Hadas Ben-Eli

Objective: The aim of the study was to compare visual performance and patient-reported visual function among the enhanced monofocal TECNIS Eyhance, conventional monofocal Sensar, and multifocal Synergy intraocular lenses (IOLs) (Johnson & Johnson Surgical Vision, Inc., Santa Ana, CA, USA). Methods: This prospective comparative observational study included patients assessed after cataract surgery with Eyhance, Sensar, or Synergy implantation. Uncorrected and corrected visual acuity were measured at distance, intermediate, and near, and contrast sensitivity was assessed using the Pelli-Robson chart. Participants completed the validated Visual Function Index (VF-14) and three nonvalidated exploratory questions addressing unaided intermediate vision. Eye-level outcomes were analyzed using linear mixed-effects models accounting for fellow-eye correlation and adjusted for age and preoperative spherical equivalent. The VF-14 was analyzed once per participant. Results: Fifty-two participants were enrolled, of whom 51 contributed 84 eligible eyes to the analysis: 40 Eyhance, 26 Synergy, and 18 Sensar eyes. Among the 51 analyzed participants, 31 (60.8%) were women. Mean age of participants was 69.98 ± 7.90 years, with an age range of 48–85 years. Adjusted uncorrected distance visual acuity did not differ among the IOL groups (p = 0.994). Synergy provided better uncorrected intermediate and near visual acuity than Eyhance and Sensar (overall p < 0.001 for both), whereas Eyhance and Sensar did not differ. Corrected visual acuity did not differ significantly among the groups at any distance. Contrast sensitivity differed at distance (p = 0.007) and near (p = 0.011); Synergy had lower values than both monofocal-type IOLs, whereas Eyhance and Sensar were comparable. Adjusted VF-14 scores did not differ among the groups (p = 0.451). Exploratory intermediate-vision responses favored Synergy but demonstrated a pronounced ceiling effect. Conclusions: All three IOLs provided comparable uncorrected distance visual acuity. Synergy was associated with better unaided intermediate and near visual acuity but lower contrast sensitivity, whereas Eyhance showed no objective advantage over Sensar. Overall patient-reported visual function did not differ among the groups, and findings from the additional intermediate-vision questions were exploratory.

Assessing the duration patients can sustain visual tasks before symptom onset provides clinically relevant insight into functional vision and visual discomfort, supporting diagnosis, monitoring, and management of binocular and accommodative disorders. The Vision Quality of Life with Time (VisQuaL-T) questionnaire quantifies how long individuals can perform visual tasks before symptom onset, providing a measure of vision-related quality of life. Although validated in English, it had not been evaluated in Hebrew. This study aimed to translate and validate the VisQuaL-T in Hebrew, assess its test-retest reliability, and examine its concurrent validity relative to the Convergence Insufficiency Symptom Survey (CISS). Fifty healthy participants (mean age 23.2 ± 6.2 years; 62% female; range 12-34) with best-corrected Snellen visual acuity ≤6/6 (0.0 LogMAR) and stereopsis ≤250 arcseconds were recruited. Participants completed the Hebrew VisQuaL-T (10 items) twice, 14 days apart, and the CISS (15 items) once. Translation followed a forward-backward protocol. Non-parametric analyses were applied due to non-normally distributed data. Reliability was assessed using the Wilcoxon Signed-Rank Test, Bland-Altman analysis, and Spearman correlation. Internal consistency was evaluated using Cronbach's alpha and convergent validity with the CISS using Spearman's rho. Mean VisQuaL-T scores at the two administrations were 2.48 ± 0.50 and 2.39 ± 0.56 (p = 0.10). Agreement between administrations was high, with strong test-retest reliability (Rs = 0.80, p < 0.001), except for item 6. Scores did not differ significantly from English normative data (p = 0.65). Internal consistency was high for all questionnaires (Cronbach's α = 0.80-0.85). A moderate negative correlation was observed between VisQuaL-T and CISS scores (Rs = -0.42, p < 0.001). No significant associations were found with age or gender. The Hebrew VisQuaL-T demonstrates strong reliability, internal consistency, and concurrent validity, supporting its use as a clinical and research instrument for assessing vision-related quality of life in Hebrew-speaking populations.

Introduction: Emergency Department (ED) visits for ophthalmic conditions are common, yet a significant proportion of cases are non-emergent, contributing to ED overcrowding. This study examines the demographics and clinical characteristics of ophthalmic ED visits at Hadassah Medical Center in Jerusalem, Israel. Methods: A retrospective study was conducted on 1,406 patients who presented to the ophthalmic ED between January and June 2018. Data collected from electronic medical records included demographics, chief complaints, diagnoses (classified using ICD-9), and follow-up recommendations. Statistical analyses were performed to assess associations between patient characteristics and clinical outcomes. Results: The study cohort had a mean age of 37.1 ± 23.1 years, with 56.6% male patients. The most common age groups were 15– 34 years (35%) and ≥ 50 years (32%). Anterior segment disorders were the most frequent diagnosis (42.4%), while 15.6% of patients had no ocular pathology. Males had a significantly higher prevalence of ocular trauma (22.1% vs. 12% in females, p< 0.001). Patients aged ≥ 50 years were more likely to present with visual disturbances (43.6%) and required follow-up care more frequently than younger groups. Overall, 83.6% of patients were referred for follow-up ophthalmic care. Conclusion: A substantial proportion of ophthalmic ED visits were for non-emergency conditions, highlighting the need for better triage strategies and expanded community-based ophthalmic services. Although urgency versus non-urgent visits were uncategorized, the proportion of cases without ocular pathology and those referred for follow-up visits was measured as proxy indicators. Increasing public awareness and improving primary eye care accessibility may reduce ED overcrowding and optimize resource utilization. Future studies should explore long-term trends and the impact of healthcare interventions on ophthalmic emergency care.

Objective: The aim of this study was to assess the safety and preliminary efficacy of repetitive magnetic stimulation (RMS) as a treatment intervention for dry eye disease (DED), focusing on symptom reduction. Methodology: This investigation involved 22 adult participants (85% females, aged between 22 and 79 years) diagnosed with moderate-to-severe DED. These individuals were subjected to RMS treatment targeting one or both eyes using the VIVEYE-Ocular Magnetic Neurostimulation System version 1.0 (Epitech-Mag LTD; National Institute of Health (NIH) clinical trials registry #NCT03012698). A placebo-controlled group was also included for comparative analysis, with all subjects being monitored over a three-month period. The evaluation of safety encompassed monitoring changes in best corrected visual acuity, ocular pathology, and the reporting of adverse events. Participant tolerance was gauged through questionnaires, measurements of intraocular pressure (IOP), Schirmer’s test, and vital signs. The efficacy of the treatment was assessed by comparing pre- and post-treatment scores for fluorescein staining (according to National Eye Institute (NEI) grading) and patient-reported outcomes. Results: No statistically significant changes were found in visual acuity, IOP, or Schirmer’s test results between the RMS-treated and control groups (p < 0.05), indicating that RMS does not negatively impact these ocular functions. However, RMS treatment was associated with improved tear film stability (p = 0.19 vs. p = 0.04) and corneal health (p = 0.52 vs. p = 0.004), with no improvements in the control group. Initial symptom improvement was observed in both RMS-treated and placebo groups (p = 0.007 vs. p = 0.008), suggesting a potential therapeutic benefit of RMS for ocular surface conditions beyond a placebo effect. Conclusions: This study presents RMS as a promising therapeutic approach for DED, highlighting its potential to promote corneal epithelial repair, enhance tear film stability, and improve patient-reported symptoms without negatively impacting IOP, visual acuity, or tear production. This confirms the safety and suggests the efficacy of RMS therapy for dry eye conditions.

Background: This study aimed to compare the anterior segment characteristics of patients with central serous chorioretinopathy (CSCR) to those with diabetic retinopathy (DR) and healthy controls. Additionally, it explored the possible associations between quality of life and anxiety with CSCR. Methods: A single-center, cross-sectional study involving patients aged 23–61 years diagnosed with CSCR or DR, and healthy patients. Comprehensive ophthalmic examinations included best-corrected visual acuity (BCVA, LogMAR), objective and subjective refraction, and anterior and posterior segments optical coherence tomography (OCT) imaging. Participants completed the Quality-of-Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) and the Beck Anxiety Inventory (BAI). Statistical analysis included Kruskal–Wallis, Tukey post-hoc, Chi-square, and Spearman correlation tests to compare the three groups. Results: A total of 53 patients were recruited (16 CSCR, 8 DR, 29 controls; 52.8% males), with an additional 16 CSCR patients completed only the questionnaires. CSCR and DR patients were the same age as the controls (43.8 ± 9.0, 42.7 ± 9.9, 37.06 ± 13.61 years, respectively, p = 0.19). CSCR and DR patients had similar BCVA, lower than controls (0.19 ± 0.30, 0.15 ± 0.13, 0.01 ± 0.02 LogMAR, respectively, p < 0.01). CSCR patients exhibited more hyperopic refraction compared to healthy controls (p < 0.01) and reported significantly lower life enjoyment and satisfaction than DR and healthy individuals (51.56 ± 9.17, 53.75 ± 7.81, 60.03 ± 7.32, respectively, p < 0.01). No significant correlations were found between anxiety levels and pupil size, anterior chamber depth (ACD), amplitude of accommodation (AA), and intraocular pressure (IOP) among study groups (p > 0.05). Conclusions: CSCR patients demonstrated lower life enjoyment and satisfaction, reduced BCVA, and hyperopic refraction compared to healthy patients. They also tended to have higher stress and anxiety levels. Both CSCR and DR patients shared similar anterior segment characteristics.

Purpose: To evaluate the sensitivity and specificity of the PlusOptix S12C device in detecting amblyopia risk factors (ARFs) in children aged 2–7 years, in accordance with the 2020 Israeli Ministry of Health (MOH) directives and the 2021 American Association for Pediatric Ophthalmology and Strabismus (AAPOS) guidelines. Methods: A cross‐sectional, observational study was conducted at a tertiary care hospital. Children presenting for vision testing were screened using the PlusOptix S12C device, and results were compared with the gold standard cycloplegic refraction and cover test. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for the overall population and subpopulations based on ARFs. Results: A total of 196 children aged 24–84 months were screened (46.4% boys, mean age: 56.94 ± 17.52 months). The PlusOptix S12C demonstrated an overall sensitivity and specificity of 85.5% and 82.3%, respectively. Sensitivity for hyperopia (>4.00 D) was lower (47.7%), while specificity was 81.7%. For strabismus (>8 Δ), sensitivity and specificity were 67.8% and 91.1%, respectively. The device failed to produce readings in 21.9% of children, primarily those with significant refractive errors or strabismus. Conclusions: The PlusOptix S12C demonstrated good overall sensitivity and specificity for detecting ARFs, making it a valuable tool for large‐scale paediatric vision screening, including in very young children. However, its inherent limitations in detecting high hyperopia and strabismus, combined with the high prevalence of these conditions in the untestable group, highlight the need for supplementary evaluation. Children who receive a ‘no result’ or ‘unable‐to‐read’ outcome on the device should be referred for a full examination, including cycloplegic refraction, to ensure ARFs are not missed. While the device aligns well with the 2021 AAPOS and MOH guidelines, careful attention to its limitations in high‐risk subpopulations is essential to optimise screening efficacy and outcomes.

Cataract surgery, a common procedure for vision restoration, exhibits variable outcomes based on patient demographics. This study aimed to elucidate the effects of age and sex on risk factors, intraoperative complications, and postoperative outcomes of cataract surgery. A single-center retrospective cohort study analyzed 691 eyes from 589 individuals who underwent surgery at a tertiary referral center, using electronic medical records to assess preoperative risk factors, intraoperative complications, and best corrected visual acuity (BCVA) pre- and post-operatively, alongside demographic data. The study found that males aged 65–75 years had significantly higher rates of functional postoperative BCVA (91% for males vs. 79% for females, p = 0.007), a disparity not attributable to differences in surgical complications or risk factor prevalence. Age-specific thresholds were identified where BCVA improvements significantly declined beyond 65 years for females and 75 years for males. The likelihood of worsened BCVA post-surgery increased with age for both sexes, with a notable decline in BCVA improvement between the 55–65 years and 65–75 years age groups. These findings underscore the critical influence of sex and age on cataract surgery outcomes, advocating for the integration of these factors into preoperative evaluations to better tailor the timing and planning of cataract surgery and optimize clinical outcomes.

Introduction and Purpose: The developmental eye movement (DEM) test is designed to assess saccadic eye movements and visual‐verbal automaticity in children. This study aimed to assess whether there is a need for independent DEM Hebrew norms and to compare DEM results for Hebrew‐speaking children with eight other language norms. Methods: The DEM test was administered to 224 Hebrew‐speaking children aged 6–13 years who met the inclusion criteria and read the numbers in Hebrew. Test C of the DEM was performed twice, once from right (R) to left (L) and once from L to R, in random order. Age group and language comparisons, including vertical and horizontal reading speeds, errors and horizontal/vertical (H/V) ratios in both directions were analysed. Results: The participants were almost evenly distributed between the sexes (46.8% female). Statistically significant differences were found between age groups (6–9 and 10–13 years) for vertical and horizontal reading speeds and H/V ratios in both directions ( p < 0.001). Older children, as compared to younger children, exhibited faster vertical and horizontal times, with fewer errors, as well as lower ratios ( p < 0.001). No significant difference was noted between reading directions for horizontal time and H/V ratio within both age groups (6–9 year olds: p = 0.27 and p = 0.06; 10–13 year olds: p = 0.89 and p = 0.49, respectively). Comparison of DEM norms across languages showed significant differences, with post‐hoc analysis revealing specific language‐related variations. DEM results for Hebrew‐speaking children had similar outcomes to both original English and French values. Conclusions: This study compared DEM results of Hebrew‐speaking children and scores across nine languages. DEM test values for Hebrew‐speaking children aligned with norms from other languages, particularly the French and original English norms, with consistent ratio scores. It is recommended for practitioners who test Hebrew‐speaking children to continue using the original English norms and to enable the children to read using their preferred reading direction.

Background/Objectives: Cataract surgery, a very common and critical procedure for restoring vision, has outcomes that can vary based on patient demographics. This study aimed to elucidate the effects of age and sex on the risk factors, intraoperative complications, and postoperative outcomes of cataract surgery. Subjects/Methods: Conducted as a single-center retrospective cohort study, it analyzed 691 eyes from 589 individuals who underwent surgery at a tertiary referral center, utilizing data from electronic medical records to assess preoperative risk factors, intraoperative complications, and pre- and post-operative best corrected visual acuity (BCVA) along with demographic data. Results: The main results highlighted that males aged 65-75 years exhibited significantly higher rates of functional postoperative BCVA (91% for males vs. 79% for females, p=0.007), a disparity that is not explained by differences in surgical complications or risk factor prevalence. Furthermore, the study identified age-specific thresholds where BCVA improvements significantly declined beyond 65 years for females and 75 years for males. The likelihood of worsened BCVA post-surgery increased with age for both sexes, with a significant decline in BCVA improvement transitioning from 55-65 years to 65-75 years age groups. Conclusions: The findings underscore the critical influence of both sex and age on cataract surgery outcomes, revealing significant sex-specific age thresholds that signal lesser improvements in postoperative BCVA. These insights advocate for the integration of patient age and sex into preoperative evaluations to better tailor the timing and planning of cataract surgery, ultimately aiming to optimize clinical outcomes.

Background: This study explores vision care priorities and coping mechanisms for Israeli evacuees and following the October 7th, 2023, attack by Hamas, which displaced 150,000 individuals, with about 15,000 being evacuated to the Dead Sea area. Faced with minimal health care infrastructure in the Dead Sea area and often lacking personal belongings, including eyeglasses and ocular medicine, these evacuees confronted significant vision care challenges. This context sets the stage for investigating the emergency vision care needs and solutions for populations affected by conflict and displacement. Methods: In response to this crisis, a consortium led by Hadassah Academic College’s Department of Optometry and the Dept. of Ophthalmology at Hadassah Medical Center established ophthalmic clinics in the Dead Sea region. These clinics offered comprehensive vision care services, including refractive and vision examinations, ophthalmological assessments, ocular imaging, and provision of free glasses. The setup included multiple stations for different vision tests, staffed by an interdisciplinary team of professionals. The study analyzes the effectiveness of these clinics, patient flow challenges, and the psychological impact of vision care in a crisis setting. Results: Approximately 800 evacuees received examinations, with around 700 pairs of glasses distributed. Notable cases included emergency referrals for serious conditions and instances where glasses served as psychological support. The operation highlighted the necessity of vision care during crises and its potential psychological and social implications. The clinics successfully provided immediate vision care, but challenges in patient flow and insufficient electronic medical record integration were noted. The experience underscores the importance of prepared eye care interventions in crises. Recommendations for health policy decision-makers include establishing a national emergency vision care network, developing standardized treatment protocols, training local health workers, and raising public awareness about eye health in emergencies. Conclusions: The consortium’s effort in providing urgent vision care to evacuees from the Hamas attack on Israel demonstrates the critical role of rapid, organized eye care in crisis situations. Vision care, along with hearing and mobility, is often overlooked during evacuations but is vital for the well-being and survival of evacuees, especially under trying circumstances. This project serves as a model for future humanitarian interventions, emphasizing the importance of addressing overlooked healthcare issues once the immediate crisis has passed, and the need for strategic planning in health care policy for similar emergency scenarios.