Vision-related quality of life comparison for emmetropes, myopes after refractive surgery, and myopes wearing spectacles or contact lenses

PURPOSE: To compare the vision-related quality of life among emmetropes, myopes who had refractive surgery, and myopes who wore spectacles and/or contact lenses. METHODS: This cross-sectional study assessed vision-related quality of life using the Vision Quality of Life Index. Participants were age 18 years or older with a presenting visual acuity of 20/40 or better and no other ocular pathology. Responses were compared among three groups: emmetropes (spherical equivalent [SE] < 0.50 to > -0.50 diopters [D]), myopes (SE < or = -0.50 D) who wore spectacles and/or contact lenses, and myopes who had refractive surgery. RESULTS: The study population included 64 emmetropes, 66 myopes who wore spectacles and/or contact lenses, and 65 myopes who had refractive surgery. No significant differences were found between the refractive surgery and emmetropic groups. In contrast, the spectacle and/or contact lens group had significantly increased odds of having concerns about injuring themselves (odds ratio = 11.5, 95% confidence interval [CI] 2.3, 57.1), difficulties coping with demands in life (odds ratio = 23.6, 95% CI 23.8, 198.1), difficulties fulfilling roles (odds ratio = 5.6, 95% CI 1.4, 22.1), and less confidence joining in everyday activities (odds ratio = 30.6, 95% CI 3.2, 292.3) compared to emmetropes. CONCLUSIONS: Myopia corrected with spectacles or contact lenses had a negative impact on some areas of vision-related quality of life. However, individuals with myopia who had refractive surgery enjoyed the same vision-related quality of life as those with emmetropia. The potential improvement in vision-related quality of life should be considered when recommending treatment for myopia.     

青少年近视眼配戴RGPCL、Ortho—K及框架眼镜一年后调节滞后的差异

目的探讨青少年近视眼配戴硬性透气性角膜接触镜（rigid gas permeable contact lens,RGPCL）、角膜塑型镜（orthokeratology,Ortho—K,OK镜）及框架眼镜后调节滞后的差异。方法70名（70眼）9～14岁中低度青少年近视眼患儿,行医学验光、角膜曲率、角膜地形图检查后,根据检查结果、患儿及家长依从性等综合评估,对其中25名患儿选择配戴RGPCL,25名患儿配戴Ortho—K,其余20名患儿配戴框架眼镜。配戴期间每3个月复查1次,1年以后测定RGPCL组戴镜屈光度、Ortho—K组脱镜后的残余屈光度及框架眼镜组的屈光度．并使用开放视野型红外验光仪测量其在2～5D调节刺激下的调节反应．计算相对应的调节滞后和调节反应／刺激（AR／AS）斜率。对相关数据采用单因素方差分析的LSD检验。结果总共有57人完成测量。在2D调节刺激水平下,RGPCL、Ortho—K和框架眼镜组的调节滞后值间差异无统计学意义（P〉0．05）;在3D、4D、5D调节刺激水平下,3组问的调节滞后值差异均具有统计学意义（F=4．373,P〈0．05;F=5．833,P〈0．01;F=6．157,P〈0．01）,Ortho—K组的调节滞后值最小,RGPCL组次之,而框架眼镜组的调节滞后值最大。调节反应／刺激（AR／AS）斜率也呈现同样趋势,但3组间差异无统计学意义（P〉0．05）。结论配戴RGPCL和Ortho—K1年后,患儿在高调节需求时的调节滞后值明显低于框架眼镜组,其在延缓青少年近视进展中可以起到积极的作用。     

Circadian rhythm: corneal curvature and refractive changes after wearing contact lenses

The ciradian rhythm of habitual contact lens (PMMA) wearers is characterized by steepening of corneal curvature and increasing myopia after lenses have been worn during the day and flattening of corneal curvature and decreasing myopia after lenses have been removed overnight.     

Evaluation of refractive correction for standard automated perimetry in eyes wearing multifocal contact lenses

AIM: To evaluate the refractive correction for standard automated perimetry (SAP) in eyes with refractive multifocal contact lenses (CL) in healthy young participants. METHODS: Twenty-nine eyes of 29 participants were included. Accommodation was paralyzed in all participants with 1% cyclopentolate hydrochloride. SAP was performed using the Humphrey SITA-standard 24-2 and 10-2 protocol under three refractive conditions: monofocal CL corrected for near distance (baseline); multifocal CL corrected for distance (mCL-D); and mCL-D corrected for near vision using a spectacle lens (mCL-N). Primary outcome measures were the foveal threshold, mean deviation (MD), and pattern standard deviation (PSD). RESULTS: The foveal threshold of mCL-N with both the 24-2 and 10-2 protocols significantly decreased by 2.2-2.5 dB CONCLUSION: Despite the induced mydriasis and the optical design of the multifocal lens used in this study, our results indicated that, when the dome-shaped visual field test is performed with eyes with large pupils and wearing refractive multifocal CLs, distance correction without additional near correction is to be recommended.     

A comparison of wavefront aberrations in eyes wearing different types of soft contact lenses.

PURPOSE: The purpose of this study is to investigate the optical quality of eyes wearing different types of soft contact lenses (sCLs) using wavefront aberrometry. METHOD: A psychophysical aberrometer (WFA1000B; BriteEye, SuZhou, China) was used to measure wavefront aberrations for 56 eyes of 28 subjects under four conditions: 1) without contact lenses (non-CL), 2) with lathe-cut contact lenses (lathe-cut CL; Shuliang, Weicon Optics, Shanghai, China), 3) with cast-molded contact lenses (cast-molded CL; Vistavue, J&J Vision Care, U.S.), and 4) with spun-cast contact lenses (spun-cast CL; Lanfenzhiji, Justcome Optics, Beijing, China). The three types of sCLs were made from different materials and lens design. The root mean square (RMS) values of the wavefront aberrations and individual Zernike aberrations were calculated and compared among the CL-wearing conditions. RESULTS: Astigmatism was not significantly changed by any of the three soft contact lenses when compared with the non-CL condition. However, a significant difference in the RMS values of higher-order aberrations was observed between the lens types (F=8.29, p<0.0001). Induced higher-order aberrations were found for both the cast-molded CL and the spun-cast CL conditions. There were significant differences in the aberrations in each of the higher orders between the CL conditions (F=3.77, p=0.011 for third order; F=5.31, p=0.002 for fourth order; F=13.86, p<0.0001 for fifth and higher orders). More higher-order Zernike aberrations such as coma and spherical aberration were induced by cast-molded CLs and/or the spun-cast CLs. CONCLUSION: Wavefront aberrations in the eyes with soft contact lenses vary from one individual lens type to another. Although the variation in wavefront aberrations could be attributed to the differences in the methods of manufacture, influences from other factors such as the lens material and lens design could not be excluded and deserve further investigation.     

软性角膜接触镜与透气性硬性角膜接触镜对像差的影响

目的 分析配戴软性角膜接触镜、透气性硬性角膜接触镜（rigid gas-permeable contact lens,RGP）患者波前像差及角膜地形图在配戴前后的变化,探讨角膜接触镜对人眼屈光系统成像质量的影响.设计前瞻性随机对照临床研究.研究对象近视眼患者41例（80眼）.方法 软镜组20例（40眼）配戴软性角膜接触镜,RGP组21例（40眼）配戴RGP镜片,患者治疗前后作角膜地形图及波前像差检查,随访观察12个月.主要指标观察配戴接触镜治疗前后角膜地形图及波前像差的变化.结果 软镜组患者治疗后角膜表面规则指数（surface regularityindex,SRI）及角膜表面非对称指数（surface asymne-tryindex,SAI）有所增加,而RGP组SRI及SAI轻度下降;戴镜条件下,两组的整体波前像差（软镜组：0.58;RGP组：0.91）均低于治疗前裸眼的整体波前像差（软镜组：0.71;RGP组：1.21）;配戴后裸眼条件下,RGP组整体像差低于治疗前,且以低阶像差下降为主,而软镜组整体像差高于治疗前,各阶像差呈均匀上升趋势.结论 良好配适状态下的角膜接触镜均可使像差减小,使患者获得优质的光学矫正.     

Evaluation of vision-related quality of life of patients wearing photochromic lenses.

PURPOSE: A two-period, crossover study was undertaken comparing next-generation gray photochromic Transitions Lenses (Transitions Optical, Inc., Pinellas Park, FL) with clear lenses and a study purple-colored photochromic lens to evaluate enhancement to vision-related quality of life (VRQOL). METHODS: Fifty-two patients were randomized into one of four lens crossover groups: gray-->clear; clear-->gray; gray-->purple; and purple-->gray. Each lens was worn for 30 days. VRQOL was measured using a previously administered questionnaire, the Transitions Vision Related Quality of Life' (TVRQOL) survey instrument (see Appendix to this article). Differences in responses related to each lens worn in the comparison were recorded. RESULTS: Overall, next-generation gray Transitions Lenses were associated with the greatest improvement in VRQOL compared to clear or purple lenses. The gray lens proved statistically superior to the clear lens, across four of the five subscales. When given the choice of which lens they would like to continue to wear, 85% (23 of 27) of the patients preferred the gray lens. No statistically significant difference was observed between the gray lens and the study purple lens. CONCLUSIONS: Next-generation gray Transitions Lenses offer patients significant and clinically meaningful improvements in VRQOL, and are superior to clear lenses. A patient's overall visual experience is best served by proper product selection to provide optimal visual acuity and VRQOL performance.     

Traditional methods for the treatment of presbyopia: spectacles, contact lenses, bifocal contact lenses

Today, many options are available for the correction of presbyopia. New technology perpetually surfaces to offer better ideas and designs to meet the visual demands of the presbyopic population. This article provides information on various modalities for spectacle and contact lens correction of presbyopia. It is based on current information at the time of publication and is not intended to be a fitting guide.     

Predictors of quality of life in refractive surgery

PURPOSE: To investigate predictors of quality of life in refractive surgery: psychological status, quality of vision, visual acuity, and patient satisfaction. METHODS: In a prospective study, 143 patients were evaluated preoperatively and after the third postoperative month using the same questionnaire. Quality of vision, visual acuity, well-being, self-esteem, coping, and patient satisfaction were analyzed with 47 parameters. Refractive procedures included PRK, LASIK, and phakic IOL. Four groups of low (G1), medium (G2), and high myopia (G3) and hyperopia (G4) were individualized to compare the results. RESULTS: We noted a mean postoperative best corrected visual acuity (BCVA) of 20/25 or more for the G1, G2, and G4 groups. For the G3 group, the mean BCVA was increased, with a gain of two Snellen Lines from 20/50 to 20/32. Postoperative patient satisfaction improved, with a significant difference (p<0.05) in all groups. We noted no significant difference in all myopic groups in well-being and no significant decrease in G4. Concerning self-esteem and coping, scores improved, with a significant difference in G3 group (p<0.05). Quality of vision was directly correlated with improvement of quality of life (psychological status), satisfaction scores, and BCVA preoperatively and postoperatively in all patients, but no correlation was noted between visual acuity and patient satisfaction. CONCLUSION: In spite of good refractive results, modification of patient satisfaction depends on quality of vision and quality of life (psychological status) scores. These results give us a new tool that provides useful additional information in refractive surgery.     

屈光手术后新兵生活质量评价

目的:评价屈光手术后新兵生活质量.方法:采用以人群为基础的横断面调查.应用屈光矫正生活质量影响量表(QIRC)对615例屈光手术后新兵的生活质量进行评价.对不同组间QIRC量表总得分进行比较,包括术前屈光不正程度、术后时间、手术方式和术后恢复时间等.结果:屈光手术后新兵平均QIRC量表总得分为49.15±7.89.术前屈光不正程度不同有显著差异(F=4.16,P＜0.05),其中低度近视组得分(50.67±7.59)明显好于高度近视组(47.57±7.52).而术后6mo以内得分(49.18±7.86)和术后6mo以上得分(49.18±8.03)没有统计学差异.行表层切削得分(46.68±6.09)最低,但并没有统计学差异(t=1.99,P＞0.05),行MK-LASIK,SBK,FS-LASIK,ReLEx flex或SMILE等其他手术方式得分也无统计学差异.屈光手术后有不良主诉的新兵得分(45.85±6.66)较低,和全部相比有统计学差异(t=5.28,P＜0.01).结论:除去有术后并发症的,屈光手术后新兵生活质量较好,术前低度近视新兵术后生活质量好于高度近视新兵.     

A quality of life assessment of military recruits after refractive surgery

AIM: To evaluate the quality of life of recruits after refractive surgery. METHODS: Population-based, cross-sectional study. Using the Quality of Life Impact of Refractive Correction (QIRC) questionnaire, the quality of life in 615 recruits underwent refractive surgery was evaluated. The overall score and each question score of QIRC were compared between subgroups of different strength of preoperative refractive error, postoperative interval, type of surgical procedure and postoperative recovery. RESULTS: The mean overall QIRC score of recruits underwent refractive surgery was 49.15±7.89. Significant difference was found for strength of preoperative refractive error (F=4.16, P<0.05), with the low myopia group (50.67±7.59) had significantly better scores than those with high myopia (47.57±7.52, F=4.16, P<0.05). Recruits after a postoperative interval no more than 6mo (49.18±7.86) scored equally to those of more than 6mo (49.18±8.03). Recruits underwent surface ablation surgery scored lowest (46.68±6.09), but showed no significant difference when compared with all underwent refractive surgery (t=1.99, P>0.05). Scores of recruits underwent mechanical microkeratome laser in situ keratomileusis (MK-LASIK), Sub-Bowman’s keratomileusis (SBK), femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK), femtosecond lenticule extraction (ReLEx flex) or small-incision lenticule extraction (ReLEx SMILE) procedure showed no significant difference too. Recruits had adverse complaints postoperatively (45.85±6.66) scored lower when compared with all underwent refractive surgery (t=5.28, P<0.01). CONCLUSION: The quality of life of recruits after refractive surgery was good except those with postoperative complications. Preoperative low myopia recruits had better quality of life than medium and high myopia ones.     

Increased eotaxin in tears of patients wearing contact lenses

PURPOSE: Giant papillary conjunctivitis in patients wearing contact lenses occurs after intolerance and/or allergy to contact lenses. Eotaxin is a CC chemokine with a potent and specific chemotactic effect for eosinophils, which are involved in allergies. The purpose of this study is to measure the eotaxin levels in tears of patients wearing contact lenses and in normal subjects. Eotaxin levels were also correlated with the grade of giant papillary conjunctivitis. METHODS: Around 10 microL of tears were collected with glass capillaries in 16 patients wearing contact lenses and in 10 normal volunteers. Giant papillary conjunctivitis was graded from 0 to 4 by reference to standard slit-lamp photographs of the superior tarsal conjunctiva. Eotaxin concentration in tears was measured by ELISA using mouse anti-human eotaxin monoclonal antibodies. For the statistical analysis of the results, the paired Wilcoxon/Kruskal-Wallis test was used. RESULTS: The mean concentration of eotaxin was 2698+/-233 (SEM) pg/mL in patients wearing contact lenses and 1498+/-139 pg/mL in normal subjects. The difference was statistically significant (P=0.0004). The mean score of papilla grade was 1.75+/-0.19 in patients wearing contact lenses and 0.2+/-0.13 in normal subjects (P<0.0001). Papilla grade could be correlated to the eotaxin level in tears (R2=0.6562 and P<0.0001). CONCLUSION: An increase of eotaxin levels in tears was measured in patients wearing contact lenses. Eotaxin levels correlated with the severity of giant papillary conjunctivitis. These data suggest that eotaxin could play a role in papilla formation.     

Visual performance of subjects wearing presbyopic contact lenses.

PURPOSE: The purpose of this study is to assess the visual performance of subjects wearing gas-permeable (GP) multifocal contact lenses, soft bifocal contact lenses, GP monovision lenses and spectacles. METHODS: The study included 32 subjects between the ages of 42 and 65 years wearing GP monovision, the Acuvue Bifocal (Vistakon), the Essentials GP Multifocal (Blanchard), and progressive addition lenses (PAL; spectacles group). There were eight subjects in each of these groups who were already wearing these modalities. Binocular low (18%) and high (95%) contrast acuities were recorded using the Bailey-Lovie chart; binocular contrast sensitivity from 1.5 to 18 cycles per degree (cpd) measured with the Vistech VCTS 6500 system, and monocular glare sensitivity at three luminance settings (400, 100, and 12 foot lamberts) was measured using the brightness acuity tester (BAT). Binocular near visual task performance (a modified version of letter counting method used in previous presbyopic studies) was also assessed. RESULTS: For the contact lens-wearing groups, subjects wearing GP multifocals provided the best binocular high and low contrast acuity followed by soft bifocal wearers. There was relative parity between the binocular high and low contrast acuity with PAL and GP multifocal wearers. Monovision acuity, measured binocularly, was determined to be lower than the other three groups with this difference being most significant with high contrast acuity. Among contact lens-wearing groups, it was observed that GP multifocal lens wearers experienced the lowest amount of monocular disability glare followed by soft bifocal wearers and monovision wearers. Subjects wearing soft bifocal lenses and monovision demonstrated slightly reduced binocular contrast sensitivity at all spatial frequencies. In the contact lens groups, GP multifocal lens wearers had the highest binocular contrast sensitivity at all spatial frequencies, on parity with PAL wearers, except at the highest spatial frequency (18 cpd) at which PAL wearers had better vision. Error scores for the binocular near visual task performance between the four groups revealed subjects with GP multifocal lenses and PAL wearers to have the least errors, followed by monovision users and then soft bifocal wearers with the most errors. CONCLUSION: Subjects wearing GP multifocals, soft bifocals, monovision, and PAL spectacles have good binocular contrast sensitivity, satisfactory binocular low and high contrast acuity, and increased sensitivity to glare. Presbyopic subjects requiring the use of contact lenses under dim light levels could benefit from GP multifocal lenses. Contrast and glare sensitivity evaluations provide significant information regarding the visual performance of the presbyopic contact lenses and should be included in regular presbyopic contact lens fitting.     

接触镜致角膜病变的临床研究

目的 分析研究长期戴矫正近视的接触镜引起的角膜病变。方法 对32例(64眼)曾长期戴软性角膜接触镜(观察组)和38例(76眼)戴框架眼镜(对照组)要求行LASIK手术的近视者进行术前的角膜形态学检查、裂隙灯检查及泪液检查。结果 长期配戴接触镜所致角膜新生血管18例36眼,占56.25％,眼干燥症10例20眼,占31.25％。对角膜中央内皮测量进行两组间t检验,P<0.05,差异有显著意义。结论 戴角膜接触镜致角膜病变的发病率高于戴框架眼镜(对照组)者,角膜中央内皮细胞密度明显低于对照组者。