Optometry Commons^™

Impact Of The Covid-19 Pandemic On Visual Outcomes Of Diabetic Macular Edema Patients At A Tertiary Care Veterans Affairs Center, Philip Zhou, Jie Gao, Xiaofan Huang, Kristen A Staggers, Kristin Biggerstaff, Silvia Orengo-Nania, Roomasa Channa

Faculty, Staff and Students Publications

PURPOSE: There are limited studies on factors that impacted retina clinic patient outcomes during the COVID-19 pandemic. We aimed to evaluate visual and anatomic outcomes in patients with diabetic macular edema (DME) requiring anti-VEGF injections at the veterans' affairs tertiary care eye clinic in Houston, TX.

METHODS: Patient volume from April 2020 was compared to that of April 2019 to determine attendance changes. To evaluate outcomes, we reviewed patients with DME who had scheduled appointments during April 2020. We tracked changes in central foveal thickness (CFT) and Snellen visual acuity (VA) measurements. Patient outcomes were classified as poor (defined as …

Mucosal Immunology Of The Ocular Surface, Cintia S De Paiva, Anthony J St Leger, Rachel R Caspi

Faculty, Staff and Students Publications

The eye is a sensory organ exposed to the environment and protected by a mucosal tissue barrier. While it shares a number of features with other mucosal tissues, the ocular mucosal system, composed of the conjunctiva, Meibomian glands, and lacrimal glands, is specialized to address the unique needs of (a) lubrication and (b) host defense of the ocular surface. Not surprisingly, most challenges, physical and immunological, to the homeostasis of the eye fall into those two categories. Dry eye, a dysfunction of the lacrimal glands and/or Meibomian glands, which can both cause, or arise from, sensory defects, including those caused …

Bacteroides Ovatus Colonization Influences The Abundance Of Intestinal Short Chain Fatty Acids And Neurotransmitters, Thomas D Horvath, Faith D Ihekweazu, Sigmund J Haidacher, Wenly Ruan, Kristen A Engevik, Robert Fultz, Kathleen M Hoch, Ruth Ann Luna, Numan Oezguen, Jennifer K Spinler, Anthony M Haag, James Versalovic, Melinda A Engevik

Faculty, Staff and Students Publications

Gut microbes can synthesize multiple neuro-active metabolites. We profiled neuro-active compounds produced by the gut commensal Bacteroides ovatus in vitro and in vivo by LC-MS/MS. We found that B. ovatus generates acetic acid, propionic acid, isobutyric acid, and isovaleric acid. In vitro, B. ovatus consumed tryptophan and glutamate and synthesized the neuro-active compounds glutamine and GABA. Consistent with our LC-MS/MS-based in vitro data, we observed elevated levels of acetic acid, propionic acid, isobutyric acid, and isovaleric acid in the intestines of B. ovatus mono-associated mice compared with germ-free controls. B. ovatus mono-association also increased the concentrations of intestinal GABA …

Analysis Of Tear-Film Breakup Using Fluorescence Video Recordings, Tobin Driscoll, Richard Braun, Rayanne Luke, Carolyn G. Begley

Biology and Medicine Through Mathematics Conference

No abstract provided.

Investigating The Effect Of Dissolved Oxygen-Assisted Corneal Cross-Linking (Cxl) On Porcine Corneas, Julianni Dar

Electronic Theses and Dissertations

Corneal cross-linking is a clinical procedure that is known to stop the progression of keratoconus, an eye disease that affects the cornea’s structure, ultimately leading to vision loss in its advanced stages. The typical treatment plan includes riboflavin and UV-A exposure in the hope to increase the mechanical properties of the cornea. There are two types of CXL pathways, with Type-II CXL requiring oxygen. Naturally, the dissolved oxygen is limited in the cornea; therefore, limiting the effect of Type-II CXL. This study proposes to improve the Type-II CXL contribution by integrating dissolved oxygen during the standard CXL treatment used in …

A Trained Eye: Optometrists' View Into Primary Care, Louis C. Magee Iii

Honors Theses

The aim of this thesis is to explore and present the auxiliary responsibilities of doctors of optometry, particularly those involved with primary health care such as screening for serious diseases. This idea was approached by researching the technological capabilities of optometrists, the diseases and conditions they commonly detect, as well as the barriers preventing some people from receiving proper eye care. The importance of optometrists as primary care providers is steadily rising alongside their capabilities. There are many instances within a routine eye exam in which an optometrist is able to detect and recommend treatment of a serious disease. Also …

Book Review: The Ophthalmic Laser Handbook, William L. Miller Od, Ms, Phd

Optometric Clinical Practice

Book Review: Freisberg L, Lighthizer N, Skorin, Jr. L, Stonecipher K, and Zimmerman A. The Ophthalmic Laser Handbook. First Edition. Wolters Kluwer Health; 2021. $102.00, 350 pages, Paperback ISBN: 978-1975170172, e-book ISBN: 978-1975170219

Case Report: Bartonella Quintana-Associated Neuroretinitis, Kelly Seidler Od, Kelly A. Malloy Od

Optometric Clinical Practice

Background: Neuroretinitis is a self-limiting condition which typically causes monocular vision loss with good potential for visual recovery. It may be idiopathic or associated with infectious or inflammatory conditions which can carry systemic implications. Neuroretinitis classically presents with disc edema followed by development of a macular star pattern of exudates. It is most commonly attributed to Cat Scratch Disease, or Bartonella henselae infection. However, there have been few published reports of Bartonella quintana associated neuroretinitis.

Case Report: A 60-year-old patient presented with unilateral vision loss preceded by flu-like illness. The patient had exposure to a recently adopted cat. …

Bilateral, Full-Thickness Macular Holes While Undergoing Chemotherapy, Sarah Dieter Od, Brett Garee Od Ms, Susan Zacatelco Od, Julie Henry Od

Optometric Clinical Practice

Background: Bilateral, full-thickness macular holes are a rare condition that can substantially affect quality of life. Macular hole diagnosis and treatment is key for these patients.

Case Report: A 71 year old Caucasian male presented with a chief complaint of distance blur in both eyes, worsening over the past 1-2 weeks. He had no diagnosis of diabetes. He added that his prostate cancer had spread and that his last treatment ended 9 days ago. He was ultimately diagnosed with bilateral, full-thickness macular holes. Referral to a retinal specialist for surgical management yielded good results.

Conclusion: This is …

Cefuroxime-Induced Toxic Maculopathy: A Cataract Co-Management Conundrum, Leonid Skorin Jr., Do, Od, Ms

Optometric Clinical Practice

Background: Cefuroxime-induced toxic maculopathy can occur when an incorrect dilution is injected intracamerally after cataract surgery. This results in a guarded visual prognosis. Cefuroxime-induced toxic maculopathy can also occur sporadically even when the medication dilution is the standard correct dosage. These patients usually recover their vision by the first postoperative week.

Case Report: A 72-year-old Caucasian female developed cefuroxime-induced toxic maculopathy after uneventful cataract surgery. Investigation of the case confirmed that she had a sporadic response to the cefuroxime. It was verified that she received the standard correct dilution of cefuroxime intracamerally. The patient showed a significant improvement in her …

Isolated Optic Neuropathy As The Presenting Sign Of Neurosyphilis, Kasey Zann Od, Molly Johnson Od, James Fabian Od

Optometric Clinical Practice

Background: Detection and treatment of syphilitic ocular disease without a known history of syphilis is often difficult due to its varied presentations. Early diagnosis and treatment are the key to reducing risk of permanent vision loss, particularly with optic nerve and retinal manifestations.

Case Report: This case report describes a 44 year-old male who was diagnosed with neurosyphilis through his work-up for unilateral optic neuropathy.

Conclusion: This report illustrates the importance of including syphilis lab testing in the setting of optic nerve edema. Syphilis should be considered in any inflammatory ocular disease, especially in patients with atypical presentations and high-risk …

Medication-Induced Oculomotor Dysfunction: A Report Of Two Cases, Eric Lee Od

Optometric Clinical Practice

Background: Consideration of current medications and their interactions as a source of new onset oculomotor dysfunction is imperative for providing good eye care. Medication etiology should be particularly suspected when the symptoms begin with the initiation of a new medication and resolved with discontinuation of the same medication.

Case Reports: Presented are two cases demonstrating that it is prudent to be aware of medications capable of inducing oculomotor dysfunction. Each case reveals instances of acute oculomotor dysfunction after the initiation of a central nervous system affecting medication. Case 1 details a partial pupil sparing third nerve palsy after initiating the …

Longstanding Crystalline Retinopathy Secondary To Intravitreal Triamcinolone Injection, Katherine Thomas Od, Jeffery Curry Od

Optometric Clinical Practice

Background: Crystalline retinopathy has many disparate etiologies with varying potentials in visual outcome. Due to the potential severity of these outcomes, differentiation of etiology is critical to guide both follow up and treatment regimen. Diagnosis can be facilitated with a thorough medical history, clinical presentation, and imaging such as optical coherence tomography (OCT).

Case Report: This case demonstrates a rare incidence of crystalline retinopathy in a 65-year-old male attributed to a single intravitreal triamcinolone acetonide (IVTA) injection with 8 year follow up data, followed by a review of other types of crystalline retinopathy secondary to pharmaceutical agents.

Conclusion: A complete …

It’S As Easy As Learning To Fly A Plane, Paul B. Freeman Od

Optometric Clinical Practice

Letter from the Editor-in-Chief

Safety And Efficacy Of Systemic Anti-Scg3 Therapy To Treat Oxygen-Induced Retinopathy, Chang Dai, Hong Tian, Amit Bhatt, Guanfang Su, Keith A Webster, Wei Li

Faculty, Staff and Students Publications

BACKGROUND: To circumvent possible systemic side effects, anti-angiogenic drugs targeting vascular endothelial growth factor (VEGF) for ocular neovascular diseases in adults are approved only for intravitreal administration. However, intravitreal injection itself can elicit injection-related adverse effects, and premature eyes of infants with retinopathy of prematurity (ROP) may be particularly susceptible to intravitreal injection. Therefore, an unmet clinical need is to develop safe systemic anti-angiogenic therapies for ROP. We recently reported that secretogranin III (Scg3) is a disease-restricted angiogenic factor and that systemic anti-Scg3 mAb alleviates ROP in animal models with minimal side effects on developing eyes and organs. The aim …

Safety And Efficacy Of Systemic Anti-Scg3 Therapy To Treat Oxygen-Induced Retinopathy, Chang Dai, Hong Tian, Amit Bhatt, Guanfang Su, Keith A Webster, Wei Li

Faculty, Staff and Students Publications

BACKGROUND: To circumvent possible systemic side effects, anti-angiogenic drugs targeting vascular endothelial growth factor (VEGF) for ocular neovascular diseases in adults are approved only for intravitreal administration. However, intravitreal injection itself can elicit injection-related adverse effects, and premature eyes of infants with retinopathy of prematurity (ROP) may be particularly susceptible to intravitreal injection. Therefore, an unmet clinical need is to develop safe systemic anti-angiogenic therapies for ROP. We recently reported that secretogranin III (Scg3) is a disease-restricted angiogenic factor and that systemic anti-Scg3 mAb alleviates ROP in animal models with minimal side effects on developing eyes and organs. The aim …

Progressive Lenses And Acute Anisomentropia, Alena Lane

Conference Papers

The aim of the poster is to demonstrate that presbyopic patients with acute anisometropia can continue using progressive lenses. Acute or induced anisometropia occurs when a sudden change in the prescription is introduced. A typical example of this occurs following the cataract operation to one eye. The problem arises when the difference in refractive power of both eyes after the operation is 2.00D and more. The difference in lens power can cause the eyes to see different size images and lead to difficulties in fusing them. Additionally, when an image is viewed off axis through the spectacle lens away from …

Interpersonal Communication In Eye Care: An Analysis Of Potential Impacts On Cataract Surgery Candidates’ Expectations And Behaviors, Amy Hellem, Sara Labelle, Cynthia Matossian, Paul Karpecki

Communication Faculty Articles and Research

Purpose: To identify cataract surgery candidates’ knowledge, beliefs, desires and emotions as they relate to cataract surgery generally as well as to their behavioral intent to adhere to a doctor-recommended pre-surgical ocular surface prep routine designed to improve refractive outcomes and prevent surgical complications.

Methods: This national, noninterventional, cross-sectional, mixed methods survey included 278 US adults ages 65 and older with no history of cataract surgery in either eye.

Results: Only 20% of participants said they want to have cataract surgery, and even fewer (8%) said they wish they could have cataract surgery right away. Fear was the predominant emotion …

Clinical Presentation, Treatment, And Genetic And Histopathological Analysis Of Juvenile Cataracts And Secondary Glaucoma In A Rhesus Macaque (Macaca Mulatta), M Isabel Casanova, Rui Chen, Laura M Garzel, Katherine J Olstad, Soohyun Kim, Ronald Alan Harris, Yumei Li, Muthuswamy Raveendran, Qingnan Liang, Jun Wang, Glenn Yiu, John Timothy Stout, Jeffrey A Roberts, Jeffrey Rogers, Ala Moshiri, Sara M Thomasy

Faculty, Staff and Students Publications

This report describes the clinical and histological findings, genetic study, and treatment in a 1.3-year-old rhesus macaque with bilateral cataracts and unilateral secondary glaucoma. Intravitreal injection of gentamicin decreased the intraocular pressure from 56 to <2 mm Hg. A putative genetic cause of the cataracts was not identified.

Single-Cell Transcriptional Profiling Of Murine Conjunctival Immune Cells Reveals Distinct Populations Expressing Homeostatic And Regulatory Genes, Jehan Alam, Ghasem Yazdanpanah, Rinki Ratnapriya, Nicholas Borcherding, Cintia S De Paiva, Dequan Li, Stephen C Pflugfelder

Faculty, Staff and Students Publications

Immune cells in the exposed conjunctiva mucosa defend against environmental and microbial stresses. Expression profiling by single-cell RNA sequencing was performed to identify conjunctival immune cell populations expressing homeostatic and regulatory genes. Fourteen distinct clusters were identified, including myeloid cells (neutrophils, monocytes, macrophages), dendritic cells (DC), and lymphoid cells (B, T, γδT, ILC2, and NK) lineages. Novel neutrophil [lipocalin (Lcn2) high and low), and MHCIIlo macrophage (MP) clusters were identified. More than half of the cells map to myeloid and dendritic cell populations with differential expression profiles that include genes with homeostatic and regulatory functions: Serpinb2 (MHCIIlo macrophage), …

Retinal Organoids Derived From Rhesus Macaque Ipscs Undergo Accelerated Differentiation Compared To Human Stem Cells, Antonio Jacobo Lopez, Sangbae Kim, Xinye Qian, Jeffrey Rogers, J Timothy Stout, Sara M Thomasy, Anna La Torre, Rui Chen, Ala Moshiri

Faculty, Staff and Students Publications

PURPOSE: To compare the timing and efficiency of the development of Macaca mulatta, a nonhuman primate (NHP), induced pluripotent stem cell (rhiPSC) derived retinal organoids to those derived from human embryonic stem cells (hESCs).

RESULTS: Generation of retinal organoids was achieved from both human and several NHP pluripotent stem cell lines. All rhiPSC lines resulted in retinal differentiation with the formation of optic vesicle-like structures similar to what has been observed in hESC retinal organoids. NHP retinal organoids had laminated structure and were composed of mature retinal cell types including cone and rod photoreceptors. Single-cell RNA sequencing was conducted at …

Big Data Analysis Of Vision Screening Standards Used To Evaluate Fitness To Drive, Michael Moore, John Butler, Daniel Ian Flitcroft, James Loughman

Articles

Purpose: Visual acuity (VA) assessment is the most commonly performed vision screening method for drivers. The standards and repeat assessment intervals used, however, are arbitrary, lack an evidence base and are highly variable across different countries. This study utilizes the power of Big Data to provide evidence-based recommendations for standardized driver vision screening.

Methods: Anonymized electronic medical record data were gathered from 40 Irish optometry practices comprising 81,184 unique patients. A Kaplan-Meier Survival (KMS) analysis was used to determine the effect of increasing age and time since screening on the likelihood of passing the VA standard for driving. A logistic …

Gut-Derived Butyrate Suppresses Ocular Surface Inflammation, Laura Schaefer, Humberto Hernandez, Rosalind A Coats, Zhiyuan Yu, Stephen C Pflugfelder, Robert A Britton, Cintia S De Paiva

Faculty, Staff and Students Publications

Dry eye is a common ocular inflammatory disorder characterized by tear film instability and reduced tear production. There is increasing evidence that homeostasis of the ocular surface is impacted by the intestinal microbiome. We are interested in investigating the potential role of microbially produced small molecules in mediating the interaction between the intestinal microbiota and the ocular surface. One such molecule is butyrate, a short-chain fatty acid (SCFA) produced by certain members of the gut microbiota through fermentation of dietary fiber. Here we show that SCFA transporter SLC5A8 is expressed in vivo in murine conjunctival and corneal epithelium. Pre-treatment of …

Exaggerated False Positives By Popular Differential Expression Methods When Analyzing Human Population Samples, Yumei Li, Xinzhou Ge, Fanglue Peng, Wei Li, Jingyi Jessica Li

Faculty, Staff and Students Publications

When identifying differentially expressed genes between two conditions using human population RNA-seq samples, we found a phenomenon by permutation analysis: two popular bioinformatics methods, DESeq2 and edgeR, have unexpectedly high false discovery rates. Expanding the analysis to limma-voom, NOISeq, dearseq, and Wilcoxon rank-sum test, we found that FDR control is often failed except for the Wilcoxon rank-sum test. Particularly, the actual FDRs of DESeq2 and edgeR sometimes exceed 20% when the target FDR is 5%. Based on these results, for population-level RNA-seq studies with large sample sizes, we recommend the Wilcoxon rank-sum test.

Genetic Subtyping And Phenotypic Characterization Of The Immune Microenvironment And Myc/Bcl2 Double Expression Reveal Heterogeneity In Diffuse Large B-Cell Lymphoma, Zijun Y Xu-Monette, Li Wei, Xiaosheng Fang, Qingyan Au, Harry Nunns, Máté Nagy, Alexandar Tzankov, Feng Zhu, Carlo Visco, Govind Bhagat, Karen Dybkaer, April Chiu, Wayne Tam, Youli Zu, Eric D Hsi, Fredrick B Hagemeister, Xiaoping Sun, Xin Han, Heounjeong Go, Maurilio Ponzoni, Andrés J M Ferreri, Michael B Møller, Benjamin M Parsons, J Han Van Krieken, Miguel A Piris, Jane N Winter, Yong Li, Bing Xu, Maher Albitar, Hua You, Ken H Young

Faculty, Staff and Students Publications

PURPOSE: Diffuse large B-cell lymphoma (DLBCL) is molecularly and clinically heterogeneous, and can be subtyped according to genetic alterations, cell-of-origin, or microenvironmental signatures using high-throughput genomic data at the DNA or RNA level. Although high-throughput proteomic profiling has not been available for DLBCL subtyping, MYC/BCL2 protein double expression (DE) is an established prognostic biomarker in DLBCL. The purpose of this study is to reveal the relative prognostic roles of DLBCL genetic, phenotypic, and microenvironmental biomarkers.

EXPERIMENTAL DESIGN: We performed targeted next-generation sequencing; IHC for MYC, BCL2, and FN1; and fluorescent multiplex IHC for microenvironmental markers in a large cohort of …

Visual Pigment-Deficient Cones Survive And Mediate Visual Signaling Despite The Lack Of Outer Segments, Hui Xu, Nange Jin, Jen-Zen Chuang, Zhao Zhang, Xiaoyue Zhong, Zhijing Zhang, Ching-Hwa Sung, Christophe P Ribelayga, Yingbin Fu

Faculty, Staff and Students Publications

Rhodopsin and cone opsins are essential for light detection in vertebrate rods and cones, respectively. It is well established that rhodopsin is required for rod phototransduction, outer segment disk morphogenesis, and rod viability. However, the roles of cone opsins are less well understood. In this study, we adopted a loss-of-function approach to investigate the physiological roles of cone opsins in mice. We showed that cones lacking cone opsins do not form normal outer segments due to the lack of disk morphogenesis. Surprisingly, cone opsin-deficient cones survive for at least 12 mo, which is in stark contrast to the rapid rod …

Surgical Training In Ophthalmology: Role Of Eyesi In The Era Of Simulation-Based Learning, Sehrish Nizar Ali Momin, Abdul Sami Memon, Muhammad Bilal Malik, Pir Salim Meher

Section of Ophthalmology

Recent advancements in surgical training methods have escalated the need for simulators. The EyeSi simulation has played a major role in Ophthalmology training by providing opportunity to the novice residents to grasp the surgical steps of the procedure and master the skill by repeated attempts. Participants were assessed on single level of cataract module and their consecutive scores were assessed with each attempt. It was found that repetitive practice on simulator can help develop proficiency in the desired steps that can ultimately prepare the surgical trainees for real life surgery.

Role Of Optical Coherence Tomography Angiography To Differentiate Intraretinal Microvascular Abnormalities And Retinal Neovascularization In Diabetic Retinopathy, Abdul Sami Memon, Nasir A. Memon, Pir Salim Mahar

Department of Surgery Docs

Objective: To assess proliferative diabetic retinopathy (PDR) and to describe the difference in angiographic representation of new vessels (NVs) and Intra retinal microvascular abnormalities (IRMA) on optical coherence tomography angiography (OCTA).
Methods: A cross-sectional observational study was performed at ISRA Postgraduate Institute of Ophthalmology, Karachi, from March 2018 to September 2018. Forty-two eyes of 21 patients with history of diabetes mellitus (DM) were examined. Twenty-eight eyes with a clinical diagnosis of severe non proliferative diabetic retinopathy (NPDR) or proliferative diabetic retinopathy (PDR) according to early treatment diabetic retinopathy study (ETDRS) were included and evaluated using Swept source optical coherence tomography …

Diagnosis Of Polypoidal Choroidal Vasculopathy From Fluorescein Angiography Using Deep Learning, Yu-Yeh Tsai, Wei-Yang Lin, Shih-Jen Chen, Paisan Ruamviboonsuk, Cheng-Ho King, Chia-Ling Tsai

Publications and Research

Purpose: To differentiate polypoidal choroidal vasculopathy (PCV) from choroidal neovascularization (CNV) and to determine the extent of PCV from fluorescein angiography (FA) using attention-based deep learning networks.

Methods: We build two deep learning networks for diagnosis of PCV using FA, one for detection and one for segmentation. Attention-gated convolutional neural network (AG-CNN) differentiates PCV from other types of wet age-related macular degeneration. Gradient-weighted class activation map (Grad-CAM) is generated to highlight important regions in the image for making the prediction, which offers explainability of the network. Attention-gated recurrent neural network (AG-PCVNet) for spatiotemporal prediction is applied for segmentation of PCV. …

Abnormal Perception Of Pattern-Induced Flicker Colors In Subjects With Glaucoma, Padmapriya Ramamoorthy, Nicole L Alexander, Benjamin J Frankfort

Faculty, Staff and Students Publications

Pattern-induced flicker colors (PIFCs) are subjective colors that can be elicited with rotation of an achromatic stimulus such as the Benham disk. The perceptive mechanisms underlying PIFCs are not well-understood, but are thought to be generated primarily by retinal cell types which may be dysfunctional in glaucoma. Using a custom computer-based system, we tested PIFC perception across several Benham disk parameters, including the rates of acceleration and deceleration, rotational direction, and image contrast in both control and glaucoma subjects. We defined the Benham perception limit (BPL) during acceleration as the rotational speed at which PIFCs were first detected (Benham perception …