Purpose: To determine patient preoperative anatomical features and the parameters of implantable collamer lenses (ICLs) relevant in explaining vault variability. Setting: Ophthalmology Clinic Vista Sánchez Trancón, Badajoz, Spain. Design: Retrospective case series. Methods: This study comprised 360 eyes of 360 patients implanted with myopic or toric ICLs. Pentacam imaging was used for assessing white-to-white (WTW) diameter, central keratometry, and central corneal thickness. Anterior-segment optical coherence tomography was used to measure the horizontal anterior chamber angle distance (ATA), internal anterior chamber (ACQ), crystalline lens rise (CLR), anterior chamber angle (ACA), and vault. The sample was divided according to the implanted lens size (12.6 mm, 13.2 mm, and 13.7 mm). Vault predictors were identified from the variables above using multivariate regression analysis. Results: The groups showed significant statistical differences for WTW, ATA, ACQ, ACA, and vault (P < .007 for all). In general, bigger lenses were implanted in eyes with larger transverse sizes (WTW and ATA) and deeper ACQ. Also, larger ICL diameters were associated with higher vaults. Multivariate regression analysis identified the lens size (13.2 mm as reference; 12.6 mm: β [standardized coefficients] = −0.33; 13.7 mm: β = 0.42), ATA (β = −0.42), and CLR (β = −0.25), ICL spherical equivalent (β = −0.22) and patient age (β = −0.12) as predictors of the vault size (adjusted-R 2 = 0.34 P < .001). Conclusions: The multivariate model explained 34% of vault variability. The predictors indicated the presence of different mechanisms regulating the vault. These involved the difference between the transverse size of the eye and the ICL, the crystalline lens protrusion, and the ICL properties, such as power and size.

PurposeGeneric instruments to assess health utilities can be used to express the burden of health problems in widely used indexes. That is in contrast with what can be obtained with condition-specific instruments, outcomes are very specific and difficult to compare across conditions. The purpose of this study was to assess health and visual outcomes and its determinants in patients with visual impairment (VI) using the EQ-5D-3L and the Activity-inventory (AI). MethodsParticipants were recruited in different hospitals during the PCVIP-study. A total of 134 patients with acuity 0.30 logMAR or less in the better eye were interviewed. The AI includes 46 goals split between three objectives: social functioning, recreation and daily living, was used to measure visual ability. The EQ-5D consists of five questions covering one domain each and was used to provide a measure of health states. Responses to each domain were combined to produce a single individual index.ResultsThe AI and the EQ-5D-3L showed enough discriminatory power between VI levels (p<.001) and their results were strongly correlated r(134)=.825, (p<.001). Explanatory factors for visual ability were level of VI in better eye, age and gender, R 2 =.43, (p<.001). Explanatory factors for the EQ-5D-3L were level of VI in the better eye, comorbidities and gender, R 2 =.36, (p<.001). ConclusionsOur results showed that the EQ-5D-3L is useful when characterizing the burden of VI and to compute, when necessary, quality-adjusted-life-years (QALY) changes due to VI. However, is important to consider that the EQ-5D-3L uses a coarse response scale, assesses a limited spectrum of domains and is influenced by comorbidities. This might limit its responsiveness to small changes in visual ability.

Background To identify biometric and implantable collamer lens (ICL)-related risk factors associated with sub-optimal postoperative vault in eyes implanted with phakic ICL. Methods This study reports a retrospective case series of the first operated eye in 360 patients implanted with myopic spherical or toric ICL. Preoperatively, white-to-white (WTW), central keratometry (Kc) and central corneal thickness (CCT) were measured using the Pentacam. Anterior-segment optical coherence tomography (AS-OCT, Visante) was applied preoperatively for measuring the horizontal anterior-chamber angle-to-angle distance (ATA), internal anterior chamber depth (ACD), crystalline lens rise (CLR), anterior-chamber angle (ACA) and postoperatively the vault. Eyes were divided into three vault groups: low (LVG: ≤ 250 μm), optimal (OVG: > 250 and < 1000 μm) and high (HVG: ≥ 1000 μm). Multinomial logistic regression (MLR) was used to find the sub-optimal vault predictors. Results MLR showed that CLR, ICL size minus the ATA (ICL size-ATA), age, ICL spherical equivalent (ICLSE) and ICL size as contributing factors for sub-optimal vaults (pseudo-R2 = 0.40). Increased CLR (OR: 1.01, CI: 1.00–1.01) and less myopic ICLSE (OR: 1.22, CI: 1.07–1.40) were risk factors for low vaults. Larger ICL size-ATA (OR: 41.29, CI: 10.57–161.22) and the 13.7 mm ICL (OR: 7.08, CI: 3.16–15.89) were risk factors for high vaults, whereas less myopic ICLSE (OR: 0.85, CI: 0.76–0.95) and older age (OR: 0.92, CI: 0.88–0.98) were protective factors. Conclusion High CLR and low ICLSE were the major risk factors in eyes presenting low vaults. In the opposite direction, ICL size-ATA was the major contributor for high vaults. This relationship was more critical in higher myopic ICLSE, younger eyes and when 13.7 mm ICL were used. The findings show that factors influencing the vault have differentiated weight of influence depending on the type of vault (low, optimal or high).

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The unusually large number of oculomotor and/or automaticity problems found in this normal PT population using a test based on U.S. norms highlights the need for PT-specific guidelines. It appears that DEM scores may be affected by differences in language, educational systems, and/or cultural systems. Therefore, clinicians should be aware of these findings when using the DEM test on children in countries with differing languages and cultures.

Purpose The distance between an implantable collamer lens (ICL) and the crystalline lens, namely vault, is a space regulated by the interaction of the ICL and the anatomical structures of the eye. This study analysed the differences in vault size between fellow eyes with similar anterior segment biometry. Patients and Methods A retrospective case series analysed 109 cases of patients bilaterally implanted with EVO-V4c. Patients were analysed pre- and postoperatively using anterior segment optical coherence tomography. The range of vault inter-eye differences was defined as the 95% confidence interval of the differences. Bivariate correlation was applied to seek for associations between vault inter-eye differences with biometric and lens parameters (angle-to-angle, anterior chamber depth, crystalline lens rise, central corneal thickness, central keratometry, ICL spherical equivalent, horizontal compression, postoperative pupil diameter and vault). Results Mean vault inter-eye differences were similar between fellow eyes (26.0 ± 122.5 µm). The 95% confidence interval range of the differences was ±240.1 µm, nearly 50% of the cases presented vault inter-eye differences higher than 100 µm. The vault of the first operated eye explained 81% of the variance in the second eye vault. Vault inter-eye differences were positively correlated with the level of horizontal compression and with vault magnitude. Conclusion Vaults measured in fellow eyes may present considerable differences, which can reach 25% of the common vault range. This reflects some degree of baseline variability in the vault. Clinically, these differences assume special relevance in cases where low or high vaults are expected.

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Goldmann applanation tonometry (GAT) is considered the gold standard technique for tonometry. It is a procedure involving administration of topical anaesthetic (a drug which could have several side effects). This prevents a large number of vision care practitioners from using GAT, due to legal restrictions regarding the use of these ophthalmic drugs. The purpose of this study was to establish whether the discomfort experienced during non-anaesthetic Goldmann Applanation Tonometry (NAGAT) would be acceptable to subjects. The intensity of pain inflicted by GAT, NAGAT, Non-Contact Tonometry (NCT) and Schirmer test was assessed on thirty-one subjects enrolled in the study using the Numerical Rating Scale (NRS) to assess pain. The GAT was performed on one eye and the other three procedures were carried out in random order on the fellow eye. Initially, each subject was asked to score their Maximum Pain Without Complaint (MPWC). The MPWC and the Schirmer test were used as references to grade the pain levels. The scores for the five procedures were registered using the NRS (0-10) and compared using a non-parametric statistical analysis (Friedman test and a post-hoc analysis). In addition, IOP results for GAT and NAGAT were also compared using the t-test. The scores obtained on the NRS ranged from 0-4, 0-5, 0-8, 0-7 and 3-8 with a median of 1, 1, 2, 2, and 5, respectively for NCT, GAT, NAGAT, Schirmer and MPWC. A statistically significant difference (p = 0.01) was found between the MPWC and the four clinical tests but no difference was found between the clinical tests. There was no statistically significant difference (p = 0.71) between the IOP results for GAT and NAGAT, 14.0 ± 2.0 mmHg and 13.8 ± 2.0 mmHg (mean ± 1S.D.) respectively. The Goldmann Applanation Tonometry without anaesthetic (NAGAT) can be performed with an acceptable level of discomfort for the majority of subjects and should be performed identically to a traditional GAT, informing the subjects about the possibility of feeling a small discomfort.