PURPOSE:To assess the incidence, clinical outcomes, and adverse event rates of intraocular lens (IOL) exchange in patients dissatisfied with presbyopia-correcting multifocal IOLs. SETTING:Private clinics, United Kingdom. DESIGN:Retrospective study. METHODS:Data of patients who underwent multifocal IOL implantation between 2007 and 2021 and required the exchange of IOLs due to quality of vision issues or insufficient near vision were reviewed. IOL exchanges for other reasons (dislocation, opacification, or other adverse events) were not included in the analysis. Visual and refractive outcomes of the lens exchange procedure were analyzed for the last available follow-up. RESULTS:The mean time from the primary procedure to the IOL exchange was 13.6 ± 8.3 months. The total IOL exchange rate was 0.63% (688 of 109 274 lenses). Of these, 637 exchanges (0.58%) were performed because of quality of vision issues, and 51 (0.05%) were exchanged primarily because of insufficient near vision (eg, IOL with lower near addition exchanged for an IOL with stronger near addition). Post-IOL exchange, 71.7% (493/688) and 91.3% (628/688) were within 0.50 diopter (D) and 1.00 D of emmetropia, respectively. The mean postexchange uncorrected distance visual acuity was 0.11 ± 0.21 logMAR (20/25 -0.5 ). The anatomical position of the secondary IOL was as follows: in-the-bag fixation 86.8% (597/688), ciliary sulcus fixation 12.5% (86/688), and alternative fixation (iris claw, scleral fixation, or IOL suturing) in 0.7% of cases (5/688). CONCLUSIONS:Patients requiring an IOL exchange due to dissatisfaction with multifocal lenses achieved favorable refractive and visual outcomes. In-the-bag implantation of secondary IOL was possible in most cases.

PURPOSE:To assess the incidence of primary opacification and analyze the outcomes of intraocular lens (IOL) exchange procedures. SETTING:Private clinics, United Kingdom. DESIGN:Retrospective study. METHODS:Electronic charts of all patients implanted with LENTIS lenses between 2010 and 2015 were reviewed, and the incidence of opacification was calculated. The data of patients who developed opacification were compared with those who did not. In eyes requiring IOL exchange due to opacification, visual and refractive outcomes of the last available postexchange visit were analyzed. The analysis was performed separately for eyes with multifocal and monofocal secondary IOLs. RESULTS:47 171 LENTIS IOLs were implanted of which 2426 (5.1%) opacified. Of the opacified lenses, 1568 (3.3% of the whole cohort) required an IOL exchange. The mean time from primary treatment to opacification diagnosis was 6.9 ± 2.2 years. Patients who developed opacification had a higher prevalence of preoperative myopia. Of all eyes requiring an IOL exchange, the secondary IOL was monofocal in 43.0% and multifocal in 57.0% of eyes. Postexchange corrected visual acuity was 0.00 ± 0.13 logMAR (20/20) in eyes with monofocal secondary IOLs and -0.02 ± 0.08 logMAR (20/20 +1 ) in eyes with multifocal secondary IOLs. The final anatomical position of the secondary IOL was as follows: in-the-bag fixation 67.9%, ciliary sulcus fixation 30.1%, iris-claw fixation 0.6%, and iris suturing or scleral fixation 1.4%. CONCLUSIONS:Exchange of opacified IOL was performed safely in most of the patients who developed opacification, including those with prior Nd:YAG capsulotomy, with good visual and refractive outcomes.

Purpose:To compare the performance of an enhanced and conventional monofocal IOL in eyes with early and intermediate age-related macular degeneration (AMD). Methods:This retrospective study compared one-month postoperative outcomes of patients bilaterally implanted with TECNIS Eyhance IOL (ICB00 group) or TECNIS Monofocal IOL (ZCB00 group). All patients underwent cataract surgery with pre-existing early or intermediate dry AMD. Outcome measures were monocular and binocular uncorrected distance (UDVA), intermediate (UIVA) and near (UNVA) visual acuity, monocular corrected distance visual acuity (CDVA), and refractive outcomes. Monocular visual acuities and refractive predictability were calculated for the dominant eye of each patient. Results:The ICB00 group comprised 143 eyes of 143 patients, while 164 eyes of 164 patients were included in the ZCB00 group. Preoperative characteristics were comparable between the two groups. There was no significant difference in postoperative refractive predictability, with 87.4% and 89.6% of eyes within 0.50 D of emmetropia in the ICB00 and ZCB00 groups, respectively (p=0.54). No difference was found in postoperative UDVA or CDVA between the groups. Both monocular and binocular UIVA were significantly better in the ICB00 group (monocular UIVA: 0.32±0.19 vs 0.42±0.22 logMAR, p<0.001; binocular UIVA: 0.25±0.18 vs 0.36±0.17 logMAR, p<0.001). Postoperative UNVA was also better with the ICB00 IOL (monocular UNVA: 0.58±0.16 vs 0.69±0.20 logMAR, p<0.001; binocular UNVA: 0.50±0.16 vs 0.63±0.17 logMAR, p<0.001). Conclusion:ICB00 IOL enhanced intermediate and near vision in patients with AMD while achieving the same level of corrected and uncorrected distance visual acuity.

Purpose:To evaluate patient-reported outcomes after implantation of a non-constant aberration-correcting monofocal IOL and explore factors affecting postoperative satisfaction with vision. Methods:This retrospective study comprised patients who underwent cataract surgery with bilateral implantation of CT LUCIA 621P IOL (Carl Zeiss Meditec AG, Jena, Germany). Factors affecting postoperative satisfaction with vision were evaluated, including patient demographics, clinical and non-clinical variables (visual acuities, adverse events, ocular comorbidities, general health, depression scores, personality types), and other patient-reported outcomes (visual phenomena, dry eye). Questionnaires were used to assess patient-reported visual outcomes, depression, and personality types. The outcomes of the last available clinical visit were evaluated. Results:A total of 97 patients were included, of whom 63.9% reported to be very satisfied and 30.9% were satisfied with postoperative vision. Only three patients were dissatisfied, and the reasons were mostly related to their postoperative clinical findings. In a multivariate logistic regression analysis, the patient's age and postoperative uncorrected visual acuity were significant predictors of postoperative satisfaction. Some non-clinical and clinical variables were signaling potential trends in satisfaction, but a larger cohort of patients would be required to explore them. Conclusion:Satisfaction of cataract patients implanted with a monofocal IOL remains high. When evaluating postoperative satisfaction, non-clinical factors and interactions with other patient-reported outcomes (visual phenomena or dry eye) should not be underestimated.

PURPOSE:To assess the effect of residual sphere on vision and satisfaction in pseudophakic patients. SETTING:Private clinics, United Kingdom. DESIGN:Retrospective case series. METHODS:A multivariate model evaluated the effect of 1-month residual sphere on outcomes of pseudophakic patients. Odds ratios (ORs) were calculated to assess the relative risk of not achieving ≥20/20 monocular uncorrected distance visual acuity (UDVA), ≥20/50 uncorrected near visual acuity (UNVA), and not being satisfied with vision. ORs were assessed for residual sphere -1.00 to +1.00 diopter (D) in quarter-diopter steps, using 0.00 D as a reference. RESULTS:The analysis included 38 828 multifocal and 11 571 monofocal intraocular lenses (IOLs). The residual myopic sphere ≤-0.25 D and hyperopic sphere ≥+0.50 D had a clinically meaningful effect on UDVA. Although monofocal IOLs had an improvement in UNVA with every additional 0.25 D of myopia, the change in ORs with increasing myopia was not significant for multifocal IOLs. The mean improvement in UNVA comparing eyes with 0.00 D and -1.00 D sphere was 0.26 logMAR for monofocal and 0.03 logMAR for multifocal IOLs. Low near-addition IOLs had a slightly higher gain in UNVA with increasing myopia, but the gain was not as substantial as with monofocal IOLs. The effect of ametropia on satisfaction was more pronounced for multifocal IOLs. For every 0.25 D of residual myopia, there was >25% increase in dissatisfied patients. CONCLUSIONS:Although myopia improved UNVA in eyes with monofocal IOL, multifocal IOLs did not benefit from residual myopia. Multifocal IOL patients desiring distance vision should be targeted closest to emmetropia, even if it means targeting slight hyperopia.

Purpose: To report our experience of performing immediate sequential bilateral cataract surgery (ISBCS) in patients with visually significant cataracts and reduced preoperative corrected distance visual acuity (CDVA). Methods: Data of patients who underwent ISBCS for visually significant cataracts and had preoperative CDVA <20/32 (<0.2 logMAR) in each eye were retrospectively reviewed. Refractive and visual outcomes were evaluated for the last available postoperative visit. Intraoperative and serious postoperative adverse events occurring within the first three months of surgery were reviewed. Results: A total of 1335 patients (2670 eyes) were included in the analysis, with a mean age of 71.9 +/- 9.5 years. On the last visit, 50.2% and 89.1% of eyes achieved uncorrected distance visual acuity (UDVA) 220/20 (0.0 logMAR) and 220/32 (0.2 logMAR), respectively. Of all eyes, 83.8% were within +/- 0.50D, and 96.4% were within +/- 1.00 D of emmetropia. Ten patients had postoperative bilateral ametropia of more than 1.00D in each eye, but eight of them still achieved binocular UDVA 220/40. Intraoperative events occurred in 14 eyes of 13 patients (per-eye incidence: 0.524% or 1 in 191 eyes). A total of 86 postoperative adverse events occurred in 80 eyes of 53 patients (per-eye incidence 2.996% or 1 in 33 eyes), of which cystoid macular edema was the most common. Only three eyes had CDVA reduced by more than two Snellen lines compared to preoperative CDVA, two of which were not related to cataract surgery. There was no patient with bilateral CDVA loss. Conclusion: In our cohort of patients with visually significant cataracts, ISBCS resulted in good refractive predictability and a low incidence of serious adverse events.

Purpose: To compare the outcomes of the Tecnis Eyhance ICB00 IOL, designed to enhance intermediate vision, to a conventional Tecnis Monofocal ZCB00 IOL. Methods: This retrospective analysis compared two cohorts of patients undergoing lens replacement surgery with bilateral implantation of the Tecnis ICB00 or the Tecnis ZCB00 IOL (383 patients in each group). Monocular and binocular uncorrected distance (UDVA), intermediate (UIVA; 66cm), and near (UNVA; 40cm) visual acuities, refractive predictability, and patient -reported outcomes were compared. A sub -analysis of patients with the Eyhance IOL was performed to compare patients who achieved bilateral emmetropia to those with mini-monovision. One -month postoperative outcomes were analyzed. Results: Both groups had comparable UDVA outcomes. On average, both monocular and binocular UIVAs were approximately one Snellen line better in patients implanted with Eyhance IOL (monocular UIVA: ICB00 0.23 +/- 0.18 logMAR, ZCB00 0.33 +/- 0.19 logMAR; binocular UIVA: ICB00 0.18 +/- 0.18 logMAR, ZCB00 0.26 +/- 0.20 logMAR, p < 0.01). Likewise, the mean UNVA was also one Snellen line better with the ICB00 model (monocular UNVA: ICB00 0.51 +/- 0.20 logMAR, ZCB00 0.61 +/- 0.18 logMAR; binocular UNVA: ICB00 0.42 +/- 0.19 logMAR, ZCB00 0.51 +/- 0.22 logMAR, p < 0.01). There was no difference between the two groups in overall satisfaction or visual phenomena. A subgroup of patients who achieved mini-monovision with Eyhance IOL had, on average, one Snellen line better UIVA and UNVA compared to patients with bilateral emmetropia. Conclusion: Patients receiving the enhanced monofocal IOL had better intermediate and near vision compared to those receiving the conventional monofocal IOL, with similar levels of patient -reported photic phenomena in both groups.

Purpose To compare refractive, visual, and patient-reported outcomes associated with a 1st generation wavefront-guided (WFG) treatment with those associated with a 3rd generation WFG treatment. Patients and Methods This retrospective study included patients who underwent femtosecond laser-assisted in situ keratomileusis (LASIK) for myopia/myopic astigmatism. Two random stratified samples of patients who underwent either 1stgeneration (WaveScan, Johnson & Johnson Vision, Santa Ana, CA) or 3rd generation (iDesign 2.0, Johnson & Johnson Vision, Santa Ana, CA) treatment matched on preoperative refraction were compared (4290 eyes of 2145 patients in each group). One-month postoperative visual, refractive, and patient-reported outcomes were analyzed. Refractive and monocular visual acuity analyses were performed using one random eye of each patient. Results The percentage of eyes achieving 20/20 or better uncorrected vision was 91.3% (1958/2145) in the 1st generation group and 95.9% (2056/2145) in the 3rd generation group (p<0.01). Binocularly, the percentage of patients with 20/20 or better UDVA was 97.0% (2080/2145) and 99.2% (2127/2145) in the 1st and 3rd generation groups, respectively (p<0.01). The mean postoperative MSE was −0.01 ± 0.33 D in the 1st generation group and +0.19 ± 0.33 D in the 3rd generation group (p<0.01). Postoperative refractive astigmatism had a mean value of −0.20 ± 0.26 D and −0.18 ± 0.24 D in the 1st and 3rd generation groups, respectively (p<0.01). The mean correction index of refractive astigmatism was 1.09 ± 0.53 in the 1st generation group and 1.02 ± 0.38 in the 3rd generation group, p<0.01. The overall percentage of patients satisfied with vision was 92.8% (1991/2145 patients) in the 1st generation group and 97.3% (2087/2145 patients) in the 3rd generation group (p<0.01). Conclusion For the majority of postoperative variables, there were significant differences between 1st and 3rd generation treatments. The 3rd generation treatments had better visual acuity outcomes and higher patient satisfaction.

Purpose: To evaluate outcomes and the incidence of adverse events (AEs) in patients who underwent bilateral same-day refractive lens exchange (RLE). Design: Retrospective case series. Participants: Patients of a private intraocular surgery provider in the United Kingdom who underwent RLE in both eyes on the same day with treatment dates between March 2018 and December 2021. Methods: Clinical outcomes and AEs were collected for a continuous cohort of patients undergoing bilateral same-day RLE (in the absence of visually significant cataracts) or hadmild cataracts (corrected visual acuity >= 20/40). One-month clinical outcomes were analyzed. Main Outcome Measures: Refractive outcomes and visual acuity, intraoperative and postoperative AEs, and secondary surgical interventions recorded within the first month after surgery. Results: A total of 17 330 patients (34 660 eyes) were included in the analysis. Of these, 28 827 eyes received a multifocal intraocular lens (IOL), and 5833 eyes had a monofocal IOL. The percentage of eyes within +/- 0.50 diopters (D) of intended refraction was 85.5% and 86.2% for monofocal and multifocal IOL eyes, respectively. There was a total of 55 intraoperative AEs recorded in 55 eyes of 54 patients (per-eye incidence: 0.159%). Posterior capsule tear was the most common intraoperative event occurring in 37 eyes (0.107%). The number of AEs recorded within the first postoperative month was 267, occurring in 263 eyes of 177 patients (per-eye incidence: 0.759%). These included cystoid macular edema (CME) (172 eyes; 0.496%), significant corneal edema (28 eyes; 0.081%), persistent inflammation (27 eyes; 0.078%), significantly raised intraocular pressure (27 eyes; 0.078%), toxic anterior segment syndrome (8 eyes; 0.023%), wound leak (3 eyes; 0.009%), retinal detachment (1 eye; 0.003%), and retinal tear (1 eye; 0.003%). There were 56 secondary surgical interventions recorded within the first month of surgery, occurring in 54 eyes of 47 patients (per-eye incidence: 0.156%). The most common secondary intervention was the rotation of a misaligned toric IOL (24 eyes; 0.069%). Conclusions: Elective same-day bilateral RLE had a low incidence of serious AEs, and high refractive predictability.

Purpose:To evaluate early clinical outcomes and adverse events (AEs) in cataract patients following implantation of a monofocal hydrophobic acrylic IOL with a new optimized non-constant aberration-correcting design (CT LUCIA 621P).Methods:This retrospective study included patients with visually significant cataracts who underwent implantation of the CT LUCIA 621P IOL. Refraction, corrected (CDVA) and uncorrected (UDVA) visual acuity of the last available visit were used in the analysis. Intraoperative and postoperative AEs of the cohort were reviewed.Results:A total of 191 eyes of 133 patients with the mean age of 70.2±11.2 years were included in this study. The mean follow-up time of the last available visit was 1.7±1.3 months. The mean postoperative monocular UDVA was 0.09±0.16 logMAR (≈20/25), and 74.9% (143/191) eyes achieved ≥20/25 UDVA. The percentage of eyes with manifest spherical equivalent (MSE) within ±0.50D and ±1.00D of emmetropia was 84.8% (162/191) and 98.4% (188/191), respectively. Linear regression of attempted vs achieved MSE showed a tight relationship, with the coefficient of determination close to 1 (R2=0.99), indicating a very predictable refractive correction. The reported AEs were those typically expected after cataract surgery. There were no AEs related to intraoperative manipulation with the IOL/injector or to postoperative stability of the IOL in the capsular bag. No eye lost ≥2 lines of CDVA.Conclusion:The implantation of CT LUCIA 621P resulted in good refractive predictability and visual outcomes. No IOL-related adverse events were reported.

Purpose:To evaluate clinical and subjective outcomes of a segmented bifocal IOL with a 2.0 D near addition. Patients and Methods:Retrospective analyses of patients who had undergone refractive lens exchange with bilateral implantation of the SBL-2 IOL (Lenstec, Inc., Christ Church, Barbados) were performed. The number of patients included in the study was 389 (778 eyes). Refractive, visual and patient-reported outcomes were presented for the last available visit (mean follow-up 2.05 ± 1.33 months). Results:The percentage of eyes within ±0.50D and ±1.00D of emmetropia was 82.5% (642/778) and 97.8% (761/778), respectively. The mean uncorrected intermediate visual acuity (66 cm) of the last available visit was 0.08 ± 0.15 logMAR monocularly and 0.04 ± 0.14 logMAR binocularly. The mean monocular and binocular uncorrected near visual acuity (40 cm) were 0.30 ± 0.15 logMAR and 0.24 ± 0.14 logMAR, respectively. Of all patients, 97.2% (378/389) claimed never to use any correction for distance vision, while 93.1% (362/389) of patients did not require any correction for near vision. The mean scores for visual phenomena (on the scale from 1 - no difficulty to 7 - severe difficulty) were 1.8 ± 1.3, 1.7 ± 1.2, 1.7 ± 1.2 and 1.6 ± 1.2 for glare, halo, starburst, and ghosting/double vision, respectively. Conclusion:Despite the lower near addition of SBL-2 segmented bifocal IOL, patients achieved reasonable rates of spectacle independence and a low incidence of visual phenomena.

PURPOSE:To evaluate clinical outcomes 1 year after implantation of an extended depth of focus intraocular lens (IOL) in a large series of patients. METHODS:Outcomes of patients who underwent refractive lens exchange or cataract surgery with the implantation of the AT LARA 829MP IOL (Carl Zeiss Meditec AG) were retrospectively reviewed. The near (40 cm), intermediate (66 cm), and distance visual acuity, refractive outcomes, and cumulative rate of adverse events and secondary procedures were evaluated at 12 months postoperatively. RESULTS:A total of 1,894 eyes of 977 patients were implanted with the AT LARA 829MP IOL, with 62.1% of eyes available for the 12-month visit. The overall secondary procedure rate for the whole cohort was: Nd:YAG = 7.8%, laser vision correction = 7.5%, and IOL explantation = 0.63%. The reasons for IOL exchange were intraoperative complications (3 eyes/0.16%) and quality of vision issues (9 eyes/0.48%). Of all eyes available for the 12-month visit that did not undergo laser vision correction or an IOL exchange, 72.0% had monocular uncorrected distance visual acuity of 20/20 or better and the percentage of eyes with monocular uncorrected intermediate and near visual acuity of 20/50 or better was 96.2% and 81.0%, respectively. At 12 months postoperatively, 87.6% of eyes were within ±0.50 diopters of emmetropia. No change in refraction occurred between the 6- and 12-month postoperative visits. CONCLUSIONS:The AT LARA 829MP extended depth of focus IOL is able to provide functional distance, intermediate, and near visual acuity. Complications related to the platform of the IOL were uncommon. [J Refract Surg. 2021;37(6):380-388.].

Purpose: To describe our technique of sub-Tenon's anesthesia and report adverse events and patient comfort. Setting: Optical Express, United Kingdom. Design: Retrospective case series. Methods: The outcomes of 35,850 intraocular procedures (phacoemulsification and implantation of an intraocular lens) were retrospectively reviewed and the incidence of adverse events related to sub-Tenon's anesthesia was calculated. On the first postoperative day, patients were asked to complete a questionnaire enquiring about their comfort during and after the procedure. The anesthetic solution consisted of a combination of Lidocaine and Hyaluronidase, which was administered into sub-Tenon's space with a single-use sterile polyurethane 22G x 1 '' (0.9 x 25 mm) cannula. Mild conscious sedation (midazolam) was used during anesthetic and surgical procedure. Results: No significant adverse events that would affect the posterior segment of the eye or result in vision loss were recorded. Subconjunctival haemorrhage related to sub-Tenon's anesthesia was noted in 4.3% of eyes. Five minutes after the administration of sub-Tenon's block, 80.6% of eyes had no chemosis, 14.8% had chemosis that affected only 1 quadrant of the eye and 4.5% of eyes had chemosis affecting 2 or more quadrants of the eye. Other adverse events included 14 cases of cyst/granuloma formation in the area of sub-Tenon's incision and 7 eyes required suturing of the conjunctival cut. Of all patients, 93.2% experienced no or only mild discomfort during or after surgical procedure. Conclusion: Sub-Tenon's anesthesia with the use of a flexible cannula is a safe option for ophthalmic anesthesia. No sight-threatening adverse events occurred.

PURPOSE:To identify independent factors associated with postoperative satisfaction after refractive lens exchange with an extended depth of focus intraocular lens (EDOF IOL).METHODS:Patients who underwent a refractive lens exchange with bilateral implantation of the AT LARA 829MP IOL (Carl Zeiss Meditec, Jena, Germany) and attended the 3-month follow-up visit were included in the analysis (N = 351 patients). Demographics, preoperative and postoperative clinical parameters, and patient-reported outcomes were used in a regression model to determine predictors of 3-month postoperative satisfaction.RESULTS:The mean age of the study group was 58.2 ± 7.0 years (range: 45 to 79 years) and the mean preoperative sphere ranged between -12.50 and +6.75 diopters (D). At 3 months postoperatively, 86.6% of patients were very satisfied or satisfied with outcomes and 93.2% would recommend the procedure to their family or friends. Of all patients, 90.6% achieved binocular uncorrected distance visual acuity of 20/20 or better, 92.0% achieved binocular near vision of 20/50 or better, and 85.5% of eyes were within ±0.50 D of emmetropia. Logistic regression identified postoperative dry eye symptoms, binocular near and distance visual acuity, and glare symptoms as significant independent factors affecting patient satisfaction.CONCLUSIONS:Several factors were independently predictive of postoperative satisfaction after EDOF IOL implantation and addressing these may further improve patient satisfaction with the procedure, specifically, proper management of early symptoms of dry eye, ensuring good refractive predictability to maximize unaided vision, and counseling patients about the possibility of visual phenomena in the early postoperative period. [J Refract Surg. 2020;36(3):175-184.].

PURPOSE: To evaluate clinical and patient-reported outcomes of a new extended depth of focus intraocular lens (IOL). METHODS: Data of patients treated between September 2017 and September 2018 who underwent a refractive lens exchange/cataract surgery with an implantation of the AT LARA 829MP IOL (Carl Zeiss Meditec AG, Jena, Germany) and attended the 1-week, 1-month, and 3-month follow-up visit were reviewed. RESULTS: At 3 months, the percentage of eyes within ±0.50 diopters (D) of emmetropia was 86.7%. The mean binocular uncorrected distance visual acuity was −0.05 ± 0.09 logMAR and the mean binocular unaided near vision was 0.26 ± 0.14 logMAR. Of all patients, 90.3% were satisfied with their vision. The percentage of patients spectacle-free for near and distance vision was 83.6% and 95.4%, respectively. On a scale from 1 (no difficulty) to 7 (severe difficulty), there was an average 1.2 to 1.4 units increase in glare, halo, and starburst between the preoperative and 1-month visit, and a decrease of 0.2 to 0.3 units between the 1- and 3-month visit. CONCLUSIONS: The new extended depth of focus IOL provided reasonable unaided near and distance vision, as well as spectacle independence and patient satisfaction. Some optical side effects were reported in the early postoperative period. [ J Refract Surg. 2019;35(7):426–433.]

PURPOSE:To evaluate the incidence of adverse events (AEs) in patients who underwent refractive lens exchange. DESIGN:Retrospective case series. METHODS:Setting: Private refractive surgery clinics. Patients/Study Population: Patients who underwent refractive lens exchange between July 1, 2014, and June 30, 2016. Intervention/Observation Procedures: All AEs recorded in the electronic medical record were extracted and retrospectively reviewed. The total incidence of AEs and serious AEs was calculated. Loss of 2 or more lines of corrected distance visual acuity (CDVA) was calculated for the entire cohort of patients that attended a minimum of 3 months follow-up. MAIN OUTCOME MEASURES:AEs. RESULTS:The total number of patients included was 10,206 (18,689 eyes). A multifocal intraocular lens (IOL) was implanted in 84.3% of eyes; 15.7% of eyes received a monofocal IOL. A total of 1164 AEs were recorded (1112 eyes of 1039 patients, incidence 6.0% of eyes, 1:17 eyes). The most common AE was posterior capsular opacification (PCO; 748 eyes, incidence 4.0%). Of all AEs, 171 events (occurring in 165 eyes of 151 patients, incidence 0.9%, 1:113 eyes) were classified as serious, potentially sight threatening. Loss of 2 or more lines of CDVA was 0.56% when excluding eyes where the loss of CDVA was due to PCO; the majority of these were due to macular causes. CONCLUSION:The incidence of sight-threatening AEs and significant loss of CDVA in elective refractive lens exchange surgery was low. Other than PCO, postoperative macular issues were the most common cause of vision loss in this cohort.

PURPOSE: To evaluate the incidence of adverse events (AE) following laser vision correction. DESIGN: Retrospective case series. METHODS: Optical Express, UK. PATIENTS/STUDY POPULATION: patients who underwent laser in situ keratomileusis (LASIK) or photorefractive keratectomy (PRK) between July 1, 2014, and June 30, 2016. INTERVENTION/OBSERVATION PROCEDURES: all AEs recorded in the electronic medical record were extracted and retrospectively reviewed. The total incidence of AE and serious adverse events (SAE) was calculated. Loss of 2 or more lines of corrected distance visual acuity (CDVA) was calculated for the entire cohort of patients that attended a minimum of 3 months follow-up. MAIN OUTCOME MEASURES: AEs; Preoperative and last available postoperative clinical data. RESULTS: A total of 31,921 (61,833 eyes) were included in the study for LASIK and 5,016 (9,467 eyes) for PRK. The total number of AE was 850 for LASIK (occurring in 783 eyes of 657 patients; incidence of 1.3% or 1:79 eyes) and 227 for PRK (occurring in 218 eyes of 170 patients; incidence of 2.3% or 1:43 eyes). In the LASIK group, there were 287 SAEs (271 eyes of 226 patients; incidence of 0.4% or 1:228 eyes), and the number of SAEs in PRK group was 65 (65 eyes of 39 patients; incidence 0.7% or 1:146 eyes). Combining LA-SIK and PRK data, the loss of 2 or more lines of CDVA was recorded in 0.37% of eyes. CONCLUSIONS: Contemporary LASIK and PRK are safe procedures with a low incidence of serious adverse events. (C) 2019 Elsevier Inc. All rights reserved.

PURPOSE:To compare refractive and visual outcomes, patient satisfaction, and complication rates among different age categories of patients who underwent refractive lens exchange (RLE).METHODS:A stratified, simple random sample of patients matched on preoperative sphere and cylinder was selected for four age categories: 45-49 years (group A), 50-54 years (group B), 55-59 years (group C), and 60-65 years (group D). Each group contained 320 patients. All patients underwent RLE with a multifocal intraocular lens at least in one eye. Three months postoperative refractive/visual and patient-reported outcomes are presented.RESULTS:The percentage of patients that achieved binocular uncorrected distance visual acuity 20/20 or better was 91.6% (group A), 93.8% (group B), 91.6% (group C), 88.8% (group D), P=0.16. Binocularly, 80.0% of patients in group A, 84.7% in group B, 78.9% in group C, and 77.8% in group D achieved 20/30 or better uncorrected near visual acuity (P=0.13). The proportion of eyes within 0.50 D of emmetropia was 84.4% in group A, 86.8% in group B, 85.7% in group C, and 85.8% in group D (P=0.67). There was no statistically significant difference in postoperative satisfaction, visual phenomena, dry eye symptoms, distance or near vision activities. Apart from higher rate of iritis in the age group 50-55 years, there was no statistically significant difference in postoperative complication rates.CONCLUSION:RLE can be safely performed in younger as well as older presbyopes. No significant difference was found in clinical or patient-reported outcomes.

PURPOSE:To compare clinical and quality of life outcomes between patients who underwent monovision LASIK and refractive lens exchange.METHODS:The study comprised 590 patients with refractive lens exchange and 608 patients with monovision LASIK available for 3-month postoperative clinical visits. All patients with refractive lens exchange had a Tecnis Symfony lens (Johnson & Johnson Vision Care, Inc., Santa Ana, CA) in at least one eye. Patients were divided into four refractive categories: moderate to high myopia, low myopia, plano presbyopia, and hyperopia. Three-month postoperative data were compared between monovision LASIK and refractive lens exchange for each group.RESULTS:Postoperatively, the percentage of patients with binocular uncorrected distance visual acuity of 20/20 or better, for monovision LASIK and refractive lens exchange, respectively, was as follows: moderate to high myopia: 84.7% vs 90.7% (P = .31), low myopia: 89.4% vs 85.2% (P = .45), plano presbyopia: 90.5% vs 89.9% (P = .90), and hyperopia: 77.5% vs 84.2% (P = .03). For near vision, the percentage with binocular near visual acuity of 20/40 or better (J5) at 40 cm was as follows: moderate to high myopia: 98.9% vs 90.7% (P < .01), low myopia: 100% vs 98.1% (P = .17), plano presbyopia: 96.8% vs 95.8% (P = .34), and hyperopia: 95.6% vs 95.7% (P = .96). There was a statistically significant difference in patient satisfaction in favor of monovision LASIK for moderate to high myopia (94.3% for monovision LASIK vs 79.1% for refractive lens exchange, P <.01). For all other refractive categories, there was no significant difference in patient satisfaction. All myopic patients with refractive lens exchange experienced more postoperative visual phenomena than patients with monovision LASIK. The plano presbyopia group had comparable visual phenomena between the two procedures.CONCLUSIONS:Monovision LASIK and refractive lens exchange are both reasonable options for presbyopic patients. [J Refract Surg. 2017;33(11):749-758.].

PURPOSE: To assess vision-related, quality-of-life outcomes 5 years after laser in situ keratomileusis (LASIK) and determine factors predictive of patient satisfaction.SETTING: Optical Express, Glasgow, Scotland.DESIGN: Retrospective case series.METHODS: Data from patients who had attended a clinical examination 5 years after LASIK were analyzed. All treatments were performed using the Visx Star S4 IR excimer laser. Patient reported satisfaction, the effect of eyesight on various activities, visual phenomena, and ocular discomfort were evaluated 5 years postoperatively. Multivariate regression analysis was performed to determine factors affecting patient satisfaction.RESULTS: The study comprised 2530 patients (4937 eyes) who had LASIK. The mean age at the time of surgery was 42.4 years +/- 12.5 (SD), and the preoperative manifest spherical equivalent ranged from -11.0 diopters (D) to +4.88 D. Five years postoperatively, 79.3% of eyes were within +/- 0.50 D of emmetropia and 77.7% of eyes achieved monocular uncorrected distance visual acuity (UDVA) and 90.6% of eyes achieved binocular UDVA of 20/20 or better. Of the patients, 91.0% said they were satisfied with their vision and 94.9% did not wear distance correction. Less than 2.0% of patients noticed visual phenomena, even with spectacle correction. Major predictors of patient satisfaction 5 years postoperatively were postoperative binocular UDVA (37.6% variance explained by regression model), visual phenomena (relative contribution of 15.0%), preoperative and postoperative sphere and their interactions (11.6%), and eyesight-related difficulties with various activities such as night driving, outdoor activities, and reading (10.2%).CONCLUSION: Patient-reported quality-of-life and satisfaction rates remained high 5 years after LASIK. Uncorrected vision was the strongest predictor of satisfaction. (C) 2016 ASCRS and ESCRS