest II (without glare). Media opacities were simulated using white-opacity containing Lee Fog filters (1–5) and CS measured in a randomised order. A significant (p < 0.001) reduction in photopic CS (logCS) was measured with the Pelli-Robson chart only when media opacity was simulated with Fog filter 5 (1.53 ± 0.15, 2.8 triplets reduction) compared to baseline (1.95 ± 0.03). Mean mesopic CS demonstrated a significant (all p < 0.001) reduction from baseline (1.67 ± 0.14) for Fog filters 3 (1.4 triplets, 1.45 ± 0.16), 4 (2.4 triplets, 1.31 ± 0.14) and 5 (4.3 triplets, 1.02 ± 0.15). For Mesotest II, only Fog filter 5 produced a significant reduction (0.10 ± 0.09; p < 0.001) in mean mesopic CS from baseline (0.30 ± 0.01). Mesopic CS is more vulnerable to different levels of simulated media opacity, hence should be considered clinically when assessing visual function in older drivers at risk of media opacity.

Evaluation of a Novel Non-Diffractive Extended Depth of Focus Intraocular Lens - First Results from a Prospective Study

PURPOSE

To evaluate a novel hydrophobic, non-diffractive, extended depth of focus (EDOF) intraocular lens (IOL) design in comparison to two monofocal aspheric lenses.

METHODS

Inclusion criteria for this prospective, monocentric cohort study were opacification of the crystalline lens and patients' wishes for surgery. In the case of the EDOF IOL, patients asked for a presbyopia correction. All patients received surgery on both eyes. Corrected and uncorrected distance visual acuity (CDVA, UCDVA), uncorrected and distance corrected intermediate visual acuity (UIVA, DCIVA) and defocus curves (all monocular and binocular) were compared three months postoperatively.

RESULTS

Fifty-six eyes were implanted with an EDOF IOL (LuxSmart^TM, Bausch & Lomb GmbH, Berlin, Germany), 50 eyes with a monofocal aspheric IOL: 32 eyes with a clear IOL (Polylens^® AS 61, Polytech Domilens, Roßdorf, Germany), 16 eyes with a yellow IOL (iSert^® 251, Hoya Surgical Optics GmbH, Frankfurt, Germany). Three months postoperatively, UCDVA was comparable with the EDOF IOL, versus the monofocal IOL (P > 0.9). Binocular DCIVA in the EDOF IOL was significantly higher than in the monofocal IOL (P = 0.001). Monocular DCIVA better than 20/23 Snellen was achieved in 10% with the monofocal IOL and in 68% (P < 0.0001) with the EDOF IOL. Defocus curves showed a depth of focus at 20/23 Snellen of 1.6 vs. 0.83 diopters (D) in the EDOF IOL, vs. the monofocal IOL. No patient reported halos or starbursts in non-standardized questioning.

CONCLUSION

This non-diffractive EDOF IOL provided comparably high UCDVA and significantly higher DCIVA than the mono-focal lenses, causing only mild optical phenomena.

Comparison of visual performance between extended depth of focus contact lens and single-vision contact lens in eyes with monofocal intraocular lens

PURPOSE

To assess the visual performance of extended depth of focus (EDF) contact lenses (CL) in eyes that had undergone monofocal intraocular lens (IOL) implantation, and compare that between EDF and single-vision (SV) contact lenses.

STUDY DESIGN

Prospective, randomized, crossover study METHODS: Seventeen patients implanted with monofocal IOLs were enrolled. The study was conducted using 1dayPure EDOF as a test CL and 1dayPure moisture (both SEED Co., Ltd.) as a control CL. Binocular visual acuity from far to near distances, photopic and mesopic contrast sensitivity (with and without glare), and stereopsis were evaluated after wearing the two kinds of CLs in random order. The obtained results were compared between the EDF and SV CLs.

RESULTS

Binocular visual acuity at 0.3, 0.4, 0.7, 1, and 5 m was 0.24 ± 0.12, 0.07 ± 0.09, - 0.02 ± 0.08, - 0.02 ± 0.08, and - 0.06 ± 0.07 logMAR during the EDF CL wear, respectively, and 0.39 ± 0.17, 0.26 ± 0.15, 0.04 ± 0.12, - 0.02 ± 0.08, and - 0.09 ± 0.09 during the SV CL wear, respectively. The EDF CL showed better results than the SV CL at 0.3, 0.4, and 0.7 m (p < 0.05). There were no significant differences in contrast sensitivity between the EDF and SV CLs at 1.5 cycles per degree under all conditions; however, the sensitivity of the EDF CL was generally worse than that of the SV CL from the middle to high spatial frequencies. Stereopsis at 40 cm was significantly better in the EDF CL wear than in the SV CL wear (p < 0.05).

CONCLUSIONS

The EDF CL substantially improved visual acuity at near to intermediate distances in IOL-implanted eyes. However, far visual acuity decreased under low-contrast conditions, and contrast sensitivity slightly declined at the middle to high spatial frequencies.

Development of a Method to Potentially Substitute Direct Evaluation of Mesopic Visual Acuity in Drivers

(1) Background: In mesopic lighting conditions, or under adverse environmental circumstances, visual information is reduced, which increases the risk of traffic accidents. This effect could be reduced with a precise evaluation of the visual function under mesopic conditions, but it is difficult to replicate in clinics. This study aims to develop an easy-to-adopt method to evaluate mesopic visual acuity (VA) in drivers. (2) Methods: Prospective and observational study in drivers. logMAR mesopic VA was compared with photopic VA measured under different combinations of contrast charts and filters to find the combination that responds best to mesopic conditions. (3) Results: Fifty-six drivers were examined. The best correlation was found with an 80% density filter and a Weber contrast chart of 20%. The logMAR VA for this combination was 0.01 ± 0.11, which was close to the mesopic VA values (0.01 ± 0.12). The difference between both logMAR VA was 0.00 ± 0.06 (R = 0.86; p ≤ 0.001; ICC = 0.86). (4) Conclusions: The use of 20% contrast optotypes and the interposition of an 80% filter under photopic conditions provide VA values similar to those measured under mesopic lighting conditions, making this simple system a good predictor of mesopic VA values.

Development of Methodology and Study Protocol: Safety and Efficacy of a Single Subretinal Injection of rAAV.hCNGA3 in Patients with CNGA3-Linked Achromatopsia Investigated in an Exploratory Dose-Escalation Trial

Achromatopsia is an autosomal recessively inherited congenital defect characterized by a lack of cone photoreceptor function, leading to severely impaired vision. In this clinical study, achromatopsia patients were treated with a single subretinal injection of rAAV.hCNGA3 to restore cone function. The focus of this trial was on the safety of the treatment. After surgery, patients were monitored in eight extensive visits during the first year, followed by a 4-year follow-up period with annual visits. For essential complementation of the standard ophthalmological and systemic examinations, disease-specific methods were developed to assess the safety, efficacy, and patient-reported outcomes in this trial.

[Measurement of contrast vision: mesopic or photopic vision? : Comparison of different methods for measuring contrast sensitivity within the framework of driving licence regulations]

BACKGROUND

Since 2011 the regulations for occupational driving licences make the examination of contrast vision sensitivity obligatory; however, apart from mesopic procedures no uniform regulations are available for methods and minimum requirements.

OBJECTIVE

By comparing different mesopic and photopic contrast sensitivity tests this study analyzed whether these could be equivalently used and lead to the same results.

MATERIAL AND METHODS

Contrast vision sensitivity was determined in 150 subjects with emmetropia using five different methods, i.e. the mesopic test device Mesotest II as the reference method, Rodatest 302 and Optovist as photopic test devices and two photopic test charts (Vistech chart and Mars charts). The results of passing the tests were compared and Cohens κ was determined to quantify the conformity between the tests.

RESULTS

Poor agreement was found between Mesotest II and Optovist as well as between Mesotest II and the Vistech chart. There was no agreement between Rodatest 302 or Mars charts and Mesotest II; nevertheless, the contrast vision sensitivity measured with Optovist, Rodatest 302 and the Vistech chart showed good correlation (0.46 ≤ r ≤ 0.69).

CONCLUSION

Apart from a few limitations, the reference method Mesotest II as well as Optovist and the Vistech chart are suitable for testing contrast vision sensitivity, whereas Rodatest 302 and Mars charts cannot be recommended based on the current criteria for minimum requirements. The minimum requirements must be urgently adapted and strict regulations for measurement must be formulated. In addition, due to the poor agreement between the methods an amendment of the driving licence regulations should be considered, which requires examination of both mesopic and photopic contrast vision or alternatively mesopic contrast vision alone.