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Purpose: This review emphasizes the effect of light on visual efficiency, the impact of different lighting focuses, types of lighting, and their influence on vision and productivity. Light sources and standards are intriguing subjects for ophthalmologists. Guidelines regarding the level of lighting influence on visual activities can enhance visual performance.Methods: This article was developed based on literature reviews, with a bibliographic survey conducted in databases such as PubMed, MEDLINE, Web of Science, Embase, LILACS, and SciELO., Results: Provides recommendations for understanding information regarding the influence of lighting on visual performance., Conclusion: Proper workplace lighting is crucial for improving visual efficiency, safety, productivity, and worker health. Efficient workplace lighting should avoid light sources directed towards the worker's face, prevent harmful glare, be more intense in the work area, and uniform in the rest of the room. Ophthalmologists should be knowledgeable about and provide guidance on correct lighting to ensure patient comfort and satisfaction with visual correction.

Purpose: The number of medical schools in Brazil has increased in recent years; however, vacancies for specialization in ophthalmology probably have not kept up with the growing demand. This study wants to estimate the increase in medical schools, the demand for ophthalmology specialization, and evaluate learning opportunities in ophthalmology., Methods: This was a retrospective study with research from the Ministry of Education and Brazilian Council of Ophthalmology database from 2002 to 2021. These data were checked through 120 notices published by the institutions in 2021., Results: The number of medical school vacancies increased by 370%, whereas the number of certified ophthalmology vacancies increased by 64%. There was an 11.4% misalignment between the Brazilian Council of Ophthalmology data in the Ministry of Education., Conclusion: The proportion of medical graduates has increased much more than opportunities for ophthalmology specialization. The effect on the search for unaccredited specialization positions is unknown, and policies for monitoring the specialization of ophthalmology vacancies should be established.

Purpose: To analyze teleconsultation at a public ophthalmic teaching hospital during the COVID-19 pandemic in Brazil., Methods: Medical records of patients who requested ophthalmological teleconsultation between June 2020 and March 2021 were reviewed. The main outcomes included demographic data, eye disease symptoms, hypothesized diagnosis, and management. Moreover, the results of a satisfaction survey administered after the consultation were analyzed., Results: Medical records of a total of 161 patients were reviewed. The mean age was 45.98 ± 17.57 (8-90) years, and most were women (113, 70.20%). Only 57 (35.60%) of the patients had made previous follow-up visits to the hospital. The most frequent reason for consultation was the need for a new eyeglass prescription (73, 45.34%), followed by dry eye symptoms (16, 9.93%) and pterygium (13, 8.07%). Other reasons were the monitoring of previously diagnosed eye diseases, such as glaucoma, retinopathies, strabismus, and keratoconus. Regarding the satisfaction survey, 151 (93.78%) patients answered the online questionnaire. Most reported that they were satisfied with the teleconsultation (94.03%) and would participate in a future teleconsultation (90.06%)., Conclusion: Teleconsultation could be widely used to assist patients in public ophthalmology healthcare and teaching hospitals. Even though new eyeglass prescriptions are a frequent reason for ophthalmological appointments, patients tend to be satisfied with teleconsultation, as it also provides guidance.

Purpose: The purpose of this study was to analyze the safety of primary intraocular lens implantation in a large number of eyes in children aged <24 months., Methods: The medical records of patients aged 5-24 months, who underwent primary intraocular lens implantation in the capsular bag, were reviewed. A foldable three-piece acrylic intraocular lens was implanted by the same surgeon using a single surgical technique. Patients who had <1 year of follow-up after the surgery were excluded. The main outcome measurements included visual acuity, myopic shift, follow-up complications, and additional surgeries., Results: Sixty-eight patients (93 eyes) were analyzed. The mean age of the patients at the time of surgery was 15.06 ± 6.19 months (range: 5-24 months), and the spherical equivalent 1 month after surgery was 3.62 ± 2.32 D. After 5.67 ± 3.10 years, the spherical equivalent was -0.09 ± 3.22 D, and the corrected distance visual acuity was 0.33 ± 0.33 and 0.64 ± 0.43 logMAR in bilateral and unilateral cases, respectively (p=0.000). The highest myopic shift was observed in infants who underwent surgery at ages 5 and 6 months. The most frequent complications included visual axis opacification and corectopia. Glaucoma and retinal detachment were not reported., Conclusion: Primary in-the-bag intraocular lens implantation in children aged 5-24 months is safe, and is associated with low rates of adverse events and additional surgery.

Purpose: To evaluate the relationship between the incidence of complications and functionally monocular patients' emotional reactions during phacoemulsification under topical anesthesia., Methods: We enrolled 22 functionally monocular patients (11 males and 11 females; group 1) and 19 age- and sex-matched controls (6 males and 13 females; group 2) in this prospective, interventional, cross-sectional, case control study. Demographics data, including age, sex, and educational background, were collected. Surgeries were performed by the same surgeon, and during surgery, the patients' vital signs (blood pressure and heart rate) and surgical events (duration, body movements, signs of increased vitreous cavity pressure, difficulty in performing capsulorhexis, and complications) were noted. Pre- and postoperative visual acuity was also analyzed., Results: The mean age of group 1 was 73.05 ± 13.31 years and of group 1 was 69.74 ± 16.81 years. There was no significant between-group difference in systolic and diastolic blood pressures. The average heart rate was similar in both groups, too. During surgery, the surgeon's perception of excessive eye, eyelid, or head movements in both groups was similar, in addition to signs of increased vitreous cavity pressure., Conclusion: It is safe to perform phacoemulsification under topical anesthesia in functionally monocular patients, who apparently behave similarly to binocular patients.

Purpose: To compare the postoperative refractive predictability of IOLMaster 500 and Pentacam HR on the basis of keratometry and anterior chamber depth values in eyes with an indication for multifocal intraocular lens (IOL) implantation., Methods: This was a retrospective study conducted on 118 eyes treated with phacoemulsification and multifocal intraocular lens implantation. Only the eyes that achieved emmetropia in the dynamic refraction performed on postoperative day 30 were included. Haigis' formula was used in each case to calculate the intraocular lens power, and the intraocular lens with the target refraction closest to emmetropia was implanted. Four lens calculation scenarios were tested by combining keratometry and anterior chamber depth measurements obtained using the two devices., Results: IOLMaster 500 and Pentacam HR differed with regard to mean keratometry (D 0.07 ± 0.03 D; p=0.0065) and anterior chamber depth (D 0.08 ± 0.01 mm; p<0.001). In the analysis of covariance, the following differences were obtained using the Haigis' formula when confronted with the biometric values obtained by inserting keratometry and anterior chamber depth values, respectively: Penta/IOL x IOL/Penta (0.13 ± 0.03; p<0.0001); Penta/Penta × IOL/Penta (0.13 ± 0.03; p<0.0001); Penta/IOL × IOL/IOL (0.11 ± 0.03; p=0.001); Penta/Penta × IOL/IOL (0.11 ± 0.03; p=0.002); IOL/IOL × IOL/Penta (0.02 ± 0.03; p=0.865); and Penta/IOL × Penta/Penta (0.002 ± 0.03; p=0.99). The difference was smaller when measuring the anterior chamber depth using the IOLMaster 500, regardless of which device was used to measure keratometry., Conclusions: Pentacam HR significantly differed from IOLMaster 500 when calculating keratometry. As regards the anterior chamber depth, the two devices were equally accurate.

A retrospective and analytical study was conducted by using data from the National Transplantation System on 184,575 corneal transplantations performed between January 2001 and December 2016 in order to analyze thetrends in corneal transplantation from 2001 to 2016 in Brazil. The Cochran-Armitage test, analysis of variance, and Duncan's multiple comparisons were used to verify the existence of trends, compare the mean values between regions, and verify the mean differences, respectively. A significance level of 5% was used for all tests. The analysis showed that there was a 2.4-fold increase in the number of corneal transplantations (from 6,193 [35.2 per million people (pmp)] to 14,641 [71 pmp]; p<0.001), a 50.7% increase in the efficacy of meeting the population's demand for corneal transplantation (from 35.3% to 53.2%; p<0.001), an 11-fold increase in the number of corneal transplantation centers (from 32 to 356), and a 2.5-fold increase in the number of corneal transplantation teams (from 276 to 688) in Brazil during the period studied. The waiting list for corneal transplantation decreased by 45.4% (from 23,549 [123 pmp] to 12,865 [62.4 pmp]; p<0.001), and the corneal transplantation teams performed about 19 corneal transplantations per year. The best indices were observed in the southern, midwestern, and southeastern regions, and the worst indices were in the northern and northeastern regions. Brazil has been improving its capacity to perform corneal transplantation in the past 16 years, although this improvement varies across regions. However, the population's demand for corneal transplantation is yet to be satisfactorily met, primarily due to the low number of corneal donations.

Patients undergoing cataract surgery are generally elderly, and many take drugs with systemic effects. The surgeon must be aware of the risks of continuing or discontinuing such medications perioperatively. Antiplatelet drugs and anticoagulants, prescribed to reduce the incidence of thromboembolic events, are often used in this population. This paper aims to review the perioperative use of antiplatelet and anticoagulant drugs in the setting of cataract surgery. Topical or intracameral anesthesia is preferred over anesthesia injected with needles. Aspirin can be safely continued in patients undergoing cataract surgery. Warfarin has been extensively studied, and the risk of hemorrhage associated with cataract surgery is low if the international normalized ratio is in the therapeutic range. Only a few studies of direct oral anticoagulants are available, and therefore no definite recommendations regarding those agents can be made at this time. Anesthesia in cataract surgery carries a low risk, even for patients taking anticoagulant or antiplatelet drugs. The discontinuation of this class of drugs before cataract surgery may increase the risk of thromboembolism.

Purpose:: We aimed to report and analyze topographic and refractive outcomes following corneal collagen crosslinking (CXL) in patients with progressive keratoconus (KC)., Methods:: We performed a retrospective, analytical, and observational study of 100 eyes from 74 progressive KC patients who underwent CXL at the Eye Hospital of Paraná. Keratometric values were analyzed preoperatively as well as 3 and 12 months postoperatively., Results:: For a total of 100 eyes, 68 belonged to male patients. The mean age of our study population was 19.9 ± 5.61 years. The average visual acuity and topographic parameters overall were stable after 1 year (p<0.05). After 3 months, steepest keratometry reading (K2) and maximum keratometry (Kmax) were significantly decreased (p<0.05). Regarding topographic astigmatism (dK), there was no significant difference between the 3-month and 12-month follow-ups. When we made comparisons between genders following CXL, there were no significant differences related to the changes in Kmax, K2, and spectacle-corrected distance visual acuity (SCDVA)., Conclusions:: CXL promoted stabilization or improvement of keratometric values and visual acuity. We found that keratoconus apex stability may be achieved 3 months after the procedure. There was no significant difference in keratometric and refractive values measured between male and female patients.

Purpose: To analyze the safety of warfarin therapy during cataract surgery under topical anesthesia., Methods: This was a prospective nonrandomized comparative study of 60 eyes of 60 patients treated with or without concurrent oral warfarin anticoagulant therapy, referred for cataract surgery under topical anesthesia. The sample included a treatment (n=30) and a control (n=30) group., Results: There were no records of intraoperative or postoperative intracameral bleeding complications in both the groups. At 1-month postoperative follow-up, 90.0% of patients presented spectacle-corrected visual acuity of at least 20/40., Conclusion: Cataract surgery by phacoemulsification with topical anesthesia can be successfully conducted without discontinuing warfarin.

Purpose: To evaluate whether implantation of an aspheric intraocular lens (IOL) results in reduced ocular aberrations and improved contrast sensitivity after cataract surgery and, therefore, changes on frequency-doubling technology (FDT) testing., Methods: The present prospective clinical study enrolled 25 patients with bilateral cataract (50 eyes), who randomly received either an aspheric (Akreos AO) or a spherical (Akreos Fit) IOL in one eye and the other IOL in the second eye. Assessment 12 months postoperatively included photopic and mesopic contrast sensitivity testing. Higher-order aberrations (HOAs) were computed. FDT testing was divided into four areas to evaluate the variation of the values at different points. The median values of the local pattern thresholds (median area contrast sensitivity [MACS]) obtained with that division were calculated., Results: The Akreos AO group obtained statistically significantly lower values of HOAs and spherical aberration compared with the Akreos Fit group. There was a statistically significant between-group difference in contrast sensitivity under mesopic conditions at all spatial frequencies. No statistically significant differences were observed in mean deviation and pattern standard deviation. The aspheric IOL exhibited higher MACS in all areas, although a statistically significant difference was reached only in the 20-degree field area (P=0.043)., Conclusion: Aspheric IOLs significantly reduced spherical aberration and HOAs, improving mesopic contrast sensitivity. Although there was a trend toward slightly improved FDT in the aspheric IOL group, it was not statistically significant.

Purpose: To evaluate the incidence of posterior capsule opacification (PCO) four years after the implantation of a hydrophilic acrylic intraocular lens (IOL)., Methods: Fifty-eight randomly selected eyes from 58 patients were analyzed four years after phacoemulsification and Ioflex IOL implantation. The patients underwent an ophthalmic examination to detect PCO and a detailed medical history was obtained. The patients' charts were reviewed for their corrected distance visual acuity prior to the IOL implantation, as well as for one month postoperatively. The Student's t-test was used for statistical analysis., Results: The mean age of patients without PCO was 74.6 ± 9.5 years, compared to 70.3 ± 15 years in patients with PCO. Four years after surgery, 39 of the 58 eyes (67%) had detectable PCO and 24 eyes (41.3%) had decreased visual acuity (VA) due to PCO. These patients were referred for Nd:YAG laser capsulotomy. Three patients (5.1%) had decreased VA due to glaucoma, IOL opacification, or age-related macular degeneration. Twelve eyes (20.7%) presented mild PCO with unchanged VA. Systemic arterial hypertension was reported by 45% of the patients, and in 3.5% of these cases this was associated with diabetes mellitus., Conclusion: This study found the incidence of PCO to be 67% four years after phacoemulsification and Ioflex IOL implantation.

Purpose: The goal of this cross-sectional observational study was to quantify the pattern-shift visual evoked potentials (VEP) and the thickness as well as the volume of retinal layers using optical coherence tomography (OCT) across a cohort of Parkinson's disease (PD) patients and age-matched controls., Methods: Forty-three PD patients and 38 controls were enrolled. All participants underwent a detailed neurological and ophthalmologic evaluation. Idiopathic PD cases were included. Cases with glaucoma or increased intra-ocular pressure were excluded. Patients were assessed by VEP and high-resolution Fourier-domain OCT, which quantified the inner and outer thicknesses of the retinal layers. VEP latencies and the thicknesses of the retinal layers were the main outcome measures., Results: The mean age, with standard deviation (SD), of the PD patients and controls were 63.1 (7.5) and 62.4 (7.2) years, respectively. The patients were predominantly in the initial Hoehn-Yahr (HY) disease stages (34.8% in stage 1 or 1.5, and 55.8 % in stage 2). The VEP latencies and the thicknesses as well as the volumes of the retinal inner and outer layers of the groups were similar. A negative correlation between the retinal thickness and the age was noted in both groups. The thickness of the retinal nerve fibre layer (RNFL) was 102.7 μm in PD patients vs. 104.2 μm in controls., Conclusions: The thicknesses of retinal layers, VEP, and RNFL of PD patients were similar to those of the controls. Despite the use of a representative cohort of PD patients and high-resolution OCT in this study, further studies are required to establish the validity of using OCT and VEP measurements as the anatomic and functional biomarkers for the evaluation of retinal and visual pathways in PD patients.

Purpose: To investigate the possible effect of aspherical or yellow tinted intraocular lens (IOL) on contrast sensitivity and blue-on-yellow perimetry., Methods: This prospective randomized bilateral double-masked clinical study included 52 patients with visually significant bilateral cataracts divided in two groups; 25 patients (50 eyes) received aspherical intraocular lens in one eye and spherical intraocular lens in the fellow eye; and 27 patients (54 eyes) received ultraviolet and blue light filter (yellow tinted) IOL implantation in one eye and acrylic ultraviolet filter IOL in the fellow eye. The primary outcome measures were contrast sensitivity and blue-on-yellow perimetry values (mean deviation [MD] and pattern standard deviation [PSD]) investigated two years after surgery. The results were compared intra-individually., Results: There was a statistically significant between-group (aspherical and spherical intraocular lens) difference in contrast sensitivity under photopic conditions at 12 cycles per degree and under mesopic conditions at all spatial frequencies. There were no between-group significant differences (yellow tinted and clear intraocular lens) under photopic or mesopic conditions. There was no statistically significant difference between all intraocular lens in MD or PSD., Conclusion: Contrast sensitivity was better under mesopic conditions with aspherical intraocular lens. Blue-on-yellow perimetry did not appear to be affected by aspherical or yellow tinted intraocular lens. Further studies with a larger sample should be carried out to confirm or not that hypotheses.

Purpose: To report the incidence and causes of cataract surgery cancellations in a public hospital., Methods: This is a retrospective study, which examined the number of cancellations of cataract surgery during 2009. We analyzed the type of procedure suspended (phacoemulsification or extracapsular extraction), type of anesthesia, gender, age, covenant (public/private) and the main reasons for suspension of the surgeries (clinical causes, institutional or personal)., Results: We analyzed 2,965 scheduled cataract surgeries, with 650 cancellations (21.92%). The main reason for the suspension of the procedure was clinical causes (86.90%). The winter months had the highest suspension rates of cataract surgery., Conclusion: The cancellation rate of cataract surgery in Brazilian public system seems to be the same as 10 years ago. The main cause of the suspension should be in clinical conditions (hypertension, diabetes, lack of exams, etc.).

Background: Fungal keratitis is an important cause of corneal infection mainly in tropical countries. With high morbidity due to delay in diagnosis, laboratory examination is mandatory in these cases. However, technical difficulties in obtaining samples generate a large number of false negatives. In these cases a detailed patient assessment for specific characteristics of this entity may help in diagnosis., Purpose: To create an epidemiological profile of patients with keratomycosis to assist in early diagnosis and treatment., Methods: A retrospective study was performed by searching patients with keratomycosis diagnostic on the corneal ulcers database. Information about gender, household location, educational level, occupation, age, predisposing and precipitating factors (ocular and systemic), initial etiological hypothesis, laboratory results, healing time, complications, and adjuvant treatments were collected., Results: Of 599 patients with corneal ulcer, 150 (25%) were diagnosed as fungal infection. There was a higher prevalence in males of working age and low educational level. Trauma with plant material was involved in 74 (49.33%) cases. Other factors such as workers and residents of rural areas also supports trauma with vegetal as the main risk factor identified in the study., Conclusions: Based on the collected data, it was possible to form a profile of patients with fungal ulcers treated by HC-UNICAMP.

Purpose: To analyze the results of recall absent schoolchildren to eye health projects., Methods: Cross-sectional study. Visual screening was performed in schoolchildren attending 1(st) to 4(th) grades at public schools, from 7 to 10 years-old, to select and forward to complete ophthalmic evaluation. The projects were performed during weekends, at a public school, in the same municipality. Free transportation, food and eyeglasses were offered. A second opportunity of examination was offered to the students who were absent from the first call, with the same facilities., Results: 51,509 schoolchildren had their vision tested, 14,651 (28.4%) were referred for ophthalmic examination. Of these, 8,683 (59.3%) attended the first call, 2,228 (37.3%) attended the recall and 25.5% of parents did not take their children to ophthalmic examination. The need for eyeglasses for children who attended the examination was 23.8% and 32.0% in the first opportunity and recall, respectively. The recall increased the coverage in 15.2% (59.3% to 74.5%)., Conclusion: An expressive number of parents (25.5%) did not bring their children to be examined, even at a second opportunity of exam. The facilities offered: access, free examination, transportation and glasses. Children who were absent in the first opportunity and appeared at recall had a greater need for eyeglasses. Recall increased the coverage in 15.2% (59.3% to 74.5%) and it is not recommended when financial resources are limited.

Purpose: To identify the difficulties in access to diagnosis and treatment of cataract in patients attended during a cataract campaign., Methods: A questionnaire was administered to patients selected for cataract surgery. We evaluated, among others, the following variables: prior access to ophthalmologists (public or private), reason(s) for not having surgery early in the initial service, the average cost charged by cataract surgery and intraocular lens (IOL) (private services and agreements)., Results: A total of 627 patients was evaluated. Most of them - 595 (95%) had previously attended an ophthalmologist, and in 63% of cases (375 patients) the consultation had been held for less than a year. The last evaluation was performed by the Brazilian Public Health System (SUS) in 52% of the cases (307 patients). Regarding the reason for not having surgery in the initial service, the high cost of the surgery (R$ 2.000 - R$ 4.000) and the cost of IOLs (R$ 1.000 - R$ 1.500) was the main obstacle for most attended services and private covenants., Conclusion: The results of this study suggest that the routine of ophthalmologic care in SUS at São Paulo is not prepared to answer the demand for cataract surgeries and private healthcare system still excludes a portion of the population. It is important to continue the implementation of community campaigns to serve the population that would be unable to access the surgery through conventional ways.

Purpose: To analyze the benefits after cataract surgery in professional activities., Methods: A prospective, randomized study was conducted at the Clinical Hospital of the University of São Paulo. The patients had cataract surgery by phacoemulsification (PHACO) and by extracapsular extraction (EECP)., Results: The sample consisted of 205 patients, 101 of these, submitted to phacoemulsification. The mean age in phacoemulsification group was 68.3 years ± 9 years and 69.1 years ± 8.5 years in extracapsular extraction group (p=0.70). The percentage of patients employed in phacoemulsification group was 16.83%, and in the extracapsular extraction group of 13.46%. Most patients who were not employed felt motivated to seek work. Most of the patients increased their productivity at work after surgery, 82.50% in the phacoemulsification group, and 78.60% in the other group (p=0.20)., Conclusion: Cataract surgery of both techniques has improved the productivity at work and encouraged economically inactive individuals to seek employment.

Purpose: To analyze the number of surgeries performed in outpatient surgical center at a university hospital and to assess its financial viability during and after the interruption of the Cataract National Campaign in 2006., Methods: Retrospective analytical study between 2005 and 2009 at the Clinical Hospital of the University of São Paulo (HC-FMUSP) which evaluated the economic viability of the outpatient surgical center, the number of cataract surgeries performed and the number of surgeons present daily in that unit., Results: It would be necessary to perform at least 400 procedures monthly to ensure the financial viability of the outpatient surgical center. This number was lower than the expected in the years of 2008 and 2009 (average of 370.6 and 390.1 surgeries respectively). The number of cataract fellows decreased from 13 in 2005 to 3 in 2009., Conclusion: The main factor for the reduction in the number of cataract surgeries performed in the outpatient surgical center after 2006 was the difficulty of access of the population to the hospital due to restrictions on the development of screening projects. The increased use of the operating rooms by other clinics and the decrease in the admission of new surgeons, made the outpatient surgical center appropriate and viable for the new political-economic reality.

Purpose: To check the occurrence of post-visit, the patient's understanding and the assessments of the doctor on duty about the efficacy of the process, at the ophthalmology emergency sector., Methods: It was conducted a transversal, analytical research among doctors on duty and patients being seen consecutively in the ophthalmology emergency sector of Hospital das Clínicas da Universidade de São Paulo., Results: The sample was made of 28 doctors on duty and 561 patients, 51.3% male and 48.7% female, with a mean age of 39.8 years old. From 34.1% of the patients who were previously seen by other sectors, 8.4% looked for two services and 5.7% three or more services. In the previous visits, 56.9% of the patients mentioned that they did not receive any explanation about their diagnostic. From the patients seen at Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo - FMUSP, 95.1% mentioned that the ophthalmologists explained the diagnostic and from those 84.0% understood what was explained. Among 40.4% of the patients who received medicine prescriptions in the previous services, 85.5% mentioned that they received explanation about its use and 82.9% followed the orientation. At Hospital das Clínicas - FMUSP 95.0% of the patients understood how and why to use the medicine. At the ophthalmologists point of view, more than 90.0% of the patients understood the diagnostic and the prescribed treatment., Conclusion: According to this research, for most of the patients, it was provided post-visit orientation and patients' understanding about the disease and the treatments proposed.

Purpose: To verify in two groups of patients: monocular (group 1) and binocular vision (group 2) to be submitted to cataract surgery at an University Hospital, opinions, expectances and emotional reactions related to the ocular problem, to the quality of vision and to cataract surgery., Methods: A transversal comparative and consecutive study was performed using a structured questionnaire applied by patients interview. The questionnaire was elaborated from a previous exploratory study; visual acuity and cause of the visual loss were evaluated., Results: The sample was constituted by 96 persons of group 1 (50.0% male; 50.0% female, ages ranging from 41 to 91 years; average 69.3 years ± 10.4 years) and 110 persons of group 2 (40.9% male; 59.1% female, ages ranging from 40 to 89 years; average 68.2 years ± 10.2 years). The majority of persons of both groups presented low educational level. There was no statistically significant difference between the groups in relation to gender (p=0.191), age (p=0.702) and educational level (p=0.245). No work activity was mentioned in 95.8% of the persons of group 1 and 83.6% of group 2 (p=0.005) and 30.4% of group 1 informed the impossibility to work due the visual impairment. Visual acuity of the eye to be operated was less than 0.05 in 40.6% (group 1) and in 33,6% (group 2), presented visual acuity ranging from 0.05 to 0.25. Almost the totality of the persons of both groups informed difficulties to perform activities of daily life and qualified as insufficient their visual acuities; 71.9% of the patients of group 1 and 71.6% of group 2 informed to know the reason of low vision; among these, 87.1% of group 1 and 83.3% of group 2 mentioned cataract as the reason of low visual acuity., Conclusion: It was concluded that the patients of both groups were submitted to cataract surgery with visual acuities less than the visual acuity ideally indicated; the patients with monocular vision showed visual acuities significantly less in relation to the patients with binocular vision; the majority of the patients of both groups mentioned difficulties to perform daily activities as a consequence of low vision; patients with monocular vision mentioned doubts in relation to the surgical results as compared with the patients with binocular vision; many patients of both groups did not know the cause of the visual difficulty or explained the visual difficulty by other cause than the cataract.

Purpose: This study aimed to evaluate the assistance quality through the perception of the users and municipal health managers (mayors, health secretaries and screening team)., Methods: A transversal and descriptive study was carried out., Results: The sample was comprised by 359 users and 48 managers. Medical assistance was considered excellent by 79.6% of the users, 93.7% of the managers, 87.5% of the health secretaries and 100% of the screening team. Reception received a great evaluation by 73.8% of the users and 93.8% of the selectors., Conclusion: The assistance model used at the Ophthalmologic Clinic of Divinolândia obtained a high level of satisfaction pleasing both users and managers.

Purpose: To evaluate the safety of photorefractive keratectomy (PRK) with mitomycin-C (MMC) in eyes with hyperopia after radial keratotomy., Methods: Sixty eyes of 36 consecutive patients treated with corneal wavefront-guided PRK using an Esiris-Schwind excimer laser were prospectively evaluated. Corneal epithelium was mechanically removed, followed by photoablation and use of 0.02% MMC for 20 or 40 seconds. In 16 eyes (26.7%), MMC was applied for 40 seconds. These eyes underwent ablations deeper than 100 micron or had previous corneal sutures. Patients were followed up for 12 months., Results: The mean spherical equivalent (SE) before PRK was +4.27 D +/- 2.18, and the mean best corrected visual acuity (BCVA) was 0.174 +/- 0.139 (logMAR). The planned laser SE correction was +4.74 D +/- 2.11, resulting in an ablation depth of 78 +/- 28 microm (from 33 to 148). No intraoperative complications were observed. At one year, mean SE was +0.04 D +/- 1.03 (p<0.001) and mean BCVA was 0.079 +/- 0.105 (p<0.001). There was a gain of 2 or more lines of BCVA in 20 eyes (33.3%) and only one eye (1.7%) lost 2 lines. Correlation analysis showed that the improvement in BCVA was inversely related to preoperative BCVA (r=-0.694; p<0.001). Five eyes developed peripheral haze grade 2 or 3 and one eye had central trace haze. No significant correlation was found between central or peripheral haze and the number of radial incisions, depth of the ablation or postoperative BCVA. Mean preoperative endothelial cell count was 2,681 +/- 455 cel/ mm(2) and after one year was 2,481 +/- 378 cel/mm(2) (p=0.124). One eye developed keratectasia due to the progressive widening of an inferior radial incision, which was later sutured., Conclusion: PRK with MMC was safe after one year of follow-up for the reduction of hyperopia after radial keratotomy. A major improvement in BCVA was obtained with a small incidence of haze and other complications.

Purpose: To assess the efficacy, predictability and stability of corneal wavefront-guided photorefractive keratectomy (PRK) for correcting hyperopia and astigmatism after radial keratotomy., Methods: In a prospective study, 60 eyes of 36 consecutive patients were treated with corneal wavefront-guided PRK with 0.02% mitomycin-C using an Esiris-Schwind excimer laser. Corneal epithelium was mechanically removed. All patients were followed-up for 12 months., Results: The mean time between radial keratotomy and PRK was 18.4 years +/- 3.8 (SD); mean spherical equivalent (SE) before radial keratotomy was -4.35 diopters (D) +/- 1.55. Before PRK, the mean sphere was +5.00 D +/- 2.28, mean astigmatism was - 1.47 D +/- 1.06, mean SE was +4.27 D +/- 2.18, and the mean best-corrected visual acuity (BCVA) was 0.174 +/- 0.139 (logMAR). The planned laser SE correction was +4.74 D +/- 2.11. No intraoperative complications were noted. At 12 months, mean SE was +0.04 D +/- 1.03 (P<0.001), mean astigmatism was -1.03 +/- 0.75 D (P=0.015), mean UCVA was 0.265 +/- 0.197, and mean BCVA was 0.079 +/- 0.105 (P<0.001). There was a mean gain of 1 line of BCVA and 20 eyes (33.3%) gained 2 or more lines. Only one eye lost 2 lines. A significant decrease in coma (P=0.002), trefoil (P=0.004), spherical aberration (P<0.001) and quatrefoil (P=0.002) was observed. Forty eight eyes (80%) were within +/- 1.0 D of intended SE. Mean regression from 6 to 12 months was +0.17 +/- 0.67 D., Conclusion: Corneal wavefront-guided PRK was effective, predictable and stable after one year of follow-up for the treatment of hyperopia after radial keratotomy. A significant improvement in UCVA, BCVA and corneal aberrations was obtained. ClinicalTrials.gov Identifier: NCT00917657.

Introduction: In Divinolândia (SP), the Consortium of Development of São João da Boa Vista Region Policy (CONDERG), in partnership with State University of Campinas (UNICAMP), has founded an eyeglass store to produce low cost glasses to distribute freely to their customers. The purpose is to analyze the evolution and working process of CONDERG eyeglass store in the last 13 years, since its foundation., Methods: Data were collected from CONDERG store files from 1988 to 2001. Data regarding the amount of spectacles produced per year, ability to increase the production and store feasibility were analyzed., Results: In 13 years, 16,500 spectacles were supplied. Currently, 400 spectacles are delivered per month, being 200 supported by SUS and the other 200 by CONDERG's own resources., Conclusion: The 13-year operation of CONDERG eyeglass store, the free provision of 16,500 spectacles and the increase productive ability have shown this model feasibility.

Purpose: To evaluate the corneal cross-linking (CXL) effect on symptomatic bullous keratopathy, and its impact on the visual acuity, corneal thickness and pain symptomatology., Methods: Twelve patients with symptomatic bullous keratophaty were included. A clinical examination with a specific questionnaire (pain scale-visual numeric analog scale), visual acuity, and corneal thickness measures was performed before corneal cross-linking and 7, 30 and 60 days after the procedure. In all patients, the treatment with the UVA-crosslinking was done after corneal abrasion on the slit-lamp and instillation of 0.1% riboflavin in saline for every five minutes, lasting 30 minutes. Subsequently, the patient underwent the UVA light exposure, using riboflavin and topical anesthesia, every five minutes lasting 30 minutes. The patient received 0.3% ofloxacine drops, and artificial tears until complete reepithelization. The Friedman test was used to compare the means of frequencies of visual acuity, pain symptoms and corneal thickness. A 'p' value<0.05 was considered for rejecting the null hypothesis., Results: Twelve eyes from 12 patients with recurrent epithelium erosions were treated. The mean follow-up was two months. Significant pain reduction was observed (p<0.001). Corneal thickness and visual acuity measurements presented with no significant difference., Conclusion: The potential use of cross-linking in the treatment of bullous keratopathy pain was proved to be likely. A longer follow-up to confirm whether these results can be reproduced in the long term is necessary.

Purpose: To compare the visual outcome, contrast sensitivity and wavefront analysis of patients that underwent cataract surgery and implantation of AcrySof SN60D3 multifocal intraocular lens with those who received the AcrySof SN60AT monofocal IOL., Methods: This was a prospective clinical trial of forty eyes that received the multifocal IOL and thirty-two eyes that received the monofocal IOL after phacoemulsification., Results: Values for total and spherical aberrations in the multifocal group were statistically lower than in the monofocal group. In the monofocal group, 75% achieved uncorrected intermediate visual acuities between Jaeger 1 and 6. In the multifocal group, 75% of the eyes achieved more than Jaeger 6. At least 87.5% of the multifocal group and 6.3% of the monofocal group achieved monocular uncorrected near acuity of 20/30 (J2, N5) or better. And 90.0% of the eyes in the multifocal group and 37.5% in the monofocal group achieved an uncorrected near acuity of 20/40 (J3, N6) or better. The mean spherical error was 0.11 D in the multifocal group and -0.18 D in the monofocal group (p=0.0379). The SN60D3 group compared to SN60AT group had low contrast sensitivity (log units) with statistically significant differences in 6.0 cpd in photopic conditions (p=0.014) and the SN60D3 group compared to SN60AT group had higher contrast sensitivity (log units) under mesopic conditions (p=0.044)., Conclusion: The multifocal IOLs induced less spherical aberration than monofocal IOLs and predictably good uncorrected distance and uncorrected near acuities. However, contrast sensitivity was lower in the multifocal group.

Purpose: To establish the literature basis that could support the idea that it would be possible to analyze changes at the anterior surface of the cornea induced by an air jet applied onto the eye., Methods: The PUBMED/MEDLINE literature basis regarding the following subjects was searched: videokeratography, high-speed photography, ocular response analyzer (ORA). The information concerning the goal of this paper was selected., Results: The literature showed data that support the idea of gathering 3 nowadays available technologies that could result in a new concept of 'dynamic corneal topography': the corneal topography, the air jet applied to histeresis measurement by the Ocular Response Analyzer and the high-speed photography technique used to study the tear film and the anterior surface of the cornea., Conclusion: The literature basis supports the idea of gathering the existent technologies of corneal topography, the air jet of the corneal histeresis device and the high-speed photography to create a new concept in the analysis of the corneal surface: the dynamic corneal topography.

Purpose: Comparison of the visual performance and wavefront analysis between patients with Tecnis ZM900 aspheric and AcrySof ReStor SN60D3 spheric diffractive multifocal intraocular lenses (IOL)., Methods: This prospective comparative study included 78 eyes of 39 patients. The performed ophthalmologic evaluation included near, intermediate and distance corrected and uncorrected visual acuity, contrast sensitivity measurement (under photopic and mesopic conditions) and wavefront analysis with the OPD-Scan aberrometrer., Results: Uncorrected near and distance visual acuity and aberrometry analysis were similar with both intraocular lenses; nevertheless, intermediate visual acuity and contrast sensitivity under photopic conditions were statistically better with Tecnis ZM900., Conclusion: Both studied intraocular lenses promoted excellent near and distance postoperative visual acuity, in high contrast situations. Tecnis ZM900 IOL provided good quality of vision with high contrast condition in low luminosity with reduction in spherical aberration and improvements in intermediate visual acuity when compared to Restor IOL.

Purpose: To develop in an interdisciplinary approach between ophthalmology and design areas an ergonomic +22-diopter 50-mm aspheric hand magnifier for low vision., Methods: An aluminum cylinder was cut, processed using a lathe and carved to produce a ring that accommodated a 50-mm aspheric lens, with an external depression not to slide from the holder's fingers. A cylindrical steel bar was cut, processed using a lathe and carved in order to form an externally turned ring to be screwed into the internal thread of the aluminum ring, to maintain the lens in a steady position. Both rings were submitted to electrostatic painting with a dull black electrostatic Epoxi ink, except the lower border of the external ring, to indicate the correct side of the magnifier to face the material to be read., Results: A 22-diopter 50-mm diameter aspheric lens magnifier with a black ring to be hold at its external circular depression was obtained in order to safely search the adequate reading focus with an inferior aluminum colored ring to face the object to be read and allow a less distorted reading. This is the first Brazilian high-magnification great-diameter magnifier for low vision that permits basically the focusing on an entire word, not only syllables, in order to allow a faster and more comfortable reading., Conclusions: By an interdisciplinary approach a 22-diopter 50-mm aspheric lens magnifier was developed with image and ergonomic characteristics such as to permit comfortable and adequate reading performance in cases of low vision.

Purpose: To evaluate the visual performance by high contrast visual acuity, contrast sensitivity and wavefront in myopic patients with or without astigmatism corrected with spectacles and with three different soft contact lenses [Acuvue 2 (Vistacon J&J Vision Care Inc., USA), Biomedics 55 (Ocular Science, USA), and Focus 1-2 week (Ciba Vision Corporation, USA)]., Methods: An interventional prospective clinical trial studied a sample of 40 myopic patients (-1.00 to -4.50 sph, with or without astigmatism up to -0.75 cyl). Each patient had one eye randomized to visual performance evaluation., Results: The Zywave aberrometer detected a over refraction and significant difference between Acuvue 2 and Biomedics 55 regarding spheric refractive components and spheric equivalent. Both soft contact lenses showed hypercorrection as compared to Focus 1-2 week. Visual performance was not significantly different with spectacles and the three soft contact lenses in visual acuity and contrast sensitivity measurements. The wavefront analysis detected a significant difference in a third order aberration with and without soft contact lenses, with better visual performance with Acuvue 2 and Biomedics 55., Conclusion: In visual performance evaluation with spectacles and soft contact lenses the wavefront analysis was a more sensible measurement of visual function when compared to high contrast visual acuity and contrast sensitivity. The evaluation model of visual performance with wavefront analysis developed in this investigation may be useful for further similar studies.

Purpose: To evaluate the efficacy of intravenous 500 mg methylprednisolone in addition to topical treatment with 1% prednisolone in the treatment of the first episode of corneal endothelial rejection in patients that were submitted to corneal allograft transplantation., Methods: Retrospective case-control study with 81 patients that presented the first episode of corneal endothelial rejection and were treated within the first 15 days of the onset of symptoms., Results: 67 patients were treated with 1% topical prednisolone acetate and pulsed intravenous methylprednisolone 500 mg at the diagnosis of corneal allograft rejection. Fourteen patients were submitted to topical treatment only, thus forming the control group. Forty-one of 67 patients (61.2%) that were submitted to pulsed steroid had good outcome and 26 (38.8%) presented corneal graft failure while only 4 of 14 patients (28.57%) that received only topical steroids evolved with clear grafts and the remaining 10 patients (71.43%) with graft failure. Chi-square showed statistically significant association (p<0.05) to greater success with pulsed methylprednisolone., Conclusions: This study suggests that the use of 500 mg intravenous methylprednisolone in addition to 1% topical prednisolone acetate for the treatment of endothelial corneal allograft rejection presents better outcomes in reverting corneal allograft rejection when compared to isolated use of 1% topical prednisolone acetate.