A paradigm shift in eye banking: how new models are challenging the status quo

Majid Moshirfar,1–3 Jackson L Goldberg,4 Tanner W Brown,4 William D Wagner,5 Yasmyne C Ronquillo1 1HDR Research Center, Hoopes Vision, Draper, UT, USA; 2Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT, USA; 3Utah Lions Eye Bank, John Moran Eye Center, Murray, UT, USA; 4The University of Texas Health Science Center at Houston School of Medicine, Houston, TX, USA; 5Virginia Commonwealth University School of Medicine, Richmond, VA, USA Abstract: This article presents a fact-based, direct approach in order to evaluate the strengths and short comings of both local eye banks and larger companies that have penetrated the market of eye donation. By taking a non-biased approach to the topic, the goal of this article is to create a platform, which furthers the discussion. We focus on SightLife and CorneaGen as well as local eye banks and how their models differ in terms of tissue procurement, distribution, and surgeon partnership. Keywords: SightLife, CorneaGen, Lions Eye Bank, cornea transplan

Comparing the Accuracy of the Kane, Barrett Universal II, Hill-Radial Basis Function, Emmetropia Verifying Optical, and Ladas Super Formula Intraocular Lens Power Calculation Formulas

Majid Moshirfar,1– 3,&ast; Christian A Sulit,4,&ast; Alex H Brown,4,&ast; Chase Irwin,4,5 Yasmyne C Ronquillo,1,&ast; Phillip C Hoopes1,&ast; 1Hoopes Vision Research Center, Hoopes Vision, Draper, UT, USA; 2John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT, USA; 3Utah Lions Eye Bank, Murray, UT, USA; 4University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA; 5Phoenix Veterans Affairs Health Care System, Phoenix, AZ, USA&ast;These authors contributed equally to this workCorrespondence: Majid Moshirfar, Hoopes Vision Research Center, 11820 S. State St. &num;200, Draper, UT, 84020, USA, Tel +1 801-568-0200, Fax +1 801-563-0200, Email [email protected]: To assess the accuracy of five new-generation intraocular lens (IOL) power formulas: Barrett Universal II (BUII), Emmetropia Verifying Optical (EVO) Formula, Hill-Radial Basis Function (Hill-RBF), Kane Formula, and Ladas Super Formula (LSF).Patients and Methods: This is a retrospective single-surgeon study from a refractive clinic and clinical research center in Draper, UT, USA. The primary outcome measures were mean absolute error (MAE) and median absolute error (MedAE). Secondary outcome measures were the standard deviation (SD) of each formula’s refractive prediction errors (RPE) and the percentage of eyes within ± 0.50D. Refractive predictions were compared to the postoperative spherical equivalent to determine the RPE for each formula. RPEs were optimized, and MAE, MedAE, SD of the AME, and percent of eyes achieving RPEs within the specified ranges of ± 0.125 D, ± 0.25 D, ± 0.50 D, ± 0.75 D, ± 1.0 D were calculated. Subgroup analysis between different axial lengths was attempted but yielded insufficient statistical power to draw meaningful conclusions.Results: A total of 103 eyes of 103 patients were included in our study after applying inclusion and exclusion criteria to 606 eyes from 2019 to 2021. Formulas ranked in ascending order by MAE were Kane, EVO, BUII, Hill-RBF, and LSF. The ascending rankings of MedAE were Kane, BUII, Hill-RBF, EVO, Ladas. Kane had a significantly lower MAE than Hill-RBF (p< 0.001). EVO had the lowest SD of AMEs and the highest percentage of eyes within ± 0.50 D. According to heteroscedastic testing, EVO also had a statistically significant lower SD than Hill-RBF.Conclusion: Kane was the most accurate formula in terms of MAE and MedAE. EVO and BUII achieved marginally higher MAEs than Kane, suggesting these three formulas are comparable in performance. With the exception EVO and Hill-RBF, the heteroscedastic test yielded no significant differences in SD between the formulas. Although there were multiple statistically significant differences between the formulas in terms of MAE, MedAE, and SD, these differences may not be appreciable clinically. Lastly, there were no statistically significant differences in the percent of eyes with RPEs within ± 0.50 D, suggesting similar clinical performance between formulas.Keywords: cataract surgery, refractive surgery, IOL power formulas, new generation IOL formulas, refractive lens exchange, clear lens extraction, RLE, CL

Anterior Chamber Retained Lens Fragments After Cataract Surgery: A Case Series and Narrative Review

Majid Moshirfar,1&ndash; 3 Adam L Lewis,4 James H Ellis,5 Shannon E McCabe,1,6 Yasmyne C Ronquillo,1 Phillip C Hoopes Sr1 1Hoopes Vision Research Center, Hoopes Vision, Draper, UT, USA; 2John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA; 3Utah Lions Eye Bank, Murray, UT, USA; 4Kansas City University, Kansas City, MO, USA; 5University of Utah School of Medicine, Salt Lake City, UT, USA; 6Mission Hills Eye Center, Pleasant Hill, CA, USACorrespondence: Majid MoshirfarMedical Director Hoopes Vision Research Center, Hoopes Vision, 11820 S. State Street Suite #200, Draper, UT, 84020, USATel +1 801-568-0200Fax +1 801-563-0200Email [email protected]: Retained lens fragments in the anterior chamber following cataract extraction (CE) with phacoemulsification are rare but can lead to significant patient morbidity. Our study aimed to identify risk factors associated with retained lens fragments.Methods: Patients who underwent cataract surgery and subsequently identified to have retained lens fragments in the anterior segment were included. Incidence per year, patient demographics, visual acuity, ocular biometrics, surgical technique, surgeon performing CE, and outcomes were collected retrospectively and compared to a control group.Results: Twenty-four patients were identified with retained lens fragments, with an incidence of 0.10%. The mean age was 76 years &plusmn; 6.72 (60&ndash; 80) compared to 63 &plusmn; 11.41 (22&ndash; 86) in the control group (p &lt; 0.001). Patients with UDVA 20/150 or worse experienced a greater average improvement in visual acuity compared to patients with UDVA better than 20/150 (logMAR 0.46 vs logMAR 0.05). The mean intraocular pressures before (CE), after CE but before fragment removal, and following fragment removal were 14 mmHg &plusmn; 2.59, 19 mmHg &plusmn; 8.20, and 11 mmHg &plusmn; 2.75, respectively. Twenty-two patients presented with inferiorly located fragments. Statistically significant biometrics include mean anterior chamber depth (3.1 mm &plusmn; 0.37 vs 3.33 mm &plusmn; 0.39, p = 0.01) and lens thickness (4.77 mm &plusmn; 0.44 vs 4.35 mm &plusmn; 0.44, p = &lt; 0.001). Yearly incidence rates per surgeon ranged from 0.00% to 0.85%. In 2003 and 2004, one surgeon had significantly higher incidence rates (0.31 and 0.40%) compared to the average combined rate of all surgeons throughout the study (0.10), with p values of 0.001 and 0.003, respectively. The mean number of days between CE and fragment removal was 26 &plusmn; 40 (1&ndash; 138).Conclusion: Increased patient age, shallow anterior chamber depth, and thick lens may be risk factors for retained lens fragments. There may be additional surgeon-specific risk factors. Phacoemulsification technique (Divide-and-Conquer versus Horizontal Chop) showed no significant difference.Keywords: retained lens fragments, phacoemulsification, cataract surgery, complications of cataract surgery, refractory corneal edem