Changes in higher order aberrations after central corneal regularization-a comparative two-year analysis of a semiautomated topography-guided photorefractive keratectomy combined with corneal cross-linking

Background:The optical quality in progressive keratoconus deteriorates due to ectasia and distortion of the corneal shape and optics.While corneal cross-linking(CXL)aims at stopping disease progression,“CXL-Plus”combines CXL with excimer laser ablation to improve visual function.Central Corneal Regularization(CCR)represents a therapeutic excimer laser modality specifically designed to smoothen the ectatic corneal shape and to reduce higher order aberrations(HOA).We set out to compare CXL-Plus,consisting of CXL combined with CCR,with CXL by itself for patients with progressive keratoconus.Methods:Retrospective 2-year matched group analysis of patients who either underwent CXL-Plus(n=28)or CXL as a sole procedure(n=28)for progressive keratoconus.Main outcome parameters were HOA,visual function and tomographic results 12 and 24 months postoperatively.Results:After 12 months,the total HOA root mean square wavefront error was reduced from 0.79±0.30 to 0.40±0.19μm(CXL-Plus;p<0.0001)and changed from 0.71±0.28 to 0.73±0.36μm(CXL;p=0.814).Uncorrected distance visual acuity improved from 0.70±0.35 to 0.36±0.29 logMAR(CXL-Plus;p=0.0002)and from 0.65±0.39 to 0.46±0.37 logMAR(CXL;p=0.067),translating to gains of three or more lines in 50%(CXL-Plus)and 36%(CXL)of patients.The steepest keratometry value(Kmax)regressed by 5.84 D(CXL-Plus;p<0.0001)and 0.66 D(CXL;p=0.752).For none of the investigated parameters a statistically significant change could be shown between 12 and 24 months.Conclusions:CXL-Plus in the form of a CCR reduces HOA and Kmax more effectively than CXL as a sole procedure.

Higher order aberration comparison between two aspherical intraocular lenses: MC6125AS and Akreos advanced optics

AIM: To compare higher order aberrations in two aspherical intraocular lenses(IOLs): Akreos advanced optics(AO) and Dr. Schmidt Microcrystalline 6125 aspheric anterior surface(MC6125AS) with each other. METHODS: Forty eyes of 39 patients underwent phacoemulsification and Akreos AO and MC6125 AS were implanted in their eyes in a random manner. Three months post-operatively, higher order aberrations including spherical aberration, coma aberration, and total aberrations were measured and compared.RESULTS: The total aberration was 0.24±0.17 in eyes with Dr. Schmidt and 0.20 ±0.01 in eyes with Akreos AO(P =0.361). The mean of coma aberration was 0.17 ±0.21 and 0.09 ±0.86 in Dr. Schmidt and Akreos lenses,respectively(P =0.825). Total spherical aberration was almost the same in both groups(mean: 0.05, P =0.933).Best corrected visual acuity in Akreos AO(0.10±0.68) and Dr. Schmidt(0.09±0.67) did not differ significantly(P =0.700). CONCLUSION: There is no statistically significant difference in the higher order aberrations between these two aspherical lenses.

Visual function and higher order aberration after implantation of aspheric and spherical multifocal intraocular lenses:a meta-analysis

AIMTo assess the visual outcomes of aspheric multifocal intraocular lenses (IOLs) compared with spherical multifocal IOL after cataract surgery.

Contrast sensitivity and higher-order aberrations in patients with astigmatism

Background Astigmatism is one of the most significant obstacles for achieving satisfactory visual function. This study was to evaluate the influence of astigmatism on contrast sensitivity （CS） and higher-order aberrations. Methods CS, accommodation response and wavefront aberration were measured in 113 patients with astigmatism, aged 18-36 years. Both single and binocular visual performance were examined under four lighting conditions： photopia, photopia with glare, scotopia and scotopia with glare respectively. Accommodation response was classified as normal, abnormal and low. The contribution of the power and axis of astigmatism to CS, accommodation response and wavefront aberration was analyzed. Results As the dioptric power of astigmatism increased, the loss of CS spatial frequency changed from high to intermediate, and then to low frequency. CS scores varied at different illuminance levels, descending in the following sequence： photopia, photopia with glare, scotopia, and scotopia with glare. However, the normal accommodation group showed better CS values under photopia with glare than without glare. The range of influenced direction of sine-wave gratings remained mostly at the meridian line of high dioptric power, which would be expanded when optical accommadation attenuated. The patients with symmetrical astigmatism got higher CS scores with binoculus vision than with dominant eye vision, while the patients with asymmetrical astigmatism did this only at scotopia with glare. Among higher-order aberrations, coma aberration, secondary coma aberration and the total higher order aberration were influenced by astigmatism, all of which rising with the power of astigmatism increased. Conclusions Reducing astigmatism might improve the performance of visual function. Not only the power of astigmatism should be cut down, but also the binocular axes should be made symmetrically.

Single-step transepithelial photorefractive keratectomy in high myopia：qualitative and quantitative visual functions

AIM：To investigate quantitative and qualitative optical outcomes of single-step transepithelial photorefractive keratectomy（Trans PRK）in high myopia.METHODS：In a prospective interventional case-series,30 eyes with high myopia（-6.00 to-8.75 D）with（up to-3.00 D）or without astigmatism were enrolled from Bina Eye Hospital,Tehran,Iran. One-step Trans PRK was performed with aberration-free aspherical optimized profile and SCHWIND AMARIS 500 laser. One-year follow-up results for refraction,visual acuities,vector analysis,ocular wavefront（OWF）and corneal wave-front（CWF）higher order aberrations（HOA）,contrast sensitivity（CS）,and postoperative haze were assessed.RESULTS：After the surgery,both photopic and mesopic CSs significantly improved（both P〈0.001）. We detected significant induction of OWF coma and trefoil（P〈0.001 for both）HOAs; CWF coma（P=0.002）,spherical（P〈0.001）,and tetrafoil（P=0.003）HOAs in 6 mm analysis diameter; and CWF trefoil（P=0.04）HOA in 4 mm analysis diameter. The range of mean induction observed for various HOAs was0.005-0.11 μm. The 86.7% of eyes reached an uncorrected distance visual acuity of 20/20 or better; 96.7% of eyes were within ±0.5 D of targeted spherical refraction. In vector analysis,mean correction index value was 1.03 and mean index of success was 0.22. By 12mo after the operation,no eye lost any number of corrected distancevisual acuity lines. We detected no corneal haze greater than 1~＋ throughout the follow-up.CONCLUSION：Our findings show promising effects of single-step Trans PRK on quality of vision in high myopic eyes. It also improves refraction and visual acuity.

Scheimpflug imaged corneal changes on anterior and posterior surfaces after collagen cross-linking

AIM:To compare the anterior and posterior corneal parameters before and after collagen cross-linking therapy for keratoconus.METHODS:Collagen cross-linking was performed in31 eyes of 31 keratoconus patients(mean age 30.6±8.9y).Prior to treatment and an average 7mo after therapy,Scheimpflug analysis was performed using Pentacam HR.In addition to corneal thickness assessments,corneal radius,elevation,and aberrometric measurements were performed both on anterior and posterior corneal surfaces.Data obtained before and after surgery were statistically analyzed.RESULTS:In terms of horizontal and vertical corneal radius,and central corneal thickness no deviations were observed an average 7mo after operation.Corneal higher order aberration showed no difference neither on anterior nor on posterior corneal surfaces.During follow-up period,no significant deviation was detected regarding elevation values obtained by measurement in mm units between the 3.0-8.0 mm-zones.CONCLUSION:Corneal stabilization could be observed in terms of anterior and posterior corneal surfaces,elevation and higher order aberration values 7mo after collagen cross-linking therapy for keratoconus.

In vivo optical quality of posterior-chamber phakic implantable collamer lenses with a central port

Background: The aim of this review is to summarize the optical quality results in patients following theimplantation of the V4c implantable collamer lens with a central port (ICL, STAAR Surgical Inc.).Main text: A literature search in several databases was carried out to identify those publications, both prospective,retrospective and/or comparative with other refractive surgery procedures, reporting optical outcomes of patientswho were implanted with the V4c ICL model. A total of 17 clinical studies published between 2012 and 2021 wereincluded in this review. A detailed analysis of the available data was performed including number of eyes, follow-upand preoperative spherical equivalent. Specifically, the review focused on several optical parameters includinghigher-order aberrations (HOAs), modulation transfer function (MTF) cut-off frequency and Strehl ratio. This reviewencompassed a total of 817 eyes measured using different optical devices based on Hartmann-Shack, retinal imagequality measurement and ray-tracing technologies at different follow-ups.Conclusions: The outcomes found in this review lead us to conclude that the ICL V4c model provides good opticalquality, by means of different metrics, when implanted.

In vivo optical quality of posterior-chamber phakic implantable collamer lenses with a central port

Background:The aim of this review is to summarize the optical quality results in patients following the implantation of the V4c implantable collamer lens with a central port(ICL,STAAR Surgical Inc.).Main text:A literature search in several databases was carried out to identify those publications,both prospective,retrospective and/or comparative with other refractive surgery procedures,reporting optical outcomes of patients who were implanted with the V4c ICL model.A total of 17 clinical studies published between 2012 and 2021 were included in this review.A detailed analysis of the available data was performed including number of eyes,follow-up and preoperative spherical equivalent.Specifically,the review focused on several optical parameters including higher-order aberrations(HOAs),modulation transfer function(MTF)cut-off frequency and Strehl ratio.This review encompassed a total of 817 eyes measured using different optical devices based on Hartmann-Shack,retinal image quality measurement and ray-tracing technologies at different follow-ups.Conclusions:The outcomes found in this review lead us to conclude that the ICL V4c model provides good optical quality,by means of different metrics,when implanted.