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Nicholas E Tan,1 Brayden T Wortz,2 Eric D Rosenberg,3 Nathan M Radcliffe,4,5 Preeya K Gupta6 1College of Medicine, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA; 2Undergraduate College, Wake Forest University, Winston-Salem, NC, USA; 3Department of Ophthalmology, New York Medical College, New York, NY, USA; 4Department of Ophthalmology, Mount Sinai School of Medicine, New York, NY, USA; 5New York Eye Surgery Center, Bronx, NY, USA; 6Triangle Eye Consultants, Cary, NC, USACorrespondence: Preeya K GuptaTriangle Eye Consultants, Cary, NC, USATel +1 919 391-7224Email preeyakgupta@gmail.comPurpose: To quantify features of musculoskeletal (MSK) complaints among US ophthalmologists and analyze factors related to symptom severity.Methods: Cornea, glaucoma, retina, and comprehensive practitioners were invited to complete a web-based survey via email. Data on demographics, practice and procedural volumes, wellness activities, job stress, MSK health, the Total Disability Index (TDI), and ergonomics were collected. Significance testing was performed to evaluate factors related to TDI score.Results: Of the 245 ophthalmologists contacted, 58.8% (n = 144) responded at least in part to the survey. Pain episodes were reported in 81.4% (n = 83) of 102 respondents, with 48.1% (n = 49) experiencing daily or weekly attacks. The neck, low back, and shoulders were commonly affected, yet only 57.1% (n=20) of those with shoulder pain reported a corresponding diagnosis. The mean TDI score was 6.2 ± 7.3%, indicating minimal disability related to the spine. Demographics, volume metrics, and wellness hours were each not significantly associated with TDI score (p > 0.05). Higher job stress ratings were reported by those who experienced more frequent pain attacks (p = 0.02) and those with higher TDI scores (p = 0.001). Greater difficulty with clinic, laser, and surgery job tasks was observed in respondents with higher TDI scores (p < 0.001, p = 0.005, and p < 0.001) and more bodily pain locations (p = 0.002, p = 0.002, and p = 0.001). Respondents who pursued practice modifications (p = 0.03) and treatments (p = 0.01) to reduce or prevent pain had higher mean TDI scores, and 94.2% of respondents (n = 97) were interested in learning more about ergonomics.Conclusion: Mild MSK complaints were highly prevalent among the surveyed ophthalmologists, and a similar trend could be expected for other US ophthalmologists. Greater frequency and severity of pain may contribute to physician burnout. There may be underdiagnosis of MSK pathology yet also high demand for ergonomic strategies and MSK treatments, suggesting a need for practical solutions.Keywords: ergonomics, musculoskeletal diseases, occupational diseases, ophthalmologists, surveys and questionnaires

Tanner J Ferguson,1 Nathan M Radcliffe,2 Sarah H Van Tassel,3 Brandon J Baartman,4 Vance M Thompson,4 Richard L Lindstrom,4,5 Mitch J Ibach,4,5 John P Berdahl4 1Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA; 2New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA; 3Department of Ophthalmology, Weill Cornell Medicine, New York, NY, USA; 4Vance Thompson Vision, Sioux Falls, SD, USA; 5Minnesota Eye Consultants, Minnesota, MN, USACorrespondence: Tanner J Ferguson Email tannerferg@gmail.comPurpose: To investigate the safety and tolerability of the multi-pressure dial (MPD) worn overnight for seven consecutive days.Design: Prospective, open-label, randomized, single-site study.Subjects: Twenty eyes of 10 subjects with open-angle glaucoma were fitted with an MPD and randomized to negative pressure application of − 10 mmHg in one eye (study eye) worn overnight for 7 consecutive days.Methods: Safety measures included best-corrected visual acuity (BCVA), intraocular pressure (IOP) changes from baseline during and after negative pressure application, slit lamp and dilated fundus exam findings, and rate of adverse events. Subjective assessments were completed daily by the subjects during the 7-day study period and immediately following the study period.Results: Prior to the 7-day testing period, application of 10 mmHg negative pressure reduced mean IOP from 18.2 ± 3.8 mmHg to 14.0 ± 2.1 mmHg (p< 0.01), a 22% reduction. After 7 days of consecutive nightly wear, repeat IOP measurements with the application of negative pressure showed a decrease in mean IOP from 16.9 ± 4.3 mmHg to 13.5 ± 3.7 mmHg. The observed IOP reduction was in addition to the subjects’ current treatment regimen. There were no statistically significant changes in IOP, BCVA from baseline following the 7-day period of nightly wear with the application of negative pressure. The patient-reported outcomes were favorable.Conclusion: The MPD can safely and comfortably be worn overnight. The decrease in IOP of > 20% in addition to current therapy is both clinically and statistically significant. The MPD shows promise as a potential new treatment option for nocturnal IOP control.Keywords: multi-pressure dial, open-angle glaucoma, normal-tension glaucoma, nocturnal IOP, multi-pressure glaucoma management

Nathaniel Tracer,1 Jaime E Dickerson Jr,2,3 Nathan M Radcliffe4 1NYU School of Medicine, New York, NY, USA; 2Sight Sciences, Inc, Menlo Park, CA, USA; 3North Texas Eye Research Institute, UNTHSC, Fort Worth, TX, USA; 4Mt Sinai School of Medicine, New York, NY, USACorrespondence: Nathan M RadcliffeMt Sinai School of Medicine, New York Eye Surgery Center, 1101 Pelham Parkway North, New York, NY, USATel +1 718 519 1000Email drradcliffe@gmail.comPurpose: To evaluate reduction in intraocular pressure (IOP) and medications for open-angle glaucoma (OAG) patients 12 months post-ab-interno circumferential viscodilation (VISCO360, Sight Sciences, Menlo Park, CA) in conjunction with cataract surgery.Setting: Surgical center (New York, United States).Design: Retrospective study of all OAG patients treated with 360-degree ab-interno viscodilation with cataract surgery by a single surgeon (NR) having 12 months of follow-up. Eyes were stratified by baseline IOP. Group 1: ≥ 18 mmHg (n=111). Group 2: < 18 mmHg (n=69).Methods: IOP was measured using Goldmann applanation tonometry. Medications, the number of medication-free eyes in each group at 12 months, and adverse events (AE) are reported. Analysis includes descriptive statistics and t-tests evaluating change from baseline.Results: Groups 1 and 2 had mean baseline IOP of 22 and 14.3 mmHg. Medication use was 0.9 and 1.1 for Groups 1 and 2. At 12 months IOP for Group 1 was reduced 22% to 17.2 mmHg (p< 0.0001) on 1.0 medications (p=0.7). IOP for Group 2 was similar to baseline (15.4 mmHg) but with a reduction in medications to 0.6 (p< 0.05). The proportion medication free at 12 months was 32% and 47% for Groups 1 and 2 versus 34% and 26% at baseline, respectively. There were few AE (hyphema 1.7%, IOP elevation > 10 mmHg > 30 days post-op 1.1%, mild inflammation < 1%) and no secondary surgical interventions excepting a single paracentesis, one-day postoperative.Discussion: Treatment goals for the two groups differed. Pressure reduction (Group 1) or medication reduction (Group 2). Viscodilation achieved significant IOP reduction in Group 1 and medication reduction in Group 2 with many patients (both groups) medication free at 12 months. AE were infrequent and transient.Conclusion: Circumferential ab-interno viscodilation can be combined with cataract surgery and provide an IOP lowering and medication reduction benefit sustained for at least 12 months, for many patients with OAG.Keywords: viscodilation, MIGS, open-angle glaucoma, glaucoma surgery, VISCO360, canaloplasty, OMNI