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Purpose: To evaluate refractive and visual outcomes and complications associated with phakic intraocular lens (pIOL) implantation to correct high myopia., Settings: Fernández-Vega Ophthalmological Institute, Oviedo, Spain., Design: Retrospective observational case series., Methods: Uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA), refraction, vault, and adverse effects were evaluated after 5 years with Visian ICMV4 pIOL., Results: Mean spherical equivalent (SE) dropped from -18.32 ± 2.37 diopters (D) preoperatively to -0.88 ± 0.52D 5 years postoperatively; 61% of eyes were within ±0.75 D of the target. The mean Snellen decimal CDVA and UDVA were 0.73 ± 0.23 and 0.55 ± 0.26, respectively. More than 50% of eyes achieved 20/25 or better CDVA postoperatively. Four eyes had lost 2 or 1 lines of CDVA, 10 eyes had not lost any lines from preoperatively, and 46 eyes had gained 1 or more lines of CDVA 5 years postoperatively. The safety index was 1.26 ± 0.32. Forty eyes had UDVA of 20/40 or better postoperatively. The efficacy index was 0.99 ± 0.42. At 5-year follow-up, the mean central vault was 475.28 ± 216.38 μm. No eyes showed central contact between the pIOL and crystalline lens. Nevertheless, 10 eyes showed peripheral contact with a central vault between 150 and 260 μm. Two eyes developed anterior subcapsular cataract, although only 1 eye required cataract surgery., Conclusions: Predictability, safety and effective outcomes of posterior pIOL of (- were good, as well as postoperative complications over the long term. A central vault of 260 μm was enough to prevent the peripheral contact between the pIOL and crystalline lens in eyes with high myopia., Financial Disclosure: The authors have no proprietary interest in any of the materials mentioned in this article., (Copyright © 2015 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate the prevalence of cataract after Implantable Collamer Lens phakic intraocular lens (pIOL) implantation with different models at different ages and for different refractive powers., Setting: Fernández-Vega Ophthalmological Institute, Oviedo, Spain., Design: Retrospective nonrandomized clinical study., Methods: The pIOL (models V4, V4b, or V4c) was implanted in all cases., Results: The study included 3420 eyes (1898 patients). The mean patient age at surgery was 31.2 years ± 6.4 (SD) (range 18 to 50 years) and the mean spherical refractive error, -7.27 ± 5.24 diopters (D) (range -26.5 to 12.5 D). Twenty-one eyes (0.61%) of 15 patients had pIOL explantation (all model V4) because cataract developed. The mean age of the patients who had explantation was 39.43 ± 4.57 years; 7 were younger than 40 years, and 8 were 40 years or older. The mean spherical equivalent was -10.1 ± 5.41 D; 3 eyes had a pIOL power less than -10.50 D, 4 eyes between -10.50 D and -13.50 D, and 14 higher than -13.50 D. The mean time between pIOL implantation and cataract surgery was 4.2 ± 1.8 years. No eye with implantation of the latest models (V4b and V4c) developed cataract. The mean vault distance in eyes that developed cataracts was 103 ± 69 μm., Conclusions: The incidence of cataract was low after pIOL implantation at the 6-year follow-up. The rate of cataract was higher in older patients and in those with high refractive errors., Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned., (Copyright © 2015 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To assess the effect of different disposable soft contact lenses upon corneal thickness, and upon anterior and posterior corneal curvatures using a dual-Scheimpflug imaging based device., Methods: Twenty-eight young, healthy subjects wore four different types of daily disposable soft contact lenses on four different days: Dailies Total1, Proclear 1 Day, Clariti 1-Day and 1-Day Acuvue Moist. The lenses had different material and water content. Pachymetry maps and keratometry values were obtained using the Galilei G4 twice a day: one before putting the lens on and one after an eight-hour period of contact-lens wear. Measurements were also recorded without any contact lenses being worn during a day., Results: Clariti 1-Day lens caused the greatest thickening in the central (8.9±2.8 μm; p<0.01) and in the peripheral cornea (10.1±4.6 μm; p<0.01), whereas Dailies Total1 was the lens that had the most similar behaviour to the non-contact lens scenario. All the lenses caused a slight flattening in the anterior corneal curvature, except Clariti 1-Day, which induced a very slight steepening. The four lenses caused a steepening of different magnitude in the posterior corneal curvature., Conclusions: The magnitude of the changes introduced by the use of soft contact lenses over the eight-hour wearing period was rather small. Thus it is probable it will not influence the vision nor the comfort of the subject. Also, variations on corneal parameters seem to depend on the type of contact lens used., (Copyright © 2014 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Purpose: To evaluate the predictability, stability, safety, and efficacy of Visian V4b Implantable Collamer Lens phakic intraocular lens (pIOL) implantation to treat varying degrees of myopia., Setting: Fernández-Vega Ophthalmological Institute, Oviedo, Spain., Design: Prospective nonrandomized clinical study., Methods: The uncorrected (UDVA) and corrected (CDVA) distance visual acuities, refraction, pIOL vault, and adverse effects were evaluated 12 months postoperatively., Results: The study enrolled 121 eyes (68 patients). The mean spherical equivalent decreased from -8.61 diopters (D) ± 3.41 (SD) (range -18.75 to -2.25 D) preoperatively to -0.18 ± 0.29 D (range -1.25 to 0.50 D) 12 months postoperatively; 97 eyes (80.2%) were within ±0.25 D of the target refraction and 114 eyes (94.2%) were within ±0.50 D (r(2) = 0.99). The mean Snellen decimal UDVA and CDVA were 0.91 ± 0.17 and 0.97 ± 0.09, respectively. Postoperatively, the UDVA was 20/20 or better in 80 eyes (66.1%) and 20/40 or better in 115 eyes (95.0%). The mean efficacy index was 0.96 ± 0.14. The CDVA was 20/20 or better in 103 eyes (85.1%) and 20/40 or better in all eyes. No eye lost lines of CDVA, and 22 eyes (18.2%) gained 1 or more lines of CDVA. The mean safety index was 1.04 ± 0.10. There were no intraoperative complications., Conclusions: The predictability, safety, and effectiveness of the pIOL were good throughout the 12-month follow-up and comparable to outcomes reported for previous pIOL models., Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned., (Copyright © 2015 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To assess the predictability, stability, safety, and efficacy of a collagen copolymer toric phakic intraocular lens (pIOL) to correct moderate and high astigmatism., Setting: Fernández-Vega Ophthalmological Institute, Oviedo, Spain., Design: Case series., Methods: After implantation of the TV4b toric Implantable Collamer Lens pIOL, the uncorrected (UDVA) and corrected (CDVA) distance visual acuities, refraction, toric pIOL vault, and adverse effects were evaluated over 12 months., Results: The study enrolled 35 eyes of 20 patients with a mean sphere of -5.46 diopters (D) ± 4.17 (SD) and mean cylinder of -3.14 ± 1.19 D. At 12 months, the mean sphere was -0.04 ± 0.16 D, with 97% of eyes being within ±0.50 D of the target (r(2) = 0.99), and the mean cylinder was -0.29 ± 0.42 D. For the astigmatism components, 80% of eyes were within ±0.25 D of both J0 (r(2) = 0.99) and J45 (r(2) = 0.99). The mean decimal UDVA was 0.89 ± 0.16 and the mean decimal CDVA, 0.95 ± 0.12. No eye lost lines of CDVA, and 43% of eyes gained 1 or more lines. The safety index was 1.08 at 12 months. More than 50% of eyes had a Snellen UDVA of 20/20. The efficacy index was 0.97 at 3 months and 1.01 at 12 months., Conclusion: The visual and refractive outcomes were good and highly stable throughout the follow-up, indicating that this toric pIOL model is predictable, safe, and effective in correcting low and high levels of astigmatism., Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned., (Copyright © 2014 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate the visual quality achieved in patients undergoing standard or modified implantable Collamer lens (ICL) to correct residual myopic error after laser-assisted in situ keratomileusis (LASIK) surgery., Methods: The adaptive optics visual simulator was used to simulate LASIK surgery of moderate and high myopia with a myopic regression corrected by a standard and modified ICL. Visual acuity (VA) and contrast sensitivity (CS) were measured in 14 subjects at 3- and 4.5-mm pupil. Point spread function and simulated retinal images were calculated., Results: Comparing LASIK plus standard ICL and LASIK plus modified ICL simulations, for moderate myopia, VA improvement was less than 1 line in all VA contrasts and both pupils evaluated. No statistically significant differences were found in CS between the simulations at any spatial frequency evaluated and for 3-mm pupil (p>0.05), but differences were significant at 4.5-mm pupil (p<0.05). For high myopia, the VA improvement was less than 1 line at 3-mm pupil, although it increased 2 or more lines at 4.5-mm pupil. Statistically significant differences were found in CS between the simulations for all spatial frequencies and both pupils evaluated (p<0.05), except for low and medium spatial frequencies at 3-mm pupil (p>0.05)., Conclusions: These outcomes suggest that an ICL is a good option to correct the myopic residual error after myopic LASIK. When the ICL's spherical aberration is modified, the post-LASIK eyes of high myopia are the most benefited, as these eyes are more aberrated than after moderate myopic LASIK.

Purpose: To compare optical and visual quality of implantable collamer lens (ICL) implantation and femtosecond laser in situ keratomileusis (F-LASIK) for myopia., Methods: The CRX1 adaptive optics visual simulator (Imagine Eyes, Orsay, France) was used to simulate the wavefront aberration pattern after the two surgical procedures for -3-diopter (D) and -6-D myopia. Visual acuity at different contrasts and contrast sensitivities at 10, 20, and 25 cycles/degree (cpd) were measured for 3-mm and 5-mm pupils. The modulation transfer function (MTF) and point spread function (PSF) were calculated for 5-mm pupils., Results: F-LASIK MTF was worse than ICL MTF, which was close to diffraction-limited MTF. ICL cases showed less spread out of PSF than F-LASIK cases. ICL cases showed better visual acuity values than F-LASIK cases for all pupils, contrasts, and myopic treatments (p<0.05). No statistically significant differences were found in contrast sensitivities between ICL and F-LASIK cases with -3-D myopia for both pupils for all evaluated spatial frequencies (p>0.05). For -6-D myopia, however, statistically significant differences in contrast sensitivities were found for both pupils for all evaluated spatial frequencies (p<0.05). Contrast sensitivities were better after ICL implantation than after F-LASIK., Conclusions: ICL implantation and F-LASIK provide good optical and visual quality, although the former provides better outcomes of MTF, PSF, visual acuity, and contrast sensitivity, especially for cases with large refractive errors and pupil sizes. These outcomes are related to the F-LASIK producing larger high-order aberrations.

Aims: To assess and compare the optical quality of the myopic and hyperopic implantable collamer lens (ICL) from its wavefront aberrations for different powers and pupil diameters., Settings and Design: Prospective study., Material and Methods: The wavefront aberrations of two myopic (-3 and -6 diopters (D)) and two hyperopic V4b ICLs (+3 and +6D) were measured in vitro. To assess and compare the optical quality of different powers of ICLs, we analyzed the root mean square (RMS) of total higher order aberrations (HOAs), trefoil, coma, tetrafoil, secondary astigmatism, and spherical aberration at 3- and 4.5-mm pupil. In addition, the point spread functions (PSFs) of each ICL evaluated were calculated from the wavefront aberrations at 3- and 4.5-mm pupil., Statistical Analysis: A Student's t-test for unpaired data was used for comparison between myopic and hyperopic ICLs., Results: Myopic ICLs showed negative spherical aberration, in contrast hyperopic ICLs showed positive spherical aberration, which increases when the ICL power increases, due to the innate optical properties of the lens. All ICLs evaluated had negligible amounts of other aberrations. We did not find statistical significant differences in any Zernike coefficient RMS values analyzed between myopic and hyperopic ICLs at 3- and 4.5-mm pupil (P > 0.05)., Conclusions: Myopic and hyperopic ICLs provide good and comparable optical quality for low to moderate refractive error. The ICLs evaluated showed values of wavefront aberrations clinically negligible to affect the visual quality after implantation.

Purpose: To compare the visual quality of implantable collamer lens (ICL) with and without central hole (Hole ICL and conventional ICL) at different degrees of decentering., Methods: An adaptive optics visual simulator (crx1, Imagine Eyes, Orsay, France) was used to simulate the -3, -6 and -12 dioptres (D) conventional and Hole ICLs in three conditions: centred and decentred 0.3 and 0.6 mm. Visual acuity (VA) at high-contrast, medium-contrast and low-contrast and contrast sensitivity (CS) were measured in 15 observers for 3 and 4.5 mm pupils., Results: No statistically significant differences in VA and CS were found between conventional and Hole ICLs for any ICL powers and pupil sizes evaluated (p>0.05). Regarding the effect of the ICL decentration on visual performance, we did not find statistically significant differences in VA and CS between centred, 0.3 and 0.6 mm decentred (p>0.05). Moreover, the ICL decentration affected the same manner on the conventional and Hole ICLs., Conclusions: The outcomes showed that conventional and Hole ICLs provided good and comparable visual performance for all powers and pupil sizes evaluated. Besides, ICL decentering affects the same manner both ICL models evaluated. The ICL decentering did not have any effect on the visual performance.

Purpose: To compare the optical and visual quality of a simulated Toric Implantable Collamer Lens (TICL) and a bioptics technique to treat high myopic astigmatism., Methods: An adaptive optics visual simulator was used to simulate the vision after TICL implantation and a bioptics procedure from the wavefront aberration pattern for moderate and high-myopic astigmatism. Visual acuity (VA) at different contrasts and contrast sensitivity (CS) at 10, 20 and 25 cycles degree(-1) were measured for 3 and 5-mm pupils. Modulation Transfer Function (MTF) and Point Spread Function (PSF) were calculated for a 5-mm pupil., Results: At a 3-mm pupil we only found statistically significant differences in VA between the two simulated surgeries at low-contrast for moderate- and high-myopic astigmatism (p < 0.05). Statistically significant differences were found in CS at 3-mm pupil between both procedures at the highest spatial frequency for moderate-myopic astigmatism and at all frequencies for high-myopic astigmatism (p < 0.05). At a 5-mm pupil we found statistically significant differences in VA and CS between both simulated surgeries at all contrasts and frequencies evaluated for both groups (p < 0.05). In all cases VA and CS were better with the TICL than with the bioptics technique. MTFs for the bioptics technique were worse than those computed for the TICL. The TICL showed less spread out of the PSF than the bioptics procedure., Conclusions: Simulated TICL and bioptics procedures provided good optical and visual quality, although TICL implantation provided slightly better outcomes than the bioptics procedure, especially when the pupil diameter was increased., (Ophthalmic & Physiological Optics © 2013 The College of Optometrists.)

Purpose: To evaluate distance and near contrast sensitivity (CS) under photopic and mesopic conditions before and after refractive lens exchange (RLE) and implantation of the aspheric AcrySofReSTOR (SN6AD3 model) intraocular lens (IOL)., Methods: Seventy-four eyes of 37 patients after RLE underwent bilateral implantation with the aspheric AcrySof ReSTOR IOL. The patient sample was divided into myopic and hyperopic groups. Monocular uncorrected visual acuity at distance and near (UCVA and UCNVA, respectively) and monocular best corrected visual acuity at distance and near (BCVA and BCNVA, respectively) were measured before and 6 months postoperatively. Monocular CS function was measured at three different luminance levels (85, 5 and 2.5 cd/m²) before and after RLE. Post-implantation results at 6 months were compared with those found before surgery., Results: Our results revealed that patients in both groups obtained good UCVA and BCVA after RLE at distance and near vision in relation to pre-surgery values. No statistically significant differences were found between the values of CS pre and post-RLE at distance and near, at any lighting condition and spatial frequency (p>0.002)., Conclusions: Refractive lens exchange with aspheric AcrySof ReSTOR IOL in myopic and hyperopic population provided good visual function and yield good distance and near CS under photopic and mesopic conditions.

Purpose: To evaluate visual quality differences between intraocular lenses (IOLs) in patients with previous myopic laser ablations and assess the impact of IOL decentration and tilt on visual quality., Setting: University of Valencia, Burjassot, Spain., Design: Cohort study., Methods: An adaptive optics visual simulator was used to simulate the wavefront aberration pattern of 1 aberration-correcting IOL (Acrysof IQ SN60WF), 1 aberration-free IOL (Akreos Adapt AO), and 1 spherical IOL (Triplato) under 5 IOL situations: centered, 0.2 mm and 0.4 mm decentered, and 2 degrees and 4 degrees tilted in eyes with simulated low or high myopic laser corneal ablations. Monocular distance visual acuity at 100%, 50%, and 10% contrast were measured., Results: Ten eyes of 10 patients were evaluated. When the IOLs were centered, the aberration-correcting IOL provided the best visual quality results in both groups. When the IOLs were misaligned, there was a decrease of visual quality with all simulated IOLs except the aberration-free IOL in the high myopia group. In the misaligned situations, all simulated IOLs obtained comparable visual quality results in both groups., Conclusions: The results suggest that in patients with previous myopic laser corneal ablation, aberration-correcting IOLs should be implanted. The decrease in visual quality when these IOLs are decentered or tilted demonstrates the importance of accurate implantation of these IOLs., Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned., (Copyright © 2012 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)