Th e use of premium IOLs requires more specifically than standard monofocal IOLs a thorough clinical and para clinical examination using modern equipments.
We will only mention micro-incision premium IOLs that are used
in our daily practice. All information regarding the characteristics of all available and especially multifocal IOLs are available in the SFO 2012 Report on presbyopia
Certified in wavelength laser surgery, Dr. Anthony Roberts is the founder of Shady Grove Ophthalmology in Rockville, Maryland, a private practice that he opened in 1996. Proficient in the LASIK surgery technique, Dr. Anthony Roberts has extensive experience in performing all types of refractive surgeries.
RLE, also called refractive lensectomy or clear lens exchange, is a surgical procedure where a natural lens of the eye is replaced with an artificial intraocular lens (IOL). Similar to how cataract surgery is performed, the procedure differs in that cataract is not the condition being treated. RLE has helped millions of people to correct eye problems (such as farsightedness and presbyopia) without having to wear corrective lenses. Although the surgery sounds very involved, RLE typically takes 15 minutes per eye.
Depending on specific patient need, the best IOL option varies and ophthalmologists help patients figure out what's best during consultation. When undergoing RLE, any of the three lenses can be used:
Monofocal IOL: The most basic of IOL options, the monofocal lens provides clear vision from a single angle — near, far, or intermediate.
Multifocal IOL: A premium, multifocal lens corrects vision across multiple distances at fixed references.
Accommodating IOL: The most advanced, accommodating IOL provides normal clear vision across all distances.
For more than two decades, Dr. Anthony Roberts has been an ophthalmologist engaging in private practice. The founder of Shady Grove Ophthalmology, Dr. Anthony Roberts and his team provide a range of eye services to patients, including LASIK and refractive lens exchange (RLE).
La chirurgie de la presbytie n'est pas toujours possible avec le laser. Il faut alors envisager une chirurgie du cristallin claire avec des implants multi-focaux. Ceux-ci permettent de corriger la vision de loin et près de manière définitive.
Certified in wavelength laser surgery, Dr. Anthony Roberts is the founder of Shady Grove Ophthalmology in Rockville, Maryland, a private practice that he opened in 1996. Proficient in the LASIK surgery technique, Dr. Anthony Roberts has extensive experience in performing all types of refractive surgeries.
RLE, also called refractive lensectomy or clear lens exchange, is a surgical procedure where a natural lens of the eye is replaced with an artificial intraocular lens (IOL). Similar to how cataract surgery is performed, the procedure differs in that cataract is not the condition being treated. RLE has helped millions of people to correct eye problems (such as farsightedness and presbyopia) without having to wear corrective lenses. Although the surgery sounds very involved, RLE typically takes 15 minutes per eye.
Depending on specific patient need, the best IOL option varies and ophthalmologists help patients figure out what's best during consultation. When undergoing RLE, any of the three lenses can be used:
Monofocal IOL: The most basic of IOL options, the monofocal lens provides clear vision from a single angle — near, far, or intermediate.
Multifocal IOL: A premium, multifocal lens corrects vision across multiple distances at fixed references.
Accommodating IOL: The most advanced, accommodating IOL provides normal clear vision across all distances.
For more than two decades, Dr. Anthony Roberts has been an ophthalmologist engaging in private practice. The founder of Shady Grove Ophthalmology, Dr. Anthony Roberts and his team provide a range of eye services to patients, including LASIK and refractive lens exchange (RLE).
La chirurgie de la presbytie n'est pas toujours possible avec le laser. Il faut alors envisager une chirurgie du cristallin claire avec des implants multi-focaux. Ceux-ci permettent de corriger la vision de loin et près de manière définitive.
Dr. Anthony Roberts is the founder and ophthalmologist-in-chief of Shady Grove Ophthalmology, an established eye care clinic in Rockville, Maryland. Together with his team at Shady Grove, Dr. Anthony Roberts has performed over 81,000 refractive eye surgeries, including cataract extraction and laser in-situ keratomileusis (LASIK).
Refractive eye surgery, also known as laser eye surgery, is a procedure for correcting farsightedness, nearsightedness, and astigmatism. This procedure corrects the refractive state of the eye and leads to improved vision. People who had refractive eye surgery should rarely have to use contact lenses or eye glasses.
There are several types of refractive eye surgeries, the most common are LASIK and photorefractive keratectomy. Both these surgeries use lasers to reshape the cornea, the clear outer layer at the front of the eye which functions by focusing light for vision. Since the US Food and Drug Administration approved LASIK in 1999, over 18 million Americans have undergone this surgery to treat nearsightedness, farsightedness, and astigmatism. Over 700,000 LASIK surgeries are performed each year. Other types of refractive eye surgery include refractive lens exchange, presbyopic lens exchange, and Limbal Relaxing Incisions.
Dr. Anthony Roberts, founder of Shady Grove Ophthalmology, provides comprehensive care for diseases and conditions affecting the eyes. Experienced in Lasik surgery, Dr. Anthony Roberts also routinely introduces intraocular lenses (IOLs) to treat cataracts in patients.
Based in Rockville, Maryland, Dr. Anthony Roberts provides client-centered ophthalmology care for a broad range of eyesight issues such as glaucoma, corneal disease, dry eyes, and diabetic retinopathy. Offering advanced Lasik procedures, Dr. Anthony Roberts provides extended-depth-of-focus (EDOF) intraocular lens (IOL) options to patients with complex vision challenges.
IOLs are typically implanted as part of refractive lens exchange or following cataract extraction, within the surgical treatment of presbyopia. Traditional multifocal IOLs employ diffractive optic lenses and separate light between near, intermediate, and long distances. This means that the user is only able to focus on a single distance at a time, with blur, halo, and glare sometimes occurring due to the multiple focal points.
By contrast, EDOF-IOLs provide a single elongated focal point that seamlessly improves depth of focus and range of vision. This emerging technology is ideal for patients who do not want their functional vision compromised as they shift focus across distances.
The Right Contact - Up to date information regarding contact lenses, Hyrid lenses, Soft lenses, button materials, gas permable lens and contact lens care products.
Accommodative and multifocal intraocular lensesBijan Farpour
New generation premium lenses. Accommodative and multifocal intraocular lenses used for cataract surgery and presbyopic lens exchange in modern eye surgery.
Presentation by Dr. Detlev Breyer at the World Ophthalmology Congress in Barcelona, 2018: Introduction of a new diffractive trifocal intraocular lens. Comparison with a former diffractive trifocal IOL.
Dr. Anthony Roberts is the founder and ophthalmologist-in-chief of Shady Grove Ophthalmology, an established eye care clinic in Rockville, Maryland. Together with his team at Shady Grove, Dr. Anthony Roberts has performed over 81,000 refractive eye surgeries, including cataract extraction and laser in-situ keratomileusis (LASIK).
Refractive eye surgery, also known as laser eye surgery, is a procedure for correcting farsightedness, nearsightedness, and astigmatism. This procedure corrects the refractive state of the eye and leads to improved vision. People who had refractive eye surgery should rarely have to use contact lenses or eye glasses.
There are several types of refractive eye surgeries, the most common are LASIK and photorefractive keratectomy. Both these surgeries use lasers to reshape the cornea, the clear outer layer at the front of the eye which functions by focusing light for vision. Since the US Food and Drug Administration approved LASIK in 1999, over 18 million Americans have undergone this surgery to treat nearsightedness, farsightedness, and astigmatism. Over 700,000 LASIK surgeries are performed each year. Other types of refractive eye surgery include refractive lens exchange, presbyopic lens exchange, and Limbal Relaxing Incisions.
Dr. Anthony Roberts, founder of Shady Grove Ophthalmology, provides comprehensive care for diseases and conditions affecting the eyes. Experienced in Lasik surgery, Dr. Anthony Roberts also routinely introduces intraocular lenses (IOLs) to treat cataracts in patients.
Based in Rockville, Maryland, Dr. Anthony Roberts provides client-centered ophthalmology care for a broad range of eyesight issues such as glaucoma, corneal disease, dry eyes, and diabetic retinopathy. Offering advanced Lasik procedures, Dr. Anthony Roberts provides extended-depth-of-focus (EDOF) intraocular lens (IOL) options to patients with complex vision challenges.
IOLs are typically implanted as part of refractive lens exchange or following cataract extraction, within the surgical treatment of presbyopia. Traditional multifocal IOLs employ diffractive optic lenses and separate light between near, intermediate, and long distances. This means that the user is only able to focus on a single distance at a time, with blur, halo, and glare sometimes occurring due to the multiple focal points.
By contrast, EDOF-IOLs provide a single elongated focal point that seamlessly improves depth of focus and range of vision. This emerging technology is ideal for patients who do not want their functional vision compromised as they shift focus across distances.
The Right Contact - Up to date information regarding contact lenses, Hyrid lenses, Soft lenses, button materials, gas permable lens and contact lens care products.
Accommodative and multifocal intraocular lensesBijan Farpour
New generation premium lenses. Accommodative and multifocal intraocular lenses used for cataract surgery and presbyopic lens exchange in modern eye surgery.
Presentation by Dr. Detlev Breyer at the World Ophthalmology Congress in Barcelona, 2018: Introduction of a new diffractive trifocal intraocular lens. Comparison with a former diffractive trifocal IOL.
The Right Contact - Up to date information regarding contact lenses, Hyrid lenses, Soft lenses, button materials, gas permable lens and contact lens care products.
Comparative Study of Visual Outcome between Femtosecond Lasik with Excimer La...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Artificial lenses implanted in the anterior or posterior chamber of the eye in the presence of the natural crystalline lens to correct refractive errors. Phakic IOLs an evolving technique in the field of refractive surgery for the correction of moderate to high refractive errors. Patients with high myopia (above -10 diopters) constitute only about 2% of the myopic population but 13-15% of patients presenting for refractive surgery belong to this group. The increased knowledge on anterior segment anatomy and availability of better imaging technologies along with improved IOL designs and surgical techniques have led to higher success rates with these lenses.
Compared to corneal refractive surgery , phakic IOLs compete favorably for the correction of high ametropias, with excellent predictability, efficacy, safety and quality of vision.
Orbis Chairman Robert Walters denounces manual small incision cataract surgic...Orbisemps
In a scathing attack, Orbis Charity Chairman, Rober Walters denounces the Help Me See organisation and the support to Manual Small Incision Cataract Surgery.
A 5-year old boy, with an established diagnosis of a topic
dermatitis, previously treated by topical corticosteroids and emollient cream with a good improvement, developed widespread papules on his legs, hands and forearm that appeared 5 months ago.
Methods: Retrospectively, the file records of the patients who underwent sleeve gastrectomy were examined. Demographic features, Body Mass Index (BMI), the mouth opening, Mallampati score, thyromental distance, sternomental distance, neck circumference measurements and videolaryngoscopic examination results were recorded Results: In a total of 140 consecutive patients (58 male, 82 female) were included in the study. The mean age of the study participants was 35.40 ± 9.78 and the mean BMI of the patients was 44.33 ± 7.52 kg/m2
. The mean mouth opening of the patients was 4.82 ± 0.54 cm
and the mean neck circumference was 43.52 ± 4.66 cm. The mean thyromental distance was 8.02 ± 1.00 cm and the mean sternomental distance was16.58 ± 1.53 cm. Difficult intubation was determined in 8 (5.7%) patients. In logistic regression analysis, age (p : 0.446), gender (p : 0.371), BMI (p : 0.947), snoring (p : 0.567), sleep apnea (p : 0.218), mouth opening (p : 0.687), thyromental distance (p :0.557), sternomental (p : 0.596) and neck circumference (p : 0.838) were not the independent predictors of difficult intubation. However, Mallampati score (p : 0.001) and preoperative direct laryngoscopy findings (p : 0.037) performed in outpatient clinic were the significant
predictors of difficult intubation. Interestingly, all patients with grade 4 laryngoscopy findings had difficult intubation.
Introduction: Laparoscopic surgery has been performed in Mexico since 1989, but no reports about training tendencies exist. We conducted a national survey in 2015, and here we report the results concerning training characteristics during the surgical residence of the respondents. Materials and Methods: A prospective study was conducted through a survey questioning demographic data, laparoscopic training during pre and post surgical residency and other of areas of laparoscopic practice. The sample was calculated and survey piloted before
application. Special interest in this report was placed on type and quality of training received. Data are reported in percentages.
Heterotopic Ossification (HO) is defined as pathological bone formation at locations where bone normally does not exist. The
presence of HO has been found to be a rare complication after stroke in several studies, whereas there are only sporadic references relating HO to Cerebral Palsy (CP) and few for CP and stroke. No effective treatment for HO has yet been found, whereas the cellular and molecular mechanisms have not been completely understood. Therefore, increased awareness among physicians is required, as a challenge for early diagnosis and treatment. A case of a male patient with CP, who developed HO on the paretichip joint following an ischemic stroke is presented.
Objectives: To assess the practice of food hygiene and safety, and its associated factors among street food vendors in urban areas of Shashemane, West Arsi Zone, Oromia Ethiopia, 2019.
Methods: Cross-sectional study design was applied from December 28, 2019 to January 27, 2020. Data was collected from 120 food handlers, which were selected by purposive sampling techniques. Information was gathered from interview and field observation by conducting food safety survey and using questionnaires via face to face interview. The collected data was entered using Epi Data 3.1 and finally, it was analyzed using SPSS VERSION 20.
A Division I football athlete experienced acute posterior leg pain while pushing off on the line of scrimmage. Ultrasound (US) showed a midsubstance plantaris tendon rupture, an injury that, to our knowledge, has only been described once before in the medical literature [1]. US was also used to assist with rehab progression and return to previous level of activity, which was achieved three weeks after the injury. While there currently are no guidelines regarding return to sport after this injury, this case demonstrates that once pain is controlled and ROM restored, progression through rehabilitation and return to elite level sport is simply based on symptoms.
Type 1 Diabetes (T1D), is a severe disease, representing 5-10% of all reported cases of diabetes worldwide. Fulminant Type 1 Diabetes Mellitus (FT1D) is a subtype of type 1 diabetes mellitus that is largely characterized by the abrupt onset of Diabetic Ketoacidosis (DKA) and severe hyperglycemia without insulin defi ciency. Viral infections have been hypothesized to play a major role in the pathogenesis of Fulminant Type 1 Diabetes Mellitus (FT1D) through the complete and rapid destruction of pancreatic beta cells. Coxsackie viral infection has been detected in islets of 50% of the pancreatic tissue recovered from recent-onset Type 1 Diabetes (T1D) patients. In this report we have highlighted a case where the patient developed a Group B Coxsackie virus infection culminating in the development of Fulminant Type 1 Diabetes Mellitus (FT1D).
Methods: Cercariae are released by infected water snails. To determine the occurrence of cercariae-emitting snails in SchleswigHolstein, 155 public bathing places were visited and searched for fresh water snails. Family and genus of the collected snails were determined and the snails were examined for the shedding of cercariae, using a standard method and a newly developed method.
Objective: To generate preliminary information about of enteroviruses and Enterovirus 71 (EV71) in patients with aseptic meningitis in Khartoum State, Sudan.
Method: Cerebrospinal fluid specimens were collected from 89 aseptic meningitis patients from different Khartoum Hospitals
(Mohammed Alamin Hamid Hospital, Soba Teaching Hospital, Omdurman Military Hospital, Alban Gadeed Teaching Hospital and Police Hospital) within February to May 2015. Among these 89 patients, 43 (48%) were males and 46 (52%) were females. The patient’s age ranged between 1 day and 30 years old. The collected specimens were assayed to detect enteroviruses and EV71 RNA using Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) technique
Femoral hernias, comprise 2% to 4% of all hernias in the inguinal region, and occur most commonly in women. Th ey present typically with a mass below the level of the inguinal ligament. The sac may contain preperitoneal fat, omentum, small bowel, or other structures and have a high rate of incarceration and strangulation due to the small size of the hernia neck orifice, requiring emergency surgery. We present the case of a 54-year-old female patient with intestinal occlusion due to incarcerated femoral hernia, repaired by laparoscopic approach, that gave the patient the opportunity to attend her daughter’s wedding the same day.
Small Supernumerary Marker Chromosome (sSMC) is a rare genetic condition marked by the presence of an extra chromosome to the 46 human chromosomes. This case report describes a 4 year old child with SSMC on the 46th chromosome. The child presented with delayed speech and language development, seizures and mild developmental delay. Speech and Language evaluation was carried out and management options are discussed.
A catheter is a thin tube made from medical grade materials that serve a broad range of functions, but mainly catheters are medical devices that can be inserted in the body to treat disease or perform surgical procedures. Catheters have been inserted into body cavities, ducts, or vessels to allow for drainage, administration of therapeutic fluids or gases, operational access for surgery. Catheters help perform tasks in various systems such as cardiovascular, urological, gastrointestinal, neurovascular, and ophthalmic systems. A dataset of 12 patients with varying “weights” and “heights” was recorded along with the lengths of their catheter tubes. This data set was found from two revered statistical textbooks on linear regression and the Department of Scientific Computing at Florida State University. This data set was not able to be linked to any particular clinical or experimental research studies, but the data set can be used to help catheter manufacturers and medical professionals better decide on what particular catheter lengths to use for patients knowing only their height & weight. These research insights could be helpful to healthcare professionals that have patients with incomplete or no healthcare records
to decide what catheter length to use. The main investigative inquiry that needed to be answered was how does patient weight & height influence catheter length together and separately? We conducted linear regression and other statistical analysis procedures in R program & Microsoft Excel and discovered that this data exhibited a quality called multi collinearity. With multi collinearity, all predictors (2 or more
independent variables) are not significant in an all encompassing linear aggression, but the predictors might be significant in their own individual linear regressions. Individual linear regression analyses were conducted for both patient height & weight to see how much they both contribute to varying catheter length. Patient weight was found to be more impatful than patient height in relationship to catheter length, even though height and weight are a classical example of multi collinearity predictors.
Bovine mastitis has a negative impact through economic losses in the dairy sector across the globe. A cross sectional study was carried out from September 2015 to July 2016 to determine the prevalence of bovine mastitis, associated risk factors and isolation of major causative bacteria in lactating dairy cows in selected districts of central highland of Ethiopia. A total of 304 lactating cows selected randomly from five districts were screened by California Mastitis Test (CMT) for subclinical mastitis. Based on CMT result and clinical examination, over all prevalence of mastitis at cow level was 70.62% (214/304).
Two hundred fourteen milk samples collected from CMT positive cows were cultured for isolation of major causative bacteria. From 214 milk samples,187 were culture positive and the most prevalent isolates were Staphylococcus aureus 42.25% (79/187) followed by Streptococcus agalactiae 14.43%
(27/187). Other bacterial isolates were included Coagulase Negative Staphylococcus species 12.83% (24/187), Streptococcus dysgalactiae 5.88% (11/187), Escherichia coli 13.38% (25/187) and Entrococcus feacalis 11.23% (21/187) were also isolated. Moreover, age, parity number, visible teat abnormalities,husbandry practice, barn fl oor status and milking hygiene were considered as risk factors for the occurrence of bovine mastitis and they were found significantly associated with the occurrence of mastitis (p < 0.05). The findings of this study warrants the need for strategic approach including dairy extension that focus on enhancing dairy farmers’ awareness and practice of hygienic milking, regular screening for subclinical mastitis, dry cow therapy and culling of chronically infected cows.
Kratom is an herbal product that is derived from Southeast Asian Mitragyna speciose tree leaves [1-10]. This compound is used for many purposes such as stimulation, euphoria, or analgesia [1-10]. It has been recently identified as a drug of abuse by the United States Drug Enforcement Administration [2,8]. Side-effects from this compound have not been well documented. We describe a case of a 36-year-old female who develop nephrotoxicity after taking an herbal supplement. She took kratom as an adjunctive therapy for back pain management. She developed right upper quadrant pain and nausea. Laboratory tests showed elevated liver enzymes without evidence of bile duct obstruction. Liver enzymes normalized several weeks after Kratom discontinuation. We advise clinicians to be vigilant about Kratom’s hepatotoxic potential on patient health.
The assessment, diagnosis and treatment of critically ill patients is extremely challenging. Patients often deteriorate whilst being
reviewed and their rapidly changing pathophysiology barrages healthcare professionals with new data. Furthermore, comprehensive assessments must be postponed until the patient has been stabilised. So, important data and interventions are often missed in the heat of the moment. In emergency situations, suboptimal management decisions may cause signifi cant morbidity and mortality. Fortunately, standardisation and careful design of documentation (i.e. proformas and checklists) can enhance patient safety. So, I have developed a series of checklist proformas to guide the assessment of critically ill patients. These proformas also promote the systematic recording and presentation of information to facilitate the retrieval of the precise data required for the management for critically ill patients. The proformas have been modifi ed extensively over the last twenty years based on my personal experience and extensive consultation with colleagues in several world-renowned centres of excellence. The proformas were originally developed for use in the intensive therapy unit
or high dependency unit. However, they have been adapted for use by outreach teams reviewing patients admitted outside of critical care areas. The use of these tools can direct eff orts to provide appropriate organ support and provides a framework for diagnostic reasoning.
Systemic Hypertension (HTN) accounts for the largest amount of attributable Cardiovascular (CV) mortality worldwide. There are several factors responsible for the development of HTN and its CV complications. Multicenter trials revealed that risk factors responsible for Micro Vascular Disease (MVD) are similar for those attributable to Coronary Artery Disease (CAD) which include tobacco use, unhealthy cholesterol levels, HTN, obesity and overweight, physical inactivity, unhealthy diet, diabetes, insulin resistance, increasing age and genetic predisposition. In addition, the defective release of Nitric Oxide (NO) could be a putative candidate for HTN and MVD. This study reviewed the risk stratification of hypertensive population employing cardiac imaging modalities which are of crucial importance
in diagnosis. It further emphasized the proper used of cardiac imaging to determine patients at increased CV risk and identify the management strategy. It is now known that NO has an important effect on blood pressure, and the basal release of endothelial Nitric Oxide (eNOS) in HTN may be reduced. Although there are different forms of eNOS gene allele, there is no solid data revealing the potential role of the polymorphism of the eNOS in patients with HTN and coronary vascular diseases. In the present article, the prevalence of eNOS G298 allele in hypertensive patients with micro vascular angina will be demonstrated. This review provides an update on appropriate and justified use of non-invasive imaging tests in hypertensive patients and its important role in proper diagnosis of MVD and CAD. Second, eNOS gene allele and its relation to essential hypertension and angina pectoris are also highlighted.
Methods: Two groups were selected by non-probability random sampling technique including case group of 154 patients with
suspected dengue (fever>2days and <10days) and control group of 146 patients with febrile illness other than dengue. Clinical,hematological and serologic markers of cases and control groups were analyzed. The frequency distribution was used to compare categorical serologic markers and paired sample T test was applied for hematologic variables before and after treatment of dengue using SPSS version 21.
Researchers from Utrecht recently published yet another paper on the use of Magnetic Resonance Imaging (MRI)demonstrating an additional failed attempt to understand the importance of qualitative versus quantitative imaging, and anatomic versus physiologic imaging. Th e implications of this failure here cannot be overstated.
Introduction: Stroke is an even more dramatic major public health problem in young people. Goal of the study: Contribute to the knowledge of strokes in young people. Methodology: This was a retrospective study carried out over a period of 02 years (January 2017 to December 2018) including the files of patients aged 18 to 49 years hospitalized for any suspected case of stroke in the Neurology department of the University Hospital
Center of the Sino-Central African Friendship (CHUSCA) of Bangui.
Background: This report describes a unique case of a patient that developed psychotic symptoms believed to be secondary
to a tentorial meningioma with associated hydrocephalus. These psychotic symptoms subsequently abated with placement of a
ventriculoperitoneal shunt. Case description: 60-year-old female was admitted to an inpatient psychiatric facility on a psychiatric involuntary commitment petition due to progressive paranoia, homicidal ideation and psychosis. The work up showed a calcified six cm tentorial meningioma with associated hydrocephalus. The patient initially rejected treatment but later became amenable to placement of Ventriculoperitoneal Shunt
(VPS).
More from SciRes Literature LLC. | Open Access Journals (20)
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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The use of premium IOLs requires more specifically than standard
monofocal IOLs a thorough clinical and para clinical examination
using modern equipments.
We will only mention micro-incision premium IOLs that are used
in our daily practice. All information regarding the characteristics of
all available and especially multifocal IOLs are available in the SFO
2012 Report on presbyopia [1].
Cataract surgery in 2017 must not only restore the optical media
by the removal of a cloudy lens but also correct if possible all optical
defects (myopia, hyperopia, astigmatism and presbyopia) without
creating some with a too large corneal incision [2].
There are currently four types of premium IOLs: accommodative
IOLs, IOLs with improved depth of field under development, Toric
IOLs and multifocal IOLs.
We have no experience of accommodative IOLs that are widely
used overseas.
The accuracy of IOLs power calculating devices using optical
interferometry biometry (target +/- 0.50 D) and the evolution to
astigmatism neutral micro-incisions enable us in daily practice to
customize these IOLs to each individual patient with an asphericity
(Z4 - 0) suited to the cornea.
This allows for partial presbyopia correction by depth of field
increase. This is the first step in the development of IOLs with
improved depth of field which will probably soon revolutionize our
correction possibilities by IOL customization.
In this article, we will essentially focus on multifocal and toric
IOLs.
For about 700,000 cataract procedures performed in 2012, we
can estimate to 6.5% i.e., 45,000 toric IOLs placed in France and 4%
i.e., 28,000 multifocal IOLs (25,000 multifocal IOLs and 3,000 toric
multifocal IOLs).
The multifocal IOLs market progresses slowly (40% of French
surgeons use multifocal versus 30% last year) and very variably
according to surgical orientations, refractive or not.
It is quite different with the toric IOL market that grows very
quickly with 50% of respondents using torics versus 37% last year
according to Richard Gold in 2012.
Indeed 20 to 30% of cataract patients have an astigmatism
superior to 1.25D and 10% of 2D or more.
This can largely vary with regions with 45% of patients having
more than one diopter astigmatism according to a recent Chinese
article [3].
MULTIFOCAL IOLS
Patients’ requirements have greatly increased in recent years and
even perfect distance vision correction is not enough to fully satisfy a
cataract surgery patient.
This is particularly notable in a myopic patient who had no
problem with his intermediate and near vision before his cataract
and his corrective surgery. Monocular vision and/or depth of field
increase by spherical aberrations management are not always
sufficient to reach the goal of less spectacle dependence.
Such patients will be preferentially attracted by multifocality
if they accept the induced visual compromise (halos and reduced
contrast sensitivity at low luminance).
WHICH PATIENTS ARE SUITABLE FOR THIS
SURGERY?
The most suitable patient is the one who strongly desires not to
wear glasses after having eliminated medical contra-indications and
exposed side effects especially halos.
Thus in our activity we perform more PRELEX®
or PREs biopic
Lens Exchange-acronym created by Kevin Waltz, et al. [4] in the early
1990s than multifocal implantation in cataract patients.
Patients with significant night activity should be avoided as halos
at night may disturb patients especially when driving.
These halos disappear for 20% of patients during the first month
and for 40% of patients during the first year presumably by a Neuro-
adaptation phenomenon.
They persist to varying degrees for the remaining 40% without
significant reduction in activities.
Clear information using a booklet with halos simulation (figure
1) or more sophisticated computer software may be used.
WHICH PREOPERATIVE ASSESSMENT?
Anorthopticassessmentwillbedonetoeliminateanymicrotropia.
Analysis of the cornea must be scrupulous and any disease of the
tear film must be treated beforehand because meibomian gland
dysfunction can greatly disturb patients postoperatively.
Search of the dominant eye will be systematically determined
using stenopeic hole (muscular dominant eye) in cataract cases and
adding + 0.75 or more (cortical dominant eye) to the best refraction
in case of clear lens exchange.
New apodized diffractive IOLs being pupil-dependent,
photopic (Scheimpflug data) and mesopic (Colvard Pupillometer)
measurement of the pupil will avoid narrow photopic or over dilated
scotopic pupils.
Limits of 2mm in photopic and 5 mm in scotopic will avoid any
pupillary refractive disorder postoperatively.
A mean 2.92 mm ± 0.55 mm pupil was found during the
presentation of the Phys IOL Fine Vision Trifocal IOL at the ASCRS
2012 meeting in Chicago (free paper).
Figure 1: Halos from 0 to 4. Identify the closest picture to your perception of
car headlights
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Pathological pupils are absolute contra-indications to this
surgery.
Topographic analysis in the best case using Scheimpflug camera
(Pentacam type) will eliminate pathological (fruste keratoconus) and
irregular corneas.
Scheimpflug camera analysis allows quantifying the corneal
irregularity (Total Cor. Irregular. Astg), which will be at best lower
than 0.300 m (figure 2). Multifocal implantation is possible up to
0.500 m but contra-indicated beyond [5].
This analysis is essential especially for patients who have received
previous refractive surgery.
IOL calculation should be made with great care using an optical
interferometry biometer to avoid errors beyond +/- 0.50 D and if
possible should be made several times.
In practice for PRELEX
we make two measurements on the
dominated eye and three measurements on the dominant eye at two
preoperative and one postoperative examination on the first eye (non
dominant eye operated firstly).
The formulas used are SRK-T, Hoffer Q and Haigis.
The SRK-T formula is suitable in the great majority of cases,
Hoffer Q is our preferred for hyperopic cases and Haigis for atypical
eyes.
The Haigis L formula is used for patients with a history of corneal
surgery (to be compared with the online calculator on the SAFIR
website http://www.safir.org or ASCRS website http://iolcalc.org and
with the Pentacam EKR calculator), which does not always avoid
refractive errors…
The interest of the IOL Master (Zeiss Meditec) optical coherence
interferometry biometer lies in its ULIB website which collects
optimized constants from the ophthalmic community (http://www.
augenklinik.uni-wuerzburg.de) available for direct download on the
http://cataract-community.zeiss.com site.
Astigmatism is a factor of patient dissatisfaction.
A residual astigmatism lower than 0.50D does not seem to impair
visual acuity [6], but we systematically treat astigmatism with toric
lens if possible with the goal of no residual astigmatism.
Corneal limbal incisions could be performing to treat lower
astigmatism.
You have also to adjust astigmatism correction with aging. For
example at 60 years old you can let WTR astigmatism of + 0.50D,
however zero astigmatism is the best choice for an 80 years old patient.
The Scheimpflug analysis can again maximize results by analyzing
the anterior and posterior surface of the cornea and the axis of the
total cornea.
In the following case, treatment of the one diopter direct
astigmatism in the anterior cornea will not be necessary because it is
actually 0.2D in the total cornea (Figure 3).
This other case confirms the benefit of analyzing the total cornea
with a different axis of astigmatism between the anterior surface + 0.5
D @ 76.2° and the total cornea 0.9 D @ 42.2° (Figure 4).
Pathological capsular bags or capsular bags at risk because of
uncontrolled healing should be avoided in order to prevent any
decentration of these IOLs.
Finally a macular OCT analysis is performed when there is a
doubt at fund us examination in order to eliminate an incipient
macular traction syndrome or Epiretinal Membrane (ERM) [7].
This does not prevent the occurrence of ERM after postoperative
PVDbutitseemsessentialtousfromaclinicalandforensicperspective
in order to anticipate a cystoid macular edema (Cumulative Cystoid
Macular Edema rates after large series of MICS IOL implantations,
ASCRS 2014 Boston, free paper).
WHICH IOL TYPES SHOULD BE USED?
The history of multifocal is made of hope and disillusion; this
explains the low development of this type of implantation.
In the 80s, the 3M Company has developed the first diffractive
Figure 2: WFA HO RMS ZO 4mm 0.209 m.
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IOL with imperfect results because of incision size (7 mm in extra
capsular) and IOL calculation by a less accurate US biometry.
The development of refractive IOLs in the 90s helped develop
the concept at a time when surgery was revolutionized by
phacoemulsification but with a lack of near correction.
This has led some surgeons to develop as Jacobi in 1999 diffractive
optics with far predominance for the dominant eye and near
predominance for the dominated eye. The mix and match concept
was born to compensate the inability of one single IOL to provide
patients with perfect far and near correction…
We have used the concept at this time with the AMO SA40N
refractive IOL on the dominant eye and IOL tech MF4 on the
dominated eye (SAFIR 2001 free paper).
The development of new bifocal diffractive implants in the 2000s
(Alcon ReStor and Carl Zeiss Meditec AT Lisa) has enabled a further
boost but with a lack of intermediate vision correction.
The last decisive change occurred in 2011 with the trifocal
IOL (Phys IOL Fine Vision) that restores the three distances of far
intermediate and near vision.
Mix and match are no longer required in 2014 with the use of
trifocal diffractive IOLs in both eyes [8-9-10], which largely facilitates
IOL calculation.
WHICH SURGICAL TECHNIQUE?
It seems to us that sub 2mm micro incision (CMICS or BMICS)
should be the rule in order to prevent any astigmatism induced by the
incision and the risk to increase high order aberrations [2].
If topical anesthesia is becoming increasingly popular, we have
chosen since 2012 to systematically perform sub-Tenon anesthesia to
avoid any discomfort during the procedure [11].
The second eye is operated on 2 to 5 days after the first one to
eliminate any trouble due to an eventual anisometropia.
WHICH POSTOPERATIVE FOLLOW UP?
An examination is performed at one month systematically with
treatment of any eventual residual blepharitis which may largely
disturb patient’s vision.
In case of resisting blepharitis, we use heating glasses
(Blephasteam
http://www.blephasteam.fr) that can treat the
symptoms and reassure patients who see their vision improve
immediately after a single session.
Figure 3: Benefit of posterior surface analysis.
Figure 4: Benefit of the axis of the total cornea.
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Minimal refractive errors may be treated from the third month
(bag healing) using Lasik (hypermetropia) or PRK (myopia) and
earlier in case of major error in IOL calculation by IOL replacement.
TORIC IOLS
Uncorrected astigmatism creates blurred vision, the need for
glasses, which results in optical aberrations especially for progressive
lenses, and a reduction of the visual field in particular for astigmatisms
superior to 2D [12].
Indeed some patients do not tolerate this type of correction using
glasses.
WHICH PATIENTS ARE SUITABLE FOR THIS
SURGERY?
All patients with astigmatism can benefit from this type of IOL.
Indeed very low astigmatisms may be adjusted by relaxing
incisions using diamond knife with good accuracy.
WHICH PREOPERATIVE ASSESSMENT?
The same clinical and para clinical assessment as for multifocal
IOLs is performed to define the toric IOL selection.
Examinations should be repeated when there is a discrepancy
between different devices with regards to astigmatism axis or power.
We must remember the importance of the tear film and its prior
treatment if necessary.
Corneas with too much irregular astigmatism are not good
indications (re: Total Cor. Irregular. Astg on Pentacam
).
In contrast, asymmetric but regular astigmatism gives excellent
results.
This is of major interest in keratoconus or post refractive surgery
when calculation with online calculator is sometimes difficult for
these non-standard IOLs.
The axis of total astigmatism from Scheimpflug topographers
should be considered rather than anterior astigmatism alone (Figure
4).
Many works under the leadership of Douglas D. Koch, et al. [13]
now stress the importance of calculating astigmatism of the posterior
surface of the cornea. It seems desirable to take it into account,
although the impact seems low, around 0.50D under-correction for
indirect astigmatism (current study).
Current calculations that are solely based on anterior corneal
astigmatism result in over-correction for with-the-rule or direct
astigmatism and under-correction with against-the-rule or indirect
astigmatism.
Finally, the patient’s age should be considered since astigmatism
(normal + 0.75D @ 90°) reverses with aging of the eye and a young
patient should be treated differently from an elderly one (Figure 5).
WHICHIOLTYPEANDWHICHCALCULATOR
SHOULD BE USED?
The prerequisite is an IOL as stable as possible in the capsular bag.
The axis rotation has been evaluated with different IOL models from
2.5 ± 2.6 degrees to 4.42 ± 4.31 degrees.
Vision quality will be improved especially for large pupils and
high sphero-cylindrical abnormalities by the use of bitoric IOLs.
Finally, the calculator must be as complete as possible with the
integration in the calculation of the anterior chamber depth to avoid
correction errors for too long or too short eyes.
Use of a fixed ratio can lead to cylindrical over-correction for
hyperopic eyes and under-correction for myopic eyes.
Meridian analysis, where IOL power is calculated first for the
steepest meridian then for the flattest meridian allowing to predict
ELP (Effective Lens Position) precisely [14], should be preferred.
These calculators are available from AMO, Rayner and Zeiss.
Final target
MULTIFOCAL 0 astigmatism or + 0.25D with the rule for young
patient
MONOFOCAL Patient <65 years + 0.25D to + 0.50D with the
rule (reversion with age)
Patient >65 years + 0.25D with the rule to 0D near 80 years
Who to treat?
All astigmatism
How?
With toric lens according to the calculator or with AK for very
low astigmatism
RESULT
With the rule astigmatism treatment easier with AK or TORIC
IOL and need to under correct
Against the rule astigmatism treatment more difficult with AK
or TORIC and need to overcorrect by 0.50D or check posterior
astigmatism.
WHICH SURGICAL TECHNIQUE?
Sub 2mm micro incision (CMICS or BMICS) should be preferred.
Marking in lying position should be avoided as cyclotorsion
induces an average error of 3°.
Horizontal axis marking performed manually is very imprecise
whatever the technique (slit-lamp marking in sitting position or
using a marker with level) as attested by the multitude of available
AK Nomogram100% central pachymetry
and limbal incision.
20° 30° 40°
ONE INCISION 0.25D 0.50D 0.75D
TWO
INCISIONS
1D 1.5D
IOL rotation/power loss Nomogram.
ROTATION IN DEGREE PERCENTAGE OF POWER
LOSS
1-2° 3-6%
5° 15%
10° 30%
15° 45%
20° 60%
Figure 5: Protocol of astigmatism correction.
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instruments (videotape available on YouTube.com http://www.
youtube.com/watch?v=LWCqffd7nkM).
The thickness of the marking pen itself can cause an error of 5°,
which means 15% loss of toric correction power (Figure 6).
Non-marking systems with image projection into the microscope
should solve these technical problems (Verion Alcon, Callisto
Zeiss Meditec and SG3000
SMI etc).
We are carrying out a study to compare the results of manual and
automated methods using the Zeiss non-marking system.
WHICH POSTOPERATIVE FOLLOW UP?
The post-operative follow is like any conventional cataract
surgery and IOL axis should be checked under pupil dilation in case
of bad refractive outcome.
In case of axis error or postoperative IOL rotation, IOL
repositioning under topical anesthesia causes no particular problem.
CONCLUSION
Automation, projection of images into the microscope eyepieces
and FLACS surgery (Femto Laser Assisted Cataract Surgery) are only
the beginning of the development of these IOLs.
However there is a double challenge, of public health and
economic, because if the interest for patients is no longer discussed
it is not the same for health economics: co-payment, or the difference
to be paid by the patient between a monofocal IOL (included in
the GHS) and the premium IOL, is currently tolerated by health
authorities in France but discussions are held since the beginning of
this year to cancel it.
The possibility of inclusion on the List of Reimbursable Products
and Services (LPPR) is not excluded.
Figure 6: Call is to system with marking.
If this new authority price list is frozen as are the rest of our
services we can fear for the future that companies in France will
reduce their investment in innovation for this added value IOLs…
REFRENCES
1. Beatrice Cochener, Catherine Albou-Ganem, Gilles renard. SFO 2012
Report: Presbyopia
2. Elkady B, Alio JL, Ortiz D, Montalban R. Corneal aberrations after
microincision cataract surgery. J Cataract Refract Surg. 2008; 34: 40-45.
https://goo.gl/pOFbji
3. Guan Z, Yuan F, Yuan YZ, Niu WR. Analysis of corneal astigmatism in cataract
surgery candidates at a teaching hospital in Shanghai, China. J Cataract
Refract Surg. 2012; 38:1970-1977. https://goo.gl/crwEvA
4. Bruce WR, Steven D, Richard LL, Kevin W. Prelex Story chapter 190 In
Mastering Refractive IOLs: The Art and Science Edited by David F. Chang.
https://goo.gl/THnQRm
5. Naoyuki Maeda. Assessment of corneal optical quality for Premium IOLs
with pentacam. Highlights of Ophthalmology. 2011; 39: 2-5. https://goo.gl/
ORdS1E
6. Villegas EA, Alcon E, Artal P. Minimum amount of astigmatism that should be
corrected. J Cataract Refract Surg. 2014; 40:13-19. https://goo.gl/gwTlwr
7. Braga MR, Chang D, Dewey S, Foster G, Henderson BA, Hill W, et al.
Multifocal intraocular lenses : Relative indications and contraindications for
implantation. J Cataract Refract Surg. 2014; 40: 313-322. https://goo.gl/
LQ1U5L
8. Cochener B, Lafuma A, Khoshnood B, Courouve L, Berdeaux G. Comparison
of outcomes with multifocal intraocular lenses: a meta analysis. Clin
Ophthalmol. 2011; 5: 45-56. https://goo.gl/O1J5LV
9. Cochener B, Vryghem J, Rozot P, Lesieur G, Heireman S, Blanckaert JA,
et al. Visual and refractive outcomes after implantation of a fully diffractive
trifocal lens. Clin Ophthalmol. 2012; 6: 1421-1427. https://goo.gl/Uf2xSf
10. Lesieur G. Outcomes after implantation of a trifocal diffractive IOL. J Fr
Ophtalmol. 2012; 35: 338-342. https://goo.gl/1k8TV5
11. Lundstrom M, Barry P, Henry Y, Rosen P, Stenevi U. Evidence-based
guidelines for cataract surgery: Guidelines based on data in the European
Registry of Quality Outcomes for Cataract and Refractive Surgery database.
J Cataract Refract Surg. 2012; 38: 1086-1093. https://goo.gl/gzmlt1
12. Visser N1, Bauer NJ, Nuijts RM. Toric Intraocular lenses: Historical overview,
patient selection, IOL calculation, surgical techniques, clinica loutcomes, and
complications. J Cataract Refract Surg 2013 ; 39: 624-637. https://goo.gl/
Sj3HDL
13. Koch DD1, Ali SF, Weikert MP, Shirayama M, Jenkins R, Wang L. Contribution
of posterior corneal astigmatism to total corneal astigmatism. J Cataract
Refract Surg. 2012; 38: 2080-2087. https://goo.gl/Bprvls
14. Fam HB, Lim KL. Meridional analysis for calculating the expected sphero
cylindrical refraction in eyes with toric intraocular lenses. J Cataract Refract
Surg. 2007; 33: 2072-2076. https://goo.gl/1ufKax