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This study demonstrates the use of an additive fuzzy system to control the velocity and gap of cars in a single lane two-car platoon. A throttle- only controller and a combined throttle and braker controller were tested. Simulation results show that follower cars with a combined brake/ throttle controller can maintain a constant gap when the platoon goes down hills and slows. An adaptive throttle controller uses a neural system to learn the fuzzy rules for different vehicle types.

Brandon D Ayres,1 Marc R Bloomenstein,2 Jennifer Loh,3 Thomas Chester,4 Bobby Saenz,5,6 Julio Echegoyen,7 Shane R Kannarr,8 Tomasita C Rodriguez,9 Jaime E Dickerson Jr9,10 1Private Practice, Philadelphia, PA, USA; 2Schwartz Laser Eye Center, Scottsdale, AZ, USA; 3Loh Ophthalmology Associates, Miami, FL, USA; 4Cleveland Eye Clinic, Brecksville, OH, USA; 5Rosenberg School of Optometry, University of the Incarnate Word, San Antonio, TX, USA; 6LASIK San Antonio, Kerrville, TX, USA; 7Gordon Schanzlin New Vision Institute, La Jolla, CA, USA; 8Kannarr Eye Care, Pittsburg, KS, USA; 9Sight Sciences, Menlo Park, CA, USA; 10North Texas Eye Research Institute, University of North Texas Health Science Center, Fort Worth, TX, USACorrespondence: Jaime E Dickerson Jr, Email jdickerson@sightsciences.comPurpose: To evaluate dry eye disease (DED) signs and symptoms six months after a single treatment with Localized Heat Therapy (LHT) (TearCare, Sight Sciences) for patients previously treated for six months with cyclosporine (0.05%) ophthalmic emulsion (CsA) BID (Restasis, Allergan).Setting: Nineteen ophthalmic and optometric practices in 11 US states.Design: Multicenter, cross-over, six month extension to the SAHARA randomized, controlled trial (RCT). Included patients were those randomized to CsA in Phase 1 of the SAHARA RCT.Methods: This was the second phase of the SAHARA RCT in which, following the 6-month endpoint, all patients that had been randomized to CsA discontinued CsA and were treated with LHT and subsequently followed for an additional six months. Outcome measures at 12 months for CsA patients crossed over to LHT included TBUT, OSDI and MGSS.Results: One hundred and sixty-one patients (322 eyes) were analyzed. Mean (SD) baseline TBUT prior to CsA was 4.4 (1.2) seconds, 5.6 (2.6) at 6 months which improved to 6.6 (3.2) and 6.1 (2.8) seconds (both P < 0.001) at 9 and 12 months (3, 6 months post LHT). Mean (SD) OSDI was 50.0 (14.9) at baseline and 34.2 (21.5) after CsA. With LHT at 6 months, this improved to 30.0 (20.6) and 31.0 (19.5) at 9 and 12 months (P = 0.162 vs month 6, P < 0.0001 vs baseline). MGSS was 7.1 (3.2) at baseline, 13.3 (8.2) at the end of CsA treatment which improved to 17.4 (8.8) and 16.1 (9.0) at 9 and 12 months; both P < 0.001.Conclusion: SAHARA showed 6-month superiority of LHT to CsA in clinical signs and non-inferiority in symptom scores. This extension shows that patients treated with CsA for 6 months can achieve meaningful additional improvement in signs and symptoms lasting for as long as 6 months following a single LHT treatment without the need for topical prescription therapy.Keywords: dry eye disease, meibomian gland dysfunction, restasis, tearcare, cyclosporine

Jaime E Dickerson Jr,1,2 Alison E Harvey,1 Reay H Brown1,3 1Sight Sciences, Inc., Menlo Park, CA, USA; 2North Texas Eye Research Institute, University of North Texas Health Science Center, Fort Worth, TX, USA; 3Atlanta Ophthalmology Associates, Atlanta, GA, USACorrespondence: Jaime E Dickerson Jr, Email Jaime.dickerson@unthsc.eduPurpose: To determine if there was an association between severity of glaucoma and intraocular pressure (IOP) and medication (med) outcomes for patients in the ROMEO (Retrospective, Observational, Multicenter Evaluation of OMNI) study.Setting: Eleven ophthalmology practices in 8 US states.Design: Post-hoc analysis of all eyes enrolled and treated with ab interno canaloplasty and trabeculotomy in the retrospective, multicenter ROMEO study.Methods: Eyes were grouped according to visual field mean deviation (MD): mild (MD better than − 6 dB), moderate (MD between − 6 and − 12 dB), advanced (− 12 dB or worse). IOP and med outcomes at 12 months were compared across groups. Least squares regression was used to assess the relationship of MD with month 12 IOP. Outcomes for 1st and last MD deciles were compared as a sensitivity analysis.Results: One hundred and twenty-seven eyes were available for analysis including 79 mild, 42 moderate, 6 advanced. Most eyes had a reduction in IOP at Month 12 (70%) with most at 18 mmHg or less. Percentage IOP reduction was similar across the groups (mild 16.9%, moderate 18.6%, advanced 18.0%) with mean month 12 IOP between 14 and 16 mmHg. Medications were also reduced in all three groups; − 0.8 (mild, P < 0.001), − 0.55 (moderate, P < 0.05), and − 1.0 (advanced, P = 0.139, ns). Regression analysis revealed no relationship between month 12 IOP and MD. Med reductions were observed for all groups with a reduction of 1 or more medications seen in (%, 95% CI) 69%, 59– 79 (mild), 50%, 35– 65 (moderate), and 60%, 21– 99 (advanced). Secondary interventions tended to have greater incidence with worse MD likely reflecting lower desired IOP targets.Conclusion: Analysis of data from the ROMEO study suggests that similar meaningful IOP and med reductions can be expected across the range of disease severity studied.Keywords: MIGS, canaloplasty, primary open-angle glaucoma, trabeculotomy, OMNI

Brandon D Ayres,1 Marc R Bloomenstein,2 Jennifer Loh,3 Thomas Chester,4 Bobby Saenz,5,6 Julio Echegoyen,7 Shane R Kannarr,8 Victor L Perez,9 Tomasita C Rodriguez,10 Jaime E Dickerson Jr10,11 1Private Practice, Philadelphia, PA, USA; 2Schwartz Laser Eye Center, Scottsdale, AZ, USA; 3Loh Ophthalmology Associates, Miami, FL, USA; 4Cleveland Eye Clinic, Brecksville, OH, USA; 5Rosenberg School of Optometry, University of the Incarnate Word, San Antonio, TX, USA; 6LASIK San Antonio, Kerrville, TX, USA; 7Gordon Schanzlin New Vision Institute, La Jolla, CA, USA; 8Kannarr Eye Care, Pittsburg, KS, USA; 9Department of Ophthalmology, Duke University Medical Center, Durham, NC, USA; 10Sight Sciences, Menlo Park, CA, USA; 11North Texas Eye Research Institute, University of North Texas Health Science Center, Fort Worth, TX, USACorrespondence: Jaime E Dickerson Jr, Email jdickerson@sightsciences.comPurpose: We compare outcomes in eyes with dry eye disease (DED) treated with TearCare (TC) or topical cyclosporine 0.05% (RESTASIS; CsA).Setting: Nineteen ophthalmic and optometric practices in 11 US states.Design: Multicenter, randomized, assessor-masked, controlled IRB-approved trial. Eligible subjects: ≥ 22 years of age, dry eye symptoms within 3– 6 months, Tear Break-up Time (TBUT) ≥ 1 to ≤ 7 s, Meibomian Gland Secretion Score (MGSS) ≤ 12, Ocular Surface Disease Index (OSDI) of 23– 79. Randomized (1:1) to TC or CsA. TC subjects treated at baseline and month 5; CsA was twice daily for 6 months.Methods: Follow-up visits were scheduled for Day 1, Week 1, Months 1, 3, and 6 with primary inference at Month 6. Primary outcomes: TBUT and OSDI; secondary outcomes: MGSS, conjunctival and corneal staining, eye dryness score (EDS), symptoms assessment in dry eye (SANDE) score, and Schirmer tear score (STS). Safety assessments included adverse events, best corrected visual acuity, intraocular pressure, and slit-lamp findings.Results: Overall, 345 subjects, 172 TC and 173 CsA. TBUT improved at all time points in both groups (p< 0.0001), with statistically greater improvement for TC versus CsA (p=0.0006). OSDI improved significantly at all time points in both groups (p< 0.0001) with no significant differences between treatments. MGSS and other measures of meibomian gland function improved significantly more with TC eyes versus CsA; other secondary outcomes showed significant improvements in both groups with no difference between groups. Treatment-related adverse events were uncommon (10 total, 8 in the CsA group consistent with prior CsA studies); most (9/10) mild.Conclusion: TC provides statistically superior and sustained improvement in TBUT and multiple measures of meibomian gland secretion, and non-inferior improvement in OSDI, corneal and conjunctival staining, SANDE, EDS, and STS versus CsA. TC should be a preferred treatment for DED associated with MGD.Keywords: dry eye disease, meibomian gland dysfunction, restasis, TearCare, cyclosporine

Michael D Greenwood,1 Arkadiy Yadgarov,2 Brian E Flowers,3 Steven R Sarkisian Jr,4 Afua Ohene-Nyako,5 Jaime E Dickerson Jr5,6 On behalf of the GEMINI 2 STUDY GROUP1Vance Thompson Vision, West Fargo, ND, USA; 2Omni Eye Services, Atlanta, GA, USA; 3Ophthalmology Associates, Fort Worth, TX, USA; 4Oklahoma Eye Surgeons, Oklahoma City, OK, USA; 5Sight Sciences, Menlo Park, CA, USA; 6North Texas Eye Research Institute, University of North Texas Health Science Center, Fort Worth, TX, USACorrespondence: Jaime E Dickerson, Email Jaime.dickerson@unthsc.eduPurpose: To provide long-term intraocular pressure (IOP) and ocular hypotensive medication usage outcomes through 36 months for patients treated with canaloplasty and trabeculotomy (OMNI Surgical System) combined with cataract surgery as participants in the GEMINI study.Setting: Eleven ophthalmology practices in 10 US states.Design: Non-interventional 36-month extension of the 12-month, prospective, multicenter, GEMINI study.Methods: GEMINI patients had visually significant cataract, mild-to-moderate glaucoma (ICD-10 guidelines), medicated IOP < 33 mmHg, and unmedicated mean diurnal IOP (DIOP) (after washout) 21– 36 mmHg. Patients from GEMINI were eligible for inclusion. Outcome measures were reduction in mean unmedicated DIOP, reduction in mean IOP-lowering medications, percent of eyes with ≥ 20% reduction in unmedicated DIOP, and percent of eyes with unmedicated DIOP ≥ 6 and ≤ 18 mmHg.Results: A total of 66 patients provided consent and were enrolled. Mean (SD) unmedicated DIOP was 23.1 (2.7) mmHg at baseline, 16.7 (4.1), 16.3 (3.3) at 24 and 36 months; mean reductions of 6.2 (4.1) and 6.9 (3.4) mmHg. Twelve-month IOP at the end of GEMINI was 15.6 mmHg. The proportion of eyes with ≥ 20% reduction in IOP was 77% and 78% (months 24 and 36) compared to 87% at month 12 from GEMINI. About 68% of patients had an IOP between 6 and 18 mmHg at 24 months and 71% at 36 months. Mean IOP-lowering medications was 1.7 at baseline, which was reduced to 0.4 (24 months, − 1.3) and 0.3 (36 months, − 1.4). About 74% of patients (46 of 62) were medication free at 36 months.Conclusion: GEMINI demonstrated 12-month effectiveness of canaloplasty and trabeculotomy with OMNI combined with cataract surgery for IOP and medication reduction in mild-to-moderate glaucoma. However, longer-term data is key to the decision making in the selection of a surgical treatment. This GEMINI extension demonstrates that the 12-month outcomes from GEMINI were sustained through 36 months.Keywords: canaloplasty, trabeculotomy, MIGS, OMNI, glaucoma

Brandon D Ayres,1 Marc R Bloomenstein,2 Jennifer Loh,3 Thomas Chester,4 Bobby Saenz,5,6 Julio Ehegoyen,7 Shane R Kannarr,8 Victor L Perez,9 Tomasita C Rodriguez,10 Jaime E Dickerson Jr10,11 1Private Practice, Philadelphia, PA, USA; 2Schwartz Laser Eye Center, Scottsdale, AZ, USA; 3Loh Ophthalmology Associates, Miami, FL, USA; 4Cleveland Eye Clinic, Brecksville, OH, USA; 5Rosenberg School of Optometry, San Antonio, TX, USA; 6LASIK San Antonio, Kerrville, TX, USA; 7Gordon Schanzlin New Vision Institute, La Jolla, CA, USA; 8Kannarr Eye Care, Pittsburg, KS, USA; 9Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA; 10Sight Sciences, Menlo Park, CA, USA; 11North Texas Eye Research Institute, University of North Texas Health Science Center, Fort Worth, TX, USACorrespondence: Jaime E Dickerson Jr, Email jdickerson@sightsciences.com

Blake K Williamson,1 Steven D Vold,2 Anita Campbell,3 Louis Hirsch,4 Deepan Selvadurai,5 Ardalan E Aminlari,6 Jeremy Cotliar,7 Jaime E Dickerson Jnr8,9 1The Williamson Eye Center, Baton Rouge, LA, USA; 2Vold Vision, Fayetteville, AR, USA; 3Grene Vision Group, Wichita, KS, USA; 4Mercy Eye Specialists, Springfield, MO, USA; 5Buffalo Ophthalmology, Williamsville, NY, USA; 6Morris Eye Group, Encinitas, CA, USA; 7Arthur M Cotliar Eye Care and Surgery, New York, NY, USA; 8North Texas Eye Research Institute, University of North Texas Health Science Center, Fort Worth, TX, USA; 9Sight Sciences, Inc., Menlo Park, CA, USACorrespondence: Jaime E Dickerson Jnr, Email jaime.dickerson@unthsc.eduPurpose: To provide extended safety and effectiveness follow-up for eyes treated with circumferential canaloplasty and trabeculotomy (CP+TR) that were included in the 12-month ROMEO study.Setting: Seven multi-subspecialty ophthalmology practices located in 6 states (Arkansas, California, Kansas, Louisiana, Missouri, and New York).Design: Retrospective, multicenter, IRB approved.Subjects: Eligible eyes had mild–moderate glaucoma and were treated with CP+TR with cataract surgery or as a standalone intervention.Methods: Main outcome measures were mean IOP, mean number of ocular hypotensive medications, mean change in number of medications, proportion of patients with a ≥ 20% reduction in IOP or with IOP ≤ 18 mmHg, and proportion of patients medication free. Safety outcomes were adverse events and secondary surgical interventions (SSI).Results: Eight surgeons at 7 centers contributed 72 patients stratified by pre-operative intraocular pressure (IOP); > 18 mmHg (Grp1), ≤ 18 mmHg (Grp2). Mean follow-up of 2.1 years (min 1.4, max 3.5). 2-year IOP (SD) was 15.6 mmHg (− 6.1 mmHg, − 28% from baseline) on 1.4 medications (− 0.9, − 39%) for Grp1 with cataract surgery; 14.7 mmHg (− 7.4 mmHg, − 33% from baseline) on 1.6 medications (− 0.7, − 15%) for Grp1 standalone, 13.7 mmHg (− 0.6 mmHg, − 4.2%) on 1.2 medications (− 0.8, − 35%) for Grp2 with cataract surgery, 13.3 mmHg (− 2.3 mmHg, − 14.7%) on 1.2 medications (− 1.0, − 46%) for Grp2 standalone. The proportion of patients at 2 years with either a ≥ 20% IOP reduction or IOP between 6 and 18 mmHg and no increase in medication or SSI was 75% (54 of 72, 95% CI 69.9%, 80.1%). One-third of patients (24 of 72) were medication free whereas 9 of 72 were pre-surgical. No device-related adverse events during extended follow-up; 6 eyes (8.3%) required additional surgical or laser intervention for IOP control after 12 months.Conclusion: CP+TR provides effective IOP control that is sustained for 2 years or more.Keywords: canaloplasty, trabeculotomy, MIGS, OMNI, glaucoma