Ophthalmology Commons^™

The Driving Simulator Visual Field In Glaucoma – A Novel Task To Test Available Field Of View, Deepta Ghate

Theses & Dissertations

Glaucoma causes peripheral vision loss and impaired driving performance. We developed a novel driving simulator visual field task (DSVF) in a panoramic driving simulator to map the available field of view under different perceptual task loads in naturalistic settings. Our hypothesis is that “available field of view” will decrease with increasing task load in both glaucoma subjects and controls. This is a cross-sectional study with 28 glaucoma subjects and 19 controls. DSVF (60̊ x 20̊ visual field at 2.5 m) was tested in a high-fidelity interactive driving simulator in 4 different scenarios: a) no distractions b) no driving condition with …

Terson-Like Syndrome Associated With Familial Retinal Arteriolar Tortuosity (Frat) And A Spontaneous Spinal Hemorrhage, Peter Maduka, David R. Lally

Rowan-Virtua Research Day

Background: Familial retinal arteriolar tortuosity (fRAT) is an autosomal dominant disorder that is characterized by tortuosity of the second and third order retinal arterioles in the macular and peripapillary areas. The genetics of fRAT are incompletely understood but have been associated with a missense mutation in the COL4A1 gene in some cases. fRAT is not typically associated with visual loss and prognosis is good. However, the tortuous arterioles can bleed, causing intraretinal, preretinal, and/or subretinal hemorrhages.

Objective: To describe a case of Terson-like syndrome associated with familial retinal arteriolar tortuosity (fRAT) in the setting of spontaneous spinal hemorrhage.

Results: A …

Retinal Vasculitis: A Case Study, Peter Maduka, Sarah G. Bonaffini, Naman Shah, Deepika Malik

Rowan-Virtua Research Day

Purpose: To describe a case of idiopathic retinal vasculitis.

Methods: Case report and literature review.

Case: A healthy 25-year-old female presented with a one-week history of a large floater in her right eye. Patient’s subjective complaint of floaters, including the scotoma on VF and the FA findings were most consistent with retinal vasculitis displaying predominant venous involvement. However, findings for acute macular neuroretinopathy and multiple evanescent white dot syndrome (MEWDS) were present as well. Autoimmune and infectious disease panels were negative. Neuro consult and brain MRI showed nonspecific, non contributory findings. Several weeks later, following Medrol dose pack, patient reported …

Sociodemographic And Economic Factors In Outcomes Of Tube Shunts For Neovascular Glaucoma, Wesam S Shalaby, Amirmohsen Arbabi, Jonathan S Myers, Marlene R Moster, Reza Razeghinejad, L Jay Katz, Aakriti G Shukla

Wills Eye Hospital Papers

Importance: Few studies have analyzed associations between sociodemographic factors and neovascular glaucoma (NVG) outcomes.

Aim and background: To determine the potential impact of sociodemographic and economic factors on the NVG tube shunt surgery outcomes.

Design: Retrospective, single-center, comparative case series.

Participants: Consecutive patients who underwent tube shunt surgery for NVG and had ≥6 months of follow-up.

Materials and methods: Regional average adjusted gross income (AGI) was determined by cross-referencing self-reported residential zip codes with average AGI per zip code supplied by the Internal Revenue Service. Two groups were created: (1) lower-income: individuals from neighborhoods with the lowest 10% of AGI …

3d Printed Adjustable Glasses: A New Model Of Corrective Lens Delivery For Pediatric Refractive Error In Underserved Communities, Nathan Ostlie, Mari Ogino, Donny Suh, Gabe Linke, James Hermsen

Child Health Research Institute Pediatric Research Forum

Purpose:

Uncorrected refractive error (URE) remains a major cause of preventable vision impairment in the pediatric population with large inequities in disease burden. The present study aims to elucidate the global burden of pediatric URE and explore the current lens delivery systems which address this problem. Within this framework, we introduce a new model of corrective lens delivery that may improve upon existing models.

Methods:

The present study involved an extensive literature review of epidemiological data to determine the global prevalence of URE. Prevalence data was then compared against WHO data on refractionist coverage gaps divided by region. …

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

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.

Advances In The Treatment Of Congenital Ptosis, Alon Kahana

Conference Presentation Abstracts

No abstract provided.

Ocular Surface And Fornix Reconstruction: Flaps, Grafts And Blood Supply, Alon Kahana

Conference Presentation Abstracts

No abstract provided.

The Many Uses Of 5-Fluorouracil In Oculoplastic Surgery, Alon Kahana

Conference Presentation Abstracts

No abstract provided.

Advances In The Treatment Of Thyroid Eye Disease, Alon Kahana

Conference Presentation Abstracts

No abstract provided.

Orbital Vascular Anomalies: Classification And Treatment, Alon Kahana

Conference Presentation Abstracts

No abstract provided.

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

Spring 2021 Virtual OTD Capstone Symposium

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 therapy, current …

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

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

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

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

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) and …

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 your …

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 medical …