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Purpose: To evaluate the effect of eyelid hygiene after cataract surgery on eyelid and ocular surface findings, subjective symptoms and visual function, including functional visual acuity (FVA) and higher order aberration, in a randomized controlled study. Methods: Fifty patients who underwent cataract surgery at a single institution were involved. Twenty-five patients were instructed to wipe their eyelids twice a day from one to four weeks postoperatively, whereas the other 25 patients did not perform any eyelid hygiene. Optical measurement, FVA, meibomian glands, the grade of meibum, lid margin findings, fluorescein corneal staining findings, dry eye-related subjective symptoms and surgical satisfaction were assessed both preoperatively and one month postoperatively. Results: In the eyelid hygiene group, the visual maintenance ratio of FVA improved significantly (p = 0.048) and the higher order aberration of the 4th + 6th order deteriorated less (p = 0.027) compared with the control group. Multiple regression analyses showed that the change in visual maintenance ratio was associated with surgical satisfaction (p = 0.003), change in corneal staining score (p = 0.007), history of eye diseases (p = 0.029) and eyelid hygiene (p = 0.048). Conclusions: Eyelid hygiene after cataract surgery may be effective for visual function measured with an FVA test. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the prediction accuracy of intraocular lens (IOL) power formulas with artificial intelligence (AI) for high myopia. Cases of highly myopic patients (axial length [AL], >26.0 mm) undergoing uncomplicated cataract surgery with at least 1-month follow-up were included. Prediction errors, absolute errors, and percentages of eyes with prediction errors within ±0.25, ±0.50, and ±1.00 diopters (D) were compared using five formulas: Hill-RBF3.0, Kane, Barrett Universal II (BUII), Haigis, and SRK/T. Seventy eyes (mean patient age at surgery, 64.0 ± 9.0 years; mean AL, 27.8 ± 1.3 mm) were included. The prediction errors with the Hill-RBF3.0 and Kane formulas were statistically different from the BUII, Haigis, and SRK/T formulas, whereas there was not a statistically significant difference between those with the Hill-RBF3.0 and Kane. The absolute errors with the Hill-RBF3.0 and Kane formulas were smaller than that with the BUII formula, whereas there was not a statistically significant difference between the other formulas. The percentage within ±0.25 D with the Hill-RBF3.0 formula was larger than that with the BUII formula. The prediction accuracy using AI (Hill-RBF3.0 and Kane) showed excellent prediction accuracy. No significant difference was observed in the prediction accuracy between the Hill-RBF3.0 and Kane formulas. [ABSTRACT FROM AUTHOR]

We evaluated the pupil reaction to blue and white light stimulation in 70 eyes with cataract and in 38 eyes with a selective blue-light filtering intra-ocular lens. The diameter of the pupil before stimulation was set as baseline (BPD) and, after a stimulus duration of 1 s, the post-illumination pupillary response (PIPR) was measured using an electronic pupillometer. The BPD showed no significant difference among three grades of nuclear sclerosis (NS). In contrast, the PIPRs differed significantly among the NS grades eyes including with and without subcapsular cataract (SC) and IOL eyes for white light (p < 0.05, Kruskal–Wallis test), but not for blue light. Subcapsular opacity did not affect the BPD or PIPR in all cataract grades for either light stimulus. The tendency of larger PIPR in the pseudophakic eyes than the cataract eyes for both lights, however significant difference was found only for white light (p < 0.05 for white light, p > 0.05 for blue light). Our study demonstrates retention of the PIPR for blue light, but not for white light in cataract eyes. We also confirmed that the pupillary response in pseudohakic eyes with a selective blue light-filtering intra ocular lens was greater than that in cataractous eyes for white light. [ABSTRACT FROM AUTHOR]

Purpose To evaluate the results of intraocular lens (IOL) power calculation using different corneal power measurements provided by an optical biometer combined with a dual Scheimpflug analyzer and a Placido disk topographer (Galilei G6). Setting G.B. Bietti Foundation, Rome, Italy, and Keio University Hospital, Tokyo, Japan. Design Evaluation of diagnostic technology. Methods Consecutive patients having cataract surgery were enrolled. The IOL power was calculated with the Barrett Universal II, Haigis, Hoffer Q, Holladay 1, and SRK/T formulas. Different options were used to calculate the corneal power: simulated keratometry (K) based on anterior corneal surface measurements only and total corneal power (TCP) based on ray tracing through both corneal surfaces. Three TCP measurements (TCP1, TCP2, and TCP-IOL) were evaluated. Results The study analyzed 118 eyes. The mean values of simulated K (43.74 diopters [D] ± 1.40 [SD]), TCP1 (43.13 ± 1.35 D), TCP2 (41.87 ± 1.30 D), and TCP-IOL (42.62 ± 1.35 D) were significantly different ( P < .0001). The best results were obtained using simulated K: the median absolute error ranged between 0.22 D and 0.29 D and the percentage of eyes with a prediction error of ±0.50 D or less, between 76.2% and 84.7%, depending on the formula. After constant optimization, the results using any TCP value and simulated K were similar with no statistically significant differences. Conclusions Biometric measurements provided by the Scheimpflug–Placido optical biometer can be used to accurately calculate the IOL power. Simulated K and TCP led to similar outcomes after constant optimization. [ABSTRACT FROM AUTHOR]

Purpose: To compare the visual and refractive outcomes up to 1 year postoperatively following implantation of a refractive segmented or a refractive segmented toric multifocal intraocular lens (IOL). Methods: This retrospective study included 108 eyes of 64 patients who underwent cataract surgery with implantation of a refractive segmented multifocal IOL (Lentis Mplus LS-313 MF30 IOL) (LM group) and 81 eyes of 49 patients with implantation of a refractive segmented toric multifocal IOL (Lentis Mplus LU-313 MF30T IOL) (LMT group). The visual and refractive postoperative outcomes and the rate of additional refractive procedures were evaluated up to 1 year postoperatively. Results: The uncorrected distance visual acuity (VA) and uncorrected near VA exceeded 1.0 and 0.60 in decimal VA, respectively, and both were stable postoperative groups. The postoperative subjective refractive astigmatism was also stable and the postoperative refraction was near emmetropia in both groups. No significant differences were found in the need for additional surgical refractive procedures. Conclusion: The outcomes with a refractive segmented toric multifocal IOL were comparable to those with a non-toric model despite higher preoperative corneal astigmatism. [ABSTRACT FROM AUTHOR]

Purpose: To compare the accuracy of several methods of intraocular lens (IOL) power calculations used for cataract surgery in eyes treated with phototherapeutic keratectomy (PTK) that results in changes in the anterior corneal surface and axial length; these results make power calculations less predictable. Methods: We evaluated the medical records of 23 eyes of 13 patients (mean age, 68.8 years; range 62-80 years) who underwent cataract surgery after PTK at Keio University Hospital, Tokyo, Japan. The prediction error, defined as the difference between the estimated postoperative spherical equivalent and the postoperative manifest refraction at the spectacle plane, was calculated using five formulas: SRK/T, Haigis-L, Shammas-PL, Camellin-Calossi, and OKULIX ray tracing software. We compared the median values of the arithmetic and absolute prediction errors among the five formulas. Results: The median arithmetic errors after cataract surgery for the five formulas were 0.70 D (diopter) (range −0.41 to 2.78), −0.96 D (range −2.14 to 0.81), −0.81 D (range −1.89 to 1.15), −0.04 D (range −1.35 to 1.47), and 0.68 D (range −0.61 to 2.50), respectively. Conclusion: The Camellin-Calossi formula is a good option for calculating IOL powers in eyes that underwent PTK. [ABSTRACT FROM AUTHOR]

Purpose: To compare the clinical outcomes of 3 marking methods for toric intraocular lens (IOL) implantation in cataract patients. Methods: This study included 48 eyes of 48 cataract patients who underwent cataract surgery with toric IOL implantation. The rotational errors of 3 marking methods-the iris pattern marking method (iris pattern group), the pendulum marking method (pendulum group), and the 3-point marking method (3-point group)-were assessed. Results: The respective rotational errors were 4.0° ± 3.1° (mean ± SD), 5.3° ± 4.1°, and 7.3° ± 6.0°. The iris pattern group had significantly ( P = 0.048) smaller rotational errors than did the 3-point group; no significant difference was found between the iris pattern and pendulum groups. However, the differences in postoperative uncorrected distance visual acuity and astigmatism did not reach significance among the 3 groups. Conclusion: The refractive and visual results of toric IOL implantation using the 3-point marking method were comparable to the other methods evaluated in this study, although the accuracy of the axis alignment of the toric IOLs was significantly lower than that obtained with the iris pattern method. [ABSTRACT FROM AUTHOR]

Background: This study compared post-operative quality of life and sleep according to the type of cataract opacity and color of the implanted intra-ocular lens (IOL). Methods: This is a cohort study and participants were 206 patients (average age 74.1 years) undergoing cataract surgery with the implantation of a clear ultra-violet (UV)-blocking IOL (C) or a yellow blue-light-blocking IOL (Y). Participants were evaluated using the National Eye Institute Visual Function Questionnaire (VFQ-25) and Pittsburgh Sleep Quality Index (PSQI) before surgery and 2 and 7 months after surgery. Changes in sub-scale scores of VFQ-25 and PSQI were compared. Results: Sub-scale analyses for improvement after surgery revealed significant differences in ocular pain scores on the VFQ-25 (Y>C; the higher the score, the better the outcome). Furthermore, there were significant differences between the two IOLs in terms of the sleep latency score (C>Y) and sleep disturbances score (C>Y). A posterior sub-capsular cataract was significantly correlated with improvements in ocular pain and sleep latency scores. These effects were successfully represented by the change in scores rather than absolute post-operative scores because individual standard of response may often change after intervention, recognized as a response shift phenomenon in patient-reported outcome study. Regarding seasonal differences, patients who had surgery in summer exhibited relatively better sleep quality than those who had surgery in winter. Conclusions: Analysis of sub-scales of health indices demonstrated characteristic prognoses for each IOL and cataract type. Cataract surgery may potentially contribute to systemic health in older adults. [ABSTRACT FROM AUTHOR]

Background: Previously, we reported improvements in sleep quality and gait speed after implantation of a yellow-colored, blue light-blocking intra-ocular lens (IOL). This study evaluated systemic health parameters for 7 months after cataract surgery with implantation of a clear, ultraviolet (UV)-blocking IOL. Methods: A total of consecutive 71 patients (average age 74.1 years) underwent cataract surgery with the implantation of a clear, UV-blocking IOL. Participants were evaluated using the Pittsburgh Sleep Quality Index (PSQI) and the National Eye Institute Visual Function Questionnaire (VFQ-25) before and at 2 and 7 months after surgery. Four-meter gait speed was also determined. The metabolic parameters of serum glycated hemoglobin (HbA1c), triglycerides (TGs), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) were tested. Results: The pre-operative and post-operative (2 and 7 months after surgery) results were 66.4±16.5, 79.5±12.6, and 81.0±13.0 for VFQ-25 score, 5.7±3.5, 5.1±3.1, and 4.8±2.9 for PSQI, and 0.90±0.22, 0.91±0.22, and 0.92±0.22 meters/sec for gait speed. Significant improvements following surgery were noted in the VFQ-25 score for all cases and in the PSQI for poor sleepers (preoperative PSQI >5.5) ( P<0.05, paired t-test). The gait speed and metabolic parameters showed no significant changes. Conclusions: Cataract surgery with implantation of an UV-blocking clear IOL has the potential for improving circadian rhythm and systemic health parameters. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the predictability of total postoperative spherical aberration after aspheric intraocular lens (IOL) implantation using preoperative corneal spherical aberration. Setting: Keio University Hospital, Tokyo, Japan. Methods: Corneal and ocular higher-order aberrations (HOAs) were analyzed preoperatively and postoperatively in eyes having cataract extraction with aspheric IOL implantation. The predicted postoperative total spherical aberration Z(4,0) was calculated by adding the preoperative corneal spherical aberration and the labeled spherical aberration of the IOL. The prediction error of the postoperative total spherical aberration was calculated by subtracting the predicted postoperative total spherical aberration from the postoperative total spherical aberration. Surgically induced corneal spherical aberration was calculated by subtracting the postoperative from the preoperative corneal spherical aberration. Results: There were no statistically significant differences between preoperative and postoperative corneal spherical aberration, 3rd-order aberration, or HOAs. The prediction error of the postoperative total spherical aberration was within ±0.05 μm in 9 (24.3%) of the 37 eyes evaluated and within ±0.10 μm in 18 eyes (48.6%). Statistically significantly correlations were found between the surgically induced corneal spherical aberration and prediction error of postoperative total spherical aberration, the preoperative corneal spherical aberration and surgically induced corneal spherical aberration, and the preoperative corneal spherical aberration and prediction error of postoperative total spherical aberration. Conclusions: Predictability of postoperative ocular spherical aberration after cataract surgery with aspheric IOL implantation was insufficient because of the surgically induced corneal spherical aberration. Considering surgically induced corneal spherical aberration could improve the predictability of postoperative ocular spherical aberration. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned. [Copyright &y& Elsevier]

Purpose: To evaluate the long-term efficacy of a biconvex accommodating intraocular lens (IOL) to restore near visual performance. Setting: Department of Ophthalmology, Keio University Hospital, Tokyo, Japan. Methods: This 4-year study comprised eyes that had cataract surgery with implantation of a 1CU accommodating IOL. At all postoperative visits, the following were assessed: subjective spherical equivalent (SE) refraction; uncorrected (UDVA) and corrected (CDVA) distance visual acuities; uncorrected (UNVA), distance-corrected (DCNVA), and corrected (CNVA) near visual acuities; change in minimum additional (add) power (diopters) to attain CNVA; and accommodation amplitude. A questionnaire was administered at the last visit. Results: Twelve eyes of 8 cataract patients (mean age 59.0 years ± 18.4 [SD]) were evaluated. Postoperatively, the mean SE at 1 year and 4 years was significantly more hyperopic than at 1 month (P<.05). The mean UDVA increased significantly at 4 years compared with 1 month (P<.05). There were no significant changes in CDVA, UNVA, CNVA, and DCNVA throughout the follow-up period. The change in the minimum add power to attain CNVA and in the subjective and objective accommodation amplitudes also did not change significantly over time. Eighty-three percent of patients reported being satisfied with the results. Conclusion: Four years after implantation of an accommodating IOL, most patients had good vision and were satisfied, although the accommodation amplitude for near vision was not sufficient throughout the follow-up. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned. [Copyright &y& Elsevier]

Purpose: To evaluate the feasibility of correcting spherical aberration with aspheric intraocular lenses (IOLs) in cataract surgery based on individual pupil diameter. Setting: Keio University Hospital, Tokyo, Japan. Methods: In this prospective study, eyes having cataract surgery were divided into 4 groups based on IOL type: aspheric SN (AcrySof SN60WF), aspheric ZA (Tecnis ZA9003), aspheric PY (Hoya PY-60 AD), and spherical (AcrySof Natural SN60AT). Postoperative higher-order aberrations (HOAs) of the cornea and whole eye and the pupil diameter under photopic and mesopic conditions were measured. The HOA was calculated using the individual pupil diameter. The correlation between corneal and ocular spherical aberrations and pupil diameter was evaluated. Results: Each group comprised 30 eyes. Ocular spherical aberrations were significantly lower than corneal spherical aberrations under mesopic conditions in the aspheric SN group, the aspheric ZA group, and the aspheric PY group (P<.05); there was no significant difference between the aberrations in the spherical group. Linear regression showed significant correlations between postoperative corneal and ocular spherical aberrations (β = 0.39, aspheric SN; β = 0.38, aspheric ZA; β = 0.58, aspheric PY; β = 0.79, spherical). The differences in corneal and ocular spherical aberrations were significantly correlated with pupil diameter in the aspheric IOL groups but not in the spherical IOL group. Conclusions: The amount of spherical aberration correction by aspheric IOLs varied depending on IOL type and individual pupil diameter. The linear regression equation in this study may make it possible to customize postoperative ocular spherical aberration after cataract surgery. [Copyright &y& Elsevier]

The purpose of this study was to evaluate the short-term efficacy and safety of cataract surgery for patients with iris-fixated phakic intraocular lenses (pIOLs). This study included 96 eyes of 91 patients. The changes in the logMAR uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), subjective spherical equivalent (SE), astigmatism, and endothelial cell density (ECD) were collected retrospectively. The intraoperative and postoperative complications also were investigated to assess the surgical safety. The preoperative UCVA and BCVA improved significantly at month 1 postoperatively, respectively (p < 0.001 for both comparisons). The efficacy and safety index at month 1 postoperatively were 1.02 ± 0.56 and 1.31 ± 0.64, respectively. The SE at month 1 postoperatively was significantly (p < 0.001) higher compared to preoperatively, whereas the subjective astigmatism did not differ significantly (p = 0.078). The ECD significantly decreased at month 1 (p < 0.001). The most common postoperative complication was intraocular pressure elevation exceeding 25 mmHg in 10.4% of eyes, which was controlled with medications in all cases until month 1 postoperatively. No intraoperative complications developed. Cataract surgeries for patients with iris-fixated pIOLs were performed safely with good visual outcomes. [ABSTRACT FROM AUTHOR]

In patients with genuine congenital cataract, undergoing surgery with IOL within the critical period of visual development led to better final visual acuity. Purpose: To investigate the long-term outcomes of congenital cataract surgery performed within the first 6 months of life. Setting: 11 ophthalmic surgical sites in Japan. Design: Retrospective chart review. Methods: Medical charts were retrospectively reviewed for 216 eyes of 121 patients. The age at surgery was 2.9 ± 1.7 months, with follow-up duration 13.0 ± 2.3 years. The cohort consisted of 83 cases with bilateral aphakia, 12 with bilateral pseudophakia, 20 with unilateral aphakia, and 6 with unilateral pseudophakia. Results: Surgical intervention within the critical period of visual system development (10 weeks for bilateral and 6 weeks for unilateral cases) led to significantly better final visual acuity than surgery conducted after this time frame. The incidence of secondary glaucoma was similar between groups while the occurrence of visual axis opacification was more frequent with earlier surgery. A forward stepwise multiple regression analysis revealed that the final visual acuity was significantly associated with laterality of cataract (better outcomes in bilateral cases), phakic status (with pseudophakia outperforming aphakia), presence of systemic and ocular comorbidities, and development of secondary glaucoma. Secondary glaucoma was significantly more prevalent in aphakic eyes than pseudophakic eyes. Conclusions: In patients with genuine congenital cataract, surgery within the critical period of visual development results in better final visual acuity, albeit with an increased risk of visual axis opacification. The use of IOL with sophisticated surgical techniques shows promise even in congenital cataract surgery. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate the changes in patient subjective happiness and satisfaction with cataract surgery and evaluate the association between satisfaction and types of cataract. This study surveyed 247 participants (mean age, 67.9 years) and they completed questionnaires on their satisfaction with the surgery, the subjective happiness scale (SHS) and the Pittsburgh Sleep Quality Index (PSQI) before and after surgery. The SHS increased postoperatively from 4.6 ± 0.7 to 4.8 ± 0.7 (P = 0.007) and 83.4% of patients were satisfied with the surgical results and the average satisfaction score was 4.2 out of a possible 5.0. Multiple regression analysis showed that patient satisfaction was significantly associated with the postoperative SHS (β = 0.380; P < 0.001), the postoperative PSQI (β = −0.041; P = 0.035) and the presence of a posterior subcapsular cataract (PSC) (β = 0.277; P = 0.026). This study clarified that cataract surgery may improve both visual function and patient happiness and that patient satisfaction was affected by postoperative sleep quality and the disappearance of a PSC. [ABSTRACT FROM AUTHOR]

Dry eye disease may develop and persist after cataract surgery; however, unilateral cases have not been fully documented. This cross-sectional, observational study was conducted in five eye clinics in Japan. A total of 1023 outpatients were initially enrolled, and 89 unilateral pseudophakic subjects with 1+ year of follow-up after uncomplicated cataract surgery were included. The tear break-up times (TBUTs) and keratoconjunctival staining results were compared between phakic and pseudophakic eyes. The mean age of the patients was 69.3 ± 10.4 years (32 men, 36.0%), and the mean postoperative period was 4.6 ± 4.4 (1–20) years. For the ophthalmic parameters, the TBUTs were 4.4 ± 1.9 and 3.8 ± 1.9 s (p < 0.001), the keratoconjunctival staining scores were 0.11 ± 0.38 and 0.22 ± 0.56 (p = 0.02), the spherical equivalents were −1.27 ± 2.51 and −0.99 ± 1.45 D (p = 0.21), the astigmatic errors were 0.79 ± 0.66 and 0.78 ± 0.58 D (p = 0.80), and the intraocular pressures were 13.6 ± 2.9 and 13.5 ± 2.6 mmHg (p = 0.62) for the phakic and pseudophakic eyes, respectively. The corneal status was significantly worse in the pseudophakic eyes than in the contralateral phakic eyes, even after more than one year after implant surgery. The present results suggested that long-term ocular surface problems should be examined further since they may not originate only from surgery or postoperative ocular surface diseases. [ABSTRACT FROM AUTHOR]

The aim of the present study was to measure gait velocity in cataract and simulated patients. The study was performed on 239 cataract patients, 115 age-matched subjects, and 11 simulated patients. We measured gait velocity and analyzed gait using a three-dimensional motion analysis system. Mean gait velocity before and 2 and 7 months after cataract surgery was 0.91 ± 0.19, 1.04 ± 0.21, and 1.06 ± 0.21 m/s, respectively, for males and 0.84 ± 0.22, 0.91 ± 0.24, and 0.92 ± 0.25 m/s, respectively, for females. The increase after surgery was significant in both groups at 7 months (P < 0.05). Gait velocity was significantly slower in cataract patients compared with controls before surgery, but no longer different after surgery. In simulated patients, mean velocity was 87.0 ± 11.4% of normal vision with a 3° visual field and 92.4 ± 12.3% of normal when counting fingers. Initial velocity was 89.1 ± 14.6% of normal vision with a 3° visual field and 92.7 ± 11.6% of normal when counting fingers. There was a significant difference between normal and impaired visual function (P < 0.05). The results demonstrate the close relationship between visual function and gait in cataract patients and simulated patients. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the changes in functional visual acuity before and after neodymium:YAG (Nd:YAG) laser capsulotomy. Setting: Keio University Hospital, Tokyo, Japan. Design: Case series. Methods: Eyes that had previous cataract surgery with a clinical diagnosis of central posterior capsule opacity requiring Nd:YAG laser capsulotomy were evaluated. All patients had refractive error and corrected distance visual acuity (CDVA) measurements; slitlamp microscopy examinations, including posterior capsule opacification evaluation; high-contrast visual acuity measured at 5 m using a Landolt chart; 10% low-contrast visual acuity (LCVA); functional visual acuity; wavefront examination; and a Schirmer test without anesthesia. Results: The study enrolled 9 patients (4 women, 5 men; 10 eyes) with a mean age of 57.3 years ± 7.0 (SD) (range 47 to 68 years). Although there was no significant difference in CDVA before and after Nd:YAG capsulotomy, there was a significant improvement in the mean functional visual acuity, from 0.18 ± 0.11 logMAR (range −0.03 to 0.31 logMAR) to 0.08 ± 0.07 logMAR (range −0.04 to 0.18 logMAR) (P<.05). The LCVA improved significantly after Nd:YAG laser capsulotomy (P=.003). Higher-order aberrations and the root mean square of the 4th-order coefficients decreased significantly after capsulotomy, and these aberrations were significantly correlated with functional visual acuity and LCVA. Conclusion: Results indicate that measurement of functional visual acuity is useful in assessing the quality of vision in patients who have Nd:YAG laser capsulotomy after cataract surgery. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned. [ABSTRACT FROM AUTHOR]

This study aimed to identify the type of cataract opacity associated with subjective sleep quality for cataract patients. A total of 180 consecutive patients (average age 74.2 years) underwent cataract surgery with implantation of an ultraviolet-blocking or blue light-blocking intraocular lens. The participants' subjective sleep quality was evaluated using the Pittsburgh sleep quality index (PSQI) before and at 2 months after surgery. Patients were divided into two groups for analysis: normal sleepers (preoperative PSQI ≤5) and poor sleepers (preoperative PSQI ≥6). The preoperative and postoperative PSQI scores were 2.8 ± 1.5 and 3.2 ± 2.0, respectively, for normal sleepers (n = 99), and 8.5 ± 2.9 and 7.4 ± 3.3, respectively, for poor sleepers (n = 81). The improvement in PSQI was significant in poor sleepers (p < 0.0001, Wilcoxon's test) with measured values of 0.22 ± 0.96 hours extension in sleep duration and 0.16 ± 0.62 hours shortening in sleep latency. Patients with posterior subcapsular cataract (PSC) and nuclear opacity showed the greatest improvement in PSQI score, with regression analysis identifying PSC as having a significant effect on improvement in PSQI. Significant correlations were found between the subjective sleep and cataract opacity in cataract patients. Ophthalmic personnel should therefore be aware that cataract patients with PSC have a greater potential for disability and predictable benefits from surgery in vision and subjective sleep. [ABSTRACT FROM AUTHOR]

Purpose To evaluate the effect of neodymium:YAG (Nd:YAG) laser capsulotomy on the visual function in patients with posterior capsule opacification (PCO) and good visual acuity. Setting Keio University Hospital, Tokyo, Japan. Design Observational case series. Methods Eyes were evaluated that had previous cataract surgery with a clinical diagnosis of PCO requiring Nd:YAG laser capsulotomy regardless of a good corrected distance visual acuity (CDVA) (at least 20/20). The CDVA, 10% low contrast visual acuity (LCVA), wavefront aberrations from the 3rd to 6th order, and retinal straylight were measured before and after Nd:YAG laser capsulotomy. Results The study included 16 eyes of 16 patients (10 men, 6 women; mean age 69.5 years ± 9.3 [SD]). The mean CDVA, LCVA, and straylight after Nd:YAG laser capsulotomy improved significantly ( P < .05). The root mean square (RMS) of the 3rd Zernike coefficients (S3) and the RMS of the total higher-order aberrations (HOAs) from the 3rd to 6th order decreased significantly after capsulotomy ( P < .05). The straylight correlated significantly with the total HOAs ( r = 0.727, P = .002) and S3 ( r = 0.748, P = .001) before capsulotomy. Subjective symptoms resolved after capsulotomy in all cases. Conclusions Neodymium:YAG laser capsulotomy enabled a significant improvement in visual function even in patients with PCO with good visual acuity. Straylight measurements might be useful to determine the indications for Nd:YAG laser capsulotomy when patients report visual disturbances without decreased visual acuity. Financial Disclosure None of the authors has a financial or proprietary interest in any material or method mentioned. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effect of spherical aberration on visual function under natural pupil conditions after cataract surgery. Setting: Keio University Hospital, Tokyo, Japan. Methods: This study comprised cataract patients who had cataract extraction with implantation of an acrylic intraocular lens. Preoperative and postoperative visual acuity, higher-order aberration in the whole eye, contrast sensitivity function, and pupil diameter under photopic and mesopic conditions 1 month after surgery were measured. The area under log contrast sensitivity function (AULCSF) and spherical aberration corresponding to the individual pupil diameter under photopic and mesopic conditions were evaluated. Results: One hundred seven eyes of 79 patients (30 men, 49 women; mean age 68.0 years ± 9.6 [SD]) were evaluated. The mean pupil diameter was 2.9 ± 0.50 mm under photopic conditions and 3.6 ± 0.57 mm under mesopic conditions. The mean spherical aberration was 0.03 ± 0.04 μm (range −0.12 to 0.34 μm) under photopic conditions and 0.05 ± 0.10 μm (range −0.14 to 0.55 μm) under mesopic conditions. The postoperative AULCSF without glare under photopic conditions was significantly negatively correlated with spherical aberration (P = .014). The postoperative AULCSF with and without glare under mesopic conditions was significantly negatively correlated with spherical aberration (P<.001 and P = .01, respectively). Conclusions: Postoperative spherical aberration had a significant effect on visual function under photopic and mesopic conditions. This result indicates that reduced postoperative spherical aberration improves postoperative visual function under photopic and mesopic conditions. [Copyright &y& Elsevier]

: PurposeTo examine the long-term occurrence and course of Elschnig pearl (string of pearls) formation along neodymium:YAG (Nd:YAG) laser posterior capsulotomy margins.: SettingDepartment of Ophthalmology, Keio University School of Medicine, Tokyo, Japan.: MethodsThe clinical records of eyes having an Nd:YAG posterior capsulotomy to treat posterior capsule opacification after cataract surgery were retrospectively reviewed. Kaplan-Meier and Cox proportional hazards analysis were performed.: ResultsAmong 201 eyes, string of pearls developed in 139 (69.2%). The mean follow-up after the Nd:YAG posterior capsulotomy was 32.1 months ± 25.3 (SD). At 2 years, the cumulative probability of developing string of pearls was 77.0% (95% confidence interval [CI], 70.6%-83.4%), after which it reached a plateau. Among the 139 eyes, 100 had sufficient data to be reviewed to assess the long-term outcome (mean follow-up from Nd:YAG posterior capsulotomy, 43.7 ± 26.0 months). A second Nd:YAG posterior capsulotomy was performed in 18 eyes (18.0%) to treat progression of string of pearls, typically within 2 years after the initial Nd:YAG capsulotomy. The string of pearls disappeared spontaneously in 31 eyes (31.0%). The probability of disappearance was 80.4% (95% CI, 63.4%-97.4%) 8 years after the Nd:YAG posterior capsulotomy. Cox proportional hazards analysis identified no factor significantly favoring the disappearance of the string of pearls.: ConclusionsString of pearls was a common complication after Nd:YAG laser posterior capsulotomy. About 20% of cases were progressive and required a second capsulotomy; however, most regressed over several years. [Copyright &y& Elsevier]