Effect of residual astigmatism on uncorrected visual acuity and patient satisfaction in pseudophakic patients

Schallhorn, Steven C.; Hettinger, Keith A; Pelouskova, Martina; Teenan, David; Venter, Jan A.; Hannan, Stephen J.; Schallhorn, Julie M.

doi:10.1097/j.jcrs.0000000000000560

Cited by 52 publications

(46 citation statements)

References 30 publications

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“…Among all subjects, 22.4% of the eyes had an ORA magnitude of 1.0 D or more, which was consistent with previous studies ( 4 , 28 ) reporting an ORA magnitude larger than 1.0 D in about one-third of the eyes. A growing number of evidence have shown that postoperative patients with uncorrected astigmatism error of 1.0 D or even less had symptoms of blurred vision and eye fatigue ( 6 , 7 , 30 ). Thus, better management of ORA is important for surgeons to achieve satisfactory postoperative outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…ORA is known as the vectoral difference between ACA and MA at the corneal plane ( 3 , 4 ). This difference may result in excess corneal astigmatism and resultant glare, starburst, and haloes (GASH), leading to reduced visual acuity and even visual fatigue after refractive surgery ( 5 – 7 ). Therefore, appropriate management of ORA has become increasingly important.…”

Section: Introductionmentioning

confidence: 99%

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The Distribution Pattern of Ocular Residual Astigmatism in Chinese Myopic Patients

Tang

et al. 2022

Front. Med.

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PurposeWe aimed to investigate the distribution of ocular residual astigmatism (ORA) and its associations with age, gender, manifest refraction, and other ocular indicators in Chinese patients with myopia.DesignThis is a multi-center retrospective cross-sectional study.MethodThe study included 7,893 patients with myopia (7,893 eyes) aged 18–40 years from five ophthalmic centers. Anterior segment biometrics of the eyes were collected from the Pentacam. ORA and its summated vector mean were calculated using Alpins vector analysis. Compensation factor (CF) was used to evaluate the relation between ORA and corneal astigmatism. ORA in different age, gender, and refraction groups was compared. The Spearman correlation was adopted to reveal multiple ocular indicators associated with ORA, which were integrated into a multiple linear regression model to predict ORA.ResultsDistribution of ORA was slightly positively skewed (Skewness= 2.111, Kurtosis = 19.660, KS P < 0.0001). Mean ORA was 0.74 ± 0.39 D (95% normal range: 0.14–1.54 D). Among all the subjects, 22.4% of the eyes had an ORA magnitude of 1.0 D or more. Undercompensation or full-compensation of anterior corneal astigmatism (ACA) by ORA prevailed in both J0 (76.99%) and J45 (58.48%). Women had higher ORA power than men (0.77 ± 0.36 D vs. 0.73 ± 0.41 D, P < 0.0001). Participants with less negative spherical equivalent (SE) or higher manifest astigmatism (MA) also had higher ORA (all P < 0.0001). ORA was significantly correlated with ACA (r = 0.405) and posterior corneal astigmatism (PCA, r = 0.356). The multivariate logistic regression analysis showed strong predictability of ORA magnitude >1.0 D using anterior segment parameters (area under the receiver operating characteristic curve: 0.739).ConclusionORA is present in Chinese adults with myopia and is affected by multiple ocular factors. Our findings may provide valuable information about ORA distribution in candidates for refractive surgery, helping optimize the outcome of astigmatism correction.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Distribution Pattern of Ocular Residual Astigmatism in Chinese Myopic Patients

Tang

et al. 2022

Front. Med.

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“…Similar findings also suggested a positive association between visual acuity and astigmatism (LogMAR acuity = 0.068 + 0.055 astigmatism) ( 13 ). Moreover, a case-control study revealed that low-level ORA induced by IOL implantation in patients also reduced their visual acuity ( 14 ). The reason is that astigmatism could prevent the human eye from focusing complex visual information on the retina, leading to blurred vision.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of full compensation and its association with total astigmatism: A cross-sectional study

Hu²,

Zihang³

et al. 2023

Front. Public Health

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ObjectiveTo evaluate the characteristics of full compensation and its association with the prevalence of total astigmatism (TA), and to analyze the effects of TA on uncorrected distance visual acuity (UDVA).MethodsWith random cluster sampling based on a school-based cross-sectional design, children aged 4 to 18 years were recruited in September 2020, Shandong Province, China. TA, anterior corneal astigmatism (ACA), and ocular residual astigmatism (ORA) were converted to vectorial components (J0, J45), followed by an assessment of the compensatory effect of ACA by ORA. Astigmatism was defined as a cylinder that was better than or equal to 0.75 diopters (D). Logistic regression analysis was used to assess the related factors for children with full compensation, and the generalized linear model was used to assess the influence of TA on UDVA.ResultsOut of 4,494 eligible children, data of 4,145 children (92.3%, 9.23 ± 3.15 years, 50.4% boys) were included in the statistical analysis. The prevalence of TA (27.9%) increased significantly with age (Ptrend < 0.001). The distribution of full compensation in J0 and J45 components were similar (22.1% and 25.6%, respectively), which decreased with age (Ptrend < 0.001). The closer the refractive status was to emmetropization, the higher the proportion of full compensation and the lower the prevalence of TA were. Shorter axial length (J0: Odds Ratio (OR) = 0.76, 95% confidence interval (CI): 0.61 to 0.94, P = 0.010), better UDVA (J0: OR = 0.37, 95% CI: 0.21 to 0.65, P < 0.001; J45: OR = 0.34, 95% CI: 0.20 to 0.59, P < 0.001), and longer average corneal curvature radius (J0: OR = 3.72, 95% CI: 2.18 to 6.34, P < 0.001; J45: OR = 2.82, 95% CI: 1.67 to 4.76, P < 0.001) were associated with full compensation. Higher TA was associated with a worse UDVA (β = 0.03, 95% CI: 0.02 to 0.04, P < 0.001).ConclusionsThe prevalence of TA gradually increased with age, and showed a U-shaped distribution with increased refraction. Full compensation was associated with smaller TA and better UDVA. This indicated that considering the compensatory effect of ORA is vital for astigmatism correction in clinical work, which may improve the visual quality.

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“…And this can be in part the cause of halos in our patients. However, in a recent study, it was described that the effect of residual astigmatism on visual performance and satisfaction was more evident at the 0.75 to 1.00 D.[ 35 ] Finally, the authors conclude that corneal astigmatism of 0.50 or higher must be considered to be included and managed in the surgical plan. It is an interesting point, but in our case, we have not managed that: limbal relaxing incisions were not performed and the toric option was not available when the study was conducted.…”

Section: Discussionmentioning

confidence: 99%

A prospective study of a new presbyopia pseudophakic intraocular lens: Safety, efficacy and satisfaction

Roberto

2022

Indian Journal of Ophthalmology

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Purpose: To evaluate the safety, visual performance, and patient satisfaction of a new presbyopic pseudophakic intraocular lens (IOL). Methods: A prospective non-randomized case-series study was performed in Buenos Aires, Argentina. Patients included in the study underwent a programmed Femtosecond laser assisted cataract surgery (FLACS), performed between October and December 2020, with a 6-month follow-up period. The Intensity (Hanita Lenses) IOL was bilaterally implanted. Spherical equivalent (SE) refraction, uncorrected distance and near visual acuity (UDVA/UNVA), defocus curve, endothelial cell density (ECD), central corneal thickness (CCT), and a satisfaction questionnaire were evaluated. Results: A total of 56 patients (112 eyes), aged 65 ± 6.12 years were included. The mean ± SD of preoperative SE was 1.85 ± 2.24 D (range; −4.50 to 4.75), which had decreased 6 months after surgery to −0.08 ±0.32 D (range; −0.75 to 0.63). No eyes experienced a loss of lines of vision, and 94% obtained SE values between ± 0.50 D. Defocus curve for different additions was 0.03 LogMAR (logarithm of the minimum angle of resolution) for −3.0 D, −0.005 LogMAR for −1.5 D, and −0.07 LogMAR for 0 D. The ECD, CCT remained stable ( P : 0.09 and 0.58, respectively) and all patients achieved their preoperative expectations, with a 6-month follow-up period. Conclusion: Patients who underwent a safe bilateral implantation with Intensity IOL achieved a high degree of spectacle independence and satisfaction, 6 months after surgery.

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Effect of residual astigmatism on uncorrected visual acuity and patient satisfaction in pseudophakic patients

Abstract: In pseudophakic patients, even low amounts of residual astigmatism can increase the odds of not achieving 20/20 or 20/16 uncorrected distance visual acuity.

Cited by 52 publications

References 30 publications

The Distribution Pattern of Ocular Residual Astigmatism in Chinese Myopic Patients

The Distribution Pattern of Ocular Residual Astigmatism in Chinese Myopic Patients

Characteristics of full compensation and its association with total astigmatism: A cross-sectional study

A prospective study of a new presbyopia pseudophakic intraocular lens: Safety, efficacy and satisfaction

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