RESUMO
BACKGROUND: To evaluate the optical performance and safety of a new multifocal lens with a novel optical design featuring two additional foci (or intensifiers) in patients with cataract and presbyopia. METHODS: In this single-center, non-randomized prospective observational study, 31 patients underwent implantation of the new multifocal IOL between March 2020 and November 2021 at a tertiary clinical center in Buenos Aires and Ramos Mejia, Argentina. Postoperative examinations with emphasis on uncorrected and corrected visual acuity at distance and near and at two different intermediate distances (80 cm and 60 cm) were performed during the 3 postoperative months. RESULTS: Of the 31 patients who underwent implantation of the new IOL, 30 underwent bilateral surgery (61 eyes in total). At 3 months, all 61 eyes had an uncorrected distance visual acuity (UCDVA) of at least 0.15 logMAR; 57 eyes (93%) had an uncorrected distance visual acuity (UCDVA) of 0.1 logMAR and 27 eyes (44%) had an UCDVA of 0.0 logMAR. At 80 cm, 60 eyes (98%) had an uncorrected intermediate visual acuity (UCIVA) of at least 0.1 log MAR and 48 eyes (79%) had an UCIVA of 0.0 logMAR. CONCLUSION: The new multifocal IOL with a novel optical concept (5 foci) showed a wide range of visual acuity especially at intermediate and near distances in patients undergoing cataract surgery. Uncorrected visual acuity was excellent at all tested distances, monocularly and binocularly, spectacle independence and patient satisfaction were high.
Assuntos
Lentes Intraoculares Multifocais , Presbiopia , Desenho de Prótese , Acuidade Visual , Humanos , Acuidade Visual/fisiologia , Estudos Prospectivos , Feminino , Masculino , Idoso , Pessoa de Meia-Idade , Presbiopia/fisiopatologia , Presbiopia/cirurgia , Refração Ocular/fisiologia , Implante de Lente Intraocular , Pseudofacia/fisiopatologia , Facoemulsificação , Catarata/complicações , Catarata/fisiopatologia , Lentes Intraoculares , Idoso de 80 Anos ou mais , SeguimentosRESUMO
PURPOSE: Report on the safety, efficiency and refractive outcomes of LASIK surgery in patients aged 65 or older. METHODS: This study includes a case series of patients ≥65 years that underwent corneal refractive surgery during the period June 2010 to June 2015 at Hospital Zambrano Hellion, Monterrey, Mexico. Inclusion criteria were normal topography, central corneal thickness >500 µm, preoperative manifest refraction spherical equivalent (MRSE) up to -8.5 D and +6.0 D, cylinder up to -6.0 D, CDVA of 20/25 or better and with no other ocular pathology. RESULTS: A total of 44 eyes (24 patients) were included. Mean age was 67.2 ± 2.1 years (range 65-80), with mean follow-up of 12.2 ± 1.3 months. Conventional LASIK was performed in 20 patients (group 1, 36 eyes) to improve UDVA (10 eyes myopic LASIK and 26 eyes hyperopic LASIK) and presbyopic LASIK (monovision) in 4 patients (group 2, 8 eyes) to restore near-vision performance. Preoperative MRSE group 1 was myopic: -2.79 ± 1.88 D; hyperopic +2.19 ± 1.88 D; and +2.10 ± 0.87 D in group 2. Preoperative UDVA in group 1 was 0.67 ± 0.30 LogMAR; 0.46 ± 0.18 LogMAR; and Jaeger ≥4 in 90% in group 2. Postoperative MRSE: -0.29 ± 0.86 D (myopic LASIK) (p < 0.001), +0.34 ± 0.62 D (hyperopic LASIK) (p < 0.001) and -1.25 ± 0.59 D (non-dominant eye) in presbyopic LASIK. Postoperative UDVA in myopic LASIK was 0.15 ± 0.30 (p = 0.001) and 0.11 ± 0.11 (p < 0.001) for hyperopic LASIK. In group 2, binocular UDVA was 0.16 ± 0.17 (p = 0.12) and UNVA was ≥J2 in 100% of the patients. CONCLUSION: Even though elder patients may present greater LASIK restrictions due to lens and other ocular age-related changes, patients ≥65 years that were candidates for conventional and presbyopic LASIK showed satisfactory and safe refractive and visual outcomes.
Assuntos
Córnea/cirurgia , Hiperopia/cirurgia , Ceratomileuse Assistida por Excimer Laser In Situ/métodos , Lasers de Excimer/uso terapêutico , Miopia/cirurgia , Presbiopia/cirurgia , Refração Ocular/fisiologia , Idoso , Idoso de 80 Anos ou mais , Córnea/patologia , Topografia da Córnea , Feminino , Seguimentos , Humanos , Hiperopia/fisiopatologia , Masculino , Miopia/fisiopatologia , Presbiopia/fisiopatologia , Resultado do Tratamento , Visão Binocular , Acuidade VisualRESUMO
PURPOSE: To report the results of a 1-year follow-up analysis of the safety and efficacy of the Flexivue Microlens corneal inlay. METHODS: The Flexivue Microlens corneal inlay was implanted in the nondominant eye of patients with emmetropic presbyopia (a spherical equivalent of -0.5 to 1.00 diopter) after the creation of a 300-µm deep stromal pocket, using a femtosecond laser. The patients were followed up according to a clinical protocol involving refraction, anterior segment imaging analysis (Oculyzer), and optical quality analysis (OPD-Scan). RESULTS: Thirty-one patients were enrolled in this ongoing study. The mean age was 50.7 years (range 45-60 yrs), and 70% of the patients were female. The mean uncorrected near visual acuity improved to Jaeger 1 in 87.1% of the eyes treated with the inlays. All eyes improved 4 lines at all visits. The binocular uncorrected distance visual acuity was 20/20 in all patients. Ninety percent of the patients reported that their near vision was good or excellent. Some of the patients (16.1%) lost more than 3 lines of corrected distance visual acuity. At the latest follow-up, induction of a corneal spherical aberration to improve near visual acuity was statistically significant. No other intraoperative or postoperative complication was noted. CONCLUSIONS: The Flexivue Microlens provided patients with improved near vision, as a result of a negative spherical aberration. A significant loss of corrected distance visual acuity in the operated eyes was observed. Overall, this intracorneal inlay was an effective alternative to other procedures for the correction of presbyopia.
Assuntos
Substância Própria/cirurgia , Presbiopia/cirurgia , Próteses e Implantes , Implantação de Prótese , Materiais Biocompatíveis , Sensibilidades de Contraste/fisiologia , Substância Própria/fisiopatologia , Topografia da Córnea , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Presbiopia/fisiopatologia , Estudos Prospectivos , Refração Ocular/fisiologia , Resultado do Tratamento , Acuidade Visual/fisiologiaRESUMO
Purpose: We present the first physiological evaluation of the use of the light sword lens (LSL) for presbyopia compensation. The LSL is an axially asymmetric optical element designed for imaging with extended depth of focus. Methods: A monocular visual simulator setup is implemented to measure visual acuity (VA). Physiological presbyopia is "mimicked" in human subjects by paralysis of the ciliary muscle, using topical application of a muscarinic antagonist. The effect of a contact lens-configured LSL on the mimicked presbyopia visual system is evaluated by measuring VA as a function of target vergence. The ability of the LSL to compensate presbyopia for 2 photopic luminance values was also analyzed. Results: The average VA values for 11 subjects suggest that the LSL can compensate for presbyopia across a wide range of target vergences for which the LSL was designed (-3 to 0 D). However, the proposed corrector element causes a loss of distance VA. The mean logMAR VA in that target vergence range was 0.07. The VA curves also show that luminance does not affect the expected behavior of the LSL-corrected presbyopic eye. Conclusions: These results indicate that the LSL has significant potential as a visual aid for presbyopia.
Assuntos
Lentes de Contato , Presbiopia/fisiopatologia , Acuidade Visual/fisiologia , Adolescente , Adulto , Sensibilidades de Contraste/fisiologia , Desenho de Equipamento , Humanos , Pessoa de Meia-Idade , Presbiopia/terapia , Adulto JovemRESUMO
PURPOSE: Dynamic retinoscopy (DR) is a procedure for assessing the accommodative response using a standard clinical instrument. The present study compared measurements of the amplitude of accommodation (AA) obtained using this technique with two subjective methods (modified push-down and minus lens). Additionally, the expected ranges for AA when measured by DR were determined. METHOD: AA was measured in 1298 subjects between 5 and 60 years of age using the three techniques described above. Subjects were grouped into 5-year bins, and a descriptive univariate analysis of the data performed. Goodness-of fit plots were constructed to examine the overall model fit. Centile curves were calculated from the final model. RESULTS: Mean values of AA obtained using DR were significantly lower than for the two subjective techniques. For the DR findings, no significant change was observed between 5 and 19 years of age (mean AA = 8.3 D) and between 45 and 60 years of age (mean AA = 0.6 D). AA values as a function of age were best fit by the polynomial regression equation: logAA = 1.93 + 0.49(age) - 0.19(age)(2) . CONCLUSION: Measurements of AA determined using DR are significantly lower than the normative subjective findings published previously. This difference is at least partly due to the depth-of-field of the eye. These norms markedly overestimate accommodative responsivity. DR provides a simple technique for quantifying accommodation in the clinical setting.
Assuntos
Acomodação Ocular/fisiologia , Envelhecimento/fisiologia , Retinoscopia/métodos , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Cristalino , Masculino , Pessoa de Meia-Idade , Presbiopia/fisiopatologia , Refração Ocular/fisiologia , Análise de Regressão , Acuidade Visual , Adulto JovemRESUMO
PURPOSE: To perform a feasibility study of the safety and efficacy of a corneal-contouring inlay with concurrent laser in situ keratomileusis (LASIK) to treat hyperopic presbyopia. SETTING: Private clinic, Tijuana, Mexico. DESIGN: Prospective interventional case series. METHODS: Hyperopic patients received LASIK in both eyes and a corneal inlay under the femtosecond laser flap in the nondominant eye. The inlay is designed to reshape the anterior corneal curvature, creating a near-center multifocal refractive effect. Main safety outcomes were retention of preoperative corrected distance and near visual acuities and reports of adverse events. Efficacy was determined through measurements of near, intermediate, and distance visual acuities and patient questionnaires on visual task ability and satisfaction. RESULTS: The study enrolled 16 patients. All eyes with an inlay achieved an uncorrected near visual acuity (UNVA) of 20/32 or better by the 1-week postoperative examination and at every visit thereafter. The mean monocular and binocular UNVA was 20/27 or better at all visits. The mean binocular uncorrected distance visual acuity improved significantly from 20/53 preoperatively to 20/19 postoperatively (P<10(-5)). One inlay was explanted during the study. At 1 year, all 14 patients analyzed were satisfied or very satisfied with their near, distance, and overall vision. CONCLUSIONS: The hydrogel corneal inlay with concurrent LASIK improved uncorrected near, intermediate, and distance visual acuity in hyperopic presbyopic patients with high patient satisfaction and visual task ability. This represents a new indication for this recently developed technology.
Assuntos
Substância Própria/cirurgia , Hidrogel de Polietilenoglicol-Dimetacrilato , Hiperopia/cirurgia , Ceratomileuse Assistida por Excimer Laser In Situ/métodos , Lasers de Excimer/uso terapêutico , Presbiopia/cirurgia , Implantação de Prótese , Idoso , Idoso de 80 Anos ou mais , Dominância Ocular , Estudos de Viabilidade , Feminino , Humanos , Hiperopia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Presbiopia/fisiopatologia , Estudos Prospectivos , Refração Ocular/fisiologia , Retalhos Cirúrgicos , Inquéritos e Questionários , Resultado do Tratamento , Acuidade Visual/fisiologiaRESUMO
PURPOSE: To conduct a feasibility study of the safety and efficacy of a corneal contouring inlay as a treatment for emmetropic presbyopia. METHODS: The Raindrop corneal inlay (ReVision Optics, Inc., Lake Forest, CA) was implanted on the corneal stromal bed beneath a keratotomy flap in 20 nondominant eyes of 20 patients. The implant is designed to cause a change in the curvature of the overlying cornea, with a subsequent multifocal change in refractive power. Efficacy outcome was defined as at least 75% of eyes with uncorrected near visual acuity of 0.3 logMAR (20/40 Snellen) or better at 6 months. Main safety outcomes were retention of preoperative best-corrected distance visual acuity and reports of adverse events. Other outcome measures included contrast sensitivity; near, intermediate, and distance visual acuities; patient satisfaction; spectacle use; and complications. RESULTS: All implanted eyes achieved uncorrected near visual acuity of 0.3 logMAR (20/40 Snellen) or better by the 1-week postoperative examination and remained so throughout the 1-year follow-up period, also averaging less than 0.1 logMAR (20/25 Snellen) monocularly and binocularly throughout that period. Mean binocular uncorrected distance visual acuity remained within 0.02 logMAR of the preoperative mean throughout the study. One patient who was dissatisfied with the resulting vision underwent explantation. At 1 year, 16 of 19 patients seldom or never wore glasses and all 19 were satisfied or very satisfied with their overall vision. CONCLUSIONS: The hydrogel corneal inlay improved uncorrected near and intermediate visual acuity in patients with emmetropic presbyopia, with high patient satisfaction and little effect on distance visual acuity.
Assuntos
Substância Própria/cirurgia , Emetropia/fisiologia , Hidrogel de Polietilenoglicol-Dimetacrilato , Presbiopia/cirurgia , Próteses e Implantes , Retalhos Cirúrgicos , Acuidade Visual/fisiologia , Sensibilidades de Contraste/fisiologia , Óculos , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Presbiopia/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Visão Binocular/fisiologiaRESUMO
PURPOSE: The use of monofocal, bifocal, or multifocal intraocular lenses (IOLs) is a common option to restore the refractive power of the eye in aphakic patients after cataract surgery. In this article, we study the predicted performance of two new designs of IOL, both with extended depth of focus: the quartic axicon and the light sword optical element (LSOE). These elements provide continuous focal segments spanning the range of dioptric power required for presbyopia compensation. METHODS: The performance analysis is based on the visual Strehl ratio (SR) computed in the spatial frequency domain, a neuro-optical quality metric that takes into account the effects of both the optical transfer function and the neural contrast sensitivity function. Furthermore, the classical SR and compound modulation transfer function were calculated. Some conventional transmittances of commercially available IOLs are also analyzed. RESULTS: The LSOE design has a more homogeneous behavior than other available solutions, providing a more uniform image quality over a significant fraction of the required addition range. CONCLUSIONS: The angular average of the visual SR computed in the spatial frequency domain and compound modulation transfer function indicate that both designs of extended depth of focus elements provide better optical quality on the whole addition range, except at the end points, than the discrete focus designs. The LSOE performed better than the quartic axicon in terms of uniformity of image quality within the same range.