搜索结果：Journal of cataract and refractive surgery

To evaluate spectacle independence in healthy individuals and cataract patients with different types of intraocular lenses (IOLs) and refractive targets using a Dutch translation of The Patient-Reported Spectacle Independence Questionnaire (PRSIQ). The PRSIQ is a patient-reported outcome measure that assesses patient need for, wearing of, and functioning without spectacles for distance, intermediate, and near vision. Amphia Hospital, Breda, the Netherlands. Prospective, observational, cross-sectional, single-center study. The English questionnaire was translated to Dutch following the ISPOR guidelines. 361 participants across various groups were included: healthy individuals aged younger than and older than 50 years and cataract patients with bilateral implantation of monofocal, enhanced monofocal, toric monofocal, monofocal with a myopic target, extended depth-of-focus (EDOF), or trifocal IOLs. Dichotomous scoring showed significantly different rates of complete spectacle independence: 28 of 49 (57%) for trifocals, 8 of 47 (17%) for EDOFs, 2 of 44 (5%) for monofocals, 1 of 50 (2%) for enhanced monofocals, 0 of 25 (0%) for toric monofocals, 1 of 46 (2%) for myopic targets, and 10 of 50 (20%) and 1 of 50 (2%) for healthy participants younger than and older than 50 years. Participants with minimal refractive errors reported complete spectacle independence in 20 of 28 (71%) with trifocals and 5 of 21 (24%) with EDOF IOLs. Rasch analysis showed that the questionnaire was multidimensional and thus failed to support interval scaling. The Dutch PRSIQ-NL demonstrated significant differences in self-reported complete spectacle independence across IOL types and refractive targets using dichotomous scoring. Rasch analysis showed PRSIQ-NL cannot be used for interval-scaled measurements. The PRSIQ-NL is valuable for clinical and research applications to evaluate spectacle independence using dichotomous scoring.

To evaluate clinical performance and visual outcomes of the Acunex Vario AN6V in comparison to the monofocal version, the Acunex AN6. Hanusch Hospital Vienna, Department of Ophthalmology. Prospective, randomized, monocenter trial. Patients undergoing bilateral cataract surgery were randomized to receive extended depth of field IOL, the Acunex Vario AN6V (EDF group) or the monofocal IOL Acunex AN6 (monofocal group; both Teleon Surgical B.V., Germany). Primary outcome was spectacle independence six months after surgery. Further, uncorrected and distance corrected distance, intermediate and near visual acuity, stereo vision, defocus curves and rate of photopic phenomena were assessed. A total of 50 patients were included in the study, of whom 42 completed the two months and 35 the six months visit. Two months after the procedure, a significantly higher proportion of patients in the EDF were spectacle-free during near tasks than in the monofocal group (37.5% vs. 5.3%). Uncorrected and distance-corrected intermediate (UIVA and DCIVA) as well as near (UNVA and DCNVA) visual acuities were significantly better in the EDF group (UIVA: 0.09±0.12 vs. 0.16±0.07; p=0.035; DCIVA: 0.12±0.10 vs.0.16±0.08; p=0.03; UIVA: 0.24±0.12 vs. 0.37±0.11; p=0.001; DCNVA: 0.24±0.12 vs 0.37±0.11; p=0.001) Furthermore, the EDF group had a larger range of defocus. Stereo vision and the occurrence of photopic phenomena were comparable between both groups. In comparison with the monofocal version, the EDF IOL AN6V demonstrated greater spectacle independence and significant enhancement in both intermediate and near visual acuity. Notably, the incidence, severity, and degree of perceived dysphotopsia were similar in both groups.

To evaluate the performance of intraocular lens (IOL) power calculation using standard keratometry (SK) and total keratometry (TK) in eyes after radial keratotomy (RK) surgery. A retrospective, consecutive case series study included 49 patients with cataract (65 eyes) after RK. All implanted IOLs were monofocal in-the-bag lenses. Formulas using SK included American Society of Cataract and Refractive Surgery (ASCRS) average, Barrett True K, double-K modified Holladay 1 formula (DK-Holladay), Emmetropia Verifying Optical formula 2.0 (EVO 2.0), Holladay 1, Holladay 2, PEARL-DGS, and LISA formula for patients with cataract and prior myopic refractive surgery (LISA-MRS). Formulas using TK included Barrett True K-TK, EVO 2.0-TK, Holladay 2-TK, and LISA-MRS-TK. Holladay formulas used both Wang-Koch (Holladay-WK) and Holladay axial length (Holladay-AL) adjustment. The mean prediction error (PE), mean absolute PE (MAE), median absolute error (MedAE), root mean square absolute error (RMSAE), and the percentage of eyes within ±0.25, ±0.50, ±0.75, and ±1.00 diopters (D) of PE were evaluated. In formulas using SK, the LISA-MRS formula exhibited the lowest MAE (0.71 D), lowest MedAE (0.52 D), and highest percentage of eyes within ±0.50 D of PE (49.23%). In formulas using TK, the LISA-MRS-TK formula exhibited the lowest MAE (0.78 D), lowest MedAE (0.48 D), and highest percentage of eyes within ±0.50 D of PE (52.63%). Using TK instead of SK significantly reduced the PE of both the Holladay 2 and LISA-MRS formulas. When AL was 30 mm or greater, the Holladay 1-AL formula exhibited the lowest MAE (0.68 D), lowest MedAE (0.32 D), and the highest percentage of eyes within ±0.50 D of PE (59.09%). In post-RK eyes, the LISA-MRS formula displayed the highest prediction accuracy. TK could improve the prediction accuracy of the Holladay 2 and LISA-MRS formulas.

To study the effect of varying preset intraocular (IOP) levels during phacoemulsification on the retinal perfusion using optical coherence tomography angiography (OCTA) in eyes with non-proliferative diabetic retinopathy (NPDR). Iladevi Cataract & IOL Research Centre, India. Randomized clinical trial. Patients undergoing cataract surgery with NPDR were randomized (1:1) to low (20mmHg) and high (55mmHg) intraoperative IOP. Primary outcome measure was percentage (%) change in central retinal vessel density (CRVD) on OCTA. Secondary outcome measures included impact on optic nerve perfusion (Flux Index (FI)) on OCTA and comparison of postoperative IOP. Outcome measures were evaluated within 2 hours of surgery, as well as well on day 1, 7 and 30 postoperatively. 40 eyes (40 patients) were recruited in each group. CRVD increased postoperatively, with a statistically significant increase at 1 week and 1 month in the low (vs high) IOP group. The reduction in perfusion density in the radial peripapillary capillary region did not differ significantly between groups. FI improved postoperatively in both groups, with significant improvement in low (vs high) IOP group at each follow-up visit. Postoperative IOP was comparable between groups, with a trend toward higher levels in the high IOP group. Low IOP (20 mmHg) during cataract surgery of eyes with pre-existing vascular compromise may have a beneficial effect on macular and optic nerve head perfusion, especially in the early postoperative period.

This study aimed to explore the agreement of biometric measurements and evaluate a parameter-hybrid strategy for intraocular lens (IOL) power calculations among CASIA2, IOL Master 700, and OA2000 in cataract patients. Preoperative measurements were obtained from all three devices. Parameters included axial length (AL), central corneal thickness (CCT), anterior chamber depth (ACD), lens thickness (LT), keratometry (Km, Kf, Ks), white-to-white distance (WTW), and corneal cylinder (CYL). Since the CASIA2 does not provide AL measurement, a hybrid calculation strategy was designed. IOL power was calculated using the Barrett Universal II formula in four configurations: (1) IOLMaster 700 (standalone), (2) OA2000 (standalone), (3) CASIA2-derived anterior segment parameters + IOL Master 700 AL, and (4) CASIA2-derived anterior segment parameters + OA2000 AL. Refractive prediction accuracy was evaluated at one month postoperatively. Statistical analyses included repeated-measures ANOVA, the Friedman test, intraclass correlation coefficient (ICC), and Bland-Altman plots. The three SS-OCT devices showed excellent agreement for most parameters. However, clinically significant differences were observed in corneal curvature (Km, Kf, Ks) measurements among devices. The calculated IOL power providing emmetropia showed a statistically significant result. The standard strategy using IOL Master 700 parameters yielded the highest prediction precision (lowest mean absolute error) and the highest percentage of eyes within ± 0.50 D of the target refraction. Both hybrid strategies resulted in a systematic hyperopia bias, higher prediction errors, and a reduced proportion of eyes within ± 0.50 D. All strategies maintained safety, with over 91% of eyes within ± 1.00 D. The hybrid strategy introduces a hyperopia bias and reduces refractive prediction accuracy. Using a single, consistent device for preoperative measurements is recommended for routine cataract surgery. The hybrid approach may serve only as a contingency in complex cases.

To investigate the extent of lens opacity image features measured by AS-OCT and their association with disease severity based on Lens Opacities Classification System III (LOCS III) in eyes with nuclear cataract (NC) and to determine the diagnostic performance of relative features for grading of nuclear lens opacity. Multicenter study at 2 sites. Clinical validation. A total of 127 individuals with different severity of nuclear cataract were recruited from two different clinical centers: Thailand (Thai, n=81) and Shenzhen, China (SZRM, n=46). All patients underwent AS-OCT examination, images were graded under the LOCS III standard. Automated machine learning models were developed to extract the nuclear region annotation, feature-based quantifiers were then analyzed and evaluated through classifying cataract severity based on disease severity according to LOCS III. AS-OCT pixel based features such as mean, variance, Root Mean Square (RMS), interquartile range, and percentiles significantly correlate with nuclear cataract grading (p < 0.01). Features such as variance, standard deviation, and median showed high consistency, while kurtosis and skewness were negatively correlated. Prediction model achieved 0.81 accuracy on SZRM center (F1-score 0.82), and 0.87 accuracy on Thai center (F1-score 0.83). Automated AS-OCT image features has strong consistency in lens opacity grading. Potentials are also shown in supportive diagnosis and surgical planning in nuclear cataract.

To evaluate real-world visual and refractive outcomes in the Diabetes Mellitus (DM) population. DM may impair corneal healing and neurosensory function, often serving as a relative contraindication for laser vision correction (LVC). This study evaluated visual and refractive outcomes of photorefractive keratectomy (PRK) and laser-assisted in situ keratomileusis (LASIK) in adults with controlled DM compared to healthy controls and compared the two techniques within the diabetic cohort. Care Vision Laser Center, Tel Aviv, Israel. Retrospective comparative study. This retrospective study (2013-2024) included consecutive primary PRK or LASIK procedures in adults with controlled DM (HbA1c <8.0%, no worse than mild NPDR, no diabetic macular edema) and healthy controls. Eyes were propensity-matched on baseline characteristics. Outcomes included refractive and visual measures and complications (retreatment, dry eye, glare, infectious keratitis, haze, epithelial ingrowth, DLK). After matching, 784 myopic PRK eyes (158 DM), 471 myopic LASIK eyes (96 DM), 123 myopic DM eyes (86 PRK; 37 LASIK), and 611 hyperopic LASIK eyes (31 DM) were analyzed. Mean follow-up was approximately 3-5 months. Generalized Estimating Equations (GEE)-adjusted analyses showed no significant differences in visual, refractive, or complication outcomes between DM and controls for myopic PRK or LASIK. Within the diabetic population, PRK and LASIK outcomes were comparable. Hyperopic LASIK outcomes were similar, though DM patients showed a higher retreatment rate. In carefully selected adults with controlled DM, both PRK and LASIK yielded comparable safety and visual outcomes to controls. These findings suggest LVC is viable for this population and that current guidelines may be overly conservative.

To evaluate effects of crystalline lens refractive index (LRI) on prediction error (PE) and suggest the optimal LRI in cases of dense cataract. Chukyo Hospital, Aichi, Japan. Retrospective consecutive case series study. Patients who underwent cataract surgery were enrolled and allocated into Group A (nuclear hardness &#x2264; III) and B (nuclear hardness &#x2265; IV) based on the Emery-Little classification. The swept-source optical biometer was used for biometric measurements. Assuming the postoperative axial length (AL) to be the valid value, a corrected LRI (CLRI) was calculated to make the preoperative AL equivalent to the postoperative one. In the validation group, the PE of the SRK/T formula and Barrett Universal &#x2161; (BU&#x2161;) were evaluated using the pre- and post-correction refractive indices. Of the 5196 enrolled eyes, 1084 were evaluated. In Group A, there was no significant difference between the pre- and postoperative ALs (P = .07). In Group B, the mean postoperative AL (24.09 &#xb1; 2.05 mm) was significantly shorter than the mean preoperative AL (24.12 &#xb1; 2.06 mm) (P < .001). The average CLRI in Group A and B were 1.41 and 1.42, respectively. In the validation group, the PEs using CLRI (SRK/T, 0.10 &#xb1; 0.48 D; BU&#x2161;, 0.03 &#xb1; 0.35 D) were significantly smaller than those using LRI (SRK/T, 0.18 &#xb1; 0.49 D; BU&#x2161;, 0.12 &#xb1; 0.36 D) (P < .001). In cases of high lens nucleus hardness, the use of proposed CLRI demonstrated potentials for reducing PE.

To evaluate the long-term safety, stability, and visual outcomes of diagonal haptic capture (DHC) of a 4-haptic hydrophilic acrylic intraocular lens (Akreos adapt, Bausch&Lomb) in eyes with posterior capsule deficiency and an intact anterior capsulorhexis. Single tertiary referral center. Retrospective interventional case series. Medical records were reviewed for patients who underwent cataract surgery complicated by posterior capsule rupture and in whom DHC was used for IOL fixation between 2015 and 2023. Twenty eyes of 20 patients were identified. Fellow eyes with uneventful in-the-bag implantation of the same IOL model served as controls. Median follow-up was 2 years (mean 2.6&#xb1;2.1 years; range 0-6 years) based on data from referring ophthalmologists, and 8 years (mean 6.0&#xb1;2.8 years; range 2-9 years) for patients examined at the study center. Mean postoperative corrected distance visual acuity did not differ significantly between DHC eyes and fellow eyes (p>0.4). Refractive predictability and intraocular pressure were comparable between groups. All IOLs remained well centered with normal tilt throughout follow-up. No cases of pigment dispersion glaucoma, uveitis-glaucoma-hyphema syndrome, pseudophacodonesis, or late IOL dislocation were observed. In a subset of eyes, anterior segment optical coherence tomography demonstrated adequate clearance between the IOL and posterior iris without evidence of iris chafing. Diagonal haptic capture of a 4-haptic hydrophilic acrylic IOL provided stable long-term fixation, satisfactory visual and refractive outcomes, and a low incidence of complications. However, these results may be IOL-specific.

To assess visual and refractive outcomes of intracapsular and add-on toric intraocular lens (tIOL) implantation in postkeratoplasty astigmatism. Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany. Retrospective observational analysis. This study analyzed postkeratoplasty eyes which underwent either intracapsular (G1) or supplementary sulcus-fixated tIOL implantation (G2). Refractive outcomes were assessed by performing vector analysis. 134 eyes of 117 patients with previous penetrating (n = 129, 96.3%) or deep anterior lamellar keratoplasty (n = 5, 3.7%) were included. Intracapsular tIOL implantation was performed in phakic eyes (n = 115, 85.8%), while add-on tIOL implantation in the ciliary sulcus was performed in pseudophakic eyes (n = 19, 14.2%). Data were obtained for 102 eyes (76%) at 6 weeks and for 121 eyes (90%) at 10 months. Mean IOL cylinder power was 8.4 &#xb1; 2.6 diopters (D) for G1 and 5.7 &#xb1; 0.5 D for G2. Mean uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA, logMAR/Snellen) in G1 significantly improved from 1.1 &#xb1; 0.4 (&#x223c;20/250) to 0.5 &#xb1; 0.3 (&#x223c;20/63) and from 0.5 &#xb1; 0.3 (&#x223c;20/63) to 0.2 &#xb1; 0.2 (&#x223c;20/32), respectively (both P < .001). In G2, mean UDVA and CDVA significantly improved from 1.1 &#xb1; 0.2 (&#x223c;20/250) to 0.5 &#xb1; 0.1 (&#x223c;20/63) and from 0.5 &#xb1; 0.2 (&#x223c;20/63) to 0.3 &#xb1; 0.2 (&#x223c;20/40, both P < .001), respectively. Mean refractive cylinder decreased from -6.9 &#xb1; 2.6 to -2.6 &#xb1; 1.8 D in G1 and from -8.0 &#xb1; 2.7 to -4.2 &#xb1; 1.9 D in G2 (both P < .001). Intracapsular and add-on tIOL implantation can effectively reduce moderate to high mostly regular postkeratoplasty astigmatism while improving visual acuity.

We report a complication of dexamethasone intraocular suspension 9% placed into the capsular bag at the conclusion of cataract surgery. This retrospective case series was performed at an academically affiliated multi-specialty private practice group. Documentation from postoperative visits was evaluated for the development of complications including postoperative pressure spikes, corneal edema, spherule prolapse into the anterior chamber, and changes in pupillary shape. 65 eyes of 45 patients were included in the study. Six of 65 eyes (9.2%) developed pupillary abnormalities, and five of them (83.3%) were preceded by observed prolapse of the dexamethasone spherule into the anterior chamber. In total, nine of 65 eyes (13.8%) demonstrated spherule prolapse, four of which (44.4%) had no effect on pupillary shape. Prolapse of this steroid spherule may correlate with the development of pupillary ovalization, and attempts to eliminate postoperative topical steroids will require delivery systems that prevent steroid-induced iris damage.

To evaluate the impact of intraocular lens (IOL) decentration on optical quality and performance using optical bench studies and ray-tracing numerical simulations, and to analyze how different IOL designs (monofocal, extended depth of focus [EDoF], multifocal, and toric) respond to decentration. IOL decentration may adversely affect visual outcomes, particularly with newer IOL designs. Despite advances in surgical techniques, optimal centration cannot always be guaranteed due to anatomical variability and other factors. Understanding how different IOL designs tolerate decentration is therefore essential for appropriate lens selection and optimized postoperative visual quality. A systematic review of the literature was conducted following PRISMA guidelines. Searches were performed in PubMed, Scopus, and Google Scholar using Boolean operators and truncated terms. Inclusion criteria focused on peer-reviewed optical bench studies published in English over the past 20 years. Data were extracted on optical metrics such as modulation transfer function, Strehl ratio, wavefront aberrations, and point spread function, in relation to various degrees of IOL decentration and lens types. A total of 74 studies were included. Aspheric monofocal IOLs with negative spherical aberration showed greater optical degradation with decentration compared to spherical models. Multifocal and EDoF IOLs were more sensitive to decentration, with notable reductions in image quality and contrast sensitivity, especially at higher decentration levels. Toric IOLs were particularly affected when decentration was combined with rotational misalignment. Optical quality loss was directly related to each lens's design and optical profile. IOL decentration has a measurable and clinically relevant impact on optical quality, especially in aspheric and multifocal designs. Understanding IOL behavior under decentration conditions is essential for optimizing lens selection and postoperative visual outcomes.

To determine how much of the measured surgically induced astigmatism (SIA) after cataract surgery reflects true surgical change versus measurement variability. Tertiary referral center. Retrospective single-surgeon case series. Pre- and postoperative corneal astigmatism was measured with an optical biometer (IOLMaster 700, Carl Zeiss Meditec AG) using standard keratometry (K) and total keratometry (TK) values. SIA was calculated as the vector difference between postoperative and preoperative astigmatism. To estimate the contribution of measurement variability, a Monte Carlo zero SIA noise model was constructed using noise parameters calibrated against empirical repeatability from phakic eyes (&#x3c3; = 0.12 D for K; &#x3c3; = 0.14 D for TK). Measured and simulated SIA distributions were compared using centroid analysis, cumulative distribution functions, and a performance efficiency index (PEI). Three hundred twenty-four eyes of 324 patients were analyzed for K, 269 for TK. Mean SIA magnitude was 0.38 &#xb1; 0.23 D (K) and 0.42 &#xb1; 0.25 D (TK). The observed centroids differed significantly from zero (P < .001), indicating a systematic SIA component. The PEI was 88.8% for K and 89.4% for TK. A substantial portion of measured keratometry-based SIA overlapped with the zero-SIA noise floor, leaving a modest systematic component. Noise-floor benchmarking helps contextualize SIA performance.

Presbyopia affects nearly two billion individuals worldwide and remains a major unmet challenge in refractive surgery. This systematic review evaluated the visual, refractive, and safety outcomes of phakic intraocular lenses (PIOLs) specifically designed for presbyopia correction, including multifocal and extended depth-of-focus (EDOF) models. Eligible participants were presbyopic adults undergoing unilateral or bilateral PIOL implantation. Comparisons across optical designs and fixation types were examined in relation to visual performance and adverse events. Current presbyopia-correcting options, including corneal procedures and refractive lens exchange, may compromise accommodation or optical quality. Phakic presbyopic IOLs aim to restore full-range vision while preserving the crystalline lens, potentially offering a safer, reversible alternative. This review followed PRISMA guidelines and was prospectively registered in PROSPERO (CRD420251138158). Comprehensive searches were conducted in MEDLINE, PubMed, EMBASE, Registers, and the Cochrane Library through July 2025. Eligible studies included clinical trials and observational studies reporting visual, refractive, safety, or patient-reported outcomes of presbyopia-correcting PIOLs. Risk of bias was assessed using the Cochrane and ROBINS-I tools. Six studies (354 eyes) were included. Contemporary PIOL designs; EVO Viva ICL, trifocal IPCL, and ArtiPlus achieved at least 75% of eyes within &#xb1;0.50 D of target refraction, and 80-90% of patients attained functional spectacle independence. Glare and halos were commonly reported but generally mild. No sight-threatening adverse events occurred during short-term follow-up. Early evidence suggests favorable short-term safety and functional outcomes for presbyopia-correcting PIOLs while preserving the crystalline lens and residual accommodative function. However, evidence remains limited by short follow-up, small sample sizes, and industry sponsorship. Independent, long-term studies are required to establish their definitive role in refractive surgery.

Immediate postoperative care presents an option for refining the patient care process. The purpose of this audit was to identify potential reductions in carbon emissions following the decision to move from day 1 to same-day postoperative visits in a busy refractive surgery centre. This represented an analysis of refractive surgery patients across 12-months at a single clinic (n = 603). Total carbon emission saving was calculated by patient address (Google Maps) and based on average mileage/emissions. Total distance saved was 15,396km which estimated a saving of 4.40 tonnes of CO2 emission. Two eyes underwent a re-float procedure on same day representing safety measure. Moving to a same day postoperative visit saves time and decreases secondary financial costs for patients and carers. In the presence of a confirmed safety profile, this presented additional environmental benefits by reducing carbon emissions representing an example for other clinics and potentially, other post-surgical review protocols.

To evaluate the dynamic in vivo capsular apposition to the intraocular lens (IOL) in highly myopic eyes following capsular tension ring (CTR) implantation using swept-source optical coherence tomography (SS-OCT), and to investigate its correlation with in-the-bag IOL behavior. Eye Hospital of Wenzhou Medical University, Hangzhou, Zhejiang Province, China. Prospective randomized clinical trial. Highly myopic patients undergoing cataract surgery were randomized to receive CTR implantation or not. SS-OCT was performed at 1 day, 1 week, 1 month, 3 months, and 6 months to assess capsular apposition. Postoperative aqueous depth (PAD), IOL rotation, and anterior and posterior capsular opacification (ACO/PCO) were evaluated at each follow-up visit. A total of 29 eyes with CTR implantation and 30 eyes without CTR were included. The CTR group exhibited accelerated anterior capsular apposition, demonstrated by a smaller lens-anterior capsule distance (LCD) at 1 day and a higher proportion of anterior capsular apposition at 1 week. From 1 month onward, posterior capsular apposition occurred more frequently in the CTR group. At 1 day, the average LCD positively correlated with both PAD and IOL rotation. During subsequent follow-up period, the mean capsular bend index exhibited negative correlations with the absolute changes in PAD and IOL rotational speed. The CTR group developed less severe ACO, Eyes with incomplete posterior capsular apposition had a higher risk of PCO. CTR implantation facilitates accelerated anterior and more complete posterior capsular apposition to the IOL in highly myopic eyes, which may contribute to improved postoperative IOL stability and a reduced incidence of capsular opacification.

To investigate the effect of pupillary dilation on ocular biometry and intraocular lens (IOL) power calculation with actual postoperative outcomes. Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China. Prospective cohort study. This study included 84 patients with cataract undergoing phacoemulsification. Axial length (AL), keratometry, anterior chamber depth (ACD), central corneal thickness (CCT), lens thickness (LT), and white-to-white (WTW) before and after pupillary dilation were measured using IOLMaster 700. The prediction errors (PEs) and absolute prediction errors (AEs) before and after dilation were compared, calculated by Barrett Universal II, Emmetropia Verifying Optical (EVO) 2.0, Hoffer QST, Kane, LISA, and Pearl-DGS formulas. Multiple and stepwise linear regression analyses were conducted to identify the factors associated with the shift of PE. Pupillary dilation induced significant biometric changes, including increased ACD (0.091 mm) and decreased LT (-0.036 mm), along with changes in AL, CCT, and WTW. A small but statistically significant myopic shift in mean PE was observed with postdilation compared with predilation, with the mean shifts for 5 of the 6 formulas (all except Hoffer QST) ranging from -0.045 diopters (D) (EVO 2.0; SD = 0.147; 95% CI -0.077 to -0.013) to -0.034 D (Kane; SD = 0.146; 95% CI -0.066 to -0.002). However, mean and median AE remained unchanged (P > .05). Regression analysis revealed that changes in AL, keratometry, and ACD were significant predictors of the myopic shift across all formulas. Pupillary dilation may induce a mild myopic shift in IOL power calculations compared with undilated state. However, this shift does not seem to significantly affect the overall predictive accuracy of modern IOL formulas. Further research in larger cohorts is warranted to confirm these findings.

To describe and clinically evaluate a spreadsheet-based algorithm for reproducible depth-of-focus (DoF) calculation, incorporating rule-based continuity detection derived from defocus-curve topology. Humanitas Clinical and Research Center, Rozzano, Milan, Italy. Methodological description with retrospective clinical validation. The algorithm identifies dioptric crossings of a predefined logMAR threshold by locating bracketing points and applying linear interpolation. Validation involved analyzing defocus curves (-4.0 to +1.5 D in 0.50-D steps) from monofocal pseudophakic eyes and comparing automated results with manual measurements by two experienced operators. Logic was implemented to classify continuous and discontinuous (multimodal) profiles and flag out-of-range data. Thirty pseudophakic eyes implanted with monofocal intraocular lenses were included. Depth of focus ranged from 1.10 to 3.17 D (mean 1.92 &#xb1; 0.47 D). Agreement between the algorithm and the two operators was high, with mean differences of -0.01 D (SD 0.08) and 0.00 D (SD 0.05), respectively. The inter-operator difference was 0.01 D (SD 0.09). Mean absolute error was <0.05 D. Bland-Altman limits of agreement versus the operators' mean ranged from -0.10 to +0.09 D. The proposed method ensures objective and reliable DoF quantification by minimizing subjective interpretation and manual workload. While clinical validation focused on monofocal profiles, the topology-based continuity logic provides a structured approach for analyzing complex curve profiles. A template spreadsheet is provided for implementation.

To compare the precision of six intraocular lens (IOL) power calculation formulas-Barrett Universal II, SRK/T, Haigis, Holladay I, Holladay II, and Hoffer Q-among myopic patients undergoing cataract surgery. This retrospective study included 164 eyes from 131 patients with an axial length (AL) greater than 26.0 mm who underwent uncomplicated cataract surgery with monofocal IOL implantation at a tertiary referral center between 2018 and 2021 Several biometric data points were recorded using the IOLMaster 700. Additionally, refractive prediction error was observed and defined as the difference between predicted and postoperative spherical equivalents. Formula performance was assessed using mean absolute error (MAE), mean numerical error, median absolute error, and proportion of eyes achieving predefined refractive accuracy (&#xb1;0.25 D, &#xb1;0.50 D, &#xb1;1.00 D, and &#xb1; 2.00 D). Barrett Universal II showed the lowest calculation of MAE (0.54 &#xb1; 0.71 D), followed by SRK/T (0.57 &#xb1; 0.75 D) and Haigis (0.61 &#xb1; 0.69 D). Barrett Universal II demonstrated significant predictive accuracy compared with Holladay I, Holladay II, and Hoffer Q ( P < 0.05), while no statistically significant differences were observed when compared to SRK/T and Haigis. Besides, it resulted in the highest proportions of eyes within &#xb1; 0.25 D (36.6%), &#xb1;0.50 D (59.1%), &#xb1;1.00 D (88.4%), and &#xb1; 2.00 D (98.8%). The absolute prediction error increased with AL ( P < 0.05), whereas there was no significant correlation with keratometry. In highly myopic eyes, Barrett Universal II showed numerically lower refractive prediction errors, with overall accuracy comparable to SRK/T and Haigis. No formula demonstrated consistent statistical superiority, indicating broadly equivalent performance among the leading formulas in this population.