Optometry Commons^™

A Case Of Adolescent Papilledema Secondary To Oral Hormonal Contraceptives, John D. Tassinari Od, Phil Kwok Od

Optometric Clinical Practice

Background: Papilledema, optic disc swelling secondary to elevated intracranial pressure (ICP), is a medical emergency given the gravity of possible disease etiologies, including but not limited to intracranial mass.

Case Report: A 12-year-old female with normal body mass index developed marked headaches and subsequently manifested bilateral swelling of the optic discs and retinal folds. Scanning laser ophthalmoscopy, particularly in the fundus autofluorescence mode, provided a striking image of the retinal folds. The posterior segment abnormalities were accompanied by reduced visual acuity and corresponding visual field defects. The edema of the optic nerve and retinal fluid were worse in her left …

Branch Retinal Artery Occlusion After Covid-19, Danielle Kalberer Od, Mba, Grace Tan Od

Optometric Clinical Practice

Background: A healthy, 39-year-old male patient presented with sudden onset, painless vision loss of the right eye’s superior visual field two months after a mild case of COVID-19.

Case Report: The patient was diagnosed with an acute branch retinal artery occlusion and referred to the emergency department for prompt evaluation. When the emergency workup was unremarkable the patient was referred to cardiology and hematology and follow up with a retinal specialist. The exhaustive systemic work-up was unremarkable other than recent COVID-19. Retinal perfusion to the affected area resumed in the weeks after the incident but irreversible vision loss occurred.

Conclusion: …

Ocular Myasthenia Gravis: A Case Report, Erica Vanderpool Od, Carla Gilbertson Kuiken Od

Optometric Clinical Practice

Background: Myasthenia gravis (MG) is an autoimmune disease caused by faulty transmission at the neuromuscular junction leading to fatigable muscular weakness. Ocular MG is distressing in that it can cause visual difficulties, but generalized MG can be life-threatening. MG is an acquired disorder that can easily be overlooked in clinic and is commonly misdiagnosed. Providers should be aware of the clinical features of this condition, as well as the critical testing needed to confirm the diagnosis so the appropriate management course can be implemented.

Case Report: This case features a 67-year-old Caucasian male diagnosed with ocular myasthenia gravis …

Treatment Considerations For Early Primary Open Angle Glaucoma In Active-Duty Military, Ridwan Carim-Sanni Od, Danielle Kalberer Od, Mba

Optometric Clinical Practice

Background: Glaucoma is one of the leading causes of blindness in the United States. The tools available to treat glaucoma via intraocular pressure (IOP) reduction include pharmacological therapy or surgical intervention.

Case Report: This case study explores these tools in the context of glaucoma in active-duty military personnel. It involves an active-duty army patient diagnosed with early Primary Open Angle Glaucoma (POAG) who was initially prescribed IOP-lowering medication. Barriers in treatment compliance occurred while the patient was deployed that led to significant glaucomatous changes detected when the patient returned stateside.

Conclusion: This report suggests a shift from the traditional pharmacological …

An Uncharacteristic Case Presentation Of Functional Vision Disorder, Ramandeep Kaur Od, Theresa Zerilli-Zavgorodni Od, Nancy Shenouda-Awad Od

Optometric Clinical Practice

Background: Functional Vision Disorder (FVD), also commonly referred to as functional vision loss (FVL) or non-organic vision loss (NOVL), is defined as a visual acuity (VA) loss and/or visual field (VF) loss, without any identifiable ocular or cortical pathology. Many clinicians look at FVD as a diagnosis of exclusion and while it is imperative to rule out organic pathology, FVD diagnosis must be supported by clinical findings that prove normal visual function. Incorporating supplementary tests specific for demonstrating the integrity of the visual system and the non-organic nature of the symptoms will allow clinicians to be more confident when diagnosing …

Self-Reported Functional Vision In Ush2a-Associated Retinal Degeneration As Measured By The Michigan Retinal Degeneration Questionnaire, Bela Parekh, Jacque L Duncan, Lassana Samarakoon, Michele Melia, Maria Fernanda Abalem, Chris A Andrews, Isabelle Audo, Allison R Ayala, Chris Bradley, Janet K Cheetham, Gislin Dagnelie, Todd A Durham, Rachel M Huckfeldt, Gabrielle D Lacy, Brett Malbin, Michel Michaelides, David C Musch, Nicholas Peck-Dimit, Katarina Stingl, Christina Y Weng, Alex Z Zmejkoski, K Thiran Jayasundera

Faculty, Staff and Students Publications

PURPOSE: The purpose of this study was to evaluate self-reported functional vision (FV) and the impact of vision loss in patients with USH2A-associated retinal degeneration using a patient-reported outcome (PRO) measure, the Michigan Retinal Degeneration Questionnaire (MRDQ), to correlate MRDQ scores with well-established visual function measurements.

DESIGN: An observational cross-sectional study (n = 93) of participants who had Usher Syndrome Type 2 (USH2, n = 55) or autosomal recessive non-syndromic retinitis pigmentosa (ARRP; n = 38) associated with biallelic variants in the USH2A gene.

METHODS: The study protocol was approved by all ethics boards and informed consent was obtained from …

Light Scattering By Vitreous Of Humans With Vision Degrading Myodesopsia From Floaters, Alba M Paniagua-Diaz, Justin H Nguyen, Pablo Artal, Wei Gui, J Sebag

Faculty, Staff and Student Publications

PURPOSE: Vision-degrading myodesopsia (VDM) from vitreous floaters significantly degrades vision and impacts visual quality of life (VQOL), but the relationship to light scattering is poorly understood. This study compared in vitro measures of light scatter and transmission in surgically excised human vitreous to preoperative indexes of vitreous structure, visual function, and VQOL.

METHODS: Pure vitreous collected during vitrectomy from 8 patients with VDM had wide-angle straylight measurements and dark-field imaging, performed within 36 hours of vitrectomy. Preoperative VQOL assessment with VFQ-25, contrast sensitivity (CS) measurements with Freiburg acuity contrast testing, and quantitative ultrasonography were compared to light scattering and transmission …

Accuracy Of Artificial Intelligence In Estimating Best-Corrected Visual Acuity From Fundus Photographs In Eyes With Diabetic Macular Edema, William Paul, Philippe Burlina, Rohita Mocharla, Neil Joshi, Zhuolin Li, Sophie Gu, Onnisa Nanegrungsunk, Kira Lin, Susan B Bressler, Cindy X Cai, Jun Kong, T Y Alvin Liu, Hadi Moini, Weiming Du, Fouad Amer, Karen Chu, Robert Vitti, Farshid Sepehrband, Neil M Bressler

Faculty, Staff and Students Publications

IMPORTANCE: Best-corrected visual acuity (BCVA) is a measure used to manage diabetic macular edema (DME), sometimes suggesting development of DME or consideration of initiating, repeating, withholding, or resuming treatment with anti-vascular endothelial growth factor. Using artificial intelligence (AI) to estimate BCVA from fundus images could help clinicians manage DME by reducing the personnel needed for refraction, the time presently required for assessing BCVA, or even the number of office visits if imaged remotely.

OBJECTIVE: To evaluate the potential application of AI techniques for estimating BCVA from fundus photographs with and without ancillary information.

DESIGN, SETTING, AND PARTICIPANTS: Deidentified color fundus …

Static Perimetry In The Rate Of Progression In Ush2a-Related Retinal Degeneration (Rush2a) Study: Assessment Through 2 Years, Jacque L Duncan, Peiyao Cheng, Maureen G Maguire, Allison A Ayala, David G Birch, Janet K Cheetham, Todd A Durham, Abigail T Fahim, Carel B Hoyng, Hiroshi Ishikawa, Michel Michaelides, Mark E Pennesi, José-Alain Sahel, Katarina Stingl, Christina Y Weng

Faculty, Staff and Students Publications

PURPOSE: To evaluate disease progression using static perimetry (SP) in patients with USH2A-related retinal degeneration, including Usher syndrome type 2 (USH2) and nonsyndromic autosomal recessive retinitis pigmentosa.

DESIGN: Prospective, observational cohort study.

METHODS: A total of 102 patients with biallelic disease-causing sequence variants in USH2A with baseline best-corrected visual acuity (BCVA) letter score ≥54 were recruited from 16 clinical sites in Europe and North America. SP, BCVA, full-field stimulus thresholds, spectral domain optical coherence tomography macular scans, and fundus-guided mesopic microperimetry were performed at baseline and annually. The main outcome measures were total hill of vision (V

RESULTS: The average …

Non-Traumatic Open Globe Injuries: Presenting Characteristics And Visual Outcomes, Andrew W Gross, James Z Fan, Margaret L Pfeiffer, Alice Z Chuang, Karina Richani, Eric L Crowell

Faculty, Staff and Student Publications

Purpose: To describe clinical characteristics and visual outcomes of non-traumatic open globe injuries.

Setting: A level 1 trauma centre in a large urban medical centre.

Design: Retrospective study.

Methods: Charts of non-traumatic open globe patients admitted to MHH-TMC from 1/2010 to 3/2015 were reviewed for demographics, cause, clinical characteristics, visual acuity (VA) and enucleation.

Results: Thirty eyes were included: 15 (50%) were males with a mean age of 47 (±28) years. All presented with zone 1 injury. Twenty-five (83%) had a perforated corneal ulcer. Presenting VA was count fingers (n = 3, 10%) to NLP (n = 6, 20%). Twenty-four …

Baseline Microperimetry And Oct In The Rush2a Study: Structure-Function Association And Correlation With Disease Severity, Eleonora M Lad, Jacque L Duncan, Wendi Liang, Maureen G Maguire, Allison R Ayala, Isabelle Audo, David G Birch, Joseph Carroll, Janet K Cheetham, Todd A Durham, Abigail T Fahim, Jessica Loo, Zengtian Deng, Dibyendu Mukherjee, Elise Heon, Robert B Hufnagel, Bin Guan, Alessandro Iannaccone, Glenn J Jaffe, Christine N Kay, Michel Michaelides, Mark E Pennesi, Ajoy Vincent, Christina Y Weng, Sina Farsiu

Faculty, Staff and Students Publications

PURPOSE: To investigate baseline mesopic microperimetry (MP) and spectral domain optical coherence tomography (OCT) in the Rate of Progression in USH2A-related Retinal Degeneration (RUSH2A) study.

DESIGN: Natural history study METHODS: Setting: 16 clinical sites in Europe and North AmericaStudy Population: Participants with Usher syndrome type 2 (USH2) (N = 80) or autosomal recessive nonsyndromic RP (ARRP) (N = 47) associated with biallelic disease-causing sequence variants in USH2AObservation Procedures: General linear models were used to assess characteristics including disease duration, MP mean sensitivity and OCT intact ellipsoid zone (EZ) area. The associations between mean sensitivity and EZ area with other measures, …

Combination Of Aibp, Apoa-I, And Aflibercept Overcomes Anti-Vegf Resistance In Neovascular Amd By Inhibiting Arteriolar Choroidal Neovascularization, Zhao Zhang, Megan M Shen, Yingbin Fu

Faculty, Staff and Students Publications

PURPOSE: Anti-VEGF resistance represents a major unmet clinical need in the management of choroidal neovascularization (CNV). We have previously reported that a combination of AIBP, apoA-I, and an anti-VEGF antibody overcomes anti-VEGF resistance in laser-induced CNV in old mice in prevention experiments. The purpose of this work is to conduct a more clinically relevant study to assess the efficacy of the combination of AIBP, apoA-I, and aflibercept in the treatment of anti-VEGF resistance of experimental CNV at different time points after laser photocoagulation.

METHODS: To understand the pathobiology of anti-VEGF resistance, we performed comprehensive examinations of the vascular morphology of …

Age Differential Response To Bevacizumab Therapy In Choroidal Neovascularization In Rabbits, Van Phuc Nguyen, Jessica Henry, Josh Zhe, Quynh Kieu, Wei Qian, Yingbin Fu, Xueding Wang, Yannis M Paulus

Faculty, Staff and Students Publications

Choroidal neovascularization (CNV) in young rabbits has been shown to have a rapid, robust response after treatment with bevacizumab, an anti-vascular endothelial growth factor (VEGF) medication. This investigation evaluates an age differential response to bevacizumab in older populations of rabbits using multimodal high resolution molecular imaging. Young (4 months old) and life span (14 months old) rabbits were given subretinal injections of Matrigel and VEGF to produce CNV. All CNV rabbit models were then treated with a bevacizumab intravitreal injection. Rabbits were then monitored longitudinally using photoacoustic microscopy (PAM), optical coherence tomography (OCT), color photography, and fluorescence imaging. Chain-like gold …

Impact Of Coronavirus Disease 2019 Restrictions On Retinal Detachment: A Multicenter Experience, Jesse J Jung, Jonathan S Chang, Patrick R Oellers, Mohsin H Ali, Brian K Do, Joseph J Tseng, Roberto Roizenblatt, Rajeev H Muni, Christina Y Weng, Zackery B Oakey, Sean W Tsao, Soraya Rofagha, Xavier Chan, Quan V Hoang

Faculty, Staff and Students Publications

In this retrospective, multicenter study of 261 eyes (259 patients), patients who underwent rhegmatogenous retinal detachment repair during the coronavirus disease 2019 (COVID-19) post-lockdown period experienced an additional 22-day delay, leading to significantly more epiretinal membrane and proliferative vitreoretinopathy and lower single-surgery anatomic success rates. During lockdown, perfluoropropane gas was used more commonly, and pneumatic retinopexy was used more commonly in COVID-19-positive patients.

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 …