Outcomes of Small Aperture Corneal Inlay Implantation in Patients With Pseudophakia

Huseynova, Tukezban; Kanamori, Tomomi; Waring, George O.; Tomita, Minoru

doi:10.3928/1081597x-20140120-06

Cited by 20 publications

(16 citation statements)

References 27 publications

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“…Biofinity Multifocal Center Near Contact Lenses, CooperVision), in which near miosis will improve near image quality . Also, although small pupils have been employed to expand the depth of focus of presbyopic and pseudophakic eyes, and senile pupil miosis has been implicated in expanding the depth of focus of older eyes, the current data indicate that early presbyopes are unlikely to benefit much from age‐related or near vision pupil miosis. For example, mean pupil diameters when viewing the most distant target for the 40–50 year old subjects were 5 mm compared to a mean of 5.77 mm for the under 40 year old subjects tested in identical circumstances, and at the reading distance of 50 cm (typically used by older people) pupils of the whole group were on average only 5% smaller than those observed at the 2 m test distance, predicting only very small reductions in image blur at near .…”

Section: Discussionmentioning

confidence: 81%

“…Also, it has been shown that near viewing will generate pupil miosis even in presbyopes, 25,26 which may be critical for this age group where expanded depth of focus may provide a valuable supplement to the declining accommodation. 27,28 Although the decline with age in accommodative amplitude is well documented, revealing full presbyopia (zero accommodation) at about age 50, 3,11,23,29,30 there are some uncertainties about the characteristics of accommodation during the critical [40][41][42][43][44][45][46][47][48][49][50] year range that have important clinical consequences. For example, studies of accommodative gain 10,14,15,17,31 have reported almost normal and high gain (0.8-1.0) until about age 45 in most subjects 14,31 whereas other studies 14,15,28 have reported low gain (0.0-0.2) in the early 40s.…”

Section: Introductionmentioning

confidence: 99%

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Accommodation and pupil behaviour of binocularly viewing early presbyopes

Almutairi

Altoaimi

Bradley

2017

Ophthalmic Physiologic Optic

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Purpose: To study accommodation behaviour of early presbyopes with the full suite of accommodative stimuli, and to monitor changes in spherical aberration, pupil size and image quality that accompany the accommodative response. Methods: Using a high resolution Shack-Hartmann aberrometer, we measured refractive state as a binocularly viewed 0.30 logMAR (6/12 or 20/40) letter E was moved from 2 m to 20 cm and simultaneously monitored pupil diameter and spherical aberration for 19 subjects (mean age: 42 AE 7.18 years). Refractive state was defined using three standard criteria: minRMS, paraxial, and optimum image quality using the Visual Strehl ratio metric (VSOTF). Results: Because of changes in spherical aberration, accommodative gain measured with the paraxial criterion is generally greater (on average by 34%) than the minRMS gain in early presbyopes. The slope of stimulus/response curve is relatively stable up to age 41 and then declines progressively in spite of a full binocular set of accommodative cues. Reduced accommodative gain appears once accommodative amplitude has dropped to below 3D, and gain drops to <0.5 as amplitude drops to 1.5D. This decline happens at different ages in different presbyopes. Conclusion: Prior to the early 40s, changes in accommodation are restricted to a reduction in amplitude, but during the 40s the continued loss of accommodative amplitude is accompanied by a concurrent drop in accommodative gain. Therefore, reduced near image quality in early presbyopes is caused by lower accommodative amplitudes and gains, which may explain the apparent acceleration in symptoms and near add prescriptions during the mid to late 40s.

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Section: Discussionmentioning

confidence: 81%

Section: Introductionmentioning

confidence: 99%

Accommodation and pupil behaviour of binocularly viewing early presbyopes

Almutairi

Altoaimi

Bradley

2017

Ophthalmic Physiologic Optic

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“…It restores reading vision through increased depth of focus. Although there are some problems with centering the implant i.e., the Pulfrich effect and some surgical complications, it is clear that the principle of a small pupil that moves with the eye can give a good near vision and preserve distance acuity as well [16, 25, 26]. We attempted with drops to approach this effect without surgical interference.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes of combined versus separate carbachol and brimonidine drops in correcting presbyopia

Abdelkader

Kaufman

2016

Eye and Vis

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BackgroundTo test and compare in a masked fashion the efficacy of using a parasympathomimetic drug (3% carbachol) and an alpha-2 agonist (0.2% brimonidine) in both combined and separate forms to create optically beneficial miosis to pharmacologically improve vision in presbyopia.MethodsA prospective, double-masked, randomized, controlled clinical trial was conducted. Ten naturally emmetropic and presbyopic subjects between 42 and 58 years old with uncorrected distance visual acuity of at least 20/20 in both eyes without additional ocular pathology were eligible for inclusion. All subjects received 3% carbachol and 0.2% brimonidine in both combined and separate forms, 3% carbachol alone and 0.2% brimonidine (control) alone in their non-dominant eye in a crossover manner with one week washout between tests. The subjects’ pupil sizes and both near and distance visual acuities will be evaluated pre- and post-treatment at 1, 2, 4, and 8 h, by a masked examiner at the same room illumination.ResultsStatistically significant improvement in mean near visual acuity (NVA) was achieved in all subjects who received combined 3% carbachol and 0.2% brimonidine in the same formula compared with those who received separate forms or carbachol alone or brimonidine alone (P < 0.0001).ConclusionBased on the data, the combined solution demonstrated greater efficacy than the other solutions that were tested. Improving the depth of focus by making the pupil small caused statistically significant improvement in near visual acuity, with no change in binocular distance vision.Trial registration ACTRN12616001565437. Registered 11 November 2016.

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“…Although, as expected theoretically, the inlay causes a small loss in visual sensitivity across the visual field, effects are minor . Kamra‐type corneal inlays are primarily intended for use with phakic patients but have also been used in patients with monofocal IOLs . A diffractive variant of this type of inlay, which theoretically would enhance both DOF and retinal image illuminance, has been proposed …”

Section: Surgical Pinhole Variants: Corneal Inlays and Iolsmentioning

confidence: 95%