intermediate vision in a driving simulator environment: comparison of the j&j eyhance with a conventional monofoc. iol

Conditions: Lenses, Intraocular; Pseudophakia; Near Vision; Driving

Summary: to compare (low contrast) visual acuity (va) and contrast sensitivity (cs) - both at intermediate distances under nighttime driving conditions in a driving simulator between patients with bilateral eyhance iols or bilateral conventional monofocal iols. visual function testing in the driving simulator will be assessed without and with (static) glare. additionally: assessment of individual response times, scanpath characteristics, evaluation of test retest reliability and self-evaluation of (intermediate) vision and visual impairment related to glare.

to compare (low contrast) visual acuity (va) and contrast sensitivity (cs) - both at intermediate distances under nighttime driving conditions in a driving simulator between patients with bilateral eyhance iols or bilateral conventional monofocal iols. visual function testing in the driving simulator will be assessed without and with (static) glare. additionally: assessment of individual response times, scanpath characteristics, evaluation of test retest reliability and self-evaluation of (intermediate) vision and visual impairment related to glare. simulator patients are instructed to drive with a constant speed of 40 km/h on a virtual parcours (straight lane). for testing of either (low contrast) visual acuity or contrast sensitivity, 8-position landolt c's are presented at three locations (within the simulator car, audi a4, ingolstadt/frg): (i) at the center of the instrument panel (distance 0.xx m) (ii) at the center of the navigation monitor (y.yy m) (iii) at the center of the rear monitor (z.zz m) a high resolution acoustic attention guidance for immediate gaze direction of the patients towards the three above-mentioned visual stimulus locations (i-iii) is mandatory. patients responses are recorded and response times can be extracted from the recordings. clinical ophthalmological-optical examinations * medical/ophthalmological history * (uncorrected and best-corrected) visual acuity (re,le,be) with remote and intermediate (66cm) 8 position landolt c's. * lang i stereotest (near distance) * ocular alignment \& ocular motility * efferent \& afferent pupillomotor status * mesopic contrast sensitivity without/with glare (optovist, vistec inc./olching/frg) * intraocular straylight perception (q-quant, oculus inc, wetzlar/frg) * slit lamp (anterior segment) * ophthalmoscope (central fundus and fixation) * primary objectives: log visual acuity (logva) at preset low contrast level of 1:2.7 (logcs = 0.2) and log contrast sensitivity (logcs) at a preset visual acuity level of 0.1 = 2/20) * secondary objectives: test retest reliability (as operationalized by loa = limits of agreement) and response time (i.e. time interval between onset of stimulus presentation and final response) and scanpath characteristics (fixation duration, fixation stability, annotation to regions of interest; saccade amplitude) self-evaluation (questionnaire, using visual analogue scales = vas) shapiro wilk test (statistical testing for proving/disproving normal distribution) descriptive statistics (either mean, standard deviation, in case of normally distributed data - else, median, inter-quartile range (iqr). assessment of test/retest reliability: bland altman plots, limits of agreement (loa) between-group comparison: t-test (unpaired samples), in case of normally distributed data - else, wilcoxon signed-rank test

Eligibility criteria:
inclusion criteria: * informed consent * s.p. (at least two months post surgery) bilateral uneventful iol surgery (bilateral implantation of either eyhance iol or monofocal iol) * ophthalmological history normal, except cataract and uneventful iol surgery * distant visual high-contrast acuity \> 20/25 in either eye * normal stereopsis (all figures of the lang i random dot stereo test correctly recognized) exclusion criteria: * age below 18 years * chronic eye disease (except cataract) * history of ocular surgery (except complication-free iol surgery) * visual pathway lesions * strabismus

Keywords: glare contrast sensitivity driving simulator intermediate visual acuity pseudophakia posterior chamber intraocular lenses benchmark straylight nighttime driving