Journal of refractive surgery最新文献

{"title":"Long-term Corneal Biomechanical Properties of Thin Corneas After Small Incision Lenticule Extraction Surgery: A Prospective Controlled Study.","authors":"Yong Ma, Dan Fu, Xingtao Zhou, Yu Zhao","doi":"10.3928/1081597X-20241204-02","DOIUrl":"https://doi.org/10.3928/1081597X-20241204-02","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate long-term corneal biomechanical changes in thin corneas after small incision lenticule extraction (SMILE).</p><p><strong>Methods: </strong>Patients with indications for SMILE were enrolled in this study between November 2017 and March 2018. Patients were matched for age, spherical diopter, cylinder, spherical equivalent (SE), and lenticule thickness (LT), and then categorized into the thin cornea group (preoperative thinnest central corneal thickness [CCT] of 500 µm or less, 32 eyes) or normal cornea group (CCT of greater than 500 µm, 32 eyes). Corneal biomechanical properties were measured using the Corvis ST system. Data were collected at 1 day, 3 weeks, 3 months, and 3 years postoperatively.</p><p><strong>Results: </strong>At 3 years postoperatively, the safety indexes were 1.06 ± 0.12 and 1.09 ± 0.12 (<i>P</i> = .23) in the thin cornea and normal groups, respectively; the respective effective indexes were 0.89 ± 0.23 and 0.98 ± 0.18 (<i>P</i> = .12). Recovery of overall corneal stiffness was observed in both groups. Comparative analysis of biomechanical parameters revealed that the change between preoperative and 3-year postoperative values was smaller in the thin cornea than in the normal group, without statistical significance. Correlation analysis showed that SE, LT, and CCT were the main parameters affecting changes in corneal biomechanical properties in the normal group. No significant correlations were found between the stress-strain index, Corvis biomechanical index for laser vision correction, and preoperative CCT or age.</p><p><strong>Conclusions: </strong>With rigorous preoperative screening and appropriate surgical design, thin corneas are biomechanically stable in the long term after SMILE. Moreover, postoperative biomechanical strength increases over time. <b>[<i>J Refract Surg</i>. 2025;41(1):e39-e49.]</b>.</p>","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"41 1","pages":"e39-e49"},"PeriodicalIF":2.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Visual Outcomes and IOL Stability After Panoptix Trifocal Intraocular Lens Implantation in Eyes With High Myopia.","authors":"Yinying Zhao, Fuman Yang, Yiling Jiang, Wentao Tong, Jiayan Fang, Yun-E Zhao","doi":"10.3928/1081597X-20241126-03","DOIUrl":"https://doi.org/10.3928/1081597X-20241126-03","url":null,"abstract":"<p><strong>Purpose: </strong>To observe and explore the correlation between visual outcomes and intraocular lens (IOL) stability after tri-focal IOL implantation in eyes with high myopia.</p><p><strong>Methods: </strong>Patients with highly myopic cataract (axial length > 26 mm) were enrolled in this prospective study. Thirty-one eyes (31 patients) received implantation of a trifocal IOL (AcrySof IQ PanOptix TFNT00). Uncorrected distance, intermediate, and near visual acuity (UDVA 5 m, UIVA 60 cm, UNVA 40 cm) and refractive status were evaluated at 1 day, 1 week, 4 weeks, and 3 months postoperatively. The defocus curve was plotted 3 months postoperatively. The IOL tilt, IOL decentration, postoperative aqueous depth, and adhesion of the capsule with IOL were evaluated at 2 hours, 1 week, 4 weeks, and 3 months postoperatively. The correlation between postoperative visual outcomes and dynamic changes in IOL positioning was analyzed.</p><p><strong>Results: </strong>In total, 29 eyes of 29 patients were available for analysis. UDVA, UIVA, and UNVA were 0.03 ± 0.01, 0.03 ± 0.01, and 0.02 ± 0.01 logarithm of the minimum angle of resolution (logMAR) at 3 months postoperatively (mean spherical equivalent [SE]: -0.10 ± 0.04 D). From 1 to 7 days postoperatively, UIVA (<i>P</i> = .031) and UNVA (<i>P</i> = .02) improved, SE shifted to myopic (<i>P</i> = .001), and the IOL moved forward (<i>P</i> < .001). A bimodal defocus curve showed that the visual acuity achieved 0.2 logMAR from +0.50 to -2.50 D, and the peaks were at plano and -2.50 D, reaching 0.04 ± 0.01 and 0.08 ± 0.01 logMAR. The capsular bend index reached 3.35 ± 0.06 at 3 months postoperatively. There were no significant changes in tilt and decentration during the postoperative follow-up period.</p><p><strong>Conclusions: </strong>This trifocal IOL provides excellent visual acuity at far, intermediate, and near distance in high myopia eyes. The postoperative position of the IOL was relatively stable in eyes with highly myopic cataracts. <b>[<i>J Refract Surg</i>. 2025;41(1):e56-e64.]</b>.</p>","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"41 1","pages":"e56-e64"},"PeriodicalIF":2.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Visual and Safety Outcomes of Refractive Correction Procedures Following Lens Removal for Residual Refractive Error: A Systematic Review and Meta-analysis.","authors":"Jehad Alorainy, Abdullah Alanzan, Nawaf Alghamdi, Abdulaziz Alghuligah, Raed Alnutaifi, Abdulrahman Alsubhi, Wael Otaif, Abdulrahman Almuammar","doi":"10.3928/1081597X-20241113-03","DOIUrl":"10.3928/1081597X-20241113-03","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate residual refractive errors after intraocular lens (IOL) extraction and the safety and effectiveness of refractive correction procedures.</p><p><strong>Methods: </strong>The eligibility criteria for this systematic review were patients who had undergone cataract or clear lens extraction and had experienced residual refractive error. All study designs were considered for inclusion and non-English publications, non-peer reviewed articles, books, and systematic reviews were excluded. A comprehensive electronic search strategy was employed on PubMed, Scopus, Web of Science, Cochrane, and Embase databases from January 1, 1950, to August 1, 2023.</p><p><strong>Results: </strong>This review examined 55 articles with 2,223 eyes. Piggyback IOL and IOL exchange are highly effective in correcting both myopia and hyperopia, showing significant improvements in spherical and cylindrical errors. Among corneal-based procedures, laser in situ keratomileusis offers a strong balance, with substantial reductions in both spherical and cylindrical errors, along with a favorable safety profile. Small incision lenticule extraction improves uncorrected distance visual acuity (UDVA), particularly in hyperopic patients, whereas photorefractive keratectomy is effective for both UDVA and astigmatism correction, although it has less impact on corrected distance visual acuity (CDVA). Conductive keratoplasty is effective but has greater variability and a higher incidence of complications.</p><p><strong>Conclusions: </strong>Significant improvements in spherical equivalent were consistently observed after treatment across the different procedures. Both UDVA and CDVA demonstrated notable enhancements, suggesting an overall efficacy in improving visual function. Although complications were reported, they were generally low in incidence and varied across procedure types. <b>[<i>J Refract Surg</i>. 2025;41(1):e73-e87.]</b>.</p>","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"41 1","pages":"e73-e87"},"PeriodicalIF":2.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rotational Stability and Outcomes of V4c Toric Implantable Collamer Lenses Placed at Different Lens Orientations.","authors":"Yukun Yang, Fengjiao Zhu, Yiping Ma, Jing Li, Xiaoxi Li, Xiaoming Yao","doi":"10.3928/1081597X-20241126-05","DOIUrl":"https://doi.org/10.3928/1081597X-20241126-05","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the 12-month rotational stability and outcomes of V4c toric Implantable Collamer Lenses (TICLs) (STAAR Surgical) located at two different lens orientations (horizontal or oblique).</p><p><strong>Methods: </strong>This retrospective study included a total of 403 eyes with TICL implantation, enrolled between January 2021 and December 2022, that were divided into two groups based on the minimum intended angle off the horizontal axis: horizontal with 263 eyes at an angle ±22.5 degrees or less and oblique with 140 eyes at a minimum intended angle of greater than ±22.5 degrees. A comparison was made of the preoperative characteristics, surgical outcomes, secondary surgical interventions, footplate positions, and adverse events at 1, 6, and 12 months postoperatively. The rotation-related factors were analyzed.</p><p><strong>Results: </strong>At 12 months, there were 243 eyes (92%) in the horizontal group and 130 eyes (93%) in the oblique group that were within ±0.50 diopters (D) of emmetropia. Their rotation proportion was 5.3 % and 5.7%, respectively, and their rotation angle was 9.11 ± 2.84 and 9.96 ± 2.42 degrees, respectively (<i>P</i> = .086). TICL footplates were mostly positioned on the ciliary body. No correlation was observed of lens placement axis, vault, or manifest refraction with rotation in both groups (<i>P</i> > .05). During the follow-up, no vision-threatening complications were observed in both groups. Rotation cases were successfully addressed via alignment or lens exchange.</p><p><strong>Conclusions: </strong>TICLs, when implanted across a range of lens orientations, demonstrated favorable rotational stability and postoperative outcomes. The postoperative rotational stability is independent of the placement angle of the TICL. <b>[<i>J Refract Surg</i>. 2025;41(1):e29-e38.]</b>.</p>","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"41 1","pages":"e29-e38"},"PeriodicalIF":2.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Application of the Taylor Diagram in Evaluating the Performance of IOL Formulas.","authors":"Bing Zhang","doi":"10.3928/1081597X-20241126-04","DOIUrl":"https://doi.org/10.3928/1081597X-20241126-04","url":null,"abstract":"<p><strong>Purpose: </strong>To apply a new method, the Taylor Diagram, and a new concept, the centered root mean square error (cRMSE), in evaluating the performance of IOL formulas.</p><p><strong>Methods: </strong>The preoperative biometrics were measured with the IOLMaster 700 (Carl Zeiss Meditec) and the postoperative spherical equivalent refraction (SER) was calculated in 888 anonymous patients. The Taylor Diagram was applied to visualize the centered root mean square error (cRMSE) and the correlation coefficient between the predictions and the observations (R_po). Ten formulas across generations were optimized by zeroing the mean predictive error, including SRK I, SRK II, SRK/T, Holladay I, Hoffer-Q, Haigis, Barrett Universal II, VRF, EVO 2.0, and Næser 2. The RMSE and cRMSE at a range of IOL constants around the optimized constant were calculated for SRK/T, Holladay I, Hoffer-Q, and Haigis.</p><p><strong>Results: </strong>The Taylor Diagram showed improved performance of formulas across generations and the aggregations of the same-generation formulas. The SRK I performed worst with an RMSE of 0.819 and R_po of 0.659, and the EVO 2.0 performed best with an RMSE of 0.341 and R_po of 0.930. At a range of IOL constants, cRMSE is generally much closer to the optimized value than RMSE. At a relatively wide range of constant values, cRMSEs showed no significant discrepancy with the optimized value at the optimized constant.</p><p><strong>Conclusions: </strong>The Taylor Diagram is a powerful tool for visualizing the performances of IOL formulas. Constant optimization is proved necessary. When the optimization is unavailable, cRMSE is a good approximation. <b>[<i>J Refract Surg</i>. 2025;41(1):e50-e55.]</b>.</p>","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"41 1","pages":"e50-e55"},"PeriodicalIF":2.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Nomogram to Improve the Predictability of High Myopic Astigmatism in Small Incision Lenticule Extraction Surgery.","authors":"Na Yu, Xiangtao Hou, Chang Liu, Pei Chen, Yiming Ye, Min Lan, Jing Zhuang, Keming Yu","doi":"10.3928/1081597X-20241126-01","DOIUrl":"https://doi.org/10.3928/1081597X-20241126-01","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate a new regression-derived nomogram for high myopic astigmatism in small incision lenticule extraction (SMILE) surgery.</p><p><strong>Methods: </strong>In this prospective study, data from 180 eyes with myopic astigmatism ranging from -2.50 to -4.50 diopters (D) at 3 months after SMILE surgery were analyzed to construct the astigmatic nomogram. Linear regression between target induced astigmatism and flattening effect formula was derived as a nomogram to adjust astigmatic treatment. The nomogram was applied to 112 eyes with astigmatism ranging from -2.75 to -4.50 D. Subsequently, 143 eyes (manifest refraction group) with astigmatism greater than 2.50 D from 180 eyes were compared with 112 eyes (astigmatic nomogram group). Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and refractive outcomes at 3 months postoperatively were recorded.</p><p><strong>Results: </strong>At 3 months after surgery, there was no difference in postoperative degree of astigmatism or UDVA between the two groups. In the astigmatic nomogram group, 109 (97%) of the eyes were within ±0.50 D compared with 127 (89%) in the manifest refraction group (<i>P</i> = .010). Target induced astigmatism and surgically induced astigmatism were strongly correlated in both groups. However, the average undercorrection in the manifest refraction group was 8.4% (<i>R</i>² = 0.67), whereas the astigmatic nomogram group displayed 2.7% overcorrection (<i>R</i>² = 0.86). Moreover, interestingly, all eyes in the astigmatic nomogram group had an angle of error within -5° to 5° compared with 137 (95.8%) of the eyes in the manifest refraction group (<i>P</i> = .028).</p><p><strong>Conclusions: </strong>The astigmatic nomogram, based on regression between target induced astigmatism and flattening effect, could enhance the accuracy and predictability of high myopic astigmatism correction in SMILE surgery. <b>[<i>J Refract Surg</i>. 2025;41(1):e65-e72.]</b>.</p>","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"41 1","pages":"e65-e72"},"PeriodicalIF":2.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of the Visual Outcomes and Optical Quality of Small Incision Lenticule Extraction and Toric Implantable Collamer Lens Implantation to Correct High Astigmatism.","authors":"Yuliang Wang, Yujia Liu, Jianghong Hu, Xiaoying Wang, Xingtao Zhou, Jia Huang","doi":"10.3928/1081597X-20241014-01","DOIUrl":"https://doi.org/10.3928/1081597X-20241014-01","url":null,"abstract":"<p><strong>Purpose: </strong>To compare 6-month visual outcomes and optical quality after small incision lenticule extraction (SMILE) and toric Implantable Collamer Lens (ICL) (STAAR Surgical Company) implantation for high myopia astigmatism.</p><p><strong>Methods: </strong>This was a prospective non-randomized study. Overall, 88 eyes of 88 patients with high astigmatism (≥ 2.00 diopters [D]) were enrolled, comprising 42 and 46 eyes in the SMILE and toric ICL groups, respectively. Uncorrected distance visual acuity, corrected distance visual acuity, subjective manifest refraction, and higher order aberrations (HOAs) were examined before and 6 months after surgery. The astigmatism outcomes were further analyzed using Alpins vector analysis.</p><p><strong>Results: </strong>The preoperative astigmatism was -3.20 ± 0.58 D in the SMILE group and -3.09 ± 0.81 D in the toric ICL group (<i>P</i> = .495), respectively, and the postoperative astigmatism was -0.58 ± 0.39 and -0.72 ± 0.41 D (<i>P</i> = .099) in the SMILE and toric ICL groups, respectively, at the 6-month visit. Surgically induced astigmatism, correction index, difference vector, the magnitude of error, and index of success were comparable between the two groups (<i>P</i> > .05). The Alpins vector analysis indicated a significant difference in absolute values of the angle of error between the two groups (SMILE: 3.05 ± 2.98°, toric ICL: 4.70 ± 3.84°; <i>P</i> = .027). Compared with the SMILE group, the toric ICL group exhibited significantly fewer HOAs at the 6-month follow-up visit, including total HOAs, total coma, horizontal coma, vertical coma, and spherical aberrations.</p><p><strong>Conclusions: </strong>Both SMILE and toric ICL implantation showed satisfactory efficacy and safety in correcting high myopia astigmatism, whereas toric ICL implantation induced fewer HOAs, leading to better postoperative visual quality. <b>[<i>J Refract Surg</i>. 2024;40(12):e916-e925.]</b>.</p>","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"40 12","pages":"e916-e925"},"PeriodicalIF":2.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142800971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Ocular Residual Astigmatism on Refractive Outcomes for Myopia Correction After Keratorefractive Lenticule Extraction Surgery.","authors":"Qing Su, Shuang Liang, Huazheng Cao, Mengyuan Shan, Yan Wang","doi":"10.3928/1081597X-20241016-02","DOIUrl":"https://doi.org/10.3928/1081597X-20241016-02","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the effects of ocular residual astigmatism (ORA) on refractive outcomes for patients with astigmatism after keratorefractive lenticule extraction (KLEx) and to identify the ratio of the ORA/manifest refractive cylinder at the corneal plane (MRC) resulting in a greater index of success (IOS).</p><p><strong>Methods: </strong>In total, 892 right eyes that underwent KLEx surgery were included. Astigmatic changes were evaluated using Alpins' vector analysis. Surgical outcomes grouped by ORA/MRC and ORA were compared. In stage 1, eyes were divided into two groups with an ORA/MRC cutoff value of 1. In stage 2, patients with an ORA/MRC ratio of greater than 1 were divided into two groups: those with an ORA of 1.25 diopters (D) or greater and those with an ORA of less than 0.50 D. ORA/MRC thresholds leading to a high IOS were analyzed using receiver operating characteristic (ROC) curves.</p><p><strong>Results: </strong>In stage 1, the mean IOS was 0.13 and 0.21 for the low and high ORA/MRC groups, respectively (<i>P</i> < .001). In stage 2, for high ORA/MRC, the IOS was significantly greater when the ORA was greater than 1.25 D than when the ORA was less than 0.50 D (0.27 versus 0.13, <i>P</i> < .001). ROC curves revealed that participants with an ORA/MRC ratio of greater than 1.8 were more likely to have a higher IOS (<i>P</i> < .001).</p><p><strong>Conclusions: </strong>Patients with a smaller ORA can obtain better correction results. An ORA/MRC ratio of greater than 1.8 may increase the risk of poor astigmatism correction with KLEx. The application of vector planning may improve the refractive outcomes of KLEx. <b>[<i>J Refract Surg</i>. 2024;40(12):e966-e973.]</b>.</p>","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"40 12","pages":"e966-e973"},"PeriodicalIF":2.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142801185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing Predicted Visual Acuity After SmartSight Lenticule Extraction: Identifying Key Factors With Machine Learning.","authors":"Soodabeh Darzi, Kishore Raj Pradhan, Samuel Arba-Mosquera","doi":"10.3928/1081597X-20241030-01","DOIUrl":"https://doi.org/10.3928/1081597X-20241030-01","url":null,"abstract":"<p><strong>Purpose: </strong>To develop a predictive model aimed at assessing the likelihood of improvement in corrected distance visual acuity (CDVA) for patients undergoing lenticule extraction using the SmartSight system from SCHWIND eye-tech-solutions. This model evaluates the effectiveness and weight of various clinical and procedural parameters in predicting enhancements in visual acuity.</p><p><strong>Methods: </strong>Data from 1,262 eyes treated with the SmartSight system, encompassing 86 features, were analyzed. Regression and classification techniques were employed to estimate the probability of CDVA gain, ensuring robust results by comparing different methods. The dataset was divided into training (70%, 883 treatments) and testing (30%, 379 treatments) subsets to ensure comprehensive model evaluation using machine learning methods. Feature significance was determined via analysis of variance and principal components analysis to identify impactful parameters.</p><p><strong>Results: </strong>Three principal components accounting for more than 70% of the data variance were identified. The first component was primarily linked to system settings, whereas the second and third components were associated with patient gender and laterality. Factors significantly influencing CDVA improvement included a higher spot-to-track distance ratio, tighter track distance, lower pulse energy, lower average laser power, larger spot distance, greater cap thickness, and lower dosage. These variables were ranked based on their impact on CDVA enhancement.</p><p><strong>Conclusions: </strong>Using low-energy asymmetric spacing for lenticule extraction with the SmartSight system is safe and effective. This approach improves visual outcomes for patients undergoing treatment for myopic astigmatism, offering a reliable method for predicting CDVA improvements. <b>[<i>J Refract Surg</i>. 2024;40(12):e974-e984.]</b>.</p>","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"40 12","pages":"e974-e984"},"PeriodicalIF":2.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142801187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"RBG Photoreceptors.","authors":"Luis Miguel Gutierrez","doi":"10.3928/1081597X-20241119-01","DOIUrl":"https://doi.org/10.3928/1081597X-20241119-01","url":null,"abstract":"","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"40 12","pages":"e910"},"PeriodicalIF":2.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142801194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}