Functional visual acuity after implantation of diffractive extended depth-of-focus intraocular lenses using an echelett optics

Background The prospective comparative case series aimed to evaluate all-distance visual acuity, contrast sensitivity, and functional visual acuity (FVA) of eyes with diffractive extended depth-of-focus (EDOF) intraocular lenses (IOLs) using an echelett optics and monofocal IOLs with the same platform. Methods Diffractive EDOF and monofocal IOLs were implanted in 27 eyes of 27 patients each. At 3 months after implantation, all-distance visual acuities at distances of 0.3, 0.5, 0.7, 1, 2, 3, and 5 m were measured under distance-corrected. Static visual function was also examined using photopic contrast sensitivity and area under the logarithmic contrast sensitivity function (AULCSF). Dynamic visual function was examined with FVA, and mean FVA value, visual maintenance ratio (VMR), mean response time, and number of blinks were evaluated. These outcomes were compared between the two IOLs. Results The mean distance-corrected visual acuities were better at distances of 0.7 m or nearer in eyes with EDOF IOLs. There was no difference in the contrast sensitivities (P > 0.22). In the FVA results, no difference was found in mean FVA and VMR (P > 0.68). Conclusion The static and dynamic evaluations of postoperative visual functions demonstrated that the visual function of eyes with EDOF IOLs under photopic and distance-corrected conditions was comparable to eyes with monofocal IOLs.

Redefining response in wet AMD to anti VEGF therapy based on non-OCTA versus OCTA evaluation

Purpose Anti vascular endothelial growth factor (anti VEGF) has been the mainstay of treatment in wet age-related macular degeneration (AMD). Subsequent decision to continue anti VEGF therapy depends on the treatment response quantified by functional (visual acuity) and morphological (optical coherence tomography) parameters then categorized from good to poor. Methods This study evaluates the agreement between OCT angiography (OCTA) and non-OCTA (logMAR VA plus OCT) to decide anti-VEGF treatment's continuity. After an anti VEGF treatment, on a follow up visit, a patient underwent non-OCTA evaluation (decision A) then OCTA evaluation (decision B) to judge the necessity of future anti VEGF application. Results Out of 129 eyes, on 72 eyes (49%), there were agreements on both decision arms, but on 55 eyes (42%) there was disagreement. Particularly, disagreement on 47/55 eyes was important, where OCTA advised “continue anti VEGF” and non-OCTA advised “Stop anti VEGF” therapy. Cohen's Kappa for probability of agreement to continue anti VEGF was fair (0.33) and to stop anti VEGF therapy was none (0.1). Conclusions Based on resulting disagreements between the two modalities on deciding the continuity of anti VEGF, we conclude that OCTA must be considered in the conventional decision making algorithm in patients with wet AMD under anti VEGF therapy.

Anatomical and Functional Outcome of Epiretinal Membrane Peeling Surgery

Background: The purpose of this study is to study the anatomical and functional outcome of epiretinal membrane peeling surgery by evaluating the visual outcomes, comparing the pre and post operative macular thickness and functional changes through electroretinogram.Methods: It is a non-randomized, open labelled, prospective study conducted in a tertiary eye care centre. The anatomical and functional outcome of epiretinal membrane peeling surgery was evaluated by comparing the preoperative BCVA, OCT and ERG with post operative results of the same, at 4 & 12 weeks after the surgery in 25 eyes. Results: There was a significant reduction in CFT (p ≤0.05) with marked improvement in vision on follow ups at 4 weeks and 12 weeks after removal of ERM with significant reduction in the macular edema. On post operative ERG, 18 (72%) patients showed global improvement in amplitudes and P1 implicit time as compared to their preoperative value while 2 (8%) patients showed global improvement in amplitude but there was still delay in P1 implicit time as similar to their preoperative value and 4 patients (16%) showed no improvement in global amplitude as well as in P1 implicit time.Conclusions: ERM peeling surgery in selected cases improves visual acuity significantly in majority of the patients. CFT and foveal architecture significantly improves with ERM peeling surgery which also explains the improvement in functional visual acuity. ERG interpretation goes along the improvement in best corrected visual acuity signifying improvement in functioning of macula.

Kinetic visual acuity is correlated with functional visual acuity at higher speeds

ObjectiveTo measure the kinetic visual acuity (KVA) which is the ability to identify approaching objects and the functional visual acuity (FVA) which is continuous VA during 1 min under binocular and monocular condition (non-dominant eye shielding) for healthy subjects, and related ocular parameters to explore their correlation and implication in aspect of integrated visual function.MethodsThe mean age of the 28 participants was 38.6±8.9 years (range, 23–57 years; 6 women). A KVA metre (AS-4Fα) and FVA metre (AS-28) were used to measure KVA and FVA, respectively. Multiple regression analysis was conducted to explore correlations among the measured visual function and related parameters, including age, binocularity, best-corrected visual acuity, refraction and tear break-up time.ResultsThe results of binocular KVA were better than monocular KVA at all speeds. A strong correlation was found between monocular and binocular KVA. The results of binocular FVA were better than monocular FVA (p<0.001) and there was a correlation between monocular and binocular FVA (R=0.638, p<0.001), as well as the maintenance rate for FVA (R=0.228, p=0.003). A linear mixed-effects model revealed that binocularity for KVA prediction was significant at all speeds and FVA was also significant at 60 km/h (p<0.05).ConclusionThe current results suggest that both binocularity and FVA may contribute to KVA.Trial registration numberUMIN00032385

Shortened Measurement Time of Functional Visual Acuity for Screening Visual Function

The functional visual acuity test which is the average of the visual acuities measured during a specific time frame (standard, 60 seconds) has been used recently to assess the visual function in various conditions. The availability of a shorter version of the functional visual acuity test promises to be patient friendly in that it is a simple screening test performed in a shorter period of time than the standard test. The results of measurements of the FVA test between the 30-second measurement time (short-version FVA test) and the standard 60-second measurement are compared, and the feasibility of the short-version FVA test instead of the standard FVA test is investigated. Twenty-eight healthy volunteers (25 men and 3 women) were enrolled in this prospective observational study. All subjects underwent measurement of the binocular distance-corrected visual acuity and the binocular distance-corrected FVA with the 60-second and 30-second measurement times. The interchangeability of the corrected-distance FVA, maximal VA, visual maintenance ratio, and average response time in the short-version and the standard FVA tests was evaluated using the Bland–Altman method, and the results showed agreements of the two tests except for the minimal VA. The short-version FVA test is equivalent to the standard method except for evaluating the visual acuity fluctuations and promises to be a simple visual screening test that can be performed in a shorter time.

Association among Blink Rate, Changes in Ocular Surface Temperature, Tear Film Stability, and Functional Visual Acuity in Patients after Cataract Surgery

Purpose. To investigate the association among the ocular surface temperature (OST), tear film stability, functional visual acuity (FVA), and blink rate in patients after cataract surgery. Methods. We recruited 98 eyes of 69 patients (mean age, 73.7 ± 5.2 years) 1 month after phacoemulsification with implantation of acrylic intraocular lenses and assessed slit-lamp microscopy, corrected distance VA, FVA, noninvasive tear breakup time (NIBUT), and OST. We defined the changes in the OST from 0 to 10 seconds after eye opening as the ΔOST. We measured the FVA and blink rate using the FVA measurement system. We divided the patients into two groups based on tear film stability: stable tear film (NIBUT, >5.0 seconds) and unstable tear film (NIBUT, ≤5.0 seconds). We evaluated the differences between the two groups and the association between the blink rate and other clinical parameters. Results. The unstable tear film group (56 eyes) had significantly (p<0.0001, unpaired t-test) shorter NIBUTs than the stable tear film group (42 eyes). The ΔOSTs and blink rates were significantly (p<0.0001) higher in the unstable tear film group than in the stable group. Linear single regression analysis showed that the ΔOST (r = −0.430, p<0.0001), NIBUT (r = −0.392, p<0.0001), and gender (r = −0.370, p=0.0002) were correlated significantly with the blink rate. Multiple regression analysis showed that the ΔOST independently contributed to the blink rate. Conclusions. The frequency of blinks is associated with tear film stability in patients after cataract surgery. The blink rate may be useful for evaluating the tear film stability in clinical practice. The ΔOST should be an important contributing factor to the blink rate. [This trial is registered with UMIN000026970].