Robert Montés-Micó

Visual function comparison of 2 aspheric multifocal intraocular lenses

PURPOSE: To compare visual function after bilateral implantation of the multifocal Lentis Mplus LS‐312 with a nonrotational symmetrical design (copolymer aspheric) or the Acrysof Restor SN6AD1 +3.0 D (hybrid aspheric) intraocular lens (IOL). SETTING: Fernández‐Vega Ophthalmological Institute, Oviedo, Spain. DESIGN: Comparative case series. METHODS: Six months postoperatively, corrected distance visual acuity (CDVA), distance‐corrected near visual acuity (DCNVA), the defocus curve, and photopic and mesopic contrast sensitivity with and without glare were measured. RESULTS: The mean CDVA was 0.02 ± 0.06 (SD) with the copolymer aspheric IOL and −0.06 ± 0.05 logMAR with the hybrid aspheric IOL (P=.07) and the mean DCNVA, 0.10 ± 0.06 and −0.09 ± 0.06 logMAR, respectively. The DCNVA was better with the hybrid aspheric IOL (P<.05). The defocus curve showed that the hybrid aspheric IOL provided better visual acuity from 0.00 to −5.00 diopter (D) vergences (P<.05) except for −1.00 and −1.50 D, where the IOLs were comparable. Contrast sensitivity was better with the hybrid aspheric IOL at 12 cycles per degree (cpd) and 18 cpd under photopic conditions (P<.05). No significant differences were found under mesopic conditions (P>.05). CONCLUSIONS: Both IOL models gave good and comparable visual acuity at distance. However, the hybrid aspheric IOL provided better DCNVA than the copolymer aspheric IOL. Intermediate vision was not as good as distance and near and was similar between the 2 IOLs. Photopic contrast sensitivity was better with the hybrid aspheric IOL at high spatial frequencies and comparable between IOLs at low frequencies and under mesopic conditions. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Visual simulation through different intraocular lenses using adaptive optics: Effect of tilt and decentration

PURPOSE: To analyze visual quality differences between intraocular lenses (IOLs) and assess the impact of IOL decentration and tilt on visual quality. SETTING: University of Valencia, Valencia, Spain. DESIGN: Cohort study. METHODS: The crx1 adaptive optics visual simulator was used to simulate the wavefront aberration pattern of 2 commercially available aspheric aberration‐correcting IOLs (Acrysof IQ SN60WF and Tecnis ZA9003) and 2 spherical IOLs (Akreos Adapt and Triplato) in 5 situations: centered, decentered 0.2 mm and 0.4 mm, and tilted 2 degrees and 4 degrees. Monocular distance visual acuity at 100%, 50%, and 10% contrast and the depth of focus were measured. RESULTS: Ten eyes of 10 patients were evaluated. When the IOLs were centered, there were no differences in visual acuity between the 4 IOLs at any contrast. The aberration‐correcting IOLs were more sensitive to tilt and decentration than the spherical IOLs; Tecnis ZA9003 IOL was the most sensitive to decentration and the Acrysof IQ SN60WF IOL was the most sensitive to tilt. Higher residual spherical aberration slightly improved depth of focus and the tolerance to defocus. CONCLUSIONS: The results in this study suggest that the aspheric aberration‐correcting and spherical IOLs provided comparable visual quality when centered in eyes in which the corneal higher‐order aberrations are those of the average of the human cornea. Tilt and decentration of the IOLs had an impact on visual quality, with aberration‐correcting IOLs having a greater effect than the spherical IOLs. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Intrastromal corneal ring segment implantation in 219 keratoconic eyes at different stages

BackgroundTo evaluate the visual and refractive outcomes of intrastromal corneal ring segment (ICRS) in keratoconic eyes at different stages.MethodsTwo hundred and nineteen keratoconic eyes were divided into three groups as a function of stage of keratoconus (stages I, II and III). There were 115 eyes with stage I, 84 eyes with stage II and 20 eyes with stage III. Snellen uncorrected distance visual acuity (UDVA), best corrected distance visual acuity (CDVA), and residual refractive errors analyzed using vector analysis were recorded before surgery and 6xa0months post-surgery.ResultsFor stage I, UDVA changed from 0.26u2009±u20090.19 pre-surgery to 0.58u2009±u20090.30 post-surgery (Pu2009<u20090.001) and CDVA from 0.79u2009±u20090.19 to 0.90u2009±u20090.13 (Pu2009<u20090.0001). For stage II, UDVA was 0.17u2009±u20090.15 pre-surgery and 0.35u2009±u20090.22 post-surgery (Pu2009<u20090.001) and CDVA changed from 0.56u2009±u20090.21 to 0.67u2009±u20090.20 after the surgery (Pu2009<u20090.0001). For stage III, statistically significant differences both for UDVA and CDVA were not found (Pu2009=u20090.08 and Pu2009=u20090.01 respectively). For stage I, 52.16% of the eyes gained lines of CDVA, 39.13% did not change their CDVA, and 8.67% lost lines of CDVA. For stage II, 65.48% of the eyes gained lines of CDVA, 20.24% had unchanged CDVA, and 14.28% lost lines of CDVA. For stage III, 60% of the eyes gainedu2009>2 lines of CDVA, 25% did not change their CDVA, and 15% lost lines of CDVA. A significant decrease in the spherical equivalent after surgery was found for stages I and II (Pu2009<u20090.0001) but not for stage III (Pu2009=u20090.07).ConclusionICRS implantation is an effective procedure for keratoconus treatment, being more effective for moderate keratoconus.

Visual simulation through different intraocular lenses in patients with previous myopic corneal ablation using adaptive optics: effect of tilt and decentration.

PURPOSE: To evaluate visual quality differences between intraocular lenses (IOLs) in patients with previous myopic laser ablations and assess the impact of IOL decentration and tilt on visual quality. SETTING: University of Valencia, Burjassot, Spain. DESIGN: Cohort study. METHODS: An adaptive optics visual simulator was used to simulate the wavefront aberration pattern of 1 aberration‐correcting IOL (Acrysof IQ SN60WF), 1 aberration‐free IOL (Akreos Adapt AO), and 1 spherical IOL (Triplato) under 5 IOL situations: centered, 0.2 mm and 0.4 mm decentered, and 2 degrees and 4 degrees tilted in eyes with simulated low or high myopic laser corneal ablations. Monocular distance visual acuity at 100%, 50%, and 10% contrast were measured. RESULTS: Ten eyes of 10 patients were evaluated. When the IOLs were centered, the aberration‐correcting IOL provided the best visual quality results in both groups. When the IOLs were misaligned, there was a decrease of visual quality with all simulated IOLs except the aberration‐free IOL in the high myopia group. In the misaligned situations, all simulated IOLs obtained comparable visual quality results in both groups. CONCLUSIONS: The results suggest that in patients with previous myopic laser corneal ablation, aberration‐correcting IOLs should be implanted. The decrease in visual quality when these IOLs are decentered or tilted demonstrates the importance of accurate implantation of these IOLs. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Long-term evaluation of the central vault after phakic Collamer® lens (ICL) implantation using OCT

PurposeThe aim of this work is to evaluate the changes in the central vault after using implantable Collamer® lenses (ICL) to correct myopia.MethodsThis cohort study included 133 eyes; mean spherical equivalent –9.47u2009±u20093.71 diopters (D) (range: –2.75 to –22.25 D) who underwent ICL V4 implantation. Besides a complete ophthalmologic examination, the central vaulting was measured with Visante OCT and evaluated between different periods of follow-up (1xa0week, 1, 3, and 6xa0months, and yearly postoperatively). Post-operative time ranged from 6 to 73xa0months.ResultsWithin the first 6xa0months, the mean central vaulting dropped from 510u2009±u2009238xa0μm (range 100 to 940xa0μm) to 439u2009±u2009231xa0μm (range 90 to 910) a significant decrease by 71u2009±u200958xa0μm (range –170 to 30xa0μm) (pu2009=u20090.028) with a trend to a lower reduction after this period. After 36xa0month from ICL implantation, this variation tends to be smaller with the majority of the eyes having a mean decrease smaller than 2xa0μm per month. Initial vault (Spearman Rhou2009=u2009–0.237, pu2009=u20090.006) was the factor more significantly associated with decrease in vault; eyes presenting a reduction in vault >100xa0μm had an average initial vault that was 141xa0μm and 184xa0μm higher than eyes with no change or with increase in vault over time, respectively.ConclusionsThis study shows a continuous reduction of central vault over time. The reduction is highest during the first 6xa0months and tends to be lower and slow down over time. The decrease of vaulting was more pronounced in eyes with larger initial vaulting.

Effect of simulated IOL tilt and decentration on spherical aberration after hyperopic LASIK for different intraocular lenses.

PURPOSEnTo evaluate visual quality differences among intraocular lenses (IOLs) in patients with previous hyperopic laser ablations and to assess the impact of decentration and tilt of IOLs on visual quality.nnnMETHODSnAn adaptive optics visual simulator was used to simulate the wavefront aberration pattern of one aberration-correcting IOL (AcrySof IQ SN60WF, Alcon Laboratories Inc) and two spherical IOLs with different amounts of positive spherical aberration (Akreos Adapt [Bausch & Lomb] and Triplato [AJL Ophthalmic]) in five situations-centered, 0.2 mm and 0.4 mm of decentration, and 2° and 4° of tilt-in two groups: simulated low hyperopic laser corneal ablation (low hyperopia group) and high hyperopic laser corneal ablation (high hyperopia group). Monocular distance visual acuity at 100%, 50%, and 10% contrast were measured.nnnRESULTSnTen eyes were evaluated. When the IOLs were centered, all IOLs obtained comparable results for the low hyperopia group, whereas for the high hyperopia group, the Akreos Adapt and AcrySof IQ SN60WF showed better visual acuity than the Triplato. When the IOLs were misaligned, for the low hyperopia group, the best visual acuity results were obtained with the Akreos Adapt and the most critical situation was at 0.4 mm of decentration. For the high hyperopia group, misalignments decreased visual acuity in a higher amount than for the low hyperopia group.nnnCONCLUSIONSnOur results suggest that the IOLs studied offer good visual quality when they are centered for both groups. However, tilt and decentration of monofocal IOLs have an impact on visual function in patients with hyperopic ablations. For these patients, the Akreos Adapt is the most robust to misalignments.

Visual function through 4 contact lens-based pinhole systems for presbyopia

PURPOSE: To evaluate the effects of different contact lens–based artificial pupil designs on visual performance. SETTING: University of Valencia, Burjassot, Spain, and University of Manchester, Manchester, United Kingdom. DESIGN: Comparative case series. METHODS: Presbyopic patients were evaluated using 4 artificial pupil designs in the nondominant eye. Binocular uncorrected distance visual acuity (UDVA), binocular corrected distance visual acuity (CDVA), binocular uncorrected near visual acuity (UNVA), binocular distance‐corrected near visual acuity (DCNVA), defocus curve, binocular distance, and near contrast sensitivity under photopic and mesopic conditions, and stereoacuity were measured after contact lens fitting. RESULTS: The mean UDVA and CDVA ranged from 0.04 ± 0.05 (SD) to −0.01 ± 0.04 logMAR and from −0.02 ± 0.05 to −0.05 ± 0.03 logMAR, respectively. The UNVA and DCNVA ranged from 0.37 ± 0.11 to 0.42 ± 0.20 logMAR and from 0.35 ± 0.17 to 0.38 ± 0.12 logMAR, respectively. The difference in binocular distance contrast sensitivity was statistically significant between the pinhole systems and the control group (distance‐corrected patients without pinhole lens) for 6 cycles per degree (cpd), 12 cpd, and 18 cpd; for near vision, differences were also significant for 3 cpd at the 2 luminance levels (P<.05). Stereoacuity values for near vision were not significantly different between the 4 pinhole systems (P>.05). CONCLUSIONS: Soft contact lens apertures provide good visual acuity at distance, functional intermediate vision, and poor near visual acuity and stereoacuity. An improvement in visual performance with decreasing pupil diameter was not found. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Stereopsis in bilaterally multifocal pseudophakic patients.

BackgroundThe purpose of this study was to evaluate stereoacuity in patients with bilateral implantation of an aspheric bifocal intraocular lens (IOL).MethodsThirty patients scheduled for cataract surgery were implanted with the aspheric bifocal AcrySof ReSTOR IOL. Stereoacuity was measured using the vectographic Titmus and Random dot stereotests (fixed disparity) and the Howard–Dolman apparatus (threshold disparity) under photopic conditions (85xa0cd/m2) after phacoemulsification for cataract surgery in 30 patients with low astigmatism (≤1D). Visual acuity at distance and near was also examined. All patients were examined at 1-year follow-up.ResultsMean stereoacuity with the Titmus and the Random dot sterereotests was 44.55u2009±u20091.08xa0sec arc (range, from 40 to 80) and 41.25u2009±u20091.12xa0sec arc (range, from 20 to 70) respectively. The Howard–Dolman method showed a mean value of 18.42u2009±u20096.10xa0sec arc, ranging from 11 to 30xa0sec arc. No statistically significant differences were found between the Titmus and the Random dot sterereotests values (Pu2009=u20090.189). However, these values differ significantly from that found using the Howard-Dolman method (Pu2009=u20090.005). Visual acuity at distance and near was 0.04u2009±u20090.05 and 0.04u2009±u20090.04 logMAR (about 20/20) respectively.ConclusionsDespite simultaneous images on the retina after bifocal IOL implantation, patients showed useful stereoacuity. This study confirms that retinal image blur associated with multifocality does not deteriorate stereoacuity. Stereoscopic threshold measurement with a Howard–Dolman apparatus is more accurate than vectographic tests when assessing stereoacuity after IOL surgery.

Accommodative functions with multifocal contact lenses: a pilot study

Purpose. To evaluate accommodative response and facility in presbyopic patients fitted with several types of simultaneous-image multifocal contact lenses (CLs). Methods. Six presbyopic patients, unadapted wearers of simultaneous-image bifocals, were fitted with the Focus Progressives and the low- and high-addition Pure Vision simultaneous vision multifocal CLs. Each individual wore each of the three types of lenses in successive random order. Accommodative response, accommodative facility, visual acuity, and contrast sensitivity at distance and near were evaluated in all cases. A control group of eight non-presbyopic patients was also studied. Results. The mean age was 28.6 ± 2.72 and 51.2 ± 5.81 years in the non-presbyopes and presbyopic patients, respectively. For the presbyopic group, statistically significant differences were not found for distance visual acuity between the baseline situations and with the three different CLs types. For the near visual acuity, there were no statistically significant differences between baseline situation (without add) compared with patients wearing the Focus Progressives and with PureVision Low Add. With the Purevision High Add, the near visual acuity was slightly better than baseline situation (p = 0.03). Non-presbyopic subjects showed relatively linear 1:1 stimulus response functions for all situations. Presbyopic subjects showed an increasing lag of accommodation with amplitude as they approach to the maximum amplitude for all situations. Distance and near accommodative facility rate for the presbyopic patients was zero for all conditions. Conclusions. The results of this study suggest that simultaneous-image multifocal CLs studied do not alter accommodative functions. The high add of the Purevision CL enhances near vision for advanced presbyopes compared with the other models studied.

Changes in accommodation and ocular aberration with simultaneous vision multifocal contact lenses.

Objective: The aim of this study was to evaluate ocular aberration changes through different simultaneous vision multifocal contact lenses (CLs). Methods: Eighteen young-adult subjects with a mean age of 29.8±2.11 years took part. Changes in accommodative response, spherical aberration ( ), horizontal coma ( ), vertical coma ( ), and root mean square (RMS) of higher-order aberrations (HOAs, third to sixth orders) were evaluated. Measurements were obtained with a distance-single vision CL and 2 aspheric multifocal CLs of simultaneous focus center-near design (PureVision Low Add and PureVision High Add) for 2 accommodative stimuli (−2.50 and −4.00 D). All measurements were performed monocularly with a Hartmann–Shack aberrometer (IRX-3; Imagine Eyes, Orsay, France). Results: No statistically significant differences were found in accommodative responses to −2.50- and −4.00-D stimuli between the single vision CL and the 2 multifocal CLs. Spherical aberration was found to decrease and become more negative with accommodation for both stimuli with all three CLs. Horizontal coma decreased significantly with accommodation (−2.5- and −4.00-D stimuli) for the distance-single vision CLs (P=0.002 and P=0.003). No differences were found in vertical coma Zernike coefficients. The RMS of HOAs was found to decrease only with the single vision CLs for both stimuli (P<0.01). Conclusions: Data obtained in this study suggest that in young subjects, the multifocal CLs studied do not induce large changes in accommodative response compared with the distance-single vision CLs. Spherical aberration reduced significantly with accommodation.