Manuel Rodríguez-Vallejo

Designing a new test for contrast sensitivity function measurement with iPad

PURPOSE To introduce a new application (ClinicCSF) to measure Contrast Sensitivity Function (CSF) with tablet devices, and to compare it against the Functional Acuity Contrast Test (FACT). METHODS A total of 42 subjects were arranged in two groups of 21 individuals. Different versions of the ClinicCSF (.v1 and .v2) were used to measure the CSF of each group with the same iPad and the results were compared with those measured with the FACT. The agreements between ClinicCSF and FACT for spatial frequencies of 3, 6, 12 and 18 cycles per degree (cpd) were represented by Bland-Altman plots. RESULTS Statistically significant differences in CSF of both groups were found due to the change of the ClinicCSF version (p<0.05) while no differences were manifested with the use of the same FACT test. The best agreement with the FACT was found with the ClinicCSF.v2 with no significant differences in all the evaluated spatial frequencies. However, the 95% confidence intervals for mean differences between ClinicCSF and FACT were lower for the version which incorporated a staircase psychophysical method (ClinicCSF.v1), mainly for spatial frequencies of 6, 12 and 18 cpd. CONCLUSIONS The new ClinicCSF application for iPad retina showed no significant differences with FACT test when the same contrast sensitivity steps were used. In addition, it is shown that the accurateness of a vision screening could be improved with the use of an appropriate psychophysical method.

Inter-Display Reproducibility of Contrast Sensitivity Measurement with iPad.

Purpose To evaluate the reliability of measuring CS with uncalibrated iPads. Methods Six random iPads with retina display were calibrated with a colorimeter and the correlation between Luminance (L) and pixel level (y) was computed according to an exponential function. The mean and confidence interval (±2SD) obtained from the six iPads were calculated and the bit-stealing technique was applied for expanding y from 256 to 2540 possible values. The L of the optotype was computed for the selected contrast values (logC) represented in log units, using 0.1 log and 0.05 log steps. At each particular y, the contrast was considered reliable when the mean L plus 2SD was less than half the difference of luminance between two consecutive levels of contrast. Differences between the iPads for the Experimental logC were evaluated with the Friedman test. Results Luminance properties vary between devices, which were reflected in the computed Experimental logC (p < 0.0005). The contrast was found to be reliable for 0.1 log steps in the range from 0 to −2.2 log. On the other hand, for steps of 0.05 log, the contrast was only reliable for values ranging from 0 to −1.7 log. Discussion Both luminance and contrast steps differed between iPads with the same retina display, making it necessary to calibrate each display to achieve accurate luminance and contrast steps of 0.05 log units or less. However, for screening purposes utilizing contrast steps of 0.1 log unit or greater for a validated psychophysical test, calibration is not required to achieve accurate results across the displays described herein.

From Presbyopia to Cataracts: A Critical Review on Dysfunctional Lens Syndrome

Dysfunctional lens syndrome (DLS) is a term coined to describe the natural aging changes in the crystalline lens. Different alterations in the refractive properties and transparency of the lens are produced during the development of presbyopia and cataract, such as changes in internal high order aberrations or an increase in ocular forward scattering, with a potentially significant impact on clinical measures, including visual acuity and contrast sensitivity. Objective technologies have emerged to solve the limits of current methods for the grading of the lens aging, which have been linked to the DLS term. However, there is still not a gold standard or evidence-based clinical guidelines around these new technologies despite multiple research studies have correlated their results with conventional methods such as visual acuity or the lens opacification system (LOCS), with more scientific background around the ocular scattering index (OSI) and Scheimpflug densitometry. In either case, DLS is not a new evidence-based concept that leads to new knowledge about crystalline lens aging but it is a nomenclature change of two existing terms, presbyopia and cataracts. Therefore, this term should be used with caution in the scientific peer-reviewed literature.

Prediction of surgically induced astigmatism in manual and femtosecond laser-assisted clear corneal incisions

Purpose: To assess the surgically induced astigmatism with femtosecond laser-assisted and manual temporal clear corneal incisions and to evaluate the performance of a model for prediction of the surgically induced astigmatism based on the preoperative corneal astigmatism. Methods: Clinical data of 104 right eyes and 104 left eyes undergoing cataract surgery, 52 with manual incisions and 52 with femtosecond laser-assisted incisions in each eye group, were extracted and revised retrospectively. In all cases, manual incisions were 2.2 mm width and femtosecond incisions were 2.5 mm width, both at temporal location. A predictive model of the surgically induced astigmatism was obtained by means of simple linear regression analyses. Results: Mean surgically induced astigmatisms for right eyes were 0.14D@65° (manual) and 0.24D@92° (femtosecond) (p > 0.05) and for left eyes, 0.15D@101° (manual) and 0.19D@104° (femtosecond) (p > 0.05). The orthogonal components of the surgically induced astigmatism (XSIA, YSIA) were significantly correlated (p < 0.05) with the preoperative orthogonal components of corneal astigmatism (Xpreop, Ypreop) (r = −0.29 for X and r = −0.1 for Y). The preoperative astigmatism explained 8% of the variability of the XSIA and 3% of the variability of YSIA. The postoperative corneal astigmatism prediction was not improved by the surgically induced astigmatism obtained from the model in comparison with the simple vector subtraction of the mean surgically induced astigmatism. Conclusion: Temporal incisions induce similar astigmatism either for manual or for femtosecond procedures. This can be clinically negligible for being considered for toric intraocular lens calculation due to the great standard deviation in comparison with the mean. The usefulness of the prediction model should be confirmed in patients with high preoperative corneal astigmatism.

Relative Peripheral Myopia Induced by Fractal Contact Lenses

ABSTRACT Purpose: To assess the peripheral refraction induced by Fractal Contact Lenses (FCLs) in myopic eyes by means of a two-dimensional Relative Peripheral Refractive Error (RPRE) map. Materials and Methods: This study involved 26 myopic subjects ranging from −0.50 D to −7.00 D. FCLs prototypes were custom-manufactured and characterized. Corneal topographies were taken in order to assess correlations between corneal asphericity and lens decentration. Two-dimensional RPREs were measured with an open-field autorefractor at 67 points, covering the central 60 × 30 degrees of the visual field. The bidimensional RPRE vector components: M, J0 and J45 of the difference between the values obtained with and without the FCLs in the eye were obtained. Additionally, the FCL-induced peripheral refraction in tangential and sagittal planes was computed along the horizontal meridian. Results: Induced by the FCLs, significant differences for all vector components were found in the peripheral retina. FCLs were decentered a mean of 0.7 ± 0.19 mm to the temporal cornea. The two-dimensional RPRE maps manifested the FCLs decentration. In particular, M varied asymmetrically between nasal and temporal retina after fitting the FCLs with a significant increment of the myopic shift beyond 10º (p < 0.05). No correlations were found between the amount of lens decentration and the asphericity of the cornea along temporal and nasal sides. However, significant correlations were found between the corneal asphericity and vector components of the RPRE in naked eyes. FCLs produced an increasing myopic shift in tangential and sagittal power errors along the horizontal meridian. Conclusions: As predicted by ray-tracing simulations, FCLs fitted in myopic eyes produce a myopic shift of the RPRE. The two-dimensional RPRE maps show information about the lens performance that is hidden in the conventional one-dimensional meridional representations.

Biometric Factors Associated with the Visual Performance of a High Addition Multifocal Intraocular Lens

ABSTRACT Purpose/Aim: To evaluate the impact of ocular parameters on the visual performance achieved with the multifocal intraocular lens (IOL) Bi-Flex M 677MY. Materials and Methods: About 26 subjects were included in the current study. Several physiological variables were retrieved from the 3-month follow-up visit, including pupil diameter and distance from pupil center to the vertex normal of the anterior cornea (µ). These variables were also obtained in the preoperative visit. Binocular and monocular visual acuity defocus curves were measured at 1 and 3 months after surgery, respectively. The monocular Area Under the Curve (AUC) was computed along the total range (Total Area Under the Curve (TAUC), +1.00 to −4.00 D) and for the ranges of Far (Far Area Under the Curve (FAUC), +0.50 to −0.50 D), (Intermediate Area Under the Curve (IAUC), −1.00 to −1.50 D) and Near vision (Near Area Under the Curve (NAUC), −2.00 to −4.00 D). Correlations between these areas and the postoperative physiological variables were assessed. Results: The mean µ was reduced from 0.21 to 0.10 mm after surgery, as well as pupil diameters, either photopic (−7.4%) or mesopic (−8.1%) (p < 0.05). The mean AUCs were 2.08 ± 0.74 for TAUC, 0.57 ± 0.17 for FAUC, 0.16 ± 0.09 for IAUC, and 0.81 ± 0.29 for NAUC. Significant correlations were found between NAUC and corneal power (r = −0.39, p = 0.05) as well as between IAUC and temporal decentration of the lens from vertex normal (ρ = −0.41, p = 0.04). Conclusions: The visual performance at near distance with the IOL evaluated improved in eyes with less corneal power. On the other hand, a slight temporal IOL decentration from vertex normal also improved intermediate visual acuity. The binocular defocus curve was similar to other trifocal IOLs.