Position of in-the-bag posterior chamber intraocular lenses relative to the limbus: Applications to Scleral Sutured Lenses
Vingopoulos, Filippos; Nair, Archana; See, Craig W; Iyengar, Nishanth; Haberman, Ilyse; SperberMD, Laurence; Lazzaro, Douglas R; Singh, Rishi; Ho, Allen; Gupta, Omesh; Sharma, Sumit; Modi, Yasha
PURPOSE/OBJECTIVE:To characterize the true position of in-the-bag intraocular lenses (IOLs) relative to the limbus using ultrasound biomicroscopy (UBM) and estimate scleral sutured IOL positioning. METHODS:This prospective single center study included 70 eyes of 41 patients with in-the-bag posterior chamber IOLs. Four vertical UBM captures were performed in each eye in the superior, inferior, nasal and temporal quadrants. Post-operative biometric data were collected. The primary outcome was the vertical distance of the in-the bag IOL from the sclero-corneal limbus. Secondary outcomes included anterior shift and refractive change of a theoretical scleral sutured IOL using sclerotomies at 2.5mm and 3mm posterior to the limbus. RESULTS:A total of 265 UBM images were analyzed, including 64 superior, 69 inferior, 66 nasal and 66 temporal. The true in-the-bag IOL position measured as distance posterior to the sclero-corneal limbus was 4.23 mm Â± 0.56 mm superiorly, 4.22 Â± 0.46 mm inferiorly, 3.95 Â± 0.48 mm nasally and 3.86 Â± 0.52 mm temporally. The anterior shift of a theoretical scleral sutured IOL was 0.60mm for a 3mm sclerotomy and 0.93mm for a 2.5mm sclerotomy, resulting in a theoretical myopic shift of 0.45 D and 0.79 D respectively, assuming a 15 D IOL. Larger biometric measurements correlated to a more posterior in-the-bag position. CONCLUSIONS:True in-the-bag IOL position was found to be more posterior than estimates of scleral sutured IOLs. Additional corrections in scleral sutured IOL calculations may improve refractive outcomes.
Comparative postoperative topography pattern recognition analysis using axial vs tangential curvature maps
Shah, Ravi S; Khandelwal, Sumitra S; Goshe, Jeffrey M; Haberman, Ilyse D; Randleman, J Bradley
PURPOSE/OBJECTIVE:To determine prediction accuracy of patient refractive surgery status by novice reviewers based on topography pattern analysis using axial or tangential anterior curvature maps. SETTING/METHODS:Four U.S. academic centers. DESIGN/METHODS:Prospective case-control study. METHODS:Image evaluation was performed by novice reviewers (n = 52) at 4 academic institutions. Participants were shown 60 total images from 30 eyes presenting for cataract surgery evaluation with known refractive surgery status, including 12 eyes imaged with Placido-based topography and 18 eyes imaged with Scheimpflug-based tomography. There were 12 eyes with myopic ablations, 12 eyes with hyperopic ablations, and 6 eyes with no previous refractive surgery performed. Each eye was shown in both axial and tangential curvature from either device, reviewed as a single image at a time, and masked to the map type (axial vs tangential). RESULTS:For the 52 novice reviewers included, accuracy of pattern identification was 82.9% (517 of 624) for tangential vs 55.0% (343 of 624) for axial maps for eyes with myopic ablation (P < .00001), 90.9% (567 of 624) for tangential vs 58.3% (364 of 624) for axial maps for eyes with hyperopic ablation (P < .00001), and 15.4% (48 of 312) for tangential vs 62.8% (196 of 312) for axial maps for eyes with no ablation (P < .00001). There were no significant differences between Placido and Scheimpflug devices and no significant differences across groups based on year of training. CONCLUSIONS:Tangential curvature maps yielded significantly better pattern recognition accuracy compared with axial maps after myopic and hyperopic corneal refractive surgery ablations for novice reviewers. Using tangential curvature maps, especially for challenging cases, should benefit post-LASIK intraocular lens (IOL) calculator selection and, thereby, improve IOL power calculation accuracy.
Retinal Pigment Deposition Secondary to Iatrogenic Pigment Dispersion
Rowlands, Megan A; Kaden, Talia R; Weiss, Michael J; Dedania, Vaidehi S; Lee, Gregory D; Schuman, Joel S; Haberman, Ilyse D; Schiff, William M; Modi, Yasha S
"Eye Dropping"-A Case Report of Transconjunctival Lysergic Acid Diethylamide Drug Abuse
Lo, Danielle; Cobbs, Lucy; Chua, Michael; Young, Joshua; Haberman, Ilyse D; Modi, Yasha
PURPOSE/OBJECTIVE:To report a case of bilateral toxic corneal and conjunctival epitheliopathy secondary to administration of filter paper impregnated with lysergic acid diethylamide (LSD) in the inferior conjunctival fornices. METHODS:This is a single case report of an 18-year-old man who presented to the emergency department with acute, bilateral eye pain and redness of 24 hours. The patient admitted to placing folded strips of blotting paper impregnated with LSD into the inferior fornices of his eyes the previous night. RESULTS:The patient was found to have localized bilateral corneal and conjunctival abrasions with underlying subconjunctival hemorrhage. Conjunctival abrasion was "kissing," involving the bulbar and palpebral conjunctiva, corresponding to the presumed location of the filter paper. There was no corneal stromal opacification. He was lost to follow up within 1 week of initial presentation but stated that his symptoms improved. CONCLUSIONS:To the best of our knowledge, this is the first reported case of bilateral hemorrhagic conjunctival abrasion and corneal abrasion secondary to LSD. "Kissing" conjunctival lesions, which have been previously reported with heroin use, should raise suspicion for drug abuse.
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
Student perceptions of the ophthalmology curriculum in medical school [Meeting Abstract]
Cobbs, L; Tsui, E; Haberman, I; Kim, E; Sperber, L; Wu, M; Schuman, J
Purpose: The purpose of this study is to evaluate medical student perception of the current ophthalmology curriculum without mandatory rotation at New York University School of Medicine (NYUSOM). Despite the lack of emphasis on ophthalmology in many medical school curricula, eye examination and management skills are important for physicians to master because they can reveal systemic pathology and require emergent treatment. In the context of rapidly evolving medical school curricula and lack of national ophthalmology education standards, it is important to assess ophthalmology training adequacy.
Method(s): A cross-sectional Internet survey was distributed to all currently enrolled NYUSOM students, including those pursuing dual degrees, in March to May 2017. The main parameters measured in the study were students' self-reported confidence with ophthalmology skills and satisfaction with curriculum.
Result(s): Response rate was 27.5% (166 of 604) of NYUSOM students. Many students reported they were not comfortable diagnosing eye emergencies (64%), using a direct ophthalmoscope (71%), or testing visual acuity (50%). The majority of students did not want ophthalmology to become a mandatory rotation, but reported additional in-person training would be most helpful, compared to videos, web-based didactics, lectures, or virtual training. Completion of an ophthalmology elective and more hours of ophthalmology training were associated with increased confidence with eye examination and greater satisfaction with the curriculum.
Conclusion(s): It is critical for all physicians-in-training to have adequate skills in eye examination. Identifying areas of improvement and determining the best teaching modality will be important in updating the ophthalmology curriculum for medical students. The majority of medical students are not at all or only slightly confident with eye examinations. Increasing the amount of in-person ophthalmology training in medical school improves confidence with eye examination. (Figure presented)
Epithelial remodeling after corneal cross-linking using higher fluence and accelerated treatment time [Meeting Abstract]
Straziota, C E P; Haberman, I; Broncano, A F; Kim, S W; Lang, P Z; Hafezi, F; Randleman, J B
Purpose: To evaluate changes in regional corneal epithelial thickness after corneal cross-linking using higher fluence (7.2 J/cm2) and accelerated treatment time (4 minutes) [A-CXL] in eyes with keratoconus using spectral-domain optical coherence tomography (SD-OCT) and to correlate focal epithelial and focal anterior curvature changes.
Method(s): Patients with keratoconus randomized to undergo A-CXL were prospectively measured using anterior segment SD-OCT (RTVue-100; Optovue, Inc., Fremont, CA) to compare regional corneal epithelial thickness and Scheimpflug imaging for focal axial curvature in eyes with keratoconus before and 1, 3, 6, and 12 months after accelerated CXL.
Result(s): In total, 27 eyes from 20 patients were evaluated. Prior to A-CXL, epithelium was thinnest in the inferior inner and outer temporal regions, while 12 months postoperatively epithelium was significantly thinned in the outer nasal region by 3.2 um, inner nasal by 3.2 um, outer inferonasal by 3.4 um, inner inferonasal by 1.4 um, outer inferior by 1.8 um, outer inferotemporal by 1.8 um, and outer temporal by 1.1 um (P < 0.05, all measurements), with no significant changes from 6 to 12-months. Epithelial thickness standard deviation across the central 6mm was significantly reduced by 3 months (1.4 um, P = 0.09) and remained stable (reduced by 0.09 um) at 1 year after A-CXL (P = .009). Change in epithelial thickness was poorly correlated to change in anterior curvature (r =-0.035) with wide variation between eyes.
Conclusion(s): Significant epithelial remodeling occurs after accelerated CXL in eyes with keratoconus. The epithelium becomes thinner in pre-operatively thicker regions and more regular across the central 6mm of the cornea over the first 6 months after treatment, and stabilizes by 1 year. There was minimal overall correlation between focal epithelial thickness and anterior curvature changes, with wide variability. Establishing the pattern of epithelial remodeling after cross-linking may help optimize future customized treatment protocols
Epithelial remodeling after corneal crosslinking using higher fluence and accelerated treatment time
Haberman, Ilyse D; Lang, Paul Z; Broncano, Alvaro Fidalgo; Kim, Sang Woo; Hafezi, Farhad; Randleman, J Bradley
PURPOSE/OBJECTIVE:) and accelerated treatment time (4Â minutes) in eyes with progressive keratoconus using spectral-domain optical coherence tomography (SD-OCT) and to correlate focal epithelial and focal anterior curvature changes. SETTING/METHODS:Academic medical center in the United States. DESIGN/METHODS:Prospective case series. METHODS:Patients had anterior segment SD-OCT (RTVue-100) with focal stromal and epithelial measurements and Scheimpflug imaging before and 1, 3, 6, and 12Â months after accelerated CXL. RESULTS:Twenty-seven eyes from 20 patients were evaluated. Before the accelerated CXL, the epithelium was thinnest in the inferior inner and outer temporal regions, whereas at 12Â months postoperatively, the epithelium was significantly thinned in multiple inferior and nasal regions by 1.1 to 3.2Â Î¼mÂ (PÂ <Â .05, all measurements), with no significant changes from 6 to 12Â months. Epithelial thickness standard deviation across the central 6.0Â mm was significantly reduced by 3Â months (1.4Â Î¼m, PÂ =Â .09) and remained stable at 12Â months (PÂ =Â .009). Change in epithelial thickness was poorly correlated to change in anterior curvature (rÂ =Â -0.035). CONCLUSIONS:Significant epithelial remodeling occurred after accelerated CXL in eyes with progressive keratoconus, with improved regularity across the central 6.0Â mm, by 6Â months afterÂ treatment. There was poor correlation between focal epithelial thickness and anterior curvature changes, with wide variability between patients. Establishing the pattern of epithelial remodeling after CXL might help optimize future custom treatment protocols.
Limbal Cysts: A Subset Exhibiting Cornea-Specific Cytokeratins
Charles, Norman C; Jakobiec, Frederick A; Zakka, Fouad R; Haberman, Ilyse D; Katikireddy, Kishore Reddy; Jurkunas, Ula V
Two cases of limbal cysts lined by nonkeratinizing epithelium were studied with a panel of cytokeratins. One was a long-standing lesion in a 30-year-old man, whereas the other was excised from a 40-year-old man following pterygium surgery. Each cyst was immunostained with a panel of cytokeratins that were specific exclusively and separately for corneal and conjunctival epithelia. The epithelial lining of each cyst was CK12 positive for corneal epithelium and CK13 negative for conjunctival epithelium. It is hypothesized that a subset of corneoscleral cysts contain corneal epithelium, probably derived from a type of limbal stem cell differentiation.
Arteriovenous Malformation of the Eyelid: Surgical Management and Histologic Study
Lo, Christopher; Petris, Carisa K; Haberman, Ilyse; Patel, Payal; Charles, Norman C
A raised erythematous eyelid lesion that appeared in a 31-year-old man was diagnosed as an arteriovenous malformation (AVM), with confirmatory Doppler ultrasound demonstrating high arterial flow. Surgical excision, aided by electrocautery for extensive hemorrhage, resulted in an acceptable cosmetic result. Histopathology of the excised lesion showed collapsed capillary channels lined by endothelium. AVM is rarely encountered in the eyelid.