Ophthalmology Commons^™

Ocular Syphilis: A Case Report And Public Health Discussion, Andrew L. Fine, Hope V. Daskalakis, Rutwik Pradeep Sharma M.D., Mirna Ogeilat M.D.

Advances in Clinical Medical Research and Healthcare Delivery

Ocular Syphilis describes a localized manifestation of a systemic treponema pallidum infection. It most commonly presents with decreased visual acuity due to uveitis and can occur at any time throughout the disease course. This report describes a case of undiagnosed syphilis that was serendipitously diagnosed with blood product screening. This case highlights the need for better public education and outreach pertaining to sexually transmitted infections. This report will detail this patient's clinical course and discuss how healthcare providers can aid in early disease detection to improve both patient outcomes and overall public health.

Targeting Cyp51 In The Treatment Of Acanthamoeba Keratitis, Ashkan Hassani, Vineet Sadarangani, Brad Haubrich

Annual Research Symposium

Acanthamoeba castellanii causes a rare but serious ocular infection called Acanthamoeba keratitis. Risk factors for infection include contact with contaminated water and poor hygiene of contact lenses. The first-line treatment is comprised of a months-long schedule of antibiotics. However, in cases where pharmacological interventions fail to address the infection, surgery may be necessary, with the continued risk of potential vision loss. Consequently, new treatments are needed, whether new pharmacological agents or new combination therapies with current agents. As an aerobic parasite, Acanthamoeba synthesizes ergosterol as a cell membrane insert, and ergosterol biosynthesis inhibitors (EBIs), common in antifungal pharmaceuticals, could potentially …

Efficacy And Safety Of Artificial Tears Containing Lipidure And Hypromellose For The Treatment Of Moderate Dry Eye Disease In Contact Lens Wearers, Caterina Gagliano, Marco Zeppieri, Antonio Longo, Giovanni Rubegni, Roberta Amato, Roberta Foti, Francesco Cappellani, Massimiliano Cocuzza, Federico Visalli, Ludovica Cannizzaro, Alessandro Avitabile, Giuseppe Gagliano, Lucia Lapenna, Fabiana D'Esposito

Wills Eye Hospital Papers

Background and Objectives: Dry eye disease (DED) affects 5–50% of the global population and deeply influences everyday life activities. This study compared the efficacy, tolerability, and safety of novel Respilac artificial tears containing lipidure and hypromellose (HPMC) with the widely used Nextal artificial tears, which are also HPMC-based, for the treatment of moderate DED in contact lenses (CL) wearers.

Materials and Methods: In a prospective, single-center, randomized investigation, 30 patients aged ≥18 years, diagnosed with moderate DED, and wearing CL were randomly assigned to the Respilac (n = 15) or Nextal group (n = 15). Patients self-administrated one drop of …

A Comparative Study Of Responses To Retina Questions From Either Experts, Expert-Edited Large Language Models, Or Expert-Edited Large Language Models Alone, Prashant D. Tailor, Lauren A. Dalvin, John J. Chen, Raymond Iezzi, Timothy W. Olsen, Brittni A. Scruggs, Andrew J. Barkmeier, Sophie J. Bakri, Edwin H. Ryan, Peter H. Tang, D. Wilkin Parke, Peter Belin, Jayanth Sridhar, David Xu, Ajay E. Kuriyan, Yoshihiro Yonekawa, Matthew R. Starr

Wills Eye Hospital Papers

OBJECTIVE: To assess the quality, empathy, and safety of expert edited large language model (LLM), human expert created, and LLM responses to common retina patient questions.

DESIGN: Randomized, masked multicenter study.

PARTICIPANTS: Twenty-one common retina patient questions were randomly assigned among 13 retina specialists.

METHODS: Each expert created a response (Expert) and then edited a LLM (ChatGPT-4)-generated response to that question (Expert + artificial intelligence [AI]), timing themselves for both tasks. Five LLMs (ChatGPT-3.5, ChatGPT-4, Claude 2, Bing, and Bard) also generated responses to each question. The original question along with anonymized and randomized Expert + AI, Expert, and LLM …

Effect Of Suprachoroidal Triamcinolone On Intraocular Pressure: A Systematic Review And Meta-Analysis, Altamash Shahriyar Ghazanfar, Aly Hamza Khowaja, Haroon Tayyab

Department of Ophthalmology & Visual Sciences

Background: Triamcinolone acetonide is a synthetic corticosteroid with multiple ocular uses. Like other corticosteroids, it too is associated with ocular side effects such as increased intraocular pressure (IOP), glaucoma and cataracts. Suprachoroidal administration of triamcinolone is hoped to reduce the ocular side effects of the drug, especially rises in IOP. Our systematic review and meta-analysis aims to study this phenomenon.
Objectives: The purpose of this study was to evaluate the effect of suprachoroidal triamcinolone injections on IOP.
Design: Systematic review and meta-analysis.
Methods: We utilized the Medline, Scopus and Cochrane databases for this review. Studies published till June 2023, which …

Phenotypic Features Determining Visual Acuity In Albinism And The Role Of Amblyogenic Factors., Frank A Proudlock, Rebecca J Mclean, Viral Sheth, Sarim Ather, Irene Gottlob

Cooper Medical School of Rowan University Departmental Research

Albinism is a spectrum disorder causing foveal hypoplasia, nystagmus, and hypopigmentation of the iris and fundus along with other visual deficits, which can all impact vision. Albinism is also associated with amblyogenic factors which could affect monocular visual acuity. The foveal appearance in albinism can range from mild foveal hypoplasia to that which is indistinguishable from the peripheral retina. The appearance can be quickly and easily graded using the Leicester Grading System in the clinic. However, interquartile ranges of 0.3 logMAR for the grades associated with albinism limit the accuracy of the grading system in predicting vision. Here, we discuss …

Visual Field Deficits In Albinism In Comparison To Idiopathic Infantile Nystagmus., Viral Sheth, Rebecca J Mclean, Zhanhan Tu, Sarim Ather, Irene Gottlob, Frank A Proudlock

Cooper Medical School of Rowan University Departmental Research

PURPOSE: This is the first systematic comparison of visual field (VF) deficits in people with albinism (PwA) and idiopathic infantile nystagmus (PwIIN) using static perimetry. We also compare best-corrected visual acuity (BCVA) and optical coherence tomography measures of the fovea, parafovea, and circumpapillary retinal nerve fiber layer in PwA.

METHODS: VF testing was performed on 62 PwA and 36 PwIIN using a Humphrey Field Analyzer (SITA FAST 24-2). Mean detection thresholds for each eye were calculated, along with quadrants and central measures. Retinal layers were manually segmented in the macular region.

RESULTS: Mean detection thresholds were significantly lower than normative …

Rates Of Reoperation In Duane Retraction Syndrome, Han Woong Lim, Bryce Hwang, Cyril Archambault, Scott Lambert

Wills Eye Hospital Papers

PURPOSE: To investigate the types of strabismus surgeries performed and the reoperation rate in patients with Duane retraction syndrome (DRS).

DESIGN: Retrospective cohort analysis.

PARTICIPANTS: An insurance claims data set was used to identify patients diagnosed with DRS between 2007 and 2021.

METHODS: We recorded the type of strabismus surgery performed and the timing and frequency of reoperations. The hazard ratios (HRs) for reoperation were estimated according to the surgical methods using Cox regression analysis.

RESULTS: Of the 9435 patients diagnosed with DRS, 1023 (10.8%) underwent ≥ 1 strabismus operation. The median age at surgery was 5.0 years, and patients …

Long-Term Surgical Outcomes Of Glaucoma Drainage Implants In Eyes With Preoperative Intraocular Pressure Less Than 19 Mmhg, Shahin Hallaj, Jae-Chiang Wong, Lauren E. Hock, Natasha Nayak Kolomeyer, Aakriti G. Shukla, Michael J. Pro, Marlene R. Moster, Jonathan S. Myers, Reza Razeghinejad, Daniel Lee

Wills Eye Hospital Papers

BACKGROUND: This retrospective review reports on patients who underwent glaucoma drainage implant (GDI) surgery and had baseline intraocular pressure (IOP) of ≤18 mmHg with at least one year of follow-up.

METHODS: Clinical data of 67 eyes of 67 patients were collected from patients' charts, and the outcomes of GDI were evaluated until 7 years. GDI failure was defined as IOP reduction of less than 20% from the baseline at two consecutive visits three months after surgery, decline to no light perception, or if additional glaucoma surgery was performed.

RESULTS: The average age was 65.9 ± 13.2 years. Most cases were …

Performance Of Automated Machine Learning In Predicting Outcomes Of Pneumatic Retinopexy, Arina Nisanova, Arefeh Yavary, Jordan Deaner, Ferhina Ali, Priyanka Gogte, Richard Kaplan, Kevin Chen, Eric Nudleman, Dilraj Grewal, Meenakashi Gupta, Jeremy Wolfe, Michael Klufas, Glenn Yiu, Iman Soltani, Parisa Emami-Naeini

Wills Eye Hospital Papers

PURPOSE: Automated machine learning (AutoML) has emerged as a novel tool for medical professionals lacking coding experience, enabling them to develop predictive models for treatment outcomes. This study evaluated the performance of AutoML tools in developing models predicting the success of pneumatic retinopexy (PR) in treatment of rhegmatogenous retinal detachment (RRD). These models were then compared with custom models created by machine learning (ML) experts.

DESIGN: Retrospective multicenter study.

PARTICIPANTS: Five hundred and thirty nine consecutive patients with primary RRD that underwent PR by a vitreoretinal fellow at 6 training hospitals between 2002 and 2022.

METHODS: We used 2 AutoML …

Endophthalmitis In An Elderly Patient - A Case Of Delayed Transfer And Successful Management, Vamsikalayan Borra, Roy Kondapavuluru, Sreejith Pillali, Sabhi Gull, Andres Suarez Parraga

Research Symposium

Introduction: Endophthalmitis is a severe and potentially sight-threatening condition that demands immediate attention and intervention. It is characterized by inflammation and infection within the eye, typically caused by bacterial or fungal organisms entering the eye, often following surgery or trauma. Usually present with sudden, severe eye pain, redness, decreased vision, and photophobia. As endophthalmitis can rapidly progress and cause irreversible damage to the eye, it is considered a true ocular emergency.

Case presentation: An 80-year-old woman, known to have Insulin-dependent Type 2 Diabetes mellitus and a history of breast cancer, arrived at the Emergency Department (ED) with persistent and worsening …

Development Of A Novel Covalently Bonded Conjugate Of Caprylic Acid Tripeptide (Isoleucine–Leucine–Aspartic Acid) For Wound-Compatible And Injectable Hydrogel To Accelerate Healing, Sachin B. Baravkar, Yan Lu, Abdul Razak Masoud, Qi Zhao, Jibao He, Song Hong

School of Medicine Faculty Publications

Third-degree burn injuries pose a significant health threat. Safer, easier-to-use, and more effective techniques are urgently needed for their treatment. We hypothesized that covalently bonded conjugates of fatty acids and tripeptides can form wound-compatible hydrogels that can accelerate healing. We first designed conjugated structures as fatty acid–aminoacid1–amonoacid2–aspartate amphiphiles (Cn acid–AA1–AA2–D), which were potentially capable of self-assembling into hydrogels according to the structure and properties of each moiety. We then generated 14 novel conjugates based on this design by using two Fmoc/tBu solid-phase peptide synthesis techniques; we verified their structures and purities through liquid chromatography with tandem mass spectrometry and nuclear …

A Case Of Persistent Ophthalmic Artery Occlusion After Migraine In The Setting Of Cerebral Vascular Anomalies, Khaled Moumneh, Austin Bach

West Florida Division GME Research Day 2024

No abstract provided.

The Benefits Of Medical Tetrahydrocannabinol On Glaucoma, Hunter Kane

Theses, Dissertations and Capstones

Introduction: This paper explores the potential therapeutic benefits of medical Tetrahydrocannabinol (THC) on glaucoma management, particularly in terms of intraocular pressure (IOP) reduction, ocular blood flow, and symptom management. Glaucoma, characterized by increased IOP and progressive optic nerve damage, is a leading cause of irreversible blindness. Current treatments focus on IOP control but may have inadequate efficacy or intolerable side effects, necessitating alternative approaches such as medical THC.

Methods: The study hypothesis posited that medical THC could significantly reduce IOP, enhance ocular blood flow, and improve symptom management in glaucoma patients. To test this hypothesis, a literature review supplemented by …

The Potential Beneficial Role Of Anti-Platelet/Anti-Coagulant Medications On Diabetic Retinopathy: A Scoping Review Protocol, Sarah Draud, Qingjun Wang, Lauren E. Robinson

Markey Cancer Center Faculty Publications

Diabetic retinopathy (DR) is a prevalent microvascular complication of diabetes mellitus (DM, both types 1 and 2), affecting millions of individuals worldwide. DM is known to induce changes in platelet function and hemostasis, thereby elevating the risk of thrombotic incidents. The hyperglycemic environment in DM can trigger platelet hyperactivity, potentially exacerbating the onset and progression of DR. Despite the intricate pathophysiology of DR, which involves oxidative stress, inflammation, retinal neovascularization, and the disruption of the blood-retina barrier, the specific mechanisms underlying platelet hyperactivity in the microvasculature of DM patients remain inadequately explored. Antiplatelet and anticoagulation medications have proven beneficial in …

High-Throughput Screening Of Fda-Approved Drugs For Protecting Retinal Pigment Epithelial Cells Against Er Stress Induced Cell Death: Implications For Age-Related Macular Degeneration, Shaima Ali Jawarneh

Wayne State University Theses

Purpose: Age-related macular degeneration (AMD) is a leading cause of blindness in the elderly population, characterized by the degeneration of the retinal pigment epithelium (RPE). The link between endoplasmic reticulum (ER) stress and AMD is well established, however FDA-approved medications for the treatment of AMD caused by unregulated ER stress are limited and have potential side effects. The purpose of this study was to conduct a comprehensive screening of the FDA-approved drug library in order to identify potential candidates that could be repurposed in order to protect against the degeneration and death of RPE cells due to ER stress.

Methods: …

Phase 1 Trial Of Tpi 287, A Microtubule Stabilizing Agent, In Combination With Bevacizumab In Adults With Recurrent Glioblastoma, Samuel A Goldlust, Louis B Nabors, Sigmund Hsu, Nimish Mohile, Paul J Duic, Tara Benkers, Samuel Singer, Mayank Rao, Lori Cappello, Sandra L Silberman, George Farmer

Faculty, Staff and Student Publications

BACKGROUND: Recurrent glioblastoma (rGBM) has limited treatment options. This phase 1 protocol was designed to study the safety and preliminary efficacy of TPI 287, a central nervous system penetrant microtubule stabilizer, in combination with bevacizumab (BEV) for the treatment of rGBM.

METHODS: GBM patients with up to 2 prior relapses without prior exposure to anti-angiogenic therapy were eligible. A standard 3 + 3 design was utilized to determine the maximum tolerated dose (MTD) of TPI 287. Cohorts received TPI 287 at 140-220 mg/m

RESULTS: Twenty-four patients were enrolled at 6 centers. Treatment was generally well tolerated. Fatigue, myelosuppression, and peripheral …

Aligning Eye Care Provider Beliefs With Behaviors: Exploring And Improving Ocular Surface Disease Decision-Making In A Cataract Surgery Clinic, Amy Hellem

Communication (PhD) Dissertations

Millions of cataract surgeries are performed every year in the United States, yet both surgeon reports and patient reports indicate that practices are not utilizing the diagnostic tests and treatments that are advocated in the medical literature to identify and manage ocular surface disease prior to surgery. As a result, patients risk suffering several significant consequences with regard to their vision, comfort and safety. Personal observations from my 25 years of experience working with ophthalmologists and optometrists led to curiosity regarding the root cause of undertreatment of ocular surface disease. Specifically, I had the impression that eye care providers held …

Suprachoroidal Space Injection Technique Expert Panel Guidance, Charles C. Wykoff, Robert L. Avery, Mark R. Barakat, David S. Boyer, David M. Brown, Alexander J. Brucker, Emmett T. Cunningham Jr., Jeffrey S. Heier, Nancy M. Holekamp, Peter K. Kaiser, Arshad M. Khanani, Judy E. Kim, Hakan Demirci, Carl D. Regillo, Glenn C. Yiu, Thomas A. Ciulla

Wills Eye Hospital Papers

Purpose:

To develop professional guidelines for best practices for suprachoroidal space (SCS) injection, an innovative technique for retinal therapeutic delivery, based on current published evidence and clinical experience.

Methods:

A panel of expert ophthalmologists reviewed current published evidence and clinical experience during a live working group meeting to define points of consensus and key clinical considerations to inform the development of guidelines for in-office SCS injection.

Results:

Core consensus guidelines for in-office SCS injection were reached and reported by the expert panel. Current clinical evidence and physician experience supported SCS injection as a safe and effective method for delivering retinal …

Social Determinants Of Health: Evaluation Using Rates Of Vision Screening And Follow-Up Examinations, Madeline Dyer

Williams Honors College, Honors Research Projects

Vision care is essential to the quality of life of young children, impacting them over the course of their lives. Social Determinants of Health (SDOH) affect the likelihood of a child having access to appropriate care specified by the Bright Futures. The aim of this study was to assess the impact of SDOH on the completion of vision screening and the rate of follow-up with an eye care provider when applicable. In addition, rates of instrument-based vision screening and recommended ophthalmology follow-up were compared with COI, a metric assessing the quality of resources available and the conditions that matter for …

Evaluating The Efficacy Of The Archaeal Proteasome To Alleviate Protein-Misfolding Retinopathy, Celine Brooks

Graduate Theses, Dissertations, and Problem Reports (ETD)

Nearly all neurodegenerative diseases (NDs) and some eye diseases are characterized by the presence of misfolded and aggregated proteins. The ubiquitin proteasome system (UPS) is responsible for degrading the majority of proteins including misfolded and aggregated proteins. However, in NDs the performance of the UPS is impaired, and this impairment partially comes from these protein aggregates inhibiting the proteasome. This inhibition leads to an accumulation of protein aggregates, more proteasomal inhibition, and fewer chaperones for newly synthesized proteins, triggering a collapse in proteostasis, which is thought to contribute to the pathogenesis of NDs. Consequently, stimulating proteasome function is being investigated …

A Proposal For The Use Of A Fixed Low-Energy Selective Laser Trabeculoplasty For Open Angle Glaucoma, Zachary Sacks, L. Jay Katz, Gus Gazzard, Sarah H. Van Tassel, Eytan Z. Blumenthal, Fabian S. Lerner, Augusto Azuara-Blanco, Gregory John Roy Spooner, Yoram Solberg, Thomas Samuelson, Michael Belkin

Wills Eye Hospital Papers

Selective laser trabeculoplasty (SLT) has been in routine clinical use for over 20 years with millions of patients successfully treated and a low rate of clinically significant complications. The procedure requires the clinician to manually position the laser beam on the trabecular meshwork using a gonioscopy lens and to titrate the SLT laser energy based on the amount of pigmentation in the angle, as well as the observation of small bubbles produced by the laser effect. We propose that SLT energy titration is unnecessary either to achieve intraocular pressure (IOP) reduction or to minimize potential side effects. Ample evidence to …

Genotypes Of Snps Of Key Genes Regulate Susceptibility And Drug Sensitivity To Neovascular Amd, Jinglin Cui

Theses and Dissertations (ETD)

Age-related macular degeneration (AMD), particularly its neovascular form, stands as a leading cause of blindness globally, with its prevalence in our country on a steady rise. This underscores the critical impact of neovascular AMD (nAMD) management on patient quality of life and societal burden. Current optimal treatments hinge on anti-vascular endothelial growth factor (anti-VEGF) therapies, though their efficacy varies across different drugs and individuals, highlighting the importance of precise drug selection in clinical outcomes. Research suggests that factors such as baseline vision, age, disease duration, lesion size, central retina thickness, neovascularization type, and demographic differences influence nAMD prognosis. In addition, …

Gaze Transition Entropy As A Measure Of Attention Allocation In A Dynamic Workspace Involving Automation, Zixin Cui, Tetsuya Sato, Austin Jackson, Sampath Jayarathna, Makoto Itoh, Yusuke Yamani

Psychology Faculty Publications

Real-world work environments require operators to perform multiple tasks with continual support from an automated system. Eye movement is often used as a surrogate measure of operator attention, yet conventional summary measures such as percent dwell time do not capture dynamic transitions of attention in complex visual workspace. This study analyzed eye movement data collected in a controlled a MATB-II task environment using gaze transition entropy analysis. In the study, human subjects performed a compensatory tracking task, a system monitoring task, and a communication task concurrently. The results indicate that both gaze transition entropy and stationary gaze entropy, measures of …

Patients With Floaters: Answers From Virtual Assistants And Large Language Models, Gloria Wu, Weichen Zhao, Adrial Wong, David A Lee

Faculty, Staff and Student Publications

OBJECTIVES: "Floaters," a common complaint among patients of all ages, was used as a query term because it affects 30% of all people searching for eye care. The American Academy of Ophthalmology website's "floaters" section was used as a source for questions and answers (www.aao.org). Floaters is a visual obstruction that moves with the movement of the eye. They can be associated with retinal detachment, which can lead to vision loss. With the advent of large language model (LLM) chatbots ChatGPT, Bard versus virtual assistants (VA), Google Assistant, and Alexa, we analyzed their responses to "floaters."

METHODS: Using AAO.org, "Public …

Exploring Angiotensin Ii And Oxidative Stress In Radiation-Induced Cataract Formation: Potential For Therapeutic Intervention, Vidya P. Kumar, Yali Kong, Riana Dolland, Sandra R. Brown, Kan Wang, Damian Dolland, David Mu, Milton L. Brown

Department of Biomedical and Translational Sciences Faculty Publications

Radiation-induced cataracts (RICs) represent a significant public health challenge, particularly impacting individuals exposed to ionizing radiation (IR) through medical treatments, occupational settings, and environmental factors. Effective therapeutic strategies require a deep understanding of the mechanisms underlying RIC formation (RICF). This study investigates the roles of angiotensin II (Ang II) and oxidative stress in RIC development, with a focus on their combined effects on lens transparency and cellular function. Key mechanisms include the generation of reactive oxygen species (ROS) and oxidative damage to lens proteins and lipids, as well as the impact of Ang II on inflammatory responses and cellular apoptosis. …