Every now and then, no matter where I am, when a day is particularly nice, a day sunny and warm like the summer days when I was a kid growing up in the Bronx, my memory drifts back. I often think of one day in particular. The Fourth of July when I was 8.

That day stands out because it was perfect. My family spent that entire day together from breakfast to lighting off the last of the fireworks, late into a glorious evening. As I recall that day, it unfolds into moments so perfect that only I, having been there, could possibly appreciate them.

Five decades later, I understand that what made that day so perfect was its certainty—the certainty of my parents always being there, my brother always beside me and kind neighbors who were friends. As a kid, I always had the certainty of love.

Today's headlines punctuate the perfection of that day. As certain as our lives were back in those perfect days of summer, they are as uncertain today. Earthquakes, tsunamis, radiation leaks, upheaval in the Middle East; each bring misery and uncertainty.

Even in our small eye world, upheaval resounds. Too many schools, too much debt, contentious attempts at board certification, access issues. It seems so overwhelming sometimes. Then I realize that despite it all, I am still here with you and doing well. I know the summer isn't far off and that somewhere, a kid will be spending the Fourth of July with his family and that day will be perfect.

 

Arthur B. Epstein, OD, FAAO Chief Medical Editor artepstein@optometricphysician.com

 

 

A prospective, non-randomized, clinical trial of 66 eyes of 33 hyperopic patients who underwent customized bilateral refractive surgery, which included an aspheric presbyopia treatment shape and wavefront-driven hyperopic treatment, was studied to evaluate an aspheric ablation profile to improve near vision in presbyopic patients with hyperopia and to outline the key factors of success. Surgeries were performed using the VISX STAR S4 or STAR S4 IR excimer laser system (Abbott Medical Optics). Mean preoperative refractive error was +1.77 ± 0.56 D sphere (range: 0.75 to 3.50 D) with 0.41 ± 0.34 D cylinder (range: 0.00 to 1.50 D). All patients received full distance refractive correction. No patients received monovision or were intentionally left with residual myopia. Patient satisfaction results were evaluated using a questionnaire with a 5-point scale.

A total of 60 eyes completed 6-month and 50 eyes completed 12-month postoperative follow-up. At 6 months, mean corrected distance visual acuity (CDVA) was 20/20 ± 1 line (range: 20/25 to 20/10). Mean gain in distance-corrected near visual acuity (DCNVA) was 2.7 ± 1.7 lines with a maximum of 6 lines of near. Spectacle dependence for tasks, such as reading and computer use, was reduced. At 12 months, 100% of patients had achieved binocular simultaneous uncorrected vision of 20/25 or better and J3. Refraction was stable over 12 months. Contrast sensitivity reduction was clinically insignificant. Negative spherical aberration highly correlated with postoperative improvement of DCNVA. Patients who had a larger amount of preoperative hyperopia or a greater decrease of preoperative DCNVA were more likely to have overall satisfaction.

The aspheric ablation designed to expand near functional vision was effective and stable over 12 months. The wavefront-customized hyperopic treatment significantly reduced spectacle dependence.

Selective laser trabeculoplasty (SLT) appears to be a safe and effective method to lower intraocular pressure (IOP). The exact mechanism of action for reducing IOP and inflammation levels is not known. The aim of this study was to assess inflammation after SLT treatment. Forty patients (80 eyes) were included in the study. Inclusion criteria included glaucoma (pigmentary and pseudoexfoliative glaucoma)/ocular hypertension patients treated with SLT in just one eye, both with and without eye-drops. Exclusion criteria included patients suffering from ocular or systemic inflammatory diseases treated with cortisone or immunosuppressive drugs. Inflammation was measured in two different ways: (i) clinically with a slit lamp and classified 0–4; (ii) objectively with a ‘Laser flare meter (Kowa FM 500)’. Measurements were taken before SLT, 2-hr, 1-week and 1-month after SLT treatment, both eyes were evaluated. IOP was also checked in the same way. SLT treatment was performed in 90°.

Inflammation before and after SLT showed no significant difference measured clinically with slit lamp and objectively with the laser flare meter among the groups. No inflammation or IOP reduction was found in the untreated eyes. No IOP spikes after SLT treatment were found.

Selective laser trabeculoplasty treatment seems not to induce inflammation in the anterior chamber when 90° was treated. SLT effectively and safely lowers IOP and might be considered as primary therapy.

This study evaluated the change in reading-performance parameters after implantation of the Kamra small-aperture intracorneal inlay over a 2-year follow up. Study subjects comprised naturally emmetropic presbyopic patients. Bilateral reading acuity, reading distance, reading speed, and the smallest log-scaled sentence were evaluated in a standardized testing procedure using the Salzburg Reading Desk. The minimum postoperative follow up was 24 months.

The study enrolled 32 patients. The reading desk results showed a significant improvement in each parameter tested. After a mean follow up of 24.2 months ± 0.8 (SD), the mean reading distance changed from the preoperative value of 48.1 ± 5.5 cm to 38.9 ± 6.3 cm, the mean reading acuity at best distance improved from 0.3 ± 0.14 logRAD to 0.24 ± 0.11 logRAD, and the mean reading speed increased from 142 ± 13 words per minute (wpm) to 149 ± 17 wpm. One patient lost 1 line, and 1 patient had no change. The improvement was up to 6 log-scaled lines (mean improvement 2.7 ± 1.6 lines) in the other 30 patients.

After implantation of the small-aperture intracorneal inlay, there was an improvement in all tested reading performance parameters in emmetropic presbyopic patients; the improvement was the result of an increased depth of field. These 2-year results indicate that the inlay is an effective treatment for presbyopia.