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Acute-Onset Central Serous Retinopathy After Immunization With Covid-19 Mrna Vaccine, Nicholas Fowler, Noe R. Mendez Martinez, Bernardo Velazquez Pallares, Ramiro S. Maldonado 2021 University of Kentucky

Acute-Onset Central Serous Retinopathy After Immunization With Covid-19 Mrna Vaccine, Nicholas Fowler, Noe R. Mendez Martinez, Bernardo Velazquez Pallares, Ramiro S. Maldonado

Ophthalmology and Visual Science Faculty Publications

Purpose
We report the case of a 33-year-old male who presented with unilateral central serous retinopathy three days after the injection of a COVID-19 vaccine.

Observations
A 33-year-old healthy Hispanic male referred to the ophthalmology service due to blurry vision and metamorphopsia in the right eye without any flashes, floaters, eye redness or pain. The patient reported that 69 hours prior to presentation he received the first dose of the Pfizer-BioNTech BNT162b2 mRNA COVID-19 vaccine. He denied any past ocular history or pertinent medical history. He does not take any medicines and denies stressful factors in his life. The clinical ...


Variable Accuracy, Precision, And Consistency Of Compounded Famciclovir Formulated For Management Of Feline Herpesvirus-1 In Cats, Louise M. O'Leary, Rachel A. Allbaugh, Dwayne Schrunk, Thomas E. Olson, Lionel Sebbag 2021 Iowa State University

Variable Accuracy, Precision, And Consistency Of Compounded Famciclovir Formulated For Management Of Feline Herpesvirus-1 In Cats, Louise M. O'Leary, Rachel A. Allbaugh, Dwayne Schrunk, Thomas E. Olson, Lionel Sebbag

Veterinary Clinical Sciences Publications

Objective: To evaluate compounded famciclovir suspensions for accuracy, precision, and consistency in drug content.

Procedures: Two compounded famciclovir concentrations were evaluated (250 and 400 mg/mL, 30 preparations total from nine 503A compounding pharmacies) with U.S. Food and Drug Administration (FDA)-approved famciclovir tablets as control. Drug quantification via high-performance liquid chromatography (with famciclovir reference standard and pramipexole internal standard) was performed at 0, 14, and 28 days with concentrations of 90%–110% of labeled dose considered acceptable (US Pharmacopoeia standards).

Results: FDA-approved tablets from three different manufacturers were found to be accurate and precise with acceptable drug content ...


Evaluation Of Multi-Level Barriers And Facilitators In A Large Diabetic Retinopathy Screening Program In Federally Qualified Health Centers: A Qualitative Study, Ana Bastos de Carvalho, S. Lee Ware, Tamara Belcher, Franceska Mehmeti, Eric B. Higgins, Robert Sprang, Cody Williams, Jamie L. Studts, Christina R. Studts 2021 University of Kentucky

Evaluation Of Multi-Level Barriers And Facilitators In A Large Diabetic Retinopathy Screening Program In Federally Qualified Health Centers: A Qualitative Study, Ana Bastos De Carvalho, S. Lee Ware, Tamara Belcher, Franceska Mehmeti, Eric B. Higgins, Robert Sprang, Cody Williams, Jamie L. Studts, Christina R. Studts

Ophthalmology and Visual Science Faculty Publications

BACKGROUND: Recommended annual diabetic retinopathy (DR) screening for people with diabetes has low rates in the USA, especially in underserved populations. Telemedicine DR screening (TDRS) in primary care clinics could expand access and increase adherence. Despite this potential, studies have observed high variability in TDRS rates among clinics and over time, highlighting the need for implementation supports. Previous studies of determinants of TDRS focus on patients' perspectives, with few studies targeting upstream multi-level barriers and facilitators. Addressing this gap, this qualitative study aimed to identify and evaluate multi-level perceived determinants of TDRS in Federally Qualified Health Centers (FQHCs), to inform ...


A Randomized Trial To Improve Adherence To Follow-Up Eye Examinations Among People With Glaucoma, Benjamin E Leiby, Sarah E. Hegarty, Tingting Zhan, Jonathan S Myers, L Jay Katz, Julia A Haller, Michael Waisbourd, Christine Burns, Meskerem Divers, Jeanne Molineaux, Jeffrey Henderer, Charles Brodowski, Lisa A Hark 2021 Thomas Jefferson University

A Randomized Trial To Improve Adherence To Follow-Up Eye Examinations Among People With Glaucoma, Benjamin E Leiby, Sarah E. Hegarty, Tingting Zhan, Jonathan S Myers, L Jay Katz, Julia A Haller, Michael Waisbourd, Christine Burns, Meskerem Divers, Jeanne Molineaux, Jeffrey Henderer, Charles Brodowski, Lisa A Hark

Department of Pharmacology and Experimental Therapeutics Faculty Papers

INTRODUCTION: Appointment nonadherence is common among people with glaucoma, making it difficult for eye care providers to monitor glaucoma progression. Our objective was to determine whether the use of patient navigators, in conjunction with social worker support, could increase adherence to recommended follow-up eye appointments.

METHODS: A randomized, controlled trial evaluated the effectiveness of an intervention that used patient navigators and social workers to improve patient adherence to follow-up eye care compared with usual care. Participants with glaucoma and other eye diseases (N = 344) were identified at primary care clinics in community settings through telemedicine screening of imaging and then ...


Critique Of Experimental Procedures Targeting Retinitis Pigmentosa, Jenna Goss 2021 University of Maine - Main

Critique Of Experimental Procedures Targeting Retinitis Pigmentosa, Jenna Goss

Honors College

Retinitis Pigmentosa (RP) is a group of hereditary genetic disorders, all causing degradation of the retina through loss of rod photoreceptor cells, ultimately causing loss of vision and in many cases complete blindness. Despite the prevalence o fRetinitis Pigmentosa disorders, safe and effective treatment methods have not yet been approved to stop or regain vision loss in patients diagnosed with RP. However, the ophthalmic field as a whole is working on several new technologies and procedures in order to both slow loss of vision as well as potentially regain lost sight. In this thesis, I describe the genetic causes and ...


Anterior Chamber Characteristics, Endothelial Parameters, And Corneal Densitometry After Descemet Stripping Automated Endothelial Keratoplasty In Patients With Fuchs Dystrophy., Remzi Karadag, Kristin Hammersmith, Parveen Nagra, Christopher J Rapuano 2021 Veni Vidi Eye Center, Istanbul, Turkey

Anterior Chamber Characteristics, Endothelial Parameters, And Corneal Densitometry After Descemet Stripping Automated Endothelial Keratoplasty In Patients With Fuchs Dystrophy., Remzi Karadag, Kristin Hammersmith, Parveen Nagra, Christopher J Rapuano

Wills Eye Hospital Papers

Purpose: To compare anterior segment parameters in patients with Fuchs endothelial dystrophy (FED) who underwent Descemet stripping automated endothelial keratoplasty (DSAEK) in one eye and no corneal surgery in the fellow eye.

Methods: This prospective study was conducted on 28 eyes of 14 patients with FED who underwent DSAEK in one eye at least one year prior (DSAEK group) and no corneal surgery in the fellow eye (control group). Each eye was analyzed with the anterior segment optical coherence tomography, specular microscopy, and Scheimpflug imaging systems. Data were compared between the two groups.

Results: The mean age of the patients ...


The Influence Of Axial Myopia On Optic Disc Characteristics Of Glaucoma Eyes., Jasmin Rezapour, Christopher Bowd, Jade Dohleman, Akram Belghith, James A Proudfoot, Mark Christopher, Leslie Hyman, Jost B Jonas, Massimo A Fazio, Robert N Weinreb, Linda M Zangwill 2021 Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0946, USA; Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.

The Influence Of Axial Myopia On Optic Disc Characteristics Of Glaucoma Eyes., Jasmin Rezapour, Christopher Bowd, Jade Dohleman, Akram Belghith, James A Proudfoot, Mark Christopher, Leslie Hyman, Jost B Jonas, Massimo A Fazio, Robert N Weinreb, Linda M Zangwill

Wills Eye Hospital Papers

This study characterizes differences in glaucomatous eyes with and without high axial myopia using custom automated analysis of OCT images. 452 eyes of 277 glaucoma patients were stratified into non (n = 145 eyes), mild (n = 214 eyes), and high axial myopia (axial length (AL) > 26 mm, n = 93 eyes). Optic disc ovality index, tilt and rotation angle of Bruch´s membrane opening (BMO) and peripapillary choroidal thickness (PCT) were calculated using automated and deep learning strategies. High myopic optic discs were more oval and had larger BMO tilt than mild and non-myopic discs (both p < 0.001). Mean PCT was thinnest in high myopic eyes followed by mild and non-myopic eyes (p < 0.001). BMO rotation angle, global retinal nerve fiber layer (RNFL) thickness and BMO-minimum rim width (MRW) were similar among groups. Temporal RNFL was thicker and supranasal BMO-MRW was thinner in high myopic eyes. BMO tilt and PCT showed moderate and temporal RNFL and nasal BMO-MRW showed weak but significant associations with AL in multivariable analyses (all p < 0.05). Large BMO tilt angle and thin PCT are characteristics of highly myopic discs and were not associated with severity of glaucoma. Caution should be exercised when using sectoral BMO-MRW and RNFL thickness for glaucoma management decisions in myopic eyes.


Interdisciplinary Practice For Occupational Therapy And Low Vision Rehabilitation, Priscilla Gim, Karen Park, Becki Cohill, Susan MacDermott 2021 University of St. Augustine for Health Sciences

Interdisciplinary Practice For Occupational Therapy And Low Vision Rehabilitation, Priscilla Gim, Karen Park, Becki Cohill, Susan Macdermott

Virtual OTD Capstone Symposium, Spring 2021

The purpose of this capstone project was to advocate occupational therapy in low vision rehabilitation for improved access to low vision rehabilitation (LVR) for the adult population. However, due to COVID-19 pandemic, this capstone project shifted to a research study assessing limiting factors for occupational therapy collaboration with low vision services and exploring eye physician’s perception on low vision occupational therapy.

A mixed-methods survey was conducted to explore 54 eye physicians including Doctor of Medicine (MD) specialized in ophthalmology and Doctor of Optometry (OD)’s perception on the role of low vision occupational therapy, benefit of low vision occupational ...


Safety And Improved Efficacy Signals Following Gene Therapy In Childhood Blindness Caused By Gucy2d Mutations, Samuel G. Jacobson, Artur V. Cideciyan, Allen Ho, Igor V. Peshenko, Alexandra V. Garafalo, Alejandro J. Roman, Alexander Sumaroka, Vivian Wu, Arun Krishnan, Rebecca Sheplock, Sanford Boye, Alexander Dizhoor, Shannon Boye 2021 University of Pennsylvania

Safety And Improved Efficacy Signals Following Gene Therapy In Childhood Blindness Caused By Gucy2d Mutations, Samuel G. Jacobson, Artur V. Cideciyan, Allen Ho, Igor V. Peshenko, Alexandra V. Garafalo, Alejandro J. Roman, Alexander Sumaroka, Vivian Wu, Arun Krishnan, Rebecca Sheplock, Sanford Boye, Alexander Dizhoor, Shannon Boye

Wills Eye Hospital Papers

A first-in-human clinical trial of gene therapy in Leber congenital amaurosis due to mutations in the GUCY2D gene is underway, and early results are summarized. A recombinant adeno-associated virus serotype 5 (rAAV5) vector carrying the human GUCY2D gene was delivered by subretinal injection to one eye in three adult patients with severe visual loss, nystagmus, but preserved retinal structure. Safety and efficacy parameters were monitored for 9 months post-operatively. No systemic toxicity was detected; there were no serious adverse events, and ocular adverse events resolved. P1 and P2 showed statistically significant rod photoreceptor vision improvement by full-field stimulus testing in ...


Narrative Medicine In Ophthalmology, Martina Rama 2021 Thomas Jefferson University

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 2021 Thomas Jefferson University

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 2021 Thomas Jefferson University

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 2021 Thomas Jefferson University

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 ...


A Career Of Honor And Humility: Interview With A Pioneer In Ophthalmology, Eli Cehelyk 2021 Thomas Jefferson University

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 ...


An Experience In The Wills Academic Global Ophthalmology Fellowship And Beyond, Crystal Lee, MPH 2021 Thomas Jefferson University

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 ...


Insight, Volume 1, Issue 1, 2021, 2021 Thomas Jefferson University

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
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 2021 Department of Pathology, Anatomy and Cell Biology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA; Department of Ophthalmology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA

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 2021 University of Nebraska Medical Center

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 ...


Acute Corneal Hydrops Of Presumed Traumatic Origin: An Uncontrolled Case Series (Three Horses), Louise M. O'Leary, Lionel Sebbag, L. M. Moody, K. A. Diehl, Rachel A. Allbaugh 2021 Iowa State University

Acute Corneal Hydrops Of Presumed Traumatic Origin: An Uncontrolled Case Series (Three Horses), Louise M. O'Leary, Lionel Sebbag, L. M. Moody, K. A. Diehl, Rachel A. Allbaugh

Veterinary Clinical Sciences Publications

This case series describes acute corneal hydrops in three young horses. Due to similarities in the clinical appearance and progression of the disease with that which is reported in humans and cats with acute corneal hydrops, traumatic Descemet’s membrane rupture was suspected to be the underlying aetiology in these equine cases. The horses presented with acute severe corneal oedema with intrastromal bullae formation and anterior bulging of the corneal contour. Focal posterior corneal changes were also seen in two of three cases. Mild anterior uveitis was also present. Other causes of corneal oedema (e.g. glaucoma) were ruled out ...


Umbilical Amnion And Amniotic Membrane Transplantation For Infectious Scleritis And Scleral Melt: A Case Series., Zeba Syed, Christopher J Rapuano 2021 Cornea Service, Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, United States

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 ...


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