Ophthalmology Commons^™

Room To Wiggle, Holden Caplan, Bs

inSIGHT

Uveitis – inflammation of the inside of the eye and the fifth leading cause of vision loss in the USA. Uveitis (of which there are 30-40 types) may be infectious or non-infectious, unilateral or bilateral, of sudden onset or progressing over months to years, and present in any age group. Different etiologies cause different presentations, including both onset and location (front, middle, or back; Table 1) in the eye.

Exploring The Debate: Dmek And Dsek In Corneal Transplantation, Christian Raimondo, Bs

inSIGHT

Scientific progress is rarely a linear process. This notion is especially true as it pertains to the development of surgical techniques that have the potential to shape future clinical landscapes. Corneal transplantation is no exception. From the very first iterations of full corneal transplants performed in the 19th century to the highly nuanced endothelial procedures available today, corneal medicine has served — and continues to foster — an academic arena where research discoveries and surgical innovations come together to advance the field.

Review Of Surgical Management For Closed-Angle Glaucoma, Scott Kozarsky, Ba

inSIGHT

Closed-angle glaucoma, also known as angle-closure glaucoma, is one of the major types of glaucoma. Glaucoma is a term used to describe a broad group of ocular diseases that damage the optic nerve. The type of angle closure with which the patient presents, whether acute, subacute, or chronic, will dictate their treatment. Management of these three presentations will be discussed at length later in this article. In the United States, closed-angle glaucoma is less common than open-angle glaucoma, which often has a gradual onset of intraocular pressure (IOP) elevation and optic nerve damage.

Age-Related Macular Degeneration And Emerging Treatments – With Advice From Dr. Ajay Kuriyan On Balancing Research With Clinical Responsibilities, Charles Deyoung, Ba

inSIGHT

Age-related macular degeneration (AMD) is a chronic disease of the central retina and a leading cause of vision loss worldwide. Although the early stages of AMD may present asymptomatically, the disease may progress and lead to severe visual impairment via geographic atrophy (“late dry”) or neovascular (“wet”) AMD. In geographic atrophy (GA), there is progressive atrophy of the retinal pigment epithelium (RPE), choriocapillaris, and photoreceptors due to lipofuscin (Drusen) accumulation between the RPE and Bruch’s membrane.¹ These Drusen deposits grow and create an inflammatory and metabolically dysfunctional environment for the photoreceptors supplying the macula (Figure 1).² Eventually, the …

Insight, Volume 3, Issue 1, 2023

inSIGHT

Contents

8 - Age-Related Macular Degeneration and Emerging Treatments
By Charles F. DeYoung

13 - Review of Surgical Management for Closed-Angle Glaucoma
By Scott C. Kozarsky

18 - Exploring the Debate: DMEK and DSEK in Corneal Transplantation
By Christian Raimondo

23 - Room to Wiggle
By Holden Caplan

30 - Ophthalminute Highlight
By Anza Rizvi

34 - Thyroid Eye Disease: Overview and Treatment
By Michelle Omega

38 - Current Barriers to Eye Care
By Annika G. Samuelson

Seeing Eye To Eye: An Overview Of Strabismus And Approach To Treatment, Shreya Swaminathan, Bs

inSIGHT

Strabismus is a heterogenous group of conditions characterized by the misalignment of the eyes. It may manifest as constant or intermittent deviation, meaning the eyes sometimes appear well aligned, or straight, and sometimes appear misaligned. Vision can be normal in some patients, but when associated with amblyopia, may be decreased vision in one eye. There is sometimes diminished binocular vision, with decreased depth perception.

A Look Into Oculoplastics: Repairing Lower Eyelid Defects From Carcinomas, Cameron Haghshenas, Bs

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Eyelids are the thinnest, most sensitive skin we have and can easily be damaged by sun exposure. This is evident given that 5 - 10% of all skin cancers occur on the eyelid, and over half of these occur on the lower eyelid¹. Most of such cases are basal cell carcinomas, which are slow-growing cancers that arise from the basal cell layer, the deepest part of the epidermis. If left untreated or improperly treated, these tumors can extend into adjacent tissues and bone, or recur. Squamous cell carcinomas can also occur on the lower eyelid, although they represent …

Manual Small-Incision Cataract Surgery, Ankur Nahar, Bs

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Of the 49 million people living with blindness worldwide, 15.2 million are blind due to cataracts, making it the leading cause of preventable blindness.^1,2 Furthermore, 65.2 million people experience moderate to severe vision impairment from cataracts, according to the World Report on Vision published by the World Health Organization (WHO).³ While global cataract surgery efforts have been a major success over the past three decades, an aging population has resulted in a rapid rise in cataracts, primarily in low- and middle-income countries (LMICs).^2,4 To address the increasing demand for cataract treatment, countries must perform an equal or …

Gatt: A Micro-Invasive Glaucoma Surgery And A Big Step For Glaucoma Treatment, Mose Im, Bs

inSIGHT

Glaucoma is a group of ocular diseases characterized by damage to the optic nerve that may lead to permanent vision loss. Currently, 76 million people (aged 40-80 years) suffer from glaucoma, and the prevalence is projected to increase to 111.8 million by 2040.¹ The diagnosis of glaucoma can be frightening, particularly because there is no known cure. Fortunately, recent advancements in glaucoma surgery have made more options available for patients presenting with new-onset glaucoma. In particular, patients with mild to moderate glaucoma may be eligible for newer minimally invasive glaucoma surgeries (MIGS). This review is both an overview of …

Origins Of The Wills Eye Manual: Surviving The Test Of Time, Jordan Safran, Bs

inSIGHT

The first copy of the Wills Eye Manual hit the press in late 1989; it featured a black cover page with bold gold lettering and the Wills Eye logo proudly displayed on top. Published in a time before the invention of the world wide web or the advent of digital printing, this 450-page expertly sourced ocular disease reference guide took the ophthalmology world by storm. Since its debut, the manual has served as the go-to guide for trainees and seasoned physicians alike in diagnosing and treating more than 200 ocular diseases. To date, the Wills Eye Manual has published eight …

A Day In The Life In The Wills Er, Samara Hamou, Ms1

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The Wills Eye Hospital — among the greatest eye hospitals in the country — is a force to be reckoned with. Located in Center City Philadelphia, the eight-story tall brick facility will capture your attention as you stroll down Walnut Street. The entrance to the Wills Eye Emergency Room (ER), however, is less apparent to the average city-goer. Located directly across from the Hospital, the red and blue entrance sign may go unnoticed to the unsuspecting by passer. However, for those who require expert eye care in a timely fashion, the Eye Emergency Room is a signal for the invaluable …

Neuro-Ophthalmology Subspecialty Highlight: With Dr. Sarah Thornton, Wills Eye Hospital, Joseph D. Desimone, Bs

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Neuro-Ophthalmology is a subspecialty within ophthalmology that combines the complexities of nervous system disease with the intricacies of the ocular manifestations of those diseases. Neuro-ophthalmologists work closely with neurologists, neurosurgeons, rheumatologists, and other ophthalmologists in different subspecialties, such as retina and glaucoma, to get to the source of their patients’ problems. Neuro-ophthalmology is typically a 1-year fellowship undertaken after residency training is completed, where physicians will learn the complex ways different diseases can manifest in the eye.

A New Dimension To Offer, Ari August, Bs

inSIGHT

Technological advancements are crafted, fielded, and sold from the vantage point of benefit: How can this make my life better? The origins of three-dimensional (3D) technology are no different. 3D technology targets the mind’s ability to make sense of two different angles of an image, and therefore perceive depth. Earlier models, common in movie theaters and cereal box toys, utilized red and blue lenses to outwit one’s perception of a flat image and project it into 3D images, promising deeper immersive experiences and even “x-ray vision.” More recently, the capacity of 3D technology has expanded, as seen with the recent …

Insight, Volume 2, Issue 1, 2022

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Contents

10 - A New Dimension to Offer
By Ari August

14 - Neuro-Ophthalmology Subspecialty Highlight: with Dr. Sarah Thornton, Wills Eye Hospital
By Joseph D. DeSimone

19 - A Day in the Life in the Wills Eye ER
By Samara Hamou

22 - Origins of the Wills Eye Manual: Surviving the Test of Time
By Jordan Safran

26 - GATT: A Micro-invasive Glaucoma Surgeryand a Big Step for Glaucoma Treatment
By Moses Im

31- Manual Small-Incision Cataract Surgery
By Ankur Nahar

34 - A Look into Oculoplastics: Repairing Lower Eyelids Defects From Carcinomas
By Cameron Haghshenas

38 - Seeing …

Narrative Medicine In Ophthalmology, Martina Rama

inSIGHT

While technological and medical advancements have made it possible to diagnose and treat previously deadly conditions, modern day medicine comes with a new set of challenges around the doctor-patient relationship. Scientifically competent medicine cannot always help patients cope emotionally with their health issues. For physicians, understanding patients’ experience with illness in order to comfort and accompany them through their challenges is just as important as meeting their physical health needs. Dr. Rita Charon, the founder of narrative medicine, highlights how physicians today sometimes lack the ability to connect with, empathize with, and support their patients through difficult diagnoses.¹ When …

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