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Implantation of phakic intraocular lenses (pIOLs) is a reversible refractive procedure, preserving the patient's accommodative function with minimal induction of higher order aberrations compared with corneal photoablative procedures. Despite this, as an intraocular procedure, it has potential risks such as cataracts, chronic uveitis, pupil ovalization, corneal endothelial cell loss, pigmentary dispersion syndrome, pupillary block glaucoma, astigmatism, or endophthalmitis. Currently, only two models of posterior chamber pIOLs are commercially available, the implantable collammer lens (STAAR Surgical Co.) and the phakic refractive lens (PRL; Zeiss Meditec). The number of published reports on the latter is very low, and some concerns still remain about its long-term safety. The present article reviews the published literature on the outcomes after PRL implantation in order to provide a general overview and evaluate its real potential as a surgical refractive option. [ABSTRACT FROM AUTHOR]

Purpose: To measure changes in the anterior ciliary muscle during accommodation at the nasal, superior, temporal, and inferior sectors by means of an anterior chamber optical coherence tomographer, and correlate them with vergence changes., Methods: Twenty-four subjects with healthy, phakic eyes, whose mean age was 27.1 ± 8.9 years, underwent measurement with an anterior chamber optical coherence tomographer. The anterior ciliary muscle was measured at the nasal, temporal, superior, and inferior sectors for 0, -1, -2, and -3 D of vergence. A linear model was used to assess the correlation of each eye parameter with the accommodative demand., Results: The anterior ciliary muscle area significantly increased with accommodation for each sector, with a maximum increase of about 30% for the nasal-temporal sectors and about 25% for the inferior-temporal sectors. The linear model showed a tendency toward a positive relationship between change in the ciliary muscle area of each sector and vergence., Conclusion: The anterior ciliary muscle area tends to increase with accommodation, although the increase has been shown to be symmetric between the pair sectors superior-nasal and inferior-temporal. These results may help to increase understanding of accommodation biometry and biomechanics.

Purpose: To determine the reliability of swept- source optical coherence tomography in cases in which soft contact lenses cannot be removed when acquiring biometric measurements., Methods: Eight subjects were included and only one eye per participant was analyzed. Each eye was measured six times by swept-source optical coherence tomography with the IOLMaster 700 instrument (Carl Zeiss Meditec, Jena, Germany). Axial length, central corneal thickness, anterior chamber depth, lens thickness, and keratometric measurements were evaluated for the naked eye and while wearing soft contact lenses of three different powers (-1.5, -3.0, and +2.0 D)., Results: There were statistically significant changes in axial length, central corneal thickness, anterior chamber depth, and keratometric measurements with soft contact lenses as compared to the naked eye (p<0.001). However, there were no significant differences in lens thickness outcomes between the naked eye and while wearing the three soft contact lenses (p>0.5). The changes in axial length, central corneal thickness, and anterior chamber depth were lens-specific and dependent on the thickness of the lens used., Conclusions: Sept-source optical coherence tomography based lens thickness measurements while wearing soft contact lenses are comparable to those of the naked eye. However, the thickness and the optical design of the soft contact lens may lead to significant differences in the axial lengh, central corneal thickness, anterior chamber deph, and keratometric measurements.

Purpose: To evaluate ocular biometric changes with different accommodative stimuli using a new swept-source optical biometer., Methods: Only the right eye was analyzed. Each subject was measured six times with the IOLMaster 700 swept-source optical biometer (Carl Zeiss Meditec, Jena, Germany) with the subject looking at the stimulus shown by the instrument and with the subject looking at a target placed outside the instrument at 0D of vergence. Axial length (AL), anterior chamber depth (ACD), central corneal thickness (CCT), lens thickness (LT), white-to-white (WTW), and keratometry readings (K1 and K2) were evaluated in both cases. To assess if the changes found may affect the intraocular (IOL) power calculation for surgical applications, we have applied some formulae, using the software provided by the optical biometer manufacturer, to the ocular parameters found in both situations for three different types of IOLs., Results: No statistically significant differences were found for AL, CCT, WTW, K1 and K2 between the subject looking at the stimulus of the biometer and looking at the outside target at 0D of vergence (p > 0.05). However, the measurement of ACD revealed a statistically significant reduction of 20 microns (p = 0.03) and, on the contrary, LT increased significantly 30 microns (p = 0.02). ACD and LT changes were highly correlated (R 2  = 0.91). As for the IOL power calculation, in all cases, the mean change was lower than 0.25 D both for IOL power selection and residual refraction., Conclusions: Although ACD and LT change significantly with different accommodative stimuli measured by swept-source optical biometry, these changes are not clinically relevant.

Purpose: To assess the changes in the accommodative response of the eye while reading a text under different contrast polarity conditions: black letters on white background (BoW condition) and white letters on black background (WoB condition)., Methods: Eighteen subjects with ages ranging from 21 to 41 years participated in this experimental study. The accommodative response (AR) of the eye while reading a text with BoW or WoB contrast polarity was obtained objectively with an adaptive optics system that corrected all aberrations but subject's own. Two different letter sizes (visual acuity conditions), shown on a microdisplay, were tested. The AR of each eye was measured with its natural pupil diameter at 0-3D of accommodative demand from the far point of the eye, with a step of 0.5D. The slope of the stimulus-response curve was calculated for each subject and condition., Results: The averaged maximum pupil size was bigger for reverse (WoB) than for normal (BoW) contrast with statistical significance. The slopes for the ARs of the four conditions were not significantly different from each other., Conclusions: Contrast polarity does not seem to influence the accommodative response when reading text from an electronic microdisplay., (Copyright © 2018 Spanish General Council of Optometry. Published by Elsevier España, S.L.U. All rights reserved.)

Background: We aim to assess if refractive error or age may influence the repeatability of measurements using a swept-source biometer., Methods: A total of 61 subjects were evaluated with IOLMaster 700 acquiring measurements of axial length (AL), central corneal thickness (CCT), white-to-white distance (WTW), anterior aqueous depth (AQD), lens thickness (LT), and keratometry (K) readings. Repeatability was evaluated classifying the sample according to the refractive state and age by the calculation of the within-subject standard deviation (S w ), coefficient of repeatability, and intraclass correlation coefficient., Results: Very similar S w was acquired among groups for AL, CCT, and WTW. Differences found for AQD, LT, keratometry and astigmatism among refractive and age groups were not clinically significant. Refractive groups obtained a S w for AQD between 0.016 and 0.026, while for LT was between 0.023 and 0.029 mm. Besides, S w showed values from 0.014 to 0.029 mm for keratometry. Age groups obtained a S w of 0.025 and 0.016 mm for AQD, and 0.029 and 0.018 mm for LT, respectively. S w was 0.019 vs 0.018 mm for K1, 0.014 vs 0.031 mm for K2., Conclusions: IOLMaster 700 showed good repeatability for biometric and keratometric parameters in eyes classified according to their refractive error or age.

Purpose: To compare changes in the ciliary muscle area at different sectors between pre-presbyopic and presbyopic eyes during accommodation by means of an anterior segment optical coherence tomographer (OCT)., Methods: The anterior ciliary muscle area was measured in 20 healthy and phakic pre-presbyopic eyes, whose mean age was 23.3±4.4 years, and in 20 healthy and phakic presbyopic eyes, whose mean age was 46.5±5.2 years. The relative change in the cross-sectional area of the ciliary muscle was measured at the nasal, inferior, and temporal sectors between 0 and -3 D of vergence, in -1 D step. A linear model was used to assess the correlation of each eye parameter with the accommodative demand., Results: Each population group showed a significant increase in the anterior ciliary muscle area for each sector. The maximum increase in the ciliary muscle area within the pre-presbyopic group was about 30%, and for the presbyopic one was about 25%. At the same time, it was obtained that the larger the vergence, the larger the variability. Furthermore, the linear model showed a positive tendency between the change in the ciliary muscle area of each sector and the vergence for both population groups, which coefficient of determination was in all cases greater than 0.93., Conclusion: The anterior ciliary muscle area tends to increase with accommodation. The presbyopic nasal, inferior, and temporal ciliary muscle seem to have the same contractile capability as the young presbyopic ciliary muscle. These results might help to increase the evidences in the knowledge regarding the modern understanding of accommodation biometry and biomechanics., (Copyright © 2018 Spanish General Council of Optometry. Published by Elsevier España, S.L.U. All rights reserved.)

Purpose: To assess how the monocular steady-state accommodative stimulus-response curve is modified when viewing low-pass filtered natural images., Methods: Eighteen adult subjects participated in the study. The accommodative stimulus-response curve was objectively assessed by means of a Hartmann-Shack wavefront sensor. Measurements were taken at different accommodative demands. Target images were low-pass filtered versions of a natural image that were obtained applying different digital spatial filters that limited the spatial frequency content of the natural image. Cutoff spatial frequencies were set at 30, 21, and 15 cycles per degree (cy/deg)., Results: Mean data obtained for each target were fitted to linear models. For the low-pass filtered natural image with a cutoff spatial frequency at 30 cy/deg, the slope for the averaged stimulus-response curve was 0.614, while the slopes obtained for the other two low-pass filtered images corresponding to cutoff frequencies at 21 and 15 cy/deg were 0.613 and 0.619, respectively (p < 0.01). The determination coefficient was R 2  ≥ 0.988 for all targets. An ANCOVA analysis revealed that these slopes were not significantly different from each other (p = 0.82). Additionally, accommodative error indexes were obtained to measure both the discrepancy between the regression lines and the ideal lines and the degree of correlation between the stimulus and the response., Conclusions: Our study reveals that the low and middle spatial frequencies (< 15 cy/deg) are the most important to guide to the needed levels the accommodative response to natural images.

Aim: To evaluate the repeatability of an optical device for measuring the Zernike coefficients of toric intraocular lenses (IOLs) and assess whether its toricity has any impact in its repeatability., Methods: An experienced technician used the NIMO TR1504 to measure the Zernike coefficients 30 times for an aperture of 4.50 mm for all lenses included. The IOLs included were divided into two group: toric and non-toric ones. The cylindrical powers of the toric lenses included in the present study were 1.00, 1.50, 2.25, 3.00 and 3.75 D. Finally, the repeatability of the NIMO TR1504 was described in terms of within subject standard deviation (Sw) and repeatability limit., Results: The Sw was smaller than 0.011 µm for both lens groups and all Zernike coefficients, and the difference between both groups was smaller than 0.004 µm for all Zernike coefficients. Regarding the repeatability limit, this value was smaller than 0.025 µm for the toric lens group, and smaller than 0.031 µm for the non-toric lens one for all Zernike coefficients. Furthermore, the maximum difference between both lens groups was 0.010 µm., Conclusion: The repeatability of the NIMO TR1504 to measure the optical quality is high and independent of the lens toricity. These results reflect that this system is robust and could be used to measure the in-vitro optical quality of either toric or non-toric IOLs.

Background: Current advances in ocular surgery require the evaluation of differences in automated white-to-white (WTW) measurements between systems. We aim to analyze three different commonly used devices in clinical practice: the IOLMaster 700, the Atlas 9000, and the Sirius., Methods: Ninety right eyes of ninety healthy subjects were included. Measurements of WTW distances were taken with each device for all subjects in the same session and by the same observer. Statistical comparison was carried out by means of the rANOVA procedure and the Bonferroni post-hoc test. In addition, the Bland-Altman analysis was applied in order to perform pairwise comparisons., Results: Average WTW values obtained by the IOLMaster 700, the Atlas 9000, and the Sirius devices were 12.18 ± 0.40-mm, 12.32 ± 0.37-mm and 11.90 ± 0.37-mm, respectively. There were statistically significant differences in all pairwise comparisons. Mean differences revealed that the Atlas 9000 provided the highest WTW values, followed by the IOLMaster 700 values and finally by the Sirius results, which had the lowest values. The limits of agreement obtained in all pairwise comparisons were wide, with a range between 0.64 and 0.75 mm., Conclusions: According to our results, these three devices should not be used interchangeably for WTW diameter measurements during the clinical practice.

Purpose: To assess the in vitro optical quality of monofocal aspheric toric intraocular lenses (IOLs) as a function of the cylindrical power., Methods: The in vitro optical quality of the AcrySof IQ Toric IOLs SN6AT2, SN6AT3, SN6AT4, SN6AT5 and SN6AT6 (Alcon Laboratories Inc., Forth Worth, TX, USA) was assessed with an instrument conceived for measuring Zernike's coefficients at 3.0- and 5.0-mm apertures. As a reference, the aspheric monofocal lens AcrySof IQ Aspheric SN60WF (Alcon Laboratories Inc., Forth Worth, TX, USA) was also measured. The area of visibility and cut-off frequency were used to describe the modulation transfer function (MTF) of each lens; meanwhile, the light in the bucket and the diameter of a circular area centred on the point-spread function (PSF) peak that captures 50% of the light energy were used to describe the PSF of each lens. Finally, an image simulation was computed from the Zernike values with reference purposes., Results: Small differences were found on the metrics used for describing the MTF and PSF of the lenses at both tested apertures, but these were not statistically significant (p > 0.05). Furthermore, the image simulation showed that these differences would not have clinical relevance at all., Conclusions: The optical performance of the AcrySof IQ toric IOLs in terms of MTF and PSF is good and seems to be independent of the cylindrical power and similar to a non-toric aspheric lens.

A simplified version of the human eye is known as a schematic eye model. Since the first attempts in the middle of the 19th century, numerous approaches describing new schematic eye models have been introduced. Some are able to describe the accommodation ability of the human eye. Accommodated schematic eyes could be of great interest because they explain the functionality of the human eye and they are easy to use for research purposes. Purposes include the design and testing of multifocal ophthalmic intraocular lenses, the evaluation of the effect of optical aberrations on retinal image quality, and the study of the optical performance of the eye at different distances after some refractive surgical procedures. This paper reviews and summarizes the most important features and details of accommodated schematic eye models that have been proposed in the past years., (Copyright © 2018 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: The purpose of our study was to assess the changes in ocular parameters for different accommodative demands using a new optical biometer based on swept-source optical coherence tomography (SS-OCT)., Methods: Seven subjects were included in this pilot study, and only one eye per participant was analyzed. Each eye was measured six times with the optical biometer IOLMaster 700 (Carl Zeiss Meditec, Jena, Germany). As this instrument is not able to change the vergence of the stimulus, to enable measurements at different accommodative states, a tilted first-surface mirror attached to the optical biometer was used to place the fixation stimulus at different vergences. Measurements were taken on the right eye of the subject while the left eye was looking through the mirror. Central corneal thickness (CCT), anterior chamber depth (ACD), lens thickness (LT), axial length (AL), white-to-white (WTW) distance and keratometric readings were evaluated for three different accommodative states: 0.0 diopters (D), 1.5 D, and 3.0 D., Results: No statistically significant differences were found for CCT, AL, WTW, K1 and K2 between the three accommodative states. As expected, changing the accommodative condition did not change CCT, AL, WTW, and keratometric outcomes. Nevertheless, statistically significant differences between the accommodative states were found for ACD and LT measurements. In addition, variations in ACD correlated linearly with variations in LT (R 2 ≥ 0.99) when changing the vergence of the optotype., Conclusion: A practical methodology to assess the changes in ocular parameters for different accommodative demands using the IOLMaster 700 based on SS-OCT has been described. Statistically significant changes that have been found that agree well with previous reports.

Purpose: To assess changes in anatomic structures in the anterior eye segment in terms of axial lengths with accommodation via optical coherence tomography., Methods: In this observational study, 25 eyes of 25 healthy adults were examined using the Visante® omni optical coherence tomography system. Central corneal thickness, anterior chamber depth, central lens thickness, and anterior segment length were assessed. The evaluated parameters were obtained with accommodation using different stimulus vergences, namely 0.0, -1.0, -2.0, and -3.0 D. Variation of these parameters was compared among different levels of accommodation., Results: Central corneal thickness was not altered at any stimulus vergence during accommodation (p>0.05). Conversely, anterior chamber depth was significantly reduced (p<0.05), whereas central lens thickness was significantly increased (p<0.05). Anterior segment length also increased with accommodation (p<0.05), indicating backward movement of the posterior pole., Conclusions: There are significant variations in anterior segment lengths that occur with accommodation. Studying these changes will provide useful information regarding the accommodation mechanism that can improve our understanding of this process and facilitate clinical decision-making by practitioners.

The changes in the iridocorneal angle structure during accommodation are assessed by means of anterior segment optical coherence tomography. Thirteen right eyes were included in the study. The device used for the measurement was the Visante ® omni system. The stimuli were set up at different vergences (0.0 D, -1.5 D, and -3.0 D). The angle opening distance 500 and 750, the trabecular iris space area 500 and 750, and the scleral spur angle parameters were assessed at the nasal and temporal regions. The results in the iridotrabecular angle comparing the three accommodative states of the eye did not yield any statistically significant difference at nasal or temporal angle sections. In light of our results and in the conditions of our study, the structures of the iridocorneal angle are not significantly changed with accommodation.

Purpose: The purpose was to evaluate the repeatability of a new swept-source optical biometer for measuring ocular biometric parameters., Methods: Thirty subjects with healthy and phakic eyes were included in this study, and only one eye per participant was analysed. Each eye was measured five times with the IOLMaster 700 swept-source optical biometer (Carl Zeiss Meditec, Jena, Germany). Axial length (AL), anterior chamber depth (ACD), central corneal thickness (CCT), lens thickness (LT), white-to-white (WTW), and K1 and K2 keratometric readings were evaluated. The repeatability of swept-source biometry was evaluated on the basis of five measurements captured for each patient., Results: The repeatability limits for the axial measurements AL, ACD, CCT, and LT were 0.03, 0.07, 0.004, and 0.11 mm, respectively. For the WTW distance and both keratometry readings, the repeatability limits were 0.20, 0.06, and 0.05 mm, respectively. The AL resulted in the lowest coefficient of variation, and the LT had the highest one. The spherical equivalent showed statistically significant negative correlations with the AL and ACD., Conclusion: Swept-source optical biometry showed high repeatability performance for all biometric parameters in healthy eyes, where the correlation between the spherical equivalent and AL showed the strongest value.

Aim: To simulate and compare accommodation in accommodative and non-accommodative human eye models., Methods: Ray tracing and optical design program was used. Three eye models were designed and studied: the Navarro, the Arizona and the Liou-Brennan. In order to make the Navarro and Liou-Brennan models to accommodate, specific geometric parameters of the models were altered with values that were chosen from the literature. For the Arizona model, its' mathematical functions for accommodation were used for the same accommodative demands. The simulation included four distances of accommodation for each model: at infinity, 3, 1 and 0.5 m.The results were diffraction images of a "letter F" for graphical comparison, spot diagrams on the retinal field and Modulation Transfer Function (MTF) graphs., Results: Zernike coefficients for the aberrations, Airy disk diameter, root mean square (RMS) error diameter and total axial length of the model were provided from the program. These were compared between them in all distances. The Navarro model had the smallest axial length change as a simple model. The Arizona did not change its axial length because it is designed to be accommodative. The Liou-Brennan model had different results concerning the aberrations because of the decentration of the pupil. The MTF graphs showed small differences between the models because of the differences in their designs., Conclusion: All the three models are able to simulate accommodation with the expected results. There is no model that can be assumed as the best choice. Accommodation can be simulated in non-accommodativemodels and in customized ones.

Purpose: To evaluate the static measurement of the accommodative stimulus-response curve with emoji symbols., Methods: The accommodative stimulus-response curve was measured in 18 subjects using a Hartmann-Shack sensor to obtain the objective accommodative response from the Zernike defocus term. Measurements were acquired at different accommodative demands, from 0 to 3 D with a step of 0.5 D. Detailed and nondetailed emoji targets were used with two different sizes, corresponding to the two most common visual angles used in smartphones., Results: A regression analysis was performed to fit the mean results obtained for each target. The determination coefficient was R 2 ≥ 0.988 for all targets. For the detailed targets, the slopes for the averaged stimulus-response curve were 0.65 and 0.66 for the bigger and smaller sizes, respectively. For the nondetailed targets, the slopes were 0.60 and 0.58 for the bigger and smaller sizes, respectively. p values for these slopes were statistically significant for the two types of targets ( p < 0.01)., Conclusions: Our results reveal that the replacement of a word or several words by detailed or nondetailed emoji symbols seems not to provoke a different accommodative response in normal subjects and under standard viewing conditions in the use of smartphones.

Purpose. To design an intraocular telescopic system (ITS) for magnifying retinal image and to simulate its optical and visual performance after implantation in a human eye model. Methods. Design and simulation were carried out with a ray-tracing and optical design software. Two different ITS were designed, and their visual performance was simulated using the Liou-Brennan eye model. The difference between the ITS was their lenses' placement in the eye model and their powers. Ray tracing in both centered and decentered situations was carried out for both ITS while visual Strehl ratio (VSOTF) was computed using custom-made MATLAB code. Results. The results show that between 0.4 and 0.8 mm of decentration, the VSOTF does not change much either for far or near target distances. The image projection for these decentrations is in the parafoveal zone, and the quality of the image projected is quite similar. Conclusion. Both systems display similar quality while they differ in size; therefore, the choice between them would need to take into account specific parameters from the patient's eye. Quality does not change too much between 0.4 and 0.8 mm of decentration for either system which gives flexibility to the clinician to adjust decentration to avoid areas of retinal damage.

The aim of this review is to summarize the results of using posterior chamber phakic intraocular lenses (pIOLs) to restore quality of vision in keratoconus patients. These pIOLs can correct the refractive errors associated with keratoconus and can also be combined with other surgical techniques to improve the results., (Copyright © 2017 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

The aim of this work was to ascertain whether there are differences in amplitude, latency, and peak velocity of accommodation and disaccommodation responses when different analysis strategies are used to compute them, such as fitting different functions to the responses or for smoothing them prior to computing the parameters. Accommodation and disaccommodation responses from four subjects to pulse changes in demand were recorded by means of aberrometry. Three different strategies were followed to analyze such responses: fitting an exponential function to the experimental data; fitting a Boltzmann sigmoid function to the data; and smoothing the data. Amplitude, latency, and peak velocity of the responses were extracted. Significant differences were found between the peak velocity in accommodation computed by fitting an exponential function and smoothing the experimental data (mean difference 2.36 D/s). Regarding disaccommodation, significant differences were found between latency and peak velocity, calculated with the two same strategies (mean difference of 0.15 s and -3.56 D/s, resp.). The strategy used to analyze accommodation and disaccommodation responses seems to affect the parameters that describe accommodation and disaccommodation dynamics. These results highlight the importance of choosing the most adequate analysis strategy in each individual to obtain the parameters that characterize accommodation and disaccommodation dynamics.

Diabetes mellitus is a metabolic disease with a considerable impact on healthcare owing to its increased prevalence and high mortality rate. Structural, morphological, and physiological changes in each of the ocular components have been described in detail. Autofluorescence has been described as a good indicator of metabolic activity. The aim of the present review is to provide an overview of ocular endogenous fluorophores in the cornea, the crystalline lens, and the retinal pigment epithelium, the effects of diabetes mellitus and therefore the potential of autofluorescence assessment for screening and monitoring changes in diabetic patients., (© 2016 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.)

We have reviewed a set of recently published studies that compared the anterior chamber depth (ACD) and/or white-to-white (WTW) distance obtained by means of different measuring devices. Since some of those studies reached contradictory conclusions regarding device interchangeability, this review was carried out in attempting to clarify which clinical devices can or cannot be considered as interchangeable in clinical practice to measure ACD and/or WTW distance, among these devices: A-scan, ultrasound biomicroscopy, Orbscan and Orbscan II (Bausch&Lomb Surgical Inc., San Dimas, California, USA), Pentacam and Pentacam HR (Oculus, Wetzlar, Germany), Galilei (Ziemer, Switzerland), Visante optical coherence tomography (Visante OCT, Carl Zeiss Meditec Inc., Dublin, California, USA), IOLMaster (Carl Zeiss Meditec, Jena, Germany), and Lenstar LS 900/Biograph (Haag-Streit AG, Koeniz, Switzerland/Alcon Laboratories Inc., Ft Worth, Texas, USA).

Purpose: To compare the optical quality between two intraocular lenses (IOLs): the Mini WELL Ready progressive multifocal (SIFI Medtech, Catania, Italy), and the TECNIS Symfony (Abbott Laboratories, Illinois, USA), which both provide a continuous range of vision from far to near positions., Methods: The in vitro optical quality of each lens was assessed with an instrument conceived for measuring the modulation transfer function (MTF). The optical quality of each lens was described in terms of MTF, through-focus MTF, defocus tolerance, pupil dependence, and Strehl ratio MTF. These metrics were assessed for the best lens far focus, and at four vergences (from -1.5 to -3.0 D in 0.5-D steps), at 3.0 and 4.5 mm apertures., Results: The through-focus curves of each lens showed two main areas: one corresponding to far-distance vision, and another to intermediate- and near-distance vision. Both lenses showed similar MTF curves and Strehl ratio values at both apertures. The optical quality of both lenses slightly decreased with the aperture for all vergences. Nevertheless, the quality of the progressive multifocal lens increased with the aperture at far-distance vision. This lens also showed the largest defocus tolerance at near-distance vision for both apertures., Conclusions: The results obtained in the present study suggest that both designs might enlarge the depth of focus. Whereas, the Mini WELL Ready showed better optical quality than the TECNIS Symfony at far vision with 4.5 mm aperture, and larger defocus tolerance than the diffractive lens at near-distance vision.

Background: The aim was to assess the optical quality of four Boston contact lens materials with an optical device based on Schlieren interferometry., Methods: The NIMO TR1504 (Lambda-X, Nivelles, Belgium) was used to measure higher-order aberrations and their corresponding root mean square values of four different rigid gas permeable contact lenses made from four different Boston materials: EO, ES, XO and XO2 . For each lens, 30 measurements were performed with two optical apertures: 3.0 mm and 6.0 mm. The modulation transfer function, point spread function, Strehl ratio and a simulation of the image provided by the lens were computed from the Zernike coefficients measured up to the fourth order., Results: The root mean square error of higher-order aberrations varied significantly with material type for both optical apertures (p < 0.01). The largest difference was obtained between the Boston EO and the Boston ES materials (for a 6.0 mm aperture), the mean difference being (8.3 ± 0.2) × 10(-2) µm. The modulation transfer functions, point spread functions and Strehl ratio values were similar among all Boston materials at the smaller optical aperture; however, differences between each material were more apparent for the 6.0 mm aperture, with the Boston ES material exhibiting the best optical quality., Conclusions: In terms of all metrics analysed, all Boston materials examined showed comparable optical quality for a 3.0 mm aperture but the Boston ES material displayed the best optical quality for a 6.0 mm optical aperture., (© 2016 Optometry Australia.)

Accommodation is controlled by the action of the ciliary muscle and mediated primarily by parasympathetic input through postganglionic fibers that originate from neurons in the ciliary and pterygopalatine ganglia. During accommodation the pupil constricts to increase the depth of focus of the eye and improve retinal image quality. Researchers have traditionally faced the challenge of measuring the accommodative properties of the eye through a small pupil and thus have relied on pharmacological agents to dilate the pupil. Achieving pupil dilation (mydriasis) without affecting the accommodative ability of the eye (cycloplegia) could be useful in many clinical and research contexts. Phenylephrine hydrochloride (PHCl) is a sympathomimetic agent that is used clinically to dilate the pupil. Nevertheless, first investigations suggested some loss of functional accommodation in the human eye after PHCl instillation. Subsequent studies, based on different measurement procedures, obtained contradictory conclusions, causing therefore an unexpected controversy that has been spread almost to the present days. This manuscript reviews and summarizes the main research studies that have been performed to analyze the effect of PHCl on the accommodative system and provides clear conclusions that could help clinicians know the real effects of PHCl on the accommodative system of the human eye., Competing Interests: The authors declare that there is no conflict of interests regarding the publication of this paper.

Purpose: To evaluate the visual impact of adding different spherical aberration values to an Implantable Collamer Lens phakic intraocular lens (pIOL) to increase the depth of focus using an adaptive optics visual simulator., Setting: University of Valencia, Valencia, Spain., Design: Experimental study., Methods: Wavefront aberrations in -3.00 D and -6.00 diopter (D) pIOLs were measured in vitro. Afterward, different simulated pIOL experimental prototypes were created along with variances in the spherical aberration. An adaptive optics visual simulator was used to simulate vision after the implantation of the different pIOL prototypes from their wavefront aberrations. The corrected distance visual acuity (CDVA) and depth of focus were measured in 3.0 and 4.5 mm pupils., Results: In a 3.0 mm pupil, the CDVA achieved with -3.00 and -6.00 D pIOLs and all pIOL prototypes evaluated was above 20/20 except for a -6.00 D pIOL + spherical aberration 4 at 50% CDVA contrast, which decreased to 20/25. However, in a 4.5 mm pupil, the CDVA obtained with the pIOL prototypes decreased significantly and was more pronounced when the spherical aberration induced was negative. The depth of focus increment was larger with the highest spherical aberration added and with a small pupil. Nevertheless, it was independent of the sign of the added spherical aberration., Conclusions: The outcomes show that residual negative spherical aberration after pIOL implantation will disrupt the CDVA. However, some residual positive spherical aberration after pIOL implantation increased the depth of focus with excellent CDVA, providing a possible pIOL design for young presbyopic patients., 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 compare the optical quality under large apertures among three multifocal intraocular lenses (IOLs): the TECNIS Symfony ZXR00 (Abbott Laboratories, Abbott Park, IL), the AT LISA tri 839MP (Carl Zeiss Meditec, Jena, Germany), and the Finevision (PhysIOL, Liège, Belgium)., Methods: The in vitro optical quality of each lens was assessed with an instrument that measured the modulation transfer function (MTF). The optical quality of each lens was described in terms of MTF and through focus average MTF. The Strehl ratio, cut-off frequency, area of visibility, and percentage energy were calculated to objectively describe the optical quality of each lens. These metrics were assessed for the best lens distance focus and at four vergences (from -1.50 to -3.00 D in 0.50-D steps) at a 4.5-mm aperture., Results: The through focus average MTF of the AT LISA and Finevision IOLs showed three mean areas corresponding to distance, intermediate, and near vision. The TECNIS Symfony IOL showed two main areas corresponding to distance and intermediate vision. All metrics revealed that the Finevision IOL showed the best optical quality at distance vision, the TECNIS Symfony IOL at intermediate vision, and the AT LISA IOL at near vision. The TECNIS Symfony IOL showed the most homogeneous light distribution between its best vision foci., Conclusions: The TECNIS Symfony IOL is less vergence dependent than the AT LISA and Finevision IOLs under dim conditions. These results may help clinicians to choose the proper lens depending on the patient's visual requirements., (Copyright 2015, SLACK Incorporated.)

Purpose: To assess the effect of different disposable soft contact lenses on several corneal parameters-thickness, anterior and posterior curvature, and volume-by means of a Scheimpflug imaging-based device (Pentacam HR). Diurnal variations of these parameters were taken into account., Methods: Twenty-one young, healthy subjects wore 4 different types of daily disposable soft contact lenses on 4 different days: Dailies AquaComfort Plus, SofLens, Dailies Total1, and Acuvue TruEye. The lenses had different material and water content. Pachymetry and curvature maps and corneal volume values were obtained using the Pentacam HR twice a day: one before putting the lens on and one after an 8-hour period of contact lens wear. Measurements were also taken without any contact lenses being worn., Results: Regarding corneal thickness, the lens with the most similar behavior to the naked eye scenario was the Dailies Total1, causing a thickening of 0.2 ± 0.1% in the central zone and 0.6 ± 0.2% in the periphery. All 4 lenses caused a slight but not significant flattening in the anterior corneal curvature, whereas the posterior corneal curvature only experienced a significant but small steepening with the SofLens. The use of these lenses increased corneal volume slightly., Conclusions: Variations in corneal parameters seem to depend on the type of contact lens used (material, oxygen transmissibility, water content). However, the magnitude of the changes introduced by the use of soft contact lenses over the 8-hour period was small and probably not large enough to influence either visual acuity or comfort.

Purpose: To assess the effect of seven different daily disposable contact lenses upon corneal thickness, as well as upon tear meniscus volume, by using optical coherence tomography (OCT)., Methods: Thirty-four young healthy subjects wore seven different types of daily disposable soft contact lenses, each for a period of 12h: Delefilcon A, Nelfilcon A, Omafilcon A, Filcon II3, Narafilcon A, Etafilcon A and Hilafilcon B. Central and mid-peripheral corneal thickness and lower tear meniscus volume (TMV) were measured using an OCT device during contact-lens wear at 4-h intervals throughout a 12-h period. Measurements were also recorded without any contact lenses being worn during a day., Results: In the no-lens scenario a small but significant (p<0.05) thinning in the cornea was observed after the 12-h period. Overall, as for contact-lens wear, it was the Hilafilcon B lens that caused the greatest thickness increase in the central area, whereas the Etafilcon A caused it in the mid-peripheral cornea. Delefilcon A was the lens that showed the most similar behavior to the naked eye. As for TMV, it decreased with all the lenses, but it was the Delefilcon A lens the one that caused the smallest drop in TMV (p=0.007)., Conclusions: OCT makes it possible to evaluate both corneal thickness variations and TMV changes as a result of contact-lens wear. The changes in corneal thickness hereafter presented are not clinically significant. On the other hand, TMV drop could indicate discomfort for contact-lens users., (Copyright © 2015 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Purpose: To compare the optical quality in vitro of 2 designs of the Visian Implantable Collamer Lens phakic intraocular lens (pIOL) for different powers and optical apertures., Setting: University of Valencia, Valencia, Spain., Design: Experimental study., Methods: The Nimo TR1504 deflectometry device was used to measure the V4c pIOL, which has a smaller optic diameter, and the V5 pIOL, which has a larger optic diameter. The pIOLs were measured for -3.00 diopters (D), -6.00 D, -9.50 D, and -10.50 D at different optical apertures from 3.00 to 6.00 mm depending on the IOL power and model. The root mean square of higher-order aberrations (RMS HOAs) was analyzed. The Strehl ratio, point-spread functions (PSFs), and simulated images were calculated from wavefront aberrations., Results: There were no statistically significant differences in any Zernike RMS or RMS HOAs between the 2 pIOL models with the same power and optical aperture (P > .05). Both pIOLs had negative spherical aberration that increased with the pIOL power. Strehl ratio values showed no statistically significant differences between the pIOLs with the same power and pupil aperture. Minimal differences were seen in the PSFs and simulated images between the pIOLs., Conclusions: Both pIOLs showed good and comparable in vitro optical quality similar that of a perfect lens in that they should not affect visual performance after implantation. Patients with larger pupil diameters could benefit from the pIOL with the larger optic diameter because it showed better in vitro optical quality than the previous design with a smaller optic diameter., 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: The aim was to study the interchangeability of various devices that measure anterior chamber depth (ACD) and white-to-white (WTW) distance., Methods: Eighty right eyes of eighty patients aged 20 to 40 years were included. Their spherical equivalent ranged from -4.25 to +1.00 dioptres. Each eye's ACD and the WTW distance were measured using the following devices: a Castroviejo surgical calliper, CA-200F Corneal Analyser, Orbscan II, Pentacam HR and IOLMaster 500., Results: The Pentacam HR measured significantly greater ACD (p < 0.01) than the other two devices, whereas IOLMaster 500 and Orbscan II yielded comparable (p > 0.01) distances. Nonetheless, in every device comparison, the mean difference was within clinically acceptable limits. The device comparison showed that for WTW distance measurements IOLMaster 500 yields the greatest value (p < 0.01), whereas CA-200F Corneal Analyser yields the smallest one (p < 0.01)., Conclusion: Pentacam HR, Orbscan II and IOLMaster 500 can be used interchangeably to measure ACD, whereas Orbscan II, IOLMaster 500, Castroviejo surgical calliper and CA-200F Corneal Analyser cannot be considered interchangeable, when it comes to measuring WTW distance., (© 2015 The Authors. Clinical and Experimental Optometry © 2015 Optometry Australia.)