Purpose
To report the 1‐year results of an investigation into whether there is an additive effect between 0.01% atropine and orthokeratology (ortho‐k), in a single‐masked, two‐arm, randomised ...controlled trial: Combined Atropine with Orthokeratology (AOK) for myopia control study (ClinicalTrials.gov number: NCT02955927).
Methods
Chinese children aged between 6 and 11 years with 1.00–4.00 D of myopia, astigmatism <2.50 D, and no more than 1.00 D anisometropia, were randomly assigned either to an AOK group or ortho‐k only (OK) group at a 1:1 ratio. Subjects in the AOK group instilled one drop of 0.01% atropine into each eye, 10 min before nightly wear of ortho‐k lenses. The primary outcome, axial elongation, was examined at 6‐monthly intervals, along with secondary outcomes including best‐corrected visual acuity (BCVA), manifest refraction, accommodation, pupil size, and corneal topography.
Results
29 AOK and 30 OK subjects completed the 1‐year visit. The overall axial elongation rate was significantly slower in the AOK group than in the OK group (mean (S.D.), 0.07 (0.16) mm vs 0.16 (0.15) mm, respectively; p = 0.03). A significant between‐group difference in axial elongation was observed over the first 6‐month period only (p < 0.001), but not over the second period (p = 0.818). At the 1‐year visit, increases in mean (S.D.) mesopic and photopic pupil sizes in the AOK group were 0.64 (0.48) mm and 0.36 (0.34) mm, respectively, which were significantly higher than 0.10 (0.50) mm and 0.02 (0.28) mm in the OK group (p < 0.001). At the 6‐month visit, a significant moderate negative correlation was found between axial elongation and the increase in photopic pupil size (r = −0.42, p = 0.02) in the AOK group.
Conclusions
There is an additive effect between 0.01% atropine and ortho‐k over one year, with mean axial elongation in the AOK group 0.09 mm slower than that in the OK group. It appears that the additive effect was only during the first six months; a second‐year investigation is warranted to determine whether the effect is sustained over time.
Abstract Purpose To investigate the stability of corneal astigmatism and higher-order aberrations after combined femtosecond-assisted phacoemulsification and arcuate keratotomy. Design Retrospective, ...interventional case series Methods Surgery was performed using VICTUS (Bausch & Lomb Inc, Dornach, Germany) platform. A single, 450-μm deep, arcuate keratotomy was paired at 8 mm zone with the main phacoemulsification incision in the opposite meridian. The keratotomy incisions were not opened. Corneal astigmatism and higher-order aberrations measurements obtained preoperatively, and at 2 months and 2 years postoperatively were analyzed. Results Fifty eyes of 50 patients (mean age 66.2 ± 10.5 years) were included. The mean preoperative corneal astigmatism was 1.35 ± 0.48 diopters (D). This was reduced to 0.67 ± 0.54 D at two months and 0.74 ± 0.53 D at two years postoperatively (p < 0.001). There was no statistically significant difference between postoperative corneal astigmatism over 2 years (p = 0.392). Both magnitude of error and absolute angle of error were comparable between the 2 postoperative time points (p > 0.283). At postoperative 2 months and 2 years, 72% and 70% of eyes were within 15 degrees of preoperative meridian of astigmatism, respectively. All wavefront measurements increased significantly at 2 months and 2 years (p < 0.007), except spherical aberration (p > 0.150). There was no significant difference in higher-order aberrations between 2 months and 2 years postoperatively (p > 0.486). Conclusions Our study showed the stability of femtosecond-assisted arcuate keratotomy. Further studies using other platforms and nomograms are needed to corroborate the findings of this study.
Purpose To evaluate the outcomes of femtosecond-assisted arcuate keratotomy combined with cataract surgery in eyes with low to moderate corneal astigmatism. Design Retrospective, interventional case ...series. Methods This study included patients who underwent combined femtosecond-assisted phacoemulsification and arcuate keratotomy between March 2013 and August 2013. Keratometric astigmatism was evaluated before and 2 months after the surgery. Vector analysis of the astigmatic changes was performed using the Alpins method. Results Overall, 54 eyes of 54 patients (18 male and 36 female; mean age, 68.8 ± 11.4 years) were included. The mean preoperative (target-induced astigmatism) and postoperative astigmatism was 1.33 ± 0.57 diopters (D) and 0.87 ± 0.56 D, respectively ( P < .001). The magnitude of error (difference between surgically induced and target-induced astigmatism) (−0.13 ± 0.68 D), as well as the correction index (ratio of surgically induced and target-induced astigmatism) (0.86 ± 0.52), demonstrated slight undercorrection. The angle of error was very close to 0, indicating no significant systematic error of misaligned treatment. However, the absolute angle of error showed a less favorable range (17.5 ± 19.2 degrees), suggesting variable factors such as healing or alignment at an individual level. There were no intraoperative or postoperative complications. Conclusions Combined phacoemulsification with arcuate keratotomy using femtosecond laser appears to be a relatively easy and safe means for management of low to moderate corneal astigmatism in cataract surgery candidates. Misalignment at an individual level can reduce its effectiveness. This issue remains to be elucidated in future studies.
To compare astigmatic correction between femtosecond-assisted laser in situ keratomileusis (LASIK) and small-incision lenticule extraction (SMILE).
A total of 111 patients were included in this ...prospective study. Fifty-seven eyes were treated with LASIK and 54 eyes were treated with SMILE for myopia with low to moderate (-0.25 to -4.0 D) astigmatism. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity and manifest refraction were measured preoperatively and at 1 and 3 months postoperatively. Visual and refractive outcomes were reported. Changes in refractive astigmatism were evaluated using vector analysis.
Preoperative characteristics were similar between both groups. The UDVA at 1 and 3 months was better in the LASIK group compared with the SMILE group (p<0.009). Postoperative cylinder was higher in the SMILE group (p<0.001). Fewer eyes attained the attempted cylindrical correction in the SMILE group (p<0.029). Vector analysis showed no significant difference in target-induced astigmatism (p=0.091) and angle of error (p>0.596) between the two groups. Surgically induced astigmatism was significantly lower in the SMILE group (p<0.023), while the difference vector (p<0.001) and absolute angle of error (p<0.016) were significantly higher in the SMILE group. No significant difference was found in these parameters between 1 and 3 months in both groups (p>0.122).
Our results showed that SMILE offered a less favourable astigmatic correction comparable to femtosecond-assisted LASIK in eyes with low to moderate myopic astigmatism. The alignment of treatment was more variable in SMILE, leading to a lower efficacy compared with LASIK by 3 months postoperatively.
Purpose: The purpose of this study is to present the study design and one month's preliminary results of a 2-year randomized trial, Combined Atropine with Orthokeratology (AOK), for myopia control ...study.
Methods: Children aged 6 to <11 years and with 1.00-4.00 D myopia were randomly assigned to AOK group or ortho-k alone (OK) group. Subjects are required to attend routine ortho-k aftercare visits (first-overnight, 1 week, 2 weeks, 3 weeks, 1 month, and every 3 months after commencement of lens wear). Clinical outcomes, including lens performance, changes in refractive error, unaided vision, ocular adverse events, corneal staining, lens binding and centration, and axial length, are also assessed at 6-monthly data collection visit.
Results: Data of 30 AOK and 34 OK subjects who had completed the 1-month visit were analyzed. No significant differences in baseline data were found between the two groups (P > 0.05). At the 1-month visit, first-fit success rate was 95%, with full myopia reduction. Mild corneal staining was observed in 23.3% and 30.9% and mild self-reported lens binding in 50% and 41% in AOK and OK groups, respectively, after 1-month lens wear. Mean (±standard deviation) change in axial length was significantly higher in AOK than OK subjects (AOK: −0.05 ± 0.05 mm; OK: −0.02 ± 0.03 mm) (P = 0.003).
Conclusions: After 1 month of treatment, first-fit success rate of ortho-k lenses was high in both groups of subjects; addition of 0.01% atropine in AOK subjects did not affect the lens performance or clinical responses. These results provide the assurance that it is acceptable to continue this longitudinal study, as longer study duration, usually 2 years, is required to determine the effectiveness of treatment for myopia control.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Objective
To investigate the repeatability of pupil size measurements, determined from the NIDEK OPD‐Scan III, of myopic eyes in children wearing single‐vision spectacles (SVS), undergoing ...orthokeratology (OK) and receiving combined treatment of 0.01% atropine and orthokeratology (AOK).
Methods
A single examiner took two sets of mesopic pupil size measurements from the right eyes of 80 children (SVS:16, OK: 34, AOK: 30) (mesopic 1 and mesopic 2) and two sets of photopic (photopic 1 and photopic 2) pupil size measurements (internal light source) using the NIDEK OPD‐Scan III. Each set was taken at a single visit, 15 min apart. Subjects in the OK and AOK groups had undergone treatment for at least 6 months, and the SVS subjects had no previous myopia treatment other than wearing spectacles. Repeatability of measurements was analysed using intraclass correlation coefficient (ICC), Bland‐Altman (BA) plot, and coefficient of repeatability (CoR).
Results
Mesopic 1 and 2 values were not significantly different among the three groups (p = 0.56, 0.77), hence the data were pooled for each set of measurements (mean ±S.D. values were 7.09 ± 0.61 and 7.12 ± 0.61 mm, respectively) for further analyses. ICC for repeated mesopic pupil size measurements was 0.98 (95% CI, 0.98–0.99). No significant correlation was found between the means of the mesopic 1 and 2 measurements and their differences (Pearson's r = −0.02, p = 0.83). A BA plot also demonstrated narrow 95% limits of agreement, with a CoR of 0.28 mm.
Mean photopic 1 and 2 measurements for the AOK group (3.74 ± 0.46; 3.73 ± 0.43 mm, respectively) were significantly larger (p = 0.01; 0.009) than those of the SVS and OK groups, but no significant difference was found between the latter two groups (p > 0.05). Hence, photopic 1 and 2 measurements for the SVS and OK groups were pooled (SVS‐OK) for further analyses. ICC for repeatability of the photopic measurements was 0.98 (95% CI, 0.96 to 0.99) for the SVS‐OK and AOK groups. The differences between photopic 1 and 2 measurements were not significantly correlated with their means, either in the AOK group (Pearson's r = −0.25, p = 0.19), or in the pooled SVS‐OK group (Pearson's r = −0.04, p = 0.78). BA plots also showed narrow 95% limits of agreement, and CoR was 0.25 mm and 0.23 mm in the AOK and pooled SVS‐OK groups, respectively.
Conclusion
Mesopic and photopic pupil size measurement using the NIDEK OPD‐Scan III was highly repeatable and suitable for use on children.
The retinal image quality derived from lower-order (LOA) and higher-order aberrations (HOA) for fixed 3-mm and photopic pupil diameters, in children undergoing combined 0.01% atropine and ...orthokeratology (AOK) versus those receiving orthokeratology alone (OK) over two years was evaluated.
The visual Strehl ratio based on the optical transfer function (VSOTF), derived from 2nd- to 4th-order terms (LOA and HOA combined), 2nd-order terms (LOA only), and 3rd- to 4th-order terms (HOA only) for fixed 3-mm and natural photopic pupil diameters, was compared between the two treatment groups. The individual Zernike coefficients for a fixed 3-mm pupil size of 2nd- to 4th-orders, root mean square (RMS) of LOA (Formula: see text, Formula: see text, and Formula: see text combined), HOA (3rd to 4th orders inclusive), and Coma (Formula: see text combined) were also compared between the two groups.
Right eye data of 33 AOK and 35 OK participants were analysed. Under photopic conditions, significantly lower VSOTF based on HOA only was observed in the AOK group compared with that in the OK group at all post-treatment visits (all P < 0.05); however, interactions between HOA and LOA resulted in comparable overall retinal image quality (i.e., VSOTF based on LOA and HOA combined) between the two groups at all visits (all P > 0.05). For a fixed 3-mm pupil size, the VSOTF based on HOA only, LOA only, or HOA and LOA combined, were not different between the two groups (all P > 0.05). AOK participants had slower axial elongation (mean ± SD, 0.17 ± 0.19 mm vs. 0.35 ± 0.20 mm, P < 0.001), a larger photopic pupil size (4.05 ± 0.61 mm vs. 3.43 ± 0.41 mm, P < 0.001) than OK participants, over two years.
HOA profile related to an enlarged pupil size may provide visual signal influencing eye growth in the AOK group.
Purpose
To compare the changes in higher order aberrations (HOA’s) for photopic and mesopic pupil diameters in children undergoing orthokeratology treatment (OK) or combined 0.01% atropine with ...orthokeratology treatment (AOK), and their association with axial elongation.
Methods
Children aged 6 to <11 years with 1.00–4.00 D of myopia were randomly assigned to each treatment group. Photopic and mesopic pupil diameters were quantified using automated pupillometry and HOA’s were measured with a Hartmann‐Shack aberrometer and Badal system to control for accommodation. HOA’s were rescaled to photopic and mesopic pupil diameters and fitted with a 6th order Zernike polynomial expansion. Axial length was measured using an optical biometer under cycloplegia.
Results
Baseline and six‐month data from 25 AOK and 28 OK participants were analysed. At the six‐month visit, pupil diameter was larger in the AOK group under photopic conditions (3.70 ± 0.42 vs 3.12 ± 0.33 mm, p < 0.001), along with a range of HOA metrics 3rd to 6th order and higher order root mean square error values (HO RMS), all p ≤ 0.003 and individual Zernike terms (primary spherical aberration, and oblique quadrafoil, both p ≤ 0.03). Axial elongation was greater in the OK treatment group (0.05 ± 0.08 vs −0.01 ± 0.12 mm, p = 0.02). In the AOK group, axial elongation was correlated with the increase in photopic pupil diameter (r = −0.45, p = 0.02) and with several HOA metrics; however, these associations were not observed in the OK group.
Conclusion
AOK treatment resulted in increased photopic pupil size and HOA’s, and significantly less axial elongation over a six‐month period compared to OK treatment alone. The improved myopia control observed with combination 0.01% atropine and orthokeratology may be a result of an enhanced optical effect due to a larger photopic pupil size.
To investigate whether combining 0.01% atropine with orthokeratology (AOK) has a better effect in retarding axial elongation, compared with orthokeratology alone (OK) over two years.
A total of 96 ...Chinese children aged six to < 11 years with myopia (1.00 – 4.00 D, inclusive) were randomized into either the AOK or OK group in a 1:1 ratio.
Axial length (the primary outcome), and secondary outcomes (e.g. pupil size and choroidal thickness) were measured at 1-month and at 6-monthly intervals after commencement of treatment.
Both intention-to-treat and per-protocol analyses showed significantly slower axial elongation in the AOK group than OK group over two years (P = 0.008, P < 0.001, respectively). AOK subjects had statistically slower axial elongation (adjusted mean standard error, 0.17 0.03 mm vs 0.34 0.03 mm, P < 0.001), larger increase in mesopic (0.70 0.09 mm vs 0.31 0.09 mm, P = 0.003) and photopic pupil size (0.78 0.07 mm vs 0.23 0.07 mm, P < 0.001), and greater thickening of the choroid (22.6 3.5 µm vs −9.0 3.5 µm, P < 0.001) than OK subjects over two years. Except for a higher incidence of photophobia in the AOK group (P = 0.006), there were no differences in the incidence of any other symptom or adverse events between the two groups. Slower axial elongation was associated with a larger increase in the photopic pupil size and a greater thickening in the choroid in the AOK group.
Slower axial elongation following 2-year AOK treatment may result from increased pupil dilation and a thickening in the choroid observed in the AOK group.
To document the intraocular pressure (IOP) profiles during femtosecond laser-assisted cataract surgery.
Refractive cataract surgery center.
Prospective case series.
Intraocular pressure was measured ...using a handheld portable applanation tonometer (Tono-Pen Avia) during femtosecond laser-assisted cataract surgery using the Victus platform.
Forty-one eyes of 35 patients were recruited. The mean age of the patients was 70.5 years ± 8.2 (SD) (range 51 to 85 years). The mean IOP before, during, and after suction was 17.2 ± 3.2 mm Hg (range 10 to 23 mm Hg), 42.1 ± 10.8 mm Hg (range 20 to 55 mm Hg), and 13.8 ± 3.4 mm Hg (range 9 to 25 mm Hg), respectively. The mean difference between IOP before and during suction was 25.0 ± 11.3 mm Hg (range 5 to 43 mm Hg) (P<.01, Wilcoxon signed-rank test). The mean difference between IOP during and after suction was -28.7 ± 10.8 mm Hg (range -45 to -10 mm Hg) (P<.01, Wilcoxon signed-rank test). The mean suction duration was 216 ± 15 seconds (range 180 to 245 seconds).
The increase in IOP during the suction phase of femtosecond laser-assisted cataract surgery was statistically significant compared with the baseline IOP. Caution should be taken in patients with ocular conditions that are vulnerable to IOP fluctuation.
No author has a financial or proprietary interest in any material or method mentioned.
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