Ophthalmology Commons^™

An Inside Look: Oculoplastics And “Droopy Eyelids”, Payton Boere

inSIGHT

In writing this article, I had the pleasure of speaking with Dr. Alison Watson, an oculoplastic attending surgeon at Wills Eye Hospital, all about this exciting and innovative specialty. During our discussion, she said that one of the things she loves most about this field is its diversity, including the range of procedures she gets to perform and patients she is able to treat. While there are procedures common to all oculoplastic surgeons, such as cosmetic and functional eyelid surgery to address both upper and lower eyelid malposition, reconstruction following periocular cancer resection, along with nasolacrimal surgery, Dr. Watson explained …

The Present And Future Of Artificial Intelligence In Ophthalmology, Robert Abishek, Elliot Cherkas

inSIGHT

Dr. Ravi Goel is a comprehensive ophthalmologist and cataract surgeon at Wills Eye Hospital, with a specific interest in finding ways that AI can help ophthalmologists improve their clinical care and treat more patients. Dr. Goel also publishes a daily blog, Protecting Sight, where he discusses a variety of topics ranging from advances in cataract surgery to medical education. One common thread throughout his blog is the burgeoning impact of AI on the field of ophthalmology, such as the utility of deep learning algorithms for diagnosing various diseases and the impact that improved intra-ocular lens (IOL) power calculations will have …

Off Label Innovation: Discovering New Uses For Glaucoma Drops, Glenn Oh

inSIGHT

Dr. Jason Hsu and his team (Ophthalmic Consultants of Boston, Boston, Massachusetts; Retinal Consultants of Houston, Houston, Texas; Retina Service of Wills Eye Hospital and Mid Atlantic Retina, Philadelphia, Pennsylvania; Associated Retinal Consultants, Royal Oak, Michigan) performed a multicenter randomized placebo-controlled clinical trial in which patients with nAMD who were suboptimal responders despite frequent anti-VEGF injections were randomized to use either dorzolamide-timolol drops or artificial tears.16 Eligible patients were 45 years or older with nAMD who were receiving ranibizumab or aflibercept injections at 4 - 6 week intervals (i.e., at least four injections within six months prior to enrollment) and …

A Career Of Honor And Humility: Interview With A Pioneer In Ophthalmology, Eli Cehelyk

inSIGHT

Imagine being a first-time parent in your early 30s, and you have just learned that your three-month old infant has retinoblastoma. Thanksgiving is right around the corner and you have no idea what the future holds. How would you feel? What thoughts would be racing through your head? With both hope and anxiety, you make an appointment at Wills Eye to see Dr. Carol Shields, a world-renowned expert on ocular oncology. With confidence and compassion, she walks into the room with her entire team and says, “Don’t worry, we will get everything under control for you. We will take your …

An Experience In The Wills Academic Global Ophthalmology Fellowship And Beyond, Crystal Lee, Mph

inSIGHT

Even before medical school, Dr. John Anhalt knew he wanted to serve communities all over the globe—after college, he joined the Peace Corps for two years, teaching math and science in the Kingdom of Lesotho. After seeing the vast differences between the health care in Lesotho and in the United States, Dr. Anhalt was inspired to apply to medical school with the intention of pursing a specialty in infectious disease before launching a career in global medicine. It was not until his ophthalmology rotation in University of Texas San Antonio, that he realized that ophthalmology, with its mix of medical …

Insight, Volume 1, Issue 1, 2021

inSIGHT

Contents

10 - An Experience in the Wills Academic Global Ophthalmology Fellowship and Beyond
By Crystal Lee

14 - A Career of Honor and Humility: Interview with a Pioneer in Ophthalmology
By Eli Cehelyk

19 - Off Label Innovation: Discovering New Uses for Glaucoma Drops
By Glenn Oh

22 - The Present and Future of Artificial Intelligence in Ophthalmology
By Robert Abishek & Elliot Cherkas

26 - An Inside Look: Oculoplastics and “Droopy Eyelids”
By Payton Boere

31 - Narrative Medicine in Ophthalmology
By Martina Rama

Resident Immune Cells Of The Avascular Lens: Mediators Of The Injury And Fibrotic Response Of The Lens., A. Menko, Jodirae Dedreu, Caitlin M. Logan, Heather Paulson, Alex V Levin, Janice L Walker

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Tissues typically harbor subpopulations of resident immune cells that function as rapid responders to injury and whose activation leads to induction of an adaptive immune response, playing important roles in repair and protection. Since the lens is an avascular tissue, it was presumed that it was absent of resident immune cells. Our studies now show that resident immune cells are a shared feature of the human, mouse, and chicken lens epithelium. These resident immune cells function as immediate responders to injury and rapidly populate the wound edge following mock cataract surgery to function as leader cells. Many of these resident …

Properties Of Multivesicular Release From Mouse Rod Photoreceptors Support Transmission Of Single-Photon Responses, Cassandra L. Hays, Asia L. Sladek, Greg D. Field, Wallace B. Thoreson

Journal Articles: Ophthalmology

Vision under starlight requires rod photoreceptors to transduce and transmit single-photon responses to the visual system. Small single-photon voltage changes must therefore cause detectable reductions in glutamate release. We found that rods achieve this by employing mechanisms that enhance release regularity and its sensitivity to small voltage changes. At the resting membrane potential in darkness, mouse rods exhibit coordinated and regularly timed multivesicular release events, each consisting of ~17 vesicles and occurring two to three times more regularly than predicted by Poisson statistics. Hyperpolarizing rods to mimic the voltage change produced by a single photon abruptly reduced the probability of …

Umbilical Amnion And Amniotic Membrane Transplantation For Infectious Scleritis And Scleral Melt: A Case Series., Zeba Syed, Christopher J Rapuano

Wills Eye Hospital Papers

Purpose: To report the outcomes of two cases of infectious scleritis with severe scleral thinning managed using combined mechanical debridement, cryopreserved umbilical amnion (UA) and amniotic membrane (AM) grafts, and antimicrobial therapy.

Observations: Two patients presented with severe infectious scleritis with progressive scleral melts secondary to Pseudomonas aeruginosa subsequent to pterygium surgery and intravitreal injection, respectively. Surgical debridement was followed by UA grafting, AM transplantation, and antimicrobial therapy. Epithelialization and vascularization were seen within 1–4 weeks post-operatively. At last follow up of 5–6 months, the structural integrity of the sclera remained preserved with no infection recurrence, graft necrosis, or wound …

Differential Leukocyte And Platelet Profiles In Distinct Models Of Traumatic Brain Injury, William Brad Hubbard, Meenakshi Banerjee, Hemendra J. Vekaria, Kanakanagavalli Shravani Prakhya, Smita Joshi, Qingjun Wang, Kathryn E. Saatman, Sidney W. Whiteheart, Patrick G. Sullivan

Spinal Cord and Brain Injury Research Center Faculty Publications

Traumatic brain injury (TBI) affects over 3 million individuals every year in the U.S. There is growing appreciation that TBI can produce systemic modifications, which are in part propagated through blood–brain barrier (BBB) dysfunction and blood–brain cell interactions. As such, platelets and leukocytes contribute to mechanisms of thromboinflammation after TBI. While these mechanisms have been investigated in experimental models of contusion brain injury, less is known regarding acute alterations following mild closed head injury. To investigate the role of platelet dynamics and bioenergetics after TBI, we employed two distinct, well-established models of TBI in mice: the controlled cortical impact (CCI) …

Efficacy Of An Appointment Specialist In Reducing Loss To Follow Up In A Retina Practice, Turner D. Wibbelsman, Michael Ammar, Md, Anthony Obeid, Md, Mph, Jason Hsu, Md

Phase 1

Introduction:

Although a new armamentarium has greatly benefitted patients with retinal disease, novel therapeutic approaches require more frequent clinic visits, which may lead to missed treatments and vision loss. This study characterizes patient-reported reasons for missed visits and assesses the efficacy of calling patients for rescheduling missed visits.

Methods:

This retrospective cohort study included patients who missed an appointment for an intravitreal injection between January 2018 and February 2020 at the Retina Service of Wills Eye Hospital. Two calls were made to each patient by an appointment specialist to reschedule the visit and record a reason for the …

Likelihood Of Germline Mutation With Solitary Unilateral Retinoblastoma Based On Patient Age At Presentation. A Real-World Analysis Of 482 Consecutive Patients., Martin Calotti, Carol L. Shields, Md, Philip Dockery, Md, Mph, Megan Ruben, Antonio Yaghy, Md, Madalyne A. Sunday, Emily R. Duffner, Hannah J. Levin, Olivia S. Taylor, Sara E. Lally, Md, Jerry A. Shields, Md

Phase 1

Introduction: Retinoblastoma due to germline mutation has a greater risk of bilateral presentation, and multifocal or extraocular involvement. In solitary unilateral retinoblastoma, the inheritance pattern is less understood and assumed to be somatic. We assessed the likelihood of germline inheritance in children with unilateral retinoblastoma and whether it varies based on age at presentation.

Methods: This was a retrospective case study assessing 482 consecutive patients with solitary unilateral retinoblastoma at Wills Eye Hospital between 1972 and 2020 for the likelihood of germline inheritance based on age at presentation (≤1 year vs. >1 year). Germline inheritance was deemed likely if …

White Paper On Ophthalmic Imaging For Choroidal Nevus Identification And Transformation Into Melanoma, Carol Shields, Sara E. Lally, Lauren Dalvin, Mandeep Sagoo, Marco Pellegrini, Swathi Kaliki, Ahmet Kaan Gündüz, Minoru Furuta, Prithvi Mruthyunjaya, Adrian T. Fung, Jay S. Duker, Sara M. Selig, Antonio Yaghy, Sandor R. Ferenczy, Malvina B. Eydelman, Mark S. Blumenkranz

Wills Eye Hospital Papers

Purpose: To discuss the evolution of noninvasive diagnostic methods in the identification of choroidal nevus and determination of risk factors for malignant transformation as well as introduce the novel role that artificial intelligence (AI) can play in the diagnostic process. Methods: White paper. Results: Longstanding diagnostic methods to stratify benign choroidal nevus from choroidal melanoma and to further determine the risk for nevus transformation into melanoma have been dependent on recognition of key clinical features by ophthalmic examination. These risk factors have been derived from multiple large cohort research studies over the past several decades and have garnered widespread use …

Corneal Disease And Air Pollution Levels In Detroit: Preliminary Results And Future Directions​, Sachin Ketkar, Matthew Silbergleit, Vaama Patel

Medical Student Research Symposium

Purpose: To determine if Detroit zip codes with elevated air pollution levels demonstrate increased incidence of corneal disease.

Background: 82 million people in the United States live in counties with air quality concentrations above the National Ambient Air Quality Standards. Air pollution’s detrimental effects on an individual’s health has been well documented. Much of this research has focused on the pulmonary system. The eye, another mucous membrane exposed to the external environment, has been largely ignored

Methods: After an initial literature review of similar studies, 14 corneal diseases and 5 pollutants were selected to be evaluated. Kresge Eye Institute’s patient …

Professional Coaching In Residency: A Novel Approach To Decrease Resident Burnout, Matthew Silbergleit, Shibandri Das, Mark S. Juzych, Pradeepa Yoganathan

Medical Student Research Symposium

Purpose: To implement and analyze an organizational level coaching program for ophthalmology residents at the Kresge Eye Institute (KEI) as the front-line method for prevention and management of physician burnout.

Background: Burnout is a well-documented stressor in medicine and has been shown to significantly increase unprofessional conduct and medical errors. A recent, promising model to tackle burnout in the medical field is coaching. The Harvard Business Review and American Medical Association have demonstrated the positive effects of coaching on professional performance and well-being.

Methods: We plan on utilizing the Kern Method to develop a resident wellness curriculum addressing resident burnout. …

Complication Rates In Resident Cataract Surgery After Elective Operating Room Shutdown During The Covid-19 Pandemic, Michael Schneider, Christian Mehregan Md, Collin Richards, Shibandri Das Md, Xihui Lin Md

Medical Student Research Symposium

Purpose: To assess the types of cataract surgeries being performed at one large eye institute from before and after the COVID-19 induced shutdown of elective surgeries in Spring 2020.

Methods: This is a retrospective chart review study of operative reports from resident performed cataract surgeries from January 1st, 2020 through July 31st, 2020. Cataract surgeries were categorized into Pre-COVID (Jan – Mar 2020) if they occurred prior to operating room (OR) shutdown on March 18th, 2020 and Post COVID for all cases which occurred after the shutdown orders were lifted (May – July 2020). A resident survey was also used …

Post-Operative Day 1 Versus Day 0 Follow-Up For Uncomplicated Cataract Surgeries: A Comparison Of Post-Operative Outcomes And Managements, Harsh Parekh Bs, Shibandri Das Md, Vaama Patel Md, Ryan Freedman Md, Sabba Mansoor Bs, Amanda Ismail Md, Faisal Ridha Al-Timimi Md

Medical Student Research Symposium

Purpose: To compare the postoperative outcomes and management of uncomplicated cataract surgery (CEIOL) patients seen on post-operative day zero (POD 0) versus post-operative day one (POD 1).

Methods: A retrospective chart review of 533 patients who had CEIOL at the Kresge Eye Institute from December 2017 to September 2019 was performed. Visual acuity (VA) and intraocular pressure (IOP) were collected from the pre-operative visit, and the first and second post-operative day visits. In addition, changes in management were recorded from the first post-operative day visit. Patients were excluded if they had a complex cataract procedure, had combined glaucoma filtering surgery, …

Resident Heart Rate Variability During Cataract Surgery, Ahmad Baiyasi, Shibandri Das, Ferris Bayasi, Faisal Ridha Al-Timimi

Medical Student Research Symposium

Purpose: To evaluate ophthalmology resident anxiousness and cardiovascular response by tracking resident heart rate (HR) when performing cataract surgery during their last year of residency.

Methods: A prospective analysis of 31 cataract cases, completed by three residents (two females and one male), at the Kresge Eye Institute in August and September 2020 was performed. Inclusion criteria for cases included all cataract cases performed by PGY-4 residents at the Kresge Eye Institute who downloaded the Heart Graph app supported by iOS. Residents with android mobile devices were excluded from the study. Informed consent was obtained from all residents who utilized the …

A Systematic Review On Three Major Types Of Scleral-Fixated Intraocular Lens Implantation, Ho Ming Wong, Ka Wai Kam, Christopher J Rapuano, Alvin L Young

Wills Eye Hospital Papers

PURPOSE: We performed a systematic review on 3 major types of scleral-fixated intraocular lens (SFIOL) implantations and conducted subgroup analyses on pediatric population and subjects with Marfan syndrome.

DESIGN: Systematic review.

METHODS: We performed a search in PubMed, Ovid MEDLINE, and Embase for English language articles with keywords "(sutured intraocular lens) OR (SFIOL) OR (sutureless intraocular lens) OR (glued intraocular lens) OR (intrascleral intraocular lens) OR (SFIOL)" through October 16, 2019. Articles reporting individual outcomes after SFIOL were included in this systematic review. Recorded outcome measures included intraoperative and postoperative complications, endothelial cell changes, and intraocular lens-related outcomes.

RESULTS: Our …

Optic Nerve Pit Maculopathy Worsened During Pregnancy: A Case Report, Laura A. Torrado-Cobian, George D. Fivgas

School of Medicine Faculty Publications

Background: To report a case of Optic Disc Pit (ODP) maculopathy exacerbated during pregnancy. Case presentation: A 30-year-old female developed unilateral blurry vision at 10-weeks gestation. Ophthalmic examination revealed left eye reduced visual acuity (VA) with the presence of subretinal fluid temporal to the disc extending to the fovea. On Spectral Domain Optical Coherence Tomography (SD-OCT) subretinal, and intraretinal fluid was confirmed. Laser photocoagulation was tried in an attempt to prevent surgical intervention without success; subsequently, pars plana vitrectomy, internal limiting membrane peel and gas tamponade was performed. Three-weeks later, a full thickness macular hole developed, and repeat surgery was …

Cergc And Vision Loss From Traumatic Optic Neuropathy Indud By Repetitive Closed Head Trauma Is Dependent On Timing And Force Of Impact., Reas S. Khan, Ahmara G. Ross, Puya Aravand, Kimberly Dine, Evan B. Selzer, Kenneth S. Shindler

Student Papers, Posters & Projects

Purpose: Traumatic optic neuropathy (TON) is often caused by blunt head trauma and has no currently effective treatment. Common animal models of TON induced by surgical crush injury are plagued by variability and do not mimic typical mechanisms of TON injury. Traumatic head impact models have recently shown evidence of TON, but the degree of head impact necessary to consistently induce TON is not well characterized, and it is examined here.

Methods: Traumatic skull impacts to C57BL/6J mice were induced using an electromagnetic controlled impact device. One impact performed at two depths (mild and severe), as well as three and …

Application Of Big-Data For Epidemiological Studies Of Refractive Error, Michael Moore, James Loughman, John Butler, Arne Ohlendorf, Siegfried Wahl, Daniel Ian Flitcroft

Articles

Purpose

To examine whether data sourced from electronic medical records (EMR) and a large industrial spectacle lens manufacturing database can estimate refractive error distribution within large populations as an alternative to typical population surveys of refractive error.

Subjects

A total of 555,528 patient visits from 28 Irish primary care optometry practices between the years 1980 and 2019 and 141,547,436 spectacle lens sales records from an international European lens manufacturer between the years 1998 and 2016.

Methods

Anonymized EMR data included demographic, refractive and visual acuity values. Anonymized spectacle lens data included refractive data. Spectacle lens data was separated into lenses …

Direct Multiplexing Of Low Order Aberration Modes In A Photopolymerbased Holographic Element For Analog Holographic Wavefront Sensing, Emma Branigan, Suzanne Martin, Matthew Sheehan, Kevin Murphy

Conference Papers

The fabrication of an analog holographic wavefront sensor, capable of detecting the low order defocus aberration, was achieved in an acrylamide-based photopolymer. While other implementations of holographic wavefront sensors have been carried out digitally, this process utilises a recording setup consisting only of conventional refractive elements so the cost and complexity of holographic optical element (HOE) production could be much reduced. A pair of diffraction spots, corresponding to a maximum and minimum amount of defocus, were spatially separated in the detector plane by multiplexing two HOEs with different carrier spatial frequencies. For each wavefront with a known aberration that was …

Application Of Big-Data For Epidemiological Studies Of Refractive Error, James Loughman

Articles

To examine whether data sourced from electronic medical records (EMR) and a large industrial spectacle lens manufacturing database can estimate refractive error distribution within large populations as an alternative to typical population surveys of refractive error.

Use Of Polarized Light In The Diagnosis Of "Fuzz" Granuloma In The Conjunctiva Of A Child., Andrew R. Dorion, Gordon Crabtree, R. Patrick Dorion

Student Papers, Posters & Projects

Synthetic fiber granulomas, also known as "Teddy Bear" granulomas or "Fuzz Ball granulomas," are usually seen in childhood. We present a case of a 5-year-old child with a "Fuzz Ball" granuloma of the conjunctiva. The resected specimen was processed routinely. The use of polarized light during microscopic examination of the resected tissue made the diagnosis evident due to the prominent birefringence of the synthetic foreign material fibers.

Blue Light And Adult Sleep Outcomes, Andrew Caddas

Undergraduate Distinction Papers

This study investigated the effects blue light from self-luminous devices has on adult sleeping patterns. We investigated sleep quality and duration qualitatively with a randomized, double-blind, cross-over, placebo-controlled design with a wash-out period. Participants wore blue light blocking lenses or placebo lenses whenever they were using a self-luminous device throughout each day for one week. Each morning, participants filled out a survey to report their number of hours slept, time to fall asleep, and amount of time spent on self-luminous devices. Participants took the Pittsburgh Insomnia Rating Scale (PIRS) at the end of the one week trial (See Appendix A). …

Dry Eye: Patient Education, Mark Oet

Family Medicine Clerkship Student Projects

Recent literature has shown increased incidence of dry eye and eye strain symptomatology during the COVID-19 pandemic, coinciding with an increase in screen time for almost all populations. This project aims to address this observation at a community level by creating a patient-friendly education pamphlet for Newtown Primary Care about dry eye and digital ocular strain based on American Academy of Ophthalmology guidelines.

Solutions For Fermi Questions, January 2022: Question 1: Snow Volume; Question 2: Longbow Arrow Velocity, Larry Weinstein

Physics Faculty Publications

No abstract provided.

The Role Of Simulators In Improving Vitreoretinal Surgery Training - A Systematic Review, Taha Muneer Ahmed, Rehman Siddiqui

Medical College Documents

Objective: To conduct an appraisal of current evidence regarding the effectiveness of EyeSi®-based training of vitreoretinal surgery.
Methods: The systematic review was conducted in July 2020, and comprised literature search on Cochrane Library, PubMed and Embase for articles regarding simulation training in vitreoretinal surgery. The shortlisted articles were subjected to qualitative analysis. Existing evidence was assessed, and predictions on how outcomes may be applied to improve vitreoretinal surgery training were made. The risk of bias of each study was calculated in line with the guidelines of the Cochrane Handbook.
Results: Of the 124 articles identified, 7(5.6%) were shortlisted; 5(71.4%) established …

Determining Risk Factors That Affect Progression In Patients With Nonproliferative Diabetic Retinopathy, Dalbert J Chen, Jacky C Kuo, Alex J Wright, Alice Z Chuang, Wenyaw Chan, Robert M Feldman, Eric L Crowell

Journal Articles

PURPOSE: to determine risk factors that affect nonproliferative diabetic retinopathy (NPDR) progression and establish a predictive model to estimate the probability of and time to progression in NPDR.

RESULTS: Two hundred thirty patients were included. Initially, 65 eyes (28.3%) had no retinopathy; 73 (31.7%) mild NPDR; 60 (26.1%) moderate NPDR; and 32 (13.9%) severe NPDR. Patients were followed for a mean of 5.8 years (±2.0 years; range 2.1-9.4 years). 164 (71.3%) eyes progressed during the follow-up. Time-independent risk factors affecting progression rate were age (hazard ratio (HR) = 0.99,

CONCLUSION: HbA1c level is a significant modifiable risk factor in controlling …