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We report an unusual presentation of presumed mitomycin C toxicity with possible subsequent hypersensitization to other medication toxicities. A 50-year-old female presented three months after photorefractive keratectomy with intraoperative mitomycin C for the management of persistent epithelial defects, corneal haze, and edema. She was found to have used an expansive and rapidly changing medical regimen which may have caused additional toxicity. These medications included besifloxacin, bromfenac, and ketotifen. Additives such as benzalkonium chloride and DuraSite® may have also contributed. Intraoperative mitomycin C can result in longstanding corneal haze, edema, and delayed epithelial healing in the setting of corneal refractive surgery. These may leave the cornea more susceptible to additional subsequent medication toxicities during the postoperative period. This report describes a case of mitomycin C exposure leading to a prolonged sensitivity to other medication toxicities, which has not been discussed elsewhere in the literature.

Majid Moshirfar,1– 3 James Ellis,4 Daniel Beesley,5 Shannon E McCabe,1,6 Adam Lewis,7 William B West Jnr,4 Yasmyne Ronquillo,1 Phillip Hoopes Snr1 1Hoopes Vision Research Center, Hoopes Vision, Draper, UT, USA; 2John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, UT, USA; 3Utah Lions Eye Bank, Murray, UT, USA; 4University of Utah School of Medicine, Salt Lake City, UT, USA; 5Brigham Young University, Provo, UT, USA; 6Mission Hills Eye Center, Pleasant Hill, CA, USA; 7Kansas City University College of Osteopathic Medicine, Kansas City, MO, USACorrespondence: Majid MoshirfarHoopes Vision Research Center, Hoopes Vision, Draper, UT, USATel +1 801-568-0200Fax +1 801-563-0200Email cornea2020@me.comPurpose: To compare the visual performance of the AcrySof IQ PanOptix trifocal intraocular lens and the TECNIS Symfony extended depth-of-focus lens at near and distance visual ranges.Methods: A total of 146 patients (221 eyes) who underwent phacoemulsification and cataract extraction and received either a PanOptix or Symfony lens from January 2019 to July 2020 were included in the study (83 PanOptix non-toric, 30 PanOptix toric, 70 Symfony non-toric, and 38 Symfony toric). Uncorrected distance (UDVA), uncorrected near (UNVA), and corrected distance (CDVA) visual acuity were assessed at one-day, one-month, and three-months postoperatively. Averages of UDVA, UNVA, and CDVA were taken to evaluate which lens was superior at near and distance visual ranges. Secondary outcome measures including glare, halo, dryness, and problems with night vision were documented at each postoperative visit.Results: At one month postoperatively, the average UNVA was 0.16 ± 0.14 logMAR in the PanOptix group and 0.21 ± 0.14 logMAR in the Symfony group (P=0.007); the average UDVA for the PanOptix group was 0.09 ± 0.13 logMAR compared to the Symfony group at 0.10 ± 0.14 logMAR (P=0.67); and the average CDVA was 0.02 ± 0.05 logMAR in the PanOptix group and 0.00 ± 0.04 logMAR in the Symfony group (P=0.11). At three months postoperatively, there were no statistically significant differences in UNVA, UDVA, or CDVA between the two groups (P=0.18, 0.79, 0.68 respectively). There was no statistically significant difference in secondary outcome measures at one- and three-months (P=0.49, 0.10 respectively).Conclusion: The AcrySof IQ PanOptix trifocal intraocular lens appears to afford better UNVA compared to the TECNIS Symfony extended depth-of-focus intraocular lens at one-month postoperatively, though this difference was not seen at three months postoperatively. There is no statistically significant difference in UDVA and CDVA between the two groups at postoperative day one, one-month, and three-months.Keywords: visual acuity, intraocular lens, trifocal lens, extended depth-of-focus lens

Majid Moshirfar,1– 3 Andrew C Thomson,4 William B West Jr,5 MacGregor N Hall,4 Shannon E McCabe,1 Robert J Thomson,4 Yasmyne C Ronquillo,1 Phillip C Hoopes1 1Hoopes Vision Research Center, Hoopes Vision, Draper, UT, USA; 2John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA; 3Utah Lions Eye Bank, Murray, UT, USA; 4McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA; 5University of Utah School of Medicine, Salt Lake City, UT, USACorrespondence: Majid MoshirfarHoopes Vision Research Center, 11820 S. State Street Suite #200, Draper, UT 84020, USATel +1 801-568-0200Fax +1 801-563-0200Email cornea2020@me.comPurpose: To assess a single site’s initial experience with SMILE for the treatment of myopic astigmatism and compare outcomes and vector analysis results with the US Food and Drug Administration (FDA) results and published literature.Patients and Methods: Forty-eight eyes (29 patients) with mean preoperative sphere of − 5.11 ± 1.31 diopters (D) and cylinder of − 1.12 ± 0.60 D underwent SMILE. Visual acuity, refractive, and vector analysis outcomes as well as subjective measures were reported at three and twelve months postoperatively and compared with FDA results and the published literature between 2014 and 2020 involving treatment of patients with mean cylinders of >− 0.50 to ≤− 3.00 D.Results: At three and twelve months, 43 and 32 eyes were evaluated, respectively. At twelve months, mean cylinder power was reduced to − 0.38 ± 0.38 D with 78.1% achieving ≤± 0.50 D. Uncorrected distance visual acuity (UDVA) ≥ 20/20 was achieved in 77.4% of eyes by twelve months with 100% achieving ≥ 20/30 UDVA. No loss of corrected distance visual acuity was observed in eyes seen at twelve months. Correction index (CI) at twelve months was 0.90 indicating overall undercorrection of 10%. Twelve-month CI was 0.96, 0.90, and 0.83 in eyes with preoperative cylinders of

Previous studies have demonstrated safety and efficacy using 6.0 and 6.5 mm optical zones in the WaveLight EX500 Excimer Laser System but have not evaluated if differing optical zone sizes influence refractive outcomes. This study examines visual outcomes between two study populations undergoing LASIK with either a 6.0 mm (1332 patients) or 6.5 mm (1332 patients) optical zone. Outcomes were further stratified by severity of myopia (low, moderate, and high) and astigmatism (low and high). Patients were matched by age and preoperative manifest sphere and cylinder. Postoperative measurements were then compared. The 6.5 mm group demonstrated better postoperative manifest refractive spherical equivalent (MRSE), manifest sphere, and absolute value of the difference in actual and target spherical equivalent refraction (|∆ SEQ|), within the total population, moderate myopia, and low astigmatism groups, but this did not lead to improved postoperative uncorrected distance visual acuity (UDVA) or best corrected distance visual acuity (CDVA). Though astigmatic correction and postoperative angle of error were similar between optical zone sizes, they were significantly worse with high myopia. Overall, this study demonstrates differences in visual outcomes between the 6.0 and 6.5 mm optical zone sizes that may warrant consideration, however, essentially, the results are comparable between them.

Key Points Question Do International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes accurately capture presenting symptoms of fever, cough, and dyspnea among patients being tested for coronavirus disease 2019 (COVID-19)? Findings In this cohort study, an electronic medical record review of 2201 patients tested for COVID-19 between March 10 and April 6, 2020, found that ICD-10 codes had poor sensitivity and negative predictive value for capturing fever, cough, and dyspnea. Meaning These findings suggest that symptom-specific ICD-10 codes do not accurately capture COVID-19–related symptoms and should not be used to populate symptoms in electronic medical record–based cohorts., This cohort study compares the performance of International Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes specific for fever, cough, and dyspnea with electronic medical record review for patients tested for coronavirus disease 2019 (COVID-19)., Importance International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes are used to characterize coronavirus disease 2019 (COVID-19)–related symptoms. Their accuracy is unknown, which could affect downstream analyses. Objective To compare the performance of fever-, cough-, and dyspnea-specific ICD-10 codes with medical record review among patients tested for COVID-19. Design, Setting, and Participants This cohort study included patients who underwent quantitative reverse transcriptase–polymerase chain reaction testing for severe acute respiratory syndrome coronavirus 2 at University of Utah Health from March 10 to April 6, 2020. Data analysis was performed in April 2020. Main Outcomes and Measures The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of ICD-10 codes for fever (R50*), cough (R05*), and dyspnea (R06.0*) were compared with manual medical record review. Performance was calculated overall and stratified by COVID-19 test result, sex, age group (64 years), and inpatient status. Bootstrapping was used to generate 95% CIs, and Pearson χ2 tests were used to compare different subgroups. Results Among 2201 patients tested for COVD-19, the mean (SD) age was 42 (17) years; 1201 (55%) were female, 1569 (71%) were White, and 282 (13%) were Hispanic or Latino. The prevalence of fever was 66% (1444 patients), that of cough was 88% (1930 patients), and that of dyspnea was 64% (1399 patients). For fever, the sensitivity of ICD-10 codes was 0.26 (95% CI, 0.24-0.29), specificity was 0.98 (95% CI, 0.96-0.99), PPV was 0.96 (95% CI, 0.93-0.97), and NPV was 0.41 (95% CI, 0.39-0.43). For cough, the sensitivity of ICD-10 codes was 0.44 (95% CI, 0.42-0.46), specificity was 0.88 (95% CI, 0.84-0.92), PPV was 0.96 (95% CI, 0.95-0.97), and NPV was 0.18 (95% CI, 0.16-0.20). For dyspnea, the sensitivity of ICD-10 codes was 0.24 (95% CI, 0.22-0.26), specificity was 0.97 (95% CI, 0.96-0.98), PPV was 0.93 (95% CI, 0.90-0.96), and NPV was 0.42 (95% CI, 0.40-0.44). ICD-10 code performance was better for inpatients than for outpatients for fever (χ2 = 41.30; P