改良式多焦软性角膜接触镜矫正老视的视觉效果

目的: 探讨改良式多焦点软性角膜接触镜(多焦软镜)和单光软性角膜接触镜(单焦软镜)联合验配方式矫正老视的视觉效果。方法: 前瞻性研究。于2018年1—12月在温州医科大学附属眼视光医院招募20例老视观察对象(老视度数+1.00～+2.00 D), 分别按多焦法(双眼配戴多焦软镜)、单眼视法(一眼配戴远用单焦软镜, 一眼配戴近用单焦软镜)和改良法(主视眼配戴单焦软镜, 非主视眼配戴多焦软镜)3种方法验配角膜接触镜。每种方法配戴1周, 间隔1周作为洗脱期, 分析选用单光框架眼镜和3种接触镜矫正方法矫正下的观察对象双眼远、中、近距离100%及10%的双眼对比度视力(后文中视力均为双眼视力), 同时采用VFQ-25汉化版视觉质量量表评估视觉效果。通过单因素方差分析不同方法下视力的差异。结果: 在远距视力对比中, 多焦法视力低于单光框架眼镜(t=3.91, P=0.001)和改良法(t=2.94, P=0.008)。在50 cm处100%和10%对比度时, 多焦法(100%:t=-4.76, P<0.001;10%:t=-4.22, P<0.001)、单眼视法(100%:t=-3.5...     

高近附加设计多焦软性角膜接触镜与角膜塑形镜对近视儿童调节的影响

目的 比较高近附加设计多焦软性角膜接触镜(多焦软镜)和角膜塑形镜(OK镜)对近视儿童调节的影响。方法 纳入30例近视儿童,依次配戴单焦软性角膜接触镜(单焦软镜)、多焦软镜、OK镜。分别在不同矫正状态(OK镜矫正1个月后裸眼检查)测量角膜形态、3 D和6 D调节刺激下的调节反应及调节微波动。结果 在3 D、6 D调节刺激下,配戴多焦软镜产生的调节反应均低于单焦软镜(3 D,F=5.94,P<0.01;6 D,F=4.81, P<0.05),但近似于OK镜(P> 0.05);配戴多焦软镜产生的调节微波动大于OK镜和单焦软镜(3 D,F=7.51, P<0.01;6 D,F=4.81, P<0.05),而配戴OK镜与单焦软镜的调节微波动差异无统计学意义(P>0.05)。结论 高近附加设计多焦软镜的调节反应与OK镜接近,但调节微波动高于OK镜,为近视防控机制研究进一步探索提供思路和依据。     

多焦软性角膜接触镜对周边屈光度及周边角膜屈光力的影响

目的：:观察配戴多焦软性角膜接触镜引起的周边屈光度及周边角膜屈光力的变化,研究二者之间的关系。方法：:自身对照研究。于2020年10月1─15日在温州医科大学收集成年近视受检者18例,在配戴单焦软性角膜接触镜（简称单焦软镜）和多焦软性角膜接触镜（简称多焦软镜）状态下分别采用红外自动验光仪和角膜地形图测量周边屈光度及周边...     

高度近视儿童青少年配戴多焦点软性接触镜延缓近视进展的有效性研究

目的　评估高度近视儿童青少年配戴多焦点软性亲水性接触镜延缓近视进展的有效性。方法　回顾性研究。纳入2018年11月到2020年2月于天津市眼科医院视光中心配戴多焦点软性亲水性接触镜的近视儿童青少年36例和配戴单光框架眼镜者36例（均选取右眼）,年龄为8~15岁,等效球镜度（SE）为-5.00~-10.00 D。记录患者年龄、性别等信息,收集患者基线及戴镜1年后的主觉屈光度、眼轴长度等指标。采用独立样本t检验分析两组患者基线与1年后的SE变化量及眼轴长度变化量,采用多元线性回归分析影响屈光度及眼轴长度变化的因素,二元Logistic回归分析影响进展性近视发展的因素。结果　配戴多焦点软性亲水性接触镜组患儿与单光框架眼镜组患儿相比,两组间1年的SE变化量及眼轴长度变化量差异均有统计学意义（t=5.407,P<0.001;t=-2.763,P=0.007）。多元线性回归分析发现,SE进展的主要影响因素是戴镜组别和基线眼轴长度,回归方程:SE=3.982+0.458×戴镜组别-0.138×基线眼轴长度（R²=0.375,调整R²=0.357）;眼轴变化主要影响因素为戴镜组别,回归方程:AL=0.116+0.120×戴镜组别（R²=0.097,调整R²=0.097）。对于是否成为进展性近视儿童来说,配戴单光框架眼镜组的风险是多焦点软镜的12.571倍。结论　高度近视儿童青少年配戴多焦点软性接触镜能延缓近视进展（65.4%）及眼轴生长（33.3%）。     

儿童青少年配戴多焦软性角膜接触镜对调节聚散功能的影响

目的：:比较儿童青少年近视患者配戴单光框架眼镜和多焦软性角膜接触镜（简称多焦软镜）对调节和聚散功能的影响。方法：:系列病例研究。选取2017年7─10月在温州医科大学附属眼视光医院视光门诊就诊的46例近视患者参加本研究,分别在配戴单光框架眼镜和多焦软镜时测量其调节参数和聚散参数,包括调节幅度、调节反应、调节微波动、相对...     

角膜塑形镜、周边离焦眼镜、单光眼镜对儿童近视控制的一年效果

目的 评价角膜塑形镜、周边离焦眼镜、单光眼镜控制儿童近视进展的一年效果。设计 前瞻性非随机临床对照研究。研究对象 北京市眼科研究所、北京同仁验光配镜中心、北医眼视光远程视觉服务中心的近视儿童321例,其中141例（43.9%,141/321）完成一年随访。平均年龄（11.41±2.29）岁。方法 所有儿童配镜前进行视力、睫状肌麻痹后验光、裂隙灯、Lenstar眼生物参数测量及彩色眼底照相视盘旁萎缩弧分析。根据患者及监护人要求分别选择单光眼镜（single vision spectacle lenses, SV）、角膜塑形镜（orthokeratology, OK）、周边离焦眼镜（peripheral defocus spectacel lenses, PD）三种不同的矫正方式。观察三组间屈光度进展、眼轴增长及视盘旁萎缩弧扩大率的差异。主要指标 配镜前后屈光度、眼轴长度和视盘旁萎缩弧的改变。结果 完成一年随访者SV组47例、 OK镜组70例、PD组24例。平均等效球镜度（-2.89±1.34）D,平均眼轴长度（24.92±0.34）mm。最后随访时,3组儿童眼轴长度均增长,其中OK镜组增长（0.13±0.16）mm,明显低于其他两组（F=48.820,P<0.001）。SV组屈光度增长（-0.77±0.79）D,PD组屈光度增长（-0.94±0.47）D（t=1.080,P=0.283）。SV组、PD组、OK镜组视盘旁萎缩弧扩大率分别为66.7%、38.6%和15.0%（?字2=28.341,P<0.001）。结论 随访一年的结果表明,与单光眼镜、周边离焦眼镜相比,角膜塑形镜控制屈光度进展、眼轴增长、视盘旁萎缩弧扩大的效果最佳。（眼科,2016,25： 302-306）     

角膜塑形镜矫正单眼近视对近立体视功能的影响

【摘要】 目的 观察单眼近视患者配戴角膜塑形镜后的近立体视功能。设计 回顾性病例系列。研 究对象 苏州市眼视光医院在2009年10月到2011年12月期间配戴角膜塑形镜的23例单眼近视患者, 平均年龄（12.28±2.41）岁（8～17岁）。患眼平均屈光度（-2.71±1.09）D（-1.25~-4.875 D） 。方法 配戴前检查最佳矫正对数视力,戴框架眼镜矫正后近立体视功能（Titmus立体视图）,并 于配戴后1周、1个月、3个月进行上述检查。主要指标 裸眼视力、最佳矫正视力、屈光度及框架眼 镜矫正后近立体视功能。结果 配戴前平均裸眼视力4.26±0.23,最佳矫正视力5.02±0.07;配戴 后1周、1个月、3个月裸眼视力分别为：4.97±0.07、5.03±0.08、5.05±0.06;配戴后1周裸眼视 力较配戴前最佳矫正视力低,差异有统计学意义（P=0.015）,配戴后1个月、3个月裸眼视力与配 戴前最佳矫正视力比较差异无统计学意义（P=0.257,0.090）。单眼近视程度与近立体视呈负相关 ,近视度数越高,近立体视功能越差（r2=0.726,P=0.000）。配戴前9例（39%）患者有中心凹立 体视;异常立体视者14例（61%）,其中8例黄斑立体视,4例周边立体视,2例立体盲。配戴后1周 中心凹立体视者10例（43%）,与配戴前比较无统计学差异（P=0.500）。配戴1个月后中心凹立体 视者13例（57%）,与配戴前比较无统计学差异（P=0.188）;配戴3个月后中心凹立体视者17例 （74%）,与配戴前比较有统计学意义（P=0.018）。结论 配戴角膜塑形镜后3个月的多数单眼近视 患者在提高裸眼视力的同时可获得近立体视。（眼科,2012, 21： 384-386）     

老视矫正方法的研究进展

目的老视矫正方法的日趋多样化。配戴框架凸透镜是矫正老视最常见的方式,包括传统的单光（单焦）眼镜及近年出现的双光（双焦）、渐变多焦眼镜及衍射镜片。屈光手术矫正老视可分为角膜屈光性手术、眼内晶状体摘除联合可调节型人工晶状体（IOL）植入手术和巩膜屈光性手术。角膜屈光性手术包括激光角膜手术、角膜层闻植入物手术及传导性角膜成形术。鼎状体摘除联合可调节IOL植入术的IOL可分为单焦和多焦调节型两种,有引起眩光或光晕等视觉症状的情况,疗效需进一步观察。巩膜手术视觉完整性并不理想,且可能出现严重并发症,仍需临床观察。同时monovision（MV）被越来越多的引入到老视矫正手术中并且取得了较好效果。老视矫正方法的多样化为不同的需求者提供更多的选择。     

屈光参差儿童单眼配戴角膜塑形镜的临床效果

目的：评估屈光参差儿童单眼配戴角膜塑形镜控制近视、矫正屈光参差的临床效果。方法：回顾性自身对照病例研究。收集2014 年1 月至2016 年12 月在温州医科大学附属眼视光医院单眼接受角膜塑形镜治疗的屈光参差儿童40 例,年龄9～15 岁,随访时间1 年。双眼根据是否配戴角膜塑形镜分为配戴角膜塑形镜眼组（戴镜眼组）和未配戴角膜塑形镜眼组（未戴镜眼组）。戴镜眼组40眼,等效球镜度（-2.51±0.95）D;未戴镜眼组40眼,等效球镜度（0.10±0.52）D。双眼屈光度数差异范围1.00～4.38 D,平均（2.61±1.04）D。观察戴镜前及戴镜1 年后的双眼裸眼视力（UCVA）、屈光度数、眼轴、前房深度及角膜形态参数等变化,并对数据进行配对t检验和Pearson相关分析。结果：单眼配戴角膜塑形镜1年后,双眼UCVA（LogMAR）差值由0.77±0.29下降至0.17±0.22（t=-15.865,P < 0.001）,双眼屈光度数的差值由（2.61±1.04）D下降至（2.07±1.05）D（t=-7.366,P < 0.001）,双眼眼轴的差值由（0.97±0.66）mm降至（0.67±0.63）mm（t=-5.995,P < 0.001）,双眼前房深度的差值由（0.47±0.11）mm下降至（0.01±0.13）mm（t=-2.704,P=0.027）。相关性分析发现戴镜后屈光参差减少量仅与双眼眼轴差值变化量、双眼UCVA差值变化量具有相关性（r=0.539、0.418,P < 0.001）。结论：单眼配戴角膜塑形镜对屈光参差儿童是一种安全、有效的控制近视进展、矫正屈光参差的临床方法。     

单眼近视儿童配戴角膜塑形镜对侧眼屈光状态的影响

目的：明确配戴角膜塑形镜（OK镜）后对单眼近视性屈光参差儿童对侧眼近视进展的影响及其相关因素。方法：回顾性研究。收集2017年至2020年间在温州医科大学附属眼视光医院因单眼近视初次验配OK镜或单光框架眼镜的屈光参差[双眼等效球镜度（SE）差值≥1.00D]儿童,年龄8~13 岁,近视眼的SE为-4.00~-0.75D,随访时间为1年。根据屈光状态和矫正方式分为：OK镜组50 例,其中配戴OK镜眼为OK-近视眼组,未配戴OK镜的非近视眼为OK-非近视眼组;单光框架眼镜组（SP组）54例,其中近视眼为SP-近视眼组,非近视眼为SP-非近视眼组。分析戴镜前及戴镜1年后的双眼眼轴长度、双眼眼轴差值及角膜曲率平坦轴（Kf）等参数的变化。采用配对t检验和多元线性回归分析进行数据分析。结果：①眼轴变化：戴镜1年后,OK-近视眼组与OK-非近视眼组的眼轴分别增长了（0.13±0.19）mm、（0.43±0.25）mm,二者差异有统计学意义（t=-6.50,P<0.001）;SP-近视眼组与SP-非近视眼组的眼轴分别增长了（0.33±0.19）mm、（0.27±0.22）mm,二者差异无统计学意义。OK-近视眼组眼轴增长明显慢于SP-近视眼组(β=-0.11,P=0.006),OK-非近视眼组眼轴增长明显快于SP-非近视眼组(β=0.16,P=0.001)。OK-非近视眼组眼轴增长量（ ）与年龄（X）呈负相关：=-0.104X+1.564（R2=0.27,P<0.001）。②双眼眼轴差值变化：OK镜组双眼眼轴差值由基线时的（1.06±0.41）mm减少至（0.77±0.46）mm,差异有统计学意义（t=6.65,P<0.001）。SP组双眼眼轴差值由基线时的（0.81±0.34）mm变为（0.87±0.35）mm,差异无统计学意义。③角膜曲率：OK-近视眼组基线平坦子午线上的Kf（42.42±1.30）D被压平坦至（40.73±1.33）D,二者差异有统计学意义（t=12.76,P<0.001）,OK-非近视眼组基线Kf（42.31±1.30）D变平坦至（42.18±1.27）D,二者差异有统计学意义（t=3.08,P=0.003）。而SP-近视眼组、SP-非近视眼组的基线Kf与戴镜1年后的Kf相比均无明显变化。结论：配戴OK镜能有效控制单眼近视性屈光参差儿童近视眼眼轴增长,但对于年龄较小患者可能反而会加速对侧非近视眼的近视进展,且年龄越小,近视进展速度越快。     

Comparison of multifocal and monovision soft contact lens corrections in patients with low-astigmatic presbyopia.

PURPOSE: The purpose of this study was to assess visual performance and patient satisfaction with two presbyopic soft contact lens modalities. METHODS: A crossover study of 38 patients with presbyopia was conducted. Patients were randomized first into either multifocal (Bausch & Lomb SofLens Multifocal) or monovision (SofLens 59) for 1 month. Visual performance was measured with high- and low-contrast visual acuity at distance and near and near stereoacuity. Patients' satisfaction was measured by the National Eye Institute Refractive Error Quality of Life Instrument questionnaire and by recording the patient's final lens preference. RESULTS: Patients maintained at least 20/20 binocular vision with both multifocal (MF) and monovision (MV) contact lenses under high-contrast conditions at distance and near. Under low-contrast conditions, patients lost less than a line of vision from the best spectacle correction to either multifocal or monovision contact lens correction at distance (pMF = 0.001, pMV = 0.006). Under low-contrast conditions at near, multifocal wearers lost five to six letters and monovision wearers lost two letters of vision (pMF < 0.001, pMV = 0.03, pMF/MV = 0.005). The average stereoacuity decreased by 79 s arc with monovision vs. multifocal contact lenses (p = 0.002). On the NEI-RQL, patients reported worse clarity of vision (pMF = 0.01, pMV < 0.001), more symptoms (pMF = 0.09, pMV = 0.01), and an improvement in their appearance with contact lens wear (pMF < 0.001, pMV < 0.001). Seventy-six percent of patients reported that they preferred multifocal contact lenses, and 24% preferred monovision contact lenses (p = 0.001). CONCLUSION: The majority of our patients preferred multifocals to monovision, most likely because the Bausch & Lomb SofLens Multifocal provides excellent visual acuity without compromising stereoacuity to the same degree as monovision.     

Clinical Efficacy of Pinhole Soft Contact Lenses for the Correction of Presbyopia

We investigated the clinical efficacy of pinhole soft contact lenses for presbyopia correction. Twenty participants with presbyopia wore pinhole soft contact lenses in the non-dominant eye for 2 weeks. Manifest refraction, Goldmann binocular visual field tests, contrast sensitivity tests, and biomicroscopic examinations were performed along with evaluations of questionnaire responses and the binocular corrected distance visual acuity (CDVA), distance-corrected near visual acuity (DCNVA), distance-corrected intermediate visual acuity (DCIVA), and depth of focus, both before and after 2 weeks of lens wear. DCNVA at 33 and 40 cm and DCIVA at 50 and 70 cm showed significant improvements after pinhole lens wear (P-value: <0.001, <0.001, <0.001, and 0.046, respectively), with no changes in the binocular visual field and binocular CDVA. Contrast sensitivities under photopic and mesopic conditions decreased at some frequencies; however, visual function questionnaire scores significantly improved (all P-values <0.001). These findings suggest that pinhole contact lenses effectively correct presbyopia.     

Visual performance of a multi-zone bifocal and a progressive multifocal contact lens.

PURPOSE: This study measured the relative visual performance of two planned-replacement soft contact lenses for presbyopic correction: a multi-zone bifocal (ACUVUE, Johnson & Johnson Vision Care, Jacksonville, FL) contact lens and a progressive multifocal (Focus Progressives, CIBA Vision, Duluth, GA) contact lens. METHODS: This was a randomized, double-masked, non-dispensing cross-over study. Visual performance was evaluated by log of minimal angle of resolution (LogMAR) measurement of visual acuity (VA) under a representative range of luminances (distance 250 candela[cd]/m2 and 2.5 cd/m2, near 250 cd/m2 and 50 cd/m2) and contrasts (90% and 10%). The 45 presbyopic subjects were equally distributed in three subgroups according to spectacle addition: low presbyopia (+0.75D to +1.25D); medium presbyopia (+ 1.50D to + 1.75D); and high presbyopia (+2.00 to +2.50D). RESULTS: Statistically significant differences were found in overall distance VA (P<0.001; average of four luminance-contrast combinations) and low-luminance distance VA (P=0.004), which, in both cases, favored the multi-zone bifocal lens design. For low presbyopes, the multi-zone bifocal design produced a significantly better visual performance (P=0.004) than did the progressive multifocal. Overall near VA was also significantly better (P<0.001) with the multi-zone bifocal lens. Differences in near VA were particularly marked in high-luminance conditions (high and low contrasts combined) and were statistically significant for all three presbyopic subgroups. CONCLUSIONS: Visual acuity performance with the multi-zone bifocal was superior overall to that achieved with the progressive multifocal design. This study suggests that having only one addition is detrimental to performance with the progressive multifocal lens, particularly for low presbyopes.     

多区正向光学离焦镜片对近视儿童视觉质量的影响

目的：探讨近视儿童配戴多区正向光学离焦镜片后的主观视觉质量，并与角膜塑形镜、单焦点镜 片相比较。方法：前瞻性临床研究。收集2020年7—10月在南宁爱尔眼科医院视光中心配戴多区 正向光学离焦镜片31例（31眼）（DIMS组）、OK镜32例（32眼）（OK镜组）、单焦点镜片30例（30眼） （SV组）共93例（93眼）近视患者。配戴矫正镜片1个月后，采用Oculus视功能检查仪对3组进行全 程视力、对比敏感度、中间视觉、眩光、立体视等主观视觉质量检查。数据采用单因素方差分析、 卡方检验、秩和检验、Spearman相关性分析等方法进行分析。结果：3组患儿戴镜后近、远视力相 对于基线期变化值的差异均无统计学意义。在近、远立体视锐度当中3组差异无统计学意义，3组 在600″~200″立体视视锐度的人数分别都是最少的。3 组之间的对比敏感度差异有统计学意义 （F=17.96, P<0.001），合格例数最多的DIMS组有20例（65%）被检者对比敏感度≤15%。DIMS组在 有无眩光情况下，对比度等级(1:2.7、1:2.0)的通过率均高于OK镜组、SV组，且1:2.0对比度等级更 为明显，差异均有统计学意义（均P<0.001）。立体视锐度与年龄呈负相关（r=-0.30, P=0.008），与 屈光度数无相关性。眩光与对比敏感度间呈正相关（r=0.64, P<0.001），与性别、年龄、屈光度分析 均无相关性。结论：多区正向光学离焦镜片相对于角膜塑形镜及单焦点镜片而言，可提供更好的主 观视觉质量，有好的舒适性和安全性。     

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.     

配戴多焦点硬性角膜接触镜对近视患者双眼视功能的影响

目的：探讨多焦点设计的硬性角膜接触镜对近视患者双眼视功能的影响。

方法：自身前后对照研究。于2020-07/08在川北医学院招募近视学生15人作为试验者,试验者首先配戴框架眼镜行双眼视功能检查,然后分别配戴单焦点与多焦点硬性角膜接触镜(间隔1wk),每种镜片配戴2wk后行双眼视功能检查。采用单因素方差分析比较多焦点硬性角膜接触镜(MFRGP)、单焦点硬性角膜接触镜(SVRGP)和框架眼镜双眼视功能的差异。

结果：三种镜片立体视、远距水平隐斜、远距正融像性聚散、远距负融像性聚散、近距正融像性聚散、聚散灵活度、集合近点、调节幅度、调节灵活度、负相对调节比较均无差异(P>0.05)。与框架眼镜相比,配戴MFRGP近距水平隐斜、近距负融像性聚散、调节滞后、正相对调节增大,AC/A降低(P=0.023、0.048、0.001、0.013、0.046); 与SVRGP相比,MFRGP近距水平隐斜、调节滞后、正相对调节增大,AC/A降低(P=0.014、<0.001、0.001、0.009)。

结论：配戴MFRGP会引起近距水平隐斜、调节滞后、正相对调节增大和AC/A降低,这些变化可能对配戴者近距离用眼产生一定影响,在临床应用中要考虑这些预期的变化,以便正确评估和管理患者。     

Conductive keratoplasty for symptomatic presbyopia following monofocal intraocular lens implantation

Background: To evaluate the visual outcomes of conductive keratoplasty for relief of symptomatic presbyopia of pseudophakia with monofocal intraocular lens implantation. Design: It was a prospective clinical study and set in Eye Center, Second Affiliated Hospital, Zhejiang University. Participants: This study comprised 27 eyes from 27 patients with presbyopia symptom. Methods: The patients received conductive keratoplasty via monovision approach after monofocal intraocular lens implantation and were followed up at 1 week and 1, 3, 6 and 12 months postoperatively. Main Outcome Measures: The main outcomes including uncorrected near visual acuity, uncorrected distance visual acuity, best spectacle‐corrected visual acuity, manifest refraction spherical equivalent, keratometric astigmatism, contrast and glare sensitivity, spherical aberration and pseudoaccommodation were evaluated. Results: Twelve months after conductive keratoplasty, the binocular uncorrected near visual acuity was significantly improved from logMAR 0.88 ± 0.16 preoperatively to logMAR 0.30 ± 0.13 (P < 0.05); the binocular uncorrected distance visual acuity and best spectacle‐corrected visual acuity remained unchanged; manifest refraction spherical equivalent was significantly reduced from 0.01 ± 0.68 D preoperatively to ?1.68 ± 0.39 D (P < 0.05); spherical aberration was increased from 0.266 ± 0.204 µm preoperatively to 0.358 ± 0.277 µm (P < 0.05), and pseudoaccommodation was from 1.38 ± 0.38 D to 1.73 ± 0.61 D (P < 0.05). Conclusions: Conductive keratoplasty is a safe and effective method for relief of symptomatic presbyopia of pseudophakia with monofocal intraocular lens implantation.     

Functional vision with bilateral ReZoom and ReSTOR intraocular lenses 6 months after cataract surgery

PURPOSE: To compare the visual outcomes in patients with bilateral implantation of AcrySof ReSTOR multifocal intraocular lenses (IOLs) (Alcon Laboratories) or ReZoom multifocal IOLs (Advanced Medical Optics) 6 months after cataract surgery. SETTING: Orsett and Southend Hospital, Essex, United Kingdom. METHODS: This study comprised patients who had uneventful bilateral cataract extraction with implantation of ReZoom (n = 50) or ReSTOR (n = 50) multifocal IOLs. Parameters analyzed included binocular uncorrected distance, intermediate, and near acuities; spectacle independence; subjective visual symptoms; and patient satisfaction. All parameters were evaluated 6 months after second-eye surgery. RESULTS: All patients had binocular uncorrected distance visual acuity of 20/32 or better; there was no statistically significant difference between the 2 groups. The mean binocular uncorrected near acuity was 20/26 (J1.22) in the ReSTOR group and 20/34 (J2.34) in the ReZoom group (P<.0001). The mean binocular uncorrected intermediate visual acuity was 20/42 and 20/34, respectively (P = .003). Patients in the ReZoom group reported greater satisfaction with intermediate vision (P = .04). No statistically significant difference was found in satisfaction with near vision. Eighty-six percent of ReSTOR patients and 70% of ReZoom patients did not wear glasses for daily activities; the overall satisfaction was not statistically significantly different between groups. There was no significant difference between groups in photic phenomena. CONCLUSIONS: The ReSTOR IOL provided better near vision and the ReZoom IOL better intermediate vision. Both multifocal IOLs gave excellent distance vision. Photic phenomena were comparable and clinically acceptable. ReSTOR patients had greater spectacle independence for near vision and ReZoom patients for intermediate vision. Overall spectacle independence was not statistically significantly different.     

The Quest for Spectacle Independence: A Comparison of Multifocal Intraocular Lens Implants and Pseudophakic Monovision for Patients with Presbyopia

ABSTRACT

We performed a literature review comparing multifocal intraocular lens (IOL) implantation with pseudophakic monovision to treat presbyopia. Multifocal IOLs utilize refractive or diffractive principles to treat both distance and near vision, with a single lens implant. Monovision uses traditional monofocal lens implants to treat the dominant eye for emmotropia, and the non-dominant eye for myopia. This planned anisometropia is designed to enhance intermediate or near vision. Generally, distance vision was similar with both types of lens implantation, near vision was better with multifocal IOLs, and intermediate vision appeared to be better in the monovision group. For patients requiring cataract surgery, both multifocal IOLs and monovision appear to address presbyopia with a high level of patient satisfaction. More patients reported complete spectacle independence with multifocal IOLs, but more glare and halos were reported by multifocal IOL patients as well.