AIM： To assess visual quality after presbyopia correction using an aspheric ablation profile and a micro-monovision protocol. METHODS： This is a retrospective interventional study. Fifty-four eyes of 27 patients （m...AIM： To assess visual quality after presbyopia correction using an aspheric ablation profile and a micro-monovision protocol. METHODS： This is a retrospective interventional study. Fifty-four eyes of 27 patients （mean age, 50.2±7.5y） who underwent presbyopia correction with an aspheric micro-monovision protocol were enrolled. The values of modulation transfer function （MTF） cutoff frequency, Strehl ratio, objective scattering index （OSI） and accommodation range were quantitatively assessed using the HD analyzer. Preoperative and postoperative contrast sensitivity （CS） at far （2.5 m） and near （40 cm） distance and higher-order aberrations （HOAs） were analyzed. Subjective visual satisfaction was evaluated by self-reported questionnaire regarding optical visual symptoms. RESULTS： One year after presbyopia correction, no significant differences were found in the MTF cutoff frequency, Strehl ratio and OSI, however, the lID analyzer accommodation range significantly differed postoperatively （P=0.004）. Postoperative CS at 12 and 18 cpd at near showed statistically significant improvement （P=0.020 and 0.008, respectively）. Visual performance by self-reported questionnaire revealed satisfactory results in terms of subjective visual quality improvement. CONCLUSION： Objective optical quality parameters show good visual outcomes. Subjective visual quality assessed by self-reported questionnaire in the presbyopia correction group show satisfactory results.展开更多
Presbyopia still remains the last frontier of refractive surgery.Its surgical management is under constant evolution due to the limitations that exist today with respect to its management,which is probably in relation...Presbyopia still remains the last frontier of refractive surgery.Its surgical management is under constant evolution due to the limitations that exist today with respect to its management,which is probably in relation with the multifactorial basis in which presbyopia is clinically developed in the human.Until currently,virtually all surgical techniques that have been proposed for its correction are based on the induction of pseudoaccommodation in the presbyopic eye,including multifocality.However,the real restoration of accommodation is more complex,and it has been tried by the use of different,so called,“accommodative”pseudophakic intraocular lenses(AIOL).Overall,the reported results with these lenses by independent authors have been modest in relation with the restoration of the accommodative power of the eye and these modest benefits are usually lost with time due to the long term changes in the capsular bag.This fact made these lenses to be almost abandoned in the last few years,but there are currently other AIOL models being used with innovative mechanisms of action and different anatomical support outside the capsular bag that offer encouraging preliminary results that could bring a new potential of application to these types of lenses.In this article,we will update the modern refractive surgeon about the fundamentals and provide updated information about the outcomes of AIOLs by reviewing the concept of accommodation,the different attempts that have been accomplished in the past,their demonstrated published results in human clinical trials,and the future alternatives that may arrive in the near future.展开更多
AIM: To compare the clinical outcomes of a variety of multifocal intraocular lenses(MIOLs) in patients diagnosed with presbyopia or cataracts. METHODS: This clinical trial study included 141 patients(282 eyes) with di...AIM: To compare the clinical outcomes of a variety of multifocal intraocular lenses(MIOLs) in patients diagnosed with presbyopia or cataracts. METHODS: This clinical trial study included 141 patients(282 eyes) with different MIOLs implantation. The Symfony(60 eyes), the Re STOR(100 eyes), the AT LISAtri(60 eyes), and the Pan Optix(62 eyes) intraocular lenses were evaluated in this prospective interventional study. The near, intermediate, and distant visual acuities, contrast sensitivity, and defocus curve were measured as valid criteria. To statistically analyze the results, we used the Statistical Package for Social Science software, the non-parametric Wilcoxon signed-rank t, the one-way analysis of variance and the Tukey’s post-hoc test in our analysis. Moreover, we conducted a detailed literature search on the Pub Med database in English about MIOLs, in total 59 studies were included in this review article.RESULTS: The four approaches did not show any significant difference in the best-corrected distance visual acuity(P>0.05). The defocus curves at the contrast of 100% showed that trifocal IOLs had better intermediate performance than the bifocal IOL(P<0.05). There were no statistically significant differences between AT LISAtri and Pan Optix lenses for visual acuity at all distances. The eyes with Pan Optix, Symfony, and AT LISAtri IOL showed better contrast sensitivity than those Re STOR at spatial frequencies of 1, 3, and 6 cpd in photopic and mesopic conditions(P<0.001). CONCLUSION: All four groups of the multifocal lenses were satisfying in terms of distance and near vision. Also, the group of trifocal lenses led to satisfactory outcomes in intermediate vision, without degradation in quality of vision.展开更多
Presbyopia corrections traditionally have been approached with attempts to exchange power,either at the cornea or the lens planes,inducing multifocality,or altering asphericity to impact the optical system.Treatments ...Presbyopia corrections traditionally have been approached with attempts to exchange power,either at the cornea or the lens planes,inducing multifocality,or altering asphericity to impact the optical system.Treatments that affect the visual axis,such as spectacle and contact lens correction,refractive surgeries,corneal onlays and inlays,and intraocular lenses are typically unable to restore true accommodation to the presbyopic eye.Their aim is instead to enhance‘pseudoaccommodation’by facilitating an extended depth-of-focus for which vision is sufficient.There is a true lack of technology that approaches presbyopia from a treatment based or therapy based solution,rather than a‘vision correction’solution that compromises other components of the optical system.Scleral surgical procedures seek to restore true accommodation combined with pseudoaccommodation and have several advantages over other more invasive options to treat presbyopia.While the theoretical justification of scleral surgical procedures remains controversial,there has nevertheless been increasing interest and evidence to support scleral surgical and therapeutic approaches to treat presbyopia.Enormous progress in scleral surgery techniques and understanding of the mechanisms of action have been achieved since the 1970s,and this remains an active area of research.In this article,we discuss the historic scleral surgical procedures,the two scleral procedures currently available,as well as an outlook of the future for the scleral surgical space for treating presbyopia.展开更多
文摘AIM： To assess visual quality after presbyopia correction using an aspheric ablation profile and a micro-monovision protocol. METHODS： This is a retrospective interventional study. Fifty-four eyes of 27 patients （mean age, 50.2±7.5y） who underwent presbyopia correction with an aspheric micro-monovision protocol were enrolled. The values of modulation transfer function （MTF） cutoff frequency, Strehl ratio, objective scattering index （OSI） and accommodation range were quantitatively assessed using the HD analyzer. Preoperative and postoperative contrast sensitivity （CS） at far （2.5 m） and near （40 cm） distance and higher-order aberrations （HOAs） were analyzed. Subjective visual satisfaction was evaluated by self-reported questionnaire regarding optical visual symptoms. RESULTS： One year after presbyopia correction, no significant differences were found in the MTF cutoff frequency, Strehl ratio and OSI, however, the lID analyzer accommodation range significantly differed postoperatively （P=0.004）. Postoperative CS at 12 and 18 cpd at near showed statistically significant improvement （P=0.020 and 0.008, respectively）. Visual performance by self-reported questionnaire revealed satisfactory results in terms of subjective visual quality improvement. CONCLUSION： Objective optical quality parameters show good visual outcomes. Subjective visual quality assessed by self-reported questionnaire in the presbyopia correction group show satisfactory results.
基金the funding of the framework of the Red Temática de Investigación Cooperativa en Salud(RETICS),reference number RD12/0034/0007financed by the Instituto Carlos III–General Subdirection of Networks and Cooperative Investigation Centers(R&D&I National Plan 2008–2011)the European Regional Development Fund(Fondo europeo de desarrollo regional FEDER).
文摘Presbyopia still remains the last frontier of refractive surgery.Its surgical management is under constant evolution due to the limitations that exist today with respect to its management,which is probably in relation with the multifactorial basis in which presbyopia is clinically developed in the human.Until currently,virtually all surgical techniques that have been proposed for its correction are based on the induction of pseudoaccommodation in the presbyopic eye,including multifocality.However,the real restoration of accommodation is more complex,and it has been tried by the use of different,so called,“accommodative”pseudophakic intraocular lenses(AIOL).Overall,the reported results with these lenses by independent authors have been modest in relation with the restoration of the accommodative power of the eye and these modest benefits are usually lost with time due to the long term changes in the capsular bag.This fact made these lenses to be almost abandoned in the last few years,but there are currently other AIOL models being used with innovative mechanisms of action and different anatomical support outside the capsular bag that offer encouraging preliminary results that could bring a new potential of application to these types of lenses.In this article,we will update the modern refractive surgeon about the fundamentals and provide updated information about the outcomes of AIOLs by reviewing the concept of accommodation,the different attempts that have been accomplished in the past,their demonstrated published results in human clinical trials,and the future alternatives that may arrive in the near future.
文摘AIM: To compare the clinical outcomes of a variety of multifocal intraocular lenses(MIOLs) in patients diagnosed with presbyopia or cataracts. METHODS: This clinical trial study included 141 patients(282 eyes) with different MIOLs implantation. The Symfony(60 eyes), the Re STOR(100 eyes), the AT LISAtri(60 eyes), and the Pan Optix(62 eyes) intraocular lenses were evaluated in this prospective interventional study. The near, intermediate, and distant visual acuities, contrast sensitivity, and defocus curve were measured as valid criteria. To statistically analyze the results, we used the Statistical Package for Social Science software, the non-parametric Wilcoxon signed-rank t, the one-way analysis of variance and the Tukey’s post-hoc test in our analysis. Moreover, we conducted a detailed literature search on the Pub Med database in English about MIOLs, in total 59 studies were included in this review article.RESULTS: The four approaches did not show any significant difference in the best-corrected distance visual acuity(P>0.05). The defocus curves at the contrast of 100% showed that trifocal IOLs had better intermediate performance than the bifocal IOL(P<0.05). There were no statistically significant differences between AT LISAtri and Pan Optix lenses for visual acuity at all distances. The eyes with Pan Optix, Symfony, and AT LISAtri IOL showed better contrast sensitivity than those Re STOR at spatial frequencies of 1, 3, and 6 cpd in photopic and mesopic conditions(P<0.001). CONCLUSION: All four groups of the multifocal lenses were satisfying in terms of distance and near vision. Also, the group of trifocal lenses led to satisfactory outcomes in intermediate vision, without degradation in quality of vision.
文摘Presbyopia corrections traditionally have been approached with attempts to exchange power,either at the cornea or the lens planes,inducing multifocality,or altering asphericity to impact the optical system.Treatments that affect the visual axis,such as spectacle and contact lens correction,refractive surgeries,corneal onlays and inlays,and intraocular lenses are typically unable to restore true accommodation to the presbyopic eye.Their aim is instead to enhance‘pseudoaccommodation’by facilitating an extended depth-of-focus for which vision is sufficient.There is a true lack of technology that approaches presbyopia from a treatment based or therapy based solution,rather than a‘vision correction’solution that compromises other components of the optical system.Scleral surgical procedures seek to restore true accommodation combined with pseudoaccommodation and have several advantages over other more invasive options to treat presbyopia.While the theoretical justification of scleral surgical procedures remains controversial,there has nevertheless been increasing interest and evidence to support scleral surgical and therapeutic approaches to treat presbyopia.Enormous progress in scleral surgery techniques and understanding of the mechanisms of action have been achieved since the 1970s,and this remains an active area of research.In this article,we discuss the historic scleral surgical procedures,the two scleral procedures currently available,as well as an outlook of the future for the scleral surgical space for treating presbyopia.
