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To report the refractive outcome of femtosecond laser–assisted lenticule intrastromal keratoplasty (LIKE) in correcting moderate to high hyperopia. Intraoperative effective optical zone (EOZ), centration offset, and postoperative higher order aberrations (HOAs) were analyzed to better understand factors affecting postoperative outcomes. This was a prospective, consecutive case series study of LIKE for correcting hyperopia in one department from 2018 to 2023. Refraction, tomography, uncorrected and corrected distance visual acuity (UDVA/CDVA), EOZ, and decentration offset by an innovated method using semi-automated software (ImageJ; National Institutes of Health) were analyzed. Tomography measured the preoperative and postoperative refractive tomographic changes. In the 18 eyes (9 participants) that underwent LIKE for correcting moderate to high hyperopia, the attempted spherical equivalent (SEQ) was +6.22 ± 0.85 diopters (D). One year postoperatively, 61% of all eyes had UDVA better than or equal to preoperative CDVA. In 78% of all eyes, the SEQ was less than 1.00 D from the attempted value. Compared to the programmed optical zone, the EOZ obtained after LIKE was significantly smaller (6.42 ± 0.15 vs 5.24 ± 0.23, P <.001). This was comparable to mild to moderate hyperopic LASIK treatment. The percentage of optical zone reduction was 18 ± 3%. The centration offset of the EOZ generated by LIKE was 0.27 ± 0.15 mm, and 94% of eyes had decentration within 0.5 mm. The induction of vertical coma and spherical aberration after LIKE were significantly higher. LIKE is a promising procedure to maintain stable refraction and keratometry in correcting moderate to high hyperopia with sufficient EOZ, and acceptable decentration and corneal HOAs.

Purpose To collect additional safety and efficacy data in patients with and without astigmatism requiring hyperopic correction with planned bilateral laser in situ keratomileusis (LASIK) treatment using the WaveLight EX500 excimer laser (Alcon Laboratories, Inc). Methods This was a prospective, single-arm, multicenter, interventional study of 60 eyes requiring refractive correction of hyperopia of +3.00 diopters (D) of sphere or less with or without astigmatism. Primary effectiveness endpoints were manifest refraction spherical equivalent (MRSE) within ±0.50 D at refractive stability (target > 50%) and within ±1.00 D at refractive stability (target > 75%). The primary safety endpoint was ocular adverse events. Results With refractive stability established at 3 months postoperatively, MRSE within ±0.50 D of the intended target was achieved in more than 98% of eyes (> 96% at 12 months), manifest refraction sphere within ±0.50 D of target in 95% of eyes (> 98% at 12 months), and residual refractive cylinder of 0.50 D or less in 93% of eyes (100% at 12 months). No eyes had overcorrection or undercorrection of MRSE by greater than 1.00 D at refractive stability and subsequent time points. Postoperative manifest refraction sphere and residual manifest refraction cylinder were within ±1.00 D in 100% of eyes at 12 months. Safety and patient-reported findings were consistent with previous reports, with high safety profiles. Conclusions The WaveLight EX500 excimer laser system was safe and effective for LASIK treatment of hyperopia with or without astigmatic refractive errors. [J Refract Surg. 2025;41(7):e655–e661.]

Purpose Novel spectacle lenses (MyoVision, Carl Zeiss) designed to reduce relative peripheral hyperopia have been developed and reported to be effective for preventing myopia progression in a subgroup of Chinese children. In this study we examined the efficacy of MyoVision lenses in Japanese children. Study design This was a multicenter prospective randomized double-blind placebo-controlled trial. Method We enrolled 207 participants (aged 6–12 years) with spherical equivalent refractions (SERs) ranging from −1.5 to −4.5 diopters (D) and with at least 1 myopic parent. The participants were randomized to receive either single vision lenses (SVLs) or MyoVision lenses and were followed up every 6 months for 2 years. The primary outcome was myopia progression evaluated by cycloplegic autorefraction, and the secondary outcome was elongation of axial length. Results A total of 203 children (98.1%) completed the follow-up. The mean adjusted change in SER was −1.43 ± 0.10 D in the MyoVision group, which was not significantly different from that of the control group wearing SVLs (−1.39 ± 0.07 D) at the 24-month visit ( P = .65). The adjusted axial length elongation was 0.73 ± 0.04 mm in the MyoVision group, which was not significantly different from that in the control group wearing SVLs (0.69 ± 0.03 mm) at the 24-month visit ( P = .28). Conclusion The results of this clinical trial could not verify the therapeutic effect of MyoVision for slowing down myopia progression in Japanese children. Additional studies are needed to design lenses that can reduce peripheral hyperopic defocus individually and to examine the effectiveness of these lenses in preventing myopia progression.

To assess Visian Implantable Collamer Lens (ICL) (STAAR Surgical, Monrovia, CA) implantation in the ciliary sulcus to correct pseudophakic ametropia in patients who are not candidates for a keratorefractive procedure. The authors performed a prospective non-comparative case series study of 18 patients (age: 48 to 61 years) with refractive surprise after phacoemulsification. Patients underwent implantation of a piggyback collagen copolymer lens: V4C design in 16 myopic eyes and V4B design in 2 hyperopic eyes. The position and vault of the ICLs were documented at all control visits clinically and with Pentacam (Oculus Optikgeräte, Wetzlar, Germany). Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction spherical equivalent (MRSE), intraocular pressure (IOP), and endothelial cell count were recorded at baseline and 1 week and 1, 6, 12, and 18 months postoperatively. The MRSE improved from -3.08 ± 2.37 diopters (D) preoperatively to -0.44 ± -0.23 D postoperatively, corrected with a mean ICL power of -3.20 ± 2.90 D. The mean UDVA improved from 1.03 ± 0.12 logMAR preoperatively to 0.05 ± 0.06 logMAR postoperatively (P = .00), whereas CDVA improved from 0.47 ± 0.03 logMAR preoperatively to -0.006 ± 0.02 logMAR (P = .001) postoperatively. None of the cases developed interlenticular opacification throughout the 18-month follow-up. The mean ICL vault measured by Scheimpflug tomography was 451.27 ± 178.5 µm. Acute IOP elevation with anterior uveitis developed in 2 eyes and was controlled by topical steroids and a beta-blocker. Sulcus implantation of the secondary ICL to correct pseudophakic refractive error was safe, predictable, and well tolerated in all studied eyes. [J Refract Surg. 2017;33(8):532-537.].

From the desktop to the laptop to the mobile device, personal computing platforms evolve over time. Moving forward, wearable computing is widely expected to be integral to consumer electronics and beyond. The primary interface between a wearable computer and a user is often a near-eye display. However, current generation near-eye displays suffer from multiple limitations: they are unable to provide fully natural visual cues and comfortable viewing experiences for all users. At their core, many of the issues with near-eye displays are caused by limitations in conventional optics. Current displays cannot reproduce the changes in focus that accompany natural vision, and they cannot support users with uncorrected refractive errors. With two prototype near-eye displays, we show how these issues can be overcome using display modes that adapt to the user via computational optics. By using focus-tunable lenses, mechanically actuated displays, and mobile gaze-tracking technology, these displays can be tailored to correct common refractive errors and provide natural focus cues by dynamically updating the system based on where a user looks in a virtual scene. Indeed, the opportunities afforded by recent advances in computational optics open up the possibility of creating a computing platform in which some users may experience better quality vision in the virtual world than in the real one.

Nanophthalmos is a rare, potentially devastating eye condition characterized by small eyes with relatively normal anatomy, a high hyperopic refractive error, and frequent association with angle closure glaucoma and vision loss. The condition constitutes the extreme of hyperopia or farsightedness, a common refractive error that is associated with strabismus and amblyopia in children. NNO1 was the first mapped nanophthalmos locus. We used combined pooled exome sequencing and strong linkage data in the large family used to map this locus to identify a canonical splice site alteration upstream of the last exon of the gene encoding myelin regulatory factor (MYRF c.3376-1G>A), a membrane bound transcription factor that undergoes autoproteolytic cleavage for nuclear localization. This variant produced a stable RNA transcript, leading to a frameshift mutation p.Gly1126Valfs*31 in the C-terminus of the protein. In addition, we identified an early truncating MYRF frameshift mutation, c.769dupC (p.S264QfsX74), in a patient with extreme axial hyperopia and syndromic features. Myrf conditional knockout mice (CKO) developed depigmentation of the retinal pigment epithelium (RPE) and retinal degeneration supporting a role of this gene in retinal and RPE development. Furthermore, we demonstrated the reduced expression of Tmem98, another known nanophthalmos gene, in Myrf CKO mice, and the physical interaction of MYRF with TMEM98. Our study establishes MYRF as a nanophthalmos gene and uncovers a new pathway for eye growth and development.

Purpose This study aimed to investigate the association between the axial length (AL) to average corneal curvature (CR) ratio and hyperopia reserve in preschool children. Methods AL, CR, horizontal and vertical meridians of the corneal radius (CR1, CR2), and 1% atropine cycloplegic refraction were measured in preschool children aged 3 - 6 years. The corneal curvatures were then used to calculate the AL/CR1, AL/CR2, and AL/CR ratios. Results A total of 338 children were included, comprising 178 boys (52.7%) and 160 girls (47.3%). The mean values for AL, CR, AL/CR1, AL/CR2, AL/CR, and spherical equivalent refractive error (SER) were 22.11 ± 0.88 mm, 7.77 ± 0.26 mm, 2.80 ± 0.09, 2.90 ± 0.09, 2.85 ± 0.09, and + 2.13 ± 1.46 D, respectively. AL, AL/CR1, AL/CR2, and AL/CR increased with age, showing significant differences among age groups ( P < 0.001). Conversely, SER moved from higher hyperopia toward lesser hyperopia with age, also showing significant differences among age groups ( P < 0.001). Linear regression equations were established, with Y representing hyperopia reserve and X representing AL/CR: Age 3: Y = 44.67 - 15.02X; Age 4: Y = 33.96 - 11.19X; Age 5: Y = 42.11 - 13.98X; Age 6: Y = 44.94 - 15.00X. These results suggest that the AL/CR ratio could be used to assess hyperopia reserve insufficiency. The optimal cut-off point for the receiver operating characteristic (ROC) curve was ≥ 2.91, with a sensitivity, specificity, and Youden index of 0.84, 0.88, and 0.73, respectively. The critical value of the ROC curve increased with age in children aged 3 - 6 years. Conclusion This cross-sectional study found that the hyperopia reserve in children of different ages can be estimated using the hyperopia reserve equation. Additionally, the AL/CR ratio can serve as an effective index for detecting hyperopia reserve insufficiency, with an optimal ROC curve cut-off point of ≥ 2.91 in preschool children aged 3 - 6 years, and the critical value increasing with age.

AimsTo investigate the association between hyperopia and clinically significant depression (CSD) in middle-aged and older individuals. The effect of genetic determinants of hyperopia on incident CSD was also explored.MethodsWe included participants who had available data on mean spherical equivalent (MSE) and were free of depression at baseline from the UK Biobank. For the phenotypic association, hyperopia was defined as MSE of+2.00 dioptres (D) or greater, and was divided into mild, moderate and high groups. Diagnosis of CSD across follow-up was determined based on electronic hospital inpatients records. For the genetic association analysis, the association between hyperopia Polygenic Risk Score and incident CSD was assessed. Mendelian randomisation was assessed for causality association.ResultsOver a median follow-up of 11.11 years (IQR: 10.92–11.38), hyperopia was significantly associated with incident CSD independent of genetic risk (HR 1.29, 95% CI 1.05 to 1.59) compared with emmetropia participants, especially in those hyperopic patients without optical correction (HR 1.38, 95% CI 1.07 to 1.76). In addition, participants in the high degree of hyperopia were more likely to have incident CSD than participants in the mild degree of hyperopia (P for trend=0.009). Genetic analyses did not show any significant associations between hyperopia and incident CSD (p≥0.1).ConclusionsHyperopia was significantly associated with an increased risk of incident CSD. This was independent of genetic predisposition to hyperopia, emphasising the importance of regular vision screening and correction of hyperopia to reduce the risk of CSD regardless of genetic risk.

PURPOSE: To evaluate an aspheric ablation profile to improve near vision in presbyopic patients with hyperopia and to outline the key factors of success. METHODS: A prospective, nonrandomized, clinical trial of 66 eyes of 33 hyperopic patients who underwent customized bilateral refractive surgery, which included an aspheric presbyopia treatment shape and wavefront-driven hyperopic treatment, was studied. Surgeries were performed using the VISX STAR S4 or STAR S4 IR excimer laser system (Abbott Medical Optics). Mean preoperative refractive error was +1.77±0.56 diopters (D) sphere (range: 0.75 to 3.50 D) with 0.41±0.34 D cylinder (range: 0.00 to 1.50 D). All patients received full distance refractive correction. No patients received monovision or were intentionally left with residual myopia. Patient satisfaction results were evaluated using a questionnaire with a 5-point scale. RESULTS: Sixty eyes completed 6-month and 50 eyes completed 12-month postoperative follow-up. At 6 months, mean corrected distance visual acuity (CDVA) was 20/20±1 line (range: 20/25 to 20/10). Mean gain in distance-corrected near visual acuity (DCNVA) was 2.7±1.7 lines with a maximum of 6 lines of near. Spectacle dependence for tasks, such as reading and computer use, was reduced. At 12 months, 100% of patients had achieved binocular simultaneous uncorrected vision of 20/25 or better and J3. Refraction was stable over 12 months. Contrast sensitivity reduction was clinically insignificant (1 step or 0.15 logCS). Negative spherical aberration highly correlated with postoperative improvement of DCNVA. Patients who had a larger amount of preoperative hyperopia or a greater decrease of preoperative DCNVA were more likely to have overall satisfaction. CONCLUSIONS: The aspheric ablation designed to expand near functional vision was effective and stable over 12 months. The wavefront-customized hyperopic treatment significantly reduced spectacle dependence.

To evaluate the safety and efficacy of intrastromally applied collagen cross-linking (CXL) in a comparative contralateral eye study of topography-guided femtosecond laser-assisted hyperopic LASIK. Thirty-four consecutive patients with hyperopia and hyperopic astigmatism elected to have bilateral topography-guided LASIK and were randomized to receive a single drop of 0.1% sodium phosphate riboflavin solution under the flap followed by 3-minute exposure of 10 mW/cm2 ultraviolet A (UVA) light with the flap realigned in one eye (CXL group) and no intrastromal CXL in the contralateral eye (no CXL group). All eyes were treated with the WaveLight FS200 femtosecond laser and WaveLight EX500 excimer laser (Alcon Laboratories Inc). Refractive error and keratometric, topographic, and tomographic measurements were evaluated over mean follow-up of 23 months. Preoperatively, mean spherical equivalent refraction was +3.15 +/- 1.46 diopters (D) and +3.40 +/- 1.78 D with a mean cylinder of 1.20 +/- 1.18 D and 1.40 +/- 1.80 D and mean uncorrected distance visual acuity (UDVA) (decimal) of 0.1 +/- 0.26 and 0.1 +/-0.25 in the CXL and no CXL groups, respectively. At 2 years postoperatively, mean spherical equivalent refraction was -0.20 +/- 0.56 D and +0.20 +/- 0.40 D with mean cylinder of 0.65 +/- 0.56 D and 0.76 +/- 0.72 D and mean UDVA of 0.95 +/- 0.15 and 0.85 +/- 0.23 in the CXL and no CXL groups, respectively. Eyes with CXL demonstrated a mean regression from treatment of +0.22 +/- 0.31 D, whereas eyes without CXL showed a statistically significant greater regression of +0.72 +/- 0.19 D (P = .0001). Topography-guided hyperopic LASIK with or without intrastromal CXL is safe and effective, with greater long-term efficacy (less regression) in eyes with CXL. Our data suggest that the regression seen with hyperopic LASIK may be related to biomechanical changes in corneal shape over time.