Objective evaluation of negative dysphotopsia with Goldmann kinetic perimetry

PurposeTo compare the extension of peripheral visual fields in phakic and pseudophakic patients and to evaluate whether Goldmann kinetic perimetry can be used as an objective measure of negative dysphotopsia.\u3cbr/\u3eSettingUniversity Eye Clinic, Maastricht University Medical Centre, Maastricht, the Netherlands.\u3cbr/\u3eDesignProspective and case-control study.MethodsKinetic perimetry was performed with V4e and I4e stimuli. Visual fields were assessed in the following 4 quadrants: superior temporal, superior nasal, inferior temporal, and inferior nasal. In the control group, patients were evaluated before and 1 month after cataract surgery. Biometric and perimetric data in the control group were compared with data in the patients with negative dysphotopsia (study group).ResultsEach group comprised 10 patients. In the control group, the extension of visual field did not change after surgery. Patients in the study group had a significantly shorter axial length and higher intraocular lens powers than those in the control group. The inferior temporal and inferior nasal quadrants were, respectively, 10 degrees and 6 degrees (P < .05) smaller in the study group than in the control group. In 3 patients with negative dysphotopsia, a shadow was drawn in the superior temporal and the inferior temporal quadrants during perimetry and the position of this shadow matched their subjective description of negative dysphotopsia.\u3cbr/\u3eConclusionsThe peripheral visual field did not change after cataract surgery in patients without negative dysphotopsia. Kinetic perimetry can be used for objective evaluation of patients with negative dysphotopsia because these patients had constricted peripheral visual fields or a relative temporal scotoma corresponding to the position of the shadow

Objective evaluation of negative dysphotopsia with Goldmann kinetic perimetry

PurposeTo compare the extension of peripheral visual fields in phakic and pseudophakic patients and to evaluate whether Goldmann kinetic perimetry can be used as an objective measure of negative dysphotopsia.\u3cbr/\u3eSettingUniversity Eye Clinic, Maastricht University Medical Centre, Maastricht, the Netherlands.\u3cbr/\u3eDesignProspective and case-control study.MethodsKinetic perimetry was performed with V4e and I4e stimuli. Visual fields were assessed in the following 4 quadrants: superior temporal, superior nasal, inferior temporal, and inferior nasal. In the control group, patients were evaluated before and 1 month after cataract surgery. Biometric and perimetric data in the control group were compared with data in the patients with negative dysphotopsia (study group).ResultsEach group comprised 10 patients. In the control group, the extension of visual field did not change after surgery. Patients in the study group had a significantly shorter axial length and higher intraocular lens powers than those in the control group. The inferior temporal and inferior nasal quadrants were, respectively, 10 degrees and 6 degrees (P < .05) smaller in the study group than in the control group. In 3 patients with negative dysphotopsia, a shadow was drawn in the superior temporal and the inferior temporal quadrants during perimetry and the position of this shadow matched their subjective description of negative dysphotopsia.\u3cbr/\u3eConclusionsThe peripheral visual field did not change after cataract surgery in patients without negative dysphotopsia. Kinetic perimetry can be used for objective evaluation of patients with negative dysphotopsia because these patients had constricted peripheral visual fields or a relative temporal scotoma corresponding to the position of the shadow

Effect of supplementary implantation of a sulcus-fixated intraocular lens in patients with negative dysphotopsia

Purpose: To evaluate whether the outcome of negative dysphotopsia treatment by implantation of a Sulcoflex intraocular lens (IOL) can be understood using individual biometry and optical modeling data. Setting: University Eye Clinic, Maastricht University Medical Centre, Maastricht, the Netherlands. Design: Retrospective case series. Methods: Patients with negative dysphotopsia were treated with supplementary implantation of a sulcus-fixated IOL. Preoperative and postoperative ray-tracing optical models of eyes with negative dysphotopsia were constructed in the Zemax Optic Studio program using individual biometric data. The relationship between biometric parameters, ray-tracing data, and the course of negative dysphotopsia was evaluated. Results: The study comprised 8 patients (10 eyes). After surgery, negative dysphotopsia resolved completely in 6 eyes, partially in 2 eyes, and persisted in 2 eyes. There was no relationship between the course of negative dysphotopsia and age, IOL power, or individual biometry results other than a larger angle κ that was observed in 2 patients with persistent negative dysphotopsia after surgery. Preoperative ray-tracing models showed a decrease in light irradiance at the periphery relative to the center of visual field. After sulcus-fixated IOL implantation, this decrease partially resolved, in particular, for a small pupil aperture (P <.05), and it was more prominent in patients in whom negative dysphotopsia resolved completely than in those with partial or persistent negative dysphotopsia (P =.065 at 1.5 mm aperture). Conclusions: Of all individual biometry results, only angle κ showed a relationship with the course of negative dysphotopsia. In patient-specific optical modeling of sulcus-fixated IOL implantation, the increase in simulated light irradiance at the periphery was related to the course of negative dysphotopsia

Treatment of negative dysphotopsia with supplementary implantation of a sulcus-fixated intraocular lens

Purpose\u3cbr/\u3e\u3cbr/\u3eOur aim was to evaluate the resolution of negative dysphotopsia after supplementary implantation of a sulcus-fixated intraocular lens (IOL).\u3cbr/\u3e\u3cbr/\u3eMethods\u3cbr/\u3e\u3cbr/\u3eThis was a retrospective case series. Patients with severe negative dysphotopsia were treated with supplementary implantation of the Rayner Sulcoflex Aspheric (653 L) IOL. Primary outcome measurements were subjectively reported complaints of dysphotopsia, best corrected distance visual acuity (CDVA), iris-IOL distance, anterior chamber depth (ACD) and volume (ACV), angle opening distance and trabecular-iris space area at 500 and 750 μm.\u3cbr/\u3e\u3cbr/\u3eResults\u3cbr/\u3e\u3cbr/\u3eA Rayner Sulcoflex IOL was implanted in seven patients (nine eyes) with negative dysphotopsias. Symptoms resolved completely in six eyes, partially in one eye and remained unchanged in two eyes. We did not find any significant changes in CDVA. Angle opening distance, ACD, ACV and iris-IOL distance reduced significantly after Sulcoflex IOL implantation.\u3cbr/\u3e\u3cbr/\u3eConclusions\u3cbr/\u3e\u3cbr/\u3eSupplementary implantation of a Sulcoflex IOL can successfully treat negative dysphotopsia. The decrease in anterior segment dimensions in combination with the displacement of light rays by the rounded edges of a Sulcoflex IOL may contribute to the resolution of symptoms

Effect of supplementary implantation of a sulcus-fixated intraocular lens in patients with negative dysphotopsia

\u3cp\u3ePurpose: To evaluate whether the outcome of negative dysphotopsia treatment by implantation of a Sulcoflex intraocular lens (IOL) can be understood using individual biometry and optical modeling data. Setting: University Eye Clinic, Maastricht University Medical Centre, Maastricht, the Netherlands. Design: Retrospective case series. Methods: Patients with negative dysphotopsia were treated with supplementary implantation of a sulcus-fixated IOL. Preoperative and postoperative ray-tracing optical models of eyes with negative dysphotopsia were constructed in the Zemax Optic Studio program using individual biometric data. The relationship between biometric parameters, ray-tracing data, and the course of negative dysphotopsia was evaluated. Results: The study comprised 8 patients (10 eyes). After surgery, negative dysphotopsia resolved completely in 6 eyes, partially in 2 eyes, and persisted in 2 eyes. There was no relationship between the course of negative dysphotopsia and age, IOL power, or individual biometry results other than a larger angle κ that was observed in 2 patients with persistent negative dysphotopsia after surgery. Preoperative ray-tracing models showed a decrease in light irradiance at the periphery relative to the center of visual field. After sulcus-fixated IOL implantation, this decrease partially resolved, in particular, for a small pupil aperture (P &lt;.05), and it was more prominent in patients in whom negative dysphotopsia resolved completely than in those with partial or persistent negative dysphotopsia (P =.065 at 1.5 mm aperture). Conclusions: Of all individual biometry results, only angle κ showed a relationship with the course of negative dysphotopsia. In patient-specific optical modeling of sulcus-fixated IOL implantation, the increase in simulated light irradiance at the periphery was related to the course of negative dysphotopsia.\u3c/p\u3

Effect of supplementary implantation of a sulcus-fixated intraocular lens in patients with negative dysphotopsia

PURPOSE: To evaluate whether the outcome of negative dysphotopsia treatment by implantation of a Sulcoflex intraocular lens (IOL) can be understood using individual biometry and optical modeling data. SETTING: University Eye Clinic, Maastricht University Medical Centre, Maastricht, the Netherlands. DESIGN: Retrospective case series. METHODS: Patients with negative dysphotopsia were treated with supplementary implantation of a sulcus-fixated IOL. Preoperative and postoperative ray-tracing optical models of eyes with negative dysphotopsia were constructed in the Zemax Optic Studio program using individual biometric data. The relationship between biometric parameters, ray-tracing data, and the course of negative dysphotopsia was evaluated. RESULTS: The study comprised 8 patients (10 eyes). After surgery, negative dysphotopsia resolved completely in 6 eyes, partially in 2 eyes, and persisted in 2 eyes. There was no relationship between the course of negative dysphotopsia and age, IOL power, or individual biometry results other than a larger angle κ that was observed in 2 patients with persistent negative dysphotopsia after surgery. Preoperative ray-tracing models showed a decrease in light irradiance at the periphery relative to the center of visual field. After sulcus-fixated IOL implantation, this decrease partially resolved, in particular, for a small pupil aperture (P < .05), and it was more prominent in patients in whom negative dysphotopsia resolved completely than in those with partial or persistent negative dysphotopsia (P = .065 at 1.5 mm aperture). CONCLUSIONS: Of all individual biometry results, only angle κ showed a relationship with the course of negative dysphotopsia. In patient-specific optical modeling of sulcus-fixated IOL implantation, the increase in simulated light irradiance at the periphery was related to the course of negative dysphotopsia

Effect of active evaluation on the detection of negative dysphotopsia after sequential cataract surgery: discrepancy between incidences of unsolicited and solicited complaints

\u3cbr/\u3ePurpose\u3cbr/\u3eTo evaluate the incidence of negative dysphotopsia after sequential cataract surgery.\u3cbr/\u3eMethods\u3cbr/\u3eRetrospective cohort study. The incidence of negative dysphotopsia was assessed by retrospective reviewing of medical records and interviews with patients between 2 and 4 months after sequential cataract surgery. Inclusion criteria were uncomplicated surgery, postoperative corrected distance visual acuity (CDVA) ≥20/25 Snellen and the absence of ocular comorbidity. The majority of intra-ocular lens (IOL) implants were one-piece AcrySof SN60WF (161 eyes). Other IOLs (29 eyes) were toric (SN6AT3-6), spherical (SN60AT), three-piece (MN60MA) and multifocal (ReSTOR SN6AD1, PanOptix TFNT00 and Finevision Micro F trifocal).\u3cbr/\u3eResults\u3cbr/\u3eThe study population was comprised of 95 patients with a mean age of 72 ± 10 years. Unsolicited complaints of negative dysphotopsia were reported by eight patients (8%), and two of them had a resolution of symptoms within 1 month of follow-up. Eighteen patients (19%) reported negative dysphotopsia at the time of the interview. Two patients reported bothersome negative dysphotopsia, and one of them was successfully treated with implantation of a supplementary IOL in the ciliary sulcus. Patients with negative dysphotopsia were younger than patients without dysphotopsia (p = 0.045) and had shorter axial eye length (p = 0.04), a tendency for higher IOL power (p = 0.09) and a higher CDVA (p = 0.001).\u3cbr/\u3eConclusion\u3cbr/\u3eThe incidence of unsolicited negative dysphotopsia after sequential cataract surgery appears to be a substantial underestimation of complaints identified in active interviewing. Although symptoms are not bothersome in the majority of cases, some patients with undiagnosed severe negative dysphotopsia may benefit from reassurance or secondary treatment.\u3cbr/\u3

Comparability of subjective and objective measurements of nuclear density in cataract patients

Purpose To evaluate the relationship between subjective and objective measurements of lens density and the energy of phacoemulsification. Setting University Eye Clinic, Maastricht University Medical Centre, Maastricht, the Netherlands. Design Cross‐sectional study. Methods The study population included 69 patients. Nuclear opalescence (NO) was graded with the Lens Opacities Classification System III (LOCS III). Thereafter, lens density was measured objectively with Scheimpflug imaging, anterior segment optical coherent tomography and spectral fundus reflectometry (SFR). Cumulative dissipative energy (CDE) and total ultrasound time (US t.t.) of the phacoemulsification were noted. The relationship between the different measurement techniques and energy of phacoemulsification was assessed using Spearman's correlation coefficients. Results We found moderate to strong correlations between LOCS III and objective measurements of the lens density (rho's from 0.53 to 0.78, p < 0.05) and a moderate correlation between three objective measurement techniques (rho's between 0.29 and 0.57, p < 0.05). There was a moderate correlation between CDE, US t.t. and lens density measurements (rho's from 0.29 to 0.55, p < 0.05), and the highest correlation was found between CDE and NO scores. Exclusion of patients with advanced cortical and posterior subcapsular opacities improved the correlation between SFR and lens density measurements but not the correlation with the energy of phacoemulsification. Conclusion Lens Opacities Classification System III has shown the highest correlation with phacoemulsification energy and may be a preferred technique for prediction of use of phacoemulsification energy. Advanced cortical and posterior opacities may interfere with the quality of objective measurements but do not affect the correlation between lens density measurements and phacoemulsification energy

Comparison of a trifocal intraocular lens with a+3.0 D bifocal IOL: results of a prospective randomized clinical trial

Purpose To compare visual outcomes in patients with cataract surgery and bilateral implantation of a trifocal or bifocal intraocular lens (IOL). Setting University Eye Clinic Maastricht, the Netherlands. Design Prospective randomized clinical trial. Methods Eyes with cataract and less than 1.0 diopter (D) of corneal astigmatism were randomized to receive bilateral implantation of Finevision Micro F trifocal IOLs or Acrysof IQ Restor +3.0 bifocal IOLs. Outcome measures were monocular and binocular uncorrected distance (UDVA), uncorrected intermediate (UIVA), and uncorrected near (UNVA) visual acuities; refractive outcomes; binocular defocus curve; contrast sensitivity; reading speed; patient satisfaction; and spectacle independence. Results Six months postoperatively, the mean binocular UDVA, UIVA, and UNVA in 56 eyes of 28 patients were 0.01 logMAR ± 0.11 (SD), 0.32 ± 0.15 logMAR, and 0.15 ± 0.13 logMAR in the trifocal group (n = 15) and 0.00 ± 0.09 logMAR, 0.28 ± 0.08 logMAR, and 0.12 ± 0.08 logMAR in the bifocal group (n = 13), respectively. The trifocal group showed a more continuous defocus curve and better results at −1.0 D of defocus (P &lt; .01). The mean mesopic contrast sensitivity was higher in the bifocal group (P = .02). Complete spectacle independence was reported by 80% of trifocal patients and 50% of bifocal patients. There were no significant differences in refractive outcomes, reading speed, or patient satisfaction. Conclusion This study showed noninferiority of visual outcomes with the trifocal IOL compared with the bifocal IOL, although the defocus curve was better at an intermediate distance with the trifocal IOL. Financial Disclosure Dr. Bauer received study grants from Alcon Laboratories, Inc., Carl Zeiss Meditec AG, and Physiol S.A. and a lecture fee from Alcon Surgical, Inc. Dr. Nuijts is a consultant to Alcon Surgical, Inc., Théa Pharma GmbH, and ASICO LLC; he has received study grants from Acufocus, Inc., Alcon Surgical, Inc., Carl Zeiss Meditec AG, Ophtec BV, and Physiol S.A. No other author has a financial or proprietary interest in any material or method mentioned. Cataract is an age-related eye disease leading to an impairment of patients’ daily functioning as well as optical disturbances such as glare and halos.1 In 2010, an estimated 95 million people worldwide had cataracts.2 Surgical removal of the crystalline lens and replacement with an artificial intraocular lens (IOL) is the only vision-restoring option. After implantation of a monofocal IOL, reading glasses are usually needed for near vision, whereas multifocal IOLs result in better uncorrected near visual acuity (UNVA) with a reduced overall spectacle dependence.1, 3 and 4 Multifocal IOLs function by projecting multiple images on the retina, which may result in unwanted visual phenomena such as contrast reduction, glare, and halos.3, 4, 5, 6, 7, 8, 9, 10, 11 and 12 Because most multifocal IOLs have only 2 foci, near and far, the quality of intermediate visual acuity might be insufficient for successful functioning in daily life.13 and 14 Trifocal IOLs have been developed to improve vision at intermediate distances.13 and 15 The goal of this randomized clinical trial was to compare the visual outcomes of a new trifocal IOL with those of a commonly used bifocal IOL. Patients and methods Patient Selection A randomized clinical study design was used to compare visual function and patient satisfaction after bilateral IOL implantation in patients treated for age-related cataract. Both patient enrollment and treatment took place at the University Eye Clinic Maastricht. Approval from the medical ethics committee was obtained, and all procedures were conducted according to the Declaration of Helsinki. Written informed consent was obtained from all patients. Inclusion criteria were bilateral cataract, less than 1.0 diopter (D) corneal astigmatism in both eyes, age over 42 years, and an expected postoperative corrected distance visual acuity (CDVA) of 0.3 logMAR or less. Exclusion criteria were combined ocular procedures, previous ocular surgery, ocular pathology that would limit postoperative visual outcome, suturing of the incision during surgery, and complications during surgery in the first eye. After enrollment, random allocation of study patients was performed to bilateral implantation of a trifocal IOL (trifocal group) or a bifocal IOL (bifocal group). Patients and investigators were masked. Surgical Technique Two experienced surgeons (N.B., R.N.) performed all surgical procedures, which consisted of a standard phacoemulsification technique through a 2.2 mm clear corneal incision. Surgery in the second eye was performed within 2 weeks of the first surgery in each patient. The same type of IOL was implanted in both eyes. The study used 2 types of IOLs: the Finevision Micro F trifocal IOL (Physiol S.A.) (Figure 1) and the Acrysof Restor IQ +3.0 D bifocal IOL (Alcon Surgical, Inc.) (Figure 2). The trifocal IOL is a foldable single-piece fully diffractive pupil-dependent aspheric IOL made of a hydrophilic acrylic with an ultraviolet (UV)- and blue-light inhibitor.13 and 15 It has an optic diameter of 6.15 mm, an overall diameter of 10.75 mm, and a 4-point haptic design for stability. It has +3.5 D additional power for near vision and +1.75 D additional power for intermediate vision, consists of 26 diffractive steps, and requires a minimum incision of 1.8 mm. The bifocal IOL is a foldable, single-piece, pupil-dependent aspheric biconvex IOL with a 3.6 mm center and 9 apodized diffractive steps.15 It is made of a hydrophobic acrylate/methacrylate copolymer with an UV-light and blue-light blocker. The optic diameter is 6.0 mm, and the overall diameter is 13.0 mm. It has +3.0 D additional power for near vision