Search Results (173)

Background/Objectives: To investigate visual acuity, refractive outcomes and the predictive accuracy of modern intraocular lens (IOL) power calculation formulas in eyes implanted with two presbyopia-correcting IOLs: trifocal Zeiss AT LISA TRI and the nondiffractive EDOF Teleon Comfort. Methods: This retrospective consecutive chart review included 115 patients who underwent uncomplicated bilateral cataract surgery and received either the LISA TRI (n = 56) or Comfort (n = 59). Biometric measurements were obtained preoperatively, and refractive outcomes were assessed 1, 3, and 6 months postoperatively. Postoperative spherical equivalent (SEQ) was compared to predicted SEQ using the ESCRS calculator and IOLCON platform. Outcome measures included mean prediction error and mean absolute error (MAE). Distance-corrected visual acuity (VA), uncorrected VA, defocus curves, preferred viewing distances, contrast sensitivity, and photopic reading speed were also analyzed. Results: All formulas performed better in the LISA TRI group, with significantly lower MAE and higher proportions of eyes within ±0.50 diopters (D). Systematic prediction error offsets were observed for three formulas (K6, Castrop, Hoffer QST) in the LISA TRI group and for all five formulas in the MF15 group. Refractive stability was achieved by 3 months for the LISA TRI, while 20% of Comfort eyes continued to show SEQ shifts > 0.50 D at 3 months. Defocus equivalent (DEQ) had lower proportions of eyes within ±0.50 D than SEQ. Conclusions: The LISA TRI demonstrated superior predictive accuracy, faster refractive stabilization, and stronger near performance than the Comfort. These findings support the importance of IOL-specific constant optimization and highlight the need for incorporating DEQ into routine refractive outcome evaluation. Full article

Myopia prevalence has risen dramatically worldwide, underscoring the critical need for effective interventions to slow its progression. Recent advancements in spectacle lens technology offer promising solutions, demonstrating significant efficacy in controlling myopia. This review critically examines next-generation spectacle lenses for myopia management, emphasizing their optical principles, mechanisms of action, clinical effectiveness, visual performance, compliance, and safety. Spectacle lenses incorporating technologies such as Defocus Incorporated Multiple Segments (DIMS), Highly Aspherical Lenslet Target (HALT), Diffusion Optics Technology (DOT), and Cylindrical Annular Refractive Element (CARE) lenses show a 40–60% reduction in refractive progression and axial elongation compared to traditional single-vision lenses. These lenses utilize optical strategies like simultaneous myopic defocus, peripheral contrast modulation, and controlled aberrations without compromising visual acuity, contrast sensitivity, accommodation, or binocular vision. High wearer compliance is attributed to excellent visual comfort, minimal adaptation issues, and favorable cosmetic appearance. Long-term studies further confirm sustained efficacy and safety profile. Ongoing research aimed at direct comparative trials, extended follow-up, and individualized lens designs will further define the role of these interventions. Collectively, the evidence positions next-generation spectacle lenses as a promising, evidence-based approach that may become an important component of global myopia management. Full article

We provide an automated characterization of human retinal cells, i.e., RPE’s based on the non-invasive AO-TFI retinal imaging and PR’s based on the non-invasive AO-FI retinal imaging on a large-scale study involving 171 confirmed healthy eyes from 104 participants of 23 to 80 years old. Comprehensive standard checkups based on SD-OCT and Fondus imaging modalities were carried out by Ophthalmologists from the Luzerner Kantonsspital (LUKS) to confirm the absence of retinal pathologies. AO imaging imaging was performed using the Cellularis^® device and each eye was imaged at various retinal eccentricities. The images were automatically segmented using a dedicated software and RPE and PR cells were identified and morphometric characterizations, such as cell density and area were computed. The results were stratified based on various criteria, such as age, retinal eccentricity, visual acuity, etc. The automatic segmentation was validated independently on a held-out set by five trained medical students not involved in this study. We plotted cell density variations as a function of eccentricity from the fovea along both nasal and temporal directions. For RPE cells, no consistent trend in density was observed between 0° to 9° eccentricity, contrasting with established histological literature demonstrating foveal density peaks. In contrast, PR cell density showed a clear decrease from 2.5° to 9°. RPE cell density declined linearly with age, whereas no age-related pattern was detected for PR cell density. On average, RPE cell density was found to be ≈6313 cells/mm² ($\pm \sigma =757$), while the average PR cell density was calculated as ≈10,207 cells/mm² ($\pm \sigma =1273$). Full article

Background: Choroidal hemangioma, a rare benign vascular tumor, can cause visual loss due to subretinal fluid. Photodynamic therapy (PDT) with verteporfin has been the standard treatment, with plaque brachytherapy reserved for PDT failure. Verteporfin is unavailable in many regions in the Middle East, including Jordan, leaving plaque as the main alternative; however, plaque often leads to poor visual outcomes despite tumor control. To improve visual outcomes, we introduced transpupillary thermotherapy (TTT) via laser indirect ophthalmoscopy (LIO) as a practical, widely available, vision-preserving treatment. Methods: We retrospectively reviewed 13 patients with choroidal hemangioma treated at King Hussein Cancer Center. Patients received either plaque brachytherapy or LIO-guided TTT. Clinical data included visual acuity at baseline, tumor thickness reduction, subretinal fluid status, and visual outcome. Results: All patients had unilateral circumscribed choroidal hemangioma, and 10 (77%) were males. At diagnosis, the visual acuity was ≤0.5 in all patients (100%) and <0.1 in six (46%) patients. Seven patients (54%) received LIO-guided TTT and six (46%) underwent I-125 plaque brachytherapy. Tumor thickness was 3.0–5.0 mm in 12 (92%) cases; the median thickness in the I-125 plaque brachytherapy group was 4.5 mm (range, 4.5–5.0 mm), whereas in the LIO-guided TTT group it was 3.8 mm (range, 2.9–5.0 mm). At a median follow-up of 20 months (mean 24, range 12–48 months), five out of seven patients (71%) treated with TTT showed significant visual improvement, while the remaining two (29%) had stable vision; none experienced deterioration. In contrast, none of the six plaque-treated patients (0%) demonstrated any improvement in visual acuity; four remained stable and two worsened. This difference was statistically significant (p = 0.021). Tumor thickness was reduced in both groups, with a median reduction of −56% in the plaque group and −36% in the TTT group. All patients achieved complete resolution of subretinal fluid. Conclusions: LIO-guided TTT is an effective vision-preserving treatment for choroidal hemangioma. While both modalities-controlled tumor growth, only TTT resulted in significant visual improvement. This study demonstrates that LIO-guided TTT can replace plaque brachytherapy in regions where verteporfin (PDT) is unavailable, offering an accessible, practical, and superior alternative for preserving vision in patients with choroidal hemangioma. Full article

Background/Objectives: To compare the treatment outcomes of intravitreal faricimab (IVF) and intravitreal aflibercept (IVA) in treatment-naïve patients with neovascular age-related macular degeneration (nAMD), stratified by the presence or absence of punctate hyperfluorescence (PH). Methods: This retrospective study included 301 treatment-naïve patients with nAMD who underwent either IVF or IVA. After 1:1 propensity score matching based on baseline best-corrected visual acuity (BCVA), age, and PH status, 56 eyes (28 per group) were analyzed within each PH subgroup. Outcome measures included BCVA, central retinal thickness (CRT), subfoveal choroidal thickness (SFCT), and no retinal fluid rate during the loading dose regimen, and the retreatment rate after the loading dose regimen. The prespecified primary endpoint was the 1-year retreatment rate after completion of the loading dose regimen, analyzed by Kaplan–Meier curves with log-rank tests. Comparisons were performed separately between the PH and non-PH groups. Results: In the PH group, no significant differences were observed between IVF and IVA groups in terms of BCVA, CRT, SFCT, no retinal fluid rate, or retreatment rate at any time point. In the non-PH group, IVF and IVA groups showed no significant differences in BCVA, CRT, or SFCT at any time point; however, the IVF group achieved a significantly higher no retinal fluid rate (100.0% vs. 64.3%, p < 0.001) and a lower retreatment rate at 1 year (71.4% vs. 92.9%, p = 0.004) than the IVA group. Conclusions: IVF and IVA showed comparable efficacy in nAMD with PH. In contrast, IVF demonstrated superior anatomical outcomes in nAMD without PH. These retrospective findings suggest distinct pathophysiological mechanisms between PH and non-PH subtypes. Full article

Background: This prospective pilot study included four participants with chronic visual impairment and assessed functional and electrophysiological recovery following visual evoked potential (VEP)-guided auditory biofeedback across diverse etiologies. Low vision affects more than two billion people worldwide and imposes a sustained personal and socioeconomic burden. Conventional rehabilitation emphasizes optical aids and environmental modification without directly stimulating the visual pathway. Emerging evidence indicates that auditory biofeedback based on real-time cortical activity can leverage adult neuroplasticity. Methods: Four men (mean age 58 ± 12 years) with chronic visual impairment attributable to occipital stroke, stage IV macular hole, end-stage open-angle glaucoma, or diabetic maculopathy completed ten 10-min monocular sessions with the Retimax Vision Trainer over three weeks (15 Hz pattern reversal, 90% contrast). Primary end points were best corrected visual acuity (BCVA, ETDRS letters) and P100 amplitude/latency. Fixation stability was recorded with MAIA microperimetry when feasible. A focused PubMed review (2010–2025) mapped current evidence and research gaps. Results: Median BCVA improved by seven letters (IQR 0–15); three of eight eyes gained ≥ 10 letters and none lost vision. Mean P100 amplitude increased from 1.0 ± 1.2 µV to 3.0 ± 1.1 µV, while latency shortened by 3.9 ms. Electrophysiological improvement paralleled behavioural gain irrespective of lesion site. No adverse events occurred. Conclusions: A concise course of VEP-guided auditory biofeedback produced concordant functional and neurophysiological gains across retinal, optic nerve, and cortical pathologies. These pilot data support integration of closed-loop biofeedback into routine low vision care and justify larger sham-controlled trials. Full article

Background/Objectives: Adherence to medical appointments is crucial for managing age-related macular degeneration (AMD). The COVID-19 pandemic disrupted healthcare services, potentially affecting disease control. This study aimed to assess the impact of the pandemic on appointment adherence and disease progression in AMD patients at the Western Eye Hospital in London. Methods: Patients were divided into two groups: those who attended appointments on time and those who experienced delays (n = 100 per group). We compared disease progression using demographic data, best-corrected visual acuity (BCVA), and macular thickness measured by OCT, extracted from medical records. Results: In patients without delays, BCVA remained stable pre- and post-COVID-19, although significant changes in macular thickness were observed in the central (C0), superior (S1, S2), nasal (N1), and inferior (I1, I2) macular sectors. In contrast, patients with delayed appointments showed a significant increase in N1 macular thickness from 324.00 (304.00–358.00) pre-COVID-19 to 337.50 (305.50–375.50) post-COVID-19 (p = 0.030). Post-COVID-19, patients without delays had significantly better BCVA and thinner N1 macular thickness than those with delays. A positive correlation was found between the length of appointment delays and increased macular thickness in S1 and I2 sectors. Conclusions: Timely follow-up is essential in AMD management. Appointment delays during the COVID-19 pandemic were associated with increased macular thickness and worse visual outcomes, highlighting the importance of maintaining continuity of care even during healthcare disruptions. Full article

Augmented reality features, such as overlaying information in real time, modifying the projected scene, or dynamically adjusting parameters like contrast, zoom, and brightness, show promise in addressing the specific challenges faced by people with low vision. These tailored solutions enhance their visual experiences. When combined with mobile technology, these features significantly improve the personalization of visual aids and the monitoring of patients with low vision. Retiplus emerges as a personalized visual aid and rehabilitation system, utilizing smart glasses and augmented reality technology for visual aid functions, along with a mobile app for visual assessment, aid customization, and usage monitoring. This wearable system quickly assesses visual conditions, providing deep insights into the visual perception of patients with low vision. Designed to enhance autonomy and quality of life, Retiplus seamlessly integrates into indoor and outdoor environments, enabling the programming of rehabilitation exercises for both static and ambulatory activities at home. In collaboration with specialists, the system meticulously records patient interaction data for subsequent evaluation and feedback. A clinical study involving 30 patients with low vision assessed the effect of Retiplus, analyzing its impact on visual acuity, contrast sensitivity, visual field, and ambulation. The most notable finding was an average increase of 61% in visual field without compromising ambulation safety. Retiplus introduces a new user-centered approach that emphasizes collaboration among a multidisciplinary team for the customization of visual aids, thereby minimizing the gap between the perceptions of low vision specialists and technologists regarding user needs and the actual requirements of users. Full article

This study investigates reading performances and eye movements in individuals with eccentric fixation due to age-related macular degeneration (AMD). Overall, 17 individuals with bilateral AMD (7 males; mean age 77.47 ± 5.96 years) and 17 controls (10 males; mean age 72.18 ± 5.98 years) were assessed for reading visual acuity (VA), reading speed (Minnesota low vision reading chart in Slovene, MNREAD-SI), and near contrast sensitivity (Pelli-Robson). Microperimetry (NIDEK MP-3) was used to evaluate preferential retinal locus (PRL) location and fixation stability. Eye movements were recorded with Tobii Pro-glasses 2 and analyzed for reading duration, saccade amplitude, peak velocity, number of saccades, saccade duration, and fixation duration. Individuals with AMD exhibited significantly reduced reading indices (worse reading VA (p < 0.001), slower reading (p < 0.001), and lower near contrast sensitivity (p < 0.001)). Eye movement analysis revealed prolonged reading duration, longer fixation duration, and an increased number of saccades in individuals with AMD per paragraph. The number of saccades per paragraph was significantly correlated with all measured reading indices. These findings provide insights into reading adaptations in AMD. Simultaneously, the proposed approach in analyzing eye movements puts forward eye trackers as a prospective diagnostic tool in ophthalmology. Full article

Background and Clinical Significance: Central serous chorioretinopathy (CSCR) and hydroxychloroquine (HCQ) retinopathy can both cause outer retinal changes in systemic lupus erythematosus (SLE) patients treated with HCQ and corticosteroids. Differentiating between transient steroid-induced CSCR and irreversible HCQ toxicity is critical to avoid unnecessary discontinuation of essential therapy. Case Presentation: Three female SLE patients (ages 47, 41, and 37) on long-term HCQ (25, 9, and 6 years, respectively) and recent or ongoing low-dose prednisolone presented with unilateral OCT findings, parafoveal or pericentral photoreceptor defects, with the fellow eye unaffected. Review of clinical history and serial imaging revealed transient subretinal fluid in all cases, associated with recent corticosteroid use or dose escalation. Subsequent tapering or cessation of steroids led to resolution of the fluid, and earlier OCT scans confirmed normal outer retinal morphology, indicating that these changes were residual effects of resolved CSCR rather than HCQ toxicity. In Cases 1 and 2, the best-corrected visual acuity (BCVA) in the affected eye declined from 20/22 to 20/40 during the CSCR episode and improved to 20/30 and 20/25, respectively, after subretinal fluid resolution. In Case 3, by contrast, BCVA remained stable at 20/20 throughout the pre-, during-, and post-CSCR periods. Conclusions: Resolved CSCR can mimic HCQ retinopathy. These cases emphasize the importance of detailed medication history, serial multimodal retinal imaging, and comparison with prior and fellow-eye scans to distinguish resolved CSCR from HCQ retinopathy. Such thorough evaluation and careful differential diagnosis help ensure appropriate management—avoiding unnecessary HCQ discontinuation while protecting both ocular and systemic health. Full article

Alzheimer’s disease (AD) is the leading cause of dementia worldwide and is becoming one of the most morbid diseases of this century. Recently, ocular research in AD has gained significance, as the eye, due to its close relationship with the brain, can reflect the presence of neurological disorders. Several studies have reported alterations in various ocular structures in AD, ranging from tear fluid to the retina. These changes, particularly in the retina and the optic nerve, along with cerebral atrophy affecting visual brain areas, may lead to visual dysfunctions. This narrative review summarizes and critically examines current evidence on these impairments and explores their possible underlying mechanisms. A decrease in visual acuity, contrast sensitivity, and color vision has been observed, primarily associated with retinal ganglion cell loss or damage. Furthermore, alterations in the visual field, ocular motility, and visual perception have been recorded, mainly resulting from cortical changes. These optical parameters frequently correlate with patients’ cognitive status. In conclusion, these findings highlight the importance of developing strategies to preserve visual function in these patients, helping to prevent further deterioration in their quality of life, and emphasize the potential of visual function assessment as a tool for diagnosis or predicting AD progression. Full article

Background/Objectives: Age-related macular degeneration (AMD) is a leading cause of visual impairment in older adults and often coexists with cataracts. The indication of presbyopia-correcting intraocular lenses (IOLs) in these patients remains controversial. This study aimed to evaluate the clinical performance of a non-diffractive extended depth-of-focus (EDOF) IOL (LuxSmart™) compared to a monofocal plus IOL (Tecnis Eyhance™) in cataract patients with early-stage dry AMD. Methods: In this prospective observational study, 41 patients with early-stage AMD underwent bilateral cataract surgery with either LuxSmart™ or Tecnis Eyhance™ IOL implantation, targeting postoperative emmetropia. The eye selected for analysis was the first eye scheduled for surgery. Preoperative and postoperative evaluations included high and low-contrast distance visual acuity, intermediate and near visual acuity, defocus curves, ocular light scatter (halometry), and quality of life assessment (NEI VFQ-25). Postoperative biometric accuracy and refractive outcomes were also analyzed. Results: Both IOLs showed high refractive accuracy, with 100% of eyes within ±0.50 D of target. Postoperative uncorrected distance visual acuity was 0.10 ± 0.06 LogMAR for Eyhance and 0.07 ± 0.02 for LuxSmart (p = 0.06). Low contrast VA at 20% was 0.22 ± 0.11 (Eyhance) and 0.26 ± 0.16 (LuxSmart) (p = 0.49). Depth of focus was approximately 1.75 D for both lenses. Light scatter (LDI) improved postoperatively in both groups with no significant differences (p = 0.54). VFQ-25 scores showed improvement in daily activities, though no changes were observed in driving or mental health domains. Conclusions: Both lenses are safe and effective options for early AMD patients undergoing cataract surgery, providing good functional vision at multiple distances Full article

Background/Objectives: The Tecnis Eyhance is an enhanced monofocal intraocular lens (IOL) designed to improve intermediate vision without compromising distance clarity or increasing the incidence of photic phenomena. Although short-term results have been encouraging, long-term data remain limited. This study presents the 5-year follow-up of a previously published 6-month clinical evaluation, aiming to assess the stability of visual, optical, and patient-reported outcomes over time. Methods: A single-center retrospective study of 18 patients (36 eyes) undergoing bilateral Tecnis Eyhance IOL implantation was conducted. The same cohort from the original 6-month study was re-evaluated after a mean follow-up of 5 years. Visual acuity (distance, intermediate, near), defocus curves, contrast sensitivity, optical quality, effective lens position (ELP), halo size, and patient-reported measures were assessed. Results: Visual acuity remained stable across all distances, with binocular uncorrected intermediate visual acuity (UIVA) ≤ 0.2 logMAR in all patients. No significant changes were observed in optical quality parameters or contrast sensitivity. ELP remained consistent over time (p = 0.298), and posterior capsule opacification (PCO) requiring Nd:YAG capsulotomy developed in 5% of the eyes. Halo size was mild, and subjective glare perception did not increase. Spectacle independence remained high for distance (100%) and intermediate (more than 75%) tasks. Conclusions: This 5-year follow-up study confirms the long-term stability and effectiveness of the Tecnis Eyhance IOL. These findings support its long-term use as a stable monofocal IOL with enhanced intermediate function. Full article

Low vision is a condition in which a person experiences a significant loss of visual acuity or visual field that ordinary glasses, surgery, or medication cannot correct. Individuals suffering from this condition struggle to perform daily tasks, even when using glasses or contact lenses. In some cases, telescopes are recommended for patients with low vision diagnosis because they could help them improve their quality of life. Therefore, we propose a 3D-printed Galilean telescope for low-vision patients, accessible to both the vulnerable and nonvulnerable sectors of the population, with the advantages that the fabrication time, cost, and weight are considerably reduced. The performance of the 3D-printed Galilean telescope was evaluated by comparing it to an identical N-BK7 glass Galilean telescope design, obtaining a difference of 0.49 lp/mm in optical resolution. Clinical results from a patient with low vision, obtained as part of a proof-of-concept study, showed that the 3D-printed Galilean telescope improved the patient’s visual acuity, increasing it by up to 4 lines on the LEA numbers, from 10/80 to 10/32. Additionally, the 3D telescope enhanced the patient’s contrast sensitivity, improving it from 6 cpd (cycles per degree) level 8 to 18 cpd level 4. Full article

Background: Spectacle independence is a key goal in refractive lens exchange (RLE), especially in younger, high-expectation patients. This study evaluates a novel extended monovision approach combining a monofocal aspheric intraocular lens (IOL) in the dominant eye with a rotationally asymmetric bifocal extended-depth-of-focus (EDOF) IOL in the non-dominant eye. The strategy aims to optimize full-range visual performance while minimizing photic phenomena. Methods: In this retrospective cohort study, presbyopic patients underwent bilateral RLE with a monofocal IOL (Hoya Vivinex XC1-SP; target: 0 diopters [D]) in the dominant eye and a rotationally asymmetric bifocal EDOF IOL (LENTIS LS-313 MF15; addition: +1.5 D; target: −1.25 D) in the non-dominant eye. Uncorrected distance visual acuity (UDVA, at 6 m), uncorrected intermediate visual acuity (UIVA, at 66 cm), and uncorrected near visual acuity (UNVA, at 36 cm) were assessed. Additional evaluations included binocular defocus curves, contrast sensitivity, stereoacuity, and photic phenomena. Spectacle independence and satisfaction were measured using the PRSIQ and NEI-RQL-42 questionnaires. Results: A total of 38 patients (76 eyes) were included. The mean postoperative binocular UDVA, UIVA, and UNVA were −0.03 ± 0.08, −0.08 ± 0.09, and 0.04 ± 0.08 logMAR, respectively. The defocus curve peaked at 0.0 D (6 m) with a mean visual acuity of −0.03 ± 0.08 logMAR. Functional vision better than 0.2 logMAR extended over defocus steps from +1.00 to −3.25 D. All patients were spectacle-independent for distance and intermediate vision, and 84% reported complete spectacle independence. Contrast sensitivity was within normal limits for age. Minimal photic phenomena were reported, and stereoacuity was preserved in 97% of patients (≤100 arcseconds). Conclusions: This innovative extended monovision approach, combining two different IOLs in a mini-monovision setup, provides excellent uncorrected visual acuity at all distances, high spectacle independence, and minimal side effects. It represents a compelling alternative to multifocal IOL implantation in presbyopic RLE candidates. Full article