Faculty Bibliography

This is a rare, multimodal imaging report spanning a decade of monitoring in a patient with chronic solar retinopathy showing the natural course of the disease. Spectral-domain optical coherence tomography (SD-OCT) showed mild widening of subfoveal loss of ellipsoid and interdigitation zones bilaterally, progressive retinal pigment epithelial thinning in the right eye, and hyperplasia in the left eye. Structural en face OCT showed subfoveal tissue loss bilaterally. There was no leakage on fluorescein angiography and OCT angiography (OCTA), and dense B-scan OCTA images were unremarkable. Microperimetry revealed bilateral decreased central sensitivity and eccentric fixation in the left eye. Vision remained stable throughout. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:388-392.].

Purpose/UNASSIGNED:An important, unmet clinical need is for cost-effective, reliable, easy-to-use, and portable retinal photography to evaluate preventable causes of vision loss in children. This study presents the feasibility of a novel smartphone-based retinal imaging device tailored to imaging the pediatric fundus. Methods/UNASSIGNED:Several modifications for children were made to our previous device, including a child-friendly 3D printed housing of animals, attention-grabbing targets, enhanced image stitching, and video-recording capabilities. Retinal photographs were obtained in children undergoing routine dilated eye examination. Experienced masked retina-specialist graders determined photograph quality and made diagnoses based on the images, which were compared to the treating clinician's diagnosis. Results/UNASSIGNED:Dilated fundus photographs were acquired in 43 patients with a mean age of 6.7 years. The diagnoses included retinoblastoma, Coats' disease, commotio retinae, and optic nerve hypoplasia, among others. Mean time to acquire five standard photographs totaling 90-degree field of vision was 2.3 ± 1.1 minutes. Patients rated their experience of image acquisition favorably, with a Likert score of 4.6 ± 0.8 out of 5. There was 96% agreement between image-based diagnosis and the treating clinician's diagnosis. Conclusions/UNASSIGNED:We report a handheld smartphone-based device with modifications tailored for wide-field fundus photography in pediatric patients that can rapidly acquire fundus photos while being well-tolerated. Translational Relevance/UNASSIGNED:Advances in handheld smartphone-based fundus photography devices decrease the technical barrier for image acquisition in children and may potentially increase access to ophthalmic care in communities with limited resources.

PURPOSE/OBJECTIVE:To determine whether testosterone supplementation is associated with retinal artery occlusion (RAO) or retinal vein occlusion (RVO). METHODS:Retrospective matched cohort study using data from a large national U.S. insurance database. The testosterone cohort consisted of all male patients who filled a prescription for testosterone from 2000 to 2013. Five controls were matched on age (±3 years), sex, race, and similar time in plan (±3 months) for every exposed patient. Exclusion occurred for <2 years in the plan, <1 eye care visit, medications known to affect androgen levels, and systemic diseases associated with occlusions or increased testosterone. Cox proportional hazard regression assessed the hazard of a new diagnosis of RAO or RVO while controlling for age, race, diabetes mellitus, and hypertension. RESULTS:A total of 35,784 incident testosterone users were compared with 178,860 matched controls. Ninety-three (0.3%) RAOs and 50 (0.1%) RVOs were found in the testosterone cohort and contrasted with 316 (0.2%) RAOs and 232 (0.1%) RVOs in the control group. After multivariate analysis, testosterone supplementation significantly increased the hazard of RAO (hazard ratio: 1.43, 95% confidence interval: 1.12-1.81, P = 0.004), but not of RVO (hazard ratio: 1.03, 95% confidence interval: 0.74-1.42, P = 0.86). CONCLUSION/CONCLUSIONS:Although the incidence of RAO and RVO is low in users of testosterone, supplementation therapy is associated with an increased hazard of RAO, but apparently not of RVO.

An 8-year-old girl with a history of type 1 diabetes was referred for an evaluation of pigment changes in the right macula. Curvilinear hypopigmented streaks were noted in the fovea, with corresponding disruption of the photoreceptor layer on spectral domain optical coherence tomography. On further questioning, a history of laser pointer play 2 years prior was elicited, with acknowledgement of direct laser pointing in the child's eye. The family was advised to remove any commercial laser devices from the home, and observation of the pathology was recommended.

BACKGROUND AND OBJECTIVE/OBJECTIVE:Anti-vascular endothelial growth factor (VEGF) therapy is increasing in popularity for treatment of retinopathy of prematurity (ROP). Despite many technical benefits, issues remain prompting further investigation. PATIENTS AND METHODS/METHODS:Retrospective case report and literature review. RESULTS:A 42-week-old postmenstrual age female with gestational age of 28 weeks and birth weight of 990 g presented with prominent progression of peripapillary purely tractional atypical stage 4A ROP in both eyes following intravitreal bevacizumab therapy in the right eye only. CONCLUSION/CONCLUSIONS:The authors present the first reported case, to their knowledge, of a "crunch" phenomenon tractional retinal detachment from fellow eye administration of bevacizumab. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:e102-e104.].

The authors report three cases of persistent fetal vasculature (PFV) presenting with an atypical peripheral fibrovascular stalk. A 5-month-old with congenital exotropia with a vitreous hemorrhage in the right eye underwent vitrectomy, and a mid-peripheral vitreal vascular stalk was visualized within the area of hemorrhage. The second case is of an 8-year-old with two fetal vascular remnants in the right eye: (1) a stalk superotemporally extending from the pars plana to the mid-peripheral retina that was associated with a retinal break and (2) a focal lens opacity. The third case is a 12-year-old with a history of familial exudative vitreoretinopathy and peripapillary choroidal neovascular membrane found to have a peripheral vitreal stalk in the right eye. These cases demonstrate a rare form of PFV with primarily peripheral remnants. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:e83-e88.].

Purpose : In many resource-challenged communities, there is an unmet need for coste ffective, portable, reliable, and easy-to-use, retinal photography to aid in the screening and diagnosis of posterior segment eye diseases to help prevent blindness. Smartphonebased fundus photography offers an elegant solution. While this technology is rapidly evolving in adults, it has lagged behind in the pediatric patient population. This study presents a feasibility analysis of a novel smartphone-based retinal imaging device tailored to pediatric retinal care. Methods : Our existing RetinaScope device, utilizing the smartphone's camera, Bluetooth connectivity, and processing power to perform 100-degree montaging, was modifed for use in a pediatric setting. This included a child-friendly 3D printed housing of animals, attention grabbing targets, enhanced image stitching and video-recording capability to capture continuous clips of the fundus exam. Fundus photographs were acquired in a pediatric outpatient clinic, inpatient bedside, emergency room, and during exam under anesthesia. The ease of image acquisition and comfort of the patient were assessed via a validated 5-point survey. Time for image acquisition per eye was also recorded. A subset of the images was graded by two independent, masked, expert graders and the accuracy of the grader to clinician diagnosis was compared. The study was approved by the University of Michigan Institutional Review Board Committee and has ClinicalTrials.gov Identifier NCT03076697. Results : Fundus photographs were acquired in 62 eyes of 42 patients. Mean age of the cohort was 6.7 years (range 6 weeks to 18 years). Average time to acquire a standard 5 field photograph of each eye was 2.3 min +/- 1.1 min. Patients rated their overall experience of image acquisition favorably, average Likert score 4.6 +/- 0.8. The diagnoses included: Coats disease, retinoblastoma, retinopathy of prematurity, commotio retinae, coloboma, ocular albinism, and optic nerve hypoplasia, among others. A sub-set of images was graded by two masked vitreoretinal specialists. There was 93% agreement between imagebased diagnosis and the treating clinician's diagnosis. Conclusions : We report a novel smartphone-based device for wide-field fundus photography in pediatric patients. Our device is able to rapidly acquire diagnostic quality images of the retina without causing undue distress to the patients