Ophthalmology Commons^™

Current Barriers To Eye Care, Annika Samuelson, Bs

inSIGHT

Barriers to care penetrate all aspects within our healthcare system and ophthalmology is no exception. The World Health Organization (WHO) estimates 2.2 billion people worldwide have vision impairment, half of which are due to preventable causes and/or remain untreated. In the United States, 6 million people are reported to have visual impairment and over one million people are blind.² The leading causes of blindness within the United States are macular degeneration, cataract, glaucoma, and diabetic retinopathy.³ Management of these diseases require access to early detection, therapeutic intervention, and follow up care at regular intervals; for example, nearly half …

Thyroid Eye Disease: Overview And Treatment, Michelle Omega, Ms

inSIGHT

Your immune system consists of a guided molecular army of antibodies equipped to recognize millions of foreign enemy antigens. However, in autoimmune conditions, antibodies are produced which target the cells of your own body. This is how many autoimmune diseases begin, including thyroid eye disease.

Ophthalminute Highlight: A Look Into The Popular, Educational One-Minute Videos, Anza Rizvi, Bs

inSIGHT

Ophthalminute is a series of one-minute videos designed to provide information on different, essential topics in ophthalmology. What separates the Ophthalminute videos from many of the other videos currently available is their unique ability to effectively and succinctly present information into a one-minute video to help viewers learn and better understand the fundamentals of ophthalmology. The videos showcase witty banter, enthusiastic energy, and stimulating visuals. Across YouTube, Twitter, and Instagram, Ophthalminute has received an astonishing over 2000 followers or subscribers and over 20,000 views!

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

inSIGHT

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

inSIGHT

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

inSIGHT

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

inSIGHT

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 …

Topical Anesthetic Gel Interferes With Antibacterial Efficacy Of Povidone-Iodine Both In Vitro And In Vivo, Cecilly Kelleher Bs, Jacob Im Md, Linda Kang Bs, Aleksey Mishulin Md, Sukhvinder Singh Phd, Ashok Kumar Phd

Medical Student Research Symposium

Purpose: To evaluate the effects of viscous lidocaine gel on the antimicrobial efficacy of povidone-iodine (PI) and their order of application in both in vitro and in vivo models.

Methods: In vitro antibacterial effects were tested against Staphylococcus aureus (S. aureus) with disc diffusion methods for application of lidocaine alone, PI alone, PI before lidocaine, and lidocaine before PI. Zones of inhibition were measured after incubation at 37°C overnight. Mouse eyes were colonized with S. aureus for in vivo study to which PI and/or lidocaine were applied in various combinations. Eyes were then rinsed with saline, and …

Assessment Of The Nanodropper Eye Drop Adaptor For Glaucoma Medications, Nicholas Pryde, Parker J. Williams, Faisal Ridha Al-Timimi, John Michael Guest

Medical Student Research Symposium

Assessment of the Nanodropper Eye Drop Adaptor for Glaucoma Medications

Nicholas Pryde, BS¹; Parker J. Williams, DO ¹; John-Michael Guest, MD¹; Bret A. Hughes, MD¹; Faisal Ridha MD¹

¹Kresge Eye Institute and Wayne State University Department of Ophthalmology, Detroit, MI, USA

Purpose: To determine the dispensed volume change for seven medications with and without the Nanodropper adaptor.

Methods: Sequentially, 100 µL of each medication was dispensed by micropipette into a 1.5 mL Eppendorf tube, and mass without the tube was determined with a precision balance (Practum, Germany). The mean mass was …

Conjunctival And Lingual Mucosal Neuromas Without Multiple Endocrine Neoplasia Type 2b, Talia N. Shoshany, Christopher J. Rapuano, Tatyana Milman

Wills Eye Hospital Papers

Purpose: To report a patient with conjunctival and buccal neuromas and enlarged corneal nerves without Multiple Endocrine Neoplasia 2B (MEN2B).

Observations: A 28-year-old female presented with progressively enlarging bilateral limbal conjunctival growths. Slit lamp examination was notable for enlarged corneal nerves and well-circumscribed gelatinous subepithelial limbal nodules. Systemic examination revealed similar lesions on the tongue. Conjunctival biopsy demonstrated a mucosal neuroma. The patient underwent endocrine workup for MEN2B and genetic testing for the RET-proto oncogene mutations, all of which were negative.

Conclusions and Importance: The findings in our patient may be compatible with pure mucosal neuroma syndrome. The pattern of …

Sakurabonsai: Protocol Design Of A Novel, Prospective Study To Explore Clinical, Imaging, And Biomarker Outcomes In Patients With Aqp4-Igg-Seropositive Neuromyelitis Optica Spectrum Disorder Receiving Open-Label Satralizumab, Jeffrey L Bennett, Kazuo Fujihara, Ho Jin Kim, Romain Marignier, Kevin C O'Connor, Robert C Sergott, Anthony Traboulsee, Heinz Wiendl, Jens Wuerfel, Scott S Zamvil, Veronica G Anania, Regine Buffels, Thomas Künzel, Annemarie N Lekkerkerker, Siân Lennon-Chrimes, Sean J Pittock

Wills Eye Hospital Papers

Background: Neuromyelitis optica spectrum disorder (NMOSD) is a rare, autoimmune disease of the central nervous system that produces acute, unpredictable relapses causing cumulative neurological disability. Satralizumab, a humanized, monoclonal recycling antibody that targets the interleukin-6 receptor, reduced NMOSD relapse risk vs. placebo in two Phase 3 trials: SAkuraSky (satralizumab ± immunosuppressive therapy; NCT02028884) and SAkuraStar (satralizumab monotherapy; NCT02073279). Satralizumab is approved to treat aquaporin-4 IgG-seropositive (AQP4-IgG+) NMOSD. SAkuraBONSAI (NCT05269667) will explore fluid and imaging biomarkers to better understand the mechanism of action of satralizumab and the neuronal and immunological changes following treatment in AQP4-IgG+ NMOSD.

Objectives: …