March 2021


Journal of Cataract & Refractive Surgery
In the journal: February 2021


Comparison of early visual outcomes following low-energy small incision lenticule extraction (SMILE), high-energy SMILE and LASIK for myopia and myopic astigmatism in the United States

Mitra Nejad, MD, Angela Chen, BS, Roxana Khorrami, OD, Max Nutkiewicz, BS, D. Rex Hamilton, MD
Early uncorrected visual acuity and higher order aberrations in low-energy SMILE, high-energy SMILE, and femtosecond laser-assisted LASIK were reviewed via medical records in this retrospective cohort study. High-energy SMILE was defined as 125 nJ, 3.0 μm spot spacing, while low-energy was 125 nJ–130 nJ, 4.5 μm spot spacing. UDVA was measured at postop day 1 and at 1 month. Higher order aberrations (spherical aberration, vertical coma, horizontal coma, total coma, and total HOAs) were evaluated at 1 month. The study included 49 eyes in each of the three groups. Mean UDVA at postop day 1 was significantly better in the low-energy SMILE group compared to the high-energy group, though not statistically better compared to the femtosecond LASIK group. Induced change in spherical aberration in the low-energy SMILE group was less compared to that of the LASIK group at postop month
1; other HOAs were comparable. There was no significant difference in mean UDVA or induced change in higher order aberrations at postop month 1 between low-energy SMILE and femtosecond laser-assisted LASIK.

Topography/wavefront-guided photorefractive keratectomy combined with crosslinking for the treatment of keratoconus: preliminary results

Andrea Russo, MD, Fernando Faria-Correia, MD, Miguel Rechichi, MD, Giulia Festa, MD, Francesco Morescalchi, MD, Francesco Semeraro, MD
Topography/wavefront-guided PRK with a high-definition aberrometer (VISX STAR S4 IR with iDesign 2.0, Johnson & Johnson Vision) for treatment of epithelium-off, accelerated crosslinking protocol (CXL-Plus) was evaluated in a prospective case series of 35 eyes from 19 patients with grade I or II keratoconus. Researchers saw a significant improvement in uncorrected and corrected visual acuities at 6 months of follow-up, and manifest sphere and cylinder were significantly reduced (57% of eyes and 86% of eyes had a spherical equivalent within ±0.50 and ±1.00 D, respectively, of target). Corneal irregularity indexes were significantly reduced, as were higher order aberrations. The researchers reported no significant corneal haze or safety concerns, concluding that topography/wavefront-guided PRK with simultaneous crosslinking can help regularize the cornea in mild to moderate keratoconus cases.

Measures of visual disturbance in patients receiving extended depth of focus (EDOF) or trifocal intraocular lenses

Thomas Kohnen, MD, PhD, Rajaraman Suryakumar, BS (Optom), PhD
This literature review looked at the subjective and semi-objective methods that have been used to assess visual disturbances associated with trifocal or EDOF IOLs. The goal was to help researchers and eyecare professionals better interpret data that is published and allow them to choose quality of vision measures for future studies. Subjective measures included in the review were patient-reported outcome measures (PROMs), the different type of which (traditional, Rasch-based, other validated PROMs, item banking PROMs) were discussed in the paper. Semi-objective measures discussed in the paper included a halo and glare simulator, light-distortion analyzer, vision monitor, and halometers. The authors wrote that “these tools are largely used as supplementary methods to measure visual disturbance,” and they advocated for standardization of PROMs used in clinical research in the future.

Safety and efficacy of nepafenac punctal plug delivery system in controlling postoperative ocular pain and inflammation following cataract surgery

Eric Donnenfeld, MD, Edward Holland, MD, Kerry Solomon, MD
Three clinical sites evaluated the safety and efficacy of a nepafenac punctal plug delivery system for postop pain and inflammation after cataract surgery. The prospective, randomized, double-masked, placebo-controlled Phase 2 pilot study included 56 patients whose expected postop correctable distance vision was 20/30 or better. The group that received the nepafenac punctal plug saw more patients who were pain-free at day 3 and day 7 postop compared to placebo, 69% vs. 38%, respectively, and 67% vs. 31%, respectively. There were better anterior chamber cell scores in the nepafenac group compared to placebo (patients with no anterior chamber cells were 50% vs. 19% at day 7, respectively). There was one adverse event related to the punctal plug treatment in the nepafenac group and none in the placebo group.

Predictability of residual postoperative astigmatism after implantation of a toric intraocular lens using two different calculators

Seth Pantanelli, MD, Neal Kansara, MD, Gerard Smits, PhD
Two different calculators were used to compare predictability of postop refractive astigmatism of toric IOLs in this study, which was a secondary analysis of deidentified data from a clinical trial. Preoperative biometry was used to predict postop residual astigmatism using the enVista (Bausch + Lomb) formula and the Emmetropic Verifying Optical (EVO) Toric Formula 2.0. According to the authors, 47.3% of eyes had an absolute residual astigmatism prediction of 0.5 D or less in the legacy calculator group vs. 49.1% in the EVO group; 82.7% had a residual astigmatism prediction error of 1 D or less in the with the legacy calculator compared to 89.1% with the EVO calculator. The proportion of toric IOLs with residual astigmatism that was oriented as predicted (against the rule, with the rule, or oblique) that matched the actual residual astigmatism was 62% in the dataset that used the legacy calculator and 78% with the EVO calculator. The authors concluded that the EVO formula was better in predicting residual astigmatism in eyes with low astigmatism.

iStent inject: a comprehensive survey of the literature

Jordy Goemaere, MD, Céline Trigaux, MD, Laurens Denissen, MD, Diana Dragnea, MD, Minh-Tri Hua, MD, Marie-José Tassignon, MD, PhD, Sorcha Ní Dhubhghaill, MD, PhD
This review of iStent inject (Glaukos) evaluated data for efficacy, safety, and comparison with the first generation iStent. The authors noted several studies that found the device to be safe and effective as a standalone procedure or when combined with cataract surgery. The authors noted that the literature showed safety data of iStent inject procedures is similar to that of cataract surgery alone with adverse events remaining uncommon. The authors advocated for future studies to include more information and comparison to other trabecular MIGS.

JCRS Journal of Cataract & Refractive Surgery In the journal: February2021 JCRS Journal of Cataract & Refractive Surgery In the journal: February2021
Ophthalmology News - EyeWorld Magazine
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