Search

R Doyle Stulting,1 Daniel S Durrie,2 Richard J Potvin,3 Steve H Linn,4 Ronald R Krueger,5 Mark C Lobanoff,6 Majid Moshirfar,4,7 Manoj V Motwani,8 Timothy P Lindquist,2 Karl G Stonecipher9 1Woolfson Eye Institute, Atlanta, GA, USA; 2DurrieVision, Kansas City, KS, USA; 3Science in Vision, Akron, NY, USA; 4Hoopes, Durrie, Rivera Research, Draper, UT, USA; 5Cleveland Clinic, Cleveland, OH, USA; 6North Suburban Eye Specialists, Minneapolis, MN, USA; 7John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA; 8Motwani LASIK Institute, San Diego, CA, USA; 9TLC Laser Centers, Greensboro, NC, USACorrespondence: R Doyle Stulting 224 Konawa LN, Loudon, TN 37774, USATel +1 770-804-1684Email ophtrds@emory.eduPurpose: To identify the laser programming strategy that will achieve optimal refractive outcomes of LASIK with a topography-guided laser for eyes with a disparity between cylinder measured by manifest refraction and cylinder measured by topography.Setting: Six surgeons at 5 clinical sites in the USA.Design: Retrospective data review.Methods: Preoperative, treatment, and postoperative data on 52 eyes that underwent topography-guided LASIK with the WaveLight EX500 Contoura® Vision excimer laser ablation profile in which the vectors representing the preoperative refractive cylinder and the cylinder measured by the WaveLight® Topolyzer™ VARIO Diagnostic Device (Vario cylinder) differed by >/= 0.50D and/or >/= 10 degrees of orientation were analyzed retrospectively. Data were contributed by six surgeons using the laser at 5 different clinical sites. Vector analysis of postoperative cylindrical refractive error and the actual laser programming strategy was used to calculate the cylindrical correction that would, theoretically, have completely eliminated postoperative refractive cylinder. This was compared to expected results using the preoperative manifest cylinder, the topographic cylinder, and the Phorcides Analytic Engine (Phorcides LLC, North Oaks MN; Phorcides). For analysis, subjects were stratified on the basis of the vector difference between Manifest and Topo cylinder (High, > 0.75 D; and Low, ≤ 0.75 D).Results: The poorest calculated theoretical outcomes were obtained with the manifest refraction (centroid: − 0.43, 0.22; mean calculated error vector: 0.56 ± 0.42 D; p=ns). Better outcomes were obtained with the topographically measured refraction (centroid: 0.37, 0.02; mean calculated error vector: 0.47 ± 0.33 D; p=ns). The best outcomes were obtained with Phorcides (centroid: − 0.15, 0.06; mean calculated error vector: 0.39 ± 0.28 D; p=ns). The mean error vector magnitude in the Phorcides Low group was significantly lower than for the Manifest and Topo Low groups (0.26 D vs 0.48 D and 0.33 D; p< 0.01). The mean error magnitude in the Phorcides High group was nearly 0.25 D lower than for the Manifest High group (0.48 D vs 0.70 D; p< 0.01), but was the same as for the Topo High group (0.48 D vs 0.48 D).Conclusion: Our study suggests that using the topographically measured cylinder or the cylinder selected by Phorcides will produce more desirable refractive outcomes than entry of the preoperative refractive cylinder as the basis for correction of myopia and myopic astigmatism with the WaveLight Contoura Vision excimer laser.Keywords: LASIK, topography, excimer, laser, PRK, astigmatism

A protein-expressing citrus tristeza virus-based vector construct, pT36CA-V1.3, obtained from a California isolate of the T36 strain (T36CA), was retooled into a virus-induced gene silencing system intended for use with studies of California citrus. Virus-induced gene silencing constructs engineered with a truncated Citrus macrophylla PHYTOENE DESATURASE ( CmPDS ) gene sequence in the sense or antisense orientation worked equally well to silence the endogenous CmPDS gene. In a parallel effort to optimize vector performance, two nonsynonymous nucleotides in open reading frame 1a of pT36CA-V1.3 were replaced with those conserved in the reference sequences from the T36CA cDNA library. The resulting viruses, T36CA-V1.4 (with one amino acid modification: D760N) and T36CA-V1.5 (with two amino acid modifications: D760N and P1174L), along with T36CA-V1.3, were individually propagated in Nicotiana benthamiana and C. macrophylla plants. Enzyme-linked immunosorbent assay (ELISA) measurements of extracts of the newly emerged leaves suggested that all three viruses accumulated to similar levels in N. benthamiana plants at 5 weeks postinoculation. ELISA values of T36CA-V1.4- and -V1.5-infected C. macrophylla samples were significantly higher than that of T36CA-V1.3-infected samples within an 8- to 12-month postinoculation window, suggesting a higher accumulation of T36CA-V1.4 and -V1.5 than T36CA-V1.3. However, at 36 months postinoculation, the ELISA values suggested that all three viruses accumulated to similar levels. When C. macrophylla plants infected with each of the three viruses were grafted to commercial citrus varieties, a limited number of receptor plants became infected, demonstrating a weak but nonetheless (the first) successful delivery of T36CA to California-grown commercial citrus., Competing Interests: The author(s) declare no conflict of interest.

' Candidatus Phytoplasma brasiliense' (CPB) is a phytoplasma originally discovered in South America and is known to infect a wide variety of economically important crops. It is most prevalent in Hibiscus spp., where it causes witches broom symptoms, and papaya, where it causes bunchy top. Recently, CPB was documented for the first time in North America in a new host, globe sedge. In this study, two quantitative PCR assays are developed: one using high-resolution melt curve analysis (HRMA) based on the secA gene and the other a TaqMan assay based on the dnaK gene. The secA /HRMA and dnaK /TaqMan assay successfully amplified two of the three isolates of CPB. Both assays were screened against available isolates of 16SrI, 16SrII, and 16SrIV phytoplasmas. The secA /HRMA assay failed to amplify 16SrI and 16SrIV phytoplasmas but successfully amplified 16SrII phytoplasmas. The resulting melting point (Tm) products of CPB and 16SrII phytoplasmas displayed a difference of 0.5°C, easily distinguishing them by melt curves. The dnaK /TaqMan assay failed to amplify all non-CPB phytoplasma isolates in the study. The development of these assays provides a valuable tool that will significantly improve monitoring programs in Florida and will aid in developing a better fundamental understanding of the epidemiology of this phytoplasma., Competing Interests: The author(s) declare no conflict of interest.

Huanglongbing (HLB) is a severe citrus disease worldwide. Wild Australian limes like Citrus australasica , C. inodora , and C. glauca possess beneficial HLB resistance traits. Individual trees of the three taxa were extensively used in a breeding program for over a decade to introgress resistance traits into commercial-quality citrus germplasm. We generated high-quality, phased, de novo genome assemblies of the three Australian limes using PacBio long-read sequencing. The genome assembly sizes of the primary and alternate haplotypes were determined for C. australasica (337 Mb/335 Mb), C. inodora (304 Mb/299 Mb), and C. glauca (376 Mb/379 Mb). The nine chromosome-scale scaffolds included 86-91% of the genome sequences generated. The integrity and completeness of the assembled genomes were estimated to be at 97.2-98.8%. Gene annotation studies identified 25,461 genes in C. australasica , 27,665 in C. inodora , and 30,067 in C. glauca . Genes belonging to 118 orthogroups were specific to Australian lime genomes compared to other citrus genomes analyzed. Significantly fewer canonical resistance ( R ) genes were found in C. inodora and C. glauca (319 and 449, respectively) compared to C. australasica (576), C. clementina (579), and C. sinensis (651). Similar patterns were observed for other gene families associated with potential HLB resistance, including Phloem protein 2 ( PP2 ) and Callose synthase ( CalS ) genes predicted in the Australian lime genomes. The genomic information on Australian limes developed in the present study will help understand the genetic basis of HLB resistance.

Citrus is affected by many diseases, and hence, the movement of citrus propagative materials is highly regulated in the USA. Currently used regulatory pathogen detection methods include biological and laboratory-based technologies, which are time-consuming, expensive, and have many limitations. There is an urgent need to develop alternate, rapid, economical, and reliable testing methods for safe germplasm exchange. Citrus huanglongbing (HLB) has devastated citrus industries leading to an increased need for germplasm exchanges between citrus growing regions for evaluating many potentially valuable hybrids for both HLB resistance and multilocational performance. In the present study, Next-Generation Sequencing (NGS) methods were used to sequence the transcriptomes of 21 test samples, including 15 well-characterized pathogen-positive plants. A workflow was designed in the CLC Genomics Workbench software, v 21.0.5 for bioinformatics analysis of the sequence data for the detection of pathogens. NGS was rapid and found to be a valuable technique for the detection of viral and bacterial pathogens, and for the discovery of new citrus viruses, complementary to the existing array of biological and laboratory assays. Using NGS methods, we detected beet western yellows virus, a newly reported citrus virus, and a variant of the citrus yellow vein-associated virus associated with the "fatal yellows" disease.

The orange subfamily (Aurantioideae) contains several Citrus species cultivated worldwide, such as sweet orange and lemon. The origin of Citrus species has long been debated and less is known about the Aurantioideae. Here, we compiled the genome sequences of 314 accessions, de novo assembled the genomes of 12 species and constructed a graph-based pangenome for Aurantioideae. Our analysis indicates that the ancient Indian Plate is the ancestral area for Citrus-related genera and that South Central China is the primary center of origin of the Citrus genus. We found substantial variations in the sequence and expression of the PH4 gene in Citrus relative to Citrus-related genera. Gene editing and biochemical experiments demonstrate a central role for PH4 in the accumulation of citric acid in citrus fruits. This study provides insights into the origin and evolution of the orange subfamily and a regulatory mechanism underpinning the evolution of fruit taste., (© 2023. The Author(s), under exclusive licence to Springer Nature America, Inc.)

Purpose: To optimize artificial intelligence (AI) algorithms to integrate Scheimpflug-based corneal tomography and biomechanics to enhance ectasia detection., Design: Multicenter cross-sectional case-control retrospective study., Methods: A total of 3886 unoperated eyes from 3412 patients had Pentacam and Corvis ST (Oculus Optikgeräte GmbH) examinations. The database included 1 eye randomly selected from 1680 normal patients (N) and from 1181 "bilateral" keratoconus (KC) patients, along with 551 normal topography eyes from patients with very asymmetric ectasia (VAE-NT), and their 474 unoperated ectatic (VAE-E) eyes. The current TBIv1 (tomographic-biomechanical index) was tested, and an optimized AI algorithm was developed for augmenting accuracy., Results: The area under the receiver operating characteristic curve (AUC) of the TBIv1 for discriminating clinical ectasia (KC and VAE-E) was 0.999 (98.5% sensitivity; 98.6% specificity [cutoff: 0.5]), and for VAE-NT, 0.899 (76% sensitivity; 89.1% specificity [cutoff: 0.29]). A novel random forest algorithm (TBIv2), developed with 18 features in 156 trees using 10-fold cross-validation, had a significantly higher AUC (0.945; DeLong, P < .0001) for detecting VAE-NT (84.4% sensitivity and 90.1% specificity; cutoff: 0.43; DeLong, P < .0001) and a similar AUC for clinical ectasia (0.999; DeLong, P = .818; 98.7% sensitivity; 99.2% specificity [cutoff: 0.8]). Considering all cases, the TBIv2 had a higher AUC (0.985) than TBIv1 (0.974; DeLong, P < .0001)., Conclusions: AI optimization to integrate Scheimpflug-based corneal tomography and biomechanical assessments augments accuracy for ectasia detection, characterizing ectasia susceptibility in the diverse VAE-NT group. Some patients with VAE may have true unilateral ectasia. Machine learning considering additional data, including epithelial thickness or other parameters from multimodal refractive imaging, will continuously enhance accuracy. NOTE: Publication of this article is sponsored by the American Ophthalmological Society., (Copyright © 2022. Published by Elsevier Inc.)

Methamphetamine use has become a rampant public health issue that not only causes devastating consequences to the user but also poses a burden to surrounding communities. A spectrum of ophthalmic sequelae is associated with methamphetamine use and includes episcleritis, scleritis, corneal ulceration, panophthalmitis, endophthalmitis, retinal vasculitis, and retinopathy. In many instances, prompt recognition of the condition and associated infectious process and early initiation of antimicrobial therapy are crucial steps to preventing vision loss. In this review, we summarize the reported ocular complications that may result from methamphetamine use in addition to several postulated mechanisms regarding the ocular toxicity of methamphetamine. The increasing prevalence of methamphetamine use as a public health threat highlights the need for continued investigation of this ophthalmologic issue., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Huang, Nguyen, Mammo, Albini, Hayek, Timperley, Krueger and Yeh.)

Citrus is among the most economically important fruit crops. Its vast species diversity and global production was observed by N.I. Vavilov during his international plant explorations from the early to mid-1900s. Currently, ex situ citrus collections located around the world conserve and protect citrus genetic resources, as revealed in a survey conducted in 2021. Responses were received from 43 collections in 27 countries, of which 35 provided data regarding collection composition, management practices, and security, as well as other information. The six largest citrus collections have between 1000 and 1735 accessions. The largest accession holdings are mandarins and sweet oranges, although all citrus fruit types are maintained: mandarin, sweet orange, lemon, pummelo, grapefruit, hybrids, lime, sour orange, citron, kumquat, papeda, finger lime, and crop wild relatives. Diseases pose significant threats to collections, though some collections are maintained in a clean-plant state as a result of intensive sanitation efforts. National and regional quarantine regulations often limit the export and import of citrus plants or propagative materials, thus limiting the availability of materials at an international level. Resources, both financial and human, are necessary to ensure the long-term safety and security of citrus collections on a global scale. Future efforts to develop citrus genebanking communities will provide opportunities for improved conservation, as well as collaborations and training.

A major hallmark of aging-associated diseases is the inability to evoke cellular defense responses. Transcriptional protein Nrf2 (nuclear factor erythroid-derived 2-related factor) plays a pivotal role in the oxidative stress response, cellular homeostasis, and health span. Nrf2's activation has been identified as a therapeutic target to restore antioxidant defense in aging. Here, we demonstrated that FDA-approved drug, hydralazine (Hyd), was a reactivator of the Nrf2/ARE (antioxidant response element) pathway in various ages and types of mouse (m) or human (h) lens epithelial cells (LECs) and mice lenses in-vitro/in-vivo. This led to Hyd-driven abatement of carbonyls, reduced reactive oxygen species (ROS), and reduced 4-HNE/MDA-adducts with cytoprotection, and extended lens healthspan by delaying/preventing lens opacity against aging/oxidative stress. We elucidated that Hyd activated the protective signaling by inducing Nrf2 to traverse from the cytoplasm to the nucleus and potentiated the ARE response by direct interaction of Nrf2 and ARE sequences of the promoter. Loss-of-function study and cotreatment of Hyd and antioxidant, N-acetyl cysteine (NAC) or Peroxiredoxin (Prdx)6, specified that Nrf2/ARE-driven increase in the promoter activity was Hyd-dependent. Our study provides proof-of concept evidence and, thereby, paves the way to repurposing Hyd as a therapeutic agent to delay/prevent aging and oxidative-related disorders.

Background  The ophthalmology residency matching program is the first successful medical specialty match, dating back to 1979. This article reviews the impetus for starting the match and the roles that ophthalmologists Bruce Spivey, MD, and August Colenbrander, MD, PhD, played in establishing the match and developing the machinery to make it possible. Challenges to the match's operations over the years have improved the process. Objective  This article aims to research the roles of key individuals and institutions in establishing and maintaining the ophthalmology residency matching program. Methods  Oral and written interviews with key participants in establishing and maintaining the match were conducted. Primary and secondary written materials were reviewed. Results  Two physicians played key roles in establishing the ophthalmology residency matching program. Bruce Spivey, MD, spearheaded the drive to persuade the Association of University Professors of Ophthalmology (AUPO) to support and sponsor the match. August Colenbrander, MD, PhD, created the original match algorithm and single-handedly ran the match process in the early years. Obstacles were overcome, including resistance from the Association of American Medical College's National Resident Matching Program, a challenge to the validity of the algorithm, and the threat that antitrust laws might prohibit all graduate medical education residency match programs. The ophthalmology match evolved over time to become a more formal entity, the San Francisco Matching Program (SF Match). With continued support of the AUPO, the process of matching applicants to residency programs has flourished despite contemporary challenges related to electronic applications and social media. Conclusion  The ophthalmology residency matching program has benefited applicants and teaching programs for more than four decades due to visionary founders, ongoing support of the AUPO, and strong leadership within SF Match., Competing Interests: Conflict of Interest Dr. Krueger is Chair of a Department of Ophthalmology that has a residency training program that could be affected by the information in the article., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).)

Biological indexing is based upon the ability of certain plants, referred to as indicator plants or indicators, to produce specific symptoms when inoculated with a pathogen using mechanical means or grafting. In the case of citrus viroids, clonal indicators are grafted on to vigorous rootstocks such as rough lemon (Citrus × granulata Raf.). The 'Arizona-861-S-1' citron clonal indicator (C. medica L.) can detect and bioamplify all citrus viroids; however, for specific citrus variants of the hop stunt viroid (i.e., CVd-IIb and CVd-IIc), the clonal indicator 'Parson's special # 9' mandarin (C. reticulata Blanco) is preferred. Inoculation techniques and symptom expression are described in detail. Other supporting elements, such as greenhouse conditions and propagation techniques, are also presented., (© 2022. Springer Science+Business Media, LLC, part of Springer Nature.)

Date palms (Phoenix dactylifera) are an important fruit crop of arid regions of the Middle East and North Africa. Despite its importance, few genomic resources exist for date palms, hampering evolutionary genomic studies of this perennial species. Here we report an improved long-read genome assembly for P. dactylifera that is 772.3 Mb in length, with contig N50 of 897.2 Kb, and use this to perform genome-wide association studies (GWAS) of the sex determining region and 21 fruit traits. We find a fruit color GWAS at the R2R3-MYB transcription factor VIRESCENS gene and identify functional alleles that include a retrotransposon insertion and start codon mutation. We also find a GWAS peak for sugar composition spanning deletion polymorphisms in multiple linked invertase genes. MYB transcription factors and invertase are implicated in fruit color and sugar composition in other crops, demonstrating the importance of parallel evolution in the evolutionary diversification of domesticated species.

Purpose: To assess the incidence and long-term persistence of both subjective (rainbow glare phenomenon) and objective metrics of light scattering (stray light measurement) in femtosecond laser-assisted in situ keratomileusis (FS-LASIK)., Settings: Cleveland Clinic Foundation, Cole Eye Institute., Design: Prospective, contralateral eye study in which 54 myopic eyes of 27 patients underwent LASIK using the ALLEGRETTO® Eye-Q excimer laser. Flap creation was created by IntraLASE FS60 (IL) in one eye and Wave Light FS200 (FS) in the contralateral eye. Rainbow glare and stray light measurements (C-Quant, Oculus Inc, Lynnwood, WA) were obtained preoperatively, and at 1 week, 1, 3, and 9 months postoperatively. Manifest and wavefront refractions were performed at each postoperative visit., Results: Stray light measurements in both IL and FS groups peaked at 1 week postoperatively (log 1.28 ± 0.16, p = 0.02 and log 1.26 ± 0.12, p = 0.039, respectively) with statistically significant improvement at 3 months (log 1.12 ± 0.35, p = 0.007 and log 1.20 ± 0.15, p = 0.04) and 9 months (log 1.11 ± 0.17, p = 0.008 and log 1.15 ± 0.14, p = 0.011). No statistically significant differences were found between IL and FS eyes at all time points. 11 patients reported postoperative rainbow glare at 1 week (42%), which decreased to 6 patients at 9 months (33%) in the IL treated eye. 14 patients reported postoperative rainbow glare at 1 week (54%), which decreased to 7 patients at 9 months (39%) in the FS treated eye., Conclusion: Both rainbow glare and objective light scatter were greatest at 1 week and were significantly reduced by 1 to 3 months postoperatively. Rainbow glare is a mild optical side effect of femtosecond laser LASIK that improves with time., Competing Interests: Disclosures Dr. Rocha and Dr. Mercer declare no financial interest related to this manuscript. Dr. Krueger and Dr. Dupps are consultants for Alcon.

Purpose: To analyze planning strategies for eyes that gained 1 or more lines of corrected distance visual acuity (CDVA) after topography-guided custom treatment (TCAT)., Setting: Refractive Surgery Clinic, Cleveland Clinic, Ohio, USA., Design: Retrospective case series., Methods: Eyes having TCAT by the same surgeon between February 2016 and June 2017 were enrolled. The corneal shape was captured with the Wavelight Allegretto Topolyzer diagnostic device coupled with refraction, generating an ablation profile. The cylinder magnitude and axis of laser entry were decided by the surgeon based on the manifest and measured values, assisted by additional data from the Pentacam Scheimpflug tomographer and Ladarwave ocular wavefront aberrometer., Results: The study comprised 256 eyes. At 3 months, uncorrected distance visual acuity was 20/20 or better in 95.7% and 20/15 or better in 81.4%; 25.6% gained 1 or more lines of CDVA. The measured and manifest axes differed by less than 15 degrees in 59%, between 15 degrees and 30 degrees in 18%, and by more than 30 degrees in 23%. When it differed by at least 5 degrees, the measured axis was treated in 79%, 75%, and 73% of eyes, respectively. In eyes with higher measured cylinder, 75% were treated between the manifest and measured values, with 7% at full measured value. When the manifest value was greater, 60% were treated at the total measured value and 40% in between. Whole-eye aberrometry showed a small increase in coma, spherical aberration and the total root mean square (all P < .001)., Conclusions: The TCAT procedure achieved visual acuity better than the preoperative CDVA in more than 25.0% of eyes. Tomography and wavefront aberrometry assisted in the selection process to achieve optimum visual outcomes., (Copyright © 2018. Published by Elsevier Inc.)

Purpose: To evaluate extracellular matrix regulators and inflammatory factors in a patient who developed ectasia after small incision lenticule extraction (SMILE) despite normal preoperative tomographic and biomechanical evaluation., Methods: The SMILE lenticules from both eyes of the patient with ectasia and three control patients (5 eyes) matched for age, sex, and duration of follow-up were used for gene expression analysis of lysyl oxidase (LOX), matrix metalloproteinase 9 (MMP9), collagen types I alpha 1 (COLIA1) and IV alpha 1 chain (COLIVA1), transforming growth factor-beta (TGF-beta), bone morphogenetic protein 7 (BMP7), interleukin-6 (IL-6), cathepsin K, cluster of differentiation 68, integrin beta-1, and tissue inhibitor of metalloproteinase-1 (TIMP1). Furthermore, the functional role of LOX was assessed in vitro by studying the collagen gel contraction efficiency of LOX overexpressing in primary human corneal fibroblast cells., Results: Preoperatively, manifest refraction was -9.25 diopters (D) in the right eye and -10.00 D in the left eye. Corneal thickness, Pentacam (OCULUS Optikgeräte GmbH, Wetzlar, Germany) tomography, and Corvis biomechanical indices (OCULUS Optikgeräte GmbH) were normal. The ectatic eye lenticule (left) had reduced expression of LOX and COLIA1 compared to controls without ectasia. Increased mRNA fold change expression of TGF-beta, BMP7, IL-6, cathepsin K, and integrin beta-1 was noted in the ectatic left eye compared to controls; however, MMP9 and TIMP1 levels were not altered. Ectopic LOX expression in human corneal fibroblast induced significantly more collagen gel contraction, confirming the role of LOX in strengthening the corneal stroma., Conclusions: Reduced preexisting LOX and collagen levels may predispose clinically healthy eyes undergoing refractive surgery to ectasia, presumably by corneal stromal weakening via inadequately cross-linked collagen. Preoperative molecular testing may reveal ectasia susceptibility in the absence of tomographic or biomechanical risk factors. [J Refract Surg. 2019;35(1):6-14.]., (Copyright 2019, SLACK Incorporated.)

Purpose of Review: As a flapless procedure, SMILE brings benefits to refractive surgery, such as lower corneal biomechanical impact, less dry eye risk and less stromal bed exposure. However, the longer learning curve can be a risk factor for complications. This article aims to discuss SMILE complications and proposes a categorized analysis of occurrences, dividing into two groups: intraoperative and postoperative complications. Among intraoperative, we also suggest a subdivision between those related to the laser (lenticule construction), tissue separation (lenticule dissection) and tissue removal (lenticule extraction)., Recent Findings: The majority of SMILE complications are related to surgeon inexperience and reversible if precociously diagnosed and correctly managed. Intraoperative complications related to lenticule creation such as suction loss, opaque bubble layer and black spots, are correlated with later difficulties during lenticule dissection and removal, and may lead to unwanted situations, such as cap perforation, lenticule tear and cap-lenticule adhesion. Postoperative complications as dry eye, keratitis and ectasia should not be underestimated., Summary: Analyzing what has been reported as major or unique among the complications with SMILE, and dividing them into subgroups, we aim to help refractive surgeons in becoming familiar with the things that can go wrong during SMILE. Early recognition and correct management will be fundamental for optimizing the final visual result.

Myopia is a generally benign refractive error with an increasing prevalence worldwide. It can be corrected temporarily with glasses and contact lenses and permanently with laser vision correction. The 2 main procedures currently being performed for myopia correction are photorefractive keratectomy and laser-assisted in situ keratomileusis. Each technique has its advantages, but they appear to yield similar visual outcomes 1 year after surgery. Laser vision correction for myopia was considered a paradigm shift because healthy eyes could now undergo a surgical procedure to permanently and safely correct the error by altering the center of the cornea, which was previously off limits because of the potential for loss of transparency. Customized ablation using wavefront aberrometry and its optimized profiles were created to correct higher-order aberrations and give more vision quality to patients. Topography-guided ablation, initially used for complex retreatments, shows potential to make vision even better than glasses and contact lenses in a recent study on previously untreated eyes. One major concern is to identify corneas that are at risk of developing ectasia after the procedure. Topographic and tomographic screening indices have been implemented clinically, but there is still much to learn about corneal biomechanics. A more recently developed procedure for myopia correction is small-incision lenticule extraction, in which a lenticule is created in the cornea's stroma with a femtosecond laser and extracted through a small corneal incision. Long-term outcomes and new complication risks need to be better understood as this procedure develops.

Purpose: To assess the predictive accuracy of simulation-based LASIK outcomes., Methods: Preoperative and 3-month post-LASIK tomographic data from 20 eyes of 12 patients who underwent wavefront-optimized LASIK for myopia were obtained retrospectively. Patient-specific finite element models were created and case-specific treatment settings were simulated. Simulated keratometry (SimK) values and the mean tangential curvature of the central 3 mm (Kmean) were obtained from the anterior surfaces of the clinical tomographies, and computational models were compared. Correlations between Kmean prediction error and patient age, preoperative corneal hysteresis (CH), and corneal resistance factor (CRF) were assessed., Results: The mean difference for Kmean between simulated and actual post-LASIK cases was not statistically significant (-0.13 ± 0.36 diopters [D], P = 0.1). The mean difference between the surgically induced clinical change in Kmean and the model-predicted change was -0.11 ± 0.34 D (P = 0.2). Kmean prediction error was correlated to CH, CRF, and patient age (r = 0.63, 0.53, and 0.5, respectively, P < 0.02), and incorporation of CH values into predictions as a linear offset increased their accuracy. Simulated changes in Kmean accounted for 97% of the variance in actual spherical equivalent refractive change., Conclusions: Clinically feasible computational simulations predicted corneal curvature and manifest refraction outcomes with a level of accuracy in myopic LASIK cases that approached the limits of measurement error. Readily available preoperative biomechanical measures enhanced simulation accuracy. Patient-specific simulation may be a useful tool for clinical guidance in de novo LASIK cases.

Date palms (Phoenix dactylifera) are the most significant perennial crop in arid regions of the Middle East and North Africa. Here, we present a comprehensive catalogue of approximately seven million single nucleotide polymorphisms in date palms based on whole genome re-sequencing of a collection of 62 cultivars. Population structure analysis indicates a major genetic divide between North Africa and the Middle East/South Asian date palms, with evidence of admixture in cultivars from Egypt and Sudan. Genome-wide scans for selection suggest at least 56 genomic regions associated with selective sweeps that may underlie geographic adaptation. We report candidate mutations for trait variation, including nonsense polymorphisms and presence/absence variation in gene content in pathways for key agronomic traits. We also identify a copia-like retrotransposon insertion polymorphism in the R2R3 myb-like orthologue of the oil palm virescens gene associated with fruit colour variation. This analysis documents patterns of post-domestication diversification and provides a genomic resource for this economically important perennial tree crop.

The date palm (Phoenix dactylifera L.) is one of the oldest cultivated trees and is intimately tied to the history of human civilization. There are hundreds of commercial cultivars with distinct fruit shapes, colors, and sizes growing mainly in arid lands from the west of North Africa to India. The origin of date palm domestication is still uncertain, and few studies have attempted to document genetic diversity across multiple regions. We conducted genotyping-by-sequencing on 70 female cultivar samples from across the date palm-growing regions, including four Phoenix species as the outgroup. Here, for the first time, we generate genome-wide genotyping data for 13,000-65,000 SNPs in a diverse set of date palm fruit and leaf samples. Our analysis provides the first genome-wide evidence confirming recent findings that the date palm cultivars segregate into two main regions of shared genetic background from North Africa and the Arabian Gulf. We identify genomic regions with high densities of geographically segregating SNPs and also observe higher levels of allele fixation on the recently described X-chromosome than on the autosomes. Our results fit a model with two centers of earliest cultivation including date palms autochthonous to North Africa. These results adjust our understanding of human agriculture history and will provide the foundation for more directed functional studies and a better understanding of genetic diversity in date palm., (Copyright © 2015 Mathew et al.)

Purpose: To investigate the association of the percent tissue altered (PTA) with the occurrence of ectasia after LASIK in eyes with suspicious preoperative corneal topography., Methods: This retrospective comparative case-control study compared associations of reported ectasia risk factors in 129 eyes, including 57 eyes with suspicious preoperative Placido-based corneal topography that developed ectasia after LASIK (suspect ectasia group), 32 eyes with suspicious topography that remained stable for at least 3 years after LASIK (suspect control group), and 30 eyes that developed ectasia with bilateral normal topography (normal topography ectasia group). Groups were subdivided based on topographic asymmetry into high- or low-suspect groups. The PTA, preoperative central corneal thickness (CCT), residual stromal bed (RSB), and age (years) were evaluated in univariate and multivariate analyses., Results: Average PTA values for normal topography ectasia (45), low-suspect ectasia (39), high-suspect ectasia (36), low-suspect control (32), and high-suspect control (29) were significantly different from one another in all comparisons (P < .003) except high- and low-suspect ectasia groups (P = .033), and presented the highest discriminative capability of all variables evaluated. Age was only significantly different between the high-suspect ectasia and normal topography ectasia groups, and CCT was not significantly different between any groups. Stepwise logistic regression revealed the PTA as the most significant independent variable (P < .0001), with RSB the next most significant parameter., Conclusions: There remains a significant correlation between PTA values and ectasia risk after LASIK, even in eyes with suspicious corneal topography. Less tissue alteration, or a lower PTA value, was necessary to induce ectasia in eyes with more remarkable signs of topographic abnormality, and PTA provided better discriminative capabilities than RSB for all study populations., (Copyright 2015, SLACK Incorporated.)

Purpose: To compare objective and subjective metrics from regular and high-resolution Scheimpflug devices (Pentacam) to determine their equivalence and interchangeability for refractive surgery screening., Setting: Emory Vision at Emory University, Atlanta, Georgia, USA., Design: Retrospective comparative case series., Methods: Eyes of consecutive screened refractive surgery patients were evaluated with high-resolution and regular Scheimpflug devices. Objective parameters evaluated included keratometry (K) values, central corneal thickness (CCT), and device-generated keratoconus screening indices. Masked expert reviewers subjectively graded images as normal, suspicious, or abnormal., Results: One hundred eyes of 50 patients were evaluated. The mean K values were not significantly different (anterior K: high resolution 1.21 diopters [D] ± 1.13 (SD) versus regular 1.15 ± 1.16 D, P = 0.73; posterior K: 0.34 ± 0.23 D versus regular 0.35 ± 0.23 D, P = .67). The mean CCT was significantly thinner in the high-resolution group (514.7 ± 26.6 μm versus 527.6 ± 27.6 μm (P < .0001) with limits of agreement of -12.9 to +17.5 μm. Most keratoconus screening indices were more suspicious with the high-resolution device than with the regular device except the indices of height asymmetry and height deviation. Subjectively, 60% of cases received the same score, high resolution was more suspicious in 28% of cases, and regular was more suspicious in 12% of cases; there was only slight subjective agreement between technologies (κ = 0.26 to 0.31)., Conclusions: Regular and high-resolution Scheimpflug imaging devices generated different objective values and significantly different subjective interpretations with poor inter-reviewer agreement. The high-resolution device provided a more conservative overall output. For refractive surgical screening, the 2 devices are not interchangeable., Financial Disclosure: Proprietary or commercial disclosures are listed after the references., (Copyright © 2015 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To report a new indication for flap lift of interface blood using the WaveLight FS200 femtosecond laser (Alcon Laboratories, Inc., Fort Worth, TX)., Methods: The unique evacuation canal of the FS200 femtosecond laser allows blood from injured limbal vasculature to accumulate. In rare instances, blood extends from the canal into the flap interface, requiring a flap lift. All flap lifts were performed using the microscope in the laser suite on the FS200 femtosecond laser to remove postoperative flap interface blood in 3 eyes of 3 patients., Results: All interface blood was removed and no patients experienced re-bleeding. Postoperatively, patients achieved an uncorrected visual acuity of 20/20., Conclusions: When intracanal blood is noted, planned incomplete dissection of the flap to the canal edge may prevent the progression of blood in the interface., (Copyright 2014, SLACK Incorporated.)

Purpose: To document the first presented report in December 2008 of high irradiance riboflavin/ultraviolet A (UVA) corneal cross-linking in comparison with that of standard irradiance and of fractionated exposure to increase the time for oxygen diffusion into the cornea., Methods: After in vitro studies of oxygen depletion and cross-linking density using type 1 human collagen gels, 36 ex vivo porcine globes were deepithelialized and exposed to 0.1% riboflavin drops in carboxymethylcellulose solution every 5 min for 3 initial doses and then throughout irradiation afterward. Six eyes each were irradiated with 370-nm UVA light at 2, 3, 9, and 15 mW/cm continuously and 15 mW/cm fractionated (with alternate cycles of 30 s "ON" and 30 s "OFF" exposure) using an equivalent radiant exposure of 5.4 mJ/cm. The final six eyes received no UVA exposure as a control. The exposed corneas were then dissected and subjected to extensiometry. Analysis of variance with Bonferroni post hoc test was performed between groups., Results: The stress required to induce a 10% strain for the control eyes (no UVA) was 100.6±20.9×10 N/m in comparison with the stress of 3 mW/cm (standard irradiation) at 146.7±17.6×10 N/m (P=0.009). The stress at the other equidose irradiances of 2, 9, 15 continuously, and 15 mW/cm fractionated were 140±21.9, 162.8±70, 154.1±70, and 163.0±64×10 N/m, respectively. When comparing the irradiances of 15 mW/cm continuously and fractionated to the standard irradiation, the stress was not statistically different (P=0.799 and 0.643), respectively., Conclusion: High irradiance riboflavin/UVA cross-linking with equivalent energy exposure demonstrates comparable efficacy in stiffening corneal collagen with standard irradiance, but with considerably less exposure time. Over the past 6 years, since this report was first presented, the use of high irradiance cross-linking has been gaining popularity.

Unlabelled: We describe the case of a 50-year-old woman with anterior basement membrane dystrophy and dry eyes who had femtosecond laser in situ keratomileusis (LASIK) with gas-bubble breakthrough during flap creation in both eyes. The gas-bubble breakthrough appeared beneath the applanation interface in advance of the leading laser edge in the right eye and behind the advancing laser edge in the left eye. The surgery was aborted and 5 days later, photorefractive keratectomy with mitomycin-C was performed in the right eye and LASIK in the left eye. When a gas-bubble breakthrough extends in front of the advancing laser edge of the flap, the surgery should be aborted; surface ablation can be performed as a second-stage procedure. However, if the breakthrough occurs behind the advancing laser edge, the flap can be carefully lifted and the LASIK completed., Financial Disclosure: Dr. Krueger is a consultant to Alcon Laboratories, Inc. Dr. Ribeiro has no financial or proprietary interest in any material or method mentioned., (Copyright © 2014 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate the change of epithelial and flap thickness after femtosecond laser-assisted in situ keratomileusis (LASIK) using spectral-domain optical coherence tomography (SD OCT) in correlation with the spherical equivalent refraction treated and clinical outcomes., Design: Prospective, randomized, contralateral-eye study., Methods: Forty myopic eyes underwent LASIK using an excimer laser with refraction ranging from -1.00 to -7.25 diopters (mean -3.25±1.9). Flap creation was randomized between eyes, using the IntraLASE FS60 laser (IL) in 1 eye and WaveLight FS200 laser (FS) in the contralateral eye. SD OCT was used to evaluate the epithelial and flap thickness profiles and corneal power preoperatively and at 1 week and 1, 3, and 9 months postoperatively. Manifest and wavefront refractions were performed at each postoperative visit., Results: Statistically significant epithelial thickening was observed in both IL and FS groups as early as 1 month postoperatively (P=.033 and P=.042), but this stabilized between 3 (P=.042 and P=.035) and 9 months (P=.043 and P=.041). Femtosecond-LASIK flaps were thicker in the IL group in comparison to the FS group at 3 and 9 months postoperatively (P=.003 and P=.005, respectively). There was a statistically significant correlation between the magnitude of preoperative myopic refraction and the central epithelial thickness at 1, 3, and 9 months (Pearson correlation coefficients 0.485, 0.587 and 0.576) (P=.0021, P=.0010, and P=.0011), respectively. SD OCT corneal power maps showed steepening at 3 and 9 months along with mild myopic shift., Conclusion: Progressive epithelial and flap thickening with increased corneal power were observed after femtosecond laser-assisted in situ keratomileusis for myopia with consequent stabilization between 3 to 9 months postoperatively. The magnitude of epithelial and flap thickness remodeling correlated to the preoperative myopic refractive error., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Purpose: To evaluate corneal biomechanical deformation response using Ocular Response Analyzer (ORA) and Corvis ST data., Design: Prospective observational case-control study., Methods: A total of 1262 eyes of 795 patients were enrolled. Three groups were established, according to the corneal compensated intraocular pressure (IOPcc): Group I (10-13 mm Hg), Group II (14-17 mm Hg), and Group III (18-21 mm Hg). Each group included 3 subgroups, based on central corneal thickness (CCT): Subgroups 1 (465-510 μm), 2 (510-555 μm), and 3 (555-600 μm). In addition, similar groups of CCT were divided into subgroups of IOPcc. Corneal hysteresis (CH) and corneal resistance factor (CRF) were derived from ORA. The parameters of highest concavity with the parameters of first and second applanation were recorded from Corvis ST., Results: CH and CRF, applanation 1 time, and radius of curvature at highest concavity showed significant differences between CCT subgroups for each IOPcc group (P < .0001). CH, applanation 1 and 2 time, and applanation 2 velocity, as well as deformation amplitude (DA), showed significant differences by IOP subgroups for all CCT groups. IOPcc is correlated negatively with CH (r = -0.38, P < .0001). There are positive correlations of IOPcc with applanation 1 time, applanation 2 velocity, and radius and negative correlations with applanation 2 time (r = -0.54, P < .0001), applanation 1 velocity (r = -0.118, P < .0001), and DA (r = -0.362, P < .0001)., Conclusion: ORA and Corvis ST parameters are informative in the evaluation of corneal biomechanics. IOP is important in deformation response evaluation and must be taken into consideration., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Purpose: To evaluate the satisfaction and quality of life after laser vision correction (LVC) exclusively in a physician population., Setting: Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, USA., Design: Cohort study., Methods: A 12-question survey targeted toward physicians and the unique qualities of their experience with refractive surgery was sent to physicians who had refractive surgery at the Cole Eye Institute between 2000 and 2012. In conjunction, the visual outcomes and clinical information of physicians who received the survey were reviewed., Results: Two hundred twenty-six physicians (439 eyes) met the inclusion criteria for our study. One hundred thirty-two physicians (58%) responded to the survey and reported an overall satisfaction rate of 95.3%. Respondents included surgeons (28.0%), physicians who perform procedures but not surgery (43.2%), and physicians who do not perform procedures or surgery (28.8%). Of the physicians, 84.8% reported an improvement in the quality of vision compared with the corrected preoperative vision, 39.0% reported that their ability to perform procedures accurately had improved and 1.6% said they believed their ability to perform procedures was less. Ninety-six percent reported they would have the procedure again. Visual outcomes showed high levels of surgical predictability, efficacy, and safety., Conclusion: Despite high visual demands, physicians having LVC had a high percentage of good visual outcomes, satisfaction, and quality-of-life improvements., (Copyright © 2014 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Citrus tristeza virus (CTV) isolates collected from citrus germplasm, dooryard and field trees in California from 1914 have been maintained in planta under quarantine in the Citrus Clonal Protection Program (CCPP), Riverside, California. This collection, therefore, represents populations of CTV isolates obtained over time and space in California. To determine CTV genetic diversity in this context, genotypes of CTV isolates from the CCPP collection were characterized using multiple molecular markers (MMM). Genotypes T30, VT, and T36 were found at high frequencies with T30 and T30+VT genotypes being the most abundant. The MMM analysis did not identify T3 and B165/T68 genotypes; however, biological and phylogenetic analysis suggested some relationships of CCPP CTV isolates with these two genotypes. Phylogenetic analysis of the CTV coat protein (CP) gene sequences classified the tested isolates into seven distinct clades. Five clades were in association with the standard CTV genotypes T30, T36, T3, VT, and B165/T68. The remaining two identified clades were not related to any standard CTV genotypes. Spatiotemporal analysis indicated a trend of reduced genotype and phylogenetic diversity as well as virulence from southern California (SC) at early (1907-1957) in comparison to that of central California (CC) isolates collected from later (1957-2009) time periods. CTV biological characterization also indicated a reduced number and less virulent stem pitting (SP) CTV isolates compared to seedling yellows isolates introduced to California. This data provides a historical insight of the introduction, movement, and genetic diversity of CTV in California and provides genetic and biological information useful for CTV quarantine, eradication, and disease management strategies such as CTV-SP cross protection.

Purpose: To compare the changes in corneal power (ΔK) induced by myopic ablations estimated by Placido-disk and total corneal power (TCP) ray tracing methods to the refractive change (ΔSE)., Methods: Manifest refraction, simulated keratometry from a Placido-disk based system, and TCP from a dual-Scheimpflug analyzer were obtained from 35 patients (58 eyes) before and 3 months after a myopic ablation. The change in the manifest refraction that occurred after surgery was then vertex distance corrected and compared to the changes observed in corneal power with the various systems analyzed., Results: The Placido-based simulated keratometry overestimated the corneal power after the procedure by 0.50 ± 0.53 diopters (D) when compared to refractive change in the corneal plane induced by the laser surgery (ΔSE-ΔK). The ray tracing method showed the opposite trend, with the TCP simulated keratometry showing an underestimation of the corneal power of -0.25 ± 0.48 D. The Placido system showed a direct correlation between the overestimation of the corneal power and the level of myopia, whereas the ray tracing method showed an underestimation, which was more pronounced in higher levels of myopia., Conclusions: Ray tracing methods underestimate corneal power as opposed to the overestimation in corneal power after refractive surgery, directly related to the level of myopia, observed in Placido-based systems. They have the potential to overcome the errors in calculations based on anterior curvature alone. However, ray tracing methods need to be validated and optimized before it can be used routinely in IOL calculation., (Copyright 2013, SLACK Incorporated.)

Purpose: To introduce a new sequential wavefront device with rapid sampling that can be used as an intraoperative, real-time aberrometer/refractometer for immediate diagnosis and management of refractive outcomes during cataract surgery., Methods: A unique wavefront device uses a rotating prismatic mirror to rapidly shift the incident wavefront emanating from the eye through an aperture for analysis of a sequentially sampled wavefront segment. The sampled segment is then focused onto a quad detector that localizes its angular displacement of the sampled segment's wavefront gradient. Although the device's capability is higher for other applications, the wavefront is herein rapidly sampled at 200 Hz (frames/second), with a 2-mm aperture that moves along a 5-mm outer diameter annulus to capture a real-time analysis of refractive error for intraoperative application (ie, an intraoperative wavefront movie). The prototype wavefront device has been miniaturized into a narrow profile attachment that can be fixed to an operating microscope. In pilot analysis, several eyes undergoing cataract surgery were analyzed to determine both the qualitative and quantitative change in refraction with surgical intervention in an effort to document and improve outcomes intraoperatively., Results: Clinical application of the device was easily implemented without changing or limiting the working distance, magnification, or illumination of the surgeon's ergonomics intraoperatively. The real-time wavefront outcome was visualized overlaying a live eye image, presenting the refractive error both qualitatively and quantitatively. Qualitative representation of spherical refractive error was seen as a circle, cylinder as a thin ellipse, and emmetropia as a dot. Localization of lower-order aberrations with a practical sample rate of 200 frames/ second enables a real-time visualization of qualitative refractive data coaxially aligned with the eye image and quantitatively as sphere, cylinder, and axis at the bottom of the screen. Practical evaluation of residual cylinder prior to and during limbal relaxing incision placement, rotational accuracy during toric intraocular lens alignment, and refractive effect of subtle surgical maneuvers were all achieved with this device., Conclusion: Real-time, intraoperative refraction and visualization is possible with a new sequential wavefront device attached to the operating microscope. The precision and accuracy of intraoperative documentation and refinement of outcomes is likely to be enhanced, making this an important future tool for optimizing cataract surgery outcomes., (Copyright 2013, SLACK Incorporated.)

Background: To investigate the association between femtosecond laser flap parameters, uncorrected distance visual acuity, and higher-order aberrations (HOA) after customized myopic LASIK., Methods: Retrospective review of the charts of patients who underwent uncomplicated wavefront-guided customized myopic LASIK with flap creation using the femtosecond laser. Patients were stratified by intended flap thickness, and the change in HOA from preoperative to 3 months postoperative was compared. Multivariate linear models were performed to assess the association between calculated flap thickness, intended flap diameter, HOA, and uncorrected visual acuity., Results: One hundred seventy-one eyes of 171 patients were included. There was no statistically significant difference in the induction of HOA between eyes with thin (90 μm) or thick (100 or 110 μm) intended flaps. In a multivariate model, the level of myopic correction was highly associated with the induction of total HOA, coma, and spherical aberration. There was no correlation between calculated flap thickness, uncorrected visual acuity, or HOAs. Intended flap diameter was not associated with coma or spherical aberration, but larger flap diameter was associated with better uncorrected visual acuity., Conclusions: Femtosecond laser flap thickness in the range of 90-110 μm was not associated with uncorrected visual acuity or the induction of HOA after uncomplicated customized myopic LASIK. The level of myopic correction was the largest determinant of the induction of HOA.

Purpose: To develop a method for automatizing the detection of subclinical keratoconus based on a tree classification., Design: Retrospective case-control study., Methods: setting: University Hospital of Bordeaux. participants: A total of 372 eyes of 197 patients were enrolled: 177 normal eyes of 95 subjects, 47 eyes of 47 patients with forme fruste keratoconus, and 148 eyes of 102 patients with keratoconus. observation procedure: All eyes were imaged with a dual Scheimpflug analyzer. Fifty-five parameters derived from anterior and posterior corneal measurements were analyzed for each eye and a machine learning algorithm, the classification and regression tree, was used to classify the eyes into the 3 above-mentioned conditions. main outcome measures: The performance of the machine learning algorithm for classifying eye conditions was evaluated, and the curvature, elevation, pachymetric, and wavefront parameters were analyzed in each group and compared., Results: The discriminating rules generated with the automated decision tree classifier allowed for discrimination between normal and keratoconus with 100% sensitivity and 99.5% specificity, and between normal and forme fruste keratoconus with 93.6% sensitivity and 97.2% specificity. The algorithm selected as the most discriminant variables parameters related to posterior surface asymmetry and thickness spatial distribution., Conclusion: The machine learning classifier showed very good performance for discriminating between normal corneas and forme fruste keratoconus and provided a tool that is closer to an automated medical reasoning. This might help in the surgical decision before refractive surgery by providing a good sensitivity in detecting ectasia-susceptible corneas., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Purpose: To compare the discriminating ability of corneal elevation generated by a dual Scheimpflug analyzer calculated with different reference surfaces for distinguishing normal corneas from those with keratoconus and subclinical keratoconus., Methods: A total of 391 eyes of 208 patients were prospectively enrolled in the study and divided into three groups: 167 eyes of 113 patients with keratoconus, 47 contralateral topographically normal eyes of patients with clinically evident keratoconus in the fellow eye, and 177 eyes of 95 refractive surgery candidates with normal corneas. All eyes were measured with a dual Scheimpflug analyzer (GALILEI Analyzer; Ziemer Ophthalmic Systems AG, Port, Switzerland). Maximum elevation values were recorded within the central 5-mm diameter in both anterior and posterior elevation maps. Discriminating ability of corneal elevation measurements obtained by best-fit toric and aspheric (BFTA) and best-fit sphere (BFS) reference surfaces were compared by receiver operator characteristic (ROC) curves., Results: ROC curve analysis showed that corneal elevation measured by BFTA had a significantly better ability than with BFS for distinguishing normal corneas from those with keratoconus and forme fruste keratoconus (P = .01). Posterior elevation measured by BFTA had a significantly higher predictive accuracy for forme fruste keratoconus than anterior elevation with an area under ROC curves of 0.88 and 0.80, respectively (P = .01). The sensitivity and specificity achieved with the maximum posterior elevation for detecting keratoconus and forme fruste keratoconus were 99% and 99% for keratoconus and 82% and 80% for forme fruste keratoconus with the cut-off value at 16 and 13 μm, respectively., Conclusions: The ability to discriminate between normal cornea and forme fruste keratoconus with elevation parameters was significantly improved by using BFTA instead of BFS reference surface., (Copyright 2013, SLACK Incorporated.)

Purpose: To analyze the induced corneal higher order aberrations (HOAs) after wavefront-optimized ablation., Methods: Sixty-four myopic eyes that underwent wavefront-optimized myopic LASIK were divided into three groups based on spherical equivalent (SE): low myopia group (23 eyes with SE <-3.00 diopters [D]); moderate myopia group (27 eyes with SE between -3.00 and -6.00 D); and high myopia group (14 eyes with SE >-6.00 D). Total corneal HOA, corneal spherical aberrations, corneal coma through a 6-mm pupil size, and corneal eccentricity were measured with a dual Scheimpflug imaging device preoperatively and 3 months after surgery., Results: An overall increase in total corneal HOA was observed with a mean of 0.18±0.18 μm (P<.01), although this induction was not statistically significant in the low myopic group with a mean of 0.006±0.15 μm (P=.85). Root-mean-square spherical aberration varied the most after myopic ablation, with an overall induction of positive spherical aberration of 0.27±0.25 μm (P<.001)., Conclusions: Although the wavefront-optimized profile was designed to preserve the preoperative HOAs of the total eye, a significant induction of the corneal HOAs after myopic treatment was observed. The magnitude of the induced corneal HOA was related to the amount of intended correction. Corneal wavefront profiles do not reflect the visual performance; however, they provide relevant information, which may help in optimizing new laser treatment algorithms., (Copyright 2013, SLACK Incorporated.)