Predicting prescribed magnification.

AIM: To determine the best method of estimating the optimum magnification needed by visually impaired patients. METHODS: The magnification of low vision aids prescribed to 187 presbyopic visually impaired patients for reading newspapers or books was compared with logMAR distance and near acuity (at 25 cm) and magnification predicted by +4 D step near additions. RESULTS: Distance letter (r = 0.58) and near word visual acuity (r = 0.67) were strongly correlated to the prescribed magnification as were predictive formulae based on these measures. Prediction using the effect of proximal magnification resulted in a similar correlation (r = 0.67) and prediction was poorer in those who did not benefit from proximal magnification. The difference between prescribed and predicted magnification was found to be unrelated to the condition causing visual impairment (F = 2.57, p = 0.08), the central visual field status (F = 0.57, p = 0.57) and patient psychology (F = 0.44, p = 0.51), but was higher in those prescribed stand magnifiers than high near additions (F = 5.99, p < 0.01). CONCLUSIONS: The magnification necessary to perform normal visual tasks can be predicted in the majority of cases using visual acuity measures, although measuring the effect of proximal magnification demonstrates the effect of stronger glasses and identifies those in whom prescribed magnification is more difficult to predict.     

Correlation of pupil size with visual acuity and contrast sensitivity after implantation of an apodized diffractive intraocular lens

PURPOSE: To determine whether pupil size is correlated with visual acuity and contrast sensitivity at all distances in eyes with an apodized diffractive intraocular lens (IOL). SETTING: Private Clinic, Oviedo, Spain. METHODS: Six months after surgery, the best corrected distance visual acuity, best distance-corrected near visual acuity, intermediate visual acuity, and distance contrast sensitivity under photopic (85 cd/m2) and mesopic (5 cd/m2) conditions were measured in 670 eyes of 335 consecutive patients who had implantation of the AcrySof ReSTOR Natural IOL (SN60D3, Alcon). Pupil diameters in distance vision were measured using a pupillometer. RESULTS: The logMAR best corrected distance acuity was significantly better with larger pupils (r = 0.297; P = 1.36 x 10(-8)), whereas logMAR best distance-corrected near acuity was significantly worse with larger pupils (r = 0.276, P = 1.02 x 10(-7)). For all pupil diameters, intermediate visual acuity worsened significantly as the distance of the test increased (P<.01). Statistically significant differences in photopic and mesopic contrast sensitivity at all spatial frequencies were found between the small-pupil and large-pupil groups (P<.01). Distance photopic contrast sensitivity and mesopic contrast sensitivity were better in patients with large pupils than in patients with small pupils. CONCLUSIONS: A larger pupil was correlated significantly with better distance visual acuity and with worse near visual acuity. For all pupil diameters, intermediate visual acuity worsened significantly as the distance of the test increased. Distance contrast sensitivity was better with larger pupils at all spatial frequencies in bright-light and dim-light conditions.     

ReSTOR+3D多焦点人工晶状体临床效果观察

目的：观察ReSTOR+3D多焦点人工晶状体的临床效果。 方法：选取40例80眼年龄相关性白内障患者,按同一标准分为两组,其中双眼非同期植入ReSTOR+3D多焦点人工晶状体者20例设为MIOL组;双眼非同期植入蓝光滤过型单焦点人工晶状体者20例设为SIOL组。均行透明角膜切口超声乳化白内障摘除联合人工晶状体植入术。术后1d观察术眼的裸眼远、近视力;术后1mo观察术眼的裸眼远、近视力,矫正远、近视力,最佳远矫下近视力,对比敏感度,问卷调查视觉质量、各视觉功能区满意度及脱镜率。 结果：两组患者术后均有良好的远视力;MIOL 组患者同时获得良好的近、中程视力。术后对比敏感度MIOL组较SIOL组有所下降,但无功能性意义。MIOL 组视近脱镜率85%。 结论：ReSTOR+3D多焦点人工晶状体植入可为患者提供良好的全程视力,安全有效,满意度高。     

Funktionelle Ergebnisse zweier Multifokallinsen mit unterschiedlicher Nahaddition

Background

The reduction of the near addition of multifocal intraocular lenses from +4?D to +3?D should improve the visual function in the intermediate distance. The ReSTOR +3?D is a multifocal lens with a near addition of 3?D.

Patients and methods

In a prospective study the new ReSTOR +3?D was compared to the former ReSTOR platform with 4?D near addition. A total of 40 patients received 1 of these 2 multifocal lenses bilaterally in both eyes after uneventful phacoemulsification in otherwise sound cataract eyes (20 patients ReSTOR +3?D, 20 patients ReSTOR + 4D). After 3 months the following parameters were assessed: uncorrected and corrected distance visual acuity, near vision at different distances, contrast sensitivity, defocus curve and anterior and posterior segments. The functional tests were performed monocularly and binocularly.

Results

Uncorrected binocular distance visual acuity (decimal) was 0.93 (logMAR 0.03±0.12) in the ReSTOR +3?D group and 1.05 (?0.02±0.1) in the ReSTOR +4?D group. In the intermediate distance the ReSTOR +3?D performed slightly better at 40?cm (0.68 versus 0.56) (logMAR 0.17±0.14 versus 0.24±0.18). The difference was significant (p<0.01) at 70?cm (0.69 versus 0.43) (logMAR 0.16±0.27 vs 0.37±0.2). The superior performance of the ReSTOR +3?D in the intermediate distance was also clearly visible in the defocus curves. All functional tests revealed significantly better results when performed binocularly.

Conclusion

The ReSTOR +3?D multifocal intraocular lens performed significantly better in the intermediate distance compared to the ReSTOR +4?D. The other functional tests showed excellent and equal results with both lenses. The reduction of near addition does not increase dysphotopsia, particularly halos. Complaints of unsatisfactory vision in the intermediate distance were reported only by patients with the ReSTOR +4?D. The new ReSTOR +3?D is likely to improve the acceptance of multifocal intraocular lenses.     

+3.00 D和+2.50 D近附加度数多焦点人工晶状体植入术后视觉质量比较

目的：比较+3.00 D和2.50 Diopter （D）近附加度数的渐进衍射型多焦点人工晶状体（IOL）植入术后的视觉质量。方法： 前瞻性临床研究。选择2014年5月至2015年12月在温州医科大学附属眼视光医院行白内障超声乳化吸除术的患者,根据植入多焦点IOL的类型分为2 组：近附加为+2.50 D的为观察组,近附加为+3.00 D的为对照组。术后3 个月检查屈光状态、视力（LogMAR）、离焦曲线、对比敏感度,采用客观视觉质量分析系统检测调制传递函数（MTF）、客观散射指数（OSI）等。采用问卷 调查术后生活质量。计量资料满足正态分布且方差齐,采用t 检验;方差不齐,采用校正t 检验。计数资料采用卡方检验。结果：对照组24 例（32 眼）,观察组28 例（33 眼）,2 组术后矫正远视力分别为0.03±0.06、0.05±0.07（t =-1.179,P =0.228）,远矫正下80 cm中距离视力分别为0.32±0.17、0.25±0.11（t =2.761,P =0.017）,远矫正下33 cm近距离视力分别为0.22±0.11、0.31±0.20（t =-4.188,P =0.019）。2 组的离焦曲线均形成双峰,但观察组的两峰之间曲线平缓。在-1.50 D时,观察组视力优于对照组（t =2.103, P =0.038）,在-3.00、-3.50、-4.00 D时对照组视力优于观察组（t =-3.183、-2.678、-3.330,P < 0.01）。不同环境亮度下,2 组在不同空间频率的对比敏感度差异均无统计学意义。2组的MTF截止频率、OSI值差异无统计学意义。主观视力满意度、完全脱镜率及视觉干扰现象,2 组比较差异均无统计学意义。结论：与近附加+3.00 D的多焦点IOL相比,近附加+2.50 D的多焦点IOL在远视力、客观视觉质量、患者主观视觉感受及术后脱镜率方面均无明显差异,但中间距离视力较好,30 cm处近距离视力较差。     

Quality of vision with the Acri. Twin asymmetric diffractive bifocal intraocular lens system

PURPOSE: To assess the quality of vision in patients who had implantation of asymmetric Acri.Twin bifocal diffractive intraocular lenses (IOLs) by evaluating distance and near visual acuities and photopic and mesopic contrast sensitivity under monocular and binocular conditions. SETTING: Fernández-Vega Ophthalmological Institute, Oviedo, Spain. METHODS: The study comprised 343 consecutive patients who had bilateral implantation of the Acri.Twin system: a distance-weighted 737D IOL and a near-weighted 733D IOL. Monocular and binocular best corrected distance visual acuities, best distance corrected near visual acuity, and distance contrast sensitivity under photopic (85 cd/m(2)) and mesopic (5 cd/m(2)) conditions were determined. RESULTS: Eyes with the 737D IOL had better best corrected distance acuity than eyes with the 733D IOL (mean 0.036 +/- 0.061 logMAR versus 0.141 +/- 0.131 logMAR) (P<.0001). Eyes with the 733D IOL had better best distance corrected near acuity than eyes with the 737D IOL (mean 0.015 +/- 0.115 logMAR versus 0.059 +/- 0.091 logMAR) (P = .0027). Binocularly, the Acri.Twin system allowed good distance and near vision; the means were 0.031 +/- 0.059 logMAR and 0.005 +/- 0.024 logMAR, respectively. Contrast sensitivity with the Acri.Twin system was within normal limits under photopic and mesopic conditions. Contrast sensitivity was statistically significantly better with the Acri.Twin system, followed by the 737D IOL and the 733D IOL under both illumination levels. CONCLUSIONS: Asymmetric bilateral implantation of the Acri.Twin IOL gave good simultaneous distance and near vision with improved contrast sensitivity under photopic and mesopic conditions. Differences between monocular and binocular visual acuity and contrast sensitivity were obtained because of the distance-/near-weighted light distribution of Acri.Twin IOLs.     

Symmetric bilateral implantation of a distance-dominant diffractive bifocal intraocular lens

PURPOSE: To assess visual results after symmetrical bilateral implantation of a distance-dominant bifocal diffractive intraocular lens (IOL). SETTING: Fernández-Vega Ophthalmological Institute, Oviedo, Spain. METHODS: Fifty patients had bilateral implantation of a distance-dominant diffractive bifocal 447D IOL (Acri.Tec GmbH) in a prospective study. Monocular and binocular best corrected distance visual acuities and best distance-corrected near visual acuity, binocular best distance-corrected intermediate visual acuity, and distance contrast sensitivity under photopic (85 cd/m(2)) and mesopic (5 cd/m(2)) conditions were determined. RESULTS: At the 6-month postoperative visit, the mean binocular best corrected distance acuity and best corrected distance near acuity were 0.02 +/- 0.04 logMAR and 0.04 +/- 0.03 logMAR, respectively. Binocular best corrected distance intermediate visual acuity worsened significantly as a function of the distance of the test: from 0.04 +/- 0.03 logMAR at 33 cm to 0.21 +/- 0.08 logMAR at 70 cm (P<.01). Contrast sensitivity was within normal limits under photopic and mesopic conditions. Binocular contrast sensitivity was statistically significantly better than monocular contrast sensitivity at all spatial frequencies under both illumination levels (P<.01). CONCLUSION: Bilateral implantation of the distance-dominant bifocal 447D IOL provided good simultaneous distance, near, and intermediate vision with improved contrast sensitivity under photopic and mesopic conditions.     

Intravitreal injection of resveratrol inhibits laser-induced murine choroidal neovascularization

AIM: To determine the effects of intravitreal resveratrol (RSV) on murine laser-induced choroidal neovascularization (CNV). METHODS: The toxicity of RSV to choroidal endothelial cell (CEC) was measured using thiazolyl blue tetrazolium bromide (MTT) assay. Effects of RSV on choroidal endothelial cell (CEC) migration were evaluated with a modified Boyden chamber assay, while tube formation was evaluated in a 2-D gel assay. CNV was induced by laser photocoagulation in mice. The effects of intravitreal injection of RSV on CNV development were evaluated by fluorescein angiography (FA), confocal analysis of isolectin B4 labeled choroidal flat mounts, and histologic examination of CNV membranes. Immunostaining was used to analyze the expression and phosphorylation of vascular endothelial growth factor receptor 2 (VEGFR2). RESULTS: No significant cell toxicity was observed in CEC if the concentration of RSV was less than 200 μmol/L (P>0.05). RSV inhibited vascular endothelial growth factor (VEGF)-induced CEC migration (P<0.05) and tube formation (P<0.05) in vitro. Furthermore, intravitreal injection of RSV significantly inhibited laser induced CNV formation in mice. The FA leakage, CNV volume and CNV area analysis revealed that there were 41%, 45%, and 58% reduction in RSV-treated eyes (1.691±0.1032, 178 163±78 623 μm3 and 6508±619.0 μm2, respectively) compared with those in control (2.724±0.08447, 379 676±98 382 μm3 and 16 576±2646 μm2, respectively; P<0.05). Phospho-VEGFR2 expression was much weaker in the sections of CNV lesions in RSV injected mice compared with that in control (P<0.05). CONCLUSION: Intravitreal injection of RSV exerts an inhibitory effect on CNV, which may through suppressing endothelial cell migration, tube formation and VEGFR2 phosphorylation.     

Low vision aids for reading in scar stage of age-related macular degeneration

PURPOSE: To evaluate the inter-relationship among near visual acuity, eccentricity of preferred retinal locus(PRL), and choice of low vision aids for reading in patients with bilateral age-related macular degeneration(AMD). SUBJECTS AND METHODS: The preferred eye of 44 patients having bilateral disciform stage AMD was examined. The PRL was detected and its eccentricity from the fovea was measured by scanning laser ophthalmoscopic microperimetry. Magnification of a low vision aid for reading newsprint was determined by the critical print size which was calculated using the MNREAD-J. The type of preferred aid was chosen from high-plus lens glasses, magnifiers, and closed-circuit televisions. The inter-relationship among near visual acuity, eccentricity of the PRL, and magnification and type of low vision aid for reading were evaluated. RESULTS: The magnification of the aid was correlated with the eccentricity of PRL in eyes with near visual acuity of 0.2 or less although no correlation was found in eyes with near visual acuity better than 0.3. High plus lens glasses were selected by patients with near visual acuity better than 0.2 and eccentricity of 2 degrees or less. Magnifiers were selected by patients with near visual acuity better than 0.1 and eccentricity of 5 degrees or less. Closed-circuit televisions were selected by patients with near visual acuity of 0.1 or less and eccentricity of 5 degrees or more. CONCLUSION: The eccentricity of PRL should be taken into account in determining low vision aids for reading, especially in patients with near visual acuity of 0.2 or less. Choice of the type of low vision aid depends on not only near visual acuity but also on eccentricity of PRL.     

超高度轴性近视白内障患者的视力预后及其影响因素

目的　前瞻性研究超高度轴性近视白内障患者的视力预后及其影响因素 ,为人工晶状体 (IOL)屈光度数的选择提供依据。方法　选择 2 4例 (43只眼 )超高度轴性近视 (屈光度数>- 10 0 0D ,眼轴长度 >2 7 0 0mm)合并轻、中度白内障患者 ,详细检查超声乳化白内障吸除人工晶状体植入术前、后的远视力 (VA)、最佳矫正视力 (BCVA)、近视力 (NVA)、眼轴长度及眼底病变程度 ,并进行统计学比较和多元逐步回归分析。结果　 (1)术后 1个月VA、BCVA、NVA均较术前明显提高(P <0 0 1) ;(2 )术前NVA和眼底病变程度明显影响术后视力 (P <0 0 1) ;(3)术前NVA≥ 0 1和眼轴长度 <2 9 0 0mm的患者术后视力分别好于术前NVA≤ 0 0 8和眼轴长度≥ 2 9 0 0mm的患者 (P <0 0 1) ;(4)术后NVA≤ 0 2 5的术眼主观感觉近距离视物能力下降。结论　术前NVA是视力预后的重要影响因素和预测指标 ;手术医师应根据术前NVA和患者对近距离工作的要求 ,慎重选择IOL的屈光度数。     

可调节人工晶状体植入术的早期疗效观察

目的探讨超声乳化白内障吸除可调节人工晶状体植入术的临床疗效和调节幅度。方法对75例(94只眼)白内障患者行超声乳化白内障吸除1CU型可调节人工晶状体植入术,观察并记录术眼的主观屈光状态、裸眼远视力、裸眼近视力、最佳矫正远视力、30cm处远视力矫正后近视力、30cm处最佳矫正近视力、主观调节幅度(分别采用主观移近法和负镜片法测量)。术后随访时间1～12个月,对术后1周、1个月及3个月的资料进行分析。结果术后1周、1个月及3个月裸眼近视力≥Jr5者分别占81.9%(77/94)、85.1%(80/94)及84.0%(79/94);远视力矫正后近视力≥Jr5者分别占78.7%(74/94)、79.8%(75/94)及74.5%(70/94)。采用主观移近法和负镜片法检查调节幅度,术后1周分别为(1.96±0.63)D(0.75～4.50D)和(1.74±0.59)D(0.75～4.50D),术后1个月分别为(1.89±0.54)D(0.75～3.25D)和(1.68±0.47)D(0.75～3.25D),术后3个月分别为(1.77±0.53)D(0.75～2.75D)和(1.66±0.50)D(0.75～2.75D)。术后1周、1个月及3个月2种方法测量的主观调节幅度比较,差异均无统计学意义(P>0.05)。远视力矫正后近视力和调节幅度之间为正相关(P=0.00)。结论早期观察结果显示1CU型可调节人工晶状体植入术后视功能恢复良好,患者在具有较好远视力的同时,具备良好的视近能力。远期效果有待进一步观察。     

Clinical performance of an innovative back surface multifocal contact lens in correcting presbyopia.

PURPOSE: This prospective study was designed to subjectively and objectively evaluate the performance of an aspheric multifocal back surface rigid gas permeable (RGP) contact lens. The multifocal element of this lens design consisted of an aspheric optical zone that varied according to the patient's ametropia, corneal topography, and required reading addition. METHODS: We fit 28 presbyopic subjects with an aspheric multifocal back surface RGP contact lens (age range: 45 to 68 years). Reading additions ranged from +0.75 D to +2.50 D. Subjects were assessed initially and at 2, 6, and 12 weeks for ocular changes, visual performance, and subjective responses. RESULTS: We required 116 RGP lenses to achieve an acceptable fit and visual acuity in 28 subjects (55 eyes). At the final visit, the distance logMAR acuity with the multifocal contact lens (+0.12 +/- 0.10) was not statistically different (t = -0.623, P = -0.5388) from spectacle acuity at the initial visit (+0.10 +/- 0.12). The near logMAR acuity with the multifocal contact lens at the final visit (0.36 +/- 0.12) was not statistically different from that for near acuity with spectacles at the initial visit (0.33 +/- 0.13). No slit lamp signs worsened during the study. A reduction in myopia of 0.67 D was noted by the final visit. Spectacle blur was noted if the acuity at the initial refraction was compared to the acuity with the same refraction at the final visit (t = -3.287, P = 0.0028) but not when the refractive changes were incorporated (t = 1.058, P = 0.3127). All subjects rated the performance of the lenses very highly: comfort, 86%; distance acuity, 83%; near acuity, 73%; and stability of vision, 74%. Twenty-four subjects (86%) chose the multifocal contact lens as their preference. CONCLUSION: We demonstrated that a multifocal design is able to provide acceptable distance and near correction for presbyopic patients. The aspheric geometry required can be optimized for a given patient by considering his/her degree of ametropia, as well as the corneal topography.     

弱视患者远、近视力差异的临床观察

目的  了解弱视儿童近视力和远视力是否存在差异。设计 回顾性病例系列。研究对象 弱视儿童81例（139眼）。方法 对81例初次就诊的弱视患者进行屈光矫正,分别运用标准对数远视力表和标准对数近视力表进行矫正后远、近视力的测量及分析。对所有接受检查的弱视儿童分别按年龄、屈光度和病因进行分组统计分析。主要指标 近视力,远视力。结果 不同病因弱视患者的远近视力比较：屈光不正性弱视、屈光参差性弱视、斜视性弱视患者的平均近视力分别为0.48±0.27、0.47±0.28、0.45±0.30,平均远视力分别为0.46±0.22、0.40±0.20、0.43±0.30,各组的远近视力差异均无统计学意义（P均＞0.05）。不同年龄弱视患者的远近视力比较：3岁～≤5岁组、＞5岁～≤7岁组、＞7岁～12岁组的平均近视力分别为0.41±0.23、0.56±0.29、0.46±0.31,平均远视力分别为0.39±0.18、0.52±0.22、0.42±0.23,各年龄组患者的远近视力差异均无统计学意义（P均＞0.05）。不同屈光度弱视患者的远近视力比较：≤+4.00 D组和＞+4.00 D组平均近视力分别为0.45±0.26、0.48±0.28,平均远视力为0.40±0.30、0.46±0.21,两组屈光度患者的近视力与远视力平均值差异均无统计学意义（P均＞0.05）。结论 本研究结果显示,不同病因、不同年龄段、不同屈光度的弱视患者其远、近视力无明显差异。 （眼科,2013,22： 266-268）     

Prospective visual evaluation of apodized diffractive intraocular lenses

PURPOSE: To evaluate distance, intermediate, and near visual performance in patients who had multifocal apodized diffractive intraocular lens (IOL) implantation. SETTING: Fernández-Vega Ophthalmological Institute, Oviedo, Spain. METHODS: The best corrected distance visual acuity, best distance-corrected near visual acuity, intermediate visual acuity, distance contrast sensitivity under photopic and mesopic conditions, and patient satisfaction were measured in 325 patients and 335 patients who had bilateral implantation of the model SA60D3 IOL (AcrySof ReSTOR, Alcon) and model SN60D3 IOL (AcrySof Natural ReSTOR), respectively. RESULTS: At the 6-month postoperative visit, binocular best corrected distance acuity with the ReSTOR IOL and the Natural ReSTOR IOL was 0.034 logMAR+/-0.004 (SD) and 0.019+/-0.020 logMAR, respectively (approximately 20/20). Binocular best distance-corrected near acuity was 0.011+/-0.012 logMAR and 0.035+/-0.013 logMAR, respectively (approximately 20/20). Intermediate visual acuity with both IOL models worsened significantly as a function of the distance of the test (P<.01). Photopic contrast sensitivity was within the standard normal range with both IOLs. Under mesopic conditions, contrast sensitivity with both IOLs was comparable to that with monofocal IOLs and lower, particularly at higher spatial frequencies, than under photopic conditions. No statistically significant differences in visual acuity or photopic and mesopic contrast sensitivity were found between the 2 IOL models (P>.1). A patient satisfaction questionnaire showed that both IOLs performed well and were comparable in satisfaction regarding distance, intermediate, and near activities under different lighting conditions. CONCLUSIONS: The AcrySof ReSTOR IOL and AcrySof Natural ReSTOR IOL provided good visual performance at distance and near under photopic and mesopic conditions. Intermediate vision with both models was reduced compared with distance and near vision.     

旋转非对称折射型多焦点人工晶状体植入术后早期效果

目的：观察白内障超声乳化联合旋转非对称折射型多焦点人工晶状体（IOL）植入术后患者的早期 效果。方法：前瞻性自身前后对照研究。选择2017年1-12月在武汉爱尔眼科医院行白内障超声乳化联合旋转非对称折射型多焦点IOL植入的患者36例（40眼），术后随访3个月。分别观察裸眼远、中、近视力（LogMAR），矫正远视力（LogMAR），术后等效球镜度（SE），离焦曲线，调制传递函数（MTF），眼内高阶像差，并统计患者术后视功能指数量表评分及脱镜率。数据采用配对t检验和非参数Wilcoxon配对秩和检验。结果：术后3个月裸眼远、中、近视力及矫正远视力均较术前增加（P<0.05），72%裸眼远视力优于0.1，98%矫正远视力优于0.1；88%术后SE在±1.0 D以内；离焦曲线在0.0 D及-2.5 D具有峰值，+1.0～-4.0 D屈光范围内视力均优于0.25。术后3 mm瞳孔直径下MTF数值均较术前提高（P<0.05），眼内总像差、垂直彗差及垂直三叶草较术前增加（P<0.05）。患者术后3个月视功能指数量表得分为1.0（0.0，2.0）。92%的患者看远、看近均可完全脱镜。结论：非对称区域折射型多焦点IOL能提供令人满意的远、近视力，亦能保持较大范围的中距离视力，患者术后具有较好的视觉质量及较高的生活质量。     

Refractive lens exchange with the diffractive multifocal Tecnis ZM900 intraocular lens

PURPOSE: To assess visual outcomes and patient satisfaction after refractive lens exchange followed by bilateral implantation of the multifocal Tecnis intraocular lens (IOL). METHODS: This prospective case series involved 59 eyes of 30 patients aged 56 +/- 8 years. Fifty-seven eyes were hyperopic (+3.52 +/- 1.80 diopters [D]) and 2 eyes were myopic (-1.12 +/- 0.53 D). Near, intermediate, and distance visual acuities were assessed at 1 and 6 months postoperatively. At last follow-up, patients were asked about their overall satisfaction, the occurrence of photic phenomena, difficulties driving at night, and spectacle independence. RESULTS: Six months after surgery and laser retreatment in 15 eyes, 90% of eyes achieved monocular uncorrected distance visual acuity of 20/30 or better (0.087 +/- 0.085 logMAR) and 100% of eyes could read J2 or better without correction, including 90% of eyes achieving J1 or better (0.133 +/- 0.095 logMAR). Evaluation of visual performance at 1 month versus 6 months (n = 44 eyes, no retreatment) revealed a considerable improvement of the uncorrected (0.175 +/- 0.122 vs 0.127 +/- 0.094 logMAR; P = .005) and distance-corrected (0.099 +/- 0.057 vs 0.068 +/- 0.031 logMAR; P = .001) near visual acuity whereas mean refractive errors and distance visual acuity remained unchanged. Overall, 96.4% of patients were very satisfied with the procedure and would choose the same lens again. The majority of patients (92.8%) were totally free from spectacles with only 7.2% occasionally wearing glasses for intermediate tasks. CONCLUSIONS: The multifocal Tecnis ZM900 IOL provides good distance and near vision after refractive lens exchange and a period of neuroadaptation. However, laser vision correction might be required to achieve emmetropia as well as spectacles to achieve good intermediate vision.     

Prospective study of the Acri.LISA bifocal intraocular lens

PURPOSE: To assess the visual results after bilateral implantation of the bifocal Acri.LISA 366D intraocular lens (IOL) (Acri.Tec AG). SETTING: Fernández-Vega Ophthalmological Institute, Oviedo, Spain. METHODS: Eighty-one patients had bilateral implantation of the distance-dominant bifocal Acri.LISA 366D IOL in a prospective study. Monocular and binocular best corrected distance visual acuity and best distance-corrected near visual acuity, binocular best distance-corrected intermediate visual acuity, and distance contrast sensitivity under photopic (85 cd/m(2)) and mesopic (5 cd/m(2)) conditions were determined. RESULTS: At the 3-month postoperative visit, the mean binocular best corrected distance acuity was 0.048 +/- 0.111 logMAR and the mean binocular best distance-corrected near acuity, 0.012 +/- 0.0084 logMAR (both approximately 20/20). The mean binocular best distance-corrected intermediate acuity changed significantly as a function of the distance of the test, from 0.012 +/- 0.084 logMAR (approximately 20/20) at 33 cm to 0.265 +/- 0.099 logMAR (approximately 20/40) at 70 cm (P<.01). Contrast sensitivity was within normal limits under photopic and mesopic conditions. Binocular contrast sensitivity was statistically significantly better than monocular contrast sensitivity at all spatial frequencies under both illumination levels (P<.01). CONCLUSION: The Acri.LISA 366D IOL provided a satisfactory full range of vision; a high level of uncorrected and corrected distance, intermediate, and near acuity; and improved contrast sensitivity under photopic and mesopic conditions.     

旋转非对称折射型多焦点人工晶状体植入术后影响全程视力的相关因素分析

目的　分析白内障超声乳化术联合旋转非对称折射型多焦点人工晶状体（multifocal intraocular lens,MIOL）植入术后患者远、中、近视力的影响因素。方法　采用前瞻性研究,纳入2018年8月至2019年8月在我院行白内障超声乳化术联合旋转非对称折射型MIOL（SBL-3)植入术患者35例44眼,术后随访3个月。观察术前及术后3个月患者的裸眼远视力（uncorrected distance visual acuity,UDVA）、最佳矫正远视力（corrected distance visual acuity,CDVA）及患者术后3个月时的离焦曲线,小数视力均转换为logMAR视力表示;记录术前及术后明室及暗室下瞳孔直径（pupil diameter,PD）及kappa角,日夜瞳孔中心位移以及术后眼内像差。并将上述因素与患者术后UDVA、CDVA及离焦曲线中各屈光度对应的视力进行Spearman相关性分析。结果　患者术后3个月时UDVA和CDVA LogMAR视力平均值为0.10（0.00~0.20)、0.00（0.00~0.20）,均较术前明显提高,差异均有统计学意义（均为P<0.05）;垂直彗差及垂直三叶草均较术前增大,差异均有统计学意义(均为P<0.05)。Spearman相关性分析显示,眼内水平三叶草差与-0.5 D及-1.0 D离焦水平处对应的logMAR视力相关系数分别为-0.377、-0.369（均为P<0.05）,眼内垂直三叶草差与-2.5 D离焦水平对应的logMAR视力相关系数为-0.347（P<0.05）,眼内总高阶像差与-0.5~-3.5 D离焦范围内对应的logMAR视力均呈负相关（均为P<0.05)。眼内球差与UDVA、-0.5~-2.0 D离焦水平对应的logMAR视力均呈正相关（均为P<0.05)。此外,术后明室kappa角与-0.5 D离焦水平对应的视力呈正相关(r=0.315,P<0.05)。结论　SBL-3 MIOL由于其设计特点,植入眼内后会引入特定的高阶像差,包括三叶草差及彗差。其中,三叶草差的增加对全程视力具有正相关,而垂直彗差一定程度上影响了SBL-3 MIOL植入的术后远视力。Kappa角过大可能影响SBL-3 MIOL术后近视力。     

Evaluating the visual experience: visual acuity and the visual analogue scale

PURPOSE: To attempt a comparison of the visual experience [assessed using a visual analogue scale (VAS)] with visual acuity in a group of normally-sighted adult optometric patients. METHODS: A single-item 100 mm paper VAS was administered to a sequence of 142 normally-sighted pre-presbyopic patients. Each individual was invited to indicate their recent subjective distance visual experience between the extremes of 'dreadful' (0 mm) and 'perfect' (100 mm). Each patient's binocular visual acuity was then determined at 6 m using a high-contrast logMAR chart under usual consulting room conditions. RESULTS: A weak association was revealed between the subjective indication of recent visual experience and the actual level of binocular acuity recorded in this normally-sighted group of subjects. On the basis of group responses a statistically significant discontinuity in the scores recorded with the VAS was demonstrated between patients who attained a clinical acuity better or worse than 0.10 logMAR units (6/7.5). Patient gender, age, and whether spectacles were habitually worn for distance viewing, were each revealed to be not statistically significant features. CONCLUSIONS: For normally-sighted optometric patients the subjective criterion of visual satisfaction would appear to be only loosely associated with the contemporaneous record of clinical acuity.     

Vision assessment in persons with intellectual disabilities

Purpose

To investigate the degree of visual acuity in workers with intellectual disabilities and the impact of vision on their working conditions.

Methods

We recruited 224 workers (mean age 43.77 years, SD ± 12.96; range, 19–72 years) from a workshop for those with intellectual disabilities, to participate in a vision examination program. The assessment consisted of objective refraction, visual acuity, ocular motility, near‐point of convergence, cover/uncover test, stereo acuity and colour perception. Individuals with vision deficits were fitted with spectacles following the screening program.

Results

Within the past three years, 38.9 per cent of the participants received eye care, 14.3 per cent of participants had not received eye care in more than three years, and 6.7 per cent had not received any eye care. As many as 39.7 per cent of participants did not know whether they had ever received eye care. Entering visual acuity for far vision was 0.52 dec (?0.29 logMAR) and 0.42 dec (?0.38 logMAR) for near vision. Only 14.9 per cent, 11 of all participants aged ≥50 years, owned spectacles for near vision before the examination. After subjective determination of refraction, best corrected visual acuity for far vision was 0.61 dec (?0.22 logMAR) and 0.56 dec (?0.25 logMAR) for near vision (in both cases with p < 0.001). After the examination, 44.6 per cent (33) of all workers aged ≥50 years received a recommendation for reading or bifocal spectacles. In 46 per cent of workers, the threshold of stereopsis was higher than 63 arc seconds, and some form of colour vision deficiency was measured in 12.5 per cent of participants.

Conclusions

Workers with intellectual disabilities are often unaware of their visual deficits. We found that some of their abnormalities can be solved by appropriate optical means and that they could benefit from regular eye care. These workers should be encouraged to be tested and to improve their vision with appropriate lenses.