Eyeworld

123 EW RESIDENTS October 2017 2. Kamiya K, et al. Multifocal intraocular lens explantation: a case series of 50 eyes. Am J Ophthalmol. 2014;158:215–220. 3. de Silva SR, et al. Multifocal versus monofocal intraocular lenses after cataract extraction. Cochrane Database Syst Rev. 2016;12:CD003169. 4. Vuori E, et al. Refractive surgery in anisometropic adult patients induce plastic changes in primary visual cortex. Acta Oph- thalmol. 2012;90:669–76. 5. Rosa AM, et al. Functional magnetic resonance imaging to assess the neuro- behavioral impact of dysphotopsia with multifocal intraocular lenses. Ophthalmology. 2017;124:1280–1289. 6. Mahncke HW, et al. Brain plasticity and functional losses in the aged: scientific bases for a novel intervention. Prog Brain Res. 2006;157:81–109. Contact information Uhler: TUhler@willseye.org larger studies are needed to confirm its findings and generalize its results, this study is an important contri- bution to our understanding of pa- tients' bothersome visual symptoms after multifocal IOL implantation, and it builds on our understanding of how patients may overcome such visual disability. Acknowledgments The authors would like to thank Robert Bailey, MD, Adam DeBusk, MD, Brad Feldman, MD, Leslie Hyman, MD, Christopher Rapua- no, MD, and Doug Wisner, MD, for their time and assistance in prepar- ing this manuscript. EW References 1. Wang SY, et al. Patient-centered and visual quality outcomes of premium cataract sur- gery: a systematic review. Eur J Ophthalmol. 2017:27:387–401. Functional magnetic resonance imaging to assess neuroadaptation to multifocal intraocular lenses: a longitudinal study Andreia Rosa, MD, Ângela Miranda, MSc, Miguel Patrício, PhD, Colm McAlinden, MD, Fátima Silva, PhD, Miguel Castelo-Branco, MD, Joaquim Murta, MD J Cataract Refract Surg. 2017;43(10). Article in press Purpose: To investigate the use of functional magnetic resonance imaging (fMRI) to assess neuroadaptation to multifocal intraocular lenses (IOLs). Setting: Faculty of Medicine, University of Coimbra, Portugal. Design: Prospective fixed cohort study. Methods: Thirty patients with bilateral diffractive IOL implantation following cataract surgery underwent functional MRI at postoperative intervals of 3 weeks and 6 months. A non-intervention control group (n=15) was included as proof of concept. Functional stimuli consisted of sinusoidal gratings with threshold contrast and a light source to induce disability glare. Subjective quality of vision and reading performance were assessed and wavefront analyses were conducted. Results: Glare decreased the fMRI signal measured for sinusoidal gratings initially (3 weeks), but not at 6 months (p=0.04), as confirmed by contrast detection under glare improvement (p=0.002). Patients showed increased activity of cortical areas involved in visual attention, procedural learning, effortful cognitive control and goal oriented behavior in the early postoperative period, which normalized at 6 months. There were no differences in aberrations, Strehl ratio or modulation transfer function, despite significant decreases of questionnaire symptom scores, and visual acuity and reading performance improvement. The control group remained unchanged. Conclusions: Neuroadaptation to multifocal IOLs takes place initially through recruitment of visual attentional and procedural learning networks. Thereafter, a form of long-term adaptation/functional plasticity occurs, leading to brain activity regularization toward a non-effort pattern. These findings are consistent with functional and questionnaire outcomes and are unrelated to optical properties, which reinforce the crucial role of higher-level brain regions in our perceptual construction of vision. Register Now: www.icoph.org/WOC2018

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