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In the journal: September 2020 Propensity and quantification of aerosol and droplet creation during phacoemulsification with high-speed shadowgraphy amid COVID-19 pandemic Jeremy Kieval, MD, Saba Al-Hashimi, MD, Richard Davidson, MD, D. Rex Hamilton, MD, Mitchell Jackson, MD, Scott LaBorwit, MD, Larry Patterson, MD, Karl Stonecipher, MD, and Kendall Donaldson, MD, for the ASCRS Refractive Cataract Surgery Subcommittee In a laboratory study, researchers observed and quantified aerosols and droplets generated during phacoemulsification to better understand the possibility of cataract surgery spreading COVID-19. The study was performed on enucleated goat eyes and cadaveric corneo-scler- al rims mounted on an artificial anterior chamber. Standard sculpt and quadrant removal settings were used with 2.2- and 2.8-mm tips. High-speed shadowgraphy was used to show droplets and aerosols that might form, the size of which were quantified as a mean out- come measure. The research found no aerosol generation in closed chamber, longitudinal phacoemulsification using a peristaltic pump with a straight tip. When the wound was larger, there was a leak at the main wound, with atomization observed "only when the phaco tip was completely exposed next to the ocular surface." This resulted in a droplet that was about 50 µm, which had an estimated maximum spread of 1.3 m. The authors concluded that with no aerosol generation during microincision/standard phaco, cataract surgery is safe to perform during the COVID-19 era when adequate precautions are taken to protect against other modes of transmission. The best optical zone for small incision lenticule extraction in high myopic patients Jia-Hao Zhang, MD, Shu-Rong Wang, MD, Yu-Xi He, MD, Bo-Yuan Yao, MD, Yan Zhang, MD Given the current parameters for small incision lenticule extraction (SMILE), such as cap thickness, refractive correction, residual stromal bed thickness, and optical zone diameter, highly myopic patients are less likely to be offered the procedure. This study noted that the programmed optical zone (POZ) for SMILE is adjusted between 5.0 and 8.0 mm, with 6–7 commonly used in clinical practice. A larger optical zone, the study authors wrote, can pro- vide better visual quality and fewer higher order aberrations. But a literature review identified several parameter designs for highly myopic patients that could be advantageous, including a 6.2 mm POZ for those with more than –7.5 D of myopia. A 6.1–6.4 mm POZ compared to 6.5–6.8 mm had slightly worse night vision, but total visual quality was not significantly de- creased. The authors also noted that corneal cap thickness had "limited impact on long-term visual prognosis and corneal biomechanics after adjustment of corrected spherical equivalent power according to the corneal cap thickness." Comparison of clinical outcomes of three trifocal intraocular lenses Filomena Ribeiro, MD, Tiago Ferreira, MD Clinical outcomes of three trifocal lenses—FineVision POD F (PhysIOL), RayOne Trifocal (Rayner), and AcrySof IQ PanOptix (Alcon)—were included in this prospective, randomized, comparative study. There were 15 patients in each group who received bilateral implantation of their assigned lens (90 eyes total) with visual acuity, refraction, defocus curve, contrast sen- sitivity, and subjective quality of vision assessed 3 months postop. There was no significant difference among the groups at distance, intermediate, and near visual acuity or in postop refraction. Binocular uncorrected intermediate visual acuity of 0.10 logMAR or better was observed in 93.33% of patients in each group, while uncorrected near of 0.10 logMAR or better was 86.67%, 93.33%, and 86.67% in the FineVision, RayOne, and PanOptix groups, respectively. Overall, there was no statistically significant differences in contrast sensitivity or quality of vision scores, though the authors did find that the RayOne group had less depth perception severity than the FineVision group. John Carver, MD Dec. 26, 1947–July 24, 2020 Orem, Utah Robert Livingston III, MD July 3, 1941–Aug. 1, 2020 Newberry, South Carolina Malcolm Luxenberg, MD July 29, 1935–July 26, 2020 Augusta, Georgia Mercer McClure, MD Aug. 11, 1941–July 14, 2020 Santa Ana, California Walter Platt Jr., MD Died July 12, 2020 South Dartmouth, Massachusetts Turpin Rose, MD March 10, 1937–July 11, 2020 Denver, Colorado Seligman Rosenberg, MD 1935–June 28, 2020 Fort Lee, New Jersey Melvin White, MD Sept. 3, 1927–July 11, 2020 Tampa, Florida EyeWorld honors the lives of ophthalmologists who have died recently with recognition in this space. To recognize an ophthalmologist here, send the name, location, post-nominal letters, birth date, and death date to liz@eyeworld.org. In memoriam

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