Faculty Bibliography
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department:Ophthalmology
recent-years:2
school:SOM
Total Results:
353
Hypertransmission and vision in aging and age-related macular degeneration: longitudinal data from ALSTAR2
PURPOSE/OBJECTIVE:To investigate the presence of hypertransmission (HT) in normal aging, early (e)AMD, and intermediate (i)AMD, changes over 3 years, and the impact of HTs ≥ 250 µm (LHyperTD) on seven tests of scotopic, mesopic, and photopic vision. DESIGN/METHODS:Prospective cohort study. SUBJECTS/METHODS:Participants of the Alabama Study on Early Age-Related Macular Degeneration 2. METHODS:ALSTAR2 participants underwent spectral domain optical coherence tomography angiography (OCTA), color fundus photography, and vision testing at baseline and 3-year follow-up. HT presence and stepped diameters in choroidal en face slabs were assessed with custom review software. Only LHyperTD were analyzed at follow-up. AMD was staged via AREDS 9-step. Vision at baseline and follow-up between eyes with and without LHyperTD was analyzed with linear regression. MAIN OUTCOME MEASURES/METHODS:Presence, size, and illustrative examples of HT, association with tests of photopic, mesopic and scotopic vision. RESULTS:Baseline data was available on 460 eyes of 460 patients (mean age 71.5 ± 5.7 years, 277 female; 236 normal, 134 eAMD, 90 iAMD). HT of any size were found in iAMD (86.7%), eAMD (35.1%), and normal (3.8%) eyes, with proportional LHyperTD (13.3% vs 4.2% vs 0.4%, p < 0.01). For 339 eyes (mean age 71.2 ± 5.8 years, 206 female, 181 normal, 92 eAMD, 66 iAMD), LHyperTD presence significantly increased in normal (p = 0.01) and iAMD (p < 0.01) but not in eAMD eyes. At baseline, photopic contrast sensitivity (CS), mesopic CS, and rod intercept time (for rod mediated dark adaptation, RMDA) were worse in eyes with LHyperTD compared to eyes without (all p < 0.01). At follow-up, the same were worse in LHyperTD (all p < 0.01), as well as low luminance visual acuity (p < 0.01) and scotopic light sensitivity (p = 0.05). CONCLUSION/CONCLUSIONS:LHyperTD are rare in normal and eAMD eyes and associate with mesopic and scotopic visual functions in addition to risk-indicating RMDA. Delayed RMDA reflects other factors other than LHyperTD including differences in disease stage. Our analysis of HT < 250 µm may inform other studies of early disease. LHyperTD are best utilized as imaging biomarkers for later stages of iAMD than ALSTAR2.
PMID: 40849031
ISSN: 1879-1891
CID: 5930842
Connectome of a human foveal retina
What makes human brains distinctive? The answer is hidden at least partially in the myriad synaptic connections made between neurons - the connectome. The foveal retina is a primate specialization which presents a feasible site for deriving a complete connectome of a human CNS structure. In the fovea, cells and circuits are miniaturized and compressed to densely sample the visual image at highest resolution and initiate form, color and motion perception. Here we provide a draft connectome of all neurons in a human fovea. We found synaptic connections, distinct to humans, linking short-wavelength sensitive cones to color vision pathways. Moreover, by reconstructing excitatory synaptic pathways arising from cone photoreceptors we found that over 95% of foveal ganglion cells contribute to only three major pathways to the brain. Our study reveals unique features of a human neural system and opens a door to a complete foveal connectome.
PMCID:12393462
PMID: 40894061
ISSN: 2693-5015
CID: 5930862
Delphi-Based Global Consensus on Fuchs Endothelial Corneal Dystrophy. An Endothelial Keratoplasty Learners Group Initiative
PURPOSE/OBJECTIVE:To identify areas of consensus among global experts for the management of Fuchs endothelial corneal dystrophy (FECD) in clinical practice, including its diagnosis, evaluation, decision-making principles with respect to intervention, and recommendations for performing cataract surgery in patients with FECD, including when to combine with keratoplasty. DESIGN/METHODS:Modified Delphi-based global consensus. PARTICIPANTS/METHODS:Thirty-seven ophthalmologists from around the world with significant expertise in the management and mechanisms of FECD. METHODS:A series of consensus statements about FECD were developed from three iterative rounds of structured questions and statements posed to the panel of experts. Two rounds were asynchronous electronic questionnaires, and the third round was a live virtual meeting. Experts responded anonymously to statements assessing consensus and to open-ended questions that invited diverse input. MAIN OUTCOME MEASURES/METHODS:Consensus was defined as ³70% agreement among experts. RESULTS:Consensus was reached for 90 of 91 statements after three rounds. Experts agreed that FECD is defined by the presence of central or paracentral scattered or confluent guttae with or without edema. There was strong consensus that a chronic state of subclinical edema precedes the onset of clinically detectable edema that may or may not cause symptoms. With near-unanimous consensus, disease evaluation recommendations included assessing for findings that implicate the cornea as a source of decreased vision to separate it from the effect of comorbid conditions, as this would inform whether corneal intervention is appropriate. These findings include diurnal variation in vision, clinical or subclinical (tomographic) edema, and changes or differences in central corneal thickness. Based on current evidence, experts agreed that there are no effective medical therapies for FECD, and that Descemet membrane endothelial keratoplasty is the surgical treatment of choice when indicated. CONCLUSIONS:The consensus statements provide current globally endorsed recommendations for the diagnosis and management of FECD. The guidelines are important and relevant for general ophthalmologists, who typically first diagnose and evaluate FECD, and for cornea specialists, by allowing them to benchmark their current practice patterns against expert recommendations. This could help improve patient outcomes and establish a framework adaptable to future advances and evolving technologies in the management of FECD.
PMID: 40789362
ISSN: 1879-1891
CID: 5906922
Advanced Analysis Tools for Two Wavelength Autofluorescence Imaging of Macular Xanthophyll Carotenoids: ALSTAR2 Baseline
PURPOSE/UNASSIGNED:To allow exploration of xanthophyll carotenoids in vision and age-related macular degeneration progression using two-wavelength autofluorescence imaging for macular pigment optical density (MPOD), we developed tools for automatically centering and classifying the MPOD distribution pattern. METHODS/UNASSIGNED:A subset of the ALSTAR2 baseline cohort (NCT04112667) and 44 eyes of adults aged 20 to 30 years with healthy maculas were imaged with optical coherence tomography and two-wavelength autofluorescence (MPOD module, Heidelberg Engineering). Images underwent a quality review. Two custom FIJI plugins centered the MPOD distribution by five algorithms (FOVEA, HILLCLIMB, CENTROID, MAX, CONTOUR). Others automatically classified spatial distributions into four patterns from Obana et al: Peak, Ring, Mixed, and Dip. RESULTS/UNASSIGNED:Of 651 qualifying aged eyes and 44 young eyes, the HILLCLIMB and CONTOUR methods best agreed with a manually determined foveal center. Regarding spatial distribution pattern, 445 aged eyes (68.4%) showed peaks, 118 (18.1%) rings, 41 (6.3%) mixed, and 47 (7.2%) dips. In young eyes, 40 (90%) showed peaks, 1 (2.3%) rings, 3 (6.8%) mixed, and none showed dips. Notably, peaks were significantly (P < 0.001) more prominent in men (74.1%) than women (65.0%) and pseudophakic (72.7%) than phakic (62.9%) eyes. CONCLUSIONS/UNASSIGNED:Automatic tools for MPOD centration are reliable and robust. Future studies will use the HILLCLIMB and CONTOUR algorithms. TRANSLATIONAL RELEVANCE/UNASSIGNED:Automated MPOD pattern assignment suggests that the spatial distribution of MPOD varies with gender, lens status, and possibly age. Our analytic software can be applied to large samples for studies of xanthophyll carotenoid impact on vision and age-related macular degeneration progression.
PMCID:12393178
PMID: 40838944
ISSN: 2164-2591
CID: 5929362
Customized Jones tube insertion in the management of a recurrent, deep orbital epidermoid cyst [Case Report]
A 68-year-old man with a history of remote sinus surgery presented with several months of progressive diplopia, proptosis, and epiphora. He was found to have a large, cystic mass in the lateral extraconal space of the right orbit, which was removed. Pathology demonstrated an epidermoid cyst with recurrence at post-operative month 3. Follow-up resection was performed with the insertion of a modified Jones tube into the maxillary sinus to serve as a persistent outlet and prevent future recurrence. At post-operative month 18 after tube insertion, he remains without disease recurrence. The authors describe this novel technique as a method to prevent recurrence in orbital cyst management.
PMID: 39352798
ISSN: 1744-5108
CID: 5922872
Full length title: Stellate Nonhereditary Idiopathic Foveomacular Retinoschisis and Central Anomalous Retinoschisis with mid-PEripheral Traction (CARPET)
PURPOSE/OBJECTIVE:To report the clinical and multimodal imaging (MMI) findings and long-term follow-up of stellate nonhereditary idiopathic foveomacular retinoschisis (SNIFR) contiguous with midperipheral retinoschisis (MPRS) and to describe a severe SNIFR variant termed CARPET (Central Anomalous Retinoschisis with mid-PEripheral Traction). DESIGN/METHODS:Retrospective case series. SUBJECTS/METHODS:Eleven patients (15 eyes) with SNIFR contiguous with MPRS in at least one eye at baseline or final follow-up. METHODS:MMI features, including cross-sectional and en face macular and peripheral spectral-domain optical coherence tomography (OCT) and OCT angiography, were reviewed in all cases at baseline and at the final follow-up visit. MAIN OUTCOME MEASURES/METHODS:Various courses (including progression, regression, or stability) of MPRS or SNIFR over time were evaluated. RESULTS:MPRS exhibited centripetal progression to SNIFR in 5 eyes of 3 patients with follow up of 67, 60, and 27 months, respectively, with maintenance of excellent visual acuity (range: 20/25-20/20) in 4 of these 5 eyes. In 2 eyes of 2 patients (including 1 eye with initial centripetal progression of MPRS to SNIFR), MPRS contiguous with SNIFR spontaneously resolved with long-term follow-up (77 and 48 months, respectively). SNIFR contiguous with MPRS partially regressed after 48 months in one patient, and was stable after 54 months in another. A distinctive midperipheral microvasculopathy, associated with MPRS that was contiguous with SNIFR, was identified in 7 eyes of 4 patients. Finally, 3 eyes of 3 patients exhibited additional unique features, including central neurosensory detachment and outer lamellar macular hole, which were associated with significant midperipheral traction, representing a severe variant subtype of SNIFR that we refer to as CARPET. Two of these 3 eyes progressed with short-term follow-up of 6 and 2 months, respectively, while the schisis resolved and vision improved after pars plana vitrectomy in the third case. CONCLUSIONS:MPRS can progress to SNIFR over multiple years of follow-up. SNIFR with MPRS can also spontaneously resolve or remain stable. MPRS can additionally be complicated by a midperipheral inner retinal microvasculopathy. Finally, CARPET may represent a unique and severe variant form of SNIFR driven by midperipheral vitreoretinal traction and associated with significant vision loss.
PMID: 39922381
ISSN: 2468-6530
CID: 5793032
Methylprednisolone after shoulder arthroplasty leads to decreased opioid prescriptions without an increased risk of infection: A matched cohort analysis
BACKGROUND/UNASSIGNED:Due to the increasing demand for total shoulder arthroplasty, safe opioid stewardship paired with appropriate pain management is imperative for long-term patient care. A recent study has shown the potential for methylprednisolone use in the peri-operative period in order to decrease opioid consumption postoperatively. METHODS/UNASSIGNED:The large TriNetX database was queried to identify all patients who were methylprednisolone naïve that underwent total shoulder arthroplasty with a minimum follow-up of 3 months. These patients were then further separated into two cohorts - those who received post-operative methylprednisolone within 7 days of the arthroplasty procedure and those who did not. After 1:1 propensity score matching, 1304 patients were included in each cohort for analysis. The primary outcome was opioid prescription within the 30- and 90-day postoperative period. Additional hospitalization, surgical, and medical outcomes were analyzed at 30-day, 90-day, 1-year, and 2-year time points. RESULTS/UNASSIGNED:For patients who received methylprednisolone, there were significantly fewer opioid prescriptions at 30 days (1.4 ± 1.6 versus 1.5 ± 1.8, p = 0.033) and 90 days (1.8 ± 2.3 versus 2.0 ± 3.4, p = 0.026). At both 30 and 90 day time points, there was no significant difference in the risk for medical complications like acute kidney injury, deep venous thrombosis, myocardial infarction, pulmonary embolism, pneumonia, urinary tract infection, glucose values, and A1C. between the two groups. At 1 year and 2 year time points, there was no significant difference in the risk of surgical complications like need for revision, prosthetic joint infection, surgical site infection, dislocation, wound complications, mechanical failure, periprosthetic fracture, and polywear/osteolysis. CONCLUSION/UNASSIGNED:Methylprednisolone use in the peri-operative period may lead to a decrease in the number of opioid prescriptions needed for patients post-operatively with no increased risk of surgical or medical complications. As opioids carry their own inherent risks, safe stewardship with multimodal pain regimens that include methylprednisolone may be beneficial in both the short and long term for patients. LEVEL OF EVIDENCE/UNASSIGNED:Level III Retrospective Cohort Comparison Using Large Database Prognosis Study.
PMCID:12152568
PMID: 40510507
ISSN: 0972-978x
CID: 5915572
Anti-VEGF Use for Conditions without Food and Drug Administration Approval
PMID: 40132683
ISSN: 2468-6530
CID: 5815292
Number of people treated for hepatitis C virus infection in 2014-2023 and applicable lessons for new HBV and HDV therapies
BACKGROUND AND AIMS/OBJECTIVE:The year 2023 marked the 10-year anniversary of the launch of direct-acting antivirals (DAAs) for the treatment of the hepatitis C virus (HCV). HCV treatment trends by country, region, and globally are important to monitor progress toward the World Health Organization's 2030 elimination targets. Additionally, the historical patterns can help predict the treatment uptake for future therapies for other liver diseases. METHODS:The number of people living with HCV (PLHCV) treated between 2014-2023 across 119 countries was estimated using national HCV registries, reported DAA sales data, pharmaceutical companies' reports, and estimates provided by national experts. For the countries with no available data, the average estimate of the corresponding Global Burden of Disease region was used. RESULTS:An estimated 13,816,000 (95% uncertainty intervals (UI): 13,221,000-16,415,000) PLHCV were treated, of whom 12,748,000 (12,226,000-15,231,000) were treated with DAAs, of which 11,081,000 (10,542,000-13,338,000) were sofosbuvir-based DAA regimens. Country-level data accounted for 97% of these estimates. In high-income countries, there was a 41% drop in treatment from its peak, and reimbursement was a large predictor of treatment. In low- and middle-income countries, price played an important role in expanding treatment access through the public and private markets, and treatment continues to increase slowly after a sharp drop at the end of the Egyptian national program. CONCLUSIONS:In the last 10 years, 21% of all HCV infections were treated with DAAs. Regional and temporal variations highlight the importance of active screening strategies. Without program enhancements, the number of treated PLHCV stalled in every country/region which may not reflect a lower prevalence but may instead reflect the diminishing returns of the existing strategies. IMPACT AND IMPLICATIONS/UNASSIGNED:Long-term hepatitis C virus (HCV) infection can lead to cirrhosis and liver cancer. Since 2014, these infections can be effectively treated with 8-12 weeks of oral therapies. In 2015, the World Health Organization (WHO) established targets to eliminate HCV by 2030, which included treatment targets for member countries. The current study examines HCV treatment patterns across 119 countries and regions from 2014 to 2023 to assess the impact of national programs. This study can assist physicians and policymakers in understanding treatment patterns within similar regions or income groups and in utilizing historical data to refine their strategies in the future.
PMID: 39914746
ISSN: 1600-0641
CID: 5784292
A Rising Tide Lifts all Boats: The Role of the Subspecialist in Recruitment into Pediatrics [Editorial]
PMID: 40738342
ISSN: 1097-6833
CID: 5903602
