An unexpected and persistent increase in global emissions of ozone-depleting CFC-11.

The Montreal Protocol was designed to protect the stratospheric ozone layer by enabling reductions in the abundance of ozone-depleting substances such as chlorofluorocarbons (CFCs) in the atmosphere1-3. The reduction in the atmospheric concentration of trichlorofluoromethane (CFC-11) has made the second-largest contribution to the decline in the total atmospheric concentration of ozone-depleting chlorine since the 1990s 1 . However, CFC-11 still contributes one-quarter of all chlorine reaching the stratosphere, and a timely recovery of the stratospheric ozone layer depends on a sustained decline in CFC-11 concentrations 1 . Here we show that the rate of decline of atmospheric CFC-11 concentrations observed at remote measurement sites was constant from 2002 to 2012, and then slowed by about 50 per cent after 2012. The observed slowdown in the decline of CFC-11 concentration was concurrent with a 50 per cent increase in the mean concentration difference observed between the Northern and Southern Hemispheres, and also with the emergence of strong correlations at the Mauna Loa Observatory between concentrations of CFC-11 and other chemicals associated with anthropogenic emissions. A simple model analysis of our findings suggests an increase in CFC-11 emissions of 13 ± 5 gigagrams per year (25 ± 13 per cent) since 2012, despite reported production being close to zero 4 since 2006. Our three-dimensional model simulations confirm the increase in CFC-11 emissions, but indicate that this increase may have been as much as 50 per cent smaller as a result of changes in stratospheric processes or dynamics. The increase in emission of CFC-11 appears unrelated to past production; this suggests unreported new production, which is inconsistent with the Montreal Protocol agreement to phase out global CFC production by 2010.

Historical Loss: Implications for Health of American Indians in the Blackfeet Community.

BACKGROUND: Historical loss in American Indians (AIs) is believed to contribute to high incidence of mental health disorders, yet less is known about the associations between historical loss and physical health. PURPOSE: To investigate whether frequency of thought about historical loss predicts risk factors for chronic physical health conditions in an AI community. METHODS: Using Community Based Participatory research (CBPR) and Ecological Momentary Assessment (EMA), we measured frequency of thoughts about historical loss in 100 AI adults residing on the Blackfeet reservation. Participants completed a 1-week monitoring period, during which ambulatory blood pressure and daily levels of psychological stress were measured. At the end of the week, we collected a dried blood spot sample for measurement of C-reactive protein (CRP). RESULTS: In hierarchical linear regression models controlling for demographics and relevant covariates, greater frequency of thoughts about historical loss predicted higher average daily psychological stress (B = .55, t = 6.47, p < .001, ΔR2 = .30) and higher levels of CRP (B = .33, t = 3.93, p < .001, ΔR2 = .10). Using linear mixed modeling with relevant covariates, we found that greater thoughts about historical loss were associated with higher systolic ambulatory blood pressure (B = .32, 95% CI = .22-.42, t = 6.48, p < .001, ΔR2 = .25; Fig. 1c) and greater diastolic ambulatory blood pressure (B = .19, 95% CI = .11-.27, t = 4.73, p < .001, ΔR2 = .19). CONCLUSIONS: The data suggest that frequency of thought about historical loss may contribute to increased subclinical risk for cardiovascular disease in the Blackfeet community.

Comparative hemostatic efficacy of 4F-PCC in patients with intracranial hemorrhage on factor Xa inhibitors versus warfarin.

OBJECTIVE: Patients experiencing an intracranial hemorrhage (ICH) on oral anticoagulants often require rapid reversal. This study evaluated patients taking factor Xa inhibitors or warfarin that received reversal with 4-factor prothrombin complex concentrate (4F-PCC) for an ICH. The objective of the study was to determine if the efficacy of 4F-PCC for the reversal of factor Xa inhibitors is noninferior to its use in warfarin reversal in patients with ICH. METHODS: This was a retrospective, single center, noninferiority trial. Patients presenting to the emergency department with ICH were divided into two cohorts: those taking factor Xa inhibitors versus those taking warfarin. In each cohort, patients received anticoagulation reversal with weight-based 4F-PCC. The primary endpoint was hemostatic efficacy defined as ≤20% expansion in hematoma volume on repeat computed tomography imaging. A pre-specified noninferiority margin of -10% was selected to evaluate the difference between groups for the primary endpoint. RESULTS: A total of 221 patients were included in the study (factor Xa inhibitors, n = 87; warfarin, n = 134). Effective hemostasis was achieved in 70 patients (81%) on factor Xa inhibitors compared to 111 patients (83%) on warfarin, (-2.4% difference, [95% confidence interval, -12.87 to 8.12]; p = 0.654). There was no statistically significant difference between groups with regards to the primary outcome; however, the use of 4F-PCC in factor Xa inhibitor reversal was not noninferior when compared to 4F-PCC use for warfarin reversal. Hospital length of stay and discharge disposition were similar between cohorts. CONCLUSIONS: The efficacy of 4F-PCC in reversing factor Xa inhibitor-related ICH compared to warfarin-related ICH was not significantly different between groups; however, these results did not prove noninferiority. Further study is warranted to delineate 4F-PCC's role in reversing factor Xa inhibitors in patients with ICH.

Impact of SEP-1 on broad-spectrum combination antibiotic therapy in the emergency department.

BACKGROUND: The SEP-1 measures have tied financial reimbursement to the treatment of patients with severe sepsis and septic shock. The purpose of this study was to assess the impact of a SEP-1 initiative on the utilization of broad-spectrum combination therapy (BSCT) in the emergency department (ED). METHODS: This was an IRB-approved, retrospective evaluation of adult patients who received vancomycin plus an antipseudomonal beta-lactam for a urinary tract infection (UTI) or skin or soft tissue infection (SSTI) in the ED. The primary outcome was the proportion of patients in which use of BSCT was considered appropriate based on clinical criteria. Secondary outcomes included door to antibiotic order time, door to administration time, proportion of patients continued on BSCT upon admission, duration of BSCT, and in-hospital mortality. RESULTS: A total of 400 patients were included in the analysis. Following SEP-1 implementation, appropriate use of BSCT decreased by 12%, with 54% of patients in the pre-SEP-1 group meeting clinical criteria compared to 42% in the post-SEP-1 group (p = 0.028). In the subgroup of patients with a suspected UTI the appropriate use of BSCT declined by 25% (40% vs 15%, p = 0.005). The median door to first antibiotic administration time was not significantly different between groups (63 min vs 61 min, p = 0.091). CONCLUSIONS: The implementation of the SEP-1 mandated measures was associated with an increase in the unnecessary use of BSCT. Additionally, no difference was seen in time to antibiotic administration. The results of this study demonstrate the negative impact that the SEP-1 mandate may have on antimicrobial utilization within the ED.

Atmospheric Acetaldehyde: Importance of Air-Sea Exchange and a Missing Source in the Remote Troposphere.

We report airborne measurements of acetaldehyde (CH3CHO) during the first and second deployments of the National Aeronautics and Space Administration (NASA) Atmospheric Tomography Mission (ATom). The budget of CH3CHO is examined using the Community Atmospheric Model with chemistry (CAM-chem), with a newly-developed online air-sea exchange module. The upper limit of the global ocean net emission of CH3CHO is estimated to be 34 Tg a-1 (42 Tg a-1 if considering bubble-mediated transfer), and the ocean impacts on tropospheric CH3CHO are mostly confined to the marine boundary layer. Our analysis suggests that there is an unaccounted CH3CHO source in the remote troposphere and that organic aerosols can only provide a fraction of this missing source. We propose that peroxyacetic acid (PAA) is an ideal indicator of the rapid CH3CHO production in the remote troposphere. The higher-than-expected CH3CHO measurements represent a missing sink of hydroxyl radicals (and halogen radical) in current chemistry-climate models.

A Review of Techniques to Measure Protein Sorption to Soft Contact Lenses.

PURPOSE: To compare and critically evaluate a variety of techniques to measure the quantity and biological activity of protein sorption to contact lenses over short time periods. METHODS: A literature review was undertaken investigating the major techniques to measure protein sorption to soft contact lens materials, with specific reference to measuring protein directly on lenses using in situ, ex situ, protein structural, and biological activity techniques. RESULTS: The use of in situ techniques to measure protein quantity provides excellent sensitivity, but many are not directly applicable to contact lenses. Many ex situ techniques struggle to measure all sorbed proteins, and these measurements can have significant signal interference from the lens materials themselves. Techniques measuring the secondary and tertiary structures of sorbed proteins have exhibited only limited success. CONCLUSIONS: There are a wide variety of techniques to measure both the amount of protein and the biological activity of protein sorbed to soft contact lens materials. To measure the mass of protein sorbed to soft contact lenses (not just thin films) over short time periods, the method of choice should be I radiolabeling. This technique is sensitive enough to measure small amounts of deposited protein, provided steps are taken to limit and measure any interaction of the iodine tracer with the materials. To measure the protein activity over short time periods, the method of choice should be to measure the biological function of sorbed proteins. This may require new methods or adaptations of existing ones.

Competitive Effects from an Artificial Tear Solution to Protein Adsorption.

PURPOSE: To compare the adsorption of lysozyme, lactoferrin, and albumin to various contact lens materials, between single-protein solutions and a multicomponent artificial tear solution (ATS). Additionally, extra steps were taken to distinguish loosely and tightly bound protein, the latter of which may be fully or partially denatured. METHODS: Using a previously described ATS, we measured the time-dependent adsorption of lys, lac, and alb onto one conventional hydrogel and four silicone hydrogel contact lens materials between the first minute and up to 1 week of protein interaction with the material surface. Proteins were quantified using I radiolabeling of each protein individually in ATS and buffered saline. Extra steps were taken to limit the amount of unbound I and to quantify the amount of reversibly bound protein. RESULTS: Comfilcon A, balafilcon A, and etafilcon A did not show any relevant competitive adsorption between the ATS components and lys, lac, or alb until after 1 week. Competitive adsorption effects for lys, lac, and alb were observed in as little as 1 minute on lotrafilcon B. Lotrafilcon B had no reversibly bound protein at any time points. The ionic materials balafilcon A and etafilcon A deposited significant amounts of reversibly bound lysozyme and lactoferrin in just 10 minutes. Senofilcon A apparent deposition was below our thresholds of confidence for this protein quantification method. CONCLUSIONS: Both the competition between lys, lac, and alb and ATS components and the reversibility of these bound proteins is material specific. Coadsorption of lys, lac, and alb with ATS components can increase the reversibility of their adsorption.

Profound symptomatic bradycardia requiring transvenous pacing after a single dose of tizanidine.

BACKGROUND: We report a case of profound symptomatic bradycardia after a single dose of tizanidine. CASE REPORT: A 93-year-old female became altered and was found to have hypotension and profound symptomatic bradycardia 30 min post ingestion of a single 4-mg dose of tizanidine at her physician's office. Emergency Medical Services was called to scene and patient was transported to our tertiary medical center. In the emergency department, the patient required intubation, vasopressor support, and transcutaneous pacing. An electrocardiogram revealed atrial fibrillation with slow ventricular response with a heart rate of 19 beats/min. The patient was transferred to the intensive care unit and subsequently taken for cardiac catheterization, where a transvenous pacer was placed. During the next few days, her vital signs and mental status improved, allowing for successful extubation. Before discharge, the patient received a single-chamber pacemaker. DISCUSSION: Profound symptomatic bradycardia from a single dose of tizanidine has not been reported. A review of the patient's medications did not reveal a significant cytochrome P450 drug interaction to result in an adverse effect as previously reported in the literature. CONCLUSIONS: Tizanidine should be used cautiously in elderly population and drug interactions screening should be performed.

Extraction versus in situ techniques for measuring surface-adsorbed lysozyme.

PURPOSE: To compare two techniques for measuring the activity of lysozyme deposited onto hydrogel contact lens and to image the binding of Micrococcus lysodeikticus to contact lenses. METHODS: Using a previously described protein extraction technique and a recently developed in situ technique, we measured the time-dependent activity of adsorbed lysozyme on six different contact lens materials during the first minute and up to 1 week of interaction with the material surface. Total activity of extracted lysozyme, total in situ activity, and the activity of the outer surface layer of sorbed lysozyme were determined using the two different techniques. Micrococcal cellular interaction with surface-adsorbed lysozyme was imaged using confocal microscopy. RESULTS: The differences between total extracted activities, total in situ activities, and surface activities were both measurable and material specific. In most cases, total extracted activity is greater than total in situ activity, which, in turn, is greater than surface activity. After 1 week, etafilcon A had the highest extracted activity at 137 µg/lens, followed by omafilcon A, balafilcon A, comfilcon A, senofilcon A, and lotrafilcon B at 27.4, 2.85, 2.02, 0.46, and 0.27 µg/lens, respectively. Micrococcal cell adhesion was greatest on contact lenses with high contact angles, such as balafilcon A, omafilcon A, and senofilcon A and lowest on contact lenses with low contact angles, such as etafilcon A, comfilcon A, and lotrafilcon B. Subsequent removal/prevention of adhered micrococcal cells was greatest on balafilcon A, which had the highest surface activity, and lowest on lotrafilcon B, which had the lowest surface activity. CONCLUSIONS: This study has measured and made direct comparisons between two established techniques for measuring the activity of adsorbed lysozyme. The extraction technique determines the activity of underlying layers of lysozyme or lysozyme within the matrix of the material. Conversely, the in situ technique allows conclusions to be drawn about only the biologically relevant lysozyme including the activity of just the outer surface of adsorbed lysozyme.

Silicone allergies and the eye: fact or fiction?

OBJECTIVE: The purpose of this manuscript was to review the evidence concerning the role of an allergic reaction to silicone as the basis for the reported increase in contact lens-associated infiltrates in wearers of silicone hydrogel contact lenses. METHODS: A literature review was undertaken to investigate the antigenic properties of silicone and the causes of contact lens-associated inflammatory reactions. RESULTS: Immune cells cannot interact with silicone directly but can interact with antigens on these lenses. These antigens could be due to tear film deposits, microbial contamination, or components of care systems used with these lenses. CONCLUSIONS: Inflammatory reactions associated with silicone hydrogel contact lens wear are not caused by an allergic reaction to silicone alone.

Visual Function After Implantation of Trifocal and Trifocal Toric Intraocular Lenses Using Intraoperative Aberrometry.

Purpose: To evaluate patient outcomes and visual function following trifocal and trifocal toric intraocular lens (IOL) implantation using intraoperative aberrometry at a single site in the US. Methods: This prospective, single arm study included 21 subjects that completed 3 month follow-up. Inclusion criteria were visually significant cataract and potential post-operative visual acuity of 20/25 or better. Endpoints included postoperative prediction error, refractive outcomes, uncorrected visual acuities at distance (UDVA), intermediate (UIVA), and near (UNVA), contrast sensitivity, and subject responses on the modified Visual Function Quality of Life Questionnaire (VF-14 QOL). Results: Binocular UDVA, UIVA, and UNVA were 20/25 or better in 100% (21/21), 100% (21/21), 90% (19/21) of subjects. The absolute prediction error was 0.50 D or less in 79% (33/42) of eyes, and 81% (34/42) and 86% (36/42) of eyes achieved ≤0.5 D of residual astigmatism and manifest refraction spherical equivalent, respectively. On the modified VF-14 QOL, driving at night, reading small print, and reading a newspaper or book were the tasks that had the lowest percentages of subjects reporting no difficulty or a little difficulty. Conclusion: Implantation with trifocal and trifocal toric IOLs using intraoperative aberrometry can provide high refractive precision, leading to excellent visual performance and low visual task difficulty at all ranges (distance, intermediate, and near).

An intraocular lens (IOL) is a clear artificial lens that can be used to replace the natural lens in the eye when the natural lens becomes opaque (develops a cataract). Monofocal IOLs are designed to provide good vision to see distant objects; however, spectacles may still be needed to see objects clearly up close (such as reading a book or using a digital device). Trifocal IOLs are designed to provide good vision to see objects at distance and up close, however, the power of the IOL must be accurately determined for the best visual outcomes. Devices called biometers are used by cataract surgeons to measure the eye and determine the most appropriate lens power to implant. Most biometers are used prior to surgery, however one type, intraoperative aberrometry (IA), can be used during surgery to measure the eye and determine the most appropriate lens power. The purpose of this study was to evaluate patient outcomes and visual function following trifocal IOL implantation using IA. The results of this study suggest that implantation with trifocal IOLs using IA can provide high refractive accuracy and excellent visual outcomes.

Retrospective Study Comparing Topography-Guided and Wavefront-Optimized LASIK Procedures in a Single Center.

Purpose: To compare visual outcomes of eyes that had laser refractive surgery with the Contoura Phorcides treatment plan and eyes that had laser refractive surgery with the wavefront-optimized treatment plan using the same laser. Methods: Retrospective chart review of clinical outcomes of eyes that had either Contoura with Phorcides (CP) or wavefront-optimized (WFO) corneal refractive procedures using the Wavelight EX500 (Alcon Vision, LLC). Data were collected and compared for uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refraction, change in postoperative UDVA compared to preoperative CDVA, and change in postoperative CDVA compared to preoperative CDVA. Results: Total eyes included were 348, with 227 in the CP Group and 121 in the WFO Group. Post-operatively, there was a significantly higher percentage of eyes in the CP Group that were 20/16 or better compared to the WFO Group (57%, 129 eyes, and 17%, 21 eyes, respectively; p < 0.001). The percentage of eyes that gained 1 or more Snellen lines of UDVA compared to preoperative CDVA was higher in the CP Group (47%; 107 eyes) compared to the WFO Group (12%; 14 eyes), which was statistically significant (p < 0.001). Differences in refraction were statistically significant. Conclusion: Topography-guided and wavefront-optimized treatment profiles both provided excellent refractive results. A higher percentage of eyes that were treated using Contoura with Phorcides achieved 20/16 or better unaided distance vision compared to eyes receiving a wavefront-optimized treatment plan.

Laser in situ keratomileusis (LASIK) is a common procedure performed to reshape the cornea (transparent part of the eye) and provide clear, spectacle-free vision. There are many different technologies available for surgeons to choose a treatment plan. One of the most popular is called wavefront-optimized LASIK (WFO), which takes into account the curvature of the cornea. Recently, topography-guided LASIK treatment plans that incorporate a proprietary planning software (Contoura Phorcides) have been available that can factor in the individualized surface elevation characteristics of the cornea. The purpose of this study was to compare visual outcomes in patients that had LASIK with the Contoura Phorcides treatment plan to patients that had LASIK with the WFO treatment plan. The results of this study suggest that both treatment profiles both provided excellent refractive results. In addition, a higher percentage of eyes that were treated using Contoura with Phorcides achieved 20/16 or better unaided distance vision compared to eyes receiving a WFO treatment plan.

Outcomes After Implantation of a Trifocal Toric Intraocular Lens Using Intraoperative Aberrometry, Digital Image Tracking, and Femtosecond Laser.

Purpose: To evaluate the refractive and visual acuity outcomes when using trifocal toric intraocular lenses (IOLs), femtosecond laser assisted cataract surgery (FLACS), swept-source optical coherence tomography (SS-OCT) biometry, digital image tracking (DT) and intraoperative aberrometry (IA). Methods: This prospective, single-arm, observational study of refractive and visual outcomes included 40 eyes of 34 subjects. Preoperative biometry was performed with the Argos, FLACS and digital marking with LenSx, and IA and DT with ORA. Eyes were implanted with the Clareon PanOptix toric IOL. Study outcome measures included absolute prediction error, residual refractive astigmatism, and monocular uncorrected and distance corrected visual acuity at distance (UDVA, CDVA), intermediate (UIVA, DCIVA; 60cm), and near (UNVA, DCNVA; 40cm). Results: Mean absolute prediction error (spherical equivalent) was 0.43 ± 0.36 D, and the percentage of eyes with absolute prediction error ≤ 0.5 D was 72.5% (29/40 eyes). Mean residual astigmatism was 0.36 ± 0.65 D, and the percentage of eyes with residual astigmatism ≤ 0.5 D was 80% (32/40 eyes). Monocular UDVA, UIVA, and UNVA was 20/25 or better in 75%, 64%, and 87% of eyes respectively. Monocular CDVA, DCIVA, and DCNVA was 20/25 or better in 95%, 64%, and 87% of eyes respectively. Conclusion: The results of this study suggest that trifocal toric implantation with SS-OCT, FLACS, DT, and IA can provide excellent refractive and visual outcomes.

When the natural lens inside the eye becomes opaque (develops a cataract), it can be surgically replaced with a clear artificial intraocular lens (IOL). There are many different technologies available to the cataract surgeon in order to maximize postoperative visual outcomes with implanted IOLs. These include, modern biometers, femtosecond laser-assisted cataract surgery (FLACS), trifocal IOLs, toric IOLs, image-guided digital tracking (DT), and intraoperative aberrometry (IA). Individually, good refractive outcomes have been reported with these technologies. However, there is minimal data on outcomes using a combination of all of them. The purpose of this study was to determine the refractive and visual acuity outcomes when using modern biometers, toric IOLs, FLACS, DT, IA, and trifocal IOLs. The results of this study suggest that trifocal toric implantation with modern biometry, FLACS, DT, and IA can provide excellent refractive and visual outcomes.

Evaluation of Visual Outcomes and 3-Month Refractive Stability of a New Hydrophobic Acrylic Intraocular Lens.

Purpose: To determine the refractive stability of a new hydrophobic acrylic intraocular lens (IOL) when implanted bilaterally. Methods: This was a prospective, evaluator masked, single surgeon study of 58 eyes of 29 patients. Patients were bilaterally implanted with the Clareon monofocal IOL (CNA0T0, Alcon Vision LLC). Refractive stability was evaluated between 1 and 3 months postoperatively. At 3 months postoperatively, data were also collected for binocular uncorrected and distance corrected visual acuities at distance (4 m) and intermediate (80 cm and 66 cm) and binocular defocus curve. Results: Postoperative refraction was statistically equivalent between 1 and 3 months postoperatively (p < 0.001). Mean postoperative uncorrected distance visual acuity was -0.01 ± 0.10 logMAR, and mean corrected distance visual acuity was -0.04 ± 0.06 logMAR. Mean postoperative uncorrected intermediate visual acuity was 0.16 ± 0.13 logMAR and 0.24 ± 0.14 logMAR at 80 cm and 66 cm, respectively. With distance correction in place, mean visual acuity at 80cm and 60cm was 0.16 ± 0.13 logMAR and 0.23 ± 0.14 logMAR, respectively. Conclusion: The Clareon monofocal IOL can provide stable refraction, excellent distance vision, and functional intermediate vision postoperatively.

Comparing Predictive Accuracy of a Swept Source Optical Coherence Tomography Biometer and an Optical Low Coherence Reflectometry Biometer.

Purpose: To compare the refractive accuracy resulting from calculations based on measurements with a swept-source optical coherence tomography (SS-OCT) biometer compared to calculations based on measurements with an optical low coherence reflectometry (OLCR) biometer at one month postoperatively. Methods: This was a retrospective comparative non-interventional study of preoperative biometry and postoperative refraction and visual acuity of 200 eyes. All eyes had preoperative biometry with both the Argos (Movu, a Santec company) and Lenstar LS900 (Haag-Streit AG) devices. Data were collected for mean postoperative prediction error (directional and absolute), preoperative mean K, delta K (corneal astigmatism), axial length, and anterior chamber depth. Results: The mean directional prediction error was -0.15 ± 0.47 D for Argos and -0.31 ± 0.50 D for Lenstar LS900, and there was a statistically significant mean of the differences (0.16 ± 0.24 D; p < 0.001). The mean absolute prediction error was 0.35 ± 0.34 D for Argos and 0.42 ± 0.41 D for Lenstar LS900, and there was a statistically significant mean of the differences (-0.07 ± 0.24 D; p < 0.001). Neither the differences in directional prediction error nor the differences in absolute prediction error were clinically significant. Conclusion: The directional and absolute prediction accuracies were statistically significant, but not clinically different between the Argos and Lenstar LS900 devices. In addition, differences between preoperative K, AL, and ACD measurements were not clinically significant.

Refractive Predictability of a Swept Source Optical Coherence Tomography Biometer in Long and Short Eyes Implanted with Extended Depth of Focus Intraocular Lenses.

Purpose: To determine the refractive predictability of Argos (Movu, a Santec company) measurements and the Barrett Universal II formula in long and short eyes implanted with an extended depth of focus (EDOF) intraocular lens (IOL). Methods: This retrospective, non-interventional study included 86 eyes (55 long and 31 short) of 55 patients. Preoperative biometry was performed using the Argos. Preoperative IOL power formulas were the preprogrammed Barrett Universal II (BUII). Data were collected for refractive outcomes, postoperative prediction error (directional and absolute), and monocular corrected distance visual acuity (CDVA, Snellen). Results: The mean absolute prediction error for BUII was 0.27 ± 0.26 D overall, 0.24 ± 0.20 D in long eyes, and 0.33 ± 0.33 D in short eyes. Overall, the percentage of eyes with ≤ 0.5 D prediction error was 84% for BUII. In long eyes, the percentage of eyes with ≤ 0.5 D prediction error was 90% for BUII. In short eyes, the percentage of eyes with ≤ 0.5 D prediction error was 74% for BUII. The percentage of eyes with ≤ 0.5 D of MRSE was 89% for long eyes and 94% for short eyes. Visual acuities were excellent in both long and short eyes, with > 90% of eyes 20/25 or better in each group. Conclusion: The prediction error of Argos using BUII was low in long and short eyes at one month after EDOF IOL implantation.

Comfort After Refitting Symptomatic Habitual Reusable Toric Lens Wearers with a New Daily Disposable Contact Lens for Astigmatism.

Purpose: To subjectively evaluate comfort with a daily disposable (delefilcon A for astigmatism) contact lens compared to other common weekly/monthly soft toric contact lenses in symptomatic wearers. Methods: This open-label, single arm study enrolled current reusable soft toric lens wearers with minimum score of 12 on the contact lens dry eye (CLDEQ-8) questionnaire. Subjects were also administered the CLDEQ-8 after 1 replacement schedule of their optimized habitual toric lenses (2 to 4 weeks), and after 2 weeks of wear with delefilcon A toric daily disposable lenses (Dailies Total1 for Astigmatism; Alcon Vision LLC, Fort Worth, Texas). Results: A total of 85 subjects completed the study. Mean total CLDEQ-8 score was 16.8 ± 8.1 for subjects refit with their optimized habitual toric lenses and 12.4 ± 7.5 for subjects refit with delefilcon A toric lenses, a difference of 4.3 ± 10.4 (p < 0.001). With delefilcon A toric lenses, 78.9% of subjects reported little to no intensity of eye discomfort, compared to 51.7% for the habitual toric lenses (p = 0.005). In addition, 77.7% of subjects reported little to no intensity of dryness for delefilcon A toric lenses, compared to 50.6% for the habitual toric lenses (p = 0.001). Conclusion: The subjective comfort in symptomatic habitual reusable toric contact lens wearers was improved by refitting with delefilcon A toric lenses.

Randomized and double-blind comparison of clinical visual outcomes of 2 EDOF intraocular lenses.

PURPOSE: To assess and compare the visual disturbance profiles of 2 extended depth-of-focus (EDOF) intraocular lenses (IOLs). SETTING: Private practice (West Kootenays, British Columbia, Canada). DESIGN: Prospective, randomized, single-surgeon study. METHODS: This was a double-blind prospective study of 138 eyes (69 patients) that underwent bilateral implantation of 1 of 2 EDOF IOLs. Participants were randomized to either the Symfony group or the Vivity group. Outcome measures included Questionnaire for Visual Disturbances; binocular corrected distance visual acuities at distance (6 m), intermediate (66 cm), and near (40 cm); and refractive outcomes. RESULTS: At 3 months postoperatively, 21 patients (60%) reported not experiencing glare in the Symfony group compared with 30 (88%) in the Vivity group, a difference of 28% (P = .008). Reports of experiencing starbursts were also significantly different between the Symfony and Vivity groups (23 participants [66%] Symfony and 30 participants [88%] Vivity; P = .027). In addition, 12 participants (34%) reported "moderate" or "severe" starbursts in the Symfony group compared with 3 (9%) in the Vivity group, a difference of 25% (P = .019). Visual acuities and refractive outcomes were similar between groups. CONCLUSIONS: Both EDOF lenses provide good visual outcomes at distance and intermediate with acceptable near vision. The Symfony group had increased reports of some visual disturbances, notably the frequency, severity, and bothersomeness of starbursts and glare.

The Accuracy of Flap Thickness and Diameter in LASIK Using a Femtosecond Laser.

Purpose: To evaluate the resultant thickness of the WaveLight FS200 (Alcon Vision, LLC) created LASIK flap compared to intended thickness at the surgical visit, using the WaveLight EX500 (Alcon Vision, LLC) pachymeter and the resultant flap diameter compared to intended diameter. Methods: This single arm, prospective, single surgeon study assessed the accuracy of the intended flap thickness and diameter, after successful bilateral LASIK surgery. The WaveLight FS200 femtosecond laser was used to create all flaps with an intended thickness of 120 µm. Flap thickness was calculated by subtracting the stromal bed thickness after flap lift from the preoperative corneal thickness using the WaveLight EX500 on-board optical pachymeter. Flap diameter was determined using digital analysis. Results: A total of 58 subjects (116 eyes) completed the study. The calculated mean flap thickness was 120.6 ± 9.0 µm (range 102 to 143 µm) using the EX500 pre- and post-flap pachymetry measurements. There was no statistically significant difference between the planned and achieved flap thickness (p > 0.05). The mean difference in flap diameter between planned and actual was 0.02 ± 0.05 mm. Corneal thickness measured by Pentacam at up to 2 months preoperatively versus EX500 just prior to surgery was similar, with EX500 measuring 2 µm less on average than the Pentacam. Conclusion: The results suggest that the WaveLight FS200 laser is reliable for LASIK flap thickness and diameter and accurately created flaps at the intended thickness and the intended diameter.

Randomized Trial Comparing Prediction Accuracy of Two Swept Source Optical Coherence Tomography Biometers.

Purpose: To compare the prediction accuracy of the Argos biometer using standard keratometry to the prediction accuracy of the IOLMaster 700 biometer using Total Keratometry. Methods: This was a randomized, prospective, single surgeon study of 80 right eyes of 80 patients that had preoperative biometry with both the Argos and IOLMaster 700 devices, followed by cataract surgery and intraocular lens (IOL) implantation. Prediction errors (directional and absolute) for each device were determined from the 1 month postoperative manifest refraction. Results: The directional prediction error was 0.07 ± 0.32 D for the Argos and 0.08 ± 0.34 D for the IOLMaster 700. The mean of the difference in prediction error (directional) was 0.02 D, which was not statistically significant (p > 0.05). The absolute prediction error was 0.21 ± 0.25 D for the Argos and 0.25 ± 0.24 D for the IOLMaster 700. The mean of the difference in absolute prediction error was 0.04 D, which was statistically significant (p < 0.004) but not clinically significant. The percentage of eyes with absolute prediction error ≤ 0.5 D was 91% (73 eyes) for the Argos and 88% (70 eyes) for the IOLMaster 700. This difference was not statistically significant. Conclusion: The prediction accuracies were similar between the Argos and IOLMaster 700 in eyes with normal axial length. There was a significant difference in mean absolute prediction error between devices; however, this was not clinically meaningful.