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Karl Stonecipher,1Richard Potvin2 1Physicians Protocol, Greensboro, NC, USA; 2Science in Vision, Akron, NY, USACorrespondence: Karl StonecipherPhysicians Protocol, 1002 North Church Street, Suite 101, Greensboro, NC 27408, USATel +1 336 288 8823Email Stonenc@gmail.comPurpose: To evaluate the effects of low-level light therapy (LLLT) on the resolution of recalcitrant chalazia.Patients and Methods: This was a single-site retrospective chart review of patients with chalazia, all of whom were unresponsive to previous pharmaceutical therapy or surgical intervention, who received a 15min LLLT treatment in conjunction with a standard pharmaceutical regimen. A second treatment was applied 24hrs to as late as 2months if there was no evidence of progression of resolution in appearance.Results: A total of 26 eyes of 22 patients with relevant history and treatment were reviewed, all with a history of prior pharmaceutical treatment for their chalazia. After a single 15min LLLT treatment, followed by a standard pharmaceutical regimen, 46% of eyes (12/26) showed resolution of their chalazia. Resolution was noted from 3days to one-month post-treatment. With a second treatment, the chalazia resolved in 92% of eyes (24/26). Only two eyes of the 26 (8%) required incision and curettage after LLLT treatment.Conclusion: The use of LLLT for the treatment of recalcitrant chalazia appears to be beneficial in patients who have failed topical and/or systemic therapy, significantly reducing the likelihood of requiring surgical intervention.Keywords: LLLT, low level light therapy, chalazion, chalazia &nbsp

Karl Stonecipher,1 Thomas G Abell,2 Bennett Chotiner,3 Erik Chotiner,3 Rick Potvin41Physicians Protocol, Greensboro, NC, USA; 2Abell Eyes, Lexington, KY, USA; 3Memorial Eye Institute, Harrisburg, PA, USA; 4Science in Vision, Akron, NY, USAPurpose: To evaluate the effects of combined intense pulsed light therapy (IPL) and low-level light therapy (LLLT) on clinical measures of dry eye related to severe meibomian gland disease (MGD) in subjects unresponsive to previous medical management.Patients and Methods: This was a retrospective chart review of patients treated by 4 physicians at 3 centers. All patients were documented treatment failures with traditional pharmaceutical therapy. They all had their MGD evaluated before treatment using a grading scale (0–4), tear breakup time in seconds and the Ocular Surface Disease Index (OSDI) questionnaire. To be included, all patients had to have had a short course of adjunct pharmaceutical or device-related therapy, along with a combined IPL/LLLT treatment. As well, a second MGD evaluation with the same three measures had to have been conducted 1–3months post treatment.Results: A total of 460 eyes of 230 patients were identified for inclusion in the data set. Mean OSDI scores were significantly lower after treatment; 70.4% of patients had pretreatment OSDI scores indicative of dry eye; this dropped to 29.1% of patients after treatment. A 1-step or greater reduction in MGD grading was observed in 70% of eyes, with 28% of eyes having a 2-step or greater reduction. Tear breakup time was ≤6seconds in 86.7% of eyes pretreatment, dropping to 33.9% of eyes after treatment. There were no ocular or facial adverse events or side effects related to the combined light treatment.Conclusion: The use of combined IPL/LLLT for the treatment of severe MGD appears to be beneficial in patients who have failed topical and/or systemic therapy.Keywords: LLLT, low level light therapy, IPL, intense pulsed light, meibomian gland dysfunction, ocular surface disease index&nbsp

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