To evaluate the reliability and construct validity of a Greek version of the NEI-VFQ-25 in patients with chronic ophthalmic diseases.

To assess the effect of stage 1 keratoconus (KC) and of the 2 prevalent KC therapeutic options: (1) corneal collagen cross-linking (CXL) and (2) CXL combined with topography-guided photorefractive keratectomy (t-PRK) on self-reported quality of life (QOL) by means of the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ 25). Thirty-two patients with bilateral KC stage 1 (KC group) and best-corrected visual acuity of 20/20 in both eyes were prospectively recruited. Of them, 19 KC patients underwent typical CXL treatment (CXL group), whereas 13 underwent CXL combined with t-PRK treatment (tCXL group). Only the eye with the most advanced condition received the treatment. Subjects responded to the NEI-VFQ 25 1 day before the treatment and 1 year postoperatively. Thirty-nine age-matched contact lens users formed the control group. NEI-VFQ 25 subscale and total scores were associated with spherical equivalent, mean keratometry, and a series of Scheimpflug imaging-derived corneal variance indexes by means of the Spearman correlation coefficient and multivariate linear regression analysis. Preoperatively, significant differences were detected between the KC group and the control group in VFQ 25 total and all subscale scores (P < 0.05), except "general health," "color vision," and "peripheral vision" domains. According to the multivariate linear regression analysis, the index of height decentration was the most significant predictor of VFQ 25 total score (b = 0.943; P = 0.016). Postoperatively, significant differences were detected in "mental health" and "dependency" VFQ 25 domains for both the CXL and tCXL groups (P = 0.05). Furthermore, the tCXL group demonstrated significant differences in the "near activities" (P = 0.04), "role limitations" (P = 0.02), and "driving" (P < 0.01) subscale scores. Our results suggest that KC exerts a significant impact on KC patients' QOL, even in its early stages with normal best-spectacle-corrected visual acuity. Moreover, both CXL and CXL combined with t-PRK seem to exert a beneficial impact on self-reported QOL, suggesting that they should be applied as soon as possible.

To compare the effect of monovision correction and multifocal intraocular lens (IOL) implantation on patient satisfaction, spectacle dependence, visual acuity, and dysphotopsia in cataract patients. University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece. Prospective randomized trial. Patients with a diagnosis of senile cataract with stage 2 nuclear opalescence were randomly assigned to 2 groups: monovision and multifocal IOL implantation. Uncorrected (UDVA) and corrected (CDVA) distance visual acuity, Visual Function Index-14 (VF-14) scores, and spectacle dependence were assessed prior to surgery and 6 months postoperatively. The monovision group comprised 38 patients and the multifocal IOL implantation group, 37 patients. Both techniques provided excellent refractive outcomes in UDVA and VF-14 scores (all P < .01). No significant intergroup differences were detected in VF-14 scores at the final postoperative examination. The monovision group patients presented significantly more spectacle dependence for near vision but less glare. Monovision and multifocal IOL implantation provided excellent refractive outcomes for distance vision. Multifocal IOL insertion was associated with less dependence on glasses overall but significantly more dysphotopsia. No author has a financial or proprietary interest in any material or method mentioned.

: Purpose:   To evaluate the diagnostic capacity of the Ocular Response Analyser’s keratoconus match index (KMI) and keratoconus match probability (KMP) classification in a sample of keratoconus (KC) patients.Methods:  Keratoconus match index and KMP from 114 KC eyes, randomly selected from 114 patients with bilateral keratoconus (KCG), were compared with the corresponding ones from 109 normal eyes (CG). Keratoconus match index’s predictive accuracy was assessed by receiver operating curves (ROC). Keratoconus match probability level of agreement was evaluated at the different KC stages of the Amsler–Krumeich classification. Correlations were estimated with topographic keratoconus classification (TKC), keratoconus index (KI), index of surface variance (ISV), vertical asymmetry (IVA), height asymmetry (IHA), height decentration (IHD), minimal radius (Rmin), central corneal thickness (CCT), thinnest corneal thickness (TCT) mean keratometry (Km) and intraocular pressure (IOPg).Results:  Mean KMI in KCG and CG was 0.20 ± 0.38 and 0.98 ± 0.25, respectively (p < 0.01). Significant KMI differences (p < 0.01) were detected in different KC groups [range: 0.62 ± 0.38 (KC 1), −0.62 ± 0.04 (KC 4)]. Significant correlation was detected between KC staging and KMI (r = −0.56, p < 0.0001). Keratoconus match probability identified 22.03% of the CG eyes as suspect. Moreover, KMP identified 7.01% and 23.68% of the KCG eyes as normal and suspect, respectively. Receiver operating curves analysis for KMI parameter indicated a predictive accuracy of 97.7% (cut‐off point: 0.512, sensitivity: 91.18%, specificity: 94.34%).Conclusions:  Keratoconus match index seems to be a reliable index in keratoconus diagnosis and staging. Keratoconus match probability identifies a significant percentage of topographically defined KC and CG eyes as suspect. Diagnostic capacity of these novel indexes needs to be further explored.

Corneal collagen cross-linking is a rather new technique that uses riboflavin and ultraviolet A light for collagen fiber stabilization in keratoconus corneas. Other than reversible side effects, the preliminary results of corneal collagen cross-linking studies suggest that it is a rather safe technique. In this report, we demonstrate a case of corneal melting after corneal collagen cross-linking for keratoconus corneas associated with an acute inflammatory response.

To evaluate the diagnostic capacity of the Ocular Response Analyzer's keratoconus match index (KMI) and keratoconus match probability (KMP) classification in keratoconus-suspect eyes. Department of Ophthalmology, University Clinics Saarland, Homburg, Germany. Comparative case series. The KMI and KMP parameters in keratoconus-suspect eyes and normal eyes (control group) were compared. The quantitative keratoconus percentage index was calculated for all suspect eyes. According to the thinnest corneal thickness (TCT), keratoconus-suspect eyes were divided into 2 subgroups: subgroup 1 (TCT 520 μm). The KMI's overall predictive accuracy was assessed using receiver operating characteristic (ROC) curves. The relationship between KMI and a series of Scheimpflug-derived keratoconus-related indices was evaluated using Spearman analysis. The mean KMI was 0.41 ± 0.29 (SD) in the keratoconus-suspect group (50 eyes) and 0.94 ± 0.29 in the control group (50 eyes) (P<.001). Nonsignificant KMI differences were detected between the keratoconus-suspect subgroups (subgroup 1, 27 eyes; subgroup 2, 23 eyes) (P=.059). Nonsignificant correlations were found between Scheimpflug indices and the KMI. The KMP identified 27.65% of control eyes as keratoconus suspect and 10.71%, 28.57%, and 3.57% of keratoconus-suspect eyes as being normal, having mild keratoconus, or having moderate keratoconus, respectively. The ROC analysis for the KMI indicated a predictive accuracy of 94% (cutoff point 0.72). The KMI seems to be a valuable index in the early diagnosis of keratoconus-suspect eyes. The KMP identified a significant percentage of topographically defined keratoconus-suspect eyes as normal or keratoconic. No author has a financial or proprietary interest in any material or method mentioned.