Expectations and Reality in Surgical Rehabilitation of Cataract Patients

The aim. To study the effect of surgical treatment of cataracts on the quality of life of patients and assess satisfaction with the results after implantation of a monofocal or multifocal intraocular lens (IOL), depending on the initial refraction. Materials and methods. We examined 140 patients (280 eyes) who underwent phacoemulsification with IOL (bilateral) according to the standard technique using multimodal anesthesia. The observation groups were divided depending on the initial type of refraction and the type of intraocular correction (mono- or multifocal IOL). The analysis of the results of surgical treatment of cataracts with IOL was assessed taking into account the initial refraction according to objective data, i.e. determination of distance and near visual acuity, and subjective data, i.e. the NEI-VFQ-25 quality of life questionnaire, patient questionnaire survey and assessment of the quality of vision in general, as well as distance, near, and night vision. Results and discussion. Before surgery, the mean values of indicators by all scales of the questionnaire of the quality of life related to the quality of vision ranged from 40 to 60 points and averaged 47 ± 0.5 points. After cataract surgery, the numerical indicator by each of the scales shifted to the range of 85 to 100 points. The difference in values by the scales “activity associated with distance vision” and “driving a car” was obtained. In patients with multifocal IOL, these indicators were lower compared with monofocal implantation. Dissatisfaction with distance vision was observed during the implantation of a multifocal IOL only in patients with hyperopia (12.5%), dissatisfaction with near vision was noted only in patients with myopia (16.7%), and no cases of dissatisfaction were observed in the group of patients with emmetropia. Analysis of night vision in patients with emmetropia also revealed the minimum percentage (2.5%) of cases of dissatisfaction in patients with hyperopia (5.0%) and the maximum in those with myopia (16.7%). Conclusions. IOL implantation is a single cataract treatment option that provides a high level of the patient’s satisfaction with the quality of life and visual functions. However, careful individual approach is required to select the type of implantable IOL, taking into account the patient’s needs and baseline refraction.

A comparison of clinical outcomes and optical performance between monofocal and new monofocal with enhanced intermediate function intraocular lenses: a case-control study

Background To compare clinical outcomes and optical performance of a new monofocal with enhanced intermediate function intraocular lenses (IOLs) with that of conventional monofocal IOLs. Methods Sixty eyes of 30 patients who underwent phacoemulsification with bilateral implantation of the ICB00 (15 patients) or ZCB00 (15 patients) IOLs were enrolled. Binocular corrected distance visual acuity (CDVA), distance corrected near visual acuity (DCNVA), and distance corrected intermediate visual acuity (DCIVA) were measured at 4 weeks after surgery. Patient satisfaction for overall, near, intermediate, and distance vision were assessed. The binocular defocus curves were measured. The root mean square of modulation transfer function (MTFRMS) was measured in the optical bench study. Results The mean binocular DCIVA was significantly better in the ICB00 group (0.01 logMAR) compared to the ZCB00 group (0.13 logMAR), but CDVA and DCNVA were not. The patient satisfaction for near and intermediate vision was significantly higher in the ICB00 group compared to the ZCB00. However, there was no difference in patient satisfaction for overall and distance vision between two groups. The defocus curves showed that mean visual acuity of the ICB00 group was significantly better than that of the ZCB00 group at between − 1.00 D to − 3.00 D of defocus. The ICB00 IOL had higher MTFRMS values at between − 0.50 D to − 2.00 D of defocus compared to the ZCB00 IOL. Conclusions The ICB00 IOL provides better binocular intermediate vision and higher satisfaction for near and intermediate vision than the ZCB00 IOL while maintaining excellent distance vision.

Do You See What Eye See? Measurement, Correlates, and Functional Associations of Objective and Self-Reported Vision Impairment in Aging South Africans

Objectives: Our study investigates measurement, correlates, and functional associations of vision impairment (VI) in an aging population in rural South Africa. Methods: 1582 participants aged 40–69 reported on near (NVI) and distance vision impairment (DVI) and completed objective vision tests. Logistic and linear regression were used to evaluate sociodemographic, health, and psychosocial correlates of VI and assess relationships between VI and cognitive and physical function. Results: VI prevalence was considerably higher according to objective testing (56%) versus self-reports (18%). Older adults were especially likely to underreport impairment. Objective VI was associated with age, education, cardiometabolic disease, and female sex. Conversely, self-reported VI was associated with psychosocial factors. Objective NVI and both types of DVI were associated with worse visual cognition and slower gait speed, respectively. Discussion: Self-reported and objective VI measures should not be used interchangeably in this context. Our findings highlight extensive burden of untreated VI in this region.

Determinants of compliance to the facemask directive in Greece: A population study

Purpose Primary objective of this study was to identify potential difficulties and/or discomfort when using a facemask. Moreover, to explore the impact of spectacles, contact lenses and visual acuity on the compliance to the facemask directive. Methods This is a prospective study that was conducted at the Department of Ophthalmology, University Hospital of Alexandroupolis, Greece between June 2020 and August 2020. Greek speaking citizens with permanent residency in Greece above 18 years old were included. A custom questionnaire (DeMask-20) was constructed and validated, which pertained to the perceived difficulty and discomfort when using a facemask. It contained 20 items grouped in 8 subscales (driving, near vision, distance vision, ocular discomfort, role limitation, collaboration, dependency on others, emotional stress). Perceived difficulty and discomfort when using a facemask, compliance and correlations of compliance with DeMask-20 scores, demographics, spectacle and/or contact lens use, and visual acuity were evaluated. Results The number of factors was determined through factor analysis. Cronbach’s alpha ranged from 0.716 for the “Role limitation” subscale to 0.938 for “Ocular discomfort” subscale. 1,214 participants (402 men, 812 women, mean age 36.79±12.50 years) completed the DeMask-20 instrument. Mean DeMask-20 score of all study participants was 3.79±0.71. Significant differences in DeMask-20 score were detected in gender (p = 0.009), spectacle use (p = 0.034), contact lens use (p = 0.049), and binocular distance visual acuity (bDVA) (p = 0.001). Mean compliance of all participants was 4.05±0.96. Men, people <50 years and spectacle wearers showed significantly worse compliance (p<0.05). Moreover, professional workers and professional drivers demonstrated significantly better compliance (p = 0.008 and p = 0.047). Significant correlation was detected between compliance and DeMask-20 score (p<0.001, R2 = 0.471). Significant correlations were detected with driving, near vision, distance vision, collaboration, role limitation, emotional stress (p<0.05, R2: 0.386–0.493). Conclusions Factor analysis suggested that the DeMask-20 instrument demonstrates adequate validity, while Cronbach’s alpha indicated sufficient internal consistency of all subscales. This study provided the necessary methods that could evaluate compliance trends and the efficacy of healthcare interventions against COVID-19. Our outcomes suggest that young males who use spectacles should be targeted by Greek Healthcare authorities in order to improve compliance rates.

TAKE THE RISK OR LOSE THE CHANCE!

The hallmark of keratoconus is central or paracentral stromal thinning, accompanied by apical protrusion and irregular astigmatism. Patients typically experience variable reductions in visual acuity, image distortion, and increased sensitivity to glare and light. The latter becomes of major interest when patients with keratoconus present with a cataract which contributes to a further visual decline. PURPOSE: To present a case report of a patient who underwent cataract surgery, with implantation of an intraocular implant called pinhole and correction of an irregular corneal astigmatism as a result of keratoconus. METHODS: A report of a rare case, the first implantation of XtraFocus implant in Bulgaria for the correction of keratoconus combined with cataract. RESULTS: All necessary measurements were performed using an iTrace aberrometer and IOL Master 700. The cataract removal was performed by standard phacoemulsification followed by implantation of a pinhole implant in the capsular bag. No complications related to the position of the implant were observed in the postoperative period. Optimal correction of the distance vision and near vision was achieved, and the results were monitored within six months after surgery. CONCLUSION: The pinhole implant was securely positioned in the capsular bag. Well tolerated by the patient, the implant played a key role in effectively overcoming the irregular corneal astigmatism. There is a significant improvement in visual acuity with results satisfying the patient's high expectations.

‘Should have gone to …’: bilateral papilloedema with normal CSF pressure due to vestibular schwannoma

A 24-year-old woman presented with bilateral blurring of her distance vision and ‘dizzy spells’. She had no other neurological symptoms or medical history. She consulted an optometrist, and optical coherence tomography (OCT) was performed, which demonstrated papilloedema. She was referred to the local eye clinic for assessment and from there was referred for neurological assessment.Her initial investigations revealed no abnormalities, and brain imaging was reported to be normal. In the absence of an alternative diagnosis, idiopathic intracranial hypertension (IIH) was considered and a lumbar puncture was performed. This showed elevated protein but normal cerebrospinal fluid (CSF) pressure. MRI of the brain the next day revealed a large cerebellopontine lesion in keeping with vestibular schwannoma. She was referred to neurosurgery for operative management.This case highlights three interesting points: the aetiology of her papilloedema without raised intracranial pressure, the decision to perform a lumbar puncture in suspected IIH and community OCT as a clinical adjunct.

Long term outcomes in dry age-related macular degeneration following low vision rehabilitation interventions

Background: Age-related macular degeneration (AMD) is the leading cause of loss of vision in the older age groups. In the absence of a known therapy, low vision rehabilitation aims at preserving residual functional vision at optimal levels. Long term functional outcomes from Low Vision Rehabilitation (LVR) in AMD cases were never scrutinized in the past. This study brings some clarification in this matter. Methods: This is a retrospective case series study including data up to 2 years following the baseline visit. Low Vision Assessments included microperimetry testing and recommendations for low vision devices for distance vision. Outcomes measures selected for this study were best corrected distance visual acuity, fixation stability and preferred retinal locus (PRL) topography and LVR interventions. Results: Data on 17 patients with an average age of 89.2 ± 4.4 years was collected. In those with better vision than 20/400 loss of vision was about 1.4 letter per year as tested with ETDRS charts compared with losses of four letters per year in a population without LVR interventions. Fixation stability continued to deteriorate while PRL eccentricity seemed to remain the same. In about half of cases there was a change in the topographic location of the PRL to a different retinal quadrant. Conclusion: Long term, as expected, changes were noticed in visual acuity, fixation stability and PRL topography. However, it seems that LVR interventions for distance vision help patients retain significantly better functional vision at the 2 years follow up interval when compared to others.

Optical tolerance to rotation of trifocal toric intraocular lenses as a function of the cylinder power

Background: The aim was to assess the impact of 5- and 10-degree rotations in the optical quality of a trifocal toric intraocular lens with different amounts of cylinder. Methods: Two Physiol Toric intraocular lenses with 1.5 and 3.0 D of cylinder were analysed in three different positions: centred, 5 and 10 degrees rotated. The optical quality of the intraocular lenses was evaluated with the PMTF optical bench through specific perpendicular targets. The analysis was performed by the through-focus modulation transfer function curves and the modulation transfer function corresponding to distance vision (0 D of vergence). Results: For a centred situation, the through-focus modulation transfer function curves of both intraocular lenses showed the classical three peaks corresponding to the powers of the two principal meridians of the intraocular lenses. When 5 and 10 degrees of rotation were induced, the three peaks were attenuated in both cases. The case with the intraocular lens with 3.0 D of cylinder and 10 degrees of rotation showed the worst optical quality and a significant loss of trifocality. The modulation transfer function values obtained for distance vision also showed the worst optical quality for the intraocular lens with 3.0 D of cylinder and 10 degrees of rotation. Conclusion: Rotations over 5 degrees decreased the optical quality of trifocal toric intraocular lenses, being this reduction moderate from 5 to 10 degrees for low levels of cylinder (≤1.5 D). For mid-high levels of cylinder (≥3.0 D), rotations over 5 degrees cause a significant loss of optical quality at all object distances.