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PurposeTo compare clinical outcomes of bilateral implantation of hybrid multifocal intraocular lenses (IOLs) versus mix-and-match implantation of hybrid multifocal and extended-depth-of-focus (EDOF) versus mix-and-match implantation of hybrid multifocal and enhanced monofocal IOLs.MethodsPatients with bilateral age-related cataract were randomised in one of three groups: group 1, bilateral hybrid multifocal IOL; group 2, EDOF in the dominant eye, hybrid multifocal in the non-dominant eye; group 3, enhanced monofocal in the dominant eye, hybrid multifocal in the non-dominant eye. Assessments at 6 months postoperatively included monocular and binocular uncorrected distance visual acuity (UDVA), intermediate (UIVA) and near distance (UNVA) at 40 and 33 cm, defocus curves, contrast sensitivity (CS), reading speed and questionnaires on quality of vision and dysphotopsia.Results75 patients (25 per group) were enrolled. There were no statistically significant differences in binocular UDVA and UNVA between groups (p>0.05); binocular UIVA was better for group 1 and 2 versus group 3 (p=0.030). Binocular uncorrected defocus curve showed better performance for group 1 compared with group 3 from −2.00 to −3.50 D. Significantly higher reading speed was measured for Jaeger 1 font in group 1. There were no differences in CS between groups, but higher incidence of starbursts in group 1 and higher need for near spectacles in group 3.ConclusionBilateral hybrid multifocal IOL implantation resulted in better near vision, but higher rates of photic phenomena compared with the mix-and-match groups. Combinations of IOLs may allow surgeons to fine-tune for individual patient’s needs.

Background/objective To evaluate the visual performance of a purely refractive extended depth of focus (EDF) intraocular lens (IOL). Subjects/methods A prospective, multi-center, randomized, subject/evaluator-masked study. Subjects were bilaterally implanted with the EDF test (Model ZEN00V, TECNIS PureSee™ IOL, N  = 60) or an enhanced monofocal control (Model ICB00, TECNIS Eyhance™ IOL, N  = 57) IOL. Monocular corrected distance (CDVA), intermediate (DCIVA), near acuities (DCNVA) and patient reported visual symptoms were evaluated at the 6-month visit. Monocular mesopic contrast sensitivity (CS) and depth of focus (DOF) testing were assessed at 3 months. Results CDVA (Mean ± SD) was −0.06 ± 0.08 for test and −0.05 ± 0.08 logMAR for control groups. DCIVA was 0.13 ± 0.08 for test and 0.18 ± 0.14 logMAR for control groups ( p  = 0.0127). DCNVA was 0.37 ± 0.10 for test and 0.43 ± 0.16 logMAR for control groups ( p  = 0.0137). Test lens was statistically superior for intermediate and near. Overall, 91.7% (halos), 95.0% (starbursts) and 95.0% (glare) of test lens patients reported that they did not experience, were not bothered, or were slightly bothered by specific visual symptoms, compared to 98.2%, 100% and 96.5% in the control group. The DOF range over which monocular visual acuity was 0.20 logMAR or better was −1.6 D for the test lens. Mesopic CS was comparable between both groups, falling within 0.11 log units for all measured cycles per degree with and without glare. Conclusion The EDF IOL demonstrated extended range of vision and statistically superior intermediate and near performance compared to the monofocal IOL. Distance visual acuity, contrast sensitivity and dysphotopsia profile were similar to the monofocal IOL.

Evidence suggests that covert visual attention can improve behavioral performance by modulating contrast or response gain. Herrmann et al . find that the size of the stimulus and the attention field determine which mechanism is used. These results support predictions of the normalization model of attention. Covert attention, the selective processing of visual information in the absence of eye movements, improves behavioral performance. We found that attention, both exogenous (involuntary) and endogenous (voluntary), can affect performance by contrast or response gain changes, depending on the stimulus size and the relative size of the attention field. These two variables were manipulated in a cueing task while stimulus contrast was varied. We observed a change in behavioral performance consonant with a change in contrast gain for small stimuli paired with spatial uncertainty and a change in response gain for large stimuli presented at one location (no uncertainty) and surrounded by irrelevant flanking distracters. A complementary neuroimaging experiment revealed that observers' attention fields were wider with than without spatial uncertainty. Our results support important predictions of the normalization model of attention and reconcile previous, seemingly contradictory findings on the effects of visual attention.

Purpose To examine lenticule decentration and visual quality following small incision lenticule extraction (SMILE) using either the coaxially sighted corneal light reflex (CSCLR) or the tear film mark (TFM) centration method. Methods A total of 186 eyes from 93 patients were enrolled in this prospective, randomized, contralateral eye comparison study. Each patient had one eye randomly assigned to the CSCLR group (n = 93) and the contralateral eye to the TFM group (n = 93). Visual outcomes, optical zone decentration, contrast sensitivity, corneal higher order aberrations (HOAs), and the relationships between the magnitude of decentration and induced corneal HOAs were evaluated at 3 months postoperatively. Results The magnitudes of total decentration (CSCLR: 0.23 ± 0.13; TFM: 0.22 ± 0.13; P = .996), as well as horizontal and vertical decentration, were comparable between the two methods. However, in the angle kappa greater than 200 µm subgroup, a statistically significant smaller horizontal decentered displacement was observed in the CSCLR group (0.01 ± 0.16) compared to the TFM group (0.07 ± 0.18) (P = .024). The induced HOAs and contrast sensitivity were comparable between the two methods (all P > .05). Additionally, significant correlations were identified between total decentered displacement and induced HOAs, including RMS HOAs, RMS coma, vertical coma, and RMS spherical aberration, in both groups. Conclusions Both the CSCLR and TFM methods can yield accurate treatment centration and satisfactory visual quality. However, the CSCLR method may contribute to less horizontal decentration in patients with a large preoperative pupil offset. [J Refract Surg. 2025;41(2):e144–e154.]

Purpose To assess the possible benefits of the use of perceptual learning and dichoptic therapy combined with patching in children with amblyopia over the use of only patching. Methods Quasi-experimental multicentric study including 52 amblyopic children. Patients who improved their visual acuity (VA) by combining spectacles and patching were included in patching group (PG: 20 subjects), whereas those that did not improved with patching performed visual training (perceptual learning + dichoptic therapy) combined with patching, being assigned to the visual treatment group (VT: 32 subjects). Changes in VA, contrast sensitivity (CS), and stereopsis were monitored during a 6-month follow-up in each group. Results Significant improvements in VA were found in both groups at 1 month ( p  < 0.01). The total improvement of VA was 0.18 ± 0.16 and 0.31 ± 0.35 logMAR in PG and VT groups, respectively ( p  = 0.317). The Wilcoxon effect size was slightly higher in VT (0.48 vs. 0.54) at 6 months. An enhancement in CS was observed in the amblyopic eye of the VT group for all spatial frequencies at 1 month ( p  < 0.001). Likewise, the binocular function score also increased significantly in VT group ( p  = 0.002). A prediction equation of VA improvement at 1 month in VT group was obtained by multiple linear regression analysis ( p  < 0.001, R 2  = 0.747). Conclusions A combined treatment of visual training and patching is effective for obtaining a predictable improvement of VA, CS, and binocularity in patching-resistant amblyopic children.

Purpose To compare clinical outcomes for patients implanted with either FineVision HP or FineVision Triumf intraocular lenses (IOL) (Beaver-Visitec International, Inc) following cataract surgery. Methods Twenty-six patients bilaterally implanted with the HP IOL and 27 patients with the Triumf IOL were followed up for 6 months in a prospective randomized study. Refraction, uncorrected and corrected distance visual acuity (CDVA), uncorrected and distance-corrected intermediate visual acuity (DCIVA), and uncorrected and distance-corrected near visual acuity (DCNVA) were evaluated. Defocus curves and contrast sensitivity were also measured. Patient-reported outcomes were assessed using the National Eye Institute Visual Function Questionnaire 25, and adverse events were registered. Results Ninety-four percent of the eyes in both groups were within ±1.00 diopter (D) of spherical equivalent. All of the patients had 20/20 or better binocular CDVA in both groups and 96% and 100% had 20/25 or better binocular CDIVA in the Triumf and HP IOL groups, respectively, being reduced to 32% and 91.7% for DCNVA, respectively. Differences between groups were statistically significant from −2.00 to −4.50 D with better visual acuity outcomes for the HP IOL group (P < .01). Better monocular photopic contrast sensitivity was found for the Triumf IOL group at 12 and 18 cycles per degree (P < .01). There was a statistically significant increase of the overall composite score in both groups before and after surgery (P < .001). Spectacle independence was similar between groups for distance and intermediate vision but higher for the HP IOL for near vision (96% versus 75%). There were no adverse events related to the IOLs. Conclusions Both IOLs showed good and comparable distance and intermediate visual acuities but near vision was better for the HP IOL. This model provided higher spectacle independence for near vision. [J Refract Surg. 2025;41(3):e102–e113.]

Purpose To evaluate the ability of a novel device using virtual implantation to compare the visual performance of two different types of intraocular lenses (IOLs). Methods In this prospective, masked, and randomized clinical trial, the visual performance of monofocal and lowadd bifocal IOLs was compared using a device for virtual implantation called VirtIOL. Eighty patients (< 50 years old with healthy eyes and without cataract) were enrolled in this study. Defocus curve and contrast sensitivity were measured using the Freiburg Vision and Contrast Test (FrACT). Results Expected defocus curves for the monofocal IOL and the bifocal IOL confirm the utility of the method. The monofocal IOL provided a slightly higher mean visual acuity at 0.00 diopter (D) (mean ± standard deviation: −0.18 ± 0.07 D) compared to the bifocal IOL (−0.16 ± 0.08 D), but also a slightly lower visual acuity from −1.25 to −4.00 D. The mean contrast sensitivity was significantly higher for the monofocal IOL at 7, 11, and 15 cycles per degree. The investigators attest a high usability of the method due to simple communication with the test patient and quick and uncomplicated change of test objects. Conclusions The visual performance of the monofocal and bifocal IOLs was as expected, with greater depth of focus but reduced contrast sensitivity for the bifocal IOL. The VirtIOL device represents a promising tool to predict the visual performance of IOLs before implantation in patients. [J Refract Surg. 2024;40(12):e911–e915.]

PURPOSE: To compare the visual and refractive outcomes of femtosecond laser-assisted LASIK with small-incision lenticule extraction (SMILE) in terms of visual acuity, contrast sensitivity, aberrations, and dry eye. METHODS: A single-center prospective randomized study in which patients diagnosed as having myopia presenting for refractive correction were allocated to either a LASIK or SMILE group. The primary outcome measures were refractive efficacy, predictability, and safety, postoperative contrast sensitivity, aberrations, and dry eye status. Patients were followed up at days 1 and 15 and 3 months; postoperative uncorrected visual acuity (UCVA), aberrations, dry eye, and contrast sensitivity were recorded and compared to preoperative data. Two postoperative subjective questionnaires were used to assess pain, pricking sensation, redness, glare, and overall patient satisfaction. RESULTS: At day 1 postoperatively, 48 (96%) of 50 eyes in the SMILE group achieved a UCVA of 20/20 compared with 46 (92%) of 50 eyes in the LASIK group. At day 15 postoperatively, contrast sensitivity was similar in the two groups (At day 1 postoperatively, 48 (96%) of 50 eyes in the SMILE group achieved a UCVA of 20/20 compared with 46 (92%) of 50 eyes in the LASIK group. At day 15 postoperatively, contrast sensitivity was similar in the two groups ( P = .15), but by 3 months, it was better in the SMILE group than the LASIK group at all spatial frequencies ( P < .0001). At 3 months postoperatively, 42 (84%) eyes in each group achieved a UCVA of 20/20, with 6 (12%) eyes in the SMILE group and 2 (4%) eyes in the LASIK group achieving 20/15. Higher-order aberrations at 3 months postoperatively were significantly higher in the LASIK group (0.437 ± 0.103 µm) than in the SMILE group (0.267 ± 0.07 µm; P < .001). Postoperative dry eye and glare were significantly more common following LASIK ( P < .001). CONCLUSIONS: Three-month results demonstrate that refractive accuracy, dry eye, contrast, and induced aberrations are better following SMILE rather than LASIK. [[ J Refract Surg. 2014;30(9):590–596.]

Recent studies have demonstrated that training adult amblyopes in simple visual tasks leads to significant improvements of their spatial vision. One critical question is: How much can training with one particular stimulus and task generalize to other stimuli and tasks? In this study, we estimated the bandwidth of perceptual learning in teenage and adult observers with anisometropic amblyopia and compared it to that of normal observers. We measured and compared contrast sensitivity functions--i.e., sensitivity to sine-wave gratings of various spatial frequencies--before and after training at a single spatial frequency in teenagers and adults with and without amblyopia. We found that the bandwidth of perceptual learning in the amblyopic visual system is much broader than that of the normal visual system. The broader bandwidth, suggesting more plasticity and wider generalization in the amblyopic visual system, provides a strong empirical and theoretical basis for perceptual learning as a potential treatment for amblyopia.

Purpose: To compare the clinical and aberrometric outcomes obtained with a new diffractive pentafocal intraocular lens (IOL) and a diffractive trifocal IOL. Methods: Patients bilaterally implanted with the pentafocal Intensity SeeLens IOL (Hanita Lenses) (n = 30) and the trifocal FineVision POD F IOL (PhysIOL) (n = 30) during cataract surgery were studied after 1 month for refraction, visual acuity, defocus curve, contrast sensitivity, Hartmann-Shack aberration, and double-pass aberration. The Quality of Vision (QoV) questionnaire was used to evaluate visual comfort. Results: Distance and near visual acuities were similar with the two IOLs, but distance-corrected intermediate visual acuity was better with the Intensity IOLs (0.03 ± 0.04 vs 0.11 ± 0.04 logMAR in the FineVision eyes, P < .01). The difference between objective and subjective refraction was more myopic for the Intensity IOL (−1.15 vs −0.29 diopters [D]). The defocus curve was flatter with the Intensity IOL. Contrast sensitivity was similar in both IOLs. Hartmann-Shack aberration and double-pass aberration were similar, but the modulation transfer function cut-off value was worse with the Intensity IOL: 11.6 ± 2.7 vs 15.3 ± 4.9 (P < .01). QoV scores were better with the Intensity IOL, in particular for glare, halos, and starburst. Conclusions: In this comparative series, the pentafocal Intensity IOL provided better intermediate vision and better defocus curve than the FineVision IOL, with comparable distance and near vision. The optical disturbances as reported by the patients were higher with the FineVision IOL. Additional studies will better define the aberration profile obtained with the pentafocal IOL. [J Refract Surg. 2024;40(9):e604–e613.]