Web-based telemonitoring of visual function and self-reported postoperative outcomes in cataract care: international multicenter randomized controlled trial

Purpose: To compare web-based, self-administered follow-up after cataract surgery to conventional face-to-face follow-up. Setting: Eye clinics in the Netherlands, Austria, and Germany. Design: Randomized controlled trial with an embedded method comparison study (ClinicalTrials. gov: NCT04809402). Methods: Routine patients with cataract were randomized into 2 groups: The telemonitoring group undertook web-based vision self-assessments and questionnaires from home, while the usual care group received conventional care. All participants had a 4- to 6-week postoperative clinic visit for safety and validation purposes. Outcomes included, the web test's accuracy for assessing postoperative visual acuity (VA) and refractive error, adverse event rates, and patient-reported outcome measurements (PROMs). Results: 94 participants (188 eyes) were enrolled. Web-based uncorrected distance VA testing demonstrated a negligible mean difference (-0.03 ± 0.14 logMAR) when compared with conventional Early Treatment Diabetic Retinopathy Study chart testing, with 95% limits of agreement ranging from -0.30 to 0.24 logMAR. The web-based refraction assessment overestimated the postoperative refractive error (mean difference in spherical equivalent 0.15 ± 0.67 diopters), resulting in a poorer corrected distance VA compared with subjective refraction (mean 0.1 vs -0.1 logMAR). Rates of adverse events and unscheduled consultations were minimal across both groups. Preoperative and postoperative PROM questionnaires had a 100% response rate. Visual functioning (Catquest-9SF and National Eye Institute Visual Function Questionnaire-25) improved postoperatively (mean improvement -0.80 and 16.70, respectively) and did not significantly differ between the 2 groups. Conclusions: The patients with cataract in this study effectively provided postoperative outcome data using a web interface. Both conventional and web-based follow-ups yielded similar PROMs and adverse event rates. Future developments should reduce the variability in the web-based VA test and yield representative refraction outcomes

The effect of Nd:YAG laser capsulotomy on refraction in multifocal apodized diffractive pseudophakia.

Purpose The primary goal is to evaluate the effect of Neodymium:YAG (Nd:YAG) laser posterior capsulotomy for posterior capsule opacification (PCO) on refraction in multifocal apodized diffractive pseudophakia. The secondary goal is the evaluation of the correlation between automated and subjective refraction in this type of multifocal lenses. Setting: Combined private refractive surgery clinic, Retina Total Eye Care in Driebergen, and tertiary care ophthalmology clinic at the Academic Medical Center, University of Amsterdam, the Netherlands. Methods: This retrospective chart review comprised 75 pseudophakic eyes (55 consecutive patients) with a SN6AD1 or SN6AD3 IOL after cataract surgery or refractive lens exchange, treated for posterior capsule opacification with Nd:YAG laser posterior capsulotomy. Values of monocular uncorrected distance acuity (UCDA), monocular corrected distance acuity (CDVA), spherical equivalent (SE), defocus equivalent (DE), astigmatic power vectors J0 and J45 and overall blurring strength (B) after Nd:YAG posterior capsulotomy were compared with values of before the intervention. The amount of energy used during Nd:YAG posterior capsulotomy and the severity of PCO were evaluated to determine correlation with change in refraction. Values of autorefraction were compared with those of subjective refraction to determine the correlation between the two methods. Results: Visual acuity improved statistically significant in both UDVA and CDVA (P<0.001). There were no statistically significant changes in SE, DE, J0, J45 and B in subjective refraction (P=0.369, P=0.993, P=0.524, P=0.648 and P=0.686). SE changed statistically significant in autorefraction (P=0.008) but this change was small (mean -0.10 ± 0.27) and is clinically not relevant. No statistically significant change is observed in DE, J0, J45 and B in autorefraction (P=0.584, P=0.654, P=0.336 and P=0.338). Four eyes (7,2%) in the SE and 8 eyes (14,5%) in the DE showed a change of >0,5D in subjective refraction. Of those eyes, 3 eyes (5,5%) had a deterioration of the refractive error. The amount of energy used during Nd:YAG posterior capsulotomy shows to have a very weak (J45 rho=-0.29, P=0.033) or no effect (P>0.05 for SE, DE, J0 and B) on subsequent lens movement. The severity of PCO is not related to changes in refraction (P>0.05). Autorefraction and subjective refraction are highly correlated in SE, DE and B (r2>0.59), but are weakly correlated in J0 and J45 (r2<0.14). Conclusions: Nd:YAG laser capsulotomy in multifocal pseudophakic patients mostly results in unchanged refraction. However in ~7% of eyes a change of >0,5D in subjective refraction occurs. Autorefraction can give a good prediction of SE, DE and B in subjective refraction in eyes with apodized diffractive multifocal IOLs, but can not give a good prediction of the astigmatic power vectors.

Multifocal intraocular lens implantation after previous hyperopic corneal refractive laser surgery

Purpose: To describe the outcomes in terms of the refraction and visual acuity of multifocal intraocular lens (IOL) implantation in patients with previous hyperopic corneal refractive laser surgery. Setting: Academic Medical Center, University of Amsterdam, Amsterdam, and Retina Total Eye Care, Driebergen, the Netherlands. Design: Retrospective case series. Methods: Results were analyzed 3 months after implantation of a multifocal IOL (Acrysof Restor SN6AD1) in patients after previous corneal refractive laser surgery for hyperopia. The primary outcome measures were uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and refraction. The secondary outcome measures were the number of laser enhancements and posterior capsule opacification (PCO) rates. Results: Forty eyes of 40 patients were included. Sixteen eyes (40.0%) had lens extraction because of cataract, and 24 eyes (60.0%) had refractive lens exchange. The mean postoperative UDVA was 0.16 logarithm of the minimum angle of resolution (logMAR) ± 0.18 (SD), and the mean postoperative CDVA was 0.01 ± 0.08 logMAR. The mean postoperative spherical equivalent was 0.04 ± 0.92 diopter (D). Twenty-five eyes (62.5%) were within ±0.50 D of emmetropia, and 35 eyes (87.5%) were within ±1.0 D of emmetropia. Nine eyes (22.5%) had a laser enhancement because of a residual refraction error. Eleven eyes (27.5%) had a neodymium:YAG laser capsulotomy because of PCO. Conclusions: In general, multifocal IOL implantation after corneal refractive laser surgery for hyperopia resulted in good visual acuity and refraction. The magnitude of previous hyperopia did not influence the refractive predictability

Multifocal intraocular lens implantation after previous corneal refractive laser surgery for myopia

Purpose: To describe the refraction and visual acuity outcomes of multifocal intraocular lens (IOL) implantation in patients with previous corneal refractive laser surgery for myopia. Setting: Academic Medical Center, University of Amsterdam, Amsterdam, and Retina Total Eye Care, Driebergen, the Netherlands. Design: Retrospective cohort study. Methods: The 3-month results after implantation of a multifocal IOL (Acrysof Restor) in patients who had corneal refractive laser surgery for myopia were analyzed. The primary outcome measures were corrected distance visual acuity, uncorrected distance visual acuity (UDVA), and refraction. The secondary outcome measures were number of laser enhancements, corneal irregularity, pre-laser magnitude of myopia, and posterior capsule opacification (PCO) rate. Results: Seventy-seven eyes of 43 patients were included. Twenty-nine eyes had lens extraction because of cataract, and 48 eyes had a refractive lens exchange. The mean postoperative UDVA was 0.14 logarithm of minimum angle of resolution +/- 0.22 (SD). The mean postoperative spherical equivalent was -0.38 +/- 0.78 diopter (D). Fifty-seven percent of eyes were within +/- 0.50 D of emmetropia, and 86% were within +/- 1.0 D. Sixteen eyes (20.8%) had laser enhancement because of residual refraction. Fourteen eyes (18.2%) had a neodymium:YAG laser capsulotomy because of PCO. Eyes with pre-laser myopia greater than 6.0 D had a less predictable outcome than eyes with pre-laser myopia less than 6.0 D (P = .026). Conclusions: Multifocal IOL implantation after corneal refractive laser surgery for myopia resulted in good visual acuity and refraction. Results were less predictable with myopia greater than 6.0 D. (C) 2017 ASCRS and ESCR

Evaluation of different IOL calculation formulas of the ASCRS calculator in eyes after corneal refractive laser surgery for myopia with multifocal IOL implantation

PURPOSE: To compare the accuracy of different intraocular lens (IOL) calculation formulas available on the American Society of Cataract and Refractive Surgery (ASCRS) post-refractive surgery IOL power calculator for the prediction of multifocal IOL power after previous corneal refractive laser surgery for myopia. METHODS: An analysis and comparison were performed of the accuracy of three methods using surgically induced change in refraction (ie, Masket, Modified Masket, and Barrett True-K formulas) and three methods using no previous data (ie, Shammas, Haigis-L, and Barrett True-K No History formulas). The average of all formulas was also analyzed and compared. RESULTS: Thirty-six eyes of 36 patients were included. All formulas, except for the Masket, Modified Masket, and Barrett True-K formulas, had myopic mean numerical errors that were significantly different from zero (P ≤ .01). The median absolute error of the Shammas formula (0.52 diopters [D]) was significantly higher compared to all of the other formulas (P < .05), except for the Haigis-L formula (P = .09). Comparing the formulas using no previous data, the Barrett True-K No History formula had the lowest median absolute error (0.33 D, P < .001). CONCLUSIONS: The Shammas formula showed the least accuracy in predicting IOL power in eyes with multifocal IOL implantation after previous corneal refractive laser surgery for myopia. In eyes with all available data, all formulas performed equally except for the Shammas formula, whereas in eyes lacking historical data, the Barrett True-K No History formula performed best

Indications for and outcomes of tertiary referrals in refractive surgery

To review the spectrum of disease, symptomatology, and management offered to patients referred for a second opinion after refractive surgery. A prospective cohort study was done on all patients referred from October 1, 2006, to September 30, 2011, to a tertiary eye clinic after refractive surgery of any kind (ie, corneal laser surgery, conductive keratoplasty, radial keratotomy, phakic implants, refractive lens exchanges, or any combination thereof). Data analysis was performed on all demographic and clinical aspects of this cohort, including the initial complaint, type of referral, number of complaints, procedure previously performed, diagnosis at our center, type of advice given, and rate and type of surgical intervention. One hundred thirty-one eyes (69 patients) were included. Corneal refractive surgery was performed in 82% (108 eyes), and 11% (14 eyes) were seen after phakic intraocular lens (PIOL) implantation and 7% (9 eyes) after refractive lens exchange. The most common diagnoses were tear film dysfunction (30 eyes, 23%), residual refractive error (25 eyes, 19%), and cataract (20 eyes, 15%). Most patients (42 patients, 61%) were treated conservatively. In 27 patients (39%), 36 eyes (28%) were managed surgically. Severe visual loss was seen in 1 eye. No major problems were found in most second opinions after refractive surgery referral. Dry eyes, small residual refractive error, or higher-order aberrations were the most common complaints. Surgical intervention was needed in 36 eyes (28%), almost half of which were cataract extractions. Severe visual loss was seen in 1 eye with a PIOL. There was no incidence of severe visual loss in keratorefractive and refractive lens exchange procedure

ASCRS calculator formula accuracy in multifocal intraocular lens implantation in hyperopic corneal refractive laser surgery eyes

Purpose: To evaluate the accuracy of different intraocular lens (IOL)power calculation formulas available on the American Society of Cataract and Refractive Surgery calculator in calculating multifocal IOL power in eyes with previous hyperopic corneal refractive laser surgery. Design: Retrospective case series. Setting: Amsterdam University Medical Center, University of Amsterdam, and Retina Total Eye Care, Driebergen, the Netherlands. Methods: This study compared the accuracy of 3 formulas using historical refractive data (ie, Masket, modified Masket, and Barrett True-K)and 3 formulas using no previous refractive data (ie, Shammas, Haigis-L, and Barrett True-K no-history). Results: Sixty-four eyes were included. The variance of the prediction error of the various formulas was similar and ranged from 0.27 D 2 to 0.33 D 2 (P =.99). The modified Masket formula had a significantly higher median absolute prediction error than the Masket formula, Barrett True-K formula, and mean value of all formulas (P <.001). Conclusion: All formulas showed comparable accuracy in predicting IOL power in eyes after hyperopic corneal refractive laser surgery except for the modified Masket formula, which performed less accurately than the Masket formula, Barrett True-K formula, and mean value of all formulas

Effect of Nd:YAG Laser Capsulotomy on Refraction in Multifocal Apodized Diffractive Pseudophakia

PURPOSE: To evaluate the effect on refraction of neodymium:YAG (Nd:YAG) laser posterior capsulotomy for posterior capsule opacification (PCO), and to evaluate the correlation between automated and subjective refraction in multifocal apodized diffractive pseudophakia. METHODS: A retrospective study of 75 pseudophakic eyes (50 patients) with multifocal apodized diffractive pseudophakia, treated for PCO with Nd:YAG laser posterior capsulotomy, was performed. Pre- and postintervention values of refractive and visual parameters were compared. The outcomes of autorefraction and subjective refraction were also compared. RESULTS: Uncorrected and corrected distance visual acuity improved significantly after Nd:YAG capsulotomy (P 0.59). In approximately 7% of eyes, a change of more than 0.50 diopters in spherical equivalent in subjective refraction occurred. CONCLUSIONS: In most cases, Nd:YAG laser capsulotomy in patients with multifocal pseudophakia did not result in a change in refraction. However, 7% of eyes experienced a significant change in subjective refraction. Autorefraction correlated well with subjective refraction in apodized diffractive multifocal IOLs. [J Refract Surg. 2012;28(8):545-550.] doi:10.3928/1081597X-20120723-0

Autorefraction versus subjective refraction in a radially asymmetric multifocal intraocular lens

Item does not contain fulltextPURPOSE: To evaluate whether the automated refraction (AR) correlates with subjective manifest (MR) refraction in eyes implanted with radially asymmetric multifocal intraocular lens (IOLs). METHODS: This retrospective study evaluated 52 eyes (52 patients) implanted with a radially asymmetric multifocal IOL (LS-312 MF30, Oculentis, Germany). At 3 months postoperatively, the AR and MR values were compared to determine the correlation between the sphere (S), the spherical equivalent (SE) and the astigmatic components J0 and J45. RESULTS: The difference of mean spherical measurement was +0.98D +/- 0.62, with the AR measuring more myopic. The difference of the mean spherical equivalent was +1.11D +/- 0.57, again with AR being more myopic. Both these differences were statistically significant (p < 0.001). The astigmatic components showed less differences, with the mean difference of the J0 being -0.09D +/- 0.43, and the J45 of +0.04D +/- 0.47, which were both not statistically significant (p = 0.123 and p = 0.531, respectively). Correlation analysis of the refractive parameters showed r(2) = 0.067, r(2) = 0.078, r(2) = 0.018 and r(2) = 0.015, respectively, all of which point to a low correlation between the AR and the MR. CONCLUSION: Autorefraction shows poor correlation to manifest subjective refraction with these radially asymmetric multifocal IOLs. The autorefraction systematically underestimates the spherical and spherical equivalent power, while the correlation between the astigmatic components was also low. Autorefraction seems not a valid starting point for manifest subjective refraction with these types of lenses, unless a corrective factor of about +1 dioptre is used