Different parameters in various zones of the cornea as well as corneal aberrations were stable during accommodation.
To analyse the short-term (up to one month) clinical outcomes in patients undergoing corneal laser refractive surgery and the impact on dry eye disease (DED) metrics and corneal nerves using in vivo confocal microscopy (IVCM). MethodsUnaided distance visual acuity (UDVA), corrected distance visual acuity (CDVA) and spherical equivalent refraction (SEQ) were determined in 16 and 13 patients undergoing FS-LASIK and SMILE respectively. DED metrics assessed were Ocular Surface Disease Index (OSDI), Dry Eye Questionnaire 5-items (DEQ-5), tear film osmolarity, tear meniscus height (TMH), non-invasive Keratograph break-up time (NIKBUT), ocular staining and meibomian gland atrophy. Automated analysis of corneal nerve fibre density (CNFD), corneal nerve branch density (CNBD), corneal nerve fibre length (CNFL) and corneal nerve fibre fractal dimension (CNFrD) were obtained from IVCM scans using ACCMetrics software (University of Manchester). ResultsBoth surgical techniques provided good refractive and visual outcomes. DED symptoms were found to be significantly higher after FS-LASIK compared to SMILE (p<0.05). A significant decrease in TMH (~31%) and NIKBUT (~40%) was reported after FS-LASIK (p=0.005 and p=0.001 respectively) but not after SMILE. Both procedures affected CNFD, CNBD, CNFL and CNFrD but the impact was significantly greater with FS-LASIK (p= 0.001). Only CNFL was correlated with reported symptoms (DEQ-5) after FS-LASIK (r= -0.545, p= 0.029). ConclusionFS-LASIK and SMILE provided good refractive and visual outcomes. There was an increased impact on DED symptoms following FS-LASIK compared to SMILE although there were no significant differences between the procedures for most of the other ocular surface metrics assessed. IVCM findings showed that SMILE had less impact on the corneal nerves compared to FS-LASIK.
Purpose: To analyze if Segmented Swept-Source Optical Coherence Tomography Angiography (SS OCT-A) can provide additional information on morphology and pathophysiology of macular fibrosis in Coats’ patients. Methods: A consecutive case series of three male patients (5, 7 and 15 years old), with Coats’ disease-related macular fibrosis (stage 2b-2 patients, 3b-1 patient). SS OCT-A 3×3 mm macular scans of affected eyes were performed. Results: In all three cases the inner portion of macular fibrosis displayed a dense network of vessels, continuing into deeper layers. This structure was similar to that observed in retinal angiomatous proliferations (RAP). There was associated loss of the foveal avascular zone. In one case we observed evolution of the lesion. Conclusion: SS-OCT imaging of macular fibrosis in Coats’ disease reveals a distinct intralesional vascular structure with elements resembling RAP, probably developing as a secondary process.
Background: To date there are yet no available approved therapies for Geographic Atrophy (GA) secondary to age-related macular degeneration (AMD). Methods: Single site, non-randomized safety and efficacy study presenting the preliminary results in a cohort of five late stage AMD (GA) patients successfully implanted with the Argus II Retinal Prosthesis System (Second Sight Medical Products Inc., Sylmar, CA, USA). Extensive fundus imaging including retinal photographs from which the GA area was measured. A combination of custom and traditional tests designed for very low vision subjects assessed visual function in study subjects. A Functional Low-Vision Observer Rated Assessment was carried out to evaluate the impact of the system on the subject’s daily life. In addition, a study to evaluate structural characteristics of the visual cortex of the brain was performed in one subject using magnetic resonance imaging. Results: Seven device-related adverse events were reported, four of which were classed as serious adverse events. Retinal detachment was reported in three patients and was successfully treated within 12 months of onset. Testing showed an improvement in visual function in three of five patients with the system turned on. Magnetic resonance imaging assessed in one patient after implantation indicates a selective increase in cortical myelin and thickness in visual brain regions 1 year post implantation. Conclusions: Epiretinal prostheses can successfully be implanted in those affected by GA secondary to late-stage AMD and can elicit visual percepts by electrical stimulation of residual neuroretinal elements and improve basic visual function in those affected.
Multifocal contact lenses (MCLs) are one of the solutions to correct presbyopia, but their adoption is not widespread due to factors such as discomfort, lack of awareness, a lengthy fitting process and/or unexpected visual performance. To address this situation, visual simulators can be used to aid in refining the adaptation process. This study aims to obtain accurate simulations for a novel visual simulator (SimVis Gekko; 2EyesVision, Spain) of various daily commercial soft MCL designs from four different manufacturers: Dailies Total1 (Alcon), MyDay (Coopervision), 1Day Acuvue Moist (Johnson & Johnson) and Biotrue ONEday (Bausch + Lomb). In-vitro characterization of these MCLSs -for several distance powers and additions- was obtained using a NIMO TR-1504 instrument (Lambda-X, Belgium). From the averaged relative power profiles across distance powers, phase maps were reconstructed and Through-Focus Visual Strehl (TFVS) metric was calculated for each MCL design considering different optical diameters. The SimVis Gekko simulation corresponding to each MCL design and pupil diameter was obtained computationally and validated on bench. Finally, the MCL simulations were clinically validated in a pilot study involving presbyopic patients with different refractive errors and additions. The results of the clinical validation show a good agreement between the SimVis Gekko simulations and the real MCLs (for all the designs) when measuring through-focus visual acuity (TFVA) curves and VA at three real distances. All MCL designs showed a partial correlation (rxy,z) higher than 0.90 and a Root Mean Square Error (RMSE) below 0.07 logMAR between the TFVA of SimVis Gekko simulations and Real MCLs across subjects. The validity of the simulation approach using SimVis Gekko and using experimental measurements obtained with Nimo TR-1504 was therefore confirmed by the clinical results obtained in this study, what opens the possibility of using this visual simulator to assist and speed up the fitting process of MCLs.
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