 Our next case, our next presentation is by Brian Walker. He goes to the McGovern Medical School, which is formerly known as the University of Texas of Houston, which is where I went to medical school. And he's going to talk to us about changes in keratometry and refraction and small aperture of coronial inlet implantation. Yeah, so I'm Brian Walker, but I also want to give a shout out to everyone else that I've worked with on this project, especially Dr. Mushfar to quote a current MBA, great. He's the real MVP in doing this research. But yeah, so I'm going to talk about changes in keratometry and refraction. After a camera, small aperture of coronial inlet implantation, and some of the people on this, not me at all, have ties with the actual maker of the camera inlet for you to see right there. So many of you probably already know this, but the camera small aperture of coronial inlet is a little disc made of polyvinyl and fluoride that's used for the treatment of presbyopia. So it's stuck in the non-dominant eye in an intrastromal pocket in the cornea. As you can see, those are the dimensions. And it increases depth of focus by using principles of pinhole optics. And the makers of this suggest that it's placed in a pocket created at a depth of 200 to 250 microns made by a femtosecond laser. So there's kind of a picture showing theoretically how the light passes through to help you focus at near to see better. So the indications that we kind of use for our study and evaluating people that got this was the same as the indications that this company gives as and the FDA as well that approved this for presbyopia that is placed in a non-dominant fake eye for people between 45 to 60 with those spherical colons as well as less than 0.75 adapter of sill and that require add for reading between 1 to 2.5. So just looking at the data from the FDA trial, the pivotal study, 84% of patients had a UNVA or uncorrected near visual cutie of 24 year better by 12 months, which their threshold to approve it, I believe, was 75%. So that did well. However, looking closer, one large thing that was noticed was 8.9% of the inlays were removed and 87% were due to visual complaints. Hyperopic shift being the most common thing as well as other things, myopic shift or inadequate visual benefit or just induced cylinder as well. So in our study, we evaluated 50 patients who received this inlay up to three years post-operatively looking at near visual cutie, distance visual cutie spherical equivalent, mean care tometry, the steep and flat as well, and corneal topography as well as surgically induced astigmatism, which is using the Alpen's vector method, taking the difference between the steepest and flatest reading along the axis of the steepest part of the cornea. So similar to many other studies that have been done previously on the camera, we had patients, most of them did very well at three years in terms of their visual acuity, 86% of patients had near visual cutie of 2032 or better and 88 had distance of 2025 or better at three years. So overall, it seems that the camera as shown in previous studies did very well. The interesting thing that we found that really hadn't been previously reported that there was a large increase in mean care tometry at all subsequent post-operative months, as you can see here, and that up to two years post-operatively average, throughout all our patients, there was a hyperopic shift that was noted up to 24 months. It was statistically significant at two years and then decreased slightly up to three years. So this is just to overlay the two. So at the very start, we saw an increase in care tometry with the myopic shift as we kind of expected post-operatively but subsequently, there was a pretty constant hyperopic shift in this subset of patients with an increased care tometry still. And these are just the actual numbers from those graphs. And another thing we found when looking at patients that had this hyperopic shift was that many of them had a specific pattern of steepening on coronal topography. So for example, in patient number three, you can see it really well that they're pretty even around the annulus of the body of the inlay to begin. But as time went on, you can see that there's this nice steepening right over the body of the inlay with relative central flattening over the visual axis of the cornea. And that's what it looks like is causing this hyperopic shift in a lot of the patients. So just to give you an example of a patient over time, we can see kind of not as good of a picture but he also had this ring-like pattern of steepening with a hyperopic shift. And as time went on, you can see the ring disappeared and so did the hyperopic shift in this vision. Interestingly as well, two of the patients in this study out of the 50 had an inverse pattern of steepening here on the left side with the myopic shift. So there was actually flattening over that body of the inlay with steepening centrally over the visual axis. But the majority of the patients had this on the left side with the steepening over the inlay. And lastly, we also looked to see if the inlay or the surgery was surgically inducing any stigmatism and we didn't find anything statistically significant. You can see here's the pre-ops here on the top of the average stigmatism with the left and right eyes. And it didn't change too much. This red line is the sum I didn't need for all of the patients. So just looking into the data of what we found, obviously there's alteration of satisfaction for some of the patients to have this hyperopic or myopic shift that may not like, the inlay may want it, for example, to be removed. Another implication that we thought that where it could be important was in cataract surgery. We noticed that for some of the patients with the steepening being annular and not centrally in the visual axis, the tomographer reported mean care tomorrower was about a diopter more than the actual, if you were to look at it on the coronate topography. However, looking at case reports of cataract surgeries that had been done in people after implantation, they had successful outcomes using post-operative biometry measurements and the SRKT IOA calculation formula. And as well like I previously mentioned, some people might need PRK or want removal of it due to the shifts in interactive outcomes after implantation. So one of the other things that we started thinking about is that the wound healing kind of reaction that happens after implantation of this foreign material is greater, the less shallow you place it. So for example, when they first started in planting these was around 150 to 170 microns just under a little flap and they've been going deeper and deeper. And the reason for that is because we think that, I mean, it's been shown that keratocyte populations are denser in the anterior stroma. So the deeper you go, the less you're messing with the keratocytes for lack of better terms. And the less wound healing reaction you're going to get with that steepening. So recently, after this study, they've started implanting the inlays that are slightly deeper, depth in the pocket all the way up to 300 microns. And this is all, they don't have a ton of patients yet, but as you can see from this data, the pocket depth greater than 200, they did less than 250 and greater than 250, but mostly these are around 300. You can see that there's been a less of a shift in refraction compared to the less than 250 group, as well as slightly better outcomes and vision, the numbers aren't very big. You can see right here, less than 250, we have 52 people greater than we have 27 people right now, but it is interesting going forward to see if that will help kind of alleviate some of these shifts that patients are having with this inlay implantation. Thank you for your time. Questions, comments?