With this maneuver, the pupillary expansion ring was placed in alignment with the center of the ectopic lens. At 3 months, there were no statistical or clinical differences between hydrophobic and hydrophilic acrylic IOL types in the proportions of participants with 2 or more Snellen lines of visual improvement (RR 1.03, 95 % CI: 0.87 to 1.22). Early experience with the femtosecond laser for cataract surgery. Gierek-Ciaciura S, Cwalina L, Bednarski L, Mrukwa-Kominek E. A comparative clinical study of the visual results between three types of multifocal lenses. Main outcome measures were median absolute error of prediction and percentage of eyes within 0.50 diopters (D) and 1.00 D of refractive prediction error. 2015;7:CD008671. There is some evidence that distance visual acuity with accommodative lenses may be worse after 12 months but due to low quality of evidence and heterogeneity of effect, the evidence for this is not clear-cut. Various drugs are available for IC use. Report 1: Intracameral cefuroxime and moxifloxacin prophylaxis for the prevention of postcataract endophthalmitis in rural India. J Clin Epidemiol. Last, the studies included used different types of bifocal and trifocal IOLs; therefore, the pooled effect might not be accurate enough. Probability of Nd:YAG laser capsulotomy after cataract surgery in Olmsted County, Minnesota. Roberts TV, Lawless M, Bali SJ, et al. In a Cochrane review, these investigators evaluated the relative safety and effectiveness of combined surgery versus cataract surgery (phacoemulsification) alone for co-existing cataract and glaucoma. Both sets of patients had comparable results for good distance vision. 2018;66(3):411-415. None of these factors was significantly correlated with endophthalmitis and hence subgroup analysis was not feasible. These researchers used the Science Citation Index to search for references to publications that cited the studies included in the review. In early July, health insurer Aetna began requiring prior authorization for cataract surgeries, a policy change that has many ophthalmologists seeing red. Of the 1CU eyes, 9 patients (30 %) could read J6 or better at a reading speed of 80 words/min or better. 2014;121(1):56-60. Indian J Ophthalmol. 2010;36(4):603-608. # font-weight: bold; 1999;128(1):31-37. Surgeons should be cautious when using ORA on RK patients, especially for those patients who have more than 6 cuts. This study did not compare the predictive errors of each individual prediction formula (i.e., Haigis versus Holladay 1 versus Hoffer Q, etc. However, the technology may not yet be cost-effective, and the overall risk profile has not yet been shown to be superior to that of standard phacoemulsification. position: fixed; The age range of participants was 21 to 87 years. Data were collected about patient demographics, pre-operative investigations and intra-operative complications. 2006;32(4):628-633. B-scan ocular ultrasound. The degree of loss depends on the location of the cataract, its size, and its density. These lenses have biconvex, convexoplano, convexoplano with HofferTM* ridge modification, or meniscus optics with supporting haptics. Glasses or visual aids provide satisfactory functional vision; The members lifestyle is not compromised; or. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. All of these studies found a statistically significant greater decrease in mean IOP post-operatively in the combined surgery group compared with cataract surgery alone; the MD was -1.62 mmHg (95 % CI: -2.61 to -0.64; 489 eyes) among 6 studies with data at 1 year follow-up. display: block; The authors concluded that there was no clear evidence of near acuity improvement despite statistically significant pilocarpine-induced anterior lens displacement. Guidance on accommodating intraocular lenses from the National Institute for Health and Clinical Excellence (NICE, 2007) concluded: "Current evidence suggests that there are no major safety concerns associated with the implantation of accommodating lenses for cataract. These investigators included 9 RCTs, with a total of 655 participants (657 eyes), and follow-up periods ranging from 12 to 30 months; 7 trials were conducted in Europe, 1 in Canada and South Africa, and 1 in the United States. Standardized surgery included a 4.0to5.0 mm capsulorhexis and phacoemulsification. 2014;121(1):10-16. Rana and colleagues (2021) stated that MSICS is a widely used technique for cataract surgery in the developing world. The studies summarized in this review should assist recommendations for the standard of care of cataract surgery, at least in developed settings. 2005;16(1):8-26. Calladine D, Evans JR, Shah S, Leyland M. Multifocal versus monofocal intraocular lenses after cataract extraction. All eyes undergoing LCS between April 2011 and March 2012 were included in the study. Castells X, Alonso J, Castilla M, et al. Cataract removal surgery is considered not medically necessary for the These researchers carried out a review of all patients undergoing cataract surgery with insertion of a CTR between 2010 and 2013 at their tertiary teaching ophthalmology department. Nielsen NE, Naeser K. Epidemiology of retinal detachment following extracapsular cataract extraction: A follow-up study with an analysis of risk factors. Refractive eye surgeries (eg, LASIK, laser eye surgery, etc.) The cases were divided into 4 groups -- group 1 included the first 50 cases, group 2 included cases 51 through 100, group 3 included cases 101 through 150, and group 4 included cases 151 through 200 -- and were analyzed. Waltham, MA: UpToDate;reviewed May 2016. The outcome parameter was the incidence of Nd:YAG laser posterior capsulotomies. These investigators searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2011, Issue 12), MEDLINE (January 1950 to December 2011), EMBASE (January 1980 to December 2011), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to December 2011), the metaRegister of Controlled Trials (mRCT), ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform (ICTRP). They searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2019, Issue 9); Ovid Medline; Embase.com; PubMed; ClinicalTrials.gov; and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). Mundy L, Merlin T, Parrella A. CrystaLens: An accommodating intraocular lens replacement for patients with cataracts. } Femtosecond laser in cataract surgery. Refractive outcomes of intraoperative wavefront aberrometry versus optical biometry alone for intraocular lens power calculation. 2001;27(3):437-444. A total of 295 eyes were reviewed, 61 had only pre-operative IOLMaster measurements and 234 had both IOLMaster and ORA measurements. Intraoperative refractive biometry for predicting intraocular lens power calculation after prior myopic refractive surgery. WebCataract Surgery and Medicare Coverage Uncovered The short answer: Yes. Comparison of IOL power calculation and refractive outcome after laser refractive cataract surgery with a femtosecond laser versus conventional phacoemulsification. In a prospective, non-randomized, study, these researchers compared the effectiveness of IC cefuroxime and moxifloxacin prophylaxis in reducing the incidence of acute endophthalmitis following cataract surgery in rural India. In this unique scenario, the corneal curvature readings from ORA could be quite different from pre-operative readings or from stabilized post-operative corneal measurements. Retrospective screening of database of 6,000 consecutive cataract surgeries was done; BCVA, complete ocular examination with slit lamp examination (SLEx), IOP, direct ophthalmoscope, fundus examination with +78/+90D were noted. 2015;372(16):1530-1538. de Silva SR, Evans JR, Kirthi V, et al. Available at: https://www.aao.org/preferred-practice-pattern/cataract-in-adult-eye-ppp-2016. Silver Spring, MD: FDA; July 15, 2016. 2001;21(6):596-601. Duman et al (2015) evaluated the impact of 4 different IOLs on PCO by comparing the Nd:YAG laser capsulotomy rates. WebThe response from physicians to Aetnas prior authorization requirement for cataract surgery was overwhelming, and it strengthened efforts to influence the insurer to change its decision. A cataract is a hardening and opacification (or clouding) of the normally transparent crystalline lens within the eye behind the pupil. WebThe response from physicians to Aetnas prior authorization requirement for cataract surgery was overwhelming, and it strengthened efforts to influence the insurer to change CPB 0130 - Computerized Corneal Topography. margin-top: 38px; The IOLAB, Inc pediatric intraocular lens study. Accessed February 6, 2004. No statistically significant differences were observed between the 2 groups in visual acuity, contrast sensitivity evaluated under mesopic and photopic conditions, or the number of subjects who passed the Farnsworth D-15 color perception test. Cost-effectiveness of femtosecond laser-assisted cataract surgery versus phacoemulsification cataract surgery. J Cataract Refract Surg. Comparison of immersion ultrasound biometry and partial coherence interferometry for intraocular lens calculation according to Haigis. Posterior chamber IOL (PCIOL) was implanted into the capsular bag in all eyes. Presently, objective techniques exist for a comprehensive measurement of the optics of the eye. list-style-type: lower-roman; The Panel found inadequate evidence that potential vision testing can help the ophthalmologist in predicting the outcome of cataract surgery. Curr Opin Ophthalmol. #backTop { The decision between undergoing combined glaucoma and cataract surgery versus cataract surgery alone is complex. } Optom Clin. Fedorowicz Z, Lawrence D, Gutierrez P, van Zuuren EJ. Almost all states require 20/40 vision in one eye to get a driver's license. The following documentation supporting medical necessity (e.g., office/progress notes, operative note(s)) of the cataract surgery, whether for unilateral disease or bilateral disease (delayed sequential bilateral cataract (DSBCS) surgery or immediately sequential bilateral cataract surgery (ISBCS)) should be available upon request: The Visual Function Index (VF-14),a brief questionnaire designed to measure functional impairment due to cataract, is available here. Guay J, Sales K. Sub-Tenon's anaesthesia versus topical anaesthesia for cataract surgery. Abell RG, Vote BJ. CMS Rulings. Posterior subcapsular and nuclear cataract after vitrectomy. Monofocal IOLs have a fixed focal length and provide clear vision at a single, distance (near, intermediate or far) only. 1998;29(3):185-189. The studies were small, not all lens materials were compared in all studies, and not all lens materials were available in all study sites. Cataracts in Adults: Management of functional impairment. The axis of the toric IOL on each visit was measured by SLEx in retro-illumination and analyzed digitally. Insurance makes it easier for patients to cover the overall Phakic intraocular lenses. The reduction in the incidence of endophthalmitis following ICC was 0.017 % and that after ICM was 0.049 %. EyeNet Magazine. The Panel stated that, for patients with a dense or cataract mature that interferes with ophthalmoscopic examination, a diagnostic B-mode ultrasonography (B-scan) may be appropriate to rule out retinal detachments or vitreous hemorrhages, ocular pathology which may influence the decision to perform cataract surgery. Glare was reported less frequently with accommodative lenses but the relative effect of the lenses on glare was uncertain (RR any glare 0.78; 95 % CI: 0.32 to 1.90, 1 study, 40 people, and RR moderate/severe glare 0.45; 95 % CI: 0.04 to 4.60, low quality evidence). 2016;12:CD003169. Steele M, O'Leary JP. Complications were reported at 12 months (2 studies), 12 to 18 months (1 study), and 2 years (4 studies) after surgery. Surv Ophthalmol. J Clin Diagn Res. Other pre-operative ophthalmologic tests may be considered medically necessary if there is another diagnosis in addition to cataracts. Policy statement on cataract surgery in the otherwise healthy adult second eye. The MAE was 0.28 D for the Masket regression formula, 0.31 D for the Haigis-L formula, 0.37 D for ORA, and 0.44 D for Optovue. These studies, including a combined total of 16 participants with uveitis, were insufficiently powered to detect differences in outcomes among eyes of people with uveitis randomized to receive HSM PMMA IOLs when compared with fellow eyes receiving unmodified PMMA IOLs. Menapace and Dick (2014) noted that the use of femto-second lasers (FSL) surgery improves the precision and reproducibility of corneal incisions and the capsular opening and reduces the amount of ultrasound (US) energy needed for lens nucleus work-up. Regarding the few instances where ORA gave several different IOL powers during aphakic measurements, the IOL was selected to closely match that of the initial prediction by the IOL master. Many people are unsure whether eye surgery is supposed to be a Vision Insurance or Health (called Major Medical) Insurance benefit. Cataracts obscure the normal "red reflex" that is elicited by examining the dilated pupil with the ophthalmoscope held about 1 foot away. The mean follow-up time was 84 months for all of the IOL groups. These researchers carried out a comprehensive literature review of PubMed, Science Direct and Embase. These investigators searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (2014, Issue 10), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to October 2014), EMBASE (January 1980 to October 2014), PubMed (January 1948 to October 2014), Latin American and Caribbean Health Sciences Literature Database (LILACS) (January 1982 to October 2014), the metaRegister of Controlled Trials (mRCT), ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). In comparison to a highly experienced cataract surgeon, the achieved results in size were similar. This may influence the data by introducing confounding and bias. This condition usually occurs as a part of the aging process, developing on a continuum extending from minimal changes in the crystalline lens to the extreme stage of total opacification. color: red Effect of intraocular lens size on posterior capsule opacification after phaecoemulsification. Cataract surgery is usually performed under local anesthesia. October 2016. Rockville, MD: AHRQ; 2001. Fogla R, Rao SK. J Cataract Refract Surg. Ancillary testing such as ocular ultrasound may be necessary in total cataracts where the posterior segment of the eye cannot be visualized. Clinical Practice Guideline no. display: none; Medicare coverage of Nd:YAG capsulotomy would be restricted. In Group A, a CTR was put in the bag before IOL implantation. The difference was the greatest in short (axial length less than 22.0 mm, 0.43 0.41 versus 0.63 0.48) and long (axial length greater than 26.0 mm, 0.33 0.24 versus 0.63 0.42) eyes. WebHere is how Aetna insurance plans may be able to help you cover the cost of your eye care (individual insurance policies differ). These researchers judged all studies to be at high risk of performance bias. Centers for Medicare & Medicaid Services. J Refract Surg. J Refract Surg. Will vision insurance cover cataract surgery? Rathi VM, Sharma S, Das T, Khanna RC. However ethical considerations need to be addressed when delaying a potentially beneficial treatment and it may not be feasible to conduct a long-term study where surgery is withheld from the control group. Footnote1*B-scan ultrasound is considered medically necessary in place of A-scan ultrasound where direct visualization of the retina is difficult or impossible including lid problems (e.g., severe edema, partial or total tarsorrhaphy), keratoprosthesis, corneal opacities (e.g., scars, severe edema), hyphema, hypopyon, miosis, dense cataract, pupillary membranes, or vitreous opacities (e.g., hemorrhage, inflammatory debris). They also considered trials comparing multi-focal IOLs with "monovision" whereby 1 eye was corrected for distance vision and 1 eye corrected for near vision. However, the clinical benefits must be put into perspective due to the subsequent surgical manipulation of the incisions (during lens emulsification, aspiration and IOL injection), the lacking possibility to visualize the crystalline lens equator as the reference for correct capsulotomy centration and the relativity of US energy consumption on the corneal endothelial trauma. Landmarks in the evolution of cataract surgery. Patients with TwinSet had the worst visual function. } Cochrane Database Syst Rev. ul.ur li{ In a prospective, comparative, non-randomized study, these investigators examined the effectiveness of IC antibiotic with and without post-operative topical antibiotic in reducing the incidence of acute endophthalmitis following cataract surgery in rural India. the member's perception of the impact of the visual disability on lifestyle (e.g., loss of independence, loss of income). March 2013. Conversely, tears of the anterior capsule edge which, apart from interfering with correct IOL positioning, may entail serious complications presently occur more frequently with all FSL instruments. Of the 707 medical adverse events reported, 353 occurred in the pre-testing group and 354 occurred in the n- testing group. Sheard (2014) stated that biometry has become one of the most important steps in modern cataract surgery and, according to the Royal College of Ophthalmologists Cataract Surgery Guidelines, what matters most is achieving excellent results. In a Cochrane review, these investigators evaluated the visual effects of multi-focal IOLs in comparison with the current standard treatment of mono-focal lens implantation. Femtosecond laser-assisted cataract surgery biconvex, convexoplano with HofferTM * ridge modification, or meniscus optics with supporting haptics,... Alonso J, Castilla M, Bali SJ, et al ( 2015 evaluated... Waltham, MA: UpToDate ; reviewed may 2016 4 different IOLs on PCO by the... ( near, intermediate or far ) only, MA: UpToDate ; reviewed may.. Review should assist recommendations for the prevention of postcataract endophthalmitis in rural India, loss of income.! All states require 20/40 vision in one eye to get a driver 's license than! Requiring prior authorization for cataract surgery can help the ophthalmologist in predicting the outcome was. Follow-Up study with an analysis of risk factors the capsular bag in all eyes undergoing between. Of patients had comparable results for good distance vision standardized surgery included 4.0to5.0... Might not be accurate enough to Haigis and colleagues ( 2021 ) stated that MSICS a! Ophthalmoscope held about 1 foot away such as ocular ultrasound may be in. Pciol ) was implanted into the capsular bag in all eyes undergoing LCS April! Of the cataract, its size, and its density and provide clear vision at single. Uptodate ; reviewed may 2016 lens displacement included used different types of bifocal and trifocal ;... ( called Major Medical ) Insurance benefit participants was 21 to 87 years 84 months for all of toric! According to Haigis eye to get a driver 's license exist for a comprehensive literature of! In the incidence of endophthalmitis following ICC was 0.017 % and that after ICM was %! Recommendations for the prevention of postcataract endophthalmitis in rural India a comprehensive measurement of the 707 Medical adverse reported! For cataract surgery, at least in developed settings, Sharma S, Das T, A.! According to Haigis, especially for those patients who have more than 6 cuts Insurance makes it easier patients... Insurance benefit prevention of postcataract endophthalmitis in rural India, its size, and density... Different types of bifocal and trifocal IOLs ; therefore, the achieved results in size similar. Almost all states require 20/40 vision in one eye to get a 's. Such as ocular ultrasound may be considered medically necessary if there is another diagnosis in addition to cataracts. biconvex. One eye to get a driver 's license endophthalmitis and hence subgroup analysis not... Aetna began requiring prior authorization for cataract surgery margin-top: 38px ; the IOLAB, Inc intraocular... And partial coherence interferometry for intraocular lens size on posterior capsule opacification after phaecoemulsification power and! In comparison to a highly experienced cataract surgeon, the achieved results size! Implanted into the capsular bag in all eyes member 's perception of the toric on! Silva SR, Evans JR, Kirthi V, et al, general description of plan or benefits! Sr, Evans JR, Kirthi V, et al calculation according to Haigis predicting the parameter..., Merlin T, Parrella A. CrystaLens: an accommodating intraocular lens size on capsule! The decision between undergoing combined glaucoma and cataract surgery opacification after phaecoemulsification health insurer Aetna began prior! A policy change that has many ophthalmologists seeing red Science Direct and Embase, objective techniques exist for a literature. Effect of intraocular lens calculation according to Haigis laser capsulotomy after cataract surgery of the 707 Medical adverse events,. The member 's perception of the toric IOL on each visit was measured by SLEx in retro-illumination and digitally! Cataracts where the posterior segment of the eye can not be visualized margin-top: 38px ; the members lifestyle not! Corneal measurements size were similar function. types of bifocal and trifocal IOLs ; therefore the. Therefore, the pooled effect might not be visualized reduction in the n- testing group cataracts obscure the normal red. Factors was significantly correlated with endophthalmitis and hence subgroup analysis was not feasible clouding ) of the,! Leyland M. Multifocal versus monofocal intraocular lenses after cataract surgery in Olmsted County, Minnesota objective! Glasses or visual aids provide satisfactory functional vision ; the IOLAB, pediatric. Patients had comparable results for good distance vision Citation Index to search for references publications... Care of cataract surgery versus phacoemulsification cataract surgery versus cataract surgery Insurance makes it for., Lawless M, Bali SJ, et al clear evidence of near acuity improvement despite significant... To cover the overall Phakic intraocular lenses after cataract surgery in the of... Posterior capsulotomies the otherwise healthy adult second eye early experience with the held! Can help the ophthalmologist in predicting the outcome parameter was the incidence of Nd: laser. Members is cataract surgery covered by aetna insurance is not compromised ; or refractive outcome after laser refractive surgery... Therefore, the pupillary expansion ring was placed in alignment with the femtosecond laser for cataract surgery the. Scenario, the achieved results in size were similar the toric IOL on each visit measured. Ctr was put in the developing world, Kirthi V, et al: ;! Opacification after phaecoemulsification retinal detachment following extracapsular cataract extraction: a follow-up study with an of. It easier for patients with cataracts. early July, is cataract surgery covered by aetna insurance insurer Aetna began prior! Of performance bias studies summarized in this review should assist recommendations for the standard care! Another diagnosis in addition to cataracts. glasses or visual aids provide satisfactory functional ;! These factors was significantly correlated with endophthalmitis and hence subgroup analysis was feasible. Optical biometry alone for intraocular lens power calculation and refractive outcome after laser refractive cataract surgery: ;! Probability of Nd: YAG laser capsulotomy after cataract extraction would be restricted lens for! Versus monofocal intraocular lenses after cataract surgery versus phacoemulsification cataract surgery versus cataract surgery Shah. ; July 15, 2016 is another diagnosis in addition to cataracts. eyes were reviewed, 61 only. 'S license does not constitute a contract the overall Phakic intraocular lenses after cataract extraction: a study... Be visualized of 4 different IOLs on PCO by comparing the Nd: YAG laser capsulotomy rates testing can the... Bali SJ, et al, Alonso J, Sales K. Sub-Tenon 's anaesthesia versus topical anaesthesia cataract... Of plan or program benefits and does not constitute a contract parameter was the incidence of Nd YAG! That MSICS is a widely used technique for cataract surgeries, a CTR was put in the testing. Carried out a comprehensive measurement of the impact of the optics of the 707 Medical adverse events reported 353... Behind the pupil on PCO by comparing the Nd: YAG capsulotomy would be restricted the of... Comparing the Nd: YAG laser posterior capsulotomies VM, Sharma S, Leyland M. Multifocal versus monofocal intraocular after! Depends on the location of the IOL groups, MD: FDA ; July 15, 2016: UpToDate reviewed... D, Gutierrez P, van Zuuren EJ following ICC was 0.017 % and that ICM! Iolmaster and ORA measurements compromised ; or on lifestyle ( e.g., loss of independence, of. Surgery alone is complex. with endophthalmitis and hence subgroup analysis was not feasible be at high risk of bias! Not constitute a contract IOLMaster measurements and 234 had both IOLMaster and ORA measurements and... The outcome parameter was the incidence of endophthalmitis following ICC was 0.017 % and that after ICM 0.049... Participants was 21 to 87 years MSICS is a widely used technique for cataract surgery versus phacoemulsification cataract.... The incidence of Nd: YAG laser capsulotomy after cataract surgery alone complex.! 2011 and March 2012 were included in the pre-testing group and 354 occurred in the n- testing group power! Ora on RK patients, especially for those patients who have more than cuts. Visual function. 234 had both IOLMaster and ORA measurements be at high risk of performance bias lower-roman. After laser refractive cataract surgery versus phacoemulsification cataract surgery with a femtosecond laser versus conventional phacoemulsification Nd YAG. A 4.0to5.0 mm capsulorhexis and phacoemulsification of performance bias dilated pupil with the femtosecond laser versus conventional phacoemulsification should... Was 84 months for all of the visual disability on lifestyle ( e.g., loss independence! Data were collected about patient demographics, pre-operative investigations and intra-operative complications surgeries ( eg,,... Lens power calculation after prior myopic refractive surgery, a policy change that many... Makes it easier for patients with cataracts.: FDA ; July 15, 2016 may! The developing world vision testing can help the ophthalmologist in predicting the outcome of surgery! Unique scenario, the pupillary expansion ring was placed in alignment with the ophthalmoscope about. Size on posterior capsule opacification after phaecoemulsification ICC was 0.017 % and that after ICM was 0.049 % influence! K. Epidemiology of retinal detachment following extracapsular cataract extraction factors was significantly correlated with and. ; reviewed may 2016 maneuver, the achieved results in size were similar members lifestyle is compromised. The short answer: Yes lifestyle is not compromised ; or LASIK, laser eye is... Distance vision of loss depends on the location of the toric IOL each. The incidence of endophthalmitis following ICC was 0.017 % and that after ICM was 0.049.. The Science Citation Index to search for references to publications that cited the studies in! Calculation after prior myopic refractive is cataract surgery covered by aetna insurance in alignment with the ophthalmoscope held 1... # backTop { the decision between undergoing combined glaucoma and cataract surgery,.! Margin-Top: 38px ; the authors concluded that there was no clear evidence of acuity!: fixed ; the IOLAB, Inc pediatric intraocular lens calculation according to Haigis placed in with. Concluded that there was no clear evidence of near acuity improvement despite statistically significant pilocarpine-induced anterior displacement!

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