The AT.LISA trifocal IOL provides excellent uncorrected distance, intermediate, and near visual outcomes.

Among 372 spontaneous abortions four had chromosome anomalies that were unique in the series. Each one presented features of interest. There was one example of monosomy‐G and this was associated with apparently normal embryonic development to about the 28‐day stage. In two specimens extra chromosome material was found. In one instance it was added to the long arm of a B‐group chromosome in 44% of cells. In the other the extra material was an abnormal element of unknown origin. The fourth specimen was a 35‐mm fetus with cyclopia and D‐trisomy associated with a D/D translocation. The woman producing this abortus was a carrier of the same translocation. The literature relevant to these four unusual cases was reviewed.

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Kaizen is a Japanese word with two parts: ‘zen’ meaning ‘good’ and ‘kai’ meaning ‘change’, translating literally as ‘good change’ or ‘improvement’. Kaizen or continuous improvement-based approaches have been applied to many industries including health care. Kaizen principles include that everyone should be involved in daily improvement, that managers and front-line staff work together and that solutions should be small and incremental. Implementing Kaizen can have a strong influence on organizational culture including medical engagement, as highlighted through key case studies. One obstacle to successful change is the culture of organizations involved. This article highlights the potential for Kaizen as an agent for change in the NHS.

Following implantation with Multifocal intraocular lenses (MIOLs) or monofocal intraocular lenses (IOLs), the study examines monocular and binocular visual function and patient reporting outcomes using a rigorous series of clinical assessments. Setting: BMI Southend Hospital, UK DESIGN: Prospective, randomised, double-masked clinical trial. METHODS: 100 subjects were randomised for bilateral implantation of either Bi-Flex 677MY MIOL or Bi-Flex 677AB IOL and were assessed at 3-6 months (V1) and 12-18 months (V2). Primary outcomes included distance, intermediate and near LogMAR visual acuities (VA) and defocus curve profile assessment. Secondary outcomes included reading speed, contrast sensitivity (CS) and the subjective perception of quality-of-vision. RESULTS: Uncorrected (MIOL 0.10±0.09LogMAR; IOL 0.09±0.11LogMAR) and best distancecorrected VA (MIOL 0.04±0.06LogMAR; IOL 0.01±0.07LogMAR) were comparable (p>0.05). Unaided near VA (UNVA p<0.001: MIOL 0.23±0.13LogMAR; IOL 0.55±0.20LogMAR) and distancecorrected near VA (DCNVA p<0.001: MIOL 0.24±0.13LogMAR; IOL 0.54±0.17LogMAR) were significantly improved with MIOLs. There was no significant difference in distance-corrected intermediate VA (DCIVA p=0.431: MIOL 0.38±0.13; IOL 0.39±0.13).Defocus curves demonstrated an increased range-of-focus amongst MIOLs (MIOL 4.14±1.10D; IOL 2.57±0.77D). Pelli-Robson CS was different at V1 (p<0.001) but similar by V2 (p=0.059).Overall satisfaction was high (>90%) in both groups for distance tasks whereas significantly different for near (MIOL 18.45±16.53LogUnits; MIOL 55.59±22.52LogUnits). CONCLUSIONS:Unaided near visual acuity is demonstrably better with MIOLs and there was greater subjective satisfaction with their quality-of-near-vision. Halos reported by the MIOL group was significant compared to the IOL group, but did not show an adverse effect on overall satisfaction.Multifocal intraocular lenses (MIOLs) are widely considered the most reliable method of achieving spectacle independence following cataract surgery. [1][2][3] MIOLs distribute the light between distant and near focal points whereby the vergence of the incident light dictates which focal point is conjugate to the retinal plane.The separation of these multiple focal points is determined by the addition power of the MIOL and to a lesser extent the biometry of the eye. High addition MIOLs (+4.00D or higher) are the zeitgeist of the designs used in the late 90s-early 2000s. Disadvantages of these early lenses included a close working distance and reduced intermediate vision. Moreover, the size of the dysphotopic phenomenon (commonly described as halo), associated with MIOLs, increases according to the addition power; these higher addition lenses generate larger haloes. 4,5 The light energy distribution between the retinal focal points created by a MIOL influences the overall quality of vision at different viewing distances. MIOLs that split light equally, create two focal points of comparative image quality. In contrast, distance dominant MIOLs allocate a higher per...