Jan van der Linden

Comparison of a new-generation sectorial addition multifocal intraocular lens and a diffractive apodized multifocal intraocular lens.

PURPOSE: To compare visual, refractive, and satisfactory outcomes between a new‐generation sectorial addition multifocal intraocular lens (IOL) (Lentis Mplus LS‐312; study group) and a diffractive apodized multifocal IOL (Restor SN6AD1; control group). SETTING: Private practice, Driebergen, and Department of Ophthalmology, Academic Medical Center, Amsterdam, The Netherlands. DESIGN: Comparative case series. METHODS: Refractive and visual outcomes at near and distance, patient satisfaction, and dysphotopsia scores were recorded 3, 6, and 12 months postoperatively. RESULTS: The study group comprised 90 eyes and the control group, 143 eyes. Three months postoperatively, the mean uncorrected distance visual acuity (UDVA) was not statistically significantly different between the study group and the control group (0.04 ± 0.15 logMAR [SD] versus 0.06 ± 0.25 logMAR). The control group had significantly better uncorrected near visual acuity than the study group at 30 cm (0.05 ± 0.14 logMAR versus 0.15 ± 0.08 logMAR) and 40 cm (0.05 ± 0.14 versus 0.16 ± 0.21) (P<.01 and P<.03, respectively). Patients in the control group were more satisfied with their vision (P<.001). Dissatisfaction was related to younger age at surgery and male sex (P<.0001 and P<.033 respectively). Dysphotopsia occurred in approximately 18% of cases in both groups. CONCLUSIONS: The new sectorial addition multifocal IOL performed comparably to the diffractive apodized multifocal IOL in terms of UDVA and the presence of dysphotopsia. The diffractive apodized multifocal IOL performed better at 30 cm and 40 cm reading distances and had higher patient satisfaction. Financial Disclosure: Dr. Lapid‐Gortzak has received speaker’s fees from Alcon, Simovision, Oculentis, and Medtechnika. Dr. Lapid‐Gortzak and Dr. van der Meulen have received an unrestricted research grant from Oculentis. Dr. van Velthoven has received speaker’s fees from Novartis (Netherlands). Drs. van der Linden, Nieuwendaal, and Mourits have no financial or proprietary interest in any material or method mentioned.

In-the-bag decentration of a hydrophilic radially asymmetric multifocal intraocular lens secondary to capsule contraction.

We report a case of in-the-bag decentration and tilt of a hydrophilic rotationally asymmetric multifocal intraocular lens (IOL) of the M Plus type secondary to capsule contraction. After uneventful surgery and follow-up for 3 months, progressive decentering and tilting of the IOL secondary to capsule contraction and capsulorhexis phimosis was noticed. A surgical procedure was necessary to restore correct centration of the IOL. The uncorrected distance and near visual acuities were restored to logMAR 0. Hydrophilic multifocal IOLs of this specific design may be sensitive to postoperative decentration. Capsular tension rings may alleviate the problem in a secondary repair procedure. The softness of the C-loop haptics of this IOL type may also play a role in the decentration.

Advanced personalized nomogram for myopic laser surgery: First 100 eyes

PURPOSE: To report the results in the first 100 eyes treated for myopia using a new advanced nomogram. SETTING: Private refractive surgery clinic. METHODS: This prospective interventional case series comprised 58 patients (100 eyes) consecutively treated for myopia with laser in situ keratomileusis (LASIK) or laser‐assisted subepithelial keratectomy (LASEK) performed by the same surgeon. All treatments used a new nomogram for the Zyoptix 217 Z100 excimer laser. Postoperative mean sphere, cylinder, and spherical equivalent (SE) refraction were evaluated 3 months postoperatively. Safety, efficacy, and predictability were also evaluated. RESULTS: In the LASIK group (34 eyes), the mean postoperative sphere was +0.18 diopters (D) ± 0.47 (SD), the mean postoperative cylinder was −0.10 ± 0.23 D, and the mean postoperative SE was 0.04 ± 0.36 D. In the LASEK group (64 eyes), the respective means were 0.10 ± 0.22 D, −0.05 ± 0.13 D, and +0.03 ± 0.16 D. Hyperopic overcorrection (≥+1.00 D) occurred in 4.1% of patients. Ninety‐five percent of eyes in the LASIK group and 97% of eyes in the LASIK group had an uncorrected visual acuity of 1.0 (20/20) or better. Patient satisfaction was slightly higher than that of other laser refractive surgery patients at the clinic. CONCLUSIONS: The use of the advanced nomogram increased treatment accuracy in terms of UCVA and postoperative mean refraction and reduced the rate of hyperopic overcorrection over that in earlier studies. The need for enhancement procedures was reduced, and patient satisfaction was high.

Straylight before and after hyperopic laser in situ keratomileusis or laser-assisted subepithelial keratectomy

PURPOSE: To compare straylight values before and 3 months after hyperopic laser in situ keratomileusis (LASIK) or laser‐assisted subepithelial keratectomy (LASEK) and determine the cause of any change. SETTING: Private refractive surgery clinic, Driebergen, The Netherlands. DESIGN: Comparative case series. METHODS: Straylight (by definition the measure for glare disability) was measured preoperatively and postoperatively with a C‐Quant straylight meter and recorded as log(s). The main outcome measures were the difference between postoperative and preoperative straylight values. RESULTS: The mean increase in straylight from preoperatively to postoperatively was 0.051 log(s) ± 0.158 (SD) in the LASIK group (39 eyes) and 0.031 ± 0.146 log(s) in the LASEK group (26 eyes). Although neither change was statistically significant, it was clinically significant in some cases. Haze or interface debris was seen in some eyes with increased straylight. The mean postoperative spherical equivalent refraction was −0.05 ± 0.27 diopter. CONCLUSIONS: Although straylight increased slightly after hyperopic LASIK and LASEK, the increase was not statistically significant. Some eyes with increased straylight had haze or interface debris. The cause of the increased straylight could not be determined in some cases. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned. Additional disclosures are found in the footnotes.

The limited impact of some ‘major determinants’ of the land market: Supply of land for housing in Lahore and Karachi, Pakistan

Abstract This paper compares the supply of urban land for housing in the two major cities of Pakistan: Lahore and Karachi. Conditions for land supply greatly differ between these cities: Lahore is situated in the middle of a fertile, intensively cultivated plain, where the bulk of land around the city is privately owned. Karachi is surrounded by unused semi-desert land which for the major part is public property. In the absence of a national land policy, policies are formulated at the provincial level, so there is scope for adaptation to the differing circumstances in both cities. After a description of the practice of land supply in the two cities over the past decadees, the paper concludes that there is no basic difference between the practices, and the results, of public land supply in both cities. Apparently, neither circumstantial factors, nor the legal position of land determines, or even conditions, the policies and behaviour of public agencies dealing with land supply. Under very different circumstances, it is the same sort of interest which is being served by the practice of land supply in both cities.