Faculty Bibliography
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department:Ophthalmology
recent-years:2
school:SOM
Total Results:
405
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
Home Optical Coherence Tomography-guided Management of Type 3 Macular Neovascularization
PURPOSE/OBJECTIVE:To explore the impact of home optical coherence tomography (OCT)-guided treatment personalization for type 3 macular neovascularization (MNV) in age-related macular degeneration (AMD). METHODS:A prospective home OCT trial of a patient with a one-month history of type 3 MNV under anti-angiogenic treatment (two "loading" injections). During the 23.4-week study period, the patient's treatment regimen was managed through regular self-imaging, enabling continuous monitoring of retinal fluid dynamics. RESULTS:Over the observation period, the patient performed 143 home OCT measurements (mean 6.1 per week, standard deviation 1), which prompted three in-office visits where three anti-angiogenic injections were delivered at the discretion of the investigator. The mean individualized treatment intervals established through home OCT were 8 weeks, with the patient maintaining stable visual acuity at 20/20 Snellen. Complete resolution of intraretinal fluid was noted between injection. Notably, home OCT revealed unexpected fluctuations in retinal fluid measured as hyporeflective spaces in the absence of treatment. Two out of three injections were administered after the retinal fluid volume had decreased by more than half within two, and eight days following an initial transient spike. CONCLUSION/CONCLUSIONS:The neovascular subtype as defined by the Consensus Nomenclature for Reporting Neovascular AMD Data (CONAN) may serve as a useful management framework when approaching home OCT guided treatment decisions. In type 3 disease, home OCT-guided management demonstrates significant potential for optimizing treatment. Further research is warranted to elucidate the dynamics of retinal fluid variations in different MNV subtypes.
PMID: 40700755
ISSN: 1937-1578
CID: 5901652
Objective quantification of trabecular meshwork pigmentation and correlation to primary open-angle glaucoma disease severity
PURPOSE/OBJECTIVE:In this study, we further evaluated a unique early biomarker that has been demonstrated to be correlated with primary open-angle glaucoma in a pilot study. This novel biomarker correlated an increased ratio of pigmentation in the inferior trabecular meshwork (TM) compared to the superior TM with a greater degree of visual field loss in a small subset of patients. We evaluated this association in a larger group of patients. METHODS:This is a retrospective single-center analysis of Black and Afro-Latino patients that make up the local New York inner-city community of Advanced Eyecare of New York in Queens Village and Harlem, New York City with a diagnosis of primary open-angle glaucoma. We reviewed 335 consecutive glaucoma and glaucoma suspect patients with imaging of the TM via the GS-1 gonioscope. The degree of pigmentation was then quantified using ImageJ software to measure the ratio of pigmentation in the superior to inferior TM. We then created a ratio based on these superior to inferior TM measurements for each patient and compared this ratio to the patient's mean deviation of the visual field. RESULTS:Results from 529 eyes in 335 patients demonstrated a positive correlation between the superior-inferior ratio (SIR) of pigmentation and visual field loss. The greater the degree of pigmentation asymmetry between the superior and inferior angle, the greater the extent of visual field deterioration. There was also a positive correlation between the SIR and age. CONCLUSION/CONCLUSIONS:In a larger cohort of patients with glaucoma or glaucoma suspects, on TM pigment assessment with Image J, there was a positive correlation between SIR and worsening visual field mean deviation. Further research is required to evaluate a greater number of normal patients, glaucoma suspects, and glaucoma patients. Further research is also necessary to produce automated TM images and to develop automated assessment of TM pigment density with artificial intelligence to compare with other clinical factors such as age, IOP, OCT, and retinal nerve fiber layer thickness. Since the TM is where damage initially occurs to cause glaucoma, this can potentially lead to earlier detection before IOP elevation and retinal ganglion cell loss.
PMID: 40695690
ISSN: 1943-4693
CID: 5901492
Diagnostic utility of an automated fundus-OCT camera in the emergency department: a retrospective review
BACKGROUND:Posterior segment pathology can be challenging to diagnose and may lead to irreversible vision loss. Ocular imaging modalities are limited in the emergency department (ED) where many posterior segment emergencies present. Automated fundus-OCT cameras are emerging as a rapid, user-friendly and cost-effective tool in the ED. METHODS:Fundus and OCT images were taken by residents as needed for patients undergoing ophthalmology consultation in an academic ED in 2023. Image type and quality were graded on a scale of 1 to 3 (poor, adequate, good). Medical records were reviewed to record relevant patient characteristics. Statistical analysis was performed using unequal variances T-test to compare patients with poor and at least adequate photo quality. RESULTS:288 patients were imaged with the fundus-OCT camera over 12 months. Camera utilization increased at the start of the academic year, then decreased towards the end of the academic year. Adequate diagnostic quality images were taken in 92% of color photos and 94% of OCT images. The odds of poor image quality were significantly higher in patients presenting with logMAR > 1.0 (OR 8.07, 95% CI 3.28-19.86, p < 0.001) and age > 65 (OR 4.69, 95% CI 1.94-11.34, p < 0.001). CONCLUSIONS:Fundus photography and OCT are emerging as viable imaging modalities in the ED where access to ophthalmic expertise and equipment has traditionally been limited. Automated fundus-OCT cameras can offer high quality images that may facilitate rapid and accurate diagnosis of posterior segment pathology.
PMCID:12273200
PMID: 40681995
ISSN: 1471-2415
CID: 5897662
Real-World Experience with Lifitegrast Ophthalmic Solution in Patients with Dry Eye Disease: A Provider Survey in the USA and Canada
INTRODUCTION/BACKGROUND:Lifitegrast ophthalmic solution 5% is indicated to treat signs and symptoms of dry eye disease (DED). This study assessed eyecare professionals' (ECPs) real-world experiences with lifitegrast in DED. METHODS:A total of 12 ECPs (6 ophthalmologists and 6 optometrists) with experience prescribing lifitegrast completed a cross-sectional survey on practice characteristics, lifitegrast utilization, satisfaction, and adverse events (AEs). ECPs rated satisfaction with lifitegrast overall and for specific clinical outcomes versus other prescription eye drops on a 1 (very dissatisfied) to 10 (very satisfied) Likert scale. RESULTS:ECPs reported a mean of 1288 (range, 35-6000) patients with DED treated annually, with 20.9% receiving lifitegrast. Overall, 66.7% of ECPs reported near/complete symptom resolution in patients after 1-3 months of lifitegrast treatment. Mean (range) satisfaction ratings for onset/effectiveness were 6.8 (3-9)/6.6 (3-9). Satisfaction with reduction of DED signs was generally high: increased tear film breakup time, 5.8 (3-9); reduced conjunctival/corneal staining, 6.9 (3-9); increased Schirmer test score, 6.0 (3-9); increased tear meniscus height, 6.0 (3-9); and reduced Ocular Surface Disease Index severity, 7.0 (3-10). Symptom reduction satisfaction ratings were: itching, 5.3 (1-9); dryness, 6.9 (3-9); burning/stinging, 6.3 (1-9); redness, 6.2 (4-9); pain, 6.3 (3-9); light sensitivity, 6.5 (3-9); and blurred/poor vision, 6.8 (4-9). Overall satisfaction (ECPs/patients) was rated 7.1 (3-10)/6.8 (2-9). Predominant uses of lifitegrast included contact lens-induced DED (91.7%) and DED before/after refractive or cataract surgery (83.3% each). AEs reported were consistent with the known AE profile of lifitegrast and included burning/stinging, blurred vision, and dysgeusia. CONCLUSIONS:This real-world survey showed that ECPs use lifitegrast to treat one fifth of their patients with DED and reported moderate-to-high personal and patient satisfaction with lifitegrast treatment.
PMID: 40638059
ISSN: 2193-8245
CID: 5891062
Holographic transcranial ultrasound neuromodulation enhances stimulation efficacy by cooperatively recruiting distributed brain circuits
Precision-targeted ultrasonic neuromodulation offers immense potential for studying brain function and treating neurological diseases. Yet, its application has been limited by challenges in achieving precise spatio-temporal control and monitoring of ultrasound effects on brain circuits. Here we show that transcranial ultrasound elicits direct and highly focal responses, which can be dynamically steered at spatio-temporal scales relevant for neural function. Furthermore, holographic transcranial ultrasound stimulation allows direct control of the stimulated volume and actively modulates local and mid-range network projections, effectively lowering the activation threshold by an order of magnitude. To better understand this previously unexplored excitability regime not fully explained by the conventional pressure-frequency dyad, we developed a dual modelling framework, where both an empirical and a mechanistic model were constructed to capture the intricacies of holographic transcranial ultrasound stimulation. These models achieve qualitative agreement with our experimental results, suggesting that these findings are predominantly driven by putative network interactions. Our results bring insight on the complex interaction mechanisms of ultrasound with neural tissue and highlight its potential for the noninvasive interfacing of distributed brain networks.
PMID: 40624336
ISSN: 2157-846x
CID: 5890532
Artificial Intelligence-Based Detection of Diabetic Retinopathy-Reply
PMID: 40402487
ISSN: 2168-6173
CID: 5853352
Eroded Gore-Tex Scleral Sutures and Endophthalmitis in Atopic Keratoconjunctivitis
PMID: 39674926
ISSN: 2468-6530
CID: 5764032
Standardization of Optical Coherence Tomography Angiography Nomenclature in Retinal Vascular Diseases: Consensus-based Recommendations
OBJECTIVE:To develop a consensus nomenclature for Optical Coherence Tomography Angiography (OCTA) findings in retinal vascular diseases (RVD). DESIGN/METHODS:Expert consensus using standardized online surveys with modified Likert scale. PARTICIPANTS/METHODS:RVD imaging experts, OCT biomedical engineers and the members of the International Retinal Imaging Society (IntRIS) METHODS: A PubMed literature review identified quantitative and qualitative terms forming the basis for a consensus-building process using a modified Delphi method. Agreement levels were categorized as "Accepted" (median ≥ 6), "Considerable Consensus" (median 6-7, IQR ≤ 3), "Strong Consensus" (median ≥ 8, IQR ≤ 2), and "Refined Strong Consensus" (median ≥ 8, IQR ≤ 2, with ≥ 70% responses in the 8-10 range). A multidisciplinary expert panel refined the terminology through three survey rounds, leading to a final survey conducted by IntRIS members. MAIN OUTCOME MEASURES/METHODS:Consensus on OCTA nomenclature in RVD RESULTS: The literature review identified 58 relevant papers, yielding 51 quantitative and 108 qualitative terms. A series of three surveys was used to refine the nomenclature framework for describing OCTA findings. The selected framework includes a generic term ("OCTA signal"), adjective terms ("presence/absence", "decreased/increased", "normal/abnormal"), and descriptive/etiologic terms ("of unknown cause", "due to blockage", "due to non-perfusion"). In the final survey among 44 IntRIS members, the framework achieved strong consensus for overall acceptance (median: 8.0, IQR: 7.0-9.0). The term "OCTA signal" met refined strong consensus criteria (median: 8.0, IQR: 8.0-9.0, with ≥ 70% of responses in the 8-10 range). Adjective terms, including "absence/presence" and "increased/decreased," were also rated with strong consensus (median: 8.0, IQR: 7.0-9.0). Similarly, descriptive/etiologic terms achieved strong consensus (median: 8.0, IQR: 7.0-9.0). Adoption of the framework for clinical practice and scientific reporting was rated with strong consensus (clinical: median 8.0, IQR: 7.0-9.0; scientific: median 9.0, IQR: 8.5-10.0). CONCLUSIONS:This study establishes a strong consensus framework for reporting OCTA findings in RVD for clinical and scientific contexts.
PMID: 39894444
ISSN: 2468-6530
CID: 5783562
Advancing Ocular Safety Profile Assessment: A Novel Grading Scale for Ocular Adverse Reactions Associated with Bemarituzumab
Targeted cancer therapies have transformed the landscape of cancer treatments but are often associated with off-target adverse drug reactions due to overlapping molecular pathways in healthy tissues, including those in the eye. Fibroblast growth factor receptors (FGFRs), expressed across various parts of the eye, can become unintended targets of FGFR inhibitors such as erdafitinib, infigratinib, and pemigatinib, leading to ocular adverse events (AEs) affecting the ocular surface and retina. AEs across clinical trials are graded using the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE), which may not completely capture the ocular sequelae resulting from the use of emerging therapies. As CTCAE grading is mainly through the description of symptoms and their impact on visual acuity, it is imperative to use a tool that relies more on objective findings from ophthalmologic evaluations. The novel ocular adverse reaction severity grading scale developed by Amgen in collaboration with expert ophthalmologists, accounts for the anatomical regions impacted by ocular adverse reactions and anchors each severity grade to objective observable criteria from ophthalmologic evaluations. This grading scale is being used across the clinical development program for bemarituzumab to precisely characterize the ocular safety profile, enabling cross-specialty collaboration between oncologists and eye care providers to implement appropriate management strategies. This commentary article highlights the efforts led by Amgen in collaboration with regulatory, medical, and academic fields to develop tools that facilitate early recognition of adverse reactions and appropriate interventions for patient care.
PMID: 40355729
ISSN: 2193-8245
CID: 5844032
