Lurdes Belda-Salmerón

Clinical outcomes after implantation of a posterior chamber collagen copolymer phakic intraocular lens with a central hole for myopic correction.

Purpose To evaluate the efficacy, predictability, safety, and stability of a new‐model posterior chamber Implantable Collamer Lens phakic intraocular lens (pIOL) (V4c Visian) to correct myopia. Setting Private practice, Oviedo, Spain. Design Case series. Methods This study enrolled patients who had implantation of a new pIOL design with a central hole for more natural aqueous flow, eliminating the need for neodymium:YAG iridotomy or peripheral iridectomy. The uncorrected (UDVA) and corrected (CDVA) distance visual acuities, refractive error, intraocular pressure (IOP), endothelial cell count, central vault, and adverse events were evaluated 6 months postoperatively. Results The study enrolled 138 eyes (70 patients). The mean spherical equivalent decreased from −8.73 diopters (D) ± 2.54 (SD) preoperatively to −0.03 ± 0.19 D 6 months postoperatively; 98.5% of eyes were within ±0.50 D and 100% of eyes were within ±1.00 D. The mean UDVA and CDVA were 20/20 or better in 92.1% and 95.0% of eyes, respectively, at 6 months. The safety and efficacy indices were 1.01 and 1.00, respectively. Postoperatively, the IOP remained stable over time. No significant rises in IOP (including pupillary block) and no secondary cataract were found. After 6 months, the mean vault was 482.7 ± 210.5 &mgr;m (range 90 to 970 &mgr;m) and the mean endothelial cell loss was 8.5%. Conclusions Implantation of the pIOL was effective, predictable, safe, and stable for the correction of moderate to high myopic errors. This design, which avoids iridotomy or iridectomy, provided good IOP outcomes. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

In vitro power profiles of multifocal simultaneous vision contact lenses

PURPOSE To evaluate the power profile of multifocal contact lenses (CLs) using a new technology based on quantitative deflectometry. METHODS The Nimo TR1504 was used to analyze the power distribution of multifocal CLs. The CLs under study were: Air Optix Aqua Multifocal Low, Medium and High Addition and Focus Progressives. Three lenses of each model were considered. RESULTS All multifocal CLs showed a power profile characterized by a change toward more positive power values when aperture sizes become smaller. The near refractive addition of the lenses under study was +2.61 D, +1.44 D, +1.30 D and +0.30 D for the Focus Progressives, the Air Optix Aqua Multifocal High, Medium Add and Low Add, respectively. The refractive power of the Focus Progressives did not reach the value of the nominal distance power until a radial distance of 0.9 mm from the center of the lens. For the Air Optix Aqua Multifocal Low Add the distance nominal power was reached at a radial distance of 1.5mm from the center of the lens, whereas this occurred at a distance of 1.8mm for the Air Optix Aqua Multifocal Medium and High Add. CONCLUSION The relation between the pupil diameter of the patients and the power profile of these CLs has a crucial implication on the final distance correction and near addition that these lenses provide to patients. Practitioners should know the power profile of these CLs and measure the pupil diameter of each patient in different situations in order to carry out a customized fitting.

Comparison of two artificial tear formulations for dry eye through high‐resolution optical coherence tomography

Purpose:  The aim was to determine the efficacy of two artificial eye‐drop formulations by analysing the lower tear film meniscus volume through a commercial high‐resolution spectral‐domain optical coherence tomographer.

In vitro power profiles of daily disposable contact lenses

PURPOSE To evaluate and compare the distribution of refractive power within the optic zone of different soft contact lenses and to investigate the effect of lens decentration on the power profiles. METHODS The Nimo TR1504 instrument was used to measure the optical power across different aperture diameters (from 1.5mm to 5.5mm in steps of 0.5mm) of four daily disposable contact lenses: DAILIES TOTAL1, Proclear 1-Day, SofLens daily disposable and 1-DAY ACUVUE MOIST. Measurements were performed using a wet cell. Power data were evaluated when contact lenses were in its centered position and after inducing different amounts of lens decentration (from 0.2mm to 1.0mm in steps of 0.2mm). RESULTS All contact lenses showed an increase - more negative - in lens power with distance from the lens center. The amount of change varied depending on the lens. It was about 10% of lens power for DAILIES TOTAL1 (-0.29diopters (D)), SofLens daily disposable (-0.36D), and Proclear 1-Day (-0.32D) whereas 1-DAY ACUVUE MOIST showed a percentage variation of 3.3% (-0.10D). After inducing a lens decentration up to 1mm, the power curves were shifted in the negative direction. However, the change obtained in lens power compared with well-centered position was always lower than a quarter of diopter both for all the lenses and aperture diameters. CONCLUSIONS Our results showed a variation of the refractive power from the lens center, becoming more negative toward the periphery, with a negligible effect of the decentration for all disposable contact lenses studied.

Collagen copolymer posterior chamber phakic intraocular lens for hyperopia correction: Three-year follow-up

Purpose To assess the efficacy, predictability, safety, and stability of the Visian V3 Implantable Collamer Lens posterior chamber phakic intraocular lens (PC pIOL) for moderate to high hyperopia. Setting Private clinic, Oviedo, Spain. Design Prospective nonrandomized clinical study. Methods The uncorrected (UDVA) and corrected (CDVA) distance visual acuities, manifest refraction, endothelial cell density, intraocular pressure (IOP), central vault, and adverse events were evaluated for 3 years postoperatively. Results The study comprised 73 eyes of 44 patients. The mean spherical equivalent decreased from +4.84 diopters (D) ± 1.6 (SD) (range +1.00 to +7.75 D) preoperatively to −0.13 ± 0.39 D 3 years postoperatively; 61 eyes (83.6%) were within ±0.50 D of the target refraction and all eyes were within ±1.00 D. The mean postoperative Snellen decimal UDVA and CDVA was 0.86 ± 0.17 and 0.91 ± 0.16, respectively. Most eyes (91.8%) had no change from the preoperative CDVA or gained 1 or more lines. One eye (1.4%) lost 2 lines, and no eye lost more than 2 lines. Three years postoperatively, the efficacy index was 1.02 and the safety index was 1.08. The IOP remained stable over time, with no significant increase postoperatively. The mean endothelial cell loss was 4.7%, remaining unchanged over time. No postoperative complications or adverse events, including pupillary block or secondary cataract, occurred. Conclusions Implantation of the PC pIOL was safe and effective in correcting hyperopic refractive errors, with stable visual and refractive outcomes. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

Contrast sensitivity and color perception with orange and yellow intraocular lenses.

Purpose To evaluate contrast sensitivity function (CSF) and color vision after implantation of either orange or yellow-tinted intraocular lenses (IOLs). Methods Fifty-six eyes of 28 cataract patients who had bilateral implantation of orange-tinted (PC440Y Orange, Ophtec), yellow-tinted (AcrySof Natural SN60AT, Alcon), or clear (AcrySof SA60AT, Alcon) IOLs were examined. Six months postoperatively, monocular CSF under photopic and mesopic (with and without glare) conditions were measured using the Functional Visual Analyzer. Color discrimination was determined with the Farnsworth-Munsell 100-Hue test. Results Patients implanted with orange-tinted, yellow-tinted, or clear IOLs displayed similar CSF values, with no statistically significant differences at any spatial frequency (p>0.05). There were no statistically significant differences in chromatic discrimination among the 3 groups of patients (p>0.05). Conclusions Orange or yellow blue-filtering IOL implantation is comparable to a clear IOL in terms of photopic and mesopic contrast sensitivity or color discrimination.

Foldable Iris-fixated Phakic Intraocular Lens vs Femtosecond Laser–assisted LASIK for Myopia Between −6.00 and −9.00 Diopters

PURPOSE To compare visual, refractive, and clinical outcomes of foldable iris-fixated phakic intraocular lens (PIOL) implantation versus femtosecond laser-assisted LASIK for myopia between -6.00 and -9.00 diopters (D). METHODS Forty-six myopic patients were randomized to undergo bilateral Artiflex (Ophtec BV) PIOL implantation or bilateral femtosecond laser-assisted conventional LASIK with the VISX S2 (Abbott Medical Optics). Refraction, uncorrected (UDVA) and corrected (CDVA) distance visual acuity, contrast sensitivity, corneal endothelial cell count, rate of retreatment, and complications were compared. RESULTS Twelve months after surgery, no statistically significant differences were noted in spherical equivalent refraction (P=.19) or UDVA (P=.28), whereas CDVA was better in the PIOL group (P<.001). Spherical equivalent refraction was within ±0.50 D in 42 (91.3%) LASIK eyes and 41 (89.1%) PIOL eyes (P>.99). The percentage of eyes gaining lines of CDVA was significantly higher in the PIOL group (50.0% vs 8.7%; P<.001). Contrast sensitivity was better for PIOL eyes at 1.5 cycles per degree (cpd) (P=.03) and 6 cpd (P=.008). The LASIK eyes showed a mean endothelial cell count increase of 3.7%±2.8%, whereas PIOL eyes showed a mean decrease of 9.1%±2.0% (P<.001). The rate of retreatment was similar (P=.37), and no serious complications occurred in either group. CONCLUSIONS The Artiflex PIOL provided better CDVA and contrast sensitivity at high spatial frequencies than femtosecond laser-assisted conventional LASIK, suggesting that PIOL implantation is a reasonable option for myopia between -6.00 and -9.00 D.

Iris-fixated toric phakic intraocular lens for myopic astigmatism

PURPOSE: To evaluate the efficacy, predictability, safety, stability, and complications of the Artiflex toric iris‐fixated phakic intraocular lens (pIOL) for myopic astigmatism. SETTING: Private practice surgery centers, Valencia and Terrassa, Spain. DESIGN: Cohort study. METHODS: At 12 months, refraction, uncorrected (UDVA) and corrected (CDVA) distance visual acuities, complications, pIOL misalignment, and endothelial cell count (ECC) were evaluated. Indices of success and misalignment were calculated using vector analysis. RESULTS: The study enrolled 42 eyes in 25 patients aged 21 to 39 years. The mean spherical equivalent decreased from −8.85 diopters (D) ± 2.71 (SD) to −0.37 ± 0.46 D, with 66.7% of the eyes within ±0.50 D. The mean cylinder power decreased from −2.90 D (range −1.50 to −5.00 D) to −0.39 D (range 0.00 to −1.50 D); refraction was highly stable. All eyes achieved a decimal UDVA of 0.5 or better and a CDVA of 0.8 or better. A gain of 1 line or more of CDVA was found in 69.1% of eyes. The mean clinical pIOL misalignment was 2.6 ± 1.8 degrees; 1 eye (2.4%) required surgical repositioning of the pIOL. The mean ECC decrease was 9.3% ± 1.8%; iris pigment precipitates were observed in 16.7% of eyes. Vector analysis showed excellent mean indices of success for overall (0.94 ± 0.04), spherical (0.96 ± 0.05), and astigmatic (0.95 ± 0.16) corrections; the mean angle of error was 1.8 ± 2.7 degrees. CONCLUSION: Implantation of the toric pIOL was effective, predictable, safe, and stable for the correction of myopic astigmatism. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Intra-eye visual function comparison with and without a central hole contact lens-based system: potential applications to ICL design.

PURPOSE To evaluate the effects of a central hole contact lens-based design on visual performance and to compare it with the standard version of that same contact lens without the hole (non-hole scenario). METHODS The visual performance of 10 myopic patients wearing either a central hole myopic contact lens or its corresponding standard version (non-hole contact lens) was assessed on the same eye. Monocular corrected distance visual acuity was measured under photopic conditions and monocular contrast sensitivity was measured under both photopic and mesopic conditions and higher-order ocular aberrations using Hartmann-Shack aberrometry. An in vitro optical analysis of both contact lenses was performed and a symptoms questionnaire was administered to the participants. RESULTS No statistically significant differences in terms of corrected distance visual acuity were found: -0.091 and -0.098 logMAR for the hole and non-hole contact lenses, respectively (P > .05). Contrast sensitivity was comparable between lenses and no differences were found for specific spatial frequencies or a particular luminance level (P > .05). The hole contact lenses provided excellent outcomes, essentially equivalent to those of non-hole contact lenses, even in terms of subjective symptoms such as glare or halo. In vivo and in vitro optical quality analysis revealed no statistically significant differences between the hole and the non-hole contact lenses for either pupil size (P > .1). CONCLUSION A contact lens having a central hole provides good visual and optical quality outcomes comparable to those yielded by the same lens without a hole. The results suggest that the impact of a central hole may be clinically negligible.

Visual function after implantation of a diffractive aspheric trifocal intraocular lens.

Purpose To evaluate distance, intermediate, and near vision after bilateral implantation of a diffractive aspheric trifocal intraocular lens (IOL). Methods This study enrolled 204 eyes of 102 patients who had bilateral implantation of the AT LISA tri 839MP IOL. Monocular and binocular uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA) (4 meters), monocular and binocular uncorrected near visual acuity (UNVA) and distance-corrected near visual acuity (DCNVA) (30, 40 centimeters), binocular uncorrected intermediate visual acuity (UIVA) and distance-corrected intermediate visual acuity (DCIVA) (50, 60, 70 centimeters), the defocus curve, and binocular photopic and mesopic contrast sensitivity with and without glare were evaluated over 6 months. Results No statistically significant differences in visual acuity outcomes between follow-up visits were found at any distance evaluated (p>0.05). Six months postoperatively, the mean monocular UDVA and UNVA were comparable to preoperative CDVA and DCNVA, respectively. All patients achieved a binocular CDVA of 20/25 or better. The mean binocular DCIVA ranged from 0.11 ± 0.11 (70 cm) to 0.07 ± 0.11 logMAR (50 cm). The mean binocular DCNVA was 20/25 or better in nearly 87% of patients. The defocus curve showed a wide range of useful vision, with no statistically significant differences in visual acuity at intermediate distances (p = 0.151). Mesopic contrast sensitivity was lower than under photopic conditions, particularly at medium and high spatial frequencies (p<0.001). Conclusions Bilateral implantation of this trifocal IOL provides good visual outcomes at far, intermediate, and near distances, being an effective solution to reduce spectacle dependence after lensectomy.