Internal limiting membrane peeling and inverted flap technique in macular hole: postoperative metamorphopsia and optical coherence tomography

INTRODUCTION

We compared postoperative metamorphopsia and optical coherence tomography (OCT) findings between eyes that underwent internal limiting membrane (ILM) peeling and the inverted flap (IF) technique for macular hole (MH).

METHODS

This retrospective analysis included 64 eyes of 64 patients with idiopathic MH whose MH was closed after initial surgery. Thirty-nine patients were treated with pars plana vitrectomy (PPV) with ILM peeling, and 25 patients were treated with PPV with the IF technique. Best corrected visual acuity (BCVA), severity of metamorphopsia, and OCT images were collected before and 3, 6, and 12 months postoperatively. Based on the OCT images, the status of the external limiting membrane (ELM) and ellipsoid zone and the presence of hyperreflective plugs were assessed.

RESULTS

At baseline and 3, 6, and 12 months postoperatively, BCVA and severity of metamorphopsia were not significantly different between groups. The status of the ELM was significantly worse in the IF group than in the ILM peeling group at 3 and 6 months postoperatively. Significantly more hyperreflective plugs were observed in the IF group than in the ILM peeling group at 3 and 6 months postoperatively. Stepwise multi-regression analysis revealed that hyperreflective plugs were significantly associated with the severity of metamorphopsia at 12 months postoperatively.

DISCUSSION/CONCLUSION

The alterations on the OCT were fewer in the ILM peeling group than in the IF group, while no significant differences were observed in postoperative severity of metamorphopsia between groups. Metamorphopsia was worse in eyes with hyperreflective plugs.

Assessment of myopic rebound effect after discontinuation of treatment with 0.01% atropine eye drops in Japanese school-age children

PURPOSE

Having previously demonstrated the efficacy of 0.01% atropine eye drops for inhibiting progression of childhood myopia, we conducted additional analyses to assess post-treatment changes in myopia progression.

STUDY DESIGN

Analysis of follow-up data from a previously reported randomized controlled trial METHODS: A mixed-effects model was used to compare intergroup changes in spherical equivalent (SE) and axial length (AL) at 1 month and 12 months after discontinuation of 2-year treatment with atropine or placebo in 167 school-age children.

RESULTS

Follow-up measurements were available for 149 participants at 1 month after discontinuation of treatment and for 51 participants at 12 months after discontinuation. At 1 month post-treatment, differences between the atropine and placebo groups in least squares (LS) mean changes in SE and AL, respectively, from 24 months were -0.06 diopters (D) (95% CI: -0.21, 0.08; P = .39) and 0.02 mm (95% CI: -0.05, 0.08; P = .60). At 12 months post-treatment, intergroup differences (atropine vs placebo) in LS mean changes in SE and AL, respectively, were -0.13 D (95% CI: -0.35, 0.10; P = .26) and -0.02 mm (95% CI: -0.12, 0.09; P = .75). LS mean changes in SE and AL from treatment discontinuation did not differ between the groups at 1 or 12 months post-treatment.

CONCLUSION

Axial elongation was significantly less in the atropine group than in the placebo group. The suppression effect obtained at 2 years was maintained after 12 months. The absence of intergroup differences in myopia progression since treatment cessation suggests that myopic rebound did not occur.

A novel de-novo RB1 mutation identified in a patient with bilateral retinoblastoma

Retinoblastoma manifests as ocular malignancy due to mutations in the RB1 gene. A 17-month-old girl with bilateral retinoblastoma having no family history was admitted to our hospital. The right eye was enucleated but the other was preserved with systemic chemotherapy and topical treatment. The patient has been tumor-free for over 7 years since diagnosis. All exons of RB1 were sequenced and a novel 1-base pair deletion (NM_000321.2:c.2409del, p.Asn803Lysfs*7) was detected.

Multifocal Contact Lenses and 0.01% Atropine Eye Drops for Myopia Control Study: Research Protocol for a 1-Year, Randomized, Four-Arm, Clinical Trial in Schoolchildren

OBJECTIVES

Previous studies have shown that combined use of orthokeratology and 0.01% atropine (AT) eye drops can strongly prevent axial elongation in myopic children. However, the efficacy of combined use with multifocal contact lens (MFCL) and 0.01% AT remains unclear. The aim of this trial is to clarify the efficacy of MFCL+0.01% AT combination therapy for myopia control and safety.

METHODS

This prospective study is a randomized, double-masked, placebo-controlled trial with four arms. A total of 240 children aged 6 to 12 years with myopia is recruited and randomly assigned to one of the four groups in a ratio of 1:1:1:1 as follows: group 1: MFCL+AT combination therapy, group 2: MFCL monotherapy, group 3: AT monotherapy, and group 4: placebo. The participants will continue the assigned treatment for 1 year. The primary and secondary outcomes are the comparisons of axial elongation and myopia progression in the four groups during the 1-year study period.

DISCUSSION

The present trial would determine whether the MFCL+AT combination therapy is more effective in slowing axial elongation and myopia progression in schoolchildren as compared with each monotherapy or placebo, and it also confirm acceptable safety of the combination therapy.

Vision-Related Parameters Affecting Stereopsis after Retinal Detachment Surgery

Even after successful surgery, the stereopsis of retinal detachment (RD) patients is inferior to that of normal subjects. However, it is unclear which visual dysfunction in the affected eye is responsible for the postoperative stereopsis impairment. This study included 127 patients after successful surgery for unilateral RD. Stereopsis, best-corrected visual acuity (BCVA), severity of metamorphopsia, letter contrast sensitivity and amount of aniseikonia were examined at 6-month postoperatively. Stereopsis was assessed using the Titmus Stereo Test (TST) and TNO stereotest (TNO). Postoperative stereopsis (log) in patients with RD were 2.09 ± 0.46 in the TST and 2.56 ± 0.62 in the TNO. Multivariate analysis with stepwise regression revealed postoperative TST was associated with BCVA, and TNO was associated with BCVA, letter contrast sensitivity, metamorphopsia and absolute values of aniseikonia. In a subgroup analysis that selected those with more impaired stereopsis, postoperative TST was associated with BCVA (p < 0.001), and TNO was associated with letter contrast sensitivity (p < 0.005) and absolute values of aniseikonia (p < 0.05) by multivariate analysis. Deterioration of stereopsis after RD surgery was affected by a variety of visual dysfunctions. The TST was affected by visual acuity, while the TNO was affected by contrast sensitivity and aniseikonia.

Contrast sensitivity and quality of life following intravitreal ranibizumab injection for central retinal vein occlusion

SYNOPSIS/PRECIS

We investigated the relationship between contrast sensitivity (CS) and vision-related quality of life (VR-QOL) in patients with central retinal vein occlusion following ranibizumab intravitreal injection; CS showed a stronger association with VR-QOL than visual acuity.

BACKGROUND/AIMS

To investigate the relationship between CS, VR-QOL and optical coherence tomography (OCT) findings in patients with cystoid macular oedema secondary to central retinal vein occlusion (CRVO-CMO) following intravitreal injection of ranibizumab.

METHODS

This was a multicentre, open-label, single-arm, prospective study. The study included 23 patients with CRVO-CMO who were followed up for 12 months after treatment. The best-corrected visual acuity (BCVA), letter contrast sensitivity (LCS) and OCT images were obtained every month. For VR-QOL assessment, the 25-item National Eye Institute Visual Function Questionnaire (VFQ-25) was administered to the patients before treatment and at 3, 6 and 12 months following treatment.

RESULTS

The LCS and VFQ-25 composite score improved significantly from baseline to 12 months following treatment. The multiple regression analysis revealed that the LCS of the affected eye and BCVA of the fellow eye were related to the VFQ-25 composite score following treatment. The LCS improvement showed a significant correlation with the improvement in the VFQ-25 composite score, whereas the BCVA improvement was not correlated with the improvement in the VFQ-25 composite score. Stepwise multiple regression analyses revealed that, at the time of macular oedema resolution, the distance between the external limiting membrane and retinal pigment epithelium (ELM-RPE) and average ganglion cell-inner plexiform layer (GCIPL) thickness were associated with LCS.

CONCLUSION

CS had a stronger association with VR-QOL than with BCVA in patients with CRVO-CMO. With the resolution of macular oedema, CS was associated with ELM-RPE thickness and average GCIPL thickness.

Vision-related quality of life and subscale items following intravitreal ranibizumab injections for central retinal vein occlusion

PURPOSE

To evaluate the vision-related quality of life (VR-QOL) before and after intravitreal ranibizumab injections (IVR) for central retinal vein occlusion (CRVO) and to investigate subscale items of VR-QOL in detail.

STUDY DESIGN

A multicenter, open-label, prospective and comparative study.

METHODS

Twenty-three patients with treatment naïve CRVO and 22 age-matched normal controls were included. VR-QOL was assessed by 25-Item Visual Function Questionnaire (VFQ-25) before and up to 12 months post-treatment. The VFQ-25 composite score and 12 subscales were compared between CRVO patients and normal controls.

RESULTS

The VFQ-25 composite scores of CRVO patients showed significant improvement throughout the treatment period compared with baseline. The VFQ-25 composite scores both before and after treatment for CRVO were significantly lower than in normal controls. The subscale items, including general health, general vision, near activities, social functioning, mental health, role difficulties, dependency, and peripheral vision in CRVO, were significantly lower than in the normal controls even after treatment.

CONCLUSION

Vision-related QOL was low in patients with CRVO before treatment and improved with IVR. In spite of the improvements, several subscale items remained lower than in normal controls following treatment. Attention should be paid to the patients with CRVO and their decreased visual, social and psychological QOL.

Time course of changes in vision-related quality of life following intravitreal ranibizumab treatment for branch retinal vein occlusion

To evaluate the vision-related quality of life (VR-QOL) treated by intravitreal ranibizumab (IVR) in patients with branch retinal vein occlusion (BRVO) and to assess subscale items of the VR-QOL. This was prospective, multicenter, open-label, observational study including 38 patients with unilateral BRVO who underwent IVR treatment and 28 age-matched healthy subjects. VR-QOL using the 25-item National Eye Institute Visual Function Questionnaire (VFQ-25) and best-corrected visual acuity (BCVA) were examined before and at 3, 6, and 12 months after treatment. The VFQ-25 composite score and BCVA significantly improved from 3 to 12 months after IVR treatment (P < 0.05), such that there was no significant difference between the BRVO and control groups at 12 months. All subscales of the VFQ-25, except “general health”, significantly improved after treatment, while “near vision” and “mental health” were worse than those in healthy subjects (P < 0.05). Patients with superior BRVO had a lower “near vision” score than healthy subjects after treatment (P < 0.05). BCVA in the treated eye and fellow eye had no significant relationship with the VFQ-25 composite score before and after treatment. The VR-QOL of patients with BRVO improved with IVR treatment and was comparable to that of healthy subjects after 12 months. Superior BRVO particularly affected near vision for a low level.

Clinical performance of a custom-designed soft contact lens in patients with keratoconus and intolerance to rigid contact lenses

PURPOSE

This study evaluated the efficacy and safety of YOUSOFT^® soft contact lens (CL) (TOMEY-CL) in patients with keratoconus and intolerance to rigid CLs.

STUDY DESIGN

Retrospective observational study.

METHODS

Thirty-six eyes of 20 patients (14 men and 6 women) with keratoconus and rigid CL intolerance were included in the study. Four patients were unilateral. The mean age was 33.1 ± 11.7 (± standard deviation) years, the mean spherical refractive error was - 4.99 ± 3.97 D, and the mean cylindrical refractive error was - 3.39 ± 2.13 D. The following examinations were performed at baseline and were repeated at every visit; refractometry, visual acuity, corneal topography and pachymetry with an anterior OCT system. Corneal endothelial cell density was evaluated at baseline and every 6 months. Slit-lamp examination was also performed to confirm the CL condition and ocular health at every visit.

RESULTS

Seventeen patients (85%) were able to continue using the Yousoft. Among 3 patients (15%) who dropped out, 2 were dissatisfied with their visual outcomes and one had trouble with lens handling. Uncorrected visual acuity was 1.08 ± 0.43 (range: 0.22 to 2.00) logMAR at baseline, and best CL-corrected visual acuity was 0.01 ± 0.15 (range: - 0.18 to 0.40) logMAR, showing a significant improvement after wearing Yousoft (P < 0.0001). The endothelial cell density did not change significantly, with 2373 ± 482 at baseline and 2402 ± 464 cells/mm² at the latest visit after lens prescription (P = 0.351). There were no severe complications such as corneal infiltrates or infectious keratitis throughout the study period.

CONCLUSIONS

This study showed the efficacy and acceptable safety of Yousoft for patients with keratoconus and intolerance to rigid CLs.

Improvement in Dacryoendoscopic Visibility after Image Processing Using Comb-Removal and Image-Sharpening Algorithms

Recently, a minimally invasive treatment for lacrimal passage diseases was developed using dacryoendoscopy. Good visibility of the lacrimal passage is important for examination and treatment. This study aimed to investigate whether image processing can improve the dacryoendoscopic visibility using comb-removal and image-sharpening algorithms. We processed 20 dacryoendoscopic images (original images) using comb-removal and image-sharpening algorithms. Overall, 40 images (20 original and 20 post-processing) were randomly presented to the evaluators, who scored each image on a 10-point scale. The scores of the original and post-processing images were compared statistically. Additionally, in vitro experiments were performed using a test chart to examine whether image processing could improve the dacryoendoscopic visibility in a turbid fluid. The visual score (estimate ± standard error) of the images significantly improved from 3.52 ± 0.26 (original images) to 5.77 ± 0.28 (post-processing images; p < 0.001, linear mixed-effects model). The in vitro experiments revealed that the contrast and resolution of images in the turbid fluid improved after image processing. Image processing with our comb-removal and image-sharpening algorithms improved dacryoendoscopic visibility. The techniques used in this study are applicable for real-time processing and can be easily introduced in clinical practice.

Dacryoendoscopic recanalization of lacrimal passage obstruction/stenosis after radioiodine therapy for differentiated thyroid carcinoma

Purpose

Radioiodine therapy, a standard treatment for differentiated thyroid carcinomas, is associated with several adverse events including lacrimal drainage system obstruction. Herein, we describe the first case of duct lumen recanalization using dacryoendoscopy for lacrimal passage obstruction and stenosis after radioiodine therapy.

Observations

A 48-year-old female treated with radioiodine therapy for differentiated thyroid carcinoma 5 years prior presented with epiphora in both eyes. Dacryocystography showed nasolacrimal duct stenosis in the right eye and nasolacrimal duct obstruction in the left eye. Dacryoendoscopic examination revealed right common canalicular polyps, fibrosis in the right lacrimal sac, right nasolacrimal duct stenosis, and left upper and common canaliculus stenosis. Lacrimal passage recanalization with the insertion of a nasolacrimal stent tube using dacryoendoscopy was performed on the right eye. This successfully resolved the epiphora.

Conclusions and importance

Dacryoendoscopic examination for epiphora after radioiodine therapy may help detect early-stage nasolacrimal passage obstruction/stenosis. This condition can be resolved by recanalization and insertion of a lacrimal tube, without the need for a more invasive surgical approach such as dacryocystorhinostomy.

Relationship between stereopsis and vision-related quality of life in patients with branch retinal vein occlusion

Background

To investigate the relationship between stereopsis and vision-related quality of life (VR-QOL) in patients with branch retinal vein occlusion (BRVO) before and after treatment with intravitreal ranibizumab (IVR).

Methods

This prospective multicentred observational study included 37 patients undergoing IVR treatment for unilateral BRVO and 24 age-matched healthy controls.

Stereopsis was evaluated using the TNO stereo test (TNO) and Titmus stereo test (TST) every month, and the 25-item National Eye Institute Visual Function Questionnaire (VFQ-25) was administered at baseline, then at 3, 6 and 12 months after treatment.

Results

Time course of the changes in stereopsis and VR-QOL. IVR treatment significantly reduced central fovea thickness and improved both the TNO and the TST from 2 to 12 months (both p<0.05). Stereopsis before and after IVR injection in the eyes with BRVO were significantly worse than those in control subjects (TNO, p<0.001; TST, p<0.001). The VFQ-25 composite score significantly improved from 3 to 12 months after IVR treatment (p<0.05). Univariate analysis showed that the TNO score at baseline was significantly correlated with the VFQ-25 composite score at baseline and after treatment (p<0.05, p<0.05, respectively). TST score was not associated with the VFQ-25 composite score at baseline or after treatment.

Conclusions

Treatment with IVR for BRVO improved cystoid macular oedema, which was correlated to improved stereopsis, although not to the control level. The TNO score at baseline was associated with VR-QOL in patients with BRVO.

Myopia Control With Orthokeratology: A Review

ABSTRACT

A number of studies regarding the effect of orthokeratology (OK) on myopia progression have been published and shown that it can slow myopia progression in school-aged children. Recently, OK has been considered to be one of the most effective optical treatments for myopia control. This article reviewed the peer-reviewed literature on the efficacy of OK for myopia control. Although it cannot halt myopia progression completely, the inhibitory effect on axial elongation for 2 years has been reported to be from 32% to 63%, as compared with single-vision spectacles and contact lenses. In addition, the efficacy and acceptable safety have been confirmed even in several long-term studies up to 10 years. However, the possibility of a rebound phenomenon in myopia progression after OK discontinuation remains unknown. It is also unclear how long the treatment should be continued to attain the maximum benefit in each patient. In the near future, further research including assessment of rebound phenomenon should be conducted with longer follow-up periods in more diverse populations.

The Effect of Diquafosol Ophthalmic Solution on Clinical Parameters and Visual Function in Soft Contact Lens-Related Dry Eye

INTRODUCTION

This study evaluated the efficacy and safety of diquafosol ophthalmic solution (DQS) in soft contact lens (SCL)-related dry eye using artificial tear as a control.

METHODS

This study enrolled 26 patients with SCL-related dry eye. DQS and artificial tears (AT) were instilled into the right and left eyes, respectively, with their SCLs on. Dry eye examinations (including tear film breakup time, tear volume, and staining score) were performed and visual function (including contrast sensitivity) was also evaluated before (at baseline) and after treatment (at 4- and 8-week examinations). Subjective symptoms were assessed separately in each eye using a questionnaire on dry eye in contact lens wearers. The results were compared before and after treatment, and between the right eyes treated with DQS (the DQS eye) and the left eyes treated with AT (the AT eye) using the mixed effect model.

RESULTS

Corneal and conjunctival staining scores at 8-week examination were significantly lower than those at baseline in the DQS eye (p = 0.03; p < 0.001, respectively), but no significant changes were observed in the AT eye. Most subjective symptoms improved significantly in both the DQS and AT eyes. However, major subjective symptoms (dryness and blurry vision) improved significantly only in the DQS eye at 8-week examination. Contrast sensitivity at 8-week examination in the DQS eye improved significantly at 12 cycles/degree compared to baseline (p = 0.001) and was significantly better than that in the AT eye (p = 0.03). There were no adverse events related to DQS or AT.

CONCLUSIONS

DQS was effective and safe for SCL-related dry eye. DQS also improved contrast sensitivity.

TRIAL REGISTRATION

University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR), Identification No. UMIN000024064.

Comparison of Visual Performance and Patient Satisfaction After Multifocal Intraocular Lens Implantation and During Multifocal Contact Lens Wear After Monofocal Intraocular Lens Implantation: A Pilot Study

Purpose

To compare the visual performance and patient satisfaction in multifocal intraocular lens (IOL)-implanted eyes and multifocal contact lens (CL)-wearing eyes undergoing monofocal IOL implantation.

Methods

We retrospectively assessed visual acuity at all distances (0.3, 0.5, 0.7, 1, and 5 m), contrast sensitivity function, patient satisfaction score, and the rate of spectacle independence in the multifocal IOL and multifocal CL groups.

Results

Binocular visual acuity at 0.3, 0.5, 0.7, 1, and 5 m was 0.05 ± 0.11, − 0.02 ± 0.09, − 0.02 ± 0.09, − 0.02 ± 0.09, and − 0.04 ± 0.07, respectively, in the multifocal IOL group and 0.25 ± 0.13, 0.04 ± 0.10, 0.01 ± 0.09, − 0.01 ± 0.07, and 0.00 ± 0.08, respectively, in the multifocal CL group. We found significant differences in visual acuity at all distances. The area under the log contrast sensitivity function was 1.32 ± 0.14 and 1.33 ± 0.16 in the multifocal IOL and CL groups, respectively (p = 0.444). The patient satisfaction score for overall vision was 80.2 ± 20.6 and 82.9 ± 10.5 (p = 0.889), and the rate of spectacle independence was 23.4% and 41.7% in the multifocal IOL and CL groups, respectively (p = 0.277).

Conclusions

According to our experience, both multifocal IOLs and CLs provided good near-to-distance binocular vision and subsequent high patient satisfaction in daily activities with acceptable contrast sensitivity, suggesting their viability for presbyopic correction in elderly subjects.

Relationship between stereopsis and vision-related quality of life following intravitreal ranibizumab injections for central retinal vein occlusion

The study aimed to evaluate changes in stereopsis and vision-related quality of life (VR-QOL) in patients with central retinal vein occlusion (CRVO) following intravitreal ranibizumab injection (IVR) and investigate the relationship between stereopsis and VR-QOL. This study included 23 treatment-naïve patients with non-ischemic CRVO and 13 age-matched normal controls. Stereopsis, best-corrected visual acuity (BCVA), VR-QOL, and retinal microstructures were examined pre-treatment and 12 months post-treatment. The Titmus Stereo Test (TST) and TNO stereotest (TNO) were used to evaluate stereopsis. VR-QOL was evaluated using the 25-item National Eye Institute Visual Function Questionnaire (VFQ-25). IVR immediately and significantly improved the TST values, TNO values, composite VFQ-25 score, BCVA, and central foveal thickness in patients with CRVO. The 12-month post-treatment TST and TNO values were significantly worse in the CRVO group compared to those in the normal group. At the baseline, the composite VFQ-25 score significantly correlated only with the TST value. Multivariate analysis revealed significant associations between the 12-month post-treatment composite VFQ-25 score and the baseline and 12-month post-treatment TNO values. In conclusion, IVR immediately improved stereopsis in CRVO, albeit below normal levels. Stereopsis (not visual acuity) was associated with pre- and post-treatment VR-QOL in patients with CRVO.

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.

Clinical study on the effect of multifocal contact lenses on myopia progression in myopia school children : Multifocal contact lens study for suppression of myopia progression

BACKGROUND

The efficacy of peripheral low add multifocal soft contact lenses (SCLs) for suppressing the progression of myopia is controversial. The aim of the on-going present clinical study is to investigate whether or not multifocal SCLs with + 0.50 diopters (D) addition suppress the progression of myopia in myopic elementary school children.

DESIGN

Prospective randomized controlled trial.

SUBJECTS AND METHODS

The study plans to include a total of 100 myopic school children. Target subjects are primary school male and female students with mild to moderate myopia. Children who have eye-related diseases other than myopia are excluded from the study, because they may affect the evaluation of the outcome. Subjects will be randomly assigned to wear daily disposable multifocal contact lenses with + 0.50D addition or daily disposable SCLs. Subjects will wear contact lenses on both eyes and will be observed for 2 years under a double-masked examination. Primary outcome is a change in the axial length over the 2-year period.

OBJECTIVES

The purpose of this study is to identify whether or not multifocal SCLs with + 0.5D addition suppress the progression of myopia in myopic elementary school children as compared with standard SCLs.

TRIAL REGISTRATION

1. UMIN (University Hospital Medical Information Network) UMIN000027940. Registered on July 21, 2017 2. JRCT (Japan Registry of Clinical Trials) jRCTs052180172. Registered on March 26, 2019.

Relationship between metamorphopsia and inner retinal microstructure following intravitreal ranibizumab injection for branch retinal vein occlusion

To evaluate the effects of intravitreal ranibizumab injection (IVR) on metamorphopsia in patients with branch retinal vein occlusion (BRVO), and to assess the relationship between metamorphopsia and inner retinal microstructure and other factors. Thirty-three treatment-naïve eyes of 33 patients with macular edema caused by BRVO with at least 12 months of follow-up were included. The degree of metamorphopsia was quantified using the M-CHARTS. Retinal microstructure was assessed with spectral-domain optical coherence tomography. Disorganization of the retinal inner layers (DRIL) at the first month after resolution of the macular edema (early DRIL) and at 12 months after treatment (after DRIL) was studied. Central retinal thickness (CRT), and status of the external limiting membrane as well as ellipsoid zone were also evaluated. IVR treatment significantly improved best-corrected visual acuity (BCVA) and CRT, but the mean metamorphopsia score did not improve even after 12 months. Post-treatment metamorphopsia scores showed a significant correlation with pre-treatment metamorphopsia scores (P < 0.005), the extent of early DRIL (P < 0.05) and after DRIL (P < 0.05), and the number of injections (P < 0.05). Multivariate analysis revealed that the post-treatment mean metamorphopsia score was significantly correlated with the pre-treatment mean metamorphopsia score (P < 0.05). IVR treatment significantly improved BCVA and CRT, but not metamorphopsia. Post-treatment metamorphopsia scores were significantly associated with pre-treatment metamorphopsia scores, the extent of DRIL, and the number of injections. Prognostic factor of metamorphopsia was the degree of pre-treatment metamorphopsia.

Efficacy and safety of 0.01% atropine for prevention of childhood myopia in a 2-year randomized placebo-controlled study

PURPOSE

Atropine eye drops prevent the progression of myopia, but their use has not been tested in the Japanese schoolchildren population. Here, we evaluate the efficacy and safety of 0.01% atropine eye drops for myopia control in Japanese children.

STUDY DESIGN

Multicenter (7 university hospitals), randomized, double-masked, placebo-controlled trial.

METHODS

Participants were 171 Japanese schoolchildren aged 6 to 12 years, with progressive myopia, spherical equivalence (SE) of -1.00 to -6.00 diopters (D), and astigmatism of ≤1.5 D. They were randomized to receive either 0.01% atropine (n=85) or placebo (n=86) eye drops once nightly OU for 24 months. Primary and secondary efficacy endpoints were changes in SE and axial length (AL), respectively, from baseline to month 24.

RESULTS

Data from 168 subjects were analyzed. At month 24, compliance was similar in both groups (atropine: 83.3%; placebo: 85.7%). The least squares mean change in SE and AL from baseline were, respectively, -1.26 D (95% confidence interval [CI]: -1.35, -1.17) and 0.63 mm (0.59, 0.67) for atropine and -1.48 D (- 1.57, -1.39) and 0.77 mm (0.73, 0.81) for placebo. Inter-group differences were 0.22 D (95% CI: 0.09, 0.35; P < 0.001) for SE and - 0.14 mm (-0.20, -0.08; P < 0.001) for AL. Three patients experienced mild allergic conjunctivitis side effects, with no inter-group difference in incidence (atropine: 2.4%; 2/84 patients; placebo: 1.4%; 1/84 patients).

CONCLUSION

With good compliance, 0.01% atropine is effective and safe for preventing the progression of childhood myopia.

Influence of refractive status and age on corneal higher-order aberration

This study aimed to investigate the influence of refractive status and age of patients on corneal higher-order aberrations (HOAs). Four hundred and twenty-six right eyes of 426 patients were enrolled in this study. The mean and standard deviation of patient age was 47.7 ± 22.1 years. Total HOAs, spherical-like aberration, coma-like aberration, Z^-1₃, Z¹₃, Z^-3₃, Z^-3₃ and spherical aberration (Z⁰₄) for 6-mm pupil were measured using anterior segment optical coherence tomography (AS-OCT). Subjects were classified into three groups according to the amount of spherical equivalent refractive error (SE): myopia (<-0.5 D), emmetropia (-0.5 to 0.5 D), and hyperopia (>0.5 D). The amount of corneal astigmatism was recorded. Relationship between corneal aberrations, refractive status, astigmatism, and age was analyzed. In total, total HOAs, spherical-like aberration and amount of Z^-3₃ and Z⁰₄ were significantly larger in the hyperopia group than in the myopia group. After adjustment for age, however, aberration components did not differ among the three refractive groups. In multiple regression analysis, age and corneal astigmatism showed significant correlation with aberrations, whereas amount of SE and refractive status did not. The current study indicated that age and amount of corneal astigmatism have significant influence on corneal HOAs, but refractive status (myopia, emmetropia, or hyperopia) is not associated with corneal HOAs.

Influence of posterior corneal astigmatism on the outcomes of toric intraocular lens implantation in eyes with oblique astigmatism

PURPOSE

To assess whether the outcomes of toric intraocular lens (IOL) implantation in eyes with oblique astigmatism can be improved by direct measurements of posterior corneal astigmatism using anterior segment optical coherence tomography (AS-OCT) instead of by using anterior corneal measurements alone.

STUDY DESIGN

Retrospective case series.

METHODS

Two toric IOL power calculation methods were compared: anterior corneal astigmatism was used in the keratometry group, whilst total corneal astigmatism determined by ray tracing through the measured anterior and posterior corneal surfaces was used in the AS-OCT group. In a total of 279 eyes of 232 patients, subgroup analysis was conducted for with-the-rule (WTR) (85 eyes in the keratometry group and 34 eyes in the AS-OCT group), against-the-rule (ATR) (73/29 eyes), and oblique (26/32 eyes) astigmatism.

RESULTS

In the WTR and ATR astigmatism groups, the uncorrected distance visual acuity (UDVA) was significantly better in the AS-OCT group than in the keratometry group (P = 0.012 and P < 0.001, Mann-Whitney test), and the residual astigmatism was significantly smaller in the AS-OCT group than in the keratometry group (P = 0.037 and P < 0.001). In eyes with oblique astigmatism, the UDVA (P = 0.299) and residual astigmatism (P = 0.373) of the keratometry and AS-OCT groups did not differ.

CONCLUSION

Incorporation of posterior corneal astigmatism measured with AS-OCT can significantly improve the outcomes of toric IOL implantation in eyes with WTR and ATR astigmatism, but not in eyes with oblique astigmatism.

Influence of intermittent exotropia surgery on general health-related quality of life: different perception by children and parents

PURPOSE

To assess the general health-related quality of life (QOL) in children with intermittent exotropia (IXT) before and 3 months after surgery, by interviewing individual patients and their parents.

STUDY DESIGN

Prospective, interventional case series.

METHODS

Twenty-one patients undergoing IXT surgery and their parents were included. Using the Pediatric Quality of Life Inventory (PedsQL), children and parents were separately questioned about QOL of patients.

RESULTS

The mean patients' age was 8.6 ± 3.2 years (SD), with range of 5-16 years. The children responded that all PedsQL scores were significantly improved by surgery, and the highest improvement was observed in the school subscale score. When the parents rated the children's QOL, significant improvements were limited to 3 out of 7 subscales, including the emotional, psychosocial health summary, and total scores. The improvements in the PedsQL score were not correlated with age, size of deviation changes following surgery, nor the improvement in binocular vision.

CONCLUSIONS

The general health-related QOL significantly improved by surgery in pediatric patients with IXT, while the improvement was considerably underestimated by the parents. The children reported the greatest improvement in the school functioning subscale, whereas parents failed to discern this improvement. The discrepancy in children' and parents' views can be an important factor when considering indication of corrective surgery and evaluating surgical outcomes.

Improvement in Contrast Sensitivity Function after Lacrimal Passage Intubation in Eyes with Epiphora

This prospective case series aimed to investigate the contrast sensitivity function before and after lacrimal passage intubation (LPI) in eyes with epiphora due to lacrimal passage obstruction. We included 58 eyes of 51 patients who underwent LPI for lacrimal passage obstruction. The best-corrected visual acuity (BCVA), contrast sensitivity function, and lower tear meniscus were compared before LPI and one month after lacrimal duct stent removal. The area under the log contrast sensitivity function (AULCSF) was calculated for the analyses. Lower tear meniscus was assessed using anterior segment optical coherence tomography. The BCVA was comparable (p = 0.61) before and after LPI, while AULCSF increased significantly after treatment (before LPI: 1.29 ± 0.17, after LPI: 1.37 ± 0.14, p < 0.0001). Treatment resulted in a significant increase in contrast sensitivity at all spatial frequencies, 3–18 cycles/degree (p < 0.01 for 3, p < 0.01 for 6, p < 0.0005 for 12, p < 0.05 for 18 cycles/degree). The lower tear meniscus parameters improved significantly after treatment (p < 0.005); however, no correlation between the changes in the tear meniscus and those of the AULCSF was found. The contrast sensitivity significantly improved after LPI in eyes with epiphora due to lacrimal passage obstruction.

Assessment of conjunctival flora in eyes with lacrimal passage obstruction before and after successful dacryoendoscopic recanalisation

BACKGROUND

To investigate conjunctival bacterial flora in eyes with lacrimal passage obstruction before and after dacryoendoscopic recanalisation with lacrimal tube intubation.

METHODS

One-hundred fifty eyes with lacrimal passage obstruction that were successfully treated by dacryoendoscopic recanalisation were enrolled. Conjunctival sampling was done for each eye before and 4 months after surgery. The lower fornix was rubbed by a sterile cotton swab, and the collected samples were cultured with several agar plates. Colonies were differentiated and enumerated by standard bacteriological laboratory techniques.

RESULTS

Positive bacterial growth was detected in 42.0% of all the samples before surgery, and the positivity rate significantly decreased to 26.0% after surgery (p=0.0051). The number of strains detected also decreased from 20 before surgery to 9 after surgery, especially pathogenic microorganisms decreased. In addition, drug-resistant bacteria such as penicillin-resistant Streptococcus pneumoniae and methicillin-resistant Staphylococcus aureus were detected in nine eyes before surgery but were detected only in one eye after surgery. Coagulase-negative Staphylococci and Corynebacterium spp., which are common in normal conjunctival flora, accounted for 46.5% of all the isolates before surgery and 80.9% after surgery, showing a significant increase in the rate after surgery (p<0.0001).

CONCLUSIONS

This study showed that physiological recanalisation of lacrimal passage after dacryoendoscopic surgery significantly decreased the culture positivity rate of conjunctival sac and the number of microorganism strains detected. It also decreased the number of potentially pathogenic and drug-resistant bacteria and increased the percentages of indigenous bacteria, causing the normalisation of conjunctival flora.

Transfer of orbital angular momentum of light to plasmonic excitations in metamaterials

The emergence of the vortex beam with orbital angular momentum (OAM) has provided intriguing possibilities to induce optical transitions beyond the framework of the electric dipole interaction. The uniqueness stems from the OAM transfer from light to material, as demonstrated in electronic transitions in atomic systems. In this study, we report on the OAM transfer to electrons in solid-state systems, which has been elusive to date. Using metamaterials (periodically textured metallic disks), we show that multipolar modes of the surface electromagnetic excitations (so-called spoof localized surface plasmons) are selectively induced by the terahertz vortex beam. Our results reveal selection rules governed by the conservation of the total angular momentum, which is confirmed by numerical simulations. The efficient transfer of light's OAM to elementary excitations in solid-state systems at room temperature opens up new possibilities of OAM manipulation.

Deterioration of contrast sensitivity in eyes with epiphora due to lacrimal passage obstruction

Purpose

Epiphora causes deterioration in contrast sensitivity in some eye diseases. This study was conducted to investigate contrast sensitivity in eyes with epiphora caused by lacrimal passage obstruction.

Methods

This single-center, prospective case series enrolled 57 patients with unilateral lacrimal passage obstruction. The best-corrected visual acuity (BCVA), contrast sensitivity function, and lower tear meniscus of the affected and contralateral unaffected eyes were compared. The area under the log contrast sensitivity function (AULCSF) was calculated.

Results

The BCVA did not significantly differ between the affected and contralateral eyes, while the AULCSF was significantly lower in the affected eyes than that in the contralateral eyes (median 1.35, interquartile range 1.22–1.44 vs. median 1.36, interquartile range 1.28–1.46, P = 0.032). Lower tear meniscus parameters were significantly higher in the affected eyes than those in the contralateral eyes (P < 0.005).

Conclusions

The contrast sensitivity function is significantly diminished in eyes with epiphora caused by lacrimal passage obstruction.

Preoperative aniseikonia is a prognostic factor for postoperative stereopsis in patients with unilateral epiretinal membrane

PURPOSE

To investigate stereopsis and other visual functions in patients with unilateral epiretinal membrane (ERM) and to identify vision-related parameters affecting stereopsis.

METHODS

This prospective study included 63 consecutive patients who were scheduled to undergo vitrectomy for unilateral idiopathic ERM. We examined stereopsis (Titmus Stereo Test, TST; TNO stereotest, TNO), best-corrected visual acuity (BCVA), letter contrast sensitivity, severity of metamorphopsia, and degree of aniseikonia preoperatively and 6 months postoperatively.

RESULTS

Preoperatively, we observed significant correlation between TST scores and other vision-related parameters except severity of metamorphopsia and between TNO score and all the vision-related parameters. Multiple regression analysis showed that preoperative TST and TNO scores were significantly associated with the degree of aniseikonia (both P < 0.01). ERM surgery significantly improved stereopsis, BCVA, contrast sensitivity, and metamorphopsia, but not aniseikonia. Postoperatively, TST was significantly associated with BCVA, and TNO showed association with BCVA and aniseikonia. Postoperative TST and TNO scores showed significant correlation with preoperative aniseikonia (P < 0.005 and P < 0.001, respectively).

CONCLUSIONS

Impairment of stereopsis in patients with unilateral ERM was considered to be due to retinally induced aniseikonia. Aniseikonia did not improve by surgery, and preoperative aniseikonia can be a prognostic factor for postoperative stereopsis.

Vision-related parameters that affect stereopsis in patients with macular hole

This study evaluated stereopsis and other visual functions in patients with idiopathic macular hole (MH), and sought to identify vision-related parameters that affect stereopsis. In this prospective, consecutive, comparative study, 39 eyes of 39 patients with unilateral idiopathic MH were included. At baseline and at 6 months after MH surgery, we evaluated stereopsis, with the Titmus stereo test (TST) and TNO stereotest (TNO), best-corrected visual acuity (BCVA), letter contrast sensitivity, severity of metamorphopsia, as assessed using M-CHARTS, and extent of aniseikonia, by the new aniseikonia test. Preoperative stereopsis (log) in patients with MH were 2.72 ± 0.53 (range 1.9–4.1) in the TST and 2.82 ± 0.65 (range 1.8–3.9) in the TNO. Preoperative TST was significantly correlated with letter contrast sensitivity (p < 0.05), but not with the other visual functions. TNO showed significant correlation with letter contrast sensitivity (p < 0.05) and aniseikonia (p < 0.005). Preoperative TNO was associated with aniseikonia by multivariate analysis (p < 0.005). MH surgery significantly improved stereopsis, BCVA, letter contrast sensitivity, metamorphopsia, and aniseikonia. Postoperative TST and TNO was significantly associated with BCVA by multivariate analysis. Deterioration of stereopsis in MH patients is associated with contrast sensitivity and the degree of aniseikonia.

Distribution of corneal spherical aberration in a Tanzanian population

Purpose

To investigate the distribution of corneal spherical aberration (SA) in Tanzanian people of African descent, and to examine the correlation between corneal SA and ocular parameters.

Design

Cross-sectional population-based study.

Methods

Residents aged 40 years and older in three villages in the Mkuranga district in Tanzania were enlisted as study participants. Corneal higher-order aberrations (HOAs) for the right eye were measured with a wavefront analyzer (KR-1W, Topcon) and calculated for the central 6.0-mm zone. Corneal curvature radius (CR), corneal astigmatism, and axial length (AL) were also measured and their correlation with corneal SA was assessed.

Results

The right eyes of 657 participants (336 male, 321 female) were analyzed. The mean age of the subjects was 57.2 ± 10.3 years (mean ± SD). The mean corneal SA (Zernike spherical aberration coefficient C₄⁰) was 0.188 ± 0.095 μm (-0.242 to 0.613). The SAs in about three-quarters of all subjects were between 0.10 and 0.30 μm. The root mean squares of total corneal HOAs and the third- and fourth-order aberrations were 0.629 ± 0.250 μm, 0.539 ± 0.236 μm, and 0.269 ± 0.110 μm, respectively. Corneal SA showed weak significant correlations with CR (Spearman’s rank correlation coefficient, r = -0.177, p < 0.001), corneal astigmatism (r = -0.142, p < 0.001), AL (r = -0.168, p < 0.001), and age (r = -0.085, p < 0.05).

Conclusions

This finding may be beneficial for selecting aspheric intraocular lens in this population.

IMI - Clinical Myopia Control Trials and Instrumentation Report

The evidence-basis based on existing myopia control trials along with the supporting academic literature were reviewed; this informed recommendations on the outcomes suggested from clinical trials aimed at slowing myopia progression to show the effectiveness of treatments and the impact on patients. These outcomes were classified as primary (refractive error and/or axial length), secondary (patient reported outcomes and treatment compliance), and exploratory (peripheral refraction, accommodative changes, ocular alignment, pupil size, outdoor activity/lighting levels, anterior and posterior segment imaging, and tissue biomechanics). The currently available instrumentation, which the literature has shown to best achieve the primary and secondary outcomes, was reviewed and critiqued. Issues relating to study design and patient selection were also identified. These findings and consensus from the International Myopia Institute members led to final recommendations to inform future instrumentation development and to guide clinical trial protocols.

Effect of spectacle lenses designed to reduce relative peripheral hyperopia on myopia progression in Japanese children: a 2-year multicenter randomized controlled trial

PURPOSE

Novel spectacle lenses (MyoVision, Carl Zeiss) designed to reduce relative peripheral hyperopia have been developed and reported to be effective for preventing myopia progression in a subgroup of Chinese children. In this study we examined the efficacy of MyoVision lenses in Japanese children.

STUDY DESIGN

This was a multicenter prospective randomized double-blind placebo-controlled trial.

METHOD

We enrolled 207 participants (aged 6-12 years) with spherical equivalent refractions (SERs) ranging from -1.5 to -4.5 diopters (D) and with at least 1 myopic parent. The participants were randomized to receive either single vision lenses (SVLs) or MyoVision lenses and were followed up every 6 months for 2 years. The primary outcome was myopia progression evaluated by cycloplegic autorefraction, and the secondary outcome was elongation of axial length.

RESULTS

A total of 203 children (98.1%) completed the follow-up. The mean adjusted change in SER was -1.43 ± 0.10 D in the MyoVision group, which was not significantly different from that of the control group wearing SVLs (-1.39 ± 0.07 D) at the 24-month visit (P = .65). The adjusted axial length elongation was 0.73 ± 0.04 mm in the MyoVision group, which was not significantly different from that in the control group wearing SVLs (0.69 ± 0.03 mm) at the 24-month visit (P = .28).

CONCLUSION

The results of this clinical trial could not verify the therapeutic effect of MyoVision for slowing down myopia progression in Japanese children. Additional studies are needed to design lenses that can reduce peripheral hyperopic defocus individually and to examine the effectiveness of these lenses in preventing myopia progression.

The Effect of Ocular Surface Regularity on Contrast Sensitivity and Straylight in Dry Eye

Purpose

To investigate the association between visual function and ocular surface regularity in dry eye.

Methods

We enrolled 52 eyes of 52 dry eye patients (34 dry eyes with superficial punctate keratopathy [SPK] in the central corneal region [central SPK] and 18 dry eyes without central SPK) and 20 eyes of 20 normal control subjects. All eyes had a best-corrected distance visual acuity better than 20/20. We measured two indices of contrast sensitivity function under photopic conditions: contrast sensitivity and letter contrast sensitivity. The area under the log contrast sensitivity function (AULCSF) was calculated from the obtained contrast sensitivity data. Straylight was quantified using a straylight meter.

Results

Dry eyes with central SPK had significantly decreased contrast sensitivity function, including AULCSF and letter contrast sensitivity than those without central SPK and normal eyes (P < 0.05 for each). While the straylight values in both dry eye groups did not differ, straylight values were greater than those in normal eyes (P < 0.05 for both). In dry eye, the AULCSF and letter contrast sensitivity negatively correlated with the central SPK score (R = -0.485, P < 0.001, and R = -0.541, P < 0.001, respectively).

Conclusions

In dry eye, reduced contrast sensitivity in part results from central SPK overlying the optical zone and the increased straylight results from tear film instability rather than central SPK.

Influence of intraocular lens subsurface nanoglistenings on functional visual acuity

To investigate the influence of intraocular lens subsurface nanoglistenings (SSNGs) on functional visual acuity (FVA), thirty-nine eyes of 29 patients were examined in this study. The SSNG group comprised 19 eyes of 14 patients (75.7± 5.4 years, mean ± standard deviation), and the control group comprised 20 eyes of 15 patients (73.6 ± 6.5 years). The SSNGs were diagnosed on the basis of the typical whitish IOL appearance upon slit-lamp examination and results of densitometry regarding surface light scattering using Scheimpflug images. The FVA measurement system (AS-28; Kowa, Aichi, Japan) was used to examine changes in continuous visual acuity (VA) over time, and visual function parameters such as FVA, visual maintenance ratio (VMR), maximum VA, minimum VA, standard deviation of VA, and number of blinks were assessed. The results were compared between the SSNG and control groups, and correlations of FVA parameters with the intensity of surface light scattering, time after surgery, and age were also evaluated. There were significant differences in VMR (P = 0.035) and standard deviation of VAs (P = 0.031) between the two groups, although no significant differences were found in baseline VA, FVA, maximum VA, minimum VA, and number of blinks. None of the FVA parameters showed any significant correlations with the intensity of surface light scattering, time after surgery, or age. There is a possibility that VA is unstable during a continuous gazing task in patients with SSNGs.

Influence of posterior corneal astigmatism on postoperative refractive astigmatism in pseudophakic eyes after cataract surgery

Background

To examine the influence of posterior corneal astigmatism on postoperative refractive astigmatism in pseudophakic eyes after cataract surgery.

Methods

The study enrolled 64 pseudophakic eyes of 50 patients (71.8 ± 9.9 years old, mean ± standard deviation) who had undergone phacoemulsification with non-toric IOL implantation. Refractive astigmatism was measured using an auto ref-keratometer with a 0.01- diopter (D) scale. Two types of corneal astigmatism were calculated using anterior segment optical coherence tomography; keratometric and total corneal astigmatism. Keratometric astigmatism was obtained based on anterior corneal curvature alone and total corneal astigmatism was calculated using both anterior and posterior corneal curvatures. The difference between refractive and corneal astigmatism was computed as the vector difference using 1) refractive and keratometric astigmatism and 2) refractive and total corneal astigmatism.

Results

The mean refractive, keratometric, and total corneal astigmatism was 0.92 ± 0.48 D, 0.87 ± 0.44 D, and 0.94 ± 0.46 D, respectively. The difference between refractive and keratometric astigmatism (0.70 ± 0.40 D, mean vector of 0.30 D axis 164°) was significantly larger than the difference between refractive and total corneal astigmatism (0.63 ± 0.38 D, mean vector of 0.12 D axis 137°) (P = .019).

Conclusions

The difference between refractive and total corneal astigmatism, calculated using both anterior and posterior corneal curvatures, was significantly smaller than the difference between refractive and keratometric astigmatism using anterior corneal astigmatism alone, implying that the latter overestimates the true postoperative refractive astigmatism and can cause cylindrical inaccuracy after cataract surgery.

Differences of Longitudinal Chromatic Aberration (LCA) between Eyes with Intraocular Lenses from Different Manufacturers

Several researchers have studied the longitudinal chromatic aberration (LCA) of eyes implanted with an intraocular lens (IOL). We investigated the LCA of eyes implanted with yellow-colored IOLs from three different manufacturers: Alcon Inc., HOYA Corp., and AMO Inc. The number of subjects was 11, 16, and 16, respectively. The LCA of eyes implanted with SN60WF and SN60AT (Alcon Inc.), and with XY-1 (HOYA Corp.), was the same as that of phakic eyes. The LCA of eyes with ZCB00V (AMO Inc.) was smaller than that of phakic eyes. The LCA of eyes implanted with Alcon’s and HOYA’s IOLs, but not the LCA of eyes implanted with AMO’s IOLs, was positively correlated with the powers of the IOLs. We also performed simulations to verify the impacts of LCA on visual performance for 4-mm pupil diameter; the simulations were a polychromatic modulation transfer function (MTF) and a visual Strehl ratio computed on the basis of an optical transfer function (VSOTF). We concluded that the differences between the LCA of different manufacturers do not affect visual performances when some extent of higher-order aberration (HOA) exists. The smaller HOA of AMO IOLs may enhance visual performance.

Apparent accommodation in pseudophakic eyes with refractive against-the-rule, with-the-rule and minimum astigmatism

AIM

To compare the magnitude of apparent accommodation in pseudophakic eyes with refractive against-the-rule (ATR), with-the-rule (WTR) and minimum astigmatism. Factors associated with apparent accommodation were also examined in each group.

METHODS

In total, 87 pseudophakic eyes (87 patients) that underwent monofocal intraocular lens (IOL) implantation after uneventful cataract surgery were included. There were 33, 24 and 30 eyes with refractive ATR, WTR and minimum (<0.5 dioptres) astigmatism, respectively. Age, time after surgery, pupil size, corneal and refractive astigmatism, axial length, IOL power, best-corrected visual acuity, corneal multifocality, ocular wavefront aberrations and apparent accommodation without cylindrical correction were compared among the three groups.

RESULTS

No significant difference was found in the amount of apparent accommodation between groups. In the ATR group, the amount of apparent accommodation was significantly correlated with pupil size (r=-0.470, p=0.005) and refractive astigmatism (r=0.529, p=0.001). In the WTR group, the amount of apparent accommodation was significantly correlated with coma Zernike term (r=0.409, p=0.047). In the minimum astigmatism group, corneal multifocality was significantly associated with apparent accommodation (r=0.464, p=0.009).

CONCLUSION

There was no significant difference in the average amount of apparent accommodation in pseudophakic eyes with refractive ATR, WTR and minimum astigmatism. However, the factors relevant to apparent accommodation varied depending on the status of postoperative refractive astigmatism.

Mesopic Functional Visual Acuity in Normal Subjects

To evaluate mesopic functional visual acuity (FVA) with a newly developed system in normal subjects and to compare the results with photopic FVA, sixty-eight healthy volunteers (24.03 ± 4.42 [mean ± standard deviation] years) were enrolled in this study. A commercially available FVA measurement system (AS-28; Kowa, Aichi, Japan) was modified to measure FVA under mesopic conditions as well as photopic conditions. Measurements were performed monocularly in photopic conditions during 60 seconds. After dark adaptation for 15 minutes, the same measurements were repeated in mesopic conditions. Outcomes included starting visual acuity (VA), FVA (the average of VAs), visual maintenance ratio (VMR), maximum VA, minimum VA, and numbers of blinks during the 60-second measurement session, and were compared between mesopic and photopic conditions. Starting VA was –0.11 ± 0.08 and 0.39 ± 0.12 logarithm of the minimum angle of resolution (logMAR) in photopic and mesopic conditions, respectively. FVA was –0.06 ± 0.09 and 0.52 ± 0.14 logMAR, VMR was 0.98 ± 0.02 and 0.94 ± 0.04, maximum VA was –0.15 ± 0.06 and 0.33 ± 0.12 logMAR, the minimum VA was 0.05 ± 0.12 and 0.78 ± 0.20 logMAR, and the number of blinks was 8.23 ± 7.54 and 7.23 ± 6.20, respectively. All these parameters except the number of blinks were significantly different between the two conditions (P < 0.001). Besides, the difference between maximum and minimum VAs and standard deviation of VA were significantly larger in mesopic than in photopic conditions (P < 0.001). This study revealed that not only overall visual function decline but also instability of vision under mesopic conditions even in healthy subjects.