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Carl D Regillo,1 Lisa M Nijm,2 Diana L Shechtman,3 Peter K Kaiser,4 Paul M Karpecki,5 Edwin H Ryan,6 Michael S Ip,7 Elizabeth Yeu,8 Terry Kim,9 Mohammad R Rafieetary,10 Eric D Donnenfeld11 1Mid Atlantic Retina, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA; 2Warrenville Eye Care and LASIK Center, Warrenville, IL, USA; 3Eye Centers of South Florida, North Miami Beach, FL, USA; 4Cole Eye Institute, Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA; 5Kentucky College of Optometry, University of Pikeville, Pikeville, KY, USA; 6Retina Consultants of Minnesota, Edina, MN, USA; 7Doheny Eye Center UCLA, Pasadena, CA, USA; 8Virginia Eye Consultants, Norfolk, VA, USA; 9Duke University, Durham, NC, USA; 10Charles Retina Institute, Germantown, TN, USA; 11Ophthalmic Consultants of Long Island, Garden City, NY, USACorrespondence: Carl D Regillo, Mid Atlantic Retina, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut St # 1020, Philadelphia, PA, 19107, USA, Tel +1 (215) 928-3300, Email cregillo@midatlanticretina.comAbstract: Newly approved treatments for patients with geographic atrophy are changing the treatment paradigm, highlighting the need for eye care providers (ECPs) to have a set of recommendations on how to best manage GA patients. Here, we outline how to identify various stages of age-related macular degeneration including geographic atrophy (GA) by examining optimal management scenarios implicating various ECPs and reviewing treatment considerations for patients with GA. Early identification of GA will lead to optimal patient outcomes, while a standardized management scenario will reduce clinical burden among ECPs treating patients with GA.Keywords: age-related macular degeneration, patient care, retina, treatment

Marjan Farid,1 Brandon D Ayres,2 Eric Donnenfeld,3 Ian Benjamin Gaddie,4 Preeya K Gupta,5 Edward Holland,6 Richard Lindstrom,7 Stephen C Pflugfelder,8 Paul M Karpecki,9 Kelly K Nichols,10 Christopher E Starr,11 Elizabeth Yeu12 1Gavin Herbert Eye Institute, UC-Irvine, Irvine, CA, USA; 2Wills Eye Hospital, Philadelphia, PA, USA; 3Ophthalmic Consultants of Long Island, Long Island, NY, USA; 4Gaddie Eye Centers, Louisville, KY, USA; 5Triangle Eye Consultants, Raleigh, NC and Tulane University, New Orleans, LA, USA; 6University of Cincinnati, Cincinnati, OH, USA; 7University of Minnesota, Minneapolis, MN, USA; 8Baylor College of Medicine, Houston, TX, USA; 9Kentucky Eye Institute, Lexington, KY, USA; 10University of Alabama at Birmingham, School of Optometry, Birmingham, AL, USA; 11Weill Cornell Medicine, New York, NY, USA; 12Virginia Eye Consultants, Norfolk, VA, USACorrespondence: Marjan Farid, University of California, 850 Health Sciences Road, Mail Code: 4375, Irvine, CA, 92697, USA, Tel +1 949 824-0327, Email mfarid@uci.eduPurpose: To obtain consensus on Demodex blepharitis (DB) treatment using a modified Delphi panel process.Methods: Literature search identified gaps in knowledge surrounding treatment of DB. Twelve ocular surface disease experts comprised the Demodex Expert Panel on Treatment and Eyelid Health (DEPTH). They completed a live roundtable discussion in addition to 3 surveys consisting of scaled, open-ended, true/false, and multiple-choice questions pertaining to the treatment of DB. Consensus for scaled questions using a 1 to 9 Likert scale was predefined as median scores of 7– 9 and 1– 3. For other question types, consensus was achieved when 8 of 12 panelists agreed.Results: The experts agreed that an effective therapeutic agent for treatment of DB would likely decrease the necessity of mechanical intervention, such as lid scrubs or blepharoexfoliation (Median = 8.5; Range 2– 9). When treating DB, panelists believed that collarettes serve as a surrogate for mites, and that eliminating or reducing collarettes should be the main clinical goal of treatment (Median = 8; Range 7– 9). The panelists would treat patients with at least 10 collarettes, regardless of other signs or symptoms and agreed that DB can be cured, but there is always the possibility for a reinfestation (n = 12). There was also consensus that collarettes, and therefore mites, are the primary treatment target and the way by which clinicians can monitor patient response to therapy (Median = 8; Range 7– 9).Conclusion: Expert panelists achieved consensus on key facets of DB treatment. Specifically, there was consensus that collarettes are pathognomonic for DB, that DB patients with > 10 collarettes should be treated even in the absence of symptoms, and that treatment efficacy can be tracked by collarette resolution. By increasing awareness about DB, understanding the goals of and monitoring treatment efficacy, patients will receive better care and, ultimately, better clinical outcomes.Keywords: collarettes, cylindrical dandruff, ocular surface disease, eyelid disease

Leslie O’Dell,1 Damon S Dierker,2 Douglas K Devries,3 Jaclyn Garlich,4 Walter O Whitley,5 Mark Holdbrook,6 Stephanie N Baba,6 Elizabeth Yeu5 1Medical Optometry America, Shrewsbury, PA, USA; 2Eye Surgeons of Indiana, Indianapolis, IN, USA; 3Eye Care Associates of Nevada, Sparks, NV, USA; 4Envision Optometry, Boston, MA, USA; 5Virginia Eye Consultants, Norfolk, VA, USA; 6Tarsus Pharmaceuticals, Inc, Irvine, CA, USACorrespondence: Elizabeth Yeu, Virginia Eye Consultants, 241 Corporate Boulevard, Suite 210, Norfolk, VA, 23502, USA, Tel +1 757 793 4942, Fax +1 757 319 2493, Email eyeulin@gmail.comPurpose: To evaluate the impact of Demodex blepharitis on patients’ daily activities and quality of life.Patients and Methods: In this multicenter, observational, prospective, IRB-approved study, 311 Demodex blepharitis patients aged ≥ 18 years were included. Demodex blepharitis was diagnosed based on the presence of ≥ 1.0 mite per lash (upper and lower eyelids combined), > 10 collarettes on the upper lashes, and at least mild lid margin erythema of the upper eyelid in at least one eye. All patients were asked to complete a questionnaire about their symptoms, daily activities, quality of life, and management approaches, and descriptive statistics were used to analyze the responses.Results: More than half the patients had been experiencing symptoms of blepharitis for ≥ 4 years. The three most frequent and bothersome symptoms experienced by patients were dry eyes, itchiness, and irritation. Nearly half the patients (47%) responded that they were conscious of their eyes all day, and 23% said that they were constantly worrying about their eyes. Other activities that were negatively affected included difficulty driving at night (47%), additional time needed for daily hygiene routine (30%), and difficulty in wearing eye make-up (in 34% of females). While all subjects had objective signs of Demodex blepharitis confirmed by an eye care provider, 58% said they had never previously been diagnosed with blepharitis. The most commonly used management approaches for Demodex blepharitis were artificial tears (47%), warm compresses (32%), and lid wipes (14%).Conclusion: Demodex blepharitis has a significant negative impact on daily activities and the mental and physical well-being of afflicted patients.Keywords: Demodex blepharitis, dry eye disease, collarettes, cylindrical dandruff, Demodex mites, lid margin disease

William Trattler,1 Paul Karpecki,2 Yuna Rapoport,3 Ehsan Sadri,4 Scott Schachter,5 Walter O Whitley,6 Elizabeth Yeu6 1Center for Excellence in Eye Care, Miami, FL, USA; 2Kentucky Eye Institute, Lexington, KY, USA; 3Manhattan Eye, New York City, NY, USA; 4Visionary Eye Institute, Newport Beach, CA, USA; 5Advanced Eyecare, Pismo Beach, CA, USA; 6Virginia Eye Consultants, Norfolk, VA, USACorrespondence: Elizabeth Yeu, Virginia Eye Consultants, 241 Corporate Boulevard, Suite 210, Norfolk, VA, 23502, Tel +1 757 793 4942, Fax +1 757 319 2493, Email eyeulin@gmail.comPurpose: To evaluate the prevalence of Demodex blepharitis by its pathognomonic sign, collarettes, in patients presenting for any reason to eye care clinics in the United States.Patients and Methods: In this retrospective study by 7 investigators at 6 eye care clinics, case records of consecutive patients who underwent a slit-lamp examination, regardless of chief complaint, were reviewed for Demodex blepharitis, as identified by the presence of collarettes. Patient characteristics, including age, gender, race, relevant ocular and systemic diagnoses, ocular medications, lid hygiene practices and contact lens wear, were also recorded.Results: Of 1032 patients (mean age: 60.2 ± 17.8 years), 57.7% had Demodex blepharitis. While the prevalence of Demodex blepharitis in patients with dry eye disease (DED) (58.9%) and cataract (55.7%) was similar to the overall prevalence of Demodex blepharitis, it was higher in patients with blepharitis (69.1%) and glaucoma (64.8%). Among patients with collarettes, 44.0% had never been diagnosed with blepharitis. Among those on anti-inflammatory DED treatment, 60.0% had Demodex blepharitis. Demodex blepharitis prevalence was significantly higher among those using topical tea tree oil versus those who were not (74.5% versus 56.7% p = 0.014); prevalence was comparable among those using/not using lid wipes (56.9% versus 55.5%).Conclusion: Demodex blepharitis, based on the pathognomonic finding of collarettes, is common and likely underdiagnosed among patients seeking eye care. These collarettes are still found in patients using over-the-counter treatments for blepharitis. The present study highlights the importance of screening patients for collarettes and Demodex blepharitis as part of every slit-lamp examination.Keywords: prevalence of Demodex blepharitis, collarettes, cylindrical dandruff, Demodex mites, Demodex infestation, lid margin disease

Gabriel Lazcano-Gomez,1 Sumit J Garg,2 Elizabeth Yeu,3 Malik Y Kahook4 1Department of Glaucoma, Clínica Láser y Ultrasonido Ocular, Puebla City, Puebla, Mexico; 2Department of Ophthalmology, University of California Irvine, Irvine, CA, USA; 3Department of Ophthalmology, Virginia Eye Consultants, Norfolk, VA, USA; 4Department of Ophthalmology, University of Colorado, Aurora, CO, USACorrespondence: Malik Y Kahook, Tel +1 720 848 2500, Email malik.kahook@cuanschutz.eduPurpose: To characterize the clinical outcomes of a novel ab interno minimally invasive procedure with the STREAMLINE® Surgical System for creation of incisional goniotomies and canal of Schlemm viscodilation in eyes with mild to severe primary open-angle glaucoma (POAG).Methods: In a prospective, single-arm, first-in-human case series, 20 eyes of 20 subjects with mild to severe POAG underwent creation of incisional goniotomies and canal of Schlemm viscodilation following phacoemulsification cataract extraction after washout of all intraocular pressure (IOP)-lowering medications. The angle surgery portion was performed with a single-use handpiece tipped with a microcannula that creates precise goniotomies through the trabecular meshwork into the canal of Schlemm and delivers a small volume of ophthalmic viscosurgical device directly into the canal via precise catheterization. Outcomes in this interim analysis included mean reduction in IOP and medications through 6 months of follow-up, as well as the proportion of eyes achieving IOP reduction ≥ 20% from baseline.Results: At month 6, mean IOP reduction of ≥ 20% from baseline was achieved in 89.5% of eyes (17/19). Mean (standard deviation) medicated IOP at screening was 16.3 (3.6) mmHg and unmedicated baseline IOP (after washout) was 23.5 (2.5) mmHg. Mean IOP was significantly reduced from baseline through 6 months of follow-up to 14.7 (2.4) mmHg (p< 0.001), representing an IOP reduction of 8.8 mmHg (36.9%). Overall, 57.9% (11/19) of eyes decreased dependence on IOP-lowering medications by at least one medication, and 42.1% (8/19) were medication free. Mean medication use was reduced from 2.0 (0.8) at screening to 1.1 (1.1) at 6 months (p< 0.001). Three eyes had transient IOP spikes treated with topical medications.Conclusion: The creation of incisional goniotomies and canal of Schlemm viscodilation safely and effectively reduced IOP and the need for IOP-lowering medications by both clinically and statistically significant magnitudes in eyes with mild to severe POAG undergoing concomitant phacoemulsification cataract extraction through the first 6 months of follow-up.Keywords: trabecular meshwork, canal of Schlemm, viscodilation, MIGS, glaucoma, goniotomy

Elizabeth Yeu,1,2 Omar Hashem,3 Hosam Sheha3– 5 1Virginia Eye Consultants, Norfolk, VA, USA; 2Eastern Virginia Medical School, Norfolk, VA, USA; 3Research Institute of Ophthalmology, Cairo, Egypt; 4Florida International University Herbert Wertheim College of Medicine, & Glaucoma Research Organization, Miami, FL, USA; 5Manhattan Eye, Ear and Throat Hospital, Hofstra Northwell School of Medicine, New York, NY, USACorrespondence: Hosam Sheha, Department of Ophthalmology, Manhattan Eye, Ear and Throat Hospital, 210 E 64 Street, New York, NY, 10065, USA, Tel +1 917-810-9555, Email hoss88@gmail.comPurpose: To assess the effectiveness of cryopreserved amniotic membrane (CAM) after debridement in treating epithelial basement membrane dystrophy (EBMD) prior to cataract surgery.Methods: This pilot study included 2 treatment groups: a prospective study group of 9 subjects with significant EBMD who received debridement followed by self-retained CAM, and a retrospective, control group of 10 consecutive subjects who received debridement followed by a bandage contact lens (BCL). Slit-lamp photography after fluorescein staining were used to monitor healing. Corneal topography and IOL calculation were compared at baseline and 1 month after the procedure. Refraction and ocular surface stability were also compared after cataract surgery.Results: Corneal reepithelialization after debridement occurred in 4.6 ± 0.8 days in the study group and 6.8 ± 0.6 days in the control (p < 0.05). Corneal topography showed changes in curvature from 43.5 ± 1.2D at baseline to 44.6 ± 1.2D at 1 month in the study group and from 45.0 ± 0.6D to 45.7 ± 0.8D in the control (p = 0.38). Average change in IOL calculation was 1.56 D in the study group, compared to 0.95 D in control (p = 0.29). Post-cataract refraction in both groups was within ± 0.5 Diopter of the anticipated, and corneal surface remained stable without EBMD recurrence.Conclusion: Management of ocular surface disorders prior to cataract surgery stabilizes IOL calculation and reduces postoperative refractive surprises. CAM relatively accelerated healing after debridement; however, it was not better than BCL in stabilizing the ocular surface and improving visual outcome. The use of CAM in cases of EBMD remains speculative.Keywords: amniotic membrane, cataract, EBMD, ocular surface

Preeya K Gupta,1 Laura M Periman,2 Edward Lain,3 Eric Donnenfeld,4 John Hovanesian,5 Terry Kim,6 William Trattler,7 Elizabeth Yeu,8 Edward Holland9 1Triangle Eye Consultants, Durham, NC, USA; 2Periman Eye Institute, Seattle, WA, USA; 3Sanova Dermatology, Pflugerville, TX, USA; 4Ophthalmic Consultants of Long Island, Garden City, NJ, USA; 5Harvard Eye Associates, Laguna Hills, CA, USA; 6Department of Ophthalmology, Duke University Eye Center, Durham, NC, USA; 7Center for Excellence in Eye Care, Miami, FL, USA; 8Virginia Eye Consultants, Norfolk, VA, USA; 9Cincinnati Eye Institute, Edgewood, KY, USACorrespondence: Preeya K Gupta Email preeyakgupta@gmail.comAbstract: Meibomian glands are modified oil-producing glands that produce meibum and can become dysfunctional and negatively affect the lipid layer in the tear film, resulting in ocular surface diseases such as evaporative dry eye. Abnormal keratin production and aggregation at the meibomian gland orifice has been implicated in the pathogenesis of meibomian gland dysfunction (MGD). Current treatments largely ignore the role of keratin proteins. This review paper synthesizes various publications on hyperkeratinization and its role in MGD pathogenesis and proposes a novel treatment strategy for MGD that involves the use of keratolytic agents commonly used in dermatological treatments.Keywords: meibomian gland disease, MGD, hyperkeratinization

Steven Silverstein,1 Elizabeth Yeu,2 Joseph Tauber,3 Michel Guillon,4 Lyndon Jones,5,6 David Galarreta,7 Sruthi Srinivasan,8 Venkiteshwar Manoj8 1Silverstein Eye Centers, Kansas City, MO 64133, USA; 2Virginia Eye Consultants, Norfolk, VA 23502, USA; 3Tauber Eye Center, Kansas City, MO 64155, USA; 4Ocular Technology Group International, London SW1E 6AU, UK; 5Centre for Ocular Research & Education (CORE), School of Optometry and Vision Science, Waterloo, ON NL2 3G1, Canada; 6Centre for Eye and Vision Research Limited (CEVR), Hong Kong; 7Hospital Clinico Universitario de Valladolid, Valladolid Castilla y Leon 47011, Spain; 8Alcon Research, LLC, Johns Creek, GA, USACorrespondence: Steven SilversteinSilverstein Eye Centers, Kansas City, MO 64133, USATel +1 816.358.3600Fax +1 816.358.1887Email ssilverstein@silversteineyecenters.comPurpose: To evaluate symptom relief in patients with dry eye disease (DED) following a single drop of propylene glycol-hydroxypropyl guar (PG-HPG) nanoemulsion (Systane® Complete) lubricant eye drops.Methods: This was a Phase IV, multicenter, open-label, interventional study in adult patients with DED of aqueous-deficient, evaporative, and mixed subtypes. Patients instilled one drop of PG-HPG in each eye at Day 1. Endpoints included change from baseline in dry eye symptom and soothing sensation scores on Day 1 at 0, 4, and 8 hours post-dose. Symptom scores were assessed on a 0– 10 scale (0=no symptoms; 10=worst imaginable symptom). Tolerability of the drop was assessed based on assessment score on Day 1 following instillation for overall cohort and by DED subtype.Results: A total of 134 patients received treatment (mean age: 56.6 years; female: 75.4%). Median changes from baseline at Day 1 in dry eye symptom scores were − 1.0 (95% confidence interval [CI]:-3.0,-1.0), − 2.0 (95% CI:-3.0,-2.0), and − 2.0 (95% CI:-2.0,-1.0) at 0, 4, and 8 hours respectively. Subgroup analysis showed a median change from baseline in dry eye symptom score of − 2 (95% CI:-3.0,-1.0) for aqueous-deficient and evaporative subtypes and − 1 (95% CI:-3.0,-1.0) for mixed subtype at 8 hours. Median soothing sensation scores were 3 at 0 and 4 hours and 3.5 at 8 hours, with a range of 0– 10. Median (range) tolerability assessment scores were 0 (0– 8) for burning sensation, stinging sensation, blurring, and 0 (0– 10) for foreign body sensation. Tolerability assessment scores by DED subtype confirmed that the majority of patients reported scores in the range of 0– 5 for all components and in all subgroups analyzed.Conclusion: Our study demonstrated that PG-HPG nanoemulsion provided instant/immediate and sustained symptom relief for 8 hours post-single application and was well tolerated in patients with DED, demonstrated by their responses on each of the assessment scales.Keywords: aqueous-deficient dry eye, dry eye disease, evaporative dry eye, propylene glycol-hydroxypropyl guar nanoemulsion ocular lubricant, mixed dry eye

Elizabeth Yeu,1 Steven Silverstein,2 Michel Guillon,3 Marc-Matthias Schulze,4 David Galarreta,5 Sruthi Srinivasan,6 Venkiteshwar Manoj6 1Virginia Eye Consultants, Norfolk, VA 23502, USA; 2Silverstein Eye Centers, Kansas City, MO 64133, USA; 3Ocular Technology Group International, London SW1E 6AU, UK; 4Centre for Ocular Research & Education (CORE), School of Optometry and Vision Science, University of Waterloo, Waterloo, Ontario NL2 3G1, Canada; 5Hospital Clinico Universitario de Valladolid, Valladolid Castillay Leon 47011, Spain; 6Alcon Research, LLC, Johns Creek, GA 30097, USACorrespondence: Elizabeth YeuVirginia Eye Consultants, Norfolk, VA 23502, USATel +1 757-622-2200Fax +1 757-961-0011Email eyeu@vec2020.comPurpose: To evaluate the clinical efficacy and safety of propylene glycol/hydroxypropyl-guar (PG-HPG)-based nanoemulsion (Systane® Complete) lubricant eye drops in participants with dry eye disease (DED).Participants and Methods: In this phase IV, open-label, single-arm, interventional, multicenter study, adult participants with DED – subtyped into aqueous deficient, evaporative, and mixed dry eye – were instructed to instill one drop of PG-HPG in each eye twice a day for 28 days. Endpoints included change from baseline in tear film break-up time (TFBUT) (primary) and ocular discomfort visual analog scale (VAS) score at Day 14 and TFBUT at Day 28 (secondary). Safety was assessed throughout the study. Data were analyzed for overall patient cohort and by DED subtypes.Results: A total of 134 participants received treatment (mean age: 56.6 years; female: 75.4%). At Day 14, the mean (standard deviation [SD]) TFBUT increased from 2.6 (1.00) seconds at baseline to 4.2 (2.92) seconds (mean change: 1.5 [2.80] seconds); median change was 0.8 seconds (95% CI: 0.52, 1.19) for the overall cohort; the change was maintained at Day 28 (mean change: 1.4 (2.80) seconds, median change: 0.8 seconds (95% CI: 0.49, 1.17). Subgroup analysis showed a mean change (SD) from baseline in TFBUT of 1.1 (2.41) seconds for aqueous deficient, 2.4 (3.17) seconds for evaporative, and 1.2 (2.63) seconds for mixed dry eye at Day 14, respectively. The ocular discomfort VAS score improved (decreased) from baseline at Day 14 (mean [SD] change: − 17.3 [24.80]) for the overall cohort, − 22.0 [21.73] for aqueous deficient, − 17.6 [24.17] for evaporative and − 13.1 [27.49] for mixed dry eye subgroups). Adverse events (AEs) were reported in 9 (6.7%) participants. No serious AEs were reported during the study.Conclusion: Our study findings demonstrated that PG-HPG-based nanoemulsion lubricant eye drops were effective and well tolerated in participants with DED and all of its subtypes.Keywords: aqueous deficient dry eye, dry eye disease, evaporative dry eye, propylene glycol/hydroxypropyl guar-nanoemulsion ocular lubricant, mixed dry eye

Elizabeth Yeu,1 Scott Hauswirth2 1Virginia Eye Consultants, Norfolk, VA, USA; 2Department of Ophthalmology, Sue Anschutz-Rodgers Eye Center, University of Colorado School of Medicine, Aurora, CO, USACorrespondence: Elizabeth YeuVirginia Eye Consultants, 241 Corporate Blvd, Norfolk, VA 23502, USATel +1 757-622-2200Email eyeu@vec2020.comAbstract: The diagnosis of acute infectious conjunctivitis can be difficult. Clinical ambiguity exists between the acute viral and bacterial as well as the allergic forms, which can confound diagnosis. Also, discrimination between viral or bacterial origins of infectious conjunctivitis based on historical, nonspecific, clinical signs and symptoms contributes to a high rate of misdiagnosis and overuse of antibiotic treatment. Therefore, in order to effectively treat acute infectious conjunctivitis, physicians must be aware of the clinical signs and symptoms and available diagnostic tests that can provide a more accurate differential diagnosis.Keywords: allergic conjunctivitis, bacterial conjunctivitis, conjunctivitis, viral conjunctivitis

Elizabeth Yeu,1 Albert Y Cheung,1 Richard Potvin2 1Virginia Eye Consultants, Norfolk, VA, USA; 2Science in Vision, Akron, NY, USACorrespondence: Elizabeth YeuVirginia Eye Consultants, 241 Corporate Blvd., Norfolk, VA 23502, USATel +1 757-742-3902Email eyeulin@gmail.comPurpose: To compare toric intraocular lens (IOL) outcome accuracy after using an online toric calculator that accounted for posterior corneal astigmatism versus a traditional calculator that only accounted for anterior corneal astigmatism.Patients and Methods: This was a single-arm, non-masked, non-randomized prospective study in a single private practice in Norfolk, Virginia, USA, evaluating clinical outcomes of toric IOL implantation based on a calculator that considered posterior corneal astigmatism (PCA) and effective lens position (ELP). Of interest was the distribution of the residual refraction (sphere and cylinder) at 40– 70 days postoperative. Residual refractive cylinder (RRC) was compared to the back-calculated theoretical results using a legacy calculator that did not consider PCA. Distance visual acuity (best-corrected and uncorrected) and the manifest refraction were also measured, along with preoperative and postoperative keratometry.Results: Forty-six eyes of 34 subjects were available for analysis. All eyes had a spherical equivalent refraction within 0.5D of intended. Uncorrected visual acuity was 20/25 or better in 86% of eyes targeted for emmetropia. Residual cylinder was 0.50D or less in 96% of eyes, with a maximum of 0.75D measured. The difference between residual cylinder and the expected cylinder from calculations was significantly lower for the calculator that included consideration of PCA and ELP relative to the one that did not.Conclusion: Use of a toric IOL calculator that includes consideration of posterior corneal astigmatism is recommended to optimize clinical outcomes.Keywords: posterior corneal astigmatism, cylinder, residual refraction, toric calculator

Elizabeth Yeu,1 Damien F Goldberg,2 Francis S Mah,3 Kenneth A Beckman,4,5 Jodi I Luchs,6,7 Jonathan D Solomon,8 Darrell E White,9 Preeya K Gupta101Eastern Virginia Medical School, Virginia Eye Consultants, Norfolk, VA, USA; 2Wolstan & Goldberg Eye Associates, Torrance, CA, USA; 3Scripps Clinic Torrey Pines, La Jolla, CA, USA; 4Ohio State University, Columbus, OH, USA; 5Comprehensive Eye Care of Central Ohio, Westerville, OH, USA; 6Hofstra Northwell School of Medicine, Hempstead, NY, USA; 7South Shore Eye Care, Wantagh, NY, USA; 8Bowie Vision Institute, Bowie, MD, USA; 9Skyvision Centers, Westlake, OH, USA; 10Duke University Eye Center, Durham, NC, USAPurpose: Evaluate the safety and efficacy of cryopreserved amniotic cytokine extract (ACE) in the treatment of subjects with dry eye disease (DED).Patients and methods: This was a retrospective, multicenter, chart review of adult patients with DED that instilled cryopreserved ACE drops twice-daily for 4 or 12 weeks. Patients had corneal fluorescein staining (0–20 range) and/or a lissamine green conjunctival staining score (0–18 range) of ≥3 and ≤9 in at least 1 eye and a score ≥40 (0–100 range) of eye dryness/irritation on a visual analog scale (VAS). Following completion of a treatment course, medical records were reviewed from the initiation of therapy (baseline), and at post-treatment visits (4 weeks, 8 weeks, and 12 weeks). Patient records for visual acuity, adverse events, corneal fluorescein staining, conjunctival lissamine green staining, and symptom scores of ocular dryness/irritation were reviewed for each visit, as available. Safety and tolerability were assessed through the evaluation of patient-reported adverse events recorded in the medical records.Results: A total of 54 eligible patients were identified at 7 clinical sites; 16 patients administered ACE drops for 4-weeks, and 38 patients instilled ACE drops for 12 weeks. Significant improvements in the mean changes from baseline were observed for corneal fluorescein staining, lissamine green staining, visual acuity (LogMar) and VAS ocular symptom scores at the 4-week post-treatment visit (p