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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.

PurposeTo determine the efficacy of extended depth of focus (EDOF) contact lenses for controlling myopia progression in children through a 1-year randomised clinical trial.MethodsA total of 104 children aged 7–15 years, with spherical equivalent refraction ≤−0.50 D, were randomly assigned to wear SEED 1 dayPure EDOF Mid contact lenses (n=48) or single vision spectacle lenses (n=56). Cycloplegic refraction with Shin-Nippon open field autorefractor and axial length with Lenstar LS 900 was determined at the baseline and 12-month visits. The compliance, visual discomfort and dryness questionnaires were administered during the final visit.ResultsSixty-nine children (control: n=38; treatment: 31) completed the 12-month follow-up visit, with no difference in baseline characteristics between the groups. Mean (SEM) myopia progression in the 12th month was −0.48±0.07D in the control group and −0.20±0.08D in the treatment group. Mean axial elongation was 0.22±0.03 mm and 0.11±0.03 mm in the control and treatment groups, respectively. SEED 1 dayPure EDOF Mid contact lenses slowed myopia progression by 59% (−0.28D; p=0.01) based on spherical equivalent refraction and controlled axial length by 49% (0.11 mm; p=0.007) in comparison to single vision spectacle lenses. None of the participants reported any adverse effects. While most of the participants (82%) were comfortable with the contact lenses, 11% reported occasional dryness and 14% experienced mild fluctuations in visual acuity after immediate lens wear.ConclusionDaily wear of SEED 1 dayPure EDOF Mid contact lenses in Indian children showed a significant effect in controlling myopia progression and axial elongation.

Purpose To evaluate the tolerance to refractive errors of a new purely refractive extended depth of focus (EDF) intraocular lens (IOL), TECNIS PureSee™ IOL, using preclinical and clinical metrics. Methods Preclinical evaluation included computer simulations of visual acuity (sVA) and dysphotopsia profile of different IOL designs (refractive EDF, diffractive EDF, multifocal, standard, and enhanced monofocals) using an appropriate eye model with and without ±0.50 D defocus and/or +0.75 D of astigmatism. Patients bilaterally implanted with a refractive EDF (Model ZEN00V, TECNIS PureSee™ IOL) or an enhanced monofocal (Model ICB00, TECNIS Eyhance™ IOL) IOL from a prospective, randomized study were included. At the 6-month postoperative visit, uncorrected and corrected distance vision (UDVA and CDVA), visual symptoms, satisfaction and dependency on glasses were evaluated in a subgroup of patients with absolute residual refractive error of >0.25 D in one or both eyes. Results In the presence of defocus and astigmatism, sVA was comparable for all except the multifocal IOL design. The refractive EDF was more tolerant to myopic outcomes and maintained a monofocal-like dysphotopsia profile with defocus. Binocular logMAR UDVA was −0.03 ± 0.08 for ZEN00V and −0.02 ± 0.11 for ICB00. 100% ZEN00V and 97% ICB00 patients did not need glasses and were satisfied with their distance vision. Monocular CDVA, contrast sensitivity and visual symptoms were also similar between both groups. Conclusions The clinical outcomes of the refractive EDF IOL demonstrated high quality distance vision and dysphotopsia comparable to a monofocal IOL, even in the presence of refractive error, thus matching the design expectations of the EDF IOL.

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.]

This study used fMRI to find that the dorsal visual area (V3B/KO) combines information about binocular disparity and relative motion cues to work out depth information. Humans exploit a range of visual depth cues to estimate three-dimensional structure. For example, the slant of a nearby tabletop can be judged by combining information from binocular disparity, texture and perspective. Behavioral tests show humans combine cues near-optimally, a feat that could depend on discriminating the outputs from cue-specific mechanisms or on fusing signals into a common representation. Although fusion is computationally attractive, it poses a substantial challenge, requiring the integration of quantitatively different signals. We used functional magnetic resonance imaging (fMRI) to provide evidence that dorsal visual area V3B/KO meets this challenge. Specifically, we found that fMRI responses are more discriminable when two cues (binocular disparity and relative motion) concurrently signal depth, and that information provided by one cue is diagnostic of depth indicated by the other. This suggests a cortical node important when perceiving depth, and highlights computations based on fusion in the dorsal stream.

To evaluate visual outcomes at different distances (near, intermediate, and far), depth of focus, optical quality, quantitative dysphotopsia, and patient satisfaction in two groups. The extended depth of focus (EDOF) only group (n = 40 eyes) was implanted bilaterally with an EDOF intraocular lens (IOL) and the mixed group (n = 40 eyes) was implanted with the same EDOF IOL in the dominant eye and a trifocal IOL in the fellow eye. At the 3-month postoperative visit, refractive outcomes and monocular and binocular uncorrected (UDVA) and corrected (CDVA) distance visual acuities for far UDVA, CDVA, distance-corrected intermediate visual acuity (DCIVA) at 80 cm, uncorrected near visual acuity (UNVA), distance-corrected near visual acuity (DCNVA) at 40 cm, and binocular defocus curve were evaluated. The mean spherical equivalent (SE) 3 months postoperatively was -0.16 ± 0.41 diopters (D) in the EDOF only group and -0.39 ± 0.63 D in the mixed group. In the EDOF only group, binocular visual acuities were: UDVA = -0.04 ± 0.07 logMAR (20/18); CDVA = -0.04 ± 0.06 logMAR (20/18); DCIVA (80 cm) = 0.07 ± 0.19 logMAR (20/23); DCNVA (40 cm) = 0.32 ± 0.15 logMAR (20/42); and UNVA (40 cm) = 0.24 ± 0.17 logMAR (20/35). In the mixed group, binocular visual acuities were: UDVA = 0.03 ± 0.09 logMAR (20/21) (P = .08); CDVA = -0.01 ± 0.07 logMAR (20/20) (P = .25); DCIVA (80 cm) = 0.24 ± 0.23 logMAR (20/35) (P = .08); DCNVA (40 cm) = 0.19 ± 0.07 logMAR (20/31) (P = .03); and UNVA (40 cm) = 0.18 ± 0.10 logMAR (20/30) (P = .37). Effective restoration of visual acuity was demonstrated in both groups, with high levels of visual quality and patient satisfaction. Better results in near visual acuity were demonstrated in the mixed group. [J Refract Surg. 2019;35(7):408-416.].

To evaluate and compare the objective and subjective outcomes between bilateral implantation of the extended depth of focus (EDOF) Mini Well intraocular lens (IOL) and the aspheric monofocal Mini-4-Ready IOL (both SIFI S.p.A., Catania, Italy). This prospective comparative study included 25 patients (50 eyes) bilaterally implanted with an EDOF Mini Well IOL (EDOF group) and 25 patients (50 eyes) bilaterally implanted with a Mini-4-Ready IOL (monofocal group). Three-month follow-up data included corrected and uncorrected distance visual acuity at 4 m and 80, 67, and 40 cm. Defocus curves, subjective and objective contrast sensitivity, and objective optical quality (modulation transfer function cutoff and Strehl ratio calculated with Optical Quality Analysis System [OQAS]; Visiometrics SL, Terrassa, Spain), halometry, and reading performance were measured. Subjective visual quality was evaluated based on National Eye Institute Refractive Error Quality of Life Instrument 42 (NEI RQL-42) scores. Postoperative uncorrected and corrected monocular and binocular intermediate and near visual acuity was significantly better in the EDOF group (P < .001). No differences were observed for distance visual acuity (P ⩾ .312). Defocus curve outcomes for myopic values were better in the EDOF group (P < .001). No significant differences were found in hyperopic (obtained in steps of +0.50 diopters [D] from emmetropia to 1.50 D) values (P ⩾ .095), contrast sensitivity curves (P ⩾ .087), or OQAS outcomes (P ⩾ .138). Halometric values were significantly better in the monofocal group (P < .05). There was a correlation between mean keratometry values and intermediate/near visual acuity. Significantly better NEI RQL-42 subscale scores for near vision, far vision, activity limitations, glare, dependence on correction, and suboptimal correction were noted in the EDOF group (P < .05). Intermediate and near visual acuity was better after EDOF IOL than after aspheric monofocal IOL implantation while maintaining similar levels of visual quality, except for halo perception. [J Refract Surg. 2020;36(4):214-222.].

Objective To explore the impact of AI-assisted computing systems on the effects of surgery, stereoscopic vision, and quality of life in patients with intermittent exotropia after treatment. Methods Data from a total of 108 children with intermittent exotropia were collected and randomly divided into Group A and Group B. Group A used the traditional prism calculation method, whereas Group B used the AI-assisted calculation system method. The success rate of surgery, the strabismus correction effect, postoperative stereoscopic function, far strabismus, near strabismus, horizontal and vertical perceptual eye positions, externally skewed deviation, and quality of life (Child-IXTQ score) were compared between the two groups. Results At different time points (1 day, 1 month, 3 months, and 6 months after surgery), the success rate of surgery in Group B was significantly higher than that in Group A, with an average difference in the success rate of 8.47 ± 1.92% (all P  < 0.05). Compared with those at 1 day after surgery, the incidence rates of 6-m strabismus and 33-cm strabismus in the two groups of children were significantly lower at 1, 3, and 6 months after surgery (all P  < 0.05). Compared with the preoperative conditions, the central stereoscopic vision of the two groups of children significantly increased at 1, 3, and 6 months after surgery, whereas the proportion of children without stereoscopic vision significantly decreased (all P  < 0.05). Moreover, compared with preoperative conditions and 1 month postoperatively, the proportion of far-standing stereopsis gradually increased in both groups of patients at 3 and 6 months postoperatively (all P  < 0.05). However, in terms of both central and far-standing stereoscopic vision, the rate of increase displayed by children in Group B was significantly greater than that in Group A (all P  < 0.05). At various postoperative time points, the Child-IXTQ score of Group B was higher than that of Group A. At 6 months after surgery, the Child-IXTQ score of Group B reached its highest value (84.57 ± 5.32) (all P  < 0.05). Conclusion AI-assisted computing systems can effectively improve the success rate of paediatric surgery, enhance the establishment of stereoscopic vision function, improve visual quality, and significantly improve quality of life.