To determine whether intraoperative aberrometry during cataract surgery measures higher levels of absolute astigmatism than preoperative biometry readings and which method yields a lower, final level ...of astigmatism if the two do not agree.
Retrospective record review of all patients who underwent uncomplicated cataract surgery from February 2015 to May 2019 with planned intraoperative aberrometry. Data analysis included preoperative keratometry, total astigmatism as measured by intraoperative aberrometry, intraocular lens model and power used, and postoperative manifest refraction ≥1 month after surgery. The primary outcome measure was the proportion of patients requiring astigmatism correction (≥0.5 D) when measured by preoperative keratometry vs intraoperative aberrometry. Secondary outcomes included postoperative residual astigmatism, where adjusted preoperative astigmatism fell below the 0.5 D threshold for treatment but the intraoperative measurement was ≥0.5 D or ≥1.0 D.
A total of 451 patient records were evaluated. Intraoperative aberrometry measured statistically higher levels of mean astigmatism than keratometry (0.86 D vs 0.79 D, respectively; P < 0.0001) and significantly greater astigmatism among patients with 0.5-1.5 D of adjusted preoperative astigmatism (P < 0.0001). Significantly more patients qualified for with-the-rule astigmatism correction when measured by intraoperative aberrometry (n=339; 75%) than by preoperative keratometry alone (n=314; 70%); P < 0.03. This difference did not hold for against-the-rule or oblique astigmatism. For patients whose preoperative biometry astigmatism differed from intraoperative biometry, final postoperative astigmatism was lower when corrected if the adjusted preoperative and intraoperative measurements had a vector difference of <0.5 D, but there was no additional benefit in final astigmatism reduction when the vector difference was ≥0.5 D.
Using intraoperative biometry readings can produce lower postoperative astigmatism than using preoperative biometry readings, but caution should be used when interpreting intraoperative readings that disagree with preoperative measurements with a vector magnitude of >0.5 D.
To compare patient-reported outcomes (PROs) after intraocular lens (IOL) implantation with the AcrySof IQ Vivity IOL or Vivity Toric IOL to those achieved with other multifocal IOLs.
Prospective, ...open-label, multicenter analysis of PROs, including spectacle independence, dysphotopsia, and overall satisfaction among patients who underwent cataract surgery at least 1 month previously with bilateral Vivity or Vivity Toric lenses (n=60). Results were compared to outcomes from two similar prospective studies of bilateral AcrySof IQ PanOptix or PanOptix Toric trifocal IOLs (n = 59), blended AcrySof ReSTOR 2.5/3.0 IOLs (n=72) or bilateral ReSTOR ActiveFocus 2.5 D IOLs with a mini-monovision target n = 95).
Patients in the Vivity cohort were significantly less likely to notice glare and halo in dim light (85% "none" or "just a little") compared to PanOptix (69%, p<0.03), 2.5 mini-monovision (75%, p< 0.05) or 2.5/3.0 (71%, p< 0.05) patients. Complete spectacle independence for all visual activities combined (never need glasses) with Vivity was comparable to the mini-monovision and 2.5/3.0 groups (33%, 36%, and 31%, respectively) but significantly lower than in the PanOptix cohort (83%, p < 0.0001). Satisfaction was high across all groups. There were no statistically significant differences in best-corrected visual acuity, and no new safety concerns were reported.
The AcrySof IQ Vivity extended depth of focus IOL offers an expanded range of vision and better spectacle independence than has typically been achieved with traditional monofocal IOLs, with high rates of satisfaction and a favorable dysphotopsia profile compared to diffractive multifocal IOLs.
To compare spectacle independence, patient-reported outcomes (PROs), and dysphotopsia after multifocal intraocular lens (IOL) implantation with the AcrySof PanOptix trifocal or the ReSTOR +2.5/3.0 D ...or ReSTOR +2.5 D mini-monovision multifocal IOL.
Prospective, open-label, multicenter analysis of PROs, spectacle independence, and satisfaction among patients undergoing cataract surgery who had been implanted at least 1 month previously with AcrySof IQ PanOptix or PanOptix Toric trifocal (n = 59) IOLs bilaterally. Results were compared to outcomes from a similar study with the AcrySof ReSTOR 2.5/3.0 or the ReSTOR ActiveFocus 2.5 mini-monovision lens n = 191).
Spectacle independence was significantly higher in the PanOptix cohort, with 83% of patients "never" needing glasses for any activity versus 36% in the ReSTOR 2.5 mini-monovision and 34% in the ReSTOR 2.5/3.0 cohorts. No significant differences in patient satisfaction rates were reported between the three cohorts. Glare and halo were rated "extremely" noticeable more with the PanOptix (10%) than with the ReSTOR 2.5 mini-monovision (1%) or ReSTOR 2.5/3.0 (3%). BCVA differences were not statistically significant, and no new safety concerns were reported.
The AcrySof PanOptix trifocal provides significantly greater spectacle independence across all measured activities than the AcrySof ReSTOR multifocal IOLs.
The purpose of this study was to determine the satisfaction levels of patients at least 2 years after cataract surgery implantation with bilateral accommodating or bilateral multifocal intraocular ...lenses (IOLs) and to determine the relative rate of spectacle independence and adverse symptoms in that same time frame.
Patient questionnaire administered in a single-center private practice at least 2 years after cataract surgery with presbyopia-correcting IOL implantation.
Patients who had undergone uncomplicated cataract surgery with an accommodating or multifocal IOL implant were eligible for inclusion. Patients with visually significant non-IOL-related postoperative morbidity were excluded. Patients with astigmatism or residual refractive error were not excluded. The main outcome measure was patient satisfaction at least 2 years after IOL implantation.
Sixty-eight patients who received accommodating lenses and 49 patients who received multifocal lenses completed the questionnaire. The mean age of all patients was 75.7 years at the time of survey; the mean number of years since cataract surgery was 5.4 years. Overall, there were no significant differences between the two groups or within each group between the different lenses used. About 90% of patients in each group were "very satisfied" or "somewhat satisfied" with their vision at least 2 years after the initial surgery. Conversely, only one in eleven patients found his vision to be worse than expected.
The majority of patients who received either accommodating or multifocal IOLs remain satisfied with their lens of choice more than 5 years after the original surgery. Glare and halos remain more noticeable in patients who received multifocal lenses.
Purpose: To compare OTX-DED, an investigational dexamethasone intracanalicular insert, to loteprednol 0.5% suspension applied QID for 28 days as treatments for acute exacerbations of dry eye disease ...in terms of patient symptoms, corneal staining, tear breakup time (TBUT), and ocular redness. Methods: Fifty patients with an acute exacerbation of dry eye with at least grade 1 corneal staining were randomized to receive treatment and were each evaluated in one eye at baseline, two weeks and four weeks with the standard patient evaluation of eye dryness (SPEED) questionnaire, the Oxford Scale for corneal stain, Schulze Scale for ocular redness, and intraocular pressure (IOP). Results: Forty-four patients completed the study. Significant improvement was noted from baseline to both week 2 and 4 for each treatment in SPEED scores, corneal staining, and TBUT. Ocular redness improved significantly from baseline to week 2 for loteprednol and week 4 for both drugs. No significant difference was noted between treatments in any of these evaluations at any time point. Retention (visibility) of the OTX-DED insert was 95% at week 2 and 90% at week 4. IOP rose significantly from baseline to both week 2 and 4 for eyes receiving loteprednol but not for those receiving OTX-DED. Conclusion: OTX-DED significantly improved on both signs and symptoms of eyes suffering from acute exacerbations of dry eye disease. This improvement was similar to that seen with loteprednol 0.5% suspension, a well-accepted treatment for this condition. IOP did not change significantly in patients with OTX-DED. These findings support the use of this unique intracanalicular insert for the treatment of acute dry eye once this product is approved and available for use.
The receptor for advanced glycation end products (RAGE) is thought to be a primary transporter of beta-amyloid across the blood-brain barrier (BBB) into the brain from the systemic circulation, while ...the low-density lipoprotein receptor-related protein (LRP)-1 mediates transport of beta-amyloid out of the brain. To determine whether there are Alzheimer's disease (AD)-related changes in these BBB-associated beta-amyloid receptors, we studied RAGE, LRP-1, and beta-amyloid in human elderly control and AD hippocampi. In control hippocampi, there was robust RAGE immunoreactivity in neurons, whereas microvascular staining was barely detectable. LRP-1 staining, in contrast, was clearly evident within microvessels but only weakly stained neurons. In AD cases, neuronal RAGE immunoreactivity was significantly decreased. An unexpected finding was the strongly positive microvascular RAGE immunoreactivity. No evidence for colocalization of RAGE and beta-amyloid was seen within either microvessels or senile plaques. A reversed pattern was evident for LRP-1 in AD. There was very strong staining for LRP-1 in neurons, with minimal microvascular staining. Unlike RAGE, colocalization of LRP-1 and beta-amyloid was clearly present within senile plaques but not microvessels. Western blot analysis revealed a much higher concentration of RAGE protein in AD hippocampi as compared with controls. Concentration of LRP-1 was increased in AD hippocampi, likely secondary to its colocalization with senile plaques. These data confirm that AD is associated with changes in the relative distribution of RAGE and LRP-1 receptors in human hippocampus. They also suggest that the proportion of amyloid within the brains of AD patients that is derived from the systemic circulation may be significant.
The purpose of this study is to evaluate the efficacy and safety of the laserarcs.com nomogram in reducing astigmatism among cataract patients that underwent astigmatism reduction with laser arcuate ...incisions.
In this retrospective study, 50 patients who underwent uncomplicated cataract surgery with laser arc incisions for the reduction of astigmatism with a single surgeon between the dates of January 23, 2021 and February 10, 2022 were evaluated in a single eye. Preoperative astigmatism was determined on the basis of keratometry from biometry (IOLmaster, Carl Zeiss Meditec or LenStar LS900, Haag-Streit, Bern, Switzerland) and was compared to the postoperative manifest astigmatism. The percent change in the absolute magnitude of astigmatism was calculated along with the percent of patients with various levels of postoperative astigmatism.
Mean cylinder was 0.97 ± 0.49 D pre-op and 0.21 ± 0.28 D postop. Mean reduction in cylinder was 81.4 ± 47.7% (P < 0.00001, one-sample
-test compared to a hypothetical 60% reduction in cylinder). Residual cylinder was ≤0.5 D in 90%, 0.25 D in 72%, and 0 D in 58%. Postoperative uncorrected visual acuity was 20/30 or better in 92% and 20/20 or better in 40%. Subgroup analysis showed that residual astigmatism was not affected by patient age, magnitude of preoperative astigmatism, preoperative spherical equivalent, or corneal curvature. No adverse events related to the laser arcuate incisions were noted.
Use of the LaserArcs nomogram yielded a significant reduction in preoperative astigmatism. Postoperative uncorrected visual acuity was substantially similar to best-corrected visual acuity, suggesting that many patients undergoing treatment will function without correction for distance tasks.
Eric D Donnenfeld,1 John A Hovanesian,2 Aysha G Malik,1 Aidan Wong1 1Ophthalmic Consultants of Long Island, New York, NY, USA; 2Harvard Eye Associates, Laguna Hills, CA, USACorrespondence: Eric D ...Donnenfeld, Ophthalmic Consultants of Long Island (OCLI), 711 Stewart Avenue, Suite 160, Garden City, New York, NY, 11530, USA, Tel +1 516-500-4200, Fax +1 516-742-0017, Email ericdonnenfeld@gmail.comPurpose: To evaluate clinical efficacy and patient preference for a dropless treatment regimen compared to conventional topical therapy in patients undergoing cataract surgery.Patients and Methods: In this prospective, contralateral eye study, patients with bilateral cataract were randomized to receive either intracanalicular dexamethasone insert, intracameral phenylephrine 1%/ketorolac 0.3%, and intracameral moxifloxacin (50 μg) (study group) or topical moxifloxacin 0.5%, ketorolac 0.5%, and prednisolone acetate 1.0% QID (control group). The second eye underwent cataract surgery 2 weeks later and was treated with the opposite treatment. All patients were evaluated at Days 1, 7, 14, 28, and 3 months. The primary outcome measure was postoperative ocular pain. Secondary outcomes included summed ocular inflammation score (SOIS; the sum of the mean anterior chamber cells and anterior flare score), the patient preference for medication protocol between the two eyes, and patient out-of-pocket cost of medications. Safety outcome measures included CDVA, intraocular pressure, central retinal thickness (CRT), and the incidence of reported AEs.Results: The proportion of patients with no pain was similar in both groups at all postoperative visits (p> 0.05). No statistically significant difference in SOIS score was observed between the two groups at any visit. A strong majority of the patients (94.7%) preferred the study eye’s dropless regimen over the control eye’s conventional topical therapy regimen. No statistically significant difference in mean intraocular pressure (IOP) was observed at any postoperative visit, except at Week 1. The mean CDVA was also similar in both groups at all postoperative visits (p> 0.05). The postoperative mean CRT was comparable between the two groups.Conclusion: A dropless treatment regimen is as effective as topical eyedrop administration. A higher proportion of patients who underwent bilateral cataract surgery preferred the dropless treatment regimen over the patient-administered eye drop regimen.Keywords: dropless cataract surgery, intracanalicular dexamethasone insert, dropless vs topical eyedrop administration, sustained-release steroid delivery, drop-free treatment regimen
The removal and rate of recurrence of pterygium have been discussed for years. The disorder is highly associated with environmental factors, and recurrence rates can be unacceptably high and cannot ...be successfully predicted. New techniques and graft preparations and postoperative management strategies are helping to reduce the recurrence rates and provide an ocular surface that is near ideal for future cataract or refractive surgery. This review discusses the advantages and disadvantages of various treatment strategies.
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