Purpose To evaluate the effectiveness, predictability, safety, and stability of LASIK for hyperopia. Methods A literature search of the PubMed database was last conducted in August 2025. The search yielded 198 articles that were reviewed in abstract form, 88 of which were selected for full-text review. Twenty studies (containing a total of 25 different cohorts) met the criteria for inclusion in this assessment. The panel methodologists assigned a level of evidence rating to each study. Results Two studies were rated level I, 6 studies were rated level II, and 12 studies were rated level III. Of the 18 cohorts for which effectiveness data were presented, at least 80% of eyes achieved an uncorrected distance visual acuity (UCDVA) of 20/40 or better, and in 16 of 18 cohorts, at least 50% of eyes achieved a UCDVA of 20/20 or better. Among the cohorts reporting predictability outcomes, 16 of 19 achieved more than 60% of eyes within ±0.50 diopter (D) of the intended correction. Likewise, 16 of 21 cohorts reported more than 90% of eyes within ±1.00 D of target, and all cohorts reached at least 80% within this range. Of the 23 cohorts for which safety data were presented, 19 cohorts contained no more than 3% and 15 cohorts contained no more than 1% of eyes losing 2 lines or more of Snellen corrected distance visual acuity (CDVA). The safety index (ratio of postoperative CDVA to preoperative CDVA) ranged from 0.97 to 1.05. In the cohorts in which refractive stability between 3 and 6 months was analyzed, the average spherical equivalent variation was 0.05 D (maximum, 0.3 D). Worse stability outcomes were associated with higher hyperopia treatments, slower pulse rates (< 500 Hz), older laser models, and smaller optical zones (≤ 6 mm). Conclusions LASIK for hyperopia performed using the current excimer laser models (characterized by faster pulse rates, larger optical zones, and updated ablation profiles) seems to have relatively high rates of effectiveness, predictability, safety, and stability. Financial Disclosure(s) Proprietary or commercial disclosure may be found after the references in the Footnotes and Disclosures at the end of this article.

The aim of this study is to compare the refractive outcomes in a large cohort with preoperative corneal astigmatism who underwent cataract surgery with toric intraocular lens (IOL) implantation assisted (study group) or no (control group) with an intraoperative image-guided cataract planning system (Callisto, Carl Zeiss Meditec, Jena, Germany). In this retrospective comparative database study, mean and centroid postoperative cylinder, mean absolute error (MAE) and the proportion of eyes with a prediction error (PE) within ± 0.25 D, ± 0.50 D and ± 1.00 D (both in cylinder and spherical equivalent (SE)) were compared between both groups. These endpoints were also compared depending on the type of preoperative astigmatism, i.e. against the rule (ATR), oblique or with-the-rule (WTR) astigmatism. In total, 31,176 cases were analyzed in this study. Mean (± standard deviation (SD)) postoperative cylinder was found to be significantly lower in the study group (0.419 ± 0.432 D) compared with the control group (0.443 ± 0.453 D, p < 0.001). This statistical difference was observed in eyes with ATR and oblique astigmatism when looking at subgroups. Postoperative centroid cylinder (mean @angle ± SD) was 0.042 @97° ± 0.600 D in the study group and 0.043 @100° ± 0.633 D in the control group. MAE in cylinder was significantly lower in the study group compared to the control group. A slight but significantly higher percentages (up to 3

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 report the outcomes of the Light Adjustable Lens (LAL) collected from a clinical registry. SETTING:Multiple private practices in the United States. DESIGN:Multi-center prospective observational study. METHODS:Patients who underwent bilateral LAL implantation and who had best-corrected distance visual acuity (CDVA) ≥ 20/20-2 before lens adjustment were enrolled. Assessment was performed at one visit 1-3 months after final lock-in treatment. RESULTS:A total of 1101 participants (2202 eyes) were included. Of these, 586 eyes had prior corneal refractive surgery (CRS) and 1616 had no prior CRS (No CRS). 12.3% of participants were targeted for bilateral emmetropia, 9.3% for bilateral near and 78.4% for blended vision. Of eyes targeted for emmetropia, 81.2% achieved a UDVA of >20/20 (82.2% of No CRS and 78.4% of CRS). A total of 94.3% of eyes targeted for emmetropia had a MSE of <0.5D (94.7% of No CRS, 92.8% of CRS). The mean prediction error in MSE was -0.048 ± 0.366D in No CRS and -0.016 ± 0.441D in CRS. A total of 89% of patients with blended vision and 93% of patients with bilateral emmetropic target had binocular UCVA of >20/20. In the CRS, group 87% with blended vision and 87% with binocular emmetropia achieved binocular UCVA of >20/20. Binocular UNVA of >J1 was achieved with blended vision in 85% of patients in the No CRS group and 82% of patients in the CRS group. CONCLUSIONS:In this multi-center study, patients achieved a high degree of precision with the LAL regardless of prior corneal refractive surgery.

A man aged 74 years presented with painless blurry vision in the right eye. Examination revealed a granular white opacity and prominent blood vessels in the corneal stroma, with no epithelial defect and no further findings on anterior or posterior examination. Limited workup was positive for herpes simplex virus 1 and 2 immunoglobulin G. The patient was given topical corticosteroids and oral valaciclovir, but the corneal opacity persisted. What would you do next?

Purpose: To evaluate the published literature to compare intraoperative aberrometry (IA) with preoperative biometry-based formulas with respect to intraocular lens (IOL) power calculation accuracy for various clinical scenarios. Methods: Literature searches in the PubMed database conducted in August 2022, July 2023, and February 2024 identified 157, 18, and 6 citations, respectively. These were reviewed in abstract form, and 61 articles were selected for full-text review. Of these, 29 met the criteria for inclusion in this assessment. The panel methodologists assigned a level of evidence rating to each of the articles; 4 were rated level I, 19 were rated level II, and 6 were rated level III. Results: Intraoperative aberrometry performed better than traditional vergence formulas, including the Haigis, HofferQ, Holladay, and SRK/T, and similarly to the Barrett Universal II and Hill-RBF with respect to minimization of spherical equivalent (SE) refractive error. For toric IOLs, IA outperformed formulas that only considered anterior corneal astigmatism and was similar to formulas like the Barrett Toric Calculator (BTC), which empirically account for the contribution from the posterior cornea. In eyes with a history of corneal refractive surgery, IA performed similarly to the Barrett True-K and slightly better than other tested methods, including the Haigis-L, Shammas, and Wang-Koch-Maloney formulas. Conclusions: Intraoperative aberrometry corresponds well with modern vergence formulas, including the Barrett Universal II, Hill-RBF, BTC, and Barrett True-K. It has greater accuracy than traditional vergence-based IOL power calculation formulas in eyes with and without a history of corneal refractive surgery.

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 compare the methods of corneal astigmatism management during intraocular surgery in eyes with low corneal astigmatism. DESIGN:Retrospective study. PARTICIPANTS:Patients undergoing cataract or refractive lens exchange surgery with data recorded in a cloud-based surgical planner (Veracity; Zeiss) with preoperative corneal astigmatism of between 0.75 and 1.50 diopters (D). METHODS:Eyes were divided into 3 groups: eyes with implantation of a toric intraocular lens (IOL; the toric group), eyes with nontoric IOLs that underwent limbal relaxing incisions (LRIs) or astigmatic keratotomy (AK; the LRI or AK group), and the uncorrected group, which comprised eyes with nontoric IOLs that did not receive any intentional corneal astigmatism correction. Data were stratified further according to the magnitude of preoperative corneal astigmatism into 3 categories: 0.75 D or more to less than 1.00 D, 1.00 D or more to less than 1.25 D, and 1.25 D or more to 1.50 D or less. A multivariable model was used to assess the effect of the procedure type on outcomes. MAIN OUTCOME MEASURES:Percentage of eyes achieving 0.50 D or less residual manifest astigmatism and odds ratios for the likelihood of not achieving 0.50 D or less manifest astigmatism. RESULTS:The study included 40 289 eyes (toric group, 10 100 eyes; LRI or AK group, 5811 eyes; uncorrected group, 24 378 eyes). In the group of eyes with preoperative astigmatism of 0.75 D or more to less than 1.00 D, compared with toric IOLs, the odds of not achieving 0.50 D or less manifest astigmatism increased 2.83-fold in the LRK or AK group and 5.72-fold in the uncorrected group. For corneal astigmatism of 1.00 D or more to less than 1.25 D, the odds increased 3.9-fold with LRI or AK and 7.64-fold in eyes with uncorrected astigmatism. In the eyes with 1.25 D or more to 1.50 D or less of corneal astigmatism, the odds increased 4.70-fold and 10.27-fold for the LRI or AK group and uncorrected group, respectively. The presence of against-the-rule astigmatism considerably increased the odds of not achieving 0.50 D or less manifest astigmatism, mainly in the eyes with uncorrected astigmatism. CONCLUSIONS:The toric IOL group showed the most accurate and consistent astigmatism correction, regardless of the magnitude of preoperative corneal astigmatism or axis orientation. FINANCIAL DISCLOSURE(S):Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Purpose To describe an alternate surgical technique for fluocinolone acetonide (Retisert) implantation in patients with extensive pars plana and pars plicata fibrosis secondary to chronic non-infectious uveitis. Methods This retrospective, interventional case series included five eyes of four patients who had poorly controlled chronic non-infectious uveitis. Retisert was implanted successfully using a novel approach. The device was introduced into the posterior segment through the anterior chamber and posterior capsulotomy, forgoing the need for full-thickness scleral incision and minimizing the risk of retinal detachment and associated complications. Results Five eyes underwent passage of Retisert implant through the anterior segment via a limbal incision and a posterior capsulotomy. Retisert was successfully implanted in all patients in the posterior chamber. No intraoperative or postoperative complications were encountered. Up until the last follow-up, all eyes demonstrated the stability of the implant. Visual acuity improved in four out of five eyes. Conclusions Retisert can be implanted via the anterior chamber in patients with extensive fibrosis in the pars plana and pars plicata regions. This approach may minimize the risk of retinal traction and damage to the implant when compared to the traditional full-thickness sclerotomy method in these high-risk cases.

Purpose: To report five cases of ocular scedosporiosis with associated predisposing factors, treatment courses, and clinical outcomes. Observation: This case series consists of 5 patients diagnosed with ocular scedosporiosis. Two patients were female and 3 were male. The average age was 68.4 years (range 53–85). Four of the 5 had a clear history of ocular surgery or ocular trauma with organic foreign material. Two developed sclero-keratitis. Two had cornea-only involvement. There was 1 scleritis-only case. Patients with scleritis required topical and systemic treatment. Patients with only keratitis were treated topically. The two patients with sclero-keratitis ultimately progressed to eye removal despite maximal therapy. Conclusion and importance: Ocular scedosporiosis is exceedingly rare, especially in the Unites States. We highlight similarities and differences of five ocular scedosporiosis cases. Most cases involved either ocular surgery or contamination with ground or plant matter. This case series highlights the challenge of the diagnosis and the aggressivity of this disease.

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.

Blepharitis is a common ophthalmic condition with multiple etiologies and no definitive, universal treatment. The treatment modalities for managing lid margin diseases vary depending on the disease's cause, location, and severity. For anterior blepharitis, management options include eyelid hygiene with warm compresses, eyelid scrubs, baby shampoo, and over-the-counter eyelid cleansers. Topical antibiotics and antibiotic-steroid combination drops/ointments for the eye and eyelid may accompany these. For posterior blepharitis/meibomian gland dysfunction (MGD), at-home warm compress or in-office administration of heat therapy/thermal pulsation treatment that aims to clear obstruction in the meibomian glands and restore meibum secretions to maintain a healthy tear film is recommended. In addition to the above treatment strategies, various other compounds to manage lid margin diseases are in the late stages of development. This review summarizes the available treatment modalities or those in the pipeline for treating blepharitis and MGD.

The eyelid margin is vital to ocular surface integrity. Much peer-reviewed literature has been established in eyelid margin inflammation, better known as blepharitis. The purpose was to review and understand the impact of eyelid margin disease. Anterior blepharitis causes inflammation at the eyelash base, ciliary follicles, and the palpebral skin. Posterior blepharitis occurs when there is inflammation with the posterior eyelid margin disease. In common usage, the term "blepharitis" used alone almost always refers to anterior blepharitis. Classification of eyelid margin disease should be based on etiopathogenesis, location, primary vs secondary, and chronicity. Blepharitis has several etiopathologies (infectious, inflammatory, and squamous). Meibomian gland dysfunction (MGD) can refer to the functional and/or structural problems with the meibomian gland. Meibomitis (or meibomianitis) occurs when there is inflammation associated with the MGD. The presence of blepharitis and/or MGD (with or without inflammation) can affect the ocular surface and thereby affect anterior segment and cataract surgeries. This review article evaluates the differential diagnoses of eyelid margin disease, including various forms of blepharitis, MGD, and meibomitis.

Background Incorporation of the rapid advances in ophthalmologic surgical and diagnostic techniques inherent in the field poses a challenge to residency training programs. This study investigates exposure to new technologies during residency and perception of its impact on practice patterns.Methods Ophthalmology residents at various training levels and practicing ophthalmologists who had completed their training were invited to participate in a survey study assessing exposure to various technologies in residency and in practice. Data collection occurred from December 2022 to June 2023. Descriptive statistics were performed.Results The study received 132 unique responses, including 63 ophthalmology residents and 69 practicing ophthalmologists. 65.2% (n = 45) of practicing ophthalmologists and 47.6% (n = 30) of current residents reported discussion/training on newly developed products on the market (e.g. premium IOLS, MIGS), was "minimally discussed but not emphasized" or "not discussed at all" in residency. 55.1% (n = 38) of practicing ophthalmologists reported that exposure to new technologies during residency did influence types of technologies employed during practice. The majority resident physicians reported enjoying being trained on newer technology and feeling more prepared for future changes in the field (95.2%, n = 60) and felt that having industry partnerships in residency enhances education and training (90.5%, n = 57).Conclusions Considering how to maximize exposure to newer technologies/devices during residency training is important, and may contribute to training more confident, adaptable surgeons, who are more likely to critically consider new technologies and adopt promising ones into their future clinical practice.

Purpose:To report a case of Light Adjustable Lens™ (LAL, RxSight, Aliso Viejo, CA) implantation in a patient with bilateral 50-cut radial keratotomy (RK) and discuss related preoperative, intraoperative, and postoperative considerations. Methods:A 78-year-old patient with history of bilateral 50-cut RK underwent phacoemulsification with implantation of LALs in both eyes one month apart. Although LAL technology was not approved specifically for addressing limitations in intraocular lens calculation post-RK due to corneal topography irregularity, the patient opted for this lens due to its ability to make post-operative adjustments to its refractive power. At postoperative month one following the second eye surgery, YAG capsulotomy was performed in both eyes. At postoperative month two following the second eye surgery, the patient began LAL adjustments spaced 1-2 weeks apart for a total of 2 LAL adjustments and 2 lock-in sessions. Results:Our patient achieved a final refraction of -0.25 +0.25 × 110 with an UDVA of 20/20-2 in the right eye and -0.25 +0.50 × 135 with an UDVA 20/25-1 in the left eye. Conclusions:The LAL may be a promising option for patients undergoing cataract surgery after RK, although further studies are needed to understand long-term changes in eyes with RK and the inability of LAL to address all aspects of corneal aberration.