David R Hardten

University of Minnesota Duluth, Duluth, Minnesota, United States

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Publications (77)165.63 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: To report the outcomes of photorefractive keratectomy (PRK) enhancement after LASIK for patients diagnosed as having hyperopic and myopic refractive errors.
    Journal of refractive surgery (Thorofare, N.J.: 1995) 07/2014; 30(8):549-556. · 2.78 Impact Factor
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    Bryan S Lee, David R Hardten
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    ABSTRACT: Patients with endothelial disease also often have scarring or surface corneal disease. This study examined the outcomes of phototherapeutic keratectomy (PTK) performed in patients with prior Descemet's stripping endothelial keratoplasty (DSEK).
    Clinical ophthalmology (Auckland, N.Z.) 01/2014; 8:1011-1015.
  • International ophthalmology clinics 01/2013; 53(1):65-78.
  • Bryan S Lee, David R Hardten
    Journal of Cataract and Refractive Surgery 12/2011; 37(12):2227. · 2.75 Impact Factor
  • David R Hardten
    Journal of Cataract and Refractive Surgery 07/2011; 37(7):1370. · 2.75 Impact Factor
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    David R Hardten
    Journal of refractive surgery (Thorofare, N.J.: 1995) 07/2011; 27(7):471-2. · 2.78 Impact Factor
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    Ahmad M Fahmy, David R Hardten
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    ABSTRACT: This paper reviews recent advances and investigation in the treatment of ocular surface pathology. There is significant investment in this area, paralleling the growing demand for more effective alternatives to current treatments. Clinicians are becoming more aware of surface pathology, yet the ability to treat the most common forms of ocular pathology are still limited to the few medications approved by the US Food and Drug Administration. Medicines and devices currently under investigation are very promising. It is absolutely critical to understand the emerging options and think of their role in the treatment paradigm.
    Clinical Ophthalmology 01/2011; 5:465-72.
  • Vrushali V Gosavi, David R Hardten
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    ABSTRACT: Corneal ectasia is a potentially serious complication that can occur after photorefractive keratotomy and laser-assisted in situ keratomileusis in eyes with risk factors such as inferior topographical steepening, as well as in eyes without risk factors. Better identification of forme fruste keratoconus and atypical corneas and more restraint with laser-assisted in situ keratomileusis parameters will reduce this window of corneas at risk. As we develop better technology and outcome-based evaluation criteria for preoperative screening using existing technology, we may be able to reduce the incidence of ectasia through better patient selection.
    Expert Review of Ophthalmology 08/2010; 5(4):475-481.
  • David R Hardten, Vrushali V Gosavi
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    ABSTRACT: Laser correction of refractive errors is one of the most effective surgical procedures today. Even so, the selection of patients who will have the outcomes they expect remains a major challenge. Corneal ectasia, a frustrating problem that can occur naturally with diseases such as keratoconus, has also been reported after refractive surgery. This review addresses the issues surrounding the use of surface refractive surgery in patients who may have atypical topography, which is a risk factor for ectasia. At present, available tests for predicting future corneal stability can give false positives and false negatives. Although the technology for treating irregular corneal astigmatism has improved, results in eyes with irregular astigmatism are less predictable than in eyes with regular astigmatism, even when wavefront- and topography-driven treatments are used. An increased risk for corneal instability may be associated with laser vision correction (LVC), although instability is generally thought to be less of a risk with surface ablation or photorefractive keratectomy than with laser in situ keratomileusis. Surface LVC has shown good success in improving uncorrected distance visual acuity with a relatively low rate of complications, even in eyes with topographic irregularities.
    Journal of Cataract and Refractive Surgery 09/2009; 35(8):1437-44. · 2.75 Impact Factor
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    ABSTRACT: To investigate the outcomes of wavefront-guided photorefractive keratectomy (WG PRK) using prophylactic mitomycin C (MMC) in eyes that had previously undergone radial keratotomy (RK). Retrospective, observational, consecutive case series. Thirty-two eyes of 27 patients with previous RK that underwent WG PRK with MMC. The records were reviewed of consecutive RK patients whose eyes underwent WG PRK with MMC in 4 centers with postoperative follow-up of 6 months or longer (range, 6-21 months). Eyes were divided into myopic WG PRK and hyperopic WG PRK groups based on their preoperative spherical equivalent (SE). Preoperative best spectacle-corrected visual acuity (BSCVA) was compared with postoperative uncorrected visual acuity (UCVA) and BSCVA to ascertain efficacy and safety. Change in SE and attempted versus achieved SE were evaluated. Incidences of haze and other complications were recorded. Uncorrected visual acuity, BSCVA, SE, corneal haze, and other complications. In the myopic WG PRK group (n = 9), UCVA improved by 3 lines on average (P = 0.015) with UCVA of > or =20/20 in 56% and > or =20/40 in 100% of eyes; 55% were within 0.5 diopter (D), and 100% were within 1 D of attempted refraction. In the hyperopic WG PRK group (n = 23), UCVA improved for 3 lines on average (P<0.001), with UCVA of > or =20/20 in 48% and > or =20/40 in 100% of eyes; 57% were within 0.5 D and 74% were within 1 D of attempted refraction. One eye lost 2 lines of BSCVA as a result of the development of mild to moderate haze, but recovered in 4 months. No eyes lost more than 2 lines of BSCVA. Six eyes (19%; 6/32) experienced the development of haze in the postoperative course, with mild to moderate haze in 1 eye and trace haze in the other 5 eyes. No other complications were noted. Wavefront-guided PRK with MMC in eyes with prior RK improved the UCVA significantly and was safe over the short follow-up of this series. Although haze occurred, no eye suffered persistent visual loss of 2 or more lines. Proprietary or commercial disclosure may be found after the references.
    Ophthalmology 07/2009; 116(9):1688-1696.e2. · 5.56 Impact Factor
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    ABSTRACT: To test an anecdotally reported cataract grading system predictive of a 20/50 visual threshold in cataract-induced vision loss using cobalt blue light. Hennepin County Medical Center, Minneapolis, Minneapolis VA Medical Center, Minneapolis, and Regions Hospital, St. Paul, Minnesota, USA. Four observers evaluated pure nuclear cataracts using a standardized cobalt-blue-light protocol. Observers graded a nuclear cataract as positive if the posterior capsule was visualized with cobalt blue light and negative if the posterior capsule was not visualized. Results of the grading were compared with cataract-induced vision loss in an attempt to establish a threshold for lost visual acuity in grading cataracts with cobalt blue light. The study design was prospective observation of a cohort with a visually significant cataract. This study did not show a clear visual acuity threshold for cataract-induced vision loss using a standardized cobalt-blue-light protocol. Overall, 26.3% (95% confidence interval, 13.4-40.2) of all 20/40 or less dense nuclear cataracts had visible posterior capsules using cobalt blue light, with good estimated interobserver agreement. Although cobalt blue light is selectively absorbed by yellow pigment in an aging nuclear cataract, its ability to predict visual acuity loss due to lens opacity was limited.
    Journal of Cataract and Refractive Surgery 03/2009; 35(2):312-7. · 2.75 Impact Factor
  • Ophthalmology 11/2008; 115(10):1849; autor reply 1849-50. · 5.56 Impact Factor
  • Sandy Pham-Vang, David R Hardten
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    ABSTRACT: Any etiology of epithelial defect can lead to severe bacterial keratitis. Patients with recurrent corneal erosions suffer repeated corneal epithelial defects without significant trauma and therefore are at risk of infectious keratitis more frequently than someone without recurrent erosions. A stromal infiltrate with an overlying area of epithelial defect can be challenging to differentiate between infectious and noninfectious inflammatory conditions. It is important for clinicians to appreciate the clinical findings in these cases and initiate aggressive treatment promptly. A 32-year-old woman presented with a history of anterior basement membrane dystrophy and recurrent corneal erosions. She had symptoms of redness, pain, foreign body sensation, photophobia, epiphora, and burning in her left eye that started 2 days before the visit to our office. Examination showed a large epithelial defect with dense stromal infiltrate inferiorly on the cornea that appeared white and milky with diffuse cellular infiltrate as well as 3+ cells in the anterior chamber. Laboratory results were positive for bacterial keratitis (Staphylococcus aureus). Infectious presentation should be considered visually threatening and treated immediately and aggressively. Early intervention is important to help avoid severe complications.
    Optometry (St. Louis, Mo.) 10/2008; 79(9):505-11.
  • David R Hardten, Marlane J Brown, Sandy Pham-Vang
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    ABSTRACT: To determine whether a new category of artificial tear product, carboxymethylcellulose 0.5% with compatible solutes (CMC-solutes) (Optive, Allergan, Inc., Irvine, California) improves clinical outcomes when used adjunctively with topical cyclosporine 0.05% (Restasis, Allergan, Inc., Irvine, California) for the treatment of ocular surface disease. Nineteen patients with ocular surface disease treated with cyclosporine 0.05% for at least 3 months and who had previously used other artificial tears adjunctively were enrolled. Patients discontinued their previous artificial tear and used CMC-solutes, concomitant with topical cyclosporine 0.05%. Corneal evaluation and tear production parameters were evaluated before and during combined CMC-solutes/cyclosporine treatment. Patients also completed a questionnaire before and during treatment with combined CMC-solutes/cyclosporine. Follow-up was at 1 and 3 months. Most objective measures of ocular surface health were unchanged, but an improvement in conjunctival lissamine green staining and tear break-up time was found. Conjunctival lissamine green staining scores improved from 3.4 +/- 2.5 to 1.9 +/- 2.5 by Month 3 (p = 0.004). Tear break-up time improved from 4.6 +/- 3.9 s pre-treatment to 5.3 +/- 3.8 s post-treatment (p = 0.049). Ocular Surface Disease Index (OSDI) scores improved from 16.2 +/- 9.4 at baseline to 11.5 +/- 8.9 at month 3 (p = 0.007). Subjectively, patients graded their ocular discomfort as 2.7 at baseline and as 2.3 at Month 3 (p = 0.049). At Month 3, 89.5% of patients said they liked CMC-solutes as well or better than previous drops they had used. All patients said CMC-solutes provided similar or improved relief of symptoms of dry eye than previous eye drops. There were no tear-related adverse events reported. In this study, CMC-solutes, when used in conjunction with cyclosporine 0.05%, provided patients with an improvement in objective signs and subjective symptoms of ocular surface disease compared to their previous artificial tears. Further studies are warranted.
    Current Medical Research and Opinion 10/2007; 23(9):2083-91. · 2.37 Impact Factor
  • 01/2006: pages 177-187;
  • Dennis C. Lu, David R. Hardten, Richard L. Lindstrom
    01/2006: pages 235-256;
  • Daniel H Chang, David R Hardten
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    ABSTRACT: Many patients who have undergone corneal transplantation are unable to achieve satisfactory visual acuity with spectacle and contact lens correction alone. For these patients, refractive surgery becomes a viable option to reduce the post-keratoplasty ametropia. With the many recent advances in refractive surgery for naturally occurring refractive error, new possibilities arise for application to this complicated set of patients. This review discusses key recent developments in refractive surgery after corneal transplantation. The biomechanical effects of incisional keratotomy on post-keratoplasty corneas continue to be studied, and these techniques remain a common and simple method of reducing astigmatism. Photorefractive keratectomy, previously problematic for regression and haze formation, is gaining new prominence as early experience with the adjunctive use of mitomycin C has demonstrated good results. Long-term studies with laser in-situ keratomileusis (LASIK) have continued to show good safety and efficacy. Modern developments in cataract surgery appear to have lower incidences of graft rejection and failure. Developments in lens implantation technology continue to offer expanding options for intraocular refractive surgery. Although visual rehabilitation after corneal transplantation remains a formidable challenge, developments in refractive surgery for naturally occurring ametropias directly translate into an improved ability to help these most challenging refractive cases. Continued research will bring about improved efficacy while maintaining a high level of safety.
    Current Opinion in Ophthalmology 09/2005; 16(4):251-5. · 2.64 Impact Factor
  • Raymond S Loh, David R Hardten
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    ABSTRACT: To report persistent unilateral flap edema following laser in situ keratomileusis (LASIK) in patients with asymmetrical central corneal thickness. Minnesota Eye Consultants, Minneapolis, Minnesota. Retrospective, noncomparative interventional case series. We examined 6 eyes of 3 patients with asymmetrical preoperative pachymetry who developed persistent unilateral flap edema after uneventful myopic LASIK in the eye with thicker preoperative pachymetry. All cases had asymmetrical preoperative pachymetry with flap edema developing in the eye with higher preoperative mean central corneal thickness (CCT) values, preoperative mean CCT subject eye 622 microm (range 556-664 microm) versus fellow eye 583 microm (range 510-621 microm). There was no associated ocular inflammation or rise in intraocular pressure. Significant flap edema resolved on a combination treatment of topical steroid and hypertonic saline. Laser in situ keratomileusis can cause temporary endothelial cell dysfunction or stress, which manifests as temporary flap edema and subclinical corneal thickening. The edema appears to be limited to the actual flap and there was no loss of epithelial integrity in these eyes and no clinically noticeable interface fluid. This new clinical entity appears to occur in patients with asymmetrical preoperative corneal pachymetry and is associated with postoperative specular microscopy abnormalities. In cases with unexplained asymmetrical corneal thickness, preoperative evaluation should include specular microscopy to evaluate for risk features that may increase the chances of a slower postoperative recovery.
    Journal of Cataract and Refractive Surgery 06/2005; 31(5):922-9. · 2.55 Impact Factor
  • Marlane J Brown, David R Hardten, Kimberly Knish
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    ABSTRACT: Aniridia (or partial aniridia) often occurs as a result of a penetrating ocular trauma. This condition may cause symptoms including glare, light sensitivity, reduced vision, and asymmetric appearance. Options for these patients include specialty contact lenses, corneal tattooing, and artificial iris implants. This article details six patients who experienced penetrating trauma with significant iris tissue loss and who chose to have an artificial iris implant. Six patients with traumatic aniridia were enrolled in a single-site, single-surgeon study. They were followed for one year postoperatively. All six were complex cases that had multiple eye problems, such as aphakia, corneal scarring, corneal graft rejection, and retinal detachment. All participants were male. All patients experienced decrease in glare and light sensitivity following artificial iris implant surgery. Two experienced improved best-corrected vision (BCVA). All six patients felt the cosmetic appearance of their affected eye improved. The artificial iris device provides an effective means of treating traumatic aniridia. Optometrists often work with patients who have experienced a penetrating ocular trauma, with complete or partial aniridia as a complication. In cases in which nonsurgical means are not effective in returning the patient to comfort and productivity, an artificial iris implant should be considered.
    Optometry - Journal of the American Optometric Association 04/2005; 76(3):157-64. · 1.34 Impact Factor
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    ABSTRACT: To determine the effects of Artisan lens implantation on contrast sensitivity. Prospective consecutive interventional case series. Forty-nine eyes of 30 patients with myopia and myopia with astigmatism, who underwent implantation of the Artisan iris-fixated phakic intraocular lens. Preoperative testing served as the control. Implantation of the Artisan phakic intraocular lens to correct myopia. Refractive predictability and Snellen visual acuity were evaluated preoperatively and at least 4 months postoperatively. Additionally, photopic and mesopic contrast sensitivities were measured at 1.5, 3, 6, 12, and 18 cycles per degree, with and without glare testing. The mean preoperative spherical equivalent (SE) was -12.16 diopters (D) (range, -6.88 to -18.00). The mean postoperative SE was -0.46+/-0.58 D (range, +0.50 to -1.75). Ninety percent of eyes were within 1.00 D of the predicted result, and 39% gained > or =1 lines of best-corrected visual acuity (BCVA). When compared with preoperative measurements, postoperative contrast sensitivity was increased under photopic conditions and slightly decreased under mesopic conditions. Adverse events were one wound leak requiring resuturing in the immediate postoperative period and one subluxed lens after significant blunt trauma. No eyes lost > or =2 lines of BCVA. Artisan implantation for the correction of high myopia seems to be a predictable procedure. Increases in photopic contrast sensitivity values after implantation of this phakic intraocular lens stand in distinction to the decreases in photopic contrast sensitivity previously reported after LASIK correction of this degree of myopia.
    Ophthalmology 02/2005; 112(2):278-85. · 5.56 Impact Factor

Publication Stats

977 Citations
165.63 Total Impact Points


  • 1992–2011
    • University of Minnesota Duluth
      Duluth, Minnesota, United States
  • 1992–2003
    • University of Minnesota Twin Cities
      • Department of Ophthalmology and Visual Neurosciences
      Minneapolis, MN, United States
  • 1999
    • Unidad Oftalmologica de Caracas
      El Cafetal, Estado Miranda, Venezuela
  • 1997
    • Jules Stein Eye Institute
      Maryland, United States