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EW RESIDENTS 72 June 2015 by Michael Hemond, MD, Jill Rotruck, MD, Sam Reiter, MD, Adrian Dokey, MD, Kenneth Downes, MD, and Derek Huang, MD grading of glistening severity. No correlation was found; however, due to the small sample size, the power to detect such a correlation would likely be inadequate. We recom- mend that the authors consider analyzing best corrected distance visual acuity (DCVA) and contrast sensitivity between the hydrophobic and hydrophilic lens groups. Lastly, patients in the hydrophobic IOL group with ocular comorbidities were excluded from DCVA and con- trast sensitivity analyses. It is possi- ble that patients with VA or contrast sensitivity limited by comorbidities might have less reserve to overcome the visual effects of glistenings. Recruitment of additional patients with comorbidities could be an interesting subsequent study. In a retrospective case series of 24 patients, Miyata et al 5 added as many as 6 additional years of follow-up to the results of a previous publication comparing the rate of surface light scatter development and its visual effects in hydrophobic acrylic Alcon (Fort Worth, Texas) lenses (MA60BM and SA60AT) and two Abbott Medical Optics (Abbott Park, Ill.) IOLs—the hydropho- bic acrylic AR40 and the silicone Clariflex. They confirmed the prior This month, there are three different papers that document an increase in hydrophobic acrylic IOL glistenings over time. The question is whether they are visually significant. I asked the CPMC residents to evaluate the methods used to assess this question and the conclusions from the three papers. –David F. Chang, MD, EyeWorld journal club editor I ntraocular lenses placed during cataract surgery may develop optical imperfections in the years following implantation. Three new studies investigate the development of glistenings and surface light scatter in intraocular lenses as well as their potential visu- al effects. Glistenings are fluid-filled microvacuoles seen as reflective ar- eas on biomicroscopy that can form inside artificial lenses postoperative- ly. 1 Surface light scatter is believed to result from nanometer-sized subsurface water aggregates 2 and has previously been reported to correlate with glare. 3 The current literature is divided regarding the visual effects of these lens changes. In this article, we will discuss the importance of 3 new studies regarding glistenings and surface light scatter. The article by Chang and Kugelberg 4 reported the results of a randomized clinical trial that inves- tigated the development and visual significance of glistenings in 78 eyes 9 years after the implantation of either a hydrophobic or hydrophilic acrylic IOL. The authors found that while many of the hydrophobic SA60AT IOLs developed glistenings by 9 years post-implantation, they did not develop in the hydrophilic BL27 lenses. This difference was found to be highly statistically significant (P<0.001), confirming with longer follow-up the findings of prior studies. Corrected distance visual acuity and contrast sensitivity were tested in 26 patients from the hydrophobic IOL group and visual outcomes were compared with a Do glistenings affect functional vision? Glistenings 9 years after phacoemulsification in the hydrophobic AcrySof SA60AT IOL and the hydrophilic BL27 IOL Anthony Chang, MD, Maria Kugelberg, MD, PhD J Cataract Refract Surg (June) 2015;41:Article in press Purpose: To compare the development of glistenings after implantation of a hydrophobic acrylic intraocular lens (IOL) and a hydrophilic IOL and evaluate the effect on the corrected distance visual acuity (CDVA) and contrast sensitivity 9 years postoperatively. Setting: St. Erik Eye Hospital, Stockholm, Sweden Design: Randomized clinical trial Methods: One of three senior cataract surgeons performed standard phacoemulsification in one eye of 120 patients with a cataract in this prospective study. The patients were randomized to implantation of either a hydrophobic acrylic IOL or a hydrophilic acrylic IOL. Both IOLs had sharp posterior edges. The CDVA and contrast sensitivity were measured 9 years postoperatively. Scheimpflug images of the IOLs were obtained to analyze the glistenings, which were graded subjectively at the slit lamp and quantified objectively with digital image analysis using computer software. Results: Seventy-eight of the 120 patients were available for the 9-year follow-up examination. Patients implanted with the hydrophilic IOL had significantly (P<0.001) fewer glistenings. The development of glistenings was not correlated with the IOL power, CDVA, or contrast sensitivity. Conclusions: After 9 years, the hydrophobic IOL developed more glistenings than the hydrophilic IOL. Glistenings did not affect the CDVA or contrast sensitivity. Kevin Denny, MD, chair, Department of Ophthalmology California Pacific Medical Center (CPMC) CPMC residents, from left to right: Adrian Dokey, MD, Sam Reiter, MD, Michael Hemond, MD, Kenneth Downes, MD, and Jill Rotruck, MD Source: California Pacific Medical Center EyeWorld journal club

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