Eyeworld

51 EW FEATURE December 2015 • Patient satisfaction its significance and our ability to measure it are lagging," Dr. Lawless said. Other new tools Dr. Alió has found useful in measuring such outcomes include the OSIRIS (CSO, Florence, Italy), which offers an ab- errometry based not on Hartmann- Shack but on Foucault physics, which constitutes a new technology recently incorporated in the clinical study of ocular optics. Dr. Dexl's department has de- veloped the Salzburg Reading Desk, which measures reading function under variable test circumstance, such as contrast and illumination. "While patients are able to read with an individual subjectively con- venient reading distance, the device automatically calculates the corre- sponding reading acuity—adjusted according to the reading distance— reading speed and smallest print size," Dr. Dexl said. EW Editors' note: Dr. Dexl has financial interests with SRD Vision (Salzburg, Austria). Dr. Kezirian has financial interests with ALPHAEON (Irvine, Calif.). Drs. Alió and Lawless have no financial interests related to this article. Contact information Alió: jlalio@vissum.com Dexl: a.dexl@salk.at Kezirian: guy1000@surgivision.net Lawless: michael.lawless@visioneyeinstitute.com.au in the McAlinden quality of vision questionnaire, which includes a Rasch-tested, linear-scaled, 30-item instrument on three scales providing a quality of vision (QoV) score in terms of symptom frequency, severi- ty, and bothersomeness. "It is suitable for measuring QoV in patients with all types of refractive correction, eye surgery, and eye disease that cause QoV problems," Dr. Lawless said. "It gives great insight into visual performance and is a validated questionnaire so it's as useful as an objective test." Useful tools To test contrast sensitivity, Dr. Lawless uses the CSV-1000 under photopic and mesopic conditions, uniocularly and binocularly. The tests are used with and without a glare source to truly test the visual system. Occasionally, Dr. Lawless also uses a night driving simulator, which is most useful in gauging reaction time and is only in part a measure of visual performance. Two recent advances have greatly added to the ability of oph- thalmologists to understand patient symptoms and to communicate with patients about what they are expe- riencing. The first is the use of light scatter to evaluate the quality of the visual image as it travels through the tear film, cornea, and lens to arrive at the retina. The second develop- ment is the integration of topogra- phy and ray tracing to separate the contribution of the cornea and tear film from the contribution of the lens to image quality. Among the commercially available technologies that measure those outcomes—using different approaches—are the iTrace (Tracey Technologies, Houston), Visiometrics HD Analyzer (Terrassa, Spain), and the OPD III (Marco, Jacksonville, Fla.). "The main application is in the evaluation of visual complaints in presbyopes and deciding on treat- ment options," Dr. Lawless said. "Should the patient have LASIK to correct the refractive error or a lens replacement to address the dysfunc- tional lens syndrome, for example, a lens that will no longer accommo- date?" The images provided by such devices help in counseling patients, according to Dr. Lawless, because they allow the clinician to show the patient what is happening with his or her vision. "For the first time, we have the ability to see what the patients see," Dr. Lawless said. Dr. Alió uses wavefront anal- ysis and aberrometry to measure patients' clinical outcomes in every case that there is any complaint about quality of vision or photophe- nomena. "With a wavefront sensor, KR-1W [Topcon Medical Systems, Oakland, N.J.], it is possible to separate the wavefront of the intra- ocular optics and the corneal surface and understand what exactly is hap- pening to the patient," Dr. Alió said. That approach is used for many multifocal lens recipients when newer models are used as an investi- gational device—particularly among patients reporting some type of disability or dissatisfaction related to the quality of their vision. Dr. Lawless only uses wave- front analysis and aberrometry in complicated patients or second opinions. All of his LASIK cases are wavefront-optimized treatments, rather than wavefront-guided. Occasionally, Dr. Lawless measures and separates out whole eye aber- rometry from corneal aberrometry, particularly in a post-LASIK setting where he is considering what type of intraocular lens will best minimize higher order aberrations. New options Dr. Lawless said light scatter can be measured by the Visiometrics HD Analyzer, which provides an objec- tive scatter index, and the C-Quant (Oculus, Wetzlar, Germany), which has been reported in several stud- ies to evaluate ocular forward light scatter. "Forward scatter is increasingly being recognized as visually dis- abling, but our understanding of EyeWorld Monthly Pulse EyeWorld Monthly Pulse is a reader survey on trends and patterns for the practicing ophthalmologist. Each month we send an online survey covering different topics so our readers can see how they compare to our survey. If you would like to join the hundreds of physicians who take a minute a month to share their views, please send us an email and we will add your name. 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