Comparison of Legacy and New No-History IOL Power Calculation Formulas in Postmyopic Laser Vision Correction Eyes.

PURPOSE: To compare the refractive accuracy of legacy and new no-history formulas in eyes with previous myopic laser vision correction (M-LVC). DESIGN: Retrospective cohort study. METHODS: Setting: Two academic centers Study Population: 576 eyes (400 patients) with previous M-LVC that underwent cataract surgery between 2019-2023. A SS-OCT biometer was used to obtain biometric measurements, including standard (K), posterior (PK), and total keratometry values (TK). OBSERVATION PROCEDURES: Refractive prediction errors were calculated for 11 no-history formulas: two legacy M-LVC formulas, four new M-LVC formulas using K values only, and five new M-LVC formulas using K with PK or TK. MAIN OUTCOME MEASURES: Heteroscedastic testing was used to evaluate relative formula performance, and formulas were ranked by root mean square error (RMSE). RESULTS: New M-LVC formulas performed better than legacy M-LVC formulas. New M-LVC formulas with PK/TK values performed better than versions without PK/TK values. Among new M-LVC formulas with PK/TK values, EVO 2.0-PK was superior to Hoffer QST-PK (P < 0.005). Among new M-LVC formulas using K only, Pearl DGS-K and EVO 2.0-K were both superior to Hoffer QST-K and Barrett True K NH-K formulas (all P < 0.005). CONCLUSIONS: Surgeons should favor using new no-history post M-LVC formulas over legacy post M-LVC formulas whenever possible. The top-performing M-LVC formulas (EVO 2.0-PK, Pearl DGS-PK, and Barrett True K-TK) utilized posterior corneal power values. Among formulas utilizing K alone, the EVO 2.0-K and Pearl DGS-K performed best.

The Effects of Negative Periocular Pressure on Biomechanics of the Optic Nerve Head and Cornea: A Computational Modeling Study.

Purpose: The purpose of this study was to evaluate the effects of negative periocular pressure (NPP), and concomitant intraocular pressure (IOP) lowering, on the biomechanics of the optic nerve head (ONH) and cornea. Methods: We developed a validated finite element (FE) model of the eye to compute tissue biomechanical strains induced in response to NPP delivered using the Multi-Pressure Dial (MPD) system. The model was informed by clinical measurements of IOP lowering and was based on published tissue properties. We also conducted sensitivity analyses by changing pressure loads and tissue properties. Results: Application of -7.9 mmHg NPP decreased strain magnitudes in the ONH by c. 50% whereas increasing corneal strain magnitudes by c. 25%. Comparatively, a similar increase in corneal strain was predicted to occur due to an increase in IOP of 4 mmHg. Sensitivity studies indicated that NPP lowers strain in the ONH by reducing IOP and that these effects persisted over a range of tissue stiffnesses and spatial distributions of NPP. Conclusions: NPP is predicted to considerably decrease ONH strain magnitudes. It also increases corneal strain but to an extent expected to be clinically insignificant. Thus, using NPP to lower IOP and hence decrease ONH mechanical strain is likely biomechanically beneficial for patients with glaucoma. Translational Relevance: This study provides the first description of how NPP affects ONH biomechanics and explains the underlying mechanism of ONH strain reduction. It complements current empirical knowledge about the MPD system and guides future studies of NPP as a treatment for glaucoma.

Canaloplasty and trabeculotomy with the OMNI® surgical system in OAG with prior trabecular microbypass stenting.

PURPOSE: Evaluate effectiveness and safety outcomes for patients treated with canaloplasty and trabeculotomy previously treated with a trabecular microbypass stent (TBS). METHODS: Retrospective, multicenter, IRB approved study. Patients treated with TBS (iStent/iStent inject, Glaukos) and subsequently with OMNI surgical system (OSS) (Sight Sciences). From 5 practices in 5 US states. Open-angle glaucoma (OAG), minimum 3 months follow-up after OSS surgery, Pre-OSS IOP ≥ 17 mmHg on ≥ 1 medication. No glaucoma procedures between TBS and OSS. ENDPOINTS: proportion with ≥ 20% reduction in IOP, IOP between 6 and 18 mmHg, mean IOP, change in IOP, mean number of medications. Adverse events and secondary surgical interventions (SSI). Mann-Whitney rank sum test compared pre-OSS IOP and medications with follow-up. RESULTS: Twenty seven patients. Average age (SD) 72.2 (10.8), 22/27 primary OAG (82%), mean MD - 6.2 (7.0) dB. Mean IOP before OSS 22.3 (4.3) mmHg on 2.2 (1.3) medications. At last follow-up (mean 11 months) IOP was 17.2 mmHg on 1.8 medications, - 5.1 mmHg (- 23%, p < .001), - 0.4 meds (- 18%, p = .193); ≥ 20% IOP reduction (41%), IOP ≤ 18 (56%). Adverse events were non-serious. Hyphema > 1 mm (3, 11%), BCVA decrease (4, 15%), IOP spike (2, 7%). SSI (4, 15%) had higher pre-OSS IOP (23.4 mmHg) and worse MD (- 9.6 dB). CONCLUSION: Patients uncontrolled by medication and a prior TBS would once have been candidates for trabeculectomy and tube shunts. OSS offered a minimally invasive option that provided IOP control and avoidance of traditional surgery for the majority over follow-up averaging 11 months and up to 42 months.

Short-Term Efficacy of Combined ab Interno Canaloplasty and Trabeculotomy in Pseudophakic Eyes with Open-Angle Glaucoma.

Purpose: To evaluate short-term outcomes of combined ab interno canaloplasty and trabeculotomy in pseudophakic eyes with open-angle glaucoma. Patients and Methods: Series included all pseudophakic eyes with open-angle glaucoma treated with up to 360° ab interno canaloplasty and up to 360° ab interno trabeculotomy using a purpose-engineered device (OMNI, Sight Sciences Inc). Data collected prior to surgery and out to 6-months postoperative. Surgical success defined as a 20% reduction in intraocular pressure (IOP) without increase in glaucoma medication, or discontinuation of at least one glaucoma medication without increase in IOP. Other primary endpoints included mean IOP and number of glaucoma medications. Results: The study included 67 eyes of 52 patients with a mean age of 76.5 ± 8.9 years. Preoperative mean IOP was 22.1±8.0 mmHg on 2.3±1.4 glaucoma medications. Pressure lowering effects were sustained out to 6 months postoperative with a mean IOP of 15.2±4.9 mmHg (p < 0.001) and mean medication reduction of 0.7±1.4 (p < 0.001). Surgical success rate was 69.8% (30 eyes) and correlated with preoperative IOP. Two patients required a secondary surgical intervention. Conclusion: Combined ab interno canaloplasty and trabeculotomy as a standalone procedure is an effective means of reducing IOP and medication burden in pseudophakic eyes with open-angle glaucoma.

A Survey of Eye Care Needs Among Community Health Patients in Western South Dakota.

INTRODUCTION: Community Health Centers (CHCs) provide healthcare to underserved communities, including the uninsured and underinsured. Ocular disease and visual impairment affect individuals of all ages, race, and socioeconomic standing, but are disproportionately detrimental to individuals with limited access to care. The purpose of this study is to assess the need for and potential utilization of an on-site eye care clinic at a CHC in Rapid City, South Dakota. METHODS: A 22-question survey was distributed to patients 18 years and older at Community Health Center of the Black Hills (CHCBH) to gather demographic, socioeconomic, medical, and subjective interest data. RESULTS: A total of 421 surveys were included in the analysis. Of these, 364 respondents (87%) indicated being "Very likely" or "Somewhat likely" to use an on-site eye clinic at CHCBH. A total of 217 respondents (52%) endorsed a diagnosis of an existing eye condition and/or diabetes, and 215 respondents (51%) rated their vision as "Poor" or "Very poor." Less than half of respondents indicated having health insurance such as private insurance, Medicaid, Medicare, State Children's Health Insurance Program (CHIP), Indian Health Services, Military insurance, or other public or government insurance programs (191, 45%) but showed a comparably high likelihood of using an on-site eye clinic when compared to their uninsured counterparts, 90% and 84%, respectively. Finally, 50 (12%) respondents indicated they had been referred to an eye doctor in the past, with affordability as the most cited reason for not following through with the referral. CONCLUSIONS: Survey data indicate a medical and socioeconomic need for eye care services among CHCBH patients and a high likelihood patients would seek care at an on-site clinic.

A Survey of Eye Care Needs Among Community Health Center Patients in Western South Dakota.

BACKGROUND: Community health centers (CHCs) provide healthcare to underserved communities, including the uninsured and underinsured. Ocular disease and visual impairment affect individuals of all ages, race, and socioeconomic standing, but are disproportionately detrimental to individuals with limited access to care. The purpose of this study is to assess the need for and potential utilization of an on-site eye care clinic at a CHC in Rapid City, South Dakota. METHODS: A 22-question survey was distributed to patients 18 years and older at Community Health Center of the Black Hills (CHCBH) to gather demographic, socioeconomic, medical, and subjective interest data. RESULTS: A total of 421 surveys were included in the analysis. Of these, 364 respondents (87 percent) indicated being "Very likely" or "Somewhat likely" to use an on-site eye clinic at CHCBH (95 percent CI 83-90 percent). A total of 217 respondents (52 percent) endorsed a diagnosis of an existing eye condition and/or diabetes, and 215 respondents (51 percent) rated their vision as "Poor" or "Very poor." Less than half of respondents indicated having any form of health insurance (191, 45 percent) but showed a comparably high likelihood of using an on-site eye clinic when compared to uninsured respondents, 90 percent and 84 percent, respectively. Finally, 50 (12 percent) respondents indicated being referred to an eye doctor in the past, with affordability as the most commonly cited reason for not following through with the referral. CONCLUSIONS: Survey data indicate a medical and socioeconomic need for eye care services among CHCBH patients and a high likelihood patients would seek care at an on-site clinic.

Descemet Membrane Endothelial Keratoplasty and light adjustable lens triple procedure.

PURPOSE: The objective of this series is to report the early post-operative visual outcomes of a novel triple procedure utilizing Descemet membrane endothelial keratoplasty (DMEK) plus light adjustable lens (LAL) in two patients (four eyes). METHODS: Two patients with bilateral, visually significant cataracts and Fuchs' dystrophy were selected for DMEK plus LAL triple procedure. Patient B also exhibited a high amount of preoperative astigmatism. Both patients desired spectacle independence and were initially targeted for monovision with the dominant eye corrected for distance and the nondominant eye corrected for near. Best corrected visual acuity (BCVA), uncorrected visual acuity (UCVA), and manifest refraction were recorded at each postoperative appointment and light treatment. RESULTS: In the early post-operative course, Patient A chose to pursue binocular distance correction instead of monovision. This was adjusted for accordingly using the LAL. Following final lock-in, Patient A had a distance UCVA of 20/15 in the right eye (OD) and a distance UCVA of 20/20 in the left eye (OS). Patient B was targeted for monovision. After final lock-in, Patient B had a distance UCVA of 20/15 in the dominant eye (OD) and a near UCVA of Jaeger No. 1+ in the nondominant eye (OS). CONCLUSIONS AND IMPORTANCE: The first reported cases of DMEK plus LAL triple procedures achieved exceptional UCVA at the desired target. The post-operative customizability of the LAL allows for the achievement of excellent refractive outcomes after DMEK, even in patients with significant astigmatism and in patients who change their mind regarding refractive target.

Short-Term Steady-State Pattern Electroretinography Changes Using a Multi-Pressure Dial in Ocular Hypertensive, Glaucoma Suspect, and Mild Open-Angle Glaucoma Patients: A Randomized, Controlled, Prospective, Pilot Study.

INTRODUCTION: This study evaluates the effects of the multi-pressure dial (MPD) on steady-state pattern electroretinography (ss-pERG) parameters. The study is a randomized, controlled, prospective, pilot trial in a private practice setting with ocular hypertensive (OHT), glaucoma suspect, and open-angle glaucoma (OAG) subjects. METHODS: This study included nine patients (64 ± 9.0 years, nine female) with OHT, glaucoma suspect, or mild OAG. One eye of each subject was randomized to receive negative periocular pressure, while the contralateral eye served as the intrasubject control through the goggle without negative pressure. The Diopsys High Contrast Sensitivity ss-pERG protocol was conducted on both eyes of each subject while wearing the MPD device. Application of negative periocular pressure was set at 50% of baseline intraocular pressure for each study eye. RESULTS: Following 2 h of negative periocular pressure application, the difference in MagnitudeD (MagD) from baseline for eyes randomized to receive negative periocular pressure (+ 0.17 versus - 0.26) was statistically significant (p = 0.023). Over the same period, the change in MagD/Magnitude (MagD/Mag ratio) from baseline for eyes randomized to receive negative periocular pressure was also higher (+ 0.14 versus - 0.16), compared to the control eyes, approached significance (p = 0.059). CONCLUSIONS: Following 2 h of MPD wear, the measured MagD and MagD/Mag ratio improved compared to control, suggesting that negative periocular pressure application to the anterior globe can lead to short-term improvement in one measure of retinal ganglion cell function.

Corneal Hysteresis as a Biomarker of Glaucoma: Current Insights.

The diagnosis and management of glaucoma has long been dependent on making decisions based on family history, optic nerve head evaluation, intraocular pressure, visual field testing, and optical coherence testing. Other pieces to aid in understanding glaucoma have presented throughout the years, including the role of corneal thickness. The discussion and debate on the mechanism of glaucoma have been attributed to resistance at the level of the conventional outflow pathway, perfusion pressure to the optic nerve head, cerebral spinal fluid pressure, and many more. Another piece that has emerged is corneal hysteresis, an assessment of the cornea's ability to absorb and dissipate energy. There is abundant published literature supporting corneal hysteresis being associated with the presence and severity of glaucoma, the structural and functional progression of glaucoma, and the conversion to glaucoma. The supported data in these studies add another piece, corneal hysteresis, to consider in the diagnosis and management of glaucoma.

iStent Trabecular Microbypass Stent Implantation with Phacoemulsification in Patients with Open-Angle Glaucoma: 6-Year Outcomes.

PURPOSE: To investigate the long-term safety and efficacy of an iStent trabecular microbypass stent in combination with cataract surgery in eyes with primary open-angle glaucoma (POAG). SETTING: Private practice; Sioux Falls, South Dakota. DESIGN: Retrospective, consecutive case series. METHODS: This case series included eyes implanted with a single trabecular microbypass stent in combination with phacoemulsification in patients with mild to severe POAG. Data were collected preoperatively and at day 1, week 1, month 1, and up to 6 years postoperatively. Primary outcome measures included mean intraocular pressure (IOP) and number of glaucoma medications. Safety was noted by assessing the incidence of IOP spikes and need for additional surgery. RESULTS: The study comprised 411 eyes. Mean IOP was reduced to 14.9±4.2 mmHg compared to 18.8±5.6 mmHg at baseline at 6 years postoperative. The mean number of medications was reduced to 1.2±1.0 from 1.4±1.1 at baseline. In eyes with severe stage of disease, there was a mean IOP reduction >6 mmHg at 6 years postoperative. Eyes with baseline IOP ≥18 mmHg achieved a more robust reduction in IOP. Fifteen eyes underwent a secondary glaucoma procedure. There were no intra- or postoperative complications. CONCLUSION: Trabecular microbypass stent implantation in combination with cataract surgery provides a sustained IOP reduction in eyes with mild-to-severe POAG. The degree of IOP reduction was more significant in eyes with higher baseline IOP and severe stage of disease.

iStent inject trabecular microbypass stent implantation with cataract extraction in open-angle glaucoma: early clinical experience.

BACKGROUND: Retrospective, consecutive case series to evaluate the implantation of two second-generation trabecular microbypass stents in combination with cataract surgery in a real-world, clinical setting. METHODS: The series included 56 eyes implanted with the iStent inject device with phacoemulsification. The series consisted of eyes with primary open-angle glaucoma (n = 52) and pseudoexfoliative glaucoma (n = 4). Primary outcome measures included intraocular pressure (IOP) and number of glaucoma medications. Safety outcomes included the need for secondary surgical intervention and the incidence of IOP spikes ≥10 mmHg and ≥ 15 mmHg. RESULTS: IOP was reduced by 21% to 14.7 ± 2.9 mmHg (p < 0.01) at 6 months postoperative from 18.7 ± 5.8 mmHg at baseline. Preoperatively, the mean number of glaucoma medications was 1.5 ± 0.9 and reduced by 39% to 0.9 ± 1.2 (p < 0.01) at 6 months. At 6 months, 68% of eyes had an IOP ≤15 mmHg, increased from 30% at baseline. 55% of eyes were medication-free at 6 months, up from 18% at baseline. There were no severe postoperative complications. No eyes underwent an additional glaucoma procedure. CONCLUSIONS: Implantation of the iStent inject device with concomitant cataract surgery effectively provides a sustained reduction in IOP with a markedly improved medication burden out to 6 months postoperative. The safety profile is excellent.

Trabecular microbypass stent implantation in pseudoexfoliative glaucoma: long-term results.

PURPOSE: To evaluate the long-term safety and efficacy of an iStent trabecular microbypass stent in combination with cataract surgery in pseudoexfoliative glaucoma (PXG). SETTING: Private practice, Sioux Falls, South Dakota, USA. DESIGN: Retrospective, consecutive case series. METHODS: Eyes with a preoperative diagnosis of PXG implanted with a single iStent trabecular microbypass stent with concomitant cataract surgery were included. Performance outcome measures included intraocular pressure (IOP) and number of glaucoma medications. Safety outcomes included intraoperative or postoperative complications and the need for secondary procedures. RESULTS: The series included 117 eyes. IOP was reduced by 25% to 15.3 ± 3.7 mm Hg at 5 years postoperatively from 20.5 ± 6.6 mm Hg at baseline. The statistically significant (P < .01) 36% reduction in medication use through 36 months was not sustained, and medication use was unchanged from baseline (1.4 ± 1.0) at 5 years postoperatively (1.3 ± 1.1) (P > .05). At 5 years, 52% of eyes had an IOP of 15 mm Hg or lesser, increased from 22% at baseline. There were no severe postoperative complications; 5 eyes (4%) underwent an additional glaucoma procedure. CONCLUSIONS: Implantation of a trabecular microbypass stent with concomitant cataract surgery provided a sustained reduction in IOP up to 5 years postoperatively. The long-term safety profile of the device in this population was excellent with a low rate of postoperative IOP spikes and low percentage of eyes undergoing a secondary procedure.

Characterizing Antibiotic Use in Hospitalized Patients With a Documented Penicillin Allergy.

INTRODUCTION: Patients with self-reported penicillin allergies frequently receive unnecessary broad-spectrum antibiotics, which are associated with poor outcomes for patients and healthcare systems. The objective of this study was to determine the significance of broad-spectrum antibiotic prescription among patients with a documented penicillin allergy. METHODS: Retrospective chart review identified a cohort of penicillin allergic patients admitted to the primary medical-surgical floors at Avera McKennan that received intravenous or oral antibiotics. We recorded the allergy manifestation and severity, and all antibiotics administered within 24 hours of admission. The cohort was further divided into various subgroups and analyzed using Chi-Square or a Fischer's exact test. RESULTS: 190 patients with documented penicillin allergies received antibiotics between Dec. 1, 2018, and March 31, 2019. A severe penicillin allergy was documented in 86.3 percent of cases. Cephalosporins, vancomycin, and fluoroquinolones represented 34.1 percent, 18.2 percent, and 12.7 percent of initial antibiotics, respectively. No significance was noted in the comparison of antibiotic choice between patients with a specified versus an unspecified penicillin allergy. The number of cephalosporin prescriptions was significantly lower in a surgical prophylaxis subgroup of patients compared to a non-surgical prophylaxis subgroup. CONCLUSION: Our study supports literature suggesting patients with documented penicillin allergies are at risk of unwarranted broad-spectrum antibiotic use. We noted an alarming number of unverified penicillin allergies. Prescription patterns did not appear to be altered based on verification or type of recorded allergic reaction. Surgical patients may be at greater risk. Our findings call for heightened antibiotic stewardship especially regarding patients with a documented penicillin allergy.

Conservative Management of Traumatic Optic Neuropathy Secondary to Lateral Orbital Wall Fracture.

PURPOSE: To inform rural healthcare providers about the early identification and management of traumatic optic neuropathy (TON). Specifically, we seek to legitimize expectant management as a viable approach to such cases. OBSERVATIONS: A 27-year-old female with direct posterior compressive TON with associated visual field and visual acuity deficit was managed expectantly without steroids or surgical intervention. In four months, her visual acuity improved from 20/400 to 20/50. CONCLUSTION AND IMPORTANCE: Although steroids and surgery have been common practice for treatment of TON, there is insufficient evidence to support their use in all cases. Existing research supports expectant management as a viable option. This could prove especially useful in rural settings where resources and surgical subspecialists are limited.