Comparison of Patient Outcomes following Implantation of Trifocal and Extended Depth of Focus Intraocular Lenses: A Systematic Review and Meta-Analysis

Purpose. The purpose is to compare the outcomes of implantation of trifocal intraocular lenses (TIOLs) and extended depth of focus (EDOF) intraocular lenses (IOLs). Methods. A comprehensive search of PubMed, Cochrane Library, EMBASE, and ClinicalTrial.gov was conducted in March 2020 to identify relevant studies. A meta-analysis of the results was performed. Patients implanted with EDOF IOLs or TIOLs in previous studies were included. The primary outcomes of the study were uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), and defocus curve. Results. TIOLs and EDOF IOLs provided comparable binocular UDVA (MD = -0.01, 95% CI: -0.04, 0.03, logMAR). However, EDOF IOLs provided better UIVA (MD: -0.08, 95% CI: -0.14, -0.01, logMAR) and worse UNVA (MD: 0.10, 95% CI: 0.06, 0.14, logMAR) than TIOLs. Fewer patients achieved spectacle independence after implantation of EDOF IOLs (RR: 0.74, 95% CI: 0.63, 0.87) than after implantation of TIOLs, especially for near vision (RR = 0.82, 95% CI: 0.68, 0.99). There was no statistically significant difference in contrast sensitivity (CS) under photopic or mesopic conditions with both IOLs. Patient satisfaction after implantation of both IOLs was high. Conclusion. EDOF IOLs and TIOLs provide comparable distance vision. However, EDOF IOLs provide better intermediate vision and worse near vision than TIOLs. The advantages of EDOF IOLs over TIOLs in terms of CS, aberrations, and visual disturbance are not significant. Patients are satisfied with both types of IOLs.

Prospective Interventional Non-Comparative Non-Randomized Clinical Study of A Topical Synergic Compound to Mitigate Presbyopia Effects

Purpose To assess the safety and efficacy of a novel compound with low -dose pilocarpine, brimonidine and oxymetazoline (PBO) in the near vision of a group of healthy presbyopic individuals. Design Prospective, consecutive, noncomparative, nonrandomized interventional study. Subjects Twenty-six healthy presbyopic patients presented from August to September 2021 to our clinic and were willing to participate in the study. Methods PBO compound was instilled in both eyes to assess its effect in near vision one hour after instillation.Main Outcome Measures Under corrected near visual acuity using the Jaeger notation, under corrected and corrected distance visual acuity, photopic and scotopic pupil diameter was registered before and one hour after instillation of the compound. Results Baseline binocular Jaeger notation was 5.86 +/-1.39 SD range (3-9). One hour after drop instillation, binocular Jaeger was 2.53 +/ 1.71 SD range (1 – 6) (p ≤ 0.0001) Lines gained 3.30 +/-1.40 SD range (0 – 6). Mean photopic pupilar diameter was 3.69 mm +/- 0.67 SD range (2.5 – 5 mm). Mean scotopic pupilar diameter was 4.61 mm +/- 0.78 SD range (3 – 6 mm). The mean photopic pupilar diameter was 2.27 mm +/-052 SD (1.5 – 3) (p ≤ 0.000). Scotopic pupilar diameter was 2.63 mm +/-0.53 SD range (2 – 3) (p ≤ 0.000). One patient reported no improvement in near vision. (3.8%). One patient reported dim vision rated 5 in a VAS (1 –10) (3.8%). Conclusion Low-dose pilocarpine, brimonidine, and oxymetazoline showed efficacy, improving near-distance vision one hour after instillation in a group of presbyopic patients, and safety showed few and transient secondary effects.

Development of the Near Vision Presbyopia Task-based Questionnaire for use in evaluating the impact of presbyopia

Background Presbyopia is a progressive condition that reduces the eye’s ability to focus on near objects with increasing age. After a systematic literature review identified no existing presbyopia-specific patient-reported outcome (PRO) instruments meeting regulatory guidance, a new PRO instrument, the Near Vision Presbyopia Task-based Questionnaire (NVPTQ), was developed. Results To explore the patient experience with presbyopia, concept elicitation interviews were conducted with 20 presbyopic participants. The most frequently reported impacts were difficulty with reading menus/books/newspapers/magazines, reading on a cell phone/caller ID, and reading small print. Based on these results, a task-based PRO instrument (the NVPTQ) was developed instructing participants to complete four near-vision, paper-based reading tasks (book, newspaper, nutrition label, menu) under standardized settings, and subsequently assess their vision-related reading ability and associated satisfaction. The draft NVPTQ was cognitively debriefed with a sample of 20 presbyopes, which demonstrated that most participants interpreted the items as intended and endorsed the relevance of the concepts being assessed. After the qualitative research, the draft instrument was psychometrically tested using data from a Phase 2 study. Based on item-level analyses, all items in the NVPTQ demonstrated expected response option patterns and lacked substantial floor or ceiling effects. The reliability, validity, and responsiveness of the NVPTQ Performance and Satisfaction domain scores were assessed. All domains scores had large Cronbach’s coefficient α values and good test–retest statistics, indicating that the scores are internally consistent and produce stable values over time. The pattern of correlations with a concurrent measure of visual functioning (National Eye Institute Visual Function Questionnaire 25) demonstrated that the NVPTQ domain scores were related to an alternative assessment of near-vision activities. The NVPTQ domain scores were able to distinguish between groups that were known to differ on the clinical outcome of uncorrected near visual acuity, supporting the construct validity of these scores. The NVPTQ domain scores showed evidence of responsiveness to change by being able to distinguish between groups defined as improved and not improved based on patient-reported and clinical outcomes. Conclusions This research has resulted in a content-valid and psychometrically sound instrument designed to evaluate vision-related reading ability and satisfaction with vision-related reading ability. Trial registration: ClinicalTrials.gov NCT02780115. Registered 23 May 2016, https://www.clinicaltrials.gov/ct2/show/NCT02780115?term=NCT02780115&draw=2&rank=1.

The Prevalence of Myopia in Children in Spain: An Updated Study in 2020

Background: In recent years, there was a significant increase in myopia incidence worldwide. However, it is still not clear how it affects Spanish children. Since 2016, this research team analyzed myopia prevalence and risk in 9668 children aged between 5 and 7 years. It was shown that the prevalence rates increased from 16.8% in 2016 to 20.4% in 2019. The objective of this study is to update the prevalence rate of myopia in Spain in 2020 and analyze the risk and prevention factors of myopia. Methods: The participants underwent an optometric examination, and a questionnaire on their lifestyle, family history, and geographical origin was carried out. Finally, data were analyzed using the SPSS version 27 program. Results: 1601 children from various Autonomous Communities of Spain were examined. In 2020 the myopia rates did not increase compared to 2019 (p < 0.05), although the number of hyperopes decreased and the number of emmetropes increased. Regarding age, the prevalence of myopia increased progressively over the years (p < 0.001). There was no association between gender and myopia (p > 0.05). There was a link between the time spent in near vision and family history with the prevalence of myopia (p < 0.05). Conclusions: The prevalence of myopia in Spain in children between 5 and 7 years old increased significantly between 2016 and 2020.

Ageing and ocular problems

Ageing is a common problem in modern societies. Due to sophisticated new methods in medicine, the average life expectancy significantly increased in recent years. 70 is the new 50. The new principles of food intake and processing, more exercise, and less smoking contributed to a health benefits and a longer life span of human kind. Nevertheless, there are the special problems of ageing. Numerous dysfunctions of the body may arise affecting a broad range of organs and the musculoskeletal system. The eye can also be severely affected by ageing. Vision gained more importance recently especially during the COVID-19 pandemic. Elderly people who never used computers before, had to learn computer technology in order to communicate with their family and to accomplish their everyday tasks or pay their bills. Therefore, good near vision has become crucial for elderly people. In this review article the most common ageing problems of the eye, therapies and pathophysiology of ageing processes will be reviewed and discussed. There are physiological problems of ageing and there are ocular pathologies which can be treated efficiently in time to preserve near and far visual acuity.

Comparison of phoropter and trial frame-based von Graefe heterophoria measures in non-presbyopic participants

Background: There are several clinical techniques for the subjective measurement of heterophoria. In South Africa, von Graefe (VG) is a commonly used technique to quantify heterophoria using the phoropter.Purpose: The purpose of the study was to investigate the agreement of VG heterophoria measurement using the phoropter and a trial frame.Setting: The study was conducted at an Optometry Clinic, University of Limpopo, South Africa.Methods: Both distance and near horizontal and vertical heterophoria VG measurements were performed on 88 visually-normal university students using the phoropter and trial frame. The handheld rotary prism was used on the trial frame. The 95% limits of agreement in prism diopters were compared using the Bland-Altman statistical test.Results: For distance horizontal heterophoria, the VG means were 0.39 exophoria ± 2.0Δ and 0.38 exophoria ± 1.8Δ with the phoropter and trial frame respectively. The means for near horizontal heterophoria were 3.69 exophoria ± 3.3Δ and 4.13 exophoria ± 3.27Δ with the phoropter and trial frame. For the vertical heterophoria at distance, the means and standard deviations were 0.18 hyperphoria ± 0.74 and 0.13 hyperphoria ± 0.07Δ, while at near vision they were 0.03 hyperphoria ± 0.71 and 0.07 hyperphoria ± 0.71Δ, respectively.Conclusion: Measurement of VG heterophoria testing using the phoropter and trial frame showed a high level of agreement for both distance and near vision performed through the phoropter and a trial frame. For clinical and research purposes, the phoropter and trial frame can be used interchangeably for measuring heterophoria.

Burden of near vision loss in China: findings from the Global Burden of Disease Study 2019

PurposeTo investigate the burden of near vision loss (NVL) in China by year, age and gender from 1990 to 2019.MethodsWe used estimates from the Global Burden of Disease (GBD) 2019 study to report the prevalence and disability-adjusted life-years (DALYs) due to NVL in China. Estimates of crude counts and age-standardised rates per 100 000 population are accompanied by 95% uncertainty intervals (UIs). We summarised the age-specific and sex-specific patterns and trends regarding the burden of NVL in China, compared with seven neighbouring countries.ResultsFrom 1990 to 2019, the all-age number and rate for NVL prevalence and DALYs increased significantly in China (all p<0.001). The age-standardised rate decreased from 7538.1 (95% UI 6946.3 to 8075.1) to 7392.9 (95% UI 6855.8 to 7890.5) per 100 000 population for NVL prevalence (p=0.107), and from 74.9 (95% UI 69.6 to 79.9) to 73.8 (95% UI 70.6 to 80.1) per 100 000 population for DALYs (p=0.388). Women had higher NVL prevalence (t=170.1, p<0.001) and DALYs (t=192.5, p<0.001) than men. Higher disease burden of NVL was observed in the middle-aged and elderly population. The age-standardised prevalence and DALY rate attributable to NVL in China were lower than in India, North Korea, Pakistan (all p<0.001), but higher than Russia, South Korea, Singapore and Japan (all p<0.001).ConclusionsDespite a small decrease in age-standardised prevalence and DALYs due to NVL in China in the past two decades, the existing burden is still considerable and significantly higher compared with neighbouring developed countries. An approach that includes all stakeholders is needed to further reduce this burden.