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Biomedical subjects

Robert Montés-Micó

Publications and source records attributed to Robert Montés-Micó.

At least 19 recordsLinked to original sources
PubMed2006

Femtosecond laser versus mechanical keratome LASIK for myopia.

OBJECTIVE: To assess efficacy, safety, predictability, stability, and changes in corneal higher-order aberrations (CHOAs) and contrast sensitivity (CS) after a femtosecond laser for LASIK and standard LASIK for myopia. DESIGN: Prospective, randomized, comparative clinical study. PARTICIPANTS: Two hundred eyes of 100 consecutive patients who underwent LASIK treatment using the VISX S2 laser system. A femtosecond laser for flap creation was used in 100 eyes (50 patients; spherical equivalent [SE], -2.85+/-1.79 diopters [D]), and a mechanical microkeratome was used in 100 eyes (50 patients; SE, -2.90+/-1.63 D). METHODS: Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), manifest refraction, CS by means of the Functional Acuity Contrast Test, and CHOAs by means of custom software linked to topography were evaluated preoperatively and 6 months after treatment. MAIN OUTCOME MEASURES: Efficacy, safety, predictability, stability, CHOAs, and CS were evaluated before and after surgery at 6 months' follow-up. RESULTS: At 6 months postoperatively, UCVA was 1.0 or better in 100% of the eyes. Efficacy indexes were 1.07 for the femtosecond laser for LASIK patients and 1.00 for LASIK patients. No eye lost > or =1 lines of BCVA; for the femtosecond laser for LASIK group, 24 eyes gained 1 line, and 18 eyes gained > or =2 lines; for the LASIK group, 18 eyes gained 1 line. The femtosecond laser for LASIK group showed a percentage of eyes (98%) within the 0.5-D range in SE higher than that of the LASIK group (92%). For a 3.5-mm pupil, CHOAs' root-mean-square (RMS) increased for both the femtosecond laser for LASIK (2.21-fold) and LASIK (2.81-fold) groups. For a 6-mm pupil, CHOA RMSs were increased significantly after femtosecond laser for LASIK (4.18-fold) and LASIK (5.07-fold) surgeries (P<0.01). Contrast sensitivity improved only in the femtosecond laser for LASIK group at the highest spatial frequency (18 cycles/degree; P<0.01) after surgery. CONCLUSIONS: A femtosecond laser for LASIK surgery is an effective and, in this series, safe procedure for treatment of myopia. The improvements in UCVA and CS after the femtosecond laser for LASIK are related to the differences in postoperative CHOAs found with femtosecond and microkeratome flap creation.

Adult↗
PubMed2006

Spherical aberration and contrast sensitivity after cataract surgery with the Tecnis Z9000 intraocular lens.

PURPOSE: To determine whether implantation of an intraocular lens (IOL) with a modified prolate anterior surface (Tecnis Z9000, AMO) results in reduced spherical aberration and improved contrast sensitivity after cataract surgery. SETTING: Hospital NISA Virgen del Consuelo, Valencia, Spain. METHODS: In an intraindividual randomized prospective study of 30 patients with bilateral cataract, the Tecnis Z9000 IOL was compared with 2 IOLs with spherical surfaces, the AR40e (AMO) and the Stabibag (Ioltech). Ocular aberrations for a 4.0 mm pupil and 6.0 mm pupil were measured with a Hartmann-Shack aberrometer. Quality of vision was measured by visual acuity and contrast sensitivity under mesopic and photopic conditions. RESULTS: Eyes with the Tecnis Z9000 IOL had significantly less spherical aberration and a greater Strehl ratio after surgery. Significant reduction in coma aberration was also found in some cases. Refraction, visual acuity, and contrast sensitivity were not significantly different between the 3 IOL groups. CONCLUSION: A significant reduction in spherical aberration after Tecnis Z9000 IOL implantation was achieved, but visual acuity and contrast sensitivity were not affected by the aspheric silicone IOL compared to spherical acrylic IOLs.

Aged↗
PubMed2005

Crystalline lens optical dysfunction through aging.

PURPOSE: To evaluate the optical and densitometric changes that take place in the crystalline lens with aging. DESIGN: Cross-sectional study. PARTICIPANTS: Seventy-two eyes of 72 patients of different ages (8-80 years) with a clear lens, a visual acuity of 20/25 or better, and no ocular disease. METHODS: In each case, the lens thickness, optical density, modulation transfer function (MTF), and intraocular aberrations were measured. MAIN OUTCOME MEASURES: Embryonic and fetal nucleus density, lens thickness, intraocular high-order aberration (HOA), and 0.1 MTF. RESULTS: Embryonic, anterior, and posterior fetal nucleus densities show a positive correlation with age (P<0.0001, P<0.0001, and P<0.0001, respectively). Lens thickness also shows a positive correlation with age (P<0.0001). Total ocular and corneal HOAs for a 6-mm pupil show a positive correlation with age (P = 0.036 and P<0.0001, respectively). Ocular and corneal Zernike polynomials Z4i+Z6i and intraocular spherical aberration (Z4(0)) also show a positive correlation with age (P = 0.001, P = 0.039, and P = 0.001, respectively). Intraocular coma aberration (Z3(-1)) shows a negative linear correlation with age (P<0.0001). In addition, 0.1 MTF decreased with age from 18.557 to 10.100 cycles per degree. CONCLUSION: There is a degradation of the optical quality of the crystalline lens with aging that is associated with morphological changes (thickness and density). These results are important for the consideration of lens replacement in the absence of evident cataract.

Adolescent↗
PubMed2005

Artisan iris-claw phakic intraocular lens followed by laser in situ keratomileusis for high hyperopia.

PURPOSE: To evaluate safety, efficacy, predictability, stability, complications, and patient satisfaction after Artisan phakic intraocular lens (IOL) implantation followed by laser in situ keratomileusis (LASIK) for the correction of high hyperopia. SETTING: Instituto Oftalmólogico de Alicante, Alicante, Spain. METHODS: This prospective trial included 39 eyes with a mean preoperative spherical equivalent (SE) of 7.39 diopters (D) +/- 1.30 (SD) and a cylinder between 0 and -4.25 D. The Artisan iris-fixated phakic IOL (Ophtec) for hyperopia was implanted, and LASIK was performed 6 to 8 months later. The best corrected visual acuity (BCVA), uncorrected visual acuity (UCVA), refraction, endothelial cell loss (ECL), endothelium morphologic analysis, and patient satisfaction were recorded. The minimum follow-up was 12 months. RESULTS: At 1 year, 37 eyes (94.9%) were within +/-1.00 D of emmetropia and 31 eyes (79.5%) were within +/-0.50 D. Thirty-five eyes (89.7%) achieved a UCVA of 0.5 or better. There was a statistically significant decrease in BCVA after phakic IOL implantation, but this effect was corrected after LASIK. Nine eyes (23.1%) lost 1 line of BCVA; 7 eyes (17.9%) gained at least 1 line. One eye (2.6%) showed a change in SE greater than 1.0 D over the follow-up period. The mean ECL was 10.9%, but morphologic analysis suggested no additional damage caused by LASIK over that produced by phakic IOL surgery. Overall patient satisfaction was high. CONCLUSIONS: The combination of Artisan phakic IOL implantation and LASIK safely, predictably, and effectively reduced high hyperopia. A loss of 1 line of BCVA should be expected in about one third of eyes implanted with this IOL. Halos and glare at night remain a potential problem.

Adult↗
PubMed2005

Keratectasia after bilateral laser in situ keratomileusis in a patient with previous radial and astigmatic keratotomy.

We describe a case of bilateral keratectasia after laser in situ keratomileusis (LASIK) in a patient with previous radial keratotomy and astigmatic keratotomy. The best spectacle-corrected visual acuity (BSCVA) was 20/25 in both eyes. After uneventful LASIK was performed in both eyes for low myopic astigmatism, the patient presented with progressive myopia and astigmatism and a BSCVA of 20/50 in both eyes. Videokeratography showed progressive deformation of the cornea, increasing K-values over 50.0 diopters, and irregular astigmatism. The best corrected visual acuity in both eyes improved to 20/25 with rigid poly(methyl methacrylate) contact lenses.

Adult↗
PubMed2005

Retinal image quality after microincision intraocular lens implantation.

PURPOSE: To evaluate the modulation-transfer function (MTF) in eyes implanted with a conventional intraocular lens (IOL) and 2 IOLs designed for microincision cataract surgery (MICS). SETTING: Research, Development, and Innovation Department, Instituto Oftalmológico de Alicante, Alicante, Spain. METHODS: This prospective nonrandomized consecutive series comprised 30 eyes implanted with 1 of the following IOLs: conventional acrylic foldable (AcrySof MA60BM, Alcon Laboratories) or the UltraChoice 1.0 ThinOptX (ThinOptX Inc.) or the Acri. Smart 48S (Acri.Tech) MICS IOL. The 0.5 MTF and 0.1 MTF following MICS were calculated 3 months after implantation with the Optical Quality Analysis System (OQAS) for a 5 mm pupil. The differences were statistically analyzed with the Mann-Whitney U test. RESULTS: The values of 0.5 MTF for AcrySof, UltraChoice, ThinOptX, and Acri. Smart IOLs were, respectively, 2.647 cycles per degree (cpd) +/- 0.833 (SD), 2.601 +/- 0.986 cpd, and 3.453 +/- 0.778 cpd. The mean 0.1 MTF values for the same IOLs were 8.720 +/- 3.074 cpd, 8.814 +/- 4.380 cpd, and 11.418 +/- 2.574 cpd, respectively. Statistical analysis did not show significant differences in 0.5 MTF and 0.1 MTF between the conventional IOL and MICS IOLs. CONCLUSIONS: Microincision cataract surgery IOLs showed excellent MTF performance when implanted after cataract surgery, equal to that of conventional IOLs. An in vivo MTF study may be an excellent option to evaluate IOL performance in the eye.

Acrylic Resins↗
PubMed2005

Comparison of contrast sensitivity and color discrimination after clear and yellow intraocular lens implantation.

PURPOSE: To compare contrast sensitivity and color vision in patients in whom blue-light filtering and non-yellow-tinted intraocular lenses (IOLs) were implanted. SETTING: Refractive Surgery Unit, Hospital NISA Valencia al Mar, Valencia, Spain. METHODS: Forty eyes of 20 patients were enrolled in a blue-light filtering fellow-eye control study; patients were implanted with a yellow-tinted IOL (AcrySof Natural, Alcon) in 1 eye and a non-yellow-tinted IOL (AcrySof SA60AT, Alcon) in the fellow eye after cataract surgery. Three months postoperatively, monocular contrast sensitivity function was measured with the CSV 1000-E contrast sensitivity chart at distance and the color discrimination with the Farnsworth-Munsell 100 Hue test. RESULTS: Eyes implanted with blue-light filtering IOLs showed similar contrast sensitivity to that in fellow eyes implanted with non-yellow-tinted IOLs (P>.1). Both types of IOLs showed normal contrast sensitivity values (normalized log-contrast sensitivity about 1.0). There were no statistically significant differences in chromatic discrimination between the 2 types of IOLs (P = .56). CONCLUSION: The use of blue-light filtering IOLs is more advisable because they are capable of protecting the retina against ultraviolet light without disturbance of contrast sensitivity and chromatic vision, which produces subjective impairment in visual function.

Aged↗
PubMed2005

Blue-light filtering intraocular lens in patients with diabetes: contrast sensitivity and chromatic discrimination.

PURPOSE: To evaluate potential changes in contrast sensitivity and color discrimination in diabetic patients who had cataract surgery and implantation of the blue-light filtering AcrySof Natural (SN60AT) intraocular lens (IOL) compared with an ultraviolet-only filtering (AcrySof SA60AT) IOL. SETTING: Refractive Surgery Unit, Hospital NISA Valencia al Mar, Valencia, Spain. METHODS: Forty-four eyes of 22 diabetic patients were enrolled in a blue-light filtering fellow-eye control study. Patients received yellow-tinted IOLs (AcrySof Natural) in 1 eye and non-yellow-tinted IOLs (AcrySof SA60AT) in the fellow eye. Three months after surgery, monocular contrast sensitivity function was measured with the CSV 1000-E contrast sensitivity chart at distance and color discrimination was tested with the Farnsworth-Munsell 100-hue test. RESULTS: Eyes implanted with the blue-light filtering IOLs showed better contrast sensitivity values than fellow eyes implanted with non-yellow-tinted IOLs (P<.05). The blue-light filtering IOL did not modify chromatic discrimination compared with the non-yellow-tinted IOL (P = .62). In the blue-yellow axis discrimination study, the eyes implanted with the AcrySof Natural IOL had statistically significant better color vision (P = .008). CONCLUSIONS: In diabetic patients, the AcrySof Natural IOL provides better contrast sensitivity than the AcrySof SA60AT. The blue-light filter of the AcrySof Natural IOL did not cause chromatic discrimination defects based on total error scores and improved color vision in the blue-yellow chromatic axis in diabetic patients.

Aged↗
PubMed2005

Dynamic changes in the tear film in dry eyes.

PURPOSE: To examine the dynamics of the tear film in patients with dry eye by measuring the wavefront aberrations of the anterior surface of the film. METHODS: Anterior surface aberrations for a 7-mm pupil were determined in 13 patients with dry eye at 1-second time intervals, for 15 seconds after a blink. The aberrations were calculated from the elevations provided by corneal topography. All data were decomposed using Zernike polynomials. Total, spherical, and comalike aberrations terms were studied separately. Results were compared with those in normal eyes. Outcome measures included comparison with clinical tear breakup time measurements. RESULTS: The total root mean square (RMS) wavefront aberration in patients with dry eye passed through in a minimum of 2.9 +/- 0.4 seconds after a blink in comparison to the minimum at 6.1 +/- 0.5 seconds in normal patients. In both groups, the minimum in total aberration appeared to be associated with similar changes in comalike aberrations, rather than in spherical aberrations, which increased monotonically with time. The time at which minimum RMS aberration occurred correlated reasonably well with the measured tear breakup times. CONCLUSIONS: Measurements of the dynamic changes in the optical aberrations introduced by the anterior tear film surface give valuable insights into tear film changes and may provide a convenient objective method for the diagnosis of dry eye.

Adult↗
PubMed2005

Postblink changes in the ocular modulation transfer function measured by a double-pass method.

PURPOSE: To examine the temporal changes in the modulation transfer function (MTF) of the eye after a blink. METHODS: The distance MTF of a 5-mm pupil was derived from double-pass retinal images in 20 healthy young subjects at various intervals after a blink (1 second up to 15 seconds). Such measurements include the effects of wavefront aberration, scattered light, and errors in focus and are thus more relevant to real life than are estimates of MTF based on wavefront errors alone. RESULTS: Optimal MTF by a variety of criteria was found some 6 seconds after a blink. CONCLUSIONS: Inclusion of the effects of stray light and errors of focus does not affect the finding that optimal retinal image quality occurs some time after a blink. It does not appear that a loss in optical quality is the trigger of normal blinking.

Accommodation, Ocular↗
PubMed2004

Bitoric laser in situ keratomileusis for astigmatism.

PURPOSE: To evaluate the efficacy, predictability, and safety of bitoric laser in situ keratomileusis (LASIK) for the correction of mixed astigmatism. SETTING: Instituto Oftalmológico de Alicante, Alicante, Spain. METHODS: This prospective study included 28 eyes of 21 patients with mixed astigmatism who had bitoric LASIK using the Hansatome microkeratome (Bausch & Lomb Surgical) and the Chiron Technolas 217 excimer laser (Bausch & Lomb Surgical). The main outcome measures were uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), defocus equivalent, blur strength, and refraction. RESULTS: Six months after bitoric LASIK, the mean UCVA was 0.70 +/- 0.23 (SD). The percentage of eyes with a UCVA of 20/40 or better was 78.6% and of 20/20, 21.4%. There was a statistically significant increase in the mean BCVA from 0.71 +/- 0.19 before surgery to 0.83 +/- 0.15 at 6 months (P =.0004). Three eyes (10.7%) lost 1 line of BCVA; 19 eyes (67.9%) gained 1 or more lines. The mean preoperative astigmatism of -4.04 +/- 1.13 diopters (D) was reduced to -0.67 +/- 0.79 D after surgery. The defocus equivalent was less than 1.00 D in 75.0% of eyes and less than 0.50 D in 64.3%. Vector analysis showed that the mean achieved correction was 97.4% of the intended correction. CONCLUSIONS: Bitoric LASIK was a safe, effective, and predictable procedure in the treatment of mixed astigmatism. It is a means to improving BCVA in a significant percentage of patients.

Adult↗
PubMed2004

Corneal aberrations after astigmatic keratotomy combined with laser in situ keratomileusis.

PURPOSE: To evaluate the optical aberrations in the cornea before and after astigmatic keratotomy (AK) combined with laser in situ keratomileusis (LASIK) in a group of patients with high myopic astigmatism. SETTING: Refractive Surgery Unit, NISA Hospital Virgen del Consuelo, Valencia, Spain. METHODS: Twelve patients (24 eyes) with high myopic astigmatism (from 3.50 to 6.00 diopters) participated in the study. Astigmatic keratotomy was performed as the first step to reduce astigmatism; after 2 months, the residual refractive error was corrected with LASIK. Videokeratography measurements were conducted before and after each procedure. Topography maps were used to calculate the wavefront corneal aberrations for a 6.0 mm pupil diameter. RESULTS: Total, coma-like, and spherical-like aberrations increased significantly from preoperatively to post LASIK (x6.34, x2.52, and x10.50, respectively; P<.01). Astigmatic keratotomy significantly increased coma-like (x4.04; P<.01) and spherical-like (x5.66; P<.01) aberrations. After LASIK, the coma-like aberration was significantly reduced (x0.62; P =.008) and the spherical-like aberration was significantly increased (x1.86; P<.01). CONCLUSION: Astigmatic keratotomy increased higher-order corneal aberrations, both coma-like and spherical-like, whereas LASIK performed after AK increased the spherical-like aberration and reduced the coma-like aberration.

Adult↗
PubMed2004

Changes in ocular aberrations after instillation of artificial tears in dry-eye patients.

PURPOSE: To study the effect of artificial tear instillation on ocular aberrations in dry-eye patients. SETTING: Research, Development and Innovation Department, Instituto Oftalmológico de Alicante, Alicante, Spain. METHODS: Ocular aberrations (total, spherical-like, and coma-like) were measured with a Hartmann-Shack aberrometer before and after artificial tear instillation (immediately and 10 minutes later) in 15 eyes of 15 dry-eye patients. RESULTS: Optical aberrations showed a statistically significant reduction after artificial tear instillation (P<.01). Total aberrations decreased on average by a factor of 2 to 3 times immediately after instillation; the reduction was maintained after 10 minutes (P>.01). CONCLUSIONS: After artificial tear instillation, the reduction in optical aberrations associated with an increasingly irregular tear film may cause an improvement in the optical quality of dry eyes. Wavefront analysis facilitates the evaluation of improvement in optical quality after artificial tear instillation in patients with dry eye.

Adult↗
PubMed2004

Postblink changes in total and corneal ocular aberrations.

OBJECTIVE: The purpose of this study was to determine objectively the changes in optical aberrations induced by the progressive tear film irregularity after a blink and their effects on retinal image quality. DESIGN: Prospective, consecutive, nonrandomized comparative trial (self-controlled). PARTICIPANTS: Twenty healthy subjects. MAIN OUTCOME MEASURES: Corneal and total ocular aberrations were determined in 20 subjects at various time intervals (approximately 0, 10, and 20 seconds) after a blink. Corneal and total aberrations were measured with an Orbscan II topographer (Orbtek Inc, Salt Lake City, UT) and a Zywave aberrometer (Bausch & Lomb, Irvine, CA), respectively. All data were decomposed using Zernike polynomials to yield the root mean square wavefront deviations, in micrometers (microm), for different pupil diameters (3.5, 4.5, 5.5, and 6.5 mm). A merit function (Mf), defined as the volume under the 2-dimensional modulation transfer function as computed from the total wavefront error, was taken as the image quality metric. RESULTS: Both corneal and total aberrations (third order and higher) showed a statistically significant increase with time after the blink for all pupil diameters except 3.5 mm. The magnitude of the increase was greater at larger pupil diameters. For a 6.5-mm pupil, the aberrations increased on average by a factor of 2.5 (total) and 2.5 (corneal). Increases in total aberration were related closely to increases in corneal aberration (P<0.0001). For a 6.5-mm pupil, after 20 seconds, the reduction in optical quality (Mf) among the subjects studied was 21+/-8%. CONCLUSIONS: After a blink, the gradual increase in optical aberration associated with the increasingly irregular tear film may cause a progressive reduction in the optical quality of the eye. These changes in aberration with time may partly limit the improvements in visual performance that are achievable by customized corneal ablation.

Adult↗
PubMed2004

Visual performance with multifocal intraocular lenses: mesopic contrast sensitivity under distance and near conditions.

OBJECTIVE: To evaluate distance and near visual performance under bright (photopic) and dim (mesopic) conditions in patients who had undergone uncomplicated cataract extraction with multifocal or monofocal intraocular lens (IOL) implantation. DESIGN: Prospective, nonrandomized, masked, comparative, observational case series. PARTICIPANTS: Thirty-two eyes of 32 patients after zonal-progressive multifocal IOL implantation (Allergan Medical Optics Array SA-40N) and 32 eyes of 32 age-matched patients after monofocal IOL implantation (Allergan Medical Optics SI-40NB). INTERVENTION: All eyes underwent phacoemulsification and IOL implantation. MAIN OUTCOME MEASURES: At 18 months after surgery, the monocular contrast sensitivity (CS) function was measured with sinusoidal grating charts at distance and near, at one photopic luminance level and 2 mesopic luminance levels (85, 5, and 2.5 candelas per square meter). RESULTS: Under bright conditions, CS at distance in the multifocal group was not statistically different (P>0.01) from that in the monofocal group at any tested grating spatial frequency (1.5, 3, 6, 12, and 18 cycles per degree [cpd]). At low luminances, distance CS for the multifocal group was worse than that for the monofocal group at the highest test spatial frequencies (12 and 18 cpd; P<0.01). At near, photopic CS in the multifocal group was lower than at distance; patients with only a monofocal distance correction, however, could not detect the test gratings, even at the highest available contrast. With optimal near spectacle additions (i.e., using the distance correction of the multifocal IOL), there were no significant differences between the photopic near CS values for the multifocal and monofocal groups. When the luminance was decreased, near CS at all spatial frequencies was reduced in both groups. Contrast sensitivity in the near-corrected, multifocal group was significantly worse than in the near-corrected, monofocal group at high spatial frequencies (12 and 18 cpd). CONCLUSIONS: This work supports the findings of earlier authors that the Array multifocal IOL, with its center-distance design, is distance biased. Distance CS is within normal limits under bright photopic conditions but shows deficits at higher spatial frequencies (more than approximately 12 cpd) under dim mesopic conditions. Near CS obtained with the multifocal IOL is below that which can be achieved by an appropriate monofocal near correction, for all spatial frequencies and illumination conditions.

Aged↗
PubMed2004

Temporal changes in optical quality of air-tear film interface at anterior cornea after blink.

PURPOSE: To examine temporal changes in the optical quality of the air-tear film interface at the anterior cornea after a blink. METHODS: Corneal aberrations were determined in fifteen healthy subjects at 1 second time intervals after a blink, up to a total elapsed time of 15 seconds. Corneal aberrations were obtained from corneal elevation maps measured using a Tomey TMS-2N topographer and custom software. All data were decomposed using Zernike polynomials to yield the root mean square (RMS) wavefront deviations, in micrometers, for two pupil diameters (3 and 7 mm). RESULTS: Total wavefront aberration decreased slightly with time in the first few seconds after a blink for both pupil diameters, reaching a minimum after approximately 6 seconds. Thereafter aberrations increased steadily, exceeding the immediate postblink level after approximately 10 seconds. CONCLUSIONS: In normal subjects, the contribution of the anterior cornea to the overall ocular aberration remains reasonably stable over the normal interblink interval (approximately 4 seconds) but rises to levels which could perceptibly degrade retinal image quality under circumstances where the interblink interval is increased to exceed 10 seconds, as may occur during the use of visual display screens or when performing difficult tasks.

Adult↗