Agreement and clinical comparison between a new swept-source optical coherence tomography-based optical biometer and an optical low-coherence reflectometry biometer

Purpose To compare measurements taken using a swept-source optical coherence tomography-based optical biometer (IOLmaster 700) and an optical low-coherence reflectometry biometer (Lenstar 900), and to determine the clinical impacts of differences in their measurements on intraocular lens (IOL) power predictions. Methods Eighty eyes of 80 patients scheduled to undergo cataract surgery were examined with both biometers. The measurements made using each device were axial length (AL), central corneal thickness (CCT), aqueous depth (AQD), lens thickness (LT), mean keratometry (MK), white-to-white distance (WTW), and pupil diameter (PD). Holladay 2 and SRK/T formulas were used to calculate IOL power. Differences in measurement between the two biometers were determined using the paired t-test. Agreement was assessed through intraclass correlation coefficients (ICC) and Bland–Altman plots. Results Mean patient age was 76.3±6.8 years (range 59–89). Using the Lenstar, AL and PD could not be measured in 12.5 and 5.25% of eyes, respectively, while IOLMaster 700 took all measurements in all eyes. The variables CCT, AQD, LT, and MK varied significantly between the two biometers. According to ICCs, correlation between measurements made with both devices was excellent except for WTW and PD. Using the SRK/T formula, IOL power prediction based on the data from the two devices were statistically different, but differences were not clinically significant. Conclusions No clinically relevant differences were detected between the biometers in terms of their measurements and IOL power predictions. Using the IOLMaster 700, it was easier to obtain biometric measurements in eyes with less transparent ocular media or longer AL

Effect of pharmacological pupil dilation on measurements and iol power calculation made using the new swept-source optical coherence tomography-based optical biometer

Purpose: to determine whether pupil dilation affects biometric measurements and intraocular lens (IOL) power calculation made using the new swept-source optical coherence tomography-based optical biometer (IOLMaster 700©; Carl Zeiss Meditec, Jena, Germany). Procedures: eighty-one eyes of 81 patients evaluated for cataract surgery were prospectively examined using the IOLMaster 700© before and after pupil dilation with tropicamide 1%. The measurements made were: axial length (AL), central corneal thickness (CCT), aqueous chamber depth (ACD), lens thickness (LT), mean keratometry (MK), white-to-white distance (WTW) and pupil diameter (PD). Holladay II and SRK/T formulas were used to calculate IOL power. Agreement between measurement modes (with and without dilation) was assessed through intraclass correlation coefficients (ICC) and Bland-Altman plots. Results: mean patient age was 75.17 ± 7.54 years (range: 57–92). Of the variables determined, CCT, ACD, LT and WTW varied significantly according to pupil dilation. Excellent intraobserver correlation was observed between measurements made before and after pupil dilation. Mean IOL power calculation using the Holladay 2 and SRK/T formulas were unmodified by pupil dilation. Conclusions: the use of pupil dilation produces statistical yet not clinically significant differences in some IOLMaster 700© measurements. However, it does not affect mean IOL power calculation

Diagnostic Ability of Macular Nerve Fiber Layer Thickness Using New Segmentation Software in Glaucoma Suspects

Purpose. To assess the capacity of internal retinal layer thickness measurements made at the macula using new spectral-domain optical coherence tomography (OCT) software to distinguish between healthy subjects and those with suspected glaucoma. The diagnostic performance of such measurements also was compared with that of conventional peripapillary retinal nerve fiber layer (RNFL) thickness measurements. Methods. The study included 38 subjects with suspected glaucoma and 38 age-matched healthy subjects. In one randomly selected eye of each participant, thickness measurements at the level of the macula were made of the nerve fiber layer (mRNFL), the ganglion cell layer (GCL), and the ganglion cell complex (GCC; GCL + internal plexiform layer) through automated OCT segmentation. Peripapillary RNFL thickness (pRNFL) also was determined using the conventional scan. Results. As the only variable showing intergroup variation, mRNFL in the glaucoma suspects was significantly thinner in the quadrants inner inferior (P = 0.003), inner temporal (P = 0.010), and outer inferior (P = 0.017). The variable best able to discriminate between the two groups was inner inferior mRNFL thickness, as indicated by an area below the receiver operating characteristic (ROC) curve of 0.742. Conclusions. Macular RNFL thickness measurements showed an improved diagnostic capacity over the other variables examined to distinguish between healthy subjects and glaucoma suspects

Visual outcomes after bilateral trifocal diffractive intraocular lens implantation

Background In recent years new models of intraocular lenses are appearing on the market to reduce requirements for additional optical correction. The purpose of this study is to assess visual outcomes following bilateral cataract surgery and the implant of a FineVision® trifocal intraocular lens (IOL). Methods Prospective, nonrandomized, observational study. Vision was assessed in 44 eyes of 22 patients (mean age 68.4 ± 5.5 years) before and 3 months after surgery. Aberrations were determined using the Topcon KR-1 W wave-front analyzer. LogMAR visual acuity was measured at distance (corrected distance visual acuity, CDVA 4 m), intermediate (distance corrected intermediate visual acuity, DCIVA 60 cm) and near (distance corrected near visual acuity, DCNVA 40 cm). The Pelli-Robson letter chart and the CSV-1000 test were used to estimate contrast sensitivity (CS). Defocus curve testing was performed in photopic and mesopic conditions. Adverse photic phenomena were assessed using the Halo v1.0 program. Results Mean aberration values for a mesopic pupil diameter were: total HOA RMS: 0.41 ± 0.30 μm, coma: 0.32 ± 0.22 μm and spherical aberration: 0.21 ± 0.20 μm. Binocular logMAR measurements were: CDVA −0.05 ± 0.05, DCIVA 0.15 ± 0.10, and DCNVA 0.06 ± 0.10. Mean Pelli-Robson CS was 1.40 ± 0.14 log units. Mean CSV100 CS for the 4 frequencies examined (A: 3 cycles/degree (cpd), B: 6 cpd, C: 12 cpd, D: 18 cpd) were 1.64 ± 0.14, 1.77 ± 0.18, 1.44 ± 0.24 and 0.98 ± 0.24 log units, respectively. Significant differences were observed in defocus curves for photopic and mesopic conditions (p < 0.0001). A mean disturbance index of 0.28 ± 0.22 was obtained. Conclusions Bilateral FineVision IOL implant achieved a full range of adequate vision, satisfactory contrast sensitivity, and a lack of significant adverse photic phenomena. Trial registration Eudract Clinical Trials Registry Number: 2014-003266-2

A Diagnostic Calculator for Detecting Glaucoma on the Basis of Retinal Nerve Fiber Layer, Optic Disc, and Retinal Ganglion Cell Analysis by Optical Coherence Tomography

Purpose: The purpose of this study was to develop and validate a multivariate predictive model to detect glaucoma by using a combination of retinal nerve fiber layer (RNFL), retinal ganglion cell-inner plexiform (GCIPL), and optic disc parameters measured using spectral-domain optical coherence tomography (OCT). Methods: Five hundred eyes from 500 participants and 187 eyes of another 187 participants were included in the study and validation groups, respectively. Patients with glaucoma were classified in five groups based on visual field damage. Sensitivity and specificity of all glaucoma OCT parameters were analyzed. Receiver operating characteristic curves (ROC) and areas under the ROC (AUC) were compared. Three predictive multivariate models (quantitative, qualitative, and combined) that used a combination of the best OCT parameters were constructed. A diagnostic calculator was created using the combined multivariate model. Results: The best AUC parameters were: inferior RNFL, average RNFL, vertical cup/disc ratio, minimal GCIPL, and inferior-temporal GCIPL. Comparisons among the parameters did not show that the GCIPL parameters were better than those of the RNFL in early and advanced glaucoma. The highest AUC was in the combined predictive model (0.937; 95% confidence interval, 0.911–0.957) and was significantly (P = 0.0001) higher than the other isolated parameters considered in early and advanced glaucoma. The validation group displayed similar results to those of the study group. Conclusions: Best GCIPL, RNFL, and optic disc parameters showed a similar ability to detect glaucoma. The combined predictive formula improved the glaucoma detection compared to the best isolated parameters evaluated. The diagnostic calculator obtained good classification from participants in both the study and validation groups

Handbook for Moving towards Multiprofessional Work

This handbook was supposed to be a choral artwork and the result is a very choral and artistic patchwork. In the process of building up the project ‘MOMU – Moving towards Multiprofessional Work’, we sewed, we combined patterns to define new ones. We knew our shapes were different as were our fabrics but we learned to measure and cut in order to create a larger design. The results of this is what you can see in this handbook. We hope you’ll agree that the whole is greater than the sum of the parts. It has not been easy to piece this together. These types of processes bring with them discussions, arguments, discoveries, hopes, despair and bureaucratic requirements; all inevitable parts of such a complex process. However, it is honest to say that the process has been exciting and paves the way for future and productive collaborations. Along the way some of the participants left us: Carola Boehm and Esther Mercado; some others joined us: Pedro de la Paz. Some changes took place in our universities, new roles were assumed. This is also part of the richness of the tapestry. We are very thankful to all of them for their contribution. We thank the European Union for funding this project. For all of us it was the first time we had developed an Erasmus+ KA2 project and we had to apply the ‘learning by doing formula’, but we managed. We are very thankful to teachers who volunteered to participate in the training sessions, to practitioners who gave us important input and feedback and showed us how to improve and make our teaching more practical. Thanks also to our national steering groups for their clarity and recommendations. Importantly, our gratitude extends to our students: social work and art students, who were open to new perspectives and ways of exploring their place in the world and the job market. Youth unemployment in Europe continues to be an issue, but projects like MOMU aim to address this challenge in creative ways. However, we are at the very starting point and further steps are needed to make the new competence framework we have created a reality. This handbook intends to suggest and inspire instead of guiding the reader. It offers training packages to be adapted depending on contexts, whilst highlighting our successes and failures. We suggest it is read, considered and adapted. In other words, each person willing to put it into practice will have to assume that they will have to make their own patchwork

Atlas electrónico de registros retinográficos y tomográficos: cribado, derivación, diagnóstico diferencial para el seguimiento de afecciones retinianas

El objetivo de este proyecto es estructurar un Atlas electrónico retinográfico con imágenes obtenidas con los principales y novedosos instrumentos utilizados en la actualidad para el diagnóstico de patologías retinianas. El Atlas presentará, además de las imágenes, una detallada descripción de los aspectos que debe tenerse en cuenta en el momento de realizar el cribado, el diagnóstico. Además el seguimiento de una patología y la evolución en su tratamiento. Este Atlas, que estará constituido por una extensa relación de retinografías (fotografías del fondo de ojo – retina) y tomografías de coherencia óptica (imágenes de cortes histológicos de la retina en vivo), exponiendo casos reales de patologías comunes y poco comunes, constituye una herramienta con triple función: por un lado será un elemento didáctico para el aprendizaje de patologías retinianas y el método de diagnóstico por imagen; en segundo lugar, podrá utilizarse para realizar evaluaciones tipo test; y, en tercer lugar, constituirá una completa base de datos que podrá ser utilizado como material de consulta y diagnóstico comparado en la práctica clínica. En definitiva, se trata de una herramienta muy económica de gran utilidad para un amplio grupo de profesionales sanitarios expertos y especialistas en visión y en sistema ocular

New Normative Database of Inner Macular Layer Thickness Measured by Spectralis OCT Used as Reference Standard for Glaucoma Detection

Purpose: This study examines the capacity to detect glaucoma of inner macular layer thickness measured by spectral-domain optical coherence tomography (SD-OCT) using a new normative database as the reference standard. Methods: Participants (N = 148) were recruited from Leuven (Belgium) and Zaragoza (Spain): 74 patients with early/moderate glaucoma and 74 age-matched healthy controls. One eye was randomly selected for a macular scan using the Spectralis SD-OCT. The variables measured with the instrument's segmentation software were: macular nerve fiber layer (mRNFL), ganglion cell layer (GCL), and inner plexiform layer (IPL) volume and thickness along with circumpapillary RNFL thickness (cpRNFL). The new normative database of macular variables was used to define the cutoff of normality as the fifth percentile by age group. Sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC) of each macular measurement and of cpRNFL were used to distinguish between patients and controls. Results: Overall sensitivity and specificity to detect early-moderate glaucoma were 42.2% and 88.9% for mRNFL, 42.4% and 95.6% for GCL, 42.2% and 94.5% for IPL, and 53% and 94.6% for RNFL, respectively. The best macular variable to discriminate between the two groups of subjects was outer temporal GCL thickness as indicated by an AUROC of 0.903. This variable performed similarly to mean cpRNFL thickness (AUROC = 0.845; P = 0.29). Conclusions: Using our normative database as reference, the diagnostic power of inner macular layer thickness proved comparable to that of peripapillary RNFL thickness. Translational Relevance: Spectralis SD-OCT, cpRNFL thickness, and individual macular inner layer thicknesses show comparable diagnostic capacity for glaucoma and RNFL, GCL, and IPL thickness may be useful as an alternative diagnostic test when the measure of cpRNFL shows artifacts.status: publishe

Visual simulations of presbyopic corrections through cataract opacification

29 pags.To study the viability of visual simulation of presbyopic corrections in patients with cataract, the effect and impact of the cataract on the perceived visual quality of the different simulated presbyopic corrections pre- and post-operatively.This research was supported by Madrid Regional Government IND2017/BMD7670 to XB; IMCUSTOMEYE Ref. 779960 H2020 - EU.2.1.1. Industrial Leadership to SM; SILK-EYE Ref. 833106 Excellent Science – ERC to SM; Spanish Government Grant FIS2017-84753-R to SM; and ISCIII DTS16/00127 to CD.Peer reviewe

Effects of Implantable Collamer Lens V4c Placement on Iridocorneal Angle Measurements by Fourier-Domain Optical Coherence Tomography

Purpose To assess by Fourier-domain optical coherence tomography (FDOCT) changes produced in iridocorneal angle measurements in patients undergoing Visian Implantable Collamer Lens (ICL) V4c (STAAR Surgical AG) placement. Design Prospective interventional case series. Methods In 50 eyes of 25 myopic subjects consecutively scheduled for ICL implant, FDOCT (RTVue; Optovue Inc) iridocorneal angle measurements were made before and 1 and 3 months after surgery. Trabecular-iris angle (TIA) and angle opening distance 500 μm anterior to the scleral spur (AOD500) were compared among the quadrants nasal, temporal, and inferior, and correlations with ocular variables including lens vault were examined. Results Preoperative TIA was 48.7 ± 8.7, 48.2 ± 8.7, and 48.7 ± 9.3 degrees for the nasal, temporal, and inferior quadrants, with no differences (P= 1.000). Following ICL implant, corresponding values fell to 31.2 ± 11.5, 30.0 ± 10.7, and 29.7 ± 8.1 degrees at 1 month postsurgery, indicating angle narrowing of 34%-42%, and to 30.6 ± 12.3, 30.1 ± 11.9, and 29.8 ± 12.3 degrees, respectively, at 3 months postsurgery. Angle measurements failed to vary between 1 month and 3 months postsurgery (P= .481). In 8 eyes, iridotrabecular contact attributable to surgery was observed. One month after surgery, vault measurements correlated with TIA (R = -.309;P= .048). Six variables were identified as predictors of TIA at 1 month postsurgery (R2= .907). Conclusions Although considerable angle narrowing was detected 1 month after ICL V4c implant, this narrowing remained stable at 3 months postsurgery. Factors predictive of TIA could serve to identify suitable candidates for ICL placement