Binocular function to increase visual outcome in patients implanted with a diffractive trifocal intraocular lens

Background: To evaluate binocular visual outcome for near, intermediate and distance compared to monocular visual outcome at the same distances in patients implanted with a diffractive trifocal intraocular lens (IOL). Methods: The study comprised of 100 eyes of 50 patients that underwent bilateral refractive lens exchange or cataract surgery with implantation of a multifocal diffractive IOL (AT LISA tri 839MP, Carl Zeiss Meditech, Germany). A complete ophthalmological examination was performed preoperatively and 3 month postoperatively. The main outcome measures were monocular and binocular uncorrected distance (UDVA), corrected distance (CDVA), uncorrected intermediate (UIVA), and uncorrected near visual acuities (UNVA), keratometry, and manifest refraction. Results: The mean age was 59.28 years ± 9.6 [SD] (range 44–79 years), repectively. There was significant improvement in UDVA, UIVA, UNVA and CDVA. Comparing the monocular results to the binocular results there was a statistical significant better binocular outcome in all distances (UDVA p = 0.036; UIVA p < 0.0001; UNVA p = 0.001). The postoperative manifest refraction was in 86 % of patients within ± 0.50 [D]. Conclusions: The trifocal IOL improved near, intermediate, and distance vision compared to preoperatively. In addition a statistical significant increase for binocular visual function in all distances could be found. Trial registration German Clinical Trials Register (DRKS) DRKS0000783

Femtosecond Laser-Assisted Cataract Surgery Versus Phacoemulsification Cataract Surgery (FACT): A Randomized Noninferiority Trial

PURPOSE: To report the 3-month results of a randomized trial (Femtosecond Laser-Assisted Cataract Trial [FACT]) comparing femtosecond laser-assisted cataract surgery (FLACS) with standard phacoemulsification cataract surgery (PCS). DESIGN: Multicenter, randomized controlled trial funded by the UK National Institute of Health Research (HTA 13/04/46/). PARTICIPANTS: Seven hundred eighty-five patients with age-related cataract. METHODS: This trial took place in 3 hospitals in the UK National Health Service (NHS). Randomization (1:1) was stratified by site, surgeon, and 1 or both eyes eligible using a secure web-based system. Postoperative assessments were masked to the allocated intervention. The primary outcome was unaided distance visual acuity (UDVA) in the study eye at 3 months. Secondary outcomes included corrected distance visual acuity, complications, and patient-reported outcomes measures. The noninferiority margin was 0.1 logarithm of the minimum angle of resolution (logMAR). ISRCTN.com registry, number ISRCTN77602616. MAIN OUTCOME MEASURES: We enrolled 785 participants between May 2015 and September 2017 and randomly assigned 392 to FLACS and 393 to PCS. At 3 months postoperatively, mean UDVA difference between treatment arms was -0.01 logMAR (-0.05 to 0.03), and mean corrected distance visual acuity difference was -0.01 logMAR (95% confidence interval [CI], -0.05 to 0.02). Seventy-one percent of both FLACS and PCS cases were within ±0.5 diopters (D) of the refractive target, and 93% of FLACS and 92% of PCS cases were within ±1.0 D. There were 2 posterior capsule tears in the PCS arm and none in the FLACS arm. There were no significant differences between arms for any secondary outcome. CONCLUSIONS: Femtosecond laser-assisted cataract surgery is not inferior to conventional PCS surgery 3 months after surgery. Both methods are as good in terms of vision, patient-reported health, and safety outcomes at 3 months. Longer-term outcomes of the clinical effectiveness and cost-effectiveness are awaited

Distressed in the queue? Psychophysiological and behavioral evidence for two alternative car-following techniques

Background. Nature offers numerous examples of animal species exhibiting harmonious collective movement. Unfortunately, the motorized Homo sapiens sapiens is not included and pays a price for it. Too often, drivers who simply follow other drivers are caught in the worst road threat after a crash: congestions. In the past, the solution to this problem has gone hand in hand with infrastructure investment. However, approaches such as the Nagoya Paradigm propose now to see congestion as the consequence of multiple interacting particles whose disturbances are transmitted in a waveform. This view clashes with a longlasting assumption ordering traffic flows, the rational driver postulate (i.e., drivers’ alleged propensity to maintain a safe distance). Rather than a mere coincidence, the worldwide adoption of the safety-distance tenet and the worldwide presence of congestion emerge now as cause and effect. Nevertheless, nothing in the drivers’ endowment impedes the adoption of other car-following (CF) strategies. The present study questions the a priori of safety-distance, comparing two elementary CF strategies, Driving to keep Distance (DD), that still prevails worldwide, and Driving to keep Inertia (DI), a complementary CF technique that offsets traffic waves disturbances, ensuring uninterrupted traffic flows. By asking drivers to drive DD and DI, we aim to characterize both CF strategies, comparing their effects on the individual driver (how he drives, how he feels, what he pays attention to) and also on the road space occupied by a platoon of DD robot-followers. Methods. Thirty drivers (50% women) were invited to adopt DD/DI in a driving simulator following a swinging leader. The design was a repeated measures model controlling for order. The CF technique, DD or DI, was the within-subject factor. Order (DD-DI / DI-DD) was the between-subjects factor. There were four blocks of dependent measures: individual driving performance (accelerations, decelerations, crashes, distance to lead vehicle, speed and fuel consumption), emotional dimensions (measures of skin conductance and self-reports of affective states concerning valence, arousal, and dominance), and visual behavior (fixations count and average duration, dwell times, and revisits) concerning three regions of the driving scene (the Top Rear Car –TRC- or the Bottom Rear Car –BRC- of the leading vehicle and the surrounding White Space Area -WSA). The final block concerned the road space occupied by a platoon of 8 virtual DD followers. Results. Drivers easily understood and applied DD/DI as required, switching back and forth between the two. Average speeds for DD/DI were similar, but DD drivers exhibited a greater number of accelerations, decelerations, speed variability, and crashes. Conversely, DI required greater CF distance, that was dynamically adjusted, and spent less fuel. Valence was similar, but DI drivers felt less aroused and more dominant. When driving DD visual scan was centered on the leader’s BRC, whereas DI elicited more attention to WSA (i.e., adopting wider vision angles). In spite of DI requiring more CF distance, the resulting road space occupied between the leader and the 8th DD robot was greater when driving DD

Random Changes of Accommodation Stimuli: An Automated Extension of the Flippers Accommodative Facility Test

Postprint (author's final draft