Sample records for presbyopia

  1. The Global Burden of Potential Productivity Loss from Uncorrected Presbyopia. (United States)

    Frick, Kevin D; Joy, Susan M; Wilson, David A; Naidoo, Kovin S; Holden, Brien A


    The onset of presbyopia in middle adulthood results in potential losses in productivity among otherwise healthy adults if uncorrected or undercorrected. The economic burden could be significant in lower-income countries, where up to 94% of cases may be uncorrected or undercorrected. This study estimates the global burden of potential productivity lost because of uncorrected functional presbyopia. Population data from the US Census Bureau were combined with the estimated presbyopia prevalence, age of onset, employment rate, gross domestic product (GDP) per capita in current US dollars, and near vision impairment disability weights from the Global Burden of Disease 2010 study to estimate the global loss of productivity from uncorrected and undercorrected presbyopia in each country in 2011. To allow comparison with earlier work, we also calculated the loss with the conservative assumption that the contribution to productivity extends only up to 50 years of age. The economic modeling did not require the use of subjects. We estimated the number of cases of uncorrected or undercorrected presbyopia in each country among the working-age population. The number of working-age cases was multiplied by the labor force participation rate, the employment rate, a disability weight, and the GDP per capita to estimate the potential loss of GDP due to presbyopia. The outcome being measured is the lost productivity in 2011 US dollars resulting from uncorrected or undercorrected presbyopia. There were an estimated 1.272 billion cases of presbyopia worldwide in 2011. A total of 244 million cases, uncorrected or undercorrected among people aged productivity loss of US $11.023 billion (0.016% of global GDP). If all those people aged productive, the potential productivity loss would be US $25.367 billion or 0.037% of global GDP. Correcting presbyopia to the level achieved in Europe would reduce the burden to US $1.390 billion (0.002% of global GDP). Even with conservative assumptions

  2. Prognostic and survival analysis of presbyopia: The healthy twin study (United States)

    Lira, Adiyani; Sung, Joohon


    Presbyopia, a vision condition in which the eye loses its flexibility to focus on near objects, is part of ageing process which mostly perceptible in the early or mid 40s. It is well known that age is its major risk factor, while sex, alcohol, poor nutrition, ocular and systemic diseases are known as common risk factors. However, many other variables might influence the prognosis. Therefore in this paper we developed a prognostic model to estimate survival from presbyopia. 1645 participants which part of the Healthy Twin Study, a prospective cohort study that has recruited Korean adult twins and their family members based on a nation-wide registry at public health agencies since 2005, were collected and analyzed by univariate analysis as well as Cox proportional hazard model to reveal the prognostic factors for presbyopia while survival curves were calculated by Kaplan-Meier method. Besides age, sex, diabetes, and myopia; the proposed model shows that education level (especially engineering program) also contribute to the occurrence of presbyopia as well. Generally, at 47 years old, the chance of getting presbyopia becomes higher with the survival probability is less than 50%. Furthermore, our study shows that by stratifying the survival curve, MZ has shorter survival with average onset time about 45.8 compare to DZ and siblings with 47.5 years old. By providing factors that have more effects and mainly associate with presbyopia, we expect that we could help to design an intervention to control or delay its onset time.

  3. Computer-animated model of accommodation and presbyopia. (United States)

    Goldberg, Daniel B


    To understand, demonstrate, and further research the mechanisms of accommodation and presbyopia. Private practice, Little Silver, New Jersey, USA. Experimental study. The CAMA 2.0 computer-animated model of accommodation and presbyopia was produced in collaboration with an experienced medical animator using Autodesk Maya animation software and Adobe After Effects. The computer-animated model demonstrates the configuration and synchronous movements of all accommodative elements. A new classification of the zonular apparatus based on structure and function is proposed. There are 3 divisions of zonular fibers; that is, anterior, crossing, and posterior. The crossing zonular fibers form a scaffolding to support the lens; the anterior and posterior zonular fibers work reciprocally to achieve focused vision. The model demonstrates the important support function of Weiger ligament. Dynamic movement of the ora serrata demonstrates that the forces of ciliary muscle contraction store energy for disaccommodation in the elastic choroid. The flow of aqueous and vitreous provides strong evidence for our understanding of the hydrodynamic interactions during the accommodative cycle. The interaction may result from the elastic stretch in the choroid transmitted to the vitreous rather than from vitreous pressue. The model supports the concept that presbyopia results from loss of elasticity and increasing ocular rigidity in both the lenticular and extralenticular structures. The computer-animated model demonstrates the structures of accommodation moving in synchrony and might enhance understanding of the mechanisms of accommodation and presbyopia. Dr. Goldberg is a consultant to Acevision, Inc., and Bausch & Lomb. Copyright © 2015 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

  4. Prevalence, Correlates, and Impact of Uncorrected Presbyopia in a Multiethnic Asian Population. (United States)

    Kidd Man, Ryan Eyn; Fenwick, Eva Katie; Sabanayagam, Charumathi; Li, Ling-Jun; Gupta, Preeti; Tham, Yih-Chung; Wong, Tien Yin; Cheng, Ching-Yu; Lamoureux, Ecosse Luc


    To examine the prevalence, correlates, and impact of uncorrected presbyopia on vision-specific functioning (VF) in a multiethnic Asian population. Population-based cross-sectional study. We included 7890 presbyopic subjects (3909 female; age range, 40-86 years) of Malay, Indian, and Chinese ethnicities from the Singapore Epidemiology of Eye Disease study. Presbyopia was classified as corrected and uncorrected based on self-reported near correction use. VF was assessed with the VF-11 questionnaire validated using Rasch analysis. Multivariable logistic and linear regression models were used to investigate the associations of sociodemographic and clinical parameters with uncorrected presbyopia, and its impact on VF, respectively. As myopia may mitigate the impact of noncorrection, we performed a subgroup analysis on myopic subjects only (n = 2742). In total, 2678 of 7890 subjects (33.9%) had uncorrected presbyopia. In multivariable models, younger age, male sex, Malay and Indian ethnicities, presenting distance visual impairment (any eye), and lower education and income levels were associated with higher odds of uncorrected presbyopia (all P Malay and Indian ethnicities are needed. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Computer vision syndrome in presbyopia and beginning presbyopia: effects of spectacle lens type. (United States)

    Jaschinski, Wolfgang; König, Mirjam; Mekontso, Tiofil M; Ohlendorf, Arne; Welscher, Monique


    This office field study investigated the effects of different types of spectacle lenses habitually worn by computer users with presbyopia and in the beginning stages of presbyopia. Computer vision syndrome was assessed through reported complaints and ergonomic conditions. A questionnaire regarding the type of habitually worn near-vision lenses at the workplace, visual conditions and the levels of different types of complaints was administered to 175 participants aged 35 years and older (mean ± SD: 52.0 ± 6.7 years). Statistical factor analysis identified five specific aspects of the complaints. Workplace conditions were analysed based on photographs taken in typical working conditions. In the subgroup of 25 users between the ages of 36 and 57 years (mean 44 ± 5 years), who wore distance-vision lenses and performed more demanding occupational tasks, the reported extents of 'ocular strain', 'musculoskeletal strain' and 'headache' increased with the daily duration of computer work and explained up to 44 per cent of the variance (rs = 0.66). In the other subgroups, this effect was smaller, while in the complete sample (n = 175), this correlation was approximately rs = 0.2. The subgroup of 85 general-purpose progressive lens users (mean age 54 years) adopted head inclinations that were approximately seven degrees more elevated than those of the subgroups with single vision lenses. The present questionnaire was able to assess the complaints of computer users depending on the type of spectacle lenses worn. A missing near-vision addition among participants in the early stages of presbyopia was identified as a risk factor for complaints among those with longer daily durations of demanding computer work. © 2015 The Authors. Clinical and Experimental Optometry © 2015 Optometry Australia.

  6. Impact of Uncorrected Presbyopia on the Quality of Life in Rural ...

    African Journals Online (AJOL)

    femi oloka

    ABSTRACT. Background: Few population based surveys have been done to assess the magnitude of presbyopia in developing countries and even fewer studies have found an impact on vision related quality of life in the developing world. The aim of this study is to determine the Impact of Presbyopia amongadults aged 40.

  7. Prevalence and associated factors of presbyopia among school teachers in Gondar City, Northwest Ethiopia, 2016

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    Andualem HB


    Full Text Available Hiwot Berhanu Andualem, Natnael Lakachew Assefa, Dawit Zenebe Weldemichael, Tsehay Kassa Tefera Department of Optometry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia Introduction: Presbyopia is an age-related decline in accommodation that diminishes the ability of the eye to focus on near objects. This is due to reduced elasticity of the crystalline lens as age increases. It causes near-vision impairment and affects near work, so it has significant effects on quality of life, particularly in the life of teachers, whose work depends mostly on reading and writing at short distances.Objective: The overall objective of the study was to assess the prevalence and associated factors of presbyopia among school teachers in Gondar city, Northwest Ethiopia, 2016.Methods: A cross-sectional study design with multistage simple random sampling technique was used to select 668 teachers in Gondar city. The study was conducted in 12 schools from April 15 to May 15, 2016. A pretested structured questionnaire and ophthalmic instruments for an eye examination were used as data collection tools by trained optometrists. Epi Info version 7 was used for data entry, and the data were exported to Statistical Package for Social Science version 20 for further analysis. Multivariate logistic regression was employed using enter method and odds ratio with 95% confidence interval, and p-value of ≤0.05 was considered to identify statistically significant associated factors of the outcome.Results: Prevalence of presbyopia among school teachers was 68.7%. Out of the total examined subjects, 317 (50.2% were females. On multivariate analysis, increased age, salary, work experience, cigarette smoking, pregnancy, and refractive error were positively and significantly associated with presbyopia. On the other hand, use of sunglasses and alcohol consumption were inversely and significantly associated with presbyopia.Conclusion and recommendation

  8. Quality of life and near vision impairment due to functional presbyopia among rural Chinese adults. (United States)

    Lu, Qing; Congdon, Nathan; He, Xiangdong; Murthy, Gudlavalleti V S; Yang, Amy; He, Wei


    To evaluate the impact of near-vision impairment on visual functioning and quality of life in a rural adult population in Shenyang, northern China. A population-based, cross-sectional study was conducted among persons aged 40+ years, during which functional presbyopia (correctable presenting near vision vision-related quality of life and spectacle usage questionnaires were administered by trained interviewers to determine the degree of self-rated difficulty with near tasks. A total of 1008 respondents (91.5% of 1102 eligible persons) were examined, and 776 (78%) of completed the questionnaires (mean age, 57.0 ± 10.2 years; 63.3% women). Near-vision spectacle wearers obtained their spectacles primarily from markets (74.5%) and optical shops (21.7%), and only 1.14% from eye clinics. Among 538 (69.3%) persons with functional presbyopia, self-rated overall (distance and near) vision was worse (P vision. Compared to persons without presbyopia, presbyopic persons were more likely to report diminished accomplishment due to vision (P = 0.01, adjusted for age, sex, education, and distance vision.) Difficulties with activities of daily living and resulting social impediments are common due to presbyopia in this setting. Most spectacle wearers with presbyopia in rural China obtain near correction from sources that do not provide comprehensive vision care.

  9. An ancient explanation of presbyopia based on binocular vision. (United States)

    Barbero, Sergio


    Presbyopia, understood as the age-related loss of ability to clearly see near objects, was known to ancient Greeks. However, few references to it can be found in ancient manuscripts. A relevant discussion on presbyopia appears in a book called Symposiacs written by Lucius Mestrius Plutarchus around 100 A.C. In this work, Plutarch provided four explanations of presbyopia, associated with different theories of vision. One of the explanations is particularly interesting as it is based on a binocular theory of vision. In this theory, vision is produced when visual rays, emanating from the eyes, form visual cones that impinge on the objects to be seen. Visual rays coming from old people's eyes, it was supposed, are weaker than those from younger people's eyes; so the theory, to be logically coherent, implies that this effect is compensated by the increase in light intensity due to the overlapping, at a certain distance, of the visual cones coming from both eyes. Thus, it benefits the reader to move the reading text further away from the eyes in order to increase the fusion area of both visual cones. The historical hypothesis taking into consideration that the astronomer Hipparchus of Nicaea was the source of Plutarch's explanation of the theory is discussed. © 2013 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  10. Pupil size stability of the cubic phase mask solution for presbyopia (United States)

    Almaguer, Citlalli; Acosta, Eva; Arines, Justo


    Presbyopia correction involves different types of studies such as lens design, clinical study, and the development of objective metrics, such as the visual Strehl ratio. Different contact lens designs have been proposed for presbyopia correction, but performance depends on pupil diameter. We will analyze the potential use of a nonsymmetrical element, a cubic phase mask (CPM) solution, to develop a contact or intraocular lens whose performance is nearly insensitive to changes in pupil diameter. We will show the through focus optical transfer function of the proposed element for different pupil diameters ranging from 3 to 7 mm. Additionally, we will show the images obtained through computation and experiment for a group of eye charts with different visual acuities. Our results show that a CPM shaped as 7.07 μm*(Z33-Z3-3)-0.9 μm Z20 is a good solution for a range of clear vision with a visual acuity of at least 0.1 logMar from 0.4 to 6 m for pupil diameters in the 3- to 7-mm range. Our results appear to be a good starting point for further development and study of this kind of CPM solution for presbyopia.

  11. Advanced surface ablation for presbyopia using the Nidek EC-5000 laser. (United States)

    Cantú, Roberto; Rosales, Marco A; Tepichín, Eduardo; Curioca, Andrée; Montes, Victor; Bonilla, Julio


    To present 1 to 6-month follow-up results of laser in situ keratomileusis (LASIK) using multizone presbyopic advanced surface ablation (PASA) with a peripheral near zone. LASIK was performed on 28 eyes of 17 patients (10 men and 7 women; mean age 49.8 years with a range of 37 to 62 years). Eyes had primary or enhancement treatments with the Nidek EC-5000 excimer laser. Three techniques were used: 1) total transepithelial ablation, 2) surface ablation for far vision ametropia correction, and 3) concentric peripheral near zone presbyopia correction (technique developed by Dr. A. Telandro with a modified nomogram by Dr. R. Cantú for surface ablation). One surgeon (RC) performed all surgery. We present the preoperative and postoperative measurements for far and near uncorrected visual acuity, total high order aberrations, spherical aberration (Z-12), asphericity Q index, eccentricity corneal shape factor, and total coma and trefoil aberrations. Increases occurred in negative spherical aberration, negative asphericity index, and positive eccentricity corneal shape factor. Advanced surface ablation for presbyopia with a concentric peripheral near zone is a promising approach for surgical correction of presbyopia and potentially could be used with any advanced surface ablation procedure. Increases in negative spherical aberration and asphericity/ eccentricity indices seemed to increase the depth of focus of the eye, improving the near vision.

  12. Presbyopia among public senior high school teachers in the Kumasi ...

    African Journals Online (AJOL)

    Objectives: The aim was to determine the uptake of correction and prescription for presbyopia of presbyopic teachers of public Senior High School (S.H.S.). Design: Descriptive cross-sectional study. Methods: The study was conducted in 12 public S.H.S. in the Kumasi, with a total sample size of 298. Questionnaire was ...


    Zhao, Q; Wu, X X; Zhou, J; Wang, X; Liu, R F; Gao, J


    With the development of photoelectric technology and single-chip microcomputer technology, objective optometry, also known as automatic optometry, is becoming precise. This paper proposed a presbyopia optometry method based on diopter regulation and Charge Couple Device (CCD) imaging technology and, in the meantime, designed a light path that could measure the system. This method projects a test figure to the eye ground and then the reflected image from the eye ground is detected by CCD. The image is then automatically identified by computer and the far point and near point diopters are determined to calculate lens parameter. This is a fully automatic objective optometry method which eliminates subjective factors of the tested subject. Furthermore, it can acquire the lens parameter of presbyopia accurately and quickly and can be used to measure the lens parameter of hyperopia, myopia and astigmatism.

  14. [Improvement of vision through perceptual learning in the case of refractive errors and presbyopia : A critical valuation]. (United States)

    Heinrich, S P


    The idea of compensating or even rectifying refractive errors and presbyopia with the help of vision training is not new. For most approaches, however, scientific evidence is insufficient. A currently promoted method is "perceptual learning", which is assumed to improve stimulus processing in the brain. The basic phenomena of perceptual learning have been demonstrated by a multitude of studies. Some of these specifically address the case of refractive errors and presbyopia. However, many open questions remain, in particular with respect to the transfer of practice effects to every-day vision. At present, the method should therefore be judged with caution.

  15. A Novel Laser Refractive Surgical Treatment for Presbyopia: Optics-Based Customization for Improved Clinical Outcome. (United States)

    Pajic, Bojan; Pajic-Eggspuehler, Brigitte; Mueller, Joerg; Cvejic, Zeljka; Studer, Harald


    Laser Assisted in Situ Keratomileusis (LASIK) is a proven treatment method for corneal refractive surgery. Surgically induced higher order optical aberrations were a major reason why the method was only rarely used to treat presbyopia, an age-related near-vision loss. In this study, a novel customization algorithm for designing multifocal ablation patterns, thereby minimizing induced optical aberrations, was used to treat 36 presbyopic subjects. Results showed that most candidates went from poor visual acuity to uncorrected 20/20 vision or better for near (78%), intermediate (92%), and for distance (86%) vision, six months after surgery. All subjects were at 20/25 or better for distance and intermediate vision, and a majority (94%) were also better for near vision. Even though further studies are necessary, our results suggest that the employed methodology is a safe, reliable, and predictable refractive surgical treatment for presbyopia.

  16. Hyperelastic modelling of the crystalline lens: Accommodation and presbyopia (United States)

    Lanchares, Elena; Navarro, Rafael; Calvo, Begoña


    Purpose The modification of the mechanical properties of the human crystalline lens with age can be a major cause of presbyopia. Since these properties cannot be measured in vivo, numerical simulation can be used to estimate them. We propose an inverse method to determine age-dependent change in the material properties of the tissues composing the human crystalline lens. Methods A finite element model of a 30-year-old lens in the accommodated state was developed. The force necessary to achieve full accommodation in a 30-year-old lens of known external geometry was computed using this model. Two additional numerical models of the lens corresponding to the ages of 40 and 50 years were then built. Assuming that the accommodative force applied to the lens remains constant with age, the material properties of nucleus and cortex were estimated by inverse analysis. Results The zonular force necessary to reshape the model of a 30-year-old lens from the accommodated to the unaccommodated geometry was 0.078 newton (N). Both nucleus and cortex became stiffer with age. The stiffness of the nucleus increased with age at a higher rate than the cortex. Conclusions In agreement with the classical theory of Helmholtz, on which we based our model, our results indicate that a major cause of presbyopia is that both nucleus and cortex become stiffer with age; therefore, a constant value of the zonular forces with aging does not achieve full accommodation, that is, the accommodation capability decreases.

  17. [fs-Lentotomy: presbyopia reversal by generating gliding planes inside the crystalline lens]. (United States)

    Lubatschowski, H; Schumacher, S; Wegener, A; Fromm, M; Oberheide, U; Hoffmann, H; Gerten, G


    Based on the Helmholtz theory for accommodation, increasing sclerosis of the lens nucleus and cortex is the main cause for the development of presbyopia. Existing therapies, however, do not reverse the stiffness of the crystalline lens and thus do not regain real accommodation ability. A new approach to restore the flexibility of the lens has been realised by utilising the non-linear interaction of ultrafast laser pulses with transparent tissue, the so-called photodisruption. This process has been used to create micro-incisions which act as gliding planes inside the crystalline lens without opening the eye globe. This treatment method, known as fs-lentotomy, enables regeneration of real dynamic accommodation. For the first time, 3D structures for gliding planes were successfully generated in experiments with human donor lenses of different ages. An average increase in anterior-posterior lens thickness of 100 mum accompanied by a decrease of equatorial lens diameter was observed as a direct consequence of fs-lentotomy. This is attributed to the increased flexibility, as the force of the capsule bag moulds the lens tissue more spherically. Moreover, in vivo experiments on rabbit eye lenses did not induce an increasing opacification (cataract) over a six-month follow-up period. However, the incisions were still detectable using Scheimpflug imaging and histopathological techniques, although the visibility of the incisions was declining. Furthermore, no side effects were observed during the wound healing process and during a six-months follow-up period. Based on these findings fs-lentotomy might have the potential to become a procedure for the reversal of presbyopia. Copyright Georg Thieme Verlag KG Stuttgart . New York.


    Directory of Open Access Journals (Sweden)

    E. N. Eskina


    Full Text Available Purpose. To compare the efficacy, safety and predictability of presbyopia correction by the PRK with application of a bi-aspheric multifocal profile on the cornea with PresbyMax software for patients with hyperopia and myopia.Patients and methods: There were 2 patients group of 25 people each (50 eyes. They were operated with PRK method with application of a multifocal biaspheric profile for simultaneous correction of ametropia and presbyopia. Group I — patients with myopia and presbyopia. Group II — patients with hypermetropia and presbyopia.Results. In the group 1 year post operation binocular DUCVA was 0,93±0,19, NUCVA — 0,86±0,14, IUCVA — 0,67±0,11. Only two eyes (4 % lost DBCVA on the 1–2 lines. Target refraction of a dominant eye — emmetropia was 72 % of patients, 28 % observed myopia of –0,75 D. Target refraction of a nondominant eye was –0,75, 68 % had this result, 28 % had deviation –0,50 D of the target refraction, and 4 % — 1,00 D. In group 2 a year post operation binocular DUCVA was 0,96±0,16, NUCVA — 0,77±0,19, IUCVA — 0,64±0,15. Only two eyes (4 % lost DBCVA on the 1–2 lines. Target refraction of a dominant eye — emmetropia was 72 % of patients, 28 % observed myopia of –0,75 D. Target refraction of a nondominant eye was –0,75, 68 % had this result, 32 % had deviation to –0,75 D of the target refraction.Conclusions. PRK with application of a bi-aspheric multifocal profile on the cornea using PresbyMAX software and µ-monovision is effective for correction myopia and hypermetropia. Simultaneous correction of ametropia and presbyopia by the PRK method with the application of the multifocal biospheric profile to the cornea with the formation of a slight anisometropia (the concept of µ-monovision with the PresbyMax software is an effective, safe and predictable method of surgical intervention, both in myopia and hypermetropia.

  19. Four corneal presbyopia corrections: simulations of optical consequences on retinal image quality. (United States)

    Koller, Tobias; Seiler, Theo


    To investigate the possibility of multifocal or aspherical treatment of the cornea with optical ray tracing. Institute for Refractive and Ophthalmic Surgery, Zurich, Switzerland. The optical consequences of 4 corneal shapes-global optimum (GO) for curvature and asphericity, central steep island (CSI), decentered steep island (DSI), and centered steep annulus (CSA)-for presbyopia correction were analyzed using a modified Liou-Brennan eye model and ray tracing with a commercial optic design software (Zemax, Zemax Development Corp.). The ocular optical configuration for far vision was a point light source at a distance of 5 m, 1 degree up, and a pupil diameter of 5.0 mm and for near vision, 0.4 m distance, 1 degree up, and a pupil diameter of 2.5 mm. The curvature radius (R) of the cornea and its asphericity (Q) were used as operands to optimize (simultaneously for near and far vision) the quality of the retinal image described by means of the minimum spot diameter or the root-mean-square (RMS) wavefront error. Starting from an emmetropic eye optimized for R and Q, the RMS wavefront error in the retina was 0.07 microm (far) and 1.42 microm (near). The GO resulted in a wavefront error of 1.42 microm (far) and 0.52 microm (near); improvement of near vision using reading glasses is possible. The CSI yielded 0.91 microm (far) and 0.13 microm (near); spectacles did not improve far or near vision. The DSI and CSA had significantly worse results for near and far vision. Of the options studied, GO and CSI seemed the most promising alternatives for corneal presbyopia correction. Although reading glasses can improve near vision in GO, reading glasses did not improve near vision in CSI-treated eyes. The CSI treatment is critically dependent on centration and a reverse treatment is difficult to achieve.

  20. Switchable Liquid Crystal Contact Lenses for the Correction of Presbyopia

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    James Bailey


    Full Text Available Presbyopia is an age-related disorder where the lens of the eye hardens so that focusing on near objects becomes increasingly difficult. This complaint affects everyone over the age of 50. It is becoming progressively more relevant, as the average age of the global population continues to rise. Bifocal or varifocal spectacles are currently the best solution for those that require near and far vision correction. However, many people prefer not to wear spectacles and while multifocal contact lenses are available, they are not widely prescribed and can require significant adaptation by wearers. One possible solution is to use liquid crystal contact lenses that can change focal power by applying a small electric field across the device. However, the design of these contact lenses must be carefully considered as they must be comfortable for the user to wear and able to provide the required change in focal power (usually about +2D. Progress towards different lens designs, which includes lens geometry, liquid crystal choices and suitable alignment modes, are reviewed. Furthermore, we also discuss suitable electrode materials, possible power sources and suggest some methods for switching the lenses between near and far vision correction.

  1. Simulation of the Effect of Different Presbyopia-Correcting Intraocular Lenses With Eyes With Previous Laser Refractive Surgery. (United States)

    Camps, Vicente J; Miret, Juan J; García, Celia; Tolosa, Angel; Piñero, David P


    To simulate the optical performance of three presbyopia-correcting intraocular lenses (IOLs) implanted in eyes with previous laser refractive surgery. A simulation of the through-focus modulation transfer function (MTF) was performed for three presbyopia-correcting IOLs (Mplus, Oculentis GmbH, Berlin, Germany; Symfony, Johnson & Johnson Vision, Santa Ana, CA; and Mini Well, SIFI S.p.A., Lavinaio, Italy) in one eye with previous myopic LASIK and another with hyperopic LASIK. Real topographic data and the wavefront aberration profile of each IOL obtained with a Hartmann-Shack sensor were used. In the eye with myopic LASIK, all IOLs lost optical quality at near and intermediate distances for 4- and 4.7-mm pupil size. For 3-mm pupil size, the Mini Well IOL showed the best intermediate and near MTF and maintained the far focus independently of the pupil. In the eye with hyperopic LASIK, the Mini Well IOL showed an intermediate, distance, and -4.00-diopter (D) foci for all pupils. The Symfony IOL showed a depth of focus at far and intermediate distance for 3-mm and a focus at -2.50 D in the rest. The Mplus showed a focus of -4.50 and -3.00 D for the 3- and 4-mm pupil, respectively. The Mini Well and Symfony IOLs seem to work better than the Mplus IOL in eyes with previous myopic LASIK. With previous hyperopic LASIK, the Mini Well IOL seems to be able to provide acceptable near, intermediate, and far foci for all pupil sizes. These findings should be confirmed in future clinical studies. [J Refract Surg. 2018;34(4):222-227.]. Copyright 2018, SLACK Incorporated.

  2. [Multifocal phakic intraocular lens implant to correct presbyopia]. (United States)

    Baikoff, G; Matach, G; Fontaine, A; Ferraz, C; Spera, C


    Presbyopic surgery is considered as the new frontier in refractive surgery. Different solutions are proposed: myopization of one eye, insertion of an accommodative crystalline lens, scleral surgery, the effects of which are still unknown, and finally multifocal phakic implants. We therefore decided to undertake a prospective study under the Huriet law to determine its efficacy and specify the conditions required for an anterior chamber multifocal phakic implant. Fifty-five eyes of 33 patients received an anterior chamber foldable multifocal phakic implant. Twenty-one females and 12 males underwent surgery. Initial refraction was between -5D and +5D. The implant's single addition was +2.50. Recuperating a distant uncorrected visual acuity of 0.6 or better and near uncorrected vision of Parinaud 3 or better can be considered a very good postoperative result. Average follow-up was 42.6+/-18 weeks. Mean postoperative refraction was -0.12+/-0.51 D. Mean postoperative uncorrected visual acuity was 0.78+/-0.20. Postoperative uncorrected visual acuity was Parinaud 2.3+/-0.6. Eighty-four percent of eyes operated on recuperated 0.6 or better without correction and Parinaud 3 or better without correction. Lenses in four eyes were explanted for different reasons, essentially optical, and no severe anatomical complications were observed. Placing an anterior chamber multifocal phakic implant to correct presbyopia is an effective technique with good predictability and has the advantage of being reversible in case of intolerance, optical parasite effects or undesired complications. Considering the particularity of this surgery, it is imperative to respect very strict inclusion criteria: anterior chamber depth equal to or above 3.1 mm, open angle, endothelial cell count equal to or above 2000 cells/mm2, absence of an incipient cataract or the slightest evidence of macular alteration.

  3. Multifocal Intraocular Lens Results in Correcting Presbyopia in Eyes After Radial Keratotomy. (United States)

    Kim, Kyeong Hwan; Seok, Kyung-Won; Kim, Wan Soo


    To report results of multifocal intraocular lens (IOL) implantation in 2 patients with refractive error and presbyopia after previous radial keratotomy (RK). A refractive multifocal IOL with rotational asymmetry (LS313-MF30; Oculentis, Berlin, Germany) was implanted. The first patient was a 60-year-old man with myopia who underwent unilateral RK 20 years before. His uncorrected distance visual acuity (UDVA) was 20/400, and his distance corrected near vision was J9 in both eyes. Six months after bilateral surgery, his binocular UDVA and uncorrected near visual acuity (UNVA) improved to 20/20 and J1, respectively, although he experienced diurnal fluctuation. The second patient was a 55-year-old woman with hyperopia who underwent bilateral RK 18 years before. Uncorrected distance visual acuity was 20/25 in both eyes, but UNVA was between J9 and J10. Three months after unilateral surgery, UDVA and UNVA of the postsurgical eye improved to 20/20 and J1, respectively. Neither patient reported any significant photic phenomena, and both were satisfied with the results of treatment. The desirable clinical outcomes and levels of satisfaction expressed by these patients indicate that surgery using this particular multifocal IOL may benefit presbyopic patients with previous RK.

  4. Axial movement of the dual-optic accommodating intraocular lens for the correction of the presbyopia: Optical performance and clinical outcomes

    Directory of Open Access Journals (Sweden)

    Javier Tomás-Juan


    Full Text Available Presbyopia occurs in the aging eye due to changes in the ciliary muscle, zonular fibers, crystalline lens, and an increased lens sclerosis. As a consequence, the capacity of accommodation decreases, which hampers to focus near objects. With the aim of restoring near vision, different devices that produce multiple focuses have been developed and introduced. However, these devices are still unable to restore accommodation. In order to achieve that goal, dual-optic accommodating Intraocular Lenses have been designed, whose anterior optic displaces axially to increase ocular power, and focus near objects. Although dual-optic accommodating IOLs are relatively new, their outcomes are promising, as they provide large amplitudes of accommodation and a greater IOL displacement than single-optic accommodating IOLs. The outcomes show comfortable near vision, higher patients’ satisfaction rates, and minimal postoperative complications like Posterior Capsular Opacification and Anterior Capsular Opacification, due to their design and material.

  5. Axial movement of the dual-optic accommodating intraocular lens for the correction of the presbyopia: optical performance and clinical outcomes. (United States)

    Tomás-Juan, Javier; Murueta-Goyena Larrañaga, Ane


    Presbyopia occurs in the aging eye due to changes in the ciliary muscle, zonular fibers, crystalline lens, and an increased lens sclerosis. As a consequence, the capacity of accommodation decreases, which hampers to focus near objects. With the aim of restoring near vision, different devices that produce multiple focuses have been developed and introduced. However, these devices are still unable to restore accommodation. In order to achieve that goal, dual-optic accommodating Intraocular Lenses have been designed, whose anterior optic displaces axially to increase ocular power, and focus near objects. Although dual-optic accommodating IOLs are relatively new, their outcomes are promising, as they provide large amplitudes of accommodation and a greater IOL displacement than single-optic accommodating IOLs. The outcomes show comfortable near vision, higher patients' satisfaction rates, and minimal postoperative complications like Posterior Capsular Opacification and Anterior Capsular Opacification, due to their design and material. Copyright © 2014. Published by Elsevier Espana.

  6. Outcomes of presbyopia-correcting intraocular lenses after laser in situ keratomileusis. (United States)

    Chow, Sharon S W; Chan, Tommy C Y; Ng, Alex L K; Kwok, Alvin K H


    Laser in situ keratomileusis (LASIK) is the most common refractive surgery in young patients, which aims at providing a clear distance vision without the use of spectacles. With time, these patients develop symptomatic cataract, which affects activities of daily living, and to improve visual acuity, intraocular lens (IOL) implantation can be considered. In post-myopic LASIK patients, to allow continuation of spectacle independence, the implantation of presbyopia-correcting IOLs is a suitable option. The purpose of this retrospective case series is to report the visual outcome and quality in post-myopic LASIK eyes after the implantation of AT LISA tri839MP IOL. Twenty eyes of 13 patients with history of myopic LASIK within 20 years underwent phacoemulsification by one single surgeon. All eyes were implanted with AT LISA tri839PMP IOL, and their outcomes were evaluated at 6 months postoperation. The mean postoperative uncorrected distance visual acuity (VA) is 0.28 ± 0.29, while the corrected distance VA is 0.06 ± 0.14. The mean postoperative uncorrected near VA is 0.02 ± 0.05, while the corrected near VA is 0.01 ± 0.02. The mean postoperative manifest refraction spherical equivalent (SE) is - 0.92 ± 0.76D. There is a statistically significant difference between the preoperative and postoperative refraction (p = 0.02), which shows a postoperative myopic shift. There is also a statistically significant difference between the mean targeted SE and postoperative manifest refraction SE (p = 0.00). Only one out of 20 eyes (5%) reported halo and glare symptoms. Ten out of 20 eyes (50%) are able to achieve spectacles independence. In conclusion, in post-myopic LASIK eyes, AT LISA tri839MP provides a good visual outcome at both near and distance, but is more predictable at near than at distance. There is a myopic shift in the postoperative SE. Visual quality is satisfactory and has not been exacerbated. Most patients can remain to be


    Directory of Open Access Journals (Sweden)

    E. I. Belikova


    Full Text Available Purpose: To evaluate the results of intraocular correction of presbyopia by monovision in patients with cataract and primary corneal astigmatism and conduct a comparative analysis of these outcomes with the results of binocular multifocal IOLs implantation. Patients and methods. There were 21 patients with bilateral cataract surgery performed using toric monofocal intraocular lenses (monovision group in the study. The indications for the operation were: 1 primary corneal astigmatism ≥ 1.0D in patients with cataract, 2 inability to conduct excimer laser correction. Reduction of spectacle dependence by monovision was discussed during preoperative conversation. The age of patients range from 32 to 65 years. Target refraction: Emetronopia on the dominant eye (DG and myopia at 1.0–2.0 D in the non-dominant eye (NDG. Evaluation included measurement of uncorrected visual acuity, refraction, stereopsis, contrast sensitivity and patient satisfaction. The results were compared with the outcomes of binocular multifocal Iols implantation in 22 patients (44 eyes. Results. The spherical component decreased from 3.39±2.63D to 0.34±0.24D, cylinder decreased from 3.05±1.47D to 0.44±0,35D (P <0.01 in the monovision group three months after surgery . The deviation from target refraction was 0.30±0.35D. The mean difference between postoperative refraction on the two eyes was 1.92±0.57D. Postoperative corrected visual acuity significantly exceeded preoperative parameters. In 18 patients (88% the stereoscopic visual acuity did not exceed 60 seconds and corresponded to the age norm, in 3 patients (12% it was at the level of 80–100 arc seconds. In patients with multifocal IOLs, the stereovision values were identical (Ferrer-Blasco T. et al, 2008. Conclusion. The monovision is an effective method of reducing dependence on additional correction in patients with cataract and corneal astigmatism. Refractive outcomes, binocular visual acuity, predictability and

  8. Effect of the Femtosecond Laser on an Intracorneal Inlay for Surgical Compensation of Presbyopia during Cataract Surgery: Scanning Electron Microscope Imaging. (United States)

    Ibarz, Marta; Rodríguez-Prats, Jose Luis; Hernández-Verdejo, Jose Luis; Tañá, Pedro


    To investigate the effect of the femtosecond laser-assisted cataract surgery (FLACS) on porcine eyes implanted with a Kamra corneal inlay and to describe how the inlay may change the effect of the femtosecond laser on the lens. FLACS was performed on six porcine eyes and a Kamra corneal inlay had been implanted, exploring the lens under the surgical microscope. Another Kamra corneal inlay was attached to the upper part of the transparent hemisphere used for calibration of the femtosecond laser. Capsulorhexis, arcuate incisions, and phacofragmentation were carried out. The Kamra corneal inlay was compared with a nontreated one using a scanning electron microscope (SEM), and the hemisphere was analyzed with a surgical microscope. Capsulorhexis and phacofragmentation were completed in all the porcine eyes, although accuracy to determine the exact effect on the lens was not possible to achieve. The effect of the femtosecond laser on the PMMA hemisphere through the Kamra corneal inlay showed the capsulorhexis was placed outside the outer margin of the inlay and a sharply sculpted fragmentation pattern with a three-dimensional (donut-shaped) annulus untreated beneath it. SEM images of the nontreated and the treated inlays were comparable. No ultrastructural changes were found in the treated Kamra corneal inlay. FLACS can be performed with a Kamra corneal inlay for surgical compensation of presbyopia without the risk of damaging the inlay. The Kamra corneal inlay acts as a screen that avoids the laser to reach the areas beneath its shadow, but not the exposed areas of the lens.

  9. The relationship between body and ambient temperature and corneal temperature

    DEFF Research Database (Denmark)

    Kessel, Line; Johnson, Leif; Arvidsson, Henrik Sven


    Exposure to elevated ambient temperatures has been mentioned as a risk factor for common eye diseases, primarily presbyopia and cataract. The aim of the present study was to examine the relationship among ambient, cornea, and body core temperature.......Exposure to elevated ambient temperatures has been mentioned as a risk factor for common eye diseases, primarily presbyopia and cataract. The aim of the present study was to examine the relationship among ambient, cornea, and body core temperature....

  10. Facts about Presbyopia (United States)

    ... NEI Intranet (Employees Only) *PDF files require the free Adobe® Reader® software for viewing. This website is maintained by the NEI Office of Science Communications, Public Liaison, and Education. Technical questions about this website can be addressed ...

  11. International Society of Refractive Surgery of the American Academy of Ophthalmology (United States)

    ... Eye Drop Targets Miosis and Accommodation, Femtosecond Laser Lens Softening for Presbyopia Correction Read Outlook ... system below. Google Calendar Outlook or Apple Calendar Yahoo Calendar Note: ...

  12. Keratorefractive Effect of High Intensity Focused Ultrasound Keratoplasty on Rabbit Eyes

    Directory of Open Access Journals (Sweden)

    Zhiyu Du


    Full Text Available Purpose. To evaluate high intensity focused ultrasound (HIFU as an innovation and noninvasive technique to correct presbyopia by altering corneal curvature in the rabbit eye. Methods. Eighteen enucleated rabbit eyes were treated with a prototype HIFU keratoplasty. According to the therapy power, these eyes were divided three groups: group 1 (1 W, group 2 (2 W, and group 3 (3 W. The change in corneal power was quantified by a Sirius Scheimpflug camera. Light microscopy (LM and transmission electron microscopy (TEM were performed to determine the effect on the corneal stroma. Results. In the treated eyes, the corneal curvature increases from 49.42 ± 0.30 diopters (D and 48.00 ± 1.95 D before procedure to 51.37 ± 1.11 D and 57.00 ± 1.84 D after HIFU keratoplasty application in groups 1 and 3, respectively. The major axis and minor axis of the focal region got longer when the powers of the HIFU got increased; the difference was statistically significant (p<0.05. LM and TEM showed HIFU-induced shrinkage of corneal stromal collagen with little disturbance to the underlying epithelium. Conclusions. We have preliminarily exploited HIFU to establish a new technique for correcting presbyopia. HIFU keratoplasty will be a good application prospect for treating presbyopia.

  13. Refractive errors in presbyopic patients in Kano, Nigeria

    African Journals Online (AJOL)

    Annals of African Medicine, Vol. ... Information extracted includes patient's age, sex, and types of refractive error. ... All patients had basic eye examination and streak retinoscopy at two third meter working distance. ... symptoms may start earlier or later than this age .... presbyopia was associated with reduced workers'.

  14. The ageing eye

    African Journals Online (AJOL)


    Nov 10, 2007 ... Treatment of presbyopia. In the early stages of ... cells decreases and their morphology changes, rendering the aged cornea more ... (senile miosis), giving rise to night vision problems. Therefore .... risk of lung cancer to smokers and is .... Active screening for visual loss in the elderly should become routine.

  15. Common eye disorders in the elderly – a short review | Visser ...

    African Journals Online (AJOL)

    As the eye ages, certain changes occur that may affect vision. Presbyopia is corrected by the use of reading glasses. Cataracts are common and vision can be restored following a reasonably simple operation. Visual loss due to glaucoma can be minimised by early detection and treatment, but once vision has been lost it ...

  16. Macroeconomic landscape of refractive surgery in the United States. (United States)

    Corcoran, Kevin J


    This review examines the economic history of refractive surgery and the decline of laser-assisted in-situ keratomileusis (LASIK) in the USA, and the emergence of refractive cataract surgery as an area of growth. Since it peaked in 2007 at 1.4 million procedures per year, LASIK has declined 50% in the USA, whereas refractive cataract surgery, including presbyopia-correcting intraocular lenses (IOLs), astigmatism-correcting IOLs, and femtosecond laser-assisted cataract surgery, has grown to 350 000 procedures per year, beginning in 2003. Patients are price-sensitive and responsive to publicity (good or bad) about refractive surgery and refractive cataract surgery. LASIK's decline has been partially offset by the emergence of refractive cataract surgery. About 11% of all cataract surgery in the USA involves presbyopia-correcting IOLs, astigmatism-correcting IOLs, or a femtosecond laser. From the surgeon's perspective, there are high barriers to entry into the marketplace for refractive surgery and refractive cataract surgery due to the high capital cost of excimer and femtosecond lasers, the high skill level required to deliver spectacular results to demanding patients who pay out of pocket, and the necessity to perform a high volume of surgeries to satisfy both of these requirements. Probably, less than 7% of US cataract surgeons can readily meet all of these requirements.

  17. Morphology and accommodative function of the vitreous zonule in human and monkey eyes. (United States)

    Lütjen-Drecoll, Elke; Kaufman, Paul L; Wasielewski, Rainer; Ting-Li, Lin; Croft, Mary Ann


    To explore the attachments of the posterior zonule and vitreous in relation to accommodation and presbyopia in monkeys and humans. Novel scanning electron microscopy (SEM) and ultrasound biomicroscopy (UBM) techniques were used to visualize the anterior, intermediate, and posterior vitreous zonule and their connections to the ciliary body, vitreous membrane, lens capsule, and ora serrata, and to characterize their age-related changes and correlate them with loss of accommodative forward movement of the ciliary body. alpha-Chymotrypsin was used focally to lyse the vitreous zonule and determine the effect on movement of the accommodative apparatus in monkeys. The vitreous attached to the peripheral lens capsule and the ora serrata directly. The pars plana zonule and the posterior tines of the anterior zonule were separated from the vitreous membrane except for strategically placed attachments, collectively termed the vitreous zonule, that may modulate and smooth the forward and backward movements of the entire system. Age-dependent changes in these relationships correlated significantly with loss of accommodative amplitude. Lysis of the intermediate vitreous zonule partially restored accommodative movement. The vitreous zonule system may help to smoothly translate to the lens the driving forces of accommodation and disaccommodation generated by the ciliary muscle, while maintaining visual focus and protecting the lens capsule and ora serrata from acute tractional forces. Stiffening of the vitreous zonular system may contribute to age-related loss of accommodation and offer a therapeutic target for presbyopia.

  18. [Adaptive optics for ophthalmology]. (United States)

    Saleh, M


    Adaptive optics is a technology enhancing the visual performance of an optical system by correcting its optical aberrations. Adaptive optics have already enabled several breakthroughs in the field of visual sciences, such as improvement of visual acuity in normal and diseased eyes beyond physiologic limits, and the correction of presbyopia. Adaptive optics technology also provides high-resolution, in vivo imaging of the retina that may eventually help to detect the onset of retinal conditions at an early stage and provide better assessment of treatment efficacy. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  19. Incidência das ametropias no Hospital Universitário em Campo Grande (MS entre 1996 e 1998 Incidence of ametropias in the University Hospital of Campo Grande (MS between 1996 and 1998

    Directory of Open Access Journals (Sweden)

    Eduardo Velasco de Barros


    Medical Files (SAME was carried out, applying a research protocol to 2,361 charts of patients presenting some type of ametropia who were attended at the NHU between 1996 and 1998, with information on sex, age and type of ametropia (myopia, hyperopia, astigmatism or presbyopia. The data were analyzed and discussed. Results: There was prevalence of females (60% in all cases of ametropia, the greatest number of attended people being patients with presbyopia (987 cases, followed by hyperopia (701, myopia (434 and astigmatism (239. Myopia was present mostly in the age range of 20 to 29 years, hyperopia between 0 and 9 years and astigmatism between 10 and 39 years, while the highest incidence of presbyopia was in the age range over 40 years. Conclusion: The number of female patients is higher than that of males, even considering each ametropia separately. Some hypotheses are proposed. Myopia is more frequent at ages between 10 and 39 years. Hyperopia occurs more frequently in children and newborns, tending to decrease with age because of eyeball increase. Astigmatism was characterized as a defect occurring in adolescents and young adults. Presbyopia was the commonest refraction error and its incidence occurred in the age range over 40 years, similarly to data found in the literature.

  20. Artificial pupil versus contralateral balanced contact lens fit for presbyopia correction

    Directory of Open Access Journals (Sweden)

    Santiago García-Lázaro


    Full Text Available Purpose: To assess and compare the effects of contact lens-based artificial pupil design and contralateral balanced multifocal contact lens combination (CBMCLC on visual performance. Methods: This randomized crossover study conducted at the University of Valencia, Spain included 38 presbyopic patients using an artificial pupil contact lens in the nondominant eye and a CBMCLC. After a month of lens wear, the binocular distance visual acuity (BDVA, binocular near visual acuity (BNVA, defocus curve, binocular distance, and near contrast sensitivity and near stereoacuity (NSA were measured under photopic conditions (85 cd/m2. Moreover, BDVA and binocular distance contrast sensitivity were examined under mesopic conditions (5 cd/m2. Results: Visual acuity at an intermediate distance and near vision was better with the CBMCLC than with the artificial pupil (p<0.05. Statistically significant differences were found in contrast sensitivity between the two types of correction for distance (under mesopic conditions and for near vision, with the CBMCLC exhibiting better results in both cases (p<0.05. The mean NSA values obtained for the artificial pupil contact lens were significantly worse than those for the CBMCLC (p=0.001. Conclusion: The CBMCLC provided greater visual performance in terms of intermediate and near vision compared with the artificial pupil contact lens.

  1. Making perceptual learning practical to improve visual functions. (United States)

    Polat, Uri


    Task-specific improvement in performance after training is well established. The finding that learning is stimulus-specific and does not transfer well between different stimuli, between stimulus locations in the visual field, or between the two eyes has been used to support the notion that neurons or assemblies of neurons are modified at the earliest stage of cortical processing. However, a debate regarding the proposed mechanism underlying perceptual learning is an ongoing issue. Nevertheless, generalization of a trained task to other functions is an important key, for both understanding the neural mechanisms and the practical value of the training. This manuscript describes a structured perceptual learning method that previously used (amblyopia, myopia) and a novel technique and results that were applied for presbyopia. In general, subjects were trained for contrast detection of Gabor targets under lateral masking conditions. Training improved contrast sensitivity and diminished the lateral suppression when it existed (amblyopia). The improvement was transferred to unrelated functions such as visual acuity. The new results of presbyopia show substantial improvement of the spatial and temporal contrast sensitivity, leading to improved processing speed of target detection as well as reaction time. Consequently, the subjects, who were able to eliminate the need for reading glasses, benefited. Thus, here we show that the transfer of functions indicates that the specificity of improvement in the trained task can be generalized by repetitive practice of target detection, covering a sufficient range of spatial frequencies and orientations, leading to an improvement in unrelated visual functions. Thus, perceptual learning can be a practical method to improve visual functions in people with impaired or blurred vision.

  2. Prevalence and causes of ocular morbidity in Mbeere District, Kenya. Results of a population-based survey.

    Directory of Open Access Journals (Sweden)

    Kahaki Kimani

    Full Text Available PURPOSE: Ocular morbidity (OM describes any eye disease regardless of resultant visual loss. Ocular morbidity may affect large numbers of people in low income countries and could lead to many episodes of care. However there is limited evidence about the prevalence of ocular morbidity or resulting health-seeking behavior. This study in Mbeere District, Kenya, set out to explore both these issues. METHODS: A cross-sectional household survey was conducted in 2011. Trained teams moved from house to house examining and questioning residents on ocular morbidity and health-seeking behavior. Data were collected on standardized proformas and entered into a database for analysis. RESULTS: 3,691 people were examined (response rate 91.7%. 15.52% (95% CI 13.86-16.92 had at least one ocular morbidity in at least one eye. The leading cause was presbyopia which affected 25.11% (95% CI 22.05-28.45 of participants over 35 and increased with age. Other leading causes of OM were conditions that affected the lens (32.58% and the conjunctiva (31.31%. No association was found between educational attainment or employment and OM. 9.63% (7.87-11.74 self-reported an ocular morbidity in the previous six months and 45.94% (95% CI 37.1-55.04 stated that they had sought treatment for the condition. CONCLUSION: A large number of people were affected by an ocular morbidity in this survey. Most of these people could potentially be managed in their own communities through primary care services (e.g. those with presbyopia. Further work is required to understand the best way of providing an effective, equitable service for ocular morbidity.

  3. Management of digital eye strain. (United States)

    Coles-Brennan, Chantal; Sulley, Anna; Young, Graeme


    Digital eye strain, an emerging public health issue, is a condition characterised by visual disturbance and/or ocular discomfort related to the use of digital devices and resulting from a range of stresses on the ocular environment. This review aims to provide an overview of the extensive literature on digital eye strain research with particular reference to the clinical management of symptoms. As many as 90 per cent of digital device users experience symptoms of digital eye strain. Many studies suggest that the following factors are associated with digital eye strain: uncorrected refractive error (including presbyopia), accommodative and vergence anomalies, altered blinking pattern (reduced rate and incomplete blinking), excessive exposure to intense light, closer working distance, and smaller font size. Since a symptom may be caused by one or more factors, a holistic approach should be adopted. The following management strategies have been suggested: (i) appropriate correction of refractive error, including astigmatism and presbyopia; (ii) management of vergence anomalies, with the aim of inducing or leaving a small amount of heterophoria (~1.5 Δ Exo); (iii) blinking exercise/training to maintain normal blinking pattern; (iv) use of lubricating eye drops (artificial tears) to help alleviate dry eye-related symptoms; (v) contact lenses with enhanced comfort, particularly at end-of-day and in challenging environments; (vi) prescription of colour filters in all vision correction options, especially blue light-absorbing filters; and (vii) management of accommodative anomalies. Prevention is the main strategy for management of digital eye strain, which involves: (i) ensuring an ergonomic work environment and practice (through patient education and the implementation of ergonomic workplace policies); and (ii) visual examination and eye care to treat visual disorders. Special consideration is needed for people at a high risk of digital eye strain, such as computer

  4. [Physiological mechanisms of the etiology of visual fatigue during work involving visual stress]. (United States)

    Korniushina, T A


    Physiological parameters of vision were studied in three professional groups (a total of 1204 subjects): microscope operators, subjects working with magnifying glasses, and computer users. General and specific features of visual system fatigue formation were identified. Because of complete (in microscope operators) or partial (in subjects working with magnifying glasses and display users) "deprivation" of accommodation, these subjects develop early presbyopia (at the age of 30-35 years). In microscope operators long strain of accommodation system leads to professional myopia, while display users develop pseudomyopia. The highest overstrain is observed after 4 years of work in microscope operators, after 5 years in magnifying glass users, and after 6 years in computer users.

  5. A clinical study of patient acceptance and satisfaction of Varilux Plus and Varilux Infinity lenses. (United States)

    Cho, M H; Barnette, C B; Aiken, B; Shipp, M


    An independent study was conducted at the UAB School of Optometry to determine the clinical success with Varilux Plus (Varilux 2) and Varilux Infinity progressive addition lenses (PAL). Two hundred eighty patients (280) were fit between June 1988 and May 1989. The acceptance rate of 97.5 percent was based on the number of lenses ordered versus the number of lenses returned. Patients were contacted by telephone and asked to rate their level of satisfaction with their PALs. A chi-square (non-parametric) test revealed no statistically significant differences in levels of satisfaction with respect to gender, PAL type, or degree of presbyopia. Also, neither refractive error nor previous lens history had a measurable impact on patient satisfaction.

  6. Magnitude, temporal trends, and projections of the global prevalence of blindness and distance and near vision impairment: a systematic review and meta-analysis. (United States)

    Bourne, Rupert R A; Flaxman, Seth R; Braithwaite, Tasanee; Cicinelli, Maria V; Das, Aditi; Jonas, Jost B; Keeffe, Jill; Kempen, John H; Leasher, Janet; Limburg, Hans; Naidoo, Kovin; Pesudovs, Konrad; Resnikoff, Serge; Silvester, Alex; Stevens, Gretchen A; Tahhan, Nina; Wong, Tien Y; Taylor, Hugh R


    Global and regional prevalence estimates for blindness and vision impairment are important for the development of public health policies. We aimed to provide global estimates, trends, and projections of global blindness and vision impairment. We did a systematic review and meta-analysis of population-based datasets relevant to global vision impairment and blindness that were published between 1980 and 2015. We fitted hierarchical models to estimate the prevalence (by age, country, and sex), in 2015, of mild visual impairment (presenting visual acuity worse than 6/12 to 6/18 inclusive), moderate to severe visual impairment (presenting visual acuity worse than 6/18 to 3/60 inclusive), blindness (presenting visual acuity worse than 3/60), and functional presbyopia (defined as presenting near vision worse than N6 or N8 at 40 cm when best-corrected distance visual acuity was better than 6/12). Globally, of the 7·33 billion people alive in 2015, an estimated 36·0 million (80% uncertainty interval [UI] 12·9-65·4) were blind (crude prevalence 0·48%; 80% UI 0·17-0·87; 56% female), 216·6 million (80% UI 98·5-359·1) people had moderate to severe visual impairment (2·95%, 80% UI 1·34-4·89; 55% female), and 188·5 million (80% UI 64·5-350·2) had mild visual impairment (2·57%, 80% UI 0·88-4·77; 54% female). Functional presbyopia affected an estimated 1094·7 million (80% UI 581·1-1686·5) people aged 35 years and older, with 666·7 million (80% UI 364·9-997·6) being aged 50 years or older. The estimated number of blind people increased by 17·6%, from 30·6 million (80% UI 9·9-57·3) in 1990 to 36·0 million (80% UI 12·9-65·4) in 2015. This change was attributable to three factors, namely an increase because of population growth (38·4%), population ageing after accounting for population growth (34·6%), and reduction in age-specific prevalence (-36·7%). The number of people with moderate and severe visual impairment also increased, from 159·9 million

  7. Population need for primary eye care in Rwanda: A national survey.

    Directory of Open Access Journals (Sweden)

    Tess Bright

    Full Text Available Universal access to Primary Eye Care (PEC is a key global initiative to reduce and prevent avoidable causes of visual impairment (VI. PEC can address minor eye conditions, simple forms of uncorrected refractive error (URE and create a referral pathway for specialist eye care, thus offering a potential solution to a lack of eye health specialists in low-income countries. However, there is little information on the population need for PEC, including prevalence of URE in all ages in Sub-Saharan Africa.A national survey was conducted of people aged 7 and over in Rwanda in September-December 2016. Participants were selected through two-stage probability proportional to size sampling and compact segment sampling. VI (visual acuity<6/12 was assessed using Portable Eye Examination Kit (PEEK; URE was detected using a pinhole and presbyopia using local near vision test. We also used validated questionnaires to collect socio-demographic and minor eye symptoms information. Prevalence estimates for VI, URE and need for PEC (URE, presbyopia with good distance vision, need for referrals and minor eye conditions were age and sex standardized to the Rwandan population. Associations between age, sex, socio-economic status and the key outcomes were examined using logistic regression.4618 participants were examined and interviewed out of 5361 enumerated (86% response rate. The adjusted population prevalence of VI was 3.7% (95%CI = 3.0-4.5%, URE was 2.2% (95%CI = 1.7-2.8% and overall need for PEC was 34.0% (95%CI = 31.8-36.4%. Women and older people were more likely to need PEC and require a referral.Nearly a third of the population in Rwanda has the potential to benefit from PEC, with greater need identified in older people and women. Universal access to PEC can address unmet eye health needs and public health planning needs to ensure equitable access to older people and women.

  8. Visualization of the macula during elective pars plana vitrectomy in the presence of a dual-optic accommodating intraocular lens. (United States)

    Marques, Eduardo F; Ferreira, Tiago B; Castanheira-Dinis, António


    We describe the case of a 69-year-old patient who had pars plana vitrectomy (PPV) for epiretinal membrane removal 18 months after cataract surgery with implantation of a dual-optic accommodating IOL (Synchrony). During PPV, visualization of the macula was perfect, and the postoperative visual outcome was excellent. To our knowledge, this is the first report of retinal visualization during PPV in the presence of a dual-optic accommodating IOL. When choosing a presbyopia-correcting IOL, surgeons should consider the advantage of macula visualization with an IOL with monofocal optics. Dr. Marques is a consultant to Abbott Medical Optics, Inc. No other author has a financial or proprietary interest in any material or method mentioned. Copyright © 2014 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

  9. Effect of Unifocal versus Multifocal Lenses on Cervical Spine Posture in Patients with Presbyopia. (United States)

    Abbas, Rami L; Houri, Mohamad T; Rayyan, Mohammad M; Hamada, Hamada Ahmad; Saab, Ibtissam M


    There are many environmental considerations which may or may not lead to the development of faulty cervical mechanics. The design of near vision lenses could contribute to the development of such cervical dysfunction and consequently neck pain. Decision making regarding proper type of lens prescription seems important for presbyopic individuals. To investigate the effect of unifocal and multifocal lenses on cervical posture. Thirty subjects (18 females and 12 males) participated in the study with an age range from 40 to 64 years. Each subject wore consequently both unifocal and multifocal lenses randomly while reading. Then lateral cervical spine X-ray films were taken for each subject during each lens wearing. X-ray films were analyzed with digital software (Autocad software, 2 D) to measure segmental angles of the cervical vertebrae (Occiput/C1, C1/C2, C2/C3, C3/C4, C4/C5, C5/C6, C6/C7, C3/C7, C0/C3, and occiput/C7). Higher significant extension angle in the segments C0/C7, C1/C2, C5/C6, C6/C7, and C3/C7 (p<0.05) during multifocal lenses wearing were observed in contrast with higher flexion angle between C3/C4 and C4/C5 (p<0.05) with unifocal lenses wear. Multifocal lens spectacles produces increased extension in the cervical vertebrae angles when compared with the use of unifocal lenses.

  10. Ophthalmic Disorders in Adults with Down Syndrome

    Directory of Open Access Journals (Sweden)

    Sharon J. Krinsky-McHale


    Full Text Available A myriad of ophthalmic disorders is associated with the phenotype of Down syndrome including strabismus, cataracts, and refractive errors potentially resulting in significant visual impairment. Ophthalmic sequelae have been extensively studied in children and adolescents with Down syndrome but less often in older adults. In-depth review of medical records of older adults with Down syndrome indicated that ophthalmic disorders were common. Cataracts were the most frequent ophthalmic disorder reported, followed by refractive errors, strabismus, and presbyopia. Severity of intellectual disability was unrelated to the presence of ophthalmic disorders. Also, ophthalmic disorders were associated with lower vision-dependent functional and cognitive abilities, although not to the extent that was expected. The high prevalence of ophthalmic disorders highlights the need for periodic evaluations and individualized treatment plans for adults with Down syndrome, in general, but especially when concerns are identified.

  11. Imaging properties of the light sword optical element used as a contact lens in a presbyopic eye model. (United States)

    Petelczyc, K; Bará, S; Lopez, A Ciro; Jaroszewicz, Z; Kakarenko, K; Kolodziejczyk, A; Sypek, M


    The paper analyzes the imaging properties of the light sword optical element (LSOE) applied as a contact lens to the presbyopic human eye. We performed our studies with a human eye model based on the Gullstrand parameterization. In order to quantify the discussion concerning imaging with extended depth of focus, we introduced quantitative parameters characterizing output images of optotypes obtained in numerical simulations. The quality of the images formed by the LSOE were compared with those created by a presbyopic human eye, reading glasses and a quartic inverse axicon. Then we complemented the numerical results by an experiment where a 3D scene was imaged by means of the refractive LSOE correcting an artificial eye based on the Gullstrand model. According to performed simulations and experiments the LSOE exhibits abilities for presbyopia correction in a wide range of functional vision distances.

  12. Evaluation of binocular function among pre- and early-presbyopes with asthenopia

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    Reindel W


    Full Text Available William Reindel,1 Lening Zhang,1 Joseph Chinn,2 Marjorie Rah1 1Vision Care, Bausch & Lomb Inc, Rochester, NY, 2J Chinn LLC, Lafayette, CO, USA Purpose: Individuals approaching presbyopia may exhibit ocular symptoms as they contend with visual demands of near work, coupled with natural age-related changes in accommodation. Therefore, accommodation and vergence of 30- to 40-year-old, myopic, soft contact lens wearing subjects with symptoms of asthenopia and no history of using multifocal lenses were evaluated.Patients and methods: In this prospective, observational study, 253 subjects with asthenopia were evaluated by 25 qualified practitioners, each at a different clinical site. Subjects were 30–40 years in age, had symptoms of soreness, eyestrain, tired eyes, or headaches with near work, regularly performed 2–3 consecutive hours of near work, and were undiagnosed with presbyopia. Amplitude of accommodation (AC and near point convergence (NPC were measured with a Royal Air Force binocular gauge. Triplicate push up and push down AC and NPC measures were recorded, and average AC values were compared to those calculated using the Hofstetter formula (HF. Results: The average AC push up/push down value was significantly better than the HF prediction for this age range (8.04±3.09 vs 6.23±0.80 D, although 22.5% of subjects had mean AC below their HF value (5.36±0.99 D. The average NPC push up/push down value was 12.0±4.69 cm. The mean binocular AC value using the push up measure was significantly better than the push down measure (8.5±3.4 vs 7.6±3.0 D. The mean NPC value using the push up measure was significantly worse than the push down measure (13.0±5.0 vs 11.0±4.7 cm. The most frequent primary diagnosis was ill-sustained accommodation (54%, followed by accommodative insufficiency (18%, and accommodative infacility (12%. Conclusion: Based upon a standardized assessment of accommodation and vergence, ill-sustained accommodation was the

  13. Long-sightedness in old wild bonobos during grooming. (United States)

    Ryu, Heungjin; Graham, Kirsty E; Sakamaki, Tetsuya; Furuichi, Takeshi


    Some scientists have suggested that, among Hominidae, prolonged postmenopausal longevity evolved uniquely in humans [1], while others disagree [2]. There have, however, been few empirical studies on how physiological aging and somatic durability in humans compare to our closest relatives - chimpanzees and bonobos [3]. If prolonged lifespan is selected for in humans, physiological aging, including reproductive and somatic senescence, might be different for Pan and Homo. But it seems that the parameters of reproductive senescence, such as the age of having their final offspring and the number of years between generations, are not very different between chimpanzee and human females [4]. Here, we report evidence for five cases of long-sightedness (presbyopia) in old wild bonobos, exhibited during grooming. Our results suggest that senescence of the eye has not changed much since the divergence of Pan and Homo from their common ancestor. Copyright © 2016 Elsevier Ltd. All rights reserved.

  14. Epidemiological survey of school-age children with low vision in Zhouqu County of Gannan Tibetan autonomous prefecture of Gansu province

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    Le-Xin Yang,


    Full Text Available AIM: To have a detailed picture of school-age children's eyesight status, and the main factors that caused their low vision in Zhouqu County of Gannan Tibetan autonomous prefecture of Gansu province. METHODS: The census work of knowing school-age children's eyesight status was implemented through visual inspection, conventional ophthalmic examination, optometry checks, etc. The results were compared with other domestic epidemiological data. RESULTS: Altogether 536 people with low vision were identified through survey and the rate was 21.12%. Among those people, the number of myopia patients accounted for 80.59% and the prevalence rate was 17.02%. Besides, the prevalence rate of presbyopia was 2.05%, amblyopia 2.76%, strabismus 1.02%, ocular trauma 0.95%, and congenital eye disease 0.71%. CONCLUSION: The prevalence rate of low vision was related with several factors such as gender and nationality. The rate increases with age and the myopia is the primary element that causes low vision.

  15. Resident and young physician experience with complex cataract surgery and new cataract and refractive technology: Results of the ASCRS 2016 Young Eye Surgeons survey. (United States)

    Schallhorn, Julie M; Ciralsky, Jessica B; Yeu, Elizabeth


    A survey was offered to attendees of the 2016 annual meeting of the American Society of Cataract and Refractive Surgery (ASCRS) as well as online to ASCRS members. Of the 429 self-identified surgeons in training or those with fewer than 5 years in practice, 83% had performed complex cataract surgery using iris expansion devices or capsular tension rings (63%) and 70% had implanted a toric intraocular lens (IOL). A minority of respondents had performed laser-assisted cataract surgery (27%) or implanted presbyopia-correcting IOLs (39%), and only half (50%) had performed laser vision correction (LVC). Comfort with complex cataract and IOL procedures improved with increasing number of cases performed until greater than 10 cases. From this we can conclude that young surgeons have adequate exposure to complex cataracts but lack experience in refractive surgery and new IOL technology. Reported surgeon confidence improved with increased experience and exposure. Copyright © 2017 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

  16. Pupil diameter, working distance and illumination during habitual tasks. Implications for simultaneous vision contact lenses for presbyopia. (United States)

    Cardona, Genís; López, Sílvia


    To determine working distance, pupil diameter and illumination in real life conditions in a sample of presbyopic participants performing habitual tasks. A total of 59 presbyopic subjects (aged between 45 and 63 years) with different occupational backgrounds participated in the study. Participants were first interviewed regarding their habitual tasks with the aid of an ad hoc questionnaire, following which in-office photopic and mesopic pupil diameter was determined. Pupil diameter was also evaluated while participants conducted each of the self-reported habitual tasks by taking a photograph, which was later submitted to image analysis. In addition, working distance was determined with a measuring tape and the illumination that reached the pupil during each of the different tasks was measured, in lux, with a light meter. The four most common habitual tasks were computer use, reading, sewing and sports. A high intersubject variability was found in pupil diameter, working distance and illumination conditions while conducting the same task. Statistically significant differences were found between the in-office measured photopic and mesopic pupil diameters and those obtained while participants were conducting their habitual tasks in real life conditions (all p<0.001). Potential multifocal contact lens users may present with different ages, different jobs or hobbies and different preferences regarding lighting conditions and working distances. This results in different pupil size, even within the same task. This information may be critical when selecting a particular lens design and add power. Eye care practitioners are therefore advised to assess pupil diameter in real life conditions. Copyright © 2015 Spanish General Council of Optometry. Published by Elsevier Espana. All rights reserved.

  17. Pupil diameter, working distance and illumination during habitual tasks. Implications for simultaneous vision contact lenses for presbyopia

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    Genís Cardona


    Conclusions: Potential multifocal contact lens users may present with different ages, different jobs or hobbies and different preferences regarding lighting conditions and working distances. This results in different pupil size, even within the same task. This information may be critical when selecting a particular lens design and add power. Eye care practitioners are therefore advised to assess pupil diameter in real life conditions.

  18. Refractive Lenticule Implantation for Correction of Ametropia: Case Reports and Literature Review. (United States)

    Lazaridis, A; Messerschmidt-Roth, A; Sekundo, W; Schulze, S


    The ReLEx® technique allows correction of refractive errors through the creation and extraction of refractive stromal lenticules. Contrary to excimer laser corneal refractive procedures, where the stromal tissue is photoablated, the extracted lenticules obtained with ReLEx® can be preserved. Recent studies and case reports have described autologous re-implantation and allogeneic implantation of refractive lenticules into femtosecond-laser created stromal pockets in order to reverse the refractive outcome of a myopic corneal refractive procedure, correct hyperopia, aphakia, presbyopia and treat keratoconus. The use of stromal lenticules has also been described for therapeutic purposes, with an allogenic lenticule being transplanted under a LASIK flap in order to restore corneal volume and reduce the refractive error in a case of excessive stromal tissue removal after LASIK. This review summarises the results of the latest case reports and studies that describe the implantation of cryopreserved or fresh refractive stromal lenticules and discusses the feasibility, safety and refractive outcomes of the procedure, on the basis of published literature as well as our own experience. Georg Thieme Verlag KG Stuttgart · New York.

  19. Can reliable values of Young's modulus be deduced from Fisher's (1971) spinning lens measurements? (United States)

    Burd, H J; Wilde, G S; Judge, S J


    The current textbook view of the causes of presbyopia rests very largely on a series of experiments reported by R.F. Fisher some three decades ago, and in particular on the values of lens Young's modulus inferred from the deformation caused by spinning excised lenses about their optical axis (Fisher 1971) We studied the extent to which inferred values of Young's modulus are influenced by assumptions inherent in the mathematical procedures used by Fisher to interpret the test and we investigated several alternative interpretation methods. The results suggest that modelling assumptions inherent in Fisher's original method may have led to systematic errors in the determination of the Young's modulus of the cortex and nucleus. Fisher's conclusion that the cortex is stiffer than the nucleus, particularly in middle age, may be an artefact associated with these systematic errors. Moreover, none of the models we explored are able to account for Fisher's claim that the removal of the capsule has only a modest effect on the deformations induced in the spinning lens.

  20. Factors influencing hand/eye synchronicity in the computer age. (United States)

    Grant, A H


    In using a computer, the relation of vision to hand/finger actuated keyboard usage in performing fine motor-coordinated functions is influenced by the physical location, size, and collective placement of the keys. Traditional nonprehensile flat/rectangular keyboard applications usually require a high and nearly constant level of visual attention. Biometrically shaped keyboards would allow for prehensile hand-posturing, thus affording better tactile familiarity with the keys, requiring less intense and less constant level of visual attention to the task, and providing a greater measure of freedom from having to visualize the key(s). Workpace and related physiological changes, aging, onset of monocularization (intermittent lapsing of binocularity for near vision) that accompanies presbyopia, tool colors, and background contrast are factors affecting constancy of visual attention to task performance. Capitas extension, excessive excyclotorsion, and repetitive strain injuries (such as carpal tunnel syndrome) are common and debilitating concomitants to computer usage. These problems can be remedied by improved keyboard design. The salutary role of mnemonics in minimizing visual dependency is discussed.

  1. Presbypropria: the effects of physiological ageing on proprioceptive control. (United States)

    Boisgontier, Matthieu P; Olivier, Isabelle; Chenu, Olivier; Nougier, Vincent


    Several changes in the human sensory systems, like presbycusis or presbyopia, are well-known to occur with physiological ageing. A similar change is likely to occur in proprioception, too, but there are strong and unexplained discrepancies in the literature. It was proposed that assessment of the attentional cost of proprioceptive control could provide information able to unify these previous studies. To this aim, 15 young adults and 15 older adults performed a position matching task in single and dual-task paradigms with different difficulty levels of the secondary task (congruent and incongruent Stroop-type tasks) to assess presumed age-related deficits in proprioceptive control. Results showed that proprioceptive control was as accurate and as consistent in older as in young adults for a single proprioceptive task. However, performing a secondary cognitive task and increasing the difficulty of this secondary task evidenced both a decreased matching performance and/or an increased attentional cost of proprioceptive control in older adults as compared to young ones. These results advocated for an impaired proprioception in physiological ageing.

  2. Near vision correction and work productivity among textile workers

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    Kovin S. Naidoo


    Full Text Available Purpose: Uncorrected presbyopia (near vision impairment is prevalent in approximately 517 million people worldwide; this prevalence ranges from 30% to 80% in Africa. Good near vision is needed for a range of tasks; therefore, uncorrected presbyopia can negatively affect the quality of life of individuals, impact families and society, and potentially have negative implications on employment and labour work productivity. This study aimed to determine the impact of near vision correction on the work productivity of clothing factory workers. Methods: We conducted a cross-sectional study and sampled all workers who were aged 40 years and older and who performed near vision tasks (e.g. machinist, cutter, zip sewer, clothing pressers and quality controllers in seven clothing factories. We included workers who were employed for at least 3 months and whose uncorrected near visual acuity could be improved and corrected to better than 6/9 with spectacle correction. Workers were provided with near vision spectacles, and changes in their work productivity were evaluated after 6 months, using the factories’ output records as an indicator for measurement. Results: The final sample comprised 268 individuals, with 56% of African origin (n = 151 and 49% (n = 115 Indian origin. There were mainly females (94% in the sample, and the average age was 48 years (± 5.5 years, range 40–62 years. The overall post-correction mean production score (70.5 [SD ± 19.9] was significantly higher than the overall pre-correction mean production score (67.0 [SD ±20.3] (p < 0.001. The average change in production score was 3.5 (95% confidence interval [CI] 2.7–4.3, and the percent difference was 6.4% (95% CI 5.2–7.7. The increase in work productivity was significant for individuals of African (p < 0.001 and Indian origins (p < 0.001 but not for those of mixed race (p = 0.364; n = 2. Post-correction, the production scores of women increased significantly by 6.6% (95% CI 5.3

  3. Visual performance after bilateral implantation of 2 new presbyopia-correcting intraocular lenses: Trifocal versus extended range of vision. (United States)

    Monaco, Gaspare; Gari, Mariangela; Di Censo, Fabio; Poscia, Andrea; Ruggi, Giada; Scialdone, Antonio


    To compare the visual outcomes and quality of vision of 2 new diffractive multifocal intraocular lenses (IOLs) with those of a monofocal IOL. Fatebenefratelli e Oftalmico Hospital, Milan, Italy. Prospective case series. Patients had bilateral cataract surgery with implantation of a trifocal IOL (Panoptix), an extended-range-of-vision IOL (Symfony), or a monofocal IOL (SN60WF). Postoperative examinations included assessing distance, intermediate, and near visual acuity; binocular defocus; intraocular and total aberrations; point-spread function (PSF); modulation transfer function (MTF); retinal straylight; and quality-of-vision (QoV) and spectacle-dependence questionnaires. Seventy-six patients (152 eyes) were assessed for study eligibility. Twenty patients (40 eyes) in each arm of the study (60 patients, 120 eyes) completed the outcome assessment. At the 4-month follow-up, the trifocal group had significantly better near visual acuity than the extended-range-of-vision group (P = .005). The defocus curve showed the trifocal IOL had better intermediate/near performance than the extended-range-of-vision IOL and both multifocal IOLs performed better than the monofocal IOL. Intragroup comparison of the total higher-order aberrations, PSF, MTF, and retinal straylight were not statistically different. The QoV questionnaire results showed no differences in dysphotopsia between the multifocal IOL groups; however, the results were significantly higher than in the monofocal IOL group. Both multifocal IOLs seemed to be good options for patients with intermediate-vision requirements, whereas the trifocal IOL might be better for patients with near-vision requirements. The significant perception of visual side effects indicates that patients still must be counseled about these effects before a multifocal IOL is implanted. Copyright © 2017 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

  4. Semiautomated analysis of optical coherence tomography crystalline lens images under simulated accommodation. (United States)

    Kim, Eon; Ehrmann, Klaus; Uhlhorn, Stephen; Borja, David; Arrieta-Quintero, Esdras; Parel, Jean-Marie


    Presbyopia is an age related, gradual loss of accommodation, mainly due to changes in the crystalline lens. As part of research efforts to understand and cure this condition, ex vivo, cross-sectional optical coherence tomography images of crystalline lenses were obtained by using the Ex-Vivo Accommodation Simulator (EVAS II) instrument and analyzed to extract their physical and optical properties. Various filters and edge detection methods were applied to isolate the edge contour. An ellipse is fitted to the lens outline to obtain central reference point for transforming the pixel data into the analysis coordinate system. This allows for the fitting of a high order equation to obtain a mathematical description of the edge contour, which obeys constraints of continuity as well as zero to infinite surface slopes from apex to equator. Geometrical parameters of the lens were determined for the lens images captured at different accommodative states. Various curve fitting functions were developed to mathematically describe the anterior and posterior surfaces of the lens. Their differences were evaluated and their suitability for extracting optical performance of the lens was assessed. The robustness of these algorithms was tested by analyzing the same images repeated times.

  5. Augmented reality with image registration, vision correction and sunlight readability via liquid crystal devices. (United States)

    Wang, Yu-Jen; Chen, Po-Ju; Liang, Xiao; Lin, Yi-Hsin


    Augmented reality (AR), which use computer-aided projected information to augment our sense, has important impact on human life, especially for the elder people. However, there are three major challenges regarding the optical system in the AR system, which are registration, vision correction, and readability under strong ambient light. Here, we solve three challenges simultaneously for the first time using two liquid crystal (LC) lenses and polarizer-free attenuator integrated in optical-see-through AR system. One of the LC lens is used to electrically adjust the position of the projected virtual image which is so-called registration. The other LC lens with larger aperture and polarization independent characteristic is in charge of vision correction, such as myopia and presbyopia. The linearity of lens powers of two LC lenses is also discussed. The readability of virtual images under strong ambient light is solved by electrically switchable transmittance of the LC attenuator originating from light scattering and light absorption. The concept demonstrated in this paper could be further extended to other electro-optical devices as long as the devices exhibit the capability of phase modulations and amplitude modulations.

  6. Rapid assessment of visual impairment (RAVI in marine fishing communities in South India - study protocol and main findings

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    Madala Sreenivas R


    Full Text Available Abstract Background Reliable data are a pre-requisite for planning eye care services. Though conventional cross sectional studies provide reliable information, they are resource intensive. A novel rapid assessment method was used to investigate the prevalence and causes of visual impairment and presbyopia in subjects aged 40 years and older. This paper describes the detailed methodology and study procedures of Rapid Assessment of Visual Impairment (RAVI project. Methods A population-based cross-sectional study was conducted using cluster random sampling in the coastal region of Prakasam district of Andhra Pradesh in India, predominantly inhabited by fishing communities. Unaided, aided and pinhole visual acuity (VA was assessed using a Snellen chart at a distance of 6 meters. The VA was re-assessed using a pinhole, if VA was Results The data collection was completed in Conclusion There is a high prevalence of visual impairment in marine fishing communities in Prakasam district in India. The data from this rapid assessment survey can now be used as a baseline to start eye care services in this region. The rapid assessment methodology (RAVI reported in this paper is robust, quick and has the potential to be replicated in other areas.

  7. Translating ocular biomechanics into clinical practice: current state and future prospects. (United States)

    Girard, Michaël J A; Dupps, William J; Baskaran, Mani; Scarcelli, Giuliano; Yun, Seok H; Quigley, Harry A; Sigal, Ian A; Strouthidis, Nicholas G


    Biomechanics is the study of the relationship between forces and function in living organisms and is thought to play a critical role in a significant number of ophthalmic disorders. This is not surprising, as the eye is a pressure vessel that requires a delicate balance of forces to maintain its homeostasis. Over the past few decades, basic science research in ophthalmology mostly confirmed that ocular biomechanics could explain in part the mechanisms involved in almost all major ophthalmic disorders such as optic nerve head neuropathies, angle closure, ametropia, presbyopia, cataract, corneal pathologies, retinal detachment and macular degeneration. Translational biomechanics in ophthalmology, however, is still in its infancy. It is believed that its use could make significant advances in diagnosis and treatment. Several translational biomechanics strategies are already emerging, such as corneal stiffening for the treatment of keratoconus, and more are likely to follow. This review aims to cultivate the idea that biomechanics plays a major role in ophthalmology and that the clinical translation, lead by collaborative teams of clinicians and biomedical engineers, will benefit our patients. Specifically, recent advances and future prospects in corneal, iris, trabecular meshwork, crystalline lens, scleral and lamina cribrosa biomechanics are discussed.

  8. Cataract Surgery From 1918 to the Present and Future-Just Imagine! (United States)

    Olson, Randall J


    To review the history of cataract surgery over the past 100 years, and to offer predictions about new developments that may occur during the next 50 years. Interpretive essay. Review of historical literature and author experiences pertaining to cataract surgery, with commentary and perspective. By this time, cataract surgery has advanced to the point that Kelman's introduction of phacoemulsification and use of intraocular lenses (IOLs), both very controversial when initially introduced, have become state of the art. Outpatient surgery, minimally limited mobility, sutureless incisions, and topical anesthesia also have become key components of standard treatment. The author envisions availability of medications for nuclear sclerosis and presbyopia, expansion of lens surgery for refractive purposes with postsurgical adjustment and unprecedented precision, increased mechanization of lens removal with emphasis on uncomplicated surgery rather than refractive precision, and accommodating IOLs all becoming standard. Acknowledging and appreciating the past contributions of pioneers in cataract surgery is vital to understanding the development of today's clinical care. Clues as to the future do help give us a possible scenario worthy of such conjecture. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Role of Aquaporin 0 in lens biomechanics

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    Sindhu Kumari, S.; Gupta, Neha [Physiology and Biophysics, Stony Brook University, Stony Brook, NY (United States); Shiels, Alan [Washington University School of Medicine, St. Louis, MO (United States); FitzGerald, Paul G. [Cell Biology and Human Anatomy, School of Medicine, University of California, Davis, CA (United States); Menon, Anil G. [University of Cincinnati College of Medicine, Cincinnati, OH (United States); Mathias, Richard T. [Physiology and Biophysics, Stony Brook University, Stony Brook, NY (United States); SUNY Eye Institute, NY (United States); Varadaraj, Kulandaiappan, E-mail: [Physiology and Biophysics, Stony Brook University, Stony Brook, NY (United States); SUNY Eye Institute, NY (United States)


    together they help to confer fiber cell shape, architecture and integrity. To our knowledge, this is the first report identifying the involvement of an aquaporin in lens biomechanics. Since accommodation is required in human lenses for proper focusing, alteration in the adhesion and/or water channel functions of AQP0 could contribute to presbyopia. - Highlights: • AQP0 aids in lens biomechanics. • AQP0 provides lens stiffness. • AQP0 is critical for lens transparency. • AQP0 could play a significant role in lens accommodation in human. • Alteration in the function(s) of lens AQP0 could lead to presbyopia.

  10. Trends in refractive surgery at an academic center: 2007-2009

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    Kuo Irene C


    Full Text Available Abstract Background The United States officially entered a recession in December 2007, and it officially exited the recession in December 2009, according to the National Bureau of Economic Research. Since the economy may affect not only the volume of excimer laser refractive surgery, but also the clinical characteristics of patients undergoing surgery, our goal was to compare the characteristics of patients completing excimer laser refractive surgery and the types of procedures performed in the summer quarter in 2007 and the same quarter in 2009 at an academic center. A secondary goal was to determine whether the volume of astigmatism- or presbyopia-correcting intraocular lenses (IOLs has concurrently changed because like laser refractive surgery, these "premium" IOLs involve out-of-pocket costs for patients. Methods Retrospective case series. Medical records were reviewed for all patients completing surgery at the Wilmer Laser Vision Center in the summer quarter of 2007 and the summer quarter of 2009. Outcome measures were the proportions of treated refractive errors, the proportion of photorefractive keratectomy (PRK vs. laser-assisted in-situ keratomileusis (LASIK, and the mean age of patients in each quarter. Chi-square test was used to compare the proportions of treated refractive errors and the proportions of procedures; two-tailed t-test to compare the mean age of patients; and two-tailed z-test to compare proportions of grouped refractive errors in 2007 vs. 2009; alpha = 0.05 for all tests. Refractive errors were grouped by the spherical equivalent of the manifest refraction and were considered "low myopia" for 6 diopters (D of myopia or less, "high myopia" for more than 6 D, and "hyperopia" for any hyperopia. Billing data were reviewed to obtain the volume of premium IOLs. Results Volume of laser refractive procedures decreased by at least 30%. The distribution of proportions of treated refractive errors did not change (p = 0.10. The

  11. Trends in refractive surgery at an academic center: 2007-2009. (United States)

    Kuo, Irene C


    The United States officially entered a recession in December 2007, and it officially exited the recession in December 2009, according to the National Bureau of Economic Research. Since the economy may affect not only the volume of excimer laser refractive surgery, but also the clinical characteristics of patients undergoing surgery, our goal was to compare the characteristics of patients completing excimer laser refractive surgery and the types of procedures performed in the summer quarter in 2007 and the same quarter in 2009 at an academic center. A secondary goal was to determine whether the volume of astigmatism- or presbyopia-correcting intraocular lenses (IOLs) has concurrently changed because like laser refractive surgery, these "premium" IOLs involve out-of-pocket costs for patients. Retrospective case series. Medical records were reviewed for all patients completing surgery at the Wilmer Laser Vision Center in the summer quarter of 2007 and the summer quarter of 2009. Outcome measures were the proportions of treated refractive errors, the proportion of photorefractive keratectomy (PRK) vs. laser-assisted in-situ keratomileusis (LASIK), and the mean age of patients in each quarter. Chi-square test was used to compare the proportions of treated refractive errors and the proportions of procedures; two-tailed t-test to compare the mean age of patients; and two-tailed z-test to compare proportions of grouped refractive errors in 2007 vs. 2009; alpha = 0.05 for all tests. Refractive errors were grouped by the spherical equivalent of the manifest refraction and were considered "low myopia" for 6 diopters (D) of myopia or less, "high myopia" for more than 6 D, and "hyperopia" for any hyperopia. Billing data were reviewed to obtain the volume of premium IOLs. Volume of laser refractive procedures decreased by at least 30%. The distribution of proportions of treated refractive errors did not change (p = 0.10). The proportion of high myopes, however, decreased (p = 0

  12. Short-term visual result after simultaneous photorefractive keratectomy and small-aperture cornea inlay implantation

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    Moshirfar M


    Full Text Available Majid Moshirfar,1,2 Ryan T Wallace,3 David F Skanchy,4 Jordan D Desautels,5 Steven H Linn,1 Phillip C Hoopes Jr,1 Daniel S Durrie1,6 1Hoopes, Durrie, Rivera, Research Center, Hoopes Vision, Draper, UT, 2Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT, 3Brigham Young University, Provo, UT, 4McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, 5Tufts University School of Medicine, Boston, MA, 6Durrie Vision, Overland Park, KS, USA Purpose: To report the short-term results of simultaneous photorefractive keratectomy (PRK and small-aperture cornea inlay implantation (KAMRA surgery in treating presbyopia. Methods: Simultaneous PRK and KAMRA inlay surgery was performed on 21 patients from July 2015 to March 2016. Follow-up exams were conducted at 1, 3, and 6 months postoperatively. Our patients were also divided preoperatively into three categories: myopic, hyperopic, and emmetropic. Over the 6-month period, the main outcome measures were uncorrected near visual acuity (UNVA, changes in best-corrected distance visual acuity, and mean spherical equivalent refraction. Results: At 6-month follow-up, 83% (10/12 of patients had a monocular UNVA of 20/40 or better, and 75% had a binocular UNVA of 20/40 (J5 or better. At 6 months, the overall mean refractive spherical equivalent (MRSE was -0.60 D (±0.42 standard deviation [SD], range: -1.38 to -0.13 with a mean change of -0.43 D (±1.19 SD, range: -1.5 to 2.63 compared to preoperative data. Overall, 91% (10/11 of patients were within a ±0.5 D range of our target -0.75 D for KAMRA use. One-hundred percent (5/5 of the hyperopes, 50% (1/2 of emmetropes, and 100% (4/4 of myopes met the targeted range. At 6 months, the MRSE for the hyperopic subgroup (n=5 was 0.33 D (±0.20 SD, the MRSE for the emmetropic subgroup (n=2 was -1.19 D (±0.19 SD, and the MRSE for the myopic

  13. Role of Aquaporin 0 in lens biomechanics

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    Sindhu Kumari, S.; Gupta, Neha; Shiels, Alan; FitzGerald, Paul G.; Menon, Anil G.; Mathias, Richard T.; Varadaraj, Kulandaiappan


    confer fiber cell shape, architecture and integrity. To our knowledge, this is the first report identifying the involvement of an aquaporin in lens biomechanics. Since accommodation is required in human lenses for proper focusing, alteration in the adhesion and/or water channel functions of AQP0 could contribute to presbyopia. - Highlights: • AQP0 aids in lens biomechanics. • AQP0 provides lens stiffness. • AQP0 is critical for lens transparency. • AQP0 could play a significant role in lens accommodation in human. • Alteration in the function(s) of lens AQP0 could lead to presbyopia

  14. Ocular morbidity and health seeking behaviour in Kwara state, Nigeria: implications for delivery of eye care services.

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    Laura Senyonjo

    Full Text Available There is currently limited information as to which conditions are most prevalent in communities in developing countries. This makes effective planning of eye services difficult.3,899 eligible individuals were recruited and examined in a cross-sectional survey in Asa Local Government Area, Nigeria. Those who self-reported an ocular morbidity were also asked about their health-seeking behaviour. Health records of local facilities were reviewed to collect information on those presenting with ocular morbidities.25.2% (95% CI: 22.0-28.6 had an ocular morbidity in at least one eye. Leading causes were presbyopia and conditions affecting the lens and conjunctiva. The odds of having an ocular morbidity increased with age and lower educational attainment. 10.1% (7.7-13.0 self-reported ocular morbidity; 48.6% (40.4-56.8 of them reported seeking treatment. At the facility level, 344 patients presented with an ocular morbidity over one month, the most common conditions were red (26.3% or itchy (20.8% eyes.Ocular morbidities, including many non vision impairing conditions, were prevalent with a quarter of the population affected. The delivery of eye care services needs to be tailored in order to address this need and ensure delivery in a cost-effective and sustainable manner.

  15. [State of accommodation depending on age of emmetropic and hypermetropic subjects engaged in diamond sorting]. (United States)

    Feĭgin, A A; Korniushina, T A


    Accommodation was studied in 449 diamond sorters aged 17 to 51 engaged in this work for 1 to 34 years with emmetropic and hypermetropic refraction. Questionnaires helped detect subjects who had no complaints of vision (group A) and those with asthenopia complaints (group B). In both groups, in emmetropic and hypermetropic subjects, the furthest point of clear vision was converging the eye by 1.96 +/- 0.04 diopters on an average, that is, there was pseudomyopia. In hypermetropic subjects with occupational ophthalmopathy the nearest point is withdrawn starting from the age of 31-35 till it merges with the furthest point in subjects over 45, that is, the accommodation volume becomes nearly nuel. The results of this study contradict the assumption existing in ophthalmology about an earlier onset of presbyopia in hypermetropia than in other types of refraction. Early correction of near vision is connected with superimposition of accommodation deterioration in ametropia. It is recommended to carry out rehabilitative measure as soon as the first asthenopia signs manifest; these measures should be aimed at weakening of refraction by the site of the furthest clear vision point. In subjects aged 31-35 with occupational ophthalmopathy refraction by the nearest clear vision point should be enhanced if possible.

  16. Implantation of a multifocal toric intraocular lens with a surface-embedded near segment after repeated LASIK treatments. (United States)

    Khoramnia, Ramin; Auffarth, Gerd U; Rabsilber, Tanja M; Holzer, Mike P


    We report a 66-year-old patient who presented with increasing hyperopia, astigmatism, and presbyopia in both eyes 8 years after bilateral laser in situ keratomileusis (LASIK) and LASIK enhancement in the left eye aiming for spectacle independence. Bilateral multifocal toric Lentis Mplus intraocular lenses (IOLs) with an embedded near segment and individually customized cylinder correction were implanted uneventfully following phacoemulsification. The Haigis-L formula after previous hyperopia correction was chosen for IOL power calculation and provided reliable results. Emmetropia was targeted and achieved. Three months postoperatively, the uncorrected distance visual acuity had increased from 0.40 logMAR to 0.10 logMAR in the right eye and from 0.20 logMAR to 0.00 logMAR in the left eye. The patient gained 6 lines of uncorrected near visual acuity: 0.20 logMAR in the right eye and 0.10 logMAR in the left eye. This case shows that customized premium IOL implantation can provide accurate results even in challenging cases. The International Vision Correction Research Centre, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany, has received research grants, lecture fees, and travel reimbursement from Oculentis GmbH. Copyright © 2012 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

  17. An evaluation of estimation methods for determining addition in presbyopes. (United States)

    Bittencourt, Leonardo Catunda; Alves, Milton Ruiz; Dantas, Daniel Oliveira; Rodrigues, Pablo Felipe; Santos-Neto, Edson dos


    The optical correction of presbyopia must be handled individually. Our aim was to compare the methods used in addition to the refractive near vision, with the final addition used in presbyopic patients. Eighty healthy subjects with a mean age of 49.7 years (range 40 to 60 years) were studied. Tentative near additions were determined using four different techniques: one-half amplitude accommodation with minus lenses (AAL); one-third accommodative demand with positive lens (ADL); balanced range of accommodation with minus and positive lenses (BRA) and crossed cylinder test with initial myopisation (CCT). The power of the addition was then refined to arrive at the final addition. The mean tentative near additions were lower than the final addition for ADL and BRA addition methods. The mean differences between tentative and final additions were low for all the tests examined (less than 0.25 D). The intervals between the 95% limits of agreement differed substantially and were always higher than ±0.50 D. All the methods used displayed similar behavior and provided a tentative addition close to the final addition. The coefficient of agreements (COA) detected suggests that every tentative addition should be adjusted according to the particular needs of the patient.

  18. An evaluation of estimation methods for determining addition in presbyopes

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    Leonardo Catunda Bittencourt


    Full Text Available PURPOSE: The optical correction of presbyopia must be handled individually. Our aim was to compare the methods used in addition to the refractive near vision, with the final addition used in presbyopic patients. METHODS: Eighty healthy subjects with a mean age of 49.7 years (range 40 to 60 years were studied. Tentative near additions were determined using four different techniques: one-half amplitude accommodation with minus lenses (AAL; one-third accommodative demand with positive lens (ADL; balanced range of accommodation with minus and positive lenses (BRA and crossed cylinder test with initial myopisation (CCT. The power of the addition was then refined to arrive at the final addition. RESULTS: The mean tentative near additions were lower than the final addition for ADL and BRA addition methods. The mean differences between tentative and final additions were low for all the tests examined (less than 0.25 D. The intervals between the 95% limits of agreement differed substantially and were always higher than ±0.50 D. CONCLUSION: All the methods used displayed similar behavior and provided a tentative addition close to the final addition. The coefficient of agreements (COA detected suggests that every tentative addition should be adjusted according to the particular needs of the patient.

  19. Objective quality of vision in presbyopic and non-presbyopic patients after pseudoaccommodative advanced surface ablation. (United States)

    Cantú, Roberto; Rosales, Marco A; Tepichín, Eduardo; Curioca, Andrée; Montes, Víctor; Ramirez-Zavaleta, J Gustavo


    To analyze the objective quality of vision at 6 months postoperatively after pseudoaccommodative (presbyopic) advanced surface ablation (PASA). The study comprised 62 eyes of 35 patients with 6-month follow-up that underwent primary or secondary treatments using PASA. Pre- and postoperative results of distance and near uncorrected visual acuity (UCVA), spherical aberration (coefficient of the Z12 Zernike polynomial), and the asphericity (Q) index were reviewed. The corresponding wavefront maps (total, low, and high order aberrations) and the corresponding point spread function and modulation transfer function (MTF) were also calculated. Our results show that PASA improves distance and near mean UCVA, increases negative spherical aberration and negative asphericity index, and improves the corresponding MTF. Pseudoaccommodative advanced surface ablation is a promising approach for the surgical correction of presbyopia with distance refractive error (myopia and hyperopia with or without astigmatism). This PASA technique could theoretically be used in non-presbyopic patients with refractive error or post cataract patients with monofocal intraocular lenses. The increase in negative spherical aberration and asphericity/eccentricity index seems to increase the depth of focus of the eye, improving the near vision and compensating the age-related lens changes. Rather than creating a multifocal cornea, PASA appears to create an improved aspheric (prolate) ablation profile.

  20. [Energy and memory efficient calculation of the accommodation demand in the artificial accommodation system]. (United States)

    Nagel, J A; Beck, C; Harms, H; Stiller, P; Guth, H; Stachs, O; Bretthauer, G


    Presbyopia and cataract are gaining more and more importance in the ageing society. Both age-related complaints are accompanied with a loss of the eye's ability to accommodate. A new approach to restore accommodation is the Artificial Accommodation System, an autonomous micro system, which will be implanted into the capsular bag instead of a rigid intraocular lens. The Artificial Accommodation System will, depending on the actual demand for accommodation, autonomously adapt the refractive power of its integrated optical element. One possibility to measure the demand for accommodation non-intrusively is to analyse eye movements. We present an efficient algorithm, based on the CORDIC technique, to calculate the demand for accommodation from magnetic field sensor data. It can be shown that specialised algorithms significantly shorten calculation time without violating precision requirements. Additionally, a communication strategy for the wireless exchange of sensor data between the implants of the left and right eye is introduced. The strategy allows for a one-sided calculation of the demand for accommodation, resulting in an overall reduction of calculation time by 50 %. The presented methods enable autonomous microsystems, such as the Artificial Accommodation System, to save significant amounts of energy, leading to extended autonomous run-times. © Georg Thieme Verlag KG Stuttgart · New York.

  1. Improvement of uncorrected visual acuity (UCVA and contrast sensitivity (UCCS with perceptual learning and transcranial random noise stimulation (tRNS in individuals with mild myopia

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    Rebecca eCamilleri


    Full Text Available Perceptual learning has been shown to produce an improvement of visual acuity (VA and contrast sensitivity (CS both in subjects with amblyopia and refractive defects such as myopia or presbyopia. Transcranial random noise stimulation (tRNS has proven to be efficacious in accelerating neural plasticity and boosting perceptual learning in healthy participants. In this study we investigated whether a short behavioural training regime using a contrast detection task combined with online tRNS was as effective in improving visual functions in participants with mild myopia compared to a two-month behavioural training regime without tRNS (Camilleri et al., 2014. After two weeks of perceptual training in combination with tRNS, participants showed an improvement of 0.15 LogMAR in uncorrected VA (UCVA that was comparable with that obtained after eight weeks of training with no tRNS, and an improvement in uncorrected CS (UCCS at various spatial frequencies (whereas no UCCS improvement was seen after eight weeks of training with no tRNS. On the other hand, a control group that trained for two weeks without stimulation did not show any significant UCVA or UCCS improvement. These results suggest that the combination of behavioural and neuromodulatory techniques can be fast and efficacious in improving sight in individuals with mild myopia.

  2. Effect of multizone refractive multifocal contact lenses on standard automated perimetry. (United States)

    Madrid-Costa, David; Ruiz-Alcocer, Javier; García-Lázaro, Santiago; Albarrán-Diego, César; Ferrer-Blasco, Teresa


    The aim of this study was to evaluate whether the creation of 2 foci (distance and near) provided by multizone refractive multifocal contact lenses (CLs) for presbyopia correction affects the measurements on Humphreys 24-2 Swedish interactive threshold algorithm (SITA) standard automated perimetry (SAP). In this crossover study, 30 subjects were fitted in random order with either a multifocal CL or a monofocal CL. After 1 month, a Humphrey 24-2 SITA standard strategy was performed. The visual field global indices (the mean deviation [MD] and pattern standard deviation [PSD]), reliability indices, test duration, and number of depressed points deviating at P0.5% on pattern deviation probability plots were determined and compared between multifocal and monofocal CLs. Thirty eyes of 30 subjects were included in this study. There were no statistically significant differences in reliability indices or test duration. There was a statistically significant reduction in the MD with the multifocal CL compared with monfocal CL (P=0.001). Differences were not found in PSD nor in the number of depressed points deviating at P0.5% in the pattern deviation probability maps studied. The results of this study suggest that the multizone refractive lens produces a generalized depression in threshold sensitivity as measured by the Humphreys 24-2 SITA SAP.

  3. Spectacle independence and subjective satisfaction of ReSTOR® multifocal intraocular lens after cataract or presbyopia surgery in two European countries

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    Béatrice Cochener


    Full Text Available Béatrice Cochener1, Luis Fernández-Vega2, Jose F Alfonso2, Frédérique Maurel3, Juliette Meunier4, Gilles Berdeaux5,61Centre Hospitalier de Brest, Brest, France; 2Instituto Oftalmologico Fernandez Vega, Oviedo, Spain; 3IMS Health, Health Economics Department, Puteaux, France; 4Mapi Values, Lyon, France; 5Alcon France, Health Economics Department, Rueil-Malmaison, France; 6Conservatoire National des Arts et Métiers, Paris, FrancePurpose: To determine the percentage of patients implanted bilaterally with ReSTOR® requiring spectacles at 18 months, the patient satisfaction, and factors that predict spectacles independence.Methods: The medical and surgical data were collected from patient records. The ‘Freedom from Spectacles Value Scale’ (FGVS was used to rank their experiences via telephone interview. A Bayesian network was used to predict postoperative spectacles use.Results: 304 patients (65.6 years were included. Postoperative visual acuity was ≥0.8 in 93.3% of patients for near vision and in 88.6% of patients for distance vision. After surgery, 87.2% of the patients were spectacles free. 88.2% of the patients rated their vision as being better following the surgery and 93.1% thought that surgery resulted in a positive change. FGVS mean scores (5 the most favorable rating were: ‘Practical Advantages’ 3.8, ‘Psychological Advantages’ 3.8, ‘Evaluation of the Result’ 4.5, ‘Feelings’ 4.4, and ‘Global Judgement’ 4.4. Patients who stated that spectacles wear was particularly bothersome and those who thought that their appearance was more favorable without spectacles were 3 times more likely not to wear spectacles postoperatively.Conclusion: ReSTOR® provides patients with good distance and near vision, a high rate of spectacles independence, and a high degree of patient satisfaction.Keywords: cataract surgery, multifocal intraocular lens, patient satisfaction, spectacles independence

  4. Epithelial ingrowth following laser in situ keratomileusis (LASIK): prevalence, risk factors, management and visual outcomes. (United States)

    Ting, Darren Shu Jeng; Srinivasan, Sathish; Danjoux, Jean-Pierre


    The number of laser in situ keratomileusis (LASIK) procedures is continuing to rise. Since its first application for correcting simple refractive errors over 25 years ago, the role of LASIK has extended to treat other conditions, including postkeratoplasty astigmatism/ametropia, postcataract surgery refractive error and presbyopia, among others. The long-term effectiveness, predictability and safety have been well established by many large studies. However, due to the creation of a potential interface between the flap and the underlying stroma, interface complications such as infectious keratitis, diffuse lamellar keratitis and epithelial ingrowth may occur. Post-LASIK epithelial ingrowth (PLEI) is an uncommon complication that usually arises during the early postoperative period. The reported incidence of PLEI ranged from 0%-3.9% in primary treatment to 10%-20% in retreatment cases. It can cause a wide spectrum of clinical presentations, ranging from asymptomatic interface changes to severe visual impairment and flap melt requiring keratoplasty. PLEI can usually be treated with mechanical debridement of the affected interface; however, additional interventions, such as alcohol, mitomycin C, fibrin glue, ocular hydrogel sealant, neodymium:yttriumaluminum garnet laser and amniotic membrane graft, may be required for recurrent or refractory cases. The aims of this review are to determine the prevalence and risk factors of PLEI; to describe its pathogenesis and clinical features and to summarise the therapeutic armamentarium and the visual outcome of PLEI.

  5. Retrospective Comparison of Visual Outcomes After KAMRA Corneal Inlay Implantation With Simultaneous PRK or LASIK. (United States)

    Moshirfar, Majid; Bean, Andrew E; Albarracin, Julio C; Rebenitsch, Ronald L; Wallace, Ryan T; Birdsong, Orry C


    To report a retrospective study of simultaneous LASIK versus photorefractive keratectomy (PRK) with accompanying small-aperture cornea inlay implantation (KAMRA; AcuFocus, Inc., Irvine, CA) in treating presbyopia. Simultaneous LASIK/inlay and simultaneous PRK/inlay was performed on 79 and 47 patients, respectively. Follow-up examinations were conducted at 1, 3, and 6 months postoperatively. The main outcome measures were safety, efficacy, predictability, and stability with primary emphasis on monocular uncorrected near visual acuity (UNVA). Both groups met U.S. Food and Drug Administration criteria for efficacy with 95% and 55% of the LASIK/inlay group and 83% and 52% of the PRK/inlay group having a monocular UNVA of 20/40 (J5) and 20/25 (J2), respectively, at 6-month follow-up. Ninety-two percent of the LASIK/inlay group and 95% of the PRK/inlay group had a UDVA of 20/40 or better at 6 months. Two eyes lost one line of corrected distance visual acuity (CDVA). Mild hyperopic shift was noted in both groups at 6 months. Simultaneous PRK/inlay and LASIK/inlay meet the U.S. Food and Drug Administration standards for efficacy and safety based on 6-month preliminary results and have similar outcomes to emmetropic eyes. [J Refract Surg. 2018;34(5):310-315.]. Copyright 2018, SLACK Incorporated.


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    Efstathios T. Detorakis


    Full Text Available Introduction: A previous study has employed shear-wave ultrasound elastographic imaging to assess corneal rigidity in an ex-vivo porcine eye model. This study employs the same modality in vivo in a rabbit eye model in order to assess lens, ciliary body and total ocular rigidity changes following the instillation of atropine and pilocarpine. Methods: Ten non-pigmented female rabbits were examined. Measurements of the lens, ciliary body and total ocular rigidity as well as lens thickness and anterior chamber depth were taken with the Aixplorer system (SuperSonic Imagine, Aix-en-Provence, France with the SuperLinear™ SL 15-4 transducer in both eyes at baseline as well as after pilocarpine and atropine instillation. The IOP was also measured with the TonoPen tonometer. Results: Changes in rigidity in the examined areas following atropine instillation were statistically not significant. Ciliary body rigidity was significantly increased whereas lens and total ocular rigidity were significantly reduced following pilocarpine instillation. The decrease in lens rigidity following pilocarpine was significantly associated with the respective increase in ciliary body rigidity. Conclusions: Shear-wave ultrasound elastography can detect in vivo rigidity changes in the anterior segment of the rabbit eye model and may potentially be applied in human eyes, providing useful clinical information on conditions in which rigidity changes play an important role, such as glaucoma, pseudoexfoliation syndrome or presbyopia.

  7. Evaluation of iridociliary and lenticular elasticity using shear-wave elastography in rabbit eyes. (United States)

    Detorakis, Efstathios T; Drakonaki, Eleni E; Ginis, Harilaos; Karyotakis, Nikolaos; Pallikaris, Ioannis G


    A previous study has employed shear-wave ultrasound elastographic imaging to assess corneal rigidity in an ex-vivo porcine eye model. This study employs the same modality in vivo in a rabbit eye model in order to assess lens, ciliary body and total ocular rigidity changes following the instillation of atropine and pilocarpine. Ten non-pigmented female rabbits were examined. Measurements of the lens, ciliary body and total ocular rigidity as well as lens thickness and anterior chamber depth were taken with the Aixplorer system (SuperSonic Imagine, Aix-en-Provence, France) with the SuperLinear™ SL 15-4 transducer in both eyes at baseline as well as after pilocarpine and atropine instillation. The IOP was also measured with the TonoPen tonometer. Changes in rigidity in the examined areas following atropine instillation were statistically not significant. Ciliary body rigidity was significantly increased whereas lens and total ocular rigidity were significantly reduced following pilocarpine instillation. The decrease in lens rigidity following pilocarpine was significantly associated with the respective increase in ciliary body rigidity. Shear-wave ultrasound elastography can detect in vivo rigidity changes in the anterior segment of the rabbit eye model and may potentially be applied in human eyes, providing useful clinical information on conditions in which rigidity changes play an important role, such as glaucoma, pseudoexfoliation syndrome or presbyopia.

  8. Reading ability with pseudophakic monovision and with refractive multifocal intraocular lenses: comparative study. (United States)

    Ito, Misae; Shimizu, Kimiya


    To the compare the reading ability after bilateral cataract surgery in patients who had pseudophakic monovision achieved by monofocal intraocular lens (IOL) implantation and patients who had refractive multifocal IOL implantation. Department of Ophthalmology, Kitasato University Hospital, Kanagawa, Japan. This study evaluated patients who had bilateral cataract surgery using the monovision method with monofocal IOL implantation to correct presbyopia (monovision group) or who had bilateral cataract surgery with refractive multifocal IOL implantation (multifocal group). In the monovision group, the dominant eye was corrected for distance vision and the nondominant eye for near vision. The maximum reading speed, critical character size, and reading acuity were measured binocularly without refractive correction using MNREAD-J acuity charts. The monovision group comprised 38 patients and the multifocal group, 22 patients. The mean maximum reading speed was 350.5 characters per minute (cpm) +/- 62.3 (SD) in the monovision group and 355.0 +/- 53.3 cpm in the multifocal group; the difference was not statistically significant. The mean critical character size was 0.24 +/- 0.12 logMAR and 0.40 +/- 0.16 logMAR, respectively (P<.05). The mean reading acuity was 0.05 +/- 0.12 logMAR and 0.19 +/- 0.11 logMAR, respectively (P<.01). The monovision group had better critical character size and reading acuity results. The monovision method group had better reading ability; however, careful patient selection is essential.

  9. Visualization of femtosecond laser pulse-induced microincisions inside crystalline lens tissue. (United States)

    Stachs, Oliver; Schumacher, Silvia; Hovakimyan, Marine; Fromm, Michael; Heisterkamp, Alexander; Lubatschowski, Holger; Guthoff, Rudolf


    To evaluate a new method for visualizing femtosecond laser pulse-induced microincisions inside crystalline lens tissue. Laser Zentrum Hannover e.V., Hannover, Germany. Lenses removed from porcine eyes were modified ex vivo by femtosecond laser pulses (wavelength 1040 nm, pulse duration 306 femtoseconds, pulse energy 1.0 to 2.5 microJ, repetition rate 100 kHz) to create defined planes at which lens fibers separate. The femtosecond laser pulses were delivered by a 3-dimension (3-D) scanning unit and transmitted by focusing optics (numerical aperture 0.18) into the lens tissue. Lens fiber orientation and femtosecond laser-induced microincisions were examined using a confocal laser scanning microscope (CLSM) based on a Rostock Cornea Module attached to a Heidelberg Retina Tomograph II. Optical sections were analyzed in 3-D using Amira software (version 4.1.1). Normal lens fibers showed a parallel pattern with diameters between 3 microm and 9 microm, depending on scanning location. Microincision visualization showed different cutting effects depending on pulse energy of the femtosecond laser. The effects ranged from altered tissue-scattering properties with all fibers intact to definite fiber separation by a wide gap. Pulse energies that were too high or overlapped too tightly produced an incomplete cutting plane due to extensive microbubble generation. The 3-D CLSM method permitted visualization and analysis of femtosecond laser pulse-induced microincisions inside crystalline lens tissue. Thus, 3-D CLSM may help optimize femtosecond laser-based procedures in the treatment of presbyopia.

  10. Hard sphere-like glass transition in eye lens α-crystallin solutions. (United States)

    Foffi, Giuseppe; Savin, Gabriela; Bucciarelli, Saskia; Dorsaz, Nicolas; Thurston, George M; Stradner, Anna; Schurtenberger, Peter


    We study the equilibrium liquid structure and dynamics of dilute and concentrated bovine eye lens α-crystallin solutions, using small-angle X-ray scattering, static and dynamic light scattering, viscometry, molecular dynamics simulations, and mode-coupling theory. We find that a polydisperse Percus-Yevick hard-sphere liquid-structure model accurately reproduces both static light scattering data and small-angle X-ray scattering liquid structure data from α-crystallin solutions over an extended range of protein concentrations up to 290 mg/mL or 49% vol fraction and up to ca. 330 mg/mL for static light scattering. The measured dynamic light scattering and viscosity properties are also consistent with those of hard-sphere colloids and show power laws characteristic of an approach toward a glass transition at α-crystallin volume fractions near 58%. Dynamic light scattering at a volume fraction beyond the glass transition indicates formation of an arrested state. We further perform event-driven molecular dynamics simulations of polydisperse hard-sphere systems and use mode-coupling theory to compare the measured dynamic power laws with those of hard-sphere models. The static and dynamic data, simulations, and analysis show that aqueous eye lens α-crystallin solutions exhibit a glass transition at high concentrations that is similar to those found in hard-sphere colloidal systems. The α-crystallin glass transition could have implications for the molecular basis of presbyopia and the kinetics of molecular change during cataractogenesis.

  11. Disparity-driven vs blur-driven models of accommodation and convergence in binocular vision and intermittent strabismus. (United States)

    Horwood, Anna M; Riddell, Patricia M


    To propose an alternative and practical model to conceptualize clinical patterns of concomitant intermittent strabismus, heterophoria, and convergence and accommodation anomalies. Despite identical ratios, there can be a disparity- or blur-biased "style" in three hypothetical scenarios: normal; high ratio of accommodative convergence to accommodation (AC/A) and low ratio of convergence accommodation to convergence (CA/C); low AC/A and high CA/C. We calculated disparity bias indices (DBI) to reflect these biases and provide early objective data from small illustrative clinical groups that fit these styles. Normal adults (n = 56) and children (n = 24) showed disparity bias (adult DBI 0.43 [95% CI, 0.50-0.36], child DBI 0.20 [95% CI, 0.31-0.07]; P = 0.001). Accommodative esotropia (n = 3) showed less disparity-bias (DBI 0.03). In the high AC/A-low CA/C scenario, early presbyopia (n = 22) showed mean DBI of 0.17 (95% CI, 0.28-0.06), compared to DBI of -0.31 in convergence excess esotropia (n=8). In the low AC/A-high CA/C scenario near exotropia (n = 17) showed mean DBI of 0.27. DBI ranged between 1.25 and -1.67. Establishing disparity or blur bias adds to AC/A and CA/C ratios to explain clinical patterns. Excessive bias or inflexibility in near-cue use increases risk of clinical problems. Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.

  12. Growth of the human lens in the Indian adult population: Preliminary observations

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    Ashik Mohamed


    Full Text Available Context: The eye lens grows throughout life by the addition of new cells inside the surrounding capsule. How this growth affects the properties of the lens is essential for understanding disorders such as cataract and presbyopia. Aims: To examine growth of the human lens in the Indian population and compare this with the growth in Western populations by measuring in vitro dimensions together with wet and dry weights. Settings and Design: The study was conducted at the research wing of a tertiary eye care center in South India and the study design was prospective. Materials and Methods: Lenses were removed from eye bank eyes and their dimensions measured with a digital caliper. They were then carefully blotted dry and weighed before being placed in 5% buffered formalin. After 1 week fixation, the lenses were dried at 80 °C until constant weight was achieved. The constant weight was noted as the dry weight of the lens. Statistical Analysis Used: Lens parameters were analyzed as a function of age using linear and logarithmic regression methods. Results: Data were obtained for 251 lenses, aged 16-93 years, within a median postmortem time of 22 h. Both wet and dry weights increased linearly at 1.24 and 0.44 mg/year, respectively, throughout adult life. The dimensions also increased continuously throughout this time. Conclusions: Over the age range examined, lens growth in the Indian population is very similar to that in Western populations.

  13. What the comprehensive economics of blindness and visual impairment can help us understand

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    Kevin D Frick


    Full Text Available Since the year 2000, the amount written about the economics of blindness and visual impairment has increased substantially. In some cases, the studies listed under this heading are calculations of the costs related to vision impairment and blindness at a national or global level; in other cases the studies examine the cost-effectiveness of strategies to prevent or modify visual impairment or blindness that are intended to be applied as a guide to treatment recommendations and coverage decisions. In each case the references are just examples of many that could be cited. These important studies have helped advocates, policy makers, practitioners, educators, and others interested in eye and vision health to understand the magnitude of the impact that visual impairment and blindness have on the world, regions, nations, and individuals and the tradeoffs that need to be made to limit the impact. However, these studies only begin to tap into the insights that economic logic might offer to those interested in this field. This paper presents multiple case studies that demonstrate that the economics of blindness and visual impairment encompasses much more than simply measures of the burden of the condition. Case studies demonstrating the usefulness of economic insight include analysis of the prevention of conditions that lead to impairment, decisions about refractive error and presbyopia, decisions about disease and injury treatment, decisions about behavior among those with uncorrectable impairment, and decisions about how to regulate the market all have important economic inputs.

  14. In Vitro Aberrometric Assessment of a Multifocal Intraocular Lens and Two Extended Depth of Focus IOLs

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    Vicente J. Camps


    Full Text Available Purpose. To analyze the “in vitro” aberrometric pattern of a refractive IOL and two extended depth of focus IOLs. Methods. A special optical bench with a Shack-Hartmann wavefront sensor (SH was designed for the measurement. Three presbyopia correction IOLs were analyzed: Mini WELL (MW, TECNIS Symfony ZXR00 (SYM, and Lentis Mplus X LS-313 MF30 (MP. Three different pupil sizes were used for the comparison: 3, 4, and 4.7 mm. Results. MW generated negative primary and positive secondary spherical aberrations (SA for the apertures of 3 mm (−0.13 and +0.12 μm, 4 mm (−0.12 and +0.08 μm, and 4.7 mm (−0.11 and +0.08 μm, while the SYM only generated negative primary SA for 4 and 4.7 mm apertures (−0.12 μm and −0.20 μm, resp.. The MP induced coma and trefoil for all pupils and showed significant HOAs for apertures of 4 and 4.7 mm. Conclusions. In an optical bench, the MW induces negative primary and positive secondary SA for all pupils. The SYM aberrations seem to be pupil dependent; it does not produce negative primary SA for 3 mm but increases for higher pupils. Meanwhile, the HOAs for the MW and SYM were not significant. The MP showed in all cases the highest HOAs.

  15. Evaluation of a device for standardized measurements of reading performance in a prepresbyopic population. (United States)

    Arad, Tschingis; Baumeister, Martin; Bühren, Jens; Kohnen, Thomas


    Automated measurements of reading performance are required for clinical trials involving presbyopia-correcting surgery options. Repeatability of a testing device for reading (Salzburg Reading Desk) was evaluated in a prepresbyopic population. Subjective reading performance of 50 subjects divided into 2 age groups (23-30 years and 38-49 years) with distance-corrected eyes was investigated with different log-scaled reading charts. At study entry, refractive parameters were measured and distance visual acuity assessed. Two standardized binocular measurements were performed for each subject (32.24 ± 9.87 days apart [mean ± SD]). The repeatability of the tests was estimated using correlation coefficients, Wilcoxon signed-rank test, and Bland-Altman method. The test parameters at both maximum reading rate (MRR) measurements demonstrate a strong relationship of age group 2 subjects (correlation coefficient [r] = 0.74 p = 10-4) and of younger subjects (age group 1: r = 0.69, p = 10-4). Prepresbyopic subjects of age group 2 showed moderate results for near reading distance (r = 0.67, p = 10-4); by contrast, younger subjects had poorer results (r = 0.55, p = 10-3). The Wilcoxon signed-rank test revealed agreement between measurements and Bland-Altman plots showed a wide data spread for MRR and near reading distance in both groups. The device measures repeatedly selected reading performance parameters of near real world conditions, such as MRR, in prepresbyopic populations if several factors are taken into account. The option to choose preferred distance leads to more variance in measuring repeated reading performance. German Clinical Trials Register (DRKS) registration reference number: DRKS00000784.

  16. Extended depth of focus contact lenses vs. two commercial multifocals: Part 1. Optical performance evaluation via computed through-focus retinal image quality metrics. (United States)

    Bakaraju, Ravi C; Ehrmann, Klaus; Ho, Arthur

    To compare the computed optical performance of prototype lenses designed using deliberate manipulation of higher-order spherical aberrations to extend depth-of-focus (EDOF) with two commercial multifocals. Emmetropic, presbyopic, schematic eyes were coupled with prototype EDOF and commercial multifocal lenses (Acuvue Oasys for presbyopia, AOP, Johnson & Johnson & Air Optix Aqua multifocal, AOMF, Alcon). For each test configuration, the through-focus retinal image quality (TFRIQ) values were computed over 21 vergences, ranging from -0.50 to 2.00D, in 0.125D steps. Analysis was performed considering eyes with three different inherent aberration profiles: five different pupils and five different lens decentration levels. Except the LOW design, the AOP lenses offered 'bifocal' like TFRIQ performance. Lens performance was relatively independent to pupil and aberrations but not centration. Contrastingly, AOMF demonstrated distance centric performance, most dominant in LOW followed by MED and HIGH designs. AOMF lenses were the most sensitive to pupil, aberrations and centration. The prototypes demonstrated a 'lift-off' in the TFRIQ performance, particularly at intermediate and near, without trading performance at distance. When compared with AOP and AOMF, EDOF lenses demonstrated reduced sensitivity to pupil, aberrations and centration. With the through focus retinal image quality as the gauge of optical performance, we demonstrated that the prototype EDOF designs were less susceptible to variations in pupil, inherent ocular aberrations and decentration, compared to the commercial designs. To ascertain whether these incremental improvements translate to a clinically palpable outcome requires investigation through human trials. Copyright © 2017 Spanish General Council of Optometry. Published by Elsevier España, S.L.U. All rights reserved.

  17. Comparison of FDA safety and efficacy data for KAMRA and Raindrop corneal inlays

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    Majid Moshirfar


    Full Text Available AIM: To provide a side-by-side analysis of the summary of safety and effectiveness data (SSED submitted to the FDA for the KAMRA and Raindrop corneal inlays for the correction of presbyopia. METHODS: SSED reports submitted to the FDA for KAMRA and Raindrop were compared with respect to loss of corrected distance visual acuity (CDVA, adverse event rates, induction of astigmatism, retention of contrast sensitivity, stability of manifest refractive spherical equivalent (MRSE, and achieved monocular uncorrected near visual acuity (UNVA at 24mo. RESULTS: Totally 442/508 of KAMRA patients and 344/373 Raindrop patients remained enrolled in the clinical trials at 24mo. The proportion of KAMRA and Raindrop patients who lost ≥2 lines of CDVA at 24mo was 3.4% and 1%, respectively. The adverse event rate was comparable between the devices. No significant inductions of astigmatism were noted. Both technologies induced a transient myopic shift in MRSE followed by a hyperopic shift and subsequent stabilization. Totally 87% of KAMRA and 98% of Raindrop patients attained a monocular UNVA of J5 (20/40 or better at 24mo, 28% of KAMRA and 67% of Raindrop patients attained a monocular UNVA of J1 (20/20 or better at 24mo. CONCLUSION: Both devices can be considered safe and effective, however, the results of corneal inlay implantation are mixed, and long-term patient satisfaction will likely depend on subjective expectations about the capabilities of the inlays. Variability in surgical technique and postoperative care within and between the two clinical trials diminishes the comparative power of this article.

  18. Refractive lens exchange with a multifocal diffractive aspheric intraocular lens

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    Teresa Ferrer-Blasco


    Full Text Available PURPOSE: To evaluate the safety, efficacy and predictability after refractive lens exchange with multifocal diffractive aspheric intraocular lens implantation. METHODS: Sixty eyes of 30 patients underwent bilateral implantation with AcrySof® ReSTOR® SN6AD3 intraocular lens with +4.00 D near addition. Patients were divided into myopic and hyperopic groups. Monocular best corrected visual acuity at distance and near and monocular uncorrected visual acuity at distance and near were measured before and 6 months postoperatively. RESULTS: After surgery, uncorrected visual acuity was 0.08 ± 0.15 and 0.11 ± 0.14 logMAR for the myopic and hyperopic groups, respectively (50% and 46.67% of patients had an uncorrected visual acuity of 20/20 or better in the myopic and hyperopic groups, respectively. The safety and efficacy indexes were 1.05 and 0.88 for the myopic and 1.01 and 0.86 for the hyperopic groups at distance vision. Within the myopic group, 20 eyes remained unchanged after the surgery, and 3 gained >2 lines of best corrected visual acuity. For the hyperopic group, 2 eyes lost 2 lines of best corrected visual acuity, 21 did not change, and 3 eyes gained 2 lines. At near vision, the safety and efficacy indexes were 1.23 and 1.17 for the myopic and 1.16 and 1.13 for the hyperopic groups. Best corrected near visual acuity improved after surgery in both groups (from 0.10 logMAR to 0.01 logMAR in the myopic group, and from 0.10 logMAR to 0.04 logMAR in the hyperopic group. CONCLUSIONS: The ReSTOR® SN6AD3 intraocular lens in refractive lens exchange demonstrated good safety, efficacy, and predictability in correcting high ametropia and presbyopia.

  19. Prevalence of uncorrected refractive errors in adults aged 30 years and above in a rural population in Pakistan

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    Abdullah, A.S.; Azam, M.; Nigar, M.


    Uncorrected refractive errors are a leading cause of visual disability globally. This population-based study was done to estimate the prevalence of uncorrected refractive errors in adults aged 30 years and above of village Pawakah, Khyber Pakhtunkhwa (KPK), Pakistan. Methods: It was a cross-sectional survey in which 1000 individuals were included randomly. All the individuals were screened for uncorrected refractive errors and those whose visual acuity (VA) was found to be less than 6/6 were refracted. In whom refraction was found to be unsatisfactory (i.e., a best corrected visual acuity of <6/6) further examination was done to establish the cause for the subnormal vision. Results: A total of 917 subjects participated in the survey (response rate 92%). The prevalence of uncorrected refractive errors was found to be 23.97% among males and 20% among females. The prevalence of visually disabling refractive errors was 6.89% in males and 5.71% in females. The prevalence was seen to increase with age, with maximum prevalence in 51-60 years age group. Hypermetropia (10.14%) was found to be the commonest refractive error followed by Myopia (6.00%) and Astigmatism (5.6%). The prevalence of Presbyopia was 57.5% (60.45% in males and 55.23% in females). Poor affordability was the commonest barrier to the use of spectacles, followed by unawareness. Cataract was the commonest reason for impaired vision after refractive correction. The prevalence of blindness was 1.96% (1.53% in males and 2.28% in females) in this community with cataract as the commonest cause. Conclusions: Despite being the most easily avoidable cause of subnormal vision uncorrected refractive errors still account for a major proportion of the burden of decreased vision in this area. Effective measures for the screening and affordable correction of uncorrected refractive errors need to be incorporated into the health care delivery system. (author)

  20. Finite element modelling of radial lentotomy cuts to improve the accommodation performance of the human lens. (United States)

    Burd, H J; Wilde, G S


    The use of a femtosecond laser to form planes of cavitation bubbles within the ocular lens has been proposed as a potential treatment for presbyopia. The intended purpose of these planes of cavitation bubbles (referred to in this paper as 'cutting planes') is to increase the compliance of the lens, with a consequential increase in the amplitude of accommodation. The current paper describes a computational modelling study, based on three-dimensional finite element analysis, to investigate the relationship between the geometric arrangement of the cutting planes and the resulting improvement in lens accommodation performance. The study is limited to radial cutting planes. The effectiveness of a variety of cutting plane geometries was investigated by means of modelling studies conducted on a 45-year human lens. The results obtained from the analyses depend on the particular modelling procedures that are employed. When the lens substance is modelled as an incompressible material, radial cutting planes are found to be ineffective. However, when a poroelastic model is employed for the lens substance, radial cuts are shown to cause an increase in the computed accommodation performance of the lens. In this case, radial cuts made in the peripheral regions of the lens have a relatively small influence on the accommodation performance of the lens; the lentotomy process is seen to be more effective when cuts are made near to the polar axis. When the lens substance is modelled as a poroelastic material, the computational results suggest that useful improvements in lens accommodation performance can be achieved, provided that the radial cuts are extended to the polar axis. Radial cuts are ineffective when the lens substance is modelled as an incompressible material. Significant challenges remain in developing a safe and effective surgical procedure based on this lentotomy technique.

  1. Vision Impairment and Ocular Morbidity in a Refugee Population in Malawi. (United States)

    Kaphle, Dinesh; Gyawali, Rajendra; Kandel, Himal; Reading, Angela; Msosa, Joseph Matiya


    To provide screening services and obtain information on the eye health status and distribution of visual impairments in a refugee population of the sole refugee camp in Malawi. A general eye screening at Dzaleka refugee settlement camp was organized in November 2012. Final-year optometry students conducted detailed optometry examinations, including visual acuity (VA) assessment for near and distance, retinoscopy, and subjective refraction in cases with distance VA less than 6/12 or near VA less than N8, anterior and posterior segment evaluation. Their findings were then verified by an optometrist. The World Health Organization definition of vision impairment was followed, and the cause of vision impairment was determined at the end of each examination. Where possible, participants requiring refractive correction were provided spectacles free of cost. Of a total 635 participants examined, around one-half were male with 61% in the 16 to 49 years age group. The overall prevalence of presenting blindness, severe vision impairment, and vision impairment were 1.3% (95% confidence interval [95% CI], 0.5 to 2.4), 0.5% (95% CI, 0.0 to 1.1), and 3.6% (95% CI, 2.3 to 5.2), respectively. Overall vision impairment (VA vision impairment, and vision impairment were cataracts, refractive errors, and corneal opacities, respectively; and more than 90% of the overall vision impairment was avoidable. Refractive errors and presbyopia were the most common morbidity, present in more than two-thirds of the participants examined. Only 5% of all the participants ever had a previous eye examination. The prevalence and causes of blindness and vision impairment in a refugee population are comparable with those of the general population. Lack of basic eye care services in the health center for refugees is a major concern. The health care facility in the settlement camp needs to be upgraded to provide comprehensive eye care including refractive care services.


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    N. N. Temirov


    Full Text Available Aim. To analyze visual acuity, clinical refraction, and defocusing tolerance after the implantation of monofocal IOL with rotational asymmetric optic (Lentis Mplus 313 MF compared with Acrysof ReSTOR SN6AD1.Materials and methods. Phacoemulsification was performed in a total of 194 patients (288 eyes, i.e., 144 patients (188 eyes with cataract and 50 patients (100 eyes with presbyopia and high ametropia. The patients were divided into two groups. Study group included 132 patients (194 eyes implanted with Lentis Mplus while control group included 62 patients (94 eyes implanted with Acrysof ReSTOR. Uncorrected distance (5 m, intermediate (50‑70 cm, and near (20‑40 cm visual acuity under photopic (85 cd/m2 and mesopic (8 cd/m2 conditions were measured, objective and subjective refractometry were performed, and defocusing tolerance was evaluated.Results. Postoperatively, uncorrected distance and near visual acuity was high while intermediate visual acuity was moderately low. Lentis Mplus patients had better near and intermediate visual acuity under mesopic conditions as compared with Acrysof ReSTOR patients. Emmetropia (target refraction was achieved in 90.2% of study group patients and in 87.2% of control group patients. In patients implanted with Lentis Mplus, refraction was measured by subjective method. Optimal A-constant for Lentis Mplus and Acrysof ReSTOR was 118.0 and 118.6, respectively. Under defocusing, Lentis Mplus patients had better visual acuity than Acrysof ReSTOR patients. This indirectly confirms better intermediate vision.Conclusions. Lentis Mplus provides better vision at various distances that does not almost depend on light levels and induces minimal dysphotopsia. 

  3. Comparison of visual outcomes and subjective visual quality after bilateral implantation of a diffractive trifocal intraocular lens and blended implantation of apodized diffractive bifocal intraocular lenses

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    Gundersen KG


    viewing distances from 60 to 40 cm, corresponding to computer or reading distance.Keywords: ReSTOR, At LISA tri, multifocal IOL, cataract, presbyopia

  4. Extended depth of focus contact lenses vs. two commercial multifocals: Part 2. Visual performance after 1 week of lens wear. (United States)

    Bakaraju, Ravi C; Tilia, Daniel; Sha, Jennifer; Diec, Jennie; Chung, Jiyoon; Kho, Danny; Delaney, Shona; Munro, Anna; Thomas, Varghese

    To compare the visual performance of prototype contact lenses designed via deliberate manipulation of higher-order spherical aberrations to extend-depth-of-focus with two commercial multifocals, after 1 week of lens wear. In a prospective, participant-masked, cross-over, randomized, 1-week dispensing clinical-trial, 43 presbyopes [age: 42-63 years] each wore AIROPTIX Aqua multifocal (AOMF), ACUVUE OASYS for presbyopia (AOP) and extended-depth-of-focus prototypes (EDOF) appropriate to their add requirements. Measurements comprised high-contrast-visual-acuity (HCVA) at 6m, 70cm, 50cm and 40cm; low-contrast-visual-acuity (LCVA) and contrast-sensitivity (CS) at 6m and stereopsis at 40cm. A self-administered questionnaire on a numeric-rating-scale (1-10) assessed subjective visual performance comprising clarity-of-vision and lack-of-ghosting at various distances during day/night-viewing conditions and overall-vision-satisfaction. EDOF was significantly better than AOMF and AOP for HCVA averaged across distances (p≤0.038); significantly worse than AOMF for LCVA (p=0.021) and significantly worse than AOMF for CS in medium and high add-groups (p=0.006). None of these differences were clinically significant (≤2 letters). EDOF was significantly better than AOMF and AOP for mean stereoacuity (36 and 13 seconds-of-arc, respectively: p≤0.05). For clarity-of-vision, EDOF was significantly better than AOP at all distances and AOMF at intermediate and near (p≤0.028). For lack-of-ghosting averaged across distances, EDOF was significantly better than AOP (p<0.001) but not AOMF (p=0.186). EDOF was significantly better than AOMF and AOP for overall-vision-satisfaction (p≤0.024). EDOF provides better intermediate and near vision performance than either AOMF or AOP with no difference for distance vision after 1 week of lens wear. Copyright © 2017 Spanish General Council of Optometry. Published by Elsevier España, S.L.U. All rights reserved.

  5. Utilizing three years of epidemiological data from medical missions in Cambodia to shape the mobile medical clinic formulary

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    Jeany Kim Jun


    Full Text Available Objective: The purpose of this project was to gather epidemiological data on common diseases and medications dispensed during medical mission trips to Cambodia to shape the mobile medical clinic formulary. Methods: Data for patients seen during week-long mobile medical clinics was collected in Cambodia during Septembers 2012 to 2014. Each patient’s gender, age, weight, blood pressure, glucose, pertinent laboratory values, diagnoses, and medications dispensed were collected. Blood pressure and glucose levels were measured in patients 18 years and above. Data collected onto paper intake forms were transferred onto spreadsheets without patient identifying information and analyzed for aggregate means, common diseases, and most dispensed medications. This project received institutional review board approval. Results: A total of 1,015 patients were seen over three years. Women made up 61.4%, and the mean age was 41.8 years. The most common diagnosis was gastrointestinal disorders (22.9% that included gastroesophageal reflux disease and intestinal parasites. Next, 20.1% of patients had hypertension (BP>140/90, 18.0% had presbyopia, 15.4% had back and joint pain, followed by 8.8% with headache, including migraines. Approximately 8.4% of patients had hyperglycemia (RPG >140 mg/dl. The top five medications dispensed were acetaminophen, omeprazole, multivitamin, ibuprofen, and metformin. For hypertension, amlodipine and lisinopril were dispensed. Conclusion: Cambodia lacks systematic public health collection of epidemiological data for prevalence of diseases. Hence, investigators collected and analyzed information from week-long mobile medical clinics over three years. Proton-pump inhibitors and H. pylori lab tests were recommended for gastrointestinal disorders. Acetaminophen and ibuprofen were recommended for pain. Angiotensin-converting-enzyme inhibitors and dihydropyridine calcium channel blockers were recommended over diuretics since patients were

  6. [Crystalline lens photodisruption using femtosecond laser: experimental study]. (United States)

    Chatoux, O; Touboul, D; Buestel, C; Balcou, P; Colin, J


    technique usable in the ultra precise crystalline lens cutting. Experimental studies in vivo are necessary in order to define of them the applications (surgery of the cataract and presbyopia) and limits in the cavitations bubbles kinetic and transfer. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

  7. The Relationship between Anisometropia and Amblyopia (United States)

    Barrett, Brendan T.; Bradley, Arthur; Candy, T. Rowan


    This review aims to disentangle cause and effect in the relationship between anisometropia and amblyopia. Specifically, we examine the literature for evidence to support different possible developmental sequences that could ultimately lead to the presentation of both conditions. The prevalence of anisometropia is around 20% for an inter-ocular difference of 0.5D or greater in spherical equivalent refraction, falling to 2-3%, for an inter-ocular difference of 3D or above. Anisometropia prevalence is relatively high in the weeks following birth, in the teenage years coinciding with the onset of myopia and, most notably, in older adults starting after the onset of presbyopia. It has about one-third the prevalence of bilateral refractive errors of the same magnitude. Importantly, the prevalence of anisometropia is higher in highly ametropic groups, suggesting that emmetropization failures underlying ametropia and anisometropia may be similar. Amblyopia is present in 1-3% of humans and around one-half to two-thirds of amblyopes have anisometropia either alone or in combination with strabismus. The frequent co-existence of amblyopia and anisometropia at a child’s first clinical examination promotes the belief that the anisometropia has caused the amblyopia, as has been demonstrated in animal models of the condition. In reviewing the human and monkey literature however it is clear that there are additional paths beyond this classic hypothesis to the co-occurrence of anisometropia and amblyopia. For example, after amblyopia secondary to either deprivation or strabismus has emerged, anisometropia often follows. In cases of anisometropia with no apparent deprivation or strabismus, questions remain about the failure of the emmetropization mechanism that routinely eliminates infantile anisometropia. Also, the chronology of amblyopia development is poorly documented in cases of ‘pure’ anisometropic amblyopia. Although indirect, the therapeutic impact of refractive

  8. Comparison between bilateral implantation of a trifocal intraocular lens and blended implantation of two bifocal intraocular lenses

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    Vilar C


    , with the trifocal group showing significantly better performance at intermediate distances and better CS under photopic conditions. Keywords: trifocal, blend, cataract surgery, IOL, multifocal, presbyopia

  9. Influência do astigmatismo corneano na acuidade visual final após implante de AcrySof® ReSTOR®: relato de caso Influence of corneal astigmatism in final visual acuity after implantation of AcrySofTM ReSTOR TM: case report

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    Ricardo de Carvalho Rocha


    Full Text Available Atualmente tem-se desenvolvido novos tipos de lentes intra-oculares (LIO que objetivam eliminar a presbiopia e o seu uso vem se popularizando. Descreve-se o caso de um paciente com catarata bilateral e irregularidades corneanas e astigmatismo maior que 2 D à topografia, no qual implantou-se a LIO AcrySof® ReSTOR® no olho esquerdo associado à realização de incisões limbares relaxantes para tentar diminuir o astigmatismo corneano observado. A acuidade visual pós-operatória, tanto para perto quanto para longe, ficou abaixo das expectativas, sem melhora à refração e sem uma outra alteração que a justificasse, além das citadas. Após 45 dias, sem melhora da acuidade visual, efetuou-se o explante desta LIO, seguindo-se de implante de uma monofocal, sendo observada melhora da acuidade visual corrigida final. Assim, o presente caso clínico reforça a necessidade de uma correta seleção pré-operatória dos pacientes candidatos ao implante deste tipo de LIO multifocal, atentando inclusive para os dados topográficos.Currently, new types of intraocular lenses have been developed aiming to eliminate presbyopia and the use has become more popular. The authors report the case of a patient with bilateral cataract and corneal irregularities and astigmatism higher than 2D in the corneal topography, in which AcrySofTM ReSTOR TM intraocular lens was implanted in the left eye associated to relaxing limbal incisions trying to reduce corneal astigmatism. The near and distance postoperative visual acuity were worse than expected, with no improvement with refraction. Apparently, no other reason apart from irregular astigmatism/multifocal lens justified the low vision. After 45 days, with no visual acuity improvement, the intraocular lens was explanted and a monofocal one was implanted. The final corrected visual acuity improved. Thus, the present case emphasizes the need of a correct preoperative selection of patients to implant this type of

  10. Prevalência de transtornos oculares na população de idosos residentes na cidade de Veranópolis, RS, Brasil Prevalence of ocular diseases in a population of elderly residents of the city of Veranópolis, Brazil

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    Flávio Antônio Romani


    Full Text Available OBJETIVO: Avaliar os transtornos oculares e a sua prevalência em pessoas com 80 anos de idade, ou mais, na cidade de Veranópolis, Rio Grande do Sul, Brasil. MÉTODOS: 187 idosos foram submetidos a exame oftalmológico por meio de inspeção externa, motilidade extrínseca, medidas de acuidade visual para longe e perto, tonometria de aplanação, biomicroscopia, cicloplegia, fundoscopia direta e esquiascopia estática. RESULTADOS: As doenças mais prevalentes foram: presbiopia em 173 (92,5% pacientes, catarata em 160 (85,6%, ectrópio senil em 130 (69,5%, hipermetropia em 130 (69,5% e a degeneração macular relacionada à idade (DMRI em 59 (31,5%. Na população estudada, 85 (45,4% pacientes apresentaram baixa visual acentuada cujas causas principais eram a catarata em 46 (54,1% e erros de refração em 16 (18,9% dos idosos. A principal causa de queixas dos idosos foi relacionada com a presença de ectrópio senil. CONCLUSÃO: Doenças comuns como a catarata e os erros de refração continuam a ser um desafio para os oftalmologistas, pois são importantes causas de dificuldade visual nos idosos, com conseqüente perda de qualidade em suas vidas.ABSTRACT PURPOSE: To evaluate the prevalence of diseases of the eye in a population aged 80 years and above in the city of Veranopolis, Rio Grande do Sul, Brazil. METHODS: 187 elderly people were submitted to ophthalmologic tests including external inspection, ocular motility examination, visual acuity determination for near and far distance, applanation tonometry, biomicroscopy, cyclopegia, direct fundus examination and static skiascopy. RESULTS: The most prevalent disease was presbyopia in 173 (92,5% patients, cataract in 160 (85,6%, age-related ectropion in 130 (69,5%, hypermetropia in 130 (69,5% and age-related macular degeneration (ARMD in 59 (31,5% patients. 85 (45,4% patients presented marked low vision whose main causes were cataract in 46 (54,1% and refractive error in 16 (18,9% of the studied

  11. Accommodation: The role of the external muscles of the eye: A consideration of refractive errors in relation to extraocular malfunction. (United States)

    Hargrave, B K


    Speculation as to optical malfunction has led to dissatisfaction with the theory that the lens is the sole agent in accommodation and to the suggestion that other parts of the eye are also conjointly involved. Around half-a-century ago, Robert Brooks Simpkins suggested that the mechanical features of the human eye were precisely such as to allow for a lengthening of the globe when the eye accommodated. Simpkins was not an optical man but his theory is both imaginative and comprehensive and deserves consideration. It is submitted here that accommodation is in fact a twofold process, and that although involving the lens, is achieved primarily by means of a give - and - take interplay between adducting and abducting external muscles, whereby an elongation of the eyeball is brought about by a stretching of the delicate elastic fibres immediately behind the cornea. The three muscles responsible for convergence (superior, internal and inferior recti) all pull from in front backwards, while of the three abductors (external rectus and the two obliques) the obliques pull from behind forwards, allowing for an easy elongation as the eye turns inwards and a return to its original length as the abducting muscles regain their former tension, returning the eye to distance vision. In refractive errors, the altered length of the eyeball disturbs the harmonious give - and - take relationship between adductors and abductors. Such stresses are likely to be perpetuated and the error exacerbated. Speculation is not directed towards a search for a possible cause of the muscular imbalance, since none is suspected. Muscles not used rapidly lose tone, as evidenced after removal of a limb from plaster. Early attention to the need for restorative exercise is essential and results usually impressive. If flexibility of the external muscles of the eyes is essential for continuing good sight, presbyopia can be avoided and with it the supposed necessity of glasses in middle life. Early attention

  12. Role of Aquaporin 0 in lens biomechanics. (United States)

    Sindhu Kumari, S; Gupta, Neha; Shiels, Alan; FitzGerald, Paul G; Menon, Anil G; Mathias, Richard T; Varadaraj, Kulandaiappan


    fiber cell shape, architecture and integrity. To our knowledge, this is the first report identifying the involvement of an aquaporin in lens biomechanics. Since accommodation is required in human lenses for proper focusing, alteration in the adhesion and/or water channel functions of AQP0 could contribute to presbyopia. Copyright © 2015 Elsevier Inc. All rights reserved.

  13. Comparison of outcomes with multifocal intraocular lenses: a meta-analysis

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    Béatrice Cochener


    Full Text Available Béatrice Cochener1, Antoine Lafuma2, Babak Khoshnood2, Laurène Courouve2, Gilles Berdeaux3,41Centre Hospitalier Universitaire Brest, Brest, France; 2Cemka Eval, Bourg la Reine, France; 3Alcon France, Rueil-Malmaison, France; 4Conservatoire National des Arts et Métiers, Paris, FrancePurpose: To compare the clinical outcome of different multifocal intraocular lenses (IOLs based on information reported in the international literature.Methods: All comparative clinical trials that involved implanting at least one multifocal IOL in patients with cataract or presbyopia were extracted from the literature. Clinical outcomes included uncorrected near visual acuity, uncorrected distance visual acuity, visual acuity, spectacle independence, and halos. Random effects meta-analyses were conducted to compare outcomes for the different IOL types.Results: Twenty papers were identified describing 11 monofocal IOLs and 35 multifocal IOLs (19 diffractive, including 12 ReSTOR®, 14 refractive, and two accommodative patient cohorts. Multifocal and monofocal uncorrected distance visual acuity was 0.165 (0.090–0.240 and 0.093 (0.088–0.098, respectively. Compared with monofocal IOLs, multifocal IOLs produced better uncorrected near visual acuity (0.470 [0.322–0.618] versus 0.141 [0.131–0.152]; P < 0.0001, resulting in higher spectacle independence (incidence rate ratio [IRR] 3.62 [2.90–4.52]; P < 0.0001. Compared with refractive multifocal IOLs, diffractive multifocal IOLs produced a similar uncorrected distance visual acuity (0.105 [0.098–0.111] versus 0.085 [0.029–0.140]; P ≤ 0.78, not significant and better uncorrected near visual acuity (0.217 [0.118–0.317] versus 0.082 [0.067–0.098]; P < 0.0001 resulting in higher spectacle independence (IRR 1.75 [1.24–2.48]; P < 0.001. Compared with other multifocal IOLs, ReSTOR produced a better uncorrected distance visual acuity (0.067 [0.059–0.076] versus 0.093 [0.088–0.098]; P < 0.0001 and better

  14. Perfil oftalmológico dos alunos do programa alfabetização solidária em quatro municípios do Ceará Ophthalmological profile of adult students belonging to a literacy program in four cities of Ceará

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    Islane Castro Verçosa


    assess visual acuity, ophthalmologists and residents in Ophthalmology, auxiliary personnel and secretaries. RESULTS: We observed that almost half of the students (46% showed visual acuity equal to or below 0.8 in both eyes; 81.4% of the population needed optic correction and 37% needed corrective lenses for presbyopia. The majority of the population was between 41 and 50 years old, 56% of the students were female. Thirty-eight percent of the students showed some ophthalmologic pathology. We found that pterygium and cataracts were the most frequent. CONCLUSION: The program should include as prerequisite an ophthalmologic examination of each student prior to enrollment for best results.

  15. Reasons not to select patients for corneal refractive surgery Razões para recusar candidatos à cirurgia refrativa corneana

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    André Luiz Parolin Ribeiro


    Full Text Available Purpose: To present how the section of Refractive Surgery of the Federal University of São Paulo assesses the candidates and the reasons to indicate for corneal refractive surgery. Methods: We examined 1626 patients. Anamnesis, complete ophthalmologic examination and corneal topography were performed in all patients. The patients spontaneously seeked evaluation at the Refractive Surgery Section by telephone without a previous screening. Reasons to refuse patients for refractive surgery were previously established by the Refractive Surgery Section. Results: Based on current technology and clinical experience, 265 patients (16.29% were refused for excimer laser corneal refractive surgery. Myopia of patients who had insufficient preoperative corneal pachymetry for the laser treatment was the main cause for refusal (51 patients. Cataract (45 patients, keratoconus (31 patients, amblyopia (21 patients, hyperopia > 5 diopters and mixed astigmatism (19 patients, presbyopia (unaware ness of the need for optical correction after the procedure; 16 patients, pupillary diameter > 5mm (9 patients, single eye (9 patients, progressive myopia (8 patients, postradial keratotomy (7 patients and low ametropia (7 patients were among the reasons for the refusal. Conclusion: Candidates for excimer laser corneal refractive surgery may present risk factors that should be known in order to avoid complications.Objetivo: O objetivo deste estudo é mostrar como o setor de Cirurgia Refrativa da Escola Paulista de Medicina da Universidade Federal de São Paulo avalia seus candidatos e quais as razões para não selecioná-los para cirurgia refrativa. Métodos: Foram examinados 1626 pacientes. Anamnese, avaliação oftalmológica completa e topografia corneana foram realizadas em todos os pacientes. Os pacientes procuraram avaliação no setor de Cirurgia Refrativa espontaneamente sem triagem prévia. Resultados: Não foram selecionados 265 pacientes (16,29% para cirurgia

  16. Condição ocular entre trabalhadores de uma indústria metalúrgica brasileira Ocular condition in a brazilian ironmaster industry

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    Thais Zamudio Igami


    ocular complains. Glasses were prescribed when necessary. RESULTS: Most of the evaluated employees in this industry was male (62.5%, ageing from 20 to 29 year old (41%. Visual acuity was normal in 95.5% of the eyes.The majority of the individuals (84% did not need glasses prescription. Fifty-five percent of the employees were considered as normal eye carriers, 13.6% presented presbyopia, 10% presented myopic astigmatism and 7.7% hyperopic astigmatism. Visual impairment was present in 2,4% and blindness in one eye of 0,4% of the studied individuals. The main cause of visual impairment was refractive errors and amblyopia. CONCLUSION: The majority of the employees, in this particular industry, presented with a normal ophthalmic examination. None of them had bilateral blindness.

  17. Condições oftalmológicas de pacientes com síndrome da imunodeficiência adquirida com longo tempo de seguimento Ophthalmologic conditions of aids patients with long-term follow-up

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    Márcia Abelin Vargas


    retinitis. Each patient had been submitted to one ophthalmologic examination. General data of the patients were obtained from the medical records. RESULTS: The majority of the patients presented visual acuity in the best eye between logMAR 0.0 (68.3% and 0.1 (26.9%. Optic prescription for refractive errors benefited 39.4% of the patients in Group II but none of the patients in Group I. Presbyopia was corrected in 27.3% of Group II and in 12.5% of Group I patients. No current ocular AIDS-related manifestations were detected in any group. Ocular posterior segment alterations, all of them consisting of retinitis / retinochoroiditis scars, were found in 10 patients, 7 (16.7% belonging to Group I and 3 (7.1% to Group II. CONCLUSION: Ten (24.4% patients presented visual alteration due to age. Except for the patients presenting previous retinitis and retinochoroiditis, all the other patients were in good ophthalmic conditions and most of them were in immunologic recovery due to the use of highly active antiretroviral therapy.

  18. Estrategias de prevención de la opacidad de la cápsula posterior Strategies for the prevention of the posterior capsule opacification

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    Iván Hernández López


    de la opacidad del saco capsular.The posterior capsule opacification (PCO is the most important aspect in the cataract surgery nowadays. It continues being the more frequent late postoperative complication after cataract surgery associated with decrease of the visual acuity and other visual problems that lead to important social, economical and medical impacts. The laser capsulotomy is an effective procedure for the treatment of this complication but it is far from being the ideal method since it can be associated to considerable complications. This is the reason why several research studies recently have directed their attention to PCO-preventing strategies such as the design of intraocular lenses, modified and/or improved surgical techniques, additional implants, use of cytotoxic agents and drugs as well as new technologies. The gene therapy, among the novel interventions in study, seems to be a promising strategy in this field. Up to the present, there is not a unique method that avoids in a definitive way the development of the capsular opacification. The ophthalmologists should use the combination of all these methods available which have demonstrated a proved effectiveness in the reduction of PCO. Attaining long-term excellent visual result is the main purpose of the modern cataract surgery as well as paving the road towards novel surgical interventions for the treatment of presbyopia in patients older than 40 years. In order to achieve that goal, it is essential to avoid the opacification of the posterior capsule, even more with the use of multifocal and accommodative lenses that are more vulnerable to the opacity than the monofocal lenses. Therefore, we may dare to say that the biggest breakthrough in the modern cataract surgery is still awaiting: the definitive eradication of posterior capsule opacification.

  19. Monovisión con lente intraocular monofocal en pacientes présbitas Monovision with monofocal intraocular lens in prebyopic patients

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    Patricia Andújar Coba


    the refractive results achieved in presbyopic patients, both hyperopic and myopic, with monovision METHODS: A prospective, longitudinal and descriptive study was carried out in 21 patients, 13 myopic and 8 hyperopic, who underwent lens surgery to correct presbyopia based on the monovision procedure at the Microsurgery Service of the "Ramón Pando Ferrer" Cuban Institute of Ophthalmology from February 2009 to February 2010. The variables were pre and postoperative visual acuity with/without correction, both near and distant, and spheral equivalents. Mean and standard deviation values were used to present all variables. RESULTS: It was found that average visual acuity with correction improved from 0,7 and 0,9 in myopic and hyperopic patients respectively to 0,88 and 0,94 of binocular visual acuity without correction in the postoperative phase, thus correcting their average spheral equivalents of 8,27 diopters (D and +6,26 D in each group. The average visual acuity for near vision for both groups was Jeager (J 2 and the average spheral equivalents reached for distant vision were -0,32 D for myopic and +0,26 D for hyperopic patients. For near vision, i.e. in the non- dominant eye, the spheral equivalent values were 1,6 D for the first group and 1,3 D for the second group. CONCLUSIONS: After surgery there was an undoubted improvement in visual acuity without correction, in near as well as in distant vision. Spherical equivalents were widely modified for both groups in both the dominant and the non-dominant eye, improving vision at both distances. The achieved results corroborate that the benefits brought about by monovision in near vision are more important than the damages it causes in distant vision, making it very successful for certain groups of patients.

  20. Accommodative intraocular lens versus standard monofocal intraocular lens implantation in cataract surgery. (United States)

    Ong, Hon Shing; Evans, Jennifer R; Allan, Bruce D S


    Following cataract surgery and intraocular lens (IOL) implantation, loss of accommodation or postoperative presbyopia occurs and remains a challenge. Standard monofocal IOLs correct only distance vision; patients require spectacles for near vision. Accommodative IOLs have been designed to overcome loss of accommodation after cataract surgery. To define (a) the extent to which accommodative IOLs improve unaided near visual function, in comparison with monofocal IOLs; (b) the extent of compromise to unaided distance visual acuity; c) whether a higher rate of additional complications is associated the use of accommodative IOLs. We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2013, Issue 9), Ovid MEDLINE, Ovid MEDLINE in-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily Update, Ovid OLDMEDLINE (January 1946 to October 2013), EMBASE (January 1980 to October 2013), Latin American and Caribbean Health Sciences Literature Database (LILACS) (January 1982 to October 2013), the metaRegister of Controlled Trials (mRCT) (, ( and the WHO International Clinical Trials Registry Platform (ICTRP) ( We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 10 October 2013. We include randomised controlled trials (RCTs) which compared implantation of accommodative IOLs to implantation of monofocal IOLs in cataract surgery. Two authors independently screened search results, assessed risk of bias and extracted data. All included trials used the 1CU accommodative IOL (HumanOptics, Erlangen, Germany) for their intervention group. One trial had an additional arm with the AT-45 Crystalens accommodative IOL (Eyeonics Vision). We performed a separate analysis comparing 1CU and AT-45 IOL. We included four RCTs, including 229 participants (256 eyes

  1. Adaptive Optics for Industry and Medicine (United States)

    Dainty, Christopher


    pt. 1. Wavefront correctors and control. Liquid crystal lenses for correction of presbyopia (Invited Paper) / Guoqiang Li and Nasser Peyghambarian. Converging and diverging liquid crystal lenses (oral paper) / Andrew X. Kirby, Philip J. W. Hands, and Gordon D. Love. Liquid lens technology for miniature imaging systems: status of the technology, performance of existing products and future trends (invited paper) / Bruno Berge. Carbon fiber reinforced polymer deformable mirrors for high energy laser applications (oral paper) / S. R. Restaino ... [et al.]. Tiny multilayer deformable mirrors (oral paper) / Tatiana Cherezova ... [et al.]. Performance analysis of piezoelectric deformable mirrors (oral paper) / Oleg Soloviev, Mikhail Loktev and Gleb Vdovin. Deformable membrane mirror with high actuator density and distributed control (oral paper) / Roger Hamelinck ... [et al.]. Characterization and closed-loop demonstration of a novel electrostatic membrane mirror using COTS membranes (oral paper) / David Dayton ... [et al.]. Electrostatic micro-deformable mirror based on polymer materials (oral paper) / Frederic Zamkotsian ... [et al.]. Recent progress in CMOS integrated MEMS A0 mirror development (oral paper) / A. Gehner ... [et al.]. Compact large-stroke piston-tip-tilt actuator and mirror (oral paper) / W. Noell ... [et al.]. MEMS deformable mirrors for high performance AO applications (oral paper) / Paul Bierden, Thomas Bifano and Steven Cornelissen. A versatile interferometric test-rig for the investigation and evaluation of ophthalmic AO systems (poster paper) / Steve Gruppetta, Jiang Jian Zhong and Luis Diaz-Santana. Woofer-tweeter adaptive optics (poster paper) / Thomas Farrell and Chris Dainty. Deformable mirrors based on transversal piezoeffect (poster paper) / Gleb Vdovin, Mikhail Loktev and Oleg Soloviev. Low-cost spatial light modulators for ophthalmic applications (poster paper) / Vincente Durán ... [et al.]. Latest MEMS DM developments and the path ahead