Johnson Vision Research Articles

Validation of a Digital Simulation Model for Maintenance in a High-Volume Automated Manufacturing Facility

Digitalization in manufacturing is the conversion of information into digital format, the integration of this digital data and technologies into the manufacturing process and the use of those technologies (eg: simulation) to change a business model to provide new revenue and value-producing opportunities. Digitalization may be seen as the increased generation, analysis, and use of data to improve the efficiency of the overall manufacturing system. Simulation in manufacturing is often applied in situations where conducting experiments on a real system is impossible or very difficult due to cost or time to carry out the experiment is too long. A key input to the simulation model of automated equipment is the acquisition of valid data in relation to cycle time and reliability of various workstations on this line. As a consequence of being able to simulate equipment processes and interact with this validated simulation model, both the understanding of how the production system will perform under varying reliability and cycle time conditions is achieved. The simulation model then enables the experimentation of ‘what if scenarios’ that can be tested easily, while also providing a valuable tool to inform the maintenance personnel what station reliabilities they need to target in order to sustain a high performing manufacturing line.The author has adopted an open source simulation tool (JaamSim) to develop a digital model of an automated production line in a Johnson & Johnson Vision Care (JJVC) manufacturing facility. This research demonstrated how a digital model was validated for use. The validated digital model can then be used by the author/facility engineering teams to perform scenario testing during the design stage of the line. This simulation model can also be used as a subset of an optimization system to determine recommended optimum line parameters to maximize line performance, either during the line design or when line is in operation.

Comparison Between an Intraocular Lens With Extended Depth of Focus (Tecnis Symfony ZXR00) and a New Monofocal Intraocular Lens With Enhanced Intermediate Vision (Tecnis Eyhance ICB00).

Purpose:This study compared the extended depth of focus (EDOF) intraocular lens (IOL) (ZXR00; Tecnis Symfony, Johnson & Johnson Vision, Santa Ana, CA, US) to a novel, higher-order aspheric monofocal IOL (ICB00; Tecnis Eyhance, Johnson & Johnson Vision, Santa Ana, CA, US) which uses the same platform and material.Methods:Medical records of patients undergoing cataract surgery with ZXR00 or ICB00 implantation between March 2020 and January 2021 and with the data available for the 3-month visit were reviewed. The uncorrected near, intermediate, and distance visual acuity (VA); corrected distance VA; and optical quality parameters were the main outcome measures.Results:Among the 174 enrolled patients, 72 and 102 received the ZXR00 and ICB00, respectively. The average patient ages were 59.6 ± 10.6 (range: 49 to 70) and 65.2 ± 8.2 (range: 45 to 82) years in the ZXR00 and ICB00 groups, respectively, with significantly older patients in the ICB00 group. The other baseline parameters were not different for the 2 groups. Compared to the ICB00 group, the ZXR00 group showed markedly superior near VA (P < 0.05) at 3 months postoperatively. In terms of optical quality, ICB00 was, statistically, significantly superior to ZXR00.Conclusions:The ZXR00 showed remarkable near vision and defocus curve smoothness, while the ICB00 achieved better optical quality. The 2 IOLs had comparable distance and intermediate vision.

Antiviral effect of multipurpose contact lens disinfecting solutions against coronavirus

PurposeTo evaluate the antiviral potential of five multipurpose disinfecting solutions against coronavirus (mouse hepatitis virus, a surrogate for SARS-CoV-2 human corona virus). MethodsTest solutions (Biotrue, renu Advanced [Bausch and Lomb], ACUVUE RevitaLens [Johnson and Johnson Vision], cleadew [Ophtecs corp.] or AOSept Plus [Alcon]) were mixed with the coronavirus mouse hepatitis virus at 104 plaque forming units (PFU)/mL as the final concentration and incubated at room temperature for the specified disinfection time. Surviving virus from each sample was then quantified by standard plaque forming unit assay and the reduction of PFU for each disinfectant was compared to the phosphate buffer saline (PBS) treated negative control. A regimen test was also conducted using Biotrue. ResultsThe three multipurpose disinfecting solutions Biotrue (containing PHMB and polyquaternium-1), renu Advanced (PHMB, polyquaternium-1 and alexidine) and ACUVUE RevitaLens (polyquaternium-1 and alexidine) did not kill the coronavirus at the manufacturers recommended disinfection time in the stand alone test. After treatment, the virus’s titer (3.8 ± 0.2 log10 for Biotrue, 3.7 ± 0.1 log10 for renu and 3.7 ± 0.2 log10 for RevitaLens) was similar to the negative control (3.7 ± 0.1 log10; p ≥ 0.996). AOSept Plus (hydrogen peroxide) and cleadew (povidone iodine) significantly (p < 0.001) reduced the numbers of coronaviruses to below the detection limit (i.e. killed 3.7 ± 0.1 log10 viruses compared to control). However, there was a significant reduction (p = 0.028) in numbers of coronaviruses attached to lenses when using the regimen test with Biotrue. ConclusionsThis study shows that oxidative contact lens disinfecting solutions (i.e. those containing povidone-iodine or hydrogen peroxide) provide superior antiviral activity against a coronavirus surrogate of SARS-CoV-2, unless the full regimen test (rub, rinse, disinfect) is used.

Depth of field measures in pseudophakic eyes implanted with different type of presbyopia-correcting IOLS

To evaluate depth of field (DOF) provided by different presbyopia-correcting intraocular lens (IOL) designs, comparing the results obtained using different criteria for defining the defocus tolerance. A total of 150 eyes undergoing cataract surgery were enrolled and divided into 6 groups depending on the IOL implanted: AT.LISA Tri (Carl Zeiss Meditec), FineVision (PhysIOL), PanOptix (Alcon Laboratories), Tecnis Symfony (Johnson & Johnson Vision), Miniwell (SIFI MedTech) and Tecnis Synergy (Johnson & Johnson Vision). Subjective DOF was obtained from defocus curves with absolute and relative criteria of tolerance of 0.1 logMAR. Aberrometry was also measured and the visual strehl optical transference function (VSOTF) with percentage of degradation of 90%, 80% and 60% was used to quantify objectively the DOF. Tecnis Symfony, Tecnis Synergy and Panoptix IOL groups showed better subjective and objective DOF compared to the rest of IOL groups, being these differences statistically significant differences (p < 0.001). Comparison between subjective and objective DOF showed that subjective measures were higher for all IOLs, being also these differences statistically significant for all groups (p < 0.001). A moderate significant correlation was found between absolute subjective criteria and VSOTF60% (r = 0.73, p < 0.05). Objective and subjective measures of DOF are not comparable due to differences in methodologies and criterions to define the level of degradation tolerance. Nevertheless, both objective and subjective measures showed a trend to a greater DOF for Tecnis Symfony and Tecnis Synergy IOLs compared to most of trifocal diffractive designs, with the exception of PanOptix.

Building a sustainable high-performance customer experience and product performance (CxPP): the JJV experience

PurposeThe paper provides insight on the customer experience through product performance (CxPP) initiative; which was developed by Johnson &amp; Johnson Vision to monitor and conduct product performance improvements to enhance the customer experience effort and protect sales. The piece explains the basic tenets for CxPP execution and upkeep. It also explains the methods used to create, evaluate and monitor the CxPP initiative while illustrating the ways in which the initiative functions and adds value to any firm implementing it.Design/methodology/approachThe paper utilizes a descriptive approach to explain the basic tenants of the CxPP initiative. The paper utilizes the define, measure, analyze, improve and control (DMAIC) framework to explain the tenets of the CxPP initiative. Each section of the paper utilizes descriptions of internal processes and research to further explain and justify implementation of the CxPP imitative across firms. Moreover, the piece explains the methods used to create, evaluate and monitor the CxPP initiative while illustrating the ways in which the initiative functions and adds value to the firm.FindingsAccording to JJV Quality Assurance experts, the CxPP initiative is a long-term approach that supports synergy across departments to enhance product quality, improve customer satisfaction and protect sales. By implementing the CxPP approach, JJV was able to uncover and solve four distinct defect categories that affect product quality and customer experience, thus demonstrating the importance and benefits of the CxPP initiative for any organization.Research limitations/implicationsDue to the chosen research approach, the study lacks specificity. As a result, it is recommended that future implementation of the proposed initiative opts for more testable propositions.Practical implicationsDue to competitive considerations, note that no empirical data will be shared in the findings. The scaling of the principles of this approach should be universal. But the execution; types of projects, type of customer need and feedback should be specific to each environment.Originality/valueThis paper fulfills an identified need to study the relationship between product quality, customer satisfaction and sales.

Clinical Outcomes With a New Continuous Range of Vision Presbyopia-Correcting Intraocular Lens.

To evaluate the clinical outcomes including patient-reported outcome measures in a sample of eyes undergoing bilateral cataract surgery with implantation of a new model of presbyopia-correcting intraocular lens (IOL). This non-randomized prospective case series enrolled 206 eyes of 103 patients undergoing phacoemulsification cataract surgery with bilateral implantation of the TECNIS Synergy IOL (Johnson & Johnson Vision). High and low contrast visual acuity, refractive, defocus curve, and patient-reported visual performance (Catquest-9SF questionnaire) outcomes were evaluated during a 3-month follow-up. A total of 96.1% (99 of 103) and 91.3% (94 of 103) of patients achieved binocular postoperative uncorrected distance (UDVA) and near visual acuity (UNVA) of 0.00 logMAR (20/20), respectively. Mean postoperative mesopic UNVA for both eyes was 0.14 ± 0.03 logMAR. Likewise, mean binocular UDVA and UNVA were 0.00 ± 0.03 and 0.04 ± 0.02 logMAR. An almost flat mean defocus curve was obtained, with visual acuities between 0.00 and 0.10 logMAR for most defocus levels in both eyes. A reduction of contrast led to a limited but statistically significant change in UNVA in both eyes (P < .001). The Rasch calibrated scoring of item 2 and the Rasch calibrated mean score of the Catquest-9SF questionnaire increased significantly with surgery (P < .001). This new presbyopia-correcting IOL provides a continuous range of functional focus, with a limited deterioration under mesopic conditions, which is perceived as a satisfactory outcome by the patient if proper patient selection is performed. [J Refract Surg. 2021;37(4):256-262.].

Visual outcomes and patient satisfaction after implantation of a presbyopia-correcting intraocular lens that combines extended depth-of-focus and multifocal profiles.

To evaluate clinical outcomes delivered by a new hybrid presbyopia-correcting intraocular lens (IOL): TECNIS Synergy ZFR00V IOL model (Johnson & Johnson Vision). Hospital da Luz Lisboa, Lisbon, Portugal. Prospective observational study. Patients undergoing bilateral IOL implantation were included. Visual acuity (VA) was measured for far distance, intermediate (66 cm), and near (40 cm) vision under both photopic and mesopic conditions. In addition, at the 3-month follow-up visit, the defocus curve was obtained for binocular vision, and questionnaires were administered to measure spectacle independence and level of satisfaction ( quality of vision and Catquest-SF9) with the surgical outcomes. 54 eyes of 27 patients were included. At the 3-month follow-up, under photopic conditions, VA values were as follows: corrected distance VA (CDVA) = -0.02 ± 0.07, distance-corrected intermediate VA = 0.03 ± 0.11, and distance-corrected near VA (DCNVA) = 0.00 ± 0.08, whereas under mesopic conditions, VA values were as follows: CDVA = -0.01 ± 0.05 and DCNVA = 0.07 ± 0.09. The binocular defocus curve revealed that mean VA was better than 0.30 logMAR within the +1.00 to -4.00 diopters (D) interval, and better than 0.10 logMAR between +0.50 and -3.00 D. All patients achieved distance vision spectacle freedom, whereas 3.7% of them said they used them in certain intermediate or near vision situations. As much as 88% of the patients reported being fairly satisfied or very satisfied. The TECNIS Synergy ZFR00V IOL model used for cataract surgery is capable of restoring visual function while providing very good intermediate and near vision, under both photopic and mesopic conditions, resulting in a high level of patient satisfaction.

Comparative Surface Imaging Study of Multifocal Diffractive Intraocular Lenses.

To analyse and compare the surface topography and roughness of three different types of diffractive multifocal IOLs. Using scanning electron microscope (SEM, Inspect F, 5.0 KV, maximum magnification up to 20,000) and atomic force microscope (AFM, Park Systems, XE-100, non-contact, area profile comparison, 10 × 10 µm, 40 × 40 µm), the surface quality of the following diffractive IOLs was studied: the AcrySof IQ PanOptix (Alcon, USA), the AT LARA 829MP (Carl Zeiss Meditec, Germany), and Tecnis Symfony (Johnson&Johnson Vision, USA). The measurements were made over three representative areas (central non-diffractive optic, central diffractive optic, and diffractive step) of each IOL. Roughness profile in terms of mean arithmetic roughness (Ra) and root-mean-squared roughness (Rq) values were obtained and compared statistically. In SEM examination, all IOLs showed a smooth optical surface without any irregularities at low magnification. At higher magnification, Tecnis Symfony showed unique highly regular, concentric, and lineate structures in the diffractive optic area which could not be seen in the other studied diffractive IOLs. The differences in the measured Ra and Rq values of the Tecnis Symfony were statistically significant compared to the other models (p < 0.05). Various different topographical traits were observed in three diffractive multifocal IOLs. The Ra values of all studied IOLs were within an acceptable range. Tecnis Symfony showed statistically significant higher surface Ra values at both central diffractive optic and diffractive step areas. Furthermore, compared to its counterparts, Tecnis Symfony demonstrated highly ordered, concentric pattern in its diffractive surfaces.

Multifocal and Extended Depth of Focus Intraocular Lenses: A Comparison of Data from the United States Food and Drug Administration Premarket Approval Trials.

To review and compare the results of unpublished premarket approval studies for recent multifocal and extended depth of focus (EDOF) intraocular lenses. Lenses without previously published pre-market approval trials were identified and clinical and patient-reported outcomes were reviewed and compared. Lenses included the DFT/DAT (Acrysof Vivity) EDOF lens, the TFNT/TFAT (PanOptix) trifocal lens, and the SV25T (ReStor ActiveFocus) lens (all from Alcon Laboratories, Inc), as well as the ZXR/ZXT (Tecnis Symfony and Symfony Toric), the ZLB00 (Tecnis Multifocal +3.25), and the ZKB00 (Tecnis Multifocal +2.75, all Tecnis lenses from Johnson & Johnson Vision). All lenses produced equivalent distance vision and superior intermediate and near vision compared to monofocal controls. Patient-reported difficulty with glare, halos, and starbursts was higher in the multifocal and EDOF lens cohort compared to monofocal controls. Spectacle independence was higher in the multifocal and EDOF cohort with the exception of the SV25T (ActiveFocus) lens, which was not significantly different than the control lens. Clinical trial data from the U.S. Food and Drug Administration premarket approval studies supports multifocal and EDOF lenses as an effective treatment for aphakia and presbyopia. [J Refract Surg. 2021;37(2):98-104.].

Quality of view through extended depth of focus intraocular lens in a model eye.

To compare the quality of images viewed through an extended depth of focus (EDF) intraocular lens (IOL) to that through multifocal or monofocal IOL. Experimental study METHODS: EDF IOL (Symfony®, ZXR00V, Johnson & Johnson Vision), diffractive multifocal (ZLB00, + 3.25D or ZMB00, + 4.0D), or monofocal (ZCB00V) IOL with a spherical power of + 20.0 diopter (D) was placed in a fluid-filled model eye with corneal aberrations similar to those of human eyes. A United States Air Force Resolution Grating Target was glued to the posterior surface of the model eye and viewed through a flat contact lens, a 60D or 128D wide-angle non-contact lens (Resight®) or wide-angle contact lens (MiniQuad®). The contrast of the grating images recorded with the EDF and multifocal IOLs were compared to those through the monofocal IOL. The grating images viewed through the flat contact lens were slightly blurred when viewed through the EDF IOL but clearer than those through the multifocal IOLs with very blurred images in the periphery. The contrast of the images viewed through the EDF and multifocal IOLs through the flat contact lens was significantly lower than through the monofocal IOL (P < 0.02). The contrast of the images viewed through the EDF IOL with 60D or 128D wide-angle non-contact lens was significantly lower than through the monofocal IOL (P < 0.05) but not with wide-angle contact lens. Our results suggest that vitreous surgeons can accomplish a clearer view during vitrectomy in EDF IOL-implanted eyes with a wide-angle viewing contact lens and a flat contact lens than in multifocal IOL-implanted eyes.

Meibomian Gland Morphology Among Patients Presenting for Refractive Surgery Evaluation.

PurposeTo report the prevalence of meibomian gland atrophy and gland tortuosity in patients presenting for refractive surgery evaluation.MethodsCross-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.ResultsOne 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).ConclusionMeibomian 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.

Clinical outcomes after femtosecond laser assisted cataract surgery with implantation of the TECNIS Symfony intraocular lens

AIM: To evaluate the clinical outcomes in terms of vision across distances (near, intermediate, and far), contrast sensitivity and subjective patient satisfaction after femtosecond laser-assisted cataract surgery (FLACS) with implantation of an extended range of vision (ERV) intraocular lens (IOL). METHODS: Forty patients (55 eyes) undergoing bilateral or monocular FLACS with implantation of the ERV IOL TECNIS Symfony (Johnson &amp; Johnson Vision) were enrolled. Uncorrected distance (UDVA), intermediate (UIVA) and near visual acuities (UNVA) were evaluated at 3mo after surgery, as well the defocus curve, contrast sensitivity, patient satisfaction and spectacle independence. RESULTS: No severe complications occurred. All eyes showed a central position of the IOL in the capsular bag without tilting at 3mo after surgery. 3mo postoperative mean logMAR visual acuity at 5 m, 67 cm and 40 cm were -0.04 ±0.08, -0.17±0.22, 0.37±0.17, respectively. All patients obtained satisfactory UDVA and UIVA, as well as functional UNVA, meeting the needs of daily life. Spectacle independence rate was 94.55%. Contrast sensitivity results did not differ from those obtained with monofocal aspheric lenses. Likewise, no moderate and severe photic phenomena were reported. Mean patient satisfaction scores with distance, intermediate and near vision were 9.0, 9.0, and 7.0, respectively. CONCLUSION: FLACS with implantation of the ERV IOL TECNIS Symfony provides a successful visual restoration at far, intermediate distance and a functional-range near vision acuity, with minimal level of disturbing photic phenomena, and high rates of spectacle independence and patient satisfaction.

Through-Focus Energy Efficiency and Longitudinal Chromatic Aberration of Three Presbyopia-Correcting Intraocular Lenses.

PurposeTo compare the chromatic performance of the Bausch & Lomb Versario 3F trifocal intraocular lens (IOL) with the PhysIOL FineVision MicroF trifocal IOL and the Johnson & Johnson Vision TECNIS Symfony ZXR00 extended range of vision (ERV) IOL.MethodsThe through-focus energy efficiency (TF-EE) was measured in vitro with red (R), green (G), and blue (B) wavelengths and was used to obtain the focus powers and longitudinal chromatic aberrations (LCAs) for each IOL. Other metrics, derived from the RGB TF-EE curves, were assessed for a more complete description of the chromatic performance of the IOLs.ResultsBoth of the trifocal IOLs, although not specifically designed to tackle chromatic aberrations, showed acceptable LCA (≤0.50 D) in all foci with more balanced R and B efficiencies of their foci. Despite having the lowest TF-EE value at all foci, the Versario 3F demonstrated the most balanced chromatic performance with the smoothest energy transition among all foci and the smallest chromatic span. The Symfony lens effectively reduced LCA at distance and intermediate foci (≤0.36 D), despite the unbalanced and asymmetric R and B efficiencies at its foci.ConclusionsTo fully describe the chromatic performance of an IOL it is necessary to take into account not only the LCA but also the RGB TF-EE and chromatic span. This comprehensive analysis suggests that, in comparison with the other IOLs under study, the Versario 3F lens might contribute to further mitigating the impact of chromatic aberration.Translational RelevanceThe in vitro bench testing of the optical properties of modern presbyopia-correcting intraocular lenses (more specifically in this work, the polychromatic through-focus energy efficiency and longitudinal chromatic aberration) provides objective and complementary information that helps to interpret the visual quality outcomes of pseudophakic patients obtained in clinics.

Comparison between bilateral implantation of a trifocal intraocular lens (Alcon Acrysof IQ® PanOptix) and extended depth of focus lens (Tecnis® Symfony® ZXR00 lens).

To compare the visual performance outcomes following bilateral cataract surgery using trifocal intraocular lens (Alcon Acrysof IQ® PanOptix) and extended depth of focus lens (Tecnis® Symfony® ZXR00 lens). In this prospective, non-randomized, comparative trial, a total of 40 subjects (80 eyes) were divided into two different groups and submitted to bilateral cataract surgery and implantation of the two different IOLs, Alcon Acrysof IQ® PanOptix® TNFT00 in group A and Tecnis® Symfony® ZXR00 lens (Johnson & Johnson Vision) in group B, was assessed. The uncorrected and corrected near (33cm), intermediate (60cm), and far (4m) binocular visual acuity was measured, and visual binocular defocus curves were also measured in the photopic condition with a long-distance visual acuity and the qualitative visual function was assessed by NEI VFQ-25. Group A comprised 20 patients; 11 women (55%) and 9 men (45%) with a mean age of 62.1 ± 5.4. In group B 20 patients were recruited; 12 women (60%) and 8 men (40%) with a mean age of 63.2 ± 6.1. The postoperatively calculated mean sphere was + 0.35 ± 0.12 D and - 0.14 ± 0.13 D in groups A and B, respectively. The postoperative uncorrected distance visual acuity (UDVA) as well as uncorrected intermediate visual acuity (UIVA) were statistically equal in both groups (P = 0.12, P = 0.17); meanwhile, the postoperative uncorrected near visual acuity (UNVA) was significantly better in patients with PanOptix IOL implantation (P = 0.01) compared to the binocular defocus curve; the results of the PanOptix group were better than the Symfony group in intermediate and near distance (P = 0.089, P = 0.001) and according to the VFQ-25 questionnaire, then ear vision score as well as sum score turned out to be significantly higher in groups A than B (P = 0.001 and P = 0.015, respectively). Both strategies were able to provide good vision for far, intermediate and near distances.

Visual and Refractive Outcomes with a New Topography-integrated Wavefront-guided Lasik Procedure

ABSTRACT Purpose To evaluate the clinical outcomes of laser in situ keratomileusis (LASIK) using a new approach for the calculation of the ablation profile based on wavefront vertexing from pupil plane to corneal. Methods One hundred eyes of 50 patients (age, 21–41 years) with low and moderate myopia were enrolled in this prospective case series. All of them underwent topography-integrated wavefront-guided (TI-WFG) LASIK using the STAR S4IR excimer laser platform (Johnson & Johnson Vision). Visual, refractive, ocular aberrometric, ocular scattering index (OSI) and patient satisfaction outcomes were evaluated after a 90-day follow-up period. Astigmatic changes were evaluated by vector analysis. Results A significant reduction in sphere and cylinder (p < .001) was observed, with a significant improvement in uncorrected (UDVA) and corrected distance visual acuity (CDVA) (p < .001). Postoperative spherical equivalent was within ±0.50 and ±1.00 D in 91.1% (82/90) and 98.9% (89/90) of eyes, respectively. UDVA was 20/20 or better in 98.9% (89/90) of eyes. A total of 50.0% (45/90) of eyes gained 1 line of CDVA. Mean postoperative astigmatic correction index and angle of error were 1.01 ± 0.56 and 0.17 ± 0.18º. Postoperative high-order aberrometric coefficients were below 0.50 μm in 92.2% (83/90) of eyes. Mean postoperative OSI was 0.71 ± 0.44. All patients referred to be satisfied with the final outcomes and would recommend the procedure to their friends and relatives. Conclusions TI-WFG LASIK is a new approach for myopia and myopic astigmatism correction, with preservation of the ocular optical quality and high level of patient satisfaction associated.

Optical Performance of a Monofocal Intraocular Lens Designed to Extend Depth of Focus.

To test the performance of a new monofocal intraocular lens, intended to extend depth of focus (Tecnis Eyhance, ICB00; Johnson & Johnson Vision, Inc) (ICB-IOL), in comparison to a standard monofocal IOL (Tecnis 1-piece, ZCB00; Johnson & Johnson Vision, Inc) (ZCB-IOL) of the same platform and material. Assessment of the optical performance of the two IOLs was made in vitro using an optical test bench with a model eye. The spherical aberration, modulation transfer function (MTF), and area under the MTF (MTFa) were obtained for pupil sizes ranging from 2 to 5 mm. Through-focus MTFa curves between -3.00 and +1.00 diopters (D) were obtained with three pupil sizes (2, 3, and 4.5 mm). Halo formation was also assessed for both lenses. The ICB-IOL had slightly worse optical quality at its best focus (ie, lower MTF scores at distance vision) and more negative spherical aberration than the ZCB-IOL for pupils ranging from 2 to 3 mm. The maximum of the through-focus MTFa curve of the ICB-IOL with a 2-mm pupil shifted to a myopic defocus of -0.50 D. For larger pupils (≥ 3.5 mm), there were no differences in spherical aberration, MTF scores, and halo energy between the two lenses. The new ICB-IOL is a modified monofocal lens with 0.50 D of additional power in its central 2-mm zone and more negative spherical aberration values, which induce a myopic shift of the maximum of optical quality and could improve intermediate vision. For pupils larger than 3.5 mm, there were no differences between IOLs. The new ICB-IOL design would produce photic phenomena comparable to a standard IOL. [J Refract Surg. 2020;36(9):625-632.].

Comparison of the clinical efficacy of AcrySof® IQ and TECNIS® toric intraocular lenses: A real-world study.

Corneal astigmatism significantly compromises uncorrected visual acuity (UCVA) after phacoemulsification with implantation of traditional spherical or non-spherical monofocal intraocular lens (IOL). Toric IOL provides an effective way to gain favorable postoperative UCVA for the patients with cataracts with corneal astigmatism. There are numerous types of toric IOLs; however AcrySof® IQ toric IOL (Alcon Laboratories, Inc.) and TECNIS® toric IOL (Johnson & Johnson Vision; Johnson & Johnson) are most frequently used in our clinical practice. The purpose of the current study was to compare the clinical efficacy of AcrySof IQ with TECNIS toric IOL implantation, and to provide a clinical basis on selecting an appropriate toric IOL before cataract surgery for patients with corneal astigmatism. A total of 30 patients with cataract (44 eyes) with corneal astigmatism [0.82-7.27 diopters (D)], who have undergone phacoemulsification with toric IOL implantation between October 2012 and December 2017, were included in the current retrospective cohort study. Patients were divided into two groups: One group (26 eyes) received the AcrySof IQ toric IOL (AcrySof group) and the other group (18 eyes) received the TECNIS toric IOL (Tecnis group). The indexes of curative effect, such as uncorrected and corrected distance visual acuity (UDVA and CDVA, respectively), refractive outcomes, contrast sensitivity (CS), IOL rotation, and satisfaction, were evaluated. Both toric IOLs significantly improved UDVA and CDVA. Postoperative mean residual astigmatism was similar in the AcrySof group and in the Tecnis group (0.75±0.50 and 0.78±0.90 D; P=0.896). There was no statistically significant between postoperative CS in the AcrySof and Tecnis groups. Rotations of >10˚ were considered to be significant and were identified in three eyes. The mean IOL rotation showed no statistically significant difference (AcrySof group, 0.24±5.54˚; Tecnis group, -0.19±6.28˚; P=0.416). The mean patient satisfaction score was 8.46±1.21 in the AcrySof group and 8.78±1.44 in the Tecnis group (P=0.260). The results of the current study indicated that patients with cataracts with corneal astigmatism undergoing phacoemulsification with AcrySof IQ and TECNIS toric IOL implantation achieved similar clinical efficacy in term of visual outcomes, refraction correction, CS, rotational stability and satisfaction.

Contact Lens-Related Microbial Keratitis and Host Genetics.

Department of Ophthalmology & Visual Sciences, Case Western Reserve University; and Contact Lens Service, University Hospitals of Cleveland Eye Institute. L. Szczotka-Flynn have received research funding related to this topic from Alcon Laboratories and the National Institutes of Health, National Eye Institute 5R21EY029445-02. L. Szczotka-Flynn have received other non related funding from Johnson & Johnson Vision Care, Inc and Alcon Laboratories.

Visual performance comparison of 2 extended depth-of-focus intraocular lenses

To compare the visual acuity and satisfaction outcomes of 2 different concepts of extended depth-of-focus intraocular lenses (EDOF IOLs). University Eye Hospital Bochum, Germany. Prospective randomized comparative clinical trial. Patients undergoing cataract surgery with the implantation of 2 different concept EDOF IOLs. In the first group (IC-8 Group), a monofocal 1-piece Tecnis Z B00 IOL (Johnson & Johnson Vision Care, Inc.) was implanted in the dominant eye, and an IC-8 IOL (AcuFocus) was implanted in the nondominant eye. In the second group (Symfony Group), a Tecnis Symfony IOL (Johnson & Johnson Vision Care, Inc.) was implanted in both eyes. The target refraction of the dominant eye was emmetropia and slight myopia (mini-monovision, -0.75 diopters) in the nondominant eye. Visual and refractive outcomes and patient satisfaction rates were evaluated 3 months postoperatively. This study comprised 76 eyes of 38 patients. No intraoperative or postoperative complications occurred in either group. Target refraction was reached in both groups without statistically significant differences. The uncorrected distance visual acuity (UDVA, photopic and mesopic light conditions) was excellent in both groups with statistically significantly better results in the IC-8 goup (logarithm of the minimum angle of resolution; IC-8 Group (0.1 ± 0.07 logarithm of the minimum angle of resolution [logMAR]; Symfony Group 0.07 ± 0.1 logMAR, P value .02 [photopic]; IC-8 group 0.12 ± 0.09 logMAR, Symfony group 0.22 ± 0.1 logMAR, P value < .01 [mesopic]). Binocular uncorrected intermediate visual acuity (UIVA) and uncorrected near visual acuity (UNVA) were also good in both groups without statistically significant differences (UIVA: IC-8 Group, 0.01 ± 0.07 logMAR, Symfony Group 0.01 ± 0.08 logMAR, P value .35; UNVA: IC-8 Group 0.14 ± 0.11, Symfony Group 0.09 ± 0.08, P value .14). Subjective satisfaction was high in both groups. Both EDOF IOLs provided a very good UDVA with superior results in the IC-8 Group, and a good UIVA and UNVA under photopic light conditions. Subjective patient satisfaction was higher in the IC-8 Group.

Treatment of Optic Neuritis With Erythropoietin (TONE): A Randomized, Double-Blind, Placebo-Controlled Study

Background: The human cytokine erythropoietin (EPO) conveys neuroprotection in preclinical models and has shown ambiguous results in phase 2 clinical trials in optic neuritis. We assessed the efficacy and safety of EPO in optic neuritis as a clinically isolated syndrome in a sufficiently powered RCT. Methods: This randomized, placebo-controlled, double-blind phase 3 trial conducted at 12 German tertiary care centres included participants aged 18-50 years with an acute presentation of unilateral optic neuritis within 10 days, visual acuity ≤ 0·5 and without previously known multiple sclerosis. Participants were randomly assigned (1:1) to receive either 33.000 IU erythropoietin or placebo intravenously for three days as an adjunct to high-dose methylprednisolone (1000 mg/day). Block Randomisation was performed with randomly varying block sizes, stratified by study site and distributed using sealed envelopes. All trial participants and all study staff were masked from treatment assignment with the exception of the trial pharmacist. The first primary outcome was the amount of retinal nerve fibre layer (RNFL) atrophy, measured by optic coherence tomography (OCT) as the difference in RNFL thickness between the affected eye at week 26 and the unaffected eye at baseline. The second primary outcome was low contrast visual acuity at week 26, measured as the 2·5% Sloan chart score of the affected eye. Analysis was performed in a set of all randomised participants for whom treatment was started and at least one follow-up OCT measurement was available. Safety was analysed in all patients who received at least one dose of the trial medication. Findings: The study enrolled 108 participants between November 25 th , 2014 and October 9 th , 2017, 55 of which were assigned to EPO and 53 to placebo. Five patients were excluded from the primary analysis due to screening failure, revised diagnosis or loss to follow-up, yielding a full analysis set of 52 EPO and 51 placebo recipients. The adjusted mean treatment difference of EPO versus placebo was 1·02 µm of RNFL atrophy (95% CI -5·51 to 7·55; p=0·76; unadjusted 15·9 vs 14·7 µm) and -4·03 (-13·6 to 5·01; p=0·38) on the letter score for low contrast visual acuity (unadjusted 49·06 vs 49·60). One patient in the EPO group developed a sinus venous thrombosis which was treated with anticoagulants and resolved without sequelae. Interpretation: EPO conveyed neither functional nor structural neuroprotection in the visual pathways after optic neuritis. Trial Registration: This trial is registered with ClinicalTrials.gov (NCT01962571). Funding Statement: German Ministry of Health and Science (BMBF), Clinical trials programme. Declaration of Interests: WL reports grants from the German Federal Ministry for Education and Research (BMBF) and the German Research Foundation (DFG). He received speakers’ honoraria from and worked on advisory boards for Alcon, Allergan, Santhera, Boehringer Ingelheim, and Merz Pharma. SK has received a doctoral fellowship with funding from the University of Freiburg, Faculty of Medicine and the Else Kroner-Fresenius foundation. GI has received funding from Novartis and Janssen Pharmaceutica. BG and FB have nothing to report. MV has worked on an advisory board for Roche Pharma. SH has received funding from the DFG, the German Federal Institute for Sport Science and the German Ophthalmological Society. PA reports reports grants, personal fees, and non-financial support from Allergan, Biogen, Celgene, Ipsen, Merck, Merz Pharmaceuticals, Novartis, Roche, and Teva outside the submitted work. JU has received a doctoral fellowship with funding from the Ministry of Science, Research and Arts Baden-Wuerttemberg as part of the HAW-Prom program. She received a speakers’ honorary from AMO Ireland (affiliated to Johnson & Johnson Vision) and is co-inventor of patents/patent applications with the numbers 10 2017 126 741, WO 2020/089284 A1 and 20 174 551.0. MW is a managing partner of Blickshift GmbH and coinventor of patent applications WO 2020/089284 A1 and 20 174 551.0. MH reports grants from Bristol-Myers Squibb and speaker’s honoraria from Amgen, Baxter Deutschland, CSL Behring, Biotest Pharma, Fresenius Kabi, Leo Pharma, Merck Serono, Novartis Pharma, Pfizer, Roche Pharma, and Sun Pharmaceuticals Industries. SW has served as a consultant for Bayer, Novartis, Chengdu Kanghong Biotech, Zeiss, and Roche and has received grant support from Zeiss and Heidelberg Engineering. RD was funded by the BMBF, the DFG, and the Hertie Foundation. Ethics Approval Statement: The study protocol was approved by the institutional review boards and ethics committees of each participating site under the conduct of the ethics committee of the University of Freiburg, Germany.