Purpose To evaluate corneal biomechanical deformation response using Ocular Response Analyzer (ORA) and Corvis ST data. Design Prospective observational case-control study. Methods A total of 1262 ...eyes of 795 patients were enrolled. Three groups were established, according to the corneal compensated intraocular pressure (IOPcc): Group I (10-13 mm Hg), Group II (14-17 mm Hg), and Group III (18-21 mm Hg). Each group included 3 subgroups, based on central corneal thickness (CCT): Subgroups 1 (465-510 μm), 2 (510-555 μm), and 3 (555-600 μm). In addition, similar groups of CCT were divided into subgroups of IOPcc. Corneal hysteresis (CH) and corneal resistance factor (CRF) were derived from ORA. The parameters of highest concavity with the parameters of first and second applanation were recorded from Corvis ST. Results CH and CRF, applanation 1 time, and radius of curvature at highest concavity showed significant differences between CCT subgroups for each IOPcc group ( P < .0001). CH, applanation 1 and 2 time, and applanation 2 velocity, as well as deformation amplitude (DA), showed significant differences by IOP subgroups for all CCT groups. IOPcc is correlated negatively with CH ( r = −0.38, P < .0001). There are positive correlations of IOPcc with applanation 1 time, applanation 2 velocity, and radius and negative correlations with applanation 2 time ( r = −0.54, P < .0001), applanation 1 velocity ( r = −0.118, P < .0001), and DA ( r = −0.362, P < .0001). Conclusion ORA and Corvis ST parameters are informative in the evaluation of corneal biomechanics. IOP is important in deformation response evaluation and must be taken into consideration.
To evaluate the effectiveness of accelerated corneal collagen crosslinking (CXL) with riboflavin for keratoconus by the change in dioptric power and corneal topography.
Private practice, Tokyo, ...Japan.
Case series.
The accelerated CXL treatments (KXL system) were performed using a 10-minute riboflavin 0.1% (Vibex Rapid) soak and a 3-minute ultraviolet-A (UVA) irradiance at a level of 30 mW/cm(2). This corresponds to a total radiant exposure of 5.4 J/cm(2). Preoperative and 1, 3, and 6 months postoperative examinations were performed.
The study enrolled 39 eyes of 22 patients. The mean uncorrected distance visual acuity showed a statistically significant improvement, from 1.11 ± 0.42 logMAR preoperatively to 0.89 ± 0.53 logMAR 6 months postoperatively (P<.01). The mean maximum keratometry readings also changed significantly, from 49.95 ± 6.11 diopters (D) preoperatively to 49.19 ± 5.82 D at 6 months (P<.01). There were no statistically significant changes in the endothelial cell density between preoperatively and postoperatively.
The changes after accelerated CXL were similar to those after conventional CXL. Thus, accelerated CXL has the potential to efficiently treat and halt the progression of keratoconus and may be an effective, efficient therapeutic option for treating corneal ectatic disease.
No author has a financial or proprietary interest in any material or method mentioned.
To determine tolerance to residual astigmatism and visual performance in eyes implanted with a monofocal intraocular lens (IOL) designed to extend the depth of focus (Tecnis Eyhance, DIB00; Johnson & ...Johnson Vision) compared to eyes implanted with a standard monofocal IOL (Tecnis ZCB00; Johnson & Johnson Vision).
This prospective, observational study enrolled consecutive patients who underwent routine cataract surgery and implantation of either the DIB00 (n = 20) or ZCB00 (n = 20) IOL. Astigmatic defocus was induced with a plus cylinder from +0.50 to +2.00 diopters (D) in 0.50-D steps for each astigmatic orientation (against-the-rule ATR, with-the-rule WTR, and oblique). Outcome measures included the comparison of mean visual acuity at each step of defocus, astigmatic defocus curves, and near and intermediate visual acuity.
Eyes implanted with the DIB00 demonstrated greater astigmatic tolerance and were more likely to maintain 20/40 or better visual acuity with up to +2.00 D of induced ATR and oblique astigmatism than the ZCB00 IOLs. The DIB00 group showed 1.3 lines better visual acuity at 2.00 D of ATR astigmatic defocus and 1 line better than the ZCB00 group at 1.50 D of oblique astigmatic defocus. Although the distance visual acuity was comparable, near and intermediate visual acuities (both distance-corrected and uncorrected) were better for the DIB00 IOL than for the standard ZCB00 IOL.
The monofocal IOL designed to extend the depth of focus (DIB00 group) showed greater tolerance to induced astigmatism in ATR and oblique orientations and superior uncorrected and distance-corrected near and intermediate visual acuity than the standard monofocal IOL of the same IOL platform.
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To compare biometry measurements obtained by a partial interferometer biometer (IOLMaster 500) to the new Scheimpflug tomography with an integrated axial length biometer module (Pentacam AXL).
...Cataract patients who underwent biometric measurements with the IOL Master 500 and the Pentacam AXL from July to November 2017 were enrolled in this study. Comparisons were performed for axial length (AL), keratometry (K), and anterior chamber depth (ACD). The Pearson correlation coefficient and the 95% limits of agreement (LoA) were calculated. Paired Student's
-tests and Bland-Altman plots were used to assess the differences between devices.
One hundred and sixty-six eyes of 92 patients were analyzed. There were no statistically significant differences in AL (p=0.558) or flat K (p=0.196) values between the IOL Master 500 and Pentacam AXL measurements. Statistically significant differences were found between the two devices with respect to steep K, ACD, and mean K measurements (p<0.001).
Both devices provided similar measurements of AL and flat K, though there were statistically significant differences in ACD, steep K, and mean K measurements.
To assess the efficacy of a small aperture corneal inlay (KAMRA, AcuFocus Inc) to improve near vision in emmetropic presbyopes.
Prospective, nonrandomized, multicenter clinical trial in presbyopic ...emmetropes aged 45 to 60 years. A small corneal pocket or flap was created in the nondominant eye by femtosecond laser or mechanical microkeratome, and the inlay (N=507) placed on the stromal bed. Uncorrected visual acuity was measured for the implanted eye at near (40 cm), intermediate (80 cm), and distance (20 ft) using ETDRS charts with the Optec 6500 Vision Tester (Stereo Optical Inc) at the preoperative, and 1-, 3-, 6-, 9-, 12-, and 18-month postoperative examinations. Contrast sensitivity (CS) was measured with best distance correction in the implanted eye using the Optec system and FACT chart under photopic (85 cd/m(2)) and mesopic (3 cd/m(2)) conditions preoperatively and at 1-year follow-up.
Mean patient age was 52.87±3.64 years. Monocular mean uncorrected near visual acuity was J8 (0.482±0.925 logMAR) preoperatively, J3 (0.185±0.848 logMAR) at 1 month (n=506, P<.0001), and J2 (0.139±0.851 logMAR) at 18 months (n=99, P<.0001). Mean uncorrected intermediate visual acuity was 20/35 (0.239±0.837 logMAR) preoperatively and 20/26 (0.139±0853 logMAR) at 18 months (P<.0001). Mean uncorrected distance visual acuity (UDVA) was 20/20 (0.011±0.890 logMAR) at 18 months. Photopic (P<.001) and mesopic (P<.0001) monocular contrast sensitivities were within the range of the normal population at 1 year.
The KAMRA corneal inlay improved near visual acuity with minimal impact on UDVA or mesopic contrast sensitivity in the implanted eye.
To evaluate the prediction of postoperative anatomical lens position (ALP) using intraoperative spectral-domain optical coherence tomography (SD-OCT) lens anatomy metrics in patients who underwent ...femtosecond laser-assisted cataract surgery.
Intraoperative SD-OCT (Catalys; Johnson & Johnson Vision) and postoperative optical biometry (IOLMaster 700; Carl Zeiss Meditec AG) were used to assess anterior segment landmarks, including lens thickness, lens volume, anterior chamber depth, lens meridian position (LMP), and measured ALP. LMP was defined as the distance from the corneal epithelium to the lens equator, and ALP was defined as the distance from the corneal epithelium to the IOL surface. Eyes were divided into groups according to axial length (> 22.5 mm, 22.5 to 24.5 mm, and > 24.5 mm) and IOL type (Tecnis ZCB00 Johnson & Johnson Vision; AcrySof SN-60WF Alcon Laboratories, Inc, or enVista MX60E Bausch & Lomb) to further analyze the correlation between LMP and ALP. Theoretical effective lens position was back-calculated using a specific formula. Primary outcome was correlation between postoperative measured ALP and LMP.
A total of 97 eyes were included in this study. Linear regression analysis displayed a statistically significant correlation between intraoperative LMP and postoperative ALP (
= 0.522;
< .01). No statistically significant correlation was observed between LMP and lens thickness (
= 0.039;
= .06) or between ALP and lens thickness (
= 0.02;
= .992). The greatest predictor for ALP was LMP (β = 0.766,
< .001;
= 0.523).
Intraoperative SD-OCT-measured LMP correlated better than anterior chamber depth and axial length to postoperative ALP. Further studies are necessary to analyze the impact of preoperative or intraoperative LMP measurements on postoperative refractive outcomes.
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To evaluate the safety and efficacy of simultaneous Kamra corneal inlay implantation and laser in situ keratomileusis (LASIK) for the treatment of presbyopia in emmetropic, hyperopic, or myopic ...patients.
Private center, Tokyo, Japan.
Cohort study.
Patients had bilateral LASIK with simultaneous implantation of a corneal inlay in the nondominant eye to treat presbyopia and ametropia between September 2009 and April 2010. The efficacy and safety were determined by the spherical equivalent (SE) in the eye with the inlay.
The study enrolled 360 eyes of 180 patients with a mean age of 52.4 years ± 5.1 (SD) (range 41 to 65 years). Sixty-four patients were available for the 6-month postoperative examination. The mean logMAR uncorrected near visual acuity in the eye with the inlay improved 7 lines in hyperopic eyes, 6 lines in emmetropic eyes, and 2 lines in myopic eyes. The mean logMAR uncorrected distance visual acuity improved by 3 lines, 1 line, and 10 lines, respectively.
Simultaneous intracorneal inlay implantation and LASIK to treat presbyopia with emmetropia, hyperopia, or myopia was clinically safe and effective, yielding improvement in distance and near visual acuity. Patients were satisfied with decreased dependence on reading glasses regardless of the preoperative SE range. However, postoperative symptoms, such as dry eyes, halo, glare, or night-vision disturbances, occurred occasionally.
Dr. Waring has a financial interest in and is world surgical monitor for Acufocus. No other author has a financial or proprietary interest in any material or method mentioned.
To evaluate the visual outcomes after implantation of a Kamra small-aperture corneal inlay into a femtosecond-created corneal pocket to treat presbyopia in patients who had previous laser in situ ...keratomileusis (LASIK).
Private center, Tokyo, Japan.
Prospective interventional case series.
Post-LASIK presbyopic patients had inlay implantation into a corneal pocket created by a femtosecond laser at a depth of 200 μm or 250 μm a minimum of 80 μm below the previous LASIK flap interface in the nondominant eye. Uncorrected and corrected distance visual acuities, near visual acuity, and a patient questionnaire on satisfaction, the use of reading glasses, and visual symptoms were evaluated.
The study enrolled 223 eyes (223 patients) with a mean age of 53.6 years (range 44 to 65 years) and a mean manifest spherical equivalent of -0.18 diopter (D) (range -1.00 to +0.50 D). The mean uncorrected distance visual acuity in the operated eye decreased 1 line from 20/16 preoperatively to 20/20 6 months postoperatively (P<.001). The mean uncorrected near visual acuity improved 4 lines from Jaeger (J) 8 to J2 (P<.001). At 6 months, significant improvements were observed in patient dependence on reading glasses and patient satisfaction with vision without reading glasses.
The 6-month results suggest that implantation of a small-aperture inlay in post-LASIK presbyopic patients improves near vision with a minimal effect on distance vision, resulting in high patient satisfaction and less dependence on reading glasses.
Drs. Tomita and Waring are consultants to Acufocus, Inc. Dr. Tomita is a consultant to Ziemer Group AG. No other author has a financial or proprietary interest in any material or method mentioned.
To compare ray-tracing aberrometry, Hartmann-Shack wavefront analysis, automated refraction, and manifest refraction in patients with echelette diffractive intraocular lenses (IOLs) and patients with ...monofocal IOLs with negative spherical aberration.
Pseudophakic patients implanted with an echelette diffractive IOL (Tecnis ZXR00; Johnson & Johnson Vision) and a control group consisting of patients implanted with a negative spherical aberration monofocal IOL (Tecnis ZCBOO, Johnson & Johnson Vision) were included in this study. Ray-tracing aberrometry (iTrace; Tracey Technologies Corp.), Hartmann-Shack wavefront analysis (LADARWave; Alcon Laboratories, Inc.), automated refraction (Topcon KR-8800; Topcon Medical Systems, Inc.), and manifest refraction spherical equivalent were performed 1 to 3 months postoperatively.
Thirty-two eyes implanted with a ZXR00 IOL and 30 eyes implanted with a ZCBOO IOL were enrolled in this study. The ZXR00 IOL group yielded more myopic results with automated refactions (-0.62 ± 0.41 diopters D), Hartmann-Shack wavefront analysis (-0.85 ± 0.40 D), and ray-tracing aberrometry (-0.45 ± 0.64 D), compared to manifest refraction (-0.12 ± 0.44 D) (P < .001). Hartmann-Shack wavefront analysis showed a statistically significant myopic shift (-0.39 ± 0.47 D) in the ZCBOO group compared to ray-tracing aberrometry, automated refraction, and manifest refraction spherical equivalent (-0.14 ± 0.56, -0.14 ± 0.50, and -0.06 ± 0.44 D, respectively; P < .001).
Manifest refraction techniques unique to echelette technology should be used to avoid over-minus end points. Autorefractors and aberrometers commonly use near-infrared light; thus, myopic results are expected with echelette achromatic technology. J Refract Surg. 2020;36(5):334-339..
Technology in cataract surgery is constantly evolving to meet the goals of both surgeons and patients. Recent major advances in refractive cataract surgery include innovations in preoperative and ...intraoperative diagnostics, femtosecond laser-assisted cataract surgery (FLACS), and a new generation of intraocular lenses (IOLs). This paper presents the latest technologies in each of these major categories and discusses how these contributions serve to improve cataract surgery outcomes in a safe, effective, and predictable manner.
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