To evaluate depth of field (DOF) provided by different presbyopia-correcting intraocular lens (IOL) designs, comparing the results obtained using different criteria for defining the defocus tolerance. A total of 150 eyes undergoing cataract surgery were enrolled and divided into 6 groups depending on the IOL implanted: AT.LISA Tri (Carl Zeiss Meditec), FineVision (PhysIOL), PanOptix (Alcon Laboratories), Tecnis Symfony (Johnson & Johnson Vision), Miniwell (SIFI MedTech) and Tecnis Synergy (Johnson & Johnson Vision). Subjective DOF was obtained from defocus curves with absolute and relative criteria of tolerance of 0.1 logMAR. Aberrometry was also measured and the visual strehl optical transference function (VSOTF) with percentage of degradation of 90%, 80% and 60% was used to quantify objectively the DOF. Tecnis Symfony, Tecnis Synergy and Panoptix IOL groups showed better subjective and objective DOF compared to the rest of IOL groups, being these differences statistically significant differences (p < 0.001). Comparison between subjective and objective DOF showed that subjective measures were higher for all IOLs, being also these differences statistically significant for all groups (p < 0.001). A moderate significant correlation was found between absolute subjective criteria and VSOTF60% (r = 0.73, p < 0.05). Objective and subjective measures of DOF are not comparable due to differences in methodologies and criterions to define the level of degradation tolerance. Nevertheless, both objective and subjective measures showed a trend to a greater DOF for Tecnis Symfony and Tecnis Synergy IOLs compared to most of trifocal diffractive designs, with the exception of PanOptix.
To assess the clinical validation of the Myah device in a pediatric population by evaluating the repeatability of biometric evaluations and analyzing its agreement with the Myopia Master system. A total of 51 children (51 eyes) were enrolled. Repeated measurements of flat (K1) and steep (K2) corneal radius, white-to-white (WTW) distance and axial length (AL) were performed with the Myah device. The same parameters were obtained from a subgroup (30 eyes) with the Myopia Master for the agreement analysis. The repeatability was assessed using the intrasubject standard deviation (Sw) and the intraclass correlation coefficient (ICC). The agreement was analyzed using the Bland–Altman method and the paired Student t-test. The Sw was 0.018 D, 0.021 D, 0.071 mm and 0.017 mm for K1, K2, WTW and AL, respectively (ICC ≥ 0.971). The mean difference and limits of agreement when comparing instruments were −0.013 (−0.102/0.077) for K1 (p = 0.16), −0.058 (−0.127/0.012) for K2 (p < 0.001), 0.151 (−0.370/0.673) for WTW (p < 0.001) and 0.030 (−0.091/0.151) for AL (p = 0.009). In conclusion, the Myah device provides consistent measurements of corneal radius, WTW distance and AL in a healthy pediatric population, validating their usefulness in clinical practice. These measurements could be used interchangeably with those provided by the Myopia Master device, although with some caution.
In recent years, virtual reality (VR) has emerged as a new safe and effective tool for neurorehabilitation of different childhood and adulthood conditions. VR-based therapies can induce cortical reorganization and promote the activation of different neuronal connections over a wide range of ages, leading to contrasted improvements in motor and functional skills. The use of VR for the visual rehabilitation in amblyopia has been investigated in the last years, with the potential of using serious games combining perceptual learning and dichoptic stimulation. This combination of technologies allows the clinician to measure, treat, and control changes in interocular suppression, which is one of the factors leading to cortical alterations in amblyopia. Several clinical researches on this issue have been conducted, showing the potential of promoting visual acuity, contrast sensitivity, and stereopsis improvement. Indeed, several systems have been evaluated for amblyopia treatment including the use of different commercially available types of head mounted displays (HMDs). These HMDs are mostly well tolerated by patients during short exposures and do not cause significant long-term side effects, although their use has been occasionally associated with some visual discomfort and other complications in certain types of subjects. More studies are needed to confirm these promising therapies in controlled randomized clinical trials, with special emphasis on the definition of the most adequate planning for obtaining an effective recovery of the visual and binocular function.
Retinal sensitivity in healthy eyes tends to decrease with age as well as the stability of the pattern of fixation. A normative database in terms of retinal sensitivity threshold and fixation performance can be established in this type of eyes.
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