Optical Express

London, United Kingdom

Optical Express

London, United Kingdom

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Schallhorn S.,University of California at San Francisco | Brown M.,Optical Express | Venter J.,Optical Express | Hettinger K.,Optical Express | Hannan S.,Optical Express
Journal of Refractive Surgery | Year: 2014

PURPOSE: To determine the relationship between lowlight pupil size and patient-reported outcomes 1 month after wavefront-guided LASIK in young patients with myopia. METHODS: Retrospective case series of 10,944 eyes of 5,563 young patients with myopia who underwent wavefront-guided LASIK (6.0-mm optical zone). Preoperative pupil size was measured under low-light conditions with an infrared pupillometer. Visual and refractive outcomes were evaluated at 1 month postoperatively. A questionnaire was administered to assess patient-reported outcomes including satisfaction with the procedure, night driving, and glare and halo visual symptoms. RESULTS: The average patient age was 29.8 years (range: 18 to 40 years). The mean preoperative manifest spherical equivalent of -3.49 diopters (D) (range: -0.50 to -11.75 D) was reduced to -0.04 ± 0.29 D at 1 month, with 94% of eyes achieving an uncorrected distance visual acuity of 20/20 or better. The mean lowlight pupil diameter was 6.6 mm (range: 4 to 9 mm) and 1,514 patients (27.2%) had a diameter of 8 mm or larger. No correlation between pupil diameter and patient-reported outcomes was found (r range: -0.02 to 0.07). Logistic regression analysis identified postoperative uncorrected distance visual acuity and postoperative manifest refraction as significant predictors of night halo complaints after wavefront-guided LASIK (P < .01). CONCLUSIONS: In this large series of young patients with myopia treated with wavefront-guided LASIK, lowlight pupil diameter was not predictive of surgery satisfaction, ability to perform activities, or visual symptoms at 1 month postoperatively. Copyright © SLACK Incorporated.


Schallhorn S.C.,University of California at San Francisco | Venter J.A.,Optical Express | Hannan S.J.,Optical Express | Hettinger K.A.,Optical Express
Clinical Ophthalmology | Year: 2015

Purpose: The purpose of this study was to evaluate the refractive and visual outcomes of wavefront-guided laser in situ keratomileusis (LASIK) in eyes with myopic astigmatism and cylindrical component $2.0 diopter (D). Methods: In this retrospective study, 611 eyes that underwent LASIK for simple or compound myopic astigmatism were analyzed. Preoperative refractive cylinder ranged from -2.00 D to -6.00 D (mean -2.76±0.81 D), and the sphere was between 0.00 D and -9.75 D (mean -2.79±2.32 D). Predictability, visual outcomes, and vector analysis of changes in refractive astigmatism were evaluated. Results: At 3 months after LASIK, 83.8% of eyes had uncorrected distance visual acuity of 20/20 or better, 90.3% had manifest spherical equivalent within ±0.50 D, and 79.1% had residual refractive cylinder within ±0.50 D of intended correction. The mean correction ratio for refractive cylinder was 0.92±0.14, the mean error of angle was -0.45°±2.99°, and the mean error vector was 0.37±0.38 D. A statistically significant correlation was found between the error of magnitude (arithmetic difference in the magnitudes between surgically induced refractive correction and intended refractive correction) and the intended refractive correction (r=0.26, P,0.01). Conclusion: Wavefront-guided LASIK for the correction of myopic astigmatism is safe, effective, and predictable. © 2015 Schallhorn et al.


Schallhorn S.,University of California at San Francisco | Brown M.,Optical Express | Venter J.,Optical Express | Teenan D.,Optical Express | And 2 more authors.
Journal of Refractive Surgery | Year: 2014

Purpose: To provide an initial retrospective evaluation of early postoperative outcomes after wavefront-guided myopic LASIK using a new-generation Hartmann-Shack wavefront sensor. METHODS: A noncomparative, retrospective study of 243 eyes of 126 patients that underwent primary wavefront-guided LASIK, using wavefront data obtained with a new Hartmann-Shack aberrometer (iDesign Advanced WaveScan aberrometer; Abbott Medical Optics, Inc., Santa Ana, CA). Visual acuity, refraction, and patient satisfaction were evaluated 1 month after surgery. RESULTS: The manifest spherical equivalent was reduced from -3.28 ± 1.79 diopters (D) (range: -9.88 to -0.38 D) before surgery to -0.03 ± 0.29 D (range: -1.00 to +1.25 D) 1 month after surgery. The manifest spherical equivalent was within 0.50 and 1.00 D of target in 93.0% and 99.6% of eyes, respectively. Manifest astigmatism preoperatively (-0.72 ± 0.67 [range: 0.0 to -5.00 D]) was reduced to -0.14 ± 0.20 (range: 0.0 to -1.00 D) at 1 month and the vector-derived correction ratio (surgically induced refractive change/intended refractive correction) was 1.02 ± 0.30. Uncorrected distance visual acuity of 20/16, 20/20, and 20/25 or better was achieved in 79.0%, 93.4%, and 96.7% of eyes, respectively. No eyes lost two or more lines of corrected distance visual acuity, whereas a gain of one or more lines was observed in 14.0%. Most patients (98.5%) reported that they were satisfied with the outcome of their procedure. CONCLUSIONS: Wavefront-guided LASIK using the new aberrometer in this retrospective evaluation was effective, safe, and predictable in the early postoperative time period for the correction of myopia with high patient satisfaction. Copyright © SLACK Incorporated.


Schallhorn S.,Optical Express | Tanzer D.,U.S. Navy | Sanders D.R.,Center for Clinical Research | Sanders M.,Center for Clinical Research | And 2 more authors.
Journal of Refractive Surgery | Year: 2010

PURPOSE: To compare changes in simulated night driving performance after Visian Toric Implantable Collamer Lens (TICL; STAAR Surgical) implantation and photorefractive keratectomy (PRK) for the correction of moderate to high myopic astigmatism. METHODS: This prospective, randomized study consisted of 43 eyes implanted with the TICL (20 bilateral cases) and 45 eyes receiving conventional PRK (VISX Star S3 excimer laser) with mitomycin C (22 bilateral cases) for moderate to high myopia (-6.00 to -20.00 diopters[D] sphere) measured at the spectacle plane and 1.00 to 4.00 D of astigmatism. As a substudy, 27 eyes of 14 TICL patients and 41 eyes of 21 PRK patients underwent a simulated night driving test. The detection and identification distances of road signs and hazards with the Night Driving Simulator (Vision Sciences Research Corp) were measured with and without a glare source before and 6 months after each procedure. RESULTS: No significant difference was noted in the pre- to postoperative Night Driving Simulator in detection distances with and without the glare source between the TICL and PRK groups. The differences in identification distances without glare were significantly better for business and traffic road signs and pedestrian hazards in the TICL group relative to the PRK group whereas with glare, only the pedestrian hazards were significantly better. A clinically relevant change of Night Driving Simulator performance (>0.5 seconds change in ability to identify tasks postoperatively) was significantly better in the TICL group (with and without glare) for all identification tasks. CONCLUSIONS: The TICL performed better than conventional PRK in the pre- to postoperative Night Driving Simulator testing with and without a glare source present. Copyright © SLACK Incorporated.


Venter J.A.,Optical Express | Pelouskova M.,Optical Express | Collins B.M.,Optical Express | Schallhorn S.C.,Optical Express | Hannan S.J.,Optical Express
Journal of Cataract and Refractive Surgery | Year: 2013

Purpose: To report the effectiveness, patient satisfaction, and complication rate with a zonal refractive intraocular lens (IOL) in a high volume of patients. Setting: Private clinic, London, United Kingdom. Design: Case series. Methods: Retrospective data of patients with binocular Lentis Mplus IOLs were analyzed. The main outcome measures were uncorrected distance visual acuity (UDVA), uncorrected near visual acuity (UNVA), corrected distance visual acuity, manifest refraction, patient satisfaction, and complications. One-month, 3-month, and 6-month data were analyzed. Results: The study comprised 9366 eyes of 4683 patients. The mean spherical equivalent changed from +1.73 diopters (D) ± 3.37 (SD) preoperatively to -0.02 ± 0.60 D at 3 months and +0.03 ± 0.60 D at 6 months. Ninety-five percent of patients achieved a binocular UDVA of 6/7.5 (0.1 logMAR) or better 3 months postoperatively. The mean binocular UNVA was 0.155 ± 0.144 logMAR and 0.159 ± 0.143 logMAR at 3 months and 6 months, respectively. Severe dysphotopsia requiring an IOL exchange occurred in 55 eyes. Patient satisfaction was high, with 97.5% of patients willing to recommend the procedure. Conclusions: The zonal refractive IOL provided excellent distance and near visual acuity. The postoperative complication rate was clinically acceptable, and patient satisfaction high. Financial Disclosure: Dr. Schallhorn is a consultant to Abbott Medical Optics, Inc. No author has a financial or proprietary interest in any material or method mentioned. © 2013 ASCRS and ESCRS.


Venter J.A.,Optical Express | Oberholster A.,Optical Express | Schallhorn S.C.,Optical Express | Pelouskova M.,Optical Express
Journal of Refractive Surgery | Year: 2014

PURPOSE: To evaluate refractive and visual outcomes of secondary piggyback intraocular lens implantation in patients diagnosed as having residual ametropia following segmental multifocal lens implantation. METHODS: Data of 80 pseudophakic eyes with ametropia that underwent Sulcoflex aspheric 653L intraocular lens implantation (Rayner Intraocular Lenses Ltd., East Sussex, United Kingdom) to correct residual refractive error were analyzed. All eyes previously had in-the-bag zonal refractive multifocal intraocular lens implantation (Lentis Mplus MF30, models LS-312 and LS-313; Oculentis GmbH, Berlin, Germany) and required residual refractive error correction. Outcome measurements included uncorrected distance visual acuity, corrected distance visual acuity, uncorrected near visual acuity, distance-corrected near visual acuity, manifest refraction, and complications. One-year data are presented in this study. RESULTS: The mean spherical equivalent ranged from -1.75 to +3.25 diopters (D) preoperatively (mean: +0.58 ± 1.15 D) and reduced to -1.25 to +0.50 D (mean: -0.14 ± 0.28 D; P < .01). Postoperatively, 93.8% of eyes were within ±0.50 D and 98.8% were within ±1.00 D of emmetropia. The mean uncorrected distance visual acuity improved significantly from 0.28 ± 0.16 to 0.01 ± 0.10 logMAR and 78.8% of eyes achieved 6/6 (Snellen 20/20) or better postoperatively. The mean uncorrected near visual acuity changed from 0.43 ± 0.28 to 0.19 ± 0.15 logMAR. There was no significant change in corrected distance visual acuity or distance-corrected near visual acuity. No serious intraoperative or postoperative complications requiring secondary intraocular lens removal occurred. CONCLUSIONS: Sulcoflex lenses proved to be a predictable and safe option for correcting residual refractive error in patients diagnosed as having pseudophakia. Copyright © SLACK Incorporated.


Venter J.A.,Optical Express | Pelouskova M.,Optical Express | Bull C.E.L.,Optical Express | Schallhorn S.C.,Optical Express | Hannan S.J.,Optical Express
Journal of Cataract and Refractive Surgery | Year: 2015

Purpose To evaluate the efficacy, safety, predictability, and patient satisfaction after refractive lens exchange with a zonal refractive intraocular lens (IOL) with an inferior reading addition in emmetropic patients. Setting Optical Express, London, United Kingdom. Design Retrospective case series. Methods Emmetropic presbyopic patients who had implantation of a Lentis Mplus LS-313 MF30 IOL were evaluated. Inclusion criteria were sphere between -0.50 diopter (D) and +1.00 D with no more than 0.75 D of refractive cylinder and an uncorrected distance visual acuity (UDVA) of 6/6 or better in each eye. The main outcome measures were monocular and binocular UDVA, uncorrected near visual acuity (UNVA), corrected distance visual acuity (CDVA), and patient satisfaction. Three months data are presented. Results Four hundred forty eyes of 220 patients were evaluated. The mean monocular UDVA changed from -0.04 logMAR ± 0.06 (SD) preoperatively to -0.04 ± 0.11 logMAR postoperatively (P =.39). The mean CDVA was -0.10 ± 0.05 logMAR preoperatively and -0.09 ± 0.06 logMAR postoperatively (P =.06). At 3 months, 99.7% of eyes were within ±1.00 D of emmetropia. The mean UNVA was 0.13 ± 0.14 logMAR monocularly and 0.10 ± 0.12 logMAR binocularly. On the patient satisfaction questionnaire, 91.9% of patients said the refractive procedure improved their lives and 93.5% were willing to recommend it to friends and family. Three patients requested IOL exchange because of severe night-vision phenomena or unsatisfactory quality of vision. Conclusion Refractive lens exchange with this zonal refractive IOL was safe in emmetropic presbyopic patients. Financial Disclosure Dr. Schallhorn is a consultant to Abbott Medical Optics. No other author has a financial or proprietary interest in any material or method mentioned. © 2015 ASCRS and ESCRS.


Hofmeister E.M.,Naval Medical Center San Diego | Bishop F.M.,Naval Medical Center San Diego | Kaupp S.E.,Naval Medical Center San Diego | Schallhorn S.C.,Optical Express
Journal of Cataract and Refractive Surgery | Year: 2013

Purpose: To evaluate the safety and efficacy of mitomycin-C (MMC) 0.01% (0.1 mg/mL) in preventing haze formation after wavefront-guided photorefractive keratectomy (PRK) for higher myopia at 3 exposures. Setting: United States Navy Refractive Surgery Center, San Diego, California, USA. Design: Double-masked randomized prospective trial. Methods: Sixty-, 30-, and 15-second exposures of MMC 0.01% were compared in wavefront-guided PRK for higher myopia. One eye received MMC (surgical sponge) and the other a placebo. All eyes received a 4-month tapering postoperative topical steroid regimen. Endothelial cell densities, haze scores, high- and low-contrast acuities, and manifest refraction were measured preoperatively and 1, 3, 6, and 12 months postoperatively. Outcomes were analyzed as repeated measures over time. Results: The mean preoperative manifest refraction spherical equivalent was -5.98 diopters (D) (range -4.4 to -8.0 D). No eye developed more than trace haze. There was a significant difference in haze scores between MMC-treated eyes and untreated eyes at 1 and 3 months (P=.034) but no difference at 6 and 12 months. Endothelial cell densities decreased in the treated eyes and untreated eyes at all 3 exposures at 1 month but returned to baseline by 6 months. There was no difference in acuities or refractions with or without MMC. Conclusions: Mitomycin-C may not be needed to prevent haze after modern PRK with a 4-month steroid taper. There was no clinically significant difference in haze formation between MMC eyes and control eyes at the concentration and exposures used. Financial Disclosure: Dr. Schallhorn is a consultant to Abbott Medical Optics, Inc. No author has a financial or proprietary interest in any material or method mentioned. © 2013 ASCRS and ESCRS Published by Elsevier Inc.


Venter J.,Optical Express | Pelouskova M.,Optical Express
Journal of Cataract and Refractive Surgery | Year: 2013

Purpose: To evaluate the refractive outcomes and rotational stability after implantation of a multifocal toric intraocular lens (IOL) with a surface-embedded near section. Setting: Private center, London, United Kingdom. Design: Case series. Methods: This study evaluated eyes with more than 1.50 diopters (D) of preexisting corneal astigmatism. After phacoemulsification, Lentis Mplus toric IOLs were implanted in all cases. The main outcome measures were refraction, uncorrected (UDVA) and corrected (CDVA) distance visual acuities, uncorrected near visual acuity (UNVA), keratometry, and IOL position. Three-month postoperative data are presented. Results: The study enrolled 89 eyes (58 patients). The mean monocular postoperative UDVA and UNVA were 0.03 logMAR ± 0.11 (SD) and 0.17 ± 0.14 logMAR, respectively. The mean refractive cylinder decreased from 2.90 ± 1.31 D preoperatively to 0.50 ± 0.39 D postoperatively (P<.001). The mean difference between the planned axis of implantation and the actual axis postoperatively was 2.53 ± 2.27 degrees. Conclusion: The multifocal toric IOL with a surface-embedded near section effectively corrected preexisting corneal astigmatism. The IOL was stable in the capsular bag, there were no visually significant complications, and there was no significant rotation out to 3 months postoperatively. Financial Disclosure: Neither author has a financial or proprietary interest in any material or method mentioned. © 2013 ASCRS and ESCRS.


Venter J.,Optical Express | Blumenfeld R.,Optical Express | Schallhorn S.,Optical Express | Pelouskova M.,Optical Express
Journal of Refractive Surgery | Year: 2013

PURPOSE: To report the outcomes of the correction of mixed astigmatism with non-penetrating femtosecond laser intrastromal astigmatic keratotomy in patients with previous refractive surgery. METHODS: One hundred twelve eyes that had low mixed astigmatism after excimer laser surgery, refractive lens exchange, or phakic intraocular lens implantation underwent intrastromal astigmatic keratotomy using paired symmetrical non-penetrating intrastromal arcuate keratotomies created 60 μm from the surface to 80% depth at 7 mm diameter. Outcome measures included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), subjective refraction, and keratometry. A coupling ratio was calculated to assess the change in spherical equivalent. Average follow-up was 7.6 ± 2.9 months. Patients were divided into two groups: no excimer laser corneal ablation and previous excimer laser surgery. Preoperative and postoperative data were compared between groups and analyses were performed on the whole group of eyes. RESULTS: Overall, the mean UDVA improved significantly from 0.18 ± 0.14 to 0.02 ± 0.12 logMAR (6/9 to ≈6/6 Snellen) (P < .01). The mean absolute subjective cylinder decreased significantly from 1.20 ± 0.47 diopters (D) preoperatively to 0.55 ± 0.40 D postoperatively (P < .01). Subjective sphere decreased significantly from +0.61 ± 0.33 to +0.17 ± 0.36 D (P < 0.01). The mean CDVA was -0.03 ± 0.08 logMAR (≈ 6/6 Snellen) preoperatively and -0.05 ± 0.09 logMAR (≈ 6/5 Snellen) postoperatively (P = .06). The coupling ratio was 0.92 ± 0.45. There was no statistically significant difference in the preoperative and postoperative sphere, cylinder, UDVA, CDVA, and coupling ratio between groups. No surgical complications occurred. CONCLUSIONS: Femtosecond laser intrastromal astigmatic keratotomy was effective at reducing refractive error in patients where other surgical options were exhausted. Predictability and efficacy could be improved with nomogram refinement. Copyright © SLACK Incorporated.

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