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beta zone peripapillary atrophy as a predictor of glaucomatous structural and functional progression [Meeting Abstract]

Geevarghese, A; Lavinsky, F; Ishikawa, H; Wu, M; Liu, M; Tauber, J; Panarelli, J; Madu, A A; Schuman, J S; Wollstein, G
Purpose : The presence of s zone peripapillary atrophy (PPA) has been associated with glaucoma. We performed a retrospective longitudinal study to evaluate s zone PPA area as a predictor for glaucomatous structural and functional progression. Methods : Subjects with glaucoma and >4 visits were included. Subjects had Humphrey visual field (Zeiss, Dublin, CA) testing, spectral-domain OCT (Cirrus HD-OCT; Zeiss) optic nerve head (ONH) and macula scans. s zone PPA was manually delineated on the baseline en face ONH scan as the area contiguous with the optic disc with the presence of hyper-and hyporeflectivity. Mixed effects linear models accounting for intra-subject correlation, follow-up time, scan's signal strength and ethnicity, were performed to determine if baseline PPA area was associated with glaucoma severity. Subsequent models incorporating the interaction term between time and baseline PPA area were performed to determine if baseline PPA area affected the rate of change in parameters of glaucoma over time. Results : 81 eyes (56 subjects) aged 62.8+/-14.1 years with an average follow-up time 3.9+/-1.3 years were analyzed. PPA was significantly associated with mean deviation (MD), visual field index (VFI), and inferior retinal nerve fiber layer (RNFL), (p=0.033, 0.038, and 0.034, respectively), but not with average RNFL, or macular ganglion cell inner plexiform layer (GCIPL) global and sectoral measurements and ONH parameters. No significant association was detected between s zone PPA area and the rate of progression for any parameter except for VFI (p =0.035). Conclusions : Although baseline s zone PPA area is associated with some indicators of glaucoma severity, it is not a significant predictor of the rate of glaucomatous progression (except for VFI)
EMBASE:632697506
ISSN: 1552-5783
CID: 4586072

Preferred OCTA scanning protocol for glaucoma discrimination [Meeting Abstract]

Rai, R S; Lucy, K; Tracer, N; Wu, M; De, Los Angeles Ramos Cadena M; Kokroo, A; Rathi, S; Madu, A; Jimenez-Roman, J; Lazcano-Gomez, G; Shin, J W; Rim, S K; Ishikawa, H; Schuman, J S; Wollstein, G
Purpose : OCT Angiography (OCTA) can be used to measure retinal vessel density (VD). These scans can be of various sizes and may be centered on the optic nerve head (ONH) or macula. In this study, we examined the glaucoma discrimination performance of VD using different scanning sizes and locations and compared it with the performance of conventional structural and functional biomarkers to identify the best glaucoma discrimination scanning protocol. Methods : 79 healthy and glaucomatous eyes (50 subjects) were included in the study. Subjects with diabetes, vascular disease, or who were using medications known to affect retinal thickness were excluded. 3x3 and 6x6mm ONH and macula OCTA images were obtained using Cirrus HD-OCT Angioplex (Zeiss, Dublin, CA). Global and sectoral VD was calculated using native software on the device. Area under the receiver operating characteristics (AUC) was used to determine the discrimination ability of VD, retinal nerve fiber layer (RNFL) thickness, rim area, cup-to-disc (C/D) ratio, ganglion cell inner plexiform layer (GCIPL) thickness, and visual field mean deviation (MD). Bootstrapping was used for comparison between the AUCs. Results : Subjects with glaucoma had statistically significantly different measurements than healthy individuals for all tested parameters except for the majority of macula VD (both 3x3 and 6x6 scanning sizes; Table). VD measurements that had the best glaucoma discrimination ability were acquired from the ONH from all sectors of the 3x3 scans and in the outer and full sectors in the 6x6 scans (Table). For these ONH parameters, no significant difference was detected from the best discriminating parameter (average RNFL and rim area). All macula VD measurements had significantly worse discrimination performance. Conclusions : Among VD scanning options, the ONH scans are the most suitable for glaucoma discrimination. However, the coarse sampling in the larger scan (6x6mm) reduces this capability inside and immediately adjacent to the ONH
EMBASE:629665102
ISSN: 1552-5783
CID: 4168642

Peripapillary Vessel Density as a Glaucoma Biomarker throughout the Glaucoma Severity Spectrum [Meeting Abstract]

Rai, Ravneet Singh; Lucy, Katie; Tracer, Nathaniel; Wu, Mengfei; Liu, Mengling; Cadena, Maria de los Angeles Ramos; Rathi, Siddarth; Madu, Assumpta; Ishikawa, Hiroshi; Schuman, Joel; Wollstein, Gadi
ISI:000488628107168
ISSN: 0146-0404
CID: 4154342

Assessment of mentorship needs during ophthalmology residency [Meeting Abstract]

Tsui, E; Lo, C; Kim, E; Haberman, I; Sperber, L T; Madu, A; Lazzaro, D; Schuman, J
Purpose: Mentorship during various stages of medical training has been demonstrated to improve satisfaction in training and also to shape career goals. There are few studies evaluating formal mentorship programs within ophthalmology residency. We aim to evaluate the mentorship needs of ophthalmology residents, which may provide the framework to establish a formal mentorship program.
Method(s): An online cross-sectional survey was distributed in May 2017 to all residents (n=20) in the New York University School of Medicine ophthalmology residency program to evaluate their perspectives on mentorship. The questionnaire consisted of multiple choice and Likert-type questions.
Result(s): The response rate was 100% (20/20 of surveyed residents), of which 7 were PGY- 2, 6 were PGY-3, and 7 were PGY-4. Seventy-five percent (15/20) of residents reported that mentorship was "very important" during residency. Approximately two-thirds of residents (13/20) had participated in a formal mentorship program prior to residency. Eighty percent (16/20) of residents reported that two mentors were an ideal number, while 20% preferred three mentors. Sixty percent (12/20) of residents had already identified an informal mentor during residency. Respondents replied that "accessibility" was the most important quality in a mentor followed by "willingness to write a letter of recommendation". Gender, age, and academic ranking were the least frequently selected as important qualities in a mentor. The most common reason for pursuing a mentor was "seeking career guidance", followed by "obtaining a letter of recommendation" and "seeking someone as an advocate or confidant". The least commonly selected reason for seeking a mentor was "improvement of clinical skills".
Conclusion(s): Ophthalmology residents view mentorship as an important part of their training. Residents prioritize accessibility and career guidance as important aspects of mentorship and many are seeking a faculty member who may contribute a reference letter in the future. The results of this survey have contributed to the development of a formalized residency mentorship program, and help guide mentorship objectives and practice
EMBASE:628582956
ISSN: 1552-5783
CID: 4001372

Combination Ipilimumab and Nivolumab for Metastatic Melanoma Associated With Ciliochoroidal Effusion and Exudative Retinal Detachment

Tsui, Edmund; Madu, Assumpta; Belinsky, Irina; Yannuzzi, Lawrence A; Freund, K Bailey; Modi, Yasha S
PMID: 29145556
ISSN: 2168-6173
CID: 2785192

Laser in-situ keratomileusis infection: review and update of current practices

Mozayan, Arash; Madu, Assumpta; Channa, Prabjot
PURPOSE OF REVIEW: To review new clinically relevant data regarding the prevention cause and treatment of laser in-situ keratomileusis (LASIK) infections. RECENT FINDINGS: Many recent studies of post-LASIK infectious keratitis show the predominance of atypical mycobacteria and Gram-positive cocci and the growing number of other rare pathogens. The American Society of Cataract and Refractive Surgery White Paper treatment paradigm remains the model for initial treatment of LASIK-associated infectious keratitis. SUMMARY: Improved understanding of the risk factor, different causes, along with a high degree of suspicion on initial presentation is crucial in order to provide the appropriate management in LASIK-associated infectious keratitis.
PMID: 21552125
ISSN: 1531-7021
CID: 2311172

Refractive surgery and the glaucoma patient

Shrivastava, Anurag; Madu, Assumpta; Schultz, Jeffrey
PURPOSE OF REVIEW: Patients considering corneal refractive surgery undergo extensive preoperative testing, but current protocols may not address the management of glaucoma appropriately. This review outlines the current body of literature on the diagnostic and management challenges that exist in the treatment of glaucoma patients undergoing laser ablative surgery, and makes recommendations to improve current perioperative protocols. RECENT FINDINGS: As permanent structural alterations to the cornea after laser-assisted in-situ keratomileusis surgery make Goldmann applanation tonometry inaccurate, the advent of new diagnostic modalities and recommendations to accurately measure postoperative intraocular pressure (IOP) and subtle damage to the optic nerve have been further analyzed and tested. SUMMARY: As IOP is the only modifiable risk factor in the treatment of glaucoma to date, traditional diagnostic and treatment algorithms may not be appropriate for refractive surgery patients. Glaucoma remains a relative contraindication to refractive procedures, but as new diagnostic modalities emerge, our ability to diagnose and manage these patients may improve. More uniform recommendations need to be implemented to improve our long-term management of these patients.
PMID: 21552127
ISSN: 1531-7021
CID: 2311162

Resident laser refractive surgery training

Madu, Assumpta A; Ali, Tofik
PURPOSE OF REVIEW: The Residency Review Committee Ophthalmology of the Accreditation Council for Graduate Medical Education has recently established guidelines pertaining to the minimum operative requirements for training ophthalmology residents in refractive surgery. Despite being one of the most frequently performed ophthalmic surgical procedures, there is a paucity of literature on residency training in refractive surgery. Moreover, the literature indicates that only half of training programs offer surgical exposure to trainees. The purpose of this article is to review recent research on training ophthalmology residents in refractive surgery and offer an approach to incorporating laser refractive surgery curriculum in residency education. RECENT FINDINGS: Kwon et al. performed a national survey to evaluate current trends in resident laser in-situ keratomileusis (LASIK) training in the USA. The result shows that 54% of respondents had resident-performed LASIK surgery with 9.1% of surveyed programs not offering any LASIK experience. In addition, residents in the study performed a mean of 4.4 LASIK surgeries (range 1-10) during residency training starting during the second year. SUMMARY: The data emerging from the survey show that refractive surgery experience is fundamental to the education of the ophthalmology resident. Although the demand for refractive surgery continues to gain pace with millions of such procedures performed worldwide, only a little over half of ophthalmology residency programs offer residents the opportunity to gain surgical experience. With the current mandate, programs must now look for strategies to provide laser refractive surgical experience to residents.
PMID: 20467320
ISSN: 1531-7021
CID: 2311182

Etiology and treatment of the inflammatory causes of cystoid macular edema

Cho, Hyung; Madu, Assumpta
Cystoid macular edema in its various forms can be considered one of the leading causes of central vision loss in the developed world. It occurs in a wide variety of pathologic conditions and represents the final common pathway of several basic processes. Therapeutic approaches to cystoid macular edema depend on a clear understanding of its contributing pathophysiologic mechanisms. This review will discuss the mechanism of ocular inflammation in cystoid macular edema with a particular focus on the inflammatory causes: post-operative, uveitic, and after laser procedures. A variety of pharmacologic agents targeting inflammatory molecules have been shown to reduce macular edema and improve visual function. However, the long-term efficacy and safety of most new therapies have yet to be established in controlled clinical trials.
PMCID:3218725
PMID: 22096351
ISSN: 1178-7031
CID: 2311192

Participation-based training of peripheral health workers in the erradication effort of onchocerciasis (riverblindness) in Benin [Meeting Abstract]

Madu, AA; Mammo, R; Alexander, M
ISI:000227980402070
ISSN: 0146-0404
CID: 2793382