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Yilin Feng,1 Nandini Venkateswaran,1 Amanda Steele,2 Eric D Rosenberg,3 Preeya K Gupta2,4 1Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA; 2Triangle Eye Consultants, Raleigh, NC, USA; 3Department of Ophthalmology, New York Medical College, Valhalla, NY, USA; 4Department of Ophthalmology, Tulane University, New Orleans, LA, USACorrespondence: Preeya K Gupta, Email preeyakgupta@gmail.comPurpose: To evaluate the impact of TearCare (TC) treatment on clinical, quality of life, and functional visual outcome metrics in patients with dry eye disease (DED) and meibomian gland disease (MGD).Methods: This is a prospective, single-center clinical trial. Adults with MGD and a DED diagnosis and tear break-up time (TBUT) < 10 seconds were included. All subjects had at least 20/40 vision and no surgery or new treatment for DED within 60 days prior to enrollment. All patients had one baseline visit prior to undergoing TC and one follow-up visit 1 month after TC. At each visit, the meibomian gland secretion score (MGSS), TBUT, and corneal fluorescein staining (KFL) were assessed. DED symptoms were evaluated using the Ocular Surface Disease Index (OSDI) questionnaire, Visual Function Questionnaire 25 (VFQ-25), and the Fatigue Severity Scale. Reading speed was determined through the International Reading Speed Texts (IReST), Minnesota Low Vision Reading Test (MNREAD), and Wilkins Rate of Reading Test (WRRT).Results: Thirty-two subjects were included. The average age was 55.9 years. Sixteen (52%) participants had a clinically significant improvement in reading speed after treatment with TC, defined as > 10 words per minute increase in their IReST score. Improvement on the IReST and the MNREAD reached statistical significance (p = 0.012 and p = 0.028, respectively). OSDI scores significantly decreased and VFQ-25 scores significantly increased after TC treatment (p < 0.001). All of the clinical exam parameters showed statistically significant improvements after treatment (p < 0.001).Conclusion: TC is an effective treatment both clinically and with respect to visual function. Patients who had TC exhibited improvements in quality of life and improved reading speed after a single treatment. This treatment should be frequently considered and utilized to reduce the disease burden of DED related to MGD.Keywords: thermal pulsation, tearcare, meibomian gland dysfunction, dry eye disease, reading speed

Preeya K Gupta,1,2 Rolando Toyos,3 John D Sheppard,4 Melissa Toyos,3 Francis S Mah,5 Brian Bird,6 Pamela E Theriot,7 Don Higgins8 1Triangle Eye Consultants, Raleigh, NC, USA; 2Department of Ophthalmology, Tulane University, New Orleans, LA, USA; 3Toyos Clinic, Nashville, TN, USA; 4Virginia Eye Consultants, Norfolk, VA, USA; 5Scripps Clinic, La Jolla, CA, USA; 6Department of Ophthalmology, Eastern Virginia Medical School, Norfolk, VA, USA; 7Lusk Eye Specialists, Shreveport, LA, USA; 8Dry Eye Treatment Center of Connecticut, Plainville, CT, USACorrespondence: John D Sheppard, Virginia Eye Consultants, 241 Corporate Blvd, Norfolk, VA, USA, Tel +1 757 622-2200, Fax +1 757 622-4866, Email jsheppard@cvphealth.comAbstract: Dry eye disease (DED) is a common, multifactorial ocular disease impacting 5% to 20% of people in Western countries and 45% to 70% in Asian countries. Despite the prevalence of DED and the number of treatment approaches available, signs and symptoms of the disease continue to limit the quality of life for many patients. Standard over-the-counter treatment approaches and behavior/environmental modifications may help some cases but more persistent forms often require pharmacological interventions. Approved and investigational pharmaceutical approaches attempt to treat the signs and symptoms of DED in different ways and tend to have varying tolerability among patients. While several pharmacological approaches are the standard for persistent and severe disease, mechanical options provide alternate treatment modalities that attempt to balance efficacy and comfort. Newer approaches target the causes of DED, utilizing novel delivery methods to minimize irritation and adverse events. Here, we review approved and investigational approaches to treating DED and compare patient tolerability.Keywords: dry eye disease, tolerability, safety, pharmaceutical interventions, mechanical interventions

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

Cina Karimaghaei,1,2,&ast; Amir Ali,3,&ast; Nida Safdar,4,5 Anika Tanwani,3 Mary Schmitz-Brown,2 Touka Banaee,2 Jaafar El-Annan,2 Praveena K Gupta2 1Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA; 2Department of Ophthalmology and Visual Sciences, University of Texas Medical Branch, Galveston, TX, USA; 3School of Medicine, University of Texas Medical Branch, Galveston, TX, USA; 4Department of Ophthalmology, Nazareth Hospital, Trinity Health Mid-Atlantic, Philadelphia, PA, USA; 5IC Laser Eye Care, Bensalem, PA, USA&ast;These authors contributed equally to this workCorrespondence: Praveena K Gupta Professor, Department of Ophthalmology and Visual Sciences, University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA, Tel +1 409-747-5823, Fax +1 409 747-5824, Email prgupta@utmb.eduPurpose: To compare the PRN anti-VEGF injection patterns of four retina specialists with respect to the visual and anatomic outcomes in the management of wet age-related macular degeneration (AMD).Methods: Medical records of patients who received bevacizumab, ranibizumab, and aflibercept anti-VEGF injections (years 2010– 2020) by four retina specialists were reviewed for frequency, injection intervals, best corrected visual acuity (BCVA), and central macular thickness, center involved (CMT) for statistical analysis. Outcomes measured were change in logMAR BCVA and CMT from the first to last injection visit.Results: Out of 137 AMD patients, 172 eyes were injected by four retina specialists in PRN fashion. Although all four specialists started the injection at similar baseline BCVA and CMT (p > 0.1), significant differences in mean injection number (9.0, p = 0.0001), injection intervals (5.06 weeks, p = 0.001), and total length of treatments (53.3 weeks, p = 0.0001) were observed. The mean change in logMAR BCVA between the first and last injection was − 0.05, − 0.22, 0.07, and 0.06 for the four specialists, respectively (p = 0.031), and the mean change in CMT was – 53.3, − 41.4, − 72.7, and − 21.9 μm (p = 0.41), respectively.Conclusion: Despite similar baseline criteria for injections by the retina specialists, different anti-VEGF injection regimens were practiced resulting in variations in BCVA and CMT outcomes. This suggests a need in establishing a universally adoptable injection regimen with possible integration of the confounding factors to reduce burden on both patients and retina specialists.Keywords: retina specialists, practice patterns, anti-VEGF, central macular thickness, best corrected visual acuity, exudative age-related macular degeneration

Karima Khimani,1,&ast; Victoria Koshevarova,2,&ast; Alfred A Mathew,2 Akshaya K Gupta,1 Mary Schmitz-Brown,1 Praveena K Gupta1 1Department of Ophthalmology and Visual Sciences, University of Texas Medical Branch, Galveston, TX, USA; 2School of Medicine, University of Texas Medical Branch, Galveston, TX, USA&ast;These authors contributed equally to this workCorrespondence: Praveena K Gupta, Department of Ophthalmology and Visual Sciences, University of Texas Medical Branch at Galveston, 301 University Blvd, Galveston, TX, 77555-1108, USA, Tel +409 747 5823, Fax +1 409 747 5824, Email prgupta@utmb.eduPurpose: Long-term video game play and its effects on the skills used in surgical simulators have been previously studied, but little information is available about short-term video game warm-ups and subsequent ophthalmic surgical simulation performance. In this study, we hypothesize that a video game warm-up will improve performance on the Eyesi Ophthalmic Surgical Simulator.Methods: Twenty medical students with no prior surgical simulation experience were recruited for the study. Information regarding prior video game experience was gathered, and half of the participants were then randomly assigned to play a video game session prior to Eyesi performance. All subjects completed three sets of Eyesi modules, and the scores and time to completion were recorded. Bivariate analysis including Fisher’s Exact test and Wilcoxon rank-sum test were used for statistical analysis.Results: The warm-up group scored higher in Navigation, Bimanual, and Forceps modules (33.6, 39.7, 7.2, respectively) compared to non-warm-up group (27.3, 27.3, 3.6, respectively). In addition, average times (sec) were lower (310.5, 117.4, 229.2, respectively) compared to non-warm-up group (321.9, 163.3, 235.8, respectively). It was also observed that significantly more participants in the warm-up group had reported a history of spending > 15 hours per week playing video games compared to the non-warm-up group (80% vs 20%, p=0.0402).Conclusion: In our pilot study, there appears to be a positive trend between video game warm-up and Eyesi simulation performance; however, no statistically significant difference was observed due to lower power. This trend can be explained by a greater collective video game experience within the warm-up group, mechanical factors (increased flexibility and grip strength after playing video games) and feeling more relaxed after the video game warm-up. Larger follow-up studies are needed to further investigate the relationship between short-term video game use on ophthalmic surgical simulation performance.Keywords: Eyesi, education, surgery, simulation, video game

Nandini Venkateswaran,1 Yandong Bian,1 Preeya K Gupta2 1Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA; 2Triangle Eye Consultants, Cary, NC, USACorrespondence: Preeya K Gupta, Email preeyakgupta@gmail.comAbstract: Dry eye disease (DED) is a prevalent ocular surface disease. Like with any chronic disease, patients with DED can experience episodic flares. There are many existing and upcoming treatments for the chronic treatment of DED, yet treatments for DED flares are limited. Loteprednol etabonate 0.25% is an FDA approved treatment modality for the short-term treatment of the signs and symptoms of DED. This medication is formulated with the customized mucus-penetrating particle (MPP) technology, which has a greater ability to penetrate the ocular surface and more effectively deliver the active steroid to the ocular surface tissues as compared with conventional steroid preparations. There is also increasing utility of loteprednol etabonate 0.25% in the treatment of DED before and/or after cataract or refractive surgery or as induction therapy prior to starting chronic immunomodulatory medication for DED.Keywords: dry eye disease, dry eye disease flares, loteprednol etabonate 0.25%, mucus penetrating particle technology, ocular surface inflammation

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

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

Cassandra C Brooks, Preeya K Gupta Department of Ophthalmology, Duke University Eye Center, Durham, NC, USACorrespondence: Preeya K GuptaDuke University Eye Center at Page Road, 4709 Creekstone Drive, Suite 100, Durham, NC 27703, USAEmail preeya.gupta@duke.eduPurpose: To report the prevalence of meibomian gland atrophy and gland tortuosity in patients presenting for refractive surgery evaluation.Methods: Cross-sectional study of consecutive patients presenting for refractive surgery evaluation at the Duke Eye Center from December 2018 through January 2020. All patients underwent clinical examination and meibography imaging (Lippiview II, Johnson and Johnson Vision, CA) of the lower eyelids bilaterally. Images were graded by a masked rater using a previously validated 5-point meiboscale (0– 4) for gland atrophy and 3-point scale for gland tortuosity (0– 2). Lipid layer thickness and partial blinks were also recorded.Results: One hundred and twenty patients (49 male) aged 21 to 62 years (mean 35.2 ± 9.2 years) were reviewed. The mean meiboscale was 1.1 ± 1.0 and the mean tortuosity score was 1.0 ± 0.7. Among all patients, 72.5% (n = 87) had any evidence of meibomian gland atrophy (meiboscale > 0) and 69.2% (n = 83) had any evidence of meibomian gland tortuosity (tortuosity grade ≥ 1). The majority of patients (n = 52) with gland atrophy had mild gland atrophy (meiboscale = 1). The mean meiboscale was 0.89 ± 0.79 and 1.38 ± 1.07 for those < 35 years and >/= 35 years old, respectively (p = 0.01). There was a moderate positive relationship between meiboscale and tortuosity (Spearman’s rho 0.3829, p < 0.001).Conclusion: Meibomian gland atrophy is a common occurrence in patients presenting for refractive surgery evaluation. Clinicians should consider incorporating meibography as part of refractive surgery evaluation, and proactively treat meibomian gland disease given the known association between meibomian gland dysfunction, dry eye disease, and the potential for suboptimal post-operative outcomes.Keywords: dry eye disease, meibomian gland, refractive surgery, pre-operative evaluation

Gary Wortz,1 Preeya K Gupta,2 Philip Goernert,3 Caleb Hartley,1 Brayden Wortz,2 Jin Chiu,1 Nikita Jaber1 1Commonwealth Eye Surgery, Lexington, KY 40504, USA; 2Duke Eye Center, Durham, NC 27704, USA; 3Department of Psychology, Brandon University, Brandon, MB R7A 6A9, CanadaCorrespondence: Gary WortzCommonwealth Eye Surgery, 2353 Alexandria Drive #350, Lexington, KY 40504, USATel +1 859 224-2655Fax +1 859 223-7147Email 2020md@gmail.comPurpose: To evaluate real-world outcomes of astigmatism management with femtosecond laser arcuate incisions in patients with low corneal astigmatism (< 1.0 D) using a novel formula for arcuate incision calculation compared to outcomes after conventional cataract surgery without surgical management of astigmatism.Patients and Methods: The Wörtz-Gupta™ Formula (available at www.lricalc.com) was used to calculate femtosecond laser arcuate parameters for 224 patients with < 1 D of corneal astigmatism who underwent cataract surgery; lens power was determined with the Barrett Universal II formula. Uncorrected distance visual acuity (UCDVA) and refractive astigmatism measurements were obtained, with an average follow-up of 4 weeks.Results: The average preoperative cylinder was similar (0.61 D in the femtosecond group [n=124] and 0.57 D in the conventional group [n=100] (P> 0.05)). More patients had ≤ 0.5 D of postoperative corneal astigmatism in the femtosecond group (n=110/124, 89%) than in the conventional group (n=71/100, 71%), respectively (P=0.001). The mean absolute postoperative refractive astigmatism was higher in the conventional surgery group than in the femtosecond group (0.43 ± 0.4 D vs 0.26 ± 0.28 D); these differences were statistically significant (P< 0.001). The percentage of patients with UCDVA of 20/20 or better vision was higher in the femtosecond group (62%) than the conventional group (48%) (P=0.025).Conclusion: Using the femtosecond laser for arcuate incisions in combination with a novel nomogram can provide excellent anatomic and refractive outcomes in patients with lower levels of preoperative astigmatism at the time of cataract surgery.Keywords: femtosecond laser-assisted cataract surgery, arcuate incision, visual acuity, refractive outcome, corneal astigmatism

Samuel F Passi,1,2 Cassandra C Brooks,1 Atalie C Thompson,1 Preeya K Gupta1 1Department of Ophthalmology, Duke University, Durham, NC, USA; 2Minnesota Eye Consultants, Bloomington, MN, USACorrespondence: Preeya K Gupta Email preeya.gupta@duke.eduPurpose: To evaluate the optical quality and tear film quality in patients with dry eye syndrome (DES) before and after using an intranasal neurostimulation device to stimulate tear production.Methods: Cross-sectional review of 33 eyes in 21 patients with DES who underwent optical quality and tear film analysis as part of their routine dry eye evaluation pre- and post-neurostimulation trial in office. Optical quality was assessed by measuring the objective scattering index (OSI) and modulation transfer function (MTF). The time to blink and mean tear film OSI were used to analyze the tear film.Results: Optical quality after the use of the intranasal neurostimulator improved with an average decrease (improvement) in OSI of 0.30± 0.68 (P=0.015) and an average increase (improvement) in MTF of 2.12± 9.2 (P=0.15). Pre-intranasal neurostimulation OSI had a positive correlation with age (Spearman’s rho 0.60, p < 0.001), while MTF had a negative correlation (Spearman’s rho − 0.38, p = 0.03). Pre-intranasal neurostimulation OSI had a negative correlation with MTF (Spearman’s rho − 0.85, p < 0.001) and a positive correlation with tear film mean OSI (Spearman’s rho 0.85, p < 0.001).Conclusion: The optical quality of patients with DES is improved with the use of intranasal neurostimulation for tear production, and there was a trend towards improved MTF though not statistically significant. Future studies are needed to follow patients longitudinally.Keywords: neurostimulation, objective scatter index, modulation transfer function, dry eye syndrome

C Ellis Wisely,1 Cason B Robbins,2 Sandra Stinnett,1 Terry Kim,1 Robin R Vann,1 Preeya K Gupta1 1Duke University, Department of Ophthalmology, Durham, NC, USA; 2Duke University, School of Medicine, Durham, NC, USACorrespondence: Preeya K GuptaDuke University Eye Center at Page Road, 4709 Creekstone Drive Suite 100, Durham, NC 27703, USATel +1 919-660-5234Email preeya.gupta@duke.eduPurpose: To assess the effect of an educational video on 1) patient knowledge about cataract surgery, 2) patient perception of preoperative assessment visit quality, 3) face-to-face time with the surgeon, and 4) choices regarding premium intraocular lenses (IOLs) or laser-assisted cataract surgery (LACS).Setting: Eye clinic in an academic medical center.Design: Prospective survey of patients who randomly viewed or did not view an educational video.Methods: Patients of three cataract surgeons completed a survey during cataract surgery preoperative visits. One group viewed an educational video about cataract surgery, while the other did not. All patients received their surgeon’s typical preoperative counseling.Results: A total of 101 patients were surveyed. Out of 101 patients, 58 viewed the educational video. Patients who viewed the video exhibited stronger learning outcomes; in particular, patients who viewed the video scored higher on cataract surgery educational assessments than those who did not (83% vs 76%, p=0.032), particularly on the assessment of postoperative visual expectations (98% vs 80%, p=0.003). Differences in educational assessment scores between groups were not affected by which surgeon patients saw (p=0.807). Patients who watched the video were more likely to agree their surgeon provided quality explanations (93% vs 74% strongly agreed, p=0.025) and trended toward greater perception the surgeon spent enough time with them (p=0.067). Video education did not affect face-to-face surgeon time with patients (p=0.212) or choices of multifocal IOLs (p=0.795), toric IOLs (p=0.321), or LACS (p=0.940).Conclusion: Video education during preoperative cataract surgery assessments improved patient understanding of cataract surgery and perception of preoperative visits. Video education is easily integrated into preoperative visits and can enhance the preoperative experience.Keywords: cataract surgery, video education, patient experience

Cassandra C Brooks, 1 Sayena Jabbehdari, 1, 2 Preeya K Gupta 1 1Department of Ophthalmology, Duke University Eye Center, Durham, NC, USA; 2Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USACorrespondence: Preeya K GuptaDepartment of Ophthalmology, Duke University Eye Center, 4709 Creekstone Drive, Suite 100, Durham, NC 27703, USATel +1 919 660-5234Fax +1 919 660-5070Email preeya.gupta@duke.eduAbstract: Inflammation and pain are two prevalent findings after ocular surgery. Corticosteroids are widely administrated as a core treatment to control post-surgical inflammation and pain. Improper patient adherence to post-operative eye drop regimens, limited bioavailability of topical eye drops, and the negative impact of preservatives used in many of these eye drops, has made a strong case for novel therapies in the treatment of post-operative pain and inflammation. This review of the literature will focus on the role of intracanalicular sustained-release dexamethasone (Dextenza, Ocular Therapeutix, Bedford, MA, USA) for the management of ocular inflammation and pain.Keywords: dexamethasone, sustained-release, intracanalicular, ocular inflammation, ocular pain, ophthalmic surgery

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

Terry Kim,1 Kenneth Sall,2 Edward J Holland,3 R Kim Brazzell,4 Susan Coultas,4 Preeya K Gupta1 1Department of Ophthalmology, Duke University Eye Center, Durham, NC, USA; 2Sall Research Medical Center, Inc, Artesia, CA, USA; 3Department of Ophthalmology, Cincinnati Eye Institute, University of Cincinnati, Cincinnati, OH, USA; 4Kala Pharmaceuticals, Inc, Waltham, MA, USA Purpose: KPI-121 is a nanoparticle suspension of loteprednol etabonate with improved ocular pharmacokinetics compared with marketed formulations. The efficacy and safety of KPI-121 1% ophthalmic suspension (INVELTYS™) dosed twice daily (BID) were evaluated in participants who had undergone cataract surgery. Materials and methods: In two multicenter, randomized, double-masked, parallel-group, vehicle-controlled clinical trials, 386 participants with ≥ grade 2 anterior chamber cells (≥6 cells) on the day following routine cataract surgery were treated with KPI-121 1% and 325 participants were treated with placebo (vehicle); each group was dosed BID for 2 weeks. Primary efficacy endpoints were complete resolution of ocular inflammation by slit-lamp biomicroscopy and complete resolution of subject-rated ocular pain at Days 8 and 15 with no rescue medication before Day 15. Safety assessments included adverse events (AEs), visual acuity, intraocular pressure measurements, and evaluation of ocular AEs by slit-lamp biomicroscopy and dilated ophthalmoscopy. Results: Both trials achieved statistical significance favoring KPI-121 1% BID for both primary efficacy endpoints. Combined data analysis showed that significantly more participants treated with KPI-121 vs vehicle achieved complete resolution of anterior chamber cells at Days 8 and 15 (P≤0.0001) and complete clearing of ocular pain at Days 4, 8, and 15 (P

Samuel F Passi,* Atalie C Thompson,* Preeya K Gupta Department of Ophthalmology, Duke University Eye Center, Durham, NC, USA *These authors contributed equally to this work Purpose: To compare the agreement and efficiency of a swept source-optical coherence tomography biometer, IOLMaster 700 (IOLM700), and a low-coherence optical reflectometry biometer, LENSTAR LS 900 (LS900), when acquiring biometry measurements during cataract evaluation.Methods: A retrospective chart review of biometry measurements that were performed in 64 eyes of 32 patients on the same day using the LS900 and the IOLM700. The total image acquisition time per subject was compared between the two machines using a Wilcoxon rank-sum test. Bland–Altman plots showing the mean difference and 95% limits of agreement were graphed. Intraclass correlation coefficients (ICCs) were calculated for the mean axial length (AL), anterior chamber depth (ACD), lens thickness (LT), and two keratometry mean values (K1 and K2) that were output from each device.Results: The average time to complete biometry measurements in both eyes was significantly shorter for the IOLM700 compared with the LS900 (44.5±12.4 vs 168.8±67.2 seconds, P

Morgan R Godin, Preeya K Gupta Department of Ophthalmology, Division of Cornea and Refractive Surgery, Duke University Eye Center, Durham, NC, USA Abstract: A new topical ophthalmic medication, lifitegrast 5%, was recently approved by the US Food and Drug Administration for use in dry eye patients. Lifitegrast is an integrin antagonist that decreases inflammation on the ocular surface, thereby improving dry eye disease (DED). Through a series of prospective, multicenter, randomized, masked, placebo-controlled studies in >2,000 patients total, lifitegrast was shown to be effective for improvement in both the signs and symptoms of DED. A subsequent study focused on the safety profile of lifitegrast and demonstrated that the majority of adverse events were mild and resolved over time. Lifitegrast is now available for use in clinical practice. Keywords: OPUS-1, OPUS-2, OPUS-3, SONATA, LFA-1, ICAM-1, OSDI, ocular surface

Michelle J Kim, Sandra S Stinnett, Preeya K Gupta Department of Ophthalmology, Duke University Eye Center, Durham, NC, USA Purpose: The goal of this study was to evaluate the effect of thermal pulsation treatment on tear film parameters, specifically osmolarity and matrix metalloproteinase-9 (MMP-9), in patients with meibomian gland dysfunction (MGD) and dry eye disease (DED).Methods: A single-center review of 189 eyes that underwent thermal pulsation treatment was performed. Data were collected on pre and posttreatment osmolarity, MMP-9, tear break-up time (TBUT), and ocular surface disease index (OSDI) score. Statistical analyses were performed to detect any significant differences after treatment.Results: Thermal pulsation treatment led to significant improvements in TBUT (mean increase from 4.5 to 8.5 seconds [P307 mOsm/L (ie, diagnostic for DED), there was a significant improvement in the mean tear osmolarity from 317.1 to 306.6 mOsms/L after treatment (P=0.002). Conclusion: Treating MGD is an important component of caring for the DED patient. Thermal pulsation treatment can improve MMP-9 levels on the ocular surface of patients with MGD and DED, as well as improve osmolarity in those with abnormal initial values. The present study suggests that meibomian glands play an important role in tear film dynamics and, as such, effective therapy such as thermal pulsation treatment aimed at improving meibomian gland health, can aid the restoration of normal tear film parameters and decrease patient symptoms of DED and MGD. Keywords: thermal pulsation, dry eye disease, meibomian gland dysfunction, osmolarity, matrix metalloproteinase-9