Faculty Bibliography

Purpose : To study the clinic attendance rates and comorbidities in patients with and without diabetic retinopathy Methods : We conducted a retrospective review of all patients scheduled and attended a retina practice between January 2016 - December 2016. Patient charts were divided into nondiabetics, non-proliferative diabetic retinopathy(NPDR), and proliferative diabetic retinopathy(PDR). Attendance rate was calculated for non-diabetic patients and diabetic patient groups. Additional data collected included: history of prior laser procedures(PRP, focal),history of intra-vitreal injections, presence of DME, comorbidities including HTN,HLD,CVD requiring stent or surgery,CKD requiring dialysis, history of amputation, smoking status. Predictive factors for noncompliance were assessed. Results : There were 14,550 scheduled visits (10344 nondiabetics and 4206 diabetics). The no show rate for nondiabetics was 13.8% and was 10.2% for all diabetics. A subgroup analysis of a total of 1038 diabetic retinopathy patients (484 NPDR, 554 PDR) with 2978(1061 NPDR, 1917 PDR) visits were reviewed, with an overall no show rate of 10.5% in NPDR and 9.3% in PDR. There is a nonsignifiant trend towards higher attendance rates in patients with more scheduled visits (89.3% for 1-3, 92.1% for 4-6, and 93.2% for 7 or more scheduled visits; one-way ANOVA,F=2.06, p=0.13). There is a nonsignificant trend of increasing number of comorbidities associated with higher rates of no show visits (9.4% for 0, 7.9% for 1,10.7% for 2, 11.6% for 3, and 7.7% for 4 comorbidities). Smoking did not significantly affect show rates (nonsmokers 10.4%,former 8.0%,current 8.5%). Higher no show rates are found in NPDR and PDR patients with prior treatment with focal laser (13.4%vs7.8% for NPDR, p=0.013 and 12.1%vs8.7%,P=0.026). Prior treatment with anti- VEGF injections were associated with lower no show rates (6.5%vs10.5%, P< 0.05). Conclusions : Contrary to physician bias, patients without diabetes and those with varying degrees of diabetic retinopathy did not demonstrate differing levels of clinic attendance. Additionally, as the scheduled visits increased, patients with diabetic retinopathy were more likely to show, although this was not statistically significant. Medical comorbidities demonstrated a nonsignificant trend towards lower compliance with clinic attendance, which is important to reconcile when deciding a treatment paradigm

Purpose : To evaluate characteristics and outcomes, specifically recurrence of retinal tears and progression to retinal detachment, of patients presenting with acute horseshoe tears. Methods : We retrospectively reviewed the electronic health records of a consecutive series of patients presenting to a retinal consultant practice with acute symptoms of vitreous separation who were found to have a typical horseshoe type retinal tear(s) (HST), without retinal detachment. 103 patients (115 eyes) were included from 2014 and 2017. All patients were examined by a single retinologist with indirect ophthalmoscopy, scleral indentation and contact lens biomicroscopy. The tears were treated by the same provider with transpupillary laser photocoagulation with the standard technique. All included eye had at least a 3 month follow up time. Results : There were 42 females and 61 males. Average age was 60.4yrs (range 27-83yrs). All eyes had a documented posterior vitreous detachment (PVD) at the time of presentation; 21.7% had vitreous hemorrhage. 22.6% of eyes had lattice degeneration. Of the 115 eyes, 86.1% were phakic; 13.9% were pseudophakic. Mean follow up time was 16mos (range 3-40mos). 13% of all eyes experienced a new tear(s) in that same eye, 2 eyes (<2%) had a third break; 1 eye had a fourth break (<1 %). In eyes with lattice degeneration occurrence of new tears was 19.2%, in eyes without lattice it was 11.2% and in eyes with previous cataract surgery it was 25%. New tears occurred between 14 and 789 days (2.16 years); 73.3% occurred within 3mos of initial presentation. 7.0% of all eyes, 6.7% of eyes without lattice, 7.7 % of eyes with lattice and 12.5% of eyes with previous cataract surgery progressed to RD in the same eye. RD's occurred at an average of 0.87mos (range: <1 -4mos) after initial treatment; 75% of RD's occurred within 1mo. Epiretinal membrane (ERM), was seen in 10.4% of eyes treated for acute tears at an average of 12.4mos (range: <1 -38mos) after presentation. As of yet, none of these eyes have required treatment for ERM. Conclusions : Acute retinal tears demand careful follow up since new retinal tears occurred in 13% of all eyes, 19% of eyes with lattice and 25% of pseudophakic eyes. 73.3% of new tears occurred within 3mos. The rate of progression to RD was 7.0%, most occurring within 1 mo. Close follow up, especially in the first few months, is critical for detecting and treating new tears and complications

Purpose: No clear guidelines exist regarding when to perform vitrectomy and membrane peel surgery for idiopathic epiretinal membranes. Here we analyzed a cohort of patients diagnosed with idiopathic epiretinal membranes and compared those who desired and were offered surgery versus those who were not. Since epiretinal membranes are generally non-progressive, surgery was only offered to patients who had significant symposium and diminished acuity. Methods: We retrospectively analyzed a consecutive series of 100 eyes from one vitreoretinal surgeon (79 patients) diagnosed with idiopathic epiretinal membranes who were referred from general ophthalmologists. For each eye we determined the best corrected visual acuity (BCVA, in LogMAR), central macular thickness (CMT) using SD-OCT (urn), age (years) and gender. Using Microsoft Excel using two-tailed t-tests we compared these parameters in patients who had and had not chosen to undergo surgery. In surgical patients, pre-op values were used. Exclusion criteria included patients with any other eye pathology that may have affected vision or macular thickness as well as surgical patients for whom we did not have pre-op data. Results: 21 eyes underwent surgery and 79 were observed. Mean age of patients undergoing surgery was 67.7 years (SD 7.65) and 71.9 years (SD 10.10) in those who opted against surgery (p=.048). Mean pre-op visual acuity in surgical patients was 0.57 (20/75; SD 0.27) compared to 0.27 (20/40+; SD 0.22) in non-surgical patients (p=<.0001). Central macular thickness was 531.4mum (SD 81.28) in surgical patients and 370.1 urn (SD 81.36) in non-surgical patients (p=<.0001). Conclusions: In our retrospectively examined cohort of 100 eyes with idiopathic epiretinal membrane, patients who were offered and accepted surgical treatment were significantly younger and had worse visual acuity and more distorted anatomy (greater central macular thickness) than those patients who did not undergo surgery

Purpose: Myopic foveoschisis (MF) in patients with myopic degeneration was not well appreciated prior to the advent of high resolution optical coherence tomography (OCT) imaging. Information is still limited on the clinical course of patients with MF. In our study we aim to provide additional data on the clinical outcomes of patients with MF. Methods: We performed a retrospective review of patients with a diagnosis of myopic degeneration with posterior staphyloma from a New York City retinal subspecialty practice to identify patients with evidence of MF present on OCT. In cases of MF the demographic data, clinical course, and imaging, including OCT and fluorescein angiography, were evaluated. Results: 196 patients with myopic degeneration and posterior staphyloma were identified: 9 eyes of 8 patients had MF on OCT. Age at incidence of MF ranged from 47 to 73 years old. Six were females, 2 were males. Mean follow up from incidence of MF was 47 months. Seven of the 8 patients had unilateral MF during the period of observation; one patient developed bilateral MF. Four of the 9 eyes underwent surgery. Of the 5 that did not receive surgery, 2 were noted to have anatomic improvement on OCT and maintained stable acuity and 3 demonstrated stable OCT findings but with a reduction in visual acuity. Of the 4 patients who underwent surgical intervention, 3 of the 4 had repair of macular hole, and one underwent repair of a subtotal retinal detachment. Time from development of MF to time of macular hole development was 4, 11, and 49 months in the 3 eyes. Two of the 3 eyes with macular holes had stable visual acuity following repair, one of the eyes showed improved visual acuity. The retinal detachment was repaired with anatomic improvement of the foveoschisis. Myopic choroidal neovascularization did not develop in any of the 9 eyes during the period of follow up. Conclusions: Our data are consistent with prior studies indicating that the course of MF is highly variable, ranging from nonprogression (3/9), spontaneous resolution (2/9) or macular hole formation (3/9). Surgical outcomes can be favorable

BACKGROUND AND OBJECTIVE: To evaluate choroidal involvement in acute posterior multifocal placoid pigment epitheliopathy (APMPPE). PATIENTS AND METHODS: Retrospective study in five eyes of three patients evaluated through multimodal imaging, including enhanced-depth imaging optical coherence tomography (OCT), ultra-wide field color photography, fundus autofluorescence, and fluorescein angiography (FA). Choroidal thickness and structure were evaluated on OCT. RESULTS: During the acute phase, choroidal OCT showed choroidal thickening and a lucency at the level of the inner choroid. Subclinical lesions detected in the retinal periphery using wide-field retinal imaging were isoautofluorescent and corresponded to choriocapillaris filling-defects on FA. At final follow-up, all patients showed resolution of choroidal thickening and the inner choroidal lucency, as well as the disappearance of subclinical lesions. CONCLUSION: These results suggest a transient ischemic choroiditis in APMPPE that may lead to secondary permanent retinal pigment epithelium damage in the posterior pole but not in the retinal periphery. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:20-26.].